Objective: To systematically evaluate the incidence of adverse reactions to coronavirus disease 2019 (COVID-19) vaccination. Methods: We systematically searched PubMed, Embase, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP Database from the inception of each database to August 31, 2021. Randomized controlled clinical trials (RCTs) on the safety of different types of COVID-19 vaccines were retrieved and analyzed. A random or fixed-effects model was used with an odds ratio as the effect size. The quality of each reference was evaluated. The incidence of the adverse reactions of the placebo group and the vaccination group was compared. Heterogeneity and publication bias were taken care of by meta-regression and sub-group analyses. Results: A total of 13 articles were included, with 81 287 subjects. Compared with the placebo group, the vaccination group showed a higher combined risk ratio (RR) of total adverse reactions (RR=1.67, 95% CI: 1.46-1.91, P<0.01), local adverse reactions (RR=2.86, 95% CI: 2.11-3.87, P<0.01), systemic adverse reactions (RR=1.25, 95% CI: 0.92-1.72, P=0.16), pain (RR=2.55, 95% CI: 1.75-3.70, P<0.01), swelling (RR=4.16, 95% CI: 1.71-10.17, P=0.002, fever (RR=2.34, 95% CI: 1.84-2.97, P<0.01), fatigue (RR=1.36, 95% CI: 1.32-1.41, P<0.01) and headache (RR=1.22, 95% CI: 1.18-1.26, P<0.01). The subgroup analysis showed the incidence of adverse reactions of the vaccination group after injection of the three COVID-19 vaccines (inactivated viral vaccines, mRNA vaccines and adenovirus vector vaccines) was higher than that of the placebo group, and the difference between the placebo group and the vaccination group in the mRNA vaccine subgroup and the adenovirus vector vaccine subgroup was statistically significant (P<0.01). The incidence of adverse reactions after injection of COVID-19 vaccine in subgroups of different ages was significantly higher than that in the placebo group (P<0.01). Conclusions: COVID-19 vaccines have a good safety, among which adenovirus vector vaccine has the highest incidence of adverse reactions. Both adolescents and adults vaccinated with novel coronavirus vaccine have a certain proportion of adverse reactions, but the symptoms are mild and can be relieved by themselves. Our meta-analysis can help boost global awareness of vaccine safety, promote mass vaccination, help build regional and global immune barriers and effectively curb the recurrency of COVID-19.

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Objective: To identify the influential factors of healthcare staff resilience in disasters. Methods: In this qualitative study, the influential factors of healthcare staff resilience in disasters were investigated through interviewing 20 experts. The interviews were conducted face-to-face, and MAXQDA software version 10 was used to organize the data and thematic analysis. Results: The participants included 5 medical emergency technicians, 5 physicians, 2 Red Crescent technicians, and 8 nurses. The main influential factors of healthcare providers’ resilience were limited relief infrastructure, supportive empowerment, organizational capitals, and contradictory consequences. Other important factors were resource limitation, confusion and uncertainty, empowerment training, comprehensive support, human and value capital, social capital, physical capital, suffering, disability, calm, and excellence. Conclusion: Improving healthcare providers’ resilience can be achieved by reducing uncertainty, providing the physical, economic, and human resources, strengthening motivation and comprehensive supports. It is suggested that disaster managers consider all identified dimensions to improve the resilience of healthcare providers to serve better in disasters. Moreover, researchers should study each dimension to provide profound knowledge regarding resilience in disasters.

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Objectives: To determine the occurrence of arrhythmia and its associated risk factors in the first week after acute myocardial infarction (MI). Methods: A total of 100 patients with acute MI were recruited, who were followed up for one week to determine the occurrence of arrhythmia and its association with electrolyte disturbances, left ventricular ejection fraction (LVEF), and demographic factors. Univariate and multivariate logistic regression was used to identify significant risk factors of arrhythmia. Results: Among 100 cases, arrhythmia was seen in 27 patients. Sinus tachycardia was the commonest, followed by ventricular premature beats and sinus bradycardia. Ejection fraction, serum calcium and magnesium were significantly different between non-arrhythmia and arrhythmia patients (P<0.05). Multivariate logistic regression analysis showed that ejection fraction was an independent significant risk factor of arrhythmia. Patients with ejection fraction >40% had a significantly lower risk of arrhythmia with an adjusted odds ratio of 0.22 (95% CI: 0.08 to 0.64). Conclusions: Arrhythmia is common in the first week after myocardial infarction. The type of arrhythmia and the type of block may depend on the heart muscles involved during myocardial infarction. Ejection fraction is a risk factor that may affect the occurrence of arrhythmia.

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Objective: To investigate health literacy, behavioral and psychosocial characteristics in coronary artery patients. Methods: Between March 2019 and 2020 years, 275 coronary artery patients aged ≥50 years were included in the study. Turkish Health Literacy Scale-32 and Beck Depression Inventory were used to collect the data. Results: General health literacy index score was 31.7 and the prevalence of limited health literacy was 59.3%. Adequate health literacy was 2.8 fold higher in the 50-64 age group, 3.1 fold higher among men, 3.4 fold higher among married and 5.3 fold higher among those who believed in the necessity of individual protective practices (P<0.05). Significant differences were also found in different working status, living places, perceived economic situation, perceived general health status, comorbidities, family history of coronary artery disease, angiography history, material skills on reading and understanding, level of depressive syptom, commitment to individual protective practices health check-ups, utilizing health services, cigarette and alcohol use, and exercise and nutrition between limited and adequate health literacy (P<0.05). Logistic regression analysis showed that adequate health literacy was significantly higher among younger patients (OR: 2.81; 95% CI: 1.46-5.62), male gender (OR: 3.10; 95% CI: 1.46-6.58), married (OR: 3.42; 95% CI: 1.39-8.44) and those with belief in individual protective practices (OR: 5.3; 95% CI: 1.93-14.96). Conclusions: Health literacy is poor among coronary artery patients and behavioral and psychosocial variables differ with health literacy levels. To keep cardiovascular health among these patients, health literacy-based interventions should be adopted in coronary artery clinics, especially for risky population.

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Rationale: Cardiac pulmonary arrest is the most challenging and dreaded complication of neuraxial blockade. Patient’s concern: A 21-year-old patient at 37 weeks of gestation, with previous lower segment Caesarean section pregnancy presented for elective Caesarean section. Diagnosis: Cardiac arrest after performing a subarachnoid block. Intervention: Maternal resuscitation. Outcome: Return of spontaneous circulation was achieved within 4-5 min of cardiopulmonary resuscitation. A single live healthy male baby was delivered. Lesson: A careful preoperative evaluation, adequate preload, constant vigilant monitoring to recognize vasovagal response at the earliest, and immediate initiation of resuscitative measures play the most important role in saving the precious lives in case of pregnant patients undergoing Caesarean section under subarachnoid block.

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Objective: To assess the potential toxicity of hydroalcoholic extract of Allium affine (A. affine) aerial parts after acute and sub-acute administration in female and male Wistar rats. Methods: For acute toxicity assay, animals orally received the limit test dose of 2 000 mg/kg of A. affine extract and were observed for 2 weeks. For sub-acute toxicity study, rats were orally treated with 125, 250, and 500 mg/kg/day of the extract over 28 days, and hematological, biochemical, and histological evaluations were then conducted. Results: All rats were alive with normal body weight gain over 14 days, with LD₅₀>2 000 mg/kg. No abnormality in body weight changes but significant increases in the relative weight of spleen and lung were detected after administration of the highest dose of extract for 28 days in sub-acute assay. Hematological analysis showed prominent elevations in total white blood cells in male rats and neutrophils count in female rats after exposure to 500 mg/kg of A. affine extract. In biochemical evaluations, significant increases in serum creatinine level (female rats, 250 and 500 mg/kg) and in aspartate aminotransferase (male and female rate, 500 mg/kg) and alanine aminotransferase (male, 250 and 500 mg/kg and female, 500 mg/kg) activities, however, notable decreases in serum blood glucose (male rats, 125 and 500 mg/kg), triglycerides (male rats, 500 mg/kg and female rates, 250 mg/kg), and low-density lipoprotein cholesterol levels (male, 250 mg/kg) were found. Histological examinations presented slight portal inflammation in liver tissue, moderate pneumocyte hyperplasia, congestion and peri-bronchial inflammation in lung tissue, and mild histiocytosis and lymphoid follicular activation in spleen tissue after exposure to 500 mg/kg of A. affine extract in male and female animals. Conclusions: The present investigation reveals the safety of A. affine extract at doses of lower than 250 mg/kg in rats and monitoring of lung, spleen, and liver functions is suggested during excessive and prolonged uses.

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