Smoking enhances suicide risk-a significant role in the COVID-19 pandemic?

The COVID-19 outbreak has severely affected the whole world. Considerable evidence suggests that tobacco smoking is associated with increased severity of COVID-19 and death in COVID-19 patients. Tobacco smoking cessation is necessary to decrease COVID-19-related hospitalizations and deaths. In this commentary, I suggest that tobacco smoking cessation is also needed to reduce suicidal behavior during and after the COVID-19 pandemic. Significant evidence suggests that the COVID-19 pandemic leads to increased tobacco consumption as smokers use more tobacco to cope with pandemic-related stress, anxiety, depression and loneliness. Multiple studies have demonstrated that tobacco smoking is associated with suicidal ideation, suicide attempts, suicide death and a contributing factor in the pathophysiology of suicide. Smoking may increase the probability of development of post-COVID syndrome because it increases severity of COVID-19. Suicide risk may be increased in individuals with post-COVID syndrome. Smoking prevention and cessation should be a target of suicide prevention interventions during and after the COVID-19 pandemic. The COVID-19 pandemic enhances the need to act to integrate tobacco smoking cessation in the health care as a standard of patient care.

Reduction in hospitalizations and deaths in COVID-19 positive abdominal organ transplant recipients following implementation of a protocol for early treatment with bamlanivimab

Purpose: In December of 2020, our program was identifying up to twenty COVID-19 positive abdominal transplant recipients per week. After seeing our high hospitalization and mortality rate, we implemented a programmatic response, that included Bamlanivimab administration to all eligible patients. The purpose of this abstract is to review the outcomes of COVID-19 infection in our patients, evaluate the efficacy of our program's response, and determine if outpatient monoclonal antibody therapy impacted hospitalization and death rates. Methods: A database was created to track the outcomes of all liver and kidney transplant recipients who had a confirmed COVID-19 infection via PCR testing. On December 21, 2020, we implemented the following protocol for all symptomatic patients who did not meet hospital admission criteria (WHO Class 2 or 3): 1) Staff and patient education for communications regarding patient's symptom progression;2) home monitoring using Pulse Oximetry;and 3) outpatient Bamlanivimab administration to all patients who were identified within 10 days of a positive test. Results: As of February 2021, we have identified 105 liver transplant recipients and 116 kidney transplant recipients who have tested positive for COVID-19. These patients were between 27 days and 18.8 years after transplant (Median 1007 days). The case counts and disease severity before and after the protocol was implemented are shown in Figure 1. Concerningly, hospitalized recipients had a 31% and 46% mortality for liver and kidney respectively. To study outpatient Balanivimab therapy, we excluded all patients who presented as inpatient admissions. 86 liver and 91 kidney patients were initially identified as WHO Class 2 or 3. Of these patients, 15 Liver and 16 Kidney patients were treated with Bamlivamab. When comparing those patients who could have potentially been treated to those who received Bamlivamab, we reduced our rates of hospitalization from 29% to 10% and death from 13% to zero. Chi-squared analysis comparing the association between disease progression and antibody administration was significant (p=.04). Conclusions: Our findings show the severity of morbidity and mortality of COVID-19 in abdominal transplant patients. Our early experience suggests that outpatient bamlanivimab therapy can reduce disease progression and prevent hospitalization. All eligible patients should be offered this therapy and we will continue to accumulate data in this regard.

Unique technology preferences in older adults with type 1 diabetes

Older adults with type 1 diabetes (OAwT1D) face challenges such as hypoglycemia, cognitive dysfunction, and physical limitations. Limited data on their technology use is available. We evaluated technology preferences in OAwT1D stratified by tech-savviness. Adults ≥ 65 years old (n=26) were enrolled at two sites during the COVID-19 pandemic. Subjects were stratified as tech-savvy or non-tech savvy based on the Pew Technology Survey. Health-related quality of life was assessed by the SF-36 Survey. Semi-structured telephone interviews were conducted (n=23) and analyzed for thematic content using ATLAS.ti v8.0. Individuals were all well-educated;those in the tech-savvy group were younger, more likely to be employed, and reported better physical functioning (Table 1). Per interview data, all subjects used a computer, smartphone, or the internet;the non-savvy group relied more on others to help download information or navigate content. Subjects preferred in-person training, menu systems with data access in 3 steps, flexibility of data access and entry, and/or a help menu. For device management, 6/23 subjects downloaded their data to share with care teams and 14/23 subjects cited healthcare providers as their primary tech support. OAwT1D have unique preferences for technology use and training. Customized training for device use and patient support should be considered to maximize device benefits in this high-risk group.

Psychopathological consequences related to COVID-19 infection: The most relevant reactions of the general population

IntroductionAs a result of the emergence of coronavirus disease 2019 (COVID-19) outbreak caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the Chinese city of Wuhan, a situation of socio-economic crisis and profound psychological distress rapidly occurred worldwide.ObjectivesThis work aimed to comprehensively review the current literature about the impact of COVID-19 infection on the mental health in the general population.MethodsA detailed review has been conducted in order to identify the main psychopatological consequences related to Covid-19 infection in the general population.ResultsVarious psychological problems and important consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively. The psychological impact of quarantine related to COVID-19 infection has been additionally documented together with the most relevant psychological reactions in the general population related to COVID-19 outbreak.ConclusionsThe role of risk and protective factors against the potential to develop psychiatric disorders in vulnerable individuals with Covid-19 infection need to be carefully addressed in the clinical practice.

Results and learnings from amber, a decentralized phase i study assessing the pharmacokinetic and pharmacodynamic profile of inhaled velsecorat, a non-steroidal, selective glucocorticoid receptor modulator, in adolescents with asthma

Rationale Asthma is characterized by chronic inflammation;inhaled corticosteroids (ICS) are the preferred antiinflammatory treatment at all severity levels. Velsecorat, a once-daily inhaled non-steroidal selective glucocorticoid receptor (GR) modulator potentially has an improved risk-benefit profile compared to ICS. The aim of this Phase 1 study (AMBER, NCT03976869) was to establish the pharmacokinetic (PK) and pharmacodynamic (PD) profile of velsecorat in adolescents to enable inclusion of this population in phase 3 studies. Necessitating long site visits, PK studies are challenging to conduct in adolescents, disrupt patient school attendance and interfere with the daily lives of the patients' families. In AMBER, we revolutionized the conduct of this type of study by bringing the study directly to the patient's home (Figure 1). Methods This open-label, multi-center study enrolled 36 adolescents (12-17 years) with Global Initiative for Asthma (GINA) step 2 asthma. After a 2-3-week washout of asthma controller, patients received 360μg velsecorat inhaled once-daily for two weeks, with short acting β-agonists allowed as rescue medication. The primary objective was to determine steady state PK;key secondary endpoints were safety and change from baseline in;trough FEV1, plasma cortisol, and asthma control as measured by the asthma control questionnaire-5 (ACQ-5). Study site visits were combined with telemedicine and home nursing visits, as well as collection of daily dairy data via smartphone app. Results Following administration of velsecorat, individual steady state exposure parameters in patients aged 12-14 and 15-17 years were within the same range. Change from baseline in adjusted mean plasma cortisol levels, mean ACQ-5 scores and mean Day15 FEV1 were limited and not clinically significant. Velsecorat was well tolerated, and no new safety concerns were identified. During the COVID-19 pandemic, patient recruitment was accelerated, highlighting that the decentralized design of AMBER, was more suitable for social distancing practices than the traditional site-centric trial model. Participant and caregiver surveys administered at study end revealed that most participants were willing to participate in similar decentralized trials in the future. Conclusions Overall, the results support the advancement of velsecorat into phase 3 studies including adolescents. AMBER offered a convenient and patient-centric study experience for adolescents and their families during the pandemic. Decentralized studies has the potential to become a new standard by offering a flexible convenient, safe and patient-friendly study format for an adolescent population, as shown by the high recruitment and retention rate during the peak of the COVID-19 pandemic.

Post-COVID syndrome and suicide risk.

A significant number of coronavirus disease SARS-CoV-2 (COVID-19) patients continue to have symptoms related to COVID-19 after the acute phase of illness. This post-COVID condition is sometimes called 'post-COVID syndrome', 'long COVID' or 'post-acute COVID-19'. Persistent psychiatric symptoms among COVID-19 survivors such as depression, anxiety, post-traumatic symptoms and cognitive impairment may be related to psychological factors and neurobiological injury. COVID-19 related neurological symptoms including anosmia, ageusia, dizziness, headache and seizures may persist for a long time after the acute COVID-19 illness. Many COVID-19 survivors experience persistent physical symptoms such as cough, fatigue, dyspnea and pain after recovering from their initial illness. There is a high probability that symptoms of psychiatric, neurological and physical illnesses, as well as inflammatory damage to the brain in individuals with post-COVID syndrome increase suicidal ideation and behavior in this patient population. COVID-19 survivors without post-COVID syndrome may also be at elevated suicide risk. Studies of suicidality in COVID-19 survivors are urgently needed and will be a new area of suicide research. An appropriate management of psychiatric, neurological and medical conditions may reduce suicide risk among COVID-19 survivors with or without post-COVID syndrome.