Clinical and laboratory indicators in predicting the risk of chronic heart failure in COVID-19 survivors.

Coronavirus disease has many systemic disease symptoms and has severe consequences for the cardiovascular system. Objective. To assess the role of clinical and laboratory indicators in determining the risk of chronic heart failure (CHF) in COV-ID-19 survivors. Material and methods. In total, 151 patients treated in a monoinfectious hospital from 03.11.20 to 10.02.21 with a confirmed diagnosis of COVID-19 were retrospectively selected. Medical history and laboratory data were collected by reviewing electronic medical records. The data included age, gender, body mass index, smoking status, and comorbidities. The laboratory data included the results of hematology and blood chemistry, coagulation, and the levels of acute-phase proteins. The CHF occurrence was used as the study endpoint. Results and discussion. The study patients were divided into two groups depending on the presence of CHF: group 1 included 46 patients with CHF, and group 2 included 105 patients without CHF. The median age was 66.2 (50-92) years;91 (60.3%) were females. Laboratory tests, such as levels of the hs-C-reactive protein, lactate dehydrogenase, procalcitonin, creatinine, and bilirubin, were statistically significantly different in patients of the study groups, and the median values were higher in patients with CHF. Neutrophil-lymphocyte ratio (NLR) showed statistically significant differences between groups: in patients with CHF, the median was 4.97% compared to 3.62% (p=0.011) in those without CHF. The most significant predictors of an increased risk of CHF were age >=66 years (OR=8.038, p<0.001), procalcitonin level >=0.09 ng/mL (increased the CHF risk by 3.8 times, p<0.001), thrombocy-topenia <=220x109/L (p=0.010), an NLR ratio >=4.11% (p=0.010), and a history of chronic kidney disease (p=0.018). Conclusion. A model has been developed to determine the factors closely associated with the risk of chronic heart failure in CO-VID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Managing the menopause during the pandemic

The structure of the presentation will be 1) Pandemic-Epidemiology 2) General Pandemic-Management 3) HRT and COVID 4) Different spectrum of menopausal symptoms (Europe/Asia) 5) Different risks lead to different HRT. 1) Pandemic-Epidemiology: SARS-COVID-19 has got to be a new disease, China was the first to suffer from the pandemic starting in December 2019 with spread all over the world. Diagnosis, treatment and protective measures have started in Europe in March 2020;up from autumn 2022 in Europe the pandemic changed to endemic, but protective measures still should be continued in risk patients like in hospitals and nursing homes. Rehabilitation will for long-time be an issue like treatment of "Post-" and "Long-COVID". China pursued a zero-COVID-policy until Dec 2022. The sudden stop of almost all measures led to a sharp increase in infections, which shows that the disease will remain a global risk. 2) General Pandemic-Management: Protective measures like vaccination, surgical masks, screening/testing, isolation management, travel/residence history in high-risk regions, education of patients and families had to be the first priority, ahead of other issues such as the management of menopause. 3) HRT and COVID: Already the first prelimary data assessed in Wuhan/China have shown that women with low estradiol-levels had more severe infections with COVID. An analysis of health records of 68,466 COVID-positive patients from 17 countries showed that the fatality risk for women > 50 years receiving HRT was reduced by more than 50% compared to those women not taking HRT (Seeland, 2020). Likewise from a case-control study analyzing the self-reported data of 1.6 million UK menopausal women through the COVID-Symptoms Study Smartphone application (control populations adjusted for age, body mass index, and smoking status) was concluded, that HRT not only can be used, but even can protect from COVID-infections and/or their sequelae (Costeira, 2021). 4) The different spectrum of menopausal symptoms (independent of COVID-infections) comparing data in Europe (showing more vasomotor symptoms) and China (more somatic symptoms) will be presented, including own data. 5) Different risks during HRT consequently lead to different use of HRT, especially more transdermal estrogen combined with progesterone in Europe due to much higher VTE-risk, but more management of the high bleeding-problems in China using individualized (mostly oral) estrogen/progestogen combinations. Copyright © 2023

Knowledge About Preventive Health Guidelines for Inflammatory Bowel Diseases in Patients: A Quality Improvement Project

Introduction: Preventive care guidelines for patients with Inflammatory Bowel Disease (IBD) emphasize the need for a patient-centered interdisciplinary approach, with assessment and management of the patient's physical and mental health as well as the IBD. There is no data about compliance with current IBD preventive care guidelines in Puerto Rico. This study aims to evaluate current IBD preventive care in the clinic, and knowledge among patients and gastroenterologists about the preventive care guidelines. The 3-phase study includes retrospective medical record review, an anonymous online survey of gastroenterologists, and an anonymous survey of patients. We report the results of the patient survey. Method(s): Adult patients with an established diagnosis of at least 6 months of ulcerative colitis (UC), Crohn's disease (CD) or indeterminate colitis (IC), were recruited from the IBD Clinics and through IBDrelated social media. Questionnaires were filled in the clinic and online using Google forms. Statistical analysis was performed using descriptive statistics. Comparisons of proportions and means between groups was based on Fisher's exact and chi square tests. The study was approved by the MSC IRB. Result(s): 83 patients completed the survey, 42 from the clinics and 41 through social media. 60% had CD, 47.4% were diagnosed more than 10 years ago, 57.9% were younger than 38 years old and 68% were on immunosuppressants/biologics. 83.13% and 60.24% of patients knew that COVID and Influenza vaccines were indicated, respectively. However only 42.17%, 36.14%, 32.53% and 31.33% of patients knew about indications for HPV, pneumococcal, varicella and zoster vaccines, respectively. There was a significant difference about knowledge regarding screening for latent TB (p=0.019), anxiety and depression (p= 0.03) and smoking status (p=0.033) between CD and UC/IC patients, as shown in Table. Conclusion(s): Our study showed a significant lack of knowledge about IBD preventive care in patients. Strategies to improve patient education are needed. The results of the review of records from the clinic as well as the knowledge of gastroenterologists will point out other deficiencies in the healthcare system and help design methods to improve patient care. Another aspect that needs to be explored is access to preventive measures such as vaccines. (Table Presented).

Identification Symptoms and Underlying Diseases Related to COVID-19 And Prediction of Death Status Using Artificial Neural Network and Logistic Regression: A Data Mining Approach

Background and Objectives: Due to the high prevalence of COVID-19 disease and its high mortality rate, it is necessary to identify the symptoms, demographic information and underlying diseases that effectively predict COVID-19 death. Therefore, in this study, we aimed to predict the mortality behavior due to COVID-19 in Khorasan Razavi province. Method(s): This study collected data from 51, 460 patients admitted to the hospitals of Khorasan Razavi province from 25 March 2017 to 12 September 2014. Logistic regression and Neural network methods, including machine learning methods, were used to identify survivors and non-survivors caused by COVID-19. Result(s): Decreased consciousness, cough, PO2 level less than 93%, age, cancer, chronic kidney diseases, fever, headache, smoking status, and chronic blood diseases are the most important predictors of death. The accuracy of the artificial neural network model was 89.90% in the test phase. Also, the sensitivity, specificity and area under the rock curve in this model are equal to 76.14%, 91.99% and 77.65%, respectively. Conclusion(s): Our findings highlight the importance of some demographic information, underlying diseases, and clinical signs in predicting survivors and non-survivors of COVID-19. Also, the neural network model provided high accuracy in prediction. However, medical research in this field will lead to complementary results by using other methods of machine learning and their high power.Copyright © 2022 The Authors.

Clinical and laboratory indicators in predicting the risk of chronic heart failure in COVID-19 survivors

Coronavirus disease has many systemic disease symptoms and has severe consequences for the cardiovascular system. Objective. To assess the role of clinical and laboratory indicators in determining the risk of chronic heart failure (CHF) in COV-ID-19 survivors. Material and methods. In total, 151 patients treated in a monoinfectious hospital from 03.11.20 to 10.02.21 with a confirmed diagnosis of COVID-19 were retrospectively selected. Medical history and laboratory data were collected by reviewing electronic medical records. The data included age, gender, body mass index, smoking status, and comorbidities. The laboratory data included the results of hematology and blood chemistry, coagulation, and the levels of acute-phase proteins. The CHF occurrence was used as the study endpoint. Results and discussion. The study patients were divided into two groups depending on the presence of CHF: group 1 included 46 patients with CHF, and group 2 included 105 patients without CHF. The median age was 66.2 (50-92) years;91 (60.3%) were females. Laboratory tests, such as levels of the hs-C-reactive protein, lactate dehydrogenase, procalcitonin, creatinine, and bilirubin, were statistically significantly different in patients of the study groups, and the median values were higher in patients with CHF. Neutrophil-lymphocyte ratio (NLR) showed statistically significant differences between groups: in patients with CHF, the median was 4.97% compared to 3.62% (p=0.011) in those without CHF. The most significant predictors of an increased risk of CHF were age >=66 years (OR=8.038, p<0.001), procalcitonin level >=0.09 ng/mL (increased the CHF risk by 3.8 times, p<0.001), thrombocy-topenia <=220x109/L (p=0.010), an NLR ratio >=4.11% (p=0.010), and a history of chronic kidney disease (p=0.018). Conclusion. A model has been developed to determine the factors closely associated with the risk of chronic heart failure in CO-VID-19 survivors.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

COPD criteria-led discharge impacts on inpatient COPD management

Introduction/Aim: A chronic obstructive pulmonary disease (COPD) criteria-led discharge (CLD) pathway created on evidence-based guidelines was introduced at Canterbury Hospital to reduce unwanted clinical variation detected during a previous Agency for Clinical Innovation (ACI) audit. This audit aims to review whether adherence to COPD evidence-based guidelines improved after the CLD introduction. Method(s): The electronic medical records of patients admitted to Canterbury Hospital between 14/02/2022 and 01/08/2022 with a diagnosis of COPD, defined as DRG codes E65A and E65B, were reviewed. Data including patient demographics, admission dates, vaccination status, smoking status and cessation counselling, oxygen targets, inhalers, antibiotics, steroids and referrals on discharge were recorded in REDCap. Deidentified data was extracted into excel, grouped based on admission date being pre or post the CLD implementation date of 09/05/2022. The chi square test was used to determine significance. Result(s): A total of 66 patients were included for analysis (n = 25 pre-intervention, n = 39 post-intervention). Appropriate steroid discharge plans and inhaler technique reviews improved post CLD implementation. Antibiotic usage was more consistent with community acquired pneumonia guidelines rather than infective exacerbation of COPD for both groups. Vaccination documentation was generally poor aside from for Coronavirus disease (COVID-19), though there was significant improvement in the discussion of influenza vaccine post CLD. Documentation of oxygen targets did not improve. Referrals to outpatient respiratory services were high in both groups. Conclusion(s): Introduction of a COPD CLD improved adherence to some aspects of COPD evidence-based management at Canterbury Hospital. Further initiatives should be considered targeting appropriate antibiotic usage, oxygen targets and discussion of preventative measures such as vaccination.

A new score to predict severe respiratory failure and guide anakinra treatment in COVID-19 pneumonia: analysis of the randomized SAVE-MORE trial

Introduction: Anakinra treatment is approved for the treatment of COVID-19 pneumonia in hospitalized adults in need of oxygen and at risk for progression into severe respiratory failure (SRF) defined as circulating concentrations of the biomarker suPAR (soluble urokinase plasminogen activator receptor) >= 6 ng/mL by the EMA and has been authorized for emergency use by FDA under an EUA [1]. This is based on the results of the randomized SAVE-MORE trial where suPAR >= 6 ng/ mL was used to select patients at risk for SRF [2]. The suPAR test is not commercially available in the USA and an alternative method of patient selection was needed. Method(s): In collaboration with the US FDA, an alternative method to select patients most likely to have suPAR >= 6 ng/mL based on commonly measured patient characteristics was developed. Patients with at least 3 of the following criteria are considered likely to have suPAR >= 6 ng/ ml: age >= 75 years, severe pneumonia by WHO criteria, current/previous smoking status, Sequential Organ Failure Assessment score >= 3, neutrophil-to-lymphocyte ratio >= 7, hemoglobin <= 10.5 g/dl, history of ischemic stroke, blood urea >= 50 mg/dl and/or history of renal disease. Result(s): The positive predictive value of this new score was 95.4% in SAVE-MORE population. However, a lower sensitivity meant a small proportion of patients with suPAR >= 6 ng/ml will not be identified by the new score. The adjusted hazard ratio for survival at 60 days for patients meeting this score and who receive anakinra is 0.45 (Fig. 1). Conclusion(s): The developed score predicts accurately patients with suPAR levels >= 6 ng/mL and may be used as an alternative to guide anakinra treatment in patients with COVID-19 pneumonia. Based on these subgroup results, patients in SAVE-MORE who met the new score appeared to show beneficial efficacy results with treatment of anakinra consistent with the overall studied population.

Evaluation of Bladder Cancer Patients' Utilization of Urologic Telehealth Services

INTRODUCTION AND OBJECTIVE: Infection control practices and public policy in response to the COVID-19 pandemic shifted healthcare practices towards a telemedicine format. Even two years after peak onset of the pandemic, many clinics, including our own institution, maintain a working telehealth option for patient visits, with some patients even preferring this modality of care delivery. Our objective was to evaluate patient utilization of telehealth visits versus inperson visits at our institution and whether this was impacted by demographics, medical history, and socioeconomic factors. METHOD(S): Medical Record Numbers for all patients with bladder cancer were pulled via accessible billing-level data from the period 7/1/2019-2/28/2022. Chart review was conducted to pull clinical data on patients including telehealth versus in person visits, demographic data, clinical stage, comorbidities (diabetes, smoking status, BMI), rural/urban status by zip code (>50,000, <50,000 individuals) and income levels by zip code (25K-49.9K, 50K-99.9K, <100K), payor status, patient distance, and gas savings/carbon footprint. RESULT(S): 430 patients completed in person visits while 268 completed telehealth visits. There was no statistically significant difference for in person visits vs. telehealth visits regarding patients' race (p=0.541), ethnicity (p=0.394) age (p=0.862), urban/rural status (p=0.507), payor status (p=0.127), mean zip code income (p=0.175), and comorbidities (p=0.626 for diabetes, p=0.706 for smoking, p=0.459 for BMI), and clinical stage (p=0.07). There was a statistically significant difference in mean distance (14.85 miles versus 26.86 miles, p<0.01). CONCLUSION(S): Post-pandemic, telehealth usage and acceptability among patients with bladder cancer remains high. Patients' with bladder cancer receive care from their urologist via in person visits versus telehealth at similar rates irrespective of their urban/rural status, demographics, payor status, relevant comorbidities, or relative income. Patients are more likely to engage in care with their urologist via telehealth if they live farther from a large urban academic center, which produces an economical and environmental impact via gas/time savings and reduced carbon footprint.

Sex Modifies the Effect of Covid-19 and Pasc Status on Arterial Stiffness

Background: Sex differences in immunological responses to COVID-19 infection and mechanisms that may contribute towards post-acute sequelae of SARS-Co-V2 (PASC) have been reported. However, evidence on the effects of COVID infection on vascular dysfunction and PASC are limited. Method(s): FDA approved EndoPAT device was used to measure endothelial function [Reactive Hyperemia Index (RHI)] and arterial stiffness [Augmentation Index standardized at 75 beats/min (AI@75;higher AI = worse arterial elasticity)] in an adult cohort (age >=18 years) with a history of COVID-19 infection (COVID+) or confirmed SARS-CoV2 antibody negative (COVID-). Generalized linear regression was used to compute estimates of RHI and AI@75. Adjusted models included age, sex, race, blood pressure, lipids, body mass index (BMI), smoking status, and pre-existing comorbidities. Two-way interactions were used to determine if the effects of COVID or PASC status on endothelial function depends on age, sex, race, smoking status, or prevalent comorbidities. Result(s): 61.99% (n=305) of study participants were COVID- and 187 (38.01%) were COVID+. Among COVID+, 57.22% (n=107) were female, 31.72% (n=59) were non-white race, and the average age was 46.64+/-13.79 years. COVIDparticipants had a smaller proportion (38.03%) of female sex (p< .0001), lower BMI [COVID+ (30.79+/-8.95 kg/m2) vs. COVID- (27.76+/-5.89 kg/m2);p< .0001], and higher proportion of smokers [COVID+ (17.78%) vs. COVID- (58.22%);p< .0001]. The average follow-up was 349.68+/-276.76 days and 109 (22.15%) COVID+ experienced PASC. 42.48% (n=80) of COVID+ and 41.64% (n=127) of COVID- had RHI<= 1.67 (p=0.8). The average AI@75 among COVID+ without PASC was 3.63+/-16.24, with PASC was 10.5+/-14.72, and 3.11+/-15.97 among COVID- (p=0.0001). Male sex had the lowest AI@75 (-0.08+/-14.9) compared to female sex (10.75+/-15.3;< .0001). In adjusted models, PASC, female sex had 8.14+/-2.95 higher AI@75 compared to PASC, male sex (p=0.006), 18.58+/-2.99 higher AI@75 compared to COVID+ without PASC, male sex (p< .0001), 13.81+/-2.11 higher AI@75 compared to COVID-, male sex (p< .0001), and 4.97+/-2.28 higher AI@75 compared to COVID-, female sex (p=0.03). Sex was not associated with RHI or modified the effect of COVID or PASC status on endothelial function Conclusion(s): The effect of COVID and PASC status on arterial stiffness depends on sex. Female sex is associated with increased arterial stiffness (worse arterial elasticity) in the post-acute phase of COVID-19. (Figure Presented).

Clinical Outcomes of Stage III Non-small Cell Lung Cancer Patients Treated With Radical Radiotherapy in a Institution in Brazil

Introduction: Lung cancer is the leading cause of cancer death. Most cases are diagnosed at advanced stages. Stage III cancers are treated in a curative manner, despite the low success rate. Our objective was to define the clinical and epidemiological profile of stage III non-small cell lung cancer (NSCLC) patients (pts) treated with radiotherapy (RT) and their response to therapy. Method(s): It is a retrospective and observational study of all non-surgical stage III NSCLC pts treated with RT with curative intent at a public cancer center in the south of Brazil between January/2016 and June/2022. Data collected: dates of biopsy, treatment initiation, image progression or relapse, death and last registration;ECOG-PS;sex;smoking status;histology;stage (TNM 7th Ed) and chemotherapy (CT) use. Survival analysis were performed using the Kaplan-Meier method and factors associated with the events were analyzed using Cox regression. Groups were compared with chi-square and Kruskal-Wallis tests. Result(s): Eighty-seven pts were identified;median age 63 years-old;46 (52%) male, 78 (90%) former or present smokers;51 (62%) ECOG-PS 0/1;49 (58%) squamous (sq) histology;48 (60%) stage IIIb;60 (68%) had abdomen, bone and brain scans;64 (73%) had concurrent CT, 11(13%) sequential and 12 (14%) exclusive RT;64 (74%) concluded RT;53 (60%) had disease progression or relapse and 47 (54%) died. It took a median of 77 days (d) from biopsy to treatment initiation, without difference between pre or during COVID-19 pandemic. The follow-up was of 305d, progression free survival 192d and overall survival 253d (median for all), using the treatment initiation as baseline date. Younger pts and ECOG-PS 0/1 pts were more commonly treated with concurrent CT (X2:8,87;p 0,0054 and X2:10,82;p 0,004 respectively). No factor influenced progression free survival on uni or multivariable analyses. Factors correlated with overall survival on univariable analysis were: ECOG-PS (hazard ratio (HR) 2,02;p 0,010);bone scan (HR 0,5;p 0,028);treatment conclusion (HR 3,53;p<0,0001). Multivariable analysis: ECOG-PS (HR 2,95;p 0,017), non-sq histology (HR 2,26;p 0,044);RT conclusion (HR 4,69;p<0,0001). Conclusion(s): Our study shows shorter overall and progression free survival than literature, with a large portion of patients being treated with ECOG-PS of 2 or greater and without adequate systemic staging. About one-quarter of patients did not conclude the treatment, and this was the most negative factor impacting survival next to ECOG-PS.Copyright © 2023

Household secondhand smoking and asthma exacerbation during the covid-19 pandemic in Japanese junior high school students

Background: There is evidence that secondhand smoke exposure, particularly indoor smoking exposure, increases the risk of asthma exacerbations. This relationship might be modified in the era of a pandemic of covid-19 when the overall spread of viral infection may decrease due to precaution. Method(s): In this public school-based longitudinal paper questionnaire study in 2019 and 2021, the students and parents of junior high schools were asked whether the student had ever been diagnosed as wheezy bronchitis or asthma by a doctor and whether they had wheezing or whistling in the chest in the last 12 months. The presence of smokers in the household and their location of smoking (outside only or indoor) were also asked. Student sex, parental age, household income, and the region of the school were employed as covariates. Result(s): Of 1926 students who registered in 2019, 1482 (76.9%) responded in 2021. A total of 351 (23.4%) ever had a doctor diagnosis of asthma. The rate of students who reported asthma symptoms decreased from 27.4% in 2019 to 8.6% in 2021. The rate of asthma symptoms significantly increased depending on the presence of smokers in the household and the location of smoking in 2019;22.1% (44/199) in the students with no smokers in the household, 29.2% (19/65) smokers with smokers who smoke only outside the home, and 39.1% (34/87) with indoor smokers. This association remained significant in 2021, although there were some improvements in the overall smoking status in the household;5.5% (12/217), 12.3% (7/50), and 14.3% (11/77), respectively. The adjusted odds ratio of asthma symptoms in the students with indoor smokers, as compared with no smokers in the household, was 1.92 (95% confidential intervals (CI), 1.06-3.48) in 2019 and 2.92 (95% CI, 1.03-8.21) in 2021. Conclusion(s): These results suggest that household indoor smoking exposure may have an adverse effect on asthma symptoms even in the era of the covid-19 pandemic.

Post-COVID-19 cardiovascular complications and their association with clinical characteristics, symptoms and comorbidities - the LATE-COVID study

Background: Among many complications of coronavirus disease 2019 (COVID-19) there is a wide range of cardiovascular (CV) problems ranging from mild to severe ones. Even asymptomatic patients and those with mild course of COVID-19 may develop severe CV complications. Factors leading to such state have not been extensively studied so far. Purpose(s): We aimed to assess which factors were linked to the severe complications of COVID-19. Method(s): We included 200 consecutive patients admitted to the Department of Cardiology and Adult Congenital Heart Diseases of the Polish Mother's Memorial Research Institute (PMMHRI) due to post-Covid cardiovascular complications. SARS-CoV2 infection was confirmed with real-life PCR testing. Laboratory tests, 24-hour ECG monitoring and echocardiography were performed in all patients from the investigated group. For the purposes of our study severe complications were defined as: Myocarditis, a decrease of ejection fraction >10% from the pre-disease value, thromboembolic complications, angina pectoris requiring myocardial revascularization and the new onset of atrial fibrillation of supraventricular tachycardia. Some patients presented more than one of the above. Statistical analysis was performed using the software Statistica v.13 (TIBCO Software Inc., Palo Alto, CA, USA). Data were presented as mean +/-SD or median (25th- 75th percentile) for continuous variables and as proportions for categorical variables. Comparisons between groups were performed using Student's t-test for independent variables and the Mann-Whitney U test or chi2 test with Yates's correction, as appropriate. For all calculations p-values <0.05 were considered statistically significant. Result(s): Finally, we included 200 consecutive patients (aged 54+/-16 years, 76 males - 38%), hospitalized for COVID-19 complications after a median 3 (2-6) months following the acute phase of infection. On admission patients presented with dyspnea (23%), impairment of exercise tolerance (47%), chest pain (32%), increase in blood pressure (29%), palpitations (25%), weight loss (13%), brain fog (6%), general malaise (11%), headache (5%), limb pain (13%), swelling (14%). Severe complications of COVID-19 were diagnosed in 31 patients (16%).Taking into consideration symptoms, the presence of severe COVID-19 complications was significantly associated with dyspnoea and deterioration of exercise tolerance. In comparison to patients with mild complications, severe ones were linked to age (the older patients, the higher risk), previous history of heart failure and diabetes mellitus. We did not observe statistically significant differences in severity of complications depending on smoking status (Tables 1 and 2). Conclusion(s): Previous history of heart failure and diabetes mellitus as well as symptoms (dyspnoea and deterioration of exercise tolerance) along with older age are related to more severe complications following COVID- 19.

Changes in demographic and smoking history trends in patients referred to a London thoracic malignancy specialist centre between 2010-2021: The Guy's Cancer Centre experience

Background In the UK it is estimated that 10-15% of lung cancer cases occur in never-smokers. This study demonstrates the changes of the demographic characteristics, including the smoking status, of all the patients referred to the thoracic malignancy unit at Guy's Cancer Centre, South East London, between 2010 and 2021. Methods We included patients with a documented ICD10 diagnosis of bronchus and lung malignancy who were referred to Guy's thoracic malignancy unit from 2010 until 2021. A total of 6861 patients with a diagnosis of lung cancer were identified. We collected baseline demographic and clinical characteristics, including smoking status and socio-economic status for all the patients. Descriptive statistics were utilised to highlight the dynamic changes over the years of the referred patients. Results The number of referrals per year remained overall stable from 2010 until 2019, with a decrease in the number of referrals in 2020 and 2021, most likely due to the COVID-19 pandemic. We observed a gradual increase in the percentage of never smokers among the lung cancer patients: 5%, 8%, 10% and 13% of the referred patients were never smokers in the years 2010, 2015, 2018 and 2021 respectively. Median age remained stable across the years (range 68-71 years). Male percentage was 56%, 55%, 53% and 53% in 2010, 2015, 2018 and 2021 respectively. From the patients that we had a documented ethnic background the proportion of White/Black/Asian/Other or Mixed ethnicity remained stable across the years with a median 87%, 7%, 3%, and 3% respectively. The most common histological diagnosis was adenocarcinoma, followed by squamous cell carcinoma and small cell lung carcinoma. Conclusions The proportion of never-smoking to smoking related lung cancer has gradually increased between 2010 and 2021. There was little variability in age, sex and ethnic background. Never-smoking lung cancer is a distinct biological entity, therefore, further research should focus on the understanding of the aetiology and the risk factors leading to the development of lung cancer, in the absence of a history of tobacco exposure. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc.

Smoking habits during the COVID pandemic: data from Greek healthcare professionals' population

Background: Although smoking is associated with more severe outcomes of COVID-19, little is known about smoking habits during the COVID pandemic. Healthcare professionals (HCPs) are significant role models for the society and their smoking habits are critical concerning the general public attitudes. Aim(s): to determine the smoking levels of HCPs, to assess the effect of the pandemic on their smoking attitude and to evaluate possible associations with their psychological status. Method(s): An anonymous online survey was conducted among HCPs of Northern Greece in 2020 by emails delivered from the local medical and nursing stuff associations including basic information (age, gender, marriage, education level, etc.), smoking status (Heaviness of Smoking Index (HSI)) contact with COVID-19 patients, quarantine status, current physical condition, Sleep Condition Indicator (SCI), DAR-5 (anger), PHQ-4(depression and anxiety), Loneliness scale (LS). Result(s): 1057 HCPs answered (males 45.3%) 79% doctors with mean age 45.2+/- 11.7years and HIS 2.4+/-1.7. 32% of HCPs smoked: 24.9% smoked more cigarettes during the pandemic, 14.2% smoked less, 7% stopped smoking and 54% did not change their smoking habits. There was an association between alcohol use and smoking (p=0.002). A weak but significant correlation was found between LS and HIS (r=0.22, p=0.02) and especially with 'how soon after you wake up do you have your first cigarette' (r=0.28, p=0.001). SCI, LS and PHQ-4 of HCPs that smoked more were significantly higher compared with the other groups. Conclusion(s): During the pandemic, most of the HCPs that smoked continued their smoking habits as before, 25% increased their cigarettes and only 7% stopped.

Dual Oxygenation in Covid-19 - a Retrospective Cohorot Study

Background: Concerns regarding the availability of Positive Pressure Ventilation (PPV) have led the quest for alternative methods of oxygenation. One such method is Dual Oxygenation - the addition of a reservoir mask (RM) on top of a high flow nasal cannula (HFNC). Thus far, this method has not been formally evaluated. Method(s): The registry of all patients hospitalized between 1/1/2020-31/8/2021, in any one of six dedicated COVID19 wards of our tertiary hospital were reviewed. Inclusion required: 1) severe hypoxemia requiring the use of HFNC and 2) 18 years of age or older. Exclusion criteria were: 1) PPV (either noninvasive or invasive) initiated for any reason other than refractory hypoxemia (e.g. surgery) or 2) transfer to another facility while still on HFNC. The primary outcome was mortality within 30 days from the first application of HFNC. Secondary outcomes were the initiation of invasive intermittent positive pressure ventilation (IPPV) and admission to an ICU. Result(s): A total of 461 patients were included in the final analysis: 219 were treated with the combination of HFNC and RM (dual oxygenation) and 242 with HFNC alone (controls). No significant differences in the incidence of chronic diseases, smoking status or body mass index and markers of disease severity at presentation were noted between the groups. Mortality within 30 days of HFNC initiation (23.7% vs. 32.4%, Pv=0.048), rates of IPPV (49.3% vs. 58.7%, Pv=0.043) and ICU admissions (42.4% vs. 52.1%, Pv=0.039) were all significantly lower in the dual oxygenation group. Conclusion(s): Our study suggests that dual oxygenation may improve the short term prognosis of patients hospitalized with COVID-19 associated hypoxemic respiratory failure.

Predictive factors of persistent dyspnea after COVID-19 pneumonia

Persistent dyspnea (PD) is a common symptom in long Covid-19 syndrome. The aim of our study was to identify the prevalence and the predictive factors of PD This is a prospective study of patients infected with mild to severe SARS COV2 pneumonia and followed up at consultation dedicated to post COVID syndrome 4 weeks after infection. Dyspnea was assessed by the modified Medical Research Counsil score mMRC. Symptoms of post-traumatic stress disorder (PTSD) were assessed by Posttraumatic Stress Disorder Checklist5 and retained if score>23. The diagnosis of hyperventilation syndrome was made through the use of the Nijmegen questionnaire with a score>23. Post-COVID-19 Functional Status (PCFS) scale has been filled. Result(s): A total of 254 patients were enrolled. The population was majority male (62%) with a median age of 64 years old. One month after the infection, 53.2 % of the patients reported a PD and it was grade 1 or 2 mMRC in 87% of cases. PD was correlated with the severity of the initial dyspnea during the infection(16%,40%and 48% of patients suffered from mild,moderate and severe dyspnea respectively ;p=0.04). The initial presence of cough (65% ;p=0.007) and asthenia (89% ;p=0.003) were predictive factors of PD Women were more likely to report PD (p<0.001;p=0.041). There were no difference with the degree of scanner impairment, smoking status, and hospital stay with PD. Impairment of QL, hyperventilation syndrome(21% ;p=0.007) and PTSD(60% ;p<0.001)were associated with PD Conclusion(s): PD is common in women and not associated with the severity of scanner impairment. Furthermore, dyspnea has an important impact on physical status and mental health in patients with post-COVID syndrome.

The Relationship Between Functional Status and Fatigue After COVID-19 Infection

Introduction: After COVID-19 infection, symptoms last for weeks or months. In this study, it was aimed to examine the relationship between functional status and fatigue and the associated factors in patients with COVID-19. Method(s): Patients with COVID-19 infection who applied to 13 centers were included into the study according to the inclusion criteria. Age, gender, height, body weight, body mass index (BMI), marital status, smoking status and amount, presence, duration of chronic disease, Charlson comorbidity index, regular exercise habit, time of diagnosis with COVID-19, presence of hospitalization,length of hospital stay, intubation status, home oxygen therapy need, participation in PR program, presence of dyspnea, cough, sputum, mMRC score, post-COVID functional status scale, fatigue severity scale, EQ-5D-5L Questionnaire scores were recorded. Result(s): Of the 1095 patients, 603 (55%) were male and 492 (45%) were female. Their mean age was 50+/-14 years. The most common chronic lung disease was COPD (11%), while 266 patients (29%) had non-pulmonary systemic disease. The median time of COVID-19 diagonosis was 5 months ago with 47% hospitalization rate. The median value of post-COVID functional status scale was 1 (0:4), and fatigue severity scale score was 4.4 (1:7). There was a significant correlation between post-COVID functional status and fatigue severity scale (r=0.43, p <0.01). Conclusion(s): Functional status and fatigue were found to be related primarily to quality of life and then patients' age, BMI, presence of chronic and systemic lung disease, regular exercise habits before COVID-19, hospitalization and its duration, home oxygen therapy and symptoms.

Oncological emergencies in lung cancer patients during 2019 and SARS-CoV-2 pandemic year

Lung cancer (LC) is frequently related to oncological emergencies (OE). We performed a retrospective analysis to characterize OE in LC from 2019 to 2020 and to determine the effects of SARS-CoV-2 pandemic. T-test or Mann- Whitney was used to compare independent continuous variables. Comparison between proportions was tested through Chi-square. The association between clinical variables and 6-months mortality was tested through uni and multivariable logistic regression.82 patients were admitted due to OE. The median age was 66 years old and 73.1% were male. The two most frequent OE were brain metastasis (45.1%) and vena cava syndrome (15.8%). OE was the first manifestation of LC in 45.2% of cases and only 24.4% were alive 6 months after the OE. Neurological OE was associated with lower risk of 6-months mortality compared to cardiovascular and respiratory OE, regardless of gender, age, stage, histology, smoking status and cancer treatment [OR 0.255 (CI 0.72-0.90), p=0.035)]. SCLC had shorter time between diagnosis and OE compared to NSCLC (p=0.016), as well as patients with distant metastasis compared to local disease (p=0.02) and in those without previous cancer treatment (p<0.001). When comparing patients admitted with OE in 2019 and 2020, there were no differences in the following variables: 6-months mortality (p=0.741), OE as first manifestation of LC (p=0.913), time between diagnosis and OE (p=0.670), stage (p=0.276) and type of OE (p=0.733). In this study, SCLC, metastatic disease and no previous cancer treatment were associated with lesser time until OE and brain metastasis was associated with better prognosis. There were no differences in relevant clinical variables between 2019 and 2020.

Persistent Post-COVID: The first wave, one year after

Introduction: Although many patients recover from a COVID-19 infection, a relevant proportion experiences long term symptoms from 'Post-COVID'. Several questions remain about the cause and duration of Post-COVID. This study assesses the long term burden of patients with COVID-19 during the first wave of the pandemic in the Netherlands from February 2020 until July 2020. The secondary aim was to find potential risk factors for long term symptoms. Method(s): In this prospective cohort study, all participants self-registered and filled in the Assessment of the Burden of COVID-19 (ABCoV) tool (van Noort E, et al. JMIR Form Res 2021;5(3):e22603) directly after their infection and one year later. Curavista kindly provided access to the ABCoV tool and their database. The dataset contained 161 patients at T0 (first time registration) and T1 (one year after registration). We categorized demographics (sex, smoking status, age, weight, BMI, and exercise level), ABCoV overall score, and ABCoV scores per domain (symptom status, mental status and functional status). Risk factors for Post-COVID were explored through linear regression analysis. Result(s): A subgroup of patients (12%) reported substantial symptoms at T1 and is therefore categorized as suffering from persistent Post-COVID. A majority of this group (60%) reported an overall increase in complaints: 89% in mental status, 35% in functional status, and 39% in pulmonary status. Secondary, results show that smoking, high BMI and lack of exercise at baseline are risk factors for developing long term symptoms. No correlations were found between sex or age. Conclusion(s): Due to these specific risk factors, it might imply that behavioral aspects are pivotal in primary prevention of Post-Covid.

SARS CoV-2 infection in a cohort of patients from a smoking cessation program in Bogota

Objective: to describe in a cohort of patients from a tobacco cessation program how many presented COVID-19 and required hospitalization, and to evaluate differences between patients with active smoking and ex-smokers. Material(s) and Method(s): 246 patients from the Fundacion Neumologica Colombiana (EXFUMAIRE) smoking cessation program since 2015 were included. Two telephone contacts were made in 12 months to complete a 10 question questionnaire on respiratory and non-respiratory symptoms, diagnosis of SARS CoV-2 infection, smoking status, treatment received and complications. Result(s): 238 patients (96.7%) answered at least one call. The average age was 59 years, 49% women and with an IPA of 23.8. The most frequent comorbidities were respiratory (46%), cardiovascular (25.6%) and metabolic (2.8%). The cessation rate at 12 months was 62.2%. Of the total, 17 patients (7.7%) had COVID-19, one required hospitalization (5.9%). and reinfection was documented in one. There were no complications or deaths associated with COVID-19. There were 60 patients (25.2%) who underwent at least one screening test for any reason. Cardiovascular comorbidities were higher in patients without COVID-19 (p=0.008). There were no differences between groups with and without COVID in age, sex, other comorbidities, degree of smoking, smoking status, dependency, or motivation. Conclusion(s): A high telephone response was obtained from the participants (96.3%). The cessation rate at 12 months was 62.2%, the percentage of diagnosis of COVID-19 was low (7.7%), the same as the hospitalization rate in infected patients, and there was no associated mortality. There were no differences with respect to smoking status.