Inequities in the deployment of COVID-19 vaccine in the WHO Eastern Mediterranean Region, 2020-2021

The WHO Eastern Mediterranean Region (EMR) is characterised by a large range in routine immunisation coverage. We reviewed progress in access, deployment efforts, and use of COVID-19 vaccines in the EMR to identify bottlenecks and propose recommendations. We compiled and analysed data reported to WHO regarding the number of vaccines provided emergency use authorisation (EUA) in each country, the number of vaccine doses allocated and delivered by COVAX, the number of vaccine doses received bilaterally, the date of initiation of vaccination, vaccine usage rate and overall vaccination coverage. In June-July and October-November 2021, we conducted two rounds of a regional survey to assess vaccine acceptance and calculated the weighted proportion of individuals who would get vaccinated once a vaccine is available and recommended. We stratified the analysis according to four groups based on their participation status in COVAX, from the highest to lowest income, that is, (1) fully self-financing high-income countries (group 1), (2) fully self-financing upper middle-income countries (group 2), (3) Advance Market Commitment (AMC) countries not eligible to receive Gavi support (group 3) and (4) AMC countries eligible for Gavi support (group 4). As of 31 December 2021, the median number of vaccines provided with EUA was 6 for group 1, 11 for group 2, 8 for group 3 and 9 for group 4. On the same date, COVAX had delivered 179 793 310 doses to EMR countries. Vaccination started on 10 December 2020 in group 1, on 13 December 2020 in group 2, on 30 December 2020 in group 3 and on 20 January 2021 in group 4. The regional acceptance survey (first round) pointed to higher vaccine acceptance in group 1 (96%), than in others, including group 2 (73.9%), group 3 (78.8%) and group 4 (79.3%), with identical patterns in the second round (98%, 78%, 84% and 76%), respectively. Usage of vaccine allocated by COVAX to participating countries was 89% in group 1, 75% in group 2, 78% in group 3 and 42% in group 4. The full dose and partial dose coverage decreased with the income groups of countries, from 70% and 6% in group 1, to 43% and 8% in group 2, to 33% and 11% in group 3, and 20% and 8% in group 4. All 22 EMR countries introduced COVID-19 vaccines by 21 April 2021, but with major inequities in coverage. Additional efforts are needed to address the determinants of unequal vaccine coverage at all stages of the result chain to improve vaccine equity.

Assessment of genotoxicity risk in operation room personnel by the alkaline comet assay

This study was conducted to evaluate the possible genotoxic effects of waste anesthetic gases. Comet assay was performed on peripheral blood lymphocytes of 60 volunteers: 20 healthy unexposed office workers and 40 operation room (OR) personnel at Tanta University Hospital (Egypt). The exposed personnel were anesthetists (6 females and 7 males), surgeons (10 males), nurses (9 females), and technicians (8 males). The study revealed significantly increased comet parameters (mean comet tail length and mean percentage of DNA in the tail) in peripheral blood lymphocytes of OR personnel in comparison with control individuals. The maximum DNA damage was observed in anesthesia technicians, whereas the nurses showed the least DNA damage. Furthermore, significant difference was observed between smoker and nonsmokerOR personnel in relation to mean comet tail length. However, no significant difference was seen due to age, gender, or duration of exposure. Also, significant increase in mean percentage of tail DNA was observed in smoker individuals of both exposed and control groups. As a conclusion, this study points to the risk of DNA damage in personnel who are exposed to waste anesthetic gases.

Identification and culture of olfactory neural progenitors from GFP mice

The olfactory epithelium (OE) is one of the best sources for obtaining adult stem cells from the nervous system, because it contains neural progenitors that regenerate continuously throughout life. The OE is accessible through the nasal cavity, which facilitates stem cell harvest for examination and transplantation. The mitotic activity of OE progenitors can be stimulated by intranasal irrigation with zinc sulfate (ZnSO4). In the study reported here, we focused on OE from a transgenic mouse line transfected with green fluorescent protein (GFP). Histological examination demonstrated the site of highest yield of OE in the transgenic and wild type littermates. Cultures were established from that site four days in vitro following ZnSO4 exposure. The GFP-derived primary cultures contained a heterogeneous population of fluorescent cells. After 10-12 days, a population of round, mitotically active cells emerged that formed fluorescent neurospheres. The neurosphere forming cells (NSFCs) were collected and subcultured up to four times. The NSFCs were primarily neuronal with only a few cells of glial lineage. Furthermore, the NSFCs were nestin positive and keratin negative, suggesting that they were neural progenitors. The endogenous GFP fluorescence of these cells provides a readily identifiable label that will facilitate their identification following transplantation into nontransfected hosts. They should provide a useful model for evaluating the potential therapeutic utility of OE progenitors in neurodegenerative diseases and neurotrauma repair.

Spinal versus epidural anesthesia during transurethral resection of the prostate

The operative superiority of epidural anesthesia during transurethral resection of the prostate (TURP) stimulated this study. Twenty patients scheduled for TURP were randomly allocated to receive either spinal anesthesia (n = 10) with 8 ml bupivacaine 0.5%+ 5ml lignocaine 2%. During and after the operative procedure, PR, BP, ECG, and pulse oximetry were monitored, and blood Hb and Hct, plasma free Hb, and serum sodium and potassium levels were measured. Both techniques resulted in similar PR and BP changes. TURP with spinal anesthesia resulted in more prolonged period of hyponatremia and more increased duration of raised plasma free Hb.