Timing of corticosteroids in non-severe non-hospitalized COVID-19 patients: open-label, two-center, randomized controlled study (TICS-COV19 study).

BACKGROUND/AIMS: Corticosteroids (CSs) are frequently used in coronavirus disease 2019 (COVID-19); however, their utility remains controversial in mild to moderate cases. The timing of CSs initiation during the disease course remains unaddressed. The study aims to evaluate the impact of early CSs in non-severe COVID-19. METHODS: A randomized controlled, open-label study was conducted on 754 COVID-19 patients randomized into a study group (n = 377) in which patients received CSs with COVID-19 protocol and a control group (n = 377) in which patients received COVID-19 protocol only. RESULTS: Both groups were comparable regarding baseline characteristics, presenting symptoms, and inflammatory markers. The composite endpoint (need for O2, need for hospitalization or 28-day mortality) was significantly (p = 0.004) lower in the CS group 42 (11.14%) versus the control group 70 (18.67%) with odds ratio 0.55 (95% confidence interval [CI], 0.36 to 0.83), absolute risk reduction 7.53% (95% CI, 2.46% to 12.59%) and number needed to treat of 13.29 (95% CI, 7.94 to 40.61). Regarding severity at day 10, only (11.1%) of the study group patients were severe versus (18.7%) of the control group patients (p < 0.001). The median time-to-return to daily activity in the CS group was 8.0 days, while in the control group, it was 22.0 days (p < 0.001). CONCLUSION: In non-severe COVID-19, CS may decrease hospitalization, severity, and mortality.

Prevalence of common sensitizing aeroallergens in patients with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD), a skin disease burden worldwide, is a complex, multifactorial, chronic inflammatory disease. Prevalence of AD is increasing in developing countries and identifying the causative allergens is a major challenge. Aeroallergens are shown to aggravate atopic dermatitis. PURPOSE: Explore the prevalence of aeroallergens sensitization in patients with AD and its possible relation with AD severity. METHODS: Cross-sectional study of 132 patients diagnosed to have atopic dermatitis. Atopy was detected by serum specific IgE to a panel of the most encountered aeroallergens. RESULTS: From the 132 patients, elevated specific IgE was detected in 72.7 % from which 59.1 % were mild and 86.4 % are moderate/severe as well as 15.9 % are mono-sensitized and 54.5 % are poly-sensitized with poly-sensitization being more in severe cases compared to mild cases (68.2 % vs 4.5 %). Regarding specific IgE to different aeroallergens, the most prevalent were Dermatophagoides pteronyssinus (50 %), followed by Dermatophagoides farinae (34.1 %), Birch pollen (20.5 %), cat epithelium (18.2 %) Regweed (15.9 %), and Cockroach (9.1 %). However, moderate to severe cases were more sensitized to candida (p = 0.012), mix grass pollen (p = 0.002), ragweed (0.00), mite (p = 0.037) and cat epithelium (p = 0.007). CONCLUSION: Dermatophagoides pteronyssinus, Dermatophagoides farinae, Birch pollen, cat epithelium Regweed and Cockroach are the most frequent sensitizing aeroallergens in atopic dermatitis.

Allergy and hematological malignancies risk: A possible implication of Immunoglobulin E, TNF-α and Interleukin 10.

AllergoOncology is a current focus of scientific interest. A possible link between allergies and hematologic malignancies (HMs) existed, but the results are controversial. While some studies concluded that allergy is a risk factor for HMs, others consider allergy a protective factor. We aimed to investigate the frequency of allergic disorders among individuals with hematological malignancies versus hematological malignancies free individuals and to detect the possible implication of serum level of Immunoglobulin (Ig) E, interleukin (IL)-10 and tumor necrosis factor (TNF) α. 75 patients with HMs and 75 healthy controls were enrolled. Diagnosis of allergy was made by history, clinical examination, and skin prick testing (SPT), while measurements of serum total IgE, IL 10 and TNFα were done by ELISA. Allergy was diagnosed in 6.7% of the patients and 42.7% of the healthy controls (P<0.001). There was a statistically significant decrease in serum total IgE and TNF-α and in patients than controls (P=0.002, <0.001), respectively. In contrast, IL-10 showed no significant differences between the two groups. In conclusion, allergic disorders are less frequent in patients with HMs than healthy controls. Lack of allergic conditions, low serum total IgE and TNFα may be independent risk factors for hematological malignancies.

Natural killer NKG2A and NKG2D in patients with colorectal cancer.

BACKGROUND: Natural-killer group 2 (NKG2), a characteristic receptor of natural killer (NK) cell family, assumes a vital role in modulating NK cytotoxic function. We aimed to detect mRNA expression of both NKG2A and NKG2D in serum NK cells obtained from colorectal cancer (CRC) patients. METHODS: We enrolled 36 patients with newly diagnosed CRC, as well as 15 group matched healthy individuals. The patients were further classified into: 23 non-metastatic CRC (group 1) and 13 metastatic CRC (group 2). We detected the expression of NKG2A and NKG2D serum levels for all participants utilizing real-time polymerase chain reaction (RT-PCR). RESULTS: NKG2D and NKG2A mRNA levels in peripheral blood mononuclear cells (PBMCs) were significantly elevated in patients with CRC compared to controls (P<0.01). NKG2D or NKG2A showed sensitivity (77.8, 83.33%) and specificity (73.33, 100%) respectively using receiver-operating characteristic (ROC) curve analysis for discrimination between patients and controls, whereas group 1 and group 2 showed no statistical significant difference in NKG2D and NKG2A levels (P>0.05). CONCLUSIONS: Our work is one of the first research that could detect an increase in NKG2D in CRC. In spite of their defensive role in tumor immune surveillance, NKG2D and NKG2A and their ligands could have misused as tumor survival tool, empowering immune avoidance and suppression.

Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity.

BACKGROUND: Apart from endoscopic interventions, readily attainable cost-effective biomarkers for ulcerative colitis (UC) assessment are required. For this purpose, we evaluated differential leucocytic ratio, mainly neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) as simple available indicators of disease activity in patients with ulcerative colitis. METHODS: Study conducted on 80 UC patients who were classified into two groups of 40 each according to Mayo score and colonoscopic findings. Group 1 (active UC) and group 2 (inactive UC). Another 40 group-matched healthy participants were enrolled. White blood cell count, NLR, LMR, C-reactive protein, and Erythrocyte sedimentation rate were measured and recorded. RESULTS: Significant elevation of NLR was observed in active UC group compared to inactive UC and controls (2.63 ± 0.43, 1.64 ± 0.25, 1.44 ± 0.19 respectively; p < 0.0001). The optimal NLR cut-off value for active UC was > 1.91, with a sensitivity and a specificity of 90% and 90% respectively. The mean LMRs of active UC was significantly lower compared with inactive UC patients and controls (2.25 ± 0.51, 3.58 ± 0.76, 3.64 ± 0.49 respectively; p < 0.0001). The cut-off value of LMR for determining the disease activity was ≤ 2.88 with a sensitivity of 90% and a specificity of 90%. NLR, LMR, and CRP were found to be significant independent markers for discriminating disease activity (p = 0.000). Besides, NLR was significantly higher in patients with pancolitis and positively correlated with endoscopically severe disease. CONCLUSION: NLRs and LMRs are simple non-invasive affordable independent markers of disease activity in UC.

Adaptation, test-retest reliability, and construct validity of the Physical Activity Neighborhood Environment Scale in Nigeria (PANES-N).

BACKGROUND: This study adapted the Physical Activity Neighborhood Environment Scale (PANES) to the Nigerian context and assessed the test-retest reliability and construct validity of the Nigerian version (PANESN). METHODS: A multidisciplinary panel of experts adapted the original PANES to reflect the built and social environment of Nigeria. The adapted PANES was subjected to cognitive testing and test retest reliability in a diverse sample of Nigerian adults (N = 132) from different neighborhood types. Intraclass Correlation Coefficients (ICC) was used to assess test-retest reliability, and construct validity was investigated with Analysis of Covariance for differences in environmental attributes between neighborhoods. RESULTS: Four of the 17 items on the original PANES were significantly modified, 3 were removed and 2 new items were incorporated into the final version of adapted PANES-N. Test-retest reliability was substantial to almost perfect (ICC = 0.62-1.00) for all items on the PANES-N, and residents of neighborhoods in the inner city reported higher residential density, land use mix and safety, but lower pedestrian facilities and aesthetics than did residents of government reserved area/new layout neighborhoods. CONCLUSION: The PANES-N appears promising for assessing environmental perceptions related to physical activity in Nigeria, but further testing is required to assess its applicability across Africa.