AbstractBackgroundThe safety of COVID-19 vaccines has been demonstrated in selected populations in recent studies, but more data in specific groups is needed to inform vaccine choice and health policy.ObjectivesAn international, online survey was conducted to compare the safety, tolerability and reactogenicity of available COVID-19 vaccines in different recipient groups.MethodsThis survey was launched in February 2021, for 11 days. Recipients of a first COVID-19 vaccine dose ≥7 days prior to survey completion were eligible. The incidence and severity of vaccination side effects were assessed.ResultsSurvey was completed by 2,002 respondents, of whom 26.6% had prior COVID-19 infection (68.8% laboratory confirmed). Prior COVID-19 infection was associated with increased risk of any side effect (risk ratio 1.08, 95% confidence intervals [1.05-1.11]), fever (2.24 [1.86-2.70]), breathlessness (2.05 [1.28-3.29]), flu-like illness (1.78 [1.51-2.10]), fatigue (1.34 [1.20-1.49]) and local reactions (1.10 [1.06-1.15]). It was also associated with increased risk of severe side effects, leading to hospital care (1.56 [1.14-2.12]).While mRNA vaccines were associated with a higher incidence of any side effect (1.06 [1.01-1.11]) compared to viral vector-based vaccines, these were generally milder (p<0.001), mostly local reactions. Importantly, mRNA vaccine-recipients reported considerably lower incidence of systemic reactions (RR<0.6) including anaphylaxis, swelling, flu-like illness, breathlessness and fatigue, and of side effects requiring hospital care (0.42 [0.31-0.58]).ConclusionFor the first time, our study links prior COVID-19 illness with increased incidence of vaccination side effects and demonstrates that mRNA vaccines cause milder, less frequent systemic side effects, but more local reactions.Key messages–People with prior COVID-19 illness appear to experience significantly increased incidence and severity of side effects after receiving the COVID-19 vaccine.–In this first head-to-head comparison of the safety and reactogenicity of different types of vaccines, it was demonstrated that mRNA vaccines cause milder, less frequent systemic side effects, compared to viral vector vaccines, but more local reactions.Tweetable SummaryA survey of >2000 COVID-19 vaccine-recipients links prior COVID-19 illness with increased incidence of vaccination side effects; mRNA vaccines cause milder, less frequent systemic side effects, but more local reactions.

Factor V Leiden G1691A (FVL) and Factor II prothrombin G20210A (PGM) mutations are the leading causes of thrombophilia. In this study, we have investigated the prevalence of the FVL G1691A and PGM G20210A single nucleotide polymorphisms (SNPs) among Libyan deep vein thrombosis (DVT) and myocardial infarction (MI) patients. SNP genotyping was performed using high-resolution melt analysis (HRM) and DNA sequencing. Biochemical parameters conducted on 112 males and 93 females showed no significant difference in means between the control group and the deep vein thrombosis and myocardial infarction groups. For Factor V Leiden, 40 samples were genotyped. Of the 40 samples, 6 (15.0%) of them were heterozygous and no one was homozygous. As for Factor II SNP, 59 samples were genotyped and only 2 (3.3%) were heterozygous. All the heterozygous samples showed 100% concordance between the HRM-PCR and DNA sequence analysis. Our study showed, for the first time, that both the FVL and PGM mutations are present among Libyan DVT and MI patients and that the FVL mutation is significantly associated with DVT but not with MI. However, our results do not support the association of PGM G20210A mutation with DVT or MI.

An online survey was conducted to compare the safety, tolerability and reactogenicity of available COVID-19 vaccines in different recipient groups. This survey was launched in February 2021 and ran for 11 days. Recipients of a first COVID-19 vaccine dose ≥7 days prior to survey completion were eligible. The incidence and severity of vaccination side effects were assessed. The survey was completed by 2002 respondents of whom 26.6% had a prior COVID-19 infection. A prior COVID-19 infection was associated with an increased risk of any side effect (risk ratio 1.08, 95% confidence intervals (1.05–1.11)), fever (2.24 (1.86–2.70)), breathlessness (2.05 (1.28–3.29)), flu-like illness (1.78 (1.51–2.10)), fatigue (1.34 (1.20–1.49)) and local reactions (1.10 (1.06–1.15)). It was also associated with an increased risk of severe side effects leading to hospital care (1.56 (1.14–2.12)). While mRNA vaccines were associated with a higher incidence of any side effect (1.06 (1.01–1.11)) compared with viral vector-based vaccines, these were generally milder (p < 0.001), mostly local reactions. Importantly, mRNA vaccine recipients reported a considerably lower incidence of systemic reactions (RR < 0.6) including anaphylaxis, swelling, flu-like illness, breathlessness and fatigue and of side effects requiring hospital care (0.42 (0.31–0.58)). Our study confirms the findings of recent randomised controlled trials (RCTs) demonstrating that COVID-19 vaccines are generally safe with limited severe side effects. For the first time, our study links prior COVID-19 illness with an increased incidence of vaccination side effects and demonstrates that mRNA vaccines cause milder, less frequent systemic side effects but more local reactions.

Despite the relative abundance of sunny weather, surprisingly, there is increasing evidence that vitamin D deficiency is extremely prevalent in females of reproductive age in Middle East countries. There is also increasing interest in the non-classical roles of vitamin in health and disease including its relation to incidence of gestational diabetes, its impact on glycaemic control in diabetes mellitus, and its association with some complications of pregnancy like preeclampsia. The objective of this study was to estimate the prevalence of Vitamin D deficiency in pregnant diabetic patients in west Libya and analyse potential links to socioeconomic and cultural factors. This is a cross sectional observational study. Random plasma was collected form expected mothers attending the Antenatal Diabetes Clinic at Tripoli’s Main Maternity Hospital. Demographics and socioeconomic and cultural factors were recorded at the same time. Samples were analysed for vitamin D level and biochemical screening panel. Vitamin D level was obtained from 160 patients (mean age 35 years). Over all 95 % of the study population had vitamin D levels below normal (defined as vitamin D level of < 20 ng/mL). Results were subcategorised into severe deficiency (<10 ng/ml, 51.9%-83 patients), deficiency (< 20 ng/mL, 43.1%, 69 patients), insufficiency (20 - 30 ng/ml, 3.8%, 6 patients) and sufficient (> 30 ng/ml, only 1.3%, 2 patients). All patients were taking daily vitamin D Supplements at a dose of 400 IU as per hospital policy. Vitamin D deficiency is extremely prevalent in pregnant diabetic patients in Libya. There is no clear association with socioeconomic risk factors like employment, type of accommodation or geographic distribution. However, most of the study population had life style characterized by minimal exposure to direct sun light. Routine supplementation of Vitamin D in doses of 400 IU/day does not appear to ameliorate the severity of vitamin D deficiency in this group.

SeptiFast is a real-time PCR assay which targets ribosomal DNA sequences of bacteria and fungi, enabling detection and identification of the commonest pathogens in blood within a few hours, including those acquired in healthcare settings. We report here the first detailed assessment of SeptiFast that focuses on healthcare-associated bloodstream infections which develop during routine critical care.

Patients with Kidney transplants are known to be at increased risk of non-tuberculous mycobacterial infections ( 1 – 3 ). This can take the form of skin infection, lung infection and more seriously disseminated disease. The increased risk is related to the reduced cellular immunity due to immune suppressant drugs. Very little is known about the risk of Kidney transplantation in patients who are already known to have Non-tuberculous mycobacterial infection. (Published: 22 September 2014) Citation: Libyan J Med 2014, 9 : 25766 - http://dx.doi.org/10.3402/ljm.v9.25766

The extra demand imposed upon the Libyan health services during and after the Libyan revolution in 2011 led the ailing health systems to collapse. To start the planning process to re-engineer the health sector, the Libyan Ministry of Health in collaboration with the World Health Organisation (WHO) and other international experts in the field sponsored the National Health Systems Conference in Tripoli, Libya, between the 26th and the 30th of August 2012. The aim of this conference was to study how health systems function at the international arena and to facilitate a consultative process between 500 Libyan health experts in order to identify the problems within the Libyan health system and propose potential solutions. The scientific programme adopted the WHO health care system framework and used its six system building blocks: i) Health Governance; ii) Health Care Finance; iii) Health Service Delivery; iv) Human Resources for Health; v) Pharmaceuticals and Health Technology; and vi) Health Information System. The experts used a structured approach starting with clarifying the concepts, evaluating the current status of that health system block in Libya, thereby identifying the strengths, weaknesses, and major deficiencies. This article summarises the 500 health expert recommendations that seized the opportunity to map a modern health systems to take the Libyan health sector into the 21st century.

British Journal of DermatologyVolume 168, Issue 2 p. 446-447 Correspondence Cutaneous Mycobacterium haemophilum infection in a patient receiving infliximab for psoriasis A. Aslam, A. Aslam Dermatology Centre,Search for more papers by this authorR.L. Green, R.L. Green Department of DermatopathologySearch for more papers by this authorL. Motta, L. Motta Department of DermatopathologySearch for more papers by this authorM. Ghrew, M. Ghrew Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K. E-mail: rich1975@aol.comSearch for more papers by this authorC.E.M. Griffiths, C.E.M. Griffiths Dermatology Centre,Search for more papers by this authorR.B. Warren, R.B. Warren Dermatology Centre,Search for more papers by this author A. Aslam, A. Aslam Dermatology Centre,Search for more papers by this authorR.L. Green, R.L. Green Department of DermatopathologySearch for more papers by this authorL. Motta, L. Motta Department of DermatopathologySearch for more papers by this authorM. Ghrew, M. Ghrew Department of Respiratory Medicine, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K. E-mail: rich1975@aol.comSearch for more papers by this authorC.E.M. Griffiths, C.E.M. Griffiths Dermatology Centre,Search for more papers by this authorR.B. Warren, R.B. Warren Dermatology Centre,Search for more papers by this author First published: 20 July 2012 https://doi.org/10.1111/j.1365-2133.2012.11164.xCitations: 7 Funding sources: none. Conflicts of interest: R.B.W. has acted as a consultant, speaker and/or had funding support for research from Abbott, Janssen, Pfizer and MSD, all of whom manufacture biological agents. C.E.M.G. has acted as a speaker and consultant for Abbott, Pfizer, Leo, Janssen, Novartis and MSD. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume168, Issue2February 2013Pages 446-447 RelatedInformation

We write to report the case history of a 60-year-old woman who presented to our hospital with leukocytoclastic vasculitis complicated by acute kidney injury and pulmonary hemorrhage. She also was found to have cryoglobulinemia (immunoglobulin G, 0.20 g/L; immunoglobulin M, 0.31 g/L). Plasma exchange and hemodialysis therapy were initiated; per our usual routine, dialysate was warmed to 36.5°C and the circuit was anticoagulated with 500 to 1,000 U/h of heparin. No problems with clotting or thrombosis occurred. Her pulmonary function progressively deteriorated, and 12 days later, she was admitted to the intensive care unit in acute respiratory failure.After intubation, plasma exchange continued and continuous venovenous hemofiltration was started using a Gambro-Prismaflex machine (Gambro Hospal Ltd, Cambridgeshire, UK) and a double-lumen hemofiltration catheter inserted into the right internal jugular vein. In accordance with the unit protocol, a heparin infusion was added to the afferent limb of the circuit at a dose of 1,000 U/h and a 20% predilution technique was started. After a short period, blood clotted within the filter; this recurred several times after changing the filter.We reasoned that blood may have clotted within the circuit because of cryoglobulin precipitation induced by the relatively low temperatures encountered during hemofiltration. Although both afferent and efferent limbs were warmed by the machine, the replacement fluid (Lactosol; Gambro) was not warmed before entering the circuit at room temperature. We subsequently warmed the replacement fluid to 37.5°C using continuous ambulatory peritoneal dialysis warming beds and wrapped it in foil to prevent heat loss. Predilution in the circuit also was increased to 50%. After these measures, the filter ran for several days without further episodes of clotting. When we reattempted continuous venovenous hemofiltration with fluid that was not warmed before entering the circuit, clotting recurred; warming was recommenced with no further clotting.We believe this is the first case report of this technique. We write to report the case history of a 60-year-old woman who presented to our hospital with leukocytoclastic vasculitis complicated by acute kidney injury and pulmonary hemorrhage. She also was found to have cryoglobulinemia (immunoglobulin G, 0.20 g/L; immunoglobulin M, 0.31 g/L). Plasma exchange and hemodialysis therapy were initiated; per our usual routine, dialysate was warmed to 36.5°C and the circuit was anticoagulated with 500 to 1,000 U/h of heparin. No problems with clotting or thrombosis occurred. Her pulmonary function progressively deteriorated, and 12 days later, she was admitted to the intensive care unit in acute respiratory failure. After intubation, plasma exchange continued and continuous venovenous hemofiltration was started using a Gambro-Prismaflex machine (Gambro Hospal Ltd, Cambridgeshire, UK) and a double-lumen hemofiltration catheter inserted into the right internal jugular vein. In accordance with the unit protocol, a heparin infusion was added to the afferent limb of the circuit at a dose of 1,000 U/h and a 20% predilution technique was started. After a short period, blood clotted within the filter; this recurred several times after changing the filter. We reasoned that blood may have clotted within the circuit because of cryoglobulin precipitation induced by the relatively low temperatures encountered during hemofiltration. Although both afferent and efferent limbs were warmed by the machine, the replacement fluid (Lactosol; Gambro) was not warmed before entering the circuit at room temperature. We subsequently warmed the replacement fluid to 37.5°C using continuous ambulatory peritoneal dialysis warming beds and wrapped it in foil to prevent heat loss. Predilution in the circuit also was increased to 50%. After these measures, the filter ran for several days without further episodes of clotting. When we reattempted continuous venovenous hemofiltration with fluid that was not warmed before entering the circuit, clotting recurred; warming was recommenced with no further clotting. We believe this is the first case report of this technique. Support: None. Financial Disclosure: None.

We read the recent paper by Nseir et al. 1 Nseir S. Deplanque X. Di Pompeo C. Diarra M. Roussell-Delvallez M. Durocher A. Risk factors for relapse of ventilator-associated pneumonia related to non-fermenting Gram negative bacilli: a case-control study. J Infect. 2008; 56: 319-325 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar with interest. The authors identified inappropriate initial antibiotic prescribing as an independent risk factor for relapse of ventilator-associated pneumonia (VAP) related to non-fermenting gram negative bacilli. The paper adds to evidence of the importance of appropriate initial antibiotic therapy in the management of VAP which has been shown to limit morbidity and mortality. 2 Iregui M. Ward S. Sherman G. Fraser V.J. Kollef M.H. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002; 122: 262-268 Crossref PubMed Scopus (840) Google Scholar Use of targeted antibiotics should improve patient outcomes by treating identified pathogens, avoiding potentially inappropriate or costly broad-spectrum antibiotics and reduce the emergence of antibiotic resistance. 3 Joffe A. Muscedere J. Marshall J. Su Y. Heyland D. The safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study. J Crit Care. 2008; 23: 82-90 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar , 4 Thomas J. Forrest A. Bhavani S. Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy. Antimicrob Agents Chemother. 1998; 42: 521-527 PubMed Google Scholar

Editor,—Ahya et al reported a case of transfusion associated graft versus host disease (TA-GVHD) in a non-immunocompromised patient resulting from blood transfusion after coronary artery bypass grafting (CABG).1 They concluded that this devastating complication of transfusion is probably underreported. There is no doubt that diagnosing this condition needs a high index of suspicion because its manifestations can be seen in other more common conditions such as septicaemia. Moreover, histological diagnosis needs specialist expertise in tissue typing. We report another patient with TA-GVHD acquired following elective four-vessel CABG and perioperative transfusion of a total of six units of blood. A 68 year old man was admitted three weeks after surgery with a seven day history of skin rash, breathlessness, cough, and expectoration of brown sputum. He had an extensive erythrodermic maculopapular eruption, oral thrush, tachycardia, hypotension, bilateral chest crepitations, and mild hepatomegaly. His condition worsened progressively …