Background The consequences of the COVID-19 pandemic on physical and mental health in addition to the global economy are huge. Vaccination is a pivotal measure to decrease COVID-19 morbidity and mortality and to help bring the pandemic under control. Yet, success of the vaccination process depends on the population’s willingness to be vaccinated which may be determined by their level of knowledge about and trust in currently available COVID-19 vaccines. Therefore, this study aims to assess the knowledge, attitude, and acceptance of Palestinians towards COVID-19 vaccines. Methods A national cross-sectional study was distributed in different Palestinian regions to assess the knowledge and attitude of Palestinians toward COVID-19 vaccines using an online questionnaire, it included three sections; sociodemographic characteristics, knowledge assessment questions, and attitude assessment questions. Results A total of 6226 participants completed the questionnaire; among them, 41.36% believed that vaccines are safe, 69.02% agreed that vaccines are vital to protect from COVID-19; in addition, 55.1% approve administering the vaccine once available, and 37.86% do not believe their benefits outweigh the risks. The Source of information for 22.07% of participants in social media, while 11.92% rely on health care providers. Participants’ attitudes and knowledge were significantly affected by gender, governorate, age, education level, and marital status (P <0.001). Conclusion The findings suggest that there is good knowledge and attitude toward the vaccination process against COVID-19 in Palestine, although low acceptance was detected. Awareness campaigns are required to spread reliable knowledge about COVID-19 vaccines.

Recent evidence suggests that vaccination against influenza may reduce the clinical outcomes of COVID-19. This study looked at the link between influenza vaccination and the severity of COVID-19 infection. We searched five databases until August 2021. We included studies that reported the relationship between influenza vaccination and COVID-19 outcomes. We pooled the data as risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CIs), the data pooled using fixed and random effects models according to the heterogeneity of results. Sixteen observational studies with 191,496 COVID-19 patients were included. In terms of mechanical ventilation, our analysis showed a significant favor for the influenza vaccinated group over the non-vaccinated group (RR = 0.72, 95% CI [0.54, 0.96], P = 0.03). However, the analysis indicated no statistically significant differences between vaccinated and non-vaccinated groups in the term of mortality rate (RR = 1.20, 95% CI [0.71, 2.04], P = 0.50), hospital admissions (RR = 1.04, 95% CI [0.84, 1.29], P = 0.75), intensive care admissions (RR = 0.84, 95% CI [0.44, 1.62], P = 0.60). There were no significant differences between those who had received the influenza vaccine and those who had not in COVID-19 clinical outcomes, except for mechanical ventilation which showed a significantly lower risk in the influenza vaccinated group compared to the non-vaccinated one. However, future research is encouraged as our data have limitations, and the influenza vaccine is regularly updated. Also, this does not exclude the importance of the influenza vaccine during the COVID-19 pandemic.

Background and objective More than five million individuals died because of problems connected to COVID-19. SARS-Cov-2 poses a particular challenge to expectant mothers, who comprise one of the most vulnerable segments of the population. Our aim is to demonstrate the maternal and neonatal safety of the COVID-19 vaccine during pregnancy. Methods We searched PubMed, Cochrane Library, Scopus, Web of Science (WOS), Embase, Ovid, MedRxiv, and BioRxiv databases from inception till December 2021 and then updated it in April 2022. Additionally, we searched ClinicalTrials.gov, Research Square and grey literature. Cohort, case–control studies, and randomized controlled trials detecting the safety of the Covid-19 vaccine during pregnancy were included. We used the Cochrane tool and Newcastle–Ottawa Scale to assess the risk of bias of the included studies and the GRADE scale to assess the quality of evidence. A meta-analysis was conducted using review manager 5.4. Results We included 13 studies with a total number of 56,428 patients. Our analysis showed no statistically significant difference in the following outcomes: miscarriage (1.56% vs 0.3%. RR 1.23; 95%CI 0.54 to 2.78); length of maternal hospitalization (MD 0.00; 95%CI -0.08 to 0.08); puerperal fever (1.71% vs 1.1%. RR 1.04; 95%CI 0.67 to 1.61); postpartum hemorrhage (4.27% vs 3.52%. RR 0.84; 95%CI 0.65 to 1.09); instrumental or vacuum-assisted delivery (4.16% vs 4.54%. RR 0.94; 95%CI 0.57 to 1.56); incidence of Apgar score ≤ 7 at 5 min (1.47% vs 1.48%. RR 0.86; 95%CI 0.54 to 1.37); and birthweight (MD -7.14; 95%CI -34.26 to 19.99). Conclusion In pregnancy, the current meta-analysis shows no effect of SAR-CoV-2 vaccination on the risk of miscarriage, length of stay in the hospital, puerperal fever, postpartum hemorrhage, birth weight, or the incidence of an Apgar score of ≤ 7 at 5 min.

Background There have been varying reports on the potential occurrence and severity of changes to menstruation including the median cycle length, days of bleeding, bleeding heaviness, and menstrual pain, following receipt of COVID‐19 vaccinations. We aimed to assess potential postvaccination menstrual changes in women residing in the Middle East. Methods We implemented a cross‐sectional online survey‐based study. Data about the participants' demographic characteristics, menstruation experience, and vaccination status were collected and analyzed among six Arab countries. Results Among 4942 menstruating females included in this study, females who had received one or more doses of COVID‐19 vaccination reported a higher frequency of back pain, nausea, tiredness, pelvic pain with periods, unprescribed analgesics use, and passage of loose stools. They also reported higher scores describing average and worst menstrual pain. Fully vaccinated females reported heavier flow and more days of bleeding. Conclusion Our findings indicate that COVID‐19 vaccine may have an effect on menstruation in terms of menstrual pain and bleeding heaviness. The evidence needs to be further investigated in longitudinal studies.

Background and ObjectivesIn young people aged < 50 years, cervical artery dissection (CeAD) is among the most common causes of stroke. Currently, there is no consensus regarding the safest and most effective antithrombotic treatment for CeAD. We aimed to synthesize concrete evidence from studies that compared the efficacy and safety of antiplatelet (AP) versus anticoagulant (AC) therapies for CeAD. Methods We searched major electronic databases/search engines from inception till September 2021. Cohort studies and randomized controlled trials (RCTs) comparing anticoagulants with antiplatelets for CeAD were included. A meta-analysis was conducted using articles that were obtained and found to be relevant. Mean difference (MD) with 95% confidence interval (CI) was used for continuous data and odds ratio (OR) with 95% CI for dichotomous data. Results Our analysis included 15 studies involving 2064 patients, 909 (44%) of whom received antiplatelets and 1155 (56%) received anticoagulants. Our analysis showed a non-significant difference in terms of the 3-month mortality (OR 0.47, 95% CI 0.03-7.58), > 3-month mortality (OR 1.63, 95% CI 0.40-6.56), recurrent stroke (OR 0.97, 95% CI 0.46-2.02), recurrent transient ischaemic attack (TIA) (OR 0.93, 95% CI 0.44-1.98), symptomatic intracranial haemorrhage (sICH) (OR 0.38, 95% CI 0.12-1.19), and complete recanalization (OR 0.70, 95% CI 0.46-1.06). Regarding primary ischaemic stroke, the results favoured AC over AP among RCTs (OR 6.97, 95% CI 1. 25-38.83). Conclusion Our study did not show a considerable difference between the two groups, as all outcomes showed non-significant differences between them, except for primary ischaemic stroke (RCTs) and complete recanalization (observational studies), which showed a significant favour of AC over AP. Even though primary ischaemic stroke is an important outcome, several crucial points that could affect these results should be paid attention to. These include the incomplete adjustment for the confounding effect of AP-AC doses, frequencies, administration compliance, and others. We recommend more well-designed studies to assess if unnecessary anticoagulation can be avoided in CeAD.