Acute embolisms in multiple arterial districts following Ad26.COV2-S vaccine.

A case of multiple arterial thrombosis/embolisms in a 74-year-old Caucasian man with no other cardiovascular risk factors who received Ad26.COV2-S vaccine 16 days before is reported. The unusual presentation required a longer diagnostic workup. The clinical manifestations and the therapy-specific response suggest an unusual presentation of Vaccine-induced immune thrombotic thrombocytopenia (VITT).

Evidence of hepatitis E virus (HEV) infection in human and pigs in Sardinia, Italy.

INTRODUCTION: The aim of this study was to determine the seroprevalence of anti-HEV antibodies in humans sera and to study HEV prevalence in swine from different Sardinian farms, testing viral HEV-RNA in bile samples. METHODS: In the first six months of 2008, 532 subjects of whom 402 blood donors and 130 workers at zoonotic risk, were enrolled. Anti-HEV were determined with an enzyme linked immunosorbent assay (ELISA). In positive subjects, RNA was extracted and tested by RT-Nested-PCR. From July 2006 to March 2007, 95 bile samples were collected from randomly selected pigs. RNA was extracted from 250 microl of bile and tested by RT-Nested-PCR. RESULTS: The overall prevalence of anti-HEV antibodies was 4.3%; 5.0% among blood donors and 2.3% among workers at zoonotic risk, with no statistically significant differences between sex, age classes and occupation. The search for HEV-RNA in the subjects positive for antibodies, gave negative results. HEV genome was detected in 6 of the 95 swine bile samples tested. Sequences were clustered within the genotype 3 and are edited on GenBank under accession number: from FJ850960 to FJ850962 and from FJ883000 to FJ883002. DISCUSSION: The overall prevalence of anti-HEV shows that the virus circulates without giving origin to cases of acute hepatitis. The low prevalence value found in workers at zoonotic risk do not apparently support the hypothesis of professional risk. In this study, HEV-RNA was isolated from pigs in Sardinia for the first time confirming the role of swine as HEV reservoir and the possibility of virus transmission to humans.

Migraine and antiphospholipid antibodies: no association found in migraine-discordant monozygotic twins.

Migraine headache (with and without aura) is common in the general population and is known to be influenced by genetic factors with heritability estimates between 34-57%. Antiphospholipid syndrome (APS) is a hypercoagulable state characterized by clinical features including venous and arterial thromboses, pregnancy loss and migraine, and by association with antiphospholipid antibodies (aPL). Numerous small studies have investigated whether aPL are associated with migraine in the general population--with contradictory results. In this study, the question was addressed by studying the prevalence of aPL in members of monozygotic (MZ) twin pairs differing in their migraine status. Such twins provide a unique natural experiment, matched as they are for age, sex and genetic factors, and allow the role of environmental factors, such as aPL, to be determined. Despite 95% power to detect a difference of 0.59 IgG units per litre in anticardiolipin antibody IgG titres, no difference in prevalence of aPL could be detected in migraine-discordant MZ twins.

Clinical accuracy for diagnosis of antiphospholipid syndrome in systemic lupus erythematosus: evaluation of 23 possible combinations of antiphospholipid antibody specificities.

OBJECTIVES: To evaluate the clinical accuracy of antiphospholipid antibody (aPL) specificities both individually and/or in combination, in a wide cohort of systemic lupus erythematosus (SLE) patients in an attempt to identify a panel of tests that may provide the best accuracy for diagnosing antiphospholipid syndrome (APS). PATIENTS AND METHODS: This study included 230 patients (218 women, mean age 42.7 ± 11.9 years, mean disease duration 12.2 ± 8.7 years), all fulfilling the 1982 criteria for SLE. All patients were tested for lupus anticoagulant (LA), anti-cardiolipin (aCL), anti-ß(2) glycoprotein I (anti-ß2GPI), solid phase anti-prothrombin (aPT), anti-phosphatidylserine/prothrombin (aPS/PT), and anti-phosphatidylethanolamine (aPE) antibodies. Sensitivity, specificity and predictive values were calculated. The diagnostic accuracy for each combination of tests was assessed by ROC and their area under the curve analysis as well as by the Youden's index (YI). RESULTS: Testing for six aPL derived 23 possible combinations of results. Among them, LA + anti-ß(2)GPI + aPS/PT had the best diagnostic accuracy for APS as a whole and individually for both thrombosis and pregnancy loss (AUC 0.712, OR 3.73 [95% CI 1.82-5.38], P = 0.0001, YI = 0.32 and AUC 0.709, OR 3.75 [95% CI 2.13-6.62], P = 0.0001, YI = 0.37 and AUC 0.677, OR 4.82 [95% CI 2.17-10.72], P = 0.0007, YI = 0.38, respectively) and the best specificity when compared with all the other obtainable combination of tests. Triple positivity for LA + anti-ß(2)GPI + aPS/PT was more strongly associated with clinical events (thrombosis and/or PL) when compared with double or single positivity (OR 23.2 [95% CI 2.57-46.2] vs. OR 7.3 [95% CI 2.21-25.97], OR 5.7 [95% CI 2.12-17.01] or OR 3.11 [95% CI 1.56-7.8] for single positivity for LA, aPS/PT and anti-ß(2)GPI, respectively). CONCLUSIONS: Combining LA, anti-ß(2)GPI and aPS/PT improves the diagnostic power and helps in stratifying the risk for each patient, according to their aPL profile.

The clinical value of testing for antibodies to phosphatidylethanolamine (aPE) in patients with systemic lupus erythematosus (SLE).

UNLABELLED: The value of testing for aPE in venous thrombosis and fetal death is in constant debate. We evaluated if testing for aPE has a diagnostic value in patients with SLE. PATIENTS AND METHODS: We included 224 patients. aPE were tested by an in-house ELISA using FCS. RESULTS: aPE were found in 41% of the patients. IgG and IgM aPE were more frequently found along with other aPL than in those negative for aPL (p=0.003 and p=0.01). IgG aPE were more frequently found in patients with definite APS than in those without (p=0.003). aPE were more frequent in patients with thrombosis than in those without, particularly the IgG isotype (p=0.03). When subdividing between venous and arterial thrombosis, only an association between IgG aPE with venous thrombosis was retained (p=0.01). Titres of IgG aPE were significantly higher in patients with arterial or those with venous thrombosis, when compared to the patients without thrombosis (p=0.004 and p=0.001). Titres of IgM aPE were higher in patients with arterial thrombosis when compared to those without (p=0.014). No associations were found between the presence of aPE and/or pregnancy morbidity. The presence of aPE did not correlate with that of any other aPL. After multivariate analysis all clinical associations failed to retain significance. CONCLUSIONS: aPE are frequently seen in SLE and do not correlate with other routinely tested aPL. Although more prevalent, aPE is not an independent risk factor for thrombosis or pregnancy morbidity in patients with SLE.