Platelets have significant role in modulating clot formation. Additionally, emerging data indicates that platelets have considerable roles in inflammation and immune response. Platelets gather at the damaged cite and adhere to white blood cells. Subsequently, they release cytokines and chemokines which are chemotactic for neutrophils and monocytes. Therefore, platelets are necessary for targeting lymphocytes, neutrophils and monocytes to inflammation site. Those interactions enhance inflammation. Moreover, platelets serve as an immune cell by engulfing microbes. Presence of platelets affect prognosis in some bacterial or viral infection and several other diseases.
Mesangial IgA deposition is the hallmark of IgA nephropathy. In some cases, crescentic involvement which might be associated with systemic leukocytoclastic vasculitis is documented; in such cases, the disease is called Henoch-Schonlein purpura (IgA vasculitis). Even more rarely, the coexistence of IgA nephropathy and ANCA seropositivity was reported. IgA nephropathy might be complicated by acute kidney injury due to different causes. Herein, we present a patient with mesangial IgA deposition and ANCA seropositivity, who developed acute kidney injury, hematuria, and hemoptysis during the course of COVID-19 disease and was diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis based on clinical, laboratory, and radiological findings. The patient was treated successfully with immunosuppressive therapy. We also made a systematic review of the literature to reveal and present the cases with COVID-19 and ANCA-associated vasculitis.
Background: Matrix metalloproteinases (MMPs) play an important role in bone resorption and are regulated by tissue inhibitors of metalloproteinases (TIMPs). We investigated the use of MMP2/TIMP2 and MMP9/TIMP1 ratios as biomarkers of bone resorption in geriatric osteoporosis and evaluated the relationship between osteoporosis and geriatric syndromes.Methods: This analytical cross-sectional study involved 87 patients (41 with osteoporosis) treated at the geriatric outpatient clinic of a university hospital. The demographic characteristics, comprehensive geriatric assessment scores, laboratory findings, and bone mineral density of the patients were recorded. Serum MMP9, TIMP1, MMP2, and TIMP2 levels were analyzed by enzyme-linked immunosorbent assay (ELISA).Results: We enrolled 41 and 46 patients with and without osteoporosis, respectively. The groups showed no significant differences in MMP2/TIMP2 and MMP9/TIMP1 ratios (p=0.569 and p=0125, respectively). While the basic activities of daily life (BADL) scores in the osteoporosis group were higher than those in the group without osteoporosis, the instrumental activities of daily life (IADL) scores were significantly lower (p=0.001 and p=0.007, respectively). No significant differences were observed in Mini-Nutritional Assessment, Mini-Mental State Examination, and Geriatric Depression Scale scores (p=0.598, p=0.898, and p=0.287, respectively). Conclusion: This is the first study to examine the relationship between osteoporosis and several geriatric syndromes, as well as the relationship between osteoporosis and serum MMP, TIMP values, and MMP/TIMP ratios in geriatric patients. Our results showed that osteoporosis causes dependency in both BADLs and IADLs, and that the MMP2/TIMP2 and MMP9/TIMP1 ratios provided no additional benefit in demonstrating bone resorption in geriatric osteoporosis.
BACKGROUND AND AIMS Sarcopenia is characterized by an involuntary loss of skeletal muscle mass, strength, and function and is usually associated with older age. However, sarcopenia may also be seen at younger ages in patients with chronic kidney disease. The European Working Group on Sarcopenia in Older People (EWGSOP) recently proposed a standardized definition of sarcopenia. We aimed to investigate the incidence of sarcopenia and associated factors in renal transplant recipients. METHOD We examined consecutive adult (age >18 years) renal transplant recipients under regular follow-up in our outpatient clinic during December 2021. We assessed the muscle strength with a handgrip test using a dynamometer and with a chair stand test. Using the Sergi formula, we used bioimpedance analysis to estimate the appendicular skeletal mass. Finally, we measured the gait speed to assess physical performance. Probable sarcopenia was defined as the presence of low muscle strength. Following that, sarcopenia was diagnosed with low muscle quantity in patients with probable sarcopenia according to the revised criteria by the EWGSOP. We retrieved the clinical and laboratory data from the patients’ medical records. RESULTS We recruited a total of 93 kidney transplant recipients (mean age: 59 ± 1.4, male gender 58.1%). About 15.0% of the patients were cadaveric transplants. Probable sarcopenia was found in 31 patients (33.3%), of which 14 (15.0%) were diagnosed with sarcopenia. Diabetes mellitus and lower albumin levels were the significant factors associated with the presence of probable sarcopenia (P = 0.01, P = 0.015, respectively; Table 1). On the other hand, sarcopenia was significantly associated with cadaveric transplantation (P = 0.02; Table 2). CONCLUSION We found that probable sarcopenia and sarcopenia were highly prevalent in our relatively young renal transplant recipients. We recommend active screening for the presence of sarcopenia in renal transplant recipients, especially in the cadaveric ones.
CLINICAL HISTORYA 35-year-old man with no significant medical history presented with a light violaceous, painless tumoral lesion of 3-4 cm in size on his left arm 8 months ago. This lesion did not respond to topical steroids and subsequently spread to the back, abdomen, and all extremities (Fig. 1A). HISTOPATHOLOGICAL FINDINGSAccording to skin biopsy, the tumor cells showed an immature blastic appearance and they were positive for cluster of differentiation (CD)4 and CD56 and, also, CD123 and CD68 were positive which specifically showed perinuclear dot-like staining pattern (Figs. 1B-G). These cells were all negative for myeloperoxidase, terminal deoxynucleotidyl transferase (TdT), CD117, and CD34.
Fabry disease (FD) is a rare, X-linked inherited lysosomal storage disorder, characterized by the accumulation of globotriaosylceramide (Gb3) due to the deficiency or absence of alpha-galactosidase A. Due to the accumulation of Gb3, cardiac, renal, neurological, and skin manifestations can be observed. Enzyme replacement therapy (ERT) with agalsidase alfa or agalsidase beta is the cornerstone in the management of FD. Both enzymes are clinically effective and widely used. In this study, we present a 19-year-old male patient with FD who had received ERT for almost two and half years without any complications. In January 2021, he was diagnosed with COVID-19 infection. Later, he developed an infusion reaction during his first ERT infusion following the resolution of COVID-19 infection. The patient experienced shortness of breath, shivering, and rash. Despite decreased infusion rate and premedication in repetitive infusion, his symptoms were not resolved. Subsequently, he developed an IgE antibody against agalsidase beta, and his skin prick test was positive. Since IgG positivity against agalsidase beta was also detected, agalsidase beta was replaced with agalsidase alfa. The patient did not experience any allergic reaction with agalsidase alfa. Moderate to severe allergic reactions during ERT infusion should be alarming for IgE development. Furthermore, COVID-19 should be considered a trigger for allergic reaction against ERT in patients with FD.
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