SARS-CoV-2 vaccine-associated subacute thyroiditis: insights from a systematic review

8nononePurpose: To perform a systematic review on published cases of subacute thyroiditis (SAT) secondary to SARS-CoV-2 vaccination, to highlight main features and increase the awareness of this condition. Methods: Original reports of SAT developed after SARS-CoV-2 vaccination (mRNA, viral vector, or inactivated virus vaccines) were retrieved from a search of electronic databases. Individual patient data on demographics, medical history, type of vaccine, workup and therapies were collected. Wilcoxon rank-sum, Kruskal–Wallis and chi-squared tests were employed for comparisons. Results: 30 articles including 48 reports were retrieved, 3 additional cases evaluated by the Authors were described and included for analysis. Of the 51 patients, 38 (74.5%) were women, median age was 39.5 years (IQR 34–47). Patients developed SAT after a median of 10 days (IQR 4–14) after the vaccine shot. Baseline thyroid exams revealed thyrotoxicosis in 88.2% of patients, decreasing at 31.6% at follow-up. Corticosteroids were used in 56.4% of treated patients. Patients undergoing non-mRNA vaccines were most frequently Asian (p = 0.019) and reported more frequently weight loss (p = 0.021). All patients with a previous diagnosis of thyroid disease belonged to the mRNA vaccine group. Conclusion: SARS-CoV-2 vaccine-associated SAT is a novel entity that should be acknowledged by physicians. Previous history of thyroid disease may predispose to develop SAT after mRNA vaccines, but further studies and larger cohorts are needed to verify this suggestion. SARS-CoV-2 vaccine-associated SAT is usually of mild/moderate severity and could be easily treated in most cases, thus it should not raise any concern regarding the need to be vaccinated.openS. Ippolito; D. Gallo; A. Rossini; B. Patera; N. Lanzo; G. F. M. Fazzino; E. Piantanida; M. L. TandaIppolito, S.; Gallo, D.; Rossini, A.; Patera, B.; Lanzo, N.; Fazzino, G. F. M.; Piantanida, E.; Tanda, M. L

MALATTIA DI KAWASAKI E MAS INDOTTA DA INFEZIONE DA EBV IN PAZIENTE CON LINFOISTIOCITOSI EMOFAGOCITICA DI TIPO 2

L’HLH, rara patologia da alterata risposta infiammatoria sistemica, presenta elevata mortalità, se non diagnosticata e trattata tempestivamente. Il quadro clinico è caratterizzato da febbre elevata persistente, epatosplenomegalia, citopenia di almeno due linee cellulari, linfoadenopatia generalizzata, rash, iperferritinemia, ipertrigliceridemia, ipofibrinogenemia, ipertransaminasemia e alterazioni della coagulazione. La HLH è divisa in primaria o familiare (autosomica recessiva) e secondaria (S. Autoinfiammatorie, infezioni, trapianti, ecc). La terapia si basa su chemioterapia (protocollo HLH94 e HLH2004) e, per le HLH familiari, e trapianto di midollo osseo. Fra le forme familiari, il tipo 2 è il più frequente, secondario a mutazione della perforina. Descriviamo il caso di una bambina di 4 anni con febbre elevata (> 40°C) da 11 gg, non responsiva a FANS, paracetamolo, antibiotici, associata ad epatosplenomegalia, ipertransaminasemia (10xvn), anemizzazione (Hb: 8,9), piastrinopenia (plt: 57.000), neutropenia (N: 1.300) ingravescenti, iponatremia, ipoalbuminemia, ipofibrinogenemia, iperferritinemia (3924), edema sottocutaneo prevalente al volto e agli arti. Viene posta diagnosi di Malattia di Kawasaki (MK) tipica (febbre, rash, edema al dorso dei piedi, mesoadenia laterocervicale, congiuntivite non purulenta, cheilite) con HLH (6/8 criteri, sec. classificazione HLH study group of the Histiocyte society). Sono presenti versamento pericardico e iper-rifrangenza della coronaria dx. La PCR per EBV è positiva e l’aspirato midollare conferma il quadro di HLH. La bambina è stata trattata con steroidi (30 mg/kg/die) e IGEV, con rapida remissione. La bambina ha continuato la terapia con corticosteroidi ed è stata inviata presso centro di trapianto di midollo osseo, poiché l’espressione della perforina su linfociti NK e CD8+ è assente e il gene della perforina PRF1 presenta i seguenti alleli: varianti Thr450Met a segregazione materna e Val538Phe e Gln540LysfsTer73 a segregazione paterna. La MK riconosce come possibile trigger una infezione da EBV, peraltro possibile causa di HLH secondaria. La peculiarità del caso consiste nell’esordio tardivo di HLH su base genetica, in questa paziente espressione di complicanza di MK secondaria ad un trigger virale

The effectiveness of distance-based interventions for smoking cessation and alcohol moderation among cancer survivors:A meta-analysis

Objective: The objective of this study is to evaluate current evidence for the effectiveness of distance-based interventions to support smoking cessation (SC) or alcohol moderation (AM) among cancer survivors. Secondary, differences in effectiveness are explored regarding multibehaviour interventions versus single-behaviour interventions targeting SC or AM only. Methods: A systematic search of PubMed, PsycINFO, Web of Science, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials was conducted. Intervention studies with and without control groups and randomized controlled trials were included. Random effects meta-analyses were conducted for the main outcomes: SC and AM rates at the follow-up closest to 6 months. Using subgroup analyses and meta-regression, effectiveness of single-behaviour versus multibehaviour interventions was evaluated. Results: A total of 17 studies with 3796 participants; nine studies on SC only, eight studies on multibehaviour interventions including an SC or AM module, and no studies on AM only were included. All studies had at least some concerns regarding bias. Distance-based SC interventions led to higher cessation rates than control conditions (10 studies, odds ratio [OR] = 1.56; 95% CI, 1.13-2.15, P =.007). Single-behaviour SC interventions reduced smoking rates compared with baseline (risk difference [RD] = 0.29; 95% CI, 0.19-0.39, P <.0001), but multibehaviour interventions did not (RD = 0.13; 95% CI, −0.05 to 0.31, P = 0.15). There was insufficient evidence that distance-based multibehaviour interventions reduced alcohol use compared with controls (three studies, standardized mean difference [SMD] = 0.12; 95% CI, −0.08 to 0.31, P =.24). Conclusions: Distance-based SC interventions are effective in supporting SC among cancer survivors. Single-behaviour SC interventions appear more effective than multibehaviour interventions. No evidence was found for the effectiveness of distance-based AM interventions for cancer survivors