History Of Previous Infection Research Articles

Subgingival Plaque as a Potential Reservoir for SARS-CoV-2 Virus in Patients Recovered from COVID-19 Infection: A Cross-sectional Study

Background Subgingival plaque biofilm is a potential harboring site for bacteria and viruses, serving as a source of entry into the bloodstream. The presence of Severe Acute Respiratory Syndrome Coronavirus 2 RNA (SARS-CoV-2 RNA) in subgingival plaque could be a possible source for cross infection due to aerosol contamination during dental procedures. Objectives The objective of this study was to investigate the presence of SARS-CoV-2 RNA in the subgingival plaque biofilm of patients who recovered from COVID-19 infection. Materials and Methods Ten subjects visiting the Outpatient clinic with a previous history of COVID-19 infection were recruited for this cross-sectional study. Subgingival plaque sample was collected from all four quadrants using a sterile curette. Nasopharyngeal and oropharyngeal swabs were taken from all the subjects. Reverse transcriptase real-time qualitative polymerase chain reaction (RT-PCR) was used to determine the presence of SARS-CoV-2 RNA using BAG SARS-CoV-2 RT-PCR kit targeting E gene, RdRp gene, and internal control. Results Ten participants (seven females and three males) with a previous history of COVID-19 infection were included in the study. Six participants previously presented with mild COVID-19 infection (uncomplicated upper respiratory tract infection, mild fever, cough, sore throat, nasal congestion, malaise, headache, without evidence of breathlessness or hypoxia), and four participants previously presented with moderate COVID-19 infection (dyspnea and or hypoxia, fever, cough, SpO2 90%–94% on room air, respiratory rate more or equal to 24 per minute) according to clinical management protocol for COVID-19, Government of India. The nasopharyngeal, oropharyngeal, and subgingival plaque samples tested negative for SARS-CoV-2 RNA. Conclusion The absence of the SARS-CoV-2 virus in the subgingival plaque sample of patients recovered from COVID-19 infection suggests that dental plaque could not be a potential reservoir of the virus. However, clinicians should take at most precautions while treating the patients recovered from COVID-19 infection and should anticipate a change in subgingival environment leading to alteration in periodontal disease progression.

550. Effectiveness of Remdesivir for Treatment of COVID-19 in the Outpatient Setting

Abstract Background Remdesivir (REM) was the first FDA-approved treatment for COVID-19. A clinical trial evaluated the effectiveness of REM for the outpatient treatment of COVID-19, showing an 87% lower risk of hospitalization and death when given within the first 7 days of infectious symptoms in confirmed infection. "Real-world" studies evaluating the outpatient use of REM when Omicron was the predominant variant have not been published. We aim to evaluate the use of REM in the outpatient setting (REM-OP) at our institution. Methods VA Northern California Health Care System developed an outpatient clinic for the treatment of COVID-19 after FDA approval of REM-OP in January 2022. Patients had to meet institutional criteria for outpatient management of COVID-19 with REM, including a confirmed positive PCR test, lack of supplemental oxygen, risk for severe disease, and reliable transportation. We retrospectively evaluated patients given REM-OP from 1/21/2022 - 413/2022 when Omicron was the predominant variant in our region. Data were obtained using a data query of outpatient REM prescriptions. Subsequently, the administrations of REM were verified and patient variables, including risk factors for progression to severe disease, COVID vaccination, history of previous infection, and subsequent hospitalization or death within 30 days, were collected via manual chart review. Results 88 patients received REM-OP with a mean age of 70.0 (SD +/- 11.4) with a predominantly male (92%) and white (67%) population. Most patients had received a least one dose of COVID-19 vaccination but 17% were unvaccinated. The most common risk factors for progression to severe disease included age (75% were over age 65), diabetes (45%), hypertension (64.8%), and cardiovascular disease (31.8%). 98% of patients met at least one risk factor for progression to severe disease and 95% completed REM-OP. 93% of patients received REM within 7 days of symptom onset. Of the 88 patients who were treated, 5 patients were admitted within 30 days (2/5 were due to COVID-19 infection), and 2 patients died (1 of which was attributed to COVID-19). Patient Characteristics Comparison to PINETREE Clinical Trial Conclusion REM-OP during the Omicron surge in our single-center retrospective study had comparable effectiveness to its use in a clinical trial during the Delta surge. Disclosures All Authors: No reported disclosures

Complex Combination of Pulmonary Embolism, Stroke, and ST-Segment Elevation Myocardial Infarction in Young Patient with Recent COVID-19 Infection and Newly Diagnosed Lung Carcinoma

BACKGROUND: Ischemic stroke, pulmonary embolism (PE), and acute ST-segment elevation myocardial infarction (STEMI) are very rarely all present in younger patients without classical risk factors or a family history of dyslipidemia or cardiovascular disease. They represent a medical emergency and necessitate fast diagnosis, treatment, and search for etiology, not explained purely by atherosclerosis. Thrombophilia testing should be considered in younger patients with several major thrombotic episodes, although there is much disagreement concerning the importance of homocysteine level testing in patients with arterial and venous thrombotic events, including PE. COVID-19 infection may trigger several thrombotic complications caused by unique immunothrombotic processes. CASE PRESENTATION: A 44-year-old patient complaining of chest pain was admitted at our clinic due to acute anterior STEMI. He has a previous medical history of ischemic stroke, COVID-19 infection, and PE in the past 2 months. Newly, diagnosed lung adenocarcinoma was confirmed by biopsy 10 days before STEMI admission, without surgical or previous hemotherapy. The patient was on regular anticoagulant therapy with rivaroxaban 20 mg OAD and antiplatelet therapy with Aspirin due to previous PE and ischemic stroke. Patient denied standard risk factors, family history for cardiovascular disease or any previous minor or major bleedings, history of anemia, liver, or renal dysfunction. Acute stroke was confirmed by brain computed tomography imaging. Thrombophilia panel testing revealed homozygote mutations for MTHFR 677 gene, heterozygote mutation for integrin subunit alpha 2, and fibrinogen B beta chain) genes. The patient was treated with low molecular weight heparin, aspirin, clopidogrel, and heart failure therapy in the acute phase. Clinical consultations were performed with a team of doctors which included a cardiologist, neurologist, and oncologist. Patients have a high bleeding risk, assessed by HAS-BLEED score of 4. CONCLUSION: Our patient is a rare case of serious multi-vascular thrombotic events with underlying thrombophilia, lung cancer, and past COVID-19 infection complicated by pulmonary embolism, ischemic stroke, and STEMI.

Association between cigarette smoke exposure and urinary bladder cancer in Scottish terriers in a cohort study

Canine urothelial carcinoma (UC) initially responds favorably to treatment, but is ultimately lethal in most cases. Research to identify modifiable risk factors to prevent the cancer is essential. The high breed-associated risk for UC, e.g. 20-fold higher in Scottish terriers, can facilitate this research. The objective was to identify environmental and host factors associated with UC in a cohort of Scottish terriers. Information was obtained through dog owner questionnaires for 120 Scottish terriers ≥ 6 years old participating in a bladder cancer screening study, with comparisons made between dogs that did or did not develop UC during the 3 years of screening. Univariable models were constructed, and variables with P < 0.20 were included when building the multivariable model, and then removed using a backward stepwise procedure. P < 0.05 was considered statistically significant. Urine cotinine concentrations were measured by liquid chromatography-mass spectrometry to further investigate potential cigarette smoke exposure. Biopsy-confirmed UC which was found in 32 of 120 dogs, was significantly associated with the dogs living in a household with cigarette smokers (odds ratio [OR], 6.34; 95 % confidence intervals [CI], 1.16–34.69; P = 0.033), living within a mile of a marsh or wetland (OR, 21.23; 95 % CI, 3.64–123.69; P = 0.001), and history of previous bladder infections (OR, 3.87; 95 % CI, 1.0–14.98; P = 0.050). UC was diagnosed in 18 of 51 dogs (35.3 %) with quantifiable cotinine concentrations, and six of 40 dogs (15.0 %) without quantifiable cotinine concentrations in their urine (P = 0.0165). In conclusion, the main modifiable risk factor for UC in this cohort of dogs was exposure to second-hand tobacco smoke.

Vector-borne parasites in dogs from Ukraine translocated to Poland following Russian invasion in 2022

IntroductionSince 24 February 2022, the day the Russian aggression against Ukraine began, millions of refugees and thousands of pets crossed the Polish-Ukrainian border. Additionally, an unknown number of shelter and stray dogs and cats were rescued and translocated to Poland by private persons and non-profit organizations. The aim of the present study was to examine rescued dogs and cats for presence of canine vector-borne parasites to determine the role of armed conflict in spreading these parasites.MethodsIn July 2022 blood samples were collected from two animal shelters in central Poland hosting dogs and cats rescued from Ukraine. Animals were imported from various regions of Ukraine, including eastern and southeastern Ukraine (military conflict area). Fifty-three dogs (51 from two shelters and two owned ones) and one shelter cat were examined by molecular methods (PCR and sequencing) for the presence of Babesia/Theileria spp., Dirofilaria spp. and Hepatozoon spp. DNA.ResultsWe detected Dirofilaria immitis, a parasite species non-endemic in Poland, in two dogs translocated from Ukraine (2/53 = 3.8% [95% CI 0.5–13.0%]). One dog had a history of previous heartworm infection. High prevalence of Hepatozoon canis (51% [95% CI 36.8–64.9%]) was noted among translocated dogs. Prevalence of Dirofilaria repens in Ukrainian dogs (18.9% [95% CI 9.4–32.0%) was similar to prevalence in dogs from central Poland (12%). Co-infection of D. repens and D. immitis was found in two dogs and six dogs were co-infected by D. repens and H. canis. Hepatozoon canis infection was also identified in an imported cat.ConclusionWe confirmed that this military conflict has facilitated the spread of canine vector-borne parasites, including zoonotic species.Graphical

The relationship between the number of COVID-19 vaccines and infection with Omicron ACE2 inhibition at 18-months post initial vaccination in an adult cohort of Canadian paramedics

The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, has rapidly evolved since late 2019, due to highly transmissible Omicron variants. While most Canadian paramedics have received COVID-19 vaccination, the optimal ongoing vaccination strategy is unclear. We investigated neutralizing antibody (NtAb) response against wild-type (WT) Wuhan Hu-1 and Omicron BA.4/5 lineages based on the number of doses and past SARS-CoV-2 infection, at 18 months post-initial vaccination (with a Wuhan Hu-1 platform mRNA vaccine [BNT162b2 or mRNA-1273]). Demographic information, previous COVID-19 vaccination, infection history, and blood samples were collected from paramedics 18 months post-initial mRNA COVID-19 vaccine dose. Outcome measures were ACE2 percent inhibition against Omicron BA.4/5 and WT antigens. We compared outcomes based on number of vaccine doses (two vs. three) and previous SARS-CoV-2 infection status, using the Mann-Whitney U test. Of 657 participants, the median age was 40 years (IQR 33–50) and 251 (42 %) were females. Overall, median percent inhibition to BA.4/5 and WT was 71.61 % (IQR 39.44–92.82) and 98.60 % (IQR 83.07–99.73), respectively. Those with a past SARS-CoV-2 infection had a higher median percent inhibition to BA.4/5 and WT, when compared to uninfected individuals overall and when stratified by two or three vaccine doses. When comparing two vs. three WT vaccine doses among SARS-CoV-2 negative participants, we did not detect a difference in BA.4/5 percent inhibition, but there was a difference in WT percent inhibition. Among those with previous SARS-CoV-2 infection(s), when comparing two vs. three WT vaccine doses, there was no observed difference between groups. These findings demonstrate that additional Whttps://www.covid19immunitytaskforce.ca/citf-databank/#accessing https://www.covid19immunitytaskforce.ca/citf-databank/#accessinguhan Hu-1 platform mRNA vaccines did not improve NtAb response to BA.4/5, but prior SARS-CoV-2 infection enhances NtAb response.

Antibiotics susceptibility patterns of uropathogenic bacteria: a cross-sectional analytic study at Kanifing General Hospital, The Gambia

BackgroundAntimicrobial resistance poses a public health threat for the treatment of community-acquired urinary tract infections. This study determined the susceptibility patterns of uropathogens and associated risk factors among outpatients diagnosed with urinary tract infections at the Kanifing General Hospital in the Gambia.MethodsA cross-sectional analytic study was conducted among patients with suspected urinary tract infections at Kanifing General Hospital from March to May 2021. Data on socio-demographic and other risk factors were collected from the study participants using a structured pre-tested questionnaire. Mid-stream urine samples were collected, and bacteria identification and antimicrobial susceptibility testing done using standard microbiological methods. Descriptive and inferential statistical analysis were done to determine factors associated with urinary tract infection at 95% confidence level and a p -value < 0.05.ResultsA total of 422 patients were enrolled with 82.5% (348/422) being females. The prevalence of community acquired urinary tract infection was 12.8% (54/422). Escherichia coli was the most prevalent isolate (74.1%, 40/54), followed by Klebsiella spp (8.5%, 10/54). Antimicrobial resistance was highest for Ampicillin (87.0%, 47/54), Trimethoprim/Sulfamethoxazole (77.8%, 42/54) and Tetracycline (75.9%, 41/54). Uropathogens sensitivity was 77.8% (42/54) for Nitrofurantoin and 75.9% (41/54) for Ceftazidime. Being female (aOR 5.90 95% CI = 1.48–23.67), previous history of urinary tract infection (aOR 2.34, 95% CI = 1.06–5.14), use of unprescribed antibiotics (aOR 2.0, 95% CI = 1.05–3.62) and having no formal education (aOR 8.02, 95% CI = 1.04–62.0) were significant factors associated for having uropathogenic bacterial infection.ConclusionE. coli was the most prevalent uropathogen isolated. Ciprofloxacin, Nitrofurantoin and Ceftazidime were the most sensitive antibiotics. Routine surveillance of susceptibility of uropathogenic bacteria would be helpful to update clinicians on the choice of antibiotics.

Estimation of SARS-CoV-2 IgG Antibodies in Healthcare Worker-Administered Covishield and Covaxin Vaccines at a Tertiary Care Hospital in Jharkhand, India.

Introduction To mitigate the impact of the COVID-19 pandemic caused by the SARS-CoV-2 virus, global distribution of vaccines such as Covishield and Covaxin has been undertaken. This research aimed to assess the responses and potential differences between these vaccines by examining the presence and levels of SARS-CoV-2 IgG antibodies in healthcare professionals who received them. Methodology A comprehensive cross-sectional study was conducted at a tertiary care facility in Ranchi involving 227 healthcare professionals who had completed both doses of either Covishield or Covaxin. Blood samples were collected and subjected to chemiluminescence immunoassayanalysis to measure IgG antibodies. Demographic data, immunization records, and previous COVID-19 infections were recorded. Statistical analyses, including analysis of variance (ANOVA), linear regression, and independent sample t-tests were performed. Results Antibody titers exhibited variability, potentially influenced by factors. There was no difference in antibody titers between recipients of Covishield and Covaxin vaccines. Linear regression analysis revealed a correlation between antibody levels and the number of days after vaccination. Factors such as age, gender, blood group, and prior COVID-19 infections did not significantly impact antibody titers. Conclusions This study contributes to responses elicited by Covishield and Covaxin vaccines among healthcare workers. The results highlight that Covishield showed a higher mean titer value than Covaxin, which is not statistically significant. The overall model showed statistically significant results indicating age, type of vaccine, number of days after vaccination, blood group, and previous history of COVID-19 infection collectively influenced the CoV-2 IgG titer values. The findings indicate that age, number of days after vaccination, and prior history of COVID-19 infection have substantial relationships with the CoV-2 IgG titer, but sex, vaccine type, and blood group show lesser, nonsignificant associations.

High seroprevalence of antibodies against arboviruses in postpartum women in Salvador, Brazil

ObjectivesArboviruses represent a major challenge to public health in Brazil. Dengue (DENV) virus has been endemic for decades, and the introduction of Zika (2015) and Chikungunya (2014) viruses (CHIKV) has imposed a significant burden on the country. The present study aimed to investigate the seroprevalence of Zika virus (ZIKV), DENV and CHIKV in women in Salvador, Bahia-Brazil. MethodsCross-sectional study involving postpartum women admitted to a maternity hospital in Salvador, Brazil. Anti-ZIKV, anti-DENV and anti-CHIKV immunoglobulin G was measured by enzyme-linked immunosorbent assay. ResultsA total of 302 women were enrolled with a median age: 26 years, interquartile range (21-33). Most self-declared as mixed-race or black skin color (92.4%). The seroprevalence was 57% for ZIKV); 91.4% for DENV, and 7.6% for CHIKV. Most participants denied awareness of previous arboviral infection, although 67 (22.3%) reported a previous history of ZIKV infection, 34 (11.1%) DENV infection and 9 (3%) CHIKV infection. ConclusionOur data indicate a high prevalence of past ZIKV and DENV infections in the population studied. Most of the participants remain susceptible to future CHIKV infection, highlighting the need for preventive and educational interventions. Our results suggest the need for continuous epidemiological surveillance of arboviral diseases, particularly among women residing in at-risk regions.

Acute ankle injuries: association between sprain severity and ancillary findings.

We retrospectively identified the magnetic resonance imaging findings of acute ankle sprains (<15 days). Participants with a history of previous sprains, arthritis, tumors, infections, or inflammatory conditions were excluded. Images were independently evaluated by two musculoskeletal radiologists and assessed for osseous, chondral, tendon, and ligamentous injuries and anatomical variations. Participants were divided into low-grade versus high-grade sprain groups, according to the presence of a complete tear in at least one component of the lateral ligament complex. The final study group comprised 100 magnetic resonance images (mean age, 36 years), the majority of males (54%), the right ankle (52%), and a mean sprain duration of 5 days. Participants with high-grade sprains presented with increased rates of medial malleolus edema (p<0.001), moderate and large articular effusions (p=0.041), and shorter calcaneonavicular distance (p=0.008). Complete tears of the anterior talofibular ligament and calcaneofibular ligaments were observed in 100% and 51.2% of the participants in the High-Grade Group, respectively. The deltoid ligament complex was partially torn in this group (55.8% versus 8.8%, p<0.001). Extensor tendon retinaculum lesions occurred significantly more frequently in this group (41.9%) compared to the overall study population (23%) (p<0.001). Participants with high-grade ankle sprains presented with shorter calcaneonavicular distances and increased rates of medial malleolus edema, deltoid complex partial tears, extensor retinaculum lesions, and articular effusion.

Role of Bangladesh Medical College Hospital (B.M.C.H) Protocol in Achieving Zero Shunt Infection in Paediatric Hydrocephalus

Ventriculoperitoneal shunt infection is one of the most dreadful complications of shunt surgery. Though topical, intravenous, and intraventricular antibiotics have been used; the infection rate is still high. It is a retrospective cohort study from Jan 2018 to Dec 2022 in Bangladesh Medical College, performed by a single Neurosurgeon. Objective: To see the effectiveness of the B.M.C.H protocol of shunt surgery in minimizing shunt infection. Method: 83 pediatric Ventriculo Peritoneal shunt cases were selected, who met the inclusion criteria. They were divided into 2 groups. One group had an Ommaya reservoir with or without endoscopic third ventriculostomy (failed) and was subject to cerebrospinal fluid aspiration for a considerable period followed by a shunt. The other group had conventional shunt (non-Ommaya) surgery. Results: The overall infection rate in our hospital in shunt surgery is 3.6%. Among the non-Ommaya or conventional shunt group, it reached 7.1%, while among the Ommaya group, there was not a single shunt infection in the follow-up period. 47% of babies came from the poorest population of the country. There was no significant relationship found between infection with a history of previous infection, per operative use of an endoscope, early age, or preterm birth. Follow up period was between 6 to 18 months. Conclusions: In a non-specialized hospital in a third-world country with limited neurosurgical capacity, following B.M.C.H. protocol, we found the babies who had Ommaya reservoir and underwent regular cerebrospinal fluid aspiration for a period of time before Ventriculo peritoneal shunt surgery were infection free in the long and short time follow up.

The changing spectrum of infection with BCMA and GPRC5D targeting bispecific antibody (bsAb) therapy in patients with relapsed refractory multiple myeloma.

There is a paucity of granular data on infection risk with B-cell maturation antigen (BMCA) and GPRC5D bispecific antibodies (bsAb) in relapsed/refractory multiple myeloma (RRMM). The aim of our multi-institutional study was to characterize the incidence, etiologies, and risk factors of infections from the start of therapy to the last follow-up or 90 days after study exit. A total of 66 patients received BCMA bsAb monotherapy, 15 GPRC5D bsAb monotherapy, and 15 GPRC5D bsAb combination therapy with daratumumab and/or pomalidomide. While the infection rate per 100 days was 0.57 for BCMA bsAb, it was 0.62 for GPRC5D bsAb combination and 0.13 for GPRC5D bsAb monotherapy; P=0.05. The proportion of infections that were grade ≥3 was higher in the BCMA bsAb group compared to the GPRC5D groups (58% vs. 36%; P=0.04). Grade 5 events were observed in 8% (n=8) of the patients, all treated with BCMA bsAb. The 9 month cumulative incidence of any grade of infection was similar in the BCMA and GPRC5D-combination groups (57% and 62%) and significantly higher than in the GPRC5D-mono group (16%); P=0.012. The cumulative incidence of grade ≥3 infections was highest in the BCMA group reaching 54% at 18 months; P=0.06. Multivariate analysis showed that BCMA bsAb therapy or GPRC5D combination therapy, history of previous infections, baseline lymphopenia, and baseline hypogammaglobulinemia were significantly associated with a higher risk of grade ≥3 infections. Our results indicate that BCMA bsAb and GPRC5D-combination therapies in RRMM are associated with higher cumulative incidence of infection and grade ≥3 infection compared to GPRC5D bsAb mono.

Comparative analysis of the effectiveness difference of SARS-COV-2 mRNA vaccine in different populations in the real world: A review.

Coronavirus disease 2019 (COVID-19) has ravaged the world since December 2019. Up to now, it is still prevalent around the world. Vaccines are an important means to prevent the spread of COVID-19 and reduce severe disease and mortality. Currently, different types of novel coronavirus vaccines are still being developed and improved, and the relevant vaccines that have been approved for marketing have been widely vaccinated around the world. As vaccination coverage continues to grow, concerns about the efficacy and safety of vaccines after real-world use have grown. Some clinical studies have shown that vaccine effectiveness is closely related to antibody response after vaccination. Among them, the advantages of COVID-19 messenger ribonucleic acid (mRNA) vaccine, such as better adaptability to variant strains and better immune response ability, have attracted great attention. However, different populations with different genders, ages, previous COVID-19 infection history, underlying diseases and treatments will show different antibody responses after mRNA vaccination, which will affect the protection of the vaccine. Based on this, this paper reviews the reports related severe acute respiratory syndrome Coronavirus 2 mRNA vaccines, and summarizes the effectiveness of vaccines in different populations and different disease states and looked forward to the precise vaccination strategy of the vaccine in the future.

Perception and Willingness towards COVID-19 Vaccination in Pregnant Females in Jinnah Hospital, Lahore

Objective: To identify perceptions, concerns and barriers affecting willingness for COVID-19 vaccination among pregnant females. Method: This was a cross-sectional study conducted on 356 pragnent women from Gynae outdoor department of Jinnah Hospital, Lahore from August 2021 to January 2022. It was a cross sectional study conducted on 365 pregnant women from gynae outdoor department of Jinnah Hospital, Lahore. After informed consent, data were collected with the help of a semi-structured questionnaire; entered, cleaned and analyzed using SPSS version 20.0. Chi Square was applied as a test of significance where p value is 0.05 Results: Among 365 females, only 58(15.9%) were vaccinated. About 6(10.4%) women received vaccination in the 1st trimester and 26(44.8%) each in the 2nd and 3rd trimester. Significant contributors for vaccination were vaccination center location, advice from health care provider, perception about vaccine safety and vaccine protection, supportive family attitude, previous history of COVID-19 infection and suspicious rumors. Conclusion: Vaccine hesitancy and rejection can be minimized through a multipronged strategy to combat infodemic and to educate the public. Health care providers can play a vital role through their effect communication and counseling.

Acute COVID-19 in unvaccinated children without a history of previous infection during the delta and omicron periods

ABSTRACT Background The Omicron variant has been the predominant severe acute respiratory syndrome coronavirus 2 variant circulating in Korea since January 2022. This study evaluated and compared the clinical characteristics of children with coronavirus disease 2019 (COVID-19) between the Delta and Omicron periods. Methods The medical records of children aged < 12 years diagnosed with acute COVID-19 (<2 weeks of symptom onset) at seven university-affiliated hospitals were retrospectively reviewed. Children with a previous history of COVID-19 or vaccination were excluded. The clinical characteristics of the included children during the Delta (1 August 2021 to 15 January 2022) and Omicron (16 January to 30 June 2022) periods were compared. Results Among the 515 children included in the study, 36 (7.0%) and 479 (93.0%) were diagnosed with COVID-19 during the Delta and Omicron periods, respectively. A total of 142 (27.6%) were hospitalized, and the hospitalization rate was higher during the Delta period than the Omicron period (91.7% vs. 22.8%, p < 0.001). The incidence of fever (p = 0.009), vomiting (p = 0.031), and seizures (p = 0.007) was higher during the Omicron period, whereas the incidence of rhinorrhea (p = 0.027) was higher during the Delta period. Clinical severity and outcomes were comparable between the two periods. During the Omicron period, 6.4% of the hospitalized children received oxygen therapy and 1.8% received intensive care. Conclusion The incidence of fever and seizures was higher during the Omicron period in pediatric patients without a history of vaccination or previous COVID-19. However, the clinical severity was similar during both periods.

Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study

Emergence of the SARS-CoV-2 omicron (B.1.1.529) variant with high immune evasion has led to the development and roll-out of bivalent mRNA vaccines targeting original and omicron strains. However, real-world observational data on effectiveness of bivalent vaccines are scarce. We aimed to assess the relative effectiveness of a fourth vaccine dose with the BA.1-adapted or BA.4/BA.5-adapted bivalent vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals in Singapore. We conducted a retrospective cohort study among Singapore residents aged 18 years and older who had received three monovalent mRNA vaccine doses and were eligible for a fourth dose. Data were collected from official databases on COVID-19 cases and vaccinations maintained by the Singapore Ministry of Health. We analysed the incidence of medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission between Oct 14, 2022, and Jan 31, 2023, by previous infection status and type of fourth vaccine dose received. Inverse probability-weighted Cox regressions were used to estimate hazard ratios (HRs). 2 749 819 individuals were included in the analysis. For the SARS-CoV-2-naive group, a fourth monovalent vaccine dose did not confer additional protection over three monovalent doses against symptomatic infection (HR 1·09 [95% CI 1·07-1·11]), whereas the bivalent vaccine did provide additional protection (0·18 [0·17-0·19]). Among individuals with previous infection, the HR was 0·87 (95% CI 0·84-0·91) and 0·14 (0·13-0·15) with receipt of the fourth monovalent and bivalent doses, respectively. Against COVID-19-related hospital admission, the bivalent vaccine (HR 0·12 [95% CI 0·08-0·18] in SARS-CoV-2-naive participants and 0·04 [0·01-0·15] in previously infected participants) conferred greater benefit compared with the fourth monovalent dose (0·84 [0·77-0·91] in SARS-CoV-2-naive participants and 0·85 [0·69-1·04] in previously infected participants). A fourth dose with the bivalent vaccine was substantially more effective against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission than four monovalent doses among both SARS-CoV-2-naive and previously infected individuals. Boosters with the bivalent vaccine might be preferred in this omicron-predominant pandemic, regardless of previous infection history. None.

Knowledge, Attitudes, and Concerns Regarding COVID-19 Vaccination Among Unvaccinated Elderly People in the Aseer Region, Saudi Arabia.

Vaccination is the best weapon to prevent any disease, especially pandemics like COVID-19, and building herd immunity is the best way to control the disease's spread. On one side, vaccine availability is important, and on the other, its successful distribution is faced with difficulty in a wide geographical area. Availability and distribution go hand in hand, which is the public health challenge. Vaccines are taking over, clearing up concerns about vaccination and making the public ready. The high-risk public should receive vaccines without resistance, which is of utmost importance. Unvaccinated older adults are at higher risk for COVID-19 infection, morbidity, and mortality. The reasons why older people who have not been vaccinated against COVID-19 do not want to receive vaccines when they are available include a lack of knowledge about COVID-19 vaccination and listening to incorrect sources of information. With this background, this study aimed to assess the knowledge, attitudes, and concerns of unvaccinated older adults in the Aseer Region, Saudi Arabia. A community-based cross-sectional study was planned to find out the knowledge and attitudes of the elderly in the Assir Region, Saudi Arabia. A total of 434 unvaccinated elderly persons were recruited randomly from the list of elderly (>60 years) who were unvaccinated. The data was gathered using a structured interview schedule in Arabic. Out of 434 participants, more than half (54.8%) were male. Most of the participants were Saudi citizens (91.5%). Of the participants, nearly one-fifth (19.8%) of them had a previous history of COVID-19 infection. The participants' main sources of information about vaccination against COVID-19 were the mass media (41.9%), followed by word of mouth from friends, families, or neighbors (41.7%), and social media (16.4%). More than three-fourths of them (85.7%) had poor knowledge regarding the COVID-19 vaccination. The participants' poor knowledge grades were mainly among those aged >80 years, illiterate, unemployed participants, and current smokers. Those participants relying on social media had the highest number of concerns (6.663.21) regarding the safety and efficacy of vaccines. Most participants have poor knowledge, and their knowledge of COVID-19 vaccination is limited. Participants whose main source of knowledge is the mass media need to intensify their education activities in the mass media. Social media, whose primary source of information is social media, has the greatest number of issues that require immediate attention. Social media content must be scanned, and misinformation needs to be addressed.

Outcomes of Incidental Durotomy Repair in Thoracolumbar Spine Surgery: An Institutional Experience With Orthopedic Residents.

Background The occurrence of incidental durotomies (IDs) following spinal operations is a widely recognized issue. Complications such as poor outcomes, extended hospitalization, prolonged immobilization, infections, and revision surgeries are all potential consequences of inadequate durotomy management during the initial surgery. This study aims to describe the outcomes of ID repair in thoracolumbar spine surgery in terms of the Oswestry Disability Index (ODI) score and visual analog scale (VAS) when performed with the active involvement of orthopedic residents in the surgical procedure. Methodology Between April 2021 and April 2023, a hospital-based observational study was conducted among 110 patients hospitalized in the orthopedic ward at R.L. Jalappa Hospital and Research Center in Kolar, Karnataka, who required IDs due to an accidental dural tear or a postoperative CSF fluid leak following thoracolumbar spine procedures. Patients with a previous history of thoracolumbar spine surgery, vertebral tumors, spinal metastasis, infections, e.g., spondylodiscitis, or Pott's spine were excluded. The ODI score and VAS score were calculated on the postoperative day, one month, and three months following surgery. Results The mean age of the study participants was 62.81 + 10.49 years, with a male preponderance of 67.2% among the study participants. The mean BMI of study participants was 23.77 kg/m2. Approximately 24.5% of participants had a prior history of spinal surgery. Among 110 patients, 32 had postoperative complications. Six patients reported experiencing urinary retention, followed by five with CSF leakage and one with a postural headache(five cases). Based on the ODI score, mild disability was seen in 32.7% of the study samples at three months of follow-up. Based on the VAS score, moderate pain was seen among all the study samples at three months of follow-up. The ANOVA test revealed statistically significant differences in ODI and VAS score reductions between the immediate postoperative period and the one-month and three-month follow-up periods (p = 0.001 and p = 0.0247, respectively). Conclusion Less than one-third of the samples had postoperative complications. At three months, ODI scores showed mild disability in one-third of the study samples. At three months, all study samples had moderate VAS pain. The improvement in ODI and VAS scores from the day after surgery through the one-month and three-month follow-up periods was statistically significant.

Disease duration and herpes zoster infection related to neutropenia in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease involving several organs. Neutropenia in patients with SLE may be a factor associated with infection leading to higher morbidity and mortality. There are several inconsistent predictors of neutropenia in patients with SLE. The present study is a retrospective, analytical study, which aimed to identify other predictors of neutropenia in patients with SLE. Patients with SLE who had been regularly followed up for ≥1 year were included in this study. Clinical factors, including history of disease, comorbidities, previous infection, laboratory results and treatment, were collected. The primary analyzed indicator was the occurrence of neutropenia. Factors associated with neutropenia were calculated by multivariate logistic regression analysis. A total of 84 patients met the study criteria. Of those 84 patients, 36 (42.86%) developed neutropenia. There were seven factors placed in the predictive model for neutropenia. Two factors were independently associated with the presence of neutropenia: Disease duration and herpes zoster infection. The first factor was negatively related with neutropenia with an adjusted odds ratio of 0.70 (95% confidence interval, 0.54, 0.92), whereas herpes zoster infection was an independent risk factor for neutropenia with an adjusted odds ratio of 8.46 (95% confidence interval, 1.30, 54.80). In conclusion, the present study revealed that short duration of disease and herpes zoster infection are predictors of neutropenia in patients with SLE.

Active Medical Learner Engagement Results in the Discovery That One Size Does Not Fit All in Overcoming COVID-19 Vaccine Hesitancy.

Vaccine hesitancy is an ongoing public health concern defined as the refusal of a vaccine that is readily available. Therefore, we developed a project to explore why patients in a safety net medical center were hesitant or refused the COVID-19 vaccine. The project was conducted by healthcare learners to promote "learning by doing". Responses were collected through a previously developed and ongoing survey among both hospitalized and ambulatory patients that had no previous history of COVID-19 infection, were currently infected, or had recovered from COVID-19. Results were analyzed using a priori power analysis and Chi-squared test. We discovered that different self-reported ethnic groups had different reasons for vaccine hesitancy; specifically, 69% of Black/African American respondents stated that their main reason for hesitancy was vaccine safety compared to 13.9% of non-Hispanic Whites (p = 0.005). Furthermore, our cohort was significantly more likely to disagree rather than agree with the statement: "getting vaccinated is important for the health of others in my community"(p = 0.016). The learners discovered that a more specific approach to vaccine education would be required to understand and overcome vaccine hesitancy in our cohort of socioeconomic and ethnically diverse groups.