Disease Severity Parameters Research Articles

FACTORS ASSOCIATED WITH CIRCULATING ZONULIN IN INFLAMMATORY BOWEL DISEASE.

Inflammatory bowel disease (IBD) comprises the spectrum between Crohn's disease (CD) and ulcerative colitis (UC), a condition whose prevalence in countries such as Brazil has increased significantly in recent years. Changes in the intestinal epithelial barrier function and, consequently, an increase in intestinal permeability, have been suggested as important factors in the pathogenesis of different autoimmune conditions, including IBD. Therefore, there is a need for a practical tool to assess gut barrier integrity in these patients. To study factors associated with serum zonulin levels, a marker of intestinal permeability, in patients with IBD. This was a cross-sectional observational study that included 117 patients with IBD and 32 healthy controls. Disease activity was assessed by the Simple Clinical Colitis Activity Index (SCCAI) in UC and by the Harvey-Bradshaw Index (HBI) in CD subjects. Zonulin levels were measured by ELISA and inflammatory cytokines by Cytometric Bead Array, using commercially available kits. The mean age of IBD patients was 44.0±15.9 years, 66.7% were female, 57 subjects were diagnosed with CD and 60 with UC. At evaluation, clinical remission was observed in 56.7% of CD patients and in 59.2% of UC subjects. No differences were observed in zonulin levels when comparing IBD patients with the control group (95.28 ng/mL vs 96.61 ng/mL, P=0.573) and when comparing patients with CD to those with UC (79.68 ng/mL vs 106.10 ng/mL, P=0.887). Among IBD group, zonulin concentrations were higher among females, correlated positively with body mass index (BMI) and age; and negatively with hemoglobin and hematocrit. In patients with UC, zonulin correlated negatively with hemoglobin, hematocrit, and albumin; and positively with BMI and SCCAI. Among CD patients, zonulin was positively correlated with age and BMI, but not with HBI. No correlations were observed between zonulin and circulating cytokines in IBD patients. In this cohort mostly comprised of patients in clinical remission, serum zonulin levels were not higher in patients with IBD than healthy controls, and correlated with variables not linked to baseline disease, such as sex, age and BMI. However, zonulin correlated with clinical and laboratory parameters of disease severity and activity among subjects with UC, but not among patients with CD. These findings indicate a potential role for zonulin as a biomarker in IBD, particularly in UC.

Retinal changes in bipolar disorder as an endophenotype candidate: Comparison of OCT-detected retinal changes in patients, siblings, and healthy controls

Optical coherence tomography (OCT) is a non-invasive imaging technique that detects retinal changes reflecting neurodegeneration. In recent studies in patients with bipolar disorder (BD) abnormal OCT findings have shown. In this study, we aimed to investigate the retinal changes in BD patients and their healthy siblings (HS) by comparing them with the healthy control (HC) group and to explore these findings as potential endophenotype candidates. 31 patients with BD, 31 age-matched HSs and 46 HCs were included and peripapillary retinal nerve fiber layer (RNFL), ganglion cell layer (GCL)+inner plexiform layer (IPL) and macular volume (MV) thicknesses were measured by OCT. The relationship between disease severity parameters, functionality and OCT measurements in the patient group was also investigated. In results, the mean RNFL thicknesses did not differ between groups. All GCL+IPL thicknesses were found to be significantly lower in the patient and sibling groups compared to the HCs. GCL+IPL thicknesses were significantly correlated with functionality of patients and severity of the disorder. Our findings suggest that analysis of retinal layers with OCT may be a beneficial indicator to show neuronal changes in BD and GCL+IPL may be a suitable endophenotype candidate.

Relationship between platelet parameters and disease severity and coagulpathy in covid 19

Objectives: Coagulopathy plays an important role in the clinical course of Covid-19 disease. The aim of our study is to examine the factors affecting the severity of this disease and to examine whether there is a relationship between platelet parameters and disease severity and coagulopathy markers.
 Methods: The study was planned single-center, retrospective, and cross-sectional. 189 patients diagnosed with Covid-19 were admitted to the Internal Medicine Department. Patients were divided into 3 clinical categories according to the severity of the disease. The relationship between mean platelet volume and other platelet parameters, and disease severity and coagulopathy parameters were statistically analyzed.
 Results: The study included 189 patients.182 of whom were discharged and 7 of whom died. The average age of the patients was 54.13 ± 14.21. D-Dimer levels were compared between the groups and were found to be significantly higher in cases of severe pneumonia. The group with severe pneumonia group had a higher PDW level than other groups. MPV was detected over 10 fl in the severe pneumonia group, but no statistically significant difference was found with the other groups. PT and INR levels are higher in patients with upper respiratory tract infection (URTI) compared to patients with mild to moderate pneumonia. APTT levels were found to be higher in patients with URTI than in patients with severe pneumonia. 
 Conclusion: In our study, PDW height and MPV height were determined from the findings showing platelet activation in patients with severe pneumonia. If an increase in these parameters is detected in patients diagnosed with the Covid 19 disease, close follow-up should be performed in terms of the development of complications.

Effect of information-motivation-behavior skills on adherence of continuous positive airway pressure therapy in patients with obstructive sleep apnea hypopnea syndrome.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disease that seriously affects health. Continuous positive airway pressure (CPAP) therapy is the preferred treatment for moderate-to-severe OSAHS patients. However, poor adherence to CPAP is a major obstacle in the treatment of OSAHS. Information-motivation-behavioral (IMB) skills, as a kind of mature technology to change the behavior, has been used in various health areas to improve treatment adherence. This study aims to explore the effects of the IMB skills intervention on CPAP adherence in OSAHS patients. Patients who were primary diagnosed with moderate-to-severe OSAHS were randomly divided into the IMB group (n=62) and the control group (n=58). The patients in the IMB group received CPAP therapy and the IMB skills intervention for 4 weeks. The patients in the control group received CPAP therapy and a usual health care provided by a registered nurse. We collected the baseline data of the general information, including age, sex, body mass index (BMI), the Epworth Sleepiness Scale (ESS) score, the Hospital Anxiety and Depression Scale (HADS) score, and indicators about disease severity [apnea-hypopnea index (AHI), percentage of time with arterial oxygen saturation SaO2<90% (T90), average SaO2, lowest SaO2, arousal index]. After CPAP titration, we collected CPAP therapy-relevant parameters (optimal pressure, maximum leakage, average leakage, 95% leakage, and residual AHI), score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. After 4 weeks treatment, we collected the ESS score, HADS score, CPAP therapy-relevant parameters, effective CPAP therapy time per night, CPAP therapy days within 4 weeks, CPAP adherence rate, score of satisfaction and acceptance of CPAP therapy, and score of willingness to continue CPAP therapy. Visual analog scale (VAS) of 0-5 was used to evaluate the satisfaction and acceptance of IMB intervention measures in the IMB group. There were no significant differences in the baseline level of demographic parameters, ESS score, HADS score, disease severity, and CPAP therapy related parameters between the IMB group and the control group (all P>0.05). There were no significant differences in score of willingness to continue CPAP therapy, as well as score of satisfaction and acceptance of CPAP therapy after CPAP titration between the IMB group and the control group (both P>0.05). After 4 weeks treatment, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group were significantly decreased, while the score of satisfaction and acceptance of CPAP therapy and willingness to continue CPAP therapy of the IMB group were significantly increased (all P<0.05); while the above indexes in the control group were not different before and after 4 weeks treatment (all P<0.05). Compared with the control group, the ESS score, HADS score, maximum leakage, average leakage, and 95% leakage of the IMB group after 4 weeks treatment were significantly lower (all P<0.05); the effective CPAP therapy time, CPAP therapy days within 4 weeks, score of satisfaction and acceptance of CPAP therapy, score of willingness to continue CPAP therapy of the IMB group were significantly higher (all P<0.05). The rate of CPAP therapy adherence in 4 weeks of the IMB group was significantly higher than that of the control group (90.3% vs 62.1%, P<0.05). The VAS of overall satisfaction with IMB skills intervention measures was 4.46±0.35. IMB skills intervention measures can effectively improve the adherence of CPAP therapy in OSAHS patients, and is suitable for clinical promotion.

Small Fibre Peripheral Alterations Following COVID-19 Detected by Corneal Confocal Microscopy.

A large spectrum of neurological manifestations has been associated with coronavirus disease 2019 (COVID-19), and recently, the involvement of small fibers has been suggested. This study aims to investigate the involvement of small peripheral nervous fibers in recovered COVID-19 patients using in-vivo corneal confocal microscopy (CCM). Patients recovered from COVID-19 and a control group of healthy subjects underwent in-vivo CCM. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), corneal nerve fiber total branch density (CTBD), corneal nerve fiber area (CNFA), corneal nerve fiber width (CNFW), fiber tortuosity (FT), number of beadings (NBe), and dendritic cells (DC) density were quantified. We enrolled 302 eyes of 151 patients. CNBD and FT were significantly higher (p = 0.0131, p < 0.0001), whereas CNFW and NBe were significantly lower (p = 0.0056, p = 0.0045) in the COVID-19 group compared to controls. Only CNBD and FT resulted significantly correlated to antiviral drugs (increased) and corticosteroids (decreased). No significant relationship with disease severity parameters was found. COVID-19 may induce peripheral neuropathy in small fibers even months after recovery, regardless of systemic conditions and therapy, and CCM may be a useful tool to identify and monitor these morphological changes.

The cognitive profile of Friedreich ataxia: a systematic review and meta-analysis

BackgroundStudy the cognitive profile of individuals with Friedreich ataxia (FRDA) and seek evidence for correlations between clinical, genetic and imaging characteristics and neuropsychological impairments.MethodsBased on PRISMA guidelines, a meta-analysis was realized using the Pubmed and Scopus databases to identify studies (1950–2021) reporting neuropsychological test results in genetically confirmed FRDA and control participants in at least one of the following cognitive domains: attention/executive, language, memory and visuo-spatial functions as well as emotion. Studies using identical outcomes in a minimum of two studies were pooled. Pooled effect sizes were calculated with Cohen’s d.ResultsEighteen studies were included. Individuals with FRDA displayed significantly lower performance than individuals without FRDA in most language, attention, executive function, memory visuospatial function, emotion regulation and social cognitive tasks. Among the included studies, thirteen studies examined the relationship between neuropsychological test results and clinical parameters and reported significant association with disease severity and six studies reviewed the relationship between neuroimaging measures and cognitive performance and mainly reported links between reduced cognitive performance and changes in cerebellar structure.ConclusionsIndividuals with FRDA display significantly lower performances in many cognitive domains compared to control participants. The spectrum of the cognitive profile alterations in FRDA and its correlation with disease severity and cerebellar structural parameters suggest a cerebellar role in the pathophysiology of FRDA cognitive impairments.

Is sacral neuromodulation effective in patients with Parkinson's disease? A retrospective review.

Parkinson's disease (PD) is the second-most common degenerative neurologic disease worldwide. Overactive bladder (OAB) is prevalent in this population but can be challenging to treat. Sacral neuromodulation (SNM) is an attractive option but remains understudied. We have utilized SNM in PD patients and herein describe our outcomes. We performed a retrospective chart review of PD patients who underwent peripheral nerve evaluation (PNE) or Stage 1 SNM from 2000 to 2020. The primary outcome was progression to a permanent implant. The impact of PD stage and preprocedural urodynamic (UDS) parameters on test-phase outcome were investigated. Long-term efficacy was assessed using Wilcoxon matched-pairs test looking at a change in urinary symptoms (frequency, nocturia, incontinence episodes, and pad use) documented at follow-up visits and further need for treatment. Thirty-four patients underwent test phase SNM (7 PNE and 27 Stage 1). Median follow-up was 11 (interquartile range 5.8-29.8) months. Indications included refractory OAB (30/34) and nonobstructive urinary retention (4/34). Overall, 82% (28/34) of patients proceeded to a permanent implant. 71% (5/7) of PNEs were successful. Test-phase success did not differ based on PD disease severity or UDS parameters. In patients with OAB/urgency incontinence who progressed to the permanent implant, there was a statistically significant improvement in their urinary symptoms from baseline. Most (68%) patients were able to discontinue OAB medications post-implant. The overall lead revision rate was 14% (4/28) and 3 devices required removal. SNM is an efficacious treatment option for PD patients with a high percentage of patients having improvement in their urinary symptoms.

Assessment of Carpal Tunnel Syndrome Severity by Ultrasound and Electrodiagnosis Study

Carpal tunnel syndrome (CTS) is the upper limb neuropathic entrapment. Electrodiagnostic study (EDX) is the gold standard for diagnosis. However, EDX is not always abnormal in CTS beside its relatively high cost which requires the search for alternative modalities. Objectives: To investigate ultrasound (US) has a function in the evalution of CTS as well as determination disease severity. Subjects and Methods: A case-control experiment which involve 50 CTS patients (65 wrists) and 30 healthy subjects (30 wrists). Electrodiagnostic study involve nerve coduction test (NCS) were performed for all included wrists, with ultrasound measure the cross-sectional area (CSA) of the median nerve. Results: The result of 65 affected wrists with CTS is classified for 40 (61.15%) wrist mild disease, 19 wrists (29.23%) demonstrated a moderate disease and 6 wrists (9.23%) had severe disease. The mean in mild, moderate, and severe cases, median nerve CSA was determined 11.21±1.22 mm2, 15.09±0.1.14 mm2 and 17.88±0.2.1 mm2, respectively with highly significant differences between the three categories. Furthermore, all three categories had higher CSA than control (8.73±0.45 mm2) with highly significant differences. In patients, CSA demonstrated a significant linked with median distal sensory latency (r = 0.71 8, p &lt;0.001), median motor distal latency (r = 0.818, p &lt; 0.001) and age (r = 0.316, p = 0.0 1) and a negative significant with median nerve conduction velocity (r= -0.837, p &lt; 0.001). US demonstrated excellent diagnostic values. The sensitivity and specificity of US in the context of discriminate patients and controls at cut off value of CSA = 10 mm2 were 92% and 100%, respectively. Furthermore, US can effectively discriminate between mild, moderate and severe cases CTS with sensitivity levels ranging from 83%- 100% and 94%-100% specificity. The optimal cut off values ranges between 13.2-16.2 mm2. Conclusions: The CSA of the median nerve is increased and the degree of enlargement significantly correlates with the parameters of disease severity. However, the CSA of the nerve does not associate with the gender of patients or the side of the affected wrist. Ultrasound of CST of median nerve has an excellent diagnostic value in the disinguish between patients and controls, with 92 percent sensitivity and 99 percent specificity, respectively. The optimum cut off value is 10 mm2. Also, US can effectively distinguish mild, moderate and severe cases CTS with Sensitivity levels ranging from 83%- 100% and 94%-100% Specificity. The optimal values cut off ranges between 13.2-16.2 mm2.

PREDICTIVE RELEVANCE OF DIFFERENT CLINICAL AND LABORATORY FINDINGS FOR HIGHER MORTALITY IN PATIENTS WITH COVID-19 IN A SINGLE CENTER COHORT: NEUTROPHIL/ LYMPHOCYTE RATIO, HIGH CRP, GGT AND CREATININE LEVELS ARE ASSOCIATED WITH HIGH MORTALITY

Objective: Early detection of mortality risk is important in patients diagnosed with of coronavirus disease 2019 (COVID-19). Therefore, we aimed to evaluate the predictive value of different clinical and laboratory parameters in disease severity and mortality in patients with COVID-19. Materials and Methods: Patients admitted to hospital with a diagnosis of COVID-19 were evaluated retrospectively. The patients’ admission date, discharge date, intensive care transfer/ death date, contact history, smoking, symptoms at the time admission, vital markers at admission, and laboratory parameters were recorded. Results: The study included a total of 347 patients, of whom 168 (48.4%) were women. The mean age of the patients was 59.69±16.87 (14-97) years, while 40.9% (n=142) were aged over 65 years. Overall, 10.1% (n=35) of the patients required transfer to an intensive care unit and 8.4% (n=29) were deceased. When clinical parameters were evaluated at the time of admission, oxygen saturation was found to be lower in the group that died. (79.51±6.95) compared to the survivors (88.78±6.11) (p&lt;0.001). Additionally, male gender (p=0.05), advanced age (p&lt;0.001),&nbsp;positive PCR result (p=0.036), congestive heart failure (p=0.044), severe COVID-19 involvement on thorax CT (p&lt;0.001), and presence of at least one comorbidity (p=0.003) were observed at a higher rate in the mortality group. In the multivariate analyses, increased values of the NLR (HR: 1.04, 95% CI: 1.00-1.08), creatinine (OR: 1.37, 95% CI: 1.13-1.66), CRP (=-0.18, OR: 0.98, 95% CI: 0.97-0.99), GGT (OR: 1.006, 95% CI: 1.001-1.012), age (OR: 5.67, 95% CI: 2.24-14.38), male gender (OR: 2.38, 95% CI: 0.98-5.75), and presence of any comorbidity (OR: 5.23, 95% CI: 2.08-13.13) were associated with mortality. Conclusions: Several clinical and laboratory parameters, such as advanced age, male gender, presence of any comorbidity, and NLR, GGT, CRP and creatinine levels at the time of admission can predict mortality in COVID-19 patients. These parameters obtained at the time of admission can contribute to the reduction of mortality through a closer clinical and laboratory follow-up in these patients.

Bacterial co-infections in community-acquired pneumonia caused by SARS-CoV-2, influenza virus and respiratory syncytial virus

BackgroundA mismatch between a widespread use of broad-spectrum antibiotic agents and a low prevalence of reported bacterial co-infections in patients with SARS-CoV-2 infections has been observed. Herein, we sought to characterize and compare bacterial co-infections at admission in hospitalized patients with SARS-CoV-2, influenza or respiratory syncytial virus (RSV) positive community-acquired pneumonia (CAP).MethodsA retrospective cohort study of bacterial co-infections at admission in SARS-CoV-2, influenza or RSV-positive adult patients with CAP admitted to Karolinska University Hospital in Stockholm, Sweden, from year 2011 to 2020. The prevalence of bacterial co-infections was investigated and compared between the three virus groups. In each virus group, length of stay, ICU-admission and 30-day mortality was compared in patients with and without bacterial co-infection, adjusting for age, sex and co-morbidities. In the SARS-CoV-2 group, risk factors for bacterial co-infection, were assessed using logistic regression models and creation of two scoring systems based on disease severity, age, co-morbidities and inflammatory markers with assessment of concordance statistics.ResultsCompared to influenza and RSV, the bacterial co-infection testing frequency in SARS-CoV-2 was lower for all included test modalities. Four percent [46/1243 (95% CI 3–5)] of all SARS-CoV-2 patients had a bacterial co-infection at admission, whereas the proportion was 27% [209/775 (95% CI 24–30)] and 29% [69/242 (95% CI 23–35)] in influenza and RSV, respectively. S. pneumoniae and S. aureus constituted the most common bacterial findings for all three virus groups. Comparing SARS-CoV-2 positive patients with and without bacterial co-infection at admission, a relevant association could not be demonstrated nor excluded with regards to risk of ICU-admission (aHR 1.53, 95% CI 0.87–2.69) or 30-day mortality (aHR 1.28, 95% CI 0.66–2.46) in adjusted analyses. Bacterial co-infection was associated with increased inflammatory markers, but the diagnostic accuracy was not substantially different in a scoring system based on disease severity, age, co-morbidities and inflammatory parameters [C statistic 0.66 (95% CI 0.59–0.74)], compared to using disease severity, age and co-morbidities only [C statistic 0.63 (95% CI 0.56–0.70)].ConclusionsThe prevalence of bacterial co-infections was significantly lower in patients with community-acquired SARS-CoV-2 positive pneumonia as compared to influenza and RSV positive pneumonia.

Association Between Real-time Polymerase Chain Reaction Cycle Threshold Value and Clinical Severity in Neonates and Infants Infected With Bordetella pertussis.

Polymerase chain reaction (PCR) is highly sensitive and is thus the standard method for diagnosing pertussis. Real-time PCR is widely used because of its accuracy and the simplicity of the simultaneous cycle threshold (Ct) value, which represents the copy numbers of the target gene. Little is known of the association of Ct value with pertussis severity in neonates and infants. This study determined Ct values in neonates and infants diagnosed with pertussis by real-time PCR using nasopharyngeal samples at Vietnam National Children's Hospital in Hanoi in 2017 and 2019. The association of disease severity and clinical parameters were analyzed using univariate and multivariate analyses. We evaluated 108 patients with pertussis [median age: 63 days, interquartile range (IQR): 41-92 days]. Only 6/108 (6%) received at least 1 dose of a pertussis-containing vaccine. Among them, 24 (22.2%) had severe disease requiring care in a pediatric intensive care unit, 16 (13.8%) required mechanical ventilation, and 3 (2.6%) died. The median Ct value was lower in patients with severe disease (19.0, IQR: 16.5-22.0, n = 24) than in those without severe disease (25.5, IQR: 20.0-30.0, n = 84) (P = 0.002). Logistic regression analyses demonstrated that PCR Ct value [odds ratio (OR): 1.783, 95% confidence interval (CI): 1.013-3.138, P = 0.045], age (OR: 3.118, 95% CI: 1.643-5.920, P = 0.001), and white blood cell counts (OR: 0.446, 95% CI: 0.261-0.763, P = 0.003) remained significantly associated with severe disease. Real-time PCR Ct values for pertussis might be useful as a predictor of severe disease in neonates and infants.

Anti-Inflammatory, Antimicrobial, and Vasoconstriction Activities of an Anti-Hemorrhoidal Mixture of Alchemilla vulgaris, Conyza bonariensis, and Nigella sativa: In Vitro and Clinical Evaluations

Nigella sativa, Conyza bonariensis, and Alchemilla vulgaris are highly recommended in Greco-Arab traditional medicine as anti-hemorrhoid medicinal plants. The efficacy and safety of a topical cream (HPC) consisting of water–ethanol extracts of these three plants were evaluated here in vitro and in a randomized, double-blind, placebo-controlled study (RDBPC). HPC showed no significant cytotoxic effects in fibroblast cell line 3T3 (LDH-release and MTT assay); it inhibited the nitric oxide production by cultured monocyte cell line THP-1 in a dose-dependent manner (reaching the control levels of untreated cells at a concentration of 100 μg/mL). HPC showed a dose-dependent antibacterial activity against Escherichia coli (60% inhibition compared to Ampicillin at 5 mg/disc) and a significant vasoconstriction effect on intestinal vein rings (40% increase compared to phenylephrine). In a RDBPC with 77 hemorrhoidal disease (patients ages 19–61 years with a median grade of hemorrhoids of 2.0), we determined the anti-hemorrhoid efficacy and safety of HPC. The patients were randomly assigned to the HPC group (54 patients) or the placebo group (23 patients). They were asked to apply 2–3 mL of HPC or placebo twice daily for 6 days. The degree of hemorrhoidal disease severity, hemorrhage severity, pain, and itching served as an evaluation of the HPC efficacy. Compared to the placebo group, the obtained results showed that 6 days of treatment with HPC reduced the indexes of hemorrhage severity, severity of pain, and severity of itching to 0–1, 1, and 1 after 6 days, respectively. In conclusion, patients treated with HPC had a significant clinical improvement in all disease severity parameters compared to placebo. In vitro evaluations proved HPC to have significant antimicrobial, anti-inflammatory, and vasoconstriction effects. Therefore, HPC represents an interesting alternative treatment for hemorrhoidal disease.

P244 COVID-19 vaccine does not increase the likelihood of disease exacerbation in IBD: results from a population-based study

BackgroundWhile short-term safety data of COVID-19 vaccination has been reassuring, it is theoretically possible that the vaccine-associated immune activation could trigger immune dysregulation and thus exacerbation of IBD. We used the epi-Israeli IBD Research Nucleus (IIRN) database to perform a population-based study exploring the effect of COVID-19 vaccination on disease course in IBD patients.MethodsWe included all IBD patients insured in two of the four Israeli HMOs, covering 35% of the population, by validated algorithms, and selected those who received two doses of Pfizer BNT162b2 vaccine. These were matched to unvaccinated IBD patients by demographics, parameters of disease severity at baseline generated by hierarchical clustering of laboratory data, and length of time from previous exacerbation to baseline. The primary outcome was rate of IBD exacerbation as defined by proxies of hospitalizations, treatment escalation, and commencement of corticosteroid or enema. The study period was December, 2020 to June, 2021Results707 pairs of vaccinated and unvaccinated IBD patients were compared. The pairs matched exactly for gender, district, IBD type and disease severity, and ±1 year for age at IBD diagnosis and at vaccination. Mean age was 38.5±13.5 years and median follow-up was 98 days (IQR 16–143). No difference in the outcome was found between the groups from the 2nd vaccination to the end of follow-up, with risk of exacerbation in vaccinated patients of 29% and risk in unvaccinated patients 26% (p=0.3).ConclusionCOVID-19 vaccinated IBD patients demonstrated a rate of IBD exacerbation following vaccination that was no different from that of unvaccinated patients. The multifaceted immune activation induced by the vaccine did not result in worsening IBD disease course. These results provide further reassurance for IBD patients receiving the vaccine.

P335 Utility of Intestinal Ultrasound in Monitoring Disease Activity in Ulcerative Colitis Patients Treated with Biologics

Abstract Background Given the invasive nature and high cost of frequent and repeated endoscopies needed to monitor UC, search for non-invasive diagnostic alternative is warranted. Intestinal ultrasound is a cost-effective, well-tolerated, non-invasive and readily available „point-of-care“ tool for the management of patients with Crohn’s disease. The role and widespread use of IUS for UC is still limited. We aimed to evaluate association between UC disease activity assessed by IUS on one hand and standard clinical, biochemical, and endoscopic parameters on the other one. Methods A single center, noninterventional retrospective chart review of adult UC patients treated with biologics at a tertiary center was performed. Routine clinical (stool frequency score – SFS, and rectal bleeding score – RBS), biochemical (FC), endoscopic (Mayo Endoscopic Subscore - MES), and IUS parameters (bowel wall thickness - BWT and colonic wall hyperemia assessed by colour Doppler imaging - CDS) were assessed before initiating biologics. Normal distribution was assessed using Shapiro-Wilk tests. Spearman correlation coefficients were calculated and ROC analysis was carried out. Results Total of, 44 patients (50% females, mean age, 37.4 ±, 14.05 years) with predominantly extensive UC (75%) were analysed. Positive correlation was observed between combination of BWT and level of CDS with SFS (rs = 0.68, p &amp;lt;, 0.01, N = 33) as well as with RBS (rs = 0.44, p &amp;lt;, 0.01, N = 34). Moreover FC values were in positive correlation with BWT (rs = 0.54, p &amp;lt;, 0.01, N = 36), levels of CDS (rs = 0.66, p &amp;lt;, 0.01, N = 33) and combination of BWT coupled with level of CDS (rs = 0.7, p &amp;lt;, 0.01, N = 33). In case of clinical active UC (SFS, 2/3 + RBS, 2/3 + FC &amp;gt;150 mg/g) correlation coefficient between FC level and BWT coupled with level of CDS rises to rs = 0.72, p &amp;lt;, 0.01, N = 30. Positive correlation of CDS with MES (rs = 0.65, p &amp;lt;, 0.01, N = 16) as well as between combination of BWT + level of CDS with MES (rs = 0.6, p &amp;lt;, 0.02, N = 16) was observed. Interestingly, positive correlation between BWT and MES didn′t reach statistical significance (rs = 0.42, p = 0.1, N = 16). The area under the curve (AUC) for the FC values and disease activity (defined as SFS, 2/3 + RBS, 2/3 + BWT &amp;gt;4 mm + presence of CDS) was, 0.96 (SE:, 0.03;, 95% CI, 0.89–0.99, p&amp;lt;0.01). FC values &amp;gt;134 mg/g were associated with active disease (sensitivity, 89.3%, specificity, 87.5%). Conclusion Results of this study show a good correlation between IUS and clinical, biochemical and endoscopic parameters of UC disease severity. IUS as a monitoring tool can be helpful in estimation of UC disease activity and can guide daily management of patients treated with biologics.

The relationship of obstructive sleep apnea risk with the disease severity and clinical parameters in COPD population

Aim: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) have common pathophysiological mechanisms affecting the prognosis of each other. This study aims to investigate the relationship between the presence of OSA risk and the severity of COPD and to determine the possible clinical features for OSA risk for COPD patients.&#x0D; Material and Method: The patients (n=181) who applied to the outpatient clinics of pulmonology between September - November 2019 with the diagnosis of COPD, were analyzed cross-sectionally. Demographic features, anthropometric measurements, comorbidities, smoking status, and severity of dyspnea, respiratory functions, and exacerbation frequency in the last year were evaluated. All patients were questioned with the Epworth sleepiness scale (ESS) for detecting excessive daytime sleepiness (EDS), and the STOP-Bang for determining the risk of OSA. &#x0D; Results: The rate of diabetes, waist and hip circumference measurements, median ESS score, and EDS ratio were found to be higher in patients with moderate/high OSA risk when compared to patients with low OSA risk. In the multivariate regression model; lower oxygen saturation (OR: 0.83; p=0.007) and higher ESS score (OR=1.28; p

Stabil Kronik Obstrüktif Akciğer Hastalığı Olan Hastalarda Klinik Parametreler ve İnflamasyon Belirteçlerinin Pulmoner Hipertansiyon ile İlişkisi

Aim: Inflammation is an important mechanism in the development of pulmonary arterial hypertension (PAH) in patients with COPD. In this study, we investigated the relationship of disease severity parameters and inflammation with PAP in COPD patients. Material and Methods: A patient group consisting of 80 patients with stable COPD including who were obtaining treatment at the outpatient clinic of Kırıkkale University Faculty of Medicine Department of Pulmonary Medicine were included in the study along with a control group of 46 individuals who were compatible with the patient group in terms of age and gender and did not have any airway obstruction. Spirometry measurements were performed (FEV1, FVC, FEV1/FVC, MEF and PEF). Systolic pulmonary artery pressure (sPAP) measurements and standard doppler echocardiography were performed at the outpatient clinic of the department of cardiology. Results: CRP was found to be significantly higher in patients with stable COPD compared to the control group. sPAP values of COPD patients were significantly higher than those of the control group. A statistically significant positive relationship was observed between the sPAP value and age (p = 0.006). There was no statistically significant relationship between sPAP and MCIRS score (p = 0.700). A statistically weak negative relationship was observed between sPAP and FVC% (p = 0.053) Conclusion: Development of PAH increases morbidity and mortality. Therefore, patients with advanced stages of COPD should be screened using echocardiography, which is an easy-to-use, fast and repeatable measurement method to check for PAH development.

Will 14-3-3η Be a New Diagnostic and Prognostic Biomarker in Rheumatoid Arthritis? A Prospective Study of Its Utility in Early Diagnosis and Response to Treatment.

Results Serum14-3-3η levels were significantly higher in all RA patients than in controls (P < 0.001), its sensitivity was 86.7% and 88.3% in early and established RA patients with a significant difference with RF and ACCP at early disease, and the specificity was 96.7%. There was a significant reduction of 14-3-3η levels 6 months after treatment in the first group (p=0.004), and there was a significant positive correlation between serum 14-3-3η levels and parameters of disease activity and severity. Conclusion 14-3-3η could be a novel, potent, and efficacious diagnostic, and prognostic marker for RA with high sensitivity, that may become a new therapeutic target for RA.

Role of synovial fibroblast subsets across synovial pathotypes in rheumatoid arthritis: a deconvolution analysis

ObjectivesTo integrate published single-cell RNA sequencing (scRNA-seq) data and assess the contribution of synovial fibroblast (SF) subsets to synovial pathotypes and respective clinical characteristics in treatment-naïve early arthritis.MethodsIn this in...

Pattern of Conventional Coagulation and Thromboelastographic Parameters in Patients with COVID-19 Diseases and Association of COVID-Associated Coagulopathy with Mortality in Intensive Care Unit.

Background:Knowledge of underlying pathophysiology of coagulopathy is evolving and the pattern of coagulation parameters in coronavirus disease 2019 (COVID-19)–associated diseases is still not very clear.Aims:In the present study, we aimed to find out the pattern and distribution of conventional coagulation parameters and thromboelastographic (TEG) parameters in COVID-19–associated coagulopathy (CAC) in survivors and nonsurvivors at 28 days.Setting and Design:The present prospective observational study was conducted at a tertiary care COVID-19 intensive care unit (ICU) facility from March 21, 2020, to July 15, 2021.Materials and Methods:Admission clinical and laboratory data (conventional coagulation, inflammatory and TEG parameters, and disease severity parameters) of 64 COVID-19 patients admitted to the ICU were collected. Patients were divided into two groups, i.e., survivors and nonsurvivors.Statistical Analysis:Data were compared between two groups, i.e., survivors versus no survivors on 28 days using Student's t-test/Mann–Whitney U-test or Chi-square test/Fisher's exact test.Results:Admission mean plasma fibrinogen levels (474.82 ± 167.41 mg.dL−1) and D-dimer were elevated (1.78 [0.66, 3.62] mg.mL−1) in the COVID-19 ICU patients. Overall, COVID-19 patients had mean lower normal platelet count (150 ± 50 × 103 cells.mm−3), with marginally elevated prothrombin time (16.25 ± 3.76 s) and activated partial thromboplastin time (38.22 ± 16.72 s). A 65.6% (42/64) TEG profile analysis showed a normal coagulation profile, and the rest 21.9% (14/64) and 12.5% (8/64) had hypercoagulable and hypocoagulable states, respectively. Plasma D-dimer level was markedly elevated in nonsurvivors compared to survivors (P < 0.05), while no other conventional coagulation parameters and TEG profile demonstrated statistically significant between the two groups.Conclusion:Markedly elevated plasma D-dimer level was observed in nonsurvivors of COVID-19 ICU patients. A large portion of COVID-19 ICU patients had a normal TEG profile. Conventional coagulation parameters and TEG profile were similar between survivors and nonsurvivors.

Profiling and multivariate analysis of serum cytokines in patients with generalized pustular psoriasis

Introduction: Generalized pustular psoriasis (GPP) is a chronic autoinflammatory disease characterized by fever, erythema, and sterile pustules occurring over large areas of the skin. The immunopathogenesis of GPP remains poorly understood. We aimed to profile serum cytokine levels in patients with GPP and analyze treatment-associated changes in cytokine levels. Methods: Twenty-four patients who were diagnosed with GPP and received drug treatment, together with 28 unaffected controls, were recruited in this study. Levels of 27 cytokines in serum samples from pre- and post-treated patients as well as unaffected controls were assessed using a Bio-Plex multiplex immunoassay. Multivariate analysis of cytokine levels and clinical parameters was conducted. Results: Serum levels of interleukins interleukin (IL)-1β, IL-1Ra, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p70), IL-13, IL-17, granulocyte colony-stimulating factor (G-CSF), interferon-γ (IFN-γ), IFN-γ-induced protein 10 (IP-10), monocyte chemoattractant protein-1, tumor necrosis factor-α, and vascular endothelial growth factor were significantly elevated (p &lt; .05) in patients with GPP compared with controls. Serum levels of IL-6, G-CSF, IL-8, IFN-γ, IL1-Ra, IL-10, IL-13, and IL-1β were correlated with GPP severity (r &gt; 0.4, p &lt; .001). Following treatment, serum levels of IL-6, IL-7, IL-12, IFN-γ, IL-1β, IL-4, IL-8, IL-10, IL-13, G-CSF, and IP-10 were significantly decreased (p &lt; .05) compared with pretreatment levels. Among these cytokines, levels of IL-6, IL-7, IL-8, IL-12, IL-13, and IP-10 were reduced to normal levels. Conclusion: GPP patients exhibited markedly elevated levels of cytokines and chemokines involved in both type 1 and type 2 immune responses, suggesting hypercytokinemia occurs in GPP patients. IL-6 showed the strongest correlation with GPP disease severity and other clinical parameters such as CRP level and fever, thus representing an index for GPP severity. Our data comprehensively documented the cytokine profiles of GPP patients and may provide insights into GPP pathogenesis.