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Abstract The 2022 multi-country Monkeypox (Mpox) outbreak has added concerns to scientific research. However, unanswered questions about the disease remain. These unanswered questions lie in different aspects, such as transmission, the affected community, clinical presentations, infection and prevention control and treatment and vaccination. It is imperative to address these issues to stop the spread and transmission of disease. We documented unanswered questions with Mpox and offered suggestions that could help put health policy into practice. One of those questions is why gay, bisexual or other men who have sex with men (gbMSM) are the most affected community, underscoring the importance of prioritizing this community regarding treatment, vaccination and post-exposure prophylaxis. In addition, destigmatizing gbMSM and implementing community-based gbMSM consultation and action alongside ethical surveillance can facilitate other preventive measures such as ring vaccination to curb disease transmission and track vaccine efficacy. Relevant to that, vaccine and drug side effects have implied the questionability of their use and stimulated the importance of health policy development regarding expanded access and off-label use, expressing the need for safe drug and vaccine development manufacturing. The possibility of reverse zoonotic has also been raised, thus indicating the requirement to screen not only humans, but also their related animals to understand the real magnitude of reverse zoonosis and its potential risks. Implementing infection prevention and control measures to stop the virus circulation at the human–animal interface that includes One Health approach is essential.

Background Human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) can cause severe and fatal complications; knowledge about these diseases is essential for promoting safe sex practices and modifying behaviours that are harmful to one’s health. This study investigates Syrian people’s understanding, attitudes, and behaviors towards HIV/AIDS and STIs, aiming to identify factors promoting safe sex practices and modifying harmful behaviors. Methods This online cross-sectional study was conducted in Syria between 3 September and 23 November 2022, involving all 18+ individuals. The questionnaire was adapted from a previous study containing 74 questions from five sections: socio-demographic information, knowledge and practice regarding STIs, knowledge and practice regarding HIV/AIDS, attitude towards HIV/AIDS, and attitude regarding STIs and analyzed using descriptive and multivariate logistic regression. Results The study involved 1073 participants mostly aged between 18–30, with 55.3% females. Over half had good awareness of STIs and HIV/AIDS, with 55% and 63% respectively. Specifically, the overall knowledge level of STI type, signs/symptoms, risks of transmission, preventive methods, and complications for untreated STIs were (45.7%), (52.9%), (58.1%), (66.1%), and (59.6%), respectively. Medical field respondents had higher knowledge of HIV (P-value < 0.05, OR = 2). Conclusion Our results show that Syrian people have a knowledge level of STIs and HIV was moderate. However, the attitude toward STIs was negative, as less than half of the participants had a good attitude. It is essential to solve these knowledge gaps, especially in low-income countries such as Syria.

Abstract Background Soluble guanylate cyclase (sGC) stimulators have been investigated for heart failure (HF) in several randomized controlled trials (RCTs). However, its place in the management guidelines of either HFrEF or HfpEF is still inconclusive. Methods We conducted a network meta-analysis synthesizing RCTs investigating sGC for HF management, which were retrieved by systematically searching five databases until January 24th, 2023. Dichotomous outcomes were pooled using risk ratio (RR) along with confidence interval (CI). Results Eight RCTs with a total of 7307 patients were included. Vericiguat 10 mg significantly reduced the composite cardiovascular (CVS) mortality and HF hospitalization in HF (RR: 0.88, 95% CI [0.79; 0.98]) and in HFrEF (RR: 0.87, 95% CI [0.78; 0.97]); however, it was not effective in HFpEF (RR: 0.69, 95% CI [0.15; 3.05]). Also, vericiguat 10 mg showed no difference compared to placebo regarding the incidence of all-cause mortality (RR: 0.96, 95% CI [0.84; 1.10]), any adverse events (AEs) (RR: 0.94, 95% CI [0.83; 1.07]), any serious AEs (RR: 0.91, 95% CI [0.81; 1.01]), and any AEs leading to drug discontinuation (RR: 1.14, 95% CI [0.92; 1.40]). Conclusion Vericiguat 10 mg was effective in reducing the composite CVS mortality and HF hospitalization, with an acceptable safety profile. This was only observed in HFrEF patients, but not in HFpEF patients. However, our data regarding other agents (riociguat and praliciguat) and HFpEF can be underpowered, warranting further RCTs to clarify vericiguat 10 mg place in HFrEF management guidelines and to investigate sGC stimulators for HFpEF in large-scale trials.

Abstract Background In this meta-analysis, we aimed to update the clinical evidence regarding the efficacy and safety of TXA in the prevention of PPH. Methods A literature search of PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library from inception until December 2022 was conducted. We included randomized controlled trials (RCTs) comparing TXA with a placebo among pregnant women. All relevant outcomes, such as total blood loss, the occurrence of nausea and/or vomiting, and changes in hemoglobin, were combined as odds ratios (OR) or mean differences (MD) in the meta-analysis models using STATA 17 MP. Results We included 59 RCTs (18,649 patients) in this meta-analysis. For cesarean birth, TXA was favored over the placebo in reducing total blood loss (MD= -2.11 mL, 95%CI [-3.09 to -1.14], P

As vaccination against COVID-19 became more widespread, side-effects that were not initially detected during clinical trials became more prominent. The aim of this systematic review is to discuss reports of adverse cardiovascular events associated with COVID-19 vaccination. Databases were searched from inception up to August 2022 to identify case reports and case series reporting on patients with cardiovascular disease after COVID-19 vaccination. This study assessed 150 published cases. Of these, 109 were case reports and 41 were case series. The majority of patients were male (n=302, 86.6%), with a mean age of 27.6 ± 16.7 years. Of the included patients, 268 (76.6%) had myocarditis, 50 (14.6%) had myopericarditis, 8 (2.3%) had pericarditis, and only 4 (1.1%) had stress-induced cardiomyopathy. Moreover, 30 (8.6%) and 11 (3.1%) were diagnosed with arrhythmia and ischaemic heart disease, respectively. Ultimately, cardiovascular complications after COVID-19 vaccination include myocarditis, myopericarditis, ischaemic heart disease and arrhythmia. The young population, especially young male patients, could be more vulnerable to myocarditis.

AimsWe performed this meta-analysis to evaluate the efficacy and safety of glucagon-like peptide-1 receptor-agonists (GLP-1RA) treatment on cardio-metabolic parameters among antipsychotic-treated patients with schizophrenia.MethodsWe searched the Web of Science, Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, and Scopus for relevant Randomized Clinical trials (RCTs) from inception until 1 August 2022. Documents were screened for qualified articles, and all concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) in the meta-analysis models using Review Manager (RevMan version 5.4).ResultsPooling data from 7 RCTs (398 patients) showed that GLP-1 RA was superior to placebo with regard to body weight [MD = - 4.68, 95% CI (-4.90,−4.46), P < 0.00001], waist circumference [MD = - 3.66, 95% CI (-3.89,−3.44), P < 0.00001], body mass index (BMI) [MD = - 1.09, 95% CI (-1.25,−0.93), P < 0.00001], systolic blood pressure (SBP) [MD = - 3.07, 95% CI (-3.61,−2.53), P < 0.00001], and diastolic blood pressure (DBP) [MD = - 2.02, 95% CI (-2.42,−1.62), P < 0.00001]. The total effect did not favor either of the two groups with respect to insulin and respiratory adverse events {[MD = - 0.06, 95% CI (-0.36, 0.24), p = 0.70], [RR = 0.66, 95% CI (0.31, 1.40), p = 0.28]; respectively}.ConclusionOur analysis revealed that GLP-1 RA treatment is safe and effective on cardio-metabolic parameters over control in antipsychotic-treated patients with schizophrenia. Nevertheless, the present evidence is not sufficient to confirm the safety and efficacy of GLP-1RA treatment on insulin and respiratory adverse events. Therefore, further studies are recommended.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022333040.

ABSTRACT. Background: Hearing loss is generally classified as conductive hearing loss (CHL) and sensory-neural hearing loss (SNHL). It has been reported that COVID-19 infection may affect the vestibular-hearing system causing dizziness, tinnitus, vertigo, and hearing impairment. However, other studies reported that COVID-19 did not lead to significant hearing impairment. Many studies in the literature have reported hearing loss as a complication of COVID-19 vaccines. However, no systematic review or meta-analysis summarizes the literature on this topic. Method: We performed a comprehensive search for the following databases: PubMed, Cochrane (Medline), Web of Science, and Scopus. All studies published in English till October 2022 were included. These include case reports, case series, prospective and retrospective observational studies, and clinical trials reporting hearing loss following COVID-19 vaccines. Newcastle Ottawa scale (NOS) was used to assess the risk of bias for observational studies. NIH tools were used for non-controlled before and after clinical trials and case reports and case series. A third author solved any disagreements. We analyzed the data using SPSS Software version 26. Results: A total of 630 patients were identified, with a mean age of 57.3 that ranged from 15 to 93 years old. The majority of the patients were females, 339 (53.8%). In addition, 328 out of 609 vaccinated patients took the Pfizer-BioNTech BNT162b2 vaccine, while 242 (40%) took the Moderna COVID-19 vaccine. The mean time from vaccination to hearing impairment was 6.2, ranging from a few hours to one month after the last dose. Most patients reported unilateral sensorineural hearing loss post-vaccination 593 (94.1%). In order to report the fate of cases, a follow-up was initiated with a mean of 15.6 and a range of 2 to 63 days after the initiation of the treatment. A total of 20 patients were fully recovered, and 11 reported no response. Three out of 328 patients who took the Pfizer-BioNTech BNT162b2 vaccine fully recovered, while five reported partial recovery. According to the chi-squared test, there is a statistically significant difference between patients in terms of fate and the type of COVID-19 vaccination (P-value = 0.001) while reporting no significant difference in dose number prior to the onset of the symptoms (P-value = 0.65) and gender (P-value = 0.4). The ANOVA test was conducted to compare vaccine types and the number of doses in terms of mean time from vaccination to hearing impairment onset. The results found a significant difference between vaccine types (P-value < 0.000) while showing no significance in terms of the number of doses prior to the onset (P-value = 0.6). Conclusion: There is a statistically significant difference between patients in terms of fate and the type of COVID-19 vaccination while reporting no significant difference in dose number prior to the onset of the symptoms and gender. Further, we concluded that there is a significant difference between vaccine types while showing no significance in terms of the number of doses prior to the onset.

Background: During the last two years, the world witnessed an urgent need for vaccines to tackle the coronavirus disease 2019 (COVID-19) pandemic. Several side effects, mainly non-life-threatening, were reported following COVID-19 vaccination. There are increasing concerns about the potential effects of COVID-19 vaccines on menstrual cycle (MC) changes amid a paucity of scientific studies on this crucial issue. The present study aimed to assess the changes in menstrual cycle (MC) among Jordanian women after receiving a COVID-19 vaccine. Method: An online-based cross-sectional study was conducted from 10 to 24 August 2021. The main menstruation-related complaints were identified and included in the survey tool that targeted Jordanian women who received at least one dose of a COVID-19 vaccine. Results: A total of 633 married and unmarried women were recruited, 222 (35.1%) and 411 (64.9%), respectively. Unmarried women showed a significantly higher occurrence of menstruation dysfunctions after getting a COVID-19 vaccine compared to married women (p = 0.001). During MC, around 34.3% of participants were suffered from increasing back and abdominal pains. The most common dysfunction was a prolonged MC (24.8%), while only 16.1% experienced pre-menstruation bleeding. Additionally, 19.4% of participants stated that the MC dysfunctions last for one month, 8.7 % for two months, and 35.4% for more than two months. Conclusion: This study showed that COVID-19 vaccines negatively affected the MC in terms of the occurrence of dysfunctions and accompanying symptoms. However, further studies are required to investigate the characteristics of women who are more likely to be affected and the potential mechanisms underlying these effects.

Background: Peptic ulcer disease is a gastrointestinal disorder due to the imbalance between the defense mechanism and gastric acid secretion. It affects 5-10% of the population worldwide and induces eight million deaths every year globally. In Sudan, this disease represents one of the major health problems. Limited studies have shown the knowledge level of Sudanese about aggravating factors of Peptic ulcer disease, which lead to more prevalent complications. Therefore, this study aimed to assess awareness about aggravating factors of peptic ulcer disease among the population of Khartoum state, Sudan. Method: A descriptive cross-sectional study targeted the general population in Khartoum state during the period from January to June 2022. We used an online survey form to collect data from the study population. The distribution of the questionnaire was done via social media tools. We analyzed the data using SPSS Software version 26. Results: The study included 398 participants, 40.7% of them male and 59.3% female, with mean age equal to 24.9 (SD=8.9), and a range between (18-64). Most of the participants (77.1%) were unmarried and (89.2%) were educated. The type of food was the most known risk factor (79.1%) and the weather changes were the least known risk factor (8.5%) that have effects on peptic ulcers. There also was a significant difference between educated and non-educated people based on the awareness of peptic ulcer risk factors, as the second was higher (p>0.000). Furthermore, people with peptic ulcers and people who have one or more members of their family with peptic ulcers scored more than nonpatients and those who did not have (p>0.000, p= 0.04; respectively). Conclusion: In conclusion, awareness about aggravating factors of peptic ulcers was variable among the population in Khartoum state. Our study findings revealed a high knowledge effect of type of food, helicobacter pylori, analgesic medications, drinking coffee, smoking, and social stress of the majority population. As for other factors, weather changes, genetic factors, and body weight were associated with a poor level of awareness. Lastly, these results need to be affirmed by furthermore research with a large sample among the general population in different regions in Sudan.

Background: A cesarean section (CS) is one of the most common operations globally, with an estimated 18.5 million surgical procedures each year. Accordingly, music therapy has become a trendy possible solution in many clinical conditions and surgical procedures. However, most previous studies have shown conflicting findings regarding the efficacy of music in reducing pain and anxiety in women with cesarean delivery. Therefore, in this meta-analysis, we aimed to investigate whether music intervention has a beneficial effect on preoperative, intraoperative, and postoperative anxiety, pain, and vital signs in women with cesarean section. Method: We conducted a comprehensive search of Scopus, Web of Science, PubMed, and Cochrane Central was conducted for relevant randomized controlled trials (RCTs) from inception until August 2022. Data were extracted from eligible studies and pooled as standardized mean difference (SMD) or mean difference (MD) values in a random-effect model meta-analysis, using RevMan software. All the steps of this study were performed according to the PRISMA statement guidelines. Results: Thirteen RCTs were included in this meta-analysis with a total of 1513 patients. Our study showed that music was superior to control in terms of overall anxiety score (SMD = - 0.26, 95% CI [- 0.39, - 0.14], p

Background: Mental health disorders and low quality of life are considered common psychiatric problems resulting from the COVID-19 pandemic. Despite the significant importance of the knowledge and research about COVID-19 mental consequences, few studies are addressing it locally in Jordan. Therefore, the present study aims to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on university students' mental health and life quality. Method: A retrospective cohort study was undertaken for students in Jordanian universities using an online questionnaire. Our survey consisted of the Generalized Anxiety Disorder 2‐item (GAD-2), The Patient Health Questionnaire 2-item (PHQ-2), UCLA Loneliness Scale, and the COVID-19–Impact on Quality of Life (COV19-QoL) scale to examine students' quality of life, loneliness, besides examining the difference between depression and anxiety, independently, before and during COVID-19 pandemic among Jordanian universities students. We analyzed the data using SPSS Software version 26. Results: The study included 537 participants, 371 (69.1%) of them were female, with a mean age of participants equal to 19.1 ± 0.84, with a range of 17 to 22 years. Most of the participants were second-year students 393 (54.6%) and more than half of the participants never weekly exercised. the prevalence of depression, anxiety, and loneliness after the COVID-19 pandemic were 305 (56.8%), 311 (57.9%), and 371 (69.1%); respectively. Chi-square analysis revealed that females with loneliness, depression, and anxiety were statistically predominant (p=0.014, p=0.023, p=0.000; respectively). In contrast, there was no significant difference among basic academic years students in terms of these mental outcomes. The impact of the Covid-19 pandemic on depression scores of singles was significantly higher than those who were in relationships (p= 0.008). The less depressed students were those who sleep at the night and those who have hobbies (p=0.02, p=0.007; respectively). Conclusion: Our study results highlighted and supported a significant change in the participants’ scores regarding their mental status before and after the outbreak. Furthermore, several factors preserve the mental health of students against the consequences of the COVID-19 crisis, such as gender, having hobbies, being in a relationship, bedtime, and sleep hours. Additionally, the study found that loneliness, anxiety, and depression can predict life quality. Eventually, the government should provide more attention to the student’s psychological issues. Future research should investigate which group of students have more susceptibility to being mentally affected by similar outbreaks to develop specific and efficient actions that are targeted to these certain groups, thus improving the chance of the psychological benefits. Key Words: Cohort, COVID-19, Depression, Mental Health

Background: Magnesium is one of the most important nutritional factors that have a beneficial effect on pregnant women. Many studies evaluated the role of oral magnesium supplements as a non-pharmacological intervention for mother and neonatal protection in terms of these outcomes. There is a conflict between several clinical trials about the efficacy of oral magnesium supplements during pregnancy. Therefore, in this review, we represent class 1 evidence and address an unmet clinical need on the efficacy of different types of oral magnesium in pre-eclampsia, and prenatal outcomes in pregnant women. Method: During the preparation of this meta-analysis, we followed the PRISMA statement guidelines. A literature search of the Web of Sciences, Cochrane Central Register of Controlled Trials, and PubMed were conducted from inception until September 2022. We included randomized controlled trials (RCTs) comparing oral magnesium whether citrate, oxide, or aspartate hydrochloride with a placebo. The records of quality studies were screened and extracted. Additionally, the pre-eclampsia, preterm birth, and neonatal intensive care unit (NICU) admissions data were pooled as odds ratio (OR) in a fixed-effect model using Review Manager (v.3). Subgroup analysis was performed to investigate the efficacy of each type of oral magnesium on the outcomes. Results: Five RCTs were included in this meta-analysis with a total of 2370 patients. The overall effect did not favor either of the two groups in terms of pre-eclampsia (OR= 0.99, 95% CI, [0.72, 1.37], p = 0.9), preterm birth (OR= 0.87, 95% CI, [0.62, 1.22], p = 0.4), and NICU admissions (OR= 1.37, 95% CI, [0.84, 2.22], p = 0.2). Based on the subgroup analysis findings, the use of oral magnesium supplements whether citrate, oxide, or aspartate hydrochloride in this population did not significantly increase or decrease the incidence of pre-eclampsia, preterm birth, and NICU admissions when compared with the control group. Conclusion: Ultimately, oral magnesium supplementation whether citrate, oxide, or aspartate hydrochloride may not have a beneficial effect on maternal and fetal outcomes during pregnancy. Therefore, the current evidence is insufficient to confirm the efficacy of oral magnesium for care practice among pregnant women. Despite that, these results need to be affirmed by major RCTs using magnesium supplements which have related to neonatal and maternal outcomes.

Background: Over 1 million new Sexual transmitted disease (STIs) are acquired daily throughout the globe, according to WHO data, with the majority of cases being asymptomatic. In Syria, statistics on STI awareness, attitude, and practice are few, and there is little information on Syrians' sexual and reproductive health concerns. The present research aims to determine which individuals factors best predict knowledge, attitudes, and behaviours about HIV/AIDS and other STIs in a Syrian population. Method: In the Syrian governorates between August 15 and September 16, 2022, a descriptive community-based cross-sectional survey was carried out. Syrian nationality, male or female, aged at least 18 years, citizen of any Syrian governorate, and willingness to engage in the survey were the study's inclusion criteria. Based on a previous study, a modified online semi-structured questionnaire was made on Google Form and used to collect the data. The questionnaire was divided into five main section that socio-demographic information, knowledge and practice relating STIs, knowledge and practice relating HIV/AIDS, attitude toward HIV/AIDS and attitude toward STIs. Results: The research involved 1076 individuals in total. More over half (55%) of them were women, with the majority (86%) of them being between the ages of 18 and 30. Only 739 respondents (67%) were aware of voluntary counselling and testing (VCT), and only 35% were aware of the means by which HIV infection may be prevented. The most often mentioned AIDS/HIV-related statistic was that those who have several sex partners have a greater chance of contracting HIV (92%). Furthermore, just 66% and 44%, respectively, of respondents knew how STDs are transmitted. In general, individuals' understanding of STDs was rated at 56%. Furthermore, 50% of the individuals had a positive attitude about the STD information. We used a logistic model to tease out the role of demographics and found that men were 1.43 times more likely to be aware of AIDS/HIV than women were. Additionally, residents of cities were 1.42 times more likely than residents of rural areas to be knowledgeable about STDs. Conclusion: According to this research, Syrians' knowledge, attitudes, and behaviors about STIs, HIV, and other diseases were generally insufficient. This provides definitive evidence that HIV programmes need to verify that Syrian people have access to basic information about HIV/AIDS and other STIs. As a result, the health organizations should conduct both international and local helpful interventions in order to address this medical problem and enhance the awareness of the Syrian community about HIV/AIDS and other STIs illnesses as soon as possible.

Introduction: The subpectoral direct-to-implant (SP-DTI) surgical technique is the standard and most common for breast reconstruction which could reduce implant visibility and palpability, and it manipulates the pectoralis major muscle with some post-operative complications such as muscle spasm, animation deformities, and pain while the prepectoral direct-to-implant (PP-DTI) approach leaves the muscle intact. Therefore, we conducted this meta-analysis to assess the efficacy and safety of the PP-DTI procedure after mastectomies compared to the standard breast reconstruction. Methods: We performed a comprehensive search for the following databases: PubMed, Cochrane (Medline), Web of Science, and Scopus. All studies published in English till February 2022 were included. These include randomized and non-randomized clinical trials comparing Operation Time, Duration of Hospitalization (DOH), Breast Animation Deformity (BAD), Implant loss, Wound infection and dehiscence, seroma as well as post-operative pain. The study’s quality will be assessed according to the Cochrane risk-of-bias tool for randomized trials (RoB2) and the ROBINS-I risk of bias tool to assess non-randomized studies of interventions. Results: There were 28 comparative studies including 3851 patients carried out breast reconstruction surgeries. Post-operative complications were comparable between the two groups as follows: implant loss (OR 1.17, 95% CI [0.71-1.94]), wound dehiscence (OR 0.76, 95% CI [0.43-1.32]), wound infection (OR 1.09, 95% CI [0.78-1.53]), and seroma (OR 0.78, 95% CI [0.56-1.09]). The PP-DTI group was significantly less likely to develop BAD compared to SP-DTI group (OR 0.02, 95% CI [0.00-0.12]). Patients undergoing PP-DTI reconstruction had significantly reduced postoperative pain (SMD -0.55, 95% CI [-0.78 - -0.32]). Operation time and DOH were significantly lower among PP-DTI group ((SMD -0.35, 95% CI [-0.61 - -0.08]), (SMD -0.89, 95% CI [-1.48 - -0.30], respectively)). Conclusion Following mastectomy, PP-DTI breast reconstruction significantly reduced post-operative pain, BAD, DOH, intra-operative time compared with SP-DTI reconstruction, although there was no significant difference in complication rate. A PP-DTI is a simple and safe alternative to the subpectoral technique allowing early discharge and improving patient's quality of life. Future well-designed multicenter randomized controlled trials that compare two approaches and discuss the cost-effectiveness are needed. Keywords: PP-DTI, SP-DTI, Meta-analysis, cosmetics.

Background: The COVID-19 pandemic has had a devastating impact worldwide, especially among patients with cancer as they are more likely to experience severe infection and worse outcomes than the general population. Cancer patients have been excluded from the confirmatory clinical trials which create a gap in the clinical data addressing the effectiveness and safety of the vaccines in this group of immunocompromised patients. Therefore, this study aims to evaluate the findings of all relevant individual studies about the serological response to COVID-19 vaccines in cancer patients compared with healthy participants. Method: We searched for published relevant studies in the following electronic databases: PubMed, Scopus, Cochrane Library, and Web of Science from inception until 1st August 2022. Data were extracted from eligible studies and pooled as a risk ratio or mean difference (MD) in the network meta-analysis model with the corresponding 95% confidence interval. We used the random effect model in case of significant heterogeneity, otherwise, a fixed-effect model was used. We analyzed the data using R version 4 for windows. Results: We included 42 studies (3 randomized controlled trials and 39 observational) with a total of 11357 patients in this network meta-analysis. The pooled effect estimates showed that healthy participants were better than cancer patients with solid and hematological tumors in seroconversion [(RR = 0.81; 95% CI 0.75, 0.87; P < 0.00001)), (RR = 0.61; 95% CI 0.54, 0.69; P < 0.00001); respectively]. However, the pooled effect estimates showed that there was no difference between healthy participants and Cancer patients with solid tumors in terms of Covid-19 antibody titer, T-cell response, and adverse events (MD = -160.82; 95% CI -3089.28, 2768.18; P = 0.91), (RR = 1.10; 95% CI 0.69,1.75; P = 0.69), (RR = 1.06; 95% CI 0.88,1.27; P= 0.54), respectively. Additionally, there was no significant difference between the different types of vaccines in terms of COVID-19 antibody titer. Conclusion: In conclusion, the current evidence demonstrated that the seroconversion rate in healthy participants was higher than in patients with solid and hematological cancers. Nevertheless, our network meta-analysis revealed no significant difference between the two groups in terms of Covid-19 antibody titer, T-cell response, and adverse events. Accordingly, the present evidence is not sufficient to confirm the safety and efficacy of covid-19 vaccine among cancer patients. Therefore, further studies are recommended.

Introduction: Blood loss is an inevitable complication and a major contributor to maternal morbidity and mortality at cesarean deliveries. Several trials have investigated the of using Misoprostol to prevent hemorrhage-related complications in women undergoing cesarean section. Objective: We aimed to detect a potential preference regarding the efficacy and safety of rectal Misoprostol over Oxytocin as a uterotonic agent. Methods: We searched PubMed, Scopus, Web of Science, Cochrane, and other databases for the relevant trials from inception to September 2022. We included randomized clinical trials (RCTs) that compared rectal Misoprostol versus Oxytocin to control bleeding in women undergoing cesarean delivery. Our primary outcomes were the intra- and postoperative blood loss, and hemoglobin drop after delivery. Secondary outcomes included need for blood transfusion, need for additional uterotonics, difference in operative time, as well as safety outcomes such as the incidence of shivering, pyrexia, nausea, and vomiting. Results: Our search strategy revealed 1007 unique records, of them we retrieved full texts of 19 articles to check their adherence to our eligibility criteria. Nine RCTs with 1490 participants were included. We found a significant reduction in postoperative blood loss (MD: -27.9 mL; 95% CI: -53.8, -2.1, p = 0.03), and Hb drop after delivery (MD: 0.11 mg/dl, 95% CI: 0.04, 0.19, p = 0.003). There is no significant difference regarding intraoperative blood loss, operative time, need for blood transfusion, or need for additional uterotonics. We could not find a significant difference between the 2 groups regarding safety outcomes except for a higher shivering incidence in Misoprostol group (RR: 2.99; 95% CI: 1.69, 5.29, p = 0.002). Conclusion: We found a significant reduction in postoperative blood loss with a potential favorable safety profile in women who administrated rectal Misoprostol compared to Oxytocin administration. Our findings recommend and prefer rectal Misoprostol as a cheaper and effective uterotonic agent over Oxytocin which is expensive and require adequate cold chain for transportation and storage.

Introduction: Once the COVID-19 pandemic was declared, the world was waiting for the clue that would be able to cut down the progression of the disease. Vaccines play a crucial role in reducing the disease and saving many people worldwide. However, there are several side effects of these vaccines, like pain, fatigue, fever, and neurological defects like Bell’s palsy. In this systematic review, we presented evidence about the occurrence of Bell’s palsy followed by COVID-19 vaccination. Methods: We searched PubMed, SCOPUS, EBSCO, and Web of Science (WOS) from inception till October 2022. The quality assessment was conducted using the Joanna Briggs Institute, National Institute of Health, and Newcastle-Ottawa. The analysis was conducted on SPSS. Results: Thirty-five records were involved in our study. The results of our cases revealed that most of the patients (62.8%) experienced unilateral facial paralysis. Also, the majority of the cases were reported after the first dose, and most cases were after Pfizer, AstraZeneca, and Sputnik V vaccines, respectively. The patients who were treated with corticosteroids, IVIG, and anti-viral drugs, showed marked recovery afterward. Conclusion: The rate ratio of Bell’s palsy after COVID-19 vaccination was 25.3 per 1,000,000. The ratio was higher after the first dose compared to the second dose and was higher among those who took Oxford/AstraZeneca vaccine compared to other vaccines. However, this condition was reported in a small number of cases among a large number of vaccinated people worldwide. It is important to note that the benefits of getting vaccinated far outweigh any potential risks.

The study of the effects of SARS-CoV-2 infection and/or vaccination on semen fluid analysis (SFA) parameters is still incomplete. The aim of this study is to assess the effect of COVID-19 infection and vaccination on sperm parameters for a sample of individuals visiting multi-infertility clinics in Jordan. SFA records were collected retrospectively between September and November 2021 and analyzed using Jamovi software (version 2.2.5 for Windows); p-values < 0.05 were considered statistically significant. Sperm concentration, progressive motility, normal morphology, and semen liquefaction time, volume, and viscosity were compared among two data categories. In the first category of data, SFA records from 354 participants were separated into four groups: only vaccinated, infected and vaccinated, neither infected nor vaccinated, and only infected. In the other category, SFA from 49 subjects before their infection and/or vaccination and after were classified into the same mentioned groups and analyzed. There were no statistically significant differences between the studied parameters in the SFA records in the first data category and the second. Nevertheless, the sperm concentration was higher among vaccinated subjects compared to unvaccinated ones (p = 0.04). It is concluded that SARS-CoV-2 infection and vaccines have no negative effects on SFA parameters.