The Effectiveness of Biological Agents on Chronic Rhinosinusitis with Nasal Polyposis in Patients with Comorbid Asthma: A Multicenter Real-Life Study from Türkiye.

Background and Objectives: Real-life data on the efficacy of biologic agents (BAs) on asthma-comorbid CRSwNP are needed. Our primary goal is to investigate the effects of BAs on CRSwNP symptoms, as well as endoscopic and tomography scores. Our secondary goal is to show a reduction in the frequency of acute sinusitis exacerbations and the need for surgery. Materials and Methods: We conducted a multicenter, retrospective, real-life study. We screened the patients with asthma-comorbid CRSwNP treated with omalizumab or mepolizumab. A total of 69 patients (40 F/29 M; omalizumab n = 55, mepolizumab n = 14) were enrolled. We compared the visual analog scale (VAS), sinonasal outcome test-22 (SNOT-22), nasal congestion score (NCS), Lund-Mackay computed tomography score (LMS), and total endoscopic polyp scores (TPS) before and after BAs. We evaluated the endoscopic sinus surgery (ESS) and acute exacerbations of chronic rhinosinusitis (AECRS) frequencies separately, according to the BAs. Results: The overall median (min-max) age was 43 (21-69) years. The median (min-max) of biologic therapy duration was 35 (4-113) months for omalizumab and 13.5 (6-32) for mepolizumab. Significant improvements were seen in VAS, SNOT-22, and NCS with omalizumab and mepolizumab. A significant decrease was observed in TPS with omalizumab [95% CI: 0-4] (p < 0.001), but not with mepolizumab [95% CI: -0.5-2] (p = 0.335). The frequency of ESS and AECRS were significantly reduced with omalizumab [95% CI: 2-3] (p < 0.001) and [95% CI: 2-5] (p < 0.001); and mepolizumab [95% CI: 0-2] (p = 0.002) and [95% CI: 2-8.5] (p < 0.001), respectively. There was no significant difference in LMS with either of the BAs. Conclusions: Omalizumab and mepolizumab can provide a significant improvement in the sinonasal symptom scores. BAs are promising agents for CRSwNP patients with frequent exacerbations and multiple surgeries.

An atypical presentation of COVID-19: Hidden risk for seniors to misdiagnose.

The outbreak of coronavirus disease (COVID-19) was announced as a pandemic by the World Health Organization in March 2020. Clinical manifestations include cough, fever, dyspnea, myalgia, and loss of sense of smell and taste. Less common extrapulmonary signs and symptoms such as cutaneous manifestations, diarrhea, confusion, functional decline have been reported in the literature. Older patients with multiple comorbidities are at a greater risk for severe disease and death and are vulnerable to atypical presentations due to changes in organ systems, multimorbidity, cognitive impairment, and sensory disturbances. In this case, a 77-year-old patient diagnosed with COVID-19 pneumonia presented with atypically acute urticaria with angioedema was reported. Although there were no typical signs of the disease, such as cough or shortness of breath, the patient's laboratory values, and chest imaging were compatible with COVID-19. Therefore, the diagnosis of COVID-19 should be considered in older patients presenting with subtle signs or cutaneous manifestations.

[Treatment with Intravenous Acyclovir Desensitization for Severe Acyclovir Allergy: A Case of Herpes Encephalitis]. / Ciddi Asiklovir Alerjisinde Intravenöz Asiklovir Desensitizasyon Tedavisi: Herpes Ensefaliti Olgusu.

Herpes simplex virus (HSV) is a sporadic viral encephalitis agent that causes high mortality and morbidity, accompanied by neurological dysfunction findings. Acyclovir is the only antiviral treatment option that should be initiated in all patients with suspected encephalitis as soon as possible. Acyclovir is rarely possible to cause allergic reactions. It may occur in a wide range from generalized cutaneous rash to Stevens-Johnson syndrome. A case of HSV-1 encephalitis who had no treatment option other than intravenous acyclovir and was successfully treated with intravenous desensitization was presented in this report. A 59-year-old male patient was admitted to the emergency department with complaints of high fever and altered consciousness. Diagnostic lumbar puncture was performed and intravenous acyclovir treatment was initiated empirically with the preliminary diagnosis of encephalitis. On the third day of the treatment, HSV type 1 polymerase chain reaction (PCR) was detected as positive. Acyclovir treatment was discontinued due to the development of a severe allergic reaction on the fifth day of acyclovir treatment. Allergic symptoms of the patient regressed with discontinuation of acyclovir treatment and application of concomitant methylprednisolone treatment. The intravenous acyclovir desensitization protocol was applied to the patient, and the patient was successfully treated. In this case, it has been shown that intravenous acyclovir desensitization can be applied in the treatment of life-threatening infections with no treatment options other than intravenous acyclovir. Our case is the first adult case in the literature to be treated with intravenous acyclovir desensitization.

Can Anxiety Affect Dermographism and Atopy Test Outcomes?

AIM: The effect of anxiety on dermographism and atopy test results had never been elaborated. Factors that may affect cutaneous reactivity in skin tests should be determined to improve the accuracy and reliability of results. Age, sex, dermographism, race, seasons of the year, circadian rhythm, and some drugs have been shown to affect skin test results. The aim of this study was to investigate the effect of anxiety on dermographism and atopy tests. METHOD: According to Beck Anxiety Scale, 101 individuals with high anxiety levels were compared with the other 101 individuals with an anxiety level of 7 and below. Skin prick test response, presence of phadiatope, and dermographism were evaluated in all participants. RESULTS: There were 41 (40.6%) and 34 patients (33.7%) with a Beck anxiety score >7 who tested positive in the skin test and Phadiatop, respectively. Moreover, 47 (46.5%) and 42 patients (41.6%) in the control group had positive results in the skin test and Phadiatop, respectively, and there was no statistical difference between the variables (p > 0.05). Dermographism was present in 37 (36.6%) and 30 patients (29.7%) in the study and control groups, respectively. According to Beck anxiety scores, there was no statistically significant difference between the groups in terms of the presence of dermographism, skin prick test positivity, and Phadiatop positivity (p = 0.078, p = 0.395, p = 0.245, respectively). Symptomatic dermographism was found more frequently in the anxiety group (p < 0.05). CONCLUSION: In our study, anxiety does not affect atopy test results. Although anxiety levels did not affect the atopy test results, there was a relationship between anxiety levels and dermographism.

Primary Antibody Deficiencies With Pulmonary Complications: A Single-Center Experience.

Background Primary immunodeficiencies are a heterogeneous group of genetic diseases caused by one or more abnormalities in the immune system. Although pulmonary complications are common in patients with primary immunodeficiency diseases, these complications contribute significantly to morbidity and mortality. Aim The aim of our study was to evaluate the distribution of the features of pulmonary radiological involvement and demographic findings in this patient group. Materials and methods The files of patients who were treated and followed up with the diagnosis of primary immunodeficiency between 2014 and 2021 were analyzed retrospectively. Demographic data, symptoms, additional diseases, and computed tomography findings of the patients were recorded. Results The mean age of 32 cases was 37.34±13.54 (20-69) and the age of diagnosis was 28.90±15.75 (1-62). Twenty of the cases were male and 10 were female. The most common symptom was diarrhea with 53.1% and cough with 34.4%. The most common radiological finding is bronchiectasis in 75% of cases. Twenty-one (65.6%) of the cases had recurrent pneumonia before diagnosis and no pneumonia was observed after intravenous immunoglobulin replacement therapy. Three of the cases (9.4%) died during the follow-up. Conclusions Primary immunodeficiency should be considered in patients with bronchiectasis and a history of recurrent pneumonia, and further investigations should be performed. Early diagnosis of patients with primary immunodeficiency is very important for the early detection and treatment of malignancy and the interstitial lung disease that may develop.

B Cell Subgroups as Potential Biomarkers in Predominantly Antibody Deficiencies with Complications.

BACKGROUND: Predominantly antibody deficiencies (PADs) are the most prevalent primary immunodeficiencies that are caused by genetic disorders and result in impairment of the immune system. Therefore, PAD diagnosis has been extensively studied, yet their B-cell defects and underlying genetic alterations remain largely unknown. The aim of this study is to determine the immunological differences in PAD patients categorized by patients showing different complications such as splenomegaly, bronchiectasis, and chronic diarrhea. METHODS: A total of 45 participants, consisting of 27 patients diagnosed with PAD and 18 healthy control individuals were included in this study. The relationship between B cell subgroups in PAD patients and control groups are investigated. Additionally, the association between B cell subgroups and complications such as splenomegaly, bronchiectasis, and chronic diarrhea in PAD patients are studied. RESULTS: In this study, we found an association between splenomegaly and various B cell subgroups such as naive B cells, CD21low B cells, and SW memory B cells. In the correlation analysis, we found a negative correlation between naive B cells and splenomegaly. Additionally, to the best of our knowledge, this study is the first to show a statistically significant association between memory B cells and chronic diarrhea as well as between transitional B cells and bronchiectasis. CONCLUSIONS: This study provides biomarkers to predict PAD patients' clinical progression or disease complications.

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography.

OBJECTIVES: The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity. METHODS: A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated. RESULTS: The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m2) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index. CONCLUSIONS: LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

May mepolizumab used in asthma correct subfertility?

INTRODUCTION: Asthma is one of the most common chronic airway disease among reproductive period of women. Chronic inflammation in asthma, eosinophilia, high steroid treatment and uncontrolled asthma may cause infertility by affecting the reproductive organs, menstrual cycle and quality of life. Some patients with severe asthma have frequent exacerbations associated with persistent eosinophilic inflammation despite continuous treatment with high-dose inhaled glucocorticoids with or without oral glucocorticoids. Mepolizumab (anti-IL-5) is a succesful option of treatment. CASES: First case; 25-year-old female patient has been diagnosed having asthma and rhinitis for 5 years. Even she had desired pregnancy for 3 years, she was unable to have a baby, and had been diagnosed having primary infertility. Second case; 36 years old female had rhinitis for 6 years and asthma for 4 years Although she used the same contraception method (withdrawal,condom) for years, she did not get pregnant until receiving the second dose of mepolizumab treatment. RESULT: Two women were treated with mepolizumab for eosinophilic severe asthma and they got pregnant. CONCLUSION: Unexplained infertility in people with severe eosinophilic asthma may be corrected by mepolizumab treatment. However, there is not enough data regarding the use of mepolizumab during pregnancy.

Can the neutrophil-lymphocyte ratio predict type 1 hereditary angioedema attacks?

The neutrophil-lymphocyte ratio is a simple and easily used parameter for the assessment of inflammation. We aimed to determine the predictive potential of the neutrophil-lymphocyte ratio regarding episode occurrence in patients with hereditary angioedema. Sixty-six patients with Type 1 hereditary angioedema and 60 healthy controls were included in the study. The laboratory results of the patients in their episode-free periods were similar to those of the healthy controls. The median of neutrophil-lymphocyte ratio was higher during episodes when compared to normal periods (3.5 versus 2.0, p < .001). A significant positive correlation was present between the episode count and the neutrophil-lymphocyte ratio calculated during the episodes (r = 0.557, p < .001). We can conclude that the neutrophil-lymphocyte ratio, which is cheap and easy to calculate, can be used by clinicians as a predictive parameter for prediction of the episode count in patients with hereditary angioedema.