Patient Preferences for Lung Cancer Interception Therapy

Objectives: Interception therapy requires an individual to take a treatment today to prevent a future medical event. Patients must trade off treatment burdens incurred today against future benefits. We examined the preferences of high-risk lung cancer (LC) individuals for potential interception therapies that reduce the risk of developing lung cancer. Method(s): An online discrete-choice experiment (DCE) was developed for hypothetical LC interception treatments with four attributes: reduction in risk of LC over 3 years, injection site reaction severity, nonfatal serious infection risk, and death from serious infection risk. Respondents chose between two alternative treatments or a no-treatment option. The DCE was analyzed using random-parameters logit, and maximum acceptable risk for an LC risk reduction was calculated. Logit analysis explored characteristics of respondents who always selected no treatment. Result(s): The sample included 803 adults aged 50-80 years with at least a 20 pack-year smoking history. Respondents had an average willingness to accept interception therapy (alternative-specific constant=1.30, 95% CI: 0.91-1.69). Respondents viewed larger reductions in the risk of LC as most important. Respondents were willing to accept increases in risk of nonfatal serious infection up to 15% for a 15% improvement in relative LC risk reduction and increases in risk of death from serious infection up to 1.5% for a 23% improvement in relative LC risk reduction. However, 16% of respondents selected 'no treatment' for all DCE questions. Older respondents, current smokers who have never tried to quit, and those who did not get regular skin exams for cancer and/or COVID-19 vaccine were more likely to opt out of interception therapy. Conclusion(s): Generally, individuals at high risk of LC are willing to consider interception therapy. Study results can support benefit-risk assessments for future systemic LC interception treatments, and the results may have implications for other therapeutic areas.Copyright © 2023

A Case of Ocular Myasthenia Gravis Seen by Rheumatology as Suspected Mononeuritis Multiplex in an Adult Male Shortly after Pfizerbiontech Sars-Cov-2 Vaccination

Background/Aims Myasthenia gravis (MG) is an antibody-mediated autoimmune disease targeting proteins at the postsynaptic membrane of the neuromuscular junction. MG is thought to occur in genetically susceptible individuals following an environmental trigger. SARS-CoV-2 infection has been associated with new-onset autoimmune disease, new-onset MG, and exacerbations of pre-existing MG, with molecular mimicry between SARS-CoV-2 epitopes and autoantigen-induced autoreactivity thought to be part of the underlying mechanism. We report a case of newonset ocular MG following first dose Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination which was referred to rheumatology as suspected mononeuritis multiplex. Methods A 53-year-old man of East Asian ethnicity presented to the emergency department (ED) with sudden onset diplopia and left lateral gaze restriction 7 days after receiving his first dose of the Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination. He had longstanding myopia and dry eyes but no other medical history, no regular medications or significant family history. He was a current smoker, with a 50-pack year history. He did not drink alcohol or use any recreational drugs. He was found to have an isolated left VI cranial nerve (CN) palsy with an otherwise normal ocular and physical examination. Blood tests were unremarkable apart from raised cholesterol, and he was discharged with a suspected self-limiting microvascular CN lesion. Three weeks later he presented to ED with worsening diplopia, increasingly restricted eye movements, headache, nausea, vomiting and blurred vision. Ophthalmology assessment noted new right sided CN III and VI palsy, persistent left CN VI palsy, and vertical diplopia in all fields of gaze. Neurological and physical examination were normal. Bloods including an autoimmune screen were unremarkable. SARS-CoV-2 Spike antibodies were positive consistent with SARS-CoV-2 vaccination but not infection. Intracranial and thoracic imaging were unremarkable. He was referred to and seen by both rheumatology and neurology as a case of suspected mononeuritis multiplex. Results A diagnosis of ocular MG was confirmed with positive serum acetylcholine receptor antibodies, and he was started on prednisolone, and pyridostigmine to good effect. Daily forced vital capacity (FVC) showed no respiratory muscle involvement, and nerve conduction studies and electromyography were normal, excluding secondary generalisation. Conclusion A review of the literature found 14 reported cases of new-onset MG all within 4 weeks following SARS-CoV-2 vaccine. Whilst these cases provide interesting insights into the pathogenesis of autoimmune conditions such as MG, they are not epidemiological studies to inform vaccine safety. Ultimately, current evidence suggests that the risks of SARS-COV-2 infection outweigh the risk of vaccine-related adverse events, therefore we suggest clinicians should be aware of potential new-onset autoimmune conditions, but support the safety of SARSCOV2 vaccination. Further, research into possible immunological mechanisms behind this phenomenon, including identifying potential epitopes inducing molecular mimicry, could help establish the likelihood of a causative link.

Predictors of outcomes in patients hospitalised with COVID-19 pneumonitis

Introduction/Aim: Medium and long-term impacts of COVID-19 pneumonitis are being increasingly recognised. Our study aimed to evaluate outcomes of hospitalised COVID-19 patients with moderate-to-severe respiratory compromise. Method(s): Patients admitted to a tertiary centre with COVID-19 pneumonitis (March 2020-October 2022) were followed in the Post-COVID Respiratory Clinic at 6-24 weeks. Baseline demographics, admission details, pulmonary function tests (PFTs), and clinic data were collected. Univariable and multivariable logistic regression were performed to investigate for predictors of persisting respiratory symptoms (dyspnoea, cough, chest pain) and functional limitation (self-reported). Result(s): 125 patients (64.8%male, 63.2+/-16.7years, 42.5% former/current smokers, BMI 31.0+/-8.0kg/m2, 49.6% fully vaccinated) with median follow-up time of 85 [interquartile range (IQR) 64-131] days were included. Pre-existing conditions included lung disease (29.6%), immunocompromise (15.2%), diabetes (24.8%) and hypertension (43.6%). 35.2% required ICU care (14.4% mechanical ventilated, 4% ECMO), 44.8% received high flow nasal prong oxygen and/or continuous positive airway pressure (CPAP). At initial clinic follow up, 65.4% had persisting X-ray changes. Mean predicted FEV1, FVC, DLCO were 86.8+/-20.7%, 85.3+/-20.3%, 82.2+/-19.8% respectively. Symptoms included dyspnoea (63.2%), fatigue (24.2%), cognitive dysfunction (12.9%) and musculoskeletal complaints (10.5%). Univariate predictors of continued respiratory and/or functional disability included age [odds ratio (OR) 1.03, 95%confidence interval (CI) 1.01-1.06, p = 0.01), prior lung disease (OR2.98, 95%CI 1.05-8.48, p = 0.04), hypertension OR2.61, 95%CI 1.09-6.22, p = 0.03) and length of hospital stay (LOHS) (OR1.03, 95%CI 1.00-1.07, p = 0.04). On multivariable analysis, only LOHS was independently predictive of continued respiratory and functional limitations (OR1.03, 95%CI 1.00-1.07, p = 0.02). Conclusion(s): Patients recovering from COVID-19 pneumonitis have a large burden of disability at follow-up. Older age, hypertension, lung disease and LOHS are risk factors for delayed recovery.

A single centre analysis of stage of presentation of LungCancer pre and post Covid-19 pandemic

Introduction/Aims: This study investigated whether the Covid-19 pandemic affected lung cancer presentation, inparticular whether patients presented with later stage disease at diagnosis. Method(s): This retrospective cohort study analysed new primary lung cancers staged at Lung Cancer multi-disciplinary meeting in a tertiary referral centre. We compared cancer stage in a 6-month period before the Covid-19pandemic (Apr'19-Sept'19, Group 1) to a similar period following the start of the pandemic (Sept'20-Feb'21, Group2). Comparison of patient demographics, tumour staging and treatment referrals were made. Result(s): In Group 1, 91 new lung cancers were staged at the Lung Cancer MDT, with a median age of 68. 58% ofpatients were male. In Group 2, fewer patients (41) were staged, with a median age of 70, with the majority beingfemale (56%). 39% of those in Group 2 were current smokers versus 29.6% in Group 1. Median tumour size at timeof diagnosis was larger in Group 2 (5.6cm vs 4.1cm), reflecting overall upgrading from T3 to T4. Group 2 presentedwith higher stage nodal disease, where 36.5% of patients presented with N3 disease, versus 20.9% in Group 1. Bothgroups saw approximately 30% of patients with metastatic disease (M-stage) at time of presentation. Conclusion(s): This study suggests patients are presenting with more advanced disease following the pandemic, with larger tumours, and higher burden of nodal disease. The cause for this is likely multifactorial, and may include patient reluctance to present to doctors for review. Further study is required to explore factors such as patient education and lung cancer screening that may prevent this trend towards later presenting disease.

Lung ultrasound : an economic solution to estimate the severity of SARS-COV2 pneumonia

Lung ultrasound: an economic solution to estimate the severity of SARS-COV2 pneumonia Introduction: Healthcare spendings increased worldwide since the beginning of the SARS-COV2 pandemic. Compared to CT scan generally performed to evaluate the severity of SARS-COV 2 pneumonia, lung ultrasound costs less. Aim(s): The aim of this study is to determine whether lung ultrasound can replace CT scan in evaluating the severity of SARS-COV 2 pneumonia. Method(s): Fifty five patients with positive RT-PCR were included. CT scan and lung ultrasound were realized on admission day. We compared the CT Scan severity score to the lung ultrasound score. Result(s): The studied group had 35 male and 20 female. Twenty five percent of the patients were active smokers. The most common comorbidities were hypertension, diabetes and dyslipidemia. According to the lung ultrasound score, the patients had a mild to moderate, severe and critical pneumonia in 43,6%, 36,4 % and 9,1% of the cases respectivally. Lung ultrasound score cut-of was 14 and 24. There was a significant correlation between the extent of SARS-COV2 parenchymal lesions evaluated by CT scan and lung ultrasound score. (R=0,318, p = 0,018). Conclusion(s): Lung ultrasound is a reliable and economic alternative to CT scan in the initial assessment of SARSCOV 2 severity.

Inflammatory Bowel Disease in the elderly, a survey of elderly patient demographics, diseaserelated complications and compliance with vaccination and screening services

Background: Inflammatory Bowel Disease (IBD) in the elderly (>60yrs) is becoming more prevalent in concordance with the ageing population and the rising incidence of IBD. An increasing number of patients are receiving a diagnosis of IBD in later years in addition to those with known IBD transitioning to elderly. The presentation, disease course, risk of complications and choice of medical therapies differ in this group from younger cohorts. We aimed to examine patient demographics and the incidence of adverse effects/complications amongst elderly IBD patients. We also sought to identify appropriate vaccination rates and uptake with screening services. Method(s): In a single tertiary centre, IBD patients aged >60 attending the outpatient clinic or admitted acutely were invited to complete an anonymous written survey. Result(s): 28 patients surveyed to date. 61% (n=17) had a diagnosis of UC. 54% were female (n=15). Mean age was 67.5, while mean age at diagnosis was 50 (range 19-65). 25% (n=7) received a diagnosis of IBD after 60 years, of which 57% were female. Mean BMI was 25.9. 25% (n=7) reported an infection in the last 6 months, all of whom required treatment with antibiotics. There was only one case of infection requiring hospitilisation, a patient on biologic therapy who developed a clostridium difficile infection. COVID-19 affected 39% (n=11), none required hospitilisation. 21% (n=6) report 2 or more comorbidities, of which 50% report a recent infection requiring treatment. All patients who required IBD surgery (n=5) had a high BMI. 57% (n=16) had a smoking history, with 14% (n=4) being active smokers. Infliximab and salofalk granules were the most prescribed IBD treatments. 46% were on biologics (n=13), with anti-TNF being the most common (29%). 25% (n=7) reported steroid use in the last year while 14% were not currently on IBD treatment. 21.4% (n=6) reported prior malignancy, skin cancer being most common. 50% of cancer sufferers were smokers. 100% have had a minimal of two COVID-19 vaccines. 64% (n=18) have had a flu-vaccine in the last 12 months with 75% (n=21) report annual flu-vaccine uptake. 61% (n=17) had the pneumococcal vaccine. Bowel screening participation was 46.5% (n=13). Conclusion(s): Smoking, high BMI and multiple comorbidities were common in elderly IBD patients. Infections were common in this cohort and typically required treatment with antibiotics, however, were rarely severe or required hospitalisation. Severe infections were seen in those on biologic therapy. Biologics were commonly prescribed to elderly IBD patients. Skin cancer was the most common malignancy. There was suboptimal uptake with vaccinations and bowel screening. (Figure Presented).

Covid -19 pneumonia in women: what are the particularities?

Introduction: All over the world, the COVID-19 pandemic is having a devastating effect on the lives, Causing above six million death in word and more than twenty six thousand in Tunisia. It affected both sexes. The aim of our study was to determinate the characteristics of SARS-cov2 pneumonia in women. Method(s): A retrospective study was conducted including 356 patients admitted between September 2020 and April 2021 in the COVID-19 department of Nabeul regional hospital. Result(s): In our study, 152(42.69%) woman was included, mean age was 63.5[18-92]. Only one women was an active smoker comparing to 58 male in which almost the half had already stopped smoking. Medical past history was found in 68.8% of females dominated by cardio-vascular (51.9%) and respiratory (15.8%) diseases. No significant difference in cormorbidities was noticed in both groups (p=0.451). Five women were pregnant and 4 of them had severe pneumonia requiring a stay at the resuscitation service. Obesity was found in 35.9% of cases (61 male and 67 female). All hospitalized patients had severe COVID-19 pneumonia. The critic form (>75% of bilateral infiltrative lesions in chest CT scan) was higher in men (14.2%) than women (11.1%). There was no statistically significant difference in length of stay between the two groups (p=0.338) neither in mortality rate (p=0.946) or in severe cases needing a transfer to the resuscitation (p=0.814). Embolism seemed to be high in males (n=12) than females (n=2) (p=0.037). All EP cases were treated by DOAC. Conclusion(s): It had been clear that COVID-19 pneumonia had affected many lives during these two years from both sexes. Comorbidities, complications and mortality seems to have the same rate in both groups.

Post Coronavirus Disease 2019 (COVID-19) pulmonary fibrosis: a 12 months follow-up study

Background: limited data exist on the prevalence of radiographic abnormalities after COVID-19 pneumonia, and the extent to which High Resolution CT (HRCT) features correlate with symptoms and function after 12-month from hospitalization remains unclear. Aim(s): To prospectively assess and characterize, among all discharged patients with COVID-19, those with persisting pulmonary sequalae after 12-month follow-up. Method(s): 354 patients were evaluated in our post-COVID-clinic from June 2020 to January 2021. Symptoms and functional parameters were recorded. According to the absence or presence of HRCT abnormalities after 12-months, patients were categorized as recovered (REC) or not recovered (NOT-REC) and the extension of radiographic changes was scored. Result(s): 296/354 patients(84%) completed the 12-month follow up. 21/296(7%) presented pulmonary sequelae with a mean extension of interstitial changes of 11% of the whole lung. REC displayed a median full recovery time of 131(60-203) days. Compared to REC, NOT-REC were mainly current smokers [3(14%) vs.12(4%);p=0.05], with a longer in-hospital stay [13 (7.5-40.5) vs.10.0(6.0-16.0);p=0.02], need for a higher maximal FiO2 during hospitalization [60(29-100) vs. 33 (21-65);p<0.004] and higher intensity medical care [10(48%) vs.48(17%);p<0.001]. Conversely, lung function did not differ [FVC 97%(88-109) vs.93(82-105),p=0.32;FEV1 102% (86-116) vs. 96(85-106);p=0.11]. Conclusion(s): A low percentage of patients discharged for COVID-19 pneumonia showed fibrotic-like changes at 12month follow-up, yet with preserved lung function. They are mainly current smokers, with a higher level of medical care during hospitalization and a prolonged in-hospital stay.

Air leak in Covid 19: experience from a DGH in the UK

Introduction: We have previously described pneumothorax (PTX) and pneumomediastinum (PM) in COVID-19. Incidence is approx. 1%, and usually associated with a poor prognosis. Method(s): With Caldicott approval, all patients with Covid-19 with PTX and PM are flagged to the pleural service for ongoing analysis. Demographics and outcomes are collected. Result(s): 46 were identified (Total: 4506, 01/03/20-02/01/22): mean age 57.5 years (range 19-91). 37 (82%) male, 45 white Caucasian, 1 South East Asian, 20 ex-smokers, 8 never smokers, 1 current smoker & the rest unknown. Respiratory comorbidity was most commonly COPD (12), asthma (4), combined pulmonary fibrosis and emphysema (1), previous TB (1), & active lung cancer (1). Average estimated frailty score was 2 (range 1-6). Mean BMI was 28 (range 18.5-46.7), mean height 1.72m (range 1.55-1.84). Average number of days to air leaks is 13.29 patients had PTX [16 isolated PTX (including 6 bilateral)] & 22 had PM (4 isolated PNM). 18 patients had concurrent surgical emphysema. 10 patients were intubated at the time of air leak, 16 on CPAP or HFNC, 13 on oxygen, the rest on air. 32 were managed conservatively. Others had a variety of small, large bore and subcutaneous drains and 1 was transferred for ECMO. There were 10 deaths with 1 directly due to PTX in a 91 yr old, CFS of 6 and intercurrent stroke. 1 was associated with PM, CFS 2 & lung cancer, 1 85 yr old with CFS 4 & COPD, 1 82 yr old with CFS 3 on CPAP & the rest were on mechanical ventilation). Conclusion(s): Inpatient incidence of PTX and PM is still approximately 1%. Survival is better as overall Covid19 survival improves(direct mortality from air leak approx. 21 %) with mortality due to other factors rather than the air leak.

Tobacco smoking and severity of COVID-19: Experience from ICU department in a referral hospital during the third pandemic wave

Aim: To investigate the association between tobacco smoking habits and severity and mortality of COVID-19 disease among ICU hospitalized patients. Material: Baseline sociodemographic, co-morbidities and clinical characteristics of 222 adult (70 women) COVID-19 hospitalized patients, aged 69+/-8yrs, mean ICU length of stay 35+/-12 days, were retrospectively collected and analyzed from 01/08/2020-01/08/2021. Also, information about caregivers' tobacco smoking behaviors were obtained. Result(s): 57 patients were current smokers (35+/-4 pack/yrs) and 61 ex-smokers(28+/-9pack/yrs). E-cigarette users were 18 patients (2 ex-smokers), dual users 22 (all current smokers). 37 continued to smoke up to hospital admission. Arterial hypertension (47/35) diabetes (44/24), betamuI>30 (22/34), coronary disease (40/22) and COPD (41/28) noted as main comorbidities in current smokers and ex-smokers. CT findings of pulmonary emphysema were detected in 31% of current and ex-smokers. 51% (113) of total patients died, aged 71+/-4 yrs, and ICU length of stay 40+/-15 days. Current smokers and ex-smokers were hospitalized in ICU for a longer period 29+/-7 days (p=0.001). APACHE II (48+/-8) and SOFA score (11+/-3) were higher in current smokers and ex-smokers (p=0.003). 53% of ICU patients had a family member that smoked, and 35% of them were willing to undergo a Tobacco Prevention and Cessation Program. 90% of current smokers after ICU discharge quitted smoking. Conclusion(s): Tobacco smoking is a serious comorbidity in ICU patients hospitalized for covid 19 disease, with both current smokers and ex-smokers reveal more severe rates of mortality and morbidity.

Is smoking a risk factor for severe outcomes in COVID-19?

Introduction: Smokers are at increased risk of developing viral infections and more severe outcomes than are nonsmokers. Objectif: To evaluate the effect of current smoking on the prognostic of COVID19 infection. Method(s): This is a retrospective observational study including all patients admitted for COVID-19 pneumonia between February and August 2021 in the pulmonary department at Habib Bourguiba Hospital. We compared the demographic, clinical, biological, radiological characteristics and outcomes of 2 groups: G1: current smokers;G2: non-smokers. Result(s): Three hundred patients were included in this study (G1: n =95;G2: n =205). All the smokers were male. The mean number of daily cigarettes consumption was 17.0 cigarettes. No differences were found between the two groups regarding the age, biological inflammatory markers (D-dimer, Creactive protein, neutrophil-to-lymphocyte ratio) and extend of radiological damage. Hypertension was more prevalent in G2 (46,1% versus 27,3%, p= 0,01), however, chronic obstructive pulmonary disease was more frequent in G1(8,4 % versus 3,9 %, p= 0,034). Troponin level was significantly higher in G1 (p=0,004). The average length of hospital stay was 10 [7-16] days in G1 versus 9 [5-14] days in G2 (p=0,293). No Significant difference were found between the two groups regarding in-hospital mortality (p=0, 75) and need for mechanical ventilation (p=0, 79). Conclusion(s): Our study shows that the severity of the COVID 19 infection among smoker and non-smoker patients is similar, and smokers are not more prone than others to develop severe outcomes.

Comparison of High-Risk Pulmonary Embolism Patients with and without COVID-19

Objectives: There has been a significant increase in pulmonary embolism (PE) cases during the coronavirus disease of 2019 (COVID-19) pandemic. In this study, we aimed to compare the effects of COVID-19 positivity on morbidity and mortality in patients treated with a diagnosis of high-risk PE. Method(s): In this single-center and observational study, patients who were referred to our center with the diagnosis of PE between January 1, 2019 and 2021 were retrospectively evaluated. Patients with moderate- and low-risk PE according to the European Society of Cardiology PE guidelines, those who did not undergo computed tomography pulmonary angiography (CTPA) or the ones who did not accept treatment were excluded from the study. The patients included in the study were divided into two groups, as those with and without COVID-19, and compared in terms of demographic data, comorbidities, symptoms, thromboembolism in vessels other than the pulmonary artery, laboratory parameters, treatments, and prognosis. Result(s): A total of 384 PE cases were identified during the study period. Among them, 322 cases that were in the intermediate or low-risk category, 21 cases who did not undergo CTPA, and one case who did not accept thrombolytic therapy were excluded from the study. A total of 40 cases were included in the study. The groups with and without COVID-19 consisted of 23 and 17 patients, respectively. In the group of patients with COVID-19, inflammatory markers were higher, Wells score was lower, and thromboembolism was seen in vessels other than the pulmonary artery. The two groups were similar in terms of other laboratory parameters, demographic data, comorbidities, symptoms, treatment, and prognosis. Conclusion(s): While the involvement of COVID-19 in PE etiology does not change mortality, it may cause more thrombosis development in both venous and arterial systems outside the pulmonary area by significantly increasing inflammation. However, the lower Wells scores in COVID-19 PE cases in our study indicate that new clinical assessment tools are needed to detect PE risk in COVID-19 patients.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

Underdiagnosis of chronic obstructive pulmonary disease: a problem that persists

Introduction and objective: Chronic obstructive pulmonary disease (COPD) is a public health problem of the first order and underdiagnosis of this disease is a universal phenomenon. The objective of our study is to determine the prevalence of COPD and to analyze the clinical, radiological and functional characteristics of patients without a previous diagnosis of COPD and diagnosed with this disease in the post-COVID follow-up consultation, and to compare them with patients without COPD. Methods and materials: A study was carried out of the patients referred to the post-COVID consultation who were diagnosed with COPD in said consultation between the months of June 2020 and February 2021. The variables included were: sex, age, smoking habit, pack-year index (IPA), degree of dyspnea according to the mMRC scale, function and characteristics in chest CT. Result(s): Of the 371 patients evaluated in the post-COVID follow-up consultation, 23 of them, 11%, were diagnosed with COPD. 61% were men with a mean age of 60 +/- 11 years, 17% being active smokers, 56% ex-smokers with a mean IPA of 26 +/- 15. The rest of the variables are shown in Table 1. Significant differences were found between patients with and without COPD in terms of smoking (p<0.001) and lung function (p=0.002). No significant differences were found in the rest of the variables. 21% of COPD patients had emphysema on chest CT. Conclusion(s): The diagnosis of COPD was established in 11% of the patients evaluated in the post-COVID consultation.

Chronic obstructive pulmonary disease and COVID-19

Recently, single studies have described the picture of COVID-19 in patients with chronic obstructive pulmonary disease (COPD). Further study of this comorbid condition will help to assess the course and prognosis of each condition correctly, develop an effective plan for the management of patients with COPD during the pandemic caused by SARS-CoV-2 infection. The aim. The article is an analytical review of the scientific literature from PubMed, Google Scholar, medRxiv, bioRxiv in order to study the clinical features of COVID-19 in patients with COPD. The published studies of the new coronavirus infection showed that patients with COPD account for 2% among those infected with SARS-CoV-2. However, further studies are needed to study the course of COVID-19 in patients with COPD. The conducted studies indicate a high level of ACE2 receptors to SARS-CoV-2 in current smokers and patients with COPD, which may explain the easier penetration of SARS-CoV-2 into the host organism and the severe course of the disease in this population. Conclusion. Although a number of clinical studies strongly suggest that men have more severe COVID-19 than women, the patient's gender is not always taken into account. It is possible that the more severe course of COVID-19 is associated with the increased prevalence of smoking and COPD in men as compared to women to a lesser extent than with the high production of testosterone and X-linked inheritance of the androgen gene and the ACE2 gene. Copyright © 2022 Medical Education. All rights reserved.

Long-term follow-up of patients after COVID-19: adherence to SARS-CoV-2 vaccination and immune status

Objective. To assess the adherence of COVID-19 convalescents to vaccination against SARS-CoV-2 and immune status based on long-term follow-up (12 months or more after hospital discharge). Material and methods. Using the TARGET-VIP registry, 775 patients (age 57.5+/-1.4 years;50.6% males) with the in-hospital diagnosis of COVID-19 were followed for 13.7+/-3.0 months after discharge. Comparison groups included 190 (24.5%) subjects vaccinated against SARS-CoV-2 and 585 (75.5%) unvaccinated during the follow-up period. Immune status was assessed in a representative sample of 283 (36.5%) patients (age 56.9+/-12.7 years, 44.9% males) who came for outpatient visits 14.6+/-4.1 months after hospital discharge, including 97 (34.3%) vaccinated and 186 (65.7%) unvaccinated against SARS-CoV-2. Results. No significant differences were found between the SARS-CoV-2 vaccinated and unvaccinated groups in age, gender char-acteristics, cardiovascular disease rate, chronic non-cardiac disease rate, and proportion of smokers. In the unvaccinated group, a higher proportion of patients with a history of ICU treatment for COVID-19 and/or grade 3-4 lung injury measured by CT scans was observed: 55.0% versus 46.8% (p=0.048). The vaccinated group included less active smokers: 3.7% versus 6.0% (p=0.22). Among the patients who came to the visit, antibody titer of IgG type N was increased in 50.4% of cases, and antibody titer of IgG type S (quantitatively) - in 98.6% of cases. After 14.6+/-4.1 months of follow-up, the SARS-CoV-2 vaccinated group (12.3+/-2.7 months after COVID-19) had higher IgG type S levels (505+/-103 versus 376+/-171 BAU/mL;p<0.001) compared with unvaccinated patients and no statistically significant difference in IgG (type N) and IgM titers. The SARS-CoV-2 vaccinated group had significantly higher rates of influenza vaccination both before COVID-19 (34.8% versus 21.9%;p=0.0004) and after hospitalization for COVID-19 (37.0% versus 15.0%;p<0.0001) compared with the unvaccinated group. After COVID-19, compared to the period before hospitalization, the proportion of vaccinated against influenza in the group vaccinated against SARS-CoV-2 increased (from 34.8% to 37.0%;p=0.65) and decreased in the group unvaccinated against SARS-CoV-2 (from 21.9% to 15.0%;p=0.003). Conclusion. The study showed that only 24.5% of COVID-19 survivors were subsequently vaccinated against SARS-CoV-2 over a fol-low-up period of 13.7+/-3.0 months. One year after hospital discharge, 50.4% of patients had elevated IgG type N titer, and 98.6% of patients had high IgG type S titer, significantly higher in vaccinated patients. Adherence to influenza vaccination after hospitalization for COVID-19 increased in patients subsequently vaccinated against SARS-CoV-2 and decreased in unvaccinated patients. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

Risk Factors for COVID-19 Infection and Outcomes in People Living with HIV

Background. As the risk for concomitant COVID-19 infection in people living with HIV (PLHIV) remains largely unknown, we explored a large national database to identify risk factors for COVID-19 infection among PLHIV. Methods. Using the COVID-19 OPTUM de-identified national multicenter database, we identified 29,393 PLHIV with either a positive HIV test or documented HIV ICD9/10 codes. Using a multiple logistic regression model, we compared risk factors among PLHIV, who tested positive for COVID-19 (5,134) and those who tested negative (24,259) from January 20, 2020, to January 20, 2022. We then compared secondary outcomes including hospitalization, Intensive Care Unit (ICU) stay, and death within 30 days of test among the 2 cohorts, adjusting for COVID-19 positivity and covariates. We adjusted all models for the following covariates: age, gender, race, ethnicity, U.S. region, insurance type, adjusted Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and smoking status. Results. Among PLHIV, factors associated with higher odds for acquiring COVID-19 (Figure 1) included lower age (compared to age group 18-49, age groups 50-64 and >65 were associated with odds ratios (OR) of 0.8 and 0.75, P= 0.001), female gender (compared to males, OR 1.06, P= 0.07), Hispanic White ethnicity/race (OR 2.75, P=0.001),Asian (OR 1.35, P=0.04), and AfricanAmerican (OR1.23, P=0.001) [compared to non-Hispanic White], living in the U.S. South (compared to the Northeast, OR 2.18, P= 0.001), being uninsured (compared to commercial insurance, OR 1.46, P= 0.001), higher CCI (OR 1.025, P= 0.001), higher BMI category (compared to having BMI< 30, Obesity category 1 or 2,OR 1.2 and obesity category 3,OR1.34, P=0.001), and noncurrent smoking status (compared to current smoker, OR 1.46, P= 0.001). Compared to PLHIV who tested negative for COVID-19, PLHIV who tested positive, had an OR 1.01 for hospitalization (P = 0.79), 1.03 for ICU stay (P=0.73), and 1.47 for death (P=0.001). Conclusion. Our study found that among PLHIV, being Hispanic, living in the South, lacking insurance, having higher BMI, and higher CCI scores were associated with increased odds of testing positive for COVID-19. PLHIV who tested positive for COVID-19 had higher odds of death. (Figure Presented).

Association between Cardiorespiratory Symptoms and Lung Function in Patients with Long-Covid Signs

Background: Many patients recovered from COVID-19 infection present a variety of symptoms which limits overall quality of life, as reduced exercise performance, dysfunctional breathing, cough, dyspnea, weakness and anxiety. This condition has been named long COVID. The origin of this symptomatology is still unclear. This study has the aim to analyse the relation between symptoms and respiratory function, focusing on the alveolar capillary membrane. Method(s): Consecutive patients with long COVID 19 symptoms after 6 months were included. Patients underwent full clinical evaluation, laboratory tests, echocardiography, thoracic CTscan, spirometry including alveolar capillary membrane diffusion by means of combined carbon dioxide and nitric oxide lung diffusion (DLCO/ DLNO) and cardiopulmonary exercise test. We measured surfactant derive protein B (immature form) as blood marker of alveolar capillary function. A questionnaire allowed to evaluate symptoms. Result(s): We evaluated 204 post COVID-19 patients (age 56.5+/-14.5 y, 89 females (44%), BMI 25.7+/-4.0, 6% active smokers) referring to our hospital 171+/-85 days after the end of acute COVID-19 infection (Fig. 1). None of spirometry data was associated with long COVID 19 referred symptoms. SPB was not associated to differences in any of the referred symptoms. Subjects with lower capillary volume (VCap) have more frequently dyspnea, tiredness, fatigability and hair loss (Fig.2). CT scan lung damage correlated with SPB and membrane diffusion but not with VCap, exercise performance or VE/VCO2 slope. The strongest correlation of SPB were with lung parenchyma damage and Vcap. Conclusion(s): Our data suggest that a relevant reduction of alveolar capillary membrane function plays a central role in the long COVID cardiorespiratory symptoms. (Figure Presented).

A Cross-sectional study on effect of Covid 19 infection among smokers in Chamarajanagar district

Background: Tobacco is one of the deadliest public health threats to humankind, killing more than eight million people a year globally. Combined with COVID-19, smoking is even more lethal, in which smoked tobacco damage the lungs tissue and reduces its function drastically. So, comparing to a non-smoker the smoker has more chance of developing severe COVID-19 infection and related complications. Method(s): This cross-sectional study was conducted in a tertiary care center of Chamarajanagar District. All Adult patients who attended the study settings with previous history of Covid 19 infection and history of smoking was administered a pre-tested semi structured questionnaire after meeting inclusion criteria. The questionnaire was structured into 4 parts to meet the expected objectives. The data obtained was entered into MS Excel and analysed. Result(s): The study included 103 participants;out of which 65% belongs to the age group of more than 40 years. Majority of the study subjects were literate and semi-skilled workers which comprise 58% & 64% respectively. 81% of the study subjects were not vaccinated at the time of infection, but in contrast 97% were vaccinated at the time of interview. Majority of the subjects are current smokers (73%), and many of them prefers Beedis to smoke. A proportion of 44% are smokers for more than 15 years and half of total smokers are thinking it has ill effects on health. The major symptoms identified in our study were fever, cough & body ache. Conclusion(s): Cause effect analysis shows direct relationship between number of cigarettes smoked per day and number of days require for institutional care during infection. This leads to the necessity to quit smoked tobacco products as soon as possible in high-risk individuals for better health outcome. Copyright © 2022 Authors. All rights reserved.

Factors Linked with an Increased Risk of Death in Patients with Covid-19

Objective: The purpose of this study was to determine the factors that increase a patient's chances of death from COVID-19. Study Design: Retrospective study Place and Duration: Medicine department of Benazir Bhutto Hospital (BBH) and Holy Family Hospital (HFH), Rawalpindi during the period from November 2021 to April 2022. Method(s): Total 142 patients of both genders of confirmed coronavirus disease were included. After receiving informed written consent from each participant, detailed demographic information was obtained. This information included the participant's age, gender, body mass index, and list of co-morbidities. Frequency of mortality and factors that increase a patient's chances of death were recorded. SPSS 24.0 was used to analyze all data. Result(s): We found that 87 (61.3%) cases were males and 55 (38.7%) patients were females. Majority of the patients 53 (37.3%) had age >45 years. 65 (45.8%) patients were smokers. Severity of disease was found in 76 (53.5%) cases. There were 95 (66.9%) patients had hypertension, diabetes mellitus found in 75 (52.8%) cases, cardiovascular disease in 48 (33.8%) cases, pulmonary disease in 40 (28.2%) cases and chronic kidney disease in 34 (23.9%) cases. Among 142 patients, 27 (19.01%) patients were died. Among non-survivals, kidney dysfunction was the most common reason found in 17 cases, followed by cardiovascular and diabetes mellitus. Conclusion(s): We came to the conclusion that clinical risk factors for a fatal consequences associated with coronavirus include chronic chronic conditions, complications, and demographic variables. These risk factors include acute renal injury, diabetes, hypertension, heart disease, male sex, older age, current smoker, and obesity. The findings might be used to future study on the disease as well as its control and prevention. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Safety of Bariatric Surgery in the Older Patients during the CoVID-19 Pandemic

Background: The progressive growth of The older patients with obesity represents a challenge to The weight management teams. Although initially, old age was a relative contraindication to The surgical option, current advances in laparoscopic techniques and perioperative optimization protocols have changed The old notion. However, The performance of bariatric procedures in The older patients during The ongoing CoVID-19 pandemic carries a potential risk. This study aimed to assess The safety of bariatric surgery (BS) in older patients during The pandemic. Method(s): We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups-older patients >65-year-old (group I) and young < 65-year-old (group II). Two groups were compared for 30-day morbidity and mortality. Result(s): We included 7084 patients, The mean age was 40.35+/-11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and BMI were 119.49+/-24.4 Kgs and 43.03+/-6.9 Kg/m2, respectively. The overall comorbidities were significantly higher in group I, p= <0.001. In group II, 14.8% were current smokers, compared to 7.4% of group I. The complications in group I were significantly higher (11.4%) compared to group II (6.6%), p= 0.022. However, The mortality rate and CoVID-19 infection within 30 days were not significantly different between The two groups. Conclusion(s): Bariatric surgery during The CoVID-19 pandemic in The older patients (>65 years old) is associated with a higher complication rate than The younger age group. However, The mortality and postoperative CoVID-19 infection rates are comparable to The younger age group.