COVID-19 vaccine related menstrual irregularities: A cause of vaccine hesitation?

To, The Editor-in-Chief Vaccination against Coronavirus Disease of 2019 (Covid-19) has shown remarkable progress in controlling the ongoing pandemic. Currently, over nine billion doses of Covid-19 vaccines have been administered worldwide(1), and although this widespread vaccination has shown great progress in managing the pandemic, multiple side effects have been noted. Most of these side effects are mild such as pain at injection site, fever, rash, etc., but some are serious and long-lasting like myocarditis and other cardiovascular complications. Recently, there have been reports of several women experiencing menstrual irregularities after being administered Covid-19 vaccines, and that has created hesitation amongst women to get their shot.(2)  Table 1. summarizes the number of menstrual disturbances recorded by Medicines and Healthcare products Regulatory Agency (MHRA) Yellow Card Scheme until 22nd December 2021. While several factors have been implicated to be the cause of these irregularities, a definitive reason still remains to be established. A recent meta-analysis by Sharifian-Dorche M et al. has shown that Covid-19 vaccines induce thrombocytopenia.(3) This can result in the loss of endometrial haemostasis, and consequently, vaccinated women might experience increased blood loss/heavy menstrual bleeding (HMB). Moreover, since body's immune system is activated by Covid-19 vaccines(4), immune cells lining the uterus can contribute to early shedding of uterine wall, and that may manifest as intermenstrual bleeding (IMB) or postmenopausal bleeding (PMB). Women who have recovered from Covid-19 infection continue to suffer from menstrual irregularities for prolonged times. Therefore, the possibility of Long Covid Syndrome causing these menstrual disturbances cannot be disregarded.(5) Additionally, the prevailing gender bias in pre-and post-covid literature has led to under-reporting of events related to female reproductive health, further limiting our understanding of this subject. In conclusion, to minimize vaccine hesitation among women, it is imperative that a better understanding of these side effects should be sought. Further research should be encouraged to investigate vaccines' short- and long-term effects on reproductive health. Questions regarding menstrual cycle should be included in clinical trials for Covid-19 vaccines, and women should be encouraged to report any unusual post-vaccination changes in menstrual cycles to their doctors. Moreover, strict pharmacovigilance should be practiced to monitor people with pre-existing coagulopathies, and those on certain medications in order to limit the possibility of life-threatening conditions such as cerebral venous sinus thrombosis (CVST) after taking the Covid-19 vaccines. ---Continu

A Meta-Analysis on Incidence of Barotrauma in Patients with COVID-19 ARDS Undergoing Invasive Mechanical Ventilation

Barotrauma is a common complication in patients with Acute Respiratory Distress Syndrome (ARDS) undergoing Invasive Mechanical Ventilation (IMV) [...

Meta-Analysis comparing outcomes and need for renal replacement therapy of Transcatheter aortic valve implantation versus surgical aortic valve replacement

Acute kidney injury (AKI) is commonly associated with aortic valve replacement. Surgical aortic valve replacement (SAVR) is a known risk factor for AKI but little is known about the short- and long-term effects of transcatheter aortic valve implantation (TAVI). The purpose of our analysis is to identify the short- and long-term effect of TAVI on renal out-comes. We searched Medline and PUB MED from January 1, 2000 to November 6, 2017for randomized control trials (RCTs) comparing TAVI to SAVR in patients with severe aortic stenosis. Three hundred sixty-nine trials were identified, 6 RCTs were included in our analysis. RevMan version 5.3 was used for statistical analysis. Heterogeneity is calculated using I2statistics. Primary outcomes were AKI within 30 days and 1 year of TAVI, and requirement for renal replacement therapy. We included 5,536 patients (2,796 inTAVI and 2,740 in SAVR arm) from 6 RCTs. Baseline characteristics were similar. There was reduced incidence of AKI at 30 days of TAVI compared with SAVR, 57 versus 133(odds ratio [OR] 0.40, confidence interval [CI] 0.28 to 0.56, p \u3c0.00001, I2= 7%) with no difference at 1 year (OR 0.65, CI 0.32 to 1.32, p = 0.23, I2= 76%) and need for renal replacement therapy OR 0.95, CI 0.50 to 1.80, p = 0.87, I2= 0%). The permanent pacemaker was more frequent in the TAVI arm compared with SAVR arm, 379 versus 110, (OR 3.75, CI 1.67 to 8.42, p = 0.001, I2= 89%). In conclusion, TAVI is associated with a reduction inAKIs at 30 days despite the exposure to contrast and a higher incidence of new permanent pacemaker placement

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care