Short-term adverse effects of COVID-19 vaccines after the first, second, and booster doses: a cross-sectional survey from Punjab, Pakistan, and the implications

ABSTRACT Background: Safety and efficacy concerns regarding coronavirus disease 2019 (COVID-19) vaccines are common among the public and have a negative impact on their uptake. We aimed to report the adverse effects currently associated with the vaccine in Pakistan to build confidence among the population for its adoption. Methods: A cross-sectional study was conducted in five districts of the Punjab province of Pakistan between January and March 2022. The participants were recruited using convenience sampling. All data were analyzed using SPSS 22. Results: We recruited 1622 people with the majority aged between 25-45 years. Of these, 51% were female, including 27 pregnant women and 42 lactating mothers. Most participants had received the Sinopharm (62.6%) or Sinovac (17.8%) vaccines. The incidences of at least one side effect after the first (N = 1622), second (N = 1484), and booster doses (N = 219) of the COVID-19 vaccine were 16.5%, 20.1%, and 32%, respectively. Inflammation/erythema at the injection site, pain at the injection site, fever, and bone/muscle pain were common side effects of vaccination. No significant differences were observed in the adverse effect scores between all demographic variables except for pregnancy (P = 0.012) after the initial dose. No significant association was observed between any variable and the side effect scores of the second and booster doses of the vaccine. Conclusions: Our study showed a 16-32% prevalence of self-reported side effects after the first, second, and booster COVID-19 vaccinations. Most adverse effects were mild and transient, indicating the safety of different COVID-19 vaccines.

Assessment of corona-phobia in university students with the COVID-19 Phobia Scale (C19P-S): A cross-sectional analysis / Evaluación de la corona-fobia en estudiantes universitarios mediante la Escala de Fobia COVID-19 (C19P-S): Un análisis transversal

Abstract Introduction Disease phobia may impose distressing manifestations along with compromised quality of life, particularly in young age. COVID-19 caused substantial psychological concerns in general population which required the attention of health authorities to address the issue as soon as possible. Objective This study was aimed to determine COVID-19 phobia in Pakistani youth during the current pandemic. Method A cross-sectional study was conducted to ascertain the extent of fear of COVID-19 among university students in Lahore, Pakistan using the COVID-19 Phobia Scale (C19P-S). Psychological, somatic, social, and economic factors were ascertained among students. The relationship of demographics with the phobia score was determined through appropriate statistical tests. Result This study included 374 students with a male preponderance (64.7%). The mean C19P-S score was 59.08 ± 14.44 (IQR: 50 - 70), with no significant difference among demographics except gender (male 57.65 ± 14.77 vs female 61.70 ± 13.47; p = .009). The mean psychological, psycho-somatic, economic, and social subscale scores were 19.59 ± 5.00 (25th percentile = 16 and 75th percentile = 24), 12.29 ± 4.56 (25th percentile = 10 and 75th percentile = 15), 11.22 ± 3.67 (25th percentile = 8 and 75th percentile = 14) and 15.97 ± 4.04 (25th percentile = 13.75 and 75th percentile = 19), respectively. Male students had a significantly lower score on social and psychological subscales than females (p< .05). Discussion and conclusion One fourth of the students achieved a fear score > 70 on C19P-S. These results indicate the need of dire maneuvers for reducing corona-phobia among university students.

Resumen Introducción La fobia a las enfermedades puede imponer malestar psicológico y comprometer la calidad de vida, particularmente en edades tempranas. El COVID-19 causó serias preocupaciones psicológicas en la población en general y éstas requieren la atención de las autoridades de salud para abordar el problema cuanto antes. Objetivo Este estudio buscó determinar la fobia al COVID-19 en jóvenes paquistaníes durante la pandemia actual. Método Se realizó un estudio transversal basado en la web para evaluar el miedo al COVID-19 entre los estudiantes universitarios en Lahore; para esto se utilizó la Escala de Fobia COVID-19 (C19P-S). Se evaluaron factores psicológicos, somáticos, sociales y económicos entre los estudiantes. La relación de la demografía con la puntuación de fobia se determinó mediante pruebas estadísticas apropiadas. Resultados Este estudio incluyó a 374 estudiantes con preponderancia masculina (64.7%). La puntuación media de C19P-S fue 59.08 ± 14.44 (IQR: 50 - 70), sin diferencias significativas entre los datos demográficos, excepto el género (hombres 57.65 ± 14.77 versus mujeres 61.70 ± 13.47; p = .009). Las puntuaciones medias de las subescalas psicológicas, psicosomáticas, económicas y sociales fueron 19.59 ± 5.00 (percentil 25 = 16 y percentil 75 = 24), 12.29 ± 4.56 (percentil 25 = 10 y percentil 75 = 15), 11.22 ± 3.67 (percentil 25) = percentil 8 y 75 = 14) y 15.97 ± 4.04 (percentil 25 = 13.75 y percentil 75 = 19), respectivamente. Los estudiantes varones obtuvieron una puntuación significativamente menor en las subescalas sociales y psicológicas que las mujeres (p< .05). Discusión y conclusión Una cuarta parte de los estudiantes obtuvo una puntuación de miedo > 70 en la C19P-S. Estos resultados indican la necesidad de aplicar medidas extremas para reducir la fobia al Coronavirus entre los estudiantes universitarios.

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study / Anemia em pacientes pré-diálise: prevalência, gravidade, manejo

Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

Resumo Objetivo: anemia é uma complicação comum de doenças renais crônicas (DRC) e está significativamente envolvida na morbidade cardiovascular. O objetivo de nosso estudo foi investigar a prevalência e a gravidade da anemia em pacientes adultos pré-diálise, bem como determinar fatores preditores da terapia antianêmica. Método: estudo retrospectivo observacional foi realizado em pacientes pré-diálise adultos que recebiam tratamento no Hospital Universiti Sains Malaysia de janeiro de 2009 a dezembro de 2013. Resultados: ao todo, 615 casos elegíveis foram incluídos. A idade média dos pacientes foi de 64,1±12,0 anos. A prevalência de anemia foi de 75,8%, e a gravidade da anemia foi considerada leve em 47,7%, moderada em 32,2% e grave em 20% dos pacientes. Com base nas características morfológicas da anemia, os pacientes foram classificados em anemia normocrômica normocítica (76,9%), anemia hipocrômica microcítica (21,8%) e anemia macrocítica (1,3%). Suplementos de ferro oral foram prescritos para 38% dos pacientes e a nenhum dos pacientes foram dados eritropoietina, agentes estabilizadores (ESA) e preparações de ferro por via intravenosa. Na regressão logística, os preditores significativos de utilização da preparação antianêmica foram diminuição da hemoglobina e do hematócrito e estágios avançados da DRC. Conclusão: os resultados do presente estudo sugerem que a prevalência de anemia em pacientes pré-diálise é maior do que o atualmente aceito e está associado com a função renal; a prevalência aumenta com a diminuição da função renal. A identificação precoce e o manejo adequado da anemia não só terão um impacto positivo na qualidade de vida, mas também reduzirão internações de pacientes com DRC decorrentes de eventos cardiovasculares.

Evaluation of different formulations of IGRs against Aedes albopictus and Culex quinquefasciatus (Diptera:Culicidae)

Objective: To test the relative efficacy of pyriproxyfen and methoprene on mortality, deformity, inhibition and emergence to adult stages of Culex quinquefasciatus and Aedes albopictus. Methods: Serial dilutions (0.01–0.05 mg/L) of methoprene, pyriproxyfen 0.5 water dispersible granules (WDG) and pyriproxyfen 1.0 WDG were used to assess mortality and inhibition of 3rd instar larvae of Aedes albopictus and Culex quinquefasciatus. Each concentration and control was replicated four times in completely randomized design. Data on larval mortality, growth inhibition, deformities and adult's emergence was recorded weekly. On the basis of best comparative performance, the efficacy of pyr-iproxyfen 1.0 WDG at 0.1 g/m3 was also tested in the field by collecting treated water samples monthly for 1–6 months after field application. Twenty five 3rd instar larvae of Aedes and Culex spp. of the same cohorts were used for bioassays and compared with larvae in control cups containing 1 L of untreated tap water. Results: Results revealed variations in fatality of different insect growth regulators (IGRs) to the 3rd instar larvae of Culex and Aedes mosquitoes. Among the IGRs, pyr-iproxyfen 1.0 WDG was found best that exhibited significantly high emergence inhibition against Culex and Aedes spp. Based on the results, the IGRs were classified in terms of the tested parameters in order of pyriproxyfen 1.0 WDG > pyriproxyfen 0.5 WDG > methoprene. In case of field studies, pyriproxyfen 1.0 WDG, pool data of the entire target treated sites showed minimum adult emergence from water sampled of habitats treated with 0.1 g/m3 of pyriproxyfen 1.0 WDG. Conclusions: It is thus concluded that IGRs can be utilized as environment friendly control measures for Culex and Aedes spp. of mosquitoes on small and large scale. This will reduce the use of conventional insecticides by the public health authorities and help in reducing selection pressure of insecticides.

Attributable causes of chronic kidney disease in adults: a five-year retrospective study in a tertiary-care hospital in the northeast of the Malaysian Peninsula / Causas imputáveis da doença renal crônica em adultos: um estudo retrospectivo de cinco anos de um Hospital de Assistência Terciária no nordeste do Península da Malásia

ABSTRACT CONTEXT AND OBJECTIVE: Chronic kidney disease (CKD) is an escalating medical and socioeconomic problem worldwide. Information concerning the causes of CKD, which is a prerequisite for reducing the disease burden, is sparse in Malaysia. Therefore, this study aimed to evaluate the attributable causes of CKD in an adult population at a tertiary referral hospital. DESIGN AND SETTING: Retrospective study at Hospital Universiti Sains Malaysia (HUSM). METHODS: This was an analysis based on medical records of adult patients at HUSM. Data regarding demographics, laboratory investigations, attributable causes and CKD stage were gathered. RESULTS: A total of 851 eligible cases were included. The patients' mean age was 61.18 ± 13.37 years. CKD stage V was found in 333 cases (39.1%) whereas stages IV, IIIb, IIIa, and II were seen in 240 (28.2%), 186 (21.9%), 74 (8.7%) and 18 (2.1%), respectively. The percentage of CKD stage V patients receiving renal replacement therapy was 15.6%. The foremost attributable causes of CKD were diabetic nephropathy (DN) (44.9%), hypertension (HPT) (24.2%) and obstructive uropathy (9.2%). The difference in the prevalence of CKD due to DN, HPT and glomerulonephritis between patients ≤ 50 and > 50 years old was statistically significant. CONCLUSION: Our results suggest that DN and HPT are the major attributable causes of CKD among patients at a Malaysian tertiary-care hospital. Furthermore, the results draw attention to the possibility that greater emphasis on primary prevention of diabetes and hypertension will have a great impact on reduction of hospital admissions due to CKD in Malaysia.

RESUMO CONTEXTO E OBJETIVO: Doença renal crônica (DRC) é um problema médico e socioeconômico crescente. As informações relativas às causas da DRC são pré-requisito para reduzir a carga da doença, e são escassas na Malásia. Este estudo tem como objetivo avaliar as causas atribuíveis à DRC na população adulta de um hospital de referência terciária. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado no Hospital Universiti Sains Malaysia (HUSM). MÉTODOS: Análise de prontuários de pacientes adultos de HUSM. Foram obtidos dados demográficos, exames laboratoriais, causas atribuíveis e estágio da DRC. RESULTADOS: Um total de 851 casos elegíveis foi incluído. A idade média dos pacientes foi de 61,18 ± 13,37 anos. DRC fase V foi contabilizada em 333 casos (39,1%), enquanto casos de estágio IV, IIIb, IIIa e II foram 240 (28,2%), 186 (21,9%), 74 (8,7%) e 18 (2,1%), respectivamente. A porcentagem de pacientes com DRC estágio V recebendo a terapia de substituição renal foi 15,6%. As causas atribuíveis mais importantes da DRC foram nefropatia diabética (ND) (44,9%), hipertensão (24,2%) e uropatia obstrutiva (9,2%). A diferença na prevalência da DRC devido à ND, hipertensão e glomerulonefrite entre pacientes ≤ 50 anos e > 50 anos de idade foi estatisticamente significativa. CONCLUSÃO: Nossos resultados sugerem que a ND e a hipertensão são as principais causas atribuíveis da DRC em pacientes sob cuidados terciários na Malásia. Os resultados apontam para a possibilidade de maior ênfase na prevenção primária da diabetes e hipertensão como impactante na redução das internações hospitalares devidas a DRC na Malásia.

Severe, recurrent hiatal hernia in Schwartz syndrome

An 18 months old baby boy was brought by parents with recurrent vomiting since birth, which had increased over the past four months, failure to gain weight, and altered facial features with delayed development. The baby was reported perfectly normal looking till the age of six months. The parents were first cousins, and married for four years. This was their second child and their first baby had died within a week of birth with an encephalocele. The patient had been variably treated for pneumonia, tuberculosis and malnutrition with no improvement. On examination the baby was emaciated and stunted weighing just 6.9 kg with a length of 68 cms, but alert and apprehensive of strangers. There was blepharophimosis with twitching of the upper eyelids, a puckered mouth and abnormal posturing of the limbs. The knees and elbows were flexed, hands fisted and feet were planter flexed. All joints could be passively extended with ease. There were no dysmorphic features. At 18 months of age the baby could not sit independently, though he could cruise along furniture on tip toes, could eat with his own hand, could speak with a vocabulary of 5-6 meaningful words and had appropriate fine motor movements so that he could draw a single match stick out of its box. Though there was generalized hypertonia, the tendon jerks were not exaggerated. Gastroesophageal reflux with tetany was the initial diagnosis. Urine R/E, Serum calcium, parathormone, bicarbonate and serum albumin, serum CPK, aldolase were within normal limits. Barium meal showed a sliding hiatal hernia with marked gastro esophageal reflux and a dilated esophagus. EMG and NCS showed no evidence of myopathy or neuropathy. Ultrasonography of abdomen and CT scan of brain were normnal. Radiograph of the clavicles was normal but the lumbosacral spine showed shortening of the vertebrae. Baseline ECG was also normal. Having excluded the other conditions, a diagnosis of Schwartz syndrome with hiatal hernia was made. After initial supportive management surgical correction with fundoplication was carried out. Carbamazepine helped to revert the tone to near normal. Three months later the patient weighed 9 kg but the tone was still more than normal. Ternaline was added to the treatment and the tone remarkably improved. A repeat barium meal at that time showed normal position of the stomach and a slightly dilated esophagus