The humoral response to COVID-19 vaccinations can predict the booster effect on health care workers-toward personalized vaccinations?

BACKGROUND: Waning immunity after the coronavirus disease 2019 (COVID-19) vaccinations creates the constant need of boosters. Predicting individual responses to booster vaccines can help in its timely administration. We hypothesized that the humoral response to the first two doses of the BNT162b2 vaccine can predict the response to the booster vaccine. METHODS: A prospective cohort of hospital health care workers (HCW) that received three doses of the BNT162b2 vaccine. Participants completed serological tests at 1 and 6 months after the second vaccine dose and 1 month after the third. We analyzed predictive factors of antibody levels after the booster using multivariate regression analyses. RESULTS: From 289 eligible HCW, 89 (31%) completed the follow-up. Mean age was 48 (±10) and 46 (52%) had daily interaction with patients. The mean (±standard deviation) antibody level 1 month after the second vaccine was 223 (±59) AU/ml, and 31 (35%) had a rapid antibody decline (>50%) in 6 months. Low antibody levels 1 month after the second vaccine and a rapid antibody decline were independent predictors of low antibody levels after the booster vaccine. CONCLUSIONS: The characteristics of the humoral response to COVID-19 vaccinations show promise in predicting the humoral response to the booster vaccines.

Polygamy and birth outcomes among Bedouin women of the Negev: The contribution of social determinants and pregnancy complications.

Polygamy has been associated with adverse health outcomes. We examined the association between polygamy and adverse birth outcomes (composite score of preterm birth, low birth weight, small for gestational age, Apgar score < 7) using survey data linked to retrospective medical data of 9,872 cohort Bedouin women who bore live singletons in a large medical center in Southern Israel between 2008 and 2014. Women in polygamous marriages (18%) were more likely to have adverse birth outcomes after considering different factors (AOR = 1.28, 95% CI = 1.09-1.51), indicating that polygamy is an independent risk factor for birth outcomes that should be considered in research and clinical practice.

Sex effect on growth faltering in an indigenous ethnic minority population of infants in Israel.

OBJECTIVE: We examined sex effects on growth faltering in an indigenous population of Bedouin Arab infants born in Israel, an economically developed country. DESIGN: Retrospective cohort study. Height-for-age Z-score (HAZ) at age 6, 12, 18 and 24 months was calculated for full-term, normal-birth-weight Bedouin infants born during years 2000-2009 and attending maternal and child health (MCH) clinics. Multivariate linear regression analysis (MLRA) was used to calculate the association between sex and HAZ, controlling for year of birth, birth weight (BW) and residence by type of settlement (established settlement (ES); non-established settlement (NES)). SETTING: Bedouin are an indigenous poor community of semi-nomadic Arabs, with the highest infant mortality rate in Israel. Fifty per cent of Bedouin infants live in NES with inadequate access to running water, electricity, and rubbish and sewage disposal. All Bedouin receive free well-baby care in community-based MCH clinics. PARTICIPANTS: Full-term, normal Bedouin infants (n 5426) born during 2000-2009 and attending computerized MCH clinics who had growth measurements at age 6, 12, 18 and 24 months. RESULTS: At all ages, girls had significantly higher mean HAZ than boys (P < 0·05). Increasing birth year, residence in ES and increasing BW were positively associated with HAZ (P < 0·05) at all ages. In MLRA controlling for birth year, BW and type of settlement, sex still had a significant effect, with lower HAZ among boys at 6, 12, 18 and 24 months of age (P < 0·001 at all ages). CONCLUSIONS: Our results indicated that sex effects on growth faltering can occur in an indigenous population with low socio-economic status within an economically developed country.

Maternal and child health in Israel: building lives.

Israel is home to a child-oriented society that values strong family ties, universal child benefits, and free education for all children from 3 years of age to school grade 12. Alongside the universal health-care services that are guaranteed by the National Health Insurance Law and strong, community-based primary and preventive care services, these values have resulted in good maternal and child health. In 2015, infant and maternal mortality (3·1 deaths per 1000 livebirths and 2·0 deaths per 100 000 livebirths, respectively) were lower than the mean infant and maternal mortality of countries within the Organisation for Economic Co-operation and Development. Israel has already exceeded the developed regions' Sustainable Development Goal 2030 targets for maternal mortality, neonatal mortality, and mortality in children younger than 5 years in all population groups. Yet these accomplishments are marred by Israel's high prevalence of child poverty (more than 30%), particularly among Arabs (63%) and ultra-Orthodox Jews (67%). Although infant mortality has improved in all subpopulations since Israel was founded in 1948, infant mortality among Arabs is still more than twice as high as among Jews. To address these disparities in health, the Israeli Ministry of Health has created a special division and has funded an intervention programme to reduce the infant mortality among Bedouin Arabs. Other interventions include targeted and culturally appropriate health-care programmes and services for communities with a high number of at-risk children and young adults, dental health service for all children up to 15 years, and improved collaboration between health, education, and welfare services. The challenges faced by the Israeli health-care system include a growing trend towards medicalisation of prenatal care, ensuring staff are trained to treat developmental, behavioural, and psychosocial issues in children and their families, securing sustainable funding for health promotion and injury prevention programmes, expanding and improving the coordination of services for children with special needs or who are at risk, and programme assessment. Ensuring adequate funding for dedicated, preventive paediatric care and taking action on a nationwide scale to reduce child poverty are essential for maintaining health gains in children. In this Series paper, we describe the health indices, highlight disparities, and discuss the challenges in delivering and maintaining maternal and child health care in Israel.

Recurrence of Preterm Delivery in Women with a Family History of Preterm Delivery.

Objective This study aims to evaluate the role of a family history of preterm delivery on the risk of preterm delivery in the next generation. Study Design A retrospective population-based study was conducted. Perinatal information was gathered from 2,303 familial triads, composed of mothers (F1), daughters (F2), and children (F3). All births occurred in the same regional medical center between the years 1991 and 2013. Statistical analysis using logistic regression was performed to define the risk of F2 delivering a preterm baby (F3) if she was born preterm herself, and then to define the risk of F2 delivering preterm if her mother (F1) gave birth preterm during any of her birthing events. Results The risk for preterm delivery of the F2 parturient was 34% greater if their mother (F1) at any of her births had delivered preterm, controlling for parity, maternal age at delivery, and preeclampsia (adjusted odds ratio: 1.34, 95% confidence interval: -1.01 to 1.77; p = 0.042). Conclusion The family history of preterm delivery is an independent risk factor for preterm delivery. The family history includes the mother as well as one of the mother's sisters (F2 generation) being born preterm.

Risk Factors for Recurrent Tuberculosis among Successfully Treated Patients in Israel, 1999-2011.

BACKGROUND: Recurrent tuberculosis (TB) is one of the indices used to assess the effectiveness of the Israeli National TB Programs (NTP). OBJECTIVES: To estimate the incidence of recurrent TB in Israel and to identify the associated risk factors. METHODS: We conducted a retrospective cohort study of all TB patients who were Israeli citizens and diagnosed between 1999 and 2011 with a treatment outcome recorded as "success." We compared those who had recurrent TB with those who did not. In addition, a nested case-control study included all those who had recurrent TB with a random sample from this cohort matched by age, gender, and year of TB diagnosis. RESULTS: Of 3515 TB patients diagnosed between 1999 and 2011, 37 (1.05%) had recurrent TB during the follow-up period, with an incidence rate of 1.55 cases per 1000 person-years (PY). Male gender [hazard ratio (HR) 3.2, 95% confidence interval (95%CI) 1.4-7.4], human immunodeficiency virus (HIV) infection (HR 3.9, 95%CI 1.5-10.4), positive sputum culture [odds ratios (OR) 2.7, 95%CI 1.1-6.9], and low adherence to anti-TB treatment (OR 3.2, 95%CI 1.0-10.3) were found to be risk factors for recurrent TB. CONCLUSIONS: Male gender, HIV infection, positive sputum culture, and low adherence to anti-TB drugs during the initial TB episode were risk factors for developing recurrent TB.

[IS THERE A WAY TO REDUCE IRON DEFICIENCY ANEMIA RATES IN THE SECOND YEAR OF LIFE OF BEDOUIN CHILDREN IN THE NEGEV?]

INTRODUCTION: Iron deficiency anemia is the most common worldwide nutritional deficiency contributing to childhood morbidity and mortality. According to the official health policy in Israel, providing iron for all babies from the age of 4 months to the age of one year old is recommended. This policy also recommends providing iron supplementation for an additional 6 months for toddlers (who are one year old) with anemia (hemoglobin<11mg/dl). Despite this policy, there is still a high rate of anemia in the Negev's two year old children, especially in the Bedouin population. OBJECTIVES: Assessment of the intervention program to reduce iron deficiency anemia rates, that provides iron supplementation to Bedouin toddlers with no anemia, from the age of 1 year to 18 months and maternal knowledge about the prevention of anemia. METHODS: Type of Research: Community intervention trial study. Population study: A total of 251 toddlers aged one year old with no anemia from 6 recognized and unrecognized Bedouin villages. Intervention group: 250 toddlers who received iron supplementation; Prophylactic dosage (15 mg per day) for 6 months from the age of 1 year. Control group: 101 toddlers who did not receive iron supplementation. The hemoglobin (Hb) level was measured before and after the intervention for both groups. RESULTS: At the beginning of the study, at the age of one year there was no difference between the two groups in the average Hb level (11.8±0.5mg/dl). After the intervention of 6 months, an Hb decrease was observed in both groups: 11.5±0.8 mg/dl compared to 11.0±1.0 mg/dl in the intervention group and in the control group (p<0.001), respectively. At the study endpoint the rates of anemia in the intervention group were lower compared to the control group: 40.6% and 15.3% (p<0.001), respectively. A positive correlation was found between the toddlers Hb level and the amount of iron supplementation received through the study. CONCLUSIONS: Providing iron supplementation, from the age of 1 year for 6 months reduces the anemia risk during the second year of life. We suggest changing the recommendation to continue iron supplementation for toddlers (beyond one year old) only for children with anemia to a new policy and propose continuing iron supplementation beyond one year old to all toddlers at this age.

[TRAINING WORKSHOPS FOR BEDOUIN MOTHERS: PREVENTION OF IRON DEFICIENCY ANEMIA IN CHILDREN - RESULTS FROM A COMMUNITY TRIAL STUDY].

INTRODUCTION: Anemia is the most common nutritional deficiency in the world, contributing to childhood morbidity and mortality. Knowledge, attitudes and behavior of caretakers and parents of toddlers can significantly prevent anemia. OBJECTIVES: Assessment of workshop intervention to alter knowledge, attitudes and behavior in mothers of toddlers in the Bedouin population. METHODS: Community trial study. The intervention group included: 150 mothers of healthy one-year-old toddlers receiving workshops culturally tailored for a month in addition to standard training in "Tipat-Halav" (Baby clinic). The control group included: 101 mothers of healthy one-year-old toddlers who received standard training. At the endpoint, mothers were tested in both groups to determine levels of knowledge based on the knowledge and attitudes questionnaire, and the food intake of their children was reviewed according to the Food Frequency Questionnaire (FFQ). RESULTS: Intervention group mothers correctly answered significantly more questions on knowledge and attitudes than the control group; 87.3% of the intervention group recognized the importance of giving iron supplements to prevent anemia compared to 73.3% in the control group (p=0.004). Over three-quarters of the intervention group and half of the control group knew that food affects mental development (p=0.001). In logistic regression, neutralization of SES variables, the intervention increased the rate mothers correctly answered questions 2 to 2.6 fold compared with the control group (p˂0.05). According to the FFQ, children in the intervention group ate more iron-rich foods of animal and vegetarian origin compared to the control group (p<0.05). CONCLUSIONS: The intervention improved the knowledge and behavior of mothers in preventing anemia in toddlers. It should be required to provide information and training activities for mothers of toddlers beyond standard training, increasing the awareness of foods rich in iron. This activity can be performed using cultural workshops on iron deficiency, as was performed in this study.

[EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, PROGNOSTIC FACTORS, AND VISUAL OUTCOMES IN PATIENTS WITH OPEN OCULAR INJURIES AND INTRAOCULAR FOREIGN BODIES].

AIMS: To describe and identify clinical characteristics, prognostic factors and visual outcome in patients with intraocular foreign bodies (IOFB) in southern Israel. METHODS: We conducted a retrospective review of all cases of open globe injury with IOFB treated and followed-up for at least 6 months in the Ophthalmology Department at Soroka University Medical Center, Beer Sheva, Israel, from 1995-2011. The study population was subdivided into two groups: 1. Patients whose difference in visual acuity (VA) between presentation and end of follow-up was considered "successful" (n = 54); 2. Patients whose difference in VA between presentation and end of follow-up was considered "non-successful"(n = 14). Comparing these two groups, we analyzed the following: time from trauma to admission, time from admission to operation, location of IOB, wound zone, best corrected VA at admission. RESULTS: A total of 97.1% of the study group were males and the mean age was 28.7 ± 15.3 years. Metallic IOB were found in 73.5% of cases. The IOFB penetrated at Zone 1 in 61.8% cases, and were located at the posterior segment in 65.2 % of cases. The two subgroups differed in their best corrected VA (by LogMAR) at presentation (p value = 0.02): the patients who were defined as "successful" (n = 54) had.a higher mean VA (1.2 ± 1.3) than those (n = 14) who were defined as "non-successful" (1.1 ± 0.6). The duration of time from trauma to admission was not found to be of statistical significance (p value = 0.361, and neither did the time from admission to operation (P value = 1). CONCLUSION: We present an innovative definition of VA changes during the follow-up period in patients with open globe injuries involving IOFB. Our study showed that patients who presented with worse VA had a better chance of a "successful" outcome.

Continuous decrease of consanguineous marriages among Arabs in Israel.

OBJECTIVES: To describe the trend in the rate of consanguineous marriages among the Israeli Arab population and to identify factors associated with this custom shift in recent years. METHODS: The study was conducted between November 2009 and January 2010 in Family Health Centers. A questionnaire was presented to parents during routine visits to the center with their children. RESULTS: Information on 6,437 couples was collected. The rate of consanguineous marriages decreased from 35.8% among those married before 2000, to 28.2% among those married in 2000-2004, and to 24.0% among those married in 2005-2009 (P for trend <0.001). First cousin marriages were the most common type of consanguineous marriages in all the time periods. Consanguineous marriages were associated with consanguinity between the couples' parents (both husband and wife), a high consanguinity rate in the place of residence and younger age at marriage (wife). CONCLUSIONS: The rates of consanguineous marriages among Israeli Arabs are decreasing but still high. Because consanguineous marriages are widely acceptable, the role of public health professionals and primary care personnel is to provide comprehensive information about the potential genetic risks of consanguinity on offspring health and to increase the accessibility of premarital and preconception counseling services.

Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions.

BACKGROUND: Spontaneous abortion is the most common complication of pregnancy. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used during pregnancy. Published data are inconsistent regarding the risk of spontaneous abortion following exposure to NSAIDs. METHODS: We performed a historical cohort study involving all women who conceived between January 2003 and December 2009 and who were admitted for delivery or spontaneous abortion at Soroka Medical Center, Clalit Health Services, Israel. A computerized database of medication dispensation was linked with 2 computerized databases containing information on births and spontaneous abortions. We constructed time-varying Cox regression models and adjusted for maternal age, diabetes mellitus, hypothyroidism, obesity, hypercoagulation or inflammatory conditions, recurrent miscarriage, in vitro fertilization of the current pregnancy, intrauterine contraceptive device, ethnic background, tobacco use and year of admission. RESULTS: The cohort included 65,457 women who conceived during the study period; of these, 58,949 (90.1%) were admitted for a birth and 6508 (9.9%) for spontaneous abortion. A total of 4495 (6.9%) pregnant women were exposed to NSAIDs during the study period. Exposure to NSAIDs was not an independent risk factor for spontaneous abortion (nonselective cyclooxygenase [COX] inhibitors: adjusted hazard ratio [HR] 1.10, 95% confidence interval [CI] 0.99-1.22; selective COX-2 inhibitors: adjusted HR 1.43, 95% CI 0.79-2.59). There was no increased risk for specific NSAID drugs, except for a significantly increased risk with exposure to indomethacin (adjusted HR 2.8, 95% CI 1.70-4.69). We found no dose-response effect. INTERPRETATION: We found no increased risk of spontaneous abortion following exposure to NSAIDs. Further research is needed to assess the risk following exposure to selective COX-2 inhibitors.

Impact of multiple micronutrient supplementation ("sprinkles") on iron deficiency anemia in Bedouin Arab and Jewish infants.

BACKGROUND: A high prevalence of iron deficiency anemia persists in Bedouin Arab and Jewish pediatric populations in southern Israel. OBJECTIVES: To compare the effect of daily use of the micronutrient supplementation (MMS), "Sprinkles," a powdered formulation of iron, vitamins A and C, folic acid and zinc, with liquid iron and vitamins A and D on iron deficiency at 12 months of age. METHODS: The 621 eligible Bedouin and Jewish infants in the study were assigned to the MMS and control arms and received supplementations from age 6 to 12 months. We examined the change in hemoglobin, hematocrit, mean cell volume, red blood cell distribution, serum ferritin and transferrin saturation. In addition, we used the high Iron Deficiency Index (IDI) if two or more of the above six parameters showed abnormal levels. RESULTS: Rates of anemia decreased significantly over the 6 month period, from 58.8% to 40.6% among Bedouin infants (P = 0.037) and from 40.6 to 15.8% among Jewish infants (P = 0.017). In Bedouin infants the prevalence of high IDI decreased significantly from 79.2% to 67.4% (P = 0.010) in the MMS group, but there was no change in the controls. Among Jewish infants, the high IDI prevalence decreased from 67% to 55.6% with no statistically significant difference in the two study arms. In the multivariate analysis in Bedouin infants MMS use was associated with a reduced risk of 67% in high IDI at age 12 months as compared to controls (P = 0.001). Fewer side effects in the intervention groups in both ethnic populations were reported. CONCLUSIONS: MMS fortification of home food can be recommended as an effective and safe method for preventing iron deficiency anemia at 12 months of age.

Are Higher Body Mass Index and Worse Metabolic Parameters Associated with More Aggressive Differentiated Thyroid Cancer? A Retrospective Cohort Study.

Obesity is a risk factor for differentiated thyroid cancer (DTC), but the association with DTC aggressiveness is controversial. To evaluate the association between preoperative body mass index (BMI)/other metabolic parameters and DTC aggressiveness in our surgical cohort, we retrospectively evaluated patients following thyroid surgery who were diagnosed with DTC between December 2013 and January 2021. Baseline characteristics, histopathological features, treatment modalities, and follow-up data were studied. We conducted logistic regression to analyze the association between BMI/other metabolic parameters and adverse DTC features. The final study cohort included 211 patients (79.6% women; mean age± standard deviation 48.7 ± 15.9 years): 66 (31.3%) with normal weight, 81 (38.4%) with overweight, and 64 (30.3%) with obesity. The median follow-up was 51 months (range 7-93). Complete versus partial thyroidectomy was more common among patients living with overweight or obesity than in normal weight patients (79.7% versus 61.7%, p = 0.017, respectively). Logistic regression demonstrated that higher BMI was associated with mildly increased risk for lymph nodes metastases (odds ratio [OR] 1.077, 95% CI: 1.013-1.145), and higher triglycerides/high-density lipoprotein-cholesterol (TG/HDL-C) ratio was associated with aggressive histological variants of DTC (OR 1.269, 95% CI 1.001-1.61). To conclude, specific adverse clinical and histopathological DTC features were indeed associated with higher BMI and higher TG/HDL-C ratio.

Cytokine fingerprint differences following infection and vaccination - what can we learn from COVID-19?

COVID-19 vaccination and acute infection result in cellular and humoral immune responses with various degrees of protection. While most studies have addressed the difference in humoral response between vaccination and acute infection, studies on the cellular response are scarce. We aimed to evaluate differences in immune response among vaccinated patients versus those who had recovered from COVID-19. This was a prospective study in a tertiary medical centre. The vaccinated group included health care workers, who had received a second dose of the BNT162b2 vaccine 30 days ago. The recovered group included adults who had recovered from severe COVID-19 infection (<94% saturation in room air) after 3-6 weeks. Serum anti-spike IgG and cytokine levels were taken at entry to the study. Multivariate linear regression models were applied to assess differences in cytokines, controlling for age, sex, BMI, and smoking status. In total, 39 participants were included in each group. The mean age was 53 ±14 years, and 53% of participants were males. Baseline characteristics were similar between the groups. Based on multivariate analysis, serum levels of IL-6 (ß=-0.4, p<0.01), TNFα (ß=-0.3, p=0.03), IL-8 (ß=-0.3, p=0.01), VCAM-1 (ß=-0.2, p<0.144), and MMP-7 (ß=-0.6, p<0.01) were lower in the vaccinated group compared to the recovered group. Conversely, serum anti-spike IgG levels were lower among the recovered group (124 vs. 208 pg/mL, p<0.001). No correlation was identified between antibody level and any of the cytokines mentioned above. Recovered COVID-19 patients had higher cytokine levels but lower antibody levels compared to vaccinated participants. Given the differences, these cytokines might be of value for future research in this field.

Posttraumatic stress disorder among preschoolers exposed to ongoing missile attacks in the Gaza war.

BACKGROUND: The prevalence and manifestation of posttraumatic stress symptoms in young children may differ from that observed in adults. This study examined sociodemographic, familial, and psychosomatic correlates of posttraumatic stress disorder (PTSD) among preschool children and their mothers who had been exposed to ongoing missile attacks in the Gaza war. METHODS: One hundred and sixty-seven mothers of preschoolers (aged 4.0-6.5 years) were interviewed regarding PTSD and psychosomatic symptomatology of their children, as well as their own reactions to trauma. RESULTS: Fourteen mothers (8.4%) and 35 children (21.0%) screened positive for PTSD. Sociodemographic characteristics were not associated with PTSD among mothers or children. Among children, the only significant risk factor was having a mother with PTSD (OR = 12.22, 95% CI 2.75-54.28). Compared to children who did not screen positive for PTSD, those who did screen positive displayed significantly higher rates of psychosomatic reactions to trauma, most notably constipation or diarrhea (OR = 4.36, 95% CI 1.64-11.60) and headaches (OR = 2.91, 95% CI 1.07-7.94). CONCLUSIONS: Results of this study add to the burgeoning literature on child PTSD, emphasizing the important role of maternal anxiety and the psychosomatic reactions associated with exposure to ongoing traumatic experiences in young children.

Factors associated with childhood overweight and obesity among acculturated and new immigrants.

OBJECTIVE: To examine the relationship between acculturation and obesity among low socioeconomic status (LSES) children. DESIGN: Cross-sectional study. SETTING: Children from 12 preschools in LSES neighborhoods were recruited. PARTICIPANTS: Anthropometric measurements were obtained from 238 children (aged 4-7 years) and 224 mothers. Sociodemographic characteristics and perceptions of child's weight were collected from mothers. We compared native Israelis and immigrants for risk factors for obesity, using a 9-year cut-off to define new and acculturated immigrants. RESULTS: The combined prevalence of overweight and obesity (OWOB) among children was 29.8% (71/238) using the World Health Organization (WHO) growth standard. Mean age, sleeping hours, sex distribution and poverty level were similar between immigrants and natives. Prevalence of OWOB and current parental smoking were significantly lower among children of new immigrants (P = .02). More than 82% of mothers underestimated their child's weight status, 74.2% of OWOB children were perceived as normal-weight (NW) and 8% as thin. In a multivariable logistic-regression analysis comparing NW to OWOB children, maternal underestimation of the child's weight status (OR = 7.5; 95%CI: 3.4-16.5, P < .0001) and being born to acculturated immigrants (OR = 2.3 95% CI: 1.1-4.7, P = .03) were associated with OWOB. Ethiopian children were at lower risk for obesity. Paternal smoking increased the risk for obesity by 2-fold in non-Ethiopian, and 5-fold in Ethiopian children (OR = 2.0 and 5.0, respectively; P for interaction = .026). CONCLUSIONS: Acculturation, perception of child's weight status and parental smoking are associated with childhood OWOB. Immigration status should be considered when programs to prevent childhood obesity are implemented in mixed populations.

Open globe eye injury characteristics and prognostic factors in southern Israel: a retrospective epidemiologic review of 10 years experience.

BACKGROUND: Open globe injury (OGI) is a common cause of unilateral visual loss in all age groups. OBJECTIVES: To describe and identify clinical characteristics, prognostic factors and visual outcome in a group of patients with OGI in southern Israel. METHODS: We conducted a retrospective review of all cases of OGI examined in the ophthalmology department at Soroka University Medical Center, Beer Sheva, Israel, from 1996 to 2005. A total of 118 eyes with OGI were detected and analyzed statistically. We recorded demographic data, cause of injury, initial visual acuity (VA), associated globe morbidity and injuries, Ocular Trauma Score (OTS), surgical procedures, postoperative complications, and final VA. RESULTS: The mean age of the study group was 36.1 years and included 84% males. The median follow-up was 13.3 months (range 6-66 months). The annual incidence of open globe injuries was 3.1 cases/100,000. In 84 cases (71%) the mechanism of open eye injury was laceration. Most of the injuries were work related (45%). Bilateral injury was observed in two patients. An intraocular foreign body was observed in 45 eyes (38%). Primary surgical repair was performed in 114 eyes. Six patients (5.1%) had complications with posttraumatic endophthalmitis and 12 patients (10.1%) underwent evisceration or enucleation. Clinical signs associated with poor visual outcomes included reduced initial VA, eyelid injury, and retinal detachment at presentation. CONCLUSIONS: In our study population the most important prognostic factors in open globe injury were initial VA, eyelid injury and retinal detachment.

Assessment of a close respiratory follow-up schedule at 3 and 6 months after acute COVID-19 and its related investigations.

BACKGROUND: Respiratory sequela after acute COVID-19 is common and requires medical follow-up. Considering its vast economic impact, there is still no consensus regarding the mid-term follow-up plan after recovery. OBJECTIVE: To evaluate the necessity of a close pulmonary follow-up schedule after acute COVID-19 and its related investigations. METHODS: A prospective cohort study including adult patients after acute COVID-19 pneumonia. Patients were invited or referred to a 3- and 6-month follow-up visits at a large pulmonary institute in a tertiary center. Before each visit, patients completed demographic and clinical questionnaires, pulmonary function tests (PFTs), and chest CT scans. RESULTS: 168 patients were included after completing both visits (medians of 80 and 177 days). Their mean age was 58 ± 15 and 52% recovered from severe or critical COVID-19. Between the two visits, there was no change in DLCOc (mean 73 ± 18 %predicted in both visits) and FVC (mean 90 ± 16 vs. 89 ± 16 %predicted). The COPD assessment tool and modified Medical Research Council scale had inverse correlations with the DLCOc, and similarly did not change between the visits. Occupational exposures were the only factor associated with a change in DLCOc during follow-up (3% decrease, p = 0.04). An improvement in chest CT findings at the second visit was not associated with a change in PFTs. CONCLUSIONS: Most clinical variables did not change during a close follow-up schedule in the first six months after acute COVID-19. Such a follow-up plan does not appear necessary and should be personalized to limit excessive costs and resources.

One-year dynamics of antibody titers after three doses of SARS-CoV-2 BNT162b2 vaccine.

BACKGROUND: A third dose of the BNT162b2 SARS-CoV-2 vaccine leads to a significant increase in antibody levels, however, concerns regarding the long-term persistence of this response exist. We assessed the humoral response for one year following vaccination. METHODS: A prospective study among immunocompetent healthcare workers (HCW) who received three doses of BNT162b2. anti-spike antibody titers were measured at six predefined timepoints, from before the second vaccine dose, and up to one year afterwards, which is 4-6 months after the third dose. HCW with a history of SARS-CoV-2 infection were excluded. RESULTS: Seventy-six HCW had all the six serological measurements. Antibody titers significantly increased shortly following the third vaccine dose, and while declining, remained higher from all previous measurements for up to six months. CONCLUSIONS: A third dose of BNT162b2 leads to a profound humoral response, which remains significantly higher than previous measurements, even after 6 months.

Effectiveness of a bivalent mRNA vaccine booster dose to prevent severe COVID-19 outcomes: a retrospective cohort study.

BACKGROUND: In late 2022, the SARS-CoV-2 omicron (B.1.1.529) BA.5 sublineage accounted for most of the sequenced viral genomes worldwide. Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the omicron BA.4 and BA.5 sublineages. Since September, 2022, a single bivalent mRNA vaccine booster dose has been recommended for adults who have completed a primary SARS-CoV-2 vaccination series and are at high risk of severe COVID-19. We aimed to evaluate the effectiveness of a bivalent mRNA vaccine booster dose to reduce hospitalisations and deaths due to COVID-19. METHODS: We did a retrospective, population-based, cohort study in Israel, using data from electronic medical records in Clalit Health Services (CHS). We included all members of CHS who were aged 65 years or older and eligible for a bivalent mRNA COVID-19 booster vaccination. We used hospital records to identify COVID-19-related hospitalisations and deaths. The primary endpoint was hospitalisation due to COVID-19, which we compared between participants who received a bivalent mRNA booster vaccination and those who did not. A Cox proportional hazards regression model with time-dependent covariates was used to estimate the association between the bivalent vaccine and hospitalisation due to COVID-19 while adjusting for demographic factors and coexisting illnesses. FINDINGS: Between Sept 27, 2022, and Jan 25, 2023, 569 519 eligible participants were identified. Of those, 134 215 (24%) participants received a bivalent mRNA booster vaccination during the study period. Hospitalisation due to COVID-19 occurred in 32 participants who received a bivalent mRNA booster vaccination and 541 who did not receive a bivalent booster vaccination (adjusted hazard ratio 0·28, 95% CI 0·19-0·40). The absolute risk reduction for hospitalisations due to COVID-19 in bivalent mRNA booster recipients versus non-recipients was 0·089% (95% CI 0·075-0·101), and the number needed to vaccinate to prevent one hospitalisation due to COVID-19 was 1118 people (95% CI 993-1341). INTERPRETATION: Participants who received a bivalent mRNA booster vaccine dose had lower rates of hospitalisation due to COVID-19 than participants who did not receive a bivalent booster vaccination, for up to 120 days after vaccination. These findings highlight the importance of bivalent mRNA booster vaccination in populations at high risk of severe COVID-19. Further studies with longer observation times are warranted. FUNDING: None.