Objectives Lysosomal storage diseases (LSD) constitute an important group of metabolic diseases, consisting of approximately 60 disorders. In some types of lysosomal diseases, enzyme replacement therapy (ERT) is administered intravenously in weekly or biweekly doses. Unfortunately, scheduled ERT during COVID-19 was disrupted. We considered the possibility of adverse outcomes caused by the disruption in the treatment of patients with lysosomal storage disorders. Methods During the COVID-19 pandemic, we conducted a questionnaire that was delivered via Internet to assess how this vulnerable patient group was affected by the pandemic in terms of their access to treatment and their disease-related symptoms. Results The questionnaire was filled out by 75 patients. There were 35 patients whose treatment dose was missed because of COVID-19. The most common reason for skipping treatment was not wanting to go to the hospital for fear of contracting COVID-19. These 35 patients missed a median of four doses of ERT (range: 1–16 dosages). Twenty-one patients (60%) claimed that they were affected physically by not taking ERT (20 mucopolysaccaridoses, 1 Fabry disease), whereas 14 (40%) did not. Conclusions Interruption of ERT during the COVID-19 pandemic may have significant consequences. It may be beneficial to switch to home treatment or reserve dedicated facilities. With proper planning and management, the treatment disruptions of this particular group can be avoided.

Çıkı K, Doğru D, Kuşkonmaz B, Emiralioğlu N, Yalçın E, Özçelik U, Uçkan-Çetinkaya D, Kiper N. Pulmonary complications following hematopoietic stem cell transplantation in children. Turk J Pediatr 2019; 61: 59-70. Pediatric data about early or long-term pulmonary complications of hematopoietic stem cell transplantation (HSCT) are limited. Here we aimed to evaluate children who were treated with HSCT in the last 10 years and developed pulmonary complications following HSCT and to determine their risk factors associated with pulmonary complications.In this retrospective study, we evaluated 195 patients for the development of pulmonary complications after HSCT within a 10 years of period. Pulmonary complications developed in 71 (36.4%) patients. Of the 71 patients who had pulmonary complications, 60 had one pulmonary complication, 11 had two pulmonary complications. Pulmonary complications were diagnosed as early in 42 (51.2%) and late in 40 (48.8%) episodes. Pulmonary complications were infectious in 28 (34.1%), noninfectious in 20 (24.4%) and both infectious and nonfectious in 34 (41.5%) episodes. Pulmonary complications developed significantly more frequently in patients with malignancy, congenital immune deficiency and with at least one pulmonary disease before HSCT. The number of patients who had myeloablative conditioning regimen was significantly higher in the group of patients without pulmonary complications than the group with pulmonary complications. However, in multivariate analysis, none of these variables were shown to be effective in predicting pulmonary complications after HSCT (p>0.05). During follow up, 54 (65.8%) episodes recovered, 20 (24.3%) episodes resulted with death due to pulmonary complications, 6 (7.3%) episodes had chronic pulmonary disease (bronchiolitis obliterans (BO) and bronchiolitis obliterans organizing pneumonia (BOOP)); 2 patients (each patient with one episode) were lost to follow up. In conclusion; identifying children who are at risk for severe pulmonary complications and close longitudinal follow-up after HSCT by pediatric pulmonologists is mandatory to increase survival and life quality of these patients.

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The aims of the study were to evaluate the prevalence of sleep-disordered breathing (SDB) by using polysomnography (PSG) in children with MPS IVA and MPS VI who underwent enzyme replacement therapy (ERT) and to analyze the effect on SDB of having upper airway surgery, pulmonary functions, and exercise capacity. A retrospective cross-sectional study was conducted on patients with MPS IVA (n:17) and MPS VI (n:11) aged under 19 years who underwent polysomnography. Descriptive and nonparametric analyses were performed for demographic, PSG, pulmonary function and exercise capacity variables. The frequency of sleep apnea in the study sample was 85.7% (24/28). Four patients (14.3%) had no sleep apnea, 15 (53.6%) had mild, and nine (32.1%) had moderate-to-severe sleep apnea. Two patients (7.1%) had central sleep apnea and 22 had obstructive sleep apnea (OSA) (78.6%). Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were negatively correlated to apnea-hypopnea index (AHI) (r = À0.594, p = .009; r = À0.636, p = .005, respectively). Despite ERT and previous upper airway surgery, the prevalence of OSA was high in patients with MPS IVA-MPS IV, emphasizing the importance of PSG screening for sleep disorders. Pulmonary function tests may be useful for predicting sleep apnea in patients with MPS IVA and MPS VI.

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