ABSTRACT The current absence of gold-standard or all-aspect favorable therapies for COVID-19 renders a focus on multipotential drugs proposed to prevent or treat this infection or ameliorate its signs and symptoms vitally important. The present well-designed randomized controlled trial sought to evaluate the efficacy and safety of N-acetylcysteine as adjuvant therapy in hospitalized Iranian patients with COVID-19. Four different diets in 60 patients include; Kaletra (lopinavir/ritonavir) + hydroxychloroquine with/without N-acetylcysteine (600 mg TDS) and atazanavir/ritonavir + hydroxychloroquine with/without N-acetylcysteine (600 mg TDS), were administered in the study. At the end of the study, a further decrease in C-reactive protein was observed in groups with N-acetylcysteine (P =0.008), and no death occurred in the atazanavir/ritonavir + hydroxychloroquine + N-acetylcysteine group, showing that the combination of these drugs may reduce mortality. A significant rise in O2 saturation was observed in atazanavir/ritonavir+hydroxychloroquine+N-acetylcysteine group (P <0.05). Accordingly, oral or intravenous N-acetylcysteine, may enhance O2 saturation, blunt the inflammation trend (by reducing C-reactive protein), and reduce mortality in hospitalized patients with COVID-19. The N-acetylcysteine could be more effective as prophylactic or adjuvant therapy in stable and non-severe cases of COVID-19 with a particularly positive role in the augmentation of O2 saturation and faster reduction of the CRP level and inflammation.

Autoimmune diseases (AD) are severe pathophysiological ailments that are stimulated by an exaggerated immunogenic response towards self-antigens, which can cause systemic or site-specific organ damage. An array of complex genetic and epigenetic facets majorly contributes to the progression of AD, thus providing significant insight into the regulatory mechanism of microRNA (miRNA). miRNAs are short, non-coding RNAs that have been identified as essential contributors to the post-transcriptional regulation of host genome expression and as crucial regulators of a myriad of biological processes such as immune homeostasis, T helper cell differentiation, central and peripheral tolerance, and immune cell development. Pertaining to the differential expression of miRNA attributed in target tissues and cellular bodies of innate and adaptive immunity, a paradigm of scientific expeditions suggests an optimistic correlation between immunogenic dysfunction and miRNA alterations. Therefore, it is not astonishing that dysregulations in miRNA expression patterns are now recognized in a wide spectrum of disorders, establishing themselves as potential biomarkers and therapeutic targets. Owing to its theranostic potencies, miRNA targets have been widely utilized in the development of biosensors and other therapeutic molecules originating from the same. This article tends to deliberate and conceptualize the brief pathogenesis and pertinent epigenetic regulatory mechanism as well as miRNA networks majorly affecting five different ADs namely Rheumatoid Arthritis (RA), Diabetes, Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE) and Inflammatory Bowel Disorder (IBD) thereby providing novel theranostic interventions.

Background: In addition to the elimination diet, dietary composition may influence disease severity in patients with Eosinophilic Esophagitis (EoE) through modulation of the immune response. Aim: To explore the immunomodulatory role of nutrition before and during elimination diet in adult EoE patients. Methods: Nutritional intake was assessed in 39 Dutch adult EoE patients participating in the Supplemental Elemental Trial (SET) using 3-day food diaries. In this randomized controlled trial, diagnosed patients received either a four-food elimination diet alone (FFED) or FFED with addition of an amino acid-based formula for six weeks. Multiple linear regression analyses were performed to assess associations between the intake of nutrients and food groups per 1000 kCal and peak eosinophil count/High Power Field (PEC), both at baseline and after six weeks. Results: At baseline, we found a statistically significant negative (thus favorable) relationship between the intake of protein, total fat, phosphorus, zinc, vitamin B12, folate and milk products and PEC (p<0.05), while calcium (p=0.058) and full fat cheese/curd (p=0.056) were borderline (favorably) significant. In contrast, total carbohydrates, prepacked fruit juice and white bread were significantly positively related to PEC (p<0.05) (unfavorable), while ultra-processed meals (p=0.059) were borderline (unfavorably) significant. After dietary intervention, coffee/tea were significantly negatively (favorably) related to PEC, hummus/legumes were significantly positively (unfavorably) related with PEC, while peanuts were borderline significantly positively related (p=0.058). Conclusion: Dietary composition may be related to inflammation in adult EoE patients. High quality and anti-inflammatory diets may be a promising adjuvant therapy in the dietary management of EoE.

Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with unclear etiology. Clinical manifestations include dyspnea and nonproductive cough. Lung transplantation is the only cure, while Pirfenidone and Nintedanib are FDA-approved drugs for slowing disease progression. However, Saracatinib shows greater efficacy. This literature review assesses the safety and efficacy of IPF treatments, focusing on Pirfenidone and Nintedanib, which preserve lung function and reduce fibrosis and inflammation. We also evaluate emerging treatments such as saracatinib, pamrevlumab, pentraxin-2, BI 1015550, ziritaxestat, PBI-4050, bexotegrast, BMS-986020, TD 139, dasatinib, quercetin, and etanercept. Additional research is needed to explore the therapeutic potential and address gaps in IPF management, including exacerbation and associated pulmonary hypertension (PH). Immunosuppressive agents are used to manage IPF exacerbations, while PH is a recognized comorbidity. Clinical trials, PULSAR and SPECTRA, investigate Sotatercept as a potential PH treatment for IPF patients, showing promising results.

Introduction: Probiotics are live microorganisms that, when administered in appropriate colonies, can delay the destruction of the immune system and contribute to the maintenance of immunity in HIV patients. Probiotics play an important role in stimulating natural killer T cells, strengthening the functional gut barrier, and reducing systemic inflammation. Methods: This study was a randomized double blind clinical trial involving 30 patients treated with ART who had experienced immunological failure despite HIV viral suppression. Patients were divided into two equal groups of 15, the first group received 2 probiotic capsules daily with a colony count of 10⁹CFU per capsule containing seven strains ,after three months they were examined for CD4+ counts by flow cytometry, after a one month washout period the participants who had received probiotics were switched to placebo, and the participants who had received placebo were given probiotics for three months, and they were examined for CD4+ counts seven months after the start of the study. Results: In the first group, administration of the placebo resulted in a decrease in CD4 count in the first three months (from 202.21 to 181.79, p-value < 0.001),which may be due to the natural history of the disease. After probiotics administration, CD4 count increased significantly (from 181.79 to 243.86, p-value < 0.001). Overall, after 7 months of study, there was a significant increase in the mean CD count from 202.21 to 243.86 (p-value < 0.001). In the second group, administration of probiotics in the first three months of the study resulted in a significant increase in the mean CD4 count (from 126.45 to 175.73, p-value < 0.001).Termination of treatment with probiotics resulted in a significant decrease (from 175.73 to 138.9, p-value < 0.001)but overall the CD4 count at the end of the study was significantly higher than at baseline (p-value < 0.001).

Objective B cell activating factor (BAFF) is a key regulator of Primary Sjögren’s Syndrome (pSS), which is characterized by B lymphocyte hyperactivity. BAFF is also known as TNF ligand superfamily member 13B (TNFSF13B). This study aimed to explore whether five single nucleotide polymorphisms (SNPs) of the TNFSF13B gene (rs9514827, rs1041569, rs9514828, rs1224141, and rs12583006) are related to pSS susceptibility. Methods We searched Pubmed, Cochrane, Elsevier, Web of Science, CNKI, CQVIP, and WanFang databases (up to January 2023). In a population with pSS, the odds ratios (ORs) with 95% confidence intervals (CIs) of genotypes and each allele were provided to investigate relationships between the polymorphisms of the BAFF (TNFSF13B) gene and pSS. Results The meta-analysis in question contains three studies. In the group of pSS patients and randomly selected health controls (HCs), there was a statistically significant relationship between rs1041569 and rs12583006 and pSS susceptibility, respectively. In fixed models, there were statistical differences in pSS patients and randomly chosen HCs. Conclusions There were relationships of rs1041569 and rs12583006 in the pSS group and HC group. BAFF(TNFSF13B) genes, particularly rs1041569 and rs12583006, were related to pSS susceptibility in pSS patients.

Autoimmune diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc) are the most prevalent rheumatic autoimmune disorders affecting autologous connective tissues caused by the breakdown of the self-tolerance mechanisms of the immune system. During the last two decades, stem cell therapy has been increasingly considered as a therapeutic option in various diseases, including parkinson’s disease, alzheimer, stroke, spinal cord injury, multiple sclerosis, inflammatory bowel disease, liver disease, diabete, heart disease, bone disease, renal disease, respiratory diseases, and hematological abnormalities such as anemia. This is due to the unique properties of stem cells that divide and differentiate to the specialized cells in the damaged tissue. Moreover, they impose immunomodulatory properties affecting the diseases caused by immunological abnormalities such as rheumatic autoimmune disorders. In the present review, efficacy of stem cell therapy with two main types of stem cells, including mesenchymal stem cells, and hematopoietic stem cells in animal models or human patients of one common rheumatic autoimmune diseases, including, RA, will be reviewed. Moreover, other related issues, including safety, changes in immunological parameters, suitable choice of stem cell origin, conditioning regimen, limitations, and complications of stem cell treatment will be discussed.

Abstract Background: The purpose of this meta-analysis was to look at the relationship between hypernatremia and mortality in COVID-19 patients. Methods: We searched the PubMed, Web of science, Embase and Cochrane databases for articles published from the inception of the database until August 27, 2022. Three researchers reviewed the literature, retrieved data, and assessed the quality of the literature, respectively. A meta-analysis was performed using State 17 software to assess the value of the effect of hypernatremia on mortality in patients with new coronavirus pneumonia. Results: A total of 9 publications was finally included in this study, including a total of 11,801 patients with COVID-19, including 1,278 in the hypernatremia group and 10,523 in the normonatremia group. Meta-analysis showed that hypernatremia was associated with mortality in patients with COVID-19 [OR = 4.15, 95% CI (2.95-5.84), P = 0.002, I² = 66.7%] with a sensitivity of 0.36 [0.26, 0.48] and a specificity of 0.88 [ 0.83, 0.91]. The posterior probability of mortality was 42% in patients with COVID-19 hypernatremia and 15% in patients who did not have COVID-19 hypernatremia. Conclusion: According to available data, hypernatremia is associated with death in patients with COVID-19.

Background: Pulmonary thromboembolism (PTE) is a common complication of SARS-CoV-2, which raises the COVID-19 disease’s fatality rate from 3% to 45%. Nevertheless, due to fairly indistinguishable clinical symptoms and a lack of validated clinical prediction models, PTE diagnosis in COVID-19 patients is challenging. This study aims to investigate the applicability of hematological indices to predict PTE incidence and its severity in SARS-CoV-2 patients. Methods: A retrospective cohort study was conducted on hospitalized patients with a confirmed diagnosis of SARS-CoV-2 infection who underwent CT angiography to assess probable PTE in them. The correlation between CBC parameters one day prior to CT angiography and CT angiography outcomes, and simplified Pulmonary Embolism Severity Index (s-PESI) was investigated. Results: We discovered that among individuals with a probable PTE, males and those with higher platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios had a greater likelihood of PTE incidence. PLR was a significant and independent predictor of PTE. Moreover, a higher neutrophil count was associated with a higher s-PESI score in COVID-19 patients developing PTE. Conclusions: Among haematological indices, NLR and more precisely PLR are cost-effective and simply calculable markers that can assist physicians in determining whether or not COVID-19 patients with clinically probable PTE require CT angiography and the higher neutrophil count can be employed as an indicator of PTE severity in COVID-19 patients. Further large multicenter and prospective studies are warranted to corroborate these observations.

Introduction: Vaccination plays a fundamental role in mastering the COVID-19 pandemic and protecting vulnerable groups. Persons with autoimmune inflammatory rheumatic diseases (AIIRD), on immunosuppressive therapies, are prioritized for vaccination. However, data concerning immunogenicity and safety of the BBIBP-CorV vaccine in immunosuppressed patients are not found. This study presents data on the efficacy and safety of the BBIBP-CorV vaccine in immunosuppressed patients compared to healthy controls. Methods: Study population consisted of 100 healthy controls and 100 patients with AIIRD. Vaccination was performed according to national guidelines with the BBIBP-CorV vaccine. SARS-CoV2 neutralizing antibody titers were quantified by ELISA before initial vaccination and 1–3 months after secondary vaccination. Adverse events were assessed before study initiation and 7 days after the second dose. Disease activity was studied before entering the study and 3-8 weeks after the second dose. Results: Vaccination-induced positive immunogenic response rates and SARS-CoV2 neutralizing antibody titers were significantly lower in the AIIRD patients than healthy subjects (P<0.05). There are significant differences in neutralizing antibody titers among patients suffering from RA, SLE, SSc, and AS (P<0.01-0.05). The rates of seropositive vaccine responses were similarly distributed across all diseases. Healthy and AIIRD individuals had a similar profile in adverse events. No significant difference was observed in SARSCoV2 antibody titers between subjects suffering from side effects and those who did not have. SARS-CoV2 neutralizing antibody levels were significantly higher in SARS-CoV2-infected persons than noninfected subjects (P<0.01-0.05). Seropositive subjects had a significant increase in the percentage of vaccine-related adverse events compared to seronegative persons (P<0.05). Despite a minor change in the disease activity of patients with RA and SLE, disease activity indices were overall stable in the AIIRD patients. Conclusion: The BBIBP-CorV vaccine is effective in the development of neutralizing antibody in immunosuppressed patients without considerable reactogenicity or induction of disease flares.

Background: As people in China travel less and consume less imported frozen food during the COVID-19 pandemic, the composition ratio of allergens may have changed. Objective: To investigate the changes of composition ratio of 20 types of specific allergens from January 2020 to June 2021 of 618 patients in China. Methods: The 20 items of allergen-specific IgE (sIgE) detection includes dermatophagoides pteronyssinus, dermatophagoides farina, ambrosia artemisiifolia, salix babylonica, dander of dog, alternaria, cockroach, artemisia argyi, dander of cat, house dust, milk, hen’s egg, mutton, cod, peanut, beef, soybean, shrimp, crab and wheat. The results of detection were collected from patients of dermatology, pediatrics or allergy department. They are from 17 hospitals in China from January 2020 to June 2021, and participants were required to have at least one positive result of sIgE detection (≥0.35 IU/mL). The age ranges from 0 to 89 years old. Serum detection was performed by enzyme allegro-sorbent test (REAST). Results: The proportion of inhaled allergens in 618 patients was significantly lower than that of ingested allergens. Most of the inhaled allergens were indoor allergens. In the first half of 2020, the second half of 2020 and the first half of 2021, the positive proportions of wheat, shrimp and crab were changed. Compared with the same period in 2020, the positive proportion of wheat and shrimp in the spring of 2021 significantly decreased, while that of crab was significantly increased. The ratio fluctuation of dermatophagoides pteronyssinus and dermatophagoides farina was related to seasonal factors. There was no significant difference in the proportion of other allergens. Conclusion: The special historical background of the epidemic may have a certain influence on the change of the proportion of allergens, but it is not the only factor.

To determine distinct phenotype groups in patients with idiopathic inflammatory myopathy (IIM), and to identify the differences of clinical characteristics, laboratory findings, and the long-term outcomes in patients with antisynthetase syndrome (ASS) of different anti-aminoacyl-tRNA synthetase (ARS) antibodies. Methods: We enrolled retrospectively 280 patients with IIM, and the clinical characteristics and laboratory findings were collected. Additionally, multivariate COX regression analysis was performed to identify indicators of poor prognosis in patients with ASS. Results: 119 ASS and 161 non-ASS patients were identified in 280 patients with IIM, the occurrence rates of ILD, RP-ILD, pulmonary symptoms, arthritis, triad and mechanic’s hands with ASS group were more prevalent than non-ASS group ( p＜0.05). Among 119 patients with ASS, the highest incidence of RP-ILD occurred in the PL12 group (36.4%). There was clinical significance of statistical differences in arthritis, myositis, mechanic’s hands, triad, shawl sign, v sign, and Raynaud’s phenomenon among the 4 subgroups ( p＜0.05). At the same time, the individuals in the positive anti-Jo1 antibody group were more likely to exhibit arthritis, myositis, mechanic’s hands, triad and, v sign than the negative anti-Jo1 antibody group in patients with ASS, furthermore, statistically more prevalent ( p＜0.05). According to the multivariate COX regression analysis, mechanic’s hands, ANA, and ILD were independent risk factors for poor prognosis in patients with ASS ( p<0.001, p=0.026, and p<0.001, respectively). V sign was an independent protective factor for good prognosis in patients with ASS ( p=0.026). Conclusions: When clinical characteristics including pulmonary symptoms, arthritis, mechanic’s hands, ANA, along with ILD appear, clinicians should be on the alert for the occurrence of ASS in patients with IIM

Background Gout is a chronic non-communicable disease that might lead to multiple systemic complications if it is left untreated. The knowledge and attitudes among patients towards the diagnosis and management of gout are important indicators in determining the prognosis and predicting sequelae of the disease. This cross-sectional survey aimed to assess the knowledge, perspectives, and attitudes of patients diagnosed with gout toward the disease pathology, diagnosis, and treatment. Methodology An observational cross-sectional study was conducted at university clinics and local health facilities in central Riyadh, Saudi Arabia. Two-hundred thirteen patients diagnosed with gout were selected by non-random, non-probability convenience sampling and invited to voluntarily participate in this survey. A structured questionnaire, which was written in Arabic and pre-tested in a previous pilot study, was distributed to and collected from the participants between April 2022 and August 2022. The data were entered into an Excel (version 2010) spreadsheet. Pearson chi- square analysis was used to determine associations between dependent variables. Statistical significance was defined as a P-value <0.05. Results The study included 109 patients (51.2%) ≥51 years of age with uncontrolled gout (more than two attacks), 38% of whom were males. The variation in body mass index was not statistically significant (P=0.384). The proportions of patients with diabetes mellitus, hypertension, dyslipidemia, and osteoarthritis were significantly different between patients with uncontrolled vs. controlled gout (P=0.041). There were significant differences between patients with uncontrolled vs. controlled gout in terms of age at diagnosis and the interval between symptom onset and rheumatologist consultation (P=0.043, P=0.043, and P=0.027, respectively). Conclusion Patients were adequately informed about gout and its treatment. Gout control was significantly associated with patients’ knowledge levels, patient age, and gout therapy. There were no associations between patients’ primary complaints and gout status at the time of diagnosis

Background: As a polyphenolic compound originated from the food spice turmeric, curcumin (CUR) has various pharmacological effects, such as anti-inflammatory, anti-oxidation, anti-proliferative and anti-angiogenic activities. Psoriasis is centered on the overproduction of Th1- and Th2-related cytokines (e. g. IL-23, IL-17, TNF-α, IL-22), which is involved in the occurrence and development of its pathogenesis. However, whether CUR is involved in the treatment of psoriasis and its specific mechanisms are not fully understood. Methods: In this study, we detected the therapeutic effect of CUR (100mg/kg· d) on IMQ-induced dermatitis in mice, analyzed by PASI scores, ELISA, HE staining, immunofluorescence. Moreover, we further confirmed the alteration in the relative abundance of the gut microbiota through 16sRNA to explore whether CUR could regulate the gut microbiota of IMQ-induced mice. Result: Through intragastric administration, CUR can alleviate psoriasis-like lesions of mice by decreasing PASI scores, reducing the level of IL-6, IL-17A, IL-22, IL-23, TNF-α and TGF-β1, promoting the expression of IL-10. Moreover, 16 sRNA sequencing revealed that CUR could regulate the alteration in the abundance alteration of gut microbiota related to inflammation, such as Alistipes, Mucispirillum and Rikenella at genus level. The correlation analysis further confirmed the close association between important microflora and psoriasis-like inflammation indicators. Conclusions: CUR exerts the effect of alleviating dermatitis of psoriatic mice by regulating Th-17 related inflammatory factors. Moreover, the changes in gut microbiota via CUR may be another factor of relieving IMQ-induced lesions in mice. Therefore, CUR may be a highly promising candidate for the treatment of psoriasis.

Background/aim: To investigate the frequency and clinical relevance of an extended autoantibody (ab) profile in patients with SSc. Materials and Methods: In this cross-sectional study, serum from 100 consecutive patients was subjected to indirect immunofluorescence (HEp-20-10/primate liver mosaic) and Systemic Sclerosis Profile by EUROIMMUN (Lübeck, Germany) to evaluate ANA and autoantibodies against 13 different autoantibodies in patients with SSc less than three years. Results: 93 of 100 patients were positive for ANA by indirect immunofluorescence (IIF). The prevalence of Anti-Scl70 ab was 41%, anti-centromere (ACA) 27%, and anti-RNA polymerase (RNAPIII) 15%. Scl70 was more associated with diffuse subtype (p<0.001), ILD (p<0.001), and high mRSS (p=0.002); ACA with limited disease (p<0.001), less ILD (p<0.001), overlap (p=0.017) and low mRSS (p=0.024); RNAPIII with diffuse disease (p=0.027), ILD (p=0.016) and high mRSS (p=0.001). Fifty-three patients showed single positivity (26 anti-Scl70, 16 ACA, 6 anti-RNAPIII, 1 anti-Ku ab, 1 anti-PM/Scl100, 2 anti-PM/Scl75, 1 anti-Ro52), whereas 32 patients had multiple auto-antibody positivities. Among common SSc-specific autoantibodies, Scl70 and RNAPIII showed the highest co-occurrence (n=4). One patient was simultaneously positive for anti-RNAPIII ab and ACA, and one was positive for ACA and Scl70. The clinical features were not statistically different between single and multiple autoantibody-positivity for common SSc-specific autoantibodies (ACA, Scl70, and RNAP III), except for digital ulcer in multi-antibody positive ACA group (p=0.019). Conclusion: Based on our results, co-expression of auto-antibodies is not uncommon in SSc patients. Although SSc-specific auto-antibodies generally show known clinical features, the clinical presentation of the co-expression in specific and non-specific auto-antibody positivity continues to be important.

Our previous research developed a novel tuberculosis (TB) DNA vaccine ag85a/b showed a significant therapeutic effect on the mouse tuberculosis model by intramuscular injection (IM) and electroporation (EP). However, the action mechanisms between these two vaccine immunization methods remain unclear. In a previous study, 96 M. tuberculosis (MTB) H37Rv-infected BALB/c mice were treated with PBS, 10μg, 50μg, 100μg, and 200μg ag85a/b DNA vaccine delivered by IM and EP three times at two-week intervals, respectively. In this study, peripheral blood mononuclear cells (PBMCs) from 3 mice in each group were isolated to extract total RNA. The gene expression profiles were analyzed using gene microarray technology to obtain differentially expressed (DE) genes. Finally, DE genes were validated by real-time reverse transcription-quantitive PCR (RT-qPCR) and the GEO database. After MTB infection, most of the up-regulated DE genes were related to the digestion and absorption of nutrients or neuroendocrine, for example, Iapp, Scg2, Chga, Amy2a5, etc, and most of the down-regulated DE genes were related to cellular structural and functional proteins, especially the structure and function proteins of alveolar epithelial cell, for example, Sftpc, Sftpd, Pdpn, etc. Most of the abnormally up-regulated or down-regulated DE genes in the TB model group were recovered in the 100μg and 200μg ag85a/b DNA IM groups and four DNA EP groups. The pancreatic secretion pathway down-regulated and Rap1 signal pathway up-regulated had particularly significant changes during the immunotherapy of the ag85a/b DNA vaccine on the mouse TB model. The action target and mechanism of IM and EP are highly consistent. Tuberculosis infection caused rapid catabolism and slow anabolism in mice. For the first time, we found that the effective dose of the ag85a/b DNA vaccine immunized whether by IM or EP could significantly up-regulate immune-related pathways and recover the metabolic disorder and the injury caused by MTB.

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by hemolytic anemia, bone marrow failure, thrombophilia. COVID-19, caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with many variants including Omicron. This study depicted demographic and clinical characteristics of 20 PNH patients with SARS-Cov2 Omicron infection. All the patients hadn’t previously been administrated with complement inhibitors. They all were with high disease activity (HDA), and LDH level exceeded any documented since the diagnosis of PNH, and those reported in the literature for previously stable treatment with complement inhibitors. D-dimer level elevated in 10 patients. 2 patients developed mild pulmonary artery hypertension. Glomerular filtration rate (GFR) declined in 5 patients. 1 patient developed acute renal failure and underwent hemodialysis. Anemia and hemolysis were improved in 5 patients treated with eculizumab. Hemolytic exacerbation of PNH with COVID-19 is severe and eculizumab may be an effective treatment.

Background: T cell chemokines and its receptors play important roles in the development and progression of rheumatoid arthritis (RA). Their involvement has been reported in inflammatory autoimmune diseases. However, their role in RA in the Ghanaian population has not been explored. We evaluated the intracytoplasmic CD4+ T cell chemokine receptors in rheumatoid arthritis patients in Ghana and determined their relationship with disease activity. Methods. This case control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from the orthopaedic units of Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. A well-structured questionnaire was used to obtain sociodemographic data. Blood samples were also collected and processed for flow cytometric analysis. Statistical analyses were done using SPSS version 26.0 and R programming language. Results: This study found a significant difference in age group (p < 0.0001), marital status (p ¬= 0.0210), occupation (p = 0.0140), educational level (p = 0.0210) and religion (p = 0.0100) between RA patients and healthy controls. Moreover, haemoglobin level (p = 0.0010), waist circumference (p < 0.0001) and hip circumference (p = 0.0040) were significantly different between RA patients and healthy controls. RA patients had significantly lower levels of CD4+CD183+ compared to the control group (p < 0.001), and was positively correlated with DAS score (r = 0.0397, p = 0.789). In Receiver Operator Characteristics analysis, CD4+CD183+ could significantly detect rheumatoid arthritis with a very high area under the curve (AUC = 0.687, p = 0.018). At a cut-off of 0.082, CD4+CD183+ was the best chemokine receptor for detecting RA with a sensitivity of 90.0%, specificity of 25.9%, a positive predictive value of 69.2%, and a negative predictive value of 58.3%. Conclusion: CD4+CD183+ could serve as useful diagnostics and disease-monitoring marker for rheumatoid arthritis in the Ghanaian population.