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This study aimed to analyze the correlation between smoking and coronavirus disease 2019 (COVID-19) severity by region and gross domestic product (GDP). The regions were categorized by continent and GDP rankings. Studies conducted between June 3, 2020 and March 27, 2023 were searched to compare the severity of COVID-19 between smokers and non-smokers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Compared with never-smokers, the smokers’ COVID-19 severity scores were 1.48 (confidence interval [CI]: 1.25–1.75) in Asia, 1.24 (CI: 1.05–1.46) in the Middle East, 1.32 (1.21–1.45) in Europe, 1.39 (1.30–1.49) in North America, 1.69 (1.22–2.34) in South America, and 2.87 (1.82–4.53) in Africa. By GDP, the smokers’ COVID-19 severity scores were higher than those of never-smokers: 1.42 (1.32–1.53) in high-GDP countries, 1.33 (1.25–1.41) in middle-GDP countries (11th–50th), and 1.53 (0.85–2.76) in low-GDP countries. The COVID-19 severity in smokers was significantly higher in low-GDP countries than in high- and middle-income countries. The high COVID-19 death rate among smokers in the African continent and low-GDP countries is thought to stem from the lack of medical management systems compared with other countries. In addition to medical treatment, environmental or socioeconomic factors can increase the severity.
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Background@#Although intravenous nefopam has been used for opioid-sparing strategy and pain relief, randomized controlled trials (RCTs) have shown inconsistent findings. @*Methods@#We searched core databases, PubMed, EMBASE, and the Cochrane library for RCTs on this research question in December 2022. Standardized mean difference (SMD) and weighted mean difference (WMD) were calculated using a random-effects meta-analysis. @*Results@#Of 708 studies identified from the databases, a total of 17 RCTs (n=1,173 patients) that met the inclusion criteria were included in the final meta-analysis. Overall, the consumption of cumulative opioid analgesics was significantly lower in the nefopam group than the control group, on arrival in the postanesthesia care unit (PACU) (SMD, −0.70; 95% confidence interval [CI], −1.01 to −0.39; I2= 55.1%; n=7), at 24 hours (SMD, −0.65; 95% CI, −1.09 to −0.20; I2=87.4%; n=9), and 48 hours (SMD, −0.82; 95% CI, −1.40 to −0.24; I2=85.6%; n=6) after surgery. It also showed a significant lower pain score, on arrival in the PACU (WMD, −0.80; 95% CI, −1.27 to −0.32; I2=69.6%; n=7) and 24 hours (WMD, −0.48; 95% CI, −0.79 to −0.16; I2=0.0%, n=5). However, publication bias was observed (asymmetrical funnel plot and P for bias=0.005). @*Conclusions@#Intravenous nefopam showed an opioid-sparing effect and pain relief in the management of patients with acute postoperative pain.
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Lung cancer is the leading cause of death from cancer and the most effective way to reduce lung cancer mortality is early detection and treatment. The low-dose computed tomography (CT) can reduce the chances of lung cancer death, and used as screening test in several countries. Pulmonary nodules are a common finding in smokers, and differential diagnosis from cancer is a particularly important in lung cancer screening in smokers. We tried to find out the characteristics of lung nodules in patients who underwent smoker cancer screening. Data on low-dose lung CT findings and smoking counseling were collected for lung cancer screening patients for smokers conducted from January 2012 to June 2022. Out of a total of 1,320 patients, 1,101 had lung nodules. Lung nodules located in the right upper lobe were the most common at 30.5%, and lung nodules located in the right middle lobe were the least at 11.5%. Solid nodules were 97.3%, and ground-lass shadowing lesion was 2.4%. The average nodule size was 3.33 mm, and the largest was 43 mm. Compared to the previous test, 8.8% of the nodules were changed, and 1.8% of the total were suspected of cancer. The number of cessation patients interviewed was 138 (10.5%), and 98 were referred to smoking cessation clinics. This study shows that the lung nodule reporting rate is higher than overseas lung nodule reporting rate.
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Long coronavirus disease (COVID) syndrome is persistent symptoms and complications that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 infections. Symptoms associated with long COVID can vary widely from person to person but commonly include: fatigue, shortness of breath, chest pain or discomfort, joint pain, difficulty concentrating (brain fog), headache, loss of taste or smell, sleep disturbances, palpitations, persistent cough. Possible pathophysiologic theories are viral persistence, dysregulated immune response, autoimmune response, endothelial dysfunction, gut dysbiosis, damage to organs and tissues, neurological involvement, post-viral syndrome. Although current diagnostic and treatment options are insufficient, the management aim to alleviate symptoms, improve quality of life, and support recovery. The possible therapies and interventions that may be considered are symptomatic management, rehabilitation and exercise, respiratory support, cognitive and psychological support, sleep management, nutritional support, support groups and patient education, anti-inflammatory drugs, immuno-modulatory therapies. For patients enduring prolonged suffering from this long COVID syndrome, a multidisciplinary approach is essential for comprehensive management.
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The use of complementary alternative therapies in cancer patients are increasing with the increase in cancer incidence and treatment rates. Studies were conducted to find out about cancer patients’ knowledge and attitudes (treatment effect, intention to use) towards complementary and alternative therapies. 10 complementary alternative therapies (hyperthermia, ascorbate, thymosin, mistletoe, immunocyanin, selenium, Phellinus linteus, cholecalciferol, glutathione, herb remedies) were selected from evidence review. 100 patients who visited cancer care hospitals were surveyed about their knowledge and attitudes (effectiveness, treatment choices) by self-questionnaire. The total score for knowledge/attitude (effectiveness/intent to use) towards complementary and alternative therapies was 25.4 points (26.7 points/24.7 points, out of 40). Knowledge and attitude scores for hyperthermia were the highest, and knowledge and attitude scores for immunocyanin and glutathione were the lowest. Herbal remedies scored higher on knowledge but lower on attitude (effectiveness and choice). Vitamin C had moderate knowledge and effectiveness scores, but the highest intention-to-use score. There was a negative correlation between the effectiveness of complementary and alternative therapies and the choice of treatment regimen with lower scores as people aged. The use of complementary alternative therapies is increasing although the evidence has not been proven for the cancer cure rate or survival. It is necessary to recognize the effectiveness and limitations of complementary alternative therapies and educate patients so that they can choose the appropriate treatment. Further research is needed on the effects and side effects of various complementary alternative therapies used in addition to standard treatments.
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Picosulfate solution is widely used as a small volume bowel cleansing agent and is considered to be effective and relatively safe. A case of a 75-year-old woman ingested picosulfate powder and drank a small volume of water, subsequently experienced severe burning pain in the chest. Endoscopy was performed and showed a submucosal hemorrhage and exudative ulcers at the mid to lower esophagus. At 2 weeks, her symptoms improved with conservative treatment. However, liquid food dysphagia developed 11 weeks after ingestion. A follow-up endoscopy revealed multiple esophageal strictures, which were treated with a fully covered metal stent and esophageal balloon dilation. Consequently, the esophageal strictures improved after one year. As this case demonstrates, detailed information about picosulfate powder ingestion after dissolving it in more than 200 mL of water should be presented to patients to avoid esophageal injury.
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About 30~50% COVID-19 hospital inpatients is reported to have mild clinical presentation, and the clinical course is known to be good even in the older population. In order to compare the clinical symptoms of mild patients with COVID-19 infection by age, the clinical symptoms and laboratory results were analyzed by dividing mild patients admitted to a dedicated hospital into three groups: under the age of 64, 65-84, and above 85 years of age.There was no difference in gender ratio by age among 555 mild cases. Concomitant diseases with significant differences by age were hypertension, diabetes, stroke, and coronary artery disease.Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age. Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age.The white blood cell count (WBC), neutrophil count, monocyte, blood sugar, procalcitonin, and creatinine were significantly higher in the 85 years old or older group, and the hemoglobin, albumin, and glomerular filtration rate (GFR) were significantly lower in the 85 years old or older group.
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About 30~50% COVID-19 hospital inpatients is reported to have mild clinical presentation, and the clinical course is known to be good even in the older population. In order to compare the clinical symptoms of mild patients with COVID-19 infection by age, the clinical symptoms and laboratory results were analyzed by dividing mild patients admitted to a dedicated hospital into three groups: under the age of 64, 65-84, and above 85 years of age.There was no difference in gender ratio by age among 555 mild cases. Concomitant diseases with significant differences by age were hypertension, diabetes, stroke, and coronary artery disease.Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age. Among the symptoms, cough and sore throat were different by age, and cough was significantly higher in the group under 64 years of age.The white blood cell count (WBC), neutrophil count, monocyte, blood sugar, procalcitonin, and creatinine were significantly higher in the 85 years old or older group, and the hemoglobin, albumin, and glomerular filtration rate (GFR) were significantly lower in the 85 years old or older group.
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BACKGROUND: Osteoarthritis (OA) is a disease of old age whose prevalence is increasing. This study explored the impact of OA on household catastrophic health expenditure (CHE) in Korea. METHODS: We used data on 5,200 households from the Korea Health Panel Survey in 2013 and estimated annual living expenses and out-of-pocket (OOP) payments. Household CHE was defined when a household's total OOP health payments exceeded 10%, 20%, 30%, or 40% of the household's capacity to pay. To compare the OOP payments of households with OA individuals and those without OA, OA households were matched 1:1 with households containing a member with other chronic disease such as neoplasm, hypertension, heart disease, cerebrovascular disease, diabetes, or osteoporosis. The impact of OA on CHE was determined by multivariable logistic analysis. RESULTS: A total of 1,289 households were included, and households with and without OA patients paid mean annual OOP payments of $2,789 and $2,607, respectively. The prevalence of household CHE at thresholds of 10%, 20%, 30%, and 40% were higher in households with OA patients than in those without OA patients (P < 0.001). The presence of OA patients in each household contributed significantly to CHE at thresholds of 10% (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16–1.87), 20% (OR, 1.29; 95% CI, 1.01–1.66), and 30% (OR, 1.37; 95% CI, 1.05–1.78), but not of 40% (OR, 1.17; 95% CI, 0.87–1.57). CONCLUSION: The presence of OA patients in Korean households is significantly related to CHE. Policy makers should try to reduce OOP payments in households with OA patients.
Subject(s)
Humans , Administrative Personnel , Cerebrovascular Disorders , Chronic Disease , Family Characteristics , Health Expenditures , Heart Diseases , Hypertension , Korea , Osteoarthritis , Osteoporosis , PrevalenceABSTRACT
BACKGROUND: Pulsed radiofrequency treatment (pulsed RF) has recently been described as a non-neurodestructive or minimally neurodestructive alternative to radiofrequency heat lesions. However, there are few data to evaluate the mechanism of this therapy. The aim of this study is to explore the underlying mechanism of pulsed RF on spinal nervous system using comparative proteomic analysis. METHODS: L5 dorsal root ganglion was exposed to pulsed RF and sham treatment. Protein extracts from the spinal cord of both groups were analyzed using comparative proteomics to identify differentially expressed proteins. To validate the differential expression of proteins, we utilized western blotting and immunohistochemistry. RESULTS: The spinal cord taken from pulsed RF treated rats was found to underexpress 4-aminobutyrate aminotransferase, mitochondrial [Precursor]. Immunostaining density of gamma-aminobutyric acid measured from the spinal cord taken from pulsed RF treated rats was significantly increased compared with sham treated rats. CONCLUSIONS: We demonstrated that the decreased expression of 4-aminobutyrate aminotransferase, mitochondrial [Precursor] and increased expression of gamma-aminobutyric acid in the spinal cord after exposure of the lumbar dorsal root ganglion to pulsed RF. That might be the possible underlying mechanism of the analgesic effect of pulsed RF.