Patients with inflammatory bowel disease are not at increased risk of COVID-19 : a large multinational cohort study

The impact of COVID-19 on inflammatory bowel disease (IBD) patients under pharmacological immunosuppression is still not clearly understood. We investigated the incidence of COVID-19 and the impact of immunosuppression and containment measures on the risk of SARS-CoV-2 infection in a large IBD cohort, from a multicenter cohort from 21st of February to 30th of June, 2020. Ninety-seven patients with IBD (43 UC, 53 CD, one unclassified IBD) and concomitant COVID-19 over a total of 23,879 patients with IBD were enrolled in the study. The cumulative incidence of SARS-CoV-2 infection in patients with IBD vs. the general population was 0.406% and 0.402% cases, respectively. Twenty-three patients (24%) were hospitalized, 21 (22%) had pneumonia, four (4%) were admitted to the Intensive Care Unit, and one patient died. Lethality in our cohort was 1% compared to 9% in the general population. At multivariable analysis, age > 65 years was associated with increased risk of pneumonia and hospitalization (OR 11.6, 95% CI 2.18–62.60; OR 5.1, 95% CI 1.10–23.86, respectively), treatment with corticosteroids increased the risk of hospitalization (OR 7.6, 95% CI 1.48–40.05), whereas monoclonal antibodies were associated with reduced risk of pneumonia and hospitalization (OR 0.1, 95% CI 0.04–0.52; OR 0.3, 95% CI 0.10–0.90, respectively). The risk of COVID-19 in patients with IBD is similar to the general population. National lockdown was effective in preventing infection in our cohort. Advanced age and treatment with corticosteroids impacted negatively on the outcome of COVID-19, whereas monoclonal antibodies did not seem to have a detrimental effect.peer-reviewe

Study of clopidogrel administration in patients with systemic sclerosis regarding the serotonin production and the clinical manifestations of the disease

Objectives: Activated platelets release serotonin that binds 5-HT2B receptor on fibroblasts leading to fibroblast activation. Clopidogrel, an inhibitor of ADP-dependent platelet activation prevents fibrosis in animal models of systemic sclerosis (SSc). We aimed at assessing whether i) ADP-dependent platelet activation is increased in patients with SSc compared to healthy subjects and patients with rheumatoid arthritis (RA) and ii) whether clopidogrel can effectively suppress ADP-dependent activation, reduce circulating serotonin levels and hence, favorably affect fibrosis or vasculopathy in patients with systemic sclerosis.Methods: Thirteen patients with SSc were recruited. Platelet activation was assessed by aggregometry prior to and following 14 days of clopidogrel treatment. At the same time points serotonin, soluble vascular cell adhesion molecule 1 (s-VCAM1) and soluble intercellular cell adhesion molecule 1 (s-ICAM1), two markers of endothelial dysfunction, were measured. Results: ADP-dependent platelet activation was similar between patients with SSc (n=13), patients with RA (n=28) and healthy subjects (n=22) (mean ± SEM AU*min: 392.1 ± 58.4, 535.5 ± 61.33 and 570.9 ± 42.9 in patients with SSc, patients with RA and healthy subjects respectively, p=0.14). Clopidogrel treatment significantly reduced platelet activation in patients with SSc (mean ± SEM AU*min: 392.1 ± 58.4 vs 163.8 ± 51.7, p=0.014). Clopidogrel treatment did not affect serotonin levels but led to a significant increase in s-VCAM 1 (p=0.03). Three patients developed new digital ulcers during the study. The potential association of the study drug with the development of new digital ulcers led to early termination of the study.Conclusion: Clopidogrel may worsen markers of endothelial function and associate with development of new digital ulcers in patients with SSc.Σκοπός: Τα ενεργοποιημένα αιμοπετάλια απελευθερώνουν σεροτονίνη που συνδέεται με τον υποδοχέα 5-HT2B στους ινοβλάστες οδηγώντας στην ενεργοποίησή τους. Η κλοπιδογρέλη, ένας αναστολέας της επαγόμενης από ADP διέγερσης των αιμοπεταλίων, αναστέλλει την ίνωση σε ζωικά μοντέλα συστηματικής σκλήρυνσης (ΣΣ). Στοχεύσαμε να εκτιμήσουμε i) εάν η ADP-επαγόμενη ενεργοποίηση των αιμοπεταλίων είναι αυξημένη στους ασθενείς με Σ.Σ. σε σχέση με τους υγιείς μάρτυρες και τους ασθενείς με ρευματοειδή αρθρίτιδα (ΡΑ), ii) εάν η κλοπιδογρέλη μπορεί να αναστείλλει αποτελεσματικά την ADP-επαγόμενη ενεργοποίηση των αιμοπεταλίων, να μειώσει τα επίπεδα της κυκλοφορούσας στον ορό σεροτονίνης και επομένως να επηρεάσει θετικά την αγγειοπάθεια και την ίνωση στους ασθενείς με ΣΣ. Μέθοδοι: 13 ασθενείς με ΣΣ στρατολογήθηκαν. Η διέγερση των αιμοπεταλίων αξιολογήθηκε πριν και 14 ημέρες μετά τη χορήγηση κλοπιδογρέλης. Στα ίδια χρονικά σημεία μετρήθηκαν στο περιφερικό αίμα τα επίπεδα της σεροτονίνης και 2 δεικτών ενδοθηλιακής δυσλειτουργίας (s-VCAM1 και s-ICAM1).Αποτελέσματα: Η επαγόμενη με ADP διέγερση των αιμοπεταλίων ήταν παρόμοια μεταξύ των ασθενών με ΣΣ (n=13), των ασθενών με ΡΑ (n=28) και των υγιών εθελοντών (n=22) (mean ± SEM AU*min: 392.1 ± 58.4, 535.5 ± 61.33 and 570.9 ± 42.9 στους ασθενέις με ΣΣ, στους ασθενείς με ΡΑ και τους υγιείς εθελοντές αντίστοιχα, p=0.14). Η θεραπεία με κλοπιδογρέλη μείωσε σημαντικά την ADP-επαγόμενη διέγερση των αιμοπεταλίων στους ασθενείς με ΣΣ (mean ± SEM AU*min: 392.1 ± 58.4 vs 163.8 ± 51.7, p=0.014). Η θεραπεία δεν επηρέασε τα επίπεδα της σεροτονίνης αλλά αύξησε σημαντικά τα επίπεδα του s-VCAM1 (p=0.03). Τρεις ασθενείς εμφάνισαν δακτυλικά έλκη στη διάρκεια της μελέτης. Η πιθανή συσχέτιση του φαρμάκου της μελέτης με την ανάπτυξη δακτυλικών ελκών οδήγησε σε πρόωρο τερματισμό της.Συμπέρασμα: Η κλοπιδογρέλη πιθανά επιδεινώνει τους δείκτες ενδοθηλιακής δυσλειτουργίας και πιθανά συνδέεται με την ανάπτυξη δακτυλικών ελκών στους ασθενείς με ΣΣ

Acute Acalculous Cholecystitis Associated with Epstein–Barr Infection: A Case Report and Review of the Literature

The most common cause of acute cholecystitis (ACC) is cholelithiasis. Acute acalculous cholecystitis (AAC) is well documented in the literature related with critical illness, but viral causes such as cytomegalovirus (CMV) and Epstein–Barr virus (EBV) have also been reported. We present a rare manifestation of EBV infection, reporting a case of a 15-year-old female suffering from acute acalulous cholecystitis, and we review the relevant literature. Clinicians should be aware of this rare complication of EBV infection and properly exclude it in young patients with cholecystitis

Multicenter Cross-sectional Study of Patients with Rheumatoid Arthritis in Greece: Results from a cohort of 2.491 patients.

AIM OF THE STUDY: To evaluate the current disease characteristics, treatment and comorbidities of rheumatoid arthritis (RA) in Greece. METHODS: Multicenter, cross-sectional study with a 9-month recruitment period between 2015 and 2016. Demographics, disease characteristics, treatment and comorbidities were collected via a web-based platform. RESULTS: 2.491 RA patients were recruited: 96% from tertiary referral centers, 79% were females with a mean age of 63.1 years and disease duration of 9.9 years. Fifty-two percent were rheumatoid factor and/or anti-CCP positive, while 41% had erosive disease. Regarding treatment, 82% were on conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), 42% on biologic DMARDs (TNFi: 22%, non-TNFi: 20%) and 40% on corticosteroids (mean daily dose: 5.2 mg). Despite therapy, 36% of patients had moderate and 12% high disease activity. The most frequent comorbidities were hypertension (42%), hyperlipidemia (33%), osteoporosis (29%), diabetes mellitus (15%) and depression (12%). Latent tuberculosis infection (positive tuberculin skin test or interferon gamma release assay) was diagnosed in 13 and 15.3% of patients, respectively. Regarding chronic viral infections, 6.2% had history of herpes zoster while 2% and 0.7% had chronic hepatitis B and C virus infection, respectively. A history of serious infection was documented in 9.6%. Only 36% and 52% of the participants had ever been vaccinated against pneumococcus and influenza virus, respectively. CONCLUSION: This is one of the largest epidemiologic studies providing valuable data regarding the current RA characteristics in Greece. Half of patients were seropositive but despite therapy, half displayed residual disease activity, while preventive vaccination was limited