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Zhao M, Wang K. Short-term effects of PM 2.5 components on the respiratory infectious disease: a global perspective. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2024; 46:293. [PMID: 38976058 DOI: 10.1007/s10653-024-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/03/2024] [Indexed: 07/09/2024]
Abstract
Although previous research has reached agreement on the significant impact of particulate matter (PM2.5) on respiratory infectious diseases, PM2.5 acts as an aggregation of miscellaneous pollutants and the individual effect of each component has not been examined. Here, we investigate the effects of PM2.5 components, including black carbon (BC), organic carbon (OC), sulfate ion (SO4), dust, and sea salt (SS), on the morbidity and mortality of the recent respiratory disease, i.e. COVID-19. The daily data of 236 countries and provinces/states (e.g., in the United States and China) worldwide during 2020-2022 are utilized. To derive the pollutant-specific causal effects, optimal instrumental variables for each pollutant are selected from a large set of atmospheric variables. We find that one µg/m3 increase in OC increases the number of cases and death by about 3% to 6% from the mean worldwide during a lag of one day up to three days. Our findings remain consistent and robust when we change control variables such as the flight index and weather proxies, and also when applying a sine transformation to the positivity and death rate. When analyzing health effects among different areas, we find stronger impact in China, for its higher local OC concentration, as opposed to the impact in the United States. Health benefits from PM2.5 pollution reduction are comparatively high for developed regions, yet decreases in cases and deaths number are rather overt in less developing regions. Our research provides inspiration and reference for dealing with other respiratory diseases in the post-pandemic era.
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Affiliation(s)
- Manyi Zhao
- School of Management, and Economics, Beijing Institute of Technology, No 5 Zhongguancun South Street, Haidian District, Beijing, China
| | - Ke Wang
- School of Management, and Economics, Beijing Institute of Technology, No 5 Zhongguancun South Street, Haidian District, Beijing, China.
- Center for Energy and Environmental Policy Research, Beijing Institute of Technology, Beijing, China.
- Sustainable Development Research Institute for Economy and Society of Beijing, Beijing, China.
- Beijing Key Lab of Energy Economics and Environmental Management, Beijing, China.
- Beijing Laboratory for System Engineering of Carbon Neutrality, Beijing, China.
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Dalmau R, Alanazi AM, Arora M, Banerjee A, Bianco E, Gaalema DE, Goma FM, Hasegawa K, Komiyama M, Pérez Ríos M, Willett J, Wang Y. A Complex Interplay: Navigating the Crossroads of Tobacco Use, Cardiovascular Disease, and the COVID-19 Pandemic: A WHF Policy Brief. Glob Heart 2024; 19:55. [PMID: 38973985 PMCID: PMC11225561 DOI: 10.5334/gh.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans.
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Affiliation(s)
| | - Abdullah M. Alanazi
- King Saud Bin Abdulaziz University for Health Sciences, Saudi Arabia
- King Abdullah International Medical Research Center, Saudi Arabia
| | | | | | | | | | | | - Koji Hasegawa
- National Hospital Organization Kyoto Medical Center, Japan
| | - Maki Komiyama
- National Hospital Organization Kyoto Medical Center, Japan
| | - Mónica Pérez Ríos
- University of Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Spain
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Cho Y, Lee HK, Kim J, Yoo KB, Choi J, Lee Y, Choi M. Prediction of hospital-acquired influenza using machine learning algorithms: a comparative study. BMC Infect Dis 2024; 24:466. [PMID: 38698304 PMCID: PMC11067145 DOI: 10.1186/s12879-024-09358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Hospital-acquired influenza (HAI) is under-recognized despite its high morbidity and poor health outcomes. The early detection of HAI is crucial for curbing its transmission in hospital settings. AIM This study aimed to investigate factors related to HAI, develop predictive models, and subsequently compare them to identify the best performing machine learning algorithm for predicting the occurrence of HAI. METHODS This retrospective observational study was conducted in 2022 and included 111 HAI and 73,748 non-HAI patients from the 2011-2012 and 2019-2020 influenza seasons. General characteristics, comorbidities, vital signs, laboratory and chest X-ray results, and room information within the electronic medical record were analysed. Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGB), and Artificial Neural Network (ANN) techniques were used to construct the predictive models. Employing randomized allocation, 80% of the dataset constituted the training set, and the remaining 20% comprised the test set. The performance of the developed models was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), the count of false negatives (FN), and the determination of feature importance. RESULTS Patients with HAI demonstrated notable differences in general characteristics, comorbidities, vital signs, laboratory findings, chest X-ray result, and room status compared to non-HAI patients. Among the developed models, the RF model demonstrated the best performance taking into account both the AUC (83.3%) and the occurrence of FN (four). The most influential factors for prediction were staying in double rooms, followed by vital signs and laboratory results. CONCLUSION This study revealed the characteristics of patients with HAI and emphasized the role of ventilation in reducing influenza incidence. These findings can aid hospitals in devising infection prevention strategies, and the application of machine learning-based predictive models especially RF can enable early intervention to mitigate the spread of influenza in healthcare settings.
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Affiliation(s)
- Younghee Cho
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- Department of Digital Health, Samsung SDS, Seoul, Republic of Korea
| | - Hyang Kyu Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Joungyoun Kim
- College of Engineering, University of Seoul, Seoul, Republic of Korea
| | - Ki-Bong Yoo
- Division of Health Administration, Yonsei University, Wonju, Republic of Korea
| | - Jongrim Choi
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Yongseok Lee
- Department of Digital Health, Samsung SDS, Seoul, Republic of Korea
| | - Mona Choi
- College of Nursing, Yonsei University, Seoul, Republic of Korea.
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Rieder AS, Wyse ATS. Regulation of Inflammation by IRAK-M Pathway Can Be Associated with nAchRalpha7 Activation and COVID-19. Mol Neurobiol 2024; 61:581-592. [PMID: 37640915 DOI: 10.1007/s12035-023-03567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
In spite of the vaccine development and its importance, the SARS-CoV-2 pandemic is still impacting the world. It is known that the COVID-19 severity is related to the cytokine storm phenomenon, being inflammation a common disease feature. The nicotinic cholinergic system has been widely associated with COVID-19 since it plays a protective role in inflammation via nicotinic receptor alpha 7 (nAchRalpha7). In addition, SARS-CoV-2 spike protein (Spro) subunits can interact with nAchRalpha7. Moreover, Spro causes toll-like receptor (TLR) activation, leading to pro- and anti-inflammatory pathways. The increase and maturation of the IL-1 receptor-associated kinase (IRAK) family are mediated by activation of membrane receptors, such as TLRs. IRAK-M, a member of this family, is responsible for negatively regulating the activity of other active IRAKs. In addition, IRAK-M can regulate microglia phenotype by specific protein expression. Furthermore, there exists an antagonist influence of SARS-CoV-2 Spro and the cholinergic system action on the IRAK-M pathway and microglia phenotype. We discuss the overexpression and suppression of IRAK-M in inflammatory cell response to inflammation in SARS-CoV-2 infection when the cholinergic system is constantly activated via nAchRalpha7.
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Affiliation(s)
- Alessanda S Rieder
- Laboratory of Neuroprotection and Neurometabolic Diseases (Wyse's Lab), Department of Biochemistry, ICBS, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre RS, 90035-003, Brazil
| | - Angela T S Wyse
- Laboratory of Neuroprotection and Neurometabolic Diseases (Wyse's Lab), Department of Biochemistry, ICBS, Universidade Federal Do Rio Grande Do Sul (UFRGS), Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre RS, 90035-003, Brazil.
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Kaminski TW, Brzoska T, Li X, Vats R, Katoch O, Dubey RK, Bagale K, Watkins SC, McVerry BJ, Pradhan-Sundd T, Zhang L, Robinson KM, Nyunoya T, Sundd P. Lung microvascular occlusion by platelet-rich neutrophil-platelet aggregates promotes cigarette smoke-induced severe flu. JCI Insight 2024; 9:e167299. [PMID: 38060312 PMCID: PMC10906226 DOI: 10.1172/jci.insight.167299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/05/2023] [Indexed: 01/24/2024] Open
Abstract
Cigarette smoking is associated with a higher risk of ICU admissions among patients with flu. However, the etiological mechanism by which cigarette smoke (CS) exacerbates flu remains poorly understood. Here, we show that a mild dose of influenza A virus promotes a severe lung injury in mice preexposed to CS but not room air for 4 weeks. Real-time intravital (in vivo) lung imaging revealed that the development of acute severe respiratory dysfunction in CS- and flu-exposed mice was associated with the accumulation of platelet-rich neutrophil-platelet aggregates (NPAs) in the lung microcirculation within 2 days following flu infection. These platelet-rich NPAs formed in situ and grew larger over time to occlude the lung microvasculature, leading to the development of pulmonary ischemia followed by the infiltration of NPAs and vascular leakage into the alveolar air space. These findings suggest, for the first time to our knowledge, that an acute onset of platelet-driven thrombo-inflammatory response in the lung contributes to the development of CS-induced severe flu.
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Affiliation(s)
- Tomasz W. Kaminski
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, Wisconsin, USA
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
| | - Tomasz Brzoska
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
- Division of Hematology and Oncology, and
| | - Xiuying Li
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ravi Vats
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
- Department of Bioengineering
| | - Omika Katoch
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, Wisconsin, USA
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
| | - Rikesh K. Dubey
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, Wisconsin, USA
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
| | - Kamal Bagale
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Simon C. Watkins
- Center for Biologic Imaging, and
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryan J. McVerry
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tirthadipa Pradhan-Sundd
- Transfusion Medicine, Vascular Biology and Cell Therapy Program, VERSITI Blood Research Institute, Milwaukee, Wisconsin, USA
| | - Lianghui Zhang
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keven M. Robinson
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Toru Nyunoya
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Prithu Sundd
- Thrombosis and Hemostasis Program, VERSITI Blood Research Institute, Milwaukee, Wisconsin, USA
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute (VMI)
- Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering
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McGeoch LJ, Ross S, Massa MS, Lewington S, Clarke R. Cigarette smoking and risk of severe infectious respiratory diseases in UK adults: 12-year follow-up of UK biobank. J Public Health (Oxf) 2023; 45:e621-e629. [PMID: 37347589 PMCID: PMC10687597 DOI: 10.1093/pubmed/fdad090] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The relevance of tobacco smoking for infectious respiratory diseases (IRD) is uncertain. We investigated the associations of cigarette smoking with severe IRD resulting in hospitalization or death in UK adults. METHODS We conducted a prospective study of cigarette smoking and risk of severe IRD in UK Biobank. The outcomes included pneumonia, other acute lower respiratory tract infections (OA-LRTI) and influenza. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) of severe IRD associated with smoking habits after adjusting for confounding factors. RESULTS Among 341 352 participants with no prior history of major chronic diseases, there were 12 384 incident cases with pneumonia, 7054 with OA-LRTI and 795 with influenza during a 12-year follow-up. Compared with non-smokers, current smoking was associated with ⁓2-fold higher rates of severe IRD (HR 2.40 [2.27-2.53] for pneumonia, 1.99 [1.84-2.14] for OA-LRTI and 1.82 [95% confidence interval: 1.47-2.24] for influenza). Incidence of all severe IRDs were positively associated with amount of cigarettes smoked. The HRs for each IRD (except influenza) also declined with increasing duration since quitting. CONCLUSIONS Current cigarette smoking was positively associated with higher rates of IRD and the findings extend indications for tobacco control measures and vaccination of current smokers for prevention of severe IRD.
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Affiliation(s)
- Luke J McGeoch
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Stephanie Ross
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - M Sofia Massa
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Chang HC, Liu SF, Kuo HC, Chen KD, Liu JF, Tseng CW, Weng CM, Chou TC. Smoking cessation and influenza vaccination can reduce the healthcare burden of COPD. Tob Induc Dis 2023; 21:108. [PMID: 37637228 PMCID: PMC10458000 DOI: 10.18332/tid/167962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Influenza vaccination (INV) and smoking cessation (SC) have individual positive effects on COPD, but their synergistic impact has yet to be extensively studied. This retrospective study aimed to assess the combined effect of SC and IV on the medical burden of COPD, including medical visits, hospitalization, medical expenses, and the occurrence of respiratory failure. METHODS Patients with COPD who visited our medical center between January and October 2018 were included in the study. The patients were categorized into four groups: Group I (no SC or INV), Group II (INV only), Group III (SC only), and Group IV (both SC and INV). The outcomes analyzed were emergency utilization, hospital utilization, and occurrence of respiratory failure. Airflow limitation was stratified according to GOLD guidelines, and successful smoking cessation was defined as not smoking for at least one year. RESULTS A total of 357 patients were included in the study. Group I (119 patients) neither smoking cessation nor influenza vaccination; Group II (66 patients) had only influenza vaccination; Group III (94 patients), had only smoking cessation, Group IV (78 patients), with both smoking cessation and influenza vaccination. Group IV had lower odds of emergency utilization (OR=0.13; 95% CI: 0.07-0.25), hospital utilization (OR=0.13; 95% CI: 0.05-0.30, p<0.001), and occurrence of respiratory failure (OR=0.13; 95% CI: 0.04-0.40, p<0.001). CONCLUSIONS Combined smoking cessation and influenza vaccination are more effective in reducing the medical burden of COPD compared to either intervention alone or neither. These findings highlight the importance of promoting both smoking cessation and influenza vaccination in the management of COPD.
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Affiliation(s)
- Hui-Chuan Chang
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Feng Liu
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Chang Kuo
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kuang-Den Chen
- Institute of Translation Research in Biomedicine, Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Jui-Fang Liu
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Ching-Wan Tseng
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Mei Weng
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Teng-Ching Chou
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Imp BM, Levine T, Satre DD, Skarbinski J, Luu MN, Sterling SA, Silverberg MJ. Influenza Vaccination Uptake and Associated Factors Among Adults With and Without Human Immunodeficiency Virus in a Large, Integrated Healthcare System. Clin Infect Dis 2023; 77:56-63. [PMID: 36857440 PMCID: PMC10320060 DOI: 10.1093/cid/ciad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Influenza vaccination is recommended for adults regardless of human immunodeficiency virus (HIV) status. There may be facilitators or barriers to vaccinating people with HIV (PWH) that differ from people without HIV (PWoH). We sought to describe the uptake of influenza vaccination by HIV status and identify factors associated with vaccination. METHODS We abstracted data from the electronic health records of PWH and PWoH in Kaiser Permanente Northern California during 6 influenza seasons (2013-2018). We determined vaccination uptake and used Poisson regression models to evaluate factors associated with vaccination in PWH and PWoH. RESULTS 9272 PWH and 194 393 PWoH matched by age, sex, and race/ethnicity were included (mean age: 48 vs 49 years; men: 91% vs 90%; White race: 53% for both groups). PWH were more likely to receive the influenza vaccine (65-69% across years for PWH and 37-41% for PWoH) with an adjusted risk ratio for all years of 1.48 (95% CI: 1.46-1.50). For PWH, lower vaccination uptake was associated with several factors that suggested more complex health needs, such as lower CD4 cell counts, higher HIV viral loads, prior depression diagnoses, having Medicare insurance, and having a higher number of comorbidities. Associations with vaccination uptake were attenuated in PWH, compared with PWoH, for smoking, alcohol, and demographic factors. CONCLUSIONS PWH had an almost 50% higher uptake of influenza vaccination than PWoH, possibly reflecting greater engagement with the healthcare system. We also found that PWH with more complex health needs had reduced vaccination uptake. Findings may inform outreach strategies to increase influenza vaccination in PWH.
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Affiliation(s)
- Brandon M Imp
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Tory Levine
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Mitchell N Luu
- Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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9
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Chattopadhyay S, Malayil L, Kaukab S, Merenstein Z, Sapkota AR. The predisposition of smokers to COVID-19 infection: A mini-review of global perspectives. Heliyon 2023; 9:e17783. [PMID: 37455971 PMCID: PMC10306417 DOI: 10.1016/j.heliyon.2023.e17783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
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.
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Affiliation(s)
- Suhana Chattopadhyay
- Corresponding author. Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD-20742, USA.
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Hudmon KS, Czarnik JS, Lahey AM, Crowe SJ, Conklin M, Corelli RL, Gonzalvo JD, Hilts KE. Pharmacist-Led Implementation of Brief Tobacco Cessation Interventions during Mobile Health Access Events. PHARMACY 2023; 11:72. [PMID: 37104078 PMCID: PMC10144500 DOI: 10.3390/pharmacy11020072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
To address gaps in care for individuals from under-resourced communities disproportionately affected by tobacco use, this pharmacist-led demonstration project evaluated the feasibility of implementing tobacco use screening and brief cessation interventions during mobile health access events. A brief tobacco use survey was administered verbally during events at two food pantries and one homeless shelter in Indiana to assess the interest and potential demand for tobacco cessation assistance. Individuals currently using tobacco were advised to quit, assessed for their readiness to quit, and, if interested, offered a tobacco quitline card. Data were logged prospectively, analyzed using descriptive statistics, and group differences were assessed by site type (pantry versus shelter). Across 11 events (7 at food pantries and 4 at the homeless shelter), 639 individuals were assessed for tobacco use (n = 552 at food pantries; n = 87 at the homeless shelter). Among these, 189 self-reported current use (29.6%); 23.7% at food pantries, and 66.7% at the homeless shelter (p < 0.0001). About half indicated readiness to quit within 2 months; of these, 9 out of 10 accepted a tobacco quitline card. The results suggest that pharmacist-led health events at sites serving populations that are under-resourced afford unique opportunities to interface with and provide brief interventions for people who use tobacco.
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Affiliation(s)
- Karen Suchanek Hudmon
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA
| | - Julia S. Czarnik
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA
| | - Alexa M. Lahey
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA
| | - Susie J. Crowe
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA
- Center for Health Equity and Innovation, Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
| | - Megan Conklin
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA
- Center for Health Equity and Innovation, Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
| | - Robin L. Corelli
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA
| | - Jasmine D. Gonzalvo
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN 47907, USA
- Center for Health Equity and Innovation, Department of Pharmacy Practice, College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
| | - Katy Ellis Hilts
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, USA
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11
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SARS-CoV-2 versus Influenza A Virus: Characteristics and Co-Treatments. Microorganisms 2023; 11:microorganisms11030580. [PMID: 36985154 PMCID: PMC10051779 DOI: 10.3390/microorganisms11030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
For three years, the novel coronavirus disease 2019 (COVID-19) pandemic, caused by infection of the SARS-CoV-2 virus, has completely changed our lifestyles and prepared us to live with this novel pneumonia for years to come. Given that pre-existing flu is caused by the influenza A virus, we have begun unprecedently co-coping with two different respiratory diseases at the same time. Hence, we draw a comparison between SARS-CoV-2 and influenza A virus based on the general characteristics, especially the main variants’ history and the distribution of the two viruses. SARS-CoV-2 appeared to mutate more frequently and independently of locations than the influenza A virus. Furthermore, we reviewed present clinical trials on combined management against COVID-19 and influenza in order to explore better solutions against both at the same time.
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12
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Galanti MR, Andersson F, Caspersen IH, Peña S, Karvonen S, Magnus P, Raffetti E, Orsini N, Magnusson C, Shaaban AN, Hergens MP, Skott P. Current tobacco use and COVID-19 diagnoses in a cohort of adult clients of public dental clinics in Sweden. Sci Rep 2023; 13:1204. [PMID: 36681700 PMCID: PMC9862224 DOI: 10.1038/s41598-023-28091-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
Smoking has been linked with both increased and decreased risk of COVID-19, prompting the hypothesis of a protective role of nicotine in the pathogenesis of the disease. Studies of the association between use of smokeless tobacco and COVID-19 would help refining this hypothesis. We analysed data from 424,386 residents in the Stockholm Region, Sweden, with information on smoking and smokeless tobacco (snus) use prior to the pandemic obtained from dental records. Diagnoses of COVID-19 between February and October 2020 were obtained from health-care registers. We estimated the risk of receiving a diagnosis of COVID-19 for current smokers and for current snus users relative to non-users of tobacco, adjusting for potential confounders (aRR). The aRR of COVID -19 was elevated for current snus users (1.09 ;95%CI = 0.99-1.21 among men and 1.15; 95%CI = 1.00-1.33 among women). The risk for women consuming more than 1 can/day was twice as high as among non-users of tobacco. Current smoking was negatively associated with risk of COVID-19 (aRR = 0.68; 95% CI = 0.61-0.75); including hospital admission (aRR = 0.60; 95% CI = 0.47-0.76) and intensive care (aRR = 0.43; 95% CI = 0.21-0.89). The hypothesis of a protective effect of tobacco nicotine on COVID-19 was not supported by the findings. The negative association between smoking and COVID-19 remains unexplained.
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Affiliation(s)
- M R Galanti
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden.
| | - F Andersson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - I H Caspersen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, Postbox 222, 0213, Oslo, Norway
| | - S Peña
- Finnish Institute for Health and Welfare, Postbox 30, 00271, Helsinki, Finland
| | - S Karvonen
- Finnish Institute for Health and Welfare, Postbox 30, 00271, Helsinki, Finland
| | - P Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Skøyen, Postbox 222, 0213, Oslo, Norway
| | - E Raffetti
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - N Orsini
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - C Magnusson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, (CES), Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - A N Shaaban
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - M P Hergens
- Unit for Communicable Disease Control, Postbox 6909, 102 39, Stockholm Region, Sweden
| | - P Skott
- Department of Orofacial Medicine, Folktandvården Stockholm, Postbox 6420, 113 82, Stockholm, Sweden
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13
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Young-Wolff KC, Slama N, Alexeeff SE, Sakoda LC, Fogelberg R, Myers LC, Campbell CI, Adams AS, Prochaska JJ. Tobacco Smoking and Risk of SARS-CoV-2 Infection and Disease Severity Among Adults in an Integrated Healthcare System in California. Nicotine Tob Res 2023; 25:211-220. [PMID: 35368066 PMCID: PMC9825324 DOI: 10.1093/ntr/ntac090] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/18/2022] [Accepted: 03/31/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The relationship between tobacco smoking status and SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity is highly debated. We conducted a retrospective cohort study of >2.4 million adults in a large healthcare system to evaluate whether smoking is associated with SARS-CoV-2 infection and disease severity. AIMS AND METHODS This retrospective cohort study of 2,427,293 adults in KPNC from March 5, 2020 (baseline) to December 31, 2020 (pre-vaccine) included smoking status (current, former, never), socio-demographics, and comorbidities from the electronic health record. SARS-CoV-2 infection (identified by a positive PCR test) and COVID-19 severity (hospitalization, ICU admission or death ≤ 30 days of COVID-19 diagnosis) were estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined COVID-19 severity among patients with COVID-19 using logistic regression. RESULTS During the study, 44,270 patients had SARS-CoV-2 infection. Current smoking was associated with lower adjusted rates of SARS-CoV-2 infection (aHR = 0.64 95% CI: 0.61-0.67), COVID-19-related hospitalization (aHR = 0.48 95% CI: 0.40-0.58), ICU admission (aHR = 0.62 95% CI: 0.42-0.87), and death (aHR = 0.52 95% CI: 0.27-0.89) than never-smoking. Former smoking was associated with a lower adjusted rate of SARS-CoV-2 infection (aHR = 0.96 95% CI: 0.94-0.99) and higher adjusted rates of hospitalization (aHR = 1.10 95% CI: 1.03-1.08) and death (aHR = 1.32 95% CI: 1.11-1.56) than never-smoking. Logistic regression analyses among patients with COVID-19 found lower odds of hospitalization for current versus never-smoking and higher odds of hospitalization and death for former versus never-smoking. CONCLUSIONS In the largest US study to date on smoking and COVID-19, current and former smoking showed lower risk of SARS-CoV-2 infection than never-smoking, while a history of smoking was associated with higher risk of severe COVID-19. IMPLICATIONS In this cohort study of 2.4 million adults, adjusting for socio-demographics and medical comorbidities, current tobacco smoking was associated with a lower risk of both SARS-CoV-2 infection and severe COVID-19 illness compared to never-smoking. A history of smoking was associated with a slightly lower risk of SARS-CoV-2 infection and a modestly higher risk of severe COVID-19 illness compared to never-smoking. The lower observed COVID-19 risk for current versus never-smoking deserves further investigation. Results support prioritizing individuals with smoking-related comorbidities for vaccine outreach and treatments as they become available.
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Natalie Slama
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Renee Fogelberg
- Richmond Medical Center, Kaiser Permanente Northern California, Richmond, CA, USA
| | - Laura C Myers
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Alyce S Adams
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
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14
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Lee DH, Yang B, Gu S, Kim EG, Kim Y, Kang HK, Choe YH, Jeon HJ, Park S, Lee H. Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database. Front Endocrinol (Lausanne) 2023; 14:1077846. [PMID: 36817596 PMCID: PMC9935563 DOI: 10.3389/fendo.2023.1077846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subjects with diabetes are at higher risk of serious influenza-related complications. We aimed to investigate the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza in subjects with diabetes using a nationwide observational study performed within the recent decade. METHODS Among 105,732 subjects from the Korea National Health and Nutrition Examination Survey between 2007 and 2019, 8,632 with diabetes were included. We investigated the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza. RESULTS During the study period, the prevalence of influenza vaccination in subjects with diabetes showed a tendency to increase every year, reaching almost 60% in 2019, which was higher than the rate in subjects without diabetes. Younger age (adjusted hazard ratio (aHR) [95% CI] 11.29 [8.63-14.75] for < 50 years; 6.16 [5.21-7.29] for 50-65 years), male (aHR 1.67 [1.52-1.87]), current smoker (aHR 1.31 [1.00-1.72], lower-income status (aHR 1.46 [1.17, 1.84]), and high education level (aHR 1.30 [1.01-1.67]) were associated with being unvaccinated. Also, a poorer glycemic control with HbA1c ≥ 9% was found to be correlated with unvaccinated status (aHR 1.48 [1.15-1.90]). CONCLUSION The influenza vaccination rate is still unsatisfactory in subjects with diabetes. Young age, males, low-income level, high education level, and poor glycemic control were associated with unvaccinated status. Considering the risk-benefits of influenza vaccination in patients with diabetes, physicians should make an effort to increase vaccination rates, especially in low vaccination rate groups.
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Affiliation(s)
- Dong-Hwa Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seonhye Gu
- Department of Epidemiology and Health Informatics, Korea University, Seoul, Republic of Korea
| | - Eung-Gook Kim
- Department of Biochemistry, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Yeong Hun Choe
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyun Jeong Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungbuk National University College of Medicine and Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Seungyong Park
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Internal Medicine, Chonbuk National University Hospital-Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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15
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Kelly BC, Pawson M, Vuolo M. Social Network Ties and Responses to COVID-19 Among E-Cigarette Users. JOURNAL OF DRUG ISSUES 2023; 53:145-158. [PMID: 36606120 PMCID: PMC9684061 DOI: 10.1177/00220426221107555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Social networks can enhance behavioral changes or entrench existing patterns of behavior. We aimed to identify how network ties to other e-cigarette users shaped responses to the pandemic and e-cigarette considerations. A national U.S. survey of 562 e-cigarette users was conducted during April 2020. Participants self-reported network ties to other e-cigarette users and pandemic outcomes: receiving expressions of concern about vaping, risk for a bad COVID outcome, changes in e-cigarette risk perceptions, and considerations of quitting. Each additional e-cigarette user tie was associated with a 0.014 unit increase in expressions of concern (p < 0.001), a 0.034 unit increase in perceived risk of a bad outcome (p < 0.05), and 3.9% higher odds of quit considerations (OR = 1.039; p < 0.01). Family ties to e-cigarette users were particularly important. Additional e-cigarette users within a network shaped risk perceptions in response to COVID-19. Network ties to other e-cigarette users have implications for cessation or reduction of e-cigarette use.
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Affiliation(s)
- Brian C. Kelly
- Department of Sociology, Purdue University, West Lafayette, IN, USA,Brian C. Kelly, Department of Sociology,
Purdue University, 700 W State St, West Lafayette, IN 47907, USA.
| | - Mark Pawson
- Department of Sociology, Purdue University, West Lafayette, IN, USA
| | - Mike Vuolo
- Department of Sociology, The Ohio State
University, Columbus, OH, USA
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16
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Hämäläinen A, Savinainen E, Hämäläinen S, Sivenius K, Kauppinen J, Koivula I, Patovirta RL. Disease burden caused by respiratory syncytial virus compared with influenza among adults: a retrospective cohort study from Eastern Finland in 2017-2018. BMJ Open 2022; 12:e060805. [PMID: 36535718 PMCID: PMC9764619 DOI: 10.1136/bmjopen-2022-060805] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) is one of the most important causes of lower respiratory tract illnesses. In this study, we examined the number and severity of RSV infections among adult patients. The underlying diseases and background information of patients with RSV were examined and compared with the patients with influenza. DESIGN Retrospective cohort study. SETTING Patients receiving tertiary care services in Kuopio University Hospital (KUH) district in Eastern Finland. PARTICIPANTS 725 patients (152 with RSV infection and 573 with influenza) treated in KUH between November 2017 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Hospitalisation and mortality. RESULTS Compared with influenza, RSV caused a more serious disease in terms of hospitalisation (84.2% vs 66.0%, p<0.001), incidence of pneumonia (37.5% vs 23.2%, p<0.001), need for antibiotics (67.1% vs 47.3%, p<0.001) and supplemental oxygen (50.7% vs 31.2%, p<0.001). The all-cause mortality during hospitalisation and 30 days after discharge was higher among the RSV-infected patients (8.6% vs 3.5%, p=0.010). Solid malignancies (23.1% vs 5.0%, p=0.042) and chronic kidney disease (30.8% vs 5.8%, p=0.011) were more common among the RSV-infected non-survivors compared with survivors. RSV was an independent risk factor for hospitalisation (adjusted OR (aOR) 2.035; 95% CI 1.17 to 3.55) and mortality (aOR 2.288; 95% CI 1.09 to 4.81) compared with influenza. CONCLUSIONS Among all the screened patients, those with RSV infection were older and had more underlying conditions than patients with influenza. They had increased likelihood of hospitalisation and mortality when compared with influenza. Solid malignancies and chronic kidney disease seemed to be independent risk factors for death among RSV-infected patients. During RSV and influenza epidemics, it is important to test patients with respiratory symptoms for RSV and influenza to prevent the spread of the infections among elderly and chronically ill patients.
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Affiliation(s)
- Aleksi Hämäläinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Ellamaria Savinainen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Sari Hämäläinen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | | | - Irma Koivula
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
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17
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Kim M, Yang B, Gu S, Kim EG, Kim SR, Oh KS, Yoon WS, Bae DH, Lee JH, Kim SM, Choi WG, Bae JW, Hwang KK, Kim DW, Cho MC, Lee H, Lee DI. Secular trends and determinants of influenza vaccination uptake among patients with cardiovascular disease in Korea: Analysis using a nationwide database. Front Cardiovasc Med 2022; 9:961688. [PMID: 36267638 PMCID: PMC9576870 DOI: 10.3389/fcvm.2022.961688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Influenza vaccination reduces cardiovascular events in patients with cardiovascular disease (CVD). Identifying the factors that affect influenza vaccination uptake can help improve the prognosis in patients with CVD. This study aimed to evaluate the secular trends of influenza vaccination uptake and factors associated with lack of vaccination in individuals with CVD. Materials and methods We analyzed the annual trends and factors associated with influenza vaccination among 3,264 patients with CVD, included from the Korea National Health and Nutrition Examination Survey which reflect the health and nutritional status of the nationwide population of Korea conducted between 2007/2008 and 2018/2019. We used a stratified, multistage sampling method. Results The influenza vaccination rate was greater in patients with CVD (53–74%) than in those without CVD (28–40%). Multivariable logistic regression analysis showed that age <50 years [odds ratio (OR), 16.22; 95% confidence interval (CI), 7.72–34.07], 50–64 years (OR, 6.71; 95% CI, 4.37–10.28), male sex (OR, 1.45; 95% CI, 1.14–1.65), and asthma (OR, 0.45; 95% CI, 0.22–0.92) were independently associated with a lack of influenza vaccination. Among patients aged <65 years, smoking (OR, 2.30; 95% CI, 1.31–4.04), college graduation status (OR, 1.81; 95% CI, 1.16–2.82), and hypertension (OR, 0.70; 95% CI, 0.51–0.95) were independently associated with influenza vaccination. For individuals aged 65years, there was no significant determinant of lack of vaccination. Conclusion In patients with CVD, a continuous increase in the secular trend of influenza vaccination was demonstrated in Korea. Young age, male sex, and non-asthma status were independently associated with lack of influenza vaccination uptake.
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Affiliation(s)
- Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Seonhye Gu
- Department of Epidemiology and Health Informatics, Korea University, Seoul, South Korea
| | - Eung-Gook Kim
- Department of Biochemistry, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - So Rae Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Kyeong Seok Oh
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Woong-Su Yoon
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Dae-Hwan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Sang Min Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Woong Gil Choi
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Kyung-Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Dong-Woon Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea,*Correspondence: Hyun Lee,
| | - Dae-In Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, Cheongju, South Korea,Dae-In Lee,
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18
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McGrath JJC, Vanderstocken G, Dvorkin-Gheva A, Cass SP, Afkhami S, Fantauzzi MF, Thayaparan D, Reihani A, Wang P, Beaulieu A, Shen P, Morissette M, Jiménez-Saiz R, Revill SD, Tabuchi A, Zabini D, Lee WL, Richards CD, Miller MS, Ask K, Kuebler WM, Simpson JA, Stämpfli MR. Cigarette smoke augments CSF3 expression in neutrophils to compromise alveolar-capillary barrier function during influenza infection. Eur Respir J 2022; 60:2102049. [PMID: 35058252 DOI: 10.1183/13993003.02049-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cigarette smokers are at increased risk of acquiring influenza, developing severe disease and requiring hospitalisation/intensive care unit admission following infection. However, immune mechanisms underlying this predisposition are incompletely understood, and therapeutic strategies for influenza are limited. METHODS We used a mouse model of concurrent cigarette smoke exposure and H1N1 influenza infection, colony-stimulating factor (CSF)3 supplementation/receptor (CSF3R) blockade and single-cell RNA sequencing (scRNAseq) to investigate this relationship. RESULTS Cigarette smoke exposure exacerbated features of viral pneumonia such as oedema, hypoxaemia and pulmonary neutrophilia. Smoke-exposed infected mice demonstrated an increase in viral (v)RNA, but not replication-competent viral particles, relative to infection-only controls. Interstitial rather than airspace neutrophilia positively predicted morbidity in smoke-exposed infected mice. Screening of pulmonary cytokines using a novel dysregulation score identified an exacerbated expression of CSF3 and interleukin-6 in the context of smoke exposure and influenza. Recombinant (r)CSF3 supplementation during influenza aggravated morbidity, hypothermia and oedema, while anti-CSF3R treatment of smoke-exposed infected mice improved alveolar-capillary barrier function. scRNAseq delineated a shift in the distribution of Csf3 + cells towards neutrophils in the context of cigarette smoke and influenza. However, although smoke-exposed lungs were enriched for infected, highly activated neutrophils, gene signatures of these cells largely reflected an exacerbated form of typical influenza with select unique regulatory features. CONCLUSION This work provides novel insight into the mechanisms by which cigarette smoke exacerbates influenza infection, unveiling potential therapeutic targets (e.g. excess vRNA accumulation, oedematous CSF3R signalling) for use in this context, and potential limitations for clinical rCSF3 therapy during viral infectious disease.
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Affiliation(s)
- Joshua J C McGrath
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
- Authors contributed equally
| | - Gilles Vanderstocken
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
- Authors contributed equally
| | - Anna Dvorkin-Gheva
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Steven P Cass
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sam Afkhami
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew F Fantauzzi
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Danya Thayaparan
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Amir Reihani
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Peiyao Wang
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ashley Beaulieu
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pamela Shen
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mathieu Morissette
- Dept of Medicine, Université Laval, Quebec City, QC, Canada
- Quebec Heart and Lung Institute, Université Laval, Quebec City, QC, Canada
| | - Rodrigo Jiménez-Saiz
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
- Dept of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa, Madrid, Spain
- Dept of Immunology and Oncology, Centro Nacional de Biotecnología (CNB)-CSIC, Madrid, Spain
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Spencer D Revill
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Arata Tabuchi
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Diana Zabini
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Warren L Lee
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
| | - Carl D Richards
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthew S Miller
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
| | - Kjetil Ask
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada
- Institute of Physiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jeremy A Simpson
- Dept of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Martin R Stämpfli
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
- Dept of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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19
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Bennett B, Romm KF, Berg CJ. Changes in cigarette and e-cigarette use among US young adults from before to during the COVID-19 pandemic: News exposure and risk perceptions as potential predictors. Tob Prev Cessat 2022; 8:18. [PMID: 35601562 PMCID: PMC9074834 DOI: 10.18332/tpc/148245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION COVID-19 impacted cigarette and e-cigarette use behaviors among some individuals. This study examined COVID-19 factors and prior substance use as predictors of cigarette and e-cigarette cessation and initiation among US young adults from before to during the COVID-19 pandemic. METHODS We analyzed data from Wave 3 (Sept-Dec 2019) and Wave 5 (Sept-Dec 2020) of a 2-year, 5-wave longitudinal study of young adults across six US metropolitan areas. We examined COVID-19 news exposure, perceived smoking and e-cigarette use risk, and prior substance use, as predictors of cigarette and e-cigarette cessation and initiation, respectively. RESULTS Of W3 cigarette users (n=516), 37.8% (n=195) quit cigarettes at W5; predictors of cessation included younger age, fewer days of W3 past-month cigarette use, and no W3 e-cigarette use. Of W3 e-cigarette users (n=687), 38.7% (n=266) quit e-cigarettes at W5; predictors included greater COVID-19 news exposure, fewer days of W3 past-month e-cigarette use, and no W3 cigarette use. Of W3 cigarette non-users (n=1693), 5.0% (n=85) initiated cigarettes at W5; predictors of initiation included younger age, lower perceived smoking risk, lifetime cigarette and e-cigarette use, and W3 e-cigarette use. Of W3 e-cigarette non-users (n=1522), 6.3% (n=96) initiated e-cigarettes at W5; predictors included younger age, less news exposure, lifetime cigarette and e-cigarette use, and W3 cigarette use. CONCLUSIONS These findings underscore the need to address cigarette and e-cigarette co-use and related risk perceptions in prevention and cessation interventions.
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Affiliation(s)
- Breesa Bennett
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Katelyn F. Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
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20
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Haider MZ, Al-Mannai A, Al-Sirhan S, Elsabagh A, Nasser N, Al-Quraishi N, Ouda A, Erradi K, Ashour AA, Gupta I, Abdulmajeed J, Al-Romaihi HE, Bansal D, Musa OAH, Abd Farag EAB, Al-Thani MHJ, Al Moustafa AE. Impact of Smoking on COVID-19 Symptoms in Non-Vaccinated Patients: A Matched Observational Study from Qatar. J Multidiscip Healthc 2022; 15:531-540. [PMID: 35321233 PMCID: PMC8937311 DOI: 10.2147/jmdh.s347130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/10/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Predisposition to acute illness from COVID-19 is suggested to correlate with cigarette smoking as it augments the risk of developing cardiovascular and respiratory illnesses, including infections. However, the effects of smoking on COVID-19 symptoms are not well described and controversial. In this study, we aim to explore the associations between smoking and COVID-19 symptoms. Subjects and Methods A cross-sectional study using the Ministry of Public Health (MoPH), Qatar database was administered to a Qatari population with confirmed COVID-19 disease who filled in pre-defined phone-call questionnaire between 27th February 2020 and 31st December 2020. We analyzed 11,701 non-vaccinated COVID-19 individuals (2952 smokers and 8749 non-smokers) with confirmed RT-PCR test results. The association of smoking and the presence of symptoms as well as patient characteristics was calculated using Pearson’s Chi-square and Fisher’s exact tests, adjusting for potential covariates. Results Compared with the non-smokers, symptomatic COVID-19 infection is significantly higher in smokers. In addition, we found fever as the most common symptom developed in COVID-19 patients followed by cough, headache, muscle ache, and sore throat. As compared to other symptoms, association of smoking with chills and abdominal pain was less evident (P < 0.05 and P < 0.001, respectively). However, both groups showed similar rates of developing cough. Conclusion In conclusion, smoking is associated with COVID-19 symptoms frequency in non-vaccinated patients; nevertheless, further investigations are necessary to understand the mechanism of this association which could generate new targets for the management of COVID-19 in smoker patients.
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Affiliation(s)
| | - Amna Al-Mannai
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sally Al-Sirhan
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ahmed Elsabagh
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Nasser Nasser
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Amr Ouda
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Khadija Erradi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Anas A Ashour
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ishita Gupta
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | - Ala-Eddin Al Moustafa
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
- Biomedical Research Centre, Qatar University, Doha, Qatar
- Correspondence: Ala-Eddin Al Moustafa, College of Medicine, QU Health, Qatar University, PO Box 2713, Doha, Qatar, Tel +974 4403 7817, Fax +974 4403-3333, Email
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21
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SARS-CoV-2 and seasonal influenza: similarities and disparities. Arch Virol 2022; 167:2761-2765. [PMID: 36269417 PMCID: PMC9589861 DOI: 10.1007/s00705-022-05615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/18/2022] [Indexed: 12/14/2022]
Abstract
This report describes the differences in disease severity and clinical presentation between hospitalized patients with coronavirus disease 2019 (COVID-19) and others with seasonal influenza. A total of 136 influenza and 152 COVID-19 patients were included. Patients with influenza more frequently had dyspnea (p = 0.004), hypoxemia (p < 0.001), underlying diseases (p = 0.046), and elevated liver enzymes (p = 0.028). In contrast, patients with COVID-19 were overweight (p < 0.001), lymphopenic (p < 0.001), had elevated CRP (p = 0.011), and radiological abnormalities (p < 0.001). Patients with influenza were more severely ill on admission (NEWS > 5) (p < 0.001). However, length of hospital stay, ventilatory support, and 30-day-mortality were similar. Despite differences in clinical presentation and disease severity between influenza and COVID-19 patients, both groups had similar clinical outcomes.
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22
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Hamdan M, Badrasawi M, Zidan S, Sayarah A, Zahra LA, Dana S, Almasry T. Risk factors associated with hospitalization owing to COVID-19: a cross-sectional study in Palestine. J Int Med Res 2021; 49:3000605211064405. [PMID: 34939466 PMCID: PMC8721739 DOI: 10.1177/03000605211064405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We aimed to identify the risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization to provide evidence for improved clinical care of patients with COVID-19 infection. METHODS We conducted a cross-sectional study among 300 participants. The collected data comprised sociodemographic data, lifestyle habits, physical activity, medical history, anthropometric measurements, COVID-19-related symptoms, dietary habits prior to and after COVID-19 infection, and psychological status. RESULTS Fifty-nine participants were hospitalized. Fever, dry cough, joint pain, chills, diarrhea, and shortness of breath were significantly associated with hospitalization owing to COVID-19. Adults with obesity, diabetes mellitus, hypertension, respiratory diseases, and cardiovascular diseases had higher rates of hospitalization. The findings also showed that residential area and age were related to COVID-19 hospitalization. Furthermore, our analysis revealed that certain dietary habits were associated with hospitalization rates. CONCLUSION Our study confirmed that older age, urban residence, illiteracy, obesity, hypertension, diabetes mellitus, respiratory diseases, cardiovascular diseases, and symptoms of loss of smell and sneezing elevated the risk of hospitalization among patients with COVID-19 infection. Patients with a higher risk of hospitalization may benefit from targeted therapeutic and preventive interventions.
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Affiliation(s)
- May Hamdan
- Program of Health and Therapeutic Nutrition, College of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Manal Badrasawi
- Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, West Bank, Palestine
| | - Souzan Zidan
- Department of Nutrition and Food Technology, Faculty of Agriculture, Hebron University, Hebron, West Bank, Palestine
| | - Asma Sayarah
- Program of Health and Therapeutic Nutrition, College of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Lamia Abu Zahra
- Program of Health and Therapeutic Nutrition, College of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Shahd Dana
- Program of Health and Therapeutic Nutrition, College of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Tasneem Almasry
- Program of Health and Therapeutic Nutrition, College of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
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23
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Papazoglou DD, Baretella O, Feller M, Del Giovane C, Moutzouri E, Aujesky D, Schwenkglenks M, O’Mahony D, Knol W, Dalleur O, Rodondi N, Baumgartner C. Cross-sectional study on the prevalence of influenza and pneumococcal vaccination and its association with health conditions and risk factors among hospitalized multimorbid older patients. PLoS One 2021; 16:e0260112. [PMID: 34784405 PMCID: PMC8594840 DOI: 10.1371/journal.pone.0260112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population. METHODS Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models. RESULTS Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03-1.16; and PR 2.03, 95%CI 1.22-3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03-1.08; PR 1.24, 95%CI 1.16-1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001). CONCLUSION Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.
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Affiliation(s)
- Dimitrios David Papazoglou
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Oliver Baretella
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Denis O’Mahony
- Department of Medicine Cork, University College Cork National University of Ireland, Munster, IE, Ireland
- Department of Geriatric Medicine Cork, Cork University Hospital Group, Munster, IE, Ireland
| | - Wilma Knol
- Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Olivia Dalleur
- Louvain Drug Research Institute, and Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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24
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Moschovis PP, Lu M, Hayden D, Yonker LM, Lombay J, Taveras E, Arauz Boudreau A, Triant VA, Foulkes AS, Bassett I, Hibberd PL, Kinane TB. Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity. BMJ Open Respir Res 2021; 8:8/1/e001038. [PMID: 34740944 PMCID: PMC8573665 DOI: 10.1136/bmjresp-2021-001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Obstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age. Objectives To examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age. Methods We performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age. Measurements and main results Among 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients. Conclusions This cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.
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Affiliation(s)
- Peter P Moschovis
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mengdi Lu
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Douglas Hayden
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lael M Yonker
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jesiel Lombay
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elsie Taveras
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexy Arauz Boudreau
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Virginia A Triant
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea S Foulkes
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid Bassett
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - T Bernard Kinane
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
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25
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Nur Çelik FG, Demirel G. The impact of coronavirus pandemic on smoking behaviors in university students: an online survey in Turkey. Turk J Pharm Sci 2021; 19:416-421. [DOI: 10.4274/tjps.galenos.2021.26985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Baum U, Kulathinal S, Auranen K. Spotlight influenza: Estimation of influenza vaccine effectiveness in elderly people with assessment of residual confounding by negative control outcomes, Finland, 2012/13 to 2019/20. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 34505568 PMCID: PMC8431990 DOI: 10.2807/1560-7917.es.2021.26.36.2100054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Cohort studies on vaccine effectiveness are prone to confounding bias if the distribution of risk factors is unbalanced between vaccinated and unvaccinated study subjects. Aim We aimed to estimate influenza vaccine effectiveness in the elderly population in Finland by controlling for a sufficient set of confounders based on routinely available register data. Methods For each of the eight consecutive influenza seasons from 2012/13 through 2019/20, we conducted a cohort study comparing the hazards of laboratory-confirmed influenza in vaccinated and unvaccinated people aged 65–100 years using individual-level medical and demographic data. Vaccine effectiveness was estimated as 1 minus the hazard ratio adjusted for the confounders age, sex, vaccination history, nights hospitalised in the past and presence of underlying chronic conditions. To assess the adequacy of the selected set of confounders, we estimated hazard ratios of off-season hospitalisation for acute respiratory infection as a negative control outcome. Results Each analysed cohort comprised around 1 million subjects, of whom 37% to 49% were vaccinated. Vaccine effectiveness against laboratory-confirmed influenza ranged from 16% (95% confidence interval (CI): 12–19) to 48% (95% CI: 41–54). More than 80% of the laboratory-confirmed cases were hospitalised. The adjusted off-season hazard ratio estimates varied between 1.00 (95% CI: 0.94–1.05) and 1.08 (95% CI: 1.01–1.15), indicating that residual confounding was absent or negligible. Conclusion Seasonal influenza vaccination reduces the hazard of severe influenza disease in vaccinated elderly people. Data about age, sex, vaccination history and utilisation of hospital care proved sufficient to control confounding.
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Affiliation(s)
- Ulrike Baum
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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27
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Trent MJ, Salmon DA, MacIntyre CR. Using the health belief model to identify barriers to seasonal influenza vaccination among Australian adults in 2019. Influenza Other Respir Viruses 2021; 15:678-687. [PMID: 33586871 PMCID: PMC8404057 DOI: 10.1111/irv.12843] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Each year tens of thousands of Australians become ill with influenza, resulting in thousands of severe infections that require hospitalisation. However, only 40% of adults receive the annual influenza vaccine. We surveyed Australian adults to provide up to date, population-specific data on the predictors and barriers of seasonal influenza vaccination. METHODS We administered an online survey to a nationally representative sample of Australian adults. We designed survey questions using the theoretical constructs of the health belief model. Using simple and multivariable Poisson regression, we identified attitudes and beliefs associated with influenza vaccination in 2019. RESULTS Among 1,444 respondents, 51.7% self-reported influenza vaccination in 2019. We estimated vaccine coverage to be 44% for adults under 45, 46% for adults aged 45 to 64 and 77% for adults aged 65 and over. The strongest individual predictors of self-reported vaccination were believing the vaccine is effective at preventing influenza (APR = 3.71; 95% CI = 2.87-4.80), followed by recalling their doctor recommending the vaccine (APR = 2.70; 95% CI = 2.31-3.16). Common perceived barriers that predicted self-reported vaccination included believing the vaccine could give you influenza (APR = 0.59; 95% CI = 0.52-0.67), believing the vaccine can make you ill afterwards (APR = 0.68; 95% CI = 0.62-0.74) and preferring to develop immunity "naturally" (APR = 0.38; 95% CI = 0.32-0.45). CONCLUSION Although vaccine uptake in 2019 appears to be higher than previous years, there are perceived barriers which may limit uptake among Australians. Tailored interventions are needed to combat widespread influenza vaccine hesitancy, particularly among high-risk groups.
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Affiliation(s)
- Mallory J. Trent
- Biosecurity ProgramThe Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Daniel A. Salmon
- Departments of International Health and Health, Behavior and SocietyInstitute for Vaccine SafetyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - C. Raina MacIntyre
- Biosecurity ProgramThe Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
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28
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Esnaud R, Trzepizur W, Dautzenberg B, Ruppert AM, Malecot M. Actualités en tabacologie. REVUE DES MALADIES RESPIRATOIRES ACTUALITÉS 2021; 13:1S124-1S127. [PMID: 34188725 PMCID: PMC8227348 DOI: 10.1016/s1877-1203(21)00075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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29
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Krishnan A, Hamilton JP, Alqahtani SA, A Woreta T. A narrative review of coronavirus disease 2019 (COVID-19): clinical, epidemiological characteristics, and systemic manifestations. Intern Emerg Med 2021; 16:815-830. [PMID: 33453010 PMCID: PMC7811158 DOI: 10.1007/s11739-020-02616-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease which has had a rapid surge in cases and deaths since it is first documented in Wuhan, China, in December 2019. COVID-19 is caused by the Betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 uses angiotensin-converting enzyme 2, which is highly expressed in the human lower respiratory tract but also in other tissues, as the cellular entry receptor. Thus, COVID-19 mainly affects the respiratory system but can cause damage to other body systems, including the cardiovascular, gastrointestinal, hepatobiliary, renal, and central nervous systems. We review the pathogenesis and clinical manifestations of the infection, focusing on our current understanding of the disease mechanisms and their translation to clinical outcomes, as well as adverse effects on different body systems. We also discuss the epidemiology pathogenesis, clinical, and multi-organ consequences, and highlight some of the research gaps regarding COVID-19.
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Affiliation(s)
- Arunkumar Krishnan
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Hal 407, Baltimore, MD, 21287, USA.
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Hal 407, Baltimore, MD, 21287, USA
| | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Hal 407, Baltimore, MD, 21287, USA
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Tinsay A Woreta
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Hal 407, Baltimore, MD, 21287, USA.
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30
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Kang S, Gong X, Yuan Y. Association of smoking and cardiovascular disease with disease progression in COVID-19: A systematic review and meta-analysis. Epidemiol Infect 2021; 149:1-26. [PMID: 33975666 PMCID: PMC8220032 DOI: 10.1017/s0950268821001138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to systematically assess the association between smoking and cardiovascular disease (CVD) and disease progression among novel coronavirus pneumonia (coronavirus disease 2019 (COVID-19)) cases. PubMed database and Cochrane Library database were searched by computer to seek the epidemiological data of COVID-19 cases and literatures regarding CVDs from 1 Jan to 6 October 2020. Two researchers independently conducted literature screening, data collection and the assessment of the risk of bias of the studies included. RevMan 5.2 software was employed for meta-analysis. Funnel plot was adopted to assess the publication bias. On the whole, 21 studies comprising 7041 COVID-19 cases were included. As revealed from the meta-analysis, 14.0% (984/7027) of cases had a history of smoking, and 9.7% (675/6931) were subject to underlying CVDs. Cases with a history of smoking achieved a higher rate of COVID-19 disease progression as opposed to those having not smoked (OR 1.53, 95% CI 1.29–1.81, P < 0.00001), while no significant association could be found between smoking status and COVID-19 disease progression (OR 1.23, 95% CI 0.93–1.63, P = 0.15). Besides, smoking history elevated the mortality rate by 1.91-fold (OR 1.91, 95% CI 1.35–2.69, P = 0.0002). Moreover, underlying CVD elevated the incidence of severe disease by 2.87-fold (OR 2.87, 95% CI 2.29–3.61, P < 0.00001) and mortality by 3.05-fold (OR 3.05, 95% CI 1.82–5.11, P < 0.0001) in COVID-19 cases. As demonstrated from the current evidence, smoking displays a strong association with COVID-19 disease progression and mortality, and intensive tobacco control is imperative. Moreover, cases with CVD show a significantly elevated risk of disease progression and death when subject to COVID-19. However, the association between COVID-19 and CVD, and the potential effect exerted by smoking in the development of the two still require further verifications by larger and higher quality studies.
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Affiliation(s)
- Shiwei Kang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaowei Gong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yadong Yuan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Pak A, Adegboye OA, Eisen DP, McBryde ES. Hospitalisations related to lower respiratory tract infections in Northern Queensland. Aust N Z J Public Health 2021; 45:430-436. [PMID: 33900652 DOI: 10.1111/1753-6405.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/01/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the admission characteristics and hospital outcomes for patients admitted with lower respiratory tract infections (LRTI) in Northern Queensland. METHODS We perform a retrospective analysis of the data covering an 11-year period, 2006-2016. Length of hospital stay (LOS) is modelled by negative binomial regression and heterogeneous effects are checked using interaction terms. RESULTS A total of 11,726 patients were admitted due to LRTI; 2,430 (20.9%) were of Indigenous descent. We found higher hospitalisations due to LRTI for Indigenous than non-Indigenous patients, with a disproportionate increase in hospitalisations occurring during winter. The LOS for Indigenous patients was higher by 2.5 days [95%CI: -0.15; 5.05] than for non-Indigenous patients. The average marginal effect of 17.5 [95%CI: 15.3; 29.7] implies that the LOS for a patient, who was admitted to ICU, was higher by 17.5 days. CONCLUSIONS We highlighted the increased burden of LRTIs experienced by Indigenous populations, with this information potentially being useful for enhancing community-level policy making. Implications for public health: Future guidelines can use these results to make recommendations for preventative measures in Indigenous communities. Improvements in engagement and partnership with Indigenous communities and consumers can help increase healthcare uptake and reduce the burden of respiratory diseases.
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Affiliation(s)
- Anton Pak
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| | - Oyelola A Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Damon P Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,College of Medicine and Dentistry, James Cook University, Queensland
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
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SARS-CoV-2 infection and smoking: What is the association? A brief review. Comput Struct Biotechnol J 2021; 19:1654-1660. [PMID: 33777332 PMCID: PMC7985684 DOI: 10.1016/j.csbj.2021.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 02/06/2023] Open
Abstract
The link between smoking and the expression of SARS-CoV-2 key entry genes is discussed. Smoking-related cardiac and respiratory diseases are risk factors for COVID-19. The impact of smoking on ACE-2 and TMPRSS2 receptors expression is controversial.
Susceptibility to severe illness from COVID-19 is anticipated to be associated with cigarette smoking as it aggravates the risk of cardiovascular and respiratory illness, including infections. This is particularly important with the advent of a new strain of coronaviruses, the severe acute respiratory syndrome coronavirus (SARS-CoV-2) that has led to the present pandemic, coronavirus disease 2019 (COVID-19). Although, the effects of smoking on COVID-19 are less described and controversial, we presume a link between smoking and COVID-19. Smoking has been shown to enhance the expression of the angiotensin-converting enzyme-2 (ACE-2) and transmembrane serine protease 2 (TMPRSS2) key entry genes utilized by SARS-CoV-2 to infect cells and induce a ‘cytokine storm’, which further increases the severity of COVID-19 clinical course. Nevertheless, the impact of smoking on ACE-2 and TMPRSS2 receptors expression remains paradoxical. Thus, further research is necessary to unravel the association between smoking and COVID-19 and to pursue the development of potential novel therapies that are able to constrain the morbidity and mortality provoked by this infectious disease. Herein we present a brief overview of the current knowledge on the correlation between smoking and the expression of SARS-CoV-2 key entry genes, clinical manifestations, and disease progression.
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Key Words
- ACE2, angiotensin-converting enzyme-2
- ACEIs, Angiotensin‐converting enzyme inhibitors
- ADAM17, ADAM metallopeptidase domain 17
- ALCAM, activated leukocyte cell adhesion molecule
- ARBs, angiotensin receptor blockers
- ARDS, acute respiratory distress syndrome
- Ang, angiotensin
- BatCoV, bat coronavirus
- CLDN7, claudin 7
- COPD, chronic obstructive pulmonary disease
- COVID-19
- COVID-19, coronavirus disease 2019
- CTNNB1, catenin beta 1
- Coronavirus
- ERK, extracellular signal-regulated kinases
- HDAC6, histone deacetylase 6
- HIV-1, human immunodeficiency virus 1
- IFN, Interferons
- IPF, Idiopathic pulmonary fibrosis
- IR, Ionizing radiation
- JNK, c-Jun N-terminal kinase
- Lung disease
- MCN, mucin
- MERS, middle-East respiratory syndrome
- NO, nitric oxide
- Oral disease
- R0, R-nought
- RAS, renin-angiotensin
- RR, relative risk
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus
- Smoking
- TJP3, tight junction protein 3
- TMPRSS, transmembrane serine protease
- hrsACE2, human recombinant soluble ACE-2
- nAChR, α7 nicotinic acetylcholine receptor
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Shepherd JM, Fogle B, Garey L, Viana AG, Zvolensky MJ. Worry about COVID-19 in relation to cognitive-affective smoking processes among daily adult combustible cigarette smokers. Cogn Behav Ther 2021; 50:336-350. [PMID: 33511905 DOI: 10.1080/16506073.2020.1866657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cigarette smoking is a known risk factor for severe disease and death from respiratory infection. Initial data suggest that smoking is a risk factor for COVID-19 symptom severity. Exposure to increased pandemic-related stress and subsequent worry about COVID-19 may amplify the desire to smoke to down-regulate distress. The present investigation sought to test this conceptual model by evaluating worry about COVID-19 in relation to COVID-19 coping motives for smoking, perceived barriers for smoking cessation, and smoking abstinence expectancies. Participants were 219 daily combustible cigarette smokers (55.70% female, Mage = 41.43 years, SD = 11.06). Six separate, two-step hierarchical linear regression models were conducted for each of the criterion variables. As expected, worry about COVID-19 was significantly and positively related to COVID-19 coping motives for smoking and perceived barriers for smoking cessation. Worry about COVID-19 also was a positively significant predictor of smoking abstinence expectancies of negative mood, somatic symptoms, and harmful consequences, but not positive consequences. The present study provides novel empirical evidence that worry about COVID-19 is related to key cognitive-affective smoking processes beyond the effects of age, sex, race, ethnicity, COVID-19 exposure, smoking rate, e-cigarette use status, and anxiety symptoms. These results highlight the potential utility in assessing level of worry about COVID-19, a transdiagnostic construct, among combustible cigarette smokers to better understand cognitive-affective factors that may maintain smoking behavior in the context of the COVID-19 pandemic.
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Affiliation(s)
| | - Brienna Fogle
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA.,Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,HEALTH Institute, University of Houston, Houston, TX, USA
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34
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Krishnan A, Hamilton JP, Alqahtani SA, Woreta TA. COVID-19: An overview and a clinical update. World J Clin Cases 2021; 9:8-23. [PMID: 33511168 PMCID: PMC7809683 DOI: 10.12998/wjcc.v9.i1.8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/30/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of coronavirus disease-2019 (COVID-19, previously known as 2019 nCoV) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Wuhan City, China, has spread rapidly around the world. Most patients from the first cluster had an epidemiological connection to the Wuhan's Huanan Seafood Wholesale Market. Available evidence has shown that SARS-CoV-2 can be easily transmitted from person to person through close contact and respiratory droplets, posing a substantial challenge to public health. At present, the research on SARS-CoV-2 is still in the primary stages. However, dexa-methasone and remdesivir are appeared to be promising medical therapies. Still, there is no definite specific treatment, and the mainstay of treatment is still focused on supportive therapies. Currently, over 150 vaccines are under investigation. It is necessary to understand the nature of the virus and its clinical characteristics in order to find effectively manage the disease. The knowledge about this virus is rapidly evolving, and clinicians must update themselves regularly. The present review comprehensively summarizes the epidemiology, pathogenesis, clinical characteristics, and management of COVID-19 based on the current evidence.
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Affiliation(s)
- Arunkumar Krishnan
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21287, United States
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21287, United States
| | - Saleh A Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21287, United States
- Liver Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh 12713, Saudi Arabia
| | - Tinsay A Woreta
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, MD 21287, United States
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35
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Shastri MD, Shukla SD, Chong WC, KC R, Dua K, Patel RP, Peterson GM, O'Toole RF. Smoking and COVID-19: What we know so far. Respir Med 2021; 176:106237. [PMID: 33246296 PMCID: PMC7674982 DOI: 10.1016/j.rmed.2020.106237] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023]
Abstract
The ongoing COVID-19 pandemic has placed a spotlight on infectious diseases and their associations with host factors and underlying conditions. New data on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus are entering the public domain at a rapid rate such that their distillation often lags behind. To minimise weak associations becoming perceived as established paradigms, it is imperative that methodologies and outputs from different studies are appropriately critiqued and compared. In this review, we examine recent data on a potential relationship between smoking and COVID-19. While the causal role of smoking has been firmly demonstrated in regard to lung cancer and chronic obstructive pulmonary disease, such associations have the benefit of decades' worth of multi-centre epidemiological and mechanistic data. From our analysis of the available studies to date, it appears that a relationship is emerging in regard to patients with a smoking history having a higher likelihood of developing more severe symptoms of COVID-19 disease than non-smokers. Data on whether COVID-19 has a greater incidence in smokers than non-smokers is thus far, contradictory and inconclusive. There is therefore a need for some caution to be exercised until further research has been conducted in a wider range of geographical settings with sufficient numbers of patients that have been carefully phenotyped in respect of smoking status and adequate statistical control for confounding factors.
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Affiliation(s)
- Madhur D. Shastri
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia,Corresponding author
| | - Shakti D. Shukla
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute and the University of Newcastle, Callaghan, Australia
| | - Wai Chin Chong
- Department of Molecular and Translational Science, Monash University, Clayton, Australia
| | - Rajendra KC
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Tasmania, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW, Australia
| | - Rahul P. Patel
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Ronan F. O'Toole
- Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, College of Science, Health and Engineering, La Trobe University, La Trobe, Australia,Corresponding author
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36
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Samet JM. Tobacco Products and the Risks of SARS-CoV-2 Infection and COVID-19. Nicotine Tob Res 2020; 22:S93-S95. [PMID: 33320258 PMCID: PMC7953960 DOI: 10.1093/ntr/ntaa187] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 01/15/2023]
Abstract
Implications: This commentary addresses the state of the evidence on tobacco products,
nicotine, and COVID-19. The evidence of the effects of smoking on respiratory infections
and the immune system in general are examined and the current understanding of tobacco
products and risk for SARS-CoV-2 infection and the course of COVID-19 is addressed.
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Affiliation(s)
- Jonathan M Samet
- Office of the Dean, Colorado School of Public Health, Aurora, CO
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37
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Kelly BC, Pawson M, Vuolo M. Beliefs on COVID-19 Among Electronic Cigarette Users: Behavioral Responses and Implications for COVID Prevention and E-Cigarette Interventions. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620977828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
E-cigarette users’ beliefs about COVID-19 may shape their responses to the pandemic and their e-cigarette consumption. A U.S. national cross-sectional survey of 562 e-cigarette users was conducted in April 2020. Participants self-reported nicotine consumption, COVID-19 beliefs, beliefs about e-cigarettes, social distancing, COVID-19 disruptions, cessation considerations, and individual characteristics. Ordinary least squares (OLS) regression provided unstandardized, and standardized coefficients. Frequency of e-cigarette use is inversely associated with beliefs COVID-19 is relevant (β = −0.215). Beliefs e-cigarettes are addictive, harmful, or pose a risk to future health were positively associated with beliefs COVID-19 is relevant (β = 0.171; β = 0.164; β = 0.203), beliefs the media are truthful on COVID-19 (β = 0.133; β = 0.136; β = 0.137), and beliefs e-cigarette users are at greater risk (β = 0.279; β = 0.411; β = 0.447). All three COVID-19 beliefs (COVID relevant; media truthful; and greater risk) were positively associated with social distancing (β = 0.307; β = 0.259; β = 0.115), work disruptions (β = 0.134; β = 0.135; β = 0.130), family disruptions (β = 0.232; β = 0.131; β = 0.164), friendship disruptions (β = 0.214; β = 0.139; β = 0.133), and considerations of quitting (β = 0.250; β = 0.222; β = 0.620). Strong associations between e-cigarette beliefs and COVID-19 beliefs exist. COVID-19 beliefs are associated with behavioral responses, such as social distancing and considerations of e-cigarette cessation. Interventions may be able to leverage COVID-19 beliefs to reduce e-cigarette consumption or promote cessation during the pandemic.
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Affiliation(s)
| | | | - Mike Vuolo
- The Ohio State University, Columbus, OH, USA
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38
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Xie Y, Bowe B, Maddukuri G, Al-Aly Z. Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study. BMJ 2020; 371:m4677. [PMID: 33323357 PMCID: PMC7735416 DOI: 10.1136/bmj.m4677] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Yan Xie
- Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
- Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA
| | - Benjamin Bowe
- Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, USA
- Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA
| | - Geetha Maddukuri
- Nephrology Section, Medicine Service, VA Saint Louis Health Care System, Saint Louis, MO, USA
| | - Ziyad Al-Aly
- Clinical Epidemiology Center, Research and Development Service, VA Saint Louis Health Care System, Saint Louis, MO, USA
- Veterans Research and Education Foundation of Saint Louis, Saint Louis, MO, USA
- Nephrology Section, Medicine Service, VA Saint Louis Health Care System, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
- Institute for Public Health, Washington University in Saint Louis, Saint Louis, MO, USA
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39
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Dai M, Tao L, Chen Z, Tian Z, Guo X, Allen-Gipson DS, Tan R, Li R, Chai L, Ai F, Liu M. Influence of Cigarettes and Alcohol on the Severity and Death of COVID-19: A Multicenter Retrospective Study in Wuhan, China. Front Physiol 2020; 11:588553. [PMID: 33362576 PMCID: PMC7756110 DOI: 10.3389/fphys.2020.588553] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background The recent emergence and rapid global spread of coronavirus disease 2019 (COVID-19) is leading to public health crises worldwide. Alcohol consumption and cigarette smoking (CS) are two known risk factors in many diseases including respiratory infections. Methods We performed a multi-center study in the four largest hospitals designated for COVID-19 patients in Wuhan. There are totally 1547 patients diagnosed with COVID-19 enrolled in the study, alcohol consumption and CS history were evaluated among these patients. The epidemiology, laboratory findings and outcomes of patients contracted COVID-19 were further studied. Results Our findings indicated that COVID-19 patients with a history of CS tend to have more severe outcomes than non-smoking patients. However, alcohol consumption did not reveal significant effects on neither development of severe illness nor death rates in COVID-19 patients. Conclusion CS is a risk factor for developing severe illness and increasing mortality during the SARS-CoV-2 infection. We believe that our findings will provide a better understanding on the effects of alcohol intake and CS exposure in COVID-19 patients.
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Affiliation(s)
- Mengyuan Dai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China.,Hubei Cancer Clinical Study Center, Wuhan, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Zhen Chen
- Department of Emergency, The Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Tian
- Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Xiaofang Guo
- Department of Obstetrics & Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Diane S Allen-Gipson
- Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States.,Division of Allergy and Immunology, Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ruirong Tan
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Rui Li
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Radiation Oncology, Sichuan Cancer Center, School of Medicine, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Chai
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Fen Ai
- Department of Emergency, The Central Hospital of Wuhan Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Miao Liu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Abdel-Rahman O. Influenza and pneumonia-attributed deaths among cancer patients in the United States; a population-based study. Expert Rev Respir Med 2020; 15:393-401. [PMID: 33107375 DOI: 10.1080/17476348.2021.1842203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: To assess the patterns and trends of influenza and pneumonia-attributed deaths among cancer patients in the United States.Methods: Surveillance, Epidemiology and End Results (SEER) database was accessed and cancer patients diagnosed 1975-2016 who have been included in the SEER-9 registries were included. The primary endpoint of the study is standardized mortality rate (SMR; calculated as observed/ Expected (O/E) ratio for death from influenza and pneumonia among cancer patients).Results: The current study evaluates a total of 3,579,199 cancer patients (diagnosed 1975-2016) within the SEER-9 registries; and influenza and pneumonia-attributed deaths represent 1.5% of the recorded deaths for this cohort. SMR for influenza/ pneumonia-attributed death within the first year following cancer diagnosis was 1.88 (1.83-1.94);while SMR for influenza/pneumonia-attributed death following the first year was 1.11 (1.10-1.12). Within the first year following cancer diagnosis, SMR from influenza/pneumonia was higher among individuals with black race (SMR for white race: 1.75 (95% CI: 1.69-1.81) while SMR for black race: 2.90 (95% CI: 2.65-3.16), lung cancer (SMR for lung cancer: 4.39 (95% CI: 4.11-4.69)), head and neck cancer (SMR for oral cavity/ pharynx cancer: 4.02 (95% CI: 3.50-4.59)), lymphomas (SMR for lymphoma: 3.28 (95% CI: 2.92-3.68)), leukemias (SMR for leukemia: 3.32 (95% CI: 2.89-3.80)) and myeloma (SMR for myeloma: 3.91 (95% CI: 3.28-4.63)).Conclusions: Cancer patients are more likely to have influenza/ pneumonia-attributed death compared to the general US population. This risk is higher among patients with lung cancer, head and neck cancer, and hematological malignancies.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
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41
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Bashir S, Moneeba S, Alghamdi A, Alghamdi F, Niaz A, Anan H, Kaleem I. Comorbidities in Patients with COVID-19 and Their Impact on the Severity of the Disease. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2020. [DOI: 10.1055/s-0040-1718848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractInfection with COVID-19 is associated with significant morbidity, especially in patients with chronic medical conditions. At least one-fifth of cases require supportive care in intensive care units, which have limited availability in most developing countries. A literature search was conducted on PubMed, Medline, Scopus, Embase, and Google Scholar to find articles published by May 7, 2020 on the role of comorbidities in patients with COVID-19 and the impact of comorbidities on the disease. This review highlighted that patients with comorbidities are more likely to experience severe disease than those with no other conditions; that is, comorbidities correlated with greater disease severity in patients with COVID-19. Proper screening of COVID-19 patients should include careful inquiries into their medical history; this will help healthcare providers identify patients who are more likely to develop serious disease or experience adverse outcomes. Better protection should also be given to patients with COVID-19 and comorbidities upon confirmation of the diagnosis. This literature review showed that the comorbidities most often associated with more severe cases of COVID-19 are hypertension, cardiovascular disease, and diabetes. Individuals with these comorbidities should adopt restrictive measures to prevent exposure to COVID-19, given their higher risk of severe disease.
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Affiliation(s)
- Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Sadaf Moneeba
- Department of Bioinformatics and Biotechnology, International Islamic University Islamabad, Islamabad, Pakistan
| | - Alaa Alghamdi
- King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fouad Alghamdi
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Asim Niaz
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Hadeel Anan
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Imdad Kaleem
- Department of Bioinformatics and Biosciences, COMSATS University (CUI), Islamabad, Pakistan
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Jackson BR, Gold JAW, Natarajan P, Rossow J, Neblett Fanfair R, da Silva J, Wong KK, Browning SD, Bamrah Morris S, Rogers-Brown J, Hernandez-Romieu AC, Szablewski CM, Oosmanally N, Tobin-D'Angelo M, Drenzek C, Murphy DJ, Hollberg J, Blum JM, Jansen R, Wright DW, SeweSll WM, Owens JD, Lefkove B, Brown FW, Burton DC, Uyeki TM, Bialek SR, Patel PR, Bruce BB. Predictors at admission of mechanical ventilation and death in an observational cohort of adults hospitalized with COVID-19. Clin Infect Dis 2020; 73:e4141-e4151. [PMID: 32971532 PMCID: PMC7543323 DOI: 10.1093/cid/ciaa1459] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease (COVID-19) can cause severe illness and death. Predictors of poor outcome collected on hospital admission may inform clinical and public health decisions. Methods We conducted a retrospective observational cohort investigation of 297 adults admitted to eight academic and community hospitals in Georgia, United States, during March 2020. Using standardized medical record abstraction, we collected data on predictors including admission demographics, underlying medical conditions, outpatient antihypertensive medications, recorded symptoms, vital signs, radiographic findings, and laboratory values. We used random forest models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for predictors of invasive mechanical ventilation (IMV) and death. Results Compared with age <45 years, ages 65–74 years and ≥75 years were predictors of IMV (aOR 3.12, CI 1.47–6.60; aOR 2.79, CI 1.23–6.33) and the strongest predictors for death (aOR 12.92, CI 3.26–51.25; aOR 18.06, CI 4.43–73.63). Comorbidities associated with death (aORs from 2.4 to 3.8, p <0.05) included end-stage renal disease, coronary artery disease, and neurologic disorders, but not pulmonary disease, immunocompromise, or hypertension. Pre-hospital use vs. non-use of angiotensin receptor blockers (aOR 2.02, CI 1.03–3.96) and dihydropyridine calcium channel blockers (aOR 1.91, CI 1.03–3.55) were associated with death. Conclusions After adjustment for patient and clinical characteristics, older age was the strongest predictor of death, exceeding comorbidities, abnormal vital signs, and laboratory test abnormalities. That coronary artery disease, but not chronic lung disease, was associated with death among hospitalized patients warrants further investigation, as do associations between certain antihypertensive medications and death.
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Affiliation(s)
| | - Jeremy A W Gold
- CDC COVID-19 Emergency Response.,Epidemic Intelligence Service, CDC
| | | | - John Rossow
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC
| | | | | | - Karen K Wong
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | - Sean D Browning
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Jessica Rogers-Brown
- CDC COVID-19 Emergency Response.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Alfonso C Hernandez-Romieu
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Emory University School of Medicine
| | - Christine M Szablewski
- CDC COVID-19 Emergency Response.,U.S. Public Health Service.,Epidemic Intelligence Service, CDC.,Georgia Department of Public Health, Atlanta, Georgia
| | | | | | | | | | | | - James M Blum
- Emory University School of Medicine.,Georgia Clinical & Translational Science Alliance, Atlanta, Georgia
| | | | - David W Wright
- Emory University School of Medicine.,Grady Health System, Atlanta, Georgia
| | | | - Jack D Owens
- Phoebe Putney Memorial Hospital, Albany, Georgia
| | | | - Frank W Brown
- Emory University School of Medicine.,Emory Decatur Hospital, Decatur, Georgia
| | - Deron C Burton
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
| | | | | | - Priti R Patel
- CDC COVID-19 Emergency Response.,U.S. Public Health Service
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43
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Soares RDCM, Mattos LR, Raposo LM. Risk Factors for Hospitalization and Mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg 2020; 103:1184-1190. [PMID: 32682453 PMCID: PMC7470570 DOI: 10.4269/ajtmh.20-0483] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Brazil is, at the time of writing, the global epicenter of COVID-19, but information on risk factors for hospitalization and mortality in the country is still limited. Demographic and clinical data of COVID-19 patients until June 11th, 2020 were retrieved from the State Health Secretariat of Espírito Santo, Brazil. Potential risk factors for COVID-19 hospitalization and death were analyzed by univariate and multivariable logistic regression models. A total of 10,713 COVID-19 patients were included in this study; 81.0% were younger than 60 years, 55.2% were female, 89.2% were not hospitalized, 32.9% had at least one comorbidity, and 7.7% died. The most common symptoms on admission were cough (67.7%) and fever (62.6%); 7.1% of the patients were asymptomatic. Cardiovascular diseases (23.7%) and diabetes (10.3%) were the two most common chronic diseases. Multivariate logistic regression analysis identified an association of all explanatory variables, except for cough and diarrhea, with hospitalization. Older age (odds ratio [OR] = 3.95, P < 0.001) and shortness of breath (OR = 3.55, P < 0.001) were associated with increase of odds to COVID-19 death in hospitalized patients. Our study provided evidence that older age, male gender, Asian, indigenous or unknown race, comorbidities (smoking, kidney disease, obesity, pulmonary disease, diabetes, and cardiovascular disease), as well as fever and shortness of breath increased the risk of hospitalization. For death outcome in hospitalized patients, only older age and shortness of breath increased the risk.
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Affiliation(s)
- Rita de Cássia Menezes Soares
- Department of Quantitative Methods, Center for Exact Sciences and Technology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Rodrigues Mattos
- Department of Public Health Nursing, Anna Nery Nursing School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Letícia Martins Raposo
- Department of Quantitative Methods, Center for Exact Sciences and Technology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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44
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Smoking and COVID-19: Adding Fuel to the Flame. Int J Mol Sci 2020; 21:ijms21186581. [PMID: 32916821 PMCID: PMC7555793 DOI: 10.3390/ijms21186581] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, an infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to more than 771,000 deaths worldwide. Tobacco smoking is a major known risk factor for severe illness and even death from many respiratory infections. The effects of smoking on COVID-19 are currently controversial. Here, we provide an overview of the current knowledge on the effects of smoking on the clinical manifestations, disease progression, inflammatory responses, immunopathogenesis, racial ethnic disparities, and incidence of COVID-19. This review also documents future directions of smoking related research in COVID-19. The current epidemiological finding suggests that active smoking is associated with an increased severity of disease and death in hospitalized COVID-19 patients. Smoking can upregulate the angiotensin-converting enzyme-2 (ACE-2) receptor utilized by SARS-CoV-2 to enter the host cell and activate a ‘cytokine storm’ which can lead to worsen outcomes in COVID-19 patients. This receptor can also act as a potential therapeutic target for COVID-19 and other infectious diseases. The COVID-19 pandemic sheds light on a legacy of inequalities regarding gender, racial, and ethnic health disparities associated with active smoking, thus, smoking cessation may help in improving outcomes. In addition, to flatten the COVID-19 curve, staying indoors, avoiding unnecessary social contact, and bolstering the immune defense system by maintaining a healthy diet/living are highly desirable.
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45
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Reddy RK, Charles WN, Sklavounos A, Dutt A, Seed PT, Khajuria A. The effect of smoking on COVID-19 severity: A systematic review and meta-analysis. J Med Virol 2020; 93:1045-1056. [PMID: 32749705 PMCID: PMC7436545 DOI: 10.1002/jmv.26389] [Citation(s) in RCA: 231] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
Abstract
Various comorbidities represent risk factors for severe coronavirus disease 2019 (COVID‐19). The impact of smoking on COVID‐19 severity has been previously reported in several meta‐analyses limited by small sample sizes and poor methodology. We aimed to rigorously and definitively quantify the effects of smoking on COVID‐19 severity. MEDLINE, Embase, CENTRAL, and Web of Science were searched between 1 December 2019 and 2 June 2020. Studies reporting smoking status of hospitalized patients with different severities of disease and/or at least one clinical endpoint of interest (disease progression, intensive care unit admission, need for mechanical ventilation, and mortality) were included. Data were pooled using a random‐effects model. This study was registered on PROSPERO: CRD42020180920. We analyzed 47 eligible studies reporting on 32 849 hospitalized COVID‐19 patients, with 8417 (25.6%) reporting a smoking history, comprising 1501 current smokers, 5676 former smokers, and 1240 unspecified smokers. Current smokers had an increased risk of severe COVID‐19 (risk ratios [RR]: 1.80; 95% confidence interval [CI]: 1.14‐2.85; P = .012), and severe or critical COVID‐19 (RR: 1.98; CI: 1.16‐3.38; P = .012). Patients with a smoking history had a significantly increased risk of severe COVID‐19 (RR: 1.31; CI: 1.12‐1.54; P = .001), severe or critical COVID‐19 (RR: 1.35; CI: 1.19‐1.53; P < .0001), in‐hospital mortality (RR: 1.26; CI: 1.20‐1.32; P < .0001), disease progression (RR: 2.18; CI: 1.06‐4.49; P = .035), and need for mechanical ventilation (RR: 1.20; CI: 1.01‐1.42; P = .043). Patients with any smoking history are vulnerable to severe COVID‐19 and worse in‐hospital outcomes. In the absence of current targeted therapies, preventative, and supportive strategies to reduce morbidity and mortality in current and former smokers are crucial. The first high‐quality systematic review and meta‐analysis assessing the impact of smoking on COVID‐19 severity. To date, the largest meta‐analysis among peer‐reviewed literature assessing the impact of smoking on COVID‐19 severity, including 32,849 hospitalised patients with COVID‐19. Patients who were current smokers had an increased risk of severe COVID‐19 and severe or critical COVID‐19. Patients with a smoking history had an increased risk of severe COVID‐19, severe or critical COVID‐19, in‐hospital mortality, disease progression and need for mechanical ventilation.
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Affiliation(s)
- Rohin K Reddy
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Walton N Charles
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Atul Dutt
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul T Seed
- Department of Women and Children's Health, King's College London, London, UK
| | - Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, London, UK.,Kellogg College, University of Oxford, Oxford, UK
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46
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Soares RDCM, Mattos LR, Raposo LM. Risk Factors for Hospitalization and Mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg 2020. [PMID: 32682453 DOI: 10.4269/ajtmh.20‐0483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Brazil is, at the time of writing, the global epicenter of COVID-19, but information on risk factors for hospitalization and mortality in the country is still limited. Demographic and clinical data of COVID-19 patients until June 11th, 2020 were retrieved from the State Health Secretariat of Espírito Santo, Brazil. Potential risk factors for COVID-19 hospitalization and death were analyzed by univariate and multivariable logistic regression models. A total of 10,713 COVID-19 patients were included in this study; 81.0% were younger than 60 years, 55.2% were female, 89.2% were not hospitalized, 32.9% had at least one comorbidity, and 7.7% died. The most common symptoms on admission were cough (67.7%) and fever (62.6%); 7.1% of the patients were asymptomatic. Cardiovascular diseases (23.7%) and diabetes (10.3%) were the two most common chronic diseases. Multivariate logistic regression analysis identified an association of all explanatory variables, except for cough and diarrhea, with hospitalization. Older age (odds ratio [OR] = 3.95, P < 0.001) and shortness of breath (OR = 3.55, P < 0.001) were associated with increase of odds to COVID-19 death in hospitalized patients. Our study provided evidence that older age, male gender, Asian, indigenous or unknown race, comorbidities (smoking, kidney disease, obesity, pulmonary disease, diabetes, and cardiovascular disease), as well as fever and shortness of breath increased the risk of hospitalization. For death outcome in hospitalized patients, only older age and shortness of breath increased the risk.
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Affiliation(s)
- Rita de Cássia Menezes Soares
- Department of Quantitative Methods, Center for Exact Sciences and Technology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Rodrigues Mattos
- Department of Public Health Nursing, Anna Nery Nursing School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Letícia Martins Raposo
- Department of Quantitative Methods, Center for Exact Sciences and Technology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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47
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Capuano A, Rossi F, Paolisso G. Covid-19 Kills More Men Than Women: An Overview of Possible Reasons. Front Cardiovasc Med 2020; 7:131. [PMID: 32766284 PMCID: PMC7380096 DOI: 10.3389/fcvm.2020.00131] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/26/2020] [Indexed: 01/08/2023] Open
Abstract
The high mortality observed in Covid-19 patients may be related to unrecognized pulmonary embolism, pulmonary thrombosis, or other underlying cardiovascular diseases. Recent data have highlighted that the mortality rate of Covid-19 seems to be higher in male patients compared to females. In this paper, we have analyzed possible factors that may underline this sex difference in terms of activity of the immune system and its modulation by sex hormones, coagulation pattern, and preexisting cardiovascular diseases as well as effects deriving from smoking and drinking habits. Future studies are needed to evaluate the effects of sex differences on the prevalence of infections, including Covid-19, its outcome, and the responses to antiviral treatments.
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Affiliation(s)
- Annalisa Capuano
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Regional Centre of Pharmacovigilance, Campania Region, Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Regional Centre of Pharmacovigilance, Campania Region, Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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48
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Grundy EJ, Suddek T, Filippidis FT, Majeed A, Coronini-Cronberg S. Smoking, SARS-CoV-2 and COVID-19: A review of reviews considering implications for public health policy and practice. Tob Induc Dis 2020; 18:58. [PMID: 32641924 PMCID: PMC7336902 DOI: 10.18332/tid/124788] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION There has been significant speculation regarding the association between the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pathogen, coronavirus disease (COVID-19) and smoking. We provide an overview of the available literature regarding the association between smoking, risk of SARS-CoV-2 infection, and risk of severe COVID-19 and poor clinical outcomes, with the aim of informing public health policy and practice, particularly in England. METHODS Publications were identified utilising a systematic search approach on PUBMED and Google Scholar. Publications presenting a systematic review or meta-analysis considering the association between smoking and SARS-COV-2 infection or COVID-19 outcomes were included. RESULTS Eight studies were identified. One considered the relationship between smoking and the probability of SARS-CoV-2 infection, three considered the association between COVID-19 hospitalisation and smoking history, and six reviewed the association between smoking history and development of severe COVID-19. One study specifically investigated the risk of mortality. The studies considering risk of severe disease indicate that there is a significant association between COVID-19 and current or ever smoking. CONCLUSIONS This is a rapidly evolving topic. Current analysis remains limited due to the quality of primary data, although, early results indicate an association between smoking and COVID-19 severity. We highly recommend public health messaging to continue focusing on smoking cessation efforts.
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Affiliation(s)
- Emily J. Grundy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Taiba Suddek
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Sophie Coronini-Cronberg
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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49
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Gubernatorova EO, Gorshkova EA, Polinova AI, Drutskaya MS. IL-6: Relevance for immunopathology of SARS-CoV-2. Cytokine Growth Factor Rev 2020; 53:13-24. [PMID: 32475759 PMCID: PMC7237916 DOI: 10.1016/j.cytogfr.2020.05.009] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 mortality is strongly associated with the development of severe pneumonia and acute respiratory distress syndrome with the worst outcome resulting in cytokine release syndrome and multiorgan failure. It is becoming critically important to identify at the early stage of the infection those patients who are prone to develop the most adverse effects. Elevated systemic interleukin-6 levels in patients with COVID-19 are considered as a relevant parameter in predicting most severe course of disease and the need for intensive care. This review discusses the mechanisms by which IL-6 may possibly contribute to disease exacerbation and the potential of therapeutic approaches based on anti-IL-6 biologics.
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Affiliation(s)
- E O Gubernatorova
- Laboratory of Molecular Mechanisms of Immunity, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia; Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia.
| | - E A Gorshkova
- Laboratory of Molecular Mechanisms of Immunity, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia; Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia; Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - A I Polinova
- Laboratory of Molecular Mechanisms of Immunity, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia; Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
| | - M S Drutskaya
- Laboratory of Molecular Mechanisms of Immunity, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia; Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia.
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50
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Archie SR, Cucullo L. Cerebrovascular and Neurological Dysfunction under the Threat of COVID-19: Is There a Comorbid Role for Smoking and Vaping? Int J Mol Sci 2020; 21:E3916. [PMID: 32486196 PMCID: PMC7312781 DOI: 10.3390/ijms21113916] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
The recently discovered novel coronavirus, SARS-CoV-2 (COVID-19 virus), has brought the whole world to standstill with critical challenges, affecting both health and economic sectors worldwide. Although initially, this pandemic was associated with causing severe pulmonary and respiratory disorders, recent case studies reported the association of cerebrovascular-neurological dysfunction in COVID-19 patients, which is also life-threatening. Several SARS-CoV-2 positive case studies have been reported where there are mild or no symptoms of this virus. However, a selection of patients are suffering from large artery ischemic strokes. Although the pathophysiology of the SARS-CoV-2 virus affecting the cerebrovascular system has not been elucidated yet, researchers have identified several pathogenic mechanisms, including a role for the ACE2 receptor. Therefore, it is extremely crucial to identify the risk factors related to the progression and adverse outcome of cerebrovascular-neurological dysfunction in COVID-19 patients. Since many articles have reported the effect of smoking (tobacco and cannabis) and vaping in cerebrovascular and neurological systems, and considering that smokers are more prone to viral and bacterial infection compared to non-smokers, it is high time to explore the probable correlation of smoking in COVID-19 patients. Herein, we have reviewed the possible role of smoking and vaping on cerebrovascular and neurological dysfunction in COVID-19 patients, along with potential pathogenic mechanisms associated with it.
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Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA;
- Center for Blood-Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
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