COVID-19 outcomes in patients with and without autoimmune rheumatic diseases: A multicenter comparative study.

BACKGROUND AND OBJECTIVE: People with rheumatic diseases are particularly concerned with the coronavirus disease 2019 (COVID-19) pandemic. Our work aimed to study the impact of pre-existing autoimmune rheumatic disease (AIRD) and its immunosuppressive drugs on COVID-19 severity and outcome. PATIENTS AND METHODS: This is a multicenter case-control study performed between September 2020 and February 2021 on 130 adults with COVID-19, including 66 patients with AIRD and 64 without AIRD, who served as a control group. RESULTS: Regarding COVID-19 clinical manifestations; diarrhea, fatigue, and headache were found with significantly higher frequency in the AIRD group while a higher frequency of cough was found in the control group. Comparing COVID-19 complications, only septic shock was significantly higher in the AIRD group (P = 0.013). Both groups were treated with similar COVID-19 drugs except for tocilizumab and anticoagulants, which were statistically significantly more frequently used in the control group (P < 0.001 for both). No statistically significant difference was found between the groups in the outcome or severity of COVID-19. There was no impact of previous immunosuppressive drugs before COVID-19 on the severity of the disease except for a longer duration of recovery in patients on steroids (P < 0.001). Patients with hypertension had severe COVID-19 compared with those without (odds ratio 2.8, 95% confidence interval 1.2-6.9; P = 0.020). CONCLUSION: AIRD may not affect COVID-19 severity and outcome. Similarly, immunosuppressive medications had no effect; except that patients on systemic steroids had longer duration for recovery. Comorbid conditions, such as hypertension, may be associated with more severe COVID-19 disease course.

Association of VDR ApaI and TaqI Gene Polymorphisms with the Risk of Scleroderma and Behçet's Disease.

Vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms have been reported in autoimmune diseases. However, their role in Behçet's disease (BD) and scleroderma remains inconclusive. Our aim was to evaluate vitamin D receptor (ApaI, TaqI) gene polymorphisms in relation to Behçet's disease and scleroderma in Egyptians. The study was conducted on 54 patients with BD, 30 scleroderma patients, and 60 healthy control subjects. VDR (ApaI, TaqI) gene polymorphisms were investigated using polymerase chain reaction-restriction fragment length polymorphism technique. The "a" allele of ApaI (A/a) polymorphism was significantly associated with increased BD risk (OR = 2.09, 95% CI = 1.18-3.71, p = 0.011), while the TaqI "tt" genotype was significantly lower in BD patients as compared to control subjects (OR = 0.35, 95% CI = 0.13-0.9, p = 0.026). Carriage of "aT" VDR haplotype was significantly associated with higher BD risk (OR = 2.28, 95% = 1.14-4.56, p = 0.022). In conclusion, our findings suggest that VDR gene polymorphisms have a significant association with BD in Egyptian patients.

Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography in patients with end-stage renal disease on dialysis therapy.

BACKGROUND: Pulmonary hypertension (PH) is one of the most important comorbidities in patients undergoing hemodialysis (HD). The goal of the present work is to determine the possible etiologic factors for its occurrence. METHODS: The prevalence of PH was estimated by Doppler echocardiography in a cohort of 100 patients aged 49.3 ± 13.9 years on regular HD. Mean pulmonary artery pressure was estimated from pulmonary acceleration time by Mahan's regression equation. Pulmonary vascular resistance and pulmonary capillary wedge pressure were calculated. We focused on the effect of HD on left and right ventricle diastolic and systolic function. Right ventricle systolic function was assessed by tricuspid annular systolic excursion and pulsed Doppler myocardial performance index. Since impaired endothelial function was postulated as an underlying cause of PH, we studied the effects of HD on brachial artery endothelial function. RESULTS: The current study found that pulmonary hypertension was prevalent in 70% of patients on dialysis. Left atrium diameter, left ventricle mass indexed to body surface area, and mitral E/E' were increased in the dialysis group (4.4 ± 0.2 cm, 126.5 ± 24.6 g/m(2), and 16.9 ± 4.4, respectively, p < 0.001 for all). Pulmonary artery systolic pressure was positively correlated to duration of dialysis and negatively correlated to glomerular filtration rate (p < 0.001 and r = -0.991). Pulmonary vascular resistance was significantly increased in dialysis patients (1.9 ± 0.2 Wood units vs. 1.2 Wood units in controls, p < 0.001). Endothelial dysfunction, defined as brachial artery flow mediated dilatation <6%, was found in 46% of dialysis group. CONCLUSION: Increased pulmonary artery systolic pressure in the HD population could be attributed to left atrium dilatation and left ventricle diastolic dysfunction. Pulmonary vascular resistance was significantly increased in dialysis group. This might be explained by impaired endothelial nitric oxide synthesis that not only caused systemic vasoconstriction but also affected the pulmonary vasculature.

Early Detection of Subclinical Uremic Cardiomyopathy Using Two-Dimensional Speckle Tracking Echocardiography.

BACKGROUND: Overhydration has a deleterious effect on cardio myocytes. This study was designated to evaluate left ventricular (LV) systolic and diastolic dysfunction in patients with various stages of chronic kidney disease (CKD) using conventional, tissue Doppler and two-dimensional speckle tracking echocardiography (2DSTE). METHODS: Forty controls and 90 CKD patients, aged 49.3 ± 14 years old, were enrolled in the study. Patients were divided into 3 groups depending on their glomerular filtration rate. Group 1 (≥60 mL/min per 1.73 m(2) ), group 2 (≤60 mL/min per 1.73 m(2) ), and group 3 (≤60 mL/min per 1.73 m(2) and on regular dialysis for at least 12 months). Pulsed-Doppler and tissue Doppler studies were used to estimate LV filling pressure E/E'. Using 2DSTE, circumferential, radial, and longitudinal functions of the LV have been measured. RESULTS: LV longitudinal systolic strain, early, and late diastolic strain rates were significantly reduced in CKD patients (-16.9 ± 3.8%, 1.6 ± 0.5%, and 1.3 ± 0.4% in CKD vs. -22.5 ± 0.6%, 2.3 ± 0.2%, and 1.9 ± 0.1% in controls, P < 0.001 for all), and no difference was observed in terms of the circumferential LV functions (-22.4 ± 1.7 vs. -22.5 ± 1.4, P = 0.567). Severity of the kidney dysfunction appears to parallel with the rise of E/E' significantly (P < 0.001). CONCLUSION: In CKD, although the longitudinal and radial systolic functions were reduced, LV ejection fraction may remain within normal limits due to the preservation of the circumferential functions. Early detection of uremic cardiomyopathy might provide useful information for the risk stratification and decide the proper dialysis therapy in these patients.

Detection of Left Atrium Myopathy Using Two-Dimensional Speckle Tracking Echocardiography in Patients with End-Stage Renal Disease on Dialysis Therapy.

BACKGROUND: Left atrium (LA) deformation analysis by two-dimensional speckle tracking echocardiography (2DSTE) has recently been proposed to evaluate left ventricular (LV) filling pressure in dialysis patients. AIM: The purpose of this study was to study the LA function in dialysis patients using two-dimensional speckle tracking echocardiography correlated to prevalence of atrial fibrillation, echocardiographically pulmonary capillary wedge pressure, and right ventricle systolic pressure. METHODS: Hundred adult patients aged 49.3 ± 13.9 years on regular hemodialysis and 40 healthy individuals were enrolled in the study. Left ventricular dimensions, ejection fraction, and mass index were studied. Left atrium volume index (LAVI) was calculated by dividing left atrium volumes by body surface area. Left ventricle filling pressure was evaluated according to E/E'. Left atrium global systolic strain (LASS) was studied using 2DSTE. Left atrium stiffness was calculated noninvasively based on the ratio of E/E' to LASS. Right ventricle systolic pressure was estimated with the Bernoulli equation formula. RESULTS: Left atrium diameter, left ventricle indexed mass, mitral (E/E'), and LA stiffness were increased in dialysis group 4.4 ± 0.2 cm, 126.5 ± 24.6 g/m(2) , 16.9 ± 4.4, and 0.5 ± 0.1, respectively, P < 0.001 for all. Left atrium systolic strain was significantly decreased in dialysis patients (26.6 ± 1.9 vs. 33.7 ± 2.1%, P < 0.001). Left atrium stiffness was significantly higher in dialysis patients with atrial fibrillation (AF) compared to those without AF. CONCLUSION: Assessment of LA deformation parameters predicts LV diastolic dysfunction and right ventricle systolic pressure in dialysis patients. Left atrium function in dialysis patients was impaired before the occurrence of left atrium dilatation.