The prevalence of COVID-19 in patients with rheumatoid arthritis, multiple sclerosis, or systemic lupus erythematosus receiving biologic disease-modifying antirheumatic drugs

Introduction: The coronavirus disease (COVID-19) became a global pandemic in 2019. Some studies have shown that the virus can cause a higher mortality in people with weakened immune systems, such as the elderly, those taking immunosuppressive drugs, and those with underlying disorders, than in the general population. Objectives: The aim of this study was to evaluate the prevalence of COVID-19 in patients with rheumatic disorders who received biologic disease-modifying antirheumatic drugs (DMARDs). The effect of precautionary self-isolation in these patients was also determined. Patients and Methods: This descriptive study involved 200 patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS) who were treated with biologic DMARDs. Patients with symptoms of the coronavirus infection were invited to have a COVID-19 test that involved a COVID-19 IgG antibody test or a polymerase chain reaction (PCR) test (i.e., nasal swab). Additionally, patients were asked about their precautionary self-isolation status during this period. Results: The mean age of the patients was 51.29 years ± 13.38 years. The ratio of males to females was 27 to 173. Of the 200 patients included in the study, 156 (78%) had RA, 10 (5%) had SLE, and 34 (17%) had MS. Seventy-five percent of the patients used rituximab. Ten patients (5%) were symptomatic of COVID-19, although only four patients had a definitive diagnosis of the disease. All patients who were symptomatic of COVID-19 took rituximab. Ten percent of patients who did not observe the precautionary self-isolation period were diagnosed with COVID-19. Conclusion: Patients who receive biologic DMARDs have a lower risk of developing COVID-19 and a lower risk of mortality from the disease than the general population.

Side effects of methotrexate therapy in patients with rheumatoid arthritis

Introduction: Methotrexate is widely used as the most common disease-modifying anti-rheumatoid drug (DMARD) and is known as the first line treatment for rheumatoid arthritis (RA). Objectives: To assess the side effects of methotrexate in Iranian patients with RA and to compare them with the known side effects from previous studies. Patients and Methods: We conducted a cross-sectional study of 300 patients who fulfilled the EULAR 2010 criteria of RA. The following data were recruited from patients’ profiles; age, body mass index (BMI), duration of treatment with methotrexate, initiating dose, maximum dose and current dose of methotrexate, history of fatty liver disease or hepatitis B and concomitant use of sulfasalazine, leflunomide or hydroxychloroquine. Results: In 149 out of 300 patients (49.66%), Methotrexate therapy was stopped or tapered due to side effects including nausea (23%), flu-like symptoms (8%), hepatotoxicity (12%) and hair loss (6%). The patients with hepatotoxicity had a higher duration of treatment with methotrexate (10.35 compared with 5.83; P<0.001) and also the higher initiating dose of methotrexate (12.91 compared with 12.17; P=0.010). All of the RASS (rheumatoid arthritis severity scale) indexes including disease activity, functional impairment, and physical damage are related to the presence of hepatotoxicity (P<0.001). Conclusion: Methotrexate is an excellent and effective agent for the treatment of RA and its potential side effects during the treatment are dependent on the methotrexate dosage, the level of anti-citrullinated protein antibody (ACPA) and anti-MCV antibodies and concomitant use of other drugs such as leflunomide.

Efficacy and side effects of Sputnik V, Sinopharm and AstraZeneca vaccines to stop COVID-19; a review and discussion

We believe that vaccination is just a way to eliminate or strongly stop the COVID-19. In this regard, there are several vaccines with different efficacy and side effects. It is urgently required to have some efficient vaccines for the prevention and control of SARS-CoV-2. In this review, international databases were considered for searching relevant articles from 1 January 2020 to 1 May 2021. Keywords were COVID-19, novel coronavirus, 2019- nCoV, coronavirus disease 2019, vaccine, Sputnik V, Gamaleya, Gam-COVID-Vac, Sinopharm, BBIBP-CorV, AstraZeneca, Vaxzevria, Oxford, ChAdOx1 nCoV-19 and AZD1222. Three Sputnik V, Sinopharm and AstraZeneca vaccines are useful to gain herd immunity. Enough intervals (at least three weeks/21 days) must be considered for sufficient neutralizing antibody titers. What is important is that the vaccination should be accelerated with each of the aforementioned three vaccines to achieve herd immunity in a shorter period of time because all three vaccines provide 100% prevention of severe COVID-19.

Gut microbiota in COVID-19 treatment

A novel coronavirus (severe acute respiratory syndrome coronavirus [SARS-CoV-2]), has been causing a COVID-19 pandemic of acute respiratory syndrome in humans since December 2019. It appears to be similar in structure to the virus that caused the SARS-CoV outbreak of 18 years ago. However, in addition to the respiratory disorders, the COVID-19 patients might suffer extra-pulmonary disorders, including gut dysfunction or liver dysfunction complications, which show as gut–lung crosstalk. Fecal specimens should be considered as a source of detection of SARS-CoV-2 as one of the routine diagnostic tests in order to guide hospital’s liberation and release of quarantine of patients.

Single nucleotide polymorphisms associated with gastric cancer in Iranian patients

Gastric cancer is one of the leading worldwide cancers formed in the lining of the stomach, and is the most prevalent cancer in northern Iran. Recent interventions for the early diagnosis of gastric cancer are based on genetic susceptibility parameters and the interactions between genes and the environment. Accordingly, this narrative review was designed to summarize the genetic markers involved in Iranian patients with gastric cancer, classified by cellular function. There was a significant relationship between single nucleotide polymorphisms (SNPs) in rs1051208 C allele (RAF1), rs531564 (pri-miR-124-1), rs1053023 (STAT3), rs8193 C allele (CD44), rs3130932G allele (OCT4), rs283821943, rs2032586 (ABCB1), codons 72,248 (p53), -137 G/C (IL-18), Pro12Ala (PPARγ), rs1053023 (STAT3), rs4647603 (caspase 3), -712C>T (caspase 9), -1263 A> (caspase 9) and gastric cancer. Increased risk was observed in C677T (MTHFR). Finally, decreased risk of gastric cancer was explored in -938 C>A (bcl2). Asp299Gly (TLR-4), rs1028181-513T/C (IL-19) Pro12Ala (PPARγ) may play a crucial role in susceptibility of Helicobacter pylori and gastric pathogenesis. According to the findings, the genetic polymorphisms in the immune-associated genes were related to the gastric cancer among the Iranian patients. Therefore, further large-scale functional investigations are needed to draw definite conclusions.

Prophylactic effects of hydroxychloroquine on the incidence of COVID-19 in patients with rheumatic arthritis: an observational cohort study

Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease with substantial morbidity and mortality. Anti-malarial drugs like hydroxychloroquine are indicated in several rheumatic diseases such as RA. Some reports have suggested hydroxychloroquine for prevention of COVID-19. Objectives: Whether hydroxychloroquine has prophylactic effects for COVID-19 in rheumatic patients. Patients and Methods: In this multicenter cohort-based observational study the preventive effect of hydroxychloroquine regarding the incidence and severity of COVID-19 was investigated in patients with RA who referred to rheumatology clinics of academic hospitals of Isfahan between April and July 2020 and already have been treated with hydroxychloroquine for more than three months. Around 215 patients with RA and current use of hydroxychloroquine were recruited and followed for three months. Patients’ information was gathered using the medical record or by phone call. Results: The incidence of COVID-19 in this selected sample was 4.2% (n=9). Only one in nine patients needed hospitalization, without need for intubation or ICU care. Symptoms including dry cough, headache, body pain, malaise, dyspnea, fever, sore throat, chills, and chest pain, were reported to be statistically higher in COVID-19+ group. Conclusion: In contrast to the mortality rate in the general population of Isfahan, Iran (4.8% - until June 2020), no mortality has been reported in these patients. Therefore, it seems that the use of hydroxychloroquine has been able to reduce the incidence and severity of the disease after reaching steady-state levels. This finding has clinical importance, especially for rheumatic patients using immunomodulatory drugs.

Evaluation of the effect of Teucrium polium ointment on the episiotomy wound healing in primiparous women

Introduction: Episiotomy is a surgical incision at the vaginal opening performed in the second stage of labor during childbirth. The purpose of performing an episiotomy is to increase the size of the soft tissue of the pelvis floor and prevent damage to the perineum, facilitate delivery, and reduce the time during childbirth. Objectives: This study aimed to determine the effect of Teucriumpolium ointment on wound healing in primiparous women. Patients and Methods: This triple-blinded clinical trial was conducted on 84 primiparous women referred to Mahdieh hospital in Tehran. Participants randomly received 2% T. polium ointment and placebo. The first time the ointment was started 24 hours after delivery and continued twice a day for 10 days. Wound healing rate was measured by redness, edema, ecchymosis, discharge, and approximation (REEDA) scale on days 1, 5, and 10 postpartum. The data were analyzed using SPSS version 23. Results: The results were performed on 84 women, 43 people using T. polium ointment and 41 people using placebo ointment. There was no significant difference between the two groups regarding obstetrics and demographic characteristics at the beginning of the study. The mean scores of REEDA in the T. polium group in the first 12 hours, days 5 and 10 were significantly different from the placebo group (P<0.001). Conclusion: Wound healing following episiotomy can be accelerated due to antibacterial, anti-inflammatory, and antiseptic properties of T. polium ointment. Trial Registration: The trial protocol was approved by the Iranian registry of clinical trial (#IRCT20100130003226N18; https://en.irct.ir/trial/40004, ethical code# IR.SBMU.RETECH.1398.055).

The severity of symptoms and outcomes of patients admitted with rheumatic diseases and COVID-19; a prospective cohort study in Iran

Introduction: In severe COVID-19 patients, a pre-inflamatory condition leads to a cytokine storm syndrome. This may signify the need for using immunomodulatory drugs. Patients with rheumatic diseases (RDs) are prone to severe infectious diseases. Objectives: Whether the presence of the RD itself or the use of its drugs in patients with COVID-19 increases the severity of symptoms and outcomes remains largely unknown. Patients and Methods: In a prospective cohort study conducted in Khorshid hospital of Isfahan, Iran, 219 patients with COVID-19 were enrolled and divided into two groups of patients with a positive history for RD (n=19) and those without this history (NRD, n=200). The severity of symptoms and outcomes was compared between the groups. Results: Shortness of breath (P=0.001), cough (P=0.019), and weakness (P=0.001) were significantly higher in the RD than the NRD group after, but not before, recovery. All the patients in the RD group had comorbid diseases (hypertension, diabetes mellitus, ischemic heart disease, and cerebrovascular disease), the number of which was significantly higher than that of the NRD group (P<0.001). The Charlson Comorbidity Index (CCI) was used to predict 10-year survival in patients with multiple comorbidities. It was significantly lower in the RD group as opposed to the NRD group (P<0.001). Logistic regression also showed a non-significantly higher chance of the composite outcome (ICU admission, death status, and intubation status) in the RD group as opposed to the NRD group, both before and after adjustment for confounding factors. However, no difference was found between the RD patient who received corticosteroid as a treatment (RD-CS) and those who did not (RD-NCS). Conclusion: The results showed an increased risk for severe forms of COVID-19 in RD patients. This risk is possibly attributable to a high prevalence of comorbidities in these patients.

Accuracy of chest computed tomography and reverse transcription polymerase chain reaction in diagnosis of 2019 novel coronavirus disease; a systematic review and meta-analysis

Introduction: This study aims to measure the diagnostic accuracy of chest computed tomography (CT) and reverse transcription polymerase chain reaction assay (RT-PCR) in COVID-19 in a systematic review and meta-analysis. Methods: PubMed, Scopus, Embase, and Google Scholar, WHO, SSRN, and MedRxiv have been searched on March 26, 2020 for all the alternative names of the disease and virus. Risk of bias assessment was based on QUADAS-2. Data from English-language studies after January 12, 2019 were pooled to calculate necessary diagnostic values and underwent diagnostic test accuracy, random-effects, proportions, and subgroup meta-analysis. Results: Pooled from 27 included studies, the sensitivity of chest CT was calculated 96.6%, specificity 22.5%, diagnostic odds ratio (DOR) 8.2, positive likelihood ratio (PLR) 1.2 (95% CI: 1.1-1.4), and negative likelihood ratio (NLR) 0.15 (95% CI: 0.1-0.3). The sensitivity for initial RT-PCR was 79.7%, the specificity 100%, and NLR 0.18. Conclusion: Considering the results, in order to diagnose COVID-19 (coronavirus disease 2019), it is recommended to initially performing chest CT to rule out the uninfected people. In suspicious cases, we suggest RT-PCR to confirm the disease. Performing serial RT-PCR instead of the one-time test is highly recommended, to let the viral loads reach the diagnostic levels, especially in cases of high clinical suspicion.

Recurrent endobronchial fibro-epithelial polyposis in a 73-year-old woman

Introduction: Fibroepithelial polyp (FEP) is a benign tumor that is presented frequently in some of the organs like oral cavity, skin, colon and genitourinary tract, but in airway is rare. Case Presentation: We present a rare case in this paper, with recurrent bronchial FEP that was near completely obstructed right main bronchus that we managed her successfully with interventional bronchoscopy. In this case report we describe this rare condition. Conclusion: Airway FEP is uncommon benign tumor that may obstruct airways and rarely may be recurrent like our case.