Estimating the Risk of Death from COVID-19 in Adult Cancer Patients.

AIMS: During the coronavirus disease 2019 (COVID-19) pandemic, organisations have produced management guidance for cancer patients and the delivery of cytotoxic chemotherapy, but none has offered estimates of risk or the potential impact across populations. MATERIALS AND METHODS: We combined data from four countries to produce pooled age-banded case fatality rates, calculated the sex difference in survival and used data from four recent studies to convert case fatality rates into age/sex-stratified infection fatality rates (IFRs). We estimated the additional risk of death in cancer patients and in those receiving chemotherapy. We illustrate the impact of these by considering the impact on a national incident cancer cohort and analyse the risk-benefit in some clinical scenarios. RESULTS: We obtained data based on 412 985 cases and 41 854 deaths. The pooled estimate for IFR was 0.92%. IFRs for patients with cancer ranged from 0 to 29% and were higher in patients receiving chemotherapy (0.01-46%). The risk was significantly higher with age and in men compared with women. 37.5% of patients with a new diagnosis of cancer in 2018 had an IFR ≥5%. Survival benefits from adjuvant chemotherapy ranged from 5 to 10% in some common cancers, compared with the increased risk of death from COVID-19 of 0-3%. CONCLUSIONS: Older male patients are at a higher risk of death with COVID-19. Patients with cancer are also at a higher risk, as are those who have recently received chemotherapy. We provide well-founded estimates to allow patients and clinicians to better balance these risks and illustrate the wider impact in a national incident cohort.

Moderating effects of the valence of social interaction on the dysfunctional consequences of perseverative cognition: an ecological study in major depression and social anxiety disorder.

BACKGROUND AND OBJECTIVES: Major depression disorder (MDD) and social anxiety disorder (SAD) are characterized by the use of perseverative cognition (PC) as a dysfunctional coping strategy. We sought to investigate the dysfunctional physiological and psychological consequences of PC and how the valence of social interactions moderates such consequences in these psychopathological conditions. DESIGN/METHODS: The study combined 24-hour heart rate variability (HRV) and ecological momentary assessments in 48 individuals with MDD, SAD, and sex-matched controls. RESULTS: In all participants, PC was associated with mood worsening and reduced ability of the parasympathetic nervous system, mainly the vagus, to inhibit sympathetic arousal (i.e., reduced HRV). Individuals with SAD had the highest frequency of daily PC, while those with MDD reported that PC interfered more with their ongoing activities. In SAD, daily PC was associated with significantly lower HRV after negative social interactions. Individuals with MDD reported higher levels of sadness during PC irrespective of the valence of the preceding social interaction but higher levels of anxiety and efforts to inhibit PC following positive interactions. CONCLUSIONS: Results highlight the need to account for important moderators like the valence of social interaction when looking at the physiological consequences of maladaptive emotion regulation strategies.

Asymmetries in reciprocal baroreflex mechanisms and chronic pain severity: Focusing on irritable bowel syndrome.

BACKGROUND: Objective measures of pain severity remain ill defined, although its accurate measurement is critical. Reciprocal baroreflex mechanisms of blood pressure (BP) control were found to impact differently on pain regulation, and thus their asymmetry was hypothesized to also connect to chronic pain duration and severity. METHODS: Seventy-eight female patients with irritable bowel syndrome (IBS) and 27 healthy women were assessed for IBS severity and chronicity, negative affect, and various measures of resting autonomic function including BP, heart rate and its variability (HRV), baroreceptor-sensitivity to activations and inhibitions, gains of brady- and tachy-cardiac baro-responses, gains of BP falls/rises, and BP start points for these spontaneous baroreflexes. KEY RESULTS: IBS directly and indirectly (through increased negative affect) was associated with asymmetry between baroreceptor activations/inhibitions compared to symmetrical baroreflex reciprocity in the healthy women. In the IBS group, independently of specific IBS symptoms, pain chronicity was associated with (i) decreased BP falls coupled with either (a) decreased tachycardia associated with lower disease severity (earlier "pain resilience" mechanism), or (b) decreased bradycardia associated with higher disease severity (later "pain decompensation" mechanism), or (ii) increased BP start point for baroreceptor activations coupled with either (a) BP increase (delayed "pain adaptation" mechanism) or (b) affect-related HRV decrease (delayed "pain aggravation" mechanism). CONCLUSION AND INFERENCES: We anticipate the findings to be a starting point for validating these autonomic metrics of pain suffering and pain coping mechanisms in other chronic pain syndromes to suggest them as biomarkers of its severity and duration for profiling and correct management of chronic pain patients.

Serum level and antioxidant activity of ceruloplasmin in preeclampsia.

The antioxidants activities are decreased in the serum of women with preeclampsia. This study was aimed to determine the serum level and antioxidant activity of ceruloplasmin in preeclamptic women with gestational age over than 28 weeks. In a cross-sectional and descriptive-analytic study performed on 60 patients with preeclampsia (30 with mild and 30 with severe preeclampsia) and 30 women with normal pregnancy (control) in Tabriz al-Zahra Hospital, serum level and antioxidant activity of ceruloplasmin was evaluated. The mean gestational age was 32.94+/-2.79 week in mild preeclampsia group, 32.17+/-3.00 week in severe preeclampsia group and 32.46+/-4.04 week in control group (p = 0.821). The mean serum level of ceruloplasmin was 0.62+/-0.16 g L-1 in mild preeclampsia group, 0.61+/-0.23 g L-1 in severe preeclampsia group and 0.47+/-0.16 g L-1 in control group. The serum ceruloplasmin in control group was significantly lower (p = 0.006). The mean antioxidant activity of ceruloplasmin was 562.54+/-139.79 in mild preeclampsia group, 556.21+/-190.94 in severe preeclampsia group and 427.62+/-162.14 in control group. The antioxidant activity was measured as production of mg dL-1 of a colored product. The antioxidant activity of ceruloplasmin in control group patients was significantly lower (p = 0.002). Significant linear positive correlation was found between serum level of ceruloplasmin and antioxidant activity of ceruloplasmin (p<0.001 and r = 0.910). Serum level of ceruloplasmin is significantly lower in normal pregnancy than mild and severe preeclampsia. Antioxidant activity of ceruloplasmin is significantly lower in normal pregnancy than mild and severe preeclampsia.