Zahra Kanannejad

Infertility is a major global public health concern that affects individuals throughout their reproductive years, with many cases remaining unexplained. Considering the increasing prevalence of infertility and its socioeconomic implications, understanding its underlying causes is essential. Among the numerous genetic contributors, polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene have been studied extensively due to their influence on folate metabolism, DNA synthesis, and methylation. However, the reported association between MTHFR variants and infertility is inconsistent across populations due to differences in ethnicity, dietary folate intake, and methodological variation. This review summarizes recent evidence regarding MTHFR polymorphisms and their role in male, female, and idiopathic infertility. The C677T variant has been most consistently linked with male infertility, particularly in Asian populations. In women, MTHFR variants may contribute to infertility through altered homocysteine and folate levels, potentially affecting oocyte quality and endometrial receptivity. Genetic counseling and testing for MTHFR polymorphisms may be useful for couples with idiopathic infertility or a family history of such variants. Personalized management strategies, including folate supplementation, lifestyle modification, and targeted therapy, may improve reproductive outcomes. Further large-scale, well-designed studies are needed to clarify the clinical significance of MTHFR polymorphisms in infertility.

Background: Omalizumab, a monoclonal antibody targeting immunoglobulin E, has emerged as an effective treatment option for chronic spontaneous urticaria (CSU), particularly in cases resistant to antihistamines. This study investigates the efficacy and safety of omalizumab in patients with CSU in a real-life context in Iran, marking its first report in this setting. Methodology: This retrospective study was conducted in Shiraz, southwestern Iran, over a period from April 2023 to January 2025. We examined data from patients with antihistamine-refractory CSU who were treated with omalizumab, utilizing medical archives from the CinnaGen Company in Iran. Efficacy was assessed based on the presence of wheals and itching symptoms during the 4 weeks preceding the evaluation call. Any adverse reactions related to drug injection were monitored through patient reports. Results: A total of 245 patients were included in the study (181 females and 64 males), with a mean age of 41.51 ± 12.91 years. The average duration of the disease among participants was 47.90 months. Of the patients, 186 (75.92%) achieved a complete response, 3 (1.22%) had a partial response, 33 (13.47%) were non-responders, and 23 (9.39%) withdrew from treatment. At least 1 adverse event was reported in 17 individuals (6.94%); these adverse effects were generally mild. However, 2 patients experienced serious reactions, both of which were effectively managed. Conclusion: This study is the first to examine Iranian patients with CSU treated with omalizumab. Omalizumab represents a breakthrough for those who do not respond to standard treatments, with more than three-fourths of our patients showing improvement. However, we must consider the potential for severe adverse effects associated with this medication.

Background: Hen’s egg allergy (HEA) is a prevalent food allergy in infants and young children. This study aimed to identify the progression of HEA over 48 months and identify factors that may predict its resolution. Methods: This prospective study was conducted on infants with HEA. We collected demographic information, clinical symptoms, and potential predictive factors. Skin prick tests were performed, and the infants were monitored over 48 months, with the resolution of allergy confirmed by successful egg ingestion. Results: A total of 121 infants were initially enrolled, of whom 98 completed the 48-month follow-up. By the end of follow-up, 80.6% developed tolerance, while 19.4% had persistent allergy. Kaplan–Meier analysis showed a median time to tolerance of 24 months, with 25%, 50%, and 75% of infants achieving tolerance by 18, 24, and 36 months, respectively. A smaller skin prick test wheal size (P = 0.038), whereas erythema size was not associated with time to tolerance ( P = 0.507). Conclusion: While many infants with HEA outgrow their allergy by the age of 4, a significant minority remains affected. The size of the wheal may serve as a critical indicator of the likelihood of persistent allergy.

Allergy and lung cancer are two distinct health concerns. While allergies are typically associated with heightened immune activity, such immune responses may also influence the tumor microenvironment. This study aimed to investigate a potential link between allergic conditions and the risk of lung cancer. We conducted a case-control study analyzing 82 histologically confirmed lung cancer patients and 82 healthy controls from 2019 to 2022. Data were collected through structured questionnaires assessing asthma, allergic rhinitis (AR), food/drug allergies, and chronic urticaria. Statistical analyses included independent samples t-tests and chi-square tests, with significance set at a predetermined threshold. We observed a significant inverse association between AR and lung cancer (8.54% vs 47.56% in controls; OR=0.14, 95% CI: 0.06–0.32). No significant associations were found for asthma (7.32% vs 3.66%), chronic urticaria (3.66% vs 3.66%), drug allergy (4.88% vs 1.22%), or food allergy (2.44% vs 6.10%). The association between AR and lung cancer remained robust after adjustment for demographic factors. AR demonstrated a strong negative association with lung cancer, suggesting potential protective mechanisms distinct from other allergic conditions. These findings support the growing evidence for allergy-cancer immunomodulatory interactions and highlight the need for mechanistic studies on AR-specific pathways in oncogenesis

The COVID-19 pandemic has had a devastating impact worldwide, with Iran being one of the hardest-hit countries in the Middle East. Understanding the factors that influence the spread of the virus is crucial for developing effective mitigation strategies. This study aims to investigate the geographical and climatic risk factors associated with COVID-19 incidence in the Kohgiluyeh and Boyer-Ahmad Province of southwest Iran during the 2020−2021 epidemic period. The study involved mapping the residential addresses of 15,585 patients with COVID-19 during 2020–2021. Geographical Information System (GIS) evaluated the effects of geographical and climatic determinants, including temperature, rainfall, humidity, evaporation, elevation, slope, and land cover, on COVID-19 occurrence. The data were analyzed using univariate and multivariate binary logistic regression. In the univariate model, significant climatic factors affecting COVID-19 susceptibility included elevation (p < 0.001, OR=0.617), evaporation (p < 0.001, OR=0.635), dusty days (p < 0.001, OR=1.050), humidity (p = 0.005, OR=1.013), and rainfall (p = 0.032, OR=0.998). Additionally, urban areas (p < 0.001, OR=65), irrigated farms (p < 0.001, OR=5.723), dry farms (p < 0.001, OR=3.101), thin forests (p = 0.009, OR=2.975), and thin rangeland (p = 0.030, OR=2.571) demonstrated the highest impact on the disease distribution. In the multivariate analysis, urban areas (p < 0.001 and OR=47.123), irrigated farms (p < 0.001, OR=4.510), dry farms (p = 0.006, OR=3.002), evaporation (p < 0.001, OR=0.999), and elevation (p < 0.001, OR=0.999) were found to be the main factors related to COVID-19 occurrence. Based on the study results, individuals living in urban areas, irrigated and dry farms, as well as in regions with lower elevation and lower evaporation, have a higher risk of contracting COVID-19.

Aim: Allergic conjunctivitis (AC) is an inflammatory response of the conjunctiva triggered by exposure to common allergens, including pollen, dust mites, and animal dander. This study aimed to identify probable allergens in Iranian patients with AC. Methods: This cross-sectional study included individuals with AC from Southwestern Iran in 2024. Skin prick tests (SPTs) were performed using commercial extracts of various allergens, including tree mix, weed mix, grass mix, dust mite mix, fungi mix, as well as cat and cockroach allergens. Results: Among 92 patients with conjunctivitis, with a mean age of 23.66 ± 14.70 years, 80 patients (86.96%) had a positive SPT to at least one of the applied extracts. Sensitization rates detected by SPTs were as follows: weed mix 68.48%, tree mix 58.70%, grass mix 53.26%, dust mite mix 45.65%, cockroach 29.35%, fungi mix 22.83% and cat allergen 17.39%. A significant difference in dust mite sensitization was observed between patients with seasonal and perennial AC (p = 0.023). Conclusions: This study highlights the allergic sensitization of patients with conjunctivitis and its connections to other allergic conditions. Allergists can play a crucial role in managing conjunctivitis through comprehensive testing and holistic treatment approaches.

Pediatric respiratory allergic diseases, including asthma and allergic rhinitis, are increasingly recognized as significant global health concerns, with rising prevalence rates linked to environmental changes driven by urbanization and climate change. This review explores the impact of climatic factors such as temperature fluctuations, shifting precipitation patterns, and dust storms on air pollution and its consequences on respiratory allergic diseases in children. Evidence suggests these environmental exposures increase allergen loads and profoundly influence immune system function. Air pollutants and airborne allergens promote Type 2 helper T‐cell (Th2)‐skewed responses, leading to elevated IgE production, eosinophilic inflammation, and airway hyperreactivity. Additionally, epithelial barrier dysfunction caused by oxidative stress triggers the release of alarmins such as thymic stromal lymphopoietin, interleukin‐33 (IL‐33), and IL‐25, that activate innate lymphoid cells, and amplify allergic sensitization. Long‐term exposure to pollutants also disrupts immune tolerance by impairing regulatory T‐cell (Treg) activity and promoting persistent airway inflammation. This review highlights how these immunological pathways contribute to the severity and chronicity of allergic diseases in pediatric populations, with special attention to studies conducted in regions prone to dust storms. Understanding these mechanisms is critical for developing targeted public health strategies, improving air quality, and mitigating the health impacts of climate change on children.

Cystic echinococcosis (CE) is a significant zoonotic helminthic disease with considerable public health and economic impact in endemic regions. We aimed to analyse the climatic and environmental factors affecting the human CE cases in North Khorasan Province, northeast Iran. Using a geographic information system, we map the addresses of 316 hospitalised CE patients from 2012 to 2022 and examined the influence of climatic variables, altitude, and land cover on CE case distribution. Data were analysed using logistic regression models. Most patients were female (58.9%) and aged 21–60 years (67.4%), with liver involvement being the most common (57.3%). The multivariate model identified urban settings, irrigated and dry farms, soil temperature, and humidity as the most important geoclimatic determinants, respectively. In contrast, gardens, moderate and excellent rangelands, minimum, maximum, and mean air temperatures, and rainfall were only found to be significant factors in univariate models. High-risk areas for CE include urban and suburban regions, surrounding fields, and pastures where stray dogs and wild canids roam, livestock husbandries are present, and residents consume unsanitised vegetables. Additionally, areas with lower soil and weather temperatures and higher humidity conditions that may enhance the survival of E. granulosus eggs dispersed by canids were identified as high-risk zones. Health managers can use these findings to prioritise control programs and allocate limited resources to these areas, ultimately reducing the future incidence of CE.

Fractional exhaled nitric oxide (FeNO) has emerged as a potential biomarker for differentiating between various causes of non-chronic cough, particularly in conditions associated with airway inflammation, such as asthma. This study aimed to evaluate the diagnostic efficacy of FeNO in pediatric patients with non-chronic cough and its ability to differentiate between asthma exacerbations and respiratory tract infections. Seventy-five pediatric patients aged 10-18 years with non-chronic cough were categorized into three groups: good control asthma (GCA, n=28), acute asthma exacerbation (AAE, n=26), and respiratory tract infection (RTI, n=21). Clinical assessments included FeNO measurement, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, hemoglobin (HB), platelet count (PLT), and immunoglobulin E (IgE) levels. Univariate and multivariate multinomial logistic regression models were applied to assess the predictive value of these variables. FeNO levels were significantly higher in the AAE group (46.58±22.66 ppb) compared to the GCA and RTI groups, indicating elevated eosinophilic airway inflammation in asthma exacerbations. CRP was a significant predictor of both AAE and RTI, with a one-unit increase in CRP increasing the odds of exacerbation or infection by 2.6-fold. Body max index (BMI) was inversely associated with the risk of RTI. Hemoglobin, platelet count, and IgE levels were significantly higher in the AAE group compared to the other groups, while WBC counts, though elevated, were not statistically significant. FeNO associated with other inflammatory markers, including CRP and BMI, could enhance diagnostic accuracy and inform clinical decision-making in managing pediatric respiratory conditions. To confirm these results, future studies with larger sample sizes should be performed.

This study presents the development and evaluation of a novel chitosan/Persian gum hydrogel loaded with an internal layer of oak fruit (Jaft) and yarrow extracts, designed to enhance wound healing. The hydrogel was synthesized using chitosan and Persian gum, selected for their biocompatibility and ability to promote wound healing. The incorporation of Jaft and yarrow extracts was aimed at augmenting the hydrogel’s therapeutic efficacy. Characterization of the hydrogel using Fourier transform infrared spectroscopy (FTIR), X‐ray diffraction (XRD), and scanning electron microscopy (SEM) confirmed the successful integration of the extracts and revealed a semicrystalline structure with a porous morphology conducive to controlled drug release. In vitro studies demonstrated a pH‐responsive release profile, with faster drug release at alkaline pH (8.5) compared to acidic and neutral pH (5.5 and 7.4). The hydrogel exhibited significant antibacterial activity, particularly against Escherichia coli , with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values lower than those observed for Staphylococcus aureus . Animal studies further validated the hydrogel’s efficacy, showing enhanced wound closure, increased epidermal thickness, higher fibroblast proliferation, and reduced infection rates compared to controls. These findings suggest that the chitosan/Persian gum hydrogel, enriched with natural extracts, holds significant potential as a multifunctional wound dressing, offering a synergistic approach to infection control and tissue regeneration.