Waning COVID-19 Vaccine Effectiveness for BNT162b2 and CoronaVac in Malaysia: An Observational Study

Evaluation of vaccine effectiveness over time against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) is important. Evidence on effectiveness over time for the CoronaVac vaccine is lacking despite its widespread use globally. In Malaysia, a diverse set-up of COVID-19 vaccines was rolled out nationwide, and the waning of vaccine protection is a concern. We aimed to investigate and compare waning vaccine effectiveness against COVID-19 infections, COVID-19 related ICU admission and COVID-19 related deaths for BNT162b2 and CoronaVac vaccines. In this observational study, we consolidated nationally representative data on COVID-19 vaccination and patients′ outcomes. Data on all confirmed COVID-19 cases from 1 to 30 September 2021 were used to compare vaccine effectiveness between the ′early′ group (fully vaccinated in April to June 2021) and the ′late′ group (fully vaccinated in Jul to Aug 2021). We used a negative binomial regression model to estimate vaccine effectiveness against COVID-19 infections for both ′early′ and ′late′ groups, by comparing the rates of infection for individuals vaccinated in the two different periods relative to the unvaccinated. Among confirmed COVID-19 cases, we used logistic regression to estimate and compare vaccine effectiveness against ICU admission and deaths between the two different periods. For BNT162b2, vaccine effectiveness against COVID-19 infections declined from 90.8% (95% CI 89.4, 92.0) in the late group to 79.1% (95% CI 75.8, 81.9) in the late group. Vaccine effectiveness for BNT162b2 against ICU admission and deaths were comparable between the two different periods. For CoronaVac, vaccine effectiveness waned against COVID-19 infections from 74.4% in the late group (95% CI 209 70.4, 77.8) to 30.0% (95% CI 18.4, 39.9) in the early group. It also declined significantly against ICU admission, dropping from 56.1% (95% CI 51.4, 60.2) to 29.9% (95% CI 13.9, 43.0). For deaths, however, CoronaVac′s effectiveness did not wane after three to five months of full vaccination. Vaccine effectiveness against COVID-19 infections waned after three to five months of full vaccination for both BNT162b2 and CoronaVac in Malaysia. Additionally, for CoronaVac, protection against ICU admission declined as well. Evidence on vaccine effectiveness over time informs evolving policy decisions on vaccination.

Corneal Endothelial Changes Following Early Capsulotomy Using Neodymium:Yttrium-Aluminum-Garnet Laser

We aimed to survey whether the timing of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079–0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology.

An Earlier First Meal Timing Associate with Weight Loss Effectiveness in A 12-Week Weight Loss Support Program

Recent studies have reported that meal timing may play an important role in weight regulation, however it is unknown whether the timing of meals is related to the amount of weight loss. This study aimed to examine the relationship between indices of meal timing and weight loss during weight loss intervention in adults. A 12-week weight loss support program was conducted for 97 adults (age: 47.6 ± 8.3 years, BMI: 25.4 ± 3.7 kg/m2). After the program, body weight decreased by −3.0 ± 2.7%. Only the start of the eating window was positively correlated with the weight change rate in both sexes (men: r = 0.321, p = 0.022; women: r = 0.360, p = 0.014). The participants were divided into two groups based on the start of the eating window as follows: the early group (6:48 ± 0:21 AM) and the late group (8:11 ± 1:05 AM). The weight loss rate in the early group was significantly higher (−3.8 ± 2.7%) than that in the late group (−2.2 ± 2.5%). The present results showed that the start of the early eating window was associated with weight loss and suggested paying attention to meal timing when doing weight loss.

Volumetric Resection and Complications in Nonfunctioning Pituitary Adenoma by Fully Endoscopic Transsphenoidal Approach along 15 Years of Single-Center Experience

Objective The aim of this study was to evaluate the rate of complications and the extent of resection (EOR) of nonfunctioning pituitary adenomas by endoscopic endonasal approach (EEA) in a 15-year learning curve. Methods A total of 100 patients operated by the same surgical team were divided chronologically into two, three, and four groups, comparing differences in EOR measured by a semiautomatic software (Smartbrush, Brainlab), rate of immediate postoperative complications, and the visual and hormonal status at 6 months. Results There were no significant differences over the years in rates of postoperative complications and in visual status at 6 months. A significant linear correlation between the EOR and the number of surgeries (rho = 0.259, p = 0.007) was found. The analysis was performed in three groups because of the remarkable differences among them; the EOR were: 87.2% (early group), 93.03% (intermediate group), and 95.1% (late group) (p = 0.019). Gross total resection was achieved in 30.3, 51.5, and 64%, respectively (p = 0.017); also, the rate of reoperation and the worsening of at least one new hormonal axis were worse in the early group. Consequently, the early group had a higher risk of incomplete resection compared with the late group (odds ratio: 4.2; 95% confidence interval: 1.5–11.7). The three groups were not different in demographic and volume tumor variables preoperatively. Conclusions The first 33 interventions were associated with a lower EOR, a high volume of residual tumor, a high reoperation rate, and a higher rate of hormonal dysfunction. We did not find differences in terms of postoperative complications and the visual status at 6-month follow-up.

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort

Background Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. Methods We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. Results Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients’ characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12–22] days of mechanical ventilation (MV), with 10 patients in the “early” group (≤ day 10) and 38 patients in the “late” group (> day 10). Survivors required MV for a median of 32 [22–41] days and were ultimately decannulated with a median of 21 [15–34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12–19] versus 35 [25–47] days; p = 0.002, and 21 [16–28] versus 54 [35–72] days; p = 0.002) and spent less time on MV (respectively 17 [14–20] and 35 [27–43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34–81] versus 92 [61–118] days; p = 0.012, and 24 [11–38] versus 45 [22–71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. Conclusions Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

Early versus delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation: a comparative study

Background Few studies focus on the treatment of femoral head fracture combined with posterior hip dislocation, and the safe interval time between injury and hip reduction remains controversial. The purpose of this study was to evaluate and compare the outcome of early and delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation. Methods A total of 71 patients were evaluated in this retrospective study. Based on the time to hip reduction, they were divided into early group (within 6 h after injury) and delayed group (between 6 and 12 h after injury). The two groups were compared in reference to hospital day, fracture healing time, the occurrence of complications and final functional outcome. The Thompson-Epstein criteria, modified Merle D’Aubigné and Postel scores, visual analog scale (VAS) and Medical Outcomes Short Form 12-item questionnaire score (SF-12) were used for final functional evaluation. Results The mean hospital stay and fracture healing time in the early group were significantly lower than those in the delayed group. The incidence of infection, post-traumatic osteoarthritis, and avascular necrosis of the femoral head (ANFH) in the delayed group were higher than that in the early group. The early group had better functional outcomes in terms of Thompson-Epstein criteria, modified Merle D’Aubigné and Postel scores and physical component scale (PCS) than the delayed group. Conclusions For the treatment of femoral head fracture combined with posterior hip dislocation, the early and prompt hip reduction can effectively facilitate the fracture healing and patient rehabilitation, and obtain a better functional outcome.

Diatrizoate (Gastrograffin®) Small Bowel Follow Through for Small Bowel Obstructions: Timing and Outcomes

Introduction The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO); however, there is no data to suggest when G-SBFT should be performed. Methods We retrospectively reviewed 548 patients, admitted to 1 of 9 hospitals with a diagnosis of SBO. Patients were divided into two categories with regards to timing of G-SBFT: before (early) or after (late) 48 hours from admission. Primary outcomes were length of stay (LOS) and total cost. Secondary outcomes were operative interventions and mortality. Results Of the reviewed patients, 71% had the G-SBFT ordered early. Comparing early versus late, there were no differences in patient characteristics with regards to age, sex, or BMI. There was a significant difference between LOS (4 vs 8 days, P < 0.05) and total cost ($17,056.19 vs $33,292.00, P < 0.05). There was no difference in mortality (1.3% vs 2.6%, P = 0.239) or 30-day readmission rates (15.6% vs 15.9%, P = 0.509). Patients in the early group underwent fewer operations (20.7% vs 31.9%, P = 0.05). Discussion Patients that had a G-SBFT ordered early had a decreased LOS, total cost, and operative intervention. This suggests there is a benefit to ordering G-SBFT earlier in the hospital stay to reduce the overall disease burden, and that it is safe to do so with regards to mortality and readmissions. We therefore recommend ordering a G-SBFT within 48 hours to reduce LOS, cost, and need for an operation

P.007 Autoimmune Encephalitis Timing and Incidence: the Manitoba Experience

Background: Early treatment of autoimmune encephalitis (AE) can improve outcomes. Despite expert recommendation, it remains unclear if suspected AE patients consistently receive empiric treatments prior to availability of antibody results. Methods: Retrospective chart review of patients referred for AE testing in Manitoba. Primary outcomes were the proportion of patients treated empirically prior to the availability of antibody results. Incidence, clinical presentation, investigations, complications, mortality rates, and hospital course were secondary outcome measures. Results: We identified 151 patients from 2012-2018. 43 patients met inclusion criteria. The annual incidence of AE in Manitoba was 0.37/100,000. 28/43 (65%) patients were treated prior to availability of antibody results (“Early group”). 15/43 (35%) patients did not receive treatment (“Late group”). Significantly more Early group patients had repeat immunotherapy (p=0.001), abnormal MRI (p=0.027), and investigations for malignancy (p=0.015). Durations of hospital and intensive care admission, complication rates, and mortality rates were not different between the two groups. Conclusions: This is the first-ever AE incidence, timing, and management study of a comprehensive Canadian geopolitical and medical catchment area. Just over 1/3 of suspected AE over seven years were not treated prior to antibody results becoming available. Patients treated earlier did not experience greater complication rates.

A pilot randomized trial to study the success rate of early precut fistulotomy and its effect on radiation dose in patients with difficult biliary cannulation

Background: Role of precut fistulotomy in reducing fluoroscopy time and the radiation dose in difficult selective biliary cannulation is unknown. Methods: We performed a randomized trial where patients with difficult biliary cannulation were randomized into 2 groups: early precut fistulotomy (precut five minutes after failed standard biliary cannulation) or late precut fistulotomy (precut fifteen minutes after failed standard biliary cannulation). We compared the success rates of selective biliary cannulation, fluoroscopy time, radiation dose, complication rates, need for repeat endoscopic retrograde cholangiography (ERC) and need for other interventions Results: Of the 130 eligible patients screened, 40 patients were randomized. The technical success was comparable between early and late group. The fluoroscopy time and radiation dose were significantly less in the early group [4 minutes (3, 6) vs 15 minutes (8, 28), p=0.001] and [1.35 mGy (0.90, 1.63) vs 2.40 mGy (1.58, 3.25), p=0.010] respectively. In the late group, 60% required need for rescue precut fistulotomy. One patient from late group developed post ERC pancreatitis while 1 from early group developed perforation. Three needed other interventions due to failed second attempt. Conclusion: Early precut fistulotomy has comparable technical success and reduces the radiation dose as compared to late precut fistulotomy for difficult biliary cannulation.

Peer group-based online intervention program to empower families of those raising children with disabilities: Study protocol for a non-randomized waitlist-controlled trial

BackgroundFamilies raising children with disabilities assume risks to their health and lives. Therefore, it is necessary to support these families to improve family empowerment, which is the ability of these families to control their own lives and to promote the collaborative raising of children with disabilities. This is the first online program development and interventional study focusing on the empowerment of families raising children with disabilities who live at home in Japan.MethodThe program consisted of four online peer-based group sessions. Moreover, the families engage in several activities in stages wherein they discover their own issues, find measures to resolve them, and take action, while visualizing interfamily relationships, including social resources, and the status of their family life, with facilitators and other peer members. This study was a non-randomized, waitlist-controlled trial. It compared the results of the intervention group (early group) and the waitlist-controlled group (delayed group). The participants were allocated to the early or delayed group in the order of their applications. The main outcome was family empowerment. Other outcomes are the caregiver burden, awareness of the use of social resources, self-compassion, and the quality of life (QOL) of primary caregivers. The timing of the online surveys was as follows: the initial evaluation (Time 1 [T1]) was conducted before the start of the first early group program, and post-intervention evaluation (Time 2 [T2]) was conducted immediately (within one week) after the early group had completed all four sessions (four weeks) of the program. Follow-up evaluation (Time 3 [T3]) was conducted four weeks after the post-intervention evaluation. This timing was the same in the delayed group, but the delayed group attended the program after a four-week waiting period, compared to the early group.DiscussionThe intention is to evaluate whether the provision of the program developed in this study and the evaluation test design are feasible and to verify the efficacy of this program.Clinical trial registrationThe UMIN Clinical Trials Registry (UMIN000044172), registration date: May 19, 2021. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050422