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.

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.

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.

Stress and resilience in the workers of three health authorities of Emilia-Romagna during the COVID-19 pandemic

Aims: The aim of the present study was to study the prevalence of depression, anxiety, stress, and post-traumatic symptoms in Health-Care Workers (HCWs) of three Health Authorities of Emilia-Romagna, Italy during the COVID pandemic. Material(s) and Method(s): An online questionnaire was spread to the staff of the University Hospital of Modena and the Local Health Agencies of Modena and Romagna, including the Depression Anxiety Stress Scale (DASS-21), the Impact of Event Scale - Revised (IES-R), and the Utrecht Work Engagement Scale - Short Version (UWES-9). The scores at DASS-21 and IES-R were used as dependent variables in multivariate logistic regression models. Result(s): A total of 5868 HCWs were reached (response rate of 22.4%), 76.1% of which were women, mostly aged between 45 and 54 years. Rates of positive scores were: 27.9% DASS-21 Depression;28.4% DASS-21 Anxiety;34.7% DASS-21 Stress;21.9% IES-R. At the multivariate logistic regression, the following were statistically significant risk factors for positive scores: female sex, young age, and working at the front line. An increase in alcohol and tobacco consumption and worsening of eating habits were also strongly associated with symptoms. At UWES-9, the three samples reported lower vigor than dedication and absorption, which are at a medium-high level. Conclusion(s): HCWs have experienced high levels of emotional distress related to the COVID-19 pandemic. Significant improvements are needed not only in terms of organization and distribution of resources, but also in provision of dedicated psycho-social interventions.Copyright © 2023

The effect of having COVID-19 on anti-vaccination: observational prospective study

Objective: In this study, the effect of having had coronavirus disease-2019 (COVID-19) disease on anti-vaccination was investigated. Material and Methods: The study was conducted between February 2022-August 2022 in the COVID chest diseases clinic in our hospital. The cases who were COVID-19 vaccine hesitancy and not vaccinated against COVID-19 hospitalized in our clinic were included in the study. The level of anti-vaccination of the cases was measured with the Vaccine Hesitancy Scale (VHS). In addition, demographic informations such as age, gender, educational status, marital status, number of people living in the household, average monthly income, smoking history, and additional chronic diseases were recorded. Routine radiological and laboratory examinations, follow-up times in the clinic, and treatment results were recorded for cases like all patients hospitalized in our COVID chest diseases clinic. Results: 46 cases were included in the study. The mean age of the cases was 54.63+or-14.81 years, 24 (52.1%) were female. VHS was applied to all cases at the time of hospitalization. Since 6 cases were referred to the intensive care unit due to respiratory failure, the second VHS could not be applied to these cases, and these 6 cases were excluded from the study. A 2nd VHS was performed in the remaining 40 patients just before discharge. Each question score, A-B-C section score and total scale score were compared for the pre-COVID-19 and post-COVID-19 cases. While the VHS total score before COVID-19 infection was 36.48+or-7.36, the post-COVID-19 total score was found to be 25.65+or-9.10, a statistically significant decrease was observed (p < 0.001). It was observed that the mean scores of A-B-C decreased statistically in all sections (p < 0.001). Conclusion: As a result of our study, we found that the degree of anti-vaccine resistance decreased after the patients who were against the COVID-19 vaccine had the disease. As a result of our study, we found that the degree of COVID-19 vaccine hesitancy of patients decreased after they had the disease. We believe that conducting similar studies and sharing their results through mass media, can change the perspective of vaccine hesitancy individuals in society on this situation, especially during pandemic periods.

Corrigendum: Impact of a tobacco sales ban on the frequency of tobacco consumption in India during the COVID-19 pandemic.

[This corrects the article DOI: 10.18332/tid/161855.].

Implementation fidelity of a smoke-free workplace intervention in a private medical company: A mixed-methods process evaluation.

INTRODUCTION: Smoke-free workplaces are considered an important part of tobacco control strategies. The purpose of this study was to evaluate implementation fidelity and explore the significance of social and contextual factors for the implementation of a strict smoke-free workplace intervention in a large Danish medical company. METHODS: The UK Medical Research Council's guidance for process evaluation was used as a framework. Data were collected from approximately six months before the implementation until ten months after (2019-2020). A mixed method study design was used (a survey of 398 employees, a focus group of four employees and field visits on two days). Data were analyzed separately and later integrated through triangulation. We used the Fisher's exact test in the analysis of the questionnaire. RESULTS: We assessed the implementation fidelity through four key factors: reach, dose and delivery, mechanisms of change, and context for the intervention components. Despite compliance issues, the policy component had high implementation fidelity. However, the implementation fidelity of the smoking cessation support component was low. We identified three social mechanisms influencing the employees' responsiveness towards the policy: expectation, the social aspect of the smoking facilities, and management leadership. COVID-19 was identified as the main contextual factor affecting the implementation. CONCLUSIONS: Although not all elements of the intervention components were implemented as planned, the strict smoke-free workplace intervention is considered implemented. Further strategies can be initiated to raise implementation fidelity through better communication concerning the cessation support component, compliance, and enforcement of the policy.

Are we equally at risk of changing smoking behavior during a public health crisis? Impact of educational level on smoking from the TEMPO cohort.

BACKGROUND: The COVID-19 pandemic as a public health crisis has led to a significant increase in mental health difficulties. Smoking is strongly associated with mental health conditions, which is why the pandemic might have influenced the otherwise decline in smoking rates. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic has exacerbated existing social inequalities and because this group was more likely to smoke before the pandemic. We examined smoking prevalence in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between interpersonal changes in tobacco consumption and educational level from 2018 to 2021. METHODS: Using four assessments of smoking status available from 2009 to 2021, we estimated smoking prevalence over time, stratified by highest educational level in the TEMPO cohort and the difference was tested using chi2 test. We studied the association between interpersonal change in smoking status between 2018 and 2021 and educational attainment among 148 smokers, using multinomial logistic regression. RESULTS: Smoking prevalence was higher among those with low education. The difference between the two groups increased from 2020 to 2021 (4.8-9.4%, p < 0.001). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018 to 2021 compared to low educated smokers (aOR = 2.72 [1.26;5.89]). CONCLUSION: Current findings showed a widening of the social inequality gap in relation to smoking rates, underscoring the increased vulnerability of persons with low educational level to smoking and the likely inadequate focus on social inequalities in relation to tobacco control policies during the pandemic.

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.

Knowledge, attitude, and oral hygiene practices among law students in Davangere City: A cross-sectional study

Aim: The aim of this study was to assess dental health awareness and oral hygiene practice among law students of R L Law College, Davangere, Karnataka. Materials and Methods: A questionnaire containing 30 questions, regarding basic knowledge, attitude, and practice was distributed among 150 Law students of R L Law college of Davangere, Karnataka, India. The data obtained were tabulated in Microsoft Excel and statistically analyzed in the Statistical Package for the Social Sciences (IBM Corporation) software. Results: In the present study, only 39.4% of the participants were aware of routine dental check-ups. 8.5% of the participants visited the dental clinic twice a year and 57% of the participants had never visited a dental clinic. 37.3% of the participants were aware of oral hygiene aids. 62% of the participants used a tongue cleaner routinely and 55.5% brushed their teeth using only horizontal brushing technique. 48.6% were aware that consuming tobacco causes cancer. Only 9.2% consumed tobacco in various forms. 49% of the participants felt that all dental procedures were painful and expressed fear. 81% of the students were unaware of dental fluorosis. 65.5% of the participants agreed that dental health education is important and 21.8% thought that it might be important. Inferential statistics using the Pearson Chi-square test showed that there was a statistically significant correlation between the responses and the Year of law degree the participant was pursuing. Conclusion: In the present study, law students have satisfactory knowledge about good oral hygiene practices and oral health care. However, the knowledge acquired must be transferred into daily practice. This can be achieved by a change in their attitude toward oral hygiene maintenance. The inclusion of oral health-oriented education programs in their curriculum would improve their knowledge along with behavior, and they would be a good model to the community. This study will help us in devising an outline for the oral hygiene education of Law students of our country based on their current attitude, knowledge, and oral hygiene practice.

Limbic platform capitalism: understanding the contemporary marketing of health-demoting products on social media

The purposive design, production and marketing of legal but health-demoting products that stimulate habitual consumption and pleasure for maximum profit has been called 'limbic capitalism'. In this article, drawing on alcohol and tobacco as key examples, we extend this framework into the digital realm. We argue that 'limbic platform capitalism' is a serious threat to the health and wellbeing of individuals, communities and populations. Accessed routinely through everyday digital devices, social media platforms aggressively intensify limbic capitalism because they also work through embodied limbic processes. These platforms are designed to generate, analyse and apply vast amounts of personalised data in an effort to tune flows of online content to capture users' time and attention, and influence their affects, moods, emotions and desires in order to increase profits. Social media are central to young people's socialising, identities, leisure practices and engagement in civic life. Young people actively appropriate social media for their own ends but are simultaneously recruited as consumers who are specifically targeted by producers of limbic products and services. Social media platforms have seen large increases in users and traffic through the COVID-19 pandemic and limbic capitalism has worked to intensify marketing that is context, time and place specific, driving online purchases and deliveries of limbic products. This has public health implications that require immediate attention as existing regulatory frameworks are woefully inadequate in this era of data-driven, algorithmic marketing.

Investigating factors affecting hospitalization of patients with mucormycosis after contracting COVID-19: a systematic review

Regarding the investigation of the factors related to the hospitalization of patients with Mucormycosis after being infected with Covid-19, several preliminary studies have been conducted in the hospital, but these studies were conducted in a small environment and have a smaller sample size. Therefore, the aim of the present systematic review study is to examine the factors affecting the hospitalization of patients with mucormycosis after being infected with covid-19. Methods: The current systematic review study was conducted according to PRISMA guidelines (preferred reporting items for systematic seviews and meta-analyses). For this study, the keywords "2019-nCoV", "COVID-19", "SARS-CoV-2", "Coronaviruses", "Hospitaliz", "Factor" and "Mucormycosis" in MagIran, SID, ISI, embase databases, ProQuest, PubMed, scopus were searched. Results: diabetes mellitus, old age, high body mass index, kidney disease, high blood pressure and smoking significantly increase the need for hospitalization in patients with mucormycosis after contracting covid-19. Conclusion: The results of the present study showed that the risk of hospitalization due to Mucormycosis after the covid-19 disease is significantly related to obesity, old age and underlying diseases..

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).

Spontaneous pneumomediastinum secondary to COVID-19 in Iran: a case series study: SPM secondary to COVID-19

BACKGROUND: Pneumomediastinum is defined as open-air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air leaks into the surrounding vascular sheath through small alveolar ruptures. CASE REPORT: We want to introduce 4 different cases with different outcomes. The first case was a 60-year-old man with a history of psychological disorders, the second case was a 41-year-old man with a history of hypertension (HTN) and asthma, the third case was a 50-year-old heavy smoker with no history of an underlying disease, and the fourth case was a 60-year-old man with a history of schizophrenia. They suddenly developed an exacerbation of cough, dyspnea, chest pain, and a severe decrease in oxygen saturation during hospitalization. Antibiotic therapy, corticosteroids, and high-dose oxygen therapy were administered to the patients. One of these patients died. CONCLUSION: All patients can potentially be at risk for this complication and have a good prognosis if diagnosed early and treated properly overall.

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.