Diandric triploid partial mole versus digynic nonmolar triploidy: is morphological assessment sufficient for the diagnostic distinction?

AIMS: Diagnostic separation of diandric triploid gestation, i.e. partial mole from digynic triploid gestation, is clinically relevant, as the former may progress to postmolar gestational trophoblastic neoplasia. The aim of the study was to investigate if the combination of abnormal histology combined with ploidy analysis-based triploidy is sufficient to accurately diagnose partial mole. METHODS AND RESULTS: A genotype-phenotype correlation study was undertaken to reappraise histological parameters among 20 diandric triploid gestations and 22 digynic triploid gestations of comparable patient age, gestational weeks, and clinical presentations. Two villous populations, irregular villous contours, pseudoinclusions, and syncytiotrophoblast knuckles, were common in both groups. Villous size ≥2.5 mm, cistern formation, trophoblastic hyperplasia, and syncytiotrophoblast lacunae were significantly more common in the partial hydatidiform mole. Cistern formation had the highest positive predictive value (PPV) (93%) and highest specificity (96%) for diandric triploid gestation, although the sensitivity was 70%. Cistern formation combined with villous size ≥2.5 mm or trophoblast hyperplasia or syncytiotrophoblast lacunae had 100% specificity and PPV, but a marginal sensitivity of 60%-65%. A moderate interobserver agreement (Kappa = 0.57, Gwet's AC1 = 0.59) was achieved among four observers who assigned diagnosis of diandric triploid gestation or digynic triploidy solely based on histology. CONCLUSIONS: None of histological parameters are unique to either diandric triploid gestation or digynic triploid gestation. Cistern formation is the most powerful discriminator, with 93% PPV and 70% sensitivity for diandric triploid gestation. While cistern formation combined with either trophoblastic hyperplasia or villous size ≥2.5 mm or syncytiotrophoblast lacunae has 100% PPV and specificity for diandric triploid gestation, the sensitivity is only 60% to 65%. Therefore, in the presence of triploidy, histological assessment is unable to precisely classify 35% to 40% of diandric triploid gestations or partial moles.

Novel FOXL2 Mutation in an Ovarian Adult Granulosa Cell Tumor: Report of a Case With Diagnostic and Clinicopathologic Implications.

Adult granulosa cell tumor, the most common malignant ovarian sex cord-stromal tumor, harbors the characteristic mutation c.402C>G (p.C134W) in the FOXL2 gene in ~90% to 95% of cases. To date, no other variants of FOXL2 mutations have been identified in these tumors. Here we report the first case of an adult granulosa cell tumor with a novel FOXL2 point mutation c.398C>T (p.A133V) presenting in a 64-year-old postmenopausal woman. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia and gross examination revealed an incidental 3.2 cm right ovarian mass with a solid, bright yellow, homogeneous cut surface. Microscopically, ~30% of the tumor showed a nested growth pattern composed of uniform tumor cells with oval nuclei and a moderate amount of pale cytoplasm, while the remaining areas consisted of a bland storiform fibromatous stroma. Reticulin stain demonstrated loss of the individual pericellular network within the nested areas, while the pericellular staining pattern was retained in the background stromal component. FOXL2 sequencing analysis was performed in both components and revealed a c.398C>T (p.A133V) mutation in the nested component, whereas wild-type FOXL2 sequence was identified in the fibromatous stroma. Sections from the uterus showed a low-grade endometrioid endometrial adenocarcinoma with superficial myometrial invasion. The patient underwent adjuvant vaginal cuff brachytherapy for the endometrial carcinoma and is alive and well at 8 months follow-up. This case illustrates that new FOXL2 mutations may be detected in ovarian sex cord-stromal tumors with increasing use of routine molecular testing, adding to the complexity of the pathologic diagnosis. In the right morphologic and clinical context, a FOXL2 mutation-even if it is different from the dominant hotspot mutation c.402C>G (p.C134W)-can support the diagnosis of adult granulosa cell tumor.

Healthcare-seeking of medical students: the effect of socio-demographic factors, health behaviour and health status - a cross-sectional study in Hungary.

BACKGROUND: Medical students are more likely to have various physical and psychological issues, but less information is available about the healthcare-seeking behaviour for physical and mental health issues. The aim of this study is to determine the factors affecting medical students' healthcare-seeking when visiting a general practitioner (GP) and/or psychologist. METHODS: 688 medical students (326 International and 362 Hungarian,) participated in a cross-sectional study. The information was gathered using a self-administered online questionnaire and covered socio-demographic background, health behaviour, general and mental health status and healthcare-seeking. For analysing adjusted associations, multivariable logistic regression models were used. RESULTS: Overall, 56.8% of medical students visit the GP; and 17.2%, the psychologist. Hungarian medical students visited the GP with chronic diseases, International medical students were more likely to visit a GP when they encountered sexual activity and had chronic diseases. Moreover, there was a significant correlation between sex, alcohol consumption, and perceived stress in the total sample of psychologist visits. When Hungarian medical students were in their clinical years and had a poor self-rated mental health, they were more likely to visit a psychologist. Whereas female international medical students and those who had poor self-rated mental health were more likely to seek psychological help. CONCLUSION: Students visit a GP and/or psychologist is associated with a variety of factors, including socio-demographic background, health behaviours, and health issues. Medical schools should encourage help-seeking behaviours and early disclosure of medical students. Their ability to grasp healthcare attitudes and designing treatments will be important for both their academic success and future profession.

Influence of microbial inoculants on co-composting of lignocellulosic crop residues with farm animal manure: A review.

The rapidly developing agro-industry generates huge amounts of lignocellulosic crop residues and animal manure worldwide. Although co-composting represents a promising and cost-effective method to treat various agricultural wastes simultaneously, poor composting efficiency prolongs total completion time and deteriorates the quality of the final product. However, supplementation of the feedstock with beneficial microorganisms can mitigate these negative effects by facilitating the decomposition of recalcitrant materials, enhancing microbial enzyme activity, and promoting maturation and humus formation during the composting process. Nevertheless, the influence of microbial inoculation may vary greatly depending on certain factors, such as start-up parameters, structure of the feedstock, time of inoculation, and composition of the microbial cultures used. The purpose of this contribution is to review recent developments in co-composting procedures involving different lignocellulosic crop residues and farm animal manure combined with microbial inoculation strategies. To evaluate the effectiveness of microbial additives, the results reported in a large number of peer-reviewed articles were compared in terms of composting process parameters (i.e., temperature, microbial activity, total organic carbon and nitrogen contents, decomposition rate of lignocellulose fractions, etc.) and compost characteristics (humification, C/N ratio, macronutrient content, and germination index). Most studies confirmed that the use of microbial amendments in the co-composting process is an efficient way to facilitate biodegradation and improve the sustainable management of agricultural wastes. Overall, this review paper provides insights into various inoculation techniques, identifies the limitations and current challenges of co-composting, especially with microbial inoculation, and recommends areas for further research in this field.

[Connection between satisfaction with relationship-, life, well-being and the development of the family structure].

INTRODUCTION: The study is focusing on the relationships between several different, widely researched topics - such as satisfaction with relationship and life, well-being and the development of family structure - and examining them from different perspectives. In general, satisfaction with life, just as the subjective well-being displays high correlation with relationship satisfaction, which has effect on the development of the family structure as well. According to our assumption, those people who live in a happy and balanced relationship/marriage are happier and more satisfied with their lives. All of this is substantially influenced by one of the most important issues in people's lives/relationships, that is childbearing. This is also considerable for the development of life satisfaction and well-being. Moreover, a more balanced relationship is supposed to have a positive relationship with family cohesion, flexibility and communication within the family. METHOD: In the present study, we examined on our entire database the relationship between life satisfaction, well-being, relationship satisfaction and the possible changes in all of these relationships depending on the changes in the family structure. In our analysis, we also examined the effect of children's presence in the family in relation with relationship satisfaction. 192 people participated in the present study. RESULTS: According to the results, life satisfaction and the optimal communication within the family have a positive effect on relationship satisfaction. Satisfaction with family communication proved to be the strongest predictor. Despite our hypothesis, the number and age of children - more children and younger age - did not show a negative correlation with relatinship satisfaction. CONCLUSION: Not just during a crisis, under optimal circumstances, several factors affect relationship satisfaction, but the main influencing aspect is an optimal family structure. In a well-functioning family, the optimal level of communication has a positive effect on the development of the relationship, whereas disintegration and inadequate communication can lead to severe dysfunction both in terms of the relationship and the family unit. The results from the analysis show important conclusions and reveal new research directions, which should be examined in a larger sample in the future.

Health-related quality of life and utility outcomes with selinexor in relapsed/refractory diffuse large B-cell lymphoma.

Aim: Evaluate health-related quality of life (HRQoL) and health utility impact of single-agent selinexor in heavily pretreated patients with relapsed/refractory diffuse large B-cell lymphoma. Patients & methods: Functional Assessment of Cancer Therapy (FACT) - Lymphoma and EuroQoL five-dimensions five-levels data collected in the single-arm Phase IIb trial SADAL (NCT02227251) were analyzed with mixed-effects models. Results: Treatment responders maintained higher FACT - Lymphoma (p ≤ 0.05), FACT - General (p < 0.05) and EuroQoL five-dimensions five-levels index scores (p < 0.001) beginning in cycle 3. The estimated difference in health state utilities for treatment response and progressive disease was both statistically significant and clinically meaningful (mean difference: 0.07; p = 0.001). Conclusion: In patients with relapsed/refractory diffuse large B-cell lymphoma, objective response to selinexor was associated with HRQoL maintenance, reduction in disease-related HRQoL decrements and higher health utilities.

Lay abstract This work examined quality of life (QoL) among patients with relapsed/refractory diffuse large B-cell lymphoma with two to five prior therapies who received single-agent selinexor in the SADAL clinical trial. Analysis of patient-reported Functional Assessment of Cancer Therapy ­ Lymphoma and EuroQoL five-dimensions five-levels data showed that patients who had objective clinical response to selinexor maintained their QoL over the course of treatment. Grade ≥3 adverse events and serious adverse events were not associated with clinically meaningful negative QoL impacts. Clinical trial registration: NCT02227251 (ClinicalTrials.gov).

A Review on Stems Composition and Their Impact on Wine Quality.

Often blamed for bringing green aromas and astringency to wines, the use of stems is also empirically known to improve the aromatic complexity and freshness of some wines. Although applied in different wine-growing regions, stems use remains mainly experimental at a cellar level. Few studies have specifically focused on the compounds extracted from stems during fermentation and maceration and their potential impact on the must and wine matrices. We identified current knowledge on stem chemical composition and inventoried the compounds likely to be released during maceration to consider their theoretical impact. In addition, we investigated existing studies that examined the impact of either single stems or whole clusters on the wine quality. Many parameters influence stems' effect on the wine, especially grape variety, stem state, how stems are incorporated, when they are added, and contact duration. Other rarely considered factors may also have an impact, including vintage and ripening conditions, which could affect the lignification of the stem.

Feasibility and Safety of Controlled Active Hypothermia Treatment During Transport in Neonates With Hypoxic-Ischemic Encephalopathy.

OBJECTIVES: To evaluate the feasibility and safety of controlled active hypothermia versus standard intensive care during neonatal transport in patients with hypoxic-ischemic encephalopathy. DESIGN: Cohort study with a historic control group. SETTING: All infants were transported by Neonatal Emergency & Transport Services to a Level-III neonatal ICU. PATIENTS: Two hundred fourteen term newborns with moderate-to-severe hypoxic-ischemic encephalopathy. An actively cooled group of 136 newborns were compared with a control group of 78 newborns. INTERVENTIONS: Controlled active hypothermia during neonatal transport. MEASUREMENTS AND MAIN RESULTS: Key measured variables were timing of hypothermia initiation, temperature profiles, and vital signs during neonatal transport. Hypothermia was initiated a median 2.58 hours earlier in the actively cooled group compared with the control group (median 1.42 [interquartile range, 0.83-2.07] vs 4.0 [interquartile range, 2.08-5.79] hours after birth, respectively; p < 0.0001), and target temperature was also achieved a median 1.83 hours earlier (median 2.42 [1.58-3.63] vs 4.25 [2.42-6.08] hours after birth, respectively; p < 0.0001). Blood gas values and vital signs were comparable between the two groups with the exception of heart rate, which was significantly lower in the actively cooled group. The number of infants in the target temperature range (33-34°C) on arrival was 79/136 (58.1%) and the rate of overcooling was 16/136 (11.8%) in the actively cooled group. In the overcooled infants, Apgar scores, pH, base deficit, and eventual death rate (7/16; 43.8%) indicated more severe asphyxia suggesting poor temperature control in this subgroup of patients. Adverse events leading to pulmonary or circulatory failure were not observed in either groups during the transport period. CONCLUSIONS: Therapeutic hypothermia during transport is feasible and safe, allowing for significantly earlier initiation and achievement of target temperature, possibly providing further benefit for neonates with hypoxic-ischemic encephalopathy.

[The role of autologous hemopoietic stem cell transplantation in T-cell lymphoma. Hungarian data]. / Autológ haemopoeticus ossejt-transzplantáció szerepe T-sejtes lymphomában. Magyar adatok.

T-cell lymphoma is a poor prognostic hematological malignancy. The generally used - not sufficiently effective - induction chemotherapy should be improved with consolidative autologous hemopoetic stem cell transplantation. The authors describe the role, place and effectiveness of transplantation in this disorder. One hundred thirty three autologous stem cell transplantations were performed in the last 22 years in Hungary. Detailed results are available from the last 6 years. In this period 43 transplantations were carried out in 4 Hungarian centers. Carmustine-etoposide-cytosine arabinoside-melphalan (BEAM) conditioning regimen was used in 95%. The transplantation was done mainly in complete remission (84%), 1 year after transplantation 65% of patients were still in complete remission. Eleven patients died, 82% of them have progressive disease. Brentuximab vedotin has already proved the effectiveness, several other chemoterapeutics, monoclonal antibodies, kinase inhibitors are under investigation. In certain cases allogeneic stem cell transplantation has real indication among therapeutic options. Orv Hetil. 2017; 158(41): 1615-1619.

Exchange-Correlation Catastrophe in Cu-Au: A Challenge for Semilocal Density Functional Approximations.

Semilocal density functional approximations occupy the second rung of the Jacob's ladder model and are thus expected to have certain limits to their applicability. A recent study [Y. Zhang, G. Kresse, and C. Wolverton, Phys. Rev. Lett. 112, 075502 (2014)] hypothesizes that the formation energy, being one of the key quantities in alloy theory, would be beyond the grasp of semilocal density functional theory (DFT). Here, we explore the physics of semilocal DFT formation energies and shed light on the connection between the accuracy of the formation energy and the ability of a semilocal approximation to produce accurate lattice constants. We demonstrate that semilocal functionals designed to perform well for alloy constituents can concomitantly solve the problem of alloy formation energies.

[Actual questions about the prevention of venous thromboembolism in cancer patients receiving chemotherapy]. / A kórházi és az ambuláns kemoterápiában részesülo onkológiai betegek vénásthromboembolia-profilaxisának aktuális kérdései.

Cancer patients have a 2-7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review summarizes the current knowledge on venous thromboembolism and cancer. Notably, the risk of venous thromboembolism varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of venous thromboembolism than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors, cytokines and growth factors may directly and indirectly enhance venous thromboembolism. Chemotherapy produces ~6,5 fold increase in venous thromboembolism incidence in cancer patients compared to the general population. Prevention of this complication is challenging. The authors review the development of guidelines concerning venous thromboembolism prevention in hospitalized and also in ambulatory cancer patients treated with chemotherapy. Current guidelines recommend the use of low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent venous thromboembolism in cancer patients.

Marked differences in frequencies of statin therapy relevant SLCO1B1 variants and haplotypes between Roma and Hungarian populations.

BACKGROUND: SLCO1B1 polymorphisms are relevant in statin pharmacokinetics. Aim of this study was to investigate the genetic variability and haplotype profile of SLCO1B1 polymorphisms in Roma and Hungarian populations. Genotypes of 470 Roma and 442 Hungarian subjects for c.388A > G, c.521T > C and c.1498-1331T > C polymorphisms were determined by PCR-RFLP assay. Using these SNPs eight different haplotypes could be differentiated. RESULTS: Differences were found between Roma and Hungarians in SLCO1B1 388AA (24.5 vs. 45.5 %), GG (33.4 vs. 17.9 %) genotypes, AG + GG (75.5 vs. 54.5 %) carriers, in G allele frequency (0.545 vs. 0.362), respectively (p < 0.001). The most common SLCO1B1 haplotype was the ht8 (GTT) both in Roma (43.6 %) and in Hungarian (59.1 %) samples. The ht6 (GCT) was not present in Roma population samples Haplotype analyses showed striking differences between the Roma and Hungarian samples in ht4 (ATT, 37.2 % vs 20.8 %), ht5 (GCC, 1.15 % vs. 3.62 %) and ht8 (GTT, 43.6 % vs. 59.1 %) haplotypes (p < 0.01), respectively. Linkage disequilibrium analysis showed that the studied variants are in different linkage disequilibrium patterns depending on the ethnic origin. CONCLUSIONS: Similarly to Caucasians the 388G is the minor allele in Hungarians, however, in Roma the 388A was found to be the minor allele contrary to Indians (India). The minor allele frequency of 521T > C and 1498-1331T > C SNPs are almost three times higher in Romas than in Indians (Singapore and Gujarati, respectively). Observed allele frequency for 1498-1331T > C polymorphism reflects the measured average European rates in Hungarians. The results can be applied in population specific treatment algorithms when developing effective programs for statin therapy.

[Dental and oral surgical treatment of a B haemophilic patient with high inhibitor level. Case report]. / Magas inhibitor titeru B-haemophiliás beteg fogorvosi-szájsebészeti ellátása. Esetismertetés.

More than 1000 hemophilic male patients are registered in Hungary, from which only a trace number suffers from factor IX inhibitory hemophilia. For correct dental and oral surgical treatment of these patients mandatory cooperation is required among medical specialties, exerting multi-staged haemostatic principles. Authors represent in this case report the dental and oral surgical treatment of a B hemophilic patient with high inhibitor level and describe possible local haemostatic measures.

Hypersensitive quantification of major astringency markers in food and wine by substoichiometric quenching of silicon-rhodamine conjugates.

Tannins are chemically diverse polyphenols in plant-derived products that not only show diverse biological activities but also play a crucial role in determining the sensory attributes of food and beverages. Therefore, their accurate and cost-effective quantification is essential. Here, we identified a novel fluorescence quenching mechanism of different synthetic rhodamine fluorophores, with a high selectivity towards tannic acid (TA) and catechin-3-gallate (C3G) compared to a structurally diverse panel of tannins and polyphenols. Specific chemical conjugates of silicon-rhodamine with alkyl linkers attached to bulky apolar moieties had a limit of detection near 500 pM and a linear range spanning 5-100 nM for TA. We validated the assay on 18 distinct red wine samples, which showed high linearity (R2 = 0.92) with methylcellulose precipitation with no interference from anthocyanins. In conclusion, a novel assay was developed and validated that allows the sensitive and selective quantification of major astringency markers abundant in food and beverages.

Extended release quetiapine fumarate and pregnancy.

We report on a case of a patient with schizophrenia who was taking 700 mg extended release quetiapine fumarate during her entire pregnancy to prevent relapse. At week 41 she gave birth to a healthy boy. The newborn's weight was 3410 gramms, his height was 49 cm, his Apgar score in the first minute was 9, and at 5 minutes, it was 10.

Overconfidence at the time of COVID-19:Does it lead to laxer attitudes?

BACKGROUND: Health education campaigns often aim to create awareness by increasing objective knowledge about pathogens, such as COVID-19. However, the present paper proposes that confidence in one's knowledge more than knowledge is a significant factor that leads to a laxer attitude toward COVID-19 and hence lower support for protective measures and reduced intention to comply with preemptive behaviors. METHODS: We tested two hypotheses in three studies conducted between 2020 and 2022. In Study 1, we assessed participants' level of knowledge and confidence, as well as attitudes toward COVID-19. In Study 2, we tested the relation between fear of COVID-19 and protective behaviors. In Study 3, we used an experimental approach to show the causal effect of overconfidence on fear of COVID-19. In addition to manipulating overconfidence and measuring fear of COVID-19, we also measured prophylactic behaviors. RESULTS: In Study 1, more overconfident participants had a laxer attitude toward COVID-19. While knowledge had an increasing effect on worry, confidence in said knowledge significantly decreased worry about COVID-19. In Study 2, participants who were more worried about COVID-19 were more likely to engage in protective behaviors (e.g., wearing masks). In Study 3, we show that when overconfidence was experimentally diminished, fear of COVID-19 increased. The results support our claim that the effect of overconfidence on attitudes toward COVID-19 is causal in nature. Moreover, the results show that people with higher fear of COVID-19 are more likely to wear masks, use hand sanitizers, avoid crowded places or social gatherings, and get vaccinated. CONCLUSIONS: Managing adherence to public health measures is critical when it comes to highly infectious diseases. Our findings suggest that efficient information campaigns to increase adherence to public health measures should focus on calibrating people's confidence in their knowledge about COVID-19 to prevent the spread of the virus.

Recycled Fine and Coarse Aggregates' Contributions to the Fracture Energy and Mechanical Properties of Concrete.

This paper investigates the fracture mechanical properties of concrete, using crushed concrete aggregates (CCA) and granulated blast furnace slag (GGBS) for partial cement replacement. CCAs made from prefabricated concrete replace 100% of the fine and coarse fractions in concrete recipes with w/c ratios of 0.42 and 0.48. Two pre-treatment methods, mechanical pre-processing (MPCCA) and accelerated carbonation (CO2CCA), are investigated for quality improvements in CCA. The resulting aggregates show an increased density, contributing to an increase in the concrete's compressive strength. The novelty of this paper is the superposition of the effects of the composite parts of concrete, the aggregate and the cement mortar, and their contributions to concrete fracture. Investigations are directed toward the influence of fine aggregates on mortar samples and the influence of the combination of coarse and fine aggregates on concrete samples. The physical and mechanical properties of the aggregates are correlated with mortar and concrete fracture properties. The results show that CCA concrete achieves 70% of the fracture energy values of concrete containing natural aggregates, and this value increases to 80% for GGBS mixes. At lower w/c ratios, MPCCA and CO2CCA concretes show similar fracture energies. CO2CCA fine aggregates are the most effective at strengthening the mortar phase, showing ductile concrete behavior at a w/c ratio of 0.48. MPCCA aggregates contribute to higher compressive strengths for w/c ratios of 0.42 and 0.48. Thus, mechanical pre-processing can be improved to produce CCA, which contributes to more ductile concrete behavior.

Assessment Tools Measuring Fundamental Movement Skills of Primary School Children: A Narrative Review in Methodological Perspective.

This paper aimed to analyze fundamental movement skill (FMS) assessment tools that could be used for primary school children. In this narrative review, the Motoriktest für Vier- bis Sechjärige Kinder (MOT 4-6), Movement Assessment Battery for Children-2 (M-ABC-2), Motorische Basiskompetenzen (MOBAK) Körperkoordinationtest für Kinder (KTK), Test of Gross Motor Development (TGMD), Maastricht Motoriek Test (MMT) and the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) were analyzed from a methodological perspective, such as the number of test items, tools and types of tests, in terms of the FMS area. The analysis revealed that to assess locomotor movement skills, the BOT-2 has an excellent test for running ability, but for detecting technical difficulties, the TGMD is recommended. To test hopping, the MMT is the best test. Object control movement skills are measured with throws, dribbles and catches. Most of the tools assessed these skills, but it turned out that the TGMD is the best for measuring object control. Stability movement skills are tested with static and dynamic balance tests. Dynamic balance is more frequently used, and the MOT 4-6, KTK and BOT-2 have the most tools to use. However, the MMT is an excellent test for static balance. Fine motor movement skills are easy to assess with the MMT and MOT 4-6, since they have low equipment requirements. The BOT-2 is the best measurement tool; however, it has high equipment requirements. All of the FMS assessment tools are good; however, we concluded that although these tools are excellent for research purposes, they are difficult to apply in a school setting. Thus, teachers and coaches are advised to always select a single task from the available assessment tools that is appropriate for the skills they would like to measure.

Acquired Hemophilia A after SARS-CoV-2 Infection: A Case Report and an Updated Systematic Review.

The role of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been implicated in the pathogenesis of acquired hemophilia A (AHA). The aim of this study is to report our case and to summarize clinical studies on de novo AHA after SARS-CoV-2 infection. We performed a systematic search on the association of SARS-CoV-2 with AHA in four medical databases up to 28 May 2023. Eligible studies should include de novo AHA patients who had SARS-CoV-2 infection before or concomitant with the diagnosis of AHA. Findings were synthesized narratively. In addition, we report the case of a 62-year-old female patient, who presented to our clinic with left flank pain 2 weeks after SARS-CoV-2 infection. Clinical investigations confirmed AHA and imaging studies revealed retroperitoneal bleeding. Her hemostasis was successfully secured with bypassing agents; however, despite immunosuppressive therapy, high inhibitor titer persisted. In the systematic review, we identified only 12 relevant cases with a questionable cause-effect relationship between SARS-CoV-2 infection and AHA. Based on the qualitative analysis of the relevant publications, current clinical evidence is insufficient to support a cause-effect relationship. The analysis of data from ongoing AHA registries can serve further evidence.