Seroconversion following the first, second, and third dose of SARS-CoV-2 vaccines in immunocompromised population: a systematic review and meta-analysis.

BACKGROUND: Immunocompromised (IC) patients are at higher risk of more severe COVID-19 infections than the general population. Special considerations should be dedicated to such patients. We aimed to investigate the efficacy of COVID-19 vaccines based on the vaccine type and etiology as well as the necessity of booster dose in this high-risk population. MATERIALS AND METHODS: We searched PubMed, Web of Science, and Scopus databases for observational studies published between June 1st, 2020, and September 1st, 2021, which investigated the seroconversion after COVID-19 vaccine administration in adult patients with IC conditions. For investigation of sources of heterogeneity, subgroup analysis and sensitivity analysis were conducted. Statistical analysis was performed using R software. RESULTS: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we included 81 articles in the meta-analysis. The overall crude prevalence of seroconversion after the first (n: 7460), second (n: 13,181), and third (n: 909, all population were transplant patients with mRNA vaccine administration) dose administration was 26.17% (95% CI 19.01%, 33.99%, I2 = 97.1%), 57.11% (95% CI: 49.22%, 64.83%, I2 = 98.4%), and 48.65% (95% CI: 34.63%, 62.79%, I2 = 94.4%). Despite the relatively same immunogenicity of mRNA and vector-based vaccines after the first dose, the mRNA vaccines induced higher immunity after the second dose. Regarding the etiologic factor, transplant patients were less likely to develop immunity after both first and second dose rather than patients with malignancy (17.0% vs 37.0% after first dose, P = 0.02; 38.3% vs 72.1% after second dose, P < 0.001) or autoimmune disease (17.0% vs 36.4%, P = 0.04; 38.3% vs 80.2%, P < 0.001). To evaluate the efficacy of the third dose, we observed an increasing trend in transplant patients after the first (17.0%), second (38.3%), and third (48.6%) dose. CONCLUSION: The rising pattern of seroconversion after boosting tends to be promising. In this case, more attention should be devoted to transplant patients who possess the lowest response rate.

Global and regional burden and quality of care of non-rheumatic valvular heart diseases: a systematic analysis of Global Burden of Disease 1990-2017.

BACKGROUND: With an increase in the incidence and prevalence of non-rheumatic valvular heart diseases (NRVHDs), having a proper understanding of the disease current status in terms of quality of care and healthcare access can considerably affect further planning for the healthcare system. OBJECTIVE: In this study, we aimed to evaluate and compare the quality and equity of care concerning NRVHDs in terms of gender and sociodemographic index (SDI) using a newly proposed index. METHODS: We obtained the primary measures (e.g. incidence) from the Global Burden of Disease (GBD) data about NRVHD from 1990 to 2017 to calculate the subsequent secondary indices (e.g. mortality-to-incidence ratio) with close association to quality of care. Then, using principal component analysis (PCA), quality of care index (QCI) was calculated as a novel index from the secondary indices, rescaled to 0-100. QCI was calculated for all age groups and both genders, globally, regionally and nationally between 1990 and 2017. RESULTS: Globally, the QCI for NRVHDs in 2017 was 87.3, and it appears that gender inequity was unremarkable (gender disparity ratio = 1.00, female QCI: 90.2, male QCI: 89.7) in 2017 similar to the past three decades. Among WHO world regions, the Western Pacific Region and Eastern Mediterranean Region showed the highest (90.1) and lowest (74.0) QCI scores. Regarding SDI, the high-middle-SDI quintile with a QCI of 89.4 and the low-SDI quintile with a QCI of 77.8 were the two extremes of healthcare quality in 2017. CONCLUSION: Although global status regarding the NRVHD's quality of care is acceptable, higher attention is required for lower SDI countries.

Association between diabetic retinopathy and polymorphisms of cytokine genes: a systematic review and meta-analysis.

INTRODUCTION: Diabetic retinopathy (DR) is a medical condition caused by damage to the blood vessels of retina tissue due to diabetes mellitus. DR leads to injury in neural and vascular structures and is reported to be significantly influenced by inflammation and inflammatory mediators like cytokines. In this study, a systematic review and meta-analysis were performed to analyze the association between cytokine gene polymorphisms and DR. METHODS: We identified relevant studies from Scopus, PubMed, and Google scholar databases. Allele and genotype frequencies were pooled. Heterogeneity and publication bias were explored. The odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated to estimate the relation. RESULTS: A total of 3337 cases and 4945 controls in 19 eligible studies were included in the meta-analysis. Overall, results indicated the negative association between the cytokine gene polymorphisms and DR susceptibility in the allelic model (IFN-γ (rs2430561): OR 0.64, [CI]: 0.5 to 0.82; and TGF-ß (rs1800471): [OR] = 0.15, [CI]: 0.03 to 0.79); and also, in the dominant model (IFN-γ (rs2430561): OR = 0.4, [CI]: 0.22 to 0.75; and TGF-ß (rs1800471): OR = 0.14, [CI]: 0.05 to 0.4). CONCLUSION: The present study suggests that IFN-γ (rs2430561) and TGF-ß (rs1800471) polymorphisms are associated with decreased susceptibility to DR.

Risk of flare or relapse in patients with immune-mediated diseases following SARS-CoV-2 vaccination: a systematic review and meta-analysis.

BACKGROUND: Patients with autoimmune and immune-mediated diseases (AI-IMD) are at greater risk of COVID-19 infection; therefore, they should be prioritized in vaccination programs. However, there are concerns regarding the safety of COVID-19 vaccines in terms of disease relapse, flare, or exacerbation. In this study, we aimed to provide a more precise and reliable vision using systematic review and meta-analysis. METHODS: PubMed-MEDLINE, Embase, and Web of Science were searched for original articles reporting the relapse/flare in adult patients with AI-IMD between June 1, 2020 and September 25, 2022. Subgroup analysis and sensitivity analysis were conducted to investigate the sources of heterogeneity. Statistical analysis was performed using R software. RESULTS: A total of 134 observations of various AI-IMDs across 74 studies assessed the rate of relapse, flare, or exacerbation in AI-IMD patients. Accordingly, the crude overall prevalence of relapse, flare, or exacerbation was 6.28% (95% CI [4.78%; 7.95%], I2 = 97.6%), changing from 6.28% (I2 = 97.6%) to 6.24% (I2 = 65.1%) after removing the outliers. AI-IMD patients administering mRNA, vector-based, and inactive vaccines showed 8.13% ([5.6%; 11.03%], I2 = 98.1%), 0.32% ([0.0%; 4.03%], I2 = 93.5%), and 3.07% ([1.09%; 5.9%], I2 = 96.2%) relapse, flare, or exacerbation, respectively (p-value = 0.0086). In terms of disease category, nephrologic (26.66%) and hematologic (14.12%) disorders had the highest and dermatologic (4.81%) and neurologic (2.62%) disorders exhibited to have the lowest crude prevalence of relapse, flare, or exacerbation (p-value < 0.0001). CONCLUSION: The risk of flare/relapse/exacerbation in AI-IMD patients is found to be minimal, especially with vector-based vaccines. Vaccination against COVID-19 is recommended in this population.

Long-term disease-free survival following salvage brachytherapy for recurrent pediatric rhabdomyosarcoma: Two case reports and review of relevant literature.

PURPOSE: Rhabdomyosarcoma (RMS) is the most common pediatric soft-tissue sarcoma, mostly involving the genitourinary (GU) tract, head and neck, and extremities. This study reports the long-term outcome of two infants with recurrent GU-RMS who underwent combination therapy with chemotherapy (ChT) and salvage brachytherapy (BT). METHODS AND MATERIALS: An 18-month-old girl with vaginal bleeding and a 7-month-old boy with urinary retention presented with a diagnosis of vaginal, and bladder/prostate embryonal RMS, respectively. Surgical resection and ChT were done for both patients. However, both developed local recurrences after one year and subsequently, underwent second-line ChT and salvage interstitial high dose rate BT. RESULTS: The clinical target volumes for the first and second patients were treated to a totaldose of 32 Gy in 10 fractions and 35 Gy in 10 fractions, respectively, with two fractions delivered per day with a 6-h interval between fractions. After 9 years of follow-up, both patients are alive with natural growth and no late complication or evidence of recurrence. CONCLUSIONS: Our report shows that BT (for patients with no prior history of irradiation) could result in long-term disease-free survival in well-selected pediatric patients with recurrent GU embryonal RMS without inflicting expected adverse effects of external beam radiotherapy.

Association of sleep characteristics and respiratory symptoms at a smelting factory.

BACKGROUND: Sleep disturbance including insomnia and poor sleep quality has been shown to be a major health determinant in occupational settings. Specific occupational exposures to hazards in most workplaces can lead to various health problems, especially sleep problems. OBJECTIVE: The study aimed to investigate sleep characteristics, and their relationships with work-related exposures, demographics, and other related variables in workers of a smelting factory. METHODS: This cross-sectional study was carried out on workers in a 40-year smelting factory located in the East of Tehran Province. A total of 200 male participants were included in the study. Among them, 51 workers were from the production process staff and the rest were office workers. Their shifts were from 6 AM to 5 PM. All participants were asked about demographic characteristics and exposure to respiratory pollutants. All participants answered validated Persian versions of the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The means (SD) of age and BMI were 39.1 (8.9) years and 26.8 (4.5) kg/m2, respectively. Among all participants, 51 (25.5%) experienced exposure to a respiratory pollutant. Among all workers, 96 (48%) experienced poor sleep quality and 87 (43.5%) and 10 (5%) had subthreshold and clinical insomnia, respectively. The mean (SD) night sleep duration was 6.4 (0.96) hours. Data analysis illustrated a significant positive relationship between exposure to respiratory pollutants and insomnia (p-value = 0.03). Howewer, this association between sleep quality and exposure to repiratory pollutants was not significant (p-value = 0.25). Further analysis with binominal regression showed participants with exposure to respiratory pollutants were more susceptible to clinical insomnia (p-value = 0.02, exp(B) = 0.213), and after regressing out the effect of smoking, participants with exposure to respiratory pollutants remained susceptible to clinical insomnia. A lower night sleep duration was observed among participants with exposure to inhalational material (p-value = 0.05). CONCLUSIONS: Occupational exposures to hazardous material, including inhalational exposures, could cause sleep disturbance, which warrants more attention paid by sleep specialists.

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis.

BACKGROUND: Immunocompromised (IC) patients are at higher risk of severe SARS-CoV-2 infection, morbidity, and mortality compared to the general population. They should be prioritized for primary prevention through vaccination. This study aimed to evaluate the efficacy of COVID-19 mRNA vaccines in IC patients through a systematic review and meta-analysis approach. METHOD: PubMed-MEDLINE, Scopus, and Web of Science were searched for original articles reporting the immunogenicity of two doses of mRNA COVID-19 vaccines in adult patients with IC condition between June 1, 2020 and September 1, 2021. Meta-analysis was performed using either random or fixed effect according to the heterogeneity of the studies. Subgroup analysis was performed to identify potential sources of heterogeneity. RESULTS: A total of 26 studies on 3207 IC patients and 1726 healthy individuals were included. The risk of seroconversion in IC patients was 48% lower than those in controls (RR = 0.52 [0.42, 0.65]). IC patients with autoimmune conditions were 54%, and patients with malignancy were 42% more likely to have positive seroconversion than transplant recipients (P < 0.01). Subgroup meta-analysis based on the type of malignancy, revealed significantly higher proportion of positive seroconversion in solid organ compared to hematologic malignancies (RR = 0.88 [0.85, 0.92] vs. 0.61 [0.44, 0.86], P = 0.03). Subgroup meta-analysis based on type of transplantation (kidney vs. others) showed no statistically significant between-group difference of seroconversion (P = 0.55). CONCLUSIONS: IC patients, especially transplant recipients, developed lower immunogenicity with two-dose of COVID-19 mRNA vaccines. Among patients with IC, those with autoimmune conditions and solid organ malignancies are mostly benefited from COVID-19 vaccination. Findings from this meta-analysis could aid healthcare policymakers in making decisions regarding the importance of the booster dose or more strict personal protections in the IC patients.

Cluster analysis of insomnia symptoms during COVID-19 pandemic: a general population web-based survey in Iran.

OBJECTIVE: To investigate the prevalence of insomnia and its different phenotypes as well as their association with fear of COVID-19 in the general population. MATERIAL AND METHODS: This was a cross-sectional study conducted using an online survey (e-poll). All available participants who completed the online survey form were included in the current study. All individuals with a history of sleep problems were excluded. A questionnaire package consisted of insomnia severity index (ISI), and FCV-19 for corona fear was administered for all participants. Insomnia was defined as ISI≥8. Insomnia phenotypes were considered as: (a) DIS: difficulty initiating sleep; (b) DMS: difficulty maintaining sleep; (c) EMA: early morning awakening; and (d) combined insomnia. RESULTS: A total of 1,223 participants [827 (67.6%) female, mean age=39.82±10.75 years old], enrolled in the current survey. Based on ISI, 675 (55.2% [95%CI=52.40-57.98]) were categorized into the insomnia group. Insomnia was more prevalent in females (p=0.006), participants with 50 years old or higher (p=0.04), or high fear of COVID-19 (p<0.0001). Totally, 67.4%, 66.4%, and 55% of all participants had DIS, DMS, and EMA, respectively, in the current outbreak. Besides, 79% had impaired daily functioning, 51.6% had impaired quality of life, and 62% were worried about their sleep problem. Notably that a considerable percentage of individuals with normal ISI scores had at least one insomnia phenotype or impaired daily functioning and quality of life. Further analyses revealed a significant increasing trend in all four insomnia phenotypes prevalence with an increase in fear of COVID-19 (all p-values<0.0001). CONCLUSION: Individuals with higher age, female gender, or higher fear of COVID-19 are at higher risk of all types of insomnia as well as impaired daytime performance or quality of life.