Systemic COVID-19 vaccines Adverse Events Following Immunizations and Their Associated Factors: A Comparative Study Using Iraqi Consumers' Self-Reported Data

Introduction: Three types of COVID-19 vaccines were deployed in Iraq;PfizerBioNTech, AstraZeneca, and Sinopharm. Spontaneous self-reported safety data received directly from consumers was an important source of COVID-19 vaccine reporting sources for the first time in Iraq. Objective(s): To study the common systemic AEFIs and factors influencing them, using self-reported data by Iraqi consumers vaccinated with different COVID-19 vaccine types. Method(s): As a part of the national plan for COVID-19 vaccines safety surveillance, an online self-assessment form was designed by the national pharmacovigilance center for the public consumers across the country. The form was quadrilingual and captures the necessary information for a valid AEFI report. Demographic data, contact details, vaccination details, adverse event information, and medical history were collected. To facilitate the filling process and standardize the answers, a list of predefined common short-term AEFIs were included as a checklist, in addition to a free text for other unlisted AEFIs. A retrospective cross-sectional study using the collected responses from April, 2021 until April, 2022 was performed. Data was validated and cleaned. Analyses was performed using SPSS software version 26. Selected common short-term AEFIs were analysed. The incidence of these AEFIs were compared between vaccine types using chisquare test. Moreover, predictors of reporting these AEFIs were explored using binary logistic regression for each vaccine type. Result(s): A total of 2843 report were included, 62.0% of them were male. The age mean was 36.33 (SD +/- 12.2). The participants were more likely to report after the 1st dose (79.4%). AstraZeneca vaccine was found to produce the highest number of AEFIs per report, 4.31 (SD +/- 2.4). AstraZeneca and PfizerBioNTech were significantly associated with a higher incidence of multiple AEFIs as compared with Sinopharm (fatigue, joint pain, headache, fever, and chills). PfizerBioNTech vaccine was associated with 71 out of the 76 reported lymph nodes AEFIs. Factors that were significant predictors of higher reporting of systemic AEFIs were;for PfizerBioNTech (female gender, increased dose number, and increased likelihood of previous COVID-19 infection);AstraZeneca (younger age, female gender, and increased likelihood of previous COVID-19 infection);and in case of Sinopharm (younger age, and female gender) Conclusion(s): The results showed that AstraZeneca and PfizerBioNTech vaccines were associated with more AEFIs than Sinopharm. Predictor factors of AEFIs include;female gender in all vaccines;the presence of previous COVID-19 infection in both PfizerBioNTech and AstraZeneca vaccines;second dose in PfizerBioNTech;and younger age for both AstraZeneca and Sinopharm.

Systemic COVID-19 vaccines Adverse Events Following Immunizations and Their Associated Factors: A Comparative Study Using Iraqi Consumers' Self-Reported Data: An International Journal of Medical Toxicology and Drug Experience

Introduction: Three types of COVID-19 vaccines were deployed in Iraq;PfizerBioNTech, AstraZeneca, and Sinopharm. Spontaneous self-reported safety data received directly from consumers was an important source of COVID-19 vaccine reporting sources for the first time in Iraq. Objective: To study the common systemic AEFIs and factors influencing them, using self-reported data by Iraqi consumers vaccinated with different COVID-19 vaccine types. Methods: As a part of the national plan for COVID-19 vaccines safety surveillance, an online self-assessment form was designed by the national pharmacovigilance center for the public consumers across the country. The form was quadrilingual and captures the necessary information for a valid AEFI report. Demographic data, contact details, vaccination details, adverse event information, and medical history were collected. To facilitate the filling process and standardize the answers, a list of predefined common short-term AEFIs were included as a checklist, in addition to a free text for other unlisted AEFIs. A retrospective cross-sectional study using the collected responses from April, 2021 until April, 2022 was performed. Data was validated and cleaned. Analyses was performed using SPSS software version 26. Selected common short-term AEFIs were analysed. The incidence of these AEFIs were compared between vaccine types using chisquare test. Moreover, predictors of reporting these AEFIs were explored using binary logistic regression for each vaccine type. Results: A total of 2843 report were included, 62.0% of them were male. The age mean was 36.33 (SD ± 12.2). The participants were more likely to report after the 1st dose (79.4%). AstraZeneca vaccine was found to produce the highest number of AEFIs per report, 4.31 (SD ± 2.4). AstraZeneca and PfizerBioNTech were significantly associated with a higher incidence of multiple AEFIs as compared with Sinopharm (fatigue, joint pain, headache, fever, and chills). PfizerBioNTech vaccine was associated with 71 out of the 76 reported lymph nodes AEFIs. Factors that were significant predictors of higher reporting of systemic AEFIs were;for PfizerBioNTech (female gender, increased dose number, and increased likelihood of previous COVID-19 infection);AstraZeneca (younger age, female gender, and increased likelihood of previous COVID-19 infection);and in case of Sinopharm (younger age, and female gender) Conclusion: The results showed that AstraZeneca and Pfi-zerBioNTech vaccines were associated with more AEFIs than Sinopharm. Predictor factors of AEFIs include;female gender in all vaccines;the presence of previous COVID-19 infection in both PfizerBioNTech and AstraZeneca vaccines;second dose in PfizerBioNTech;and younger age for both AstraZeneca and Sinopharm.

Effect of nursing instructions about COVID-19 preventive measures on knowledge and reported practice of hospitalized school age children

Background: COVID-19, novel coronavirus, has been identified by the World Health Organization as a pandemic that causes highly transmittable respiratory disease. Lack of awareness about COVID-19 preventive measures represents a global threat. The aim of the current study was to evaluate the effect of nursing instructions about COVID-19 preventive measures on knowledge and reported practice of hospitalized school age children. Materials and Methods: One group pre-posttest quasi-experimental design was utilized to carry out the current study. Setting: The study was conducted in the medical wards at Cairo University Specialized Pediatric Hospital CUSPH. Sample: A purposive sample of 100 hospitalized school age children was included in the study. Data Collection Tool: Structured interview questionnaire designed by the researcher contained seventy-eight questions related to children's demographic data, general knowledge about COVID-19, symptoms, modes of transmission, treatment and prevention was used.

Surgical management of parkinson’s disease: The role of lesioning procedures in developing countries in the modern era

BACKGROUND: The known loss of dopaminergic cells in the pars-compacta of the substantia nigra that is the hallmark of Parkinson’s disease (PD). The cellular pathophysiology of the motor dysfunction is beginning to be better understood, thereby providing a stronger scientific rationale for surgical interventions. Yet, to date, there are no treatments that prevent, halt, or cure PD. Surgical strategies, offer symptomatic relief or control of motor complications associated with drug treatment. Both pallidotomy and thalamotomy were extensively used in the treatment of PD in the1950’s and 1960’s. With the introduction of levodopa (L-dopa) in the1960’s and the realization of its striking benefits, surgery was almost abandoned and used only for patients with severe tremor. Surgical therapy is now being used earlier and more often. There are currently three brain regions being considered as targets for functional neurosurgery for PD (other than transplantation) either central nervous system lesions (thalamotomy, pallidotomy, or subthalamic nucleus [STN] lesions) or deep brain stimulation. These targets are: The ventral intermediate nucleus of the thalamus, the internal segment of the Globus Pallidus, and the STN. AIM: The objective of the study was to assess the outcome (3 months and 6 months) of lesioning procedures in PD patients meeting the inclusion criteria. METHODS: A prospective clinical study conducted on ten idiopathic PD (IPD) patients during the period from October 2018 to March 2021 at Cairo University Hospitals. This study was concerned to improve the motor symptoms of IPD patients by stereotactic radiofrequency ablative procedures. Cases were restricted to ten patients due to the COVID-19 pandemic and restriction of elective cases for chronic patients at Cairo University hospitals. RESULTS: In our study, we operated on ten IPD patients who were meeting our selection criteria by ablative procedures contralateral to Parkinsonian symptoms. Age of the patients ranged 17–70 years with mean of 50.5 ± 16.35 y with predominance in males representing six patients. Mean duration of PD according to history ranged from 2 to 12 year with mean of 8 ± 3.1 years. Patients were divided into three groups according to their presentation and the operation done for them. Thalamotomy group: Preoperatively, the Unified PD Rating Scale (UPDRS) III off and on, respectively, was 24.4/15.2 and postoperatively was 13/7.4 with improvement 47%/51%. The tremor subscore was 5.4/2.8 preoperatively and 1.4/0.8 postoperatively with average of 72% improvement. The UPDRS II pre was 17.2/11.6 and post it became 10.6/7 with 39% improvement modified H & Y 2.4/1.7 pre and postoperatively (29% improvement). Pallidotomy group: Preoperatively, the UPDRS III off and on, respectively, was 38.5/23.5 and postoperatively was 28/16 with improvement 27%/32%. The rigidity subscore was 5/2.5 preoperatively and 2/1 postoperatively with average of 60% improvement. The bradykinesia subscore was 9/5.5 preoperatively and 5.5/2.5 postoperatively with average of 47% improvement. The dyskinesia subscore was 4.5 preoperatively and 1.2 postoperatively with average of 71% improvement. The UPDRS II pre was 22/12.5 and post it became 16/10 with 25% improvement modified H & Y 2.75/2.25 pre & postoperatively (18% improvement). Combined group: Preoperatively, the UPDRS III off & on respectively was 41.33/28.67 and postoperatively was 15.67/11.33 with improvement 62%/60%. The rigidity subscore was 5/3.33 preoperatively and 1.67/1 postoperatively with average of 68% improvement. The bradykinesia subscore was 10/6 preoperatively and 4/1.33 postoperatively with average of 72% improvement. The UPDRS II pre was 28.33/19.33 and post it became 16.33/10.67 with 43% improvement modified H and Y 2.83/2 pre and post-operatively (29% improvement). Postoperatively, there was a high significant statistical finding in all clinical score and subscore of Parkinsonian symptoms. CONCLUSION: The study concludes that lesioning procedure should be revisited globally using the modern tech iques of targeting and controlled thermal lesion protocols guided by capsular somatotopy and intraoperative macroelectrode stimulation, that will improve the outcome dramatically. Ablative procedures proved their efficacy in controlling motor symptoms of IPD and their cost-benefit in low and middle-income nations.

The Modality Preferred by Population of Health Services Provided During COVID-19 and Assessment of Satisfaction Among Adults in Kingdom of Saudi Arabia.

Background During the COVID-19 pandemic, there was a great transition in the modalities of health care services, such as the telemedicine landscape, with some speed. Because of the lack of vaccines or effective therapies, social distancing and quarantine were the only widely accessible precautions, creating a compelling reason for alternatives for in-person care. Many countries applied teleconsultation or provided online applications during the COVID-19 pandemic. However, it is not currently known whether this available service has satisfied the patients' needs during the COVID-19 pandemic. Aim To detect the preferred modality of health services by the Saudi population during COVID-19 and to assess the satisfaction with respect to the provided health services in the Aseer region of Saudi Arabia. Methodology A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. The tool covered participants' socio-demographic data, participants' medical and family history, COVID-19 infection, health problems during the pandemic, received services, modalities of available services, and their satisfaction regarding the provided health service. Results A total of 2102 participants completed the study questionnaire. Exactly 773 (36.8%) respondents had a health problem during the COVID-19 pandemic. The most-reported modality of health services used was calling the 937 number, which is call center of the Ministry of Health (34.7%), followed by using health applications to get an appointment (33.9%). Also, 447 (88.7%) participants reported that the provided medical services were helpful. Regarding their satisfaction, 156 (31%) were just satisfied with the provided services and 280 (55.6%) were highly satisfied. Conclusions In conclusion, the current study showed a high level of public satisfaction regarding different modalities of health services provided during the COVID-19 pandemic in Saudi Arabia. This satisfaction was moderately high among telehealth users and those who had hospital visits for health care.

Microvascular Free Tissue Transfer in the Setting of COVID-19 Associated Coagulopathy: A Case report

Summary In the era of this pandemic, the use of free flaps for elective reconstruction should proceed with caution in the COVID-19 positive patient given the associated coagulopathy. In those who require free tissue transfer in an urgent or non-elective manner, it is advisable to consider systemic anticoagulation with an associated hematologic consultation given the theoretic higher risk of flap vascular complication. We present a case report of a young healthy and otherwise asymptomatic COVID-19 positive patient whose associated coagulopathy resulted in free flap loss and need for further operations.

Emergency Restructuring of a General Surgery Residency Program During the Coronavirus Disease 2019 Pandemic: The University of Washington Experience.

Seattle, Washington, is an epicenter of the coronavirus disease 2019 epidemic in the United States. In response, the Division of General Surgery at the University of Washington Department of Surgery in Seattle has designed and implemented an emergency restructuring of the facility's general surgery resident care teams in an attempt to optimize workforce well-being, comply with physical distancing requirements, and continue excellent patient care. This article introduces a unique approach to general surgery resident allocation by dividing patient care into separate inpatient care, operating care, and clinic care teams. Separate teams made up of all resident levels will work in each setting for a 1-week period. By creating this emergency structure, we have limited the number of surgery residents with direct patient contact and have created teams working in isolation from one another to optimize physical distancing while still performing required work. This also provides a resident reserve without exposure to the virus, theoretically flattening the curve among our general surgery resident cohort. Surgical resident team restructuring is critical during a pandemic to optimize patient care and ensure the well-being and vitality of the resident workforce while ensuring the entire workforce is not compromised.