Asthma and COPD as co-morbidities in patients hospitalised with Covid-19 disease: a global systematic review and meta-analysis.

BACKGROUND: Factors predisposing to increased mortality with COVID-19 infection have been identified as male sex, hypertension, obesity, and increasing age. Early studies looking at airway diseases gave some contradictory results. The purpose of our study was to determine global variation in studies in patients hospitalized with COVID-19 in the prevalence of COPD and asthma; and to determine whether the presence of asthma or COPD affected mortality in the same hospital population. METHODS: A systematic review and meta-analysis of the published literature of COPD and asthma as co-morbidities in patients hospitalized with COVID-19 was performed, looking firstly at the prevalence of these diseases in patients hospitalized with COVID-19, and secondly at the relative risk of death from any cause for patients with asthma or COPD. RESULTS: Prevalence of both airway diseases varied markedly by region, making meaningful pooled global estimates of prevalence invalid and not of clinical utility. For individual studies, the interquartile range for asthma prevalence was 4.21 to 12.39%, and for COPD, 3.82 to 11.85%. The relative risk of death with COPD for patients hospitalized with COVID-19 was 1.863 (95% CI 1.640-2.115), while the risk with asthma was 0.918 (95% CI 0.767 to 1.098) with no evidence of increased mortality. CONCLUSIONS: For asthma and COPD, prevalence in patients hospitalized with COVID-19 varies markedly by region. We found no evidence that asthma predisposed to increased mortality in COVID-19 disease. For COPD, there was clear evidence of an association with increased mortality. TRIAL REGISTRATION: The trial was registered with PROSPERO: registration number CRD42021289886.

Efficacy of antifibrotic drugs, nintedanib and pirfenidone, in treatment of progressive pulmonary fibrosis in both idiopathic pulmonary fibrosis (IPF) and non-IPF: a systematic review and meta-analysis.

BACKGROUND: Research questions To compare the efficacy of nintedanib and pirfenidone in the treatment of progressive pulmonary fibrosis; and to compare the efficacy of anti-fibrotic therapy (grouping nintedanib and pirfenidone together) in patients with IPF versus patients with progressive lung fibrosis not classified as IPF. STUDY DESIGN AND METHODS: A search of databases including MEDLINE, EMBASE, PubMed, and clinicaltrials.gov was conducted. Studies were included if they were randomised controlled trials of pirfenidone or nintedanib in adult patients with IPF or non-IPF patients, and with extractable data on mortality or decline in forced vital capacity (FVC). Random effects meta-analyses were performed on changes in FVC and where possible on mortality in the selected studies. RESULTS: 13 trials of antifibrotic therapy were pooled in a meta-analysis (with pirfenidone and nintedanib considered together as anti-fibrotic therapy). The change in FVC was expressed as a standardised difference to allow pooling of percentage and absolute changes. The mean effect size in the IPF studies was - 0.305 (SE 0.043) (p < 0.001) and in the non-IPF studies the figures were - 0.307 (SE 0.063) (p < 0.001). There was no evidence of any difference between the two groups for standardised rate of FVC decline (p = 0.979). Pooling IPF and non-IPF showed a significant reduction in mortality, with mean risk ratio of 07.01 in favour of antifibrotic therapy (p = 0.008). A separate analysis restricted to non-IPF did not show a significant reduction in mortality (risk ratio 0.908 (0.547 to 1.508), p = 0.71. INTERPRETATION: Anti-fibrotic therapy offers protection against the rate of decline in FVC in progressive lung fibrosis, with similar efficacy shown between the two anti-fibrotic agents currently in clinical use. There was no significant difference in efficacy of antifibrotic therapy whether the underlying condition was IPF or non-IPF with progressive fibrosis, supporting the hypothesis of a common pathogenesis. The data in this analysis was insufficient to be confident about a reduction in mortality in non-IPF with anti-fibrotic therapy. Trial Registration PROSPERO, registration number CRD42021266046.

The Association between Symptoms of Nomophobia, Insomnia and Food Addiction among Young Adults: Findings of an Exploratory Cross-Sectional Survey.

No previous research has examined the association between symptoms of nomophobia and food addiction. Similarly, only a few studies have examined the association between nomophobia and symptoms of insomnia. This exploratory study utilized an online self-administered, structured questionnaire that included: basic sociodemographic and anthropometrics; the nomophobia questionnaire (NMP-Q); the insomnia severity index (ISI); and the Yale Food Addiction Scale (YFAS) in a convenience sample of young adults (18-35 years) in Bahrain (n = 654), 304 (46%) males and 350 (54%) females. Symptoms of severe nomophobia, moderate-severe insomnia, and food addiction were more common among female participants both for each disorder separately and in combination; however, differences did not reach statistical significance. For severe nomophobia, the rate for females was 76 (21.7%) and for males was 57 (18.8%) p = 0.9. For moderate-severe insomnia, the rate for females was 56 (16%) and for males was 36 (11.84%) p = 0.1. For food addiction, the rate for females was 71 (20.29%) and for males was 53 (17.43%) p = 0.3. A statistically significant association was present between nomophobia and insomnia r = 0.60, p < 0.001. No association was found between nomophobia and food addiction. Nomophobia is very common in young adults, particularly in females; nomophobia is associated with insomnia but not with food addiction.

The association between physical symptoms and depression among medical students in Bahrain.

OBJECTIVES: To examine the association between depression and physical symptoms among medical students in Bahrain. METHODS:   The present study employed a cross-sectional design.  A total of 160 students were recruited, 41.3% were male and 58.8% female, using a convenience sampling approach. Participants completed the validated Patients Health Questionnaires (PHQs) in which they provided information about demographics, physical symptoms, and depression. Results were considered significant if p <0.05. RESULTS: Nearly nineteen percent of the participants have moderate to severe depression, and 42.2% has moderate to severe physical symptoms.  Participants reported different physical symptoms, sleep problems, 40%; lethargy, 31.9%; and headaches, 23.8%. The results of the logistic regression showed that there was a significant association between age and gender (χ2(3) = 32.28, p < 0.001). Sleep and gastrointestinal symptoms were the most associated with depression, respectively (χ2(3)=49.77, p<0.001) and (χ2(3)=49.77, p< 0.05). CONCLUSIONS: The association between depression and physical symptoms are considerably high among medical students in Bahrain.  Medical educators should take such symptoms seriously among medical students as it may have serious consequences on the mental health of medical students. In practice, adequate awareness initiatives should be organized and provided for medical students to help them overcome their challenges they face. Additionally, incorporating screening self-screening strategies in the medical curriculum can be beneficial for early detections of mental health problems. The Implications and limitations of the study are discussed.