Non-alcoholic fatty liver disease (NAFLD) can lead to a prothrombotic stage increasing the risk of deep vein thrombosis (DVT). We aimed to assess the prevalence and factors associated with DVT in patients with type 2 diabetes (T2D) and biopsy-proven NAFLD. Using ICD-codes, all T2D patients who had liver biopsy done for suspected NAFLD were identified and assessed. Patients with secondary causes of hepatic steatosis (Hepatitis, excess alcohol, etc.) were excluded. Liver biopsy was staged as F0-4, advanced fibrosis (AF) being F3-4. A univariable and multivariate analysis was performed to assess factors associated with DVT. A total of 1295 patients were included in the final analysis. DVT was present in 5.5% of these patients. Our cohort consisted of 62% females, 90% were Caucasians, and 90% were obese or overweight (p = 0.59, 0.22, and 0.53, respectively). Mean platelet count was 200.1 ± 82.2 (p = 0.048) and mean HbA1c was 6.9 ± 1.7 (p = 0.71). On multivariate analysis, a 5-year increment in the age at time of T2D diagnosis was associated with 10% increase in likelihood of having DVT (OR {95% CI} 1.1 (1.01, 1.3), p = 0.031). Patients with IBD were 3-times more likely to have DVT than those without IBD and being on furosemide was associated with 2.5-times higher odds of DVT (OR {95% CI} 3.0 (1.3, 7.1), p = 0.012 and 2.5 (1.5, 4.1), p < 0.001, respectively). Our study suggests that older age, stricturing IBD disease, and use of furosemide in T2D with NAFLD increase the risk of DVT. Future prospective studies are required to confirm these findings. Clinical trial registration number: CCF 16-018 Keywords Non-alcoholic fatty liver disease (NAFLD). Deep vein thrombosis. Advanced fibrosis. Type 2 diabetes. Liver biopsy Abbreviations AF Advanced fibrosis AST Aspartate aminotransferase ALT Alanine aminotransferase ALP Alkaline phosphatase APRI AST to platelet ration index BMI Body mass index CDC Centers for Disease Control and Prevention CD Crohn's disease DVT Deep vein thrombosis FIB-4 Fibrosis-4 GGT γ-Glutamyl transpeptidase HDL High-density lipoprotein HbA1c Hemoglobin A1c This article is part of the Topical Collection on Medicine Electronic supplementary material The online version of this article (

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Background Several reports of unheeded complications secondary to the current mass international rollout of SARS-COV-2 vaccines, one of which is myocarditis occurring with the FDA fully approved vaccine, Pfizer, and others. Main body of the abstract Certain miRNAs (non-coding RNA sequences) are involved in the pathogenesis in viral myocarditis, and those miRNAs are interestingly upregulated in severe COVID-19. We hypothesize that the use of mRNA-based vaccines may be triggering the release of host miRNAs or that trigger the occurrence of myocarditis. This is based on the finding of altered host miRNA expression promoting virus-induced myocarditis. Short conclusion In conclusion, miRNAs are likely implicated in myocarditis associated with mRNA vaccines. Our hypothesis suggests the use of miRNA as a biomarker for the diagnosis of mRNA vaccine-induced myocarditis. Additionally, the interplay between viral miRNA and the host immune system could alter inflammatory profiles, hence suggesting the use of therapeutic inhibition to prevent such complications.

Background: With the current mass international roll out of several vaccines against SARS-Cov-2, several reports of unheeded complications have made headlines. One of which involves myocarditis with the now FDA fully approved vaccine, Pfizer, and others. We hypothesize through this study that a dysregulated micro-RNA response resulting from such type of vaccines can be involved in triggering myocarditis. Methodology: Embase, Medline and the Cochrane Central Register were used to search for specific keywords such as “mRNA COVID-19 vaccines” AND “Myocarditis” for relevant publications up to 1st of September 2021. The systematic review was performed using PRISMA protocolResults:Literature review has identified 26 cases series and reports involving the development of myocarditis from mRNA vaccines, a total of 89 patients were included. Age range was clearly identified in 66 patients. Among those 66 patients, 94% were below 50 years of age, also out of 89 patients, 94% were males. Myocarditis developed, after a median time of 72 hours of the 2nd dose. 90 of cases of myocarditis developed myocarditis after the 2nd dose, the few patients developing myocarditis after the first dose were either predisposed by a history of myocarditis or a history of previous COVID-19 infection. Conclusion:In conclusion, interpretation of the results in view of the suggested hypothesis, reveals that the micro-RNAs implicated in myocarditis in general are as well implicated in the pathogenesis of severe COVID-19, this can explain why patients having a first dose with a history of COVID-19 can develop myocarditis from mRNA vaccines, also the relatively higher likelihood of this complication in males and younger aged individuals can be explained by the upregulation of key myocarditis related miRNAs in those two strata, due to higher muscle mass and suggests performing a sarcopenia index in recipients of the vaccine to correlate it with the likelihood of this complication. This could later set a cut-off of this easy bed-side index to stratify cases a higher risk of this rare complication.

Background: With the current mass international roll out of several vaccines against SARS-Cov-2, several reports of unheeded complications have made headlines. One of which involves myocarditis with the now FDA fully approved vaccine, Pfizer, and others. We hypothesize through this study that a dysregulated micro-RNA response resulting from such type of vaccines can be involved in triggering myocarditis. Methodology: Embase, Medline and the Cochrane Central Register were used to search for specific keywords such as “mRNA COVID-19 vaccines” AND “Myocarditis” for relevant publications up to 1st of September 2021. The systematic review was performed using PRISMA protocolResults:Literature review has identified 26 cases series and reports involving the development of myocarditis from mRNA vaccines, a total of 89 patients were included. Age range was clearly identified in 66 patients. Among those 66 patients, 94% were below 50 years of age, also out of 89 patients, 94% were males. Myocarditis developed, after a median time of 72 hours of the 2nd dose. 90 of cases of myocarditis developed myocarditis after the 2nd dose, the few patients developing myocarditis after the first dose were either predisposed by a history of myocarditis or a history of previous COVID-19 infection. Conclusion:In conclusion, interpretation of the results in view of the suggested hypothesis, reveals that the micro-RNAs implicated in myocarditis in general are as well implicated in the pathogenesis of severe COVID-19, this can explain why patients having a first dose with a history of COVID-19 can develop myocarditis from mRNA vaccines, also the relatively higher likelihood of this complication in males and younger aged individuals can be explained by the upregulation of key myocarditis related miRNAs in those two strata, due to higher muscle mass and suggests performing a sarcopenia index in recipients of the vaccine to correlate it with the likelihood of this complication. This could later set a cut-off of this easy bed-side index to stratify cases a higher risk of this rare complication.