The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis

COVID-19 and hookah smoking cessation among women in Southern Iran: A cross-sectional study

Hookah smoking does not only transmit COVID-19 but also intensifies the symptoms of the disease. Thus, the present research aimed to explore the association between COVID-19 and hookah cessation among female smokers. The institutional-based cross-sectional study was conducted nine months after the onset of the COVID-19 pandemic. Face-to-face interviews were held between November 2020 and January 2021 to explore the pattern of hookah smoking among 561 female hookah smokers in Bandar Abbas in the south of Iran. The daily, weekly and monthly rates of hookah smoking showed a statistically significant decrease in the during COVID-19 era (p < .001). Thirteen percent of women managed to cease hookah smoking successfully during the pandemic. The odds ratio of hookah cessation was higher in single women (95% CI 1.09-5.23) as well as women with a high socioeconomic status (SES) (95% CI 4.28-24.01). It was also higher among women who initiated hookah smoking at an older age (95% CI 29-68) and among those with no hookah smoking family member (95% CI 301- 943). Fear of COVID-19 infection was the leading factor involved in hookah cessation or reduction. Entertainment was the leading barrier to successful hookah cessation behavior. It is believed that COVID-19 has directly and indirectly contributed to the reduced or ceased hookah smoking behavior. One of the reasons for the reduction of hookah smoking was the fear of aggravated symptoms and reasons for cessation included closure of coffee shops and removal of all hookahs from the city.

The Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in COPD and Non-COPD Cohorts

Patients with chronic obstructive pulmonary disease (COPD) infected with SARS-CoV-2 indicate a higher risk of severe COVID-19 course, which is defined as the need for hospitalization in the intensive care unit, mechanical ventilation, or death. However, simple tools to stratify the risk in patients with COPD suffering from COVID-19 are lacking. The current study aimed to evaluate the predictive value of the C2HEST score in patients with COPD. A retrospective analysis of medical records from 2184 patients hospitalized with COVID-19 at the University Hospital in Wroclaw from February 2020 to June 2021, which was previously used in earlier studies, assessed outcomes such as mortality during hospitalization, all-cause mortality at 3 and 6 months, non-fatal discharge, as well as adverse clinical incidents. This re-analysis specifically examines the outcomes using a COPD split. In the COPD group, 42 deaths were recorded, including 18 in-hospital deaths. In-hospital mortality rates at 3 and 6 months did not significantly differ among C2HEST strata, nor did their impact on subsequent treatment. However, a notable association between the C2HEST score and prognosis was observed in the non-COPD cohort comprising 2109 patients. The C2HEST score's predictive ability is notably lower in COPD patients compared to non-COPD subjects, with COPD itself indicating a high mortality risk. However, C2HEST effectively identifies patients at high risk of cardiac complications during COVID-19, especially in non-COPD cases.

The impact of comorbidity status in COVID-19 vaccines effectiveness before and after SARS-CoV-2 omicron variant in northeastern Mexico: a retrospective multi-hospital study

Introduction

The end of the coronavirus disease 2019 (COVID-19) pandemic has been declared by the World Health Organization on May 5, 2023. Several vaccines were developed, and new data is being published about their effectiveness. However, the clinical trials for the vaccines were performed before the Omicron variant appeared and there are population groups where vaccine effectiveness still needs to be tested. The overarching goal of the present study was to analyze the effects of COVID-19 vaccination before and after the Omicron variant in patients considering comorbidities in a population from Nuevo Leon, Mexico.

Methods

Epidemiological COVID-19 data from the Mexican Social Security Institute were collected from 67 hospitals located in northeastern Mexico, from July 2020 to May 2023, and a total of 669,393 cases were compiled, 255,819 reported a SARS-CoV-2 positive reverse transcription quantitative polymerase chain reaction (RT-qPCR) test or a positive COVID-19 antigen rapid test.

Results

Before Omicron (BO, 2020-2021), after 14 days of two doses of COVID-19 vaccine, BNT162b2 and ChAdOx1 vaccines were effective against infection in non-comorbid and all comorbid subgroups, whereas after Omicron (AO, 2022- 2023) there was no significant effectiveness against infection with none of the vaccines. Regarding hospitalization BO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 significantly protected non-comorbid patients whereas BNT162b2, ChAdOx1, and mRNA-1273, protected all comorbid subgroups against hospitalization. AO, BNT162b2, ChAdOx1, CoronaVac and mRNA-1273 were effective against hospitalization in non-comorbid patients whereas for most comorbid subgroups BNT162b2, ChAdOx1 and CoronaVac were effective against hospitalization. Non-comorbid patients were protected against death as an outcome of COVID-19 during the BO period with most vaccines whereas a reduction in effectiveness was observed AO with mRNA-1273 vaccines in patients with hypertension, and diabetes mellitus.

Discussion

BO, COVID-19 vaccines were effective against infection, hospitalization, and death whereas AO, COVID-19 vaccines failed to protect the population from COVID-19 infection. A varying effectiveness against hospitalization and death is observed AO.

Assessing the impact of long-term inhaled corticosteroid therapy on patients with COVID-19 and coexisting chronic lung disease: A multicenter retrospective cohort study

Background

Patients with chronic lung disease (CLD), such as asthma or chronic obstructive pulmonary disease, were expected to have an increased risk of clinical manifestations and severity of COVID-19. However, these comorbidities have been reported less frequently than expected. Chronic treatment with inhaled corticosteroids (ICS) may impact the clinical course of COVID-19. The main objective of this study is to know the influence of chronic treatment with ICS on the prognosis of COVID-19 hospitalized patients with CLD.

Methods

A multicenter retrospective cohort study was designed, including patients hospitalized with COVID-19. Epidemiological and clinical data were collected at admission and at seven days, and clinical outcomes were collected. Patients with CLD with and without chronic treatment with ICS were compared.

Results

Two thousand five hundred ninety-eight patients were included, of which 1,171 patients had a diagnosis of asthma and 1,427 of COPD (53.37% and 41.41% with ICS, respectively). No differences were found in mortality, transfer to ICU, or development of moderate-severe ARDS. Patients with chronic ICS had a longer hospital stay in both asthma and COPD patients (9 vs. 8 days, p = 0.031 in asthma patients), (11 vs. 9 days, p = 0.018 in COPD patients); although they also had more comorbidity burden.

Conclusions

Patients with chronic inhaled corticosteroids had longer hospital stays and more chronic comorbidities, measured by the Charlson comorbidity index, but they did not have more severe disease at admission, evaluated with qSOFA and PSI scores. Chronic treatment with inhaled corticosteroids had no influence on the prognosis of patients with chronic lung disease and COVID-19.

Eosinophils and chronic obstructive pulmonary diseases (COPD) in hospitalized COVID-19 patients

BACKGROUND

The emergence of coronavirus disease 2019 (COVID-19) as a global health emergency necessitates continued investigation of the disease progression. This study investigated the relationship between eosinophilia and the severity of COVID-19 in chronic obstructive pulmonary disease (COPD) patients.

METHODS

This cross-sectional study was conducted on 73 COPD patients infected by COVID-19 in Afzalipour Hospital, Iran. Peripheral blood samples were collected for hematological parameter testing, including eosinophil percentage, using Giemsa staining. Eosinophilia was defined as≥ 2% and non-eosinophilia as< 2%. The severity of pulmonary involvement was determined based on chest CT severity score (CT-SS) (based on the degree of involvement of the lung lobes, 0%: 0 points, 1-25%: 1 point, 26-50%: 2 points, 51-75%: 3 points, and 76-100%: 4 points). The CT-SS was the sum of the scores of the five lobes (range 0-20).

RESULTS

The average age of patients was 67.90±13.71 years, and most were male (54.8%). Non-eosinophilic COPD patients were associated with more severe COVID-19 (P= 0.01) and lower oxygen saturation (P= 0.001). In addition, the study revealed a significant difference in the chest CT severity score (CT-SS) between non-eosinophilic (9.76±0.7) and eosinophilic COPD patients (6.26±0.63) (P< 0.001). Although non-eosinophilic COPD patients had a higher mortality rate, this difference was not statistically significant (P= 0.16).

CONCLUSIONS

Our study demonstrated that reduced peripheral blood eosinophil levels in COPD patients with COVID-19 correlate with unfavorable outcomes. Understanding this association can help us identify high-risk COPD patients and take appropriate management strategies to improve their prognosis.

High prevalence of SARS-Coronavirus-2 in patients with inflammatory bowel disease and the role of soluble angiotensin converting Enzyme2

Context: Patients with inflammatory bowel disease (IBD) were found to have the higher intestinal expression of Angiotensin-Converting Enzyme2 (ACE2) that could consequently increase susceptibility to COVID-19 infection.Objective: This study reports the outcomes of COVID-19 infection in a large cohort of IBD patients. We compare levels of serum ACE and IFN-α between COVID19 patients with and without IBD. We performed a cross-sectional retrospective multicenter study.Methods: We enrolled patients with IBD screened for SARS-COV-2 in six medical centres in Iran from June to November 2020. The blood samples were drawn to measure COVID-19 IgM and IgG, and serum levels of sACE2, sACE1, and interferon-α, regardless of suspicious symptoms have done the molecular test.Results: A total of 534 IBD patients were included in the study. Of these, 109 (20.0%) cases had detectable IgG and IgM against SARS-CoV-2. sACE2 levels were higher in IBD patients than controls, whereas ACE1and IFN-α levels were similar among groups.

The Prevalence and Determinants of Hesitancy for Regular COVID-19 Vaccination among Primary Healthcare Patients with Asthma or COPD in Greece: A Cross-Sectional Study

The emergence of novel coronavirus mutations and signs of the waning immunity provided by COVID-19 vaccines underscore the importance of regular vaccination. This study aimed to investigate the prevalence of regular COVID-19 vaccination hesitancy and the factors that influence it among patients with asthma or chronic obstructive pulmonary disease (COPD) who visited primary care centers. The cross-sectional study was conducted in six primary healthcare centers in Crete, Greece (October-December 2023). Participants completed a questionnaire, which included questions about socio-demographic characteristics, health status, previous COVID-19 booster vaccination, attitudes, and beliefs about COVID-19 vaccination. Multivariate logistic regression was used to identify the factors that influenced vaccine hesitancy. Of the 264 participants, 65% exhibited hesitancy towards COVID-19 booster vaccination. Female gender, middle age, lower educational attainment, depression diagnosis, concerns about vaccine side effects, lack of confidence in vaccine efficacy, and reliance on media information were positively associated to vaccine hesitancy. Conversely, those having a cardiovascular disease or type 2 diabetes, those generally adhering to the recommendations of the treating physician, and those having previously received the flu vaccine or more than three COVID-19 vaccine doses were positively associated with regular COVID-19 vaccinations. Consequently, our findings could help develop strategies that could potentially reduce regular vaccination hesitancy among patients with asthma or COPD.

SARS-CoV-2 outbreak: role of viral proteins and genomic diversity in virus infection and COVID-19 progression

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is the cause of coronavirus disease 2019 (COVID-19); a severe respiratory distress that has emerged from the city of Wuhan, Hubei province, China during December 2019. COVID-19 is currently the major global health problem and the disease has now spread to most countries in the world. COVID-19 has profoundly impacted human health and activities worldwide. Genetic mutation is one of the essential characteristics of viruses. They do so to adapt to their host or to move to another one. Viral genetic mutations have a high potentiality to impact human health as these mutations grant viruses unique unpredicted characteristics. The difficulty in predicting viral genetic mutations is a significant obstacle in the field. Evidence indicates that SARS-CoV-2 has a variety of genetic mutations and genomic diversity with obvious clinical consequences and implications. In this review, we comprehensively summarized and discussed the currently available knowledge regarding SARS-CoV-2 outbreaks with a fundamental focus on the role of the viral proteins and their mutations in viral infection and COVID-19 progression. We also summarized the clinical implications of SARS-CoV-2 variants and how they affect the disease severity and hinder vaccine development. Finally, we provided a massive phylogenetic analysis of the spike gene of 214 SARS-CoV-2 isolates from different geographical regions all over the world and their associated clinical implications.

COVID-19 among lung cancer patients: Data from a real-life prospective French multicentric study

BACKGROUND

COVID-19 started to spread early in 2020, the precise year that lung cancer (LC) patients were recruited into the prospective epidemiological cohort KBP-2020-CPHG in French hospitals. This provides a unique opportunity to study COVID-19 incidence, survival risk factors, and overall prognosis.

METHODS

COVID data was collected before vaccination was made available. Clinical characteristics were compared (COVID vs non-COVID), incidence rate ratios were calculated based on clinical characteristics, survival (1 and 3 months) was estimated and the impact of COVID-19 on the overall prognosis of the cohort was studied.

RESULTS

In 2020, 285 out of 8,999 lung cancer patients were diagnosed with COVID-19. Diagnosis was mainly based on PCR tests (86.3 %). The annual incidence was 8.3 % (95 % CI [7.4, 9.3]); it was higher in former smokers and patients with squamous cell carcinoma or small cell carcinoma than in those with adenocarcinoma, in those with a PS score ≥2 versus 0-1, and with stages III-IV versus stages I-II. The incidence was reduced in patients who received chemotherapy or immunotherapy. 64.9 % of patients were hospitalized due to COVID-19. Risk factors for death at 1 and 3 months in COVID-19 patients were age, LC stage, and PS score. Multivariate analysis showed a major prognostic impact of COVID-19 on mortality of LC patients (hazard ratio: 4.12, 95 % CI [3.42, 4.97], p < 0.001).

CONCLUSIONS

This prospective study demonstrated the high incidence of COVID-19 in LC patients and identified as risk factors for COVID-19: smoking status, histology, PS, and stage. The impact of COVID-19 on lung cancer mortality appears major.

Clinical characteristics and outcomes among critically ill patients with cancer and COVID-19-related acute respiratory failure

BACKGROUND

Coronavirus disease 2019 (COVID-19) has affected individuals worldwide, and patients with cancer are particularly vulnerable to COVID-19-related severe illness, respiratory failure, and mortality. The relationship between COVID-19 and cancer remains a critical concern, and a comprehensive investigation of the factors affecting survival among patients with cancer who develop COVID-19-related respiratory failure is warranted. We aim to compare the characteristics and outcomes of COVID-19-related acute respiratory failure in patients with and without underlying cancer, while analyzing factors affecting in-hospital survival among cancer patients.

METHODS

We conducted a retrospective observational study at Taipei Veterans General Hospital in Taiwan from May to September 2022, a period during which the omicron variant of the severe acute respiratory syndrome coronavirus 2 was circulating. Eligible patients had COVID-19 and acute respiratory failure. Clinical data, demographic information, disease severity markers, treatment details, and outcomes were collected and analyzed.

RESULTS

Of the 215 enrolled critically ill patients with COVID-19, 65 had cancer. The patients with cancer were younger and had lower absolute lymphocyte counts, higher ferritin and lactate dehydrogenase (LDH) concentrations, and increased vasopressor use compared with those without cancer. The patients with cancer also received more COVID-19 specific treatments but had higher in-hospital mortality rate (61.5% vs 36%, P = 0.002) and longer viral shedding (13 vs 10 days, P = 0.007) than those without cancer did. Smoking [odds ratio (OR): 5.804, 95% confidence interval (CI): 1.847-39.746], elevated LDH (OR: 1.004, 95% CI: 1.001-1.012), vasopressor use (OR: 5.437, 95% CI: 1.202-24.593), and new renal replacement therapy (OR: 3.523, 95% CI: 1.203-61.108) were independent predictors of in-hospital mortality among patients with cancer and respiratory failure.

CONCLUSION

Critically ill patients with cancer experiencing COVID-19-related acute respiratory failure present unique clinical features and worse clinical outcomes compared with those without cancer. Smoking, elevated LDH, vasopressor use, and new renal replacement therapy were risk factors for in-hospital mortality in these patients.

Artificial intelligence-based analysis of the spatial distribution of abnormal computed tomography patterns in SARS-CoV-2 pneumonia: association with disease severity

BACKGROUND

The substantial heterogeneity of clinical presentations in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia still requires robust chest computed tomography analysis to identify high-risk patients. While extension of ground-glass opacity and consolidation from peripheral to central lung fields on chest computed tomography (CT) might be associated with severely ill conditions, quantification of the central-peripheral distribution of ground glass opacity and consolidation in assessments of SARS-CoV-2 pneumonia remains unestablished. This study aimed to examine whether the central-peripheral distributions of ground glass opacity and consolidation were associated with severe outcomes in patients with SARS-CoV-2 pneumonia independent of the whole-lung extents of these abnormal shadows.

METHODS

This multicenter retrospective cohort included hospitalized patients with SARS-CoV-2 pneumonia between January 2020 and August 2021. An artificial intelligence-based image analysis technology was used to segment abnormal shadows, including ground glass opacity and consolidation. The area ratio of ground glass opacity and consolidation to the whole lung (GGO%, CON%) and the ratio of ground glass opacity and consolidation areas in the central lungs to those in the peripheral lungs (GGO(C/P)) and (CON(C/P)) were automatically calculated. Severe outcome was defined as in-hospital death or requirement for endotracheal intubation.

RESULTS

Of 512 enrolled patients, the severe outcome was observed in 77 patients. GGO% and CON% were higher in patients with severe outcomes than in those without. Multivariable logistic models showed that GGO(C/P), but not CON(C/P), was associated with the severe outcome independent of age, sex, comorbidities, GGO%, and CON%.

CONCLUSION

In addition to GGO% and CON% in the whole lung, the higher the ratio of ground glass opacity in the central regions to that in the peripheral regions was, the more severe the outcomes in patients with SARS-CoV-2 pneumonia were. The proposed method might be useful to reproducibly quantify the extension of ground glass opacity from peripheral to central lungs and to estimate prognosis.

Spatio-temporal epidemiology and associated indicators of COVID-19 (wave-I and II) in India

The spatio-temporal distribution of COVID-19 across India's states and union territories is not uniform, and the reasons for the heterogeneous spread are unclear. Identifying the space-time trends and underlying indicators influencing COVID-19 epidemiology at micro-administrative units (districts) will help guide public health strategies. The district-wise daily COVID-19 data of cases and deaths from February 2020 to August 2021 (COVID-19 waves-I and II) for the entire country were downloaded and curated from public databases. The COVID-19 data normalized with the projected population (2020) and used for space-time trend analysis shows the states/districts in southern India are the worst hit. Coastal districts and districts adjoining large urban regions of Mumbai, Chennai, Bengaluru, Goa, and New Delhi experienced > 50,001 cases per million population. Negative binomial regression analysis with 21 independent variables (identified through multicollinearity analysis, with VIF < 10) covering demography, socio-economic status, environment, and health was carried out for wave-I, wave-II, and total (wave-I and wave-II) cases and deaths. It shows wealth index, derived from household amenities datasets, has a high positive risk ratio (RR) with COVID-19 cases (RR: 3.577; 95% CI: 2.062-6.205) and deaths (RR: 2.477; 95% CI: 1.361-4.506) across the districts. Furthermore, socio-economic factors such as literacy rate, health services, other workers' rate, alcohol use in men, tobacco use in women, overweight/obese women, and rainfall have a positive RR and are significantly associated with COVID-19 cases/deaths at the district level. These positively associated variables are highly interconnected in COVID-19 hotspot districts. Among these, the wealth index, literacy rate, and health services, the key indices of socio-economic development within a state, are some of the significant indicators associated with COVID-19 epidemiology in India. The identification of district-level space-time trends and indicators associated with COVID-19 would help policymakers devise strategies and guidelines during public health emergencies.

Social Distancing in the COVID-19 Pandemic: Associated Factors, Health Outcomes, and Implications

Social distancing has reemerged as a public health measure for containing the spread of COVID-19. This integrative review aims to analyze the historical use of social distancing, the current application during COVID-19, individual factors that affect social distancing practices, and consequential health outcomes. We analyzed relevant literature from searches conducted on Scopus, PubMed, and PsycINFO. We found that resources, culture, age, gender, and personality are associated with the degree to which people practice social distancing. Furthermore, social distancing changes our lifestyles and behavior and results in multifaceted health outcomes, including decreased physical activity and sunlight exposure, increased weight gain, and impaired sleep quality. On the positive side, social distancing has been linked to reduced crime rates and environmental damage, as well as better social and family ties. Future interventions may be utilized to increase adherence to social distancing practices and to mitigate the negative health effects of social distancing.

The Molecular Blueprint for Chronic Obstructive Pulmonary Disease (COPD): A New Paradigm for Diagnosis and Therapeutics

The global prevalence of chronic obstructive pulmonary disease (COPD) has increased over the last decade and has emerged as the third leading cause of death worldwide. It is characterized by emphysema with prolonged airflow limitation. COPD patients are more susceptible to COVID-19 and increase the disease severity about four times. The most used drugs to treat it show numerous side effects, including immune suppression and infection. This review discusses a narrative opinion and critical review of COPD. We present different aspects of the disease, from cellular and inflammatory responses to cigarette smoking in COPD and signaling pathways. In addition, we highlighted various risk factors for developing COPD apart from smoking, like occupational exposure, pollutants, genetic factors, gender, etc. After the recent elucidation of the underlying inflammatory signaling pathways in COPD, new molecular targeted drug candidates for COPD are signal-transmitting substances. We further summarize recent developments in biomarker discovery for COPD and its implications for disease diagnosis. In addition, we discuss novel drug targets for COPD that could be explored for drug development and subsequent clinical management of cardiovascular disease and COVID-19, commonly associated with COPD. Our extensive analysis of COPD cause, etiology, diagnosis, and therapeutic will provide a better understanding of the disease and the development of effective therapeutic options. In-depth knowledge of the underlying mechanism will offer deeper insights into identifying novel molecular targets for developing potent therapeutics and biomarkers of disease diagnosis.

Smoking and pre-existing co-morbidities as risk factors for developing severity of COVID-19 infection: Evidence from a field hospital in a rural area of Bangladesh

Since August 2020; the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in collaboration with UNICEF has been operating a COVID-19 field hospital at the Teknaf sub-district of Cox's Bazar in Bangladesh. This paper is focused on estimating the effects of a history of tobacco smoking and pre-existing co-morbidities on the severity of COVID-19 infection among adult patients admitted into the aforesaid hospital. We conducted a retrospective data analysis of COVID-19 adult patients hospitalized from August 27, 2020 to April 20, 2022. Based on inclusion criteria; a total of 788 admitted patients were included in the analysis. We conducted a Chi-squared test and Fisher's exact test for the categorical variables to see their associations. Multinomial logistic regression models were performed to explore the risk factors for the severity of COVID-19 infection. Among 788 patients, 18.4%, 18.8%, 13%, 7.1%, 3.4%, and 1.9% have had a history of smoking, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), and asthma respectively. Overall, the mean age of the patients was 40.3 ± 16.4 years and 51% were female. In multivariate analysis, history of smoking and co-morbidities were identified as the risk factors for the severity of COVID-19 infection; the history of smoking was found linked with an increase in the risk of developing critical, severe, and moderate level of COVID-19 infection- notably 3.17 times (RRR = 3.17; 95% CI: 1.3-7.68), 2.98 times (RRR = 2.98; 95% CI: 1.87-4.76) and 1.96 times (RRR = 1.96; 95% CI: 1.25-3.08) respectively more than the patients who never smoked. It was evident that patients with at least one of the selected co-morbidities such as hypertension, diabetes, COPD, CVD, and asthma exhibited a significantly higher likelihood of experiencing severe illness of COVID-19 compared to patients without any co-morbidity. History of tobacco smoking and pre-existing co-morbidities were significantly associated with an increased severity of COVID-19 infection.

Respiratory Interventions, Hospital Utilization, and Clinical Outcomes of Persons with COPD and COVID-19

Purpose

Coronavirus disease 2019 (COVID-19) impacted outcomes of persons with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). This study investigated the differences in respiratory interventions, hospital utilization, smoking status, and 30-day readmission in those with COPD and COVID-19 based on hospital survival status.

Methods

A retrospective cross-sectional study was conducted from February 2020 to October 2020 and included persons with COPD and COVID-19 infection. We examined respiratory interventions, hospital utilization and outcomes, and 30-day hospital readmission. Chi-square test analysis was used to assess categorical variables, and t-test or Mann-Whitney was used to analyze continuous data based on normality.

Results

Ninety persons were included in the study, 78 (87%) were survivors. The most common comorbidity was hypertension 71 (78.9%) (p = 0.003). Twenty-two (24%) persons were intubated, from whom 12 (15%) survived (p < 0.001). There were 25 (32.1%) and 12 (100%), (p < 0.001) persons who required an ICU admission from the survivor and non-survivor groups, respectively. Among the survivor group, fifteen (19%) persons required 30-day hospital readmission.

Conclusion

Persons with COPD and COVID-19 had a lower mortality rate (13%) compared to other studies in the early pandemic phase. Non-survivors had increased ICU utilization, endotracheal intubation, and more frequent application of volume control mode. Discharging survivors to long-term acute care facilities may reduce 30-day hospital readmissions.

Association of substance use with outcomes in mildly ill COVID-19 outpatients

BACKGROUND

Smoking, alcohol use, and non-prescription drug use are associated with worsened COVID-19 outcomes in hospitalized patients. Whether there is an association between substance use and outcomes in patients with COVID-19 who visited the Emergency Department (ED) but did not require hospitalization has not been well established. We investigated whether smoking, alcohol, and non-prescription drug use were associated with worsened COVID-19 outcomes among such patients presenting to the ED.

METHODS

We conducted a secondary analysis of a clinical trial which sought to determine the effect of early convalescent plasma administration in patients presenting to the ED within 7 days of onset of mild COVID-19 symptoms. The study recruited 511 participants who were aged 50 years or older or had one or more risk factors for severe COVID-19. The primary outcome was disease progression within 15 days after randomization, which was defined as a composite of hospital admission for any reason, seeking emergency or urgent care, or death without hospitalization. Secondary outcomes included: no hospitalization within 30 days post-randomization, symptom worsening on the 5-category COVID-19 outpatient ordinal scale within 15 days post-randomization, and all-cause mortality. Substance use was categorized into either use or never use based on participant self-report. Logistic regression models were used to determine the association between substance use and outcomes.

RESULTS

The mean age of the 511 patients enrolled was 52 years and the majority were females (274, 54%). Approximately 213 (42%) were non-Hispanic Whites, 156 (30%) Hispanics, 100 (20%) non-Hispanic Blacks, 18 (4%) non-Hispanic Asian, 8 (1%) American Indian Alaskan, and 16 (3%) unknown race. Tobacco 152 (30%) was the most common substance use reported. Alcohol use 36 (7%) and non-prescription drug use 33 (6%) were less common. Tobacco use and non-prescription drug use were associated with an increased risk for meeting the primary outcome ((tobacco: adjusted odds ratio [aOR] =2.08; 95% confidence interval [CI]: 1.37-3.15) and (drug: aOR =2.41; 95%CI: 1.17-5.00)) and increased risk for symptom worsening on the 5-category COVID-19 outpatient scale ((tobacco: aOR = 1.62; 95%CI: 1.09-2.42) and (drug: aOR = 2.32 95% CI: 1.10-4.87)) compared to non-use after adjusting for age, sex, plasma administration, and comorbidity.

CONCLUSION

Tobacco and non-prescription drug use but not alcohol use were associated with worsened COVID-19 outcomes in patients who did not require hospitalization on their initial presentation. Future studies should determine the quantity, duration, and type of drug/tobacco use that may worsen COVID-19.

One year later: How outcomes of hip fractures treated during the "first wave" of the COVID-19 pandemic were affected

The purpose of this study was to assess the impact of COVID-19 on long-term outcomes in the geriatric hip fracture population. We hypothesize that COVID + geriatric hip fracture patients had worse outcomes at 1-year follow-up. Between February and June 2020, 224 patients > 55 years old treated for a hip fracture were analyzed for demographics, COVID status on admission, hospital quality measures, 30- and 90-day readmission rates, 1-year functional outcomes (as measured by the EuroQol- 5 Dimension [EQ5D-3L] questionnaire), and inpatient, 30-day, and 1-year mortality rates with time to death. Comparative analyses were conducted between COVID + and COVID- patients. Twenty-four patients (11%) were COVID + on admission. No demographic differences were seen between cohorts. COVID + patients experienced a longer length of stay (8.58 ± 6.51 vs. 5.33 ± 3.09, p < 0.01) and higher rates of inpatient (20.83% vs. 1.00%, p < 0.01), 30-day (25.00% vs. 5.00%, p < 0.01), and 1-year mortality (58.33% vs. 18.50%, p < 0.01). There were no differences seen in 30- or 90-day readmission rates, or 1-year functional outcomes. While not significant, COVID + patients had a shorter average time to death post-hospital discharge (56.14 ± 54.31 vs 100.68 ± 62.12, p = 0.171). Pre-vaccine, COVID + geriatric hip fracture patients experienced significantly higher rates of mortality within 1 year post-hospital discharge. However, COVID + patients who did not die experienced a similar return of function by 1-year as the COVID- cohort.

Epigenetic perspectives associated with COVID-19 infection and related cytokine storm: an updated review

PURPOSE

The COVID-19 pandemic caused by the novel Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has put the world in a medical crisis for the past three years; nearly 6.3 million lives have been diminished due to the virus outbreak. This review aims to update the recent findings on COVID-19 infections from an epigenetic scenario and develop future perspectives of epi-drugs to treat the disease.

METHODS

Original research articles and review studies related to COVID-19 were searched and analyzed from the Google Scholar/PubMed/Medline databases mainly between 2019 and 2022 to brief the recent work.

RESULTS

Numerous in-depth studies of the mechanisms used by SARS-CoV-2 have been going on to minimize the consequences of the viral outburst. Angiotensin-Converting Enzyme 2 receptors and Transmembrane serine protease 2 facilitate viral entry to the host cells. Upon internalization, it uses the host machinery to replicate viral copies and alter the downstream regulation of the normal cells, causing infection-related morbidities and mortalities. In addition, several epigenetic regulations such as DNA methylation, acetylation, histone modifications, microRNA, and other factors (age, sex, etc.) are responsible for the regulations of viral entry, its immune evasion, and cytokine responses also play a major modulatory role in COVID-19 severity, which has been discussed in detail in this review.

CONCLUSION

Findings of epigenetic regulation of viral pathogenicity open a new window for epi-drugs as a possible therapeutical approach against COVID-19.

Impact of Coronavirus Disease 2019 and Vaccination Attitudes on Alpha-1 Antitrypsin Deficiency

Background

Individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) may be at increased risk of coronavirus disease 2019 (COVID-19) pneumonia since COPD is associated with an increased risk of severe COVID-19 infection.

Research Question

We hypothesized that the AlphaNet disease management program would lower COVID-19 burdens. We evaluated the prevalence of COVID-19 infection, severe COVID-19, interruptions in augmentation therapy, and intention to vaccinate.

Study Design and Methods

Data regarding COVID-19 were collected monthly from March 2020 through February 2022. Responses from 8019 individuals were analyzed to evaluate the prevalence and severity of COVID-19 infections, interruptions in AATD care, and the likelihood of vaccination.

Results

By the end of 2020, 4% of patients reported a positive COVID-19 test. Of those, 35.3% were hospitalized, with 8.6% admitted to the intensive care unit (ICU). By February 2022, the prevalence of COVID-19 infections had increased to 18.6%, with hospitalization rates of 22.1% and ICU admissions at 4.7%. Attitudes about COVID-19 vaccination assessed in December 2020 before the vaccine was widely available suggested 10.3% of patients would definitely not get the vaccine. Notably, 38.2% of those subsequently self-reported receipt of a COVID-19 vaccine.

Interpretation

The prevalence of COVID-19 infections in patients with AATD was lower than the prevalence in the general U.S. population during 2020, although with a higher hospitalization rate. This health-managed population has a high vaccination intent. Those with an initially low vaccination intent changed their minds over time. We interpret these results as showing that most AlphaNet individuals with AATD had success at navigating the COVID-19 pandemic with lower case rates than the general U.S. population.

Rhesus factor is a stronger predictor for the risk of Sars-CoV-2 and mortality than ABO blood types

Objectives

In this study, we aimed to evaluate the relationship between ABO blood groups and Rhesus factor (Rf) and severe acute respiratory syndrome coronavirus-2 (Sars-CoV-2), as well as the risk of infection susceptibility and death according to pre-existing comorbidities.

Methods

This retrospective study included patients medical record between March 2020 and March 2021. A total 470 patients were included in the study. The subjects were categorized according to diagnose of Sars-CoV-2. Also, we evaluated the subject according to severity of Sars-CoV-2 infection. The logistic and multivariate regression analysis were performed to predict possible effect of ABO and Rf types as well as comorbidities on indicators of Sars-CoV-2 severity including Intensive care unit (ICU) hospitalization, intubation, and mortality.

Results

The distribution of ABO blood type and Rf were not statistically different cases with and without Sars-CoV-2. Blood type B and A were the most groups in intubation and mortality among patients with Sars-CoV-2. However, ABO blood types had no significant effect on risk of Sars-CoV-2 and mortality while, Rf had a significantly effect on it. Additionally, Rf had a statistically significant effect on all severity indicators of Sars-CoV-2 but ABO had not.

Conclusions

While Rf was significantly associated with risk of Sars-CoV-2 and had a strong effect on ICU admission, intubation, and mortality, ABO groups were not associated with risk of disease. Intubation and mortality rates were higher in patients with blood group B (OR: 2.93 p:0.390 95 % CI [0.253–33.9], OR: 0.217 p:0.211 95 % CI [0.020–2.37]) and Rh factor + (OR: 1.63 p:0.027 95 % CI [0.046–0.828]).

Pulmonary fibrosis and COVID-19

The COVID-19 pandemic has caused the death of millions and many more have been infected worldwide. The causative virus, SARS-CoV-2, affects the lung where it elicits an aggressive inflammatory response leading to respiratory failure in severe cases. This infection has been linked to pulmonary fibrosis, a process characterized by fibroproliferation and the exaggerated deposition of collagen and other extracellular matrices. These events damage the lung architecture, especially its gas-exchanging units, leading to hypoxemic respiratory failure. The mechanisms by which the virus affects the lung remain incompletely understood, but it is postulated that after entering the airways, the virus binds to Angiotensin Converting Enzyme (ACE) receptors on the surface of epithelial cells, not only stimulating oxidative stress and inflammation, but also promoting the expression of soluble pro-fibrotic factors responsible for the accumulation of fibroblasts, their activation into myofibroblasts, and their unregulated expression of extracellular matrices. These events may trigger the rapid progression or exacerbation of underlying interstitial lung disorders or promote fibrosis in a previously healthy lung. Although the natural progression of such conditions cannot always be predicted, fibrosis may progress even after the virus has been eliminated or, in cases where it does not progress, may become irreversible, leading to long-standing symptoms like shortness of breath and exercise intolerance resulting from loss of lung function. Although COVID-19 related pulmonary fibrosis is not common, preventive measures like vaccination are encouraged, as they are expected to reduce infection or its severity, thereby decreasing the possibility of life-changing respiratory conditions such as pulmonary fibrosis.

Severity of Adverse Effects of Sinovac COVID-19 Vaccine in Postmenopausal Women: A Multicenter Experience From Pakistan

Introduction The most significant element in halting the coronavirus disease 2019 (COVID-19) epidemic was the availability of reliable and efficient vaccines. Vaccine acceptability is influenced by many factors, including perceptions of the vaccine's safety and side effects. Adverse reactions to vaccines can vary with regard to the type, although they are frequently mild, localized, temporary, and self-limiting. Therefore, this study aimed to assess the prevalence of side effects experienced by postmenopausal women after receiving the Sinovac vaccine. Methods This multicenter, prospective cross-sectional study was carried out at multiple centers in Karachi, Pakistan. In this study, the non-probability sampling method was used. The study continued from August 1, 2022, to January 31, 2023, for six months. The study comprised 600 postmenopausal women over the age of 50 years who received two doses of Sinovac COVID-19 vaccination. Demographic parameters such as gender, the existence of comorbidities, and local and systemic side effects in postmenopausal women were documented as frequencies and percentages. Age, weight, and duration of comorbidities are expressed as means and standard deviations. Results The study findings showed that the mean age of study participants was 63.93 ± 8.24 years. There were related comorbidities with hypertension and diabetes mellitus in 181 (30.2%) and 40 (6.7%) women, respectively. Fever was the most often reported side effect, with 349 (58.2%) participants reporting it and 198 (56.7%) participants reporting it as mild. After the second dose, 234 (39.5%) participants reported fever as their most frequent adverse effect, and 158 (67.5%) of them reported it was mild. Conclusion This study concluded that the most commonly reported side effects among postmenopausal women were fever, pain, and swelling at the injection site after getting either dose of Sinovac vaccine. These overall side effects were generally mild to moderate in intensity, not life-threatening, and did not require hospitalization, although fever was reported in severe intensity in some cases, particularly after the first dose.

[Efficacy of tele-rehabilitation in patients with chronic obstructive pulmonary disease: A systematic review]

Since 2020 we have lived an exceptional situation that made us experience a complete lockdown due to SARS-CoV-2, what affected the treatments of different pathologies, such as the chronic obstructive pulmonary disease (COPD). Because of those reasons, it has arisen the idea of implementing the tele-rehabilitation program as a treatment of these pathologies. The search was done between the months of October and November 2020, with the aim of analyzing and updating the efficacy of the tele-rehabilitation in patients who have COPD, finding eight articles which met the inclusion criteria. The pulmonary tele-rehabilitation is able to improve the quality of life and physical state, and decreasing the number of hospitalizations and exacerbations. Furthermore, patients showed a great level of satisfaction and adherence to this treatment program. The pulmonary tele-rehabilitation can achieve similar results as of pulmonary rehabilitation. For this reason, people who have difficulties to go to their outpatients clinic or even in a lockdown can use it. However, it is necessary to investigate which tele-rehabilitation program is better.

Neutralizing antibody and T-cell responses against SARS-CoV-2 variants by heterologous CoronaVac/ChAdOx-1 vaccination in elderly subjects with chronic obstructive pulmonary disease

BACKGROUND

Data on humoral and cellular immune responses against SARS-CoV-2 after receiving heterologous CoronaVac/ChAdOx-1 (CoVac/ChAd) vaccination in subjects with chronic obstructive pulmonary disease (COPD) are still limited. Therefore, we determined the neutralizing antibody (NAb) and T-cell responses against SARS-CoV-2 wild type (WT) and variants of concern (VOCs) in COPD patients.

METHODS

The levels of NAb as well as specific CD4 and CD8 T-cell responses against SARS-CoV-2 WT and VOCs were determined in COPD patients before and after vaccination.

RESULTS

Four weeks after vaccinations, the median levels of % inhibition of NAb against SARS-CoV-2 WT, Alpha, Beta, and Delta variants were significantly higher compared to pre-vaccination. The induction of NAb against Omicron was very low compared to other variants. At four weeks after vaccination, in comparison to pre-vaccination, the increasing trend of TNF-α-, IFN-γ-, IL-4-, IL-17-, IL-10-, and FasL-producing CD4 T-cells upon stimulation with WT spike peptides were demonstrated. No difference in T-cell responses to spike peptides of Alpha, Beta, and Delta variants and their WT homologs was observed.

CONCLUSION

Heterologous CoVac/ChAd vaccine induced the production of NAb against SARS-CoV-2 WT, Alpha, Beta, and Delta variants, but low for Omicron in COPD patients. Induction of CD4 T-cell subset responses was slightly observed by this vaccine regimen.

CLINICAL TRIALS REGISTRY

This study was approved by the Clinical Trials Registry (Study ID: TCTR20210822002).

Characteristics of COVID-19 Patients Admitted to Intensive Care Unit in Multispecialty Hospital of Riyadh, Saudi Arabia: A Retrospective Study

During the early stages of the COVID-19 pandemic, infection rates were high and symptoms were severe. Medical resources, including healthcare experts and hospital facilities, were put to the test to ensure their readiness to deal with this unique event. An intensive care unit (ICU) is expected to be required by many hospitalized patients. Many hospitals worldwide lacked resources during the pandemic's peak stages, particularly in critical care treatment. Because of this, there were issues with capacity, as well as an excessive influx of patients. Additionally, even though the research location provides medical care to a sizable population, there is a paucity of scientific data detailing the situation as it pertains to COVID-19 patients during the height of the outbreak. Therefore, this study aimed to identify and describe the features of COVID-19 patients hospitalized in the ICU of one of the multispecialty hospitals in Riyadh, Saudi Arabia. An observational retrospective study was conducted using a chart review of COVID-19 patients admitted to the ICU between March 2020 and December 2020. To characterize the patients, descriptive statistics were utilized. An exploratory multivariate regression analysis was carried out on the study cohort to investigate the factors that were shown to be predictors of death and intubation. Only 333 (29.33%) of the 1135 samples from the hospital's medical records were used for the final analysis and interpretation. More than 76% of the patients in the study were male, with a mean BMI of 22.07 and an average age of around 49 years. The most frequent chronic condition found among the patients who participated in the study was diabetes (39.34%), followed by hypertension (31.53%). At the time of admission, 63 of the total 333 patients needed to have intubation performed. In total, 22 of the 333 patients died while undergoing therapy. People with both diabetes and hypertension had a 7.85-fold higher risk of death, whereas those with only diabetes or hypertension had a 5.43-fold and 4.21-fold higher risk of death, respectively. At admission, intubation was necessary for many male patients (49 out of 63). Most intubated patients had hypertension, diabetes, or both conditions. Only 13 of the 63 patients who had been intubated died, with the vast majority being extubated. Diabetes and hypertension were significant contributors to the severity of illness experienced by COVID-19 participants. The presence of multiple comorbidities had the highest risk for intubation and mortality among ICU-admitted patients. Although more intubated patients died, the fatality rate was lower than in other countries due to enhanced healthcare management at the ICU of the study center. However, large-scale trials are needed to determine how effective various strategies were in preventing ICU admission, intubation, and death rates.

Prognostic value of R wave peak time in COVID-19 pneumonia

BACKGROUND

R wave peak time (RWPT) is also known as intrinsicoid deflection time or ventricular activation time. It shows the conduction time from the endocardium in the ventricle to the epicardium. It provides diagnostic and prognostic information for many cardiovascular diseases, such as RWPT prolongation, left ventricular hypertrophy, volume overload, conduction system abnormalities, and myocardial ischemia. Objectives The aim of this study is to investigate the relationship between COVID-19 mortality and RWPT in superficial ECG.

METHODS

This study retrospectively examined 640 patients diagnosed with COVID-19 and treated in an intensive care unit at a single center between January 2021 and June 2022. All patients included in the study had clinical and radiological characteristics and signs of COVID-19 pneumonia.

RESULTS

640 patients included in the study were divided into 2 groups: surviving and deceased. There were 510 patients in the surviving group and 130 patients in the deceased group. The deceased group was found to be significantly older. The number of patients with COPD was higher in the deceased group. Troponin, lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer and T-peak to T-end interval(Tpe) and RWPT were found to be significantly increased in the deceased group. In binary logistic regression analysis; age, COPD, LDH, CRP, troponin, D-dimer, Tpe interval, RWPT were determined as independent risk factors for mortality.

CONCLUSIONS

Prolonged RWPT is useful in risk stratification for COVID-19 pneumonia mortality.

Evaluation of 340B prescription assistance program on healthcare use in chronic obstructive pulmonary disease

Background

The federal 340B drug program was designed to stretch scarce federal resources to provide more comprehensive services for more eligible patients. To help satisfy community needs, 340B Prescription Assistance Programs (PAPs) allow eligible patients to access medications at significantly reduced costs.

Objectives

To measure the impact of reduced-cost medications for chronic obstructive pulmonary disease (COPD) through a 340B PAP on all-cause hospitalizations and emergency department visits.

Methods

This multi-site, retrospective, single-sample, pre-post cohort study involved patients with COPD who used a 340B PAP to fill prescriptions for an inhaler or nebulizer between April 1, 2018, and June 30, 2019. Data from included subjects were evaluated and compared in the year before and after each individual patient's respective prescription fill in the 340B PAP. The primary outcome evaluated the impact of 340B PAP on all-cause hospitalizations and emergency department visits. Secondary outcomes evaluated the financial impact associated with program use. Wilcoxon signed-rank test was utilized to assess changes in the outcome measures.

Results

Data for 115 patients were included in the study. Use of the 340B PAP resulted in a significant reduction in the composite mean number of all-cause hospitalizations and emergency department visits (2.42 vs 1.66, Z = -3.12, p = 0.002). There was an estimated $1012.82 mean cost avoidance per patient due to reduction in healthcare utilization. Annual program-wide prescription cost savings for patients totaled $178,050.21.

Conclusions

This study suggested that access to reduced-cost medications through the federal 340B Drug Pricing Program was associated with a significant reduction in hospitalizations and emergency department visits for patients with COPD, decreasing patients' utilization of healthcare resources.

Impact of COVID-19 Pandemic on the Exacerbation Rates in COPD Patients in Southern India - A Potential Role for Community Mitigations Measures

Introduction

The impact of the coronavirus 2 (SARS-CoV-2) pandemic and the effect of preventive health strategies on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are largely unknown. The public health model imposed during the pandemic and the lessons learnt have implications on recommending future preventive strategies for COPD care in general and exacerbations in particular.

Aim

This study endeavors to assess the role of preventive strategies of COVID-19 on exacerbation rates of COPD during the lockdown period compared to similar periods the previous year and assess the compliance to preventive strategies for COVID-19 among COPD patients.

Methods

This is a hospital-based descriptive cross-sectional study at a tertiary care center. AECOPD in patients during a period spanning five months in the pre-lockdown days was compared with exacerbation rates for a similar period during the national lockdown.

Results

Sixty-eight patients were recruited (mean age: 67.38) among whom 47 were males and 21 were females. There were only 7 (10.3%) reported admissions during the lockdown period of 5 months compared to 50 (73.5%) during the corresponding period pre-lockdown. Mild exacerbations reported during the lockdown period were also significantly less with only 17 (25%) against 58 (85.3%) during the pre-lockdown period. Adherence to measures such as donning of masks, hand hygiene, and social distancing was observed among COPD patients with good compliance to the health practices promulgated in the pandemic.

Discussion

A significant reduction in exacerbation rates among AECOPD patients during the period of lockdown was observed compared to a similar period the year prior. Noticeable were the findings that both community-based milder exacerbations and severe exacerbations necessitating hospitalizations showed a reduction during the period of lockdown. Adaptability, compliance and acceptance to usage of masks, hand hygiene measures, and norms such as physical distancing were observed in the majority of COPD patients.

Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization

Rationale

There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection.

Objective

To assess whether COPD is an independent risk factor for increased post-discharge HCU.

Methods

We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum's de-identified Clinformatics® Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on "post-discharge") in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates.

Results

We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (±9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53-1.60), 50% (RR 1.50; 95% CI 1.46-1.54), 55% (RR 1.55; 95% CI 1.53-1.56), 18% (RR 1.18; 95% CI 1.14-1.22), 16% (RR 1.16; 95% CI 1.16-1.17), and 28% (RR 1.28; 95% CI 1.24-1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU.

Conclusion

Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.

Relationship between anal swab PCR for SARS-CoV-2 with gastrointestinal clinical manifestations and severity of COVID-19 infection in Indonesia

Introduction: Coronavirus disease 2019 (COVID-19) cases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Indonesia remain high. The virus can bind with ACE2 receptor which is not only found in the lungs, but also in the digestive tract. Thus, it allows SARS-CoV-2 infection in the gastrointestinal tract, gastrointestinal manifestations, and detection of viral RNA on anal swab using polymerase chain reaction (PCR). There hasn't been similar study about the role of anal swab in Indonesia yet. Therefore, this study aims to determine the relationship between SARS-COV-2 anal swab PCR with gastrointestinal clinical manifestations, and the severity of COVID-19 in Indonesia. Methods: This is an analytical study with cross-sectional design. Samples were obtained from hospitalized COVID-19 patients from July 2020 to January 2021. Demographic data, clinical manifestations, severity, and SARS-CoV-2 anal swabs PCR were collected using case report form. Results: A total of136 patients were analyzed. 52 patients (38.2%) had positive SARS-CoV-2 anal swabs PCR and 84 patients (61.8%) had negative results. The most common gastrointestinal clinical manifestations were nausea and vomiting in 69 patients (50.7%), anorexia in 62 patients (45.6%), and abdominal pain in 31 patients (22.8%). There were 114 patients (83,8%) classified as mild-moderate symptoms and 22 patients (16,2%) classified as severe-critical symptoms. There was a statistically significant relationship between the gastrointestinal tract SARS-CoV-2 infection and gastrointestinal clinical manifestations (P=0.031). There was no statistically significant relationship between the gastrointestinal SARS-CoV-2 infection and the severity of COVID-19 infection (P = 0.844). Conclusions: This study showed there is a significant relationship between SARS-CoV-2 anal swab PCR with gastrointestinal clinical manifestations. There is no significant relationship between anal swab PCR with the severity of COVID-19 infection.

Regular Inhaled Corticosteroids Use May Protect Against Severe COVID-19 Outcome in COPD

Purpose

Population-based studies provide conflicting evidence about how inhaled corticosteroids (ICS) impact COVID-19 outcomes among COPD patients. We investigated whether regular ICS exposure affects risk, severity, or survival in SARS-CoV-2 infection, using a nationwide linked Swedish population register database.

Patients and Methods

During January-December 2020, we studied two defined Swedish adult populations - Whole population [≥40 years] (N = 5243479), and COPD subpopulation [≥40 years] (N = 133372), in three study cohorts, respectively: 1. Overall cohort (index date 1 Jan 2020), 2. COVID-19 diagnosed sub-cohort (index date = diagnosis date), and 3. COVID-19 hospitalized sub-cohort (index date = admission date). Regular exposure was defined as ≥3 ICS prescriptions in the year before index. Hazard ratios (HRs) for outcomes (COVID-19 onset, hospitalization, ICU admission, or death) related to ICS exposure were estimated using Cox regression. Confounding was controlled by propensity score methods applying Average Treatment effect in the Treated (ATT) weighting.

Results

Regular ICS use was associated with only very slightly increased onset of COVID-19, hospitalization, ICU admission, and death in the overall whole population cohort and in the overall COPD subpopulation cohort, except for ICU admission (marginally non-significant HRs, up to 1.13); and no clear increase in the diagnosed sub-cohorts. However, in the COVID-19 hospitalized COPD sub-cohort, ICS therapy showed reduced risks against progression to ICU admission and death, significant for death (HR 0.82 95% CI [0.67-0.99]).

Conclusion

For COPD patients, ICS therapy offers some protection against progression to ICU admission and death among COVID-19 hospitalized patients. Our findings alleviate concerns about increased risks of COVID-19 by ICS treatment and provide evidence supporting the continuation of ICS therapy for COPD patients.

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study

Introduction

Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities.

Methodology

Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA).

Results

A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home.

Discussion

The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation

Background

Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico.

Methods

We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation.

Results

Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous.

Conclusions

Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.

The Association of Tobacco Smoking, Second-hand Smoke, and Novel Tobacco Products With COVID-19 Severity and Mortality in Italy: Results From the COSMO-IT Study

BACKGROUND

Despite the robust evidence of an excess risk of coronavirus disease 2019 (COVID-19) severity and mortality in ever smokers, the debate on the role of current and ex-smokers on COVID-19 progression remains open. Limited or no data are available on the link between electronic cigarette (e-cigarette), heated tobacco product (HTP) and second-hand smoke (SHS) exposure and COVID-19 progression. To fill this knowledge gap, we undertook the COvid19 and SMOking in ITaly (COSMO-IT) study.

METHODS

A multi-centre longitudinal study was conducted in 2020-2021 in 24 Italian hospitals on a total of 1,820 laboratory-confirmed COVID-19 patients. We estimated multivariable odds ratios (OR) and 95% confidence intervals (CI) to quantify the association between smoking-related behaviours (ie, smoking status, e-cigarette and HTP use, and SHS exposure) and COVID-19 severity (composite outcome: intubation, intensive care unit admission and death) and mortality.

RESULTS

Compared to never smokers, current smokers had an increased risk of COVID-19 mortality (OR 2.17; 95% CI, 1.06-4.41). E-cigarette use was non-significantly associated to an increased risk of COVID-19 severity (OR 1.60; 95% CI, 0.96-2.67). An increased risk of mortality was observed for exposure to SHS among non-smokers (OR 1.67; 95% CI, 1.04-2.68), the risk being particularly evident for exposures of ≥6 hours/day (OR 1.99; 95% CI, 1.15-3.44).

CONCLUSION

This multicentric study from Italy shows a dismal COVID-19 progression in current smokers and, for the first time, in SHS exposed non-smokers. These data represent an additional reason to strengthen and enforce effective tobacco control measures and to support smokers in quitting.

An Analysis of Coronavirus Disease 2019 Infection-Related Characteristics of Chronic Obstructive Pulmonary Disease Patients with and without Inhaler Training: A Case-Control Study

OBJECTIVE

Patients with chronic obstructive pulmonary disease are among the most risky groups for Coronavirus Disease 2019. The study was conducted with a case-control group design in order to determine the coronavirus disease 2019 infection-related characteris- tics of chronic obstructive pulmonary disease patients with and without inhaler training.

MATERIAL AND METHODS

A total of 106 patients, being case group (n = 53) and control group (n = 53), were included in the study sample through purposive and simple random sampling methods. While the control group did not receive training, the case group received inhaler training in 2017-2018. Inhaler training was conducted face-to-face using the demonstration method. Patients were evaluated according to their coronavirus disease 2019 (approved by a physician positive polymerase chain reaction) status from the beginning of the pandemic to the time they were included in the study (June 2021).

RESULTS

The rate of incorrect inhaler use was determined to be 39.6% of the patients in the control group, which is statistically differ- ent from the case group (P < .001). It was also determined that 17.9% of the patients in the study sample had contracted coronavirus disease 2019. It was found that the presence of symptoms for at least 1 month following the negative polymerase chain reaction result was significantly higher in the control group (P = .018). It was determined that the case group patients were more careful compared to the control group in terms of coronavirus disease 2019 measures (P < .031). The patients in the case group reported that inhaler medicines were also effective in protecting against other respiratory system diseases (P = .006).

CONCLUSION

Few patients with chronic obstructive pulmonary disease have been infected. It was concluded that the coronavirus disease 2019 symptoms lasted longer in the control group than in the case group.

The predisposition of smokers to COVID-19 infection: A mini-review of global perspectives

Both SARS-CoV-2 and smoking tobacco adversely impact the respiratory system, damaging the airways and impairing lung function. While some studies have identified a positive association between smoking and increased susceptibility to COVID-19 infections, a few papers have concluded that smokers may be protected against such infections. Given these contradictory findings, there is an ongoing debate in the scientific community about whether or not smokers have a stronger predisposition towards COVID-19 infections. Through this mini-review, we aimed to study the relationship between tobacco smoking and COVID-19 infections by conducting a comprehensive literature search of peer reviewed articles that reported on the effects of smoking on COVID-19 susceptibility and were published globally over the past two years (January 2020-April 2022). Our search identified 31 articles that demonstrated a positive or strong relationship between smoking and COVID-19, while 13 articles had contrasting results. Additionally, we evaluated mechanistic studies suggesting that, among smokers, angiotensin-converting enzyme-2 genes are upregulated, facilitating easier binding of SARS-CoV-2, thereby increasing the risk of COVID-19 infection. In conclusion, the majority of studies in this area to date provide evidence of a strong relationship between smoking and COVID-19 infection; however, the strength of this association may vary across the smoking behaviors of differing populations. Future work could involve a meta-analysis of studies focusing on susceptibility to COVID-19 infection for different types of tobacco product smokers, which would result in a more comprehensive understanding of the predisposition of smokers towards COVID-19 infections.

The acceptance and hesitancy of COVID-19 vaccination among chronic obstructive pulmonary disease (COPD) patients

Severe acute respiratory syndrome coronavirus 2, which is responsible for the coronavirus disease 2019 (COVID-19), causes severe clinical outcomes in old individuals and patients with underlying diseases, including chronic obstructive pulmonary disease (COPD). Considering vaccination is still the most effective method to prevent COVID-19-associated death, it is imperative to evaluate COPD patients' attitudes toward the COVID-19 vaccine. This cross-sectional design study was conducted to assess vaccine acceptance and hesitancy among 212 COPD patients who attended the outpatient department from January 1, 2021, to July 31, 2022. All of the patients were not vaccinated and had undertaken lung function test at the time of our survey. Of 212 participants, 164 (77.4%) were willing to be vaccinated immediately while 48 (22.6%) were hesitant to be vaccinated. Compared with the acceptance group, patients who did not accept the vaccination instantly tended to have more comorbidities, like hypertension, coronary heart disease, recent cancers, and higher Modified British Medical Research Council score, or more frequent acute exacerbation. For the patients willing to be vaccinated, the main factors motivating them were an authorities-endorsed vaccine, free vaccination, and no obvious adverse reactions. For the hesitant group, no recommendation from the treating physician was the biggest obstacle for them to accept vaccination. Our results provide useful guidance for making intervention measures to enhance COPD patients' acceptance of a new COVID-19 vaccine. For those patients with comorbidities, treating physicians promoting messages framing the safety of vaccination is necessary to increase immunization rates.

Respiratory bacterial co-infections and their antibiotic resistance pattern in COVID-19 patients at a tertiary care centre in India

Introduction

Patients with coronavirus disease-2019 (COVID-19) are prone to develop respiratory bacterial infections irrespective of their need for mechanical ventilatory support.

Hypothesis/Gap Statement

Information about the incidence of concomitant respiratory bacterial infections in COVID- 19 patients from India is limited.

Aim

This study aimed to determine the incidence of concomitant respiratory bacterial pathogens and their drug resistance in these patients.

Methodology

A prospective study was performed by including patients who were admitted to our tertiary care centre from March 2021 to May 2021 to evaluate secondary bacterial respiratory co-infections in patients via real-time PCR (RT-PCR)-confirmed cases of COVID-19 disease caused by SARS CoV-2.

Results

Sixty-nine culture-positive respiratory samples from patients with COVID-19 were incorporated into this study. The most commonly isolated bacterial microorganisms were Klebsiella pneumoniae (23 samples, 33.33 %) and Acinetobacter baumannii (15, 21.73 %), followed by Pseudomonas aeruginosa (13, 18.84 %). Among the microorganisms isolated, 41 (59.4 %) were multidrug-resistant (MDR) and nine (13 %) were extensively drug-resistant (XDR). Among the Gram-negative bacteria isolated, K. pneumoniae showed high drug resistance. Fifty carbapenem-resistant microorganisms were isolated from the patients included in our study. Concerning the hospital stay of the patients enrolled, there was an increased length of intensive care unit stay, which was 22.25±15.42 days among patients needing mechanical ventilation in comparison to 5.39±9.57 days in patients on ambient air or low/high-flow oxygen.

Conclusion

COVID-19 patients need increased length of hospitalization and have a high incidence of secondary respiratory bacterial infections and high antimicrobial drug resistance.

Smoking and prevalence of COVID-19: Evidence from studies from January 2020 - May 2020

It is well-known that smoking tobacco harms the respiratory system and can lead to various health problems. Regarding COVID-19, a respiratory illness caused by the novel coronavirus SARS-CoV-2, smoking may have implications for both the risk of infection and the severity of the disease. Several studies have explored the association between smoking and COVID-19. However, findings have been somewhat inconsistent and vary from region to region for sample size. This article aims to study the prevalence of COVID-19 among those affected with their ongoing smoking history by computing pooled estimates of the published research. Fixed effect meta-analysis by following the guidelines of PRISMA has been carried out on 34 studies. The patients with confirmed RT-PCR and CT-scan were included, a total of 13,368; The studies' quality assessment was performed according to the Appraisal Checklist recommended by the Joanna Briggs Institute. The effect sizes of the published research are presented in the form of pooled estimates with their respective confidence intervals. Forest plots are used to represent the effect size graphically. Current smokers' effect sizes are 0.12 (CI = 0.11-0.12); for non-smokers, it is estimated to be 0.88 (CI = 0.88-0.89). The heterogeneity statistic I2 describes 0% of the total variation, meaning no heterogeneity among studies exists. A higher prevalence of COVID-19 among non-smokers is observed than the smokers.

Associations of Combustible Cigarette, Electronic Cigarette, and Dual Use With COVID Infection and Severity in the U.S.: A Cross-sectional Analysis of the 2021 National Health Information Survey

Given the potential respiratory health risks, the association of COVID infection and the use of combustible cigarettes, electronic nicotine delivery systems (ENDS), and concurrent dual use is a priority for public health. Many published reports have not accounted for known covarying factors. This study sought to calculate adjusted odds ratios for self-reported COVID infection and disease severity as a function of smoking and ENDS use, while accounting for factors known to influence COVID infection and disease severity (i.e., age, sex, race and ethnicity, socioeconomic status and educational attainment, rural or urban environment, self-reported diabetes, COPD, coronary heart disease, and obesity status). Data from the 2021 U.S. National Health Interview Survey, a cross-sectional questionnaire design, were used to calculate both unadjusted and adjusted odds ratios for self-reported COVID infection and severity of symptoms. Results indicate that combustible cigarette use is associated with a lower likelihood of self-reported COVID infection relative to non-use of tobacco products (AOR = .64; 95% CI [.55, .74]), whereas ENDS use is associated with a higher likelihood of self-reported COVID infection (AOR = 1.30; 95% CI [1.04, 1.63]). There was no significant difference in COVID infection among dual users (ENDS and combustible use) when compared with non-users. Adjusting for covarying factors did not substantially change the results. There were no significant differences in COVID disease severity between those of varying smoking status. Future research should examine the relationship between smoking status and COVID infection and disease severity utilizing longitudinal study designs and non-self-report measures of smoking status (e.g., the biomarker cotinine), COVID infection (e.g., positive tests), and disease severity (e.g., hospitalizations, ventilator assistance, mortality, and ongoing symptoms of long COVID).

The Impact of the COVID-19 Pandemic on Stress, Isolation, Smoking Behaviors, and Motivation to Quit in People with HIV Who Smoke

People with HIV (PWH) smoke at higher rates compared with the general population and have lower cessation rates. The primary aim of this study was to examine the impact of the COVID-19 pandemic on smoking in PWH. A survey was administered to participants in two smoking cessation trials in the United States. Mean cigarettes per day was 13.9 (SD 8.6), and participants reported they had smoked on average for 30.93 years (SD 10.4). More than half (55.7%) of participants (N = 140) reported not changing their smoking during the pandemic, while 15% reported decreasing, and 25% reported increasing their smoking. In bivariate analyses, worrying about food due to lack of money (χ2 = 9.13, df 2, p = 0.01) and greater Covid-related worry (rs = 0.19, p = 0.02) were significantly associated with increased smoking. Qualitative research may be needed to more clearly elucidate factors related to smoking behaviors among PWH.

The controversial effect of smoking and nicotine in SARS-CoV-2 infection

The effects of nicotine and cigarette smoke in many diseases, notably COVID-19 infection, are being debated more frequently. The current basic data for COVID-19 is increasing and indicating the higher risk of COVID-19 infections in smokers due to the overexpression of corresponding host receptors to viral entry. However, current multi-national epidemiological reports indicate a lower incidence of COVID-19 disease in smokers. Current data indicates that smokers are more susceptible to some diseases and more protective of some other. Interestingly, nicotine is also reported to play a dual role, being both inflammatory and anti-inflammatory. In the present study, we tried to investigate the effect of pure nicotine on various cells involved in COVID-19 infection. We followed an organ-based systematic approach to decipher the effect of nicotine in damaged organs corresponding to COVID-19 pathogenesis (12 related diseases). Considering that the effects of nicotine and cigarette smoke are different from each other, it is necessary to be careful in generalizing the effects of nicotine and cigarette to each other in the conducted researches. The generalization and the undifferentiation of nicotine from smoke is a significant bias. Moreover, different doses of nicotine stimulate different effects (dose-dependent response). In addition to further assessing the role of nicotine in COVID-19 infection and any other cases, a clever assessment of underlying diseases should also be considered to achieve a guideline for health providers and a personalized approach to treatment.

The Complex Association between COPD and COVID-19

Chronic obstructive pulmonary disease (COPD) is significant cause of morbidity and mortality worldwide. There is mounting evidence suggesting that COPD patients are at increased risk of severe COVID-19 outcomes; however, it remains unclear whether they are more susceptible to acquiring SARS-CoV-2 infection. In this comprehensive review, we aim to provide an up-to-date perspective of the intricate relationship between COPD and COVID-19. We conducted a thorough review of the literature to examine the evidence regarding the susceptibility of COPD patients to COVID-19 infection and the severity of their disease outcomes. While most studies have found that pre-existing COPD is associated with worse COVID-19 outcomes, some have yielded conflicting results. We also discuss confounding factors such as cigarette smoking, inhaled corticosteroids, and socioeconomic and genetic factors that may influence this association. Furthermore, we review acute COVID-19 management, treatment, rehabilitation, and recovery in COPD patients and how public health measures impact their care. In conclusion, while the association between COPD and COVID-19 is complex and requires further investigation, this review highlights the need for careful management of COPD patients during the pandemic to minimize the risk of severe COVID-19 outcomes.

Lifestyle and preventive behaviors among adults during the early phase of the COVID-19 movement control order (MCO) in Malaysia

BACKGROUND

Enforcement of the movement control order (MCO) in Malaysia caused by COVID-19 impacted people's health, social, behaviors, and economic consequences. Thus, this study aims to identify adults' lifestyle and preventive behaviors during the MCO's early phase.

MATERIALS AND METHODS

This study was conducted in April 2020 using a convenience sampling technique. A total of 9987 adults aged 18 years and above from all over Malaysia participated in the study. The questionnaire was distributed through online platforms, such as Facebook, Telegram, WhatsApp, and the official website. Descriptive statistics and Chi-square test were used to describe the categorical data and the independent T-test and one-way ANOVA tests were performed to compare continuous variables between two or more groups. The level of statistical significance was set at P < .05.

RESULTS

Selangor showed the highest participation (28.4%) and most of the respondents were females (68.2%), married (67.8%), and aged between 36 and 45 years old (34.1%). This study found that 10.3% were smokers, and 46.7% of the smokers intended to quit smoking. Most respondents took their three main meals daily (72.4%), but not even half completed daily food groups (45.1%). The frequent activities were internet surfing (18.8%) and house chores (18.2%). Almost 98% of the respondents agreed to implement preventive behaviors. This study also revealed that attitudes toward preventive behaviors significantly differed across genders, age groups, categories of marital status, and monthly income categories (P < .05). Furthermore, regarding readiness for behavior change after MCO end, only gender shows a significance difference (P < .05).

CONCLUSION

This study shed light on understanding public behavior during the early phase of the pandemic that may significantly impact public health in designing relevant regulations and policies to reduce the spread of COVID-19 infections and preparing strategies for future outbreaks or pandemics. As COVID-19 evolves, continuous efforts to promote positive behavioral changes in lifestyle and preventive behavior are needed to ensure the public practices a healthy lifestyle and complies with pandemic preventive measures.

COVID-19 outcomes in people living with HIV: Peering through the waves

OBJECTIVE

To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection.

METHODS

This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables.

RESULTS

Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999).

CONCLUSIONS

Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Effects of Smoking on COVID-19 Management and Mortality: An Umbrella Review

Introduction

Smoking status appears to lead to a poor prognosis in COVID-19 patients. However, findings from the studies conducted on this topic have not been consistent, and further exploration is required.

Methods

The objective of this umbrella review was to examine the effects of smoking on COVID-19 management and mortality. Online databases that included PubMed, Embase, Scopus, and Web of Science were searched using relevant keywords up to July 27, 2022. Articles were restricted to the English language, and the PRISMA protocol was followed.

Results

A total of 27 systematic reviews, published from 2020 to 2022, were included. Individual studies included in the systematic reviews ranged from 8 to 186, with various population sizes. The consensus from the majority of systematic reviews was that COVID-19 smoker patients experience greater disease severity, disease progression, hospitalization rate, hospital admission duration, mechanical ventilation, ICU admission, and mortality rate.

Conclusions

COVID-19 patients with a history of smoking (current and former) are vulnerable to adverse hospital outcomes and worse COVID-19 progression. Effective preventive and supportive approaches are required to decrease the risk of COVID-19 morbidity and mortality in patients with a history of smoking.

Organokines in COVID-19: A Systematic Review

Coronavirus disease 2019 (COVID-19) is a viral infection caused by SARS-CoV-2 that induces a generalized inflammatory state. Organokines (adipokines, osteokines, myokines, hepatokines, and cardiokines) can produce beneficial or harmful effects in this condition. This study aimed to systematically review the role of organokines on COVID-19. PubMed, Embase, Google Scholar, and Cochrane databases were searched, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and 37 studies were selected, comprising more than 2700 individuals infected with the virus. Among COVID-19 patients, organokines have been associated with endothelial dysfunction and multiple organ failure due to augmented cytokines and increased SARS-CoV-2 viremia. Changes in the pattern of organokines secretion can directly or indirectly contribute to aggravating the infection, promoting immune response alterations, and predicting the disease progression. These molecules have the potential to be used as adjuvant biomarkers to predict the severity of the illness and severe outcomes.

The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study

BACKGROUND

Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran.

METHODS

In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software.

RESULTS

Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors.

CONCLUSION

Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.

Synthesis of the first remdesivir cocrystal: design, characterization, and therapeutic potential for pulmonary delivery

While cocrystal engineering is an emerging formulation strategy to overcome drug delivery challenges, its therapeutic potential in non-oral applications remains not thoroughly explored. We herein report for the first time the successful synthesis of a cocrystal for remdesivir (RDV), an antiviral drug with broad-spectrum activities against RNA viruses. The RDV cocrystal was prepared with salicylic acid (SA) via combined liquid-assisted grinding (LAG) and thermal annealing. Formation of RDV-SA was found to be a thermally activated process, where annealing at high temperature after grinding was a prerequisite to facilitate the cocrystal growth from an amorphous intermediate, rendering it elusive under ambient preparing conditions. Through powder X-ray analysis with Rietveld refinement, the three-dimensional molecular structure of RDV-SA was resolved. The thermally annealed RDV-SA produced by LAG crystalized in a non-centrosymmetric monoclinic space group P2₁ with a unit cell volume of 1826.53(17) ų, accommodating one pair of RDV and SA molecules in the asymmetric unit. The cocrystal formation was also characterized by differential scanning calorimetry, solid-state nuclear magnetic resonance, and Fourier-transform infrared spectroscopy. RDV-SA was further developed as inhaled dry powders by spray drying for potential COVID-19 therapy. The optimized RDV-SA dry powders exhibited a mass median aerodynamic diameter of 4.33 ± 0.2 μm and fine particle fraction of 41.39 ± 4.25 %, indicating the suitability for pulmonary delivery. Compared with the raw RDV, RDV-SA displayed a 15.43-fold higher fraction of release in simulated lung fluid at 120 min (p =0.0003). RDV-SA was safe in A549 cells without any in vitro cytotoxicity observed in the RDV concentration from 0.05 to 10 µM.