Immune-Mediated Dermatoses in Patients with Haematological Malignancies: A Comprehensive Review

Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient's quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon

Study on possible rehabilitation and recovery of Bandar Emam Region by reducing Nickel and Iron environmental pollutant using microorganisms

Influx of metallic pollutants such as iron and nickel into marine environment has been increased drastically in current era. Due to its harmful effects on living organisms, the aim of current thesis was isolation and identification of microorganisms which could reduce iron and nickel. In order to isolate bacterial strains resistant to iron and nickel, deposit samples were collected from five stations in Imam Khomeini Port cultured on BHI agar medium containing 1000 ppm of iron and 50 ppm of nickel and incubated for 24 hours in 30 oC. Endurance threshold of strains isolated to different concentrations of iron (1000- 15000 ppm) and nickel (100- 25000 ppm) in BHI broth medium were evaluated, the most resistant strains were selected and MIC and MBC were determined. Growth curve of selected strains in the presence and absence of iron and nickel were assessed by turbidity method. Along with above mentioned process, removal amount of metal by living cells and dead biomasses of selected strains were assessed by atomic absorption analysis and then 16S rRNA method was used to identify and approve the selected strains. Results of the current study were demonstrated that among of 16 and 12 resistant strains to nickel and iron, two selected strains (number16 and 7) as the most resistant strains had MIC and MBC (29800 and 29700) and (26300 and 26500), respectively. It should be mentioned that iron’s MIC was not assessable. Results of atomic absorption analysis was demonstrated that the highest amount of nickel reduction in a medium with concentration of 194 ppm and 71 ppm were 16.7% and 63% after 72 hours by selected strain number 16 respectively and in a medium containing 158 ppm iron, after 50 hours 8.4% by selected strain 7, while dead biomass of strain 16 reduced nickel to the amount of 40.6% and it reduced 21% and 4% of iron in solutions with 46 ppm and 792 ppm of iron. Results of molecular analysis demonstrated that strain 16 was Bacillus subtilis. In addition, Bacillus subtilis which has been isolated in this study with ability of nickel and iron removal is an appropriate candidate to be used in aquatic environments

The study of burnout frequency and its association with job performance among healthcare staff

Background: Occurs as a result of long-term exposure to stress, job burnout threatens the health of personnel. Objectives: Considering the important role of healthcare personnel in maintaining and promoting people’s health, the current study investigated the job burnout frequency and its association with job performance among healthcare personnel. Methods: This correlational and cross-sectional study was conducted among all healthcare personnel of urban/rural healthcare centers in Health Office of Islam Abad-e-Gharb, Iran. A total of 136 personnel participated in this study. Data were collected using Maslach Burnout Inventory (MBI) and Hersey and Goldsmith’s job performance scale. Descriptive statistics and Mann-Whitney, Kruskal-Wallis, and Spearman correlation coefficient tests were used to analyze the data (p≤0.05). Results: The mean (SD) frequencies of job burnout and job performance were found to be 45.96±17.77 and 52.5±9, respectively. There was a significant inverse correlation between job burnout and job performance (p=0.000, r=-0.249). However, there was no significant association between job burnout and age, gender, marital status, education, and smoking factors (p≥0.05). Conclusion: The findings showed that most of the personnel experienced moderate to low levels of job burnout. Besides, job burnout was found to be a factor affecting job performance. Hence, this study calls for useful interventions to reduce job burnout and increase job performance consequently

Angioedema Masqueraders

Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye

Immune-Mediated Dermatoses in Patients with Haematological Malignancies: A Comprehensive Review

Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient\u2019s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon

Characterizing the proteome of bullous pemphigoid blister fluid utilizing tandem mass tag labeling coupled with LC\u2013MS/MS

Bullous pemphigoid is an autoimmune blistering disease caused by autoantibodies against components of the cutaneous basement membrane zone. Autoantibodies lead to complement-dependent and -independent inflammation and blistering. Blister fluid is a valuable biologic resource, as it provides insight into both systemic and local microenvironment responses. Here, we utilized liquid chromatography with tandem mass spectrometry to characterize the bullous pemphigoid blister fluid proteome. We then depleted exosomes to better understand the exosomal versus non-exosomal proteome. We identified 339 proteins in the blister fluid of bullous pemphigoid patients. Gene ontology demonstrated enrichment of several key biologic processes including innate immune response, neutrophil degranulation, platelet degranulation, and complement activation. Exosome depletion resulted in a significant decrease in normalized reporter intensities of 192 proteins, consistent with our observation of a large number of exosomal proteins found in the blister fluid. We then compared the bullous pemphigoid blister fluid proteome to prior proteomic datasets in suction blister fluid, snake bites, and thermal burns, identifying 76 proteins unique to bullous pemphigoid. These include major basic protein, eosinophil peroxidase, galectin-10, and the immunoglobulin epsilon heavy constant region, consistent with tissue eosinophilia. We lastly validated several previously reported blister fluid exosomal components. Blister fluid in bullous pemphigoid contains a mixture of numerous biologic processes. While many of these processes are shared with blistering from alternative causes, we have identified several notable features unique to bullous pemphigoid

A long-lasting emerging epidemic of anthroponotic cutaneous leishmaniasis in southeastern Iran: population movement and peri-urban settlements as a major risk factor

Background: Epidemics of cutaneous leishmaniasis (CL) are occurring more frequently and spreading faster and farther than before in many areas of the world. The present study aimed to assess a long-lasting emerging epidemic (2005�2019) of 5532 cases with anthroponotic CL (ACL) in peri-urban areas of Kerman city in southeastern Iran. Methods: This descriptive-analytical study was carried out for 15 years in Kerman province, southeastern Iran. The data were passively obtained through the health surveillance system and the Kerman Leishmaniasis Research Center. Every subject was diagnosed using direct smear microscopy. The representative causative agent was further examined by ITS1-PCR, PCR-RFLP, 7SL RNA gene sequencing and phylogenetic analyses. For each subject, a case report form designating demographic and clinical data was recorded. Results: A different pattern of ACL incidence was found in peri-urban areas compared to that in the city of Kerman. The incidence rate of ACL cases has significantly increased (P < 0.001) from 2005 to 2016 in new settlements with a gradual decline after that. The overall average risk of contracting the disease was 7.6 times higher in peri-urban areas compared to Kerman city, an old endemic focus. All isolates consisting of six variants were confirmed to be Leishmania tropica. The overall pattern of the ACL infection indicates that the etiological agent of ACL is propagated and transmitted by the bite of female Phlebotomus sergenti sandflies from person to person from dissimilar clones as reflected by the complexity of the migrants� backgrounds in the province. Conclusions: The movement of populations and establishment of new settlements in peri-urban areas close to endemic areas are major risk factors for and are directly linked to CL. The underlying factors of this emerging ACL epidemic caused by L. tropica were disasters and droughts, among others. A robust commitment to a multilateral approach is crucial to make improvements in this area. This will require decisive coordinated actions through all governmental factions and non-governmental organizations. Furthermore, active and passive case detection strategies, early diagnosis, and effective treatment could help control the disease. Figure not available: see fulltext.. © 2021, The Author(s)

Serological diagnostics in the detection of IgG autoantibodies against human collagen VII in epidermolysis bullosa acquisita: A multicentre analysis

Background: Epidermolysis bullosa acquisita (EBA) is a rare, potentially devastating autoimmune disease of the skin. IgG autoantibodies directed against type VII collagen (Col7), the major component of anchoring fibrils, induce skin fragility leading to cutaneous and mucocutaneous blister formation, which is mostly of a scarring phenotype. Thus, powerful and reproducible diagnostic assays are critical to establish the diagnosis of EBA early to avoid irreversible sequelae. Objectives: The present international, retrospective multicentre study included a large cohort of patients with EBA and evaluated the diagnostic power of four different diagnostic assays for the detection of anti-Col7 IgG autoantibodies. Methods: Overall, 95 EBA sera and 200 control sera consisting of 100 bullous pemphigoid sera, 50 pemphigus vulgaris sera and 50 sera of healthy controls were tested for anti-Col7 IgG autoantibodies using indirect immunofluorescence (IIF), two commercial enzyme-linked immunosorbent assay (ELISA) systems and Western blot (WB) analysis. EBA sera were taken from patients with positive direct immunofluorescence and IgG reactivity in at least one of the immunoserological assays (IIF, ELISA, WB). Results: A Col7-NC1/NC2 ELISA (MBL, Nagoya, Japan) showed the highest sensitivity (97\uc2\ub79%), followed by a Col7-NC1 ELISA (Euroimmun, L\uc3\ubcbeck, Germany) (89\uc2\ub75%), WB with Col7-NC1 (85\uc2\ub73%), and IIF on saline-split human skin (74\uc2\ub77%). The specificities of both ELISA systems were comparable (NC1 98\uc2\ub77%, NC1/NC2 99\uc2\ub73%). Furthermore, WB was more sensitive than IIF, which was more specific. Conclusions: The two commercially available ELISA systems allow for a highly sensitive and specific diagnosis of EBA. The sensitivity of the Col7-NC1/NC2 ELISA is significantly higher compared with the ELISA based on the Col7-NC1 domain only