Background This meta-analysis addresses the efficacy and safety of tixagevimab-cilgavimab as pre-exposure prophylaxis against COVID-19 in immunocompromised patients, particularly during the Omicron variant surge. Given the limited vaccine response in this population, alternative prophylactic strategies are critical. Methods Following PRISMA guidelines, we comprehensively searched electronic databases, including PubMed, Scopus, Web of Science, and Embase, up to June 22, 2024. We included studies assessing tixagevimab-cilgavimab’s impact on SARS-CoV-2 infection rates, hospitalization, ICU admissions, and/or mortality among immunocompromised patients. Data synthesis and analysis were conducted using RevMan and Open-Meta Analyst software. Results Analyzing data from 36 studies involving 28,950 patients, tixagevimab-cilgavimab significantly reduced SARS-CoV-2 infection rates by 4.37%, hospitalization by 0.8%, and mortality by 0.5%. Compared to no prophylaxis, the drug combination showed a notable reduction in SARS-CoV-2 infection (OR = 0.33, 95% CI: 0.22-0.50), hospitalization (OR = 0.24, 95% CI: 0.15-0.39), and mortality (OR = 0.33, 95% CI: 0.16-0.66), exhibiting a favorable safety and efficacy profile. During the Omicron surge, tixagevimab-cilgavimab consistently reduced infection risk (OR = 0.32, 95% CI: 0.17-0.58). Conclusion Tixagevimab-cilgavimab offers a significant protective effect against COVID-19, including Omicron variants, in immunocompromised patients, underscoring its role as an effective pre-exposure prophylaxis. Future studies should further explore its efficacy across different SARS-CoV-2 variants and potential synergies with vaccination efforts.

Investigating the genetic basis of dietary specialization can provide insights into the evolution of niche breadth. In this study, we used comparative genomics methods to analyze two seasonally avivorous bats (Nyatalus aviator and Ia io) to elucidate the mechanism of adaptation to the expansion of their dietary niche from insectivory to avivory. Our findings revealed that genes related to immunity and lipid metabolism underwent positive selection and convergent evolution among two avivorous bat species. We also found that immune-related genes in avivorous bats are under greater compared to bat species with other diets selective pressure and harbor fewer endogenous retroviral elements in their genomes. We also found that TLR10 is absent in the two avivorous bat species. These findings emphasized the significance of immune-driven adaptive evolution in avivory. Additionally, our results showed that the dietary evolution of avivorous bats is accompanied by convergent evolution associated with the PPAR pathway. Notably, CEPT1, the upstream gene required for the activation of the PPAR pathway, underwent positive selection and convergence, which may have affected lipid metabolism. These findings not only provided comprehensive insights into the adaptive evolution underlying the unique diet of avivorous bats but also offered novel perspectives on the molecular mechanisms underlying ecological niche evolution in a dietary context.

Genetic rescue is increasingly viewed as a promising but underutilized conservation strategy to mitigate inbreeding depression and restore genetic diversity. Yet, empirical evidence supporting its long-term efficacy is limited to a few generations. Here, we conducted an experiment with Drosophila melanogaster to test the long-term efficiency of genetic rescue in reducing population extinction risk. A recently captured wild population was maintained in the laboratory with a large census size (the base population, BP). Thirty smaller populations of N = 50 individuals (N50) were founded from the BP and maintained for 31 generations. Subsequently, three sets of 54 lines with N = 8 individuals each, were founded from these N50 populations and maintained for 33 generations. One set served as a control (non-rescued lines), while the other two sets were rescued using a single male introduced in two consecutive generations either from the BP (rescued-BP) or from the N50 (rescued-N50) populations. An analysis of pupae productivity at the time of the foundation of the lines showed substantial purging of the inbreeding load in the N50 populations. No significant differences in pupae productivity were found between the non-rescued lines and rescued-BP lines at generation 9. However, extinction rates were lower for the latter. Whole-genome sequencing of 12 individuals from a non-rescued line and 12 from a rescued-BP line revealed fewer deleterious allele copies and a lower inbreeding in the rescued one. Our results highlight the effectiveness of genetic rescue in reducing the extinction rate by efficiently selecting advantageous alleles responsible for hybrid vigour, purging of the introduced genetic load, and introducing adaptive potential.

Phenotypic plasticity is the ability of organisms to respond to environmental changes. Understanding and leveraging crop phenotypic plasticity is crucial for mitigating the threats caused by climate change. Here, we assessed phenotypic plasticity in multi-environment trials over 4 years, covering a wide geographical area, using 505 inbred lines from a Brassica napus genetic diversity panel. The observed phenotypic variation for seed oil content (SOC) was influenced by three environmental indices, i.e., precipitation, diurnal temperature range, and ultraviolet B during the flowering or pod-filling stage, alongside five plasticity genes. Leveraging this information with climate records, we developed a predictive model to estimate SOC for various planting dates in seven major production regions, and validated the accuracy of our predictions in new environments. With the quantified plasticity conferred by genetic variation in the five plasticity genes, we identified an optimal haplotype for each production region for adaptability to future climate projections. This study offers valuable insights and selection of materials to mitigate the adverse effects of climate change on agriculture.

Parentage analysis provides indispensable information for the study of ecology and evolution. However, many parentage algorithms suffer from low assignment rates, especially when the number of molecular markers is less than adequate, or when prior knowledge about the study population is limited. The present study developed a novel pipeline, which uses resampling methods as an external extension, to achieve higher assignment rates of parentage analysis. The R package provided by this study helps CERVUS, one of the commonly used parentage software, to find more potential father–mother–offspring triads. Simulations showed that the idea of resampling offers great potential to find father–mother–offspring triads that are overlooked by CERVUS, while keeps the same level of statistical confidence. Performances were also tested based on simulated data. When eight polymorphic microsatellite markers are genotyped in a population of 200 individuals, for example, the pipeline improved the assignment rates by over 10%, while the error rates did not rise. This study highlights the importance of incorporating resampling methods into parentage algorithms. The framework of resampling methods is applicable to other parentage software to find more potential parent–offspring relationships.

Plants maintain iron (Fe) homeostasis under varying environmental conditions by balancing processes such as Fe uptake, transport, and storage. In Arabidopsis, POPEYE (PYE), a basic helix-loop-helix (bHLH) transcription factor (TF), has been shown to play a crucial role in regulating this balance. In recent years, the mechanisms regulating Fe uptake have been well established but the upstream transcriptional regulators of Fe transport and storage are still poorly understood. In this study, we report that ELONGATED HYPOCOTYL5 (HY5), a basic leucine zipper (bZIP) TF which has recently been shown to play a crucial role in Fe homeostasis, interacts with PYE. Molecular, genetic and biochemical approaches revealed that PYE and HY5 have overlapping as well as some distinct roles in regulation of Fe deficiency response. We found that HY5 and PYE both act as a repressor of Fe transport genes such as YSL3, FRD3 NPF5.9, YSL2, NAS4, and OPT3. HY5 was found to directly bind on the promoter of these genes and regulate intercellular Fe transport. Further analysis revealed that HY5 and PYE directly interact at the same region on PYE and NAS4 promoter. Overall, this study revealed that HY5 regulates Fe homeostasis by physically interacting with PYE as well as independently.

Squalene (C30H50) is an acyclic triterpenoid compound renowned for its myriad physiological functions, such as anticancer and antioxidative properties, rendering it invaluable in both the food and pharmaceutical sectors. Owing to the constraints on natural resources, microbial fermentation has emerged as a prominent trend. Schizochytrium sp. known to harbor the intact Mevalonate (MVA) pathway, possesses the inherent capability to biosynthesize squalene. However, there is a dearth of reported key genes in both the MVA pathway and the squalene synthesis pathway, along with the associated promoter elements for their modification. This study commenced by cloning and characterizing 13 endogenous promoters derived from transcriptome sequencing data. Subsequently, five promoters exhibiting varying expression intensities were chosen from the aforementioned pool to facilitate the overexpression of the squalene synthase gene SQS, pivotal in the MVA pathway. Ultimately, a transformed strain designated as SQS-3626, exhibiting squalene production 2.8 times greater than that of the wild-type strain, was identified. Lastly, the optimization of nitrogen source concentrations and trace element contents in the fermentation medium was conducted. Following 120 hours of fed-batch fermentation, the accumulated final squalene yield in the transformed strain SQS-3626 reached 2.2 g/L.

Background: People with CF (pwCF) frequently have gastrointestinal symptoms (GI), including abdominal pain and irregular bowel movements. These are often embarrassing, difficult to report, and frequently missed. Thus, a GI Symptom Tracker was created and validated in the US and translated and validated in Dutch. This questionnaire consists of four subscales: Eating Challenges, Stools, Adherence Challenges and Abdominal Symptoms. Aim of this study was to investigate the relationship between GI symptoms, anxiety/depression and health-related quality of life (HRQoL) in Dutch pwCF. Methods: In this prospective, cross-sectional single-center pilot study, pwCF completed the Dutch GI Symptom Tracker, GAD-7 (anxiety), PHQ-9 (depression), and CFQ-R (HRQoL) from Sept 2021-June 2022. Regression analyses were used to analyze the univariable associations between GI symptoms, anxiety/depression and HRQoL. Results: 51 pwCF were enrolled consecutively ( n= 41 adults, 66% female, mean age (y) [range]= 32.7 [19-71] & n=10 adolescents, 70% female, mean age (y) [range]= 14.2 [12-17]). Elevated levels of anxiety (scores ≥10 on GAD-7) were found in 17% of adults and 0% of adolescents. Elevated depression scores ( ≥10 on PHQ-9) were found in 9% of adults and 20% of adolescents. GI scales ‘Eating Challenges’ and ‘Stools’ were significantly, positively associated with elevated symptoms of anxiety and depression. Most GI scales were associated with lower HRQoL. Conclusion: This is the first study investigating the link between GI symptoms assessed by the Dutch GI Symptom Tracker and anxiety/depression and HRQoL in Dutch pwCF. More GI symptoms were associated with higher anxiety and depression scores and worse health-related quality of life. Additional research is needed to better understand how mental and physical health are linked in CF.

Traumatic tracheobronchial rupture is a rare but dangerous complication after chest trauma that often causes major respiratory and circulatory disturbances requiring emergency surgery[[1, 2]](#ref-0001). Here, we report a case of tracheobronchial rupture repair surgery in which venovenous (V-V) extracorporeal membrane oxygenation (ECMO) was used as a treatment for this life-threatening complication. The patient was discharged successfully on the 38th day after surgery, and the rapid use of venovenous extracorporeal membrane oxygenation was helpful for saving this patient’s life.

Objective: A recent systematic review found that education programs in perinatal mental health (PMH) had limited effects on detection, referral, and support of parents with perinatal mental health problems (PMHPs). This qualitative study sought to explore the experiences, views and priorities of persons with lived experience (PWLEs), obstetric providers (OPs), childcare health providers (CHPs) and mental health providers (MHPs) on education in PMH. Design/Setting: We used a participatory research design, i.e. co-production by academic researchers and researchers with lived experience as equal partners. We recruited PWLEs through Maman Blues’ association and a centre for psychiatric rehabilitation, and providers through perinatal health networks. Sample/Methods: We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PWLEs; 30 OPs; 11 CHPs and 19 MHPs). We used Braun & Clarke’s inductive six-step process in the thematic analysis. Results: We found some degree of difference in the priorities for education in PMH identified by PWLEs (e.g. person-centred collaborative perinatal healthcare) and providers (e.g. knowledge about PMHPs). Providers considered PMH assessment as part of their role but reported feeling ill-prepared to do so and negative attitudes about their role in perinatal mental health care for parents with suicidal ideations or serious mental illness. Organisational factors comprised PMH integration into standard perinatal healthcare and common culture between non-MHPs and MHPs. Conclusions: Education programs in PMH should be co-designed with PWLEs and focus on providing collaborative person-centred care for all parents.

Delivering in or out of water, the OASI rates in the POOL cohort study are disturbingly highDear Dr Papageorghiou,We have read with interest the POOL study report by Sanders et al. published in your journal.1 We acknowledge that the results of this study are based on a large obstetric cohort of low-risk women.The mere conclusion of the authors is that birth in water is not associated with increased risks for mothers and babies. However, in doing so, they seem to have overlooked an important issue related to the event rate in their comparator group. Indeed, the reported obstetric anal sphincter injury (OASI) rates of 5.0% in nulliparous and 1.3% in multiparous women are remarkably, if not unacceptably high. Particularly, given the risk for serious, often untreatable complications strongly associated with such injury.The reported event rates in the pool study are an outlier when compared to the 1.6% reported in other studies.3 The reported rates in the POOL study are comparable to those reported by Gurol-Urganci et al.4 Nonetheless, 20% of the women in the Gurol-Urganci et al study had operative vaginal births, a strong risk factor for OASI. In contrast, the POOL study cohort were all low-risk spontaneous births.The POOL study describes women delivering in and out of water, but the authors do not comment if manual perineal protection was used or not in either of the groups. Applying interventions, like manual perineal protection at the time of water birth may be challenging and does not tend to be attempted in some healthcare settings.Manual perineal protection was earlier associated with a significant reduction in OASI risk in Norway and Denmark and the UK. Fodstad et al. describe that the OASI prevalence in Norway in all vaginal deliveries has reduced from 4.2% in 2004 to 1.6% in 2023, after introduction of a national program with manual perineal protection.3Gurol-Urganci et al. have also demonstrated a significant reduction OASI rates in a healthcare setting comparable to that of Saunders et al. Moreover, the RCOG and, more recently, the published report from the All-Party Parliamentary Group on Birth Trauma have recommended the roll out and implementation, underpinned by sufficient training, of the OASI care bundle to all hospital trusts to reduce risk of perineal injuries in childbirth.4 Hence, it would have been expected that a UK based study using perineal trauma as its primary outcome would address and discuss what interventions were undertaken to mitigate the risk of trauma.We believe that there is a high risk that the exceptionally high OASI rate in the comparator arm has introduced bias in this non-inferiority RCT. Sanders et al conclude that their “Study findings provide reassurance that birth in water, in the context of UK midwifery practice, is not associated with increased risks for mothers or their babies. However, given the 2015 Supreme Court Montgomery ruling stating that “clinicians should disclose risks of childbirth” one should question, why the risk of childbirth in the POOL study was so unacceptably high and still remained undiscussed?Jan Willem de Leeuw, Department of Obstetrics and Gynaecology, Ikazia Ziekenhuis Rotterdam, the NetherlandsKatariina Laine, Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, NorwayMargareta Manresa, Clinic Institute of Gynaecology, Obstetrics and Neonatology, Hospital Clinic of Barcelona, Barcelona, SpainSari Raisanen, Laurea University of Applied Sciences, Vantaa, FinlandVladimir Kalis, Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles University, Center for Pelvic-floor Disorders, Pilsen, CzechiaZdenĕk Rušavý, Department of Obstetrics and Gynaecology, Faculty of Medicine in Pilsen, Charles UniversityRenaud de Tayrac, Obstetrics and Gynaecology Department, Nimes University Hospital, University of Montpellier, Nimes, France

Objective Pilot study to identify relationships between body temperature and levels of peripheral P4 blood progesterone, and examine if these differ according to body temperature cycle pattern. Design Prospective, observational study. Setting IVIRMA IVF clinics in Madrid, Mallorca and Malaga, Spain. Population 62 data points from 18 patients undergoing hormone assisted embryo-implantation cycles that volunteered to use OvuSense, an intra-vaginal body temperature monitor. Main Outcome Measures OvuSense Raw and Smooth Temperature (°C), P4 (ng/ml). Results A graphical analysis showed an apparent relationship between P4 levels and Temperature taken on P4 blood draw day. A multilevel regression analysis using MLwiN 3.10 1 software investigated this relationship, allowing between-patient variation to be accounted for and estimated. This established a strong linear relationship between LnP4 and ST, and cross correlation was carried out which identified the optimum predictor of levels of LnP4 was ST measured on the day prior to blood sampling. Further graphical analyses showed an apparent lower luteal level of P4 for cycles flagged as atypical by OvuSense, and for negative outcomes, except on embryo transfer day. Conclusions The results provide extremely strong evidence (Z = 15.6, p < 0.0001, 2 sided) of a linear relationship between LnP4 and Smooth Temperature (ST) measured the day before blood sampling. This suggests that ST could provide a less invasive, continuous, and more practical method of assessing P4 response. Further investigation is required to establish the value for improving outcomes.

A document by Shrijan Shrestha. Click on the document to view its contents.

Borderline Personality Disorder is a highly prevalent mental illness characterized by a lack of self-awareness and difficulty in controlling emotions, which leads to extreme mental and behavioral manifestations of opposition. This may be attributed to the low psychological resilience of individuals with BPD, thus making the development of effective interventions to improve psychological resilience crucial. From the perspective of expressive writing, it emerges as a hopeful approach to reducing symptoms and improving psychological resilience. By way of expressive writing about meaningful positive emotional events, it helps the patients in objective assessment of personal issues, strengthening self-awareness, and regulating emotions. This, in turn, contributes to an improvement in psychological resilience and symptom alleviation. This case study also presents relevant implications and recommendations, including a step-by-step intervention approach, the identification of emotional changes, and an intervention process guided by appropriate values.

Empirical findings describe substantial variations in the prevalence of depression across countries. Yet clear explanations for these results are lacking. Objectives: The present study aims to replicate earlier findings on de mediation of the relation between the ability to experience meaning and severity of depression by existential anxiety. Second, the mediating role of the ability to connect to the embodied experience in the relation between the ability to experience meaning and severity of depression is investigated, as well as the direct effect of the ability to connect to the embodied experience on existential anxiety. Last, this study examines whether culture may play a role in the explanation of the variations in the severity of depression across countries. Specifically, the extent to which a culture reinforces people to connect to others, and the extent to which a culture encourages people to be open to new experiences are considered. Method: Path analysis with maximum likelihood estimation was applied on the responses of 1217 participants on a demographical questionnaire and four questionnaires about meaning, symptoms of depression, existential anxiety, and the ability to connect to the embodied experience (or the ability to ‘focus’), with an average age of 42,56 years old ( SD =14.250), living in 97 different countries. Results: Existential anxiety and the ability to connect to the embodied experience were both found as mediators of the relation between the ability to experience meaning experience and severity of depression. Also a significant direct positive effect of the ability to connect to the embodied experience on existential anxiety was found. No significant cultural differences for the indirect paths between the ability to experience meaning and severity of depression, trough existential anxiety and the ability to connect to the embodied experience, were found. Only for the direct path between the ability to experience meaning and severity of depression a significant difference was found between societies with a predominant collectivistic and societies with a predominant individualistic culture. Conclusion: These results confirm the importance of existential anxiety and the ability to connect to the embodied layer of life events in the understanding and therapeutic treatment of depression. In addition, this study suggests that existential anxiety and the ability to connect to the embodied experience might be universal underlying mechanisms in the relation between meaning experience and severity of depression. Cultural differences are situated in the possibility people have to find meaning in their lives, making them less or more prone to symptoms of depression. Yet culture appears to not affect the underlying mechanisms, i.e. existential anxiety, and the embodiment of life events.

Case report

CASE REPORT

For power data with many types, large quantities and high security requirements, data disaster recovery backup should have scalability and privacy protection. To this end, based on the characteristics of blockchain immutable, decentralized and traceable, combining it with cryptography technologies such as AONT and threshold secret sharing, a new power data disaster backup scheme is proposed, and prototype system implementation is carried out on the open source blockchain platform Ethereum. The analysis and experimental results show that the scheme can guarantee the consistency, immutability and confidentiality of backup data, and has strong scalability, which can reduce the cost of infrastructure construction and avoid the risk of single point failure.

DNA methylation plays crucial role in regulating gene expression in eukaryotic organisms. Methyl-CpG-binding domain (MBD) proteins act as readers of DNA methylation and influence gene expression. While several MBD proteins have been well characterized, the functional mechanisms of many plant MBD proteins remain unclear. In this study, we focus on elucidating the role of the Arabidopsis thaliana Methyl-CpG Binding Domain protein AtMBD1. Using AtMBD1 as bait in a yeast two-hybrid screen, we identified an interaction between AtMBD1 and the abscisic acid (ABA) receptor PYL5. This interaction was validated using BiFC (Bimolecular Fluorescence Complementation) and FRET (Fluorescence Resonance Energy Transfer) assay. Phenotypic and transcriptome analysis of atmbd1, pyl5 knock-out mutants revealed an ABA-insensitive phenotype and diminished transcriptional response to ABA. Our results establish a link between a component of the ABA signaling pathway and AtMBD1; and therefore, suggest that MBD proteins are also involved in the hormonal response to abiotic stress.

Climate change poses a direct threat to food security, with global warming leading to detrimental droughts that affect plant development and agricultural productivity. This study focused on the symbiotic relationship between plants and microorganisms, known for their pivotal role in plant adaptation to environmental stress. Strawberry plants ( Fragaria x ananassa) were inoculated with two endophytic fungi, Penicillium chrysogenum and Penicillium brevicompactum, isolated from Antarctic plants. Greenhouse experiments showed that inoculated plants had better water retention, photosynthesis, and reduced proline content and lipid peroxidation. Inoculation also boosted antioxidant activity and overall antioxidant capacity. Furthermore, a transcriptomics and cis element/transcription factor analysis revealed differentially expressed genes (DEGs) related to abscisic acid (ABA) signaling, such as dehydrins, and genes related to cellular water homeostasis such as aquaporins. The DEGs suggested an enhanced response to water stress, providing molecular insights of the potential mechanisms involved into the improved physiological performance of inoculated plants under drought and high-temperature conditions. The study underscores the importance of these molecular responses in establishing a resilient symbiotic relationship between plants and Antarctic microorganisms, offering promising avenues for further understanding and harnessing adaptive mechanisms to mitigate the impact of climate change on crop productivity.

Objective: This study aimed to evaluate the management of the COVID-19 pandemic at De Martino Public Hospital in Mogadishu, Somalia, to enhance pandemic management strategies in hospitals. Methods: In this phenomenological study, in-depth interviews were conducted with 29 key participants at De Martino Hospital, including 5 managers, 12 healthcare workers, and 12 patients. Additionally, on-site observations were carried out at the hospital. The study was conducted in 2022, and thematic content analysis was used to analyze the interview data. Results: The interviews revealed seven themes: infrastructure, prevention, communication, awareness, fear, management, and finance. The study found that the hospital generally managed the COVID-19 pandemic well. However, public awareness was deemed inadequate. Observations indicated a lack of triage procedures at the entrance. The results also highlighted a shortage of budget and poor infrastructure for COVID-19 management in the hospital. Conclusion: Effective COVID-19 pandemic management is crucial for reducing disease transmission. It is important to implement entry regulation measures, particularly screening triage procedures. Public education is needed to encourage the adoption of COVID-19 infection prevention and control practices. Additionally, sufficient funding should be allocated to ensure that hospitals have the necessary materials, equipment, and human resources for improved management of the COVID-19 pandemic.

Objectives : Allergic and infusion-related reactions represent a significant portion of reported adverse drug reactions (ADRs) at institutions providing cancer care. Insufficient documentation may result in preventable patient harm due to continued exposure to medications after known ADRs. An audit of patient health records at the study institution demonstrated notable variability in documentation practices, which served as the impetus to implement and evaluate the effectiveness of a standardized ADR documentation workflow. Methods : This multi-center, retrospective study included patients with ADRs submitted via safety reports from July 1st, 2022 to April 1st, 2023. Targeted education was provided via two online video modules, a workflow tips sheet, and an educational infographic. The primary outcome was frequency of allergy lists updated following submission of a safety event report. Secondary outcomes included frequency of standardized progress note writing, note routing, and accurate reaction type differentiation. Results : Targeted education significantly improved allergy list updating from 34.2% to 84.0% (P < 0.001), use of a standardized progress note from 47.4% to 64.2% (P = .008), and correct differentiation of reaction type from 57.7% to 76.4% (P = .02). Smaller community-based Cancer Center sites were significantly less likely to update allergy lists (7.5% vs. 24.5%, P = .017) and more likely to document incorrect reaction types (35.0% vs. 14.3%, P = .022). Conclusions : Targeted education for a standardized documentation workflow increased adherence to ADR documentation, ensuring future treatment plans are updated for patients with a history of reaction and the EHR accurately reflects ADR history.

Background Reducing infection rates has been crucial to protect healthcare workers (HCWs) during the COVID-19 pandemic. Therefore, we determined the rates and potential risk factors for SARS-CoV-2 infection in HCWs. Methods We searched MEDLINE, Embase, and Google Scholar from 1 December 2019 to 5 February 2024. The potential risk factors for SARS-CoV-2 infection in HCWs included occupational and household exposure to SARS-CoV-2; personal protective equipment (PPE) use, infection prevention and control (IPC) training; hand hygiene, aerosol generating procedures; quarantine; decontamination of high-touch areas; and working in environmental services. Odd ratios (ORs) for each risk factor were pooled from the selected studies in R. Results: From 498 initial records, 190 articles were reviewed, and 63 studies were eligible. Globally, 10% (95% confidence interval (CI): 8-12) of 279,590 HCWs were infected with SARS-CoV-2. Household exposure (OR: 7.07; 95% CI: 3.93-12.73), working as cleaner (OR: 2.72; 95% CI: 1.39-5.32), occupational exposure (OR:1.79; 95% CI: 1.49-2.14), inadequate IPC training (OR: 1.46; 95% CI: 1.14-1.87), inefficient use of PPE (OR: 1.45; 95% CI: 1.14-1.84), performing aerosol generating procedures (OR: 1.36; 95% CI: 1.21-1.52) and inadequate hand hygiene (OR: 1.17; 95% CI: 0.79-1.73) were associated with an increased SARS-CoV-2 infection. Conversely, history of quarantine and frequent decontamination of high touch areas were protective factors against SARS-CoV-2 infection (OR: 0.23; 95% CI: 0.08-0.60; and OR: 0.52; 95% CI: 0.42-0.64 respectively). These findings indicate a tiered risk of infection in HCWs. Conclusions and Relevance: We found high global SARS-CoV-2 infection rates of 10% among HCWs. Household exposures and working as cleaner were the strongest risk factors for SARS-CoV-2 infection, whereas history of quarantine and frequent decontamination of high touch areas were protective. We suggest a three-step strategy (minimising exposure and decontamination practices, IPC and aerosol-limiting procedure training, and PPE use) to mitigate the spread of SARS-CoV-2.

Optimal Timing and Feasibility of Single-Port Laparoscopic Ovarian Cystectomy on Postpartum Day Two After Vaginal DeliveryA 25-year-old woman presented at 39 weeks and 5 days of gestation, delivering vaginally at 40 weeks and 3 days. Initially, a 5 cm ovarian cyst was detected via early pregnancy ultrasound, remaining asymptomatic. Subsequent monitoring revealed an increase in cyst size to approximately 15 cm. Two days post-delivery, she underwent transumbilical single-port laparoscopic surgery, with a 2.5 cm incision at the umbilicus allowing access for cyst removal. The surgery revealed a 15 cm cyst on the left ovary and an enlarged uterus. Approximately 1500 mL of clear fluid was aspirated via a lotus suture, with the cyst wall excised and the ovary sutured under direct visualization. Immediate pathology confirmed a serous cyst. The patient recovered well and was discharged 48 hours later. Representative surgical images are provided in Fig.1.During the puerperal period, the uterus enlarges and the adnexa ascend, facilitating their extraction through the single incision. The abdominal wall laxity eases single-port enlargement, aiding in suture placement and improving cosmetic outcomes [1].Managing ovarian cysts during pregnancy involves risks of adverse outcomes, such as miscarriage or preterm labor [2]. Enlarged uterus poses challenges, increasing risks of complications like ovarian torsion and rupture, necessitating emergency interventions if managed post-delivery [3]. For asymptomatic giant ovarian cysts carried to full term, timely postpartum single-port laparoscopic surgery may be beneficial, leveraging physiological changes to reduce risks and improve surgical outcomes. These findings highlight the importance of optimal timing for surgical intervention in cases of ovarian cysts during pregnancy.