Background and Aims A few case reports of autoimmune hepatitis–like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS‐CoV‐2 vaccination in a large case series. Approach and Results We collected data from cases in 18 countries. The type of liver injury was assessed with the R‐value. The study population was categorized according to features of immune‐mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18–79) years at presentation. Liver injury was diagnosed a median 15 (range: 3–65) days after vaccination. Fifty‐one cases (59%) were attributed to the Pfizer‐BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford‐AstraZeneca (ChAdOX1 nCoV‐19) vaccine and 16 (18%) cases to the Moderna (mRNA‐1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune‐mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3–4 liver injury than for grade 1–2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune‐mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow‐up. Conclusions SARS‐CoV‐2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune‐mediated features or severe hepatitis. Outcome was generally favorable, but vaccine‐associated liver injury led to fulminant liver failure in one patient.

In this paper we want to demonstrate whether higher than normal levels of RDW, and lower than normal levels of MPV can be used as indicators of subclinical inflammation and tools for treatment decision in FMF or not. The participants in this study included 89 patients with FMF during attack-free periods and 30 healthy controls. The RDW and platelet counts were significantly higher, while the MPV was significantly lower in the patients with FMF group than healthy control group (P < 0.001; P = 0.005; P < 0.001, resp.). In the attack-free FMF group, a negative correlation was found between the MPV and RDW values (P < 0.001, r = −0.40). The positive correlation was found between the RDW and ESR (r = 0.23, P = 0.028). And the negative correlation was found between the MPV and CRP (r = −0.216, P = 0.042). Consequently, our results suggest that low MPV and high RDW levels may provide additional information about subclinical inflammation in FMF patients. But other strong predisposing factors affecting subclinical inflammation in FMF should be considered. Further studies with large numbers of patients are needed. Treatment of FMF should include not only prevention of acute attacks but also decreasing of the subclinical inflammation.

Background: It is necessary to use an effective vaccine to end the COVID-19 pandemic. CoronaVac vaccine is used in our country and we aimed to examine the level of antibody development after the second dose.Methods: This is a retrospective, cross-sectional research. The data of the people, who applied to a university hospital between January and March 2021, were analyzed. Those who had SARS-CoV-2 IgG and IgM measurement in the previous two weeks before the CoronoVac vaccine, and those who were both found negative and who had SARS-CoV-2 IgG and IgM measurement after the second dose of CoronaVac vaccine were included in the research. SARS-CoV-2 IgG/IgM were measured by VIDAS® (BioMérieux, Marcy-l'Etoile, France) device for the detection of spike protein specific IgG/IgM of SARS-CoV-2 in human serum with ELFA (Enzyme Linked Fluorescent Assay) technique.Results: 75 people were included in this research. It was found that the individuals had SARS-CoV-2 IgG and IgM measurements between 14 and 21 days after the first dose of CoronaVac vaccine. It was observed that 12% (n = 9) of the cases had a history of COVID-19. The rate of positivity for SARS CoV-2 IgG level after vaccination was 100%.Conclusions: It can be said that two doses of CoronaVac vaccine create an effective humoral immunity.

On altı yaşında erkek hasta bir saat önce başlayan, sternum arkasında, baskı tarzında şiddetli göğüs ağrısı, terleme, bulantı, kusma ve bayılma hissi yakınması ile acil servisimize başvurdu. Daha önce bilinen bir hastalığı olmayan olgunun başvurudan iki hafta öncesinde halsizlik, boğaz ağrısı, kusma ve ishal yakınmalarının olduğu; sigara, ilaç, alkol ve madde kullanımı öyküsünün olmadığı öğrenildi. AbstRActAcute myocarditis usually develops after viral infections and is often asymptomatic. However, pericarditis can accompany it. Myopericarditis due to Epstein-Barr virus (EBV) infection is very rare. A 16-year-old male presented with severe chest pain. Cardiac enzymes were elevated and electrocardiographic examination revealed widespread decreased voltage and ST-T changes on the DII, DIII, aVF, V5, and V6 leads. Left ventricular systolic functions were normal and pericardial effusion was present on echocardiographic evaluation. EBV-VCA IgM and EBV-PCR were positive; EBV myopericarditis was diagnosed in the patient. The patient responded well to intravenous immunoglobulin (IVIG) and nonsteroidal antiinflammatory therapy and recovered completely. Myopericarditis should be considered in the differential diagnosis while evaluating patients with chest pain. The Epstein-Barr virus should be kept in mind even though it rarely causes myopericarditis.

Objectives Mean platelet volume (MPV) and red cell distribution width (RDW), as a marker of inflammation, have an important role in several chronic inflammatory disorders like familial Mediterranean fever (FMF). Many studies have shown that subclinical low grade inflammation persisted during attack free periods in FMF patients. We aimed to investigate whether RDW and MPV values differ between patients with FMF during attack free periods and healthy controls. Methods In this study, 89 patients (Male/Female: 30/59, mean age:31,8±10) with FMF during attack-free periods and 30 age, sex-matched healthy controls (Male/Female:10/20, mean age:31,4±5,7) were enrolled. Erythrocyte sedimentation rate, C-reactive protein, white blood cell count, platelet count, hemoglobin, MPV and RDW levels were retrospectively recorded. The patients were evaluated in accordance with Tel-Hashomer Severity Scoring which includes six elements, including diseases onset age, dose of colchicum, number of involved sites in one attack and during the course of the disease, and the presence of pleuritic and erysipelas-like erythema. Results Mean age, male/female ratio and the mean levels of hemoglobin, white blood cell count were similar in two groups. RDW, platelet counts were significantly higher and MPV was significantly lower and in patients with FMF group (%15,59±1,6 vs %12,9±0,8 p<0,001, 289±78,2 K/uL vs 245,63±55,7 K/uL p=0,005 and 7,9±1 fL vs 9,4±0,9 fL p<0,001 respectively ). In attack-free FMF group negative correlation has been found between the MPV and RDW values (p<0,001, r=-0,40). Conclusions Our results suggest that low MPV and high RDW levels may provide additional information about persisted subclinical inflammation in FMF patients during attack-free periods. Disclosure of Interest None Declared

No abstract

Objective: The epidemiological characteristics, risk factors, complications, recurrence status, clinical and laboratory features, and treatment methods of the patients who admitted to our Pediatric Cardiology Outpatient Clinic with a pre-diagnosis of acute rheumatic fever (ARF) were evaluated. Materials and Methods: The data of 166 patients who admitted with a pre-diagnosis of ARF and were diagnosed with ARF, and the data of 51 patients who were not diagnosed with ARF, were retrospectively analyzed. Results: The patients with ARF were between the ages of 5 and 18. Most of the patients with ARF attack admitted in December (15.6%), January (13.8%), and February (13.2%). The most common complaints of the patients diagnosed with ARF were isolated joint pain and/or swelling, at 50.6%. While 91.5% of the patients were diagnosed for the first time, 8.5% had ARF recurrence. It was seen that the most common major criterion was carditis (94.6%). The severity of valve regurgitation and the rates of monoarthritis were significantly higher in patients with recurrence ( P < .05). Non-compliance with prophylaxis was observed in 10 (71.4%) of 14 patients with recurrence, and in 43 (28.2%) of 152 patients without recurrence. Anti-streptolysin O was lower ( P = .021) and alanine transaminase (ALT) was higher ( P = .019) in the recurrence group. Conclusion: Our study showed that in patients with a pre-diagnosis of ARF, a differential diagnosis should be made with other diseases. Especially in patients with joint complaints as the only major symptom, a differential diagnosis should be made. ARF recurrence is associated with non-compliance with prophylaxis, and both the severity of valve regurgitation and monoarthritis rates are higher in patients who develop recurrence. Alanine aminotransferase is significantly higher in patients with ARF recurrence.

No abstract