IntroductionDiabetes mellitus (DM) is a metabolic disorder associated with both microvascular and macrovascular complications. Mean platelet volume (MPV) is a marker of platelet activity, which plays a major role in the development of vascular complications of DM. The aim of this study is to compare the MPV levels before and after the decrease of glycated hemoglobin (HbA1c) levels in a large diabetic population.Material and methodsThis was a retrospective study conducted on type 2 diabetic patients from the outpatient clinic for 1 year between 2014 and 2015 with the participation of 595 diabetic patients.ResultsWhen we compared the basal and post-treatment values, a significant decrease of MPV and HbA1c levels was found (HbA1c: 9.41 ±1.98% vs. 7.43 ±1.29%, p < 0.001; MPV: 9.11 ±1.42 vs. 8.17 ±1.04, p < 0.001). There was also a positive correlation between the mean changes of MPV and HbA1c levels after the treatment (ΔMPV: 0.93 ±0.96 vs. ΔHbA1c: 1.96 ±1.43; p = 0.005, r = 0.115). When the participants were divided into two groups according to their basal HbA1c levels (group A: HbA1c ≤ 6.5% and group B: HbA1c > 6.5%), it was clearly seen that improvement of glucose levels led to a significant decrease in MPV levels in both groups.ConclusionsThe results of this study show that better glycemic control is associated with a significant decrease of MPV levels, regardless of whether the treatment modality is insulin or oral antidiabetic.

ObjectiveTo investigate the safety and efficacy of SARS-Cov-2 vaccination in patients with primary Sjögren syndrome (pSS) due to scarcity of data in this population. Methods By the first week of May 2021, all Big Data SS Consortium centres patients who had received at least one dose of any SARS-CoV-2vaccine were included in the study. The in-charge physician asked patients about local and systemic reactogenicity to collect SARS-CoV-2 vaccination data. ResultsThe vaccination data of 1237 patients were received. A total of 835 patients (67%) reported any adverse events (AEs), including local (53%) and systemic (50%) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%), and general symptoms were the most commonly reported systemic AEs (46%), followed by musculoskeletal (25%), gastrointestinal (9%), cardiopulmonary (3%), and neurological (2%). In addition, 141 (11%) patients reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms and fifteen (1.2%) patients reported active involvement in the glandular (n=7), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains due to post-vaccination SS flares. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 %) patients, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95% of vaccinated SS patients, according to data available. ConclusionOur data suggest that patients with pSS develop adequate humoral response and no severe AEs after SARS-CoV-2 vaccination and therefore raise no concerns about the vaccine's efficacy or safety profile in this population.

Background:Both oral functions and oral health-related quality of life (OHRQoL) are poorly affected by low salivary flow rate in patients with primary Sjögren’s syndrome (pSS).Objectives:The aim of the study was to evaluate the effects of oral dryness and OHRQoL on daily life in patients with primary Sjögren’s syndrome (pSS).Methods:In this cross-sectional study, 86 patients with pSS (M/F: 5/81; mean age: 52.4 ± 11.6 years) were included. The data were collected by clinical examination and a questionnaire regarding patient-reported outcome measures (PROMs). Patient filled PROMs regarding Oral Health Impact Profile-14 (OHIP-14) for OHRQoL, Work Productivity and Activity Impairment scale (WPAI) for Daily life and the EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI) for their symptoms. Unstimulated whole saliva flow rates (U-WSFR) of patients were calculated as ml/min. Increases in PROMs and decreases in U-WSFR reflected poor conditions. After preliminary analysis, a mediation analysis was used to evaluate the relations among variables.Results:WPAI-Daily activity impairment score was higher in patients with low U-WSFR (≤0,1 ml/min) than the others (67±29,8 vs 52,5±28,6) (p=0.042). Both U-WSFR (0,43±0,57 ml/min) and ESSPRI-Dryness score (6.31 ± 2.71) were correlated with scores of OHIP-14 (25,96±17,13)(r:- 0,38 p=0.000; r: 0,37 p=0.000) and WPAI-Daily activity impairment (57,96±29,71)(r: -0,36 p=0.004; r: 0,53 p=0.000). Moreover, scores of ESSPRI-Pain (5,16±3,12) and ESSPRI-Fatigue (5,41±2,97) were also related to WPAI-Daily activity impairment score (r: 0,41 p=0.001; r:0,49 p=0.000, respectively).In the mediation analysis, WPAI-Daily activity impairment score (57.9 ± 29.7) was directly mediated by ESSPRI-Dryness score (p=0.0010) and indirectly mediated by OHIP-14 score (25.9 ± 17.1) (p=0.0357). After mediation analysis, a bootstrap analysis with 5000 replications was applied to estimate the mediation effect to generate 95% CI. Percentile bootstrap of OHIP-14 score was found to be an effective mediator for Daily activity impairment based on 5000 bootstrap samples.Conclusion:Both oral dryness and poor OHRQoL in patients with pSS affected daily activity impairment. Therefore, the patients’ needs for improving oral health were critical components of treatment plans to improve the daily activity of SjS patients.Disclosure of Interests:None declared

Background:Since oral ulcer is a common clinical manifestation, oral health-related quality of life (OHRQoL) is affected by the presence of oral ulcer poorly in patients with Behcet’s disease (BD).Objectives:The aim of the study was to examine associated factors for poor OHRQoL status to improve treatment outcomes in patients with BD.Methods:In this retrospective study, 339 BD patients (F/M: 179/160, mean age: 36,13±9,81 years) included. Data were collected by a structured questionnaire regarding treatment expectation, Oral Health Impact Profile-14 (OHIP-14) questionnaire for OHRQoL, oral ulcer activity, and disease severity score. Treatment expectation was coded by a 5-point Likert type scale (1: symptoms were completely cured vs 5: symptoms were worsened). OHIP-14 score was between “0 point (the best score)” and “56 points (the worst score)”. The disease severity score was calculated according to the organ involvement. Then, patients were categorised as mucocutaneous involvement (n=181) and severe organ involvement (n=158). After preliminary analysis, a Moderated Mediation analysis was carried out.Results:Oral ulcer activity was seen in 63,4% of the group (n=215). OHIP-14 score (22,05±16,47) was correlated with Treatment expectations (2,35±0,98) (r: 0,36 p=0.000) in the group. Poor scores of OHIP-14 and Treatment expectations were found in patients with active oral ulcers (mucocutaneous involvement: 27,56±14,55; 2,68±0,87, vs severe organ involvement: 28,51±17,25; 2,43±0,99) compared to those of inactive patients (mucocutaneous involvement: 13,38±12,23; 1,81±0,73 vs severe organ involvement: 8,79±10,19; 1,85±1,02) (p=0.000 for all). Patients with active oral ulcers were younger (35,09±9,52) than the others (39,57±10,06) in the mucocutaneous involvement group (p=0.0011) whereas a similar relation was not seen in the severe organ involvement (p=0.233).In the moderated mediation analysis, it was found that OHIP-14 score was increased by the presence of oral ulcer in the direct path (p=0.0000) and the negative Expectation of the treatment as a first mediator (p = 0.0001) in the indirect path. Oral ulcer activity was associated with younger patients (p=0.0039). This effect was seen especially in patients with mucocutaneous involvement that had a moderator effect (p=0.0040). In addition, age was found to be a second mediator for the poor OHIP-14 score (p = 0.0053). Mediators and the moderator were found to effective for OHIP-14 score a bootstrap analysis with 5000 replications.Conclusion:OHRQoL was affected by oral ulcer activity and poor treatment expectations. Age was also found to be another critical factor for OHRQoL.Disclosure of Interests:None declared

Ankylosing Spondylitis is an autoimmune disease leading to inflammation in the joints and ligaments of the spine. ERAP1 is a major risk factor for AS and ERAP1 mutations may result in structural changes that alter the trimming efficiency, thereby altering the immune response. The underlying structural mechanisms of AS pathogenesis have not yet been fully elucidated. This study investigated ERAP1/ERAP2 allotypes using Molecular Dynamics in both monomeric and dimeric forms. ERAP1's domain IV has been found to be a favorable region for dimerization. Different allotype dimers exhibited different stability characteristics. Furthermore, the effects of allotypic variation were more pronounced in Hap2-/Hap8-coupled dimer structures and were more distinct in heterodimers. An analysis of the interchain region revealed that both H-bonding and electrostatic interactions between chains of Hap2–N392 heterodimer structures were lower than those between Hap2–Hap2 revealing that allotypic variations played a significant role in stabilizing and destabilizing dimer structures.