COVID-19 Vaccination and Menstrual Issues - A Survey

The present study was aimed to assess the menstrual issues post COVID 19 vaccination. The objectives of the study was to assess the menstrual issues post COVID 19 vaccination & to find the association between menstrual issues and socio demographic variables. The study was conducted among 100 female participants who were vaccinated against COVID 19, using purposive sampling method. The present study showed that 88% had taken Covishield and 12 % had taken Covaxin. Majority that is 68% of the female participants belonged to the age group of 18-26 years, 63 % were Hindus and 65% belonged to nuclear family. In terms of the educational status 55% were graduates and 49% were studying. Majority that is 67% had their first menstrual period at the age of 13-15 years and 91% had no menstrual problem before Covid 19 vaccination. Distribution of 88 female participants according to Covishield vaccine and the menstrual issues revealed that 14% had missed periods, 10 % had bleeding or spotting in between periods, 13 % had menstrual bleeding lasting long, 58 % had menstrual cramps, 18% had heavy periods, 24% had breast tenderness, 39% had abdominal bloating, 27% had extreme tiredness, 11% had constipation and 47% had mood swings. Distribution of 12 female participants according to Covaxin vaccine and the menstrual issues revealed that 33% had missed periods, 25% had bleeding or spotting in between periods, 08% had menstrual bleeding lasting long, 50% had menstrual cramps, 17% had heavy periods, 33% had breast tenderness, 33% had abdominal bloating, 67% had extreme tiredness, 25% had constipation and 58% had mood swings. Distribution of female participants aged <20 years who were vaccinated with Covishield/Covaxin revealed that none of the participants in this age group reported any menstrual issues except one person who had extreme tiredness after Covaxin. Chi-Square test or proportion test no possible for both Covishield and Covaxin in age group<20 as observed frequencies do not match requirements of the test. Distribution of female participants aged 20 -29 years who were vaccinated with Covishield/ Covaxin revealed that for Covishield the proportion test for menstrual cramps revealed Z=0.426 (not significant, ‘p’>0.05), abdominal bloating Z=7.249 (significant, ‘p’< 0.01) and mood swing Z= 2.558 (significant, ‘p’<0.01) For Covaxin Chi square or proportion test not possible in age group 20 - 29 years as observed frequencies do not match requirements of the test. Distribution of female participants aged 30-39 years who were vaccinated with Covishield/Covaxin revealed that for Covishield the proportion test for breast tenderness revealed Z=0.343 (not significant, ‘p’>0.05). Chi square test & proportion test for missed bleeding, periods lasting long, and cramps is not possible as the observed frequencies do not match requirements of the test. For Covaxin Chi square or proportion test not possible in age group 30 - 39 years as observed frequencies do not match requirements of the test. Distribution of female participants aged 40-49 years who were vaccinated with Covishield, majority had menstrual issues and those who were vaccinated with Covaxin 50% had no menstrual issues. Chi -Square test or proportion test no possible for both Covishield and Covaxin in age group 40-49 years as observed frequencies do not match requirements of the test. Only one female participant aged 50 years and above was vaccinated with Covishield and she had menstrual issues before vaccination too. Therefore statistical analysis possible in this case. A quantitative non- experimental survey approach was chosen for the study. Menstrual issues post COVID 19 vaccination was assessed using a structured questionnaire. Keywords: COVID 19, vaccination, Covishield, Covaxin, menstrual issues.

Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis

ObjectiveA diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is recommended for irritable bowel syndrome (IBS), if general lifestyle and dietary advice fails. However, although the impact of a low FODMAP diet on individual IBS symptoms has been examined in some randomised controlled trials (RCTs), there has been no recent systematic assessment, and individual trials have studied numerous alternative or control interventions, meaning the best comparator is unclear. We performed a network meta-analysis addressing these uncertainties.DesignWe searched the medical literature through to 2 April 2021 to identify RCTs of a low FODMAP diet in IBS. Efficacy was judged using dichotomous assessment of improvement in global IBS symptoms or improvement in individual IBS symptoms, including abdominal pain, abdominal bloating or distension, and bowel habit. Data were pooled using a random effects model, with efficacy reported as pooled relative risks (RRs) with 95% CIs, and interventions ranked according to their P-score.ResultsWe identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis.ConclusionIn a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms.

Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: A cohort study

Background The diagnostic assessment of abdominal symptoms in primary care presents a challenge. Evidence is needed about the positive predictive values (PPVs) of abdominal symptoms for different cancers and inflammatory bowel disease (IBD). Methods and findings Using data from The Health Improvement Network (THIN) in the United Kingdom (2000–2017), we estimated the PPVs for diagnosis of (i) cancer (overall and for different cancer sites); (ii) IBD; and (iii) either cancer or IBD in the year post-consultation with each of 6 abdominal symptoms: dysphagia (n = 86,193 patients), abdominal bloating/distension (n = 100,856), change in bowel habit (n = 106,715), rectal bleeding (n = 235,094), dyspepsia (n = 517,326), and abdominal pain (n = 890,490). The median age ranged from 54 (abdominal pain) to 63 years (dysphagia and change in bowel habit); the ratio of women/men ranged from 50%/50% (rectal bleeding) to 73%/27% (abdominal bloating/distension). Across all studied symptoms, the risk of diagnosis of cancer and the risk of diagnosis of IBD were of similar order of magnitude, particularly in women, and younger men. Estimated PPVs were greatest for change in bowel habit in men (4.64% cancer and 2.82% IBD) and for rectal bleeding in women (2.39% cancer and 2.57% IBD) and lowest for dyspepsia (for cancer: 1.41% men and 1.03% women; for IBD: 0.89% men and 1.00% women). Considering PPVs for specific cancers, change in bowel habit and rectal bleeding had the highest PPVs for colon and rectal cancer; dysphagia for esophageal cancer; and abdominal bloating/distension (in women) for ovarian cancer. The highest PPVs for abdominal pain (either sex) and abdominal bloating/distension (men only) related to non-abdominal cancer sites. For the composite outcome of diagnosis of either cancer or IBD, PPVs of rectal bleeding exceeded the National Institute of Health and Care Excellence (NICE)-recommended specialist referral threshold of 3% in all age–sex strata, as did PPVs of abdominal pain, change in bowel habit, and dyspepsia, in those aged 60 years and over. Study limitations include reliance on accuracy and completeness of coding of symptoms and disease outcomes. Conclusions Based on evidence from more than 1.9 million patients presenting in primary care, the findings provide estimated PPVs that could be used to guide specialist referral decisions, considering the PPVs of common abdominal symptoms for cancer alongside that for IBD and their composite outcome (cancer or IBD), taking into account the variable PPVs of different abdominal symptoms for different cancers sites. Jointly assessing the risk of cancer or IBD can better support decision-making and prompt diagnosis of both conditions, optimising specialist referrals or investigations, particularly in women.

Digestive Symptoms in UK Adults and the Perceived Effect of Foods

Objectives Fibre intakes in UK adults are below recommended levels, therefore, individuals should be encouraged to increase their consumption of fibrous foods. However, this could increase digestive symptoms in some people. To establish to what extent this might be a problem, we sought to better understand the experience of digestive symptoms and the perceived effect of foods in the UK adult population. Methods An online self-administered survey was developed using an online tool (Online Surveys) and participants were recruited via social media sites including Facebook, Twitter, LinkedIn, Reddit, forums and via word of mouth. Results Of the 238 individuals who completed the survey, 81% reported having at least 1 digestive symptom in the previous 4 weeks. The age range of respondents was 18–82 years: 77% female, 22% male and 0.4% other. The most reported symptoms were flatulence (67%), abdominal bloating (58%) and borborygmi (54%). The most concerning symptoms for respondents were abdominal bloating/distension (19%), abdominal pain and diarrhoea (both 17%). Certain foods/drinks were perceived causes of digestive symptoms in 75% of respondents and 64% routinely avoid certain foods/drinks because of this. Beans, carbonated soft drinks and spicy foods were the most common perceived causes of flatulence (30%), belching (16%) and heartburn (15%) respectively. There was a negative correlation between willingness to consume foods which induce digestive symptoms and severity of the symptoms (r = −.521, P &lt; 0.001). Increased willingness to consume foods which induce symptoms was reported when respondents found a food tasty, perceived it as healthy or it was consumed on a special occasion or seen as a luxury item compared to under normal circumstances (P &lt; 0.001). Conclusions Digestive symptoms were common among respondents and the extent to which symptoms affected individuals and influenced dietary choices varied widely. This research also demonstrates that individuals may tolerate increased digestive symptoms related to food consumption under certain circumstances. Funding Sources This research was funded by a BBSRC PhD studentship and Mondelez International.