Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis.

OBJECTIVE: To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Major databases between December 2019 and January 2023. STUDY SELECTION: Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS: Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION: COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER: CRD42020178076.

Pulmonary function test and computed tomography features during follow-up after SARS, MERS and COVID-19: a systematic review and meta-analysis.

Background: The COVID-19 pandemic follows severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remain unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19. Methods: This systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random-effects model) and proportion of CT features (Freeman-Tukey transformation random-effects model) were performed. Findings: Persistent reduction in the diffusing capacity for carbon monoxide following SARS and COVID-19 infection is seen at 6 months follow-up, and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity, linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation are reported less often. Severe/critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/moderate infection. Interpretation: Persistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome. It is yet to be determined if this is a regressive or progressive disease.

Frequency of arrhythmia symptoms and acceptability of implantable cardiac monitors in Hemodialysis patients.

BACKGROUND: Arrhythmia-related complications and sudden death are common in dialysis patients. However, routine cardiac monitoring has so far not been feasible. Miniaturization of implantable cardiac monitors offers a new paradigm for detection and management of arrhythmias in dialysis patients. The goal of our study was to determine the frequency of arrhythmia-related symptoms in hemodialysis patients and to assess their willingness to undergo implantation of a cardiac monitor. METHODS: We conducted a survey of in-center hemodialysis patients at a hemodialysis clinic in Baltimore, Maryland. We assessed the frequency of arrhythmia-related symptoms and willingness to undergo placement of an implantable cardiac monitor (LINQ, Medtronic Inc.). RESULTS: Forty six patients completed the survey. The mean age of the survey respondents was 59 years and 65% were male. Symptoms were common with 74% (n = 34) of participants reporting at least one arrhythmia-related symptom and many [22% (n = 10)] had all 3 symptoms. Among the patients with symptoms, 57% (n = 26) reported "heart skipping beats, flopping in chest or beating very hard," 61% (n = 28) reported "heart racing (palpitations)," and 37% (n = 17) reported feeling that they "passed out or almost passed out." The majority of the patients felt that the timing of the symptoms was unrelated to dialysis treatments. The acceptability of the monitoring device implantation was high, with 59% (n = 20) of patients with symptoms and 50% (n = 6) of patients without symptoms willing to consider it. The main reason for not considering the device was not wanting to have an implanted device. CONCLUSION: The prevalence of arrhythmia-related symptoms is high in hemodialysis patients and the majority would consider an implantable cardiac monitor if recommended by their physicians. Routine implantation of cardiac monitoring devices to manage arrhythmias in dialysis patients may be feasible and will provide further insights on the leading causes of morbidity and mortality in dialysis patients.

Effectiveness of Using Incentives to Improve Parolee Admission and Attendance in Community Addiction Treatment.

This study is a randomized effectiveness trial of the use of incentives to improve treatment utilization among parolees in community treatment. In prison, Admission phase parolees were randomized to Admission Incentive (N=31) or Education (N=29). Attendance phase parolees entering community treatment were randomized to Attendance Incentive (N=104) or Education (N=98). There was no main effect for incentives in either study phase. Neither admission to community treatment (Incentive 60%, Education 64%; p =.74), nor intervention completion (Incentive 22%; Education 27%; p =.46) appeared to be impacted. Time-in-treatment was predicted by age, first arrest age, and type of parole status (Cox regression p<.05), but not by treatment group. Providing incentives did not increase the likelihood that parolees enrolled in or stayed in community treatment. In light of this finding, criminal justice practitioners who are considering incentives to increase admission or retention should be aware that they may not produce the desired outcomes.