Purpose of the studyThe aim of this study was to investigate the relationship of B cell-mediated immunity with disease severity and mortality in patients with COVID-19.Study designIn this retrospective cohort and single-centre study, 208 patients with laboratory-confirmed COVID-19 were recruited. A COVID-19 severity score, ranging from 0 to 10, was used to evaluate associations between various factors. Serum immunoglobulin levels and the number of cells in B lymphocyte subsets were measured and their association with disease severity and mortality in patients with COVID-19 examined.ResultsThe median age of the patients was 50 (35–63) years and 88 (42%) were female. The number of deceased patients was 17. The median COVID-19 severity score was 8 (6–8) in deceased patients and 1 (0–2) in survivors. Deceased patients had significantly lower levels of total B lymphocytes, naive B cells, switched memory B cells, and serum IgA, IgG, IgG1 and IgG2 than recovered patients (all p<0.05). In addition, a significant negative correlation was found between the number of these parameters and COVID-19 severity scores. Decrease in the number of total B cells and switched memory B cells as well as lower serum IgA, IgG and IgG1 levels were independent risk factors for mortality in patients with COVID-19.ConclusionIn the present study, the prognosis of patients with COVID-19 was shown to be associated with the B cell subset and serum immunoglobulin levels.

This study aimed to evaluate the diagnosis, treatment and clinical monitoring of the patients with sarcoidosis and to determine their general characteristics. MATERIAL AND METHODS: We retrospectively examined demographic, clinical, laboratory and radiological findings of 100 patients who were followed-up with the diagnosis of sarcoidosis in Gazi University of Faculty of Medicine, Department of Chest Disease between 1994 and 2010. RESULTS: Mean age of the patients was 44±12 years (22-82), female/male ratio was 2.8 and no difference of the age at diagnosis was found between the genders. Most commonly seen complaints included dyspnea, cough and skin disorders. It was reported that 50% of the men and 17% of the women had a history of smoking and that smokers were presented at advanced stages (Stage 2-3) (p=0.006). Three percent of our patients had familial sarcoidosis. It was seen that 96% of the patients had pulmonary tomography at the time of diagnosis. No correlation was detected between angiotensin-converting enzyme (ACE), erythrocyte sedimentation rate and serum and urine calcium levels and the disease stage. Of the patients, 34% showed impaired respiratory function test (RFT) results and 49% showed decreased diffusing capacity of carbon monoxide (DLCO) values, most commonly with restrictive pattern, at the time of diagnosis. Forced expiratory volume in 1 second (FEV 1), forced vital capacity (FVC) and decreased DLCO values did not show a correlation with the stage of the disease (p<0.01). Of our patients, 16% were diagnosed with sarcoidosis based on clinical, laboratory and radiological findings, whereas other patients underwent some invasive interventions for tissue diagnosis. Most commonly used invasive methods included transbronchial biopsy (34%), punch biopsy (31%), mediastinoscopic or transbronchial mediastinal lymph node biopsy (22% and 9%, respectively). During the follow-up period, 43% of the patients received treatment. During the follow-up, 18 patients (18%) showed relapse in the period after the diagnosis. It was seen that relapse was more common in the patients with advanced stage, who have received treatment at the time of diagnosis (p<0.01 and p=0.04). CONCLUSION: Sarcoidosis is a multisystemic disease that may have a course with several clinical findings and that should be absolutely considered in the differential diagnosis with its commonly or rarely observed findings.

The prevalence and mortality rates of coronavirus disease 2019 (COVID-19) vary widely among populations. Mucosal immunity is the first barrier to pathogens' entry into the body.Immunoglobulin A (IgA) is the main antibody of mucosal immunity. We explored the relationship between selective immunoglobulin A deficiency (SIgAD) and the severity of COVID-19. We included 424 patients (203 females) with COVID-19. Eleven patients had SIgAD. Laboratory data on patients with SIgAD and normal IgA levels were compared. The relationship between SIgAD and severe COVID-19 infection was explored by logistic regression analysis. In univariate logistic regression analysis, the risk of severe disease in COVID-19 patients with SIgAD was approximately 7.7-fold higher than in the other patients (odds ratio [OR], 7.789; 95% confidence interval [CI], 1.665-36.690, p = 0.008), while it was 4-fold (OR, 4.053; 95% CI, 1.182-13.903, p = 0.026) higher in multivariate logistic regression analysis. Serum IgA levels were positively correlated with total lymphocyte counts, and negatively correlated with C-reactive protein (CRP) levels, which were found as a risk factor for severe COVID-19.In SIgAD patients, the number of SARS-CoV-2 viruses that pass through mucosal membranes may be increased, leading to complications such as cytokine storm syndrome and acute respiratory distress syndrome.

Patients with received anti-TNF-α therapy, are scanned with TST or Quantiferon. If latent tuberculosis infection are diagnosed, tuberculosis prophylaxis should be started pre-anti-TNF-α therapy at least one month and INH chemoprophylaxis should be completed on 9 months or RIF should be completed on 4 months. Serum liver enzymes and bilirubin measurements monthly; follow-up physical examination and chest radiography should be performed for 3 months.

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