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6. Behçet’s syndrome: providing integrated care

Author

Esatoglu SN, Kutlubay Z, Ucar D, Hatemi I, Uygunoglu U, Siva A, and Hatemi G

Subjects
Behcet disease, multidisciplinary care, diagnosis, treatment, Medicine (General), R5-920
Abstract

Sinem Nihal Esatoglu,1 Zekayi Kutlubay,2 Didar Ucar,3 Ibrahim Hatemi,4 Ugur Uygunoglu,5 Aksel Siva,5 Gulen Hatemi1 1Division of Rheumatology, Department of Internal Medicine, 2Department of Dermatology, 3Department of Ophthalmology, 4Division of Gastroenterology, Department of Internal Medicine 5Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Abstract: Behçet’s syndrome (BS) is a multisystem vasculitis that presents with a variety of mucocutaneous manifestations such as oral and genital ulcers, papulopustular lesions and erythema nodosum as well as ocular, vascular, gastrointestinal and nervous system involvement. Although it occurs worldwide, it is especially prevalent in the Far East and around the Mediterranean Sea. Male gender and younger age at disease onset are associated with a more severe disease course. The management of BS depends on the severity of symptoms. If untreated, morbidity and mortality are considerably high in patients with major organ involvement. Multidisciplinary patient care is essential for the management of BS, as it is for other multisystem diseases. Rheumatologists, dermatologists, ophthalmologists, neurologists, cardiovascular surgeons and gastroenterologists are members of the multidisciplinary team. In this study, we reviewed the epidemiology, etiology, diagnostic criteria sets, clinical findings and treatment of BS and highlighted the importance of the multidisciplinary team in the management of BS. Keywords: Behçet disease, multidisciplinary care, diagnosis, treatment, vasculitis, epidemiology, management

Published
2017

8. Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

Author

Efe, C, Dhanasekaran, R, Lammert, C, Ebik, B, Higuera-de la Tijera, F, Aloman, C, Riza Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Torgutalp, M, Purnak, T, Rigamonti, C, Gomez Aldana, A, Khakoo, N, Kacmaz, H, Nazal, L, Frager, S, Demir, N, Irak, K, Ellik, Z, Balaban, Y, Atay, K, Eren, F, Cristoferi, L, Batibay, E, Urzua, A, Snijders, R, Kiyici, M, Akyildiz, M, Ekin, N, Carr, R, Harputluoglu, M, Hatemi, I, Mendizabal, M, Silva, M, Idilman, R, Silveira, M, Drenth, J, Assis, D, Bjornsson, E, Boyer, J, Invernizzi, P, Levy, C, Schiano, T, Ridruejo, E, Wahlin, S, Efe C., Dhanasekaran R., Lammert C., Ebik B., Higuera-de la Tijera F., Aloman C., Riza Caliskan A., Peralta M., Gerussi A., Massoumi H., Catana A. M., Torgutalp M., Purnak T., Rigamonti C., Gomez Aldana A. J., Khakoo N., Kacmaz H., Nazal L., Frager S., Demir N., Irak K., Ellik Z. M., Balaban Y., Atay K., Eren F., Cristoferi L., Batibay E., Urzua A., Snijders R., Kiyici M., Akyildiz M., Ekin N., Carr R. M., Harputluoglu M., Hatemi I., Mendizabal M., Silva M., Idilman R., Silveira M., Drenth J. P. H., Assis D. N., Bjornsson E., Boyer J. L., Invernizzi P., Levy C., Schiano T. D., Ridruejo E., Wahlin S., Efe, C, Dhanasekaran, R, Lammert, C, Ebik, B, Higuera-de la Tijera, F, Aloman, C, Riza Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Torgutalp, M, Purnak, T, Rigamonti, C, Gomez Aldana, A, Khakoo, N, Kacmaz, H, Nazal, L, Frager, S, Demir, N, Irak, K, Ellik, Z, Balaban, Y, Atay, K, Eren, F, Cristoferi, L, Batibay, E, Urzua, A, Snijders, R, Kiyici, M, Akyildiz, M, Ekin, N, Carr, R, Harputluoglu, M, Hatemi, I, Mendizabal, M, Silva, M, Idilman, R, Silveira, M, Drenth, J, Assis, D, Bjornsson, E, Boyer, J, Invernizzi, P, Levy, C, Schiano, T, Ridruejo, E, Wahlin, S, Efe C., Dhanasekaran R., Lammert C., Ebik B., Higuera-de la Tijera F., Aloman C., Riza Caliskan A., Peralta M., Gerussi A., Massoumi H., Catana A. M., Torgutalp M., Purnak T., Rigamonti C., Gomez Aldana A. J., Khakoo N., Kacmaz H., Nazal L., Frager S., Demir N., Irak K., Ellik Z. M., Balaban Y., Atay K., Eren F., Cristoferi L., Batibay E., Urzua A., Snijders R., Kiyici M., Akyildiz M., Ekin N., Carr R. M., Harputluoglu M., Hatemi I., Mendizabal M., Silva M., Idilman R., Silveira M., Drenth J. P. H., Assis D. N., Bjornsson E., Boyer J. L., Invernizzi P., Levy C., Schiano T. D., Ridruejo E., and Wahlin S.

Abstract

Background and Aims: Data regarding outcome of COVID-19 in patients with autoimmune hepatitis (AIH) are lacking. Approach and Results: We performed a retrospective study on patients with AIH and COVID-19 from 34 centers in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes, defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity score–matched cohort of patients without AIH but with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase > 2 × the upper limit of normal) during COVID-19 was also evaluated. We included 110 patients with AIH (80% female) with a median age of 49 (range, 18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (P = 0.041; OR, 3.36; 95% CI, 1.05-10.78), while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (P = 0.009; OR, 0.26; 95% CI, 0.09-0.71). The rates of severe COVID-19 (15.5% versus 20.2%, P = 0.231) and all-cause mortality (10% versus 11.5%, P = 0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (P < 0.001; OR, 17.46; 95% CI, 4.22-72.13). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19. Conclusions: This international, multicenter study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in patients with AIH. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19 but did lower the risk for new-onset liver

Published
2021

9. Does intestinal obstruction influence hypo-albuminemia: assessment of the physio-pathogenesis of protein-losing enteropathy with literature review.

Author

BAKKALOGLU, O. K., BAVUNOGLU, I., ASLAN, S., ESKAZAN, T., CELIK, S., KEPIL, N., HATEMI, I., ERZIN, Y., and CELIK, A. F.

Abstract

BACKGROUND: Non-steroidal anti-inflammatory drug (NSAID) use may cause diaphragm-like lesions in the bowel. Although NSAID-enteropathy is among the causes of protein-losing enteropathy (PLE), intractable hypoalbuminemia is rare. CASE REPORT: Here, we discuss a case of NSAID-enteropathy with a diaphragm-like disease that presented with Protein Losing Enteropathy (PLE) rather than obstruction. The hypoalbuminemia recovered immediately after resection of the obstructive segment, despite ongoing annular ulcerations in the early postoperative period. Thus, it was not clear whether obstructive mechanisms influenced resistant hypoalbuminemia besides the ulcers. We also reviewed the English-written literature for “diaphragm-type lesion, NSAID-enteropathy, obstruction, and protein-losing enteropathy”. We noted that the role of obstruction in the pathophysiology of PLE was not clear. CONCLUSIONS: As our case and a couple of cases reported in literature, slow-onset obstructive pathology seems to contribute to well-known factors: inflammatory response, exudation, tight-junction dysfunction, and increase in permeability in the physiopathology of NSAID-induced PLE. Factors such as distention-induced low-flow ischemia and reperfusion, cholecystectomy-related continuous bile flow, bacterial overgrowth-related bile deconjugation and concomitant inflammation are among other potential influencers. The possible role of a slow-onset obstructive pathology in the physiopathology of NSAID-induced and other PLE needs to be further elucidated. [ABSTRACT FROM AUTHOR]

Published
2023

10. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Author

Efe, C., Lammert, C., Taşçılar, K., Dhanasekaran, R., Ebik, B., Higuera-de la Tijera, F., Calışkan, A.R., Peralta, M., Gerussi, A., Massoumi, H., Catana, A.M., Purnak, T., Rigamonti, C., Aldana, A.J. Gomez, Khakoo, N., Nazal, L., Frager, S., Demir, N., Irak, K., Melekoğlu-Ellik, Z., Kacmaz, H., Balaban, Y., Atay, K., Eren, F., Alvares-da-Silva, M.R., Cristoferi, L., Urzua, Á., Eşkazan, T., Magro, B., Snijders, R.J.A.L.M., Barutçu, S., Lytvyak, E., Zazueta, G.M., Demirezer-Bolat, A., Aydın, M., Heurgue-Berlot, A., Martin, E., Ekin, N., Yıldırım, S., Yavuz, A., Bıyık, M., Narro, G.C., Kıyıcı, M., Akyıldız, M., Kahramanoğlu-Aksoy, E., Vincent, M., Carr, R.M., Günşar, F., Reyes, E.C., Harputluoğlu, M., Aloman, C., Gatselis, N.K., Üstündağ, Y., Brahm, J., Vargas, N.C.E., Güzelbulut, F., Garcia, S.R., Aguirre, J., Anders, M., Ratusnu, N., Hatemi, I., Mendizabal, M., Floreani, A., Fagiuoli, S., Silva, M., Idilman, R., Satapathy, S.K., Silveira, M., Drenth, J.P.H., Dalekos, G.N., Assis, D.N., Björnsson, E., Boyer, J.L., Yoshida, E.M., Invernizzi, P., Levy, C., Montano-Loza, A.J., Schiano, T.D., Ridruejo, E., Wahlin, S., Efe, C., Lammert, C., Taşçılar, K., Dhanasekaran, R., Ebik, B., Higuera-de la Tijera, F., Calışkan, A.R., Peralta, M., Gerussi, A., Massoumi, H., Catana, A.M., Purnak, T., Rigamonti, C., Aldana, A.J. Gomez, Khakoo, N., Nazal, L., Frager, S., Demir, N., Irak, K., Melekoğlu-Ellik, Z., Kacmaz, H., Balaban, Y., Atay, K., Eren, F., Alvares-da-Silva, M.R., Cristoferi, L., Urzua, Á., Eşkazan, T., Magro, B., Snijders, R.J.A.L.M., Barutçu, S., Lytvyak, E., Zazueta, G.M., Demirezer-Bolat, A., Aydın, M., Heurgue-Berlot, A., Martin, E., Ekin, N., Yıldırım, S., Yavuz, A., Bıyık, M., Narro, G.C., Kıyıcı, M., Akyıldız, M., Kahramanoğlu-Aksoy, E., Vincent, M., Carr, R.M., Günşar, F., Reyes, E.C., Harputluoğlu, M., Aloman, C., Gatselis, N.K., Üstündağ, Y., Brahm, J., Vargas, N.C.E., Güzelbulut, F., Garcia, S.R., Aguirre, J., Anders, M., Ratusnu, N., Hatemi, I., Mendizabal, M., Floreani, A., Fagiuoli, S., Silva, M., Idilman, R., Satapathy, S.K., Silveira, M., Drenth, J.P.H., Dalekos, G.N., Assis, D.N., Björnsson, E., Boyer, J.L., Yoshida, E.M., Invernizzi, P., Levy, C., Montano-Loza, A.J., Schiano, T.D., Ridruejo, E., and Wahlin, S.

Abstract

Item does not contain fulltext, BACKGROUND: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). PATIENTS AND METHODS: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. RESULTS: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. CONCLUSION: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.

Published
2022

11. Effects of immunosuppressive drugs on COVID-19 severity in patients with autoimmune hepatitis

Author

Efe, C, Lammert, C, Tascilar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Purnak, T, Rigamonti, C, Aldana, A, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoglu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, M, Cristoferi, L, Urzua, A, Eskazan, T, Magro, B, Snijders, R, Barutcu, S, Lytvyak, E, Zazueta, G, Demirezer-Bolat, A, Aydin, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yildirim, S, Yavuz, A, Biyik, M, Narro, G, Kiyici, M, Akyildiz, M, Kahramanoglu-Aksoy, E, Vincent, M, Carr, R, Gunsar, F, Reyes, E, Harputluoglu, M, Aloman, C, Gatselis, N, Ustundag, Y, Brahm, J, Vargas, N, Guzelbulut, F, Garcia, S, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, S, Silveira, M, Drenth, J, Dalekos, G, Assis, D, Bjornsson, E, Boyer, J, Yoshida, E, Invernizzi, P, Levy, C, Montano-Loza, A, Schiano, T, Ridruejo, E, Wahlin, S, Caliskan, AR, Catana, AM, Aldana, AJG, Alvares-da-Silva, MR, Zazueta, GM, Narro, GC, Carr, RM, Reyes, EC, Gatselis, NK, Vargas, NCE, Garcia, SR, Satapathy, SK, Drenth, JPH, Dalekos, GN, Assis, DN, Boyer, JL, Yoshida, EM, Montano-Loza, AJ, Schiano, TD, Efe, C, Lammert, C, Tascilar, K, Dhanasekaran, R, Ebik, B, Higuera-de la Tijera, F, Caliskan, A, Peralta, M, Gerussi, A, Massoumi, H, Catana, A, Purnak, T, Rigamonti, C, Aldana, A, Khakoo, N, Nazal, L, Frager, S, Demir, N, Irak, K, Melekoglu-Ellik, Z, Kacmaz, H, Balaban, Y, Atay, K, Eren, F, Alvares-da-Silva, M, Cristoferi, L, Urzua, A, Eskazan, T, Magro, B, Snijders, R, Barutcu, S, Lytvyak, E, Zazueta, G, Demirezer-Bolat, A, Aydin, M, Heurgue-Berlot, A, De Martin, E, Ekin, N, Yildirim, S, Yavuz, A, Biyik, M, Narro, G, Kiyici, M, Akyildiz, M, Kahramanoglu-Aksoy, E, Vincent, M, Carr, R, Gunsar, F, Reyes, E, Harputluoglu, M, Aloman, C, Gatselis, N, Ustundag, Y, Brahm, J, Vargas, N, Guzelbulut, F, Garcia, S, Aguirre, J, Anders, M, Ratusnu, N, Hatemi, I, Mendizabal, M, Floreani, A, Fagiuoli, S, Silva, M, Idilman, R, Satapathy, S, Silveira, M, Drenth, J, Dalekos, G, Assis, D, Bjornsson, E, Boyer, J, Yoshida, E, Invernizzi, P, Levy, C, Montano-Loza, A, Schiano, T, Ridruejo, E, Wahlin, S, Caliskan, AR, Catana, AM, Aldana, AJG, Alvares-da-Silva, MR, Zazueta, GM, Narro, GC, Carr, RM, Reyes, EC, Gatselis, NK, Vargas, NCE, Garcia, SR, Satapathy, SK, Drenth, JPH, Dalekos, GN, Assis, DN, Boyer, JL, Yoshida, EM, Montano-Loza, AJ, and Schiano, TD

Abstract

Background: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH.

Published
2022

15. Prevalence of Gastrointestinal Symptoms in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Results of the Prospective Controlled Multinational GI-COVID-19 Study

Author

Marasco, G., Cremon, C., Barbaro, M. R., Salvi, D., Cacciari, G., Kagramanova, A., Bordin, D., Drug, V., Miftode, E., Fusaroli, P., Mohamed, S. Y., Ricci, C., Bellini, M., Rahman, M. M., Melcarne, L., Santos, J., Lobo, B., Bor, S., Yapali, S., Akyol, D., Sapmaz, F. P., Urun, Y. Y., Eskazan, T., Celebi, A., Kacmaz, H., Ebik, B., Binicier, H. C., Bugdayci, M. S., Yagci, M. B., Pullukcu, H., Kaya, B. Y., Tureyen, A., Hatemi, I., Koc, E. S., Sirin, G., Caliskan, A. R., Bengi, G., Alis, E. E., Lukic, S., Trajkovska, M., Hod, K., Dumitrascu, D., Pietrangelo, A., Corradini, E., Simren, M., Sjolund, J., Tornkvist, N., Ghoshal, U. C., Kolokolnikova, O., Colecchia, A., Serra, J., Maconi, G., De Giorgio, R., Danese, S., Portincasa, P., Di Stefano, M., Maggio, M., Philippou, E., Lee, Y. Y., Venturi, A., Borghi, C., Zoli, M., Gionchetti, P., Viale, P., Stanghellini, V., Barbara, G., Piacentini, A., Shengelia, M., Vechorko, V., Cardamone, C., Rosei, C. A., Pancetti, A., Rettura, F., Pedrosa, M., Campoli, C., Mijac, D., Korac, M., Karic, U., Markovic, A., Najdeski, A., Nikolova, D., Dimzova, M., Lior, O., Shinhar, N., Perelmutter, O., Ringel, Y., Sabo, C. M., Chis, A., Bonucchi, G., Caio, G. P. I., Ghirardi, C., Marziani, B., Rizzello, B., Aguilar, A., Capogreco, A., Aghemo, A., Di Paolo, D. M., Marconi, G., Di Sabatino, A., Tagliaferri, S., Naves, J. E., Galli, A., Dragoni, G., Nedelcu, L., Mauloni, P. A., Del Vecchio, S., Rotondo, L., Capuani, F., Montanari, D., Palombo, F., Paone, C., Mastel, G., Fontana, C., Bellacosa, L., Cogliandro, R. F., Marasco, Giovanni, Cremon, Cesare, Barbaro, Maria Raffaella, Salvi, Daniele, Cacciari, Giulia, Kagramanova, Anna, Bordin, Dmitry, Drug, Vasile, Miftode, Edgidia, Fusaroli, Pietro, Mohamed, Salem Youssef, Ricci, Chiara, Bellini, Massimo, Rahman, M Masudur, Melcarne, Luigi, Santos, Javier, Lobo, Beatriz, Bor, Serhat, Yapali, Suna, Akyol, Deniz, Sapmaz, Ferdane Pirincci, Urun, Yonca Yilmaz, Eskazan, Tugce, Celebi, Altay, Kacmaz, Huseyin, Ebik, Berat, Binicier, Hatice Cilem, Bugdayci, Mehmet Sait, Yağcı, Munkhtsetseg Banzragch, Pullukcu, Husnu, Kaya, Berrin Yalınba, Tureyen, Ali, Hatemi, İbrahim, Koc, Elif Sitre, Sirin, Goktug, Calıskan, Ali Riza, Bengi, Goksel, Alıs, Esra Ergun, Lukic, Snezana, Trajkovska, Meri, Hod, Keren, Dumitrascu, Dan, Pietrangelo, Antonello, Corradini, Elena, Simren, Magnu, Sjolund, Jessica, Tornkvist, Navkiran, Ghoshal, Uday C, Kolokolnikova, Olga, Colecchia, Antonio, Serra, Jordi, Maconi, Giovanni, De Giorgio, Roberto, Danese, Silvio, Portincasa, Pietro, Di Stefano, Michele, Maggio, Marcello, Philippou, Elena, Lee, Yeong Yeh, Venturi, Alessandro, Borghi, Claudio, Zoli, Marco, Gionchetti, Paolo, Viale, Pierluigi, Stanghellini, Vincenzo, and Barbara, Giovanni

Subjects
Male, medicine.medical_specialty, Settore MED/17 - Malattie Infettive, Coronavirus disease 2019 (COVID-19), Nausea, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), diarrhea, Disease, Gastrointestinal Symptoms, COVID-19, Acute Respiratory Syndrome, GI-COVID-19, NO, Russia, Manifestations, Interviews as Topic, Rating scale, Internal medicine, Surveys and Questionnaires, parasitic diseases, medicine, Prevalence, Humans, In patient, Prospective Studies, Respiratory system, Settore MED/12 - Gastroenterologia, Hepatology, business.industry, SARS-CoV-2, pandemic, Gastroenterology, COVID-19, Middle Aged, gastrointestinal, Gastroenteritis, Europe, Hospital admission, Egypt, Female, medicine.symptom, business, human activities
Abstract

INTRODUCTION: Gastrointestinal (GI) symptoms in coronavirus-19 disease (COVID-19) have been reported with great variability and without standardization. In hospitalized patients, we aimed to evaluate the prevalence of GI symptoms, factors associated with their occurrence, and variation at 1 month. METHODS: The GI-COVID-19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were recruited at hospital admission and asked for GI symptoms at admission and after 1 month, using the validated Gastrointestinal Symptom Rating Scale questionnaire. RESULTS: The study included 2036 hospitalized patients. A total of 871 patients (575 COVID+ and 296 COVID-) were included for the primary analysis. GI symptoms occurred more frequently in patients with COVID-19 (59.7%; 343/575 patients) than in the control group (43.2%; 128/296 patients) (P < 0.001). Patients with COVID-19 complained of higher presence or intensity of nausea, diarrhea, loose stools, and urgency as compared with controls. At a 1-month follow-up, a reduction in the presence or intensity of GI symptoms was found in COVID-19 patients with GI symptoms at hospital admission. Nausea remained increased over controls. Factors significantly associated with nausea persistence in COVID-19 were female sex, high body mass index, the presence of dyspnea, and increased C-reactive protein levels. DISCUSSION: The prevalence of GI symptoms in hospitalized patients with COVID-19 is higher than previously reported. Systemic and respiratory symptoms are often associated with GI complaints. Nausea may persist after the resolution of COVID-19 infection., Fondazione Cassa di Risparmio in Bologna; Italian Ministry of Education, University and Research; Fondazione del Monte di Bologna e Ravenna [SC1-BHC-01-2019]; European Grant H2020, DISCOvERIE [SC1-BHC-01-2019]; Italian Ministry of Health [Ricerca Finalizzata GR-2018-12367062], G.B. contribution to this research was permitted in part by funding from Fondazione Cassa di Risparmio in Bologna; the ItalianMinistry of Education, University and Research; and Fondazione del Monte di Bologna e Ravenna and European Grant H2020, DISCOvERIE, SC1-BHC-01-2019. M.R.B. is a recipient of a grant from the Italian Ministry of Health (Ricerca Finalizzata GR-2018-12367062). None of the funding organizations have had any role in the design and conduct of the study; in the collection, management, and analysis of the data; or in the preparation, review, and approval of the article.

Published
2022

16. Outcome of COVID-19 in patients with autoimmune hepatitis: an international multi-centre study

Author

Akyıldız, Murat, Efe, C.; Dhanasekaran, R.; Lammert, C.; Ebi, B.; Higuera-de la Tijera, F.; Aloman, C.; Çalışkan, A. R.; Peralta, M.; Gerussi, A.; Massoumi, H.; Catana, A. M.; Torgutalp, M.; Pürnak T.; Rigamonti, C.; Aldana, A. J. G.; Khakoo, N.; Kaçmaz, H.; Nazal, L.; Frager, S.; Demir, N.; Irak, K.; Ellik, Z. M.; Balaban, Y.; Atay, K.; Eren, F.; Cristoferi, L.; Batıbay, E.; Urzua, Á.; Snijders, R.; Kıyıcı, M.; Ekin, N.; Carr, R. M.; Harputoğlu, M.; Hatemi, İ.; Mendizabal, M.; Silva, M.; İdilman, R.; Silveira, M.; Drenth, J. P. H.; Assis, D. N.; Björnsson, E.; Boyer, J. L.; Invernizzi, P.; Levy, C.; Schiano, T. D.; Ridruejo, E.; Wahlin, S., Akyıldız, Murat, and Efe, C.; Dhanasekaran, R.; Lammert, C.; Ebi, B.; Higuera-de la Tijera, F.; Aloman, C.; Çalışkan, A. R.; Peralta, M.; Gerussi, A.; Massoumi, H.; Catana, A. M.; Torgutalp, M.; Pürnak T.; Rigamonti, C.; Aldana, A. J. G.; Khakoo, N.; Kaçmaz, H.; Nazal, L.; Frager, S.; Demir, N.; Irak, K.; Ellik, Z. M.; Balaban, Y.; Atay, K.; Eren, F.; Cristoferi, L.; Batıbay, E.; Urzua, Á.; Snijders, R.; Kıyıcı, M.; Ekin, N.; Carr, R. M.; Harputoğlu, M.; Hatemi, İ.; Mendizabal, M.; Silva, M.; İdilman, R.; Silveira, M.; Drenth, J. P. H.; Assis, D. N.; Björnsson, E.; Boyer, J. L.; Invernizzi, P.; Levy, C.; Schiano, T. D.; Ridruejo, E.; Wahlin, S.

Abstract

Background: data regarding outcome of Coronavirus disease 2019 (COVID-19) in patients with autoimmune hepatitis (AIH) are lacking. Patients and methods: we performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated. Results: we included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe COVID-19 (15.5% vs 20.2% p=0.231) and all-cause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p<0.001; OR 17.46[4.22-72.13]). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19. Conclusions: this international, multi-center study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in AIH patients. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19, but did lower the risk for new-onset liver injury during COVID-19.

Published
2021

17. Outcome of COVID-19 in Patients With Autoimmune Hepatitis: An International Multicenter Study

Author

Efe, C., Dhanasekaran, R., Lammert, C., Ebik, B., Higuera-de la Tijera, F., Aloman, C., Calışkan, A. Rıza, Peralta, M., Gerussi, A., Massoumi, H., Catana, A.M., Torgutalp, M., Purnak, T., Rigamonti, C., Aldana, A.J. Gomez, Khakoo, N., Kacmaz, H., Nazal, L., Frager, S., Demir, N., Irak, K., Ellik, Z.M., Balaban, Y., Atay, K., Eren, F., Cristoferi, L., Batıbay, E., Urzua, Á., Snijders, R.J.A.L.M., Kıyıcı, M., Akyıldız, M., Ekin, N., Carr, R.M., Harputluoğlu, M., Hatemi, I., Mendizabal, M., Silva, M., Idilman, R., Silveira, M., Drenth, J.P.H., Assis, D.N., Björnsson, E., Boyer, J.L., Invernizzi, P., Levy, C., Schiano, T.D., Ridruejo, E., Wahlin, S., Efe, C., Dhanasekaran, R., Lammert, C., Ebik, B., Higuera-de la Tijera, F., Aloman, C., Calışkan, A. Rıza, Peralta, M., Gerussi, A., Massoumi, H., Catana, A.M., Torgutalp, M., Purnak, T., Rigamonti, C., Aldana, A.J. Gomez, Khakoo, N., Kacmaz, H., Nazal, L., Frager, S., Demir, N., Irak, K., Ellik, Z.M., Balaban, Y., Atay, K., Eren, F., Cristoferi, L., Batıbay, E., Urzua, Á., Snijders, R.J.A.L.M., Kıyıcı, M., Akyıldız, M., Ekin, N., Carr, R.M., Harputluoğlu, M., Hatemi, I., Mendizabal, M., Silva, M., Idilman, R., Silveira, M., Drenth, J.P.H., Assis, D.N., Björnsson, E., Boyer, J.L., Invernizzi, P., Levy, C., Schiano, T.D., Ridruejo, E., and Wahlin, S.

Abstract

Contains fulltext : 235669.pdf (Publisher’s version ) (Closed access), BACKGROUND AND AIMS: Data regarding outcome of COVID-19 in patients with autoimmune hepatitis (AIH) are lacking. APPROACH AND RESULTS: We performed a retrospective study on patients with AIH and COVID-19 from 34 centers in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes, defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity score-matched cohort of patients without AIH but with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase > 2 × the upper limit of normal) during COVID-19 was also evaluated. We included 110 patients with AIH (80% female) with a median age of 49 (range, 18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (P = 0.041; OR, 3.36; 95% CI, 1.05-10.78), while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (P = 0.009; OR, 0.26; 95% CI, 0.09-0.71). The rates of severe COVID-19 (15.5% versus 20.2%, P = 0.231) and all-cause mortality (10% versus 11.5%, P = 0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (P < 0.001; OR, 17.46; 95% CI, 4.22-72.13). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19. CONCLUSIONS: This international, multicenter study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in patients with AIH. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19 but did lower the risk for new-onset liver injury during COVID-19.

Published
2021

28. Bone marrow transplantation for Behcet's disease: a case report and systematic review of the literature

Author

Soysal, T., primary, Saliho lu, A., additional, Esato lu, S. N., additional, Gulturk, E., additional, E kazan, A. E., additional, Hatemi, G., additional, Hatemi, I., additional, Ongoren Ayd n,  eniz, additional, Erzin, Y. Z., additional, Ba lar, Z., additional, Tuzuner, N., additional, Ferhano lu, B., additional, and Celik, A. F., additional

Published
2014
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