Trends in seasonal pollen and asthma-related morbidity among adults and children in a U.S. high-density urban center, 2001-2020.

OBJECTIVE: To analyze the long-term trends in pollen counts and asthma-related emergency department visits (AREDV) in adult and pediatric populations in the Bronx. METHODS: Daily values of adult and pediatric AREDV were retrospectively obtained from three major Bronx hospitals using ICD-10 codes and pollen counts were obtained from the Armonk station from 2001-2020. Wilcoxon Ranked Sum was applied to compare median values, while Spearman correlation was employed to examine the association between these variables, for both decades and each season. RESULTS: The median value of pediatric AREDV increased by 200% from the 1st to 2nd decade (p < 0.001) and AREDV peak shifted from predominantly the spring season in the 1st decade to the fall and winter seasons in the 2nd decade. Seasonal patterns were consistent over 20 years with summer AREDV lower than all other seasons (9 vs. 17 per day) (p < 0.001). Spring tree pollen peaks were correlated with AREDV peaks (rho = 0.34) (p < 0.001). Tree pollen exceeding 100 grains/m3 corresponded to a median of 19.0 AREDVs while all other tree pollen (0 - 99 grains/m3) corresponded to a median of 15.0 AREDVs (p < 0.001). AREDVs sharply declined in 2020, coinciding with the emergence of COVID-19. CONCLUSIONS: Pollen and AREDVs peak earlier in the spring and are more strongly interconnected, while asthma rates among children are rapidly rising, particularly in the fall and winter. These findings can advise targeted awareness campaigns for better management of asthma related morbidity.

Metformin use and mortality and length of stay among hospitalized patients with type 2 diabetes and COVID-19: A multiracial, multiethnic, urban observational study.

Introduction: Diabetes mellitus is a common comorbidity among patients with coronavirus disease 2019 (COVID-19). Diabetic patients with COVID-19 have a two-fold increased risk of death and tend to have more severe infection compared to the general population. Metformin, a first-line medication for diabetes management, has anti-inflammatory and immunomodulatory effects. Previous studies focusing on metformin and COVID-19 clinical outcomes have had mixed results, with some showing a mortality benefit or decreased complications with metformin use. To date, few studies have analyzed such outcomes among a diverse, multiracial community. Methods: This was a retrospective review of patients with Type 2 diabetes and a confirmed COVID-19 infection admitted to an urban academic medical center from January 1, 2020 to May 7, 2020. Baseline characteristics were collected. The primary outcomes of the study were in-hospital mortality and length of stay (LOS). Results: A total of 4462 patients with Type 2 diabetes and confirmed COVID-19 were identified. 41.3% were Black, and 41.5% were Hispanic. There were 1021 patients in the metformin group and 3441 in the non-metformin group. Of note, more participants in the metformin group had comorbid disease and/or advanced diabetes. We found no statistically significant differences between the metformin and non-metformin group in in-hospital mortality (28.1% vs 25.3%, P=0.08) or length of hospital stay in days (7.3 vs. 7.5, P=0.59), even after matching patients on various factors (29.3% vs. 29.6%, P=0.87; 7.7 vs. 8.1, P=0.23). Conclusion: While patients had more comorbid disease and advanced diabetes in the metformin group, there were no significant differences with regard to in-hospital mortality or length of stay due to COVID-19 compared to the non-metformin group. Prospective studies are needed to determine if there is clinical benefit for initiating, continuing, or re-initiating metformin in patients hospitalized with COVID-19.

Metformin Use among Hospitalized Patients with Diabetes and COVID-19-Clinical Characteristics and Outcomes from a Multiracial, Multiethnic Urban Cohort

Background: Diabetes mellitus (DM) confers a two-fold increased risk of death from COVID-19 and overall poorer prognosis compared to the general population. Metformin is a widely used first-line antidiabetic agent with anti-inflammatory and immunomodulatory effects. Several studies report reduced COVID-19-related mortality in patients with DM on metformin. Few studies have corroborated these findings within a multiracial, multiethnic population. Methods: This was a retrospective cohort study of patients with DM admitted with COVID-19 to 1 of 3 urban academic hospitals from 1/1/20 to 5/7/20. We compared in-hospital mortality and length of stay (LOS) in COVID-19 patients with diabetes on metformin compared to those not on metformin. Patient demographic and clinical characteristics were summarized and compared between both groups. Logistic regression and linear regression analysis were applied to study the association between metformin treatment and in-hospital mortality and LOS, respectively. Results: A total of 4462 patients were identified. Overall, 46.9% were female, with a mean age of 64.4 years;41.3% were Black and 41.5% Hispanic. There were 1021 in the metformin group and 3441 in the non-metformin group. The prevalence of hypertension (58.2% vs.37.5%, P<.0001) and coronary artery disease (13.4% vs. 6.7%, P<0.0001) was higher in the metformin group compared to the non-metformin group. BMI (30.5 vs. 29.4) , HbA1c (8.2 vs. 6.5) creatinine (1.6 vs. 2.1) , and mean number of antidiabetic agents (1.2 vs. 0.22) were also significantly higher in the metformin group. The odds of death (OR 1.0, 95% CI 0.8-1.3;p=0.900) and mean LOS (p= 0.486) were not significantly different in the metformin vs. non-metformin group, after adjusting for confounding variables. Conclusion: There was no significant difference in in-hospital mortality and LOS in the metformin vs. non-metformin group. The metformin group had a significantly higher comorbidity burden, as well as higher BMI, mean HbA1c, and creatinine. Further prospective studies are needed.

Correlation between chest CT severity score and laboratory indicators in patients with Coronavirus disease 2019 (COVID-19).

OBJECTIVE: The association between computed tomography (CT) and clinical severity of COVID-19 has been demonstrated. However, there are few studies on CT and laboratory indicators in patients in COVID-19. Our aim was to explore the correlation between chest CT images and laboratory indicators of patients with COVID-19 pneumonia. METHODS: This was a retrospective study of patients with COVID-19 diagnosed and treated at the Affiliated Hospital of Putian University from 24 January 2020 to 6 March 2020. The correlation test between first chest CT score and blood cell analysis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood biochemistry and T lymphocyte subsets (T-Ls) was investigated. RESULTS: Among the 56 patients, there were 36 (64.3%) males and 20 (35.7%) females. The mean age of the patients was 46.54 ± 15.82 (range, 15-86) years. The CT score in the moderate group was higher than in the mild group (5.06 ± 0.77 vs 1.87 ± 0.88, P < .05), and higher in the severe group than in the moderate and mild groups (10.71 ± 4.21, P < .05). In addition, the ESR was significantly higher in the severe group than mild group (32.00 (26.04, 58.24) vs 11.00 (7.84, 24.70) mm/h, P < .05). The CD3, CD4, CD8 and CD4/CD8 cells were not different (all P > .05). The CT scores of all patients correlated positively with CRP, LDH and ESR (all P < .01). CONCLUSION: The chest CT characteristics of patients with COVID-19 correlated positively with CRP, ESR and LDH, which may use one of the indicators for the assessment of disease severity.

The precision of epidemiological investigation of COVID-19 transmission in Shanghai, China.

BACKGROUND: Shanghai had a local outbreak of COVID-19 from January 21 to 24. Timely and precise strategies were taken to prevent further spread of the disease. We discussed and shared the experience of COVID-19 containment in Shanghai. PROCESS: The first two patients worked at two hospitals but no staff from the two hospitals were infected. The suspected case and his two close contacts were confirmed to be infected within 12 h. The testing rate of individuals was low. The scope of screening was minimized to two related districts and the close contact tracing was completed within 12 h, which were precise and cost-effective. CONCLUSIONS: Active monitoring, precise epidemiological investigation and timely nucleic acid testing help discover new cases, minimize the scope of screening, and interrupt the transmission.