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Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns. We undertook a self-controlled case series study to investigate hospital admissions from neurological complications in the 28 days after a first dose of ChAdOx1nCoV-19 (n = 20,417,752) or BNT162b2 (n = 12,134,782), and after a SARS-CoV-2-positive test (n = 2,005,280). There was an increased risk of Guillain-Barré syndrome (incidence rate ratio (IRR), 2.90; 95% confidence interval (CI): 2.15-3.92 at 15-21 days after vaccination) and Bell's palsy (IRR, 1.29; 95% CI: 1.08-1.56 at 15-21 days) with ChAdOx1nCoV-19. There was an increased risk of hemorrhagic stroke (IRR, 1.38; 95% CI: 1.12-1.71 at 15-21 days) with BNT162b2. An independent Scottish cohort provided further support for the association between ChAdOx1nCoV and Guillain-Barré syndrome (IRR, 2.32; 95% CI: 1.08-5.02 at 1-28 days). There was a substantially higher risk of all neurological outcomes in the 28 days after a positive SARS-CoV-2 test including Guillain-Barré syndrome (IRR, 5.25; 95% CI: 3.00-9.18). Overall, we estimated 38 excess cases of Guillain-Barré syndrome per 10 million people receiving ChAdOx1nCoV-19 and 145 excess cases per 10 million people after a positive SARS-CoV-2 test. In summary, although we find an increased risk of neurological complications in those who received COVID-19 vaccines, the risk of these complications is greater following a positive SARS-CoV-2 test. A self-controlled case series analysis of nearly 32 million people in England shows an increased risk of rare neurological complications in those who received COVID-19 vaccines and following SARS-CoV-2 infection. The results highlight 38 excess cases of Guillain-Barré syndrome per 10 million ChAdOx1nCoV-19 vaccinations., Author(s): Martina Patone [sup.1] , Lahiru Handunnetthi [sup.2] [sup.3] , Defne Saatci [sup.1] , Jiafeng Pan [sup.4] , Srinivasa Vittal Katikireddi [sup.5] , Saif Razvi [sup.6] , David Hunt [sup.7] [...]

RESULTS Of the 624 771 people with type 2 diabetes, 56.1% were men and the mean ± SD age and diabetes duration at index date were 67.0 ± 13.4 and 9.7 ± 7.4 years, respectively; the mean body mass index was 30.5 ± 6.0 kg/m SP 2 sp (Table 1). During the early phases of the COVID-19 pandemic, diabetes became associated with a poorer prognosis,[1] with an approximately three-fold increased risk of a COVID-19 death in those with diabetes compared with those without.[[2]] In an effort to understand this association, there was an increasing interest in the role of glucose-lowering medications on the risk of COVID-19 outcomes, given their pharmacological differences and potential direct effect on shared immunometabolic pathways[4]: the available evidence would suggest small absolute increased rates of COVID-19 mortality with some dipeptidyl peptidase 4 inhibitors (DPP-4i, insulin) and reduced with other medications [metformin (MF), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), sulphonylurea].[5] Alongside the role of diabetes, multiple large observational studies also showed higher risks of COVID-19-related hospitalization, intensive care unit admission and death in people from ethnic minority populations.[[6]] As type 2 diabetes is more prevalent in ethnic minority populations - particularly South Asians - determining the risk of COVID-19 outcomes in relation to different glucose-lowering therapies has implications for both patients and health care professionals.[8] We therefore designed a cohort study within the QResearch UK nationwide database to quantify the associations between prescriptions of glucose-lowering medications and (a) COVID-19 mortality, and (b) COVID-19 hospitalization in different ethnic subgroups during the first wave of the pandemic. Ethnicity and risks of severe COVID-19 outcomes associated with glucose-lowering medications: A cohort study. [Extracted from the article]

Objective: To assess differences across educational outcomes in survivors of childhood cancer (CCS) compared with peers.Design: Systematic review and meta-analysis of observational studies.Data Sources and Study Selection: Medline, EMBASE, ERIC, CINAHL and PsycInfo from inception to 1st August 2018. Any peer reviewed, comparative study with a population of any survivor of childhood cancer, from high-economy countries, reporting outcomes on educational attainment, were selected.Results: 26 studies representing 28 434 CCS, 17 814 matched controls, 6582 siblings and six population studies from 11 high-income countries, which have similar access to education and years of mandatory schooling as reported by the Organisation for Economic Cooperation and Development, were included. CCS were more likely to remain at compulsory level (OR 1.36, 95% CI 1.26 to 1.43) and less likely to complete secondary (OR 0.93, 95% CI 0.87 to 1.0) and tertiary level education (OR 0.87, 95% CI 0.78 to 0.98). They were more likely to require special educational needs (OR 2.47, 95% CI 1.91 to 3.20). Subgroup analyses revealed that survivors, irrespective of central nervous system (CNS) involvement, were less likely to progress onto secondary level compared with cancer-free peers (OR 1.77. 95% CI 1.46 to 2.15; OR 1.19, 95% CI 1.00 to 1.42, respectively). This, however, changed at tertiary level where those with CNS involvement continued to perform worse (OR 0.61, 95% CI 0.55 to 0.68) but those without appeared to perform similarly to their peers (OR 1.12, 95% CI 1.0 to 1.25).Conclusions: Compared with controls, we have elucidated significant differences in educational attainment in survivors. This is sustained across different countries, making it an international issue. CNS involvement plays a key role in educational achievement. Clinicians, teachers and policymakers should be made aware of differences and consider advocating for early educational support for survivors. [ABSTRACT FROM AUTHOR]