SMOKING AS ONE OF THE PREDICTORS OF THE SEVERITY OF THE CONDITION OF PATIENTS SUFFERING FROM A NEW CORONAVIRUS INFECTION

The relationship between smoking and the lung damage volume in patients with a confirmed new coronavirus infection diagnosis, hospitalized in a temporary infectious hospital for the treatment of patients suffering from a new coronavirus infection and community-acquired pneumonia was evaluated. This was in the Odintsovo District's Patriot Park of the Moscow region. Smoking cigarettes, both active and passive, as well as exposure to tobacco smoke on the body, are important upper and lower respiratory tract infection risk factors due to local immune response suppression. Nevertheless, data from a number of international studies indicate a significantly lower number of hospitalized smoking patients compared to nonsmokers. These indicators were investigated as the percentage and degree of lung damage, smoking history, the number of cigarettes smoked per day, and the smoker's index. In the course of the study, the data on a smaller percentage of smokers admitted to inpatient treatment were confirmed in comparison with non-smokers and smokers in the general population. There was no statistically significant difference in the volume of lung damage between smoking and non-smoking patients according to the chest organs computed tomography. At the same time, there was an increase in the volume of lung tissue damage, depending on the smoking experience. This is apparently due to the irreversible changes formation in lung tissue against a long-term smoking background. The median age of smoking patients was 56 years with a variation from 46 to 68 years. The minimum and maximum ages were 29 and 82. The median lung lesion was 32% with a variation from 23% to 39%. The minimum and maximum lung damage is 10% and 40%, respectively. A moderate correlation was found between the smoking experience and the volume of lung damage. An increase in lung damage by 0.309% should be expected with an increase in smoking experience by one full year. There was also no statistically significant difference in the number of cigarettes smoked per day and the smoker's index. All rights reserved © Eco-Vector, 2022.

Tobacco: A Looming Epidemic in Sub-Saharan African Countries

Sub-Saharan Africa, a region already burdened with HIV/AIDS, other infectious diseases, and competing priorities, is battling with the increasing burden of COVID-19 and non-communicable diseases (e.g., cardiovascular diseases, lung cancer). Africa's statistics on young people aged 13-15 years already hooked to tobacco are at an alarming 17%, matching the global trend. It is estimated that the number of smokers in sub-Saharan Africa will increase to 208 million (148%) by 2030, if robust tobacco control measures are not implemented. The chapter highlights the global trends of tobacco use, and exposure to tobacco smoke, all of which aggravate the prevalence of communicable and non-communicable diseases. The chapter also explores the harmful impact of tobacco use on people's health, suggesting that tobacco control should be a public health priority. The chapter presents the evidence for effective community-based interventions on tobacco control and prevention to reverse the tobacco epidemic in sub-Saharan Africa. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2021.

Extent of smoking at a Danish hospital with a smoke-free policy.

AIM: One-fifth of the Danish population smoke and exposure to second-hand smoke has well-documented adverse health effects. The smoking policy at hospital level prohibits hospital staff from smoking on the hospital grounds while patients and visitors may smoke in outdoor smoking cabins. This study aimed to quantify smoking at a Danish hospital and document any policy breaches. METHODS: In April 2020, we collected cigarette butts and observed smokers at the outdoor grounds to document smoking behaviour. RESULTS: In total, 7152 cigarette butts were collected during one week and 368 people were observed smoking at the outdoor grounds during four observation days. Of all collected cigarette butts, 55% were collected outside the smoking cabins and 62% of all smokers were observed smoking outside the smoking cabins. In addition, 31 staff were observed smoking. CONCLUSIONS: This study documents that smoking is prevalent at a smoke-free hospital and that the smoking policy is frequently violated. The frequency of smoking outside the cabins may at least partly be influenced by the COVID-19 pandemic. Smoking at a hospital can expose patients, visitors and staff to second-hand smoke with subsequent adverse health effects. Hospitals could play an exemplary role towards a smoke-free society (and not the exception), but the opportunity is not always seized.

INCIDENTAL PULMONARY FINDINGS ON CHEST CT SCANS IN PATIENTS WITH SUSPECTED COVID-19 PNEUMONIA: DATA FROM AN OUTPATIENT HOSPITAL

SESSION TITLE: Outcomes in Pneumonia and NTM SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The number of patients with respiratory symptoms who underwent computed tomography (CT) for suspected COVID-19 pneumonia is high. In this study, we decided to investigate the incidental non-COVID 19 related pulmonary findings due to a large number of CT scans. METHODS: It was retrospective study in Funda Hospital of Heath Ministry of Azerbaijan, Baku city and the number of enrolled patients to the study was 2567 from 1st of October 2020 to 10 30 th of March 2021.In all patients the positive RT-PCR test for COVID-19 were confirmed.Depending on COVID-19 viral pneumonia findings in lung there were two groups :1) 1589 patients with non-COVID-19 viral pneumonia;2) 978 pateins with COVID-19 viral pneumonia RESULTS: In our study CT screening for COVID-19 viral pneumonia has detected typical viral pneumonia in 38.1%(978 of 2567) patients and in 61.9%(1689 of 2567 ) was not found CT abnormalities accordingly COVID-19 viral pneumonia.Among typical CT suggested COVID19 viral pneumonia patients the incidental pulmonary findings were found in 197(20,15%) cases, was significantly common compared to non- CT suggested viral pneumonia (OR 5.34 [0.94-12.57]95%CI;p<0.001).Common CT incidental pulmonary finding was solitary pulmonary nodule (56[28.43%] vs 21[29.58%];p<0.01) and further histopathological evaluation has detected lung cancer(primary and metastatic) in 19 patients(24.68%). Bronchectasis (commonly small size syctic and tubular bronchectasis) which was also commonest in patients with viral pneumonia (OR 2.78[0.75-6.43]95%CI;p<0.004). Emphysema was found in 69(2.69%) and was common in patients with pulmonary viral manifestation(p<0.01).Lung tuberculosis with further histological and mycobacterial confirmation was as incidentally finding in 49 cases (1.87%)( focal changes, lung inflitrate,cavitation) and commonly was found in patients with CT suggested viral pneumonia (OR 2.11[0.69-5.86]95%CI;p=0.006).Pulmonary sarcoidosis was found totally in 38(1.48%) and was common in patients with viral pneumonia (p<0.01).Idiopatic pulmonary fibrosis(IPF) with typical features of usual interstitial pneumonia(UIP) was found in 31(1,21%) patients and was commonly in male with smoking history and older age (>60 years).Common risk factors for incidental pulmonary findings were:male gender(p<0.01);tobacco smoke (p<0.01);older age(p<001);previous history of lung tuberculosis(p<0.05) comorbidities such as DM and autoimmune disorders(p<0.01) CONCLUSIONS: Risk factors for COVID-19 related viral pneumonia and incidental pulmonary findings in CT scan are similar and so incidental pulmonary findings are common in CT screening for COVID-19 related viral pnemonia.Incidental pulmonary abnormalities were not associated with increased risk for ICU admission and mortality of patients. CLINICAL IMPLICATIONS: Clinicians in paracitce with COVID-19 patients,for pulmonologists,radiologists, respiratory educators, thoracic oncologists DISCLOSURES: No relevant relationships by Alizamin Sadigov

Environmental Factors.

The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. Improving outcomes depends on not only evidence-based care once ARDS has already developed but also preventing ARDS incidence. Several environmental exposures have now been shown to increase the risk of ARDS and related adverse outcomes. How environmental factors impact the risk of developing ARDS is a growing and important field of research that should inform the care of individual patients as well as public health policy.

Eastern Mediterranean Health Journal [2022;Vol.28, Issue 5]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services;and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région.

Sex-Specific Association between Environmental Tobacco Smoke Exposure and Asthma Severity among Adults with Current Asthma

Background: Tobacco smoke has been associated with negative health outcomes, including those with chronic respiratory illnesses, such as asthma. This study aimed to assess the relationship between exposure to environmental tobacco smoke (ETS), as well as tobacco use (cigarette and electronic cigarettes), on asthma severity among adults with current asthma, with stratification by sex to understand potential biological sex differences. Methods: The study population consisted of Californian adults 18 years or older with self-reported physician/health care diagnosis of asthma and still having current asthma from 2020 California Health Interview Survey. All descriptive statistics and analyses were sex-stratified and survey-weighted. Crosstabulations were used to understand the association between asthma attack and ETS or firsthand smoke exposure, while binary logistic regression models were used to assess the effect of ETS exposure, current smoking status, and control variables on asthma attack in the past 12 months, with a sub-analysis among non-smoking adults with asthma. Results: Among the primary variable of interest, 35% of males and 30% of females reported ETS exposure in the past 12 months, while 13% of males and 6% of females reported being a current smoker. Past year asthma attack was reported among 43% and 55% of males and females, respectively. Among males, after adjusting for all control variables, asthma attack was significantly higher among those with ETS exposure (OR: 1.75, 95% CI: 1.01–3.02) and among current smokers (OR: 3.82, 95% CI: 1.49, 9.81). Male non-smokers with ETS exposure had a 109% higher odds of asthma attack, compared to non-exposure individuals. Conclusion: Using a population-based survey, our results highlight the ongoing burden of tobacco use and exposure particularly among males with current asthma, further corroborate the literature on the relationship between tobacco and asthma, and highlight putative sex-specific outcomes.

Parental Knowledge, Attitude, and Practice on Tobacco Use, Smoking Cessation, and Children's Environmental Tobacco Smoke Exposure.

Background: Environmental tobacco smoke (ETS) exposure in children ranks one of the major public health problems in our time. Poor parental knowledge, attitude, and practice (KAP) on ETS often contribute to worse exposure of the kids. Thus, we aimed to document parental KAP regarding tobacco use, smoking cessation and children's ETS exposure, and to analyse how knowledge and attitude relate to practice. Methods: Self-administered KAP questionnaires were distributed to smoking parents recruited from the pediatric unit at the Prince of Wales Hospital, which provides pediatric service to a population of 1.2 million in Hong Kong. The 60-item questionnaire had a range of 0-38 for knowledge, 0-44 for attitude, and 0-40 for practice. Descriptive analyses were performed for KAP response, regression analyses were performed for the exploration of associations and identification of predictive indicators. Results: 145 smoking parents (mean age: 38.0 ± 6.7 yrs.; male: 85.5%) were included. Less than half (39.3%) of them reported a smoke-free policy at home. Among those parents who had private cars, less than half (45.2%) of them had smoke-free policy in their car that they never smoked in the car. Only 25.5% of the participants correctly answered ≥70% of the knowledge questions, and 11.8 % of the participants gave favorable responses to ≥70% of the attitude questions. The total knowledge and the total attitudes score were positively associated (r = 0.49, 95% CI: 0.35-0.79, p < 0.001), yet they were only modestly correlated with parental practice on children's ETS exposure. By multivariate regressions, potential predictive factors for more favorable parental KAP included higher household income, lower parental nicotine dependence level and breastfeeding practice. Conclusions: Parental KAP related to tobacco use and children's ETS exposure needs improvement to address the significant gap between recommended and actual practice. The weak association between knowledge and practice suggested that parental education alone is not adequate to combat ETS exposure in children.

Exposure to PM4 in Homes with Tobacco Smoke in and around Katowice, Poland

The results of a PM4 (airborne particles with an aerodynamic diameter less than 4 µm) study in Katowice and in the surrounding area in homes with and without environmental tobacco smoke (ETS) are presented. It was found that the average concentration of PM4 inside the homes with ETS was between 126 µg m−3 (in Jaworzno) and 208 µg m−3 (in Katowice)—significantly higher than in the homes without smokers (55–65 µg m−3). The mean of the indoor to outdoor ratios (I/O) for PM4 varied greatly, ranging from 0.6 in the apartments without smokers in Katowice to 5.2 in the homes with smokers in Jaworzno. The highly polluted by ETS indoor air causes children aged 14–15 living in these homes to inhale from 2.5 to 6.6 mg of PM4 more per day than their peers living in non-ETS homes. X-ray photoelectron spectroscopy (XPS) was used to determine the surface chemical composition of the studied indoor airborne particles. Carbon, including elemental carbon, and oxygen-containing species dominated the particulate surface, with traces of Si, N, S, Na, Al, Zn, and K present. The surface layer of PM4 from the homes with ETS contains significantly more carbon and less oxygen than the airborne particles collected in the homes without smokers, which can be explained by the high emission of carbon during tobacco smoking.

Demographic and Clinical Characteristics of COVID-19 in Children and the Effect of Household Tobacco Smoke Exposure on COVID-19.

OBJECTIVE: Environmental tobacco smoke (ETS) exposure is associated with many diseases, including lower respiratory tract infections, in pediatric age groups. In this study, we aimed to assess the effect of household ETS exposure on symptom frequency and clinical severity in children and adolescents with COVID-19. MATERIALS AND METHODS: This retrospective study included pediatric cases (<18 years old) with a positive SARS-CoV-2 test, who were admitted to our hospital between 20.03.2020 and 01.05.2020. Patients with respiratory diseases and active smokers were excluded. Demographic characteristics, symptoms, and clinical severity of COVID-19 were obtained from parents and children using a questionnaire and from patients' files. Household ETS exposure was assessed by questionnaire. RESULTS: A total of 167 patients (median age 145 months, 50.7 % male) were included in the study. The frequency of household ETS exposure was 50.9%, and the frequency of cough was significantly higher in exposed children than non-exposed children (71.4% vs 50.8% respectively, p=0.02). The frequency of both fever and cough was significantly higher ETS-exposed in the subgroup of cases with a mild clinical course (69.5% vs 48.1% respectively, p= 0.02 for fever and 67.8% vs 44.4% respectively, p=0.01 for cough). There was no relationship between clinical severity and household ETS exposure. CONCLUSION: Household ETS exposure may impact COVID-19 pediatric cases as demonstrated by the increased frequency of cough and fever in ETS-exposed children. As new lockdown measures are implemented, increasing public awareness about the effect of household ETS exposure on COVID-19as well as encouraging a decrease in ETS exposure are essential.

Degradation of SARS-CoV-2 receptor ACE2 by the E3 ubiquitin ligase Skp2 in lung epithelial cells.

An unexpected observation among the COVID-19 pandemic is that smokers constituted only 1.4%-18.5% of hospitalized adults, calling for an urgent investigation to determine the role of smoking in SARS-CoV-2 infection. Here, we show that cigarette smoke extract (CSE) and carcinogen benzo(a)pyrene (BaP) increase ACE2 mRNA but trigger ACE2 protein catabolism. BaP induces an aryl hydrocarbon receptor (AhR)-dependent upregulation of the ubiquitin E3 ligase Skp2 for ACE2 ubiquitination. ACE2 in lung tissues of non-smokers is higher than in smokers, consistent with the findings that tobacco carcinogens downregulate ACE2 in mice. Tobacco carcinogens inhibit SARS-CoV-2 spike protein pseudovirions infection of the cells. Given that tobacco smoke accounts for 8 million deaths including 2.1 million cancer deaths annually and Skp2 is an oncoprotein, tobacco use should not be recommended and cessation plan should be prepared for smokers in COVID-19 pandemic.

Risk for COVID-19 infection in patients with tobacco smoke-associated cancers of the upper and lower airway.

PURPOSE: Cancer patients are regarded as a group at risk for both COVID-19 infection and severe clinical course because of advanced age, comorbidities and iatrogenic immune impairment. Among them, patients with cancer of the upper and lower airways share other risk factors, mostly related to tobacco-smoke exposure, including male gender, airway epithelial damages, chronic obstructive respiratory disease (COPD), cardiovascular and cerebrovascular diseases. Clinical and pathophysiological factors shared by these conditions are reviewed. METHODS: Review of the published literature since the beginning of 2020. RESULTS: COVID-19 is a respiratory infectious disease and SARS-CoV-2 replication and shedding occurs in nasal and bronchial epithelial respiratory cells through the interaction with ACE2 and TMPRSS2 receptors, both overexpressed in smokers and former smokers. Tobacco-smoke airway exposure is also characterized by a chronic inflammation with activation of inflammatory cells and cytokine release including interleukin-6 (IL-6). A high release of cytokine in response to viral infection is documented in COVID-19 patients with adverse clinical outcomes and IL-6 is a key element of the cytokine storm syndrome leading to multi-organ damage. CONCLUSIONS: Patients with cancers of the upper and lower airways might be at increased risk of infection, morbidity and mortality from COVID-19 also because of tobacco exposure, a key factor in triggering inflammation, immunity and cancer.

Vitamin D Deficiency and Air Pollution Exacerbate COVID-19 Through Suppression of Antiviral Peptide LL37.

Vitamin D deficiency and insufficiency (VDD) are widely recognized as risk factors for respiratory tract infections. Vitamin D influences expression of many genes with well-established relevance to airway infections and relevant to immune system function. Recently, VDD has been shown to be a risk factor for acquisition and severity of COVID-19. Thus, treating VDD presents a safe and inexpensive opportunity for modulating the severity of the disease. VDD is common in those over 60 years of age, many with co-morbid conditions and in people with skin pigmentation sufficient to reduce synthesis of vitamin D. Exposure to fine particulate air pollution is also associated with worse outcomes from COVID19. Vitamin D stimulates transcription of cathelicidin which is cleaved to generate LL37. LL37 is an innate antimicrobial with demonstrated activity against a wide range of microbes including envelope viruses. LL37 also modulates cytokine signaling at the site of infections. Fine particles in air pollution can interfere with LL37 destruction of viruses and may reduce effective immune signaling modulation by LL37. While vitamin D influences transcription of many immune related genes, the weakened antimicrobial response of those with VDD against SARS-CoV-2 may be in part due to reduced LL37. Conclusion: Vitamin D plays an important role reducing the impact of viral lung disease processes. VDD is an acknowledged public health threat that warrants population-wide action to reduce COVID-19 morbidity and mortality. While vitamin D influences transcription of many immune related genes, the weakened antimicrobial response of those with VDD against SARS-CoV-2 may be in part due to reduced LL37. Action is needed to address COVID-19 associated risks of air pollution from industry, transportation, domestic sources and from primary and second hand tobacco smoke.