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1.
Intensive Care Med ; 47(9): 1021-1023, 2021 09.
Article in English | MEDLINE | ID: covidwho-1813636
2.
Saudi Med J ; 43(4): 386-393, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1789721

ABSTRACT

OBJECTIVES: To measure and assess the side-effects of Pfizer/BioNTech and AstraZeneca vaccines on residents of Saudi Arabia, as well as provide a database that gives insight into the relative safety of these 2 COVID-19 vaccines. METHODS: A community-based cross-sectional study was conducted to determine the side-effects of the two COVID-19 vaccines. The study was initiated on the 5th of June 2021 at Hail University, Hail, Saudi Arabia. The information was collected through an online survey designed on Google forms. The questionnaire was pre-tested for validity, with all information carefully reviewed. RESULTS: The study included 2,530 participants from different regions of Saudi Arabia, with a mean age of 26.9 ± 12.4 years old. The most common vaccine among the study group was Pfizer, which 73.8% of the population were provided; the remaining 26.2% received the AstraZeneca vaccine. Regarding the Pfizer vaccine, the common systemic side-effects followed the first dose, included headaches, followed by muscle pain, fever, and joint pain. Those who had the AstraZeneca vaccine reported a few more side-effects. For example, during the first dose fever was reported as the most common side-effect, followed by headache, muscle pain and fatigue. CONCLUSION: The present study confirmed that vaccine side-effects are more frequently reported by smokers and those who received the AstraZeneca vaccine. Further studies are needed to acquire a better understanding of the association between risk factors and the experiencing of post-vaccine side-effects.


Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , Vaccines , Adolescent , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Cross-Sectional Studies , Headache/chemically induced , Headache/epidemiology , Humans , Myalgia , SARS-CoV-2 , Saudi Arabia/epidemiology , Young Adult
3.
BMJ Case Rep ; 15(4)2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-1784786

ABSTRACT

A previously healthy and active middle-aged woman acquired COVID-19 as an occupational exposure with subsequent persistent post-COVID-19 symptoms including headache, dyspnoea on exertion, chest pressure, tachycardia, anosmia, parosmia, persistent myalgia, vertigo, cognitive decline and fatigue. She presented to a tertiary medical centre for further evaluation after 9 months of persistent symptoms and had a largely unremarkable workup with the exception of a persistently elevated monocyte chemoattractant protein 1, blunted cardiovagal response and non-specific scattered areas of low-level hypometabolism at the bilateral frontal, left precuneus, occipital and parietal regions on PET scan.


Subject(s)
COVID-19 , COVID-19/complications , Female , Headache/etiology , Humans , Middle Aged , Neuroimaging , SARS-CoV-2 , Syndrome
4.
Tuberk Toraks ; 70(1): 27-36, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1776525

ABSTRACT

Introduction: Neurological aspect of COVID-19 is less understood compared to its respiratory and systemic effects. We aimed to define subacute neurological sequelae in patients who recovered from mild COVID-19. Materials and Methods: This study enrolled long COVID patients who had mild infection, were non-hospitalized, and admitted to our hospital with neurological complaints occurring after COVID-19. The evaluation included detailed history of the symptoms, neurological examination, blood tests and necessary investigations relevant to their personal medical situation, and also a retrospective inquiry about their respiratory and neurological status during the acute phase of infection. Descriptive statistical measures, Chi-square and Student's t-test were utilized. Result: We identified 50 patients (29F/21M) with a mean age of 36.9 ± 1.6 (mean ± SEM). The average time from COVID-19 to admission was 99 days(min-max= 15-247). Most frequent neurological complaints were headache (42%) and cognitive dysfunction (42%). Sleep disturbance (36%), prolonged anosmia (30%), prolonged ageusia (22%), fatigue (22%), and dizziness (8%) followed. Most patients with headache experienced headache also as an acute manifestation of COVID-19 (p= 0.02). Acute-stage sleep disorders were found to be more associated with subacute cognitive symptoms than other central symptoms (p= 0.008). The most common neurological symptom in the acute phase was headache (74%). Six patients, despite the absence of any acute-stage neurological symptoms, presented with emergence of subacute neurological sequela. There were only five patients with pulmonary involvement during the acute stage, who were not different from the rest of the cohort in terms of neurological sequelae. There was no increase of inflammatory markers in the blood tests at the subacute stage, or no association of the symptoms to biochemical parameters. Conclusions: This study gives a description of neurological sequelae of mild COVID-19 at the subacute stage, in a relatively young group, and reveals that cognitive disturbances, as well as headache, are quite frequent.


Subject(s)
COVID-19 , Adult , COVID-19/complications , Headache/complications , Headache/etiology , Humans , Outpatients , Retrospective Studies
6.
BMC Med Educ ; 22(1): 226, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1770523

ABSTRACT

BACKGROUND: The COVID-19 pandemic has become a global health issue and has significantly impacted university education. As a result, learning methods have been shifted to be delivered through online learning. Online learning has increased reliance on computer screens, which can cause visual discomfort and may cause or exacerbate headaches due to prolonged screen exposure. However, time spent using electronic devices has not yet been examined in relation to the online learning experience. PURPOSE: This study assessed the online learning experiences and reported headaches associated with screen exposure time among health sciences university students. METHODS: A cross-sectional study was conducted among a convenience sample of 353 students at Saudi University. Online learning experiences, screen time exposure, and reported headache questionnaires were used to collect the data. RESULTS: Students were moderately satisfied with the online learning experience. Nevertheless, they faced many challenges with online learning that affected their communication efficacy, and they preferred that blended learning be continued. In addition, this study found a high prevalence of headache (65.72%) and a high screen exposure time among the studied students (52.69%). Increased screen time exposure is linked with increased headache and migraine reporting among students (p < 0.05). CONCLUSION: Headache is a common health issue among health professional students, and it can harm their academic performance and quality of life, especially related to online learning. Greater awareness of headaches, stress reduction and prevention programs, and ergonomic practices to deal with headaches are essential. Blended learning approaches can improve student learning and performance in health science courses.


Subject(s)
COVID-19 , Education, Distance , COVID-19/epidemiology , Cross-Sectional Studies , Education, Distance/methods , Headache/epidemiology , Headache/etiology , Humans , Pandemics , Quality of Life , Saudi Arabia/epidemiology , Screen Time , Students
7.
J Headache Pain ; 23(1): 41, 2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1770478

ABSTRACT

BACKGROUND: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are used to reduce the risk of developing Coronavirus Disease 2019 (COVID-19). Despite the significant benefits in terms of reduced risk of hospitalization and death, different adverse events may present after vaccination: among them, headache is one of the most common, but nowadays there is no summary presentation of its incidence and no description of its main features. METHODS: We searched PubMed and EMBASE covering the period between January 1st 2020 and August 6th, 2021, looking for record in English and with an abstract and using three main search terms (with specific variations): COVID-19/SARS-CoV-2; Vaccination; headache/adverse events. We selected manuscript including information on subjects developing headache after injection, and such information had to be derived from a structured form (i.e. no free reporting). Pooled estimates and 95% confidence intervals were calculated. Analyses were carried out by vaccine vs. placebo, by first vs. second dose, and by mRNA-based vs. "traditional" vaccines; finally, we addressed the impact of age and gender on post-vaccine headache onset. RESULTS: Out of 9338 records, 84 papers were included in the review, accounting for 1.57 million participants, 94% of whom received BNT162b2 or ChAdOx1. Headache was generally the third most common AE: it was detected in 22% (95% CI 18-27%) of subjects after the first dose of vaccine and in 29% (95% CI 23-35%) after the second, with an extreme heterogeneity. Those receiving placebo reported headache in 10-12% of cases. No differences were detected across different vaccines or by mRNA-based vs. "traditional" ones. None of the studies reported information on headache features. A lower prevalence of headache after the first injection of BNT162b2 among older participants was shown. CONCLUSIONS: Our results show that vaccines are associated to a two-fold risk of developing headache within 7 days from injection, and the lack of difference between vaccine types enable to hypothesize that headache is secondary to systemic immunological reaction than to a vaccine-type specific reaction. Some descriptions report onset within the first 24 h and that in around one-third of the cases, headache has migraine-like features with pulsating quality, phono and photophobia; in 40-60% of the cases aggravation with activity is observed. The majority of patients used some medication to treat headache, the one perceived as the most effective being acetylsalicylic acid.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/prevention & control , Headache/etiology , Humans , Vaccination/adverse effects
8.
Turk J Pediatr ; 64(1): 133-137, 2022.
Article in English | MEDLINE | ID: covidwho-1743163

ABSTRACT

BACKGROUND: Corona virus disease 2019 (COVID-19) includes a wide range of diseases with varying pathophysiology in children and adults. Although the disease mainly affects the respiratory tract, neurological involvement is also reported in the literature. The most common neurological complaints due to COVID-19 are headache, dizziness and anosmia. Acute necrotizing myelitis, acute demyelinating encephalomyelitis (ADEM), acute axonal neuropathy, acute transverse myelitis, and Guillian-Barre syndrome have been reported as neurological dysfunctions associated with COVID-19. CASE: A ten-year-old male patient presented with complaints of fever, headache and generalized muscle pain. The patient developed inability to walk and significant muscle weakness during the disease course, and he was diagnosed with ADEM and transverse myelitis on magnetic resonance imaging (MRI). As the etiological agent, COVID-19 was detected in both the respiratory panel sample and the cerebrospinal fluid (CSF) sample by the polymerase chain reaction (PCR) technique. Pulse steroid, IVIG, and plasmapheresis treatment were administered. He started to stand with support during follow-up. CONCLUSION: We presented a case of COVID-19 related ADEM and transverse myelitis who responded to pulse steroid, IVIG, and plasmapheresis.


Subject(s)
COVID-19 , Encephalomyelitis , Myelitis, Transverse , Adult , COVID-19/complications , Child , Encephalomyelitis/complications , Encephalomyelitis/diagnosis , Encephalomyelitis/therapy , Headache , Humans , Magnetic Resonance Imaging , Male , Myelitis, Transverse/diagnosis , Myelitis, Transverse/etiology , Myelitis, Transverse/therapy
9.
Ned Tijdschr Tandheelkd ; 129(3): 115-118, 2022 Mar.
Article in Dutch | MEDLINE | ID: covidwho-1732399

ABSTRACT

Face masks are widely used in dental practices, but little is known about the potential adverse effects of wearing a face mask, covering the mouth-and-nose area, on the condition of the eyes. During COVID-19 times, more eye-related complaints, such as irritated, burning or dry eyes, have been reported and observed as a result of the (mandatory) use of face masks, The combination of wearing a face mask and working on a computer appears to also cause more dry-eye complaints. Symptoms such as headache, double vision, blurry vision, irritated red eyes and/or dry eyes are often diagnosed under the collective term asthenopia, also called 'eye strain' in the literature in English. These work-related complaints are often accepted as 'normal', especially because they develop during the day. During the COVID-19 period, more knowledge has been gained about the use of face masks, face shields and eye health. It is therefore possible to consider whether personal protection with a face mask in the dental practice can cause eye-related complaints.


Subject(s)
COVID-19 , Masks , COVID-19/prevention & control , Headache , Humans , Masks/adverse effects , Mouth , SARS-CoV-2
10.
Hum Vaccin Immunother ; 18(1): 2039017, 2022 Dec 31.
Article in English | MEDLINE | ID: covidwho-1730547

ABSTRACT

Assessment of safety of COVID-19 vaccines is an ongoing process. This study aims to explore long-term adverse events reported by physicians and dentists who received at least two COVID-19 vaccine doses. A group of physicians and dentists were invited to complete a validated questionnaire that was composed of items on: socio-demographics, medical history, administered vaccines, and long-term adverse events (LTAE). Data of a total of 498 practitioners were included. Age ranged from 22 to 71 years (mean age= 35.75 ± 11.74) with a female majority (N = 348, 69.9%). The most frequently administered vaccines were Pfizer-BioNtech, Sinopharm and AstraZeneca vaccines. A total of 80 (16.0%) participants reported LTAEs which were mainly fatigue, menstrual disturbances, myalgia, arthralgia, dizziness, and headache (N = 32, 15, 8, 6, 4, and 4, respectively). There was no statistically significant association between LTAEs and: age, gender, or medical history (P > .05). The collective symptoms of fatigue, myalgia, arthralgia, dizziness, and headache were significantly associated with Sinopharm vaccine (P = .04). This was further confirmed by general linear multivariate model analysis. Less than 20% of COVID-19 vaccine recipients may complain of LTAEs that are mostly fatigue-related. It seems that factors such as age, gender, and medical status play a negligible role in development of these AEs. On the other hand, Sinopharm vaccine showed the highest significant association with these AEs followed by AstraZeneca vaccine.


Subject(s)
COVID-19 , Physicians , Adult , Aged , Arthralgia/chemically induced , Arthralgia/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Dentists , Dizziness , Fatigue/chemically induced , Fatigue/epidemiology , Female , Headache/chemically induced , Headache/epidemiology , Humans , Jordan , Middle Aged , Myalgia/chemically induced , Myalgia/epidemiology , SARS-CoV-2 , Saudi Arabia , Young Adult
11.
Ethiop J Health Sci ; 32(1): 205-208, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1726504

ABSTRACT

Background: Since the outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV2) in December 2019, there have been some case reports of Coronavirus disease 19 (COVID 19) associated Guillain-Barré Syndrome (GBS). GBS is an inflammatory polyradiculoneuropathy associated with numerous viral and bacterial infections. Here we describe the case of an Ethiopian man with a typical clinical and electrophysiological manifestation of GBS. Case Presentation: A 70-year-old male presented with four days history of progressive and ascending bilateral limbs weakness which end up with respiratory failure. He had an antecedent headache, loss of appetite, and generalized fatigue. Electrophysiological studies showed Acute Motor and Sensory Axonal Neuropathy whereas and cerebrospinal fluid analysis revealed albuminocytologic dissociation with positive preintubation SARS CoV2 test. He was treated with supportive care and recovered successfully. Conclusion: This case illustrates one of the few occasions when patients with mild COVID-19 develop severe neurologic manifestations. Seemingly, early identification and management can improve clinical outcomes. We would like to emphasize the need to consider screening for SARS CoV-2 in patients presenting with GBS.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Aged , COVID-19/complications , Guillain-Barre Syndrome/complications , Guillain-Barre Syndrome/diagnosis , Headache , Humans , Male , SARS-CoV-2
12.
Neurol India ; 70(1): 122-126, 2022.
Article in English | MEDLINE | ID: covidwho-1726260

ABSTRACT

Background: The COVID-19 pandemic has put the entire medical fraternity into a very challenging and demanding situation. Along with always being at the risk of COVID infection, healthcare workers (HCWs) are also facing neurological problems due to long working hours in personal protective equipment (PPE). These symptoms and their characteristics need to be observed and studied in-depth to understand the problems experienced by HCWs and to design new solutions to overcome such problems. Objectives: This study intends to evaluate the various neurological manifestations among the HCWs wearing PPE for prolonged periods. Materials and Methods: We conducted a questionnaire-based cross-sectional study at a Covid care center from western India from April 20 to June 01, 2021 by using a self-administered web-based questionnaire. A total of 256 HCWs were surveyed. The de-identified data were analyzed using JMP 15.0.0. Results: Among a total of 256 HCWs surveyed for this study, the majority (58.6%) were aged 24-35 years, with a male preponderance (65.62%, n = 168). Participants included doctors (41%), nurses (35%), paramedical staff (22%), and housekeeping staff (1%). The symptoms encountered among the HCWs wearing the PPE were headache, classified further as donning headache in 112 (44.98%), doffing headache in 56 (26.24%), slowed mentation in 48 (21.05%), and excessive sleepiness in 86 (38.74%), which affected their work performance. The age of the HCWs had a significant correlation with all the symptoms. Conclusion: Headache, slowed mentation, and excessive sleepiness was encountered among the HCWs wearing PPE, which depended upon the duration of PPE usage. The most common symptom was headache, which was of moderate to severe intensity.


Subject(s)
COVID-19 , Personal Protective Equipment , Adult , Cross-Sectional Studies , Headache/epidemiology , Headache/etiology , Health Personnel , Humans , Male , Pandemics , Personal Protective Equipment/adverse effects , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
13.
Rev Neurol ; 74(4): 141, 2022 02 16.
Article in Spanish | MEDLINE | ID: covidwho-1689519

ABSTRACT

TITLE: Cefalea asociada con el uso de equipo de protección personal durante la pandemia de la COVID-19: una forma práctica de mejorar esta condición. Réplica.


Subject(s)
COVID-19 , Personal Protective Equipment , Headache , Humans , Pandemics , SARS-CoV-2
14.
Rev Neurol ; 74(4): 141, 2022 02 16.
Article in Spanish | MEDLINE | ID: covidwho-1687871

ABSTRACT

TITLE: Cefalea asociada con el uso de equipo de protección personal durante la pandemia de la COVID-19: una forma práctica de mejorar esta condición.


Subject(s)
COVID-19 , Personal Protective Equipment , Headache/epidemiology , Humans , Pandemics , SARS-CoV-2
15.
J Neurol Sci ; 434: 120162, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1654797

ABSTRACT

IMPORTANCE: Neurological and neuropsychiatric symptoms that persist or develop three months after the onset of COVID-19 pose a significant threat to the global healthcare system. These symptoms are yet to be synthesized and quantified via meta-analysis. OBJECTIVE: To determine the prevalence of neurological and neuropsychiatric symptoms reported 12 weeks (3 months) or more after acute COVID-19 onset in adults. DATA SOURCES: A systematic search of PubMed, EMBASE, Web of Science, Google Scholar and Scopus was conducted for studies published between January 1st, 2020 and August 1st, 2021. The systematic review was guided by Preferred Reporting Items for Systematic Review and Meta-Analyses. STUDY SELECTION: Studies were included if the length of follow-up satisfied the National Institute for Healthcare Excellence (NICE) definition of post-COVID-19 syndrome (symptoms that develop or persist ≥3 months after the onset of COVID-19). Additional criteria included the reporting of neurological or neuropsychiatric symptoms in individuals with COVID-19. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data on patient characteristics, hospital and/or ICU admission, acute-phase COVID-19 symptoms, length of follow-up, and neurological and neuropsychiatric symptoms. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was the prevalence of neurological and neuropsychiatric symptoms reported ≥3 months post onset of COVID-19. We also compared post-COVID-19 syndrome in hospitalised vs. non-hospitalised patients, with vs. without ICU admission during the acute phase of infection, and with mid-term (3 to 6 months) and long-term (>6 months) follow-up. RESULTS: Of 1458 articles, 19 studies, encompassing a total of 11,324 patients, were analysed. Overall prevalence for neurological post-COVID-19 symptoms were: fatigue (37%, 95% CI: 24%-50%), brain fog (32%, 9%-55%), memory issues (27%, 18%-36%), attention disorder (22%, 10%-34%), myalgia (18%, 4%-32%), anosmia (12%, 7%-17%), dysgeusia (11%, 4%-17%) and headache (10%, 1%-21%). Neuropsychiatric conditions included sleep disturbances (31%, 18%-43%), anxiety (23%, 13%-33%) and depression (12%, 7%-21%). Neuropsychiatric symptoms substantially increased in prevalence between mid- and long-term follow-up. Compared to non-hospitalised patients, patients hospitalised for acute COVID-19 had reduced frequency of anosmia, anxiety, depression, dysgeusia, fatigue, headache, myalgia, and sleep disturbance at three (or more) months post-infection. Conversely, hospital admission was associated with higher frequency of memory issues (OR: 1.9, 95% CI: 1.4-2.3). Cohorts with >20% of patients admitted to the ICU during acute COVID-19 experienced higher prevalence of fatigue, anxiety, depression, and sleep disturbances than cohorts with <20% of ICU admission. CONCLUSIONS AND RELEVANCE: Fatigue, cognitive dysfunction (brain fog, memory issues, attention disorder) and sleep disturbances appear to be key features of post-COVID-19 syndrome. Psychiatric manifestations (sleep disturbances, anxiety, and depression) are common and increase significantly in prevalence over time. Randomised controlled trials are necessary to develop intervention strategy to reduce disease burden.


Subject(s)
COVID-19 , Adult , Anxiety/epidemiology , Anxiety/etiology , Anxiety/psychology , COVID-19/complications , COVID-19/epidemiology , Fatigue/diagnosis , Headache/epidemiology , Humans
16.
Headache ; 62(1): 1, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1642658
17.
Nat Med ; 28(1): 20-23, 2022 01.
Article in English | MEDLINE | ID: covidwho-1636011
18.
Biomed Pharmacother ; 147: 112650, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1635955

ABSTRACT

BACKGROUND: The objective of the present work was to assess the reactogenicity and immunogenicity of heterologous COVID-19 vaccination regimens in clinical trials and observational studies. METHODS: PubMed, Cochrane Library, Embase, MedRxiv, BioRxiv databases were searched in September 29, 2021. The PRISMA instruction for systemic review was followed. Two reviewers independently selected the studies, extracted the data and assessed risk of bias. The quality of studies was evaluated using the New Castle-Ottawa and Cochrane risk of instrument. The characteristics and study outcome (e.g., adverse events, immune response, and variant of concern) were extracted. RESULTS: Nineteen studies were included in the final data synthesis with 5 clinical trials and 14 observational studies. Heterologous vaccine administration showed a trend toward more frequent systemic reactions. However, the total reactogenicity was tolerable and manageable. Importantly, the heterologous prime-boost vaccination regimens provided higher immunogenic effect either vector/ mRNA-based vaccine or vector/ inactivated vaccine in both humoral and cellular immune response. Notably, the heterologous regimens induced the potential protection against the variant of concern, even to the Delta variant. CONCLUSIONS: The current findings provided evidence about the higher induction of robust immunogenicity and tolerated reactogenicity of heterologous vaccination regimens (vector-based/mRNA vaccine or vector-based/inactivated vaccine). Also, this study supports the application of heterologous regimens against COVID-19 which may provide more opportunities to speed up the global vaccination campaign and maximize the capacity to control the pandemic.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Immunogenicity, Vaccine , /therapeutic use , Arthralgia/chemically induced , /therapeutic use , Diarrhea/chemically induced , Fatigue/chemically induced , Fever/chemically induced , Headache/chemically induced , Humans , Immunization, Secondary , Injection Site Reaction/etiology , Myalgia/chemically induced , SARS-CoV-2 , Vaccination , Vaccines, Subunit/therapeutic use
19.
JAMA Netw Open ; 5(1): e2143955, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1632975

ABSTRACT

Importance: Adverse events (AEs) after placebo treatment are common in randomized clinical drug trials. Systematic evidence regarding these nocebo responses in vaccine trials is important for COVID-19 vaccination worldwide especially because concern about AEs is reported to be a reason for vaccination hesitancy. Objective: To compare the frequencies of AEs reported in the placebo groups of COVID-19 vaccine trials with those reported in the vaccine groups. Data Sources: For this systematic review and meta-analysis, the Medline (PubMed) and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched systematically using medical subheading terms and free-text keywords for trials of COVID-19 vaccines published up to July 14, 2021. Study Selection: Randomized clinical trials of COVID-19 vaccines that investigated adults aged 16 years or older were selected if they assessed solicited AEs within 7 days of injection, included an inert placebo arm, and provided AE reports for both the vaccine and placebo groups separately. Full texts were reviewed for eligibility by 2 independent reviewers. Data Extraction and Synthesis: Data extraction and quality assessment were performed independently by 2 reviewers, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and using the Cochrane risk-of-bias tool. Meta-analyses were based on random-effects models. Main Outcomes and Measures: The primary outcomes were the proportions of placebo recipients reporting overall, systemic, and local (injection-site) AEs as well as logarithmic odds ratios (ORs) to evaluate group differences. Outcomes were tested for significance using z tests with 95% CIs. Results: Twelve articles with AE reports for 45 380 participants (22 578 placebo recipients and 22 802 vaccine recipients) were analyzed. After the first dose, 35.2% (95% CI, 26.7%-43.7%) of placebo recipients experienced systemic AEs, with headache (19.3%; 95% CI, 13.6%-25.1%) and fatigue (16.7%; 95% CI, 9.8%-23.6%) being most common. After the second dose, 31.8% (95% CI, 28.7%-35.0%) of placebo recipients reported systemic AEs. The ratio between placebo and vaccine arms showed that nocebo responses accounted for 76.0% of systemic AEs after the first COVID-19 vaccine dose and for 51.8% after the second dose. Significantly more vaccine recipients reported AEs, but the group difference for systemic AEs was small after the first dose (OR, -0.47; 95% CI, -0.54 to -0.40; P < .001; standardized mean difference, -0.26; 95% CI, -0.30 to -0.22) and large after the second dose (OR, -1.36; 95% CI, -1.86 to -0.86; P < .001; standardized mean difference, -0.75; 95% CI, -1.03 to -0.47). Conclusions and Relevance: In this systematic review and meta-analysis, significantly more AEs were reported in vaccine groups compared with placebo groups, but the rates of reported AEs in the placebo arms were still substantial. Public vaccination programs should consider these high rates of AEs in placebo arms.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Placebos/adverse effects , Arm Injuries/etiology , Fatigue/etiology , Headache/etiology , Humans , Injections, Intramuscular/adverse effects , SARS-CoV-2
20.
Am J Emerg Med ; 54: 1-7, 2022 04.
Article in English | MEDLINE | ID: covidwho-1627843

ABSTRACT

Managing neurological emergencies is an essential element of emergency physicians' armamentarium, irrelevant of the specific nature of their practice. The combination of evolving literature and advances in imaging fuel the rapidly changing standards of care, especially in high-stakes diagnoses such as stroke. Navigating the emergency neurology literature to stay abreast of the current updates is becoming more challenging with the sheer volume of publications, combined with the recent dominance of COVID-19 on the literature and media attention. This review article summarizes emergency neurology literature updates that can help you improve your care of these high-risk presentations; articles covering stroke, dizziness, intracerebral hemorrhage, head trauma imaging, headache, seizures, and COVID-19 are reviewed.


Subject(s)
COVID-19 , Neurology , Dizziness/diagnosis , Dizziness/etiology , Headache , Humans , Vertigo
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