Inherited IRAK-4 Deficiency in Acute Human Herpesvirus-6 Encephalitis.

Human herpesvirus-6 (HHV-6) infection can rarely cause life-threatening conditions, such as encephalitis, in otherwise healthy children, with unclear pathogenesis. We studied a child who presented with acute HHV-6 encephalitis at the age of 10 months and who was homozygous for a novel missense mutation in IRAK4, encoding interleukin-1 receptor-associated kinase 4, identified by whole-exome sequencing. We tested the damaging impact of this mutation in silico by molecular dynamics simulations and in vitro by biochemical and functional experiments utilizing cell lines and patient's cells. We found that the mutation is severely hypomorphic, impairing both the expression and function of IRAK-4. Patient's leukocytes had barely detectable levels of IRAK-4 and diminished anti-viral immune responses to various stimuli inducing different Toll-like receptors and cytosolic nucleic acid sensors. Overall, these findings suggest that acute HHV-6 encephalitis can result from inborn errors of immunity to virus. This study represents the first report of isolated acute HHV-6 infection causing encephalitis in an inherited primary immunodeficiency, notably autosomal recessive (AR) partial IRAK-4 deficiency, and the first report of AR IRAK-4 deficiency presenting with a severe viral disease, notably HHV-6 encephalitis upon an acute infection, thereby expanding the clinical spectrum of IRAK-4 deficiency.

Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID-19 pandemic.

OBJECTIVE: This study aimed to determine the differences in attitudes and views towards influenza and pneumococcal vaccines in parents of children with asthma during the COVID-19 pandemic. MATERIALS AND METHODS: Asthmatic children in the 6-18 age group who were admitted to the pediatric allergy clinic of our hospital between October 1, 2020 and February 31, 2021 were included in the study. The parents were given a questionnaire asking about their demographics and medical history. Their attitudes and thoughts towards these two vaccines, both before and during the pandemic, and their COVID-19 stories were questioned. RESULTS: A total of 78 patients diagnosed with asthma were included in this study. While the rate of influenza vaccination before the pandemic was 29.5%, the rate of those who received or wanted to receive influenza vaccine during the pandemic was 71.8% (p = 0.001). It was observed that the rate of influenza vaccination during the pandemic increased with the regular use of asthma medication, the presence of atopy, and a history of COVID-19 infection in the family/close environment. In total, 69.2% of the parents stated that their child's pneumococcal vaccination was incomplete or they were unaware of their child's vaccination status. CONCLUSION: This study demonstrated that there was an increase in the rate and willingness of parents of asthmatic children to have their children vaccinated against influenza during the COVID-19 pandemic. As for the pneumococcal vaccine, the majority of the parents did not have enough information or they were unaware of the vaccination status of their children.

Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic.

PURPOSE: To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS: A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS: This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.

The effect of COVID-19 on lower urinary tract symptoms in elderly men.

AIMS: The COVID-19 pandemic is the most important public health problem in 2020. Millions of people have been infected or died because of the outbreak. We know the common symptoms of the disease such as fever and cough. However, all symptoms and features of COVID-19 are still were not known. We aimed to evaluate the change in lower urinary tract symptoms (LUTS) after COVID-19 in men. METHODS: We prospectively assessed 94 patients with COVID-19 during hospitalisation. The patients were divided into two groups according to age, that being over and under age 50. IPSS scores of all patients were enrolled. Additionally, we compared the scores with pre-COVID-19 values. RESULTS: LUTS scores were found to be increased in elderly patients. Additionally, the severity of the disease did not correlate with LUTS scores. CONCLUSION: LUTS may be one of the symptoms of COVID-19 in some patients. Elderly patients with increased LUTS should be evaluated for COVID-19 when the reason unclear.

The clinical impact of the COVID-19 pandemic on daily urological practice: first 3-month multicenter results from Istanbul

Background/aim: The aim of this paper was to determine the general tendencies of urology patients and effect of COVID-19 pandemic on daily urological practice at tertiary centers located in the most affected area in Turkey. Materials and methods: We retrospectively analyzed the data of 39,677 patients (group 1) that applied to 6 different large-volume tertiary centers in Istanbul for outpatient consultation, surgery, or other procedures in the 3-month period between March 16 and June 14, 2020. The distribution of the number of patients who applied to subspecialty sections of urology outpatient clinics and inpatient services were recorded by weeks. That data was compared to data obtained from 145,247 patients that applied to the same centers in the same period of the previous year (group 2). The reflection of worldwide and Turkish COVID-19 case distribution on the daily urological practice was analyzed. Results: There was a decrease in the number of patients in all subspecialty sections the in group 1 compared to group 2; however, there was a significant proportional increase in urooncology and general urology admissions. A decrease of approximately 75% was observed in the total number of surgeries (p < 0.001). We detected a negative correlation between the numbers of admission to all outpatient clinics and COVID-19 cases or deaths in Turkey (p < 0.05). The same negative correlation was present for all surgical procedures and consultations (p < 0.05). The multivariate linear regression analysis revealed that the number of cases in Turkey, and the number of deaths worldwide affect the number of outpatient clinic admissions (R2 = 0.38, p = 0.028) and urological surgery (R2 = 0.33, p = 0.020) in Turkey negatively. Conclusion: This novel pandemic has implications even for urology practice. Urological surgical procedures were more affected by COVID-19-related deaths in Turkey and worldwide. Outpatient admissions and urological surgeries decreased significantly by increasing COVID-19 case numbers in Turkey and worldwide deaths.