Recent Trends and Characteristics of Genitourinary Fistulas in Rwanda

INTRODUCTION AND OBJECTIVE: Genitourinary fistulas (GU) in Rwanda have significantly increased in recent years. We previously reported an increase in the proportion of vesicouterine, vesicocervical and uterovaginal fistulas, with the majority occurring after Cesarean section. Our goal is to examine the characteristics of our the most recent cohort. METHOD(S): A cross-sectional study was conducted of women presenting for evaluation to the International Organization for Women and Development (IWOD) in Kigali, Rwanda, from 2018 to 2019, and 2022. No data was collected during years 2020 and 2021, due to the COVID-19 pandemic. Data was collected from medical records and included region of residence, surgical history, presence of fistula, and type. RESULT(S): A total of 434 women were evaluated, of these 194 (44.7%) were diagnosed with GU fistula. In 2018, fistula types were 40 (52%) vesicovaginal, 5 (6%) urethral, 5 (6%) ureterovaginal, 23 (30%) vesicoureterine or vesicocervical, and 7 (9%) juxtacervical. In 2019, the fistula types were 26 (41%) vesicovaginal, 4 (6%) urethral, 6 (10%) ureterovaginal, 17 (27%) vesicoureterine or vesicocervical, and 10 (16%) juxtacervical. In 2022, the fistula types were 33 (61%) vesicovaginal, no urethral fistula reported, 7 (13%) ureterovaginal, 8 (15%) vesicoureterine or vesicocervical, and 6 (11%) juxtacervical. CONCLUSION(S): In comparison to our prior cohort, recent data shows a stable proportion of types of fistulas. The increased number of vesicouterine, vesicocervical, and juxtacervical fistula may be higher due to increased performance of Cesarean sections.

Humoral and cellular immunogenicity of homologous and heterologous booster vaccination in Ad26.COV2.S-primed individuals: Comparison by breakthrough infection.

Background: Whether or not a single-dose Ad26.COV2.S prime and boost vaccination induces sufficient immunity is unclear. Concerns about the increased risk of breakthrough infections in the Ad26.COV2.S-primed population have also been raised. Methods: A prospective cohort study was conducted. Participants included healthy adults who were Ad26.COV2.S primed and scheduled to receive a booster vaccination with BNT162b2, mRNA-1273, or Ad26.COV2.S. The IgG anti-receptor binding domain (RBD) antibody titers, neutralizing antibody (NAb) titers (against wild type [WT] and Omicron [BA.1 and BA.5]), and Spike-specific interferon-γ responses of the participants were estimated at baseline, 3-4 weeks, 3 months, and 6 months after booster vaccination. Results: A total of 89 participants were recruited (26 boosted with BNT162b2, 57 with mRNA-1273, and 7 with Ad26.COV2.S). The IgG anti-RBD antibody titers of all participants were significantly higher at 6 months post-vaccination than at baseline. The NAb titers against WT at 3 months post-vaccination were 359, 258, and 166 in the participants from the BNT162b2-, mRNA-1273-, and Ad26.COV2.S-boosted groups, respectively. Compared with those against WT, the NAb titers against BA.1/BA.5 were lower by 23.9/10.9-, 16.6/7.4-, and 13.8/7.2-fold in the participants from the BNT162b2-, mRNA-1273-, and Ad26.COV2.S-boosted groups, respectively, at 3 months post-vaccination. Notably, the NAb titers against BA.1 were not boosted after Ad26.COV2.S vaccination. Breakthrough infections occurred in 53.8%, 62.5%, and 42.9% of the participants from the BNT162b2-, mRNA-1273-, and Ad26.COV2.S-boosted groups, respectively. No significant difference in humoral and cellular immunity was found between individuals with and without SARS-CoV-2 breakthrough infections. Conclusion: Booster vaccination elicited acceptable humoral and cellular immune responses in Ad26.COV2.S-primed individuals. However, the neutralizing activities against Omicron subvariants were negligible, and breakthrough infection rates were remarkably high at 3 months post-booster vaccination, irrespective of the vaccine type. A booster dose of a vaccine containing the Omicron variant antigen would be required.

Internet of things platform technology used in undergraduate nursing student education: a scoping review protocol.

INTRODUCTION: Future nursing education needs to build a cutting-edge technology-based educational environment to provide a variety of consumer-oriented education. Thus, the sharing of information in nursing education needs to be considered, especially given the advancement of internet of things (IoT) technology. Before developing a horizontal platform, understanding previously developed IoT platforms is necessary to establish services and devices compatible with each other in different service areas. This scoping review aims to explore the technology used in the IoT platform for the education of nursing students in the undergraduate nursing curriculum. METHODS AND ANALYSIS: A preliminary search was completed to find initial search terms, on which a full-search strategy was developed. Search results yielded from PubMed (NCBI) were screened to ensure articles were peer-reviewed, published in English from January 1999 to August 2021, and relevant to developing, applying and evaluating IoT platforms at educational institutions for students in undergraduate nursing programmes. A full-text review of relevant articles will be conducted, and data will be extracted using the developed extraction tool. The extracted qualitative data will be analysed using a modified grounded theory approach, informing a working definition of the IoT platform and related terms. ETHICS AND DISSEMINATION: The study was exempted from ethical review by the Institutional Review Board of Nambu University, South Korea. Study results will be disseminated through peer-reviewed journals.

Metabolic syndrome and COVID-19 mortality among adult black patients in new orleans

INTRODUCTION: Coronavirus disease 2019 (COVID-19) mortality is high in patients with hypertension, obesity and diabetes mellitus, yet a plausible mechanism remains unknown. We examined the association between hypertension, obesity, hyperlipidemia, and diabetes, individually and clustered as metabolic syndrome (MetS), and COVID-19 outcomes in patients hospitalized in New Orleans during the peak of the outbreak. METHODS: This was a retrospective, observational study of consecutive COVID-19 patients hospitalized at two academic tertiary hospitals in New Orleans from March 30th to April 5th, 2020. Patients were identified as MetS using WHO criteria and compared to patients without MetS. The primary outcome for all analyses was hospital mortality. Secondary outcomes included need for ICU, invasive mechanical ventilation (IMV), a diagnosis of ARDS as defined by Berlin Criteria, hospital length of stay (LOS), and hospital readmission after initial discharge. Multivariable regression models included age, sex, race, individual hospital site and Charlson Comorbidity Index as covariates. RESULTS: Among 287 patients (mean age, 61.5 years;female, 56.8%;non-Hispanic Black, 85.4%), MetS was present in 188 (66%). MetS was significantly associated with mortality (adjusted odds ratio [aOR]: 3.42, 95% confidence interval [CI]: 1.52-7.69), ICU (aOR: 4.59, CI: 2.53-8.32), IMV (aOR: 4.71, CI: 2.50-8.87) and ARDS (aOR: 4.70, CI: 2.25-9.82), compared with non-MetS. Multivariable analyses of hypertension, obesity and diabetes individually showed no association with mortality. Obesity was associated with ICU (aOR, 2.18, CI, 1.25-3.81), ARDS (aOR, 2.44, CI, 1.28-4.65), and IMV (aOR, 2.36, CI, 1.33-4.21). Diabetes was associated with ICU (aOR, 2.22, CI, 1.24-3.98) and IMV (aOR, 2.12, CI, 1.16-3.89). Hypertension was not significantly associated with any outcome. Inflammatory biomarkers associated with MetS, C-reactive protein (CRP) and lactate dehydrogenase (LDH) were associated with mortality [CRP (aOR, 3.66, CI, 1.22-10.97), LDH (aOR, 3.49, CI, 1.78-6.83)]. CONCLUSIONS: In predominantly Black patients hospitalized for COVID-19, the clustering of hypertension, obesity and diabetes as MetS increased the odds of mortality compared with non-MetS. These findings suggest that MetS may be a composite predictor of COVID-19 lethal outcome.