Role of Genetic and Acquired Prothrombotic Risk Factors in Genesis of Sudden Sensorineural Hearing Loss.

The methylenetetrahydrofolate reductase C677T mutation, factor V G1691A (factor V Leiden) mutation, prothrombin G20210A mutation and 8 other laboratory values associated with increased thrombotic risk were analyzed in 40 patients with sudden sensorineural hearing loss (SSHL). The results were compared with those obtained from 120 controls not affected by SSHL. We found a statistically significant higher frequency of hyperhomocysteinemia in the SSHL group compared with controls, and that this was also associated with the presence of homozygosity for the MTHFR C677T mutation. The study results suggest that SSHL might be caused, among other factors, by a combination of these 2 variables. We suggest that this analysis of the MTHFR C677T mutation should be further investigated to establish the etiology of SSHL, and that the same analysis should be taken into account in those patients with high levels of homocysteine

SARS-CoV-2 infection predicts larger infarct volume in patients with acute ischemic stroke

Background and purpose: Acute ischemic stroke (AIS) is a fearful complication of Coronavirus Disease-2019 (COVID-19). Aims of this study were to compare clinical/radiological characteristics, endothelial and coagulation dysfunction between acute ischemic stroke (AIS) patients with and without COVID-19 and to investigate if and how the SARS-CoV-2 spike protein (SP) was implicated in triggering platelet activation. Methods: We enrolled AIS patients with COVID-19 within 12 h from onset and compared them with an age- and sex-matched cohort of AIS controls without COVID-19. Neuroimaging studies were performed within 24 h. Blood samples were collected in a subset of 10 patients. Results: Of 39 AIS patients, 22 had COVID-19 and 17 did not. Admission levels of Factor VIII and von Willebrand factor antigen were significantly higher in COVID-19 patients and positively correlated with the infarct volume. In multivariate linear regression analyses, COVID-19 was an independent predictor of infarct volume (B 20.318, Beta 0.576, 95%CI 6.077-34.559; p = 0.011). SP was found in serum of 2 of the 10 examined COVID-19 patients. Platelets from healthy donors showed a similar degree of procoagulant activation induced by COVID-19 and non-COVID-19 patients' sera. The anti-SP and anti-FcγRIIA blocking antibodies had no effect in modulating platelet activity in both groups. Conclusions: SARS-CoV-2 infection seems to play a major role in endothelium activation and infarct volume extension during AIS

Challenges, experiences and silenced rights of Italian LGBTQI+ foster carers

Fostering by LGBTQI+ people is an unexplored topic in Italy, even though the first juvenile court decrees of fostering by lesbian and gay people date back to 2013. This paper reports the results of an ongoing study aimed at analysing the experiences of a group of Italian LGBTQI+ foster carers

Thromboembolic events following mRNA vaccines for COVID 19: a case series

To the Editor, In response to the SARS-COV-2 pandemic, different types of vaccines have been developed: mRNA vaccines, non-replicative vector vaccines, inactivated and subunit vaccines [1]. By late December 2020, mass vaccination campaigns have started all around the world. Thromboembolic events have been reported after SARS-COV-2 vaccines [2], in particular after ChAdOx1 n COV-19 vaccine (Oxford- AstraZeneca) [3] and the Ad26.COV2.S (Johnson Johnson/Janssen) [4]. In these cases, a particular severe syndrome has been described (VITT) characterized by thrombosis, particularly at unusual sites including cerebral/splanchnic thrombosis, mild to severe thrombocytopenia and positive PF4-heparin ELISA and platelet activation assays [3, 5]. Despite the excellent safety profile of mRNA vaccines, some cases of venous thromboembolism(VTE) related to this type of vaccination have been recently reported in literature [6–8], including cerebral vein thrombosis [9–11]. Herein, we described our single centre experience of 15 cases of VTE following mRNA vaccination. From May 2021 to September 2021, 112 patients were admitted to our Institute for VTE. Among them, fifteen patients were admitted for the onset of a thromboembolic event occurred after the administration of mRNA vaccines. Nine were male and 6 were female. The median age was 51 years (range 29–74 years), with 13 patients younger than 60 years old. Overall, 11 patients received Comirnaty BNT 162b2 Pfizer/BioNTech vaccine while 4 the Spikevax 1273 Moderna vaccine

Venous thromboembolism prophylaxis in patients with multiple myeloma: where are we and where are we going?

Venous thromboembolism is a common complication of patients with hematologic malignancies, due both to release of procoagulant factors by tumor cells and to external factors, such us drugs. In multiple myeloma patients, the risk is increased by use of immunomodulants, especially when associated to multidrug therapy, during the induction phase. Prevention of venous thromboembolism in myeloma patients is highly recommended but specific guidelines are still lacking. The most common approach is to stratify the thrombotic risk according to individual, myeloma-related and therapy-related risk factors and to use aspirin for all patients, except those with two or more thrombotic risk factors who should be treated with traditional oral or parenteral anticoagulant. A more controversial approach indicates for prophylaxis either anticoagulant or aspirin, regardless of risk stratification. Recent trials investigate prophylaxis in myeloma patients with direct oral anticoagulants, based on studies showing efficacy and safety of this new class of drugs in the treatment and prophylaxis of thrombosis in patients with any malignancy. The results of these trials are encouraging but they need to be confirmed by larger studies. An international consensus about best prophylaxis to prevent venous thromboembolism in patients with multiple myeloma on treatment is still missing. Therefore, thrombosis in multiple myeloma remains an ongoing issue

Inhibitor to factor V in severe factor V congenital deficiency. A case report.

A case of severe factor V deficiency that developed an inhibitor to factor V following the treatment with fresh frozen plasma (FFP) is described. The patient had a CRM-negative form of factor V congenital deficiency: no factor V antigen could be assayed in her plasma. A sister who supposedly had a severe factor V deficiency died as a result of a severe posttransfusional hepatitis. Two other members of the family were found to be heterozygotes. After several exposures to FFP, the propositus became refractory to the treatment with the appearance of a low titre inhibitor (5 units) which, nevertheless, could not be overcome by plasma infusions