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OBJECTIVES: This study is aimed to determine the relationship between 25-OH vitamin D levels, inflammatory parameters of neutrophiltolymphocyte ratio (NLR), platelettolymphocyte ratio (PLR), creactive protein (CRP) levels and the disease severity of COVID-19 infection. BACKGROUND: Inflammation plays a key role in the pathogenesis of COVID-19 while identifying the clinical course and prognosis. The effect of vitamin D deficiency on contribution to inflammation in COVID-19 is unclear. METHODS: Based on the classification of the clinical course of COVID-19, the patients were divided into three groups, i.e., with mild (Group 1), moderate (Group 2) and severe/critical cases (Group 3). The 25-OH vitamin D values were defined as deficient, insufficient or normal. RESULTS: There were no statistically significant differences in the distribution rates of 25-OH vitamin D levels (p>0.05) between the groups. Inflammatory parameters in Group 3 were statistically significantly higher as compared to Groups1 and 2 (p<0.05). Multivariate logistic regression analysis revealed that NLR was an independent predictor of disease severity. CONCLUSION: There is no relationship between the severity of COVID-19 infection and 25-OH vitamin D deficiency. Inflammatory parameters are associated with the disease severity, while NLR is an independent predictor of severe COVID-19. There was no correlation between 25-OH vitamin D and inflammatory markers (Tab. 4, Fig. 1, Ref. 38).
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COVID-19 , Deficiencia de Vitamina D , Humanos , Inflamación , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Vitamina D , Deficiencia de Vitamina D/complicaciones , VitaminasRESUMEN
The association of rheumatoid arthritis (RA) and immune thrombocytopenic purpura (ITP) has been reported rarely. Methotrexate, which is used for RA treatment, causes thrombocytopenia. Therefore, in medical practice, physicians avoid using methotrexate for RA in patients who have both RA and ITP. Here, we report an RA case that also had ITP, which did not decrease in platelet count after methotrexate therapy. A 50-year-old woman was diagnosed with diabetes mellitus in 1990, RA in 1995, and ITP in 2000. She had received hydroxychloroquine for more than 5 years. She was treated with prednisolone 16 mg/daily between 2006 and 2007, but she discontinued this therapy because of weight gain. Laboratory findings were not remarkable, except for thrombocytopenia. We started methotrexate therapy 10 mg per week for treatment of RA, and hydroxychloroquine therapy was stopped due to nonresponse. The methotrexate dose was increased up to 15 mg/week. Her complete blood cell count was monitored frequently. We did not observe any decrease in platelet count, while active arthritis symptoms of the patient were relieved. This case shows that methotrexate may be used in patients diagnosed with RA that is associated with ITP under strict monitoring.
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PURPOSE: To retrospectively evaluate the accuracy of multi-parametric magnetic resonance (MR) imaging including fat saturated (FS) T2-weighted, short-tau inversion recovery (STIR), diffusion-weighted (DW-MR), and dynamic-contrast-enhanced MR (DCE-MR) imaging techniques in the diagnosis of early inflammatory sacroiliitis and determine the additional value of DW-MR and DCE-MR images according to recently defined 'Assessment in SpondyloArthritis international Society' criteria. MATERIALS AND METHODS: The study included 45 patients with back pain. Two radiologists estimated the likelihood of osteitis in 4 independent viewing sessions including FS T2-weighted, STIR, DW-MR and DCE-MR images. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) were calculated. RESULTS: Of the 45 patients, 31 had inflammatory back pain. Of 31, 28 (90.3%) patients had inflammatory sacroiliitis diagnosed by clinical and laboratory analysis. FS T2-weighted MR images had the highest sensitivity (42.8% for both radiologists) for detecting osteitis in patients with inflammaory sacroiliitis when compared to other imaging sequences. For specificity, PPV, NPV, accuracy, and AUC levels there were no statistically significant difference between image viewing settings. However, adding STIR, DW-MR and DCE-MR images to the FS T2-weighted MR images did not improve the above stated indices. CONCLUSION: FS T2-weighted MR imaging had the highest sensitivity when compared to other imaging sequences. The addition of DW-MR and DCE-MR images did not significantly improve the diagnostic value of MR imaging in the diagnosis of osteitis for both experienced and less experienced radiologists.