Circular medicine. a paradigm of sustainability and resilience in education and professional development

Circular economy is a model of economic, social and environmental production and consumption, aimed to build a sustainable society in tune with the available resources. In the Brundtland Report, (1987, United Nations) sustainability it is defined as an approach focused on "meeting the needs of the present without compromising the ability of future generations to meet their own needs." The European Medical Association (EMA), that has currently more than 50 000 members, is involved in the advancement of health, pursuing educational and professional goals addressed to the quality of environment, lifestyle and civil society through a circular medicine approach. This is a comprehensive strategy, integrating best medical practice, bioinformatics and molecular biology with economy, artificial intelligence and machine learning. Circular Medicine is the resilient framework linking all these topics with circular economy methods. Innovative possibilities of circular medicine are many: it is a comprehensive paradigm shift, countering a non-medicine based on simplistic algorithms with guidelines of insufficient effectiveness, reliability and generalizability, often passed off as innovative Artificial-Intelligence approaches. We launched in 2020 a still ongoing survey aimed at the dissemination of information and at a greater sensitivity of all our members and followers on these topics, striving to build circular medicine in the real-world. This position document is based on its preliminary results: 1. Studying and investigating the links among health, climate change, biodiversity, circular economy, robust Artificial Intelligence and Machine learning support are goals and needed practice suitable to be pursued by EMA and other medical and scientific associations. Circular economy will be fruitfully used in health facilities, including hospitals, with health professionals and life science researchers acting also in the role of influencers and opinion leaders. 2. The interventions based on epidemiology, environmental sciences, best practice in medicine, sustainable technologies and molecular biology, the pillars of a potential framework of circular medicine, need a robust bioinformatics and Artificial Intelligence support. 3. Academic curricula and health professionals CME courses should provide stronger digital knowledge, reliable procedures trainings and expertise along these lines. Daily routine of clinical observation and participatory dialogue are key elements for the progress toward a culture, practice and accomplishments of circular economy and medicine. 4. Molecular biology, still the most innovative field of medical and life science, has a role for strengthening the pathways of the circular economy, as a reliable and resilient basis of "circular medicine." 5. The lessons of COVID19, the ongoing battles for healthier lifestyles dealing with nutrition, exercise and against alcohol and cigarette smoking, and the concept of smart cities are some of the cornerstones of the proposed strategy for a real-world circular medicine. Debunking interventions against the misuse of scientific and medical are means for the development of circular economy and medicine. Effective roadmaps, guidelines and grids for recognizing and counteracting the overlap of bullying, imposter's fear, insufficient expertise and knowledge, fake assertions and evaluations are actively developed by EMA's ad-hoc workshops. AI knowledge and skills should be implemented within innovative molecular biology and medical best-practice academic-CME curricula.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

TOBACCO USE IN STUDENTS OF THE THIRD FACULTY OF MEDICINE OF CHARLES UNIVERSITY IN THE CZECH REPUBLIC

Objectives: This study assessed trends in tobacco use in students of the Third Faculty of Medicine of Charles University in the Czech Republic between academic years 2012/13 and 2019/2020. Methods: Two cross-sectional surveys designed to obtain information on smoking history, smoking status, tobacco products use, and cessation were conducted among 382 students of the 6-year Master's Study Programme (General Medicine) and the 3-year Bachelor's Study Programme (Public Health) in 2012/2013;and among 580 students of General Medicine and of the Bachelor's Study Programmes (Public Health, Dental Hygiene and Nursing) in 2019/2020. Results: Regular/daily smoking was reported by 4.4 ± 2.4% (with 95% CI) of General Medicine students and 4.8 ± 4.1% of Public Health students in 2012/2013, and 1.3 ± 1.1% of General Medicine students and 14.4 ± 4.8% of students of bachelor studies in 2019/2020. The share of regular and occasional smokers was higher among junior students in both academic years (23.9 ± 5.1% and 20.1 ± 4.7%, respectively) compared to senior students (23.6 ± 9.8% and 9.6 ± 5.7%). Cigarettes were the most common products used in both academic years (67.0 ± 4.7% and 45.5 ± 4.0%). There was a significant increase in proportion of students using more tobacco products in the course of the time (from 12.1 ± 3.1% to 53.7 ± 4.1%). The proportion of students who quitted smoking has risen from 11.4 ± 3.2% to 16.1 ± 3.0%. On the contrary, the proportion of students who started smoking has dropped from 15.9 ± 3.7% to 2.9 ± 1.4%. The proportion of non-smokers has risen from 57.6 ± 5.0% to 65.3 ± 3.9%. Conclusions: The study revealed some positive trends concerning tobacco use in students (decline in regular smokers among students of General Medicine, senior students, cigarette smokers, water pipe smokers;rise in non-smokers), but also negative ones (rise in regular smokers among students of Public Health, students who used more tobacco products).

Smoking increases expression of the SARS-CoV-2 spike protein-binding long ACE2 isoform in bronchial epithelium.

After more than two years the COVID-19 pandemic, that is caused by infection with the respiratory SARS-CoV-2 virus, is still ongoing. The risk to develop severe COVID-19 upon SARS-CoV-2 infection is increased in individuals with a high age, high body mass index, and who are smoking. The SARS-CoV-2 virus infects cells of the upper respiratory tract by entering these cells upon binding to the Angiotensin-converting enzyme 2 (ACE2) receptor. ACE2 is expressed in various cell types in the lung but the expression is especially high in goblet and ciliated cells. Recently, it was shown that next to its full-length isoform, ACE2 also has a short isoform. The short isoform is unable to bind SARS-CoV-2 and does not facilitate viral entry. In the current study we investigated whether active cigarette smoking increases the expression of the long or the short ACE2 isoform. We showed that in active smokers the expression of the long, active isoform, but not the short isoform of ACE2 is higher compared to never smokers. Additionally, it was shown that the expression of especially the long, active isoform of ACE2 was associated with secretory, club and goblet epithelial cells. This study increases our understanding of why current smokers are more susceptible to SARS-CoV-2 infection, in addition to the already established increased risk to develop severe COVID-19.

Asafetida (Ferula asafoetida) and its Potential Risks on Respiratory Disorders

Ferula asafoetida is an endemic species in Iran and is rich in oleo-gum resin with high economic value in the world. One important application of F. assafoetida is its traditional use for the management of respiratory ailments. The aim of this review was to collect papers dealing with F. asafoetida oleo-gum resin in respiratory tract's diseases in modern medicine. For preparing the manuscript the scientific databases (Google scholar, PubMed, Springer, Science Direct, Magiran), books, thesis, etc. were searched using the keywords of "Ferula asafoetida", "Ferula scorodesma", "Scorodesma foetida", "Northex asafoetida" plus "respiratory tract", "respiratory disorder" "infection", "cough", "trachea", "traditional medicine" up to Feb 2022 and the collected data were sum-marized, analyzed, and discussed. The results of the investigation confirmed the traditional belief on the efficacy of Ferula asafoetida in the treatment of respiratory viral infection (Coronavirus, influ-enza), cigarette smoking, asthma, cough and cancer, but most studies were limited to in vitro. There was only one registered randomized, blinded, placebo controlled clinical trial for 300 mg F. asafoet-ida aqueous extract capsules (three times a day for 14 days) on 40 patients with COVID-19 without any published results. Although, the studies implied the efficacy of F. asafoetida in the treatment of respiratory treatments, but design large clinical studies for evaluating its efficacy and safety is essential in future investigations.Copyright © 2023 Bentham Science Publishers.

Assessment of Sleep Quality among Medical Students During the Covid- 19 Pandemic

Objective: To assess the sleep quality among medical students, comparing their sleep cycles during physical and online studies along with other factors associated with sleep patterns. Study Design: Cross-sectional Questionnaire based survey Place and Duration of Study: Department of Community Medicine, HITEC Institute of Medical Sciences Taxila from 1st January 2020 to 31st March 2020 Methodology: One hundred and forty seven students were surveyed in a time period of 1 month. The questionnaire included PSQI Pittsburgh Sleep Quality Index and other clinically validated questions. Students with known sleeping disorders were excluded from this survey. Result(s): There were 81 (55.1%) females and 65 (44.2%) males with mean age 20+/-1.4 years. Out of these 94(63.9%) were classified as "Poor Sleepers" and only 53 (36.1%) were "Good Sleepers". Poor sleep quality was associated with female gender (p<0.05), day-scholar residence status (p<0.054), excessive time required to sleep (p<0.00), excessive screen time usage (p<0.007), increased hours of study (p<0.089), experiencing trouble while driving, eating and socializing (p<0.002), lack of enthusiasm (p<0.000), unsatisfactory daily activities (p<0.000) and poor daytime alertness levels (p<0.360). 104 (70.7%) were aware of the effects of melatonin on sleep, only 51 (34.7%) admitted to have used coffee to stay awake at night. 98 (66.7%) subjects were pre-exam workers, 95 (64.6%) admitted not being able to wake up easily in the morning. Conclusion(s): The students and hostelites that used less screen time slept better. Excessive daytime tiredness was also a result of poor sleeping habits. Students who studied for longer periods of time and had difficulty waking up in the morning slept poorly. Poor sleepers also find it difficult to interact and are often unambitious about performing their daily menial tasks, as well as displeased with their daily activities. As a matter of fact, we deduce that sleep quality has unanticipated consequences for medical students' social and mental health.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

The Effect of Smoking and Opioid Consumption on the Severity of the Disease and Duration of Hospitalization in COVID-19 Patients

Objective: In the Coronavirus 2019 (COVID-19) global pandemic, various studies on the target communities of this virus were widely started and rapidly progressed. Smokers and opioid consumers are one of the virus targets since they have a vulnerable respiratory system. Due to the contradictory results in previous studies and the lack of similar investigations in this area, we aimed to perform this study to investigate the effect of smoking and opioid consumption on the consequences of the COVID-19 disease. Material(s) and Method(s): In this retrospective study, the required information was collected and analyzed from the archives of Razi Hospital, Rasht, Iran. Study variables included age, sex, the need for intubation, hospital length of stay, history of current smoking or opioid consumption, and intensive care unit (ICU) admission, ICU length of stay, admission oxygen saturation, disease severity, and the outcome of death or recovery. Data were collected and divided into the case (including current cigarette smokers, opioid consumers, and cigarette-opioid consumers) and control (non-smokers and non-opioid-consumers) groups. Out of 986 patients, 489 patients met the criteria for inclusion and subsequent analysis. The average age was 69.79 +/- 16.06, and 294 (60.1%) patients were male. The median age of the case group (65.15 +/- 42.41) was older than the control group (57.45 +/- 15.71, P = 0.001). The case group consisted of more male patients than the control group (P = 0.001). Result(s): The adjusted regression models demonstrated that current cigarette smoking, opioid, and cigarette-opioid consumption did not significantly predict hospital and ICU length of stay, ICU admission, disease severity, and mortality outcomes (P > 0.05). Current cigarette smoking and opioid consumption could not be an independent predictor for the consequences of ICU admission, hospital and ICU length of stay, the need for intubation, disease severity, and mortality in COVID-19 patients.Copyright © 2023 H. S. Fayazi et al., published by Sciendo.

SARS-CoV-2 infection aggravates cigarette smoke-exposed cell damage in primary human airway epithelia.

BACKGROUND: The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide pandemic with over 627 million cases and over 6.5 million deaths. It was reported that smoking-related chronic obstructive pulmonary disease (COPD) might be a crucial risk for COVID-19 patients to develop severe condition. As cigarette smoke (CS) is the major risk factor for COPD, we hypothesize that barrier dysfunction and an altered cytokine response in CS-exposed airway epithelial cells may contribute to increased SARS-CoV-2-induced immune response that may result in increased susceptibility to severe disease. The aim of this study was to evaluate the role of CS on SARS-CoV-2-induced immune and inflammatory responses, and epithelial barrier integrity leading to airway epithelial damage. METHODS: Primary human airway epithelial cells were differentiated under air-liquid interface culture. Cells were then exposed to cigarette smoke medium (CSM) before infection with SARS-CoV-2 isolated from a local patient. The infection susceptibility, morphology, and the expression of genes related to host immune response, airway inflammation and damages were evaluated. RESULTS: Cells pre-treated with CSM significantly caused higher replication of SARS-CoV-2 and more severe SARS-CoV-2-induced cellular morphological alteration. CSM exposure caused significant upregulation of long form angiotensin converting enzyme (ACE)2, a functional receptor for SARS-CoV-2 viral entry, transmembrane serine protease (TMPRSS)2 and TMPRSS4, which cleave the spike protein of SARS-CoV-2 to allow viral entry, leading to an aggravated immune response via inhibition of type I interferon pathway. In addition, CSM worsened SARS-CoV-2-induced airway epithelial cell damage, resulting in severe motile ciliary disorder, junctional disruption and mucus hypersecretion. CONCLUSION: Smoking led to dysregulation of host immune response and cell damage as seen in SARS-CoV-2-infected primary human airway epithelia. These findings may contribute to increased disease susceptibility with severe condition and provide a better understanding of the pathogenesis of SARS-CoV-2 infection in smokers.

Post-COVID-19 fibromyalgia syndrome: A report of two case

COVID-19 is a viral infection caused by SARS-CoV-2 that primarily targets the respiratory system. COVID-19 may be followed in some patients by post-COV-ID-19 syndrome, fatigue, anxiety, and musculoskeletal pain. These symptoms may be associated with other symptoms, resulting in a constellation of symptoms consistent with fibromyalgia syndrome (FMS). Two patients were evaluated at the rheumatology outpatient clinic for diffuse persistent musculoskeletal pain after COVID-19 infection. Patients presented with generalized musculoskeletal pain, fatigue, anxiety, depression, headache, hand paresthesia, and non-restorative sleep. General examination and various laboratory investigations, including autoimmune profile and radiological investigation, were normal. After examining eighteen tender points, both patients fulfilled the 1990 ACR classification criteria for FMS. Post-COVID-19 FMS should be considered during the management of post-COVID-19 syndrome to alleviate pain and prevent worsening of symptoms during the COVID-19 pandemic.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Accounting for Potential Unmeasured Confounding in the Association between Influenza vaccination and COVID-19 Hospitalization: Sensitivity Analysis Using E-value Method

Background: Unmeasured confounding is the primary obstacle to causal inference in observational research. We aimed to illuminate the association between exposure to influenza vaccination (IV) within six months before contracting the coronavirus disease (COVID-19) and COVID-19 hospitalization in relation to unmeasured confounding using the E-value method. Material(s) and Method(s): Information about 367 patients, 103 of whom (28.07 %) had received IV, and confounders included sex, age, occupation, cigarette smoking, opium, and comorbidities were collected. We estimated the interest association using the inverse probability weighted (IPW) method. There was no information on some potential unmeasured confounders, such as socio-economic status. Therefore, we computed E-value as a sensitivity analysis, which is the minimum strength of unmeasured confounding to explain away an exposure-outcome association beyond the measured confounders completely. Result(s): IPW denoted 1.12 (95% CI: 0.71 to 1.29) times greater risk of COVID-19 hospitalization in patients exposed to IV than in unexposed individuals. Sensitivity analysis demonstrated that an E-value (95% CI) of 1.49 (1.90 to 2.15) is required to shift the RR and the corresponding confidence Interval (CI) lower and upper limits toward the null. Moreover, if they had been omitted, the most computed E-values for measured confounders were relatively larger than for unmeasured confounders. Conclusion(s): According to the context of the measured confounders, if they had been omitted, an E-value of 1.16 to 1.76, a weaker confounding could fully explain away the reported association, suggesting that no relationship exists between IV and COVID-19 hospitalization.Copyright © 2022 NRITLD.

Association between cigarette smoking patterns and severity of COVID-19: Findings from a study in 15 private Hospitals in Indonesia.

INTRODUCTION: Indonesia is ranked fourth among countries with the highest smoking rates and has the highest number of male smokers globally. This study aimed to assess the association between cigarette smoking patterns and the severity of COVID-19 among patients in 15 Indonesian hospitals. METHODS: A cross-sectional study was conducted from April to August 2020 using medical records of 490 COVID-19 patients, including the history of their smoking patterns from 15 private referral hospitals in 5 provinces. The severity was defined based on the Guidelines on the Prevention and Control of COVID-19 issued by the Indonesian Ministry of Health, which was indicated by the care provided to patients, namely outpatient, inpatient, and Intensive Care Unit (ICU) services for mild, moderate, and severe symptoms. Smoking patterns were grouped based on adult tobacco use classifications of the Centers for Disease Control and Prevention (CDC). Univariate and bivariate analyses were performed. RESULTS: The results showed that 69.8% of respondents had not smoked cigarettes, 17.1% were active smokers, and 13.1% were former smokers. A significant difference was seen in the number of cigarettes smoked by patients in the ICU, inpatients, and outpatients, among current smokers and passive smokers (p=0.018 and p=0.005, respectively). Furthermore, there was no significant difference in the severity of COVID-19 among current smokers, former smokers, and non-smokers. The time from when smoking was stopped among former smokers was not associated with the severity of COVID-19. CONCLUSIONS: There was no significant difference in COVID-19 severity between groups of smokers. Passive smoking and the number of cigarettes smoked by smokers daily were associated with the severity of COVID-19. Smoke-free policies should be implemented continuously to protect people from the dangers of secondhand smoke.

Job stressors and burnout among nurses and primary-care physicians working at a dedicated outpatient respiratory center for patients with suspected or confirmed COVID-19.

BACKGROUND: High burnout is reported among health professionals providing in-patient care to patients with coronavirus disease 2019 (COVID-19). Data are lacking on job stressors and burnout among health providers working in dedicated outpatient facilities for patients with suspected or confirmed COVID-19. METHODS: This cross-sectional study, using a parallel mixed-methods design, was carried out in 2021-2022 among 22 nurses and 22 primary-care physicians working at a COVID Outpatient Respiratory Center (CORC) (100% participation). Work conditions were assessed via the nurse- and physician-specific Occupational Stressor Index (OSI) and occupational records. Measures of the outcome included the Copenhagen Burnout Index and current tobacco use. RESULTS: Time working in CORC displayed significant multivariate associations with personal, work- and patient-related burnout among physicians and current tobacco use among nurses. Total OSI scores showed adjusted odds ratios for work-related (1.35 (1.01 ± 1.79))(1.31 (0.99 ± 1.75)) and patient-related burnout (1.35 (1.01 ± 1.81))(1.34 (1.01 ± 1.78)) among physicians and nurses, respectively. Numerous work stressors showed significant multivariate associations with burnout and smoking. Among the stressors were: being contacted outside work hours about patients, inadequate rest breaks, many patients/shifts, difficulty taking time off, insufficient pay, frequently listening to emotionally disturbing accounts, interruptions, increased workload, time pressure, and responsibility. Heavy patient burden/time pressure was most often cited as the hardest part of work in CORC. Increased employment of staff was the most frequently suggested workplace modification. Integrative assessment reveals that increased staff could ameliorate many work stressors associated with burnout and smoking in this cohort. CONCLUSIONS: Working in CORC is an extra burden. In crisis situations such as the COVID pandemic, more staff is needed. Lowering the total job stressor load is vital.

Synergistic Detrimental Effects of Cigarette Smoke, Alcohol, and SARS-CoV-2 in COPD Bronchial Epithelial Cells.

Lung conditions such as COPD, as well as risk factors such as alcohol misuse and cigarette smoking, can exacerbate COVID-19 disease severity. Synergistically, these risk factors can have a significant impact on immunity against pathogens. Here, we studied the effect of a short exposure to alcohol and/or cigarette smoke extract (CSE) in vitro on acute SARS-CoV-2 infection of ciliated human bronchial epithelial cells (HBECs) collected from healthy and COPD donors. We observed an increase in viral titer in CSE- or alcohol-treated COPD HBECs compared to untreated COPD HBECs. Furthermore, we treated healthy HBECs accompanied by enhanced lactate dehydrogenase activity, indicating exacerbated injury. Finally, IL-8 secretion was elevated due to the synergistic damage mediated by alcohol, CSE, and SARS-CoV-2 in COPD HBECs. Together, our data suggest that, with pre-existing COPD, short exposure to alcohol or CSE is sufficient to exacerbate SARS-CoV-2 infection and associated injury, impairing lung defences.

Oral contraceptives and stroke: Foes or friends.

Incidents of strokes are increased in young women relative to young men, suggesting that oral contraceptive (OC) use is one of the causes of stroke among young women. Long-term exposures to the varying combinations of estrogen and progestogen found in OCs affect blood clotting, lipid and lipoprotein metabolism, endothelial function, and de novo synthesis of neurosteroids, especially brain-derived 17ß-estradiol. The latter is essential for neuroprotection, memory, sexual differentiation, synaptic transmission, and behavior. Deleterious effects of OCs may be exacerbated due to comorbidities like polycystic ovary syndrome, sickle cell anemia, COVID-19, exposures to endocrine disrupting chemicals, and conventional or electronic cigarette smoking. The goal of the current review is to revisit the available literature regarding the impact of OC use on stroke, to explain possible underlying mechanisms, and to identify gaps in our understanding to promote future research to reduce and cure stroke in OC users.

Levels and drivers of urban black carbon and health risk assessment during pre- and COVID19 lockdown in Augsburg, Germany

This study aimed to evaluate the levels and phenomenology of equivalent black carbon (eBC) at the city center of Augsburg, Germany (01/2018 to 12/2020). Furthermore, the potential health risk of eBC based on equivalent numbers of passively smoked cigarettes (PSC) was also evaluated, with special emphasis on the impact caused by the COVID19 lockdown restriction measures. As it could be expected, peak concentrations of eBC were commonly recorded in morning (06:00–8:00 LT) and night (19:00–22:00 LT) in all seasons, coinciding with traffic rush hours and atmospheric stagnation. The variability of eBC was highly influenced by diurnal variations in traffic and meteorology (air temperature (T), mixing-layer height (MLH), wind speed (WS)) across days and seasons. Furthermore, a marked "weekend effect” was evidenced, with an average eBC decrease of ∼35% due to lower traffic flow. During the COVID19 lockdown period, an average ∼60% reduction of the traffic flow resulted in ∼30% eBC decrease, as the health risks of eBC exposure was markedly reduced during this period. The implementation of a multilinear regression analysis allowed to explain for 53% of the variability in measured eBC, indicating that the several factors (e.g., traffic and meteorology) may contribute simultaneously to this proportion. Overall, this study will provide valuable input to the policy makers to mitigate eBC pollutant and its adverse effect on environment and human health. © 2022 Elsevier Ltd

Impact of the COVID-19 pandemic on alcohol use and smoking habits

Background: It is very important to monitor changes in substance use during the pandemic period, as individuals dealing with substance use may be at greater risk for COVID-19, and stress factors and changes resulting from the pandemic may cause alterations in substance use models. Method(s): In this review, the existing literature on how COVID-19 affected people's alcohol consumption, smoking, and vaping use in different societies was evaluated. Articles that are relevant to the subject were searched using PubMed, ScienceDirect and Google Scholar and reviewed. Result(s): It was observed that due to COVID-19, there may be no alterations in these substance use types or it may result in a decrease of consumption of substances or a quit attempt due to health concerns about COVID-19 or it may cause an increase in the alcohol, or cigarette consumption. Conclusion(s): With this review we hope to present detailed information on the impact of the pandemic on alcohol consumption, and cigarette or e-cigarette use from various studies conducted in different societies all around the world and highlight the importance and necessity of new studies on this subject. Copyright © 2023 Taylor & Francis Group, LLC.

Anbar 2nd International Medical Conference, AIMCO 2022

The proceedings contain 24 papers. The topics discussed include: a newly synthetic compound of ibuprofen and gabapentin as a novel analgesic and anti-inflammatory therapeutic agent: a pharmacological study in rats' experimental models;acute aortic dissection: clinical characteristics and outcomes;assessment of diagnostic procedures and tools of COVID-19 among Iraqi patients: a systematic review;association between alcohol consumption, cigarette smoking, and helicobacter pylori infection in Iraqi patients submitted to gastrointestinal endoscopy;association of white blood cell counts, procalcitonin, C-reactive protein, interleukin-6, troponin, and ferritin with mortality in severe COVID-19;bilateral intratonsillar abscesses: a first case report in an adult patient;and disaster medicine curricula in Saudi Arabian medical schools.

COVID 19 quarantine and its impact on lifestyle of diabetic patients and on their follow up in Madinah, KSA

Objectives: This article aims to discover the impact of the coronavirus pandemic lockdown on diabetes patients living in Almadina, Saudi Arabia, in terms of their lifestyle and on their follow-up. Method(s): This is a cross-sectional, qualitative prospective study, a questionnaire was done to diabetic patients who underwent the quarantine period in Madinah, Saudi Arabia through an online questionnaire after getting informed consent to participation. The survey included personal, medical data, patient's compliance to treatment and overall lifestyle manner before and during lockdown period and psychological assessment using 10 questions of the (K10) Kessler psychological distress scale. Data analysis was performed using SPSS program version 26. Result(s): A total of patients 350 participated in the study. 56.6% of them were females(n;198), and 43.4% were males(n:152), their ages ranged from 18 years to more than 60 years. The vast majority 96.3% of participated were of Saudi nationality, while 3.7% are non-Saudi. Participants-with types 2 Diabetes represent 31.4% while 26% suffer from type 1 diabetes and the rest they don't which type they have. Results showed no significant differences in: (symptoms of low or high blood sugar, the extent to which a healthy diet is followed, the frequency of home blood sugar measurement) before and during the quarantine period. The rest of the variables shows a significant difference (P<0.05) Conclusion(s): The study showed a difference in the extent of adherence to medication during the quarantine period compared to before. A reduction constructive in lifestyle habits is detected. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Beliefs about the smoking effect on COVID-19 as significant factors in smoking cessation efforts

Owing to the various scientific evidence linking smoking to the increased risk of developing severe disease and death from the COVID-19 pandemic, now is a critical time for smokers to cut back or quit. This study aimed to analyze the influence of beliefs about smoking effects in relation to COVID-19 and attempts to quit smoking among university student smokers in Jakarta, Indonesia. This study was conducted in three different universities. As many as 198 respondents who were conveniently selected participated in this study. The health belief model (HBM) was adopted to determine the independent variables in this study. Having had a previous infection of COVID-19 influenced the smoking quitting attempts (AOR: 3.87, 1.49–10.0). Moreover, the belief that smoking increased COVID-19 severity, having a friend who reminded the respondents to not smoke during the pandemic, and having the ability to terminate smoking also increased the possibility for respondents to have a quit smoking attempt. However, perceived barriers such as feeling uncomfortable without smoking (AOR: 0.31, 0.15-0.6) were a protective factor against the attempt to quit smoking. Increasing smokers' confidence to quit smoking and education about the risk of smoking during the pandemic should be intensified to support smokers in successfully quitting the smoking habit. © 2023, Intelektual Pustaka Media Utama. All rights reserved.

Physical activity and eating changes during lockdown periods during the COVID-19 pandemic - threat of obesity pandemic

Background. The lockdown implemented due to the pandemic has the risk of setting the stage for type 2 diabetes, weight gain and cardiovascular diseases by limiting physical activity. Objectives. The aim of this study is to determine the changes in physical activity and eating habits of people during the COVID-19 lockdown. Material and methods. The data used in this study was obtained using a 25-question questionnaire and the International Physical Activity Questionnaire - Short Form (IPAQ-SF) through communication networks. Results. The mean age of the participants in the study was 43.33 +/- 11.35, 45.3% (n = 541) were male, and 54.7% (n = 652) were female. There was a significant increase in the weight of the participants before and after the 2-month lockdown during the pandemic (mean weight before: 69.19 +/- 9.11, mean weight after: 70.47 +/- 9.47, p < 0.001). It was determined that participants with higher education levels gained significantly more weight (p =0.01). It was determined that home office workers, retirees and unemployed gained significantly more weight than employee during the lockdown period (p < 0.001). According to IPAQ-SF scale scores, a significant difference was found in vigorous activity, moderate activity and walking times before and after lockdown (p < 0.001). Conclusions. During the lockdown period, those with a higher education level and those who were married or female tended to gain more weight. It was determined that home office workers and retirees gained significantly higher weight during the lockdown period. Guidelines should be created for these lockdown periods.

COVID-19 cases and deaths and smoking in Brazilian capitals and regions: an ecological study / Casos e óbitos por COVID-19 e tabagismo nas capitais e regiões brasileiras: estudo ecológico / Casos y muertes por COVID-19 y tabaquismo en las capitales y regiones Brasileñas: estudio ecológico

Objetivo: Analisar a relação entre casos e óbitos por COVID-19 e o percentual de tabagistas nas capitais e regiões do Brasil. Métodos: Realizou-se estudo ecológico nas regiões brasileiras do número de casos e óbitos por COVID-19, de março a dezembro de 2020, e a prevalência de tabagismo em 2019, a partir dos bancos de dados do Painel Coronavírus da Secretaria de Vigilância em Saúde e do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL ­ 2019). Com informações extraídas em janeiro de 2021, calcularam-se os coeficientes de incidência e mortalidade por COVID-19 por capital brasileira e região, bem como se utilizou a correlação de Pearson para verificar a relação entre as variáveis do estudo. Adotou-se nível de significância de 5%. Resultados: Análises bivariadas mostraram correlações positivas entre tabagistas do sexo feminino e coeficiente de incidência de COVID-19 nas capitais da região do Centro-Oeste (r=0,957; p=0,043), e entre fumantes do sexo masculino e coeficiente de mortalidade de COVID-19 nas capitais do Nordeste (r=0,706; p=0,034). Conclusão: O tabagismo teve impacto na incidência de casos e óbitos por COVID-19 em diversas capitais brasileiras, alertando que o fumo pode ser fator de predisposição e agravamento do estado clínico dos pacientes.

Objective: To analyze the relationship between COVID-19 cases and deaths and the percentage of smokers in the capitals and regions of Brazil. Methods: An ecological study was carried out in the Brazilian regions to assess the number of cases and deaths by COVID-19 from March to December 2020 and the prevalence of smoking in 2019 based on the Coronavirus Panel databases of the Health Surveillance Secretariat and the System for Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone-based Survey (Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico - VIGITEL ­ 2019). With information extracted in January 2021, the COVID-19 incidence and mortality coefficients were calculated by Brazilian capital and region and Pearson's correlation was used to verify the relationship between the study variables. A significance level of 5% was adopted. Results: Bivariate analyses showed positive correlations between female smokers and COVID-19 incidence coefficient in capitals of the Midwest region (r=0.957; p=0.043), and between male smokers and COVID-19 mortality coefficient in the capitals of the Northeast (r=0.706; p=0.034). Conclusion: Smoking had an impact on the incidence of COVID-19 cases and deaths in several Brazilian capitals, which warns that smoking can be a predisposing factor and worsen the clinical status of patients.

Objetivo: Analizar la relación entre casos y muertes por COVID-19 y el porcentaje de tabaquistas en las capitales y regiones del Brasil. Métodos: Fue realizado estudio ecológico en las regiones brasileñas del número de casos y muertes por COVID-19, de marzo a diciembre de 2020, y la prevalencia de tabaquismo en 2019, a partir de bases de datos del Panel Coronavirus de la Secretaria de Vigilancia en Salud y del Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (VIGITEL ­ 2019). Con informaciones extraídas en enero de 2021, se calcularon los coeficientes de incidencia y mortandad por COVID-19 por capital brasileña y región, también se utilizó la correlación de Pearson para verificar la relación entre las variables del estudio. Fue adoptado nivel de significancia de 5%. Resultados: Los análisis bivariados mostraron correlaciones positivas entre tabaquistas del sexo femenino y coeficiente de incidencia de COVID-19 en las capitales de la región del Centro-Oeste (r=0,957; p=0,043), y entre fumadores del sexo masculino y coeficiente de mortandad de COVID-19 en las capitales del Nordeste (r=0,706; p=0,034). Conclusión: El tabaquismo tuvo impacto en la incidencia de casos y muertes por COVID-19 en diversas capitales brasileñas, advirtiendo que el humo puede ser factor de predisposición y agravamiento del estado clínico de los pacientes.