Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS‐CoV‐2 patients: Could genetic factors be relevant in the clinical course of COVID‐19?

In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease‐2019 (COVID‐19). We sought to determine the clinical characteristics relevant to the clinical course of COVID‐19 by comparing the family cluster to unrelated patients with SARS‐CoV‐2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty‐nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID‐19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID‐19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID‐19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID‐19 should include such family clusters.     

Tocilizumab challenge: A series of cytokine storm therapy experiences in hospitalized COVID-19 pneumonia patients

To recognize the period of exaggerated cytokine response in patients with coronavirus disease 2019 (COVID-19) pneumonia, and to describe the clinical outcomes of using tocilizumab as a treatment option. The data of 12 adult COVID-19 pneumonia patients who were followed in the inpatient clinics of Biruni University Medical Faculty Hospital (Istanbul, Turkey) were retrospectively analyzed. Diagnostic tests, laboratory examinations, clinical findings, and computed tomography of the thorax imaging results were evaluated. A dramatic laboratory and clinical improvement was observed in 83% (10 out of 12) of patients after tocilizumab. In 17% (2 out of 12) of our patients, short-term ventilator support was required in the intensive care unit. The longest hospital stay was 18 days. However, in the end, all of our patients were discharged home with good health. Although arterial oxygen saturations (87.58 ± 3.12%) dropped in room air in the pre-tocilizumab period, post-tocilizumab they normalized in all patients (94.42 ± 1%). None of them had fever after tocilizumab treatment and the levels of C-reactive protein (13.08 ± 12.89) were almost within normal limits. Eosinophil values were quite low at the time of diagnosis (10 ± 17.06), but increased significantly post-tocilizumab (155.33 ± 192.69). There is currently no proven treatment for COVID-19 induced by novel coronavirus SARS-CoV-2. Based on our experience with twelve adult COVID-19 pneumonia patients, we can say that tocilizumab, an IL-6 inhibitor, is more beneficial in preventing the damage caused by excessive cytokine response in the body if administered at the right time and provides clinical and radiological recovery.     

Ambulatory Blood Pressure Monitoring and Echocardiographic Findings in Renal Transplant Recipients

Hypertension is common in renal transplant recipients (RTRs). Ambulatory blood pressure (BP) monitoring (ABPM) is important in diagnosing hypertension and diurnal BP variation. The authors set out to compare office BP and ABPM measurements to determine diurnal pattern and to evaluate echocardiographic findings in RTRs. ABPM and office BP measurements were compared in 87 RTRs. Echocardiographic evaluation was performed for each patient. The correlations between office and 24‐hour ABPM were 0.275 for mean systolic BP (P=.011) and 0.260 for mean diastolic BP (P=.017). Only 36.8% had concordant hypertension between office BP and ABPM, with a masked hypertension rate of 16.1% and white‐coat effect rate of 24.1%. Circadian BP patterns showed a higher proportion of nondippers (67.8%). Left ventricular mass index was increased in 21.8% of all recipients. There was a significant but weak correlation between office BP and ABPM.     

The natural course of progressive systemic sclerosis patients with interstitial lung involvement

Objective The aim of the study is to assess the natural course of systemic sclerosis (SSc) in patients with interstitial lung involvement and to evaluate the effects of treatment. Materials and methods Sixty SSc patients with interstitial lung involvement were included in the study and history and retrospective data records of the patients were reviewed. Results It was observed that 47 patients (78.3%) had Raynaud’s phenomenon, 7 patients (11.7%) had skin involvement, 5 patients (8.3%) had joint involvement, and 1 patient (1.7%) had gastrointestinal system involvement as the first manifestation of the disease. Lung involvement had developed on an average of 113±106 months after the first manifestation of the disease and was apparent within the first year in 10 patients (16.7%), between 1 and 2 years in 3 patients (5%), between 2 and 3 years in 2 patients (3.3%), between 3 and 4 years in 5 patients (8.3%), between 4 and 10 years in 21 patients (35%), and after 10 years in 19 patients (31.7%). When the symptoms of lung involvement appeared, 37 patients (61.7%) were not receiving treatment while 23 (38.3%) were using an immunosuppressive agent. The time interval of lung involvement for the treated patients was 131±95 months while it was 101±112 months in untreated patients (p>0.05). Conclusion In SSc patients with intersititial pulmonary involvement, the disease frequently starts with Raynaud’s phenomenon and pulmonary symptoms tend to appear at a mean of 7 years after the onset of disease. The first sign of the disease, the probability of interstitial pulmonary involvement, is highest during the first 15 years after. Although this probability decreases after 15 years, in up to 10% of the patients, interstitial pulmonary involvement can still occur even up to 40 years. Immunosuppressive treatment is not effective in preventing the development of pulmonary involvement. However, it delays the manifestation of pulmonary symptoms for nearly 4 years.     

Anti-cancer activity of a novel palladium(II) complex on human breast cancer cells in vitro and in vivo

Anti-cancer effects of a newly-synthesized palladium(II) complex, [Pd(sac)(terpy)](sac)·4H₂O (sac = saccharinate, and terpy = 2,2′:6′,2″-terpyridine), were tested against human breast cancer cell lines, MCF-7 and MDA-MB-231. The Pd complex had a strong anti-growth effect in a dose- and time-dependent manner in vitro. This effect was also confirmed by the experiment performed on Balb/c mice in vivo. The IC₅₀ values were 0.09 μM for MDA-MB-231 and 3.05 μM for MCF-7. It was also very effective in disrupting the formation of MDA-MB-231 tubules on matrigel, indicative of a putative anti-invasive activity. It induced apoptosis via the cell death genes of DR4 and DR5. In conclusion, this newly-synthesized Pd (II) complex represents a potentially active novel drug for the breast cancer treatment.     

The oxidant–antioxidant balance in systemic sclerosis cases with interstitial lung involvement

We aimed to assess the plasma oxidant and antioxidant levels in systemic sclerosis (SS) patients with interstitial lung involvement. Twenty-seven female SS patients and 17 healthy female volunteers were included in the study. Plasma levels of oxidants and antioxidants levels were studied of two groups. The median oxidant and antioxidant levels in study and control groups were, MDA 5.2 ± 0.4/3.7 ± 0.5 nmol/ml (P < 0.001), NO 45.4 ± 3.7/34.2 ± 2.9 nmol/l (P < 0.001), SOD 25.6 ± 2.3/24.6 ± 2.0 U/ml (P > 0.05), catalase 99.9 ± 9.9/140.0 ± 10.0 U/ml (P < 0.001), vitamin E 20.5 ± 1.3/22.6 ± 2.0%mg (P < 0.001), vitamin C 70.6 ± 8.7/83.5 ± 7.3 mg/dl (P < 0.001), respectively. There was also no correlation between plasma levels of oxidants–antioxidants levels and disease duration, duration of pulmonary signs, pulmonary function test values, HRCT scores in SS patients (P > 0.05). In our study, the oxidant burden in SS patients with interstitial lung involvement was found to be increased; however no correlation was detected between the severity of lung involvement and oxidant–antioxidant levels.