Background: Several cytokines contribute to cutaneous leishmaniasis outcomes. IL-23 is a key cytokine in inflammation and a central cytokine in controlling Th17. IL-8, also known as a neutrophil chemotactic factor in the lesion site of cutaneous leishmaniasis, indicates disease promotion. Objectives: This study aimed to evaluate the relationship of Leishmania major with IL-8 and IL-23 expression. Methods: This case-control study was performed on 25 healthy individuals and 25 cutaneous leishmaniasis patients who lived in Southwestern Iran, in 2017. Peripheral blood mononuclear cells (PBMCs) were first isolated. Total RNA was extracted and reversetranscribed into cDNA. The expression levels of IL-8 and IL-23 were measured by the real-time PCR. The data were statistically analyzed using SPSS version 16. Results: Our findings indicated that the expression of IL-8 was significantly higher in the leishmaniasis group than in the control group with the median (IQR) of 0.39 (0.92) and 0.03 (0.11), respectively (P = 0.02). The expression of IL-23 was higher in the leishmaniasis group than in the control group with the median (IQR) of 0.13 (0.43) and 0.11 (0.61), respectively (P = 0.48). The increased IL-8 expression accompanied the location sites in face and hand and the increased number of skin lesions. Conclusions: The expression of IL-8 in patients with cutaneous leishmaniasis is an index of increased activity of local neutrophils that can contribute to leishmaniasis survival or inflammation increase. However, IL-23 appears to be less important in the inflammatory reaction than IL-8.
: The patient was an 11-year-old boy who was referred to our emergency department with a chief complaint of dry cough and shortness of breath. He was diagnosed with asthma when he was three years old and was treated with inhalers as needed. On physical examination, he had respiratory distress and biphasic wheezing. The patient was initially managed as an asthma attack; however, he did not respond to the treatment completely. After a pulmonology consult, he underwent a spirometry test, which was compatible with an obstructive pattern. He was a candidate for fiberoptic bronchoscopy, which revealed findings in favor of vocal cord dysfunction (VCD) and adult-onset laryngomalacia. As part of the management of VCD, we referred him to a psychiatric clinic, evaluating for psychological problems as aggravating factors. We found that he suffered from psychological disorders, including somatic symptoms disorders and mild to moderate depression. The patient was treated for his psychiatric problems. He responded to the treatment well, and the cough and dyspnea attacks resolved gradually after a few months.
Background
Head up Tilt‐table Test (HUTT) is a practical examination of the most common type of pediatrics syncope. The electrocardiographic (ECG) changes during this test, show the autonomic defects that cause neuraly‐mediated syncope in response to tilting process.
Methods
All pediatric syncope patients referred to our center in a 1‐year period, were included in the study. HUTT was performed and patients were classified into two groups of Negative and Positive HUTT results, and the latter group was subclassified as three subgroups of “vasodepressor”, “cardioinhibitory” and “mixed type” responses to HUTT. QT and corrected QT (QTc) dispersion was measured by the baseline standard 12‐lead ECG obtained before HUTT.
Results
Eighty‐six patients with a mean age of 12.19 ± 5.34 were included. Patients with positive HUTT were significantly younger and male gender was more prevalent in this group. Mean QT dispersion was significantly higher in patients with positive HUTT result and also in patients with mixed response to HUTT compared to isolated vasodepressor response. Duration of QTc interval did not change between different study groups. Reciever‐Operating‐Characteristic (ROC) analysis showed that QT dispersion higher than 32 ms is a significant predictor of positive HUTT result (with 92% sensitivity and 98% specificity) and values higher than 40 ms can predict the mixed type of response to HUTT (with 84% sensitivity and 63% specificity).
Conclusions
Baseline myocardial repolarization disparity significantly correlates with susceptibility to symptomatic vasovagal syncope. This pathology seems to play its role mainly via excessive vagotonic response to sympathetic activation during HUTT process (known as cardioinhibitory response).
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