ABSTRACT
Background: The emergence of autoinflammatory/autoimmune disorders in COVID-19 patients has necessitated the development of new strategies for the management of these phenomena. Several viruses have been shown to cause autoimmunity by boosting the production of autoreactive lymphocytes, resulting in a lack of tolerance in the host's immune response. The SARS-CoV- 2 virus and/or its proteins can cause autoimmunity by molecular mimicry, superantigen activity, and disruption of type I IFN production. Method(s): The data of three patients who applied to the outpatient clinics of pediatric immunology and rheumatology at Uludag University Hospital between March 2020 and December 2021 and were followed up with autoimmune/autoinflammatory disease following CCovid-19- 19 infection were analyzed retrospectively. Result(s): All patients were female and aged between 2-17 years. They had SARS-COV- 2 infection which was mild a few months ago. Before the Covid-19 infection, all of the patients were in good health. The patients had no history of frequent infections or familial predisposition to rheumatic diseases. Following the Covid-19- infection, all of our patients showed fever, rash, joint discomfort, and muscle soreness. Despite the fact that myalgia affects the whole body, arthralgia was present on the wrists and knees of patients. CRP, sedimentation rate, and acute phase reactants increased in all of them. According to the American College of Rheumatology's diagnostic criteria, our first patient was diagnosed with systemic lupus erythematosus (SLE) and was treated with hydroxychloroquine, intravenous immunoglobulin treatment and anakinra. Two of three were diagnosed with systemic juvenile idiopathic arthritis (sJIA) according to the League of Associations for Rheumatology (ILAR) criteria. Only one patient had low IgG and IgA levels (Table 1). Two patients showed a decrease in CD19+ naive cells percent and numbers. Conclusion(s): Following SARS-CoV- 2 infection, autoimmune and autoinflammatory disorders such as rheumatoid arthritis, psoriatic arthritis, type 1 diabetes and Still disease have been documented in adult cases. There are limited pediatric cases on this issue. It has been suggested that the persistence of the latent immune response after COVID-19 infection happens by sensitizing the immune system to viral particles long after they have been eliminated from organisms. Is the autoimmune process the effect of a viral infection or mis-targeted immune system? These questions need deep research and discussion.
ABSTRACT
Background: Behçet's disease (BD) is an systemic infammatory vasculitis characterized by recurrent oral aphthae and genital ulcers. In the course of the disease, skin, eye, musculoskeletal, nervous system and gastrointestinal system involvements can be detected. Objectives: To evaluate the clinical, laboratory and radiological fndings of pedi-atric cases diagnosed with BD. Methods: Fifty patients (0-20 years old) who were followed up with the diagnosis of BD at the Pediatric Rheumatology outpatient clinic of Uludag University Faculty of Medicine between January 2011 and July 2021 were included in our study. The patients were diagnosed according to the diagnostic criteria of the International BD Study Group. Results: Twenty-four (48%) of the patients were male and 26 (52%) were female. The mean age at the diagnosis of patients was 9 ±4.55 years (10.75±4.55 years in boys, 12.35±3.65 years in girls). Twenty patients (36.3%) had a family history of Behçet's Disease. Oral aphthae were present in 96% (n=48) patients, while genital ulcers were in 32% (n=16) (Table 1). Of the nine patients with uveitis, 6 had panu-veitis, 2 had anterior uveitis and 1 had posterior uveitis. There was no difference in the distribution of symptoms according to the gender of the patients. HLA-B51 allel was found in 39 (78%) and ANA was positive in 14 patients (28%). Immunological tests showed that serum immunoglobulins were low in 11 (32.3%) of 34 patients. Low IgG levels were detected in 6 patients, low IgM levels were in 3, and low IgA levels were in 2. Thrombus was presented in three cases (thrombus in the right ventricle in one case, in the intracranial transverse sigmoid sinus and left jugular vein in two cases). The most commonly used drug for aphthae was colchicine (n=45, 82%). The use of biological agents according to patient manifestations is shown in Table 2. In the follow-up, clinical fndings improved in 35 patients (70%) Complete improvement was detected only with biological agents in 8 patients with uveitis. One patient was operated due to the development of complicated cataracts secondary to uveitis. Three patients were diagnosed with Covid-19, one of them was followed without treatment, while two of them were treated with favipiravir at home. Three patients with Covid-19 infection were using only colchicine treatment. Conclusion: Behçet's disease is rare in childhood. Although it is not common, life-threatening complications can be observed. To reduce morbidity and complications, physicians should be aware of manifestations and rare clinical pictures of the BD.
ABSTRACT
Aim: The present study aims to investigate and compare the uric acid of the recovered/deceased and ICU/ward COVID-19 patients. Method: The study was conducted with 397 patients with COVID-19 diagnosis. Information about 157 deceased and 240 recovered COVID-19 patients was analyzed retrospectively. Relationship between serum uric acid, Na, K, urea, and creatinine was investigated between patients in the mortal/non-mortal and ICU/ward group. Result: Of the total 397 patients in the study, 158 (39,8%) were female and 239 (60,2%) were male. Statistically significant difference in mortality was found between males and females in order (107-239, 44.8%/50-158,31, 7%;p=0.009). Total mean age (std deviation), was 63.77±16,1, the mean age in the deceased group was 71,41±11, 39, and it was 58.78±16,8 in the survived group and that is statistically significant too (p=0.001). The mean values of Uric acid with order survivor and deceased group ((4,867±1,81 (n=222)- 7, 086±3,24(n=148), P=0,000). Mean age in ICU group 69.53±12,52, in the ward group 56.24±17,1 and this age differentiation between two groups is statistically significant (p=0,001), There is a statistically significant difference in ICU care or ward was found between males and females in order (107-239, 44.8%/50-158,31,7%;p=0.009). The mean values of Uric acid with order ICU care and ward group ((6,52 ±3,1(n=217) -4,66±1,46 (n=153), P=0,000)). Serum K+ (Potassium) (4,164±0,5 (n=239)) - 4,357±0,7 (n=157), P=0,002)) levels are higher in deceased groups. The cutoff value of uric acid, which may pose a risk of mortality, was found to be 5,15 mg/dl. And the cutoff value of creatinine, which may pose a risk of mortality, was found to be 0,9 mg/dl. Conclusion: The cutoff value of uric acid, which may pose a risk of mortality, was found to be 5,15 mg/dl and the cutoff value of creatinine, which may pose a risk of mortality, was found to be 0,9 mg/dl. Advanced age, uric acid, creatinine, and potassium increase were found to be associated with mortality. © 2022 A. CARBONE Editore. All rights reserved.
ABSTRACT
Background: We aimed to evaluate the effect of the COVID-19 outbreak in our patients diagnosed with PID. Method: This is the first year of results investigating the effect of the Covid-19 pandemic on patients with primary immunodeficiency in Turkey.COVID-19 The online questionnaires prepared by us were sent to the patients via e-mail and mobile communication tools. The data obtained from filled the online questionnaire were evaluated. Results: One hundred fifty-six patients diagnosed with PID participated in the study. The median age of the patients was 15.7 years (0.24-77.2 years), and the female-to-male ratio was 0.6 (60/96). The largest group of patients included in the study was predominantly antibody deficiency (n =96, 61.5%). Most of the COVID-19 infected patients were in the PAD group, but when sorted by the number of patients in the subgroups, the highest rate of COVID-19 was in the “Congenital defects of phagocyte number or function” group (12.5%) (Table 1). The general frequency of COVID-19 infection in our PID patients was 15%. The most common symptom in COVID-19 infected patients was fever (n = 6, 40%). Symptoms according to their frequency were given in figure 1. Ninety-seven cases (62.2%) thought they had a higher risk for COVID 19 infection. In the COVID-19 pandemic, 78 cases (50%) stated that their economic situation deteriorated and 14 cases (9%) lost their jobs. Complete recovery was achieved in 12 cases and partial in 3 cases. Conclusion: It has been observed that the COVID-19 pandemic significantly affects both the health and social status of patients diagnosed with PID. New policies should be developed to improve patient's well-being, taking into account the health, social and economic effects.