AstraZeneca coronavirus disease 2019 vaccinations have recently been implicated in thromboembolism formations. Our aim was to investigate the outcomes of patients with thromboembolic events following the AstraZeneca vaccine (ChAdOx1 nCoV-19, AZD1222). A literature search was performed from December 2019 to September 2021. Eligible studies must report participants older than 18 years vaccinated with AstraZeneca and outcomes of thromboembolic events. Pooled mean or proportion were analyzed using a randomeffects model. A total of 45 unique studies (number of patients U 144, 64.6% women, mean age 21-68 years) were included. The most common presenting adverse events were headache (12.1%), intracerebral hemorrhage (7.5%), and hemiparesis (7%). The most common thromboembolic adverse events were cerebral venous sinus thrombosis (38.5%) and deep vein thrombosis/pulmonary embolism (21.1%). The most common radiologic finding were intracerebral hemorrhage and cerebral venous thrombosis. Laboratory findings included thrombocytopenia (75%) and hypofibrinogenemia (41%). On admission, 64 patients tested positive for PF4-Heparin ELISA assay (80%). Seventy-four patients were hospitalized with 22 being admitted to the ICU. A total of 78 patients recovered while 39 patients died. This meta-analysis presents evidence to suggest vaccine-induced immune thrombotic thrombocytopenia (VITT) following AstraZeneca vaccine. Clinical practice must, therefore, account for the possibility of VITT and subsequent embolic events in certain individuals' postvaccination with adenovirus-based COVID-19 vaccines. Serum anti-PF4 suggests diagnostic value for VITT and could subsequently inform treatment choices in such instances. Blood Coagul Fibrinolysis 33:90-112

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease affecting multiple joints and can also be a systemic widespread, affecting major organs. Rheumatoid arthritis is associated with greater adverse maternal and neonatal outcomes in comparison to the general obstetric population. This systematic review and meta-analysis aims to investigate the pregnancy outcomes in RA patients in comparison to the general pregnant population.Nine studies involving 11,999 RA patients met the eligibility criteria with 9,921,808 controls. Rheumatoid arthritis patients were compared with their control counterparts according to random-effects model statistical analysis.We searched databases from inception to September 8, 2021. Eligible studies reported maternal outcomes (preeclampsia, cesarean delivery, and preterm delivery) and/or neonatal outcomes. Data were pooled across using random-effects model. Subgroup analysis was conducted on RA patients alone. The review was registered prospectively with PROSPERO (CRD42021250521).In terms of maternal outcomes, there was an increased rate of cesarean delivery (odds ratio [OR], 1.55), preeclampsia (OR, 1.61), and preterm delivery (OR, 1.83) in RA patients compared with their control counterparts. In terms of neonatal outcomes, a higher rate of lower gestational weight (mean difference [MD], −0.19 kg), requirement for neonate intensive care unit admission (OR, 1.34), and stillbirths (OR, 1.99) were observed in RA patients compared with the controls. A subgroup analysis of 4 studies involving only RA patients (n = 3761) was conducted. A total of 33.2% of patients had a cesarean delivery, 7.3% had preeclampsia, 14.8% had a preterm delivery, and 9.5% of neonates had low birth weight.Compared with the general pregnant population, women with RA tend to have a higher risk of maternal and neonatal complications. As a result, this study hopes to increase awareness into the importance of counseling and managing RA patients.

ObjectiveThis systematic review and meta-analysis aims to explore overall prevalence of burnout among physicians during early and late COVID-19 pandemic and geographical differences in burnout.MethodsThis review was registered prospectively with PROSPERO (CRD42022327959). A comprehensive search of several databases, including Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, PsycINFO, and Scopus, spanning from December 2019 to May 2022 was conducted. Eligible studies included physicians or medical professionals including physicians that worked directly or indirectly with COVID-19 patients, whilst reporting burnout outcomes using a validated scale. Literature that did not include physicians or did not occur in a hospital setting were excluded. Literature including medical students were also excluded.ResultsForty-five observational studies were included, all of which were cross-sectional studies. The pooled estimate of overall prevalence of burnout was 54.60% (95% CI: 46.7, 62.2). Mean emotional exhaustion, depersonalization, and personal accomplishment was found to be 22.06% (95% CI: 18.19, 25.94), 8.72 (95% CI: 6.48, 10.95) and 31.18 (95% CI: 27.33, 35.03) respectively. Frontline workers displayed higher rates of burnout than second-line healthcare workers (HCW) (OR: 1.64, 95% CI: 1.13, 2.37). Studies from the early pandemic period reported burnout prevalence of 60.7% (95% CI: 48.2, 72) compared to a prevalence of 49.3% (95% CI: 37.7, 60.9) from the late pandemic period. Geographically, burnout was highest amongst Middle East and North Africa (MENA) studies (66.6%, 95% CI: 54.7, 78.5), followed by Europe (48.8%, 95% CI: 40.3, 57.3) and then South America (42%, 95% CI: –0.4, 84.4). Lastly, burnout prevalence overall (OR = 0.77, 95% CI: 0.36, 1.67) emotional exhaustion (MD = –0.36, 95% CI: –4.64, 3.91), depersonalization (MD = –0.31, 95% CI: –1.80, 1.18), and personal accomplishment (MD = 0.55, 95% CI: –0.73, 1.83) were found comparable between physicians and nurses.ConclusionCOVID-19 has had significant consequences on HCW burnout. Further research is needed to examine early signs of burnout and to develop effective coping strategies.