Vaccine hesitancy in the US throughout the pandemic has revealed inconsistent results. This systematic review has compared COVID-19 vaccine uptake across US and investigated predictors of vaccine hesitancy and acceptance across different groups. A search of PUBMED database was conducted till 17th July, 2021. Articles that met the inclusion criteria were screened and 65 studies were selected for a quantitative analysis. The overall vaccine acceptance rate ranged from 12 to 91.4%, the willingness of studies using the 10-point scale ranged from 3.58 to 5.12. Increased unwillingness toward COVID-19 vaccine and Black/African Americans were found to be correlated. Sex, race, age, education level, and income status were identified as determining factors of having a low or high COVID-19 vaccine uptake. A change in vaccine acceptance in the US population was observed in two studies, an increase of 10.8 and 7.4%, respectively, between 2020 and 2021. Our results confirm that hesitancy exists in the US population, highest in Black/African Americans, pregnant or breastfeeding women, and low in the male sex. It is imperative for regulatory bodies to acknowledge these statistics and consequently, exert efforts to mitigate the burden of unvaccinated individuals and revise vaccine delivery plans, according to different vulnerable subgroups, across the country.

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The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94-1.00 I 2 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13-1.00 I 2 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11-0.95 I 2 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21-0.58 I 2 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00-0.37 I 2 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2-infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19-specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.

COVID-19 is a pandemic caused by SARS-CoV-2, primarily affecting the respiratory tract. Pulmonary complications of COVID-19 may include acute respiratory distress syndrome and pulmonary embolism. Pneumothorax has been recently reported in association with COVID-19. We report a case of COVID-19 pneumonia with bilateral spontaneous pneumothorax with no known underlying lung disease or risk factors.

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We read with great interest the recently published perspective "Erroneous Communication Messages on COVID-19 in Africa." In his perspective, Seytre 1 writes about the importance of miscommunication and how it affects society's attitudes. He goes on to discuss lingering mistrust generated by misinformation during the Ebola epidemic and its lasting impact on control of the COVID-19 pandemic. Social media has penetrated every sphere of our lives. Facebook, Twitter, Instagram, and blogs impact our thinking patterns, beliefs, and mental health. We concur with the author about the impact of miscommunication on society's mental, physical, and social fabric. In addition, we would like to highlight the personal toll it can take on individual members of any community. We are sharing two cases to highlight the real-world implications of social media misinformation during the current COVID-19 pandemic. Two middle-aged South Asian men of low socioeconomic status, living in separate shared housing, were exposed to COVID-19-positive contacts. Both patients presented to a designated COVID-19 treatment facility in Qatar after ingesting chemical substances. They had no past medical or psychiatric illnesses. The first man ingested about 15 mL of a surface disinfectant but did not report any symptoms. The second man experienced multiple episodes of non-bilious vomiting after ingesting approximately 100 mL of alcoholbased hand sanitizer. Apart from mild derangement in their transaminases, other laboratory tests were unremarkable. Both patients tested positive for COVID-19, and both, fortunately, had an unremarkable clinical course. These men ingested the disinfectant and sanitizer based on a firm belief that it would protect them from SARS-COV-2 infection, built on social media advice. Unvetted information is freely available on social media. Opinion pieces are perceived as facts. There has been a perpetual stream of news on the pandemic, creating a sense of urgency and anxiety. Repeated exposure to this stream of misinformation may affect the construct of external reality. This may lead to a delusion-like experience, which has been linked to anxiety and social media overuse. 2,3 Social isolation has tipped the balance of relationships and emotional connections from real to virtual for many. Indeed, we are in a virtual, long-term, emotionally charged relationship of sorts with social media. This relationship has led to a delusion-like experience, affecting multiple people separated by space and time, with social media as the common denominator. 4-6 The two described cases are just the tip of the iceberg of a "hidden epidemic" of nonevidence-based medical advice regarding COVID-19 that is rampant on social media, and not limited by geographic, religious, cultural, or socioeconomic boundaries. This "epidemic" adds to the strain of the pandemic on medical and psychological healthcare resources. It is incumbent on us to fight this social misinformation epidemic, before it turns into another pandemic.

Euglycemic diabetic ketoacidosis (EuDKA) secondary to Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2D) is a rare but increasingly reported phenomenon. Not much is known about the burden of EuDKA in patients on SGLT2i or the associated factors. This retrospective cohort study tries to delineate the differences in factors associated with the development of EuDKA as compared to hyperglycemic DKA. We conducted a multicentre, retrospective study across three tertiary care centers under Weill Cornell affiliated-Hamad Medical Corporation, Qatar. The cohort comprised of T2D patients on SGLT2i who developed DKA between January 2015 to December 2020. The differences between the subjects who developed EuDKA or hyperglycaemic DKA (hDKA) were analyzed. A total of 9940 T2D patients were on SGLT2i during 2015–2020, out of which 43 developed DKA (0.43%). 25 developed EuKDA, whereas 18 had hDKA. The point prevalence of EuDKA in our cohort was 58.1%. EuDKA was most common in patients using canagliflozin, followed by empagliflozin and Dapagliflozin (100%, 77%, and 48.3%, respectively). Overall, infection (32.6%) was the most common trigger for DKA, followed by insulin non-compliance (13.7%). Infection was the only risk factor with a significant point estimate between the two groups, being more common in hDKA patients (p-value 0.006, RR 2.53, 95% CI 1.07–5.98). Canagliflozin had the strongest association with the development of EuDKA and was associated with the highest medical intensive care unit (MICU) admission rates (66.6%). In T2D patients on SGLT2i, infection is probably associated with an increased risk of developing EuDKA. The differential role of individual SGLT2i analogs is less clear and will need exploration by more extensive prospective studies.

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