COVID-19 infection may trigger SLE disease: A case report

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various body organs, especially the skin, joints, hematopoietic system, kidneys and central nervous system. The signs and symptoms occur depending on the inflammation in the affected tissues. Although many factors are responsible for its aetiology, it is known that some viruses such as Epstein Bar virus may also cause this disease by triggering autoimmunity. Recent studies have revealed that the immune system could be activated due to coronavirus infections and that some autoantibodies could be observed in the blood. A small number of SLE cases activated by COVID infection have been reported in the literature. The present study presented and discussed with the information in the literature a 20-year-old patient with COVID infection, diagnosed with SLE with renal involvement according to EULAR/ACR 2019 criteria by considering histopathological and immunofluorescence findings. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

EFFECTS of ANTI-SARS-COV-2 VACCINATION on SAFETY and DISEASE EXACERBATION in BEHCET'S DISEASE PATIENTS: A SINGLE CENTRE STUDY

Background: Pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), has become a major global health issue since December 2019. Patients affected by systemic rheumatic disorders represent a high-risk group for severe COVID-19. During the COVID-19 pandemic, vaccination has become one of the cornerstones of the fght against this disease. The EULAR and the ACR recommend vaccination in all patients with rheumatological diseases. There is a paucity of data regarding the safety of COVID-19 vaccines in patients with rheumatic and musculoskeletal diseases such as BehÇet's disease (BD). Objectives: In this study, we evaluated the safety and tolerance of COVID-19 vaccines, post-vaccine BD exacerbation and discontinuation of BD therapy in BD patients by retrospectively examining our BD cohort, from the patients' perspective. Methods: We retrospectively evaluated 450 BD patients followed in our clinic using hospital records and formed a retrospective cohort of patients who met the International Study Group (ISG) criteria. COVID-19 vaccination status, vaccine type (inactivated or mRNA), post-vaccine side effects and exacerbations, drug compliance, change in treatment after exacerbation, and post-vaccine COVID-19 occurrence were evaluated by interviewing patients over the phone or face to face. Patient demographics, comorbid diseases, and active BD treatments were collected from our hospital records. Disease activity was measured using the BSAS and the BDCAF form. Results: Our cohort consisted of a total of 450 BD patients. Two hundred and eighty seven patients had at least 1 dose of the COVID-19 vaccine. Of the total number of COVID-19 vaccines (n= 639), 379 (59%) were Pfzer-BionTech vaccines and 257 (41%) were Sinovac vaccines. The side-effects after frst, second, third and fourth vaccine dose were 151 (52.6%), 135 (47%), 29 (10.1%) and 3 (1%), respectively. BehÇet fare after frst, second, third and fourth vaccine dose were 151 (52.6%), 135 (47%), 16 (22.9%) and 3 (33.3%), respectively. The most common side effects were arm pain, joint pains or arthritis, malaise, while the most common BD exacerbations were arthralgia or arthritis, oral aphthae, pap-ulopustular eruption Pfzer-BionTech and Sinovac vaccines were compared in terms of side effects, there was a signifcant difference after the 1st (p<0.001) and 2nd doses (p<0.001), but no signifcant difference was found at the 3rd dose (p= 0.353) (Table 1). When Pfzer-BionTech and Sinovac vaccines were compared in terms of BD exacerbations, no signifcant difference was found after the 1st (p= 0.417), 2nd (p= 0.465) and 3rd doses (p= 0.565). Only 4 patients (1.3%) developed exacerbation with organ involvement after COVID-19 vaccine. Anterior uveitis developed in 2 patients, panuveitis in 1 patient, panuveitis and deep vein thrombosis in one patient. Conclusion: In conclusion, our study shows that the COVID-19 vaccine is well tolerated in BD patients, and that post-vaccine BehÇet's exacerbation predominantly includes mucocutaneous and articuler fndings, and exacerbations with organ involvement are rare. According to the COVID-19 vaccines, although the side effects were more in the Pfzer-BioNTech group compared to the Sinovac group, there was no difference between BehÇet's fare compared to the COVID-19 vaccines.

EVALUATION after COVID-19 VACCINATION in PATIENTS with ANTIPHOSPHOLIPID SYNDROME: A RETROSPECTIVE COHORT STUDY

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by presence of anti-phospholipid antibodies (aPL) comprising lupus anticoagulant, anti-β2-glycoprotein I and/or anti-cardiolipin antibodies together with recurrent thrombosis and/or obstetric morbidity. In the course of COVID-19, thromboembolism may ocur due to endothelial dysfunction directly related to the viral factor and systemic infammatory response. Concerns about COVID-19 vaccines began to arise after unexpected thromboembolic events were launched with the launch of vaccine campaigns around the world to prevent the disease. Objectives: The purpose of the study is to contribute to the literature on this subject by evaluating the development of any side effects or activation of the disease after the COVID-19 vaccine in our APS patients. Methods: This study was designed as a cross-sectional, retrospective cohort study. The patients who meet the Sapporo Criteria for APS which are followed up in Ankara City Hospital Rheumatology Clinic, 18 years and over and vaccinated with any of the COVID-19 vaccines, were included into the study. The files of the patients were examined in order to evaluate the side effects and APS disease activation (thrombosis, embolism or pregnancy complications) in the 3-month period after the last dose of the COVID-19 vaccines (CoronaVac and BNT162b2). Also, information of the patients was collected via telephone or reviewed at regular follow-up visits. Results: A total of 35 patients were included into the study (Table 1). In our patients, we did not observe any new thrombotic events or pregnancy complications during the 3-months observation period after COVID-19 vaccinations. The most common side effects after vaccinations were as follows;myalgia (30%), weakness (16.7%) and fever (10%) (Table 2). No patient became pregnant or gave birth during the follow-up. Conclusion: According to our results, no thrombotic events or pregnancy complications were observed after CoronaVac and BNT162b2 vaccines in APS patients. Apart from this, minor side effects related to COVID-19 vaccines were clinically acceptable level.

Anatomy of # Plandemi Infodemic: A Case Study on Misinformation Diffusion During the Covid-19 Pandemic

Just as the COVID-19 pandemic has spread with the transportation networks of the globalizing world, the infodemic is spreading globally with social media networks. The diffusion potential of social media with its complex structure of mass and interpersonal communication provides the distribution of helpful information. Yet, it can also cause the distribution of information pollution. Information pollution can become massive with the intensified interaction between users and cause infodemic. The World Health Organization secs infodcmic as a global problem that needs to be tackled as much as the pandemic in terms of human health. It leads to information pollution and misleads people's attitudes towards the virus and vaccine. After the video titled "Plandemic: The I lidden Agenda Behind COVID-19" was published on social media platforms such as Youtube and Facebook on May 4, 2020, it spread rapidly and became one of the concrete cases of the infodemic. The video spread rapidly with the shares of the viewers in the two days it was broadcast and reached the number of views close to two million. It has drawn the masses into its magic circle by packaging the COVID-19 claims that are voiced by groups prone to conspiracy theories. Although the video was taken down in a slightly short time, the misinformation it contained remained in circulation globally through interactions on social media. In this research, the reflections of the Plandemic video in Turkey were determined by the content produced by the users on Twitter via the #Plandemi hashtag. The primary purpose of the research is to examine how false information is spread in social media by giving examples. Stuctured as a case study, this research conducts network analysis and content analysis to the posts with the #Plandemi hashtag on Twitter. As a result of the network analysis, power-law distribution has been determined in the interaction between users and message production. As a result of the content analysis, it was determined that there was a contextual overlap with the Plandemic video, especially in the theme of insecurity in the health system. In this respect, the study represents an example of the global fluidity of the infodemic while describing how disinformation is spreading in Turkey in the context of COVID-19.

Evaluation of cognitive deficits in patients infected with COVID-19.

OBJECTIVE: COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected with COVID-19. PATIENTS AND METHODS: The demographic and infection-related characteristics of patients who had been infected with COVID-19 were determined. Their cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) findings were recorded. The Mini-Mental State Evaluation (MMSE), clock drawing test, forward and backward digit span tests, visual memory test, and Frontal Assessment Battery were applied to the patients. Finger agnosia and ideomotor apraxia were also determined. RESULTS: The study included 176 patients [100 female (56.8%), 76 male (43.2%), mean age 66.09±13.96 years]. About half of the patients were hospitalized for symptoms of COVID-19 infection (n=82, 46.6%). One third of these patients required intensive care (n=26, 14.8%). While 50 (45.9%) of the 109 patients diagnosed with dementia before infection were hospitalized, 32 (47.8%) of the 67 patients without a diagnosis of dementia required hospitalization (p=0.46). The most common neurological finding during COVID-19 infection was insomnia (n=36, 20.5%). The MMSE and visual memory test scores of the patients who were hospitalized for severe respiratory distress were lower than those whose treatment at home was completed (respectively 17.92±7.69/20.59±7.01, p=0.02; 2.53 ±1.73/3.69±2.80, p=0.01). The patients with moderate to severe cognitive impairment had significantly higher CRP levels at admission than the others (37.52±43.09/20.93±31.74, p=0.01, respectively). CONCLUSIONS: Cognitive damage in COVID-19 infection may be caused by ACE receptor density in the pial, hippocampal, and amygdala areas. In addition, the reason why people with severe dementia have a milder infection might be explained by the atrophy in these areas.

COVID-19 induced longitudinal extensive myelitis

Introduction: COVID-19 induced longitudinal extensive myelitis (LEM) is an extremely rare clinical manifestation. Aims and Methods: In this case study, we report a woman of LEM which appeared fifteen days after COVID-19 infection. Results: A 39-year-old woman, suffering from gradually increased weakness and severe pain at lower limbs and urinary retention was admitted to the emergency department. She was diagnosed with COVID-19 infection 15 days ago and fully recovered from respiratory symptoms. Her initial neurological examination showed loss of muscular strength in right lower limb 1/5 and left lower limb 2/5, hyperreflexia in the lower limbs and generalized allodynia. All modalities of sensation were diminished at the T10 segmental level. Her nasopharyngeal and oropharyngeal swab for polymerase chain reaction (PCR) to detect SARS-CoV-2 was positive. Cerebrospinal fluid (CSF) showed pleocytosis (whitecell count 110/mm3 ) with mostly polymorphonuclear leukocytes (90%), elevated protein (67 mg/dl) and normal glucose (78 mg/dl;concurrent serum glucose level was 96 mg/dl). Serology for SARS-CoV2 in CSF demonstrated infection (anti-SARS-CoV-2 IgG: 5.47 (negative<1). The other serum and CSF tests were negative for differential diagnosis of acute transverse myelitis. Electromyography (EMG) showed normal motor and sensory nerve conduction velocity in the upper and lower limbs. The somatosensory evoked potention test (SEP) determined prolonged latency of bilateral tibial nerve cortical responses with low-amplitudes. Cervical and thoracic MRI demonstrated a long segment of T2 hyperintensities within the central cord extending from C2-C3 level to T10 level. The patient was treated with methylprednisolone 1 g/d IV for five days. Because of her progressed neurological condition, the patient received five sessions of plasma exchange and additionally methylprednisolone 1 g IV was given for another ten days. The patient was discharged to an inpatient rehabilitation facility without any clinical improvement. Conclusions: Acute transverse myelitis have been reported during respiratory diseases due to SARS-CoV-2. Otherwise, the clinical manifestation of LEM induced by COVID-19 seen during infection is very rare. To the best of our knowledge, our case is the second one of LEM induced by COVID-19 confirmed by CSF antibody. This case remarks the importance of recognition and early treatment of LEM during COVID-19 infection.

Clinical deterioration of Alzheimer's disease patients during the Covid-19 pandemic and caregiver burden

To investigate a possible deterioration of the symptoms of Alzheimer's disease (AD) patients during a quarantine period of 60 days, and the impact on caregiver burden. This study consisted of 54 individuals (36 female, 18 male) aged 60 years and over who had been diagnosed with AD. During the quarantine period, caregivers of the patients (child, spouse, relatives) who were confined to their homes were contacted by phone and administered a survey composed of questions for neuropsychiatric symptoms and caregiver burden. Patients' mean age was 77.18±6.96 years. The most worsening symptom was forgetfulness (35.2%) and agitation (24.1%). Incoherent speech, introversion, sleep disturbance, hallucinations, carry on with hobbies, reduced personal care, changes in appetite, and incontinence were less deteriorated. Of the caregivers, 61.1% thought that something terrible would happen to the patient, and 38.9% felt they could not find time for themselves. Drug rejection increased the burden twofold. Telemedicine methods, providing opportunities for the caregiver and the patient to walk outside, and giving medication that dissolves in the mouth or epidermal patches may be useful to prevent disease progression during the lockdown.