How prevalent is COVID-19 vaccine hesitancy in low-income and middle-income countries and what are the key drivers of hesitancy? Results from 53 countries

OBJECTIVES

This study aims to estimate the levels of COVID-19 vaccine hesitancy in 53 low-income and middle-income countries, differences across population groups in hesitancy, and self-reported reasons for being hesitant to take the COVID-19 vaccine.

METHODS

This paper presents new evidence on levels and trends of vaccine hesitancy in low-income and middle-income countries based on harmonised high-frequency phone surveys from more than 120 000 respondents in 53 low-income and middle-income countries collected between October 2020 and August 2021. These countries represent a combined 53% of the population of low-income and middle-income countries excluding India and China.

RESULTS

On average across countries, one in five adults reported being hesitant to take the COVID-19 vaccine, with the most cited reasons for hesitancy being concerns about the safety of the vaccine, followed by concerns about its efficacy. Between late 2020 and the first half of 2021, there tended to be little change in hesitancy rates in 11 of the 14 countries with available data, while hesitancy increased in Iraq, Malawi and Uzbekistan. COVID-19 vaccine hesitancy was higher among female, younger adults and less educated respondents, after controlling for selected observable characteristics.

CONCLUSIONS

Country estimates of vaccine hesitancy from the high-frequency phone surveys are correlated with but lower than those from earlier studies, which often relied on less representative survey samples. The results suggest that vaccine hesitancy in low-income and middle-income countries, while less prevalent than previously thought, will be an important and enduring obstacle to recovery from the pandemic.

Chronic Administration of Ion Channel Blockers Impact Microglia Morphology and Function in a Murine Model of Alzheimer's Disease

As the population ages, a high prevalence of multimorbidity will affect the way physicians need to think about drug interactions. With microglia's important involvement in the pathology and progression of Alzheimer's disease (AD), understanding whether systemically administered drugs intended for other affections could impact microglia function, already impacted by the presence of beta-amyloid, is important. The aim of this study was to evaluate morphological changes of microglia, using in vivo 2-photon laser scanning microscopy, in a murine model of AD under systemic administration of sodium or calcium ion channel blockers in order to establish potential effects that these drugs might have on microglia under neuro-inflammatory conditions. A total of 30 mice (age 14-16 weeks, weight 20-25 g) were used, with 25 APP randomly divided into three groups. The remaining animals were CX3CR1GFP/GFP male mice (n = 5) used as WT controls. After baseline behavior testing, all animals received daily intraperitoneal injections for 30 days according to the assigned group [WT (n = 5), Control (n = 5), Carbamazepine (n = 10), and Verapamil (n = 10)]. The results showed that the Verapamil treatment improved short-term memory and enhanced exploratory behavior in APP mice. The Carbamazepine treatment also improved short-term memory but did not elicit significant changes in anxiety-related behavior. Both Verapamil and Carbamazepine reduced the surveillance speed of microglia processes and changed microglia morphology in the cortex compared to the Control group. Due to their complex molecular machinery, microglia are potentially affected by drugs that do not target them specifically, and, as such, investigating these interactions could prove beneficial in our management of neurodegenerative pathologies.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Layer specific strain analysis and QTc interval in patients with STEMI and TIMI 3 early after percutaneous coronary intervention

Background

Heart rate-corrected (QTc) interval may increase in the setting of ST-elevation myocardial infarction (STEMI) even after complete reperfusion of the infarct-related artery. The remaining ischemia affects ventricular repolarization and may be associated with an increased susceptibility for malignant ventricular arrhythmias. Two-dimensional (2D) speckle tracking echocardiography (STE) is an angle-independent technique for evaluating myocardial function. The study aimed to analyze the layers specific strain using STE in patients after percutaneous coronary intervention (PCI) and find a possible correlation with QTc interval.

Methods

74 patients with STEMI and TIMI 3 flow after PCI were enrolled. The study did not include patients with bundle branch block, pacing, or treated with drugs that could increase the QTc interval. The evaluation consisted of clinical examination and laboratory tests. 12 leads electrocardiography evaluated QTc interval. Echocardiographic acquisitions were performed in the first 24–48 hours after PCI, and data were analyzed on the workstation. The global longitudinal strain was measured from apical views, at the level of the endocardium GLSAvgEndo, transmural GLSAvg, epicardium GLSAvgEpi; the difference bewtwen endocardium and epicardium longitudinal strain: GLSAvgEndo-GLSAvgEpi. Layer-specific GLS values were measured as the average of the longitudinal strain of 17 LV segments at each individual layer (Figure 1).

Results

Patients were diveded in two groups: the first included 32 patients with a single vessel disease (43.24%) and the second, 42 patients (56.75%) with multiple vessel damage, but without other indication for revascularization except the culprit lesion. Values for layers strain and QTc interval in the first group were: GLSAvgEndo: −16.2 (SD 2.98, CV 0.18), GLSAvg: −11.46 (SD 6.98, CV 0.6), GLSAvgEndo-GLSAvgEpi: 3.54 (DS 1.06, CV 0.29), QTc: 452.5 (SD 22.65, CV 0.05) and in the second group: GLSAvgEndo: −13.22 (SD 4.01, CV 0.3), GLSAvg: −11.3 (SD 3.39, CV 0.29), GLSAvgEndo-GLSAvgEpi: 3.47 (CV 1.28, CV 0.37), QTc: 490ms (SD 43.07, CV 0.08). QTc interval correlated with and layers strain in the first group: GLSAvgEndo: r=0.56, GLSAvg: r=0.67, GLSendo-GLSepi: r=0.54, and in the second group: GLSAvgEndo: r=0.73, GLSAvg: r=0.75, GLSAvgEndo-GLSAvgEpi: r=0.62.

Conclusions

1. The present study identified decreased longitudinal strain in all myocardial layers in the first days after STEMI, even after a successful PCI. 2. Alterations of QTc dynamicity were more frequent in patients with multivessel lesions 3. The electrical instability related by QTc interval correlated with the myocardial tissue damage related by STE. The correlation was more evident in patients with multivessel disease, even with remaining nonsignificant lesions, suggesting an ongoing process of microcirculatory perfusion damage.

Funding Acknowledgement

Type of funding sources: None.

Roles of Microglial Ion Channel in Neurodegenerative Diseases

As the average age and life expectancy increases, the incidence of both acute and chronic central nervous system (CNS) pathologies will increase. Understanding mechanisms underlying neuroinflammation as the common feature of any neurodegenerative pathology, we can exploit the pharmacology of cell specific ion channels to improve the outcome of many CNS diseases. As the main cellular player of neuroinflammation, microglia play a central role in this process. Although microglia are considered non-excitable cells, they express a variety of ion channels under both physiological and pathological conditions that seem to be involved in a plethora of cellular processes. Here, we discuss the impact of modulating microglia voltage-gated, potential transient receptor, chloride and proton channels on microglial proliferation, migration, and phagocytosis in neurodegenerative diseases.

Plant growth promotion effect of plasma activated water on Lactuca sativa L. cultivated in two different volumes of substrate

Plasma activated water (PAW) can represent an alternative to chemical fertilizers in agriculture. The effects of PAW treatment applied in two concentrations (1.5 or 3.0 mg L-1 NO3-) on some morphological, physiological, biochemical parameters and yield of Lactuca sativa L. grown in two different pot volumes (400 or 3200 cm3) were investigated in this study. The results showed that both PAW concentrations did not influence the germination, once the process was initiated. Positive effects of the treatments were registered on the length of radicle and hypocotyls of lettuce at a concentration of 1.5 mg L-1 NO3- (PAW I), the chlorophyll content was significantly increased at a concentration of 3.0 mg L-1 NO3- (PAW II) and bigger pot volume, also the foliar weight and area. No significant differences between the treated and untreated plants were recorded for the root weight, leaf length and width. The dry weight was significantly higher for the lettuce treated with PAW I and II grown in big volume pots at 57 days after transplanting (DAT) and small volume pots at 64 DAT. The nitrites content of the lettuce grown in big pots was lower than of the lettuce grown in small pots, regardless of the PAW treatment. Contrary, the nitrates content was higher in the lettuce grown in big pots (up to 36.4 mg KNO3/g DW), compared to small pots (under 0.3 mg KNO3/g DW).

Optical coherence tomography microscopy in experimental traumatic brain injury

Worldwide elderly traumatic brain injury (TBI) patients tend to become an increasing burden to the society. Thus, a faster and less expensive way of evaluating TBI victims is needed. In the present study we investigated if optical coherence tomography (OCT) could be used as such a method. By using an animal model, we established if OCT can detect cortical changes in the acute phase of a penetrating TBI, in young (5–7 months) and old (20–22 months) rats. Due to the long‐term evolution of TBI's, we wanted to investigate to what extent OCT could detect changes within the cortex in the chronic phase. Adult (7–12 months) male rats were used. Surprisingly, OCT imaging of the normal hemisphere was able to discriminate age‐related differences in the mean gray values (MGV) of recorded pixels (p = .032). Furthermore, in the acute phase of TBI, OCT images recorded at 24 hr after the injury showed differences between the apparent damaged area of young and aged animals. Changes of MGV and skewness were only recorded 48 hr after injury. Monitoring the chronical evolution of the TBI with OCT revealed changes over time exceeding the normal range recorded for MGV, skewness and kurtosis, 14 and 21 days after TBI. Although in the present study we still used an extremely invasive approach, as technology improves, less invasive and non‐harmful ways of recording OCT may allow for an objective way to detect changes within the brain structure after brain injuries.

Yield and Nutritional Response of Greenhouse Grown Tomato Cultivars to Sustainable Fertilization and Irrigation Management

Tomato is considered one of the most important crops worldwide from nutritional and economic standpoints, and, in this respect, sustainable production should be a prime objective, particularly in terms of fertilization and irrigation management. The aim of this study was to compare the effects of two fertilization types (chemical or organic) and two irrigation regimes (67% or 100% of evapotranspiration replenishment) on biometrical, biochemical, and yield parameters of three indeterminate cultivars of tomato grown in a greenhouse. The results showed that the effect of organic fertilization was better compared to chemical fertilization for lycopene accumulation and antioxidant activity, as well as for the lower concentrations of any of the macroelements in the tomato fruits; therefore, organic fertilization can be used as an alternative to chemical fertilization in sustainable horticulture. In each cultivar under the same fertilization type, the effect of irrigation was significant on yield and the number of fruits, but the 100% evapotranspiration restoration did not enhance the fruit concentration of all the macroelements and microelements compared to 67% irrigation regime. Higher concentrations of macro- and microelements in the chemically fertilized fruits compared to the organic ones, regardless of the cultivar and the irrigation regime, suggest that the inorganic substances are more easily absorbed by plants under a protected environment. Organic fertilization positively affected the lycopene and antioxidant activities of tomato fruits, thus proving to be a valuable alternative to chemical fertilization in sustainable agriculture, although the product premium quality also depends on the cultivar used.

Dynamic of Phenolic Compounds, Antioxidant Activity, and Yield of Rhubarb under Chemical, Organic and Biological Fertilization

In recent years, rhubarb is being increasingly cultivated, as it provides early yields when the vegetables supply to market is deficient and shows high levels of both polyphenols content and antioxidant capacity in edible parts. In 2017, we investigated crops of the rhubarb cultivar Victoria to the fifth year of production. Comparisons were performed between three root phase fertilizations-chemical (NPK 16-16-16^®), organic (Orgevit^®), and biological (Micoseeds MB^®)-plus an unfertilized control. The determinations of polyphenols, the antioxidant capacity, and the yield indicators from the stalks (petioles) of rhubarb were made at each out of the 10 harvests carried out. The highest yield (59.16 t·ha^-1) was recorded under the chemical fertilization. The total polyphenols content and antioxidant capacity varied widely from 533.86 mg GAE·g^-1 d.w. and 136.86 mmol Trolox·g^-1 d.w., respectively in the unfertilized control at the last harvest, up to 3966.56 mg GAE·g^-1 d.w. and 1953.97 mmol Trolox·g^-1 d.w. respectively under the organic fertilization at the four harvest. From the results of our investigation, it can be inferred that the chemical fertilization was the most effective in terms of yield, whereas the sustainable nutritional management based on organic fertilizer supply led to higher antioxidant compounds and activity.

P690 Pulmonary valve endocarditis complicated with fistula between right ventricle outflow tract and aorta in a patient with patent ductus arteriosus

Background

The majority of cases of right sided infective endocarditis involve the tricuspid valve. Isolated pulmonary valve (PV) endocarditis is rare. Congenital heart disease are risk factors. Material and methods: We present the case of 36 years old male, without any known cardiovascular disease, who was admitted with signs and symptoms of heart failure, pulmonary embolism and fever. He was evaluated clinically, 12 lead ECG, pulmonary radiography, thoracic computer tomography (CT) scan, transthoracic and transesophageal echocardiography, laboratory investigations. Results: Transthoracic and transesophageal echocardiogram revealed large vegetations located on pulmonary valve, pulmonary regurgitation and dilation of the pulmonary valve, patent ductus arteriosus (PDA) with bidirectional shunt and local complications: fistula between right ventricle outflow tract (RVOT) and aorta, pleural and pericardial effusion. Blood cultures were negative. ECG aspect was right bundle branch block. Radiography and thoracic CT scan revealed pulmonary embolism aspect. The patient was treated with antibiotics and surgical option included debridement of the infected area, vegetation excision with valve replacement, relief of RVOT, fistula closure with pericardial patch and ligature of PDA. Evolution after surgical intervention was good.Conclusions: This presentation reveals a favorable evolution of a patient with infective endocarditis located to pulmonary valve. In most of cases, right heart endocarditis presents with signs and symptoms of respiratory disease and fever; these are due to septic pulmonary embolization. Isolated PV endocarditis still remains a challenging and needs carefully echocardiographic evaluation for a correct diagnosis and risk factors identification.

Biochemical and Production of Rhubarb Under Growing Technological Factors

The aim of the present study was to assess the influence of two varieties of rhubarb (Glanskin�s Perpetual and De Moldova) and two densities, 10.000 and 13.300 pl/ha on the content of macro (K, Ca, P, Mg, Fe and S), micro�elements (Al, Si and Mn), organic acids (tartaric, oxalic, citric, malic and ascorbic) and total production. The content of oxalic acid in the four versions ranged from 2.3 mg/mL juice in the case of Glanskin�s perpetual cultivation, with the density of 13.300 pl/ha at 3.8 mg/mL in the case of the Moldova variety at the same density. The content of tartaric acid varied in wide limits from 1.75 mg/mL juice to 6.5 mg/mL juice. The content of macro-elements varied within wide limits, the report being: Fe ] K ] Mg ]S ] P ] Ca. The largest production was obtained at the variety De Moldova with density of 13.300 pl/ha.

Reticulin-M, an antianaphylactic peptide secreted by reticulo-endothelial system

I. Moldovan (1923) demonstrated in the blood ultrafiltrate from anaphylactically prepared guinea pigs, which believed to anaphylactic shock, or which were previously injected with coloidal substances as India ink to stimulate the RES, an antianaphylactic principle named Reticulin-M(R). Authors extracted R from organs rich in RES with acetone, established their, peptidic nature and tested it on anaphylactic prepared guinea pig uterine horns in vitro. The peptides were fractioned by high voltage paper electrophoresis. The fractions were cut up in four groups, eluted and tested. The second basic group was identified as active and concentrated by acetone, recipitation. In conclusion several techniques were used to obtain, to test, to isolate and to concentrate R, a natural antianaphylactic peptidic factor, which may be a cytokine.