Covid-19 vaccination reported side effects and hesitancy among the Syrian population: a cross-sectional study.

INTRODUCTION: Studying post-vaccination side effects and identifying the reasons behind low vaccine uptake are pivotal for overcoming the pandemic. METHODS: This cross-sectional study was distributed through social media platforms and face-to-face interviews. Data from vaccinated and unvaccinated participants were collected and analyzed using the chi-square test, multivariable logistic regression to detect factors associated with side effects and severe side effects. RESULTS: Of the 3509 participants included, 1672(47.6%) were vaccinated. The most common reason for not taking the vaccine was concerns about the vaccine's side effects 815(44.4). The majority of symptoms were mild 788(47.1%), followed by moderate 374(22.3%), and severe 144(8.6%). The most common symptoms were tiredness 1028(61.5%), pain at the injection site 933(55.8%), and low-grade fever 684(40.9%). Multivariable logistic regression analysis revealed that <40 years (vs. ≥40; OR: 2.113, p-value = 0.008), females (vs. males; OR: 2.245, p-value< .001), did not receive influenza shot last year (vs. did receive Influenza shot last year OR: 1.697, p-value = 0.041), AstraZeneca (vs. other vaccine brands; OR: 2.799, p-value< .001), co-morbidities (vs. no co-morbidities; OR: 1.993, p-value = 0.008), and diabetes mellitus (vs. no diabetes mellitus; OR: 2.788, p-value = 0.007) were associated with severe post-vaccine side effects. Serious side effects reported were blood clots 5(0.3%), thrombocytopenia 2(0.1%), anaphylaxis 1(0.1%), seizures 1(0.1%), and cardiac infarction 1(0.1%). CONCLUSION: Our study revealed that most side effects reported were mild in severity and self-limiting. Increasing the public's awareness of the nature of the vaccine's side effects would reduce the misinformation and improve the public's trust in vaccines. Larger studies to evaluate rare and serious adverse events and long-term side effects are needed, so people can have sufficient information and understanding before making an informed consent which is essential for vaccination.

Age < 40 years, females, not receiving influenza shot, AstraZeneca vaccine, co-morbidities, and diabetes mellitus were factors significantly associated with severe post-vaccination side effects.Although most of the reported vaccine side effects were mild in severity and well-tolerated, larger prospective studies to understand the causes of rare serious adverse events and long-term side effects are needed to overcome vaccine hesitancy among people and enable them to have sufficient information and understanding before making an informed consent which is essential for vaccination.

Outcomes of patients with coronavirus disease versus other lung infections requiring venovenous extracorporeal membrane oxygenation.

Background: Patients with Coronavirus Disease (COVID-19) often develop severe acute respiratory distress syndrome (ARDS) requiring prolonged mechanical ventilation (MV), and venovenous extracorporeal membrane oxygenation (V-V ECMO).Mortality in COVID-19 patients on V-V ECMO was exceptionally high; therefore, whether survival can be ameliorated should be investigated. Methods: We collected data from 85 patients with severe ARDS who required ECMO support at the University Hospital Magdeburg from 2014 to 2021. The patients were divided into the COVID-19 group (52 patients) and the non-COVID-19 group (33 patients). Demographic and pre-, intra-, and post-ECMO data were retrospectively recorded. The parameters of mechanical ventilation, laboratory data before using ECMO, and during ECMO were compared. Results: There was a significant difference between the two groups regarding survival: 38.5% of COVID-19 patients and 63.6% of non-COVID-19 patients survived 60 days (p = 0.024). COVID-19 patients required V-V ECMO after 6.5 days of MV, while non-COVID-19 patients required V-V ECMO after 2.0 days of MV (p = 0.048). The COVID-19 group had a greater proportion of patients with ischemic heart disease (21.2% vs 3%, p = 0.019). The rates of most complications were comparable in both groups, whereas the COVID-19 group showed a significantly higher rate of cerebral bleeding (23.1 vs 6.1%, p = 0.039) and lung bacterial superinfection (53.8% vs 9.1%, p = <0.001). Conclusion: The higher 60-days mortality among patients with COVID-19 with severe ARDS was attributable to superinfection, a higher risk of intracerebral bleeding, and the pre-existing ischemic heart disease.

Impact of comorbidities on hospitalised Syrian patients with COVID-19: a retrospective study.

OBJECTIVES: This study aims to compare the clinical manifestations, laboratory findings, outcomes and overall survival time of patients with COVID-19 with and without comorbidities. DESIGN: Retrospective design. SETTING: This study was undertaken at two hospitals in Damascus. PARTICIPANTS: A total of 515 Syrian patients met the inclusion criterion, laboratory-confirmed COVID-19 infection following the Centers for Disease Control and Prevention. Exclusion criteria were suspected and probable cases that were not confirmed with a positive reverse transcription-PCR assay, and patients who self-discharged from the hospital against medical advice. PRIMARY AND SECONDARY OUTCOME MEASURES: First, assess the impacts of comorbidities on COVID-19 infection in four areas (clinical manifestations, laboratory findings, severity and outcomes). Second, calculate the overall survival time for patients with COVID-19 with comorbidities. RESULTS: Of 515 patients included, 316 (61.4%) were male and 347 (67.4%) had at least one coexisting chronic disease. Patients with comorbidities compared with no comorbidities were more vulnerable to poor outcomes such as severe infection (32.0% vs 9.5%, p<0.001), severe complications (34.6% vs 9.5%, p<0.001), the need for mechanical ventilation (28.8% vs 7.7%, p<0.001) and death (32.0% vs 8.3%, p<0.001). Multiple logistic regression showed that age ≥65 years old, positive smoking history, having ≥2 comorbidities and chronic obstructive pulmonary disease were risk factors linked to severe COVID-19 infection in patients with comorbidities. Overall survival time was lower among patients with comorbidities (vs no comorbidities), patients with ≥2 comorbidities (vs one comorbidity), and patients with hypertension, chronic obstructive pulmonary disease, malignancy or obesity (vs other comorbidities) (p<0.05). CONCLUSION: This study revealed that COVID-19 infection had poor outcomes among those with comorbidities. Severe complications, mechanical ventilation usage and death were more prevalent among patients with comorbidities compared with those with no comorbidities.

COVID-19 Disease in Syrian Patients With Cancer: Clinical Manifestations, Laboratory Findings, Treatment, and Outcomes.

PURPOSE: This study aims to describe the clinical manifestations, laboratory findings, treatment, and outcomes of patients with cancer with COVID-19 infection in Syria. The primary objective was to identify the overall survival (OS) time, and the secondary objectives were to identify factors associated with severe COVID-19 infection. METHODS: This multicenter retrospective study was undertaken at four hospitals in Damascus, Syria, between March 28, 2020, and March 29, 2021. Data extracted from medical records included clinical manifestations, radiologic findings, laboratory results, treatment, and outcomes. Survival analysis was done by using the Kaplan-Meier method and Cox regression model for follow-up and anticancer treatment patients to study the effect on OS time. The effects of potential risk factors of developing severe COVID-19 were studied by multivariable logistic regression. RESULTS: Of 114 patients included, 61 (53.51%) were male. Smokers represented 29 (25.44%), and 63 (55.26%) patients had a history of coexisting chronic diseases. The most common cancer type was breast cancer 17 (14.91%). Sixty-eight (59.65%) patients were receiving anticancer treatment within 1 month of being diagnosed with COVID-19 infection and 46 (40.35%) were outpatient follow-ups. Multiple logistic regression analysis showed that comorbidities (odds ratio: 2.814, P = .044) and anticancer treatment (odds ratio: 8.790, P < .05) were risk factors linked to severe to critical COVID-19 infection. OS time was 245 (95% CI, 217.96 to 272.47) days, lower among patients with cancer with COVID-19 infection receiving anticancer treatment compared with follow-up patients (P value < .05). CONCLUSION: Patients with cancer with COVID-19 infection receiving anticancer treatment had a lower OS time. It may be worth considering stopping anticancer treatment in patients with cancer with COVID-19 when possible in search of better outcomes.

Novel Surgical Technique to Prevent Left Ventricular Rupture After Mitral Valve Replacement.

Left ventricular rupture, also called atrioventricular disruption, remains a rare but lethal complication of mitral valve replacement. Available measures for preventing such a complication are limited to preservation of the posterior mitral leaflet and avoidance of overzealous decalcification of the annulus. Moreover, these strategies are not always feasible when annular calcifications prevent proper suture placement or when an abscess involves the mitral annulus. This report describes a surgical technique practiced in our clinic (Department of Cardiothoracic Surgery, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany) that can be used in such high-risk patients to avoid left ventricular rupture.

Case series of late complications after transcatheter mitral annuloplasty using Cardioband and surgical treatment options.

BACKGROUND: Treatment of functional mitral regurgitation using transcatheter techniques such as the Cardioband annuloplasty device (Edwards Lifesciences) has gained wide acceptance in the recent years. However, complications of such devices are rarely reported. METHODS: Here, we present a case series involving two patients with dislocation of the Cardioband device and discuss the surgical management. RESULTS: In the former the valve was re-repaired by surgical implantation of an annuloplasty ring, and in the latter the valve had to be replaced due to severe damage of the mitral valve annulus. Both patients had an uncomplicated course and were discharged to rehabilitation Center. CONCLUSION: Dislocation of the Cardioband devices can be successfully managed by surgical approaches. Depending on the extent of damage to the mitral valve annulus, the valve could be re-repaired or should be repalced.

Technical feasibility of a pneumatically driven vehicle.

In this work, the technical feasibility of an all-air vehicle is investigated. A test rig has been built for this purpose in order to assess the proposed system experimentally. The operating pressures selected are deliberately low to mitigate the heat generated/dissipated during charging and discharging of the air cylinders driving an air motor, respectively. The experimental setup consists of three cylinders charged up to 5 bar and operated via solenoid valves to control the discharge of the cylinders via a programmable logic controller. The operating modes vary according to the expected load demand on the vehicle during startup and also during cruise. The three cylinders are discharged in tandem if the demand calls for high power density, then they are operated sequentially to augment the operational range of the vehicle. A simple sprocket-chain mechanism is used for its simplicity in this proof-of-concept stage to better understand the parameters pertinent to vehicle operation, which will later be replaced by a continuously variable transmission (CVT) gear. The results show a great potential for such mode of transport, especially for vast locales, such as a hospital, golf course or a university campus, with top velocities estimated to be around 14 km/h velocities and driven sprocket powers of 0.7 hp. Other combinations of drive gear ratio and cylinder discharge sequences result in a wide range of output power and maximum speed possibilities.