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Background: The dietary approaches to stop hypertension (DASH) encourages high fruit, vegetable, and lean protein consumption and low salt, red meat, and fat intake to prevent or treat hypertension. However, besides hypertension, adherence to this diet has been shown to decrease other cardiovascular risk factors. Methods: This study assessed the relationship between the DASH diet and cardiovascular risk factors in a cross-sectional study of 2,831 adults chosen by multistage cluster sampling from 27 counties of Khuzestan province, Iran. DASH scores were calculated using data obtained from a qualitative food frequency questionnaire. Regression models were used to evaluate the association of DASH scores and common cardiovascular risk factors. Results: Significant trends were observed across quintiles of DASH scores for systolic blood pressure, fasting blood sugar, triglyceride, total cholesterol, and its components (p < 0·05). After adjusting for potential confounders such as sex, age, ethnicity, residence, wealth score, physical activity, energy intake, and family history of heart disease, the multiple regression analysis for each cardiovascular risk factor revealed that being in the highest quintile of total DASH score (OR = 0.72, 95% CI 0.52-0.99) was negatively associated with hyperglycemia. Conclusions: This study showed a positive relationship between DASH diet adherence and lower serum levels of glucose, triglycerides, and cholesterol. Prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Received: 11 November 2017; Received in revised form: 20 July 2018; Accepted: 30 July 2018 ABSTRACT Major histocompatibility complex (MHC) class II deficiency is a rare primary immunodeficiency disorder (PID) with less than 200 cases worldwide. Here, we report an 8 month-old girl with MHC class II deficiency with a novel homozygous mutation in RFXANK gene (NM_001278728: exon 5: c.495G>A: p.Trp165*) and normal CD4+ T cell counts, diagnosed by whole exome sequencing (WES) and negative HLA-DR proteins on peripheral blood mononuclear cell (PBMC) in flow cytometry. She was referred with pneumonia, prolonged fever, resistance to antibiotics (ceftriaxone, clindamycin, and vancomycin), and low serum immunoglobulin (IG) levels, while natural killer (NK), B, and T cells were normal. She received intra-venous immune-globulin (IVIG) replacement, broad spectrum antibiotics, and anti-fungal treatments. The presented case report is interesting not only because of the rarity of the PID but also due to normal CD4+ T cell counts. According to our experience, we suggest that physicians consider MHC class II deficiency in families with consanguineous marriages, even with normal CD4+ T cell counts. At the first, the diagnosis of the disease could be successfully perform using WES, and finally, treatment with hematopoietic stem cell transplantation can save the patients' lives. [ABSTRACT FROM AUTHOR]

Limited evidence has been obtained concerning the beneficial effects of autologous serum therapy in treatment of skin disorders particularly chronic urticaria. In the present study, we have assessed the effect of this treatment method in patients with chronic urticaria (CU). This randomized single-blind controlled trial was performed on fifty consecutive patients with chronic urticaria. The patients were randomly assigned to receive autologous serum (as the case group, n=35) or normal saline (as the control group, n=15) and treated with monthly autologous serum therapy or normal saline for 6 months. The considered study endpoint was changes in total severity score (TSS) at the 6 months follow-up visit. The TSS score was assessed at baseline as well as at the ninth week and the sixth month of interventions. The mean±SD of TSS at the ninth week of intervention was 10.94±3.92 in autologous serum therapy group and 11.67±2.72 in the normal saline group (p=0.458). Furthermore, the mean values of TSS at the sixth month of treatment in the study groups were 8.29±6.29 and 9.27±4.89 respectively (p=0.593). A downward trend in TSS, from baseline to the end of treatment, was seen in the case and control groups (p<0.001 for both), however the trend of this decline was insignificant between the two groups (p=0.592). The change in the trend of TSS after 6 months of treatment was independent from the administration of autologous serum when compared with normal saline administration (beta=-0.962, p=0.630). Multivariate linear regression model with the presence of baseline factors including gender, age, disease duration and history of atopy was performed to assess difference in TSS at six-month follow-up visit compared with the baseline value. Only young age was associated with more reduction of TSS (beta=0.163, p=0.023). We found no difference in the effects of autologous serum therapy and normal saline on the trend of the changes in disease severity in patients with chronic urticaria. [ABSTRACT FROM AUTHOR]

Background: The main aim of the present study is to investigate the independent association objectively measured level of physical activity (PA) and serum concentration of liver aminotransferases (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) among seemingly healthy individuals. Materials and Methods: The current secondary study was conducted in the framework of Khuzestan Comprehensive Health Study, a large population-based multicentric cross-sectional study, conducted between 2016 and 2019 on 18,966 individuals living in Khuzestan province, southwestern Iran. International PA Questionnaire was used for evaluating PA levels, and participants were divided into three groups: low, moderate, and high PA, and ALT and AST were compared between these groups. Results: The mean ± standard deviation age of participants was 38.65 ± 11.40 years. The majority of participants were female (71%). The mean concentration of ALT in total sample was 18.22 ± 13.06 (male: 23.65 ± 16.26 and female: 15.57 ± 10.06), while the mean concentration of ALT in total sample was 19.61 ± 8.40 (male: 22.44 ± 10.03 and female: 18.23 ± 7.08). A statistically significant inverse correlation was found between AST (r = −0.08, P = 0.02) and ALT (r = −0.038, P < 0.001) with total PA score. The mean concentration of ALT was 19.96 ± 13.63 in people with low PA, 17.62 ± 12.31 with moderate PA, and 18.12 ± 13.47 with high PA (P < 0.001). The mean concentration of AST in total sample was 20.37 ± 8.85 in people with low PA, 19.21 ± 8.83 with moderate PA, and 19.75 ± 8.85 with high PA (P < 0.001). The difference between people in different levels of PA in terms of mean concentration of AST was remained significant (P = 0.003); however, the difference for ALT was not remained significant after adjusting potential confounders. Conclusion: The current study based on large sample showed that PA had a statistically negative association with the concentration of liver aminotransferases in the seemingly healthy individuals; however, the observed associations were weak. People in the lowest levels of PA had the highest levels of ALT and AST. [ABSTRACT FROM AUTHOR]

Objective: Major histocompatibility complex (MHC) class II deficiency or Barelymphocyte syndrome (BLS) type II is an extremely rare primaryimmunodeficiency disorder (less than 200 cases worldwide), characterized by thepartial or complete absence of MHC class II-encoded molecules HLA-DR, -DP and -DQ. Laboratory features in these cases include normal B cell and CD8+ T cell andlow CD4+ cell counts. Here, we report an interesting case of MHC class II deficiencywith normal CD4+ T Cell counts that was diagnosed by Whole Exome Sequencing(WES).Material and Methods: The case is an 8-month-old girl born from related healthyparents with an expired sister due to the same disease with no definite diagnosis.Patient was referred to due to the lack of response to therapy with antibioticssuch as ceftriaxone, clindamycin, vancomycin, and admitted because ofpneumonia and prolonged fever. Clinical examination revealed normal B cell andT cell and NK cell numbers and low serum immunoglobulin levels. The IVIGreplacement and administration of broad-spectrum antibiotics and antifungal wasstarted. Patient was subjected to genetic study and WES was performed. MHCclass II expression was investigated looking for HLA-DR proteins on the surface ofperipheral blood mononuclear cell (PBMC) by flow cytometry.Results: A novel homozygous mutation in RFXANK gene (NM_001278728: exon5:c.G495A: p.W165X) was found that leads to a stop-gain mutation which can causeloss of function of protein. Sanger sequencing confirmed that patient ishomozygous and parents (father and mother) are carrier heterozygous for thismutation. HLA-DR expression was negative, confirmed MHC II deficiency in thispatient.Conclusion: Presented case history is interesting not only because of the rarity ofthis form of PID, but also due to normal CD4+ T cell counts. In spite of the high riskof postoperative complications, we recommended hematopoietic stem celltransplantation (HSCT) as the only curative treatment. We also recommendWES as a powerful tool in the identification of genetic causes of primaryimmunodeficiencies. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that they have no competing interests.

Follicular helper T (TFH) cells are a subset of effector CD4+ T cells that support the differentiation of antigen-specific B cells in the germinal center. TFH cells are distinct from other established CD4+ T cell subsets and possess a list of transcription factors, including BCL6, IRF4, c-Maf, Batf, NFAT1-2, and STAT3. The mentioned factors direct several activities such as cell differentiation, migration to the follicles, cell-to-cell interaction, as well as cell programming. Given that TFH cells are essential for the germinal center formation, affinity maturation and the development of most high-affinity antibodies. TFH cells may play crucial roles in different pathologic conditions, particularly autoimmune diseases. However, the mechanisms that cause functional differences of TFH cell responses are not exactly defined. In this review first the immunological profile of TFH cells will be discussed then attempts will be made to give a broad picture on the role of this key subset of T cells in autoimmune diseases.