Background and objective: The fourth dose the COVID-19 vaccine was first proposed to immunocompromised patients. The aim of the article is to systematically review the literature and report the humoral response and outcomes after the fourth dose administration in people with impaired immune system.Methods: Published studies on the humoral response, efficacy and safety of the fourth dose of the COVID-19 vaccine were analyzed in various settings of immunocompromised patients. We conducted systematic searches of PubMed, Cochrane Library and WHO COVID-19 Research Database for series published through January 31, 2023, using the search terms “fourth dose” or “second booster” or “4th dose” and “Coronavirus” or “COVID-19” or “SARS-CoV-2.” All articles were selected according to the PRISMA guidelines.Results: A total of 24 articles including 2,838 patients were comprised in the systematic review. All the studies involved immunocompromised patients, including solid organ transplant recipients, patients with autoimmune rheumatic disease, patients with human immunodeficiency virus (HIV) and patients with blood cancers or diseases. Almost all patients received BNT162b2 or mRNA-1273 as fourth dose. All the studies demonstrated the increase of antibody titers after the fourth dose, both in patients who had a serological strong response and in those who had a weak response after the third dose. No serious adverse events after the 4th dose have been reported by 13 studies. COVID-19 infection after the fourth dose ranged from 0 to 21%.Conclusion: The present review highlights the importance of the fourth dose of covid-19 vaccines for immunocompromised patients. Across the included studies, a fourth dose was associated with improved seroconversion and antibody titer levels. In particular, a fourth dose was associated with increasing immunogenicity in organ transplant recipients and patients with hematological cancers, with a very low rate of serious side effects.

Background: Performing emergency surgery for bowel obstruction continues to place a significant strain on the healthcare system. Conventional assessment methods for outcomes in bowel obstruction cases often concentrate on isolated factors, and the evaluation of results for individuals with bowel obstruction remains poorly studied. This study aimed to examine the risk factors associated with major postoperative complications. Methods: We retrospectively analyzed 99 patients undergoing surgery from 2015 to 2022. We divided the patients into two groups: (1) benign-related obstruction (n = 68) and (2) cancer-related obstruction (n = 31). We used logistic regression, KNN, and XGBOOST. We calculated the receiver operating characteristic curve and accuracy of the model. Results: Colon obstructions were more frequent in the cancer group (p = 0.005). Operative time, intestinal resection, and stoma were significantly more frequent in the cancer group. Major complications were at 41% for the cancer group vs. 20% in the benign group (p = 0.03). Uni- and multivariate analysis showed that the significant risk factors for major complications were cancer-related obstruction and CRP. The best model was KNN, with an accuracy of 0.82. Conclusions: Colonic obstruction is associated with tumor-related blockage. Malignant cancer and an increase in C-reactive protein (CRP) are significant risk factors for patients who have undergone emergency surgery due to major complications. KNN could improve the process of counseling and the perioperative management of patients with intestinal obstruction in emergency settings.

Background: Immunocompromised and clinically fragile individuals are at increased risk of herpes zoster (HZ), but vaccine uptake remains low due to organizational barriers and vaccine hesitancy (VH). This study aimed to evaluate the impact of a multidisciplinary hospital-based counseling model on attitudes toward the recombinant adjuvanted zoster vaccine (RZV). The primary objective was to assess changes in VH over time using the Vaccination Attitudes Examination (VAX) scale; secondary objectives included identifying factors associated with VH, evaluating vaccine safety, and monitoring post-vaccination HZ incidence. Methods: A prospective cohort study was conducted in a large research hospital in Rome, in collaboration with the Local Health Authority. Eligible patients were offered individualized counseling and administered two doses of the RZV. VH was assessed using the 12-item VAX scale at baseline and at one-year follow-up. Multivariable linear regression analysis was performed to investigate associations between baseline characteristics and VH scores. Results: Between July 2022 and July 2023, 178 patients were enrolled, of whom 90 completed the one-year follow-up. Baseline VH was moderate (mean VAX: 2.291/6.000); higher scores were significantly associated with younger age, female sex, and rheumatologic disease (p < 0.05). After the intervention, VAX scores improved significantly across all subscales, particularly in trust in vaccine safety and benefits (p < 0.001). RZV was well tolerated; adverse events were mild and transient. Breakthrough HZ occurred in 3.33% of cases during follow-up. Conclusions: A multidisciplinary hospital-based model effectively improved vaccine attitudes and acceptance in fragile patients. Tracking VH over time with validated tools offers insights for scaling targeted interventions in high-risk groups.

Background: Increasing evidence suggests that custodial settings are at risk for the misuse of psychoactive drugs (DM) outside their prescription. The purpose of this systematic review and meta-analysis was to determine the extent of this phenomenon of psychoactive drug misuse in prisons, exploring the classes of drugs commonly used, the characteristics of inmates who are affected, and focusing on studies that have identified the phenomenon in an evidence-based manner. Methods: From January 1 2025 to June 1 2025, we reviewed the scientific literature following PRISMA guidelines. 8826 studies were analyzed, 6 met the inclusion criteria. Results: The overall rate of DM was 24%. Prisoner characteristics associated with DM included mental disorders, psychoactive substance use, and individual characteristics of prisoners. Social factors associated with DM included significant problems with the law, drug dealing, and arrests. Conclusions: The DM issue is a non-negligible public health problem in custodial settings. Related factors can be identified and preventive actions taken.