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Nurullah Bulbuller,1 Mani Habibi,1,2 Mustafa Yuksel,3 Onur Ozener,1 Mehmet Tahir Oruc,1 Osman Zekai Oner,1 Mehmet Altug Kazak1 1General Surgery Department, Antalya Training and Research Hospital, Antalya, 2General Surgery Department, Esenler Maternity and Child Health Hospital, Istanbul, 3Urology Department, Antalya Training and Research Hospital, Antalya, Turkey Introduction: Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI). Aim: One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG). Materials and methods: Obese female patients (n=120), ≥18 years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6 months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values. Results: The mean age of the patients was 39.19 (standard deviation [SD] =9.94) years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6 months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P

Abstract This study evaluated the management of dyslipidemia in Turkey with the goal of understanding current diagnosis and treatment patterns, as well as identifying unmet needs in achieving effective low-density lipoprotein cholesterol (LDL-C) targets. Using a Delphi panel consisting of nine expert cardiologists, the study reveals key gaps in dyslipidemia management, particularly in the underutilization of combination therapies, such as statins and PCSK9 inhibitors, which are crucial for achieving LDL-C targets in high-risk patients. The findings indicate that while many patients with very high cardiovascular risk are diagnosed, a significant proportion do not receive optimal treatment to reach LDL-C levels recommended by European guidelines. Addressing these gaps could lead to more effective management of dyslipidemia and reduce the burden of cardiovascular disease in Turkey. The study’s insights provide critical recommendations for clinicians and policymakers to improve clinical practice and health outcomes through more aggressive lipid-lowering strategies.

A 15-year-old girl was admitted to an external center 1 month ago with symptoms of generalized pruritus, rash and blistering all over the body, and swelling of the eyes and lips. The patient was started on desloratadine, but there was no improvement in her symptoms. She had been diagnosed with Hashimoto’s thyroiditis 4 years ago in the pediatric endocrinology department; she had been using levothyroxine since then, and her thyroid disease was under control. The dose of antihistamine treatment was increased and montelukast was added. The patient, who had Raynaud’s phenomenon, was diagnosed with systemic lupus erythematosus and hydroxychloroquine was started, but the symptoms of urticaria and angioedema did not decrease. The patient was then started on omalizumab and urticaria was controlled under hydroxychloroquine + omalizumab. In the third month of omalizumab discontinuation, the patient is receiving hydroxychloroquine and levothyroxine treatments and continues to be followed up, being in remission in terms of chronic spontaneous urticaria.

Introduction: We aimed to reveal the current status of high-resolution magnetic resonance imaging (HR-MRI) and its potential to identify different intracranial vessel wall pathologies. We also aimed to investigate the diagnostic performance of contrast-enhanced HR-MRI T1-SPACE sequence in determining vessel wall pathologies and to determine its contribution to conventional methods. Methods: We retrospectively reviewed HR-MRI images of 33 consecutive patients with 30% or above stenosis based on clinical, digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) evaluations. All patients had a history of stroke, and 33 stenotic vessel segments in anterior-posterior circulation were reviewed. On HR-MR images, plaque eccentricity, presence or absence of intraplaque hemorrhage, contrast enhancement pattern, and plaque length were evaluated. As causes of atherosclerosis, the presence of diabetes mellitus, hemoglobin A1c, total cholesterol, trigylicerid, and high-density lipoprotein levels, history of smoking, history of taking statin drugs, and hemoglobin levels were acquired, and the correlation between these variables and plaques labeled as stable or unstable in these patients was investigated. Results: Atherosclerosis was observed in 29 of the 33 cases included in our study, and stenosis in intracranial vascular structures due to moyamoya disease was observed in 4 cases. In patients with intracranial stenosis secondary to moyamoya disease, diffuse concentric homogeneous enhancement was observed within the vessel wall in the prestenotic artery segment. In patients with stenosis due to atherosclerosis, increased heterogeneous enhancement was observed within the atheroma plaque. A significant correlation was observed between eccentric-concentric plaque and atherosclerotic segment length. Conclusion: The vessel lumen can be evaluated using CTA, MRA, and DSA, but the vessel wall cannot be evaluated using these traditional techniques. Vessel wall imaging is helpful for identifying atheromas in intracranial and cervical carotid arteries, and for determining the morphologies of vessel walls and the surrounding structures.

Malignancies, autoimmune diseases, viral and fungal infections, as well as aseptic meningitis due to certain drugs are frequently seen. Antibiotics, intravenous immunoglobulin (IVIG), non-steroidal anti-inflammatory drugs are often considered responsible. The incidence following IVIG infusion is 0.067%; however, symptoms may start to show up anywhere from 6 h to 4 days following infusion. It is challenging to diagnose and is easily overlooked because of symptoms and clinical findings that might arise from a variety of conditions, including headaches, stiff necks, and vomiting. We present a patient with Noonan syndrome who was diagnosed with common variable immunodeficiency due to recurrent illness, had IVIG replacement therapy, and developed aseptic meningitis following the initial course of treatment. No similar case has been documented before in the literature. Noonan syndrome may also be related with an increased incidence of IVIG-associated aseptic meningitis, while the explanation for this association is unclear.

Chronic spontaneous urticaria (CSU) is known by spontaneous urticarial lesions and/or angioedema resisting ≥ 6 weeks. It is reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the body and triggers urticaria and angioedema, and even might cause CSU. Although coronavirus disease 2019 (COVID-19) vaccines do not generally affect CSU patients, it has been observed that they occasionally exacerbate the disease. Here, we studied COVID-19, COVID-19 vaccines, and their effects on CSU cases. The records of 16 cases who mostly took omalizumab due to being resistant CSU cases were retrospectively reviewed. There was no problem with an inactivated (Sinovac ® ) vaccine. After mRNA (BioNTech ® ) vaccination, 2 of our patients had an exacerbation and even one had to switch to omalizumab. In 2 patients, CSU developed despite the absence of an urticaria-angioedema history and they were also unresponsive to standard antihistamine therapy and therefore had to be started on omalizumab. As a result, omalizumab had to be started in 3/8 patients after mRNA vaccination due to CSU exacerbation or treatment failure. It should be also kept in mind that SARS-CoV-2 infection and vaccination against it may exacerbate or trigger the disease in some patients.

Kutanöz mastositoz (KM), dermiste aşırı sayıda mast hücresi (MH)’nin varlığına göre kategorize edilen bir hastalık grubunu tanımlar. KM'li hastalar, sistemik mastositoz için tanı kriterlerini karşılamaz ve dermis dışında herhangi bir organ katılımı kanıtı göstermez. Bu makale tarih, prevalans ve sınıflandırmadan bahsettikten sonra kısaca MH aktivasyonunun farklı klinik özelliklerini ve tetikleyicilerini gözden geçirmekte ve son olarak güncel gözlemler ışığında çocuklarda KM yönetimini ayrıntılı olarak tartışmaktadır. KM'li hastalar, sıklıkla dermal lezyonlar üzerindeki baskılarla başlayan ve MH aracılığıyla meydana gelen semptomlardan muzdariptir. KM yönetimi, esas olarak MH tetikleyicilerinden kaçınma üzerine kuruludur. KM vakalarında tedavinin esasını anafilaksi gibi şiddetli sistemik reaksiyonlarda epinefrin otoenjektörlerinin elde mevcudiyeti ve semptomlar ortaya çıktığında antihistaminiklerin (H1/H2 histamin reseptör blokerleri) kullanılması oluşturmaktadır.

Like many microbial agents, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccination may increase the frequency and/or severity of attacks. We aimed to observe/evaluate patients with hereditary angioedema (HAE) followed by Sakarya University Research/Training Hospital pediatric allergy unit, Sakarya, Türkiye, for the effects of SARS-CoV-2 infection and COVID-19 vaccination. Ten HAE patients—3 males and 7 females—were evaluated retrospectively. Their mean age was 31.80 ± 19.15 (min. 12 – max. 66) years. Four of 10 patients were diagnosed with type 1 HAE and 6 with type 2 HAE. Two out of 6 patients (mother and daughter) diagnosed with type 2 HAE had angioedema attacks during COVID-19 disease. Six out of 10 HAE patients received different COVID-19 vaccines available in Türkiye up to third and fourth doses. There was no increase in COVID-19 vaccine-related attacks during, after 72 hours, and up to the year after vaccination. As a result, we consider it safe to administer inactivated and/or mRNA vaccines in our patients with HAE. In addition, catching SARS-CoV-2 infection was not always associated with disease exacerbation or activation.

Henoch-schönlein purpurası (HSP), çocukluk çağının non-trombositopenik palpabl purpura ile seyreden ve en sık görülen sistemik vaskülitidir. HSP cilt tutulumu, artrit, renal ve gastrointestinal sistem tutulumu ile karakterizedir. Böbrekler, kolon, eklemler gibi bazı organlarda gelişen vaskülit sonucu palpe edilebilen purpura, karın ağrısı, artrit ve böbrek hastalığı (proteinüri) görülür. Hastalar döküntü (palpable purpura), karın ağrısı, eklem şişliği ve/ya ağrısı (artrit) şikayetleri ile başvurur. HSP genellikle viral enfeksiyonlar, ilaçlar ve böcek ısırığı gibi antijenik bir stimulus ile tetiklenir. Burada purpurik döküntü ile seyreden hastalıklarla kolaylıkla karışabilen ve farklı tanılar konulabilen HSP’ li beş yaşında bir kız olgu sunulmaktadır. Purpurik döküntü ile başvuran hastalarda travma öyküsü varlığında, travmaya sekonder purpura vs. düşünülsede vaskülit benzeri değişik hastalıklarla karşılaşılabileceği akılda tutulmalıdır.

Background: The aim of this study was to provide insight into the real-life clinical presentation and outcomes of the elderly presenting with acute myocardial infarction from the Turkish Myocardial Infarction registry database. Methods: TURKMI was a nationwide, multicenter, observational, 15-day snapshot registry conducted to address the management of acute myocardial infarction patients admitted to percutaneous intervention-capable hospitals. The present analysis included the comparison of consecutively enrolled acute myocardial infarction patients aged ≥75 and

I have read the article titled “Throat microbiota alterations in patients with hereditary angioedema” by Wang et al (2022) with great interest. This study examined the change in throat microbiota and its association with laryngeal edema (LE) attacks and attack severity in hereditary angioedema (HAE) patients. This study demonstrated the comparative richness of Bacteroidetes and Prevotellaceae in recent LE attacks and detected positive association between the attack severity scores and Bacteroidetes richness. Nevertheless, I have some questions and concerns about the methodological design of their study. For instance, in the article, the description of HAE and HAE patients is not exactly correct. I do not also agree with the authors on the effect of long-term prophylactic danazol use in HAE patients of this study. It is very important when or how the swab was obtained after the LE attack. The last, not the least, point now is what the authors suggest to improve this dysbiosis in these HAE patients. The discussion to elaborate these points in the study could be helpful and enlightening for readers and future research in this area.

I have read the article titled, ''Efficacy and safety of omalizumab against chronic spontaneous urticaria: Real-world study from China'', by Wang et al with great interest. Nevertheless, there are a couple of questions raised in my mind. And clarification of some aspects of the study will help the reader benefit and have a better understanding of the study.

Amaç: Bu çalışmada 0-24 ay arası çocuklarda ön fontanel (ÖF) kapanma zamanı ve boyutlarını değerlendirmeyi amaçladık. Bu çalışmanın ikincil amacı ise ÖF boyutu ve subaraknoid mesafe genişliği arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntemler: Bu çalışmada Ocak 2020 ve Ekim 2021 tarihleri arasında hafif kafa travması nedeniyle bilgisayarlı tomografi (BT) çekilen olguların görüntüleri retrospektif olarak değerlendirildi. 3D BT görüntüleri üzerinde ön fontanel kapanması (ÖFK) değerlendirildi ve açık olanlarda ÖF alanı ölçüldü. Aksiyal BT görüntülerde subaraknoid mesafe ölçümleri gerçekleştirildi. Bulgular: Hafif kafa travması nedeniyle BT çekilen 602 çocuk çalışmaya dahil edildi. 0-24 ay arasında her aylık yaş grubunda 23-25 olgu mevcuttu. K/E oranı 284/317 idi. Radyolojik olarak 0-6 ay arası, klinik olarak 0-2 ay arası ÖFK izlenmedi. Klinik ÖFK 3. ayda başlayıp 13. ayda % 66’ya 15. ayda % 90’ın üzerine, radyolojik ÖFK ise 7. ayda başlayıp, 16. ayda % 65’e ve 24. ayda % 84’e ulaşmıştır. Ortalama ÖF alanı doğumdan 2. aya kadar artmış, 3-9 aylarda azalan dalgalı bir seyir göstermiş ve 9. aydan 2 yaşa kadar ise giderek azalmıştır. ÖF alanı ile subaraknoid mesafe genişliği arasında ilişki saptanmadı (r:0,229, p

Primer immün yetmezlik hastalık tipleri günümüzde bilindiği gibi 400 hastalığı geçmiş bulunmaktadır. Farkındalığın artması ve tanı yöntemlerinin gelişmesi ile nadir olarak görülmekten çıkmışlar ve sık görülen hastalıklar haline gelmeye başlamışlardır. Bu hastalıklara cilt bulguları açısından yaklaşmak ve tanımak bu derlemenin asıl amacıdır. Primer immün yetmezlik hastalıklarının 10 uyarıcı işaretlerinden ikisi cilt bulgularından olmakla beraber sadece (bakteriyel ya da fungal) enfeksiyöz cilt bulgularını düşündürtmektedir. Bunlardan ilki tekrarlayan derin cilt abseleri ve diğeri cilt üzerindeki persistan mantar enfeksiyonu (tinea / dermatofitoz) olmasıdır. Cilt bulgularının sık olarak primer immün yetmezlik hastalıklarında görüldüğü bilinmelidir. En sık enfeksiyonlara (bakteriyel) ait bulgular görünmesine rağmen, onu non-enfeksiyöz tipte immüno-alerjik bulgu olarak egzama (atopik dermatit) izler. İmmüno-alerjik olmayan bulgular ise epidermal displazi, telenjiektazi vb. belirtilerdir. Bu deri belirtileri, bazen ilk geliş bulgusu olabilir. Her zaman bu bulgular çok özgün olmayabilir. Bu cilt bulgularıyla beraber özellikle büyüme geriliği ya da çoklu sistem tutulumu varsa, yine bu cilt bulgusu rekurrent ve tedaviye dirençli (refrakter) ise mutlaka primer immün yetmezlik hastalığı düşünülmeli ve var olup olmadığı araştırılmalıdır.

Aralık 2019 yılında Çin’in Wuhan şehrinde etiyolojisi bilinmeyen bir pnömoni salgını tüm dünyaya yayıldı. Bu salgın yeni tip koronavirüs olan Şiddetli Akut Solunum Sendromu Coronavirus 2 (SARS-CoV-2) olarak adlandırıldı ve hastalığa COVID-19 adı verildi. Dünya Sağlık Örgütü (DSÖ) tarafından global pandemi ilan edildi. COVID -19 hastalığında ateş, öksürük, krup, nefes darlığı, koku alamama gibi semptomların yanında gastrointestinal sistem hastalıkların (GİS) semptomları da bildirilmiştir. SARS-CoV-2, akciğerlerin alveolar epitel hücrelerinde bulunan ACE-2 reseptörlerine bağlanarak pnömoniye neden olur. Ayrıca sadece akciğer hücreleri değil bağırsak epitel hücrelerinin (özellikle enterositler) de ACE-2 reseptörlerini eksprese ettiği gözlenmiştir. Son zamanlarda COVID-19 hastalarının dışkı materyalinde de SARS-CoV-2 RNA izole edilmiştir. Bu durum COVID-19 ve GİS arasında bir ilişki olabileceğini göstermektedir. Şu anda, COVID-19 için kullanılan ilaç ve birden fazla aşı mevcuttur ancak aşı üretimi, aşının etkinliği, saklama koşulları ve taşınmasındaki aksaklıklardan dolayı viral yükü azaltmak için alternatif tedaviler araştırılmaktadır. Probiyotikler, belirli dozlarda insan sağlığı üzerine faydalı etkileri olan canlı mikroorganizmalar olarak tanımlanmaktadır. Bilimsel çalışmalar probiyotiklerin antiviral özelliğini ve genel bağışıklığı güçlendirici etkisini ortaya koymuştur. Bu derleme probiyotiklerin COVID-19 hastalığındaki rolünü, SARS-CoV-2 enfeksiyonu ve mikrobiyota arasındaki olası ilişkiyi tartışmayı amaçlamaktadır.

Aralık 2019’da Çin’de başlayan SARS-CoV 2 enfeksiyonu olarak bilinen Coronavirüs pandemisi Dünya Sağlık Örgütü tarafından duyuruldu. Virüsü ile enfekte olan kişinin komorbiditesine göre mortalite oranları %6-10.5 arasında değişiklik gösteren SARS-CoV 2 bilinen üçüncü en yüksek patojeniteye sahiptir.1,2 Coronavirüs ailesine üye tek sarmallı bir RNA virüsüdür. İnsan hücresine anjiotensin dönüştürücü enzim 2 (ACE 2) reseptörü aracılığı ile giriş yapar. Renin anjiotensin sinyal yolağı, oksidatif stress ve hücre ölümü, sitokin fırtınası ve endotelyal disfonksiyon olmak üzere SARS-CoV-2 patogenezinde 4 majör yolak vardır.3 Patogenezin ve dolayısıyla semptomların gelişmesine neden olan bu yolaklar aynı zamanda mevcut tedavide kullanılan ilaçların da etki mekanizması açısından kilit noktadır. SARS-CoV-2’ye karşı etkili tedavi henüz geliştirilemediği için virüsün vücuda potansiyel giriş yollarını ve hastalığın oluşma mekanizmalarını bilmek enfeksiyonu önleme açısından büyük önem taşımaktadır.

Giriş ve Amaç: COVID-19, çocuklarda yetişkinlerle karşılaştırıldığında nispeten daha hafif klinik semptomlarla seyretmektedir. Bu çalışmada, tanı sırasında gözlenen hematolojik ve immünolojik değişiklikleri irdelemeyi amaçladık. Materyal ve Metod: Çalışmaya 22 (6 kız, 16 erkek) COVID-19 hastası alındı. Etik kuruldan onay alındı. COVID-19 hastalarında hematolojik parametreler olarak hemogram, protrombin zamanı (PT), aktive parsiyel tromboplastin zamanı (aPTT), fibrinojen, D-Dimer ve immünolojik parametre olarak flow sitometri ile lenfosit alt grupları çalışıldı. Bulgular: Hastaların medyan yaşı 8,1 (2,3-17,5) yıl idi. Elde edilen değerlerin, literatürdeki normal değerlerle kıyaslanabilmesi için hastalar yaş gruplarına ayrıldı. Medyan WBC sayısı 6.145 (3.137-11.000) /µL bulundu. Çocukların yaşı büyüdükçe beyaz küre sayısı azalma eğiliminde idi. Monosit sayıları açısından gruplar arası fark saptandı. Eozinofil, platelet/lenfosit oranı (PLR), PT, aPTT, fibrinojen, D-Dimer açısından gruplar arasında fark saptanmadı. Hastalarımızın 2-5 yaş grubunda olanlarda helper T hücreleri azalmış ve sitotoksik T hücreleri artmıştı. Buna bağlı olarak da CD4/CD8 oranı yaşa göre normalden düşüktü. Aynı oran düşüklüğü 16 yaş üzerindeki grupta da görüldü. Erişkin yaş grubuna yakın olan 16 yaş üstü grupta CD8 sayısı normale göre düşük bulundu. B hücre sayısı yaşı en küçük olan grupta azalmışken, en büyük grupta artmış bulundu. NK hücre sayıları da 16 yaş üstü grupta düşük bulunurken diğer yaş gruplarında normal veya artmış idi. Sonuç: Hemogram çalışıldığında basitçe elde edilecek platelet-lenfosit oranı (PLR) sitokin fırtınasının bir göstergesi olarak kullanılabilir ve çocuklarda CD8 aşırı ekspresyonu olmaması COVID-19 hastalığını neden erişkinlere oranla daha hafif geçirdiklerinin nedeni olabilir. NK hücrelerinin artışı da bu hastalıktan koruyucu mekanizmalardan biridir.

Allergy to fruits and vegetables are the most frequent food allergies in adolescents and adults. The most common phenotypes of fruit and vegetable allergy are pollen-food allergy syndrome (PFAS) (oral allergy syndrome) and lipid transfer protein (LTP) syndrome. In PFAS, fruit and vegetable allergy is caused by a prime sensitization to labile pollen allergens, e.g. Bet v 1 or profilin, and yielding generally mild phenotype, is made of local oropharyngeal symptoms. However, LTP syndrome occurs from a sensitization to LTPs, which are stable plant food allergens, often resulting systemic allergic reactions and moreover anaphylaxis. Component-resolved molecular diagnosis is crucial in directing the treatment of these patients. Existing therapeutic policies involve prevention and salvage medication, including epinephrine, for life-threatening LTP allergic reactions. Allergen specific pollen immunotherapy is not found to be helpful to manage PFAS, nevertheless sublingual immunotherapy against LTPs appears to be an encouraging treatment. Here, an interesting patient having abdominal pain for a long period of time whom later diagnosed by us with PFAS is discussed under the light of recent literature.

12 yaşında kız hasta, ilk doz Pfizer-BioNtech aşısından yaklaşık 10 saat sonra yüzünde başlayan, saatler içinde gövdesine yayılan ürtiker plakları nedeniyle çocuk acil polikliniğine başvurdu. Hastaya feniramin maleat ve metilprednizolon uygulandı. Antihistaminik ile eve taburcu edildi. Hastanın lezyonlarının tekrar nüksetmesi ve rekürren acil başvurularının olması üzerine hasta hospitalize edildi. Feniramin maleat, metilprednizolon ve famotidin tedavisinin 2. gününde lezyonlar kayboldu ve tekrarlamadı. Ürtiker deri ve mukozalarda ani olarak ortaya çıkan, kabarık, kırmızı-pembe, kaşıntılı, ödemli, kısa sürede kaybolan plaklar ile karakterizedir. Şüpheli tetikleyiciler gıdalar, ilaçlar, enfeksiyonlar, fiziksel ve emosyonel stres, içerdiği antijenik yapılar ve stabilizörler nedeniyle aşılar olabilir. Literatürde Pfizer-BioNtech aşısı sonrası cilt reaksiyonları tanımlanmıştır. Literatürde tanımlanan vakaların daha çok yetişkin yaşta olduğu görülmektedir. Hastamız 12 yaşında adolesan bir çocuk olduğu için bu olgumuzla literatüre katkı sağlamak istedik.

11 aylık erkek hasta 1-2 gündür öksürük ve hırıltı şikâyeti ile Çocuk Alerji ve İmmünoloji Polikliniği’ne getirildi. Özgeçmişinde inek sütü alerjisi nedenli takip edilen hastanın 1 defa bronşiolit tanısı ile nebül tedavisi alma ve 1 defa pnömoniye bağlı febril konvülziyon geçirme tanısı ile hastanede yatış öyküsü mevcuttu. Genel durumu orta olan hastanın fizik muayenesinde; akciğer sesleri bilateral sibilan ronkus, subkostal çekilme mevcut olup ekspiryum uzunluğu mevcuttu. Şiddetli bronşiolit geçiriyor olması nedeni ile nebülize salbutamol, ipratropium ve sistemik steroit tedavisi verildi. Nazofarenks sürüntüsünde insan Bokavirüs izole edildi. İnsan Bokavirüs enfeksiyonunun küçük çocuklarda hışıltı ve bronşiolitlerde önemli bir etken ve hastada ağır seyredip yoğun bakım yatışına neden olabileceği akılda tutulmalıdır. Burada, hırıltı şikâyeti ile başvuran ve bronşiolit tanısıyla yatırılan 11 aylık bir erkek hasta nazofaringeal sürüntüden etyolojik ajan olarak nadir görülen insan Bokavirüs elde edilmesine dikkat çekmek amacıyla sunulmuştur.

DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome is an acute drug-induced hypersensitivity reaction. DRESS syndrome can cause morbidity and mortality, characterized by fever, skin rash, lymphadenopathy, hematological abnormalities (eosinophilia, atypical lymphocytes), internal (liver or other) organ involvement. Drugs that most commonly cause DRESS syndrome are anticonvulsants, dapsone, sulfonamides, allopurinol and minocycline. Clinical findings usually develop 1-7 weeks after the initiation of the responsible drug, this period may extend up to three months. There are reports stating that the mortality rate reaches up to 10%, and the most important cause of mortality is liver failure. Diagnostic criteria for DRESS syndrome have been established by the RegiSCAR group. In this article, a pediatric case who developed DRESS syndrome after lamotrigine treatment was presented, and the literature on current diagnosis and treatment approaches was reviewed.

Konjenital diafragma evantrasyonu nadir görülen bir hastalık olup, klinisyen hekimlerce ayırıcı tanısı uygun şekilde yapıldıktan sonra gerekirse cerrahi tedavi uygulanan bir hastalıktır. Beş gündür prodüktif öksürük ve son 2 aydır geceleri yarım saatte bir uyanma şikâyeti ile çocuk polikliniğine başvuran 10 aylık erkek hasta sunulmaktadır. Hastanın dış merkezde çekilen akciğer grafisinde diyafragma elevasyonu görülmesi üzerine çocuk allerji ve immünoloji polikliniğine getirildi. Özgeçmişinde doğum sonrası 1. gününde morarma öyküsü ile yenidoğan yoğunbakım ünitesinde 2 gün takip edilme öyküsü mevcut. Son 2 aya kadar herhangi bir şikâyeti olmamış. Akciğer tomografisi ve batın ultrasonu ile herniasyon, subdiafragmatik kitle ve tümöral oluşum dışlandı. Yenidoğan dönemindeki grafisine de ulaşılan hastaya konjenital diafragma evantrasyonu tanısı konuldu. Asemptomatik seyrettiğinden cerrahi düşünülmedi ve takip önerildi. Nadir görülen bu olgu farkındalığı artırmak amacıyla burada sunulmaktadır.

Coronavirus disease 2019 (COVID-19) pandemic has drawn attention over old immunotherapeutic agents such as convalescent (immune) plasma (CIP). Here, an adolescent with severe COVID-19 case requiring CIP and intravenous immunoglobulin (IVIG) treatments is described. A 17-year-old male patient was brought to the emergency room with complaints of fever, fatigue, and severe cough. Two doses of CIP were infused to the patient because of the increase in persisting fever, dyspnea, and acute phase reactant levels after the third day of routine protocol treatment. IVIG therapy was begun for 2 days at a dose of 1 g/kg/day due to resurgence in acute phase reactants and progressing radiological findings following CIP transfusion. Our patient avoided mechanical ventilation and showed immediate clinical and radiological improvement with CIP transfusion followed by IVIG therapy. Timely initiation of CIP treatment followed by IVIG prevented the disease from worsening and helped to reduce the requirement for mechanical ventilation.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seemed in Wuhan, China in December 2019. SARS-CoV-2 infection in human was named as coronavirus disease 2019 (COVID-19). It has now infected more than 69 million people worldwide, becoming an epidemic responsible for more than 1,5 million deaths until 10th of December 2020. The epidemic still continues. This epidemic is the third epidemic caused by coronaviruses in the 21st century and may be the most important infectious disease representing a major public health threat to the whole world. Treatments against COVID-19 are constantly updated in the literature, based on evidence. Unfortunately, there is no definitive cure for COVID-19, and a number of drugs for use in severe cases of COVID-19 are now being studied in a number of nonrandomized or randomized trials. These include chloroquine, steroids, anti-inflammatory, and antiviral agents. Immunological treatments such as convalescent plasma, intravenous immunoglobulin, monoclonal antibodies (tocilizumab, eculizumab, itolizumab etc.), and anakinra treatments are tried in COVID-19 disease. Results from some trials look promising. Quite a few reports have also stood published so far on the use of immunological treatments for COVID-19 cases. In this review, we will discuss the key immunological treatments, mostly mentioned in the current literature, used in COVID-19 patients in detail.

Methemoglobinemia is a complication that develops when ferrous hemoglobin is oxidized to a ferric state. It may be congenital due to structural hemoglobin defects or acquired through causes such as exposure to local anesthetic drugs or intake of toxins. Methemoglobinemia is characterized by cyanosis when the blood level exceeds 10%, and at higher levels it may cause tissue hypoxemia, coma, cardiovascular collapse, or even death. The primary mechanism used to reduce the methemoglobin level in the body is the nicotinamide adenine dinucleotide phosphate-cytochrome b5 reductase pathway. This case report is a presentation of the diagnosis and treatment of prilocaine-induced methemoglobinemia in 2 recently circumcised infants admitted to the pediatric emergency department.

Severe acute respiratory syndrome coronavirus-2 is an important infectious agent that was first detected in China, causing the pandemic and death of thousands of people. Although the clinic of this disease, called coronavirus disease-19 (COVID-19), is variable, cytokine storm and different mechanisms can cause increased mortality as a result of progressive and serious clinical presentations. Since it belongs to a well-known group of viruses, researchers have gained momentum after the isolation and the identification of the features of the virus. Although specific drugs began to be developed, the first potential candidate drugs were drugs such as broad-spectrum antibiotics, antiviral agents, anti-parasitic agents, and interferon, which were planned to be used with similar indications before pandemic. Trials on all steps such as prophylactic and supporting therapies, as well as care for critically ill patients and vaccine investigation studies are still ongoing. The drugs used in the light of the guidelines were frequently updated and some changes were made as a result of reports on side effects and efficacy evaluations. Especially in some drug combinations, side effects like prolonged QT interval, drug-drug interactions, and restrictions on the use of some drugs in the pediatric age group or pregnancy limit the specific, evidence-based and reliable treatment. Although there are many drugs in the trial phase for COVID-19 treatment, the most promising and most effective drugs are discussed and summarized under the light of national guidelines and clinical evidences with all aspects of the literature.

Objective: Cardiac involvement of Coronavirus 19 disease (COVID-19) may be reflected by electrocardiographic (ECG) changes. ECG changes that may occur in hospital admission for COVID-19 in children have not yet been fully evaluated. Materials-Methods: We examined 83 children admitted to our hospital with proven COVID-19. A detailed clinical examination, 12-lead ECG and laboratory tests were recorded. And then all laboratory parameters were evaluated by age. Results: P wave amplitude was normal in 77.1% and high in 22.9% of study population. There was a significant difference in white blood cell (WBC), lymphocyte, neutrophil, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), D-dimer values between the group with P wave amplitude normal and the high group. 13.3% of patients had first degree AV block and 86.7% did not. There was a significant difference between the groups in WBC, lymphocyte, D-dimer, AST values. In our study, there was right ventricular hypertrophy (RVH) in the ECG of 17 cases. There was a significant difference in WBC, lymphocyte, D-dimer, LDH, AST values between groups with and without RVH. In addition, there were positive correlations among V1R, V6S, V1 R / S ratio and WBC, lymphocyte, D-dimer, creatinine kinase (CK), creatinine kinase isoform MB (CK-MB), LDH, AST values. Conclusions: Pathological ECG findings were associated with laboratory values used in the course of the disease. We think that ECG is a test in the course of COVID-19 in children, which may make important contributions to clinicians to manage the patients when interpreted correctly.

Hereditary angioedema (HAE) is an autosomal dominant disorder, mostly due to C1 esterase inhibitor (C1-INH) deficiency, known by recurring angioedema attacks that are nonpruritic, not accompanying with urticaria, and involve the dermis, intestinal submucosa, and upper respiratory system. The angioedema attacks are not responsive to epinephrine, glucocorticoids, or antihistamine treatments. Whereas HAE patients formerly had a few therapeutic options accessible such as anabolic androgens and antifibrinolytics. Nowadays in many parts of the world there has been remarkable progress in HAE treatment for the last two decades and clinically confirmed medications are presented for prophylactic and attack treatment. Alternatives in attack therapy contain two plasma-derived C1-INH concentrates, a recombinant C1-INH product, a kallikrein inhibitor, and a bradykinin β2 receptor antagonist. Options in prophylactic therapy include other than two plasma-derived C1-INH concentrates, subcutaneous C1-INH replacement and newest subcutaneous plasma kallikrein inhibitor Lanadelumab. In spite of these progresses, HAE patients still run into some challenges of an arduous disorder that can yield to devastating angioedema attacks related with important expenses for patients and the public. Better education of HAE patients and implementation of the self-management policy for 'on-demand' therapy will recuperate patients' life quality and negative effects of the disease. Herein the existing and promising therapeutic options are reviewed in the HAE management.

The novel coronavirus infection (SARS-CoV-2 infection), which appeared in the Wuhan region of China in late 2019, spread rapidly in a short time. A few months later, it was accepted as pandemic by the WHO (World Health Organization) and became an important threat to public health. The death rate in cases occurring in China was around 2%. Although it is thought that pregnancy is not a risk factor in the course of COVID-19 disease, it is often seen in which the cases were in the third trimester. It is striking that the maternal and neonatal implications of these infected cases during the late pregnancy period were quite good. Further studies examining more cases in the first and second trimesters, in order to determine long-term results and to clarify the risk of vertical transmission are needed.

Ağır akut solunum sendromu koronavirüsü 2 (Severe Acute Respiratory Syndrome Coronavirus-2; SARS-CoV-2), 2019 koronavirüs hastalığı (COVID-19)’na neden olarak global pandemi haline geldi. Klinik tablosu soğuk algınlığı gibi hafif semptomlara neden olduğu gibi bronşit, pnömoni gibi alt solunum yollarına ve daha ağır durumlara da (ağır akut solunum sıkıntısı sendromu [ARDS] ve ölümle sonuçlanan çoklu-organ yetmezliği gibi) yol açabilir. COVID-19 tedavisinde semptomları kontrol altına alma temel amaç olup gerektiğinde oksijen tedavisi ve mekanik ventilasyon uygulanabilir. COVID-19 önlemleri kapsamında sosyal izolasyon nedeniyle hastalarla yüz yüze görüşmeler kısıtlandı ve hastaların durumlarına göre öncelik algoritması oluşturuldu. Çoğu alerji/immünoloji vizitleri (immün yetmezliği, venom tedavisi veya ağır astımı olanlar hariç) ertelendi veya telefonda tedavi veya evde bakım tedavisi olarak verilmeye başlandı. Ancak günümüzde halen COVID-19 ve alerjik hastalıklar arasındaki bağlantı tam olarak aydınlatılmamış ve literatürde yeterli çalışma bulunmamaktadır. Bu derlemede amacımız COVID-19 ve farklı alerjik ve immünolojik hastalıkların ilişkisini güncel literatür çalışmaları ışığında ortaya koymaya çalışmaktır.

As of December 31, 2019, the Severe Acute Respiratory syndrome Coronavirus-2 (SARS-CoV-2) was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei province of China and has been responsible for over 40,000 deaths worldwide. Data on the epidemiologic characteristics and clinical features, diagnosis and management of infected children are limited. Despite the high mortality rate of Middle East Respiratory syndrome and SARS in adults, the morbidity and mortality rates in children are low. Understanding the role of paediatric population in the transmission dynamics of the outbreak is important and critical for effective disease containment with respect to the public health. The aetiology of the milder disease form caused by the CoVs, including SARS-CoV- 2, remains unknown in children. İnfected children may be asymptomatic or have fever, dry cough, and fatigue and rarely have severe disease. Asymptomatic children may be driving the transmission of CoV more than we realise. Early diagnoses and treatment along with careful isolation can limit the outbreak. Children may help in future development of immunotherapy and vaccines for SARS-CoV-2. This review aimed to summarise current data available on SARS-CoV-2 pandemic to manage the diagnosis, treatment, and prevention of CoV disease 2019 in the paediatric population.

At the end of 2019, the pandemic, which originated in China, has become a major concern all over the world. A new coronavirus, severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has been defined as the reason for a cluster of unknown pneumonia. Thus far, no precise therapy or vaccine has been shown to be effective against SARS-CoV-2 infection. Mild cases can be treated by supportive care although symptomatic treatment is not enough for critically ill patients. However, extracorporeal membrane oxygenation, convalescent (immune) plasma (CIP) and certain specific antiviral drugs for this disease are still being investigated for improving the survival rate of cases with SARS-CoV-2 infection whose condition continued to deteriorate. The use of passive immunization, for the prophylaxis and therapy of human contagious diseases, has been gone back to the 20th century. Human whole blood is also a source of antibodies. CIP consists of collecting blood plasma from someone who has recovered from a specific infection. Recent literature data show that human CIP may be an alternative option for managing coronavirus disease 2019 (COVID-19) and will be accessible when adequate numbers of individuals have improved. However, such donors should have a high titer of neutralizing immunoglobulin-containing plasma. CIP can be administered to improve the survival rate for COVID-19, together with other drugs and preventive measures, when specific management is not obtainable. On the other hand, randomized clinical trials are still necessary to assess the safety and efficiency of CIP in the therapy of COVID-19. In this article, we want to address the special role of CIP therapy in various infectious diseases from yesterday to today, including COVID-19.

Family of coronavirus has significant human and animal pathogens. In the end of December 2019, a new coronavirus was recognized as the reason of a group of pneumonia cases of unidentified etiology in Wuhan, a city in the Hubei Province of China. It has rapidly become widespread, resulting in an epidemic throughout China, followed by a pandemia, increasing number of cases in various countries throughout the world. Coronavirus disease 2019 (COVID-19) is spread through large droplets produced during coughing and sneezing by symptomatic patients as well as asymptomatic individuals before starting of their symptoms. The incubation period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is assumed to be 14 days succeeding exposure, mostly around 4 to 5 days. Individuals of all ages can acquire SARS-CoV-2 infection, although middle age and older individuals are the majority. The usual clinical characteristics involve fever, dry cough, fatigue, sore throat, rhinorrhea, conjunctivitis headache, myalgia, dyspnea, nausea, vomiting and diarrhea. Hence, there are no unique clinical features that yet dependably differentiate COVID-19 disease from other upper/lower airway viral infections. In a subgroup of cases, by the end of the first week COVID-19 disease can develop to pneumonia, pulmonary failure and death. Aim is here to discuss the COVID-19 disease beginning from virology, epidemiology and continuing with clinical manifestations, diagnosis, its complications and to finish with available therapeutic options and conclusion.

Tetanos, Clostridium tetani’nin ürettiği ekzotoksinlerin neden olduğu, nadir ve ölümcül seyredebilen bir hastalıktır. Çocukluk çağının hiçbir aşısı yapılmamış olan ve mülteci olarak ükemize gelen yedi yaş erkek hasta tüm vücutta kasılma ve ağrı şikâyeti ile başvurdu. Alınan anamnezde bir hafta önce düşme sonrası ayağına paslı çivi batma öyküsü olduğu ve sonrasında herhangi bir sağlık kuruluşuna başvurmadığı öğrenildi. Hastaya tetanos tanısı konuldu ve çocuk yoğun bakım ünitesinde izleme alındı. Hastaya tetanos aşısı ve tetanos immünglobulin yapıldı. Penisilin tedavisi başlandı. Yara yeri debride edildi. Takibinde kasılmaları artan ve solunum sıkıntısı gelişen hasta entübe edildi. Sonrasında arrest olan hastaya kardiyopulmoner resusitasyon uygulandı. Hastanın izleminde akut böbrek yetmezliği ve dissemine intravasküler koagülasyon gelişmesi üzerine çoklu organ yetmezliği düşünülen hasta takibinde exitus oldu. Sonuç olarak, görülme sıklığındaki artış nedeni ile özellikle yaralanmalar sonrası santral sinir sistemi bulguları ile başvuran hastalarda aşı öyküsü mutlaka sorgulanmalı ve ayırıcı tanıda tetanos düşünülmelidir.

Anaphylaxis is a rapidly progressive and fatal type I hypersensitivity reaction. Food, venom and drugs are the most frequent triggers of anaphylaxis. Idiopathic anaphylaxis is identified when other causes are excluded, and there is no specific trigger. A four-year-old boy presented to the hospital six times in the last 16 months with complaints of eyes and lips angioedema, urticaria and dyspnoea; some reactions were considered to be triggered by a stimulus (e.g., walnut, Turkish pizza or peach), whereas some were considered to have started spontaneously. Although he got bronchiolitis at the eighth month, there was no other history of illness. His brother is allergic to grass pollens. Physical examination revealed no pathologic findings on admission. Laboratory tests showed eosinophil count of 735/mm3, total IgE of 407 IU/mL, meadow pollen-specific IgE of 66, dust mix-specific IgE of 7 and tomato-specific IgE of 0.6 kU/L. Serum C4 and tryptase levels were normal. Various H1/H2 antihistamines, montelukast and adrenalin autoinjector were prescribed for the reactions. He was diagnosed with idiopathic anaphylaxis according to detailed anamnesis and laboratory results, although he was considered to have food-induced anaphylaxis at the beginning.

It is well-known that asthma patients show compromised production of antiviral interferons and lower expression of ACE-2, most likely owing to ACE-2 expression is inversely correlated with type 2 (Th2: T helper 2) cytokine levels of asthmatics. However, COVID-19 patients with poor outcomes show early vigorous type I interferon expression. This does not match with the pathophysiology of worse COVID-19 disease development in asthma patients. Actually, why asthma might protect against poor outcomes in COVID-19 is explained in detail in recent reviews. Some new data even show decreased mortality in asthma patients. There were no flawless data that asthma patients are at a greater risk of becoming severely ill with SARS-CoV-2 infection, although current reports from the United States and the United Kingdom indicate that asthma is much more common in children and adults with COVID-19 than was formerly described from Asia as well as from central Europe.

Dear Editor, Recent studies suggest non-severe and severe stages of SARS-CoV-2 infection. During the incubation and non-severe stage of the virus, the immune system eliminates the virus and prevent its progression which non-steroidal anti-inflammatory drugs (NSAIDs) may also interfere with immune system [1]. The severe stage includes lung inflammation where it is associated with acute immune response and cytokine storm, which may raise questions regarding the use of NSAIDs [2]. According to the reports of The French Regional Pharmacovigilance Centers (CRPVs) based on according to clinical, experimental, pharmacological, and epidemiological data in 2019, NSAIDs (especially ibuprofen) aggravates bacterial infection (in particular pulmonary infection). CRPV suggest use of the NSAIDs should be avoided in the symptomatic treatment of complications such as fever, pain, and myalgia that in case of infection [3]. In hospitals of Dutch University, thrombotic complications were observed in 31% of 184 SARS-COV-2 infected patients hospitalized in intensive care unit, and pulmonary embolism made up of 81% of these complications [4]. Arian et al. stated that there is no definitive link between ibuprofen and pulmonary embolism, and the existing data are conflicted. They argued that it is not known how ibuprofen interacts with SARS-CoV-2 mechanism, nonetheless high doses of ibuprofen should be avoided in patients with suspected thromboembolic events [5]. Furthermore, Committee on Human Medicines in UK reports there is no sufficient data on the use of ibuprofen and its association with COVID-19, or worsening symptoms [6]. According to a study investigating the effect of ibuprofen on cardiac fibrosis in diabetic rats, ibuprofen increased expression of angiotensin-converting enzyme 2 (ACE2) [7]. This is important since ACE2 receptor is a gateway for SARS-COV-2 to enter into the human body [8]. In conclusion, concerns have arisen that NSAIDs interact with COVID-19 infection or aggravates symptoms. There are no extensive and comprehensive clinical studies showing pros and cons of NSAID use in COVID-19 positive patients. It is important for COVID-19 patients to avoid high doses and be aware of side effects of ibuprofen.

High dose IVIG has been an appropriate immunomodulatory treatment option for prophylaxis of severe infections in autoimmune and inflammatory diseases [1]. It is suggested that the plasma levels of pro-inflammatory cytokines are higher in COVID-19 patients with severe clinical course and there is a cytokine storm related to the severity of the disease. Therefore, IVIG is presented as a treatment option in severe COVID-19 patients [2]. Mechanisms suggesting the benefit of IVIG in SARS-CoV2 therapy can be counted as; neutralizing antibodies binding to the ACE2 receptor to prevent viral entry into the cell, blocking receptors associated with the target cell and preventing pathogens from damaging the cell [3,4]. In addition, IVIG has IgG dimers that inhibit FcR activation on natural immune effector cells. This prevents antibody-dependent enhancement (ADE), a paradoxical condition that allows the pathogen to enter the cell [5,6]. It has also been observed to improve coagulation abnormalities in septic patients that deteriorate due to inflammatory events in the pathogenesis of COVID-19 [7]. In previous studies of SARS and MERS, the benefit of IVIG treatment has been demonstrated [8]. Wang et al. reported that 40 patients with SARS were given IVIG, 22 of whom had severe cytopenia, and a significant improvement in leukocyte and platelet counts was noted after IVIG [9]. In a case series reported by Cao et al., IVIG was given 0.3-0.5 g per kg weight per day for five days to 3 patients with severe COVID-19 pneumonia diagnosed by CT scan. It was reported that patients showed a rapid recovery 2 days after IVIG treatment and their CT scan findings were improved. In addition, no side effects were reported in any of the 3 patients [10]. Lanza et al. reported an increased need for oxygen in 42-year-old woman diagnosed with COVID-19 on the 6th day and bilateral infiltration and consolidation worsened in the CT findings, and the radiological findings and blood values were rapidly improved after 4 days of high-dose IVIG treatment [3]. IVIG can interrupt the storm of inflammatory factors at an early stage, enhance immune function. Ling and colleagues recommended early initiation of IVIG treatment for severe and critical type COVID-19 patients [11]. In summary, early use of IVIG therapy in selected cases for COVID-19 pneumonia has been reported to shorten hospital stay, reduce the need for mechanical ventilation, and benefit patients' early recovery. More controlled studies are needed to demonstrate therapeutic benefits of this IVIG therapy.

Dear Editor, COVID-19 is a new type of respiratory infection and might lead to serious pneumonia causing acute respiratory distress syndrome (ARDS). Most people infected with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) manifest as having asymptomatic or mild to moderate upper respiratory tract disease. However, a minority of all can have severe course and even death, especially elderly patients.1 Here, one of the possible reasons, BCG vaccination and its impact, causing this difference in a population is delineated more. Can BCG vaccine reprogram natural (innate) immunity and decrease spread of COVID-19? Since the first use of BCG vaccine in Europe in the 1920s, a serious decrease in infant mortality has been reported. It is not likely to explain this decline only with the decrease in tuberculosis frequency. The reason for this decrease in infant mortality was reported to be associated with decline in neonatal sepsis and respiratory infections. In another study, this hypothesis was supported by showing that the frequency of respiratory syncytial virus (RSV) infection reduced in population after BCG vaccine.2 In a South African study, 70 percent of BCG vaccinated adolescents had a decrease in respiratory infections as well. BCG application also reduced influenza A viral load in mice through affecting macrophages. Similarly, BCG vaccine increased the cytokines and peritoneal macrophages against many unrelated pathogens in mice. In the healthy population, BCG vaccination increased the release of proinflammatory cytokines (eg. IL-1β, TNF-α and IL-6).3 Could BCG vaccine be a weapon in reducing the morbidity and mortality of COVID-19? The countries such as Italy, Holland and USA applying non-universal BCG vaccination policies, it is noteworthy that COVID-19 progresses more severely, compared to the countries following the universal policy. In epidemiological studies, the rate and death of COVID-19 in countries where BCG vaccination applied was also quite lower than non-vaccinated countries. Statistical evaluation of the current data of both European countries and countries in the Northern and Southern Hemisphere, the incidence and mortality of COVID-19 per population was also found lower in BCG-vaccinated countries. If same countries were separately assessed, BCG vaccination has not been performed in Italy, England and France where mortality of COVID-19 was higher. Nevertheless the mortality rates were relatively lower in the countries (Qatar, Saudi Arabia and China); whose BCG vaccination rates in 2018 were very high at 99%, 98%, 99%; respectively.4,5 Although there are differences in genetic, demographic, non-pharmacological measures, diagnosis and reporting between nations, possible inverse direct relation between BCG vaccination and COVID-19 looks interesting. Severity of SARS-CoV-2 infection in elderly might be due to long time past after the BCG’s positive effect on innate immunity. Consistently, COVID-19 often manifests as asymptomatic/mildly symptomatic since shorter time passed in younger than in the elderly after BCG vaccination.