Protocol of a scoping review of systematic reviews and meta-analyses about COVID-19 vaccines and associated adverse events from vaccination.

The continuous dissemination of coronavirus disease of 2019 (COVID-19) literature can inform decision-makers and the public. Since the widespread use of COVID-19 vaccines, more systematic reviews have summarized the effectiveness and reported adverse events associated with vaccination. Previous systematic and scoping reviews on COVID-19 summarized various aspects surrounding COVID-19, however, a scoping review is needed to summarize the characteristics of COVID-19 vaccines and associated adverse events reported in systematic reviews and meta-analyses to provide comprehensive evidence for informed medical decision-making. We will conduct a scoping review concerning COVID-19 vaccines and adverse events from vaccines. We will search from December 2019 to present in Epistemonikos, Campbell Library, CINAHL (Ovid), MEDLINE (Ovid), Scopus, CENTRAL (Ovid), Web of Science, WHO COVID-19 database, Joanna Briggs Institute of Excellence, and COVID-19 Evidence Reviews resource. We will include systematic reviews, meta-analyses, or both of randomized controlled trials and observational studies and exclude individual randomized controlled trials and observational studies. Abstracts and full-texts will be screened prior to selection. Investigators will independently use a calibrated quantitative and qualitative data extraction sheet and rate the quality of articles with AMSTAR, resolving disagreements to aim for good agreement (≥80%). An updated scoping review of the characteristics and safety of COVID-19 vaccines would highlight the accuracy of the evidence to inform decision-making concerning COVID-19 vaccination.

Cardiovascular Disease Risk Factors and Outcomes of Acute Myocardial Infarction in Young Adults: Evidence From 2 Nationwide Cohorts in the United States a Decade Apart.

The purpose of this study was to evaluate 2 national in-patient cohorts of young adults (18-44 years) hospitalized with acute myocardial infarction (AMI) a decade apart to highlight its prevalence, associated comorbidities, and in-hospital outcomes. We identified hospitalizations for AMI in young adults in 2007 and 2017 using the weighted data from the National Inpatient Sample. We compared admission rates, sociodemographic characteristics, in-hospital morbidity, complications, mortality, rate of coronary interventions, and healthcare utilization between the 2 cohorts. We found that the admission rate of AMI increased among young adults in 2017 vs 2007. The overall admission rate was higher in males, although with a decline (77.1% vs 66.1%), whereas it rose from 28.9% to 33.9% in females. Hypertension (47.8% vs 60.7%), smoking (49.7% vs 55.8%), obesity (14.8% vs 26.8%), and diabetes mellitus (22.0% vs 25.6%) increased in the 2017 cohort. Post-AMI complications: cardiogenic shock (aOR = 1.16 [1.06-1.27]) and fatal arrhythmias heightened with comparable all-cause mortality (aOR = 1.01 [0.93-1.10], P = 0.749). Reperfusion interventions, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) decreased in the 2017 cohort (PCI; aOR = 0.95 [0.91-0.98], CABG; aOR = 0.66 [0.61-0.71], P < 0.001). Our study highlights the rise in AMI hospitalizations, plateauing of mortality, sex-based and racial disparities, the surge in post-MI complications, and a reassuring decline in the requirement of reperfusion interventions in young AMI patients over the decade.

Outcomes of Heart Failure in COVID-19 Patients: An Appalachian Experience.

Background: The Southeastern rural areas of the USA have a higher prevalence of heart failure (HF). Coronavirus disease 2019 (COVID-19) infection is associated with poor outcomes in patients with HF. Our study aimed to compare the outcomes of hospitalized HF patients with and without COVID-19 infection specifically in rural parts of the USA. Methods: We conducted a retrospective cohort study of HF patients with and without COVID-19 hospitalized in Southeastern rural parts of the USA by using the Appalachian Regional Healthcare System. Analyses were stratified by waves from April 1, 2020 to May 31, 2021, and from June 1, 2021 to October 19, 2021. Results: Of the 14,379 patients hospitalized with HF, 6% had concomitant COVID-19 infection. We found that HF patients with COVID-19 had higher mortality rate compared to those without COVID-19 (21.8% versus 3.8%, respectively, P < 0.01). Additionally, hospital resource utilization was significantly higher in HF patients with COVID-19 compared to HF patients without COVID-19 with intensive care unit (ICU) utilization of 21.6% versus 13.8%, P < 0.01, mechanical ventilation use of 17.3% versus 6.2%, P < 0.01, and vasopressor/inotrope use of 16.8% versus 7.9%, P < 0.01. A lower percentage of those with COVID-19 were discharged home compared to those without a COVID-19 diagnosis (63.4% versus 72.0%, respectively). There was a six-fold greater odds of dying in the first wave and seven-fold greater odds of dying in the second wave. Conclusions: Our study confirms previous findings of poor outcome in HF patients with COVID-19. There is a need for review of healthcare resources in rural hospitals which already face numerous healthcare challenges.

COVID-19 Infection and Late Manifestation of Pulmonary Aspergillosis.

We present the case of a 56-year-old woman who was diagnosed with severe coronavirus disease 2019 (COVID-19) pneumonia complicated by severe acute respiratory distress syndrome who was intubated for 19 days. She recovered from COVID-19 after a month. A computed tomography (CT) scan of the chest, after a month, showed improved infiltrates with a small residual cavity within the lingula. A CT angiogram showed a more confluent density in the lingular portion on follow-up 2 months later. She developed intermittent hemoptysis after 3 months in December 2020, which persisted for almost 6 months, and CT of the chest showed the lingular nodular with resolution of the cavitation. She underwent bronchoscopy with bronchoalveolar lavage, confirming Aspergillus fumigatus by galactomannan assay and histology showing branching hyphae. Once she started treatment with itraconazole, her hemoptysis resolved. The follow-up CT of the chest after 2 months of treatment did not show a cavity or a nodule in the lingula. Our patient developed invasive pulmonary aspergillosis (IPA) as a sequela of severe COVID-19 infection. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is an underrecognized complication that needs to be investigated on whether prophylactic treatment is required. Our case also demonstrates that the diagnosis of IPA needs to be considered months after COVID-19 infection when a superimposed fungal infection can occur after a viral infection if the patient continues to have persistent symptoms.

Technology addiction among school-going adolescents in India: epidemiological analysis from a cluster survey for strengthening adolescent health programs at district level.

BACKGROUND: There is limited evidence on technology addiction among adolescents in low- and middle-income countries where 90% of global adolescents live. We aimed to investigate the prevalence and correlates of technology addiction (Internet, gaming, smartphone, television) among school-going adolescents in India. METHODS: A cross-sectional survey covering the entire district (administrative unit for health) of India was conducted among representative sample of school-going adolescents using stratified cluster sampling. A total of 1729 adolescents completed the survey (age M = 12.58; SD = 0.97) by responding to Internet Addiction Test-Adolescents, Game Addiction Scale, Smartphone Addiction Scale and Television Addiction Scale. Associated factors were analyzed using binomial logistic regression analysis. RESULTS: Almost all the participants (99.59%; 95% confidence interval (CI): 99.28-99.91%) were using technology in one or other form. Prevalence of technology addiction among the users was 10.69% (95% CI: 5.26-16.11%). Phone addiction (8.91%; 95% CI: 3.31-14.52%) was the most common type followed by gaming addiction (2.55%; 95% CI: 1.16-3.95%). Technology addiction among adolescents was significantly associated with several risk factors at individual, family and school levels. CONCLUSION: Technology addiction emerges as an important public health problem among adolescents in India. An integrated socio-ecological framework with multi-level approach that targets risk factors at various levels is required to promote healthy behaviors towards technology.

Role of Near-infrared Spectroscopy in the Diagnosis and Assessment of Necrotizing Enterocolitis.

Near-infrared spectroscopy (NIRS) is a noninvasive, bedside diagnostic tool that could assist in the early diagnosis of necrotizing enterocolitis (NEC) in preterm neonates. NIRS is a safe and effective clinical tool in the neonatal intensive care unit to detect abnormal alterations in tissue perfusion and oxygenation. In addition, NIRS could also detect the complications of NEC, such as bowel necrosis and perforation. NEC is the most common gastrointestinal complication associated with preterm birth and critically ill infants. It is observed in 6-10% of preterm neonates, weighing below 1500 g, leading to considerable morbidity, mortality, and healthcare cost burden. The mortality rate ranges from 20 to 30%, highest in NEC infants undergoing surgery. NIRS is a promising diagnostic modality that could facilitate the early diagnosis of NEC and early detection of complications alone or with the imaging modalities.

Imaging for Diagnosis and Assessment of Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is inflammatory bowel necrosis of preterm and critically ill infants. The disease is seen in 6-10% of preterm infants who weigh less than 1500 g at birth and carries considerable morbidity, mortality, and healthcare cost burden. Efforts focused on timely mitigation remain restricted due to challenges in early diagnosis as clinical features, and available laboratory tests remain nonspecific until late in the disease. There is renewed interest in the radiological and sonographic assessment of intestinal diseases due to technological advances making them safe, cost-efficient, and supporting Web-based transmission of images, thereby reducing time to diagnosis by disease experts. Most of our experience has been with plain abdominal radiography, which shows characteristic features such as pneumatosis intestinalis in up to 50-60% of patients. Many patients with advanced disease may also show features such as portal venous gas and pneumoperitoneum. Unfortunately, these features are not seen consistently in patients with early, treatable conditions, and hence, there has been an unfulfilled need for additional imaging modalities. In recent years, abdominal ultrasound (AUS) has emerged as a readily available, noninvasive imaging tool that may be a valuable adjunct to plain radiographs for evaluating NEC. AUS can allow real-time assessment of vascular perfusion, bowel wall thickness, with higher sensitivity in detecting pneumatosis, altered peristalsis, and characteristics of the peritoneal fluid. Several other modalities, such as contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI), and near-infrared spectroscopy (NIRS), are also emerging. In this article, we have reviewed the available imaging options for NEC evaluation.

Pathophysiology and Management of Heart Failure in the Elderly.

The population of elderly adults is increasing globally. It has been projected that the population of adults aged 65 years will increase by approximately 80% by 2050 in the United States. Similarly, the elderly population is rising in other countries; a notable example being Japan where approximately 30% of the population are aged above 65 years. The pathophysiology and management of heart failure (HF) in this age group tend to have more intricacies than in younger age groups owing to the presence of multiple comorbidities. The normal aging biology includes progressive disruption at cellular and genetic levels and changes in molecular signaling and mechanical activities that contribute to myocardial abnormalities. Older adults with HF secondary to ischemic or valvular heart disease may benefit from surgical therapy, valve replacement or repair for valvular heart disease and coronary artery bypass grafting for coronary artery disease. While referring these patients for surgery, patient and family expectations and life expectations should be taken into account. In this review, we will cover the pathophysiology and the management of HF in the elderly, specifically discussing important geriatric domains such as frailty, cognitive impairment, delirium, polypharmacy, and multimorbidity.

An ex vivo physiologic and hyperplastic vessel culture model to study intra-arterial stent therapies.

Conventional in vitro methods for biological evaluation of intra-arterial devices such as stents fail to accurately predict cytotoxicity and remodeling events. An ex vivo flow-tunable vascular bioreactor system (VesselBRx), comprising intra- and extra-luminal monitoring capabilities, addresses these limitations. VesselBRx mimics the in vivo physiological, hyperplastic, and cytocompatibility events of absorbable magnesium (Mg)-based stents in ex vivo stent-treated porcine and human coronary arteries, with in-situ and real-time monitoring of local stent degradation effects. Unlike conventional, static cell culture, the VesselBRx perfusion system eliminates unphysiologically high intracellular Mg2+ concentrations and localized O2 consumption resulting from stent degradation. Whereas static stented arteries exhibited only 20.1% cell viability and upregulated apoptosis, necrosis, metallic ion, and hypoxia-related gene signatures, stented arteries in VesselBRx showed almost identical cell viability to in vivo rabbit models (~94.0%). Hyperplastic intimal remodeling developed in unstented arteries subjected to low shear stress, but was inhibited by Mg-based stents in VesselBRx, similarly to in vivo. VesselBRx represents a critical advance from the current static culture standard of testing absorbable vascular implants.

A Review of the Relationship of the Cerebrospinal Fluid Changes During the Dysregulation of Parathyroid Hormone With Psychiatric or Neurological Manifestations.

It is established that normal calcium and vitamin D concentrations are maintained in the body through parathyroid hormone (PTH), a signaling molecule secreted from parathyroid glands. A massive role is played by PTH in increasing calcium levels when they are extremely low in the body through different mechanisms. The dysregulation of this hormone is due to either over functioning of the gland (hyperparathyroidism) or compromised functioning in hypoparathyroidism. A detailed review was done to identify if any changes are happening in the cerebrospinal fluid (CSF) due to any pathology causing the parathormone to be dysregulated enough to, in turn, cause any further pathology in the nervous system. This may then lead to various disabling neuropsychiatric features. The calcium and vitamin D abnormalities are both directly and indirectly connected to psychiatric features like delusions, schizophrenia, disabled cognition, psychosis, coma, mania, and depression of all kinds. Moreover, their irregularities are also linked to Alzheimer's. During these manifestations, the CSF is altered concentration-wise, where elevated calcium levels inside are observed during different studies. Despite PTH's indirect connection to the CSF modifications, their association hasn't been potently proven yet, considering more observational studies should be conducted in humans and for a more extended period, along with bigger and greater numbers of CSF samples. Suppose there is a possibility of the link of CSF alterations to PTH. In that case, we can consider a pronounced increase of CSF calcium or PTH as a risk factor for debilitating neuropsychiatric diseases. In this review, the possible correlation of CSF and PTH has been discussed.

Cardiovascular Involvement in Psoriasis, Diagnosing Subclinical Atherosclerosis, Effects of Biological and Non-Biological Therapy: A Literature Review.

Psoriasis is a long-lasting, noncontagious chronic inflammatory disease of skin and joints. Previous epidemiological studies have demonstrated that psoriatic patients have a shorter life expectancy, mainly due to cardiovascular (CV) events with a higher prevalence of cardiovascular risk factors like dyslipidemia, diabetes mellitus, insulin resistance, obesity, and hypertension. Besides these risk factors, psoriasis likely plays an independent role in increasing CV events probably due to the chronic inflammatory state. This literature review aims to summarize the mechanism of atherosclerosis formation, CV risk factors, tools to diagnose subclinical atherosclerosis, and the effects of various therapies in psoriatic patients to prevent cardiovascular-related deaths in psoriasis. This review was performed by searching the relevant articles in PubMed and Google Scholar databases without including any exclusion criteria and time limitations. Our review documented that psoriatic patients are at increased risk of CV events due to chronic inflammatory profile and the associated CV risk factors. Also, anti-inflammatory therapies may prevent early subclinical atherosclerotic vascular changes reducing cardiovascular events. However, the available studies lack to establish the exact targets for CV risk factors, to assess the clinical importance of screening for subclinical vascular changes and the impact of anti-inflammatory therapies on CV risk profile in psoriatic patients. This heightened awareness about the CV involvement in psoriasis should encourage conducting large, well planned comprehensive studies to address these issues that can reduce cardiovascular morbidity and mortality.

Neuroplasticity Improves Bipolar Disorder: A Review.

Bipolar disorder (BD) is known for impairments in neurotrophic and neuroprotective processes, which translate into emotional and cognitive deficits affecting various brain regions. Using its neuroplastic properties, lithium, thus far, is the mood stabilizer used to amend the pathophysiological imbalance in BD. Neuroplasticity has gained massive popularity in the research department in the past decade, yet it lacks direct effort in changing the protocol through which physicians treat BD. Physical activity alongside cognitive therapy is theorized to produce long-term changes in the executive control network due to the assimilation of new neurons, amendment of emotional lability through hippocampal neurogenesis, and strengthening the stability of frontosubcortical and prefrontolimbic brain regions via neurogenesis. This review aims to provide an incentive for utilizing neuroplastic mechanisms concerning impairments dispensed by BD.

Transdermal Nicotine as a Treatment Option for Ulcerative Colitis: A Review.

Ulcerative colitis (UC) is primarily a disease of non-smokers or ex-smokers. Since there have been previous claims of the beneficial effects of transdermal nicotine, researchers studied its efficacy to include it in the treatment regimen: to prevent remissions and as maintenance therapy. This review aims to evaluate the efficacy of transdermal nicotine as a treatment option for mild to moderately active ulcerative colitis. We shortlisted 22 articles after a careful analysis and elimination process. These articles were reviewed and analyzed, and it was found that transdermal nicotine in combination with conventional therapy was more beneficial than individual treatment with either. Further controlled studies evaluating the appropriate dosage for remission and maintenance treatment needs to be done.

Role of Cannabis in the Incidence of Myocardial Infarction: A Review.

Legalizing cannabis use in various states in the United States has caused increased substance abuse, mostly among young people. There are very little data focussing on marijuana use and myocardial infarction (MI) incidence. The objective of the study is to analyze the published papers for cannabis-induced MI and derive a strong relation between cannabis use and MI and understand the pathophysiology. An online search was conducted in PubMed, Google Scholar, and PubMed Central to find relevant publications examining patients who developed MI due to cannabis use. Out of 32 articles that were identified for this review, 17 are case reports, one is a letter to the editor, eight are observational studies, and six are review articles. Many studies have proposed different mechanisms by which cannabis affects the body. Our study shows that marijuana can precipitate MI even if it is used for the first time. Limited data is available to comment on the mortality of patients after cannabis-induced MI. These findings highlight the necessity for public awareness to prevent the ill-effects of cannabis, especially for teenagers and older people.

COVID-19-Hospitalized Patients in Karnataka: Survival and Stay Characteristics.

The information on the clinical course of coronavirus disease 2019 (COVID-19) and its correlates which are essential to assess the hospital care needs of the population are currently limited. We investigated the factors associated with hospital stay and death for COVID-19 patients for the entire state of Karnataka, India. A retrospective-cohort analysis was conducted on 445 COVID-19 patients that were reported in the publicly available media-bulletin from March 9, 2020, to April 23, 2020, for the Karnataka state. This fixed cohort was followed till 14 days (May 8, 2020) for definitive outcomes (death/discharge). The median length of hospital stay was 17 days (interquartile range: 15-20) for COVID-19 patients. Having severe disease at the time of admission (adjusted-hazard-ratio: 9.3 (3.2-27.3);P < 0.001) and being aged ≥ 60 years (adjusted-hazard-ratio: 11.9 (3.5-40.6);P < 0.001) were the significant predictors of COVID-19 mortality. By moving beyond descriptive (which provide only crude information) to survival analyses, information on the local hospital-related characteristics will be crucial to model bed-occupancy demands for contingency planning during COVID-19 pandemic.

Stroke and Fabry Disease: A Review of Literature.

Fabry disease is an X-linked lysosomal storage disorder caused by a mutation in the alpha-galactosidase A (GLA) gene, leading to the deficiency of alpha-galactosidase A enzyme. The natural history of the affected patients (both males and females) includes neurovascular complications, such as cerebrovascular disease at a relatively young age. The pathophysiology behind the vascular involvement is primarily attributed to the accumulation of globotriaosylceramide and its derivatives in the vascular endothelium and vascular smooth muscle cells. MRI is the gold standard radiological investigation to detect the white matter lesions characteristic of Fabry disease's neurological involvement. More studies should focus on the utility of universally screening patients with young stroke for Fabry disease and the effectiveness of enzyme replacement therapy to prevent stroke. This review offers a synopsis of the current knowledge of the pathophysiology, neuroradiology, treatment, and prognosis of cerebrovascular disease in Fabry patients.

In Situ Raman Spectroscopic Studies of Liquid Carbon Tetrachloride (CCl4) Under Static and Laser-Driven Shock Compression.

High pressure (up to ∼2.2 GPa) Raman scattering studies were performed in carbon tetrachloride (CCl4) under static and dynamic compressions using diamond anvil cell (DAC) and laser-driven shock methods, respectively, and their results are compared. The laser-driven shock experiments were conducted in a glass-confined target geometry. The symmetric stretching mode ν1, symmetric bending mode ν2, and asymmetric bending mode ν4 blueshifts with pressure. Mode Gruneisen parameters were obtained for the above Raman modes. Time-resolved Raman spectroscopic (TRRS) studies were performed under laser-driven shock compression at different delay times. Shock velocity deduced from the intensity ratios of Raman signal scattered from unshocked and shocked regions of symmetric stretching mode is in agreement with the one obtained from one-dimensional hydrodynamic simulations.

Time-Resolved Vibrational Spectroscopy of Polytetrafluoroethylene Under Laser-Shock Compression.

Shock-wave-induced high pressure and nanosecond time-resolved Raman spectroscopic experiments were performed to examine the dynamic response of polytetrafluoroethylene (PTFE) in confinement geometry targets. Time-resolved Raman spectroscopy was used to observe the pressure-induced molecular and chemical changes on nanosecond time scale. Raman spectra were measured as a function of shock pressure in the 1.2-2.4 GPa range. Furthermore, the symmetric stretching mode at 729 cm-1 of CF2 was compared to corresponding static high-pressure measurements carried out in a diamond anvil cell, to see if any general trend can be established. The symmetric stretching mode of CF2 at 729 cm-1 is the most intense Raman transition in PTFE and is very sensitive to change in pressure. Therefore, it can also be utilized as a pressure gauge for large amplitude shock wave compression experiments. A maximum blueshift of 12 cm-1 for the 729 cm-1 vibrational mode has been observed for the present experimental pressure range. A comparative study on the similarities and differences from the earlier work has been done in detail. One-dimensional radiation hydrodynamic simulations were performed to validate our shock compression results and are in very good agreement.

Nazarov reactions intercepted by (4 + 3) cycloadditions with oxygen-substituted dienes.

The oxyallyl cation intermediate from the Lewis acid mediated Nazarov reaction of an allenyl vinyl ketone was intercepted by acyclic, 2-silyloxy-substituted butadienes by highly regioselective (4 + 3) cycloadditions. Stereoselectivity was often modest, but in some instances steric interactions were responsible for high selectivity. The results are consistent with concerted (4 + 3) cycloadditions. In many instances, the (4 + 3) products were susceptible to fragmentation or rearrangement in the presence of the Lewis acid.