ARB/ACEI use and severe COVID-19: a nationwide case-control study

BackgroundAngiotensin receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) have anti-inflammatory effects. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the membrane protein angiotensin-converting enzyme 2 (ACE2), which is increased by ARB/ACEI treatment, as a cell entry receptor. Therefore, the use of ARBs/ACEIs for COVID-19 remains controversial. MethodsA retrospective case-control study was conducted using COVID-19 patients previously diagnosed with hypertension before COVID-19 onset. The primary outcome was severe infection or all-cause mortality. Cases included ARB/ACEI use for [≥]30 days during the 6 months before COVID-19 onset. Primary controls included antihypertensive use other than ARBs/ACEIs (narrow control); secondary controls included all other hypertension patients (broad control). We investigated ARB/ACEI association with outcomes in general and by subgroups (age, sex, and presence of diabetes) using logistic regression models with propensity score matching. FindingsOf 234427 suspected COVID-19 patients we screened, 1585 hypertension patients were analyzed. In the 892 cases, 428 narrow controls, and 693 broad controls, severe infection or death occurred in 8{middle dot}6%, 22{middle dot}2%, and 16{middle dot}7%, respectively. ARB/ACEI use was associated with a reduced risk of severe infection or death relative to the narrow control group (adjusted odds ratio [aOR] 0{middle dot}43, 95% confidence interval [CI] 0{middle dot}28 - 0{middle dot}65) and broad control group (aOR 0{middle dot}49, 95% CI 0{middle dot}33 - 0{middle dot}71). The association was smaller for newly diagnosed hypertension patients (aOR 0{middle dot}11, 95% CI 0{middle dot}03 - 0{middle dot}42 compared to narrow control group). ARB/ACEI protective effects against severe infection or death were significantly observed in male and diabetic patients. InterpretationARB/ACEI use was associated with a lower risk of severe infection or mortality compared to other antihypertensives or ARB/ACEI nonuse. FundingNone Research in contextO_ST_ABSEvidence before this studyC_ST_ABSAnimal studies reported that ACE2 attenuates lung injury and provides a protective effect against severe pneumonia. Additionally, retrospective studies found that ARBs/ACEIs may have beneficial effects on ARDS patient survival. Previous observational studies have reported no potential harmful association of either ARBs or ACEIs with COVID-19 outcomes. Added value of this studyBy analyzing nationwide claims data in South Korea, we found that previous use of ARB/ACEI was associated with improved outcomes in COVID-19 compared with either nonuse or use of a different class of antihypertensive drugs. The risk of severe infection or death was consistently about 55% lower in those treated with ARB/ACEIs than those who were not exposed to ARB/ACEIs. The protective effect of ARB/ACEI was remained significantly among the male subgroup and patients with diabetes. This association was also observed among COVID-19 patients with newly diagnosed hypertension. Implications of all the available evidenceThese results provide supporting evidence for the continued use of ARBs/ACEIs among patients with COVID-19. Moreover, for newly diagnosed hypertension patients, initiation of ARB/ACEI use may not adversely affect COVID-19 prognosis. Given the poor prognosis of COVID-19 patients with hypertension and lack of curable strategy, these findings may have considerable clinical implications in prevention of poor outcome in patients with hypertension.

Correlation Between Frequency Doubling Technology Perimetry and Scanning Laser Polarimetry in Glaucoma Suspects and Glaucomatous Eyes

The aim of this study was to determine the relationship between the frequency doubling technology (FDT) screening algorithm and parapapillary retinal nerve fiber layer (RNFL) thickness in the eyes of glaucoma suspects and patients with open angle glaucoma. FDT C20-1 screening program and a scanning laser polarimetry (SLP) system (GDx-NFA) was used to assess 53 glaucomatous eyes, 53 glaucoma suspects and 36 normal control eyes. In glaucomatous eyes, there were correlations between the FDT the screening algorithm and RNFL retardation values in several polarimetric indices, most significantly "inferior thickness" (r = -0.321, P = 0.029). In the eyes of glaucoma suspects, however, we observed no correlation between the FDT results and RNFL retardation values (r = 0.080, P > 0.05, "inferior thickness"). In glaucomatous eyes, the abnormal scores obtained with FDT screening program correlated negatively with RNFL retardation values, as measured by SLP. Despite poor correlation between the FDT abnormal score and RNFL retardation value in glaucoma suspects, detection of abnormality using the FDT screening protocol may aid in the assessment of early glaucomatous structural damage.

Inter-hospital Comparison of Cesarean Section Rates after Risk Adjustment / 예방의학회지

OBJECTIVE: To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. METHODS: Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. RESULTS: The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. CONCLUSIONS: Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.

Complementary and Alternative Medicine Use in Korea: Prevalence, Pattern of Use, and Out-of-pocket Expenditures / 예방의학회지

OBJECTIVES: To determine the prevalence, pattern, and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. METHODS: We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/ pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. RESULTS: The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to pound $1.88 billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/ hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services and CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). CONCLUSION: CAM became a popular source of health care in Korea. Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.

Comparision of doctors' experience with and attitudes toward complementary and alternative medicine between western medicine and korean traditional medicine in office-based settings

BACKGROUD: Primary care physicians (PCPs) and ariental medical dactors (OMDs), as primary healthcare providers, could directly affect patients use of complementary and alternative medidne(CAM). This study was carried out to compare the practice experience with, the knowledge about, and the attitudes taward CAM between PCPs and OMDs in Korea. METHODS: A total of 502 PCPs and 500 OMDs in urban area of Karea were selected by the proportionate quota and systematic sampling methood. Face-to-face interviews were done with structured questionnaire. RESULTS: The rate af practice experience with and referral rate af CAM were reported 13.7% and 38.6% in PCPs, 76.8% and 85.4%. in OMDs respectively. OMDs evaluated the efficacy of each CAM higher than PCPs. Both doctors had wide variatians of knowledge in how to practice each CAM. However more than half OMDs knew how to practice chiropracic, taping therapy, aromatherapy, and iridology respectively, about 30% of PCPs high colic/enema and chiropractic. PCPs had mcire negative attitudes toward CAM and the advertisement of the other professional medidne (korean traditional medicine) than OMDs. OMDs more strongly supported the natural healing process, health-disease continuum, and psychological effect on health, and opposed Descares view on human body than PCPs. CONCLUSIONS: This study showed OMDs had more experience with, knowledge about, positive attitudes toward and supportive health concepts to CAM than PCPs. CAM practice would be diffused with chiropractic, taping therapy, aromatherapy, and iridolagy in OMDs; high colic/enema and chiropractic in PCPs.