High digit ratio (2D:4D) is associated with attack frequency and severity in hereditary angioedema patients

BACKGROUND

Hereditary angioedema (HAE) caused by a deficiency or dysfunction of the plasma protease C1-inhibitor is a rare autosomal-dominant disorder. We explored a possible correlation between the ratio of the second and fourth finger lengths (2D:4D) and the frequency of HEA attacks, and whether the ratio might predict laryngeal attack.

METHOD

We evaluated 35 HEA patients aged 19 to 66 years; 3 were subsequently excluded. The 2D:4D ratio was calculated by dividing the length of the second finger by that of the fourth finger of both hands. A structured clinical questionnaire exploring HAE course and treatment over the prior year was administered.

RESULTS

Of the 32 participants, 56.25 % (n = 18) were female. Of them, those with high 2D:4D ratios suffered significantly more laryngeal attacks than others; 93.3% of patients with high 2D:4D ratios experienced ≥5 attacks annually, significantly more than those with low ratios. Among type 2 HEA patients, 75 % of those experiencing ≥5 attacks annually had high 2D:4D ratios; all patients with low 2D:4D ratios reported <5 attacks annually. These significant effects were found for right-hand 2D:4D ratios and not left-hand 2D:4D ratios.

CONCLUSION

The data suggest that intrauterine sex hormone exposure, which affects the 2D:4D ratio, is significantly associated with HEA attack frequency and severity, and laryngeal edema.

Memory B cells and serum immunoglobulins are associated with disease severity and mortality in patients with COVID-19

PURPOSE OF THE STUDY

The aim of this study was to investigate the relationship of B cell-mediated immunity with disease severity and mortality in patients with COVID-19.

STUDY DESIGN

In this retrospective cohort and single-centre study, 208 patients with laboratory-confirmed COVID-19 were recruited. A COVID-19 severity score, ranging from 0 to 10, was used to evaluate associations between various factors. Serum immunoglobulin levels and the number of cells in B lymphocyte subsets were measured and their association with disease severity and mortality in patients with COVID-19 examined.

RESULTS

The median age of the patients was 50 (35-63) years and 88 (42%) were female. The number of deceased patients was 17. The median COVID-19 severity score was 8 (6-8) in deceased patients and 1 (0-2) in survivors. Deceased patients had significantly lower levels of total B lymphocytes, naive B cells, switched memory B cells, and serum IgA, IgG, IgG1 and IgG2 than recovered patients (all p<0.05). In addition, a significant negative correlation was found between the number of these parameters and COVID-19 severity scores. Decrease in the number of total B cells and switched memory B cells as well as lower serum IgA, IgG and IgG1 levels were independent risk factors for mortality in patients with COVID-19.

CONCLUSION

In the present study, the prognosis of patients with COVID-19 was shown to be associated with the B cell subset and serum immunoglobulin levels.

Anaphylaxis in older adult patients: a 10-year retrospective experience

Background

Despite the worldwide increase in life expectancy and the elderly population, very little is known about the characteristics of anaphylaxis in older adults.

Methods

A retrospective scan was made of the files of patients who presented at the Allergy Unit of our clinic between October 2011 and October 2021. The study included 971 patients aged ≥18 years who met the criteria for diagnosis of anaphylaxis. The patients were separated into 2 groups of adults (18–64 years) and older adults (≥65 years).

Results

The adult group included 887 (91.3%) patients and the older adult group, 84 (8.7%) patients. Comorbid diseases were seen more frequently in the older adults than in the adult group (p < 0.001). Drugs were seen to be the most common trigger of anaphylaxis in both groups, and this was more common in the older adult group (p = 0.039). Food was a more common trigger of anaphylaxis in the adult group than in the older adult group (p = 0.017). In both groups, the skin was the organ most affected, and was less affected in the older adults than in the adults (p = 0.020). Cardiovascular symptoms were seen significantly more and respiratory symptoms significantly less in the older adult group (p < 0.001, p = 0.002, respectively). Admission to the hospital and the intensive care unit was more frequent in the older adult group and rates of adrenalin administration were higher compared to the adult group (p < 0.001 for all).

Conclusion

Anaphylaxis in the older adults is generally caused by drugs. Older adults were found to have more cardiovascular symptoms and more frequent adrenalin injections, hospitalizations and intensive care unit admissions.

Evaluation of malnutrition risk and nutrition status in adult patients with common variable immunodeficiency

BACKGROUND

The aim of this study is to determine the prevalence of malnutrition in outpatients with common variable immunodeficiency (CVID) and the utility of nutrition screening tools to detect malnutrition in these patients.

METHODS

Fifty outpatients with CVID were included in the study. Nutrition risk for each patient was evaluated using four nutrition screening tools: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), and Nutritional Risk Screening 2002 (NRS-2002).

RESULTS

According to MUST, MST, SNAQ, and NRS-2002, malnutrition risk was determined to be 48% (n = 24), 26% (n = 13), 20% (n = 10), and 20% (n = 10), respectively. Malnutrition was detected in 54% (n = 27) of the patients. It was found that MUST showed a better correlation in detecting malnutrition in outpatients with CVID (κ = 0.482, P = 0.001). MUST has a higher positive and negative predictive value than other nutrition screening tools (79% and 70%, respectively). In the multivariate logistic regression analysis, it was found that low serum immunoglobulin A (IgA) levels at diagnosis increased the risk of malnutrition by ∼15 times, and low CD19⁺ B-cell counts increased the risk by approximately eight times.

CONCLUSION

The prevalence of malnutrition in patients with CVID was found to be quite high, and there was a strong correlation between malnutrition and low CD19⁺ B-cell counts and low serum IgA levels. Given the high rate of malnutrition in patients with CVID, nutrition assessment is recommended rather than starting with nutrition screening.

An association between immune status and chest CT scores in COVID-19 patients

BACKGROUND

The characteristic features of the immune responses of COVID-19 patients and how they reflect lung involvement have not been clearly elucidated.

AIM

The aim of this study was to examine the immune status and the correlations thereof with chest CT scores and lung involvement of patients with COVID-19.

METHODS

In this retrospective and single-center study, 72 patients with laboratory-confirmed COVID-19 were recruited. The counts of peripheral lymphocyte subsets (CD3⁺ T cells, CD4⁺ T cells, CD8⁺ T cells, CD19⁺ B cells and CD16⁺ 56⁺ NK cells) and those of serum immunoglobulins (IgA, IgG, IgM) were measured and their associations with chest CT scores analysed.

RESULTS

The proportions of lymphopenia in patients with extensive lung involvement were twice that in the general study population. In the severe disease group, the levels of total lymphocytes, T cells, B cells, NK cells; and serum IgA levels, were significantly lower than in the mild disease group (all P < .05). We found that the numbers of lymphocyte subsets and the IgA level negatively correlated with the chest CT scores. On multivariate regression analysis, pretreatment decreases in total lymphocytes, CD3⁺ T cells, CD4⁺ T cells, and CD19⁺ B cells, and serum IgA levels, were independent predictors of severe lung involvement.

CONCLUSIONS

The cell numbers of peripheral lymphocyte subsets and the serum IgA level were negatively correlated with the chest CT scores in COVID-19 patients. These parameters tended to independently predict severe lung involvement in such patients.

Relationship between selective IgA deficiency and COVID-19 prognosis

The prevalence and mortality rates of coronavirus disease 2019 (COVID-19) vary widely among populations. Mucosal immunity is the first barrier to pathogens' entry into the body. Immunoglobulin A (IgA) is the main antibody of mucosal immunity. We explored the relationship between selective immunoglobulin A deficiency (SIgAD) and the severity of COVID-19. We included 424 patients (203 females) with COVID-19. Eleven patients had SIgAD. Laboratory data on patients with SIgAD and normal IgA levels were compared. The relationship between SIgAD and severe COVID-19 infection was explored by logistic regression analysis. In univariate logistic regression analysis, the risk of severe disease in COVID-19 patients with SIgAD was approximately 7.7-fold higher than in the other patients (odds ratio [OR], 7.789; 95% confidence interval [CI], 1.665-36.690, p = 0.008), while it was 4-fold (OR, 4.053; 95% CI, 1.182-13.903, p = 0.026) higher in multivariate logistic regression analysis. Serum IgA levels were positively correlated with total lymphocyte counts, and negatively correlated with C-reactive protein (CRP) levels, which were found as a risk factor for severe COVID-19.In SIgAD patients, the number of SARS-CoV-2 viruses that pass through mucosal membranes may be increased, leading to complications such as cytokine storm syndrome and acute respiratory distress syndrome.

The Impact of SARS-CoV-2 Transmission Fear and the COVID-19 Pandemic on the Mental Health of Patients with Primary Immunodeficiency Disorders and Severe Asthma, and Other High-Risk Groups

ABSTRACT Objective: The effect of the COVID-19 pandemic on mental health in the long term is unclear. We evaluated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)–related transmission fear and mental-health disorders in populations at high risk for COVID-19. Materials and Methods: Healthcare workers and patients with primary immunodeficiency disorders (PIDs), severe asthma, malignancy, cardiovascular disease, hypertension, and diabetes mellitus were included in the study. The hospital anxiety and depression scale (HADS) and Fear of Illness and Virus Evaluation (FIVE) scales were applied during face-to-face interviews. Results: There was a total of 560 participants, 80 per group; 306 (55%) were female. The FIVE and HADS-A scale scores of health care workers were significantly higher than the other groups (p = 0.001 and 0.006). The second-highest scores were in patients with PID. There was no significant difference between the groups in HADS-D scores (p = 0.07). There was a significant positive correlation between FIVE scale scores and anxiety (r = 0.828; p < 0.001) and depression (r = 0.660; p < 0.001). The FIVE scale had significant discriminatory power for anxiety (AUC = 0.870, 95% confidence interval [CI] = 0.836–0.904; p < 0.0001) and depression (area under the curve = 0.760, 95% CI = 0.717–0.803; p < 0.0001). Conclusion: During the COVID-19 pandemic, mental-health disorders may develop in patients with comorbidities, especially healthcare workers. They should be referred to mental-health centers. Keywords: Asthma, COVID-19, fear of virus transmission, mental health, primary immunodeficiency

Vitamin D Deficiency Is a Predictor of Mortality in Elderly with Chronic Heart Failure

Context

The prevalence of both heart failure and vitamin D deficiency increases with age and is associated with poor outcome in the elderly.

Objectives

We aimed to investigate the relationship between all-cause mortality and vitamin D deficiency in elderly patients with chronic heart failure.

Design

It is a retrospective, observational cross-sectional study. Median follow-up time was 497 days.

Subjects and Methods

302 patients aged ≥65 years heart failure patients was categorized into tertiles based on the 25-hydroxy-vitamin D levels. Clinical and laboratory parameters were evaluated according to tertiles. Hospitalization rates and overall survival were compared between tertiles. Independent predictors of all cause mortality were defined.

Results

Patients with low vitamin D tertile were mostly women (p=0.001), and had a worse NYHA functional class (p=0.005). During follow-up, deaths were more frequent in the first tertile (p = 0.001). All-cause mortality increased significantly with decreasing vitamin D tertiles (from third tertile 7.9%, to 11.9%, to 26%; log rank test p=0.003). No significant difference was observed at the composite endpoint of mortality or HF hospitalizations (P=0.451). Multivariate analysis supported that low vitamin D concentration was an independent predictor of all causes of mortality (HR 0.93; 95% CI 0.89-0.97; p=0.004).

Conclusions

Low vitamin D levels were independent predictors of all-cause mortality in the elderly population with chronic heart failure.

Common variable immunodeficiency in adults requires reserved protocols for long-term follow-up

BACKGROUND/AIM

The aim of this study is to establish follow-up protocols for adult patients with common variable immunodeficiency (CVID) in a recently founded adult immunology clinic in the Central Anatolia Region of Turkey, where a clinical immunology center for adults was not available previously.

MATERIALS AND METHODS

A total of 25 patients with CVID aged 18 years and older were included in this study. The file format consisted of 13 pages and was developed for the purpose of the study. Separate sections were designated for identity information, medical history, disease course, previous and current laboratory and imaging studies, follow-up plans, detection and management of complications/comorbidities, and treatment results.

RESULTS

The mean age of the patients was 36.6 ± 13.4 years. The delay in diagnosis was 107 ± 95.6 months. In 92% of patients, initial symptoms resulting in admission to healthcare facilities were infections. Seventeen of 25 patients (68%) had bronchiectasis at the beginning of follow-up.

CONCLUSION

Early identification of complications and comorbidities in patients with CVID will significantly improve quality of life and survival. Close observation and standardized protocols for follow-up are essential components of management.

Sexual dysfunction, mood, anxiety, and personality disorders in female patients with fibromyalgia

BACKGROUND

We aimed to investigate the current prevalence of sexual dysfunction (SD), mood, anxiety, and personality disorders in female patients with fibromyalgia (FM).

METHODS

This case-control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders.

RESULTS

Fifty of the 96 patients (52.1%) suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5%) and arousal disorder (n=10, 10.4%). Of the 96 patients, 45 (46.9%) had a mood or anxiety disorder and 13 (13.5%) had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%), generalized anxiety disorder (8.3%), and histrionic personality disorder (10.4%).

CONCLUSION

SD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM.

Spontaneous patellar tendon rupture in a case followed up for diagnosis of systemic lupus erythematosus

Spontaneous patellar tendon rupture is a rare condition that usually occurs secondary to conditions, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), and use of steroids and fluoroquinolones. This paper presents a full-thickness patellar tendon rupture detected with magnetic resonance imaging, which was performed due to pain and swelling that started spontaneously on the front side of the left knee without a history of any trauma, of a 35-year-old male patient who had been followed up for a diagnosis of SLE for approximately 4 months and who had started taking methylprednisolone 4 mg/day 4 months prior, used it for 1 month, and then stopped using it. In patients who are followed up for a diagnosis of SLE, it should be kept in mind that there is a risk of developing a spontaneous tendon rupture secondary to chronic inflammation and use of corticosteroids.

Beta-Thalassemia Mutations in the East of Turkey

This study was planned to determine the frequency of ß-thalassemia trait and mutations in Van Lake region, which is in the eastern part of Turkey, surrounded by Iran in the east and by Iraq in the south. This study consist of 1014 healthy students, between the age of 12 and 18 years who are studying in boarding schools in Van city and cities surrounding Van Lake that includes Van, Ağrı, Hakkari, Bitlis, Muş and Siirt. The students were randomly selected according to their school numbers. Their origin was not taken into consideration in selection. Complete blood counts were performed on all donors. The accepted lower limit of mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were 78 fL and 27 pg respectively. HbA2 was measured by DE-52 microcolumn chromatography method. ß-thalassemia trait with high HbA2 was found in 6 children. ß-thalassemia homozygous form of -30 (T-A) mutation was determined in one child and HbD-Los Angeles heterozygous in another. The ß-thalassemia homozygous individual was accepted as two cases in prevalence calculation. We found that the prevalence of ß-thalassemia trait was 0.78% in this area. In DNA analyses, there were ß-thalassemia gene mutations of FSC 8/9 (+G), -30 (T-A), IVS I-110 (G-A), IVS II-1 (G-A) and IVS I-130 (G-A) in 3, 2, 1, 1 and 1 individuals, respectively. We conclude that although five different ß-thalassemia mutation exist in Van Lake region, ß-thalassemia is not a potential risk in the east of Turkey.