Inflammatory responses in SARS-CoV-2 associated Multisystem Inflammatory Syndrome and Kawasaki Disease in children: An observational study.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe inflammatory disease in children related to SARS-CoV-2 with multisystem involvement including marked cardiac dysfunction and clinical symptoms that can resemble Kawasaki Disease (KD). We hypothesized that MIS-C and KD might have commonalities as well as unique inflammatory responses and studied these responses in both diseases. In total, fourteen children with MIS-C (n=8) and KD (n=6) were included in the period of March-June 2020. Clinical and routine blood parameters, cardiac follow-up, SARS-CoV-2-specific antibodies and CD4+ T-cell responses, and cytokine-profiles were determined in both groups. In contrast to KD patients, all MIS-C patients had positive Spike protein-specific CD3+CD4+ T-cell responses. MIS-C and KD patients displayed marked hyper-inflammation with high expression of serum cytokines, including the drug-targetable interleukin (IL)-6 and IFN-γ associated chemokines CXCL9, 10 and 11, which decreased at follow-up. No statistical differences were observed between groups. Clinical outcomes were all favourable without cardiac sequelae at 6 months follow-up. In conclusion, MIS-C and KD-patients both displayed cytokine-associated hyper-inflammation with several high levels of drug-targetable cytokines.

[Functional diagnosis of pulmonary sarcoidosis]. / Funkcionalna dijagnostika plucne sarkoidoze.

Restrictive disturbances of ventilation of various degree and disorders in diffusing capacity of the lung have been reported as the most frequent disorders in pulmonary sarcoidosis. Recently, however, several authors have found the obstructive disorders of ventilation being present as well, especially in the second stage of disease, and pointed out a possibility of the airways being affected very early at the onset of disease. Present study shows the results of functional tests carried out in 70 patients with histologically verified pulmonary sarcoidosis at all three stages of the disease (classification by Würm). All of them were nonsmokers, aged 20 to 55 years, and had no symptoms of chronic bronchitis, asthma or emphysema, either in case history or clinical findings. They included spirometry, flow-volume loop, body-plethysmography, blood gas analyses at rest and after exercise and pulmonary diffusing capacity for carbon monoxide obtained by single-breath method. Results from the study show the obstructive disorders of ventilation to be dominant in the early stage, while restrictive disturbances dominate in the third stage in pulmonary sarcoidosis. Diffusing capacity of the lung should be measured in the early stage of the disease as well as in those more advanced because of a possibility that interstitial space is being affected, although there is no visible damage on a radiograph. Measurement of pulmonary diffusing capacity together with radiological findings provide a highly valuable data which is of great importance in monitoring the dynamics of this disease.