Hospital Practices and Research

Abstract Background: IL-1β is a key mediator of inflammation in the body. Upon inflammasome activation, the IL-1 receptor antagonist (IL-1Ra) serves as the primary natural inhibitor of IL-1β by competitively binding to its receptor, thereby limiting inflammatory signaling. Due to this mechanism, IL-1Ra has garnered significant interest as a biological anti-inflammatory drug.
Objectives: This study aimed to produce recombinant IL-1Ra (rIL-1Ra) in E. coli using optimized expression conditions and to develop a highly efficient purification process utilizing Ni/silica-coated magnetic nanoparticles.
Methods: The IL-1Ra gene was cloned into the pET-28a expression vector. The correct construction of the recombinant plasmid was verified by PCR and DNA sequencing. Expression of rIL-1Ra was carried out in E. coli BL21 (T7 Express) under optimized conditions (induction with 0.5 mM IPTG at 25 °C for 16-18 h). The expressed protein was analyzed by SDS-PAGE and Western blot. Purification was performed using Ni/silica-coated magnetic nanoparticles, followed by protein concentration via polyethylene glycol (PEG). The protein concentration was determined by Bradford assay, and the product was subsequently stabilized by buffer exchange into PBS (pH 7.4) through dialysis, supplemented with 10% glycerol, and stored at -20 °C.
Results: PCR and sequencing confirmed the successful construction of the expression cassette, showing the expected ~450 bp insert. SDS-PAGE and Western blot analyses detected a protein of approximately 19.8 kDa, confirming the expression and identity of rIL-1Ra. Maximum soluble expression was achieved under the optimized conditions. Purification using Ni/silica-coated magnetic nanoparticles yielded 10 mg of rIL-1Ra per 1000 ml of bacterial culture (10 mg/L).
Conclusion: The E. coli BL21 (T7 Express) system proved to be an effective and cost-efficient host for producing soluble rIL-1Ra. Furthermore, the use of Ni/silica-coated magnetic nanoparticles provided an efficient and scalable purification method, yielding a substantial amount of the recombinant protein suitable for further research and potential therapeutic applications.

Abstract Background: Among suggested medications for the treatment of COVID-19, chloroquine derivates and angiotensin-converting–enzyme inhibitors (ACEIs)/angiotensin II type 1 receptor blockers (ARBs) are the two medications with conflicting effects on the development of the disease.
Objectives: The present study aimed to evaluate COVID-19 in patients with rheumatic diseases receiving chloroquine derivate.
Methods: Every patient with proven rheumatologic diseases registered in two referral centers in Tehran and Alborz, Iran was enrolled in the present descriptive cross-sectional study between May and June 2020. At first, the symptoms of COVID-19 were assessed, and if a case had suspicious symptoms, reverse transcription-polymerase chain reaction (RT-PCR) COVID-19 tests were done. Demographic and clinical data are documented for every patient. Then, the patients were grouped once according to their COVID-19 infection status and another time according to their hydroxychloroquine use.
Results: 1159 patients enrolled in the study with a mean age of 49.39 years. Frequency of hypertension was 22.17 %, diabetics (9.49%) and 20 (1.7%) patients were positive for COVID-19 testing. The most common symptoms of the COVID-19 positive cases were cough (5.2%) and fever (4%). There was no significant difference in receiving ACEIs/ARBs or other medications between COVID-19 positive or negative patients. Among the patients receiving hydroxychloroquine, 15 patients (1.7%) had proved COVID-19 versus 5 patients (1.7%) who were not receiving these medications (P>0.999).
Conclusion: The present study demonstrated that receiving ARBs or ACEIs was not different among patients with or without COVID-19. Moreover, receiving chloroquine derivate was not related to the development of COVID-19 in patients with rheumatologic disorders.

Abstract Inrtoduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by surgical involvements, while pachymeningitis can be diagnosed by MRI and treated by medical management. In this study, we tried to present a case of GPA with optic neuritis and typical central nervous system (CNS) involvement, while there were no definite features of sinusitis or kidney injuries.
Case Presentation: A 15-year-old girl was admitted because of blurred vision in her left eye. She was a known case of GPA three years ago with initial features, including left facial nerve paresis due to pan-sinusitis and pulmonary cavity. Neurologic evaluations, including sensory and motor features, were normal, too. Ophthalmologic examinations showed that visual acuity of the right eye was good, while the visual acuity in the left eye decreased to the point of finger counting at a distance of 20 cm. The left eye Marcus gunn test was positive (3+); anterior and posterior eye segments were normal. The patient was evaluated by brain MRI with gadolinium and a pathologic enhancement in the left cavernous was seen which had a pressure effect on the optic nerve. She was treated by intravenous methylprednisolone followed by rituximab.
Conclusion: Reporting orbital mass in a patient who had GPA can be supposed as granuloma which needs a biopsy to confirm a diagnosis. In our case, the imaging manifestation was heterodox for granuloma, while neurosurgical consultation recommended drug treatment for pachymeningitis.

Abstract Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found.
Case Presentation: The patient was a 16-year-old female who presented with pain and hearing loss in both ears and reduced muscle tone in the right side of her face. After myringotomy and ventilation tube embedding in both ears, she gradually developed infectious otorrhea in both ears. Despite antibiotic and antifungal therapy for 2 weeks after surgery, the patient developed paresis in the left facial nerve and gag reflex disorder. Both magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) tests were normal, but the C-anti-neutrophil cytoplasmic antibody (CANCA) test result was about forty times higher than normal, and a sinus biopsy also verified Wegener’s granulomatosis. The patient was then treated with pulse corticosteroid and cyclophosphamide therapy. Her gag reflex healed and the ear secretions stopped, but the facial nerve palsy continued.
Conclusion: Although cranial nerve involvement in Wegener’s granulomatosis is an unusual incidence, it may occur in some cases. In the current case, otitis media and cranial nerve paresis without kidney or lung disorders were the only signs of disease onset; of course, computerized tomography (CT) scan revealed a right mandibular sinus disorder without any clinical signs. Another important point in this case is that other identified Wegener’s patients were in their fourth or fifth decade of life; thus, Wegener’s was the last choice for a diagnosis in the current case.

Abstract Accessibility to all levels of information technology has experienced rapid progress in recent years, particularly in the health sector. Rapid penetration into this technology has led to changes in lifestyles and changes in the working procedures of institutions. In 2014, the number of Internet users reached 3 billion, and this number is predicted to exceed 8 billion in 2018. Statistics estimate the number of Iranian users of the Internet to be about 45 million. In 2014, more than 80% of Internet users searched for health information. Today, the Internet plays a vital role in providing such health services as education, disease management, support, basic medical treatment decisions, and doctor-patient communication.