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Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022

  • Mohamed Salih Mahfouz ORCID logo EMAIL logo , Maha Murtada Abdelmageed , Ahmad Y. Alqassim ORCID logo , Taif Khalid Mohammed Hakami , Maryam Mohammed Alshekh , Dalal Mohsen Ali Hamithi , Fatma Dia Haidar Alakhdar , Norah Mohammed Ayyashi and Ryof Mousa Ahmad Madkhali
Published/Copyright: October 9, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

Some changes appeared in women’s menstrual cycle after receiving the coronavirus disease 2019 (COVID-19) vaccine, but the information about the pattern and characteristics of these symptoms was unclear. This study was conducted to estimate the prevalence of menstruation change and evaluate the association between COVID-19 vaccination and the occurrence of such disturbance. An online web-based survey was conducted during March–April 2022 that targeted 729 COVID-19 vaccinated women aged between 18 and 45 years in the Jazan region of Kingdom of Saudi Arabia. The tool collected demographic information, psychological data, and COVID-19 post-vaccination side effects. The overall prevalence of menstrual change among the women was 60.9% (95% CI 57.3–64.4). 66.3% and 64.1% of women, respectively, in the age group of 25–34 and 35–45 years were more affected. Most of the detected abnormalities were related to delayed menstruation and changes in pain intensity. Menstrual disturbances that occur after immunization are transient and have no long-term implications. Menstrual disorders are prevalent before vaccination, but there is a considerable increase following vaccination. Because there is no apparent cause for these post-vaccine disturbances, and their effects are difficult to anticipate, it is preferable to warn those concerned and encourage them to learn more about the biological changes causing these problems.

Keywords: COVID-19; vaccine; menstrual disturbance; Jazan

1 Introduction

The coronavirus disease 2019 (COVID-19) outbreak emerged as a serious pandemic, murdering over 4 million people worldwide and causing huge global health concerns [1,2]. So far, in the twenty-first century, humans have gone through three fatal pandemics related to emerging coronaviruses: severe acute respiratory syndrome (SARS), Middle East respiratory disease (MERS), and COVID-19. All viruses that cause acute respiratory tract infections are highly contagious and have resulted in significant mortality rates [3]. COVID-19 is diverse from both SARS-CoV and MERS-CoV [4]. COVID-19 can adapt to a new environment through mutations and are designed to modify host tropism; consequently, the risks are ongoing and long-term [4,5,6]. There was an urgent need for safe and effective prophylactic vaccines to contain the epidemic, which had severe medical, social, and economic consequences [7].

Clinical studies produced some types of vaccination that have proven to be more than 95% effective, such as Pfizer-BioNTech, Oxford University-AstraZeneca, Moderna/NIH, and Johnson & Johnson (J&J/Janssen) [8]. Vaccines provide a biochemical reaction that mimics the real infection to elicit an immune response [9,10]. It is extremely successful in the real-world environment by decreasing infections, hospital admissions, and deaths in the months after its introduction [11]. However, many side effects of the COVID-19 vaccine were reported by healthcare workers. The symptoms most commonly reported with the Pfizer-BioTech mRNA (BNT162b2) vaccine are soreness, fatigue, myalgia, headache, chills, fever, joint pain, nausea, muscle spasm, sweating, dizziness, flushing, feelings of relief, brain fogging, anorexia, localized swelling, decreased sleep quality, itching, tingling, diarrhea, nasal stuffiness, and palpitations in some cases [12]. While symptoms shown after getting Oxford-AstraZeneca (ChAdOx1 nCoV-19) vaccines are pain at the injection site and tenderness.

Looking back on various important historical crises, such as the 2003 SARS outbreak in Asia, gender-focused investigations and analyses are frequently ignored despite its importance [13]. The gender factor has also been ignored since the rapid spread of COVID-19, particularly in research on antibodies produced by vaccination [14,15]. ‏As a precautionary measure, ‏the gender implications must be taken into account by researchers and health workers during the study and development of the vaccines [16,17]. The most important gender implications that must be studied are related to women’s reproductive [18,19]. Menstrual cycle (MC) is a cyclical change that occurs periodically in the uterine endometrium. The MC length varies widely, but on average, it lasts 28 days from the start of one period to the beginning of the next. Hormones are released in a negative and positive feedback loop to organize the MC. Depending on age, occupation, and country of residence, the prevalence of irregular menstruation ranges from 5 to 35.6%. Irregular menstruation has a negative impact on women’s mental health, productivity, and work [20–24].

During the COVID-19 pandemic, especially during the vaccination campaign, many women have observed and noted changes related to the menstrual frequency, duration, regularity, and volume by a complex interplay of hormones that interact with the immune, vascular, and coagulation systems. These interactions can influence menstrual bleeding and the severity of premenstrual symptoms. Considering that women are in a unique situation to face an epidemic, changes in the menstruation observed in a large group of women who received the vaccine have not been discussed [25].

There are some concerns about whether the COVID-19 vaccine is responsible for such changes or if it is only a response to other factors in surrounding conditions that could affect the regularity and intensity of menstruation, such as stress, anxiety, inadequate nutrition, or some drugs and diseases. The main objectives of this research are to first assess if receiving either Pfizer-BioNTech mRNA (BNT16262), Oxford-AstraZeneca (ChAdOxl nCoV-19), or Moderna/NIH vaccines is associated with menstrual change among women in Jazan region, Saudi Arabia, second to evaluate the short-term side effects following receiving either Pfizer-BioNTech MRNA (BNT16262), Oxford-AstraZeneca (ChAdOx1 nCoV-19), or Moderna/NIH vaccines among women in Jazan region, Saudi Arabia, and finally to identify different factors associated with COVID-19 vaccines among women.

2 Methods

2.1 Study design, setting, and population

An analytical cross-sectional study was conducted in the Jazan region. The region is one of the 13 administrative regions of Kingdom of Saudi Arabia (KSA), located in the southwest of the country. It has an area of about 13,457 km2 and is populated with 1,603,659 people. The study targeted women of reproductive age (18–45) who received any of the COVID-19 vaccination. Exclusion criteria involved women in the pre-pubertal or post-menopausal stage (n = 51), women who reported stress (n = 116), and women suffering from hormonal disease or any disease that may affect normal menstruation (n = 264). Women who used a certain medication associated with changes in normal menstruation were also excluded from the analysis (n = 26). A detailed description of the requirement procedure is presented in Figure 1.

Figure 1 Inclusion criteria for the study.
Figure 1

Inclusion criteria for the study.

2.2 Sampling procedures

This research’s sample size was calculated based on the statistical formula for a cross-sectional survey, which is the initial sample size = (z 2 × p [1 − p])/d 2. Since there is no estimate for the impact of the COVID-19 vaccine among women, it is safer to set the prevalence at 50%. Based on the values p = 0.5, d the desired marginal error = 0.04, z = 1.96, and after accounting for a 25% non-response rate, the final sample size increased to 750 women. We adopted a mixed design between random and non-random sampling to implement the survey. In the first stage, we randomly selected 5 governates of the 13 administrative units comprising the Jazan region. In the second stage, we initiated a snowball sampling in each selected administrative unit. Women were invited to join the study via the survey link.

2.3 Data collection method and study tool

The data were collected using an online web-based questionnaire that targeted vaccinated women between 18 and 45 years old in the Jazan region of KSA. The questionnaire for this research was designed after consulting many related research [26–29] and involved approximately 80 items. The instrument included first demographics data, including age, education, marital status, occupation, mode of living, tobacco use, weight, and height (ten questions); second, history of psychological issues, any diseases, and medications affecting normal menstruation (15 questions); third, COVID-19 vaccine uptake and post-vaccination side effects of COVID-19 like fever, tenderness at the site of injection, muscles pain, headache, lethargy (15 questions); fourth, questions on menstruation patterns before COVID-19 (20 questions); and finally, menstrual problems and their relation with COVID-19 vaccinations, which included irregular menstruation, abnormal vaginal bleeding, amenorrhea, menorrhagia, dysmenorrhea, and premenstrual symptoms, after being assessed subjectively by the participants (20 questions). Our focus is assessing the possible effect of the COVID-19 vaccine on women’s menstruation. The main outcome of this study was women with a change in cycle length (in days), the first cycle after the vaccine intake. We examined the proportion of women who experienced a significant change in cycle length, and we defined irregular menstruation as periods that occur within than 24 days or after 38 days. Face validity and internal consistency based on Cronbach’s Alpha were used to evaluate the study instrument. Experts in the field evaluated the questionnaire to assess whether the instrument’s content suited its aims. The internal consistency reliability was assessed using a small number of participants (30) through a pilot study conducted before the final implementation of the research. It produced an acceptable level of (Cronbach’s Alpha = 0.70).

2.4 Statistical analysis

The data analysis was performed using the IBM SPSS Statistics for Windows, Version, 26.0. Armonk NY: IBM Corp program. Data analysis involved descriptive statistics as well as inferential statistics. Simple tabulation, frequencies, and 95% confidence intervals (CI) were used to describe the prevalence of change in menstruation. The association between menstruation change as a result of COVID-19 and a set of categorical variables was assessed using the Chi-squared test. Logistic regression analysis was used to assess the predictors of menstruation change among the studied ladies. Odds ratios and their 95% CI were calculated for each separate predictor variable. A p value less than 0.05 was used to indicate statistical significance.

2.5 Ethics

We adopted the Ethical standard of the Saudi Bioethics Committee for conducting this research. Ethical approval was obtained from the Jazan University Ethics Committee with the reference number REC-43/05/091. Informed consent was obtained from all study participants. All information was kept confidential and used for research purposes only.

3 Results

Table 1 presents the sociodemographic and vaccine characteristic of the study participants. Most of the women were in the age group (18–24) years. The majority of the women, 583 (80.0%), had undergraduate degrees. Regarding marital status, 414 (56.8%) were single, and 294 (40.3%) were married. Employment status showed that unemployed women were 509 (69.8%). The BMI status showed that almost half of them, 331 (45.4%), are of normal weight, while only 118 (16.2%) were classified as underweight. Regarding the physical activity level, 527 (72.3%) of the participants reported that they have low physical activity, 128 (17.6%) have a moderate level of activity, and 74 (10.1%) have a high level of activity. The vaccination status showed that 275 (37.7%) of the women received two doses, and 447 (61.3%) received three doses. As for the type of vaccine received in the first dose: 563 (77.2%) reported that they received Pfizer, 157 (21.5%) received Oxford (AstraZeneca), and only 9 (1.3%) received Moderna.

Table 1

Background Characteristics of the women involved in the study (n = 729)

Characteristics N %
Age groups 18–24 years 354 48.6
25–34 years 258 35.4
35–45 years 117 16.0
Educational level Primary/intermediate 10 1.4
High school 121 16.6
Undergraduate degree 583 80.0
Postgraduate 15 2.0
Marital status Single 414 56.8
Married 294 40.3
Divorced 15 2.1
Widow 6 0.8
Work status Part-time job 56 7.7
Full-time work 164 22.5
Not working 509 69.8
BMI categories Underweight 118 16.2
Normal 331 45.4
Overweight 143 19.6
Obese 74 10.2
Not sure 63 8.6
Physical activity level Low 527 72.3
Moderate 128 17.6
High 74 10.1
Any chronic condition Yes 44 6.0
No 685 94.0
Tobacco use Yes 38 5.2
No 691 94.8
Doses of COVID-19 vaccine received Only one dose 7 1.0
Two doses 275 37.7
Three doses 447 61.3
Types of vaccine received in the first dose Pfizer 563 77.2
Oxford (AstraZeneca) 157 21.5
Moderna 9 1.3

Table 2 shows surveyed women’s MC patterns before receiving the COVID-19 vaccine. Most women displayed normal bleeding days of approximately 3–8 days (95.7%). The bleeding is moderate in density for 71.1% and heaviest for 18.9% of women. The menstrual period between each cycle and the next is between 25 and 28 days for 29.2% of the women. Women’s pain does not continue throughout the menstrual period for 64.5%, while pain is persistent for 22.1%. About 52.4% could not go to work and do their activities, while 47.5% could do so. 64.9% of them use pain relievers. Almost 51.0% of women estimate the severity of the pain accompanying their period as 3–4 grades, while 27.7% rate it as being 1–2 grades. There were no important variations in normal MC patterns between the age groups of study participants (p > 0.05 for all).

Table 2

Normal pattern of menstrual cycle before receiving the vaccine among women (n = 729)

Normal pattern Total 18–24 years 25–34 years 35–45 years p-value
Bleeding days 3–8 698 (95.7) 340 (48.7) 246 (35.2) 112 (16.1) 0.783
9–20 31 (4.3) 18 (58.1) 10 (32.2) 3 (9.7)
Bleeding density Light 45 (6.2) 17 (37.8) 23 (51.1) 5 (11.1) 0.123
Moderate 518 (71.1) 248 (47.9) 181 (34.9) 89 (17.2)
Heavy 138 (18.9) 70 (50.7) 47 (34.1) 21 (15.2)
Not sure 28 (3.8) 19 (67.9) 7 (25.0) 2 (7.1)
The period between one menstrual cycle and the next Less than 22 days 83 (11.4) 31 (37.3) 31 (37.3) 21 (25.3) 0.018
22–24 196 (26.9) 89 (45.4) 71 (36.2) 36 (18.4)
25–28 213 (29.2) 99 (46.5) 76 (35.7) 38 (17.8)
29–32 101 (13.8) 56 (55.4) 33 (32.7) 12 (11.9)
33–35 25 (3.4) 13 (52.0) 9 (36.0) 3 (12.0)
More than 35 days 2 (0.3) 0 (0.0) 1 (50.0) 1 (50.0)
Not sure 109 (15.0) 66 (60.6) 37 (33.9) 6 (5.5)
Persistence of the pain throughout the menstrual bleeding Yes 161 (22.1) 82 (50.9) 52 (32.3) 27 (16.8) 0.045
No 470 (64.5) 227 (48.3) 179 (38.1) 64 (13.6)
Not sure 98 (13.4) 45 (45.9) 27 (27.6) 26 (26.5)
The Ability to go to work or complete the normal daily activities Yes 347 (47.5) 195 (56.2) 125 (36.0) 27 (7.8) <0.001
No 382 (52.4) 160 (41.9) 133 (34.8) 89 (23.3)
Using pain relievers Yes 473 (64.9) 244 (51.6) 167 (35.3) 62 (13.1) 0.008
No 256 (35.1) 110 (43.0) 91 (35.5) 55 (21.5)
The severity of the pain accompanying the period 0 29 (4.0) 10 (34.5) 10 (34.5) 9 (31.0) <0.001
1–2 202 (27.7) 75 (37.1) 80 (39.6) 47 (23.3)
3–4 372 (51.0) 188 (50.5) 130 (34.9) 54 (14.6)
5–6 126 (17.3) 81 (64.3) 38 (30.1) 7 (5.6)

Table 3 shows the prevalence of reported MC changes after receiving the vaccine among the study participants. The overall prevalence of menstrual change among the women was 60.9% (95% CI 57.3–64.4). The table further documented a constant pattern of menstruation change among the study participants (p > 0.05), except for age and educational level (p < 0.05). Regarding the type of vaccine, 60.6% of those who took Pfizer, 61.1% of those who took Oxford (AstraZeneca), and 77.8% of those who took the Moderna vaccine reported MC changes.

Table 3

Prevalence of reported MC changes after receiving the vaccine among women (n = 729)

Women with response Yes p-value
N % 95% CI
Characteristics Lower Upper
Age groups 18–24 years 198 55.9 50.7 61.0 0.026
25–34 years 171 66.3 60.4 71.8
35–45 years 75 64.1 55.2 72.4
Educational level Primary/intermediate 4 40.0 15.3 69.6 0.003
High School 65 53.7 44.8 62.4
Undergraduate degree 371 63.6 59.7 67.5
Postgraduate 4 26.7 9.7 51.7
Marital status Single 244 58.9 54.1 63.6 0.353
Married 184 62.6 57.0 68.0
Divorced 11 73.3 48.3 90.3
Widow 5 83.3 44.2 98.1
Work status Part-time job 37 66.1 53.1 77.4 0.556
Full-time work 103 62.8 55.2 69.9
Not working 304 59.7 55.4 63.9
BMI categories Underweight 73 61.9 52.9 70.3 0.661
Normal 200 60.4 55.1 65.6
Overweight 95 66.4 58.4 73.8
Obese 47 63.5 52.2 73.8
Physical activity level Low 312 59.2 55.0 63.3 0.279
Moderate 82 64.1 55.5 72.0
High 50 67.6 56.4 77.4
Any chronic condition Yes 31 70.5 56.0 82.3 0.181
No 413 60.3 56.6 63.9
Tobacco use Yes 22 57.9 42.1 72.5 0.696
No 422 61.1 57.4 64.7
Doses of COVID-19 vaccine received Only one dose 3 42.9 13.9 76.5 0.505
Two doses 172 62.5 56.7 68.1
Three doses 269 60.2 55.6 64.6
Types of vaccine received in the first dose Pfizer 341 60.6 56.5 64.5 0.575
Oxford (AstraZeneca) 96 61.1 53.4 68.5
Moderna 7 77.8 45.6 95.1
Overall Prevalence 444 60.9 57.3 64.4

Table 4 illustrates the pattern and characteristics of MC change among study participants. According to the Table, 41.8% of the women reported delay in menstruation compared with the normal pattern, while 22.9% reported early menstruation. Approximately one-quarter (23.7%) of the women stated that the bleeding density became less dense and lumpy. Those who did not notice any changes in the normal pattern of bleeding days were 64.5%. Women who noticed changes in menstrual pain intensity were 38.6%. Almost 28.3% of the women stated that these changes lasted more than 2 months after receiving the vaccine. There were no significant differences in patterns and characteristics of menstruation change according to participants’ age groups for all variables in the Table (p > 0.05 for all), except for bleeding density and period of changes (p < 0.05 for both).

Table 4

Pattern and characteristics of MC change among women (n = 729)

Characteristics All women 18–24 years 25–34 years 35–45 years p-value
Changes in the period between one menstrual cycle and the next Delay Yes, for a week 148 (20.3) 72 (48.6) 50 (33.8) 26 (17.6) 0.543
Yes, for 2 weeks 65 (8.9) 36 (55.4) 22 (33.8) 7 (10.8)
Yes, for 3 weeks 16 (2.2) 10 (62.5) 4 (25.0) 2 (12.5)
Yes, for a month 38 (5.2) 18 (47.4) 16 (42.1) 4 (10.5)
Yes, for more than a month 38 (5.2) 13 (34.2) 15 (39.5) 10 (26.3)
No, there was no noticeable delay 424 (58.2) 205 (48.3) 151 (35.6) 68 (16.1)
Early By a week 126 (17.3) 51 (40.5) 53 (42.1) 22 (17.4) 0.158
By 3 weeks 41 (5.6) 19 (46.3) 12 (29.3) 10 (24.4)
No change 562 (77.1) 284 (50.5) 193 (34.4) 85 (15.1)
Changes in bleeding density It became denser and lumpier 164 (22.5) 67 (40.9) 62 (37.8) 35 (21.3) <0.001
It became less dense and lumpy 173 (23.7) 73(42.2) 76(43.9) 24(13.9)
No changes 224 (30.7) 110 (49.1) 74 (33.0) 40 (17.9)
Not sure 168 (23.1) 104 (61.9) 46 (27.4) 18 (10.7)
Changes in the normal pattern of bleeding days Yes 148 (20.3) 55 (37.2) 60 (40.5) 33 (22.3) 0.003
No 470 (64.5) 232 (49.4) 164 (34.9) 74 (15.7)
Not sure 111 (15.2) 67 (60.4) 34 (30.6) 10 (9.0)
Persistence of pain throughout the menstrual bleeding Yes 163 (22.4) 79 (48.5) 50 (30.7) 34 (20.8) 0.183
No 566 (77.6) 275 (48.6) 208 (36.7) 83 (14.7)
Using pain relievers Yes 378 (51.8) 185 (48.9) 138 (36.5) 55 (14.6) 0.184
No 351 (48.2) 169 (48.1) 120 (34.2) 62 (17.7)
Changes in premenstrual syndrome Pain below the umbilical and hips Yes 380 (52.1) 201 (52.9) 130 (34.2) 49 (12.9) 0.006
No 349 (47.9) 153 (43.8) 128 (36.7) 68 (19.5)
Pain in the feet and thigh Yes 283 (38.8) 145 (51.2) 102(36.1) 36(12.7) 0.060
No 446 (61.2) 209(46.9) 156(35.0) 81 (18.1)
Nausea and fatigue Yes 331 (45.4) 167 (50.5) 115 (34.7) 49(14.8) 0.374
No 398 (54.6) 187 (47.0) 143 (35.9) 68 (17.1)
Numbness of the extremities Yes 175 (24.00) 93 (53.1) 56 (32.0) 26 (14.9) 0.468
No 554 (76.0) 261 (47.1) 202 (36.5) 91 (16.4)
Change in the intensity of menstrual pain than usual Got more intense 239 (32.8) 113 (47.3) 86 (36.0) 40 (16.7) 0.360
Became less severe 42 (5.8) 20 (47.6) 15 (35.7) 7 (16.7)
No change 307 (42.1) 151 (49.2) 102 (33.2) 54 (17.6)
Not sure 141 (19.3) 70 (49.6) 55 (39.0) 16 (11.4)
How many months did these changes last? Only in the first month after receiving the vaccine 100 (13.7) 51 (51.0) 32 (32.0) 17 (17.0) 0.019
For 2 months after receiving the vaccine 63 (8.6) 30 (47.6) 27 (42.9) 6 (9.5)
More than 2 months after receiving the vaccine 206 (28.3) 80 (38.8) 88 (42.7) 38 (18.5)
Not sure 360 (49.4) 193 (53.6) 111 (30.8) 56 (15.6)

Table 5 illustrates the short-term side effects of the COVID-19 vaccine among study participants. Women who reported mild and moderate symptoms were 41.8% and 42.7%, respectively, while only 5.1% suffered severe symptoms. Regarding other symptoms associated with the vaccine are as follows: 51.2% of women reported redness and swelling at the injection site. Muscle pain was reported by 78.7%, while 63.1% did not report coldness paresthesia of the extremities. Almost 79.4% of the women felt tiredness and fatigue following the vaccination. Approximately 47.4% reported that their sleep quality changed significantly, 54.5% reported high temperature, and two-thirds (64.9%) experienced a headache. No significant differences were reported in short-term symptoms according to the age groups of study participants (p > 0.05 for all).

Table 5

Short-term side effects of COVID-19 vaccine among women (n = 729)

Side effects of COVID-19 vaccine Total 18–24 years 25–34 years 35–45 years p value
Degree of the symptoms after receiving the vaccine Mild symptoms 305 (41.8) 153 (50.2) 105 (34.4) 47 (15.4) 0.899
Moderate symptoms 311 (42.7) 148 (47.6) 111 (35.7) 52 (16.7)
Severe symptoms 37 (5.1) 15 (40.5) 14 (37.8) 8 (21.7)
No 76 (10.4) 38 (50.0) 2 (36.8) 10 (13.2)
Symptoms that have been observed Redness and swelling at the injection site Yes 373 (51.2) 181 (48.5) 128 (34.3) 64 (17.2) 0.659
No 356 (48.8) 173 (48.6) 130 (36.5) 53 (14.9)
Muscle pain Yes 574 (78.7) 276 (48.1) 207 (36.1) 91 (15.8) 0.765
No 155 (21.3) 78 (50.3) 51 (32.9) 26 (16.8)
Coldness and paresthesia of the extremities Yes 269 (36.9) 139 (51.7) 87 (32.3) 43 (16.0) 0.373
No 460 (63.1) 215 (46.7) 171 (37.2) 74 (16.1)
Tiredness and fatigue Yes 579 (79.4) 280 (48.4) 207 (35.7) 92 (15.9) 0.918
No 150 (20.6) 74 (49.3) 51 (34.0) 25 (16.7)
Change in sleep quality Yes 348 (47.7) 176 (50.6) 122 (35.0) 50 (14.4) 0.417
No 381 (52.3) 178 (46.7) 136 (35.7) 67 (17.6)
High temperature Yes 397 (54.5) 191 (48.1) 145 (36.5) 61 (15.4) 0.738
No 332 (45.5) 163 (49.1) 113 (34.0) 56 (16.9)
Headache Yes 473 (64.9) 234 (49.5) 165 (34.9) 74 (15.6) 0.792
No 256 (35.1) 120 (46.9) 93 (36.3) 43 (16.8)

Univariate logistic regression analysis was conducted with “reported menstrual cycle changes after receiving the vaccine” as a dependent variable and a set of predictors that were assumed to be associated with this change. The analysis revealed that women in the age group of 25–34 years were significantly affected by this change (Crude odds ratio (COR) = 1.55, 95% CI = 1.11–2.16, p < 0.05) than women in the age group of 18–24. Doses of the COVID-19 vaccine received were also associated with a change in menstruation (COR = 2.23 for two doses and COR = 2.01) but with no statistical significance (p > 0.05) (Table 6).

Table 6

Predictors of menstruation change among the studied women based on univariate logistic Regression analysis

COR 95% CI p-value
Variable Lower Upper
Age groups (years) 18–24 REF
25–34 1.55 1.11 2.16 0.010
35–45 1.41 0.91 2.17 0.121
Educational level Primary/intermediate REF
High school 1.74 0.47 6.48 0.408
Undergraduate degree 2.63 0.73 9.41 0.138
Postgraduate 0.55 0.10 3.00 0.486
Marital status Single REF
Married 1.17 0.86 1.58 0.328
Divorced/widow 2.23 0.80 6.20 0.125
BMI categories Underweight REF
Normal 0.94 0.61 1.45 0.94
Overweight 1.22 0.73 2.03 1.22
Obese 1.07 0.59 1.96 1.07
Doses of COVID-19 vaccine received Only one dose REF
Two doses 2.23 0.49 10.15 0.301
Three doses 2.01 0.45 9.11 0.363

Abbreviations: REF = references; COR = crude odds ratio; CI = confidence interval.

4 Discussion

Although menstruation is generally not static and characterized by its variable nature from month to month across women’s reproductive lifespan, there was an increase. There were increasing concerns that COVID-19 vaccines could potentially affect the MC in women. This topic was highlighted due to the increase in complaints from some women and the reluctance of others to get immunized against the COVID-19 after realizing that the vaccine might affect the MC. Initially, this was reported by The Times newspaper, and the Medicines and Healthcare Products Regulatory Agency in the United Kingdom received nearly 4,000 reports of changes in women’s MC after receiving the COVID-19 vaccine by 17 May 2021 [30]. Male (2021) argued the possibility of a relationship between menstrual changes and receiving the COVID-19 vaccine. She also urged studies to be conducted on this topic after more than 30,000 women reported changes in their menstruation after receiving the vaccine. She notes that most women who notice changes in their MC report that things are usually back to normal by the next period [25].

In a cross-sectional study, this study investigated the prevalence of several menstrual disturbances associated with COVID-19 vaccination. The study enrolled a total of 729 women from the Jazan region between the ages of 18 and 45. As per our research, 60.9% of women had menstrual changes after receiving the COVID-19 vaccination. However, these changes do not last for long-term periods, which makes us consider that this study helps reassure many women. This outcome did not differ from many reports documenting the vaccine’s relationship and temporary menstrual disturbances. Alvergne et al. reported that only 18% of women reported MC changes after the first COVID-19 vaccine, which was considered a “very common” adverse event by the international pharmacovigilance standards [31]. Research conducted in the MENA region concluded that 86.8% of cases returned to a normal pattern in less than a month of vaccination, indicating that vaccine adverse effects are self-limiting [32].

Our research also concluded that most of the observed disturbances revolved around delay in menstruation (41.8%) and changes in pain intensity (38.6%). Almost 32.8% of the ladies had more severe menstrual pain, and 5.8% became less severe. Our research documented the persistence of pain throughout the menstrual bleeding for 22.4%, changes in blood density in most of the participants (46.2%), and an increase in the number of bleeding days for 20.3%. A study by Schoep et al. reported that 53.7% of healthy premenopausal Dutch women complained of excessive bleeding, 77.3% complained of psychological problems, and 85.4% complained of menstrual cramps [33]. These complaints were explained by several factors that could be transient such as infection, weight gain, anxiety, prolonged periods of psychological or physical stress, and endocrine diseases. All these factors may lead to the activation of the hypothalamic–pituitary–gonadal axis, disrupting the regularity of hormone secretion [34,35]. Our results were consistent with a large, well-designed study conducted in the United States, including 23,754 women, which also found delays following the vaccination dose [36]. In this regard, it should be mentioned that MC irregularities may occur not only after COVID-19 vaccination but also during/after covid infection. A recent meta-analysis [37] suggests that changes in menstrual volume and length are more associated with SARS-CoV-2 infection.

We studied the changes in the MC according to the age group and found that the age group most affected by the vaccine was between 25 and 34. In general, younger people and women have higher immunological responses than older people and men [38]. As a result, they are more likely to experience more severe side effects [39]. Several studies confirm this: In the research conducted in the Czech Republic proved that in younger people and females, a history of COVID-19 infection and comorbidities were identified as risk factors for developing side effects after COVID-19 vaccination. In addition to that, young people are more likely to develop side effects for the Pfizer vaccine [40]. Vaccine doses have a minor impact on the incidence of menstrual changes, with 42.9% in the first dose, 62.5% in the second, and 60.2% in the third. A study in Italy suggested that menstrual irregularities are slightly higher (60–70%) after the second dose [41].

COVID-19 represented a new challenge for obstetricians due to the lack of scientific evidence that could help in the different domains of reproduction and complex clinical cases [42]. Moreover, clinical trials of the current COVID-19 vaccines did not collect MC outcomes postvaccine [43]. The mechanism through which the vaccines cause menstrual symptoms is unknown. However, there is a possibility that the immune reaction is responsible for such changes. Vaccines create an immunological response that can influence the hypothalamic–pituitary–ovarian axis [42,43,44]. One of the famous hypotheses is that immune activation may transiently interfere with the hypothalamic–pituitary–adrenal axis by promoting the fluctuation of sex hormones through the positive and negative feedback loop of hormones that regulate the MC. Hypothalamic‐pituitary‐ovarian is also vulnerable to stress (e.g., poor sleep, environment, and high levels of psychological and physical stress), which results in alterations in hormonal pulsation mechanisms and MC length [45]. Based on this hypothesis and according to the World Health Organization, vaccination will increase psychological and physical stress through some of its negative effects, such as injection site pain, which is the most common local side effect, and fever, fatigue, headache, muscle aches, and joint pain, which are the most common systemic side effects [46]. As a result, we could expect menstrual alterations to be more common in people with common side effects.

Our research also focused on analyzing the general symptoms associated with the immune reaction after taking the vaccine. We found that the results were similar to other studies from Iraq and Wuhan. In Iraq, among 1,012 participants, 850 (84%) were symptomatic, and 162 (16%) were asymptomatic. The most common symptoms were: fatigue (58.1%), local injection site reactions (58%), fever (57.8%), myalgia and muscle pain (46.2%), headache (40.4%), and chills (21.4%) [47]. Similarly, Wuhan’s research found that vaccination induces fever, fatigue, headache, and muscular discomfort in vaccinated people [48]. In another hypothesis, it may be due to immune-mediated vaccine-induced thrombocytopenia. Many additional vaccines, including MMR, hepatitis A and B, diphtheria-tetanus-acellular pertussis, varicella, and even influenza, have previously been related to vaccine-induced thrombocytopenia, which can cause menstrual abnormalities [49], especially with the AstraZeneca where 6 women out of 220 people tested had high D-dimer. The test determines the likelihood of a blood clot [50]. The female gender was revealed to be a significant risk factor for high D-dimer, which was predominantly detected in women aged 55 and younger [51]. Vaccine-induced thrombotic thrombocytopenia is a rare AstraZeneca occurrence pathologically identical to heparin-induced thrombocytopenia. This is the outcome of a platelet-stimulating antibody against platelet factor 4 causing immunological thrombocytopenia [52,53].

4.1 Strength and limitations

Numerous recommendations have been made to conduct research on the topic, as several women have reported alterations in their MCs after receiving the COVID-19 vaccine. As of December 2022, few studies have been published on the relationship between COVID-19 vaccines and changes in the MC. We conducted this research as the first study in the Jazan region and Saudi Arabia, hoping that the results will help with proper counseling and vaccine awareness among women. The research has some limitations: first, the presence of recall bias for the information that occurred in the past. Second, this research explains the possible association but does not study the inevitable cause, and there are some other influencing factors (confounders). Third, the analysis was conducted without differentiating the type of vaccine and without correlating menstrual changes with the administration of the first or second dose. As a result, it is important to interpret the findings of our study with caution. Further research is highly recommended to overcome these limitations. The observed changes were only found in a group of vaccinated women and may lead some women to decline COVID-19 vaccinations.

5 Conclusion

In conclusion, we documented MC irregularities among a large segment of vaccinated women. Around 35.4% of women had no changes in their MC after immunization, while the rest of the participants had these changes. The occurrence of menstrual disturbances after vaccinations, in most cases, self-resolved within 2 months, without clinically relevant consequences. Menstrual disturbances were prevalent before vaccination, but we found a significant rise in menstrual irregularities after vaccination, especially in the case of hemorrhaging greater than normal, longer duration, and pain. As previously mentioned, these findings need further research. Based on the large number of women who initiate COVID-19 vaccines, it will be necessary to understand the underlying biological mechanisms. Also, it is essential to alert healthcare professionals and women about menstrual irregularities after the COVID-19 vaccination.

Acknowledgements

We extend our gratitude to all the women who have generously given their time to participate in this study.

  1. Funding information: This research received no external funding.

  2. Author contributions: M.S.M., A.Y.A., and M.M.A. designed the research and supervised the project. T.K.M.H., M.M.A., D.M.A.H., F.D.H.A., N.M.A., and R.M.A.M. participated in the study design, recruited the subjects, and collected and managed data collection. M.S.M. analyzed the data. The article was written by M.S.M, T.K.M.H., M.M.A., D.M.A.H., F.D.H.A., N.M.A., R.M.A.M., and M.M.A.A., and revised by A.Y.A. and M.M.A.A. All authors approved the final version of the manuscript.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Received: 2022-12-31
Revised: 2023-07-20
Accepted: 2023-08-31
Published Online: 2023-10-09

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2023-0804
Keywords for this article
COVID-19; vaccine; menstrual disturbance; Jazan
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
  51. TMT-based comprehensive proteomic profiling identifies serum prognostic signatures of acute myeloid leukemia
  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
  71. circ_0004904 regulates the trophoblast cell in preeclampsia via miR-19b-3p/ARRDC3 axis
  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
  84. Circular RNA Circ_0038467 promotes the maturation of miRNA-203 to increase lipopolysaccharide-induced apoptosis of chondrocytes
  85. An economic evaluation of fine-needle cytology as the primary diagnostic tool in the diagnosis of lymphadenopathy
  86. Midazolam impedes lung carcinoma cell proliferation and migration via EGFR/MEK/ERK signaling pathway
  87. Network pharmacology combined with molecular docking and experimental validation to reveal the pharmacological mechanism of naringin against renal fibrosis
  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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