COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

The significance of educational level in acquiring good literacy of COVID-19: a case study in Indonesia

Background. Surveys on Public Knowledge, Attitude, and Practice (PKAP) have been conducted in various countries with respondents from the public as well as health workers. Measuring the knowledge of the public about COVID-19 is very important to determine the knowledge gap among the public and also as an evaluation of the preventive efforts for COVID-19. Objective. The purpose of this research was to determine whether education level is a factor that affects one's literacy about COVID-19. Materials and Methods. This is cross-sectional research with online-based data collection using the Kobo toolbox application. The data collection was carried out from the 19th of April until the 2nd of May 2020. The number of people under study is 792. The level of knowledge was measured using 12 research questions with true or false question types. the multivariable logistic regression was carried out. Results. Most of the respondents (52.5%) were in the young age group (15-35 years old), were male (57.3%), and had a bache-lor or diploma education level (62.1%). Furthermore, most of the respondents had good knowledge (65.4%). The higher the respon-dents' educational level means, the better knowledge they had concerning COVID-19 (P=0.013). Conclusions. Public knowledge about COVID-19 is affected by their level of education. A good level of knowledge about COVID-19 was found among respondents with master's and doctoral degrees. This finding can contribute to the prevention of COVID-19, in which the priority of educating communities about COVID-19 should be given to those having an educational level below a master's degree.Copyright © the Author(s), 2023.

Current status of tobacco use, cessation and control policy in Korea.

Background: Tobacco use is a leading cause of countless deaths and disabilities worldwide. An estimated 11 million Korean adults were still using tobacco in 2020, according to the Korea National Health and Nutrition Examination Survey. This review aims to explain the current trends in tobacco use, sales, cessation, and control policies in South Korea. Current Concepts: Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Advertisements stating that HTPs are odorless, tar-free, and less harmful to health have caused sales of HTPs to grow quickly over the past 5 years, such that they account for about 15% of the total tobacco market. According to national smoking rate statistics and tobacco sales trends, declines in current smoking rates have slowed and even risen in some groups, and declines in total tobacco sales have slowed but also risen again during the coronavirus 19 pandemic. In addition, the number of visitors to smoking cessation clinics decreased just after the advent of HTPs and social distancing policies triggered by the coronavirus. Nicotine replacement therapy can serve as a drug therapy for smoking cessation, or bupropion and varenicline can be prescribed. Korea's representative tobacco control policies include the tax increase policy, non-smoking area policy, cigarette pack warning picture policy, and support policy for visiting smoking cessation clinics. Discussion and Conclusion(s): There is a pressing need to reflect tobacco control policies in line with changes in tobacco user behaviors and tobacco company marketing strategies.Copyright © Korean Medical Association.

A hybrid agent-based model integrated with a multi-stage learning-based fuzzy cognitive map

PurposeThis article proposes a novel hybrid simulation model for understanding the complex tobacco use behavior.Design/methodology/approachThe model is developed by embedding the concept of the multistage learning-based fuzzy cognitive map (FCM) into the agent-based model (ABM) in order to benefit from advantageous of each methodology. The ABM is used to represent individual level behaviors while the FCM is used as a decision support mechanism for individuals. In this study, socio-demographic characteristics of individuals, tobacco control policies, and social network effect are taken into account to reflect the current tobacco use system of Turkey. The effects of plain package and COVID-19 on tobacco use behaviors of individuals are also searched under different scenarios.FindingsThe findings indicate that the proposed model provides promising results for representing the mental models of agents. Besides, the scenario analyses help to observe the possible reactions of people to new conditions according to characteristics.Originality/valueThe proposed method combined ABM and FCM with a multi-stage learning phases for modeling a complex and dynamic social problem as close as real life. It is expected to contribute for both ABM and tobacco use literature.

Facilitators of a Campus Tobacco-free Policy: Navigating the Politics

Objective: In this paper, we discuss prioritization, formulation, and adoption of a comprehensive campus tobacco-free policy on a large, diverse campus at a public university in the United States. Methods: We examined the comprehensive campus tobacco-free policy experience through Kindgon's Multiple Streams Framework, which stipulates that policy change can happen when problem, policy, and politics align. We focus on the factors that led the political stream to align with the problem and policy streams to create a "window of opportunity" for adopting this policy. Results: The campus experience with COVID-19 helped spur policy adoption. Support from leadership, a committed faculty-administration team, engagement with stakeholders and community partners, knowledge of the policy adoption process, and sustained advocacy all contributed to policy adoption. Conclusions: Campus tobacco-free policy advocates can navigate the politics of prioritizing, formulating, and adopting a campus smoke-free policy by knowing the context and process, being comfortable with policy work, engaging with tobacco prevention stakeholders, sustaining their efforts and advocating in multiple ways, and considering implementation and evaluation early.

A Diagnostically Challenging Case of Primary Pancreatic Lymphoma

Introduction: Primary Pancreatic Lymphoma (PPL) is the exceedingly rare instance of extranodal Non-Hodgkin's Lymphoma developing mainly in the pancreas.We report a diagnostically challenging case of a patient presenting with a rapidly growing pancreatic mass, found to have PPL. Case Description/Methods: A 48-year-old female with past history of tobacco use presented with several months of cramping abdominal pain following COVID-19 infection. She denied weight loss, fevers, or night sweats. Her physical exam, CBC, CMP, lipase, LDH, and CA 19-9 were unremarkable. An abdominal ultrasound revealed a 2.8 x 1.9 x 3 cm cystic mass of the pancreatic head, most congruent with a pseudocyst. Worsening abdominal pain prompted repeat ultrasound one month later, which showed a doubling in size. Endoscopic ultrasound (EUS) with fine needle aspiration of the cystic mass and surrounding lymph nodes yielded cystic contents and reactive lymphadenopathy. Two months later, her abdominal pain worsened and repeat imaging showed further doubling in size with encasement of the celiac plexus. A second FNA performed via EUS redemonstrated cystic contents. An ultrasound-guided core needle biopsy of the mass revealed necrotic CD301 diffuse large B cell lymphoma (DLBCL). PET scan was suggestive of stage IV PPL (Figure). Imaging also identified an inguinal lymph node that returned as CD101 BCL61 high grade follicular lymphoma, which was thought to be a distinct lesion. She was started on R-CHOP. Her clinical course was complicated by the formation and subsequent rupture of a splenic artery pseudoaneurysm, gastrointestinal bleeding, anuric kidney injury, and intestinal ischemia. She ultimately transitioned to comfort care. Discussion(s): Primary pancreatic lymphoma comprises 0.6% of extranodal lymphomas and 0.2% of primary pancreatic tumors. The clinical presentation is often vague and includes abdominal pain, B symptoms, jaundice, or bowel obstruction. The diagnostic criteria according to the WHO requires that the (1) majority of tumor burden be localized to the pancreas and (2) existing nearby and distant lymph node involvement should be secondary to pancreatic presentation. A biopsy is required to diagnose PPL, which is histologically most often DLBCL. Our case highlights the challenges associated with diagnosing PPL despite two EUS with FNA. Although rare, one should proceed with a high index of suspicion for PPL in any patient presenting with a rapidly enlarging pancreatic mass.

Hepatotoxicity From Marijuana Gummies

Introduction: We report a case of drug-induced liver injury (DILI) induced by cannabis gummies containing Corydalis Rhizome. Case Description/Methods: A 37-year-old female presented to her primary care clinic with recurrent fevers, night sweats, and myalgias for 7 weeks accompanied by eye redness, brain fog, headache, nausea, and abdominal pain. She denied rashes, tick-bites, cough, dyspnea, chest pain, joint swelling, or genitourinary symptoms. Past medical history was notable for IBS, migraines, and anxiety. She reported edible marijuana use four times a week, rare alcohol use, and denied tobacco use. She denied a family history of liver disease. Physical exam was notable for tachycardia to 110 and scleral injection with the remainder of vitals and exam unremarkable. Initial labs were notable for AST 61, ALT 44 and CRP of 12. CBC, BMP, urinalysis, ESR, blood cultures, blood smear for parasite screen, tests for Lyme disease, Babesia, Tularemia, Anaplasma, Ehrlichia, Rickettsia, EBV, HIV, RPR, ANA, CMV, parvovirus B19, and chest x-ray were all negative. The patient was referred to infectious disease with further testing for West Nile, Leptospira, lymphocytic choriomeningitis virus, and COVID-19 returning negative. Repeat LFTs showed worsening transaminitis with ALT 979 and AST 712, alkaline phosphatase 88, total bilirubin 0.7, and albumin 4.9. Hepatitis workup including hepatitis A, B, and C, HSV, EBV, VZV serologies, AMA, ASMA, antiLKM Ab, acetaminophen level, INR, iron panel, CPK, TSH, and abdominal ultrasound were all normal. It was later discovered that her marijuana gummies contained Corydalis rhizome extract known to be hepatotoxic. Cessation of this drug was strongly advised. She was discharged with hepatology follow-up and underwent a liver biopsy showing patchy periportal and lobular inflammation with extension across the limiting plate, hepatocyte injury and apoptosis, and increased lipofuscin for age compatible with mild to moderate hepatitis. She had complete recovery after cessation of Corydalis-containing gummies. (Figure) Discussion: Our patient consumed '1906 Midnight', an American cannabis brand containing Corydalis rhizopus 100 mg, advertised to improve sleep, pain, and have a liver protective effect. A Korean systematic review on herbal-induced liver injury reported that Corydalis was the 3rd most frequent causative herb, with 36 cases. Although there are several personal accounts on social networking sites and other websites, there are no American-based publications reported on DILI from Corydalis. (Table Presented).

Nirmatrelvir/ritonavir - A New Culprit of Acute Pancreatitis

Introduction: Nirmatrelvir/ritonavir is a new medication approved for the treatment of COVID-19 infection. It prevents viral replication by inhibiting the SARS-CoV-2 main protease. While mild adverse effects were described, including dysgeusia, diarrhea, hypertension and myalgia1, there were no reported cases of pancreatitis. Case Description/Methods: An 81-year-old female with a past medical history of hypertension and COPD presented to the hospital complaining of abdominal pain and nausea for one day. She had no history of alcohol, tobacco or marijuana use, recent travel, or trauma. Her medications included lisinopril and prednisone, and she had completed a 5-day course of nirmatrelvir/ritonavir for the treatment of COVID-19 infection 2 days prior to presentation. On abdominal exam, she had left upper and lower quadrant tenderness. Blood tests revealed an amylase of 1333 U/L, lipase of 3779 U/L, triglycerides of 297 mg/dL and calcium of 8.7 mg/dL. CT scan revealed an indurated pancreatic body and tail with peripancreatic fluid along the paracolic gutter. Ultrasound of the abdomen and MRCP did not reveal any acute findings. IgG subclasses 1-4 were normal. Discussion(s): According to the revised Atlanta criteria, the patient had clinical findings consistent with acute pancreatitis. Common causes such as gallstone, alcohol, autoimmune and hypertriglyceridemiainduced pancreatitis were ruled out. There were no masses or structural abnormalities on imaging that might have explained her diagnosis. There have been at least 2 reported cases of lisinopril and prednisone induced pancreatitis, however according to Badalov et al.2 both of these medications are class III drugs that lack any rechallenge in the literature. Moreover, the patient had been taking these medications for many years, making them an unlikely cause of the presenting diagnosis. There are no reports of nirmatrelvir/ritonavir associated pancreatitis or known pharmacologic interaction with her home medications, and a meta-analysis conducted by Babajide et al. revealed no association between acute pancreatitis and COVID-19 infection (3). Given the negative findings stated above and the recent initiation of a new medication, nirmatrelvir/ritonavir was the likely cause of acute pancreatitis.

Changes in Diet, Physical Activity, Alcohol Consumption, and Tobacco Use in Adults During the COVID-19 Pandemic: A Systematic Review.

The COVID-19 pandemic changed various lifestyle habits worldwide due to the prevention measures implemented in each country, these changes may affect or benefit people's health. We aimed to systematically review changes in diet, physical activity (PA), alcohol consumption, and tobacco use habits during the COVID-19 pandemic in adults. Two databases: PubMed and ScienceDirect, were used for this systematic review. The research was limited to open-access, peer-reviewed original articles published in English, French, or Spanish from January 2020 to December 2022 and investigated diet, PA, alcohol consumption, and tobacco use habits before and during the COVID-19 pandemic in adults. Excluded studies were review studies, intervention studies with a sample size of fewer than 30 participants, and poor-quality articles. This review followed PRISMA 2020 guidelines (PROSPERO: CRD42023406524), whereas to assess the quality of the studies, we used the quality assessment tools developed by the BSA Medical Sociology Group for cross-sectional studies and the QATSO for the longitudinal studies. Thirty-two studies were included. Some studies reported changes to promote healthy lifestyles; 13 out of 15 articles reported an increase in healthy diet consumption habits, 5 out of 7 studies reported a decrease in alcohol consumption, and 2 out of 3 studies reported a decrease in tobacco use. On the other hand, the other studies reported changes to promote unhealthy lifestyles: 9 out of 15, and 2 out of 7 studies reported an increase in unhealthy diet and alcohol consumption habits respectively, 25 out of 25 reported a decrease in physical activity, and 13 out of 13 reported an increase in sedentary behavior. During the COVID-19 pandemic, there have been changes to promote a healthy and unhealthy lifestyle; the latter can affect people's health. Therefore, effective responses are needed to mitigate the consequences.

Clinical effectiveness of nirmatrelvir plus ritonavir in patients with COVID-19 and substance use disorders based on real-world data.

This study assessed the clinical efficacy of nirmatrelvir plus ritonavir (NMV-r) in treating patients with coronavirus disease-2019 (COVID-19) and substance use disorders (SUDs). This study included two cohorts: the first examined patients with SUDs, with and without a prescription for NMV-r, while the second compared patients prescribed with NMV-r, with and without a diagnosis of SUDs. SUDs were defined using ICD-10 codes, related to SUDs, including alcohol, cannabis, cocaine, opioid, and tobacco use disorders (TUD). Patients with underlying SUDs and COVID-19 were identified using the TriNetX network. We used 1:1 propensity score matching to create balanced groups. The primary outcome of interest was the composite outcome of all-cause hospitalization or death within 30 days. Propensity score matching yielded two matched groups of 10 601 patients each. The results showed that the use of NMV-r was associated with a lower risk of hospitalization or death, 30 days after COVID-19 diagnosis (hazard ratio (HR), 0.640; 95% confidence interval (CI): 0.543-0.754), as well as a lower risk of all-cause hospitalization (HR, 0.699; 95% CI: 0.592-0.826) and all-cause death (HR, 0.084; 95% CI: 0.026-0.273). However, patients with SUDs had a higher risk of hospitalized or death within 30 days of COVID-19 diagnosis than those without SUDs, even with the use of NMV-r (HR, 1.783; 95% CI: 1.399-2.271). The study also found that patients with SUDs had a higher prevalence of comorbidities and adverse socioeconomic determinants of health than those without SUDs. Subgroup analysis showed that the benefits of NMV-r were consistent across most subgroups with different characteristics, including age (patients aged ≥60 years [HR, 0.507; 95% CI: 0.402-0.640]), sex (women [HR, 0.636; 95% CI: 0.517-0.783] and men [HR, 0.480; 95% CI: 0.373-0.618]), vaccine status (vaccinated <2 doses [HR, 0.514; 95% CI: 0.435-0.608]), SUD subtypes (alcohol use disorder [HR, 0.711; 95% CI: 0.511- 0.988], TUD [HR, 0.666; 95% CI: 0.555-0.800]) and Omicron wave (HR, 0.624; 95% CI: 0.536-0.726). Our findings indicate that NMV-r could reduce all-cause hospitalization and death in the treatment of COVID-19 among patients with SUDs and support the use of NMV-r for treating patients with SUDs and COVID-19.

Resident Perceptions and Confidence Regarding Pediatric Preventive Care

Purpose of Study: Residents have experienced changes in educational structure, format, content, and patient experience due to the COVID-19 pandemic. Resident physicians across the country have reported changes in workload including a decrease in well child checks and immunizations resulting in limited clinical exposure. This study aimed to assess the confidence of first year pediatric residents (interns) in conducting routine preventive screening for children and to identify potential gaps in knowledge among this cohort. Methods Used: We conducted a cross-sectional observation study that included 13 categorical first year pediatric residents. A voluntary, anonymous online survey was administered in September 2022. The survey assessed confidence levels, and perceived comfort regarding common preventive pediatric encounters and screening tools. The survey included 7-questions based on the 4th Edition Bright Future's Guidelines and respondents rated their answers on a 5-point Likert scale. The surveys were distributed anonymously via e-mail using Survey Monkey, a web-based software platform that provided an intuitive interface for validated data capture. Participants were given 2 weeks to complete the survey and reminders were sent via email. Summary of Results: Eight of 13 interns participated for a response rate of 62%. Sixty-three percent of the residents had completed a subinternship in pediatrics. Of our respondents, 75% reported feeling "not at all confident" in executing well child check-ups for children <12months old and 63% reported feeling "very confident" in examining children> 13months old. Regarding the ability to perform a genitourinary examination in children >12years of age, 63% of respondents stated that they were "slightly" or "not at all confident". We asked interns to rate their confidence in providing anticipatory guidance to their patients. Interns perceived being somewhat confident regarding guidance about safe sex, tobacco use, and healthy lifestyles but less confident regarding newborn care, breast feeding and infant nutrition. Nearly 40% reported comfort in recommending and advising parents about the risks and benefits of age appropriate immunizations. We asked residents to report their ability in administering and interpreting screening tools (ASQ, MCAT, EPDS). Interns reported that were able to interpret results but lacked confidence in providing guidance. Conclusion(s): Our study identifies opportunities to bridge experiential knowledge gaps and confidence among pediatric interns who may have had limited clinical exposure to pediatrics following the COVID-19 pandemic. Graduate medical education programs should consider developing tailored educational interventions specifically geared for identified learning gaps to mitigate the challenges posed by the pandemic.

Comorbidities Associated With Myocarditis In Hospitalized COVID-19 Patients

Introduction: While COVID-19 is predominantly a lung infection, it can cause systemic viremia in susceptible patients and lead to cardiac involvement and myocarditis (MC);an inflammation of the myocardium characterized by arrhythmias, cardiogenic shock, acute heart failure, and death. Although rare, there is evidence of a surge in MC-related admissions during the COVID-19 pandemic, implying a correlation. However, the risk factors associated with MC susceptibility in these patients remain unclear. This study aims to assess the comorbidities and demographic features associated with the development of MC in adult patients with COVID-19. Method(s): Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The database provides all-payers administrative claims data on the patient level. Using ICD-10-CM codes, a cohort of patients hospitalized with a primary diagnosis of COVID-19 was identified. The study included only patients admitted to the hospital between January and October 2020 to minimize bias associated with vaccine-related MC. Within this cohort, patients diagnosed with MC during and up to one month after admission were identified and their demographic features and comorbidities to were compared to those without MC. We calculated Risk Ratios with their respective 95% CI. A p-value <0.05 was deemed significant. Result(s): We found 627,465 admissions due to COVID-19 from January to October 2020, with 506 (0.08 %) diagnosis of MC. Patients with MC were more likely to be males (60%), younger (mean age 48, SD= 23 vs. 60, SD =17 - p<0.01), and they had more comorbidities (mean Elixhauser Comorbidity Index: 7.52, SD= 5 vs. 6.9, SD = 5 - p<0.001). The development of MC was significantly associated with a history of coagulopathies [0.55(0.46-0.66);p<0.0001], asthma [1.20 (1.06-1.23);p= 0.01], deep venous thrombosis [1.54(1.38-1.68);p<0.0001], renal disease[1.15 (1.02-1.27);p= 0.03], congestive heart failure [1.24 (1.12-1.34);p=0.006], ischemic heart disease [1.25 (1.14-1.35);p=0.0001], and arrhythmias [1.24 (1.14-1.32);p< 0.0001]. However, a history of diabetes [0.89 (0.67-0.99);p=0.02], hypertension [0.71 (0.62-0.80);<0.000.1], depression [0.71(0.52-0.88);p=0.0001], and hypothyroidism [0.42(0.08-0.69);p<0.0001] was associated with lower risk of MC-related hospitalization. Other preexistent conditions including, psychosis, rheumatoid arthritis, cerebrovascular disease, obesity, tobacco use, alcohol abuse, HIV, anemia, peripheral vascular disease, and non-metastatic solid tumor were not significantly correlated with MC. Discussion(s): MC is a rare yet serious complication of COVID-19. Therefore, a better knowledge of the pathophysiology of COVID-19 and the patient factors associated with development to MC is crucial for prognostication and providing risk-adjusted treatment. Conclusion(s): Patients with a history of cardiovascular disease, renal and pulmonary disease were more likely to develop MC as a result of COVID-19. However, hypertension and diabetes were associated with lower risk of MC, which warrants further investigation.Copyright © 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.

Structural Valve Dysfunction As An Atypical Presentation Of Cardiac Sarcoidosis

Introduction: Cardiac sarcoidosis (CS) classically manifests as a restrictive cardiomyopathy or conduction abnormalities, though the full scope of phenotypes may be underrecognized. We present an atypical case of mitral regurgitation (MR) and aortic regurgitation (AR) attributed to CS. Case Presentation: A 33-year-old woman with a history of hypertension, tobacco use, and COVID-19 infection two months prior presented with worsening dyspnea on exertion, orthopnea and lower extremity edema. Initial work up revealed elevated pro-BNP and troponin, and a CXR with pulmonary edema. A prior CTA showed mediastinal and hilar lymphadenopathy. Echocardiogram was notable for mildly dilated LV, severe hypokinesis of the basal inferior myocardium, LVEF 50-55%, moderate MR and moderate AR. cMR revealed multiple foci of predominantly mid-wall late gadolinium enhancement (LGE) in the LV, including a focus adjacent to the posteromedial papillary muscle (Fig. 1). Cardiac PET showed extensive patchy, focal hypermetabolic activity in the LV inferobasal, anterobasal and anterolateral walls. With high suspicion for CS, the patient opted for treatment with steroids and follow-up PET over extracardiac lymph node biopsy due to procedural risk. Discussion(s): Isolated CS is underdiagnosed and can present with a wide range of symptoms. Detection is limited by current diagnostic criteria, namely difficulty ascertaining affected tissue, which may limit recognition of the full range of presentations. Diagnosis and treatment vary widely among institutions but there is consensus on starting immunosuppression and pursuing follow-up cardiac PET for suppression of inflammatory activity in cases of high clinical suspicion. Our patient plans to undergo repeat PET and have ongoing discussion about lymph node biopsy. COVID-19 myocarditis remains on our differential, however given the patchy nature of LGE on cMR which correlated with the FDG uptake on PET, CS is considered the most probable diagnosis. Conclusion(s): CS should be considered in the differential diagnosis for young patients with structural valve abnormalities, even in the absence of arrhythmias or cardiomyopathy. High clinical suspicion may justify early immunosuppressive treatment to prevent irreversible myocardial injury and/or fatal arrhythmias. Whether this treatment will result in resolution of the structural defects remains to be seen and further investigated.Copyright © 2022

Differences in demographics and behaviors across two web-based survey platforms: Observations from a study of risk perceptions of heated tobacco products (HTPs).

With an escalating popularity of online surveys in behavioral research, it is critical to understand how different sources of participants can yield differing outcomes. While Mturk has been used for online surveys for almost two decades, a recent introduction of online panels allows researchers to choose participants from variety of pools. This study aims to contribute to existing knowledge of how participants from different online platforms differ in their characteristics and behavioral responses which might affect the outcomes. 300 participants were recruited each from Mturk and Prime panels for a 20 mins long survey assessing perceptions and intentions to use Heated tobacco products (HTPs). Participants answered demographic and tobacco-use related questions including their vaccination and masking for COVID-19. They were shown a picture and description of a recently launched HTP. Further, participants answered questions about their awareness of HTPs, risk perception of health conditions from use of different tobacco products (cigarettes, e-cigarettes and HTPs) and perceived severity of COVID-19 infection in smokers, vapers and HTP users. Results showed significant differences in Mturk and Prime panel participants' demographics and tobacco-use. Prime panels showed more racially diverse population (chi-sq = 10.07, p < 0.02) and significantly more current smokers (chi-sq = 44.74, p < 0.01) and current e-cigarette users (chi-sq = 38.04, p < 0.01) compared with Mturk. Mean perception scores for COVID risk in tobacco users were significantly different between Prime panels and Mturk. Study highlights significant differences in sample composition and responses that might be helpful in choosing one online platform over another based on specific study requirements.

The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel.

BACKGROUND: Early in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking. METHODS: We used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May-June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses. RESULTS: Most respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04-2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%). CONCLUSIONS: While many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.

Awareness and use of tobacco products among underage individuals: findings from the altria client services underage tobacco use survey 2020-2022.

BACKGROUND: Tobacco use among underage individuals is a public health concern. Timely data about tobacco products, especially emerging products such as novel oral nicotine products (NPs), can provide critical information for the prevention of underage tobacco use. With a recent federal law raising the legal age of purchase of tobacco products from 18 to 21, it is of interest to benchmark awareness and use of tobacco products in the new underage population, young adults 18-20 years old. This study provides estimates on awareness and use of tobacco products among underage individuals 13-20 years old during May 2020 to August 2022 in the United States. METHODS: Altria Client Services Underage Tobacco Use Survey (UTUS) is a repeated cross-sectional survey conducted every quarter-year. A stratified random sampling approach was used to draw nationally representative samples of household dwelling individuals 13-20 years old. Information about the awareness and use of tobacco products was obtained via online self-administration or phone interviews after a consent/assent process. RESULTS: A sizable portion of underage individuals were aware of NPs (~ 40% among youth and ~ 50% among underage young adults), although past 30-day use was low (< 2%). The lowest levels of awareness and use were observed for heated tobacco products and snus. E-cigarettes were the most used tobacco products among underage individuals. Underage young adults (i.e., 18-20 year olds) were more likely to use tobacco products than youth (i.e., 13-17 year olds). There was no substantial change over time in the awareness and use of tobacco products during the study period despite a slight increase in past 30-day prevalence of e-cigarette use among youth between quarter 1 of 2021 and quarter 2 of 2022. CONCLUSIONS: The awareness and use of tobacco products remained relatively stable between May 2020 and August 2022. There is a notable level of awareness of novel NPs among underage individuals.

SMOKING PLAYING AS A RISK FACTOR TO OTHER DISEASES: A META-ANALYSIS

On July 21, 2021, a report from the World Health Organization indicated that there are presently 1.3 billion tobacco smokers globally. Data statistics show that the mortality rate of tobacco use is already at 3,021,098. Although smoking receives the lowest mortality rate among other communicable and non-communicable diseases in 2021, research suggests that smoking could hamper the quality of life of someone who already has an existing illness. This study investigated the adverse effects of smoking as a contributory factor to communicable diseases such as HIV/AIDS, Tuberculosis, and COVID-19, noncommunicable diseases like Malaria and Dengue, and risk factors such as alcohol and obesity. The locale of the study is Philippines. Meta-analysis is utilized in order to examine data statistics of the Philippines in comparison to its Southeast Asian neighbors. Meta-analysis was used by the author to extrapolate data from various quantitative and qualitative documents from 2000 up to the present. Specifically, open-access journal articles and data from legitimate databases like ISI Scopusindexed journals and/or websites were collated substantially. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)