Female Smokers Research Articles

Inverse Association between the Body Mass Index and the Incidence of Unruptured Intracranial Aneurysms-Insights from the Hamburg City Health Population Study.

Overweight/obese patients experience a lower incidence of subarachnoid hemorrhage (SAH) compared to non-overweight patients, even though elevated body mass index (BMI) has been associated with various SAH risk factors. Given that intracranial aneurysms are a primary cause of SAH, a potential protective effect of a high BMI on intracranial aneurysms is likely but remains insufficiently investigated. This population-based MRI study aims to conduct detailed analyses on risk factors associated with the incidence of unruptured intracranial aneurysms (UIA). Retrospective analysis of subjects enrolled in the prospective Hamburg City Health study who underwent intracranial magnetic resonance imaging (MRI) was done. MRI scans were screened for UIA using time-of-flight angiography. Subject data including medical history, laboratory examinations, and risk factors for UIA were collected, and a multivariable logistic regression model was used to investigate the relationship between risk factors and UIA incidence. 2688 subjects (mean (IQR) age, 65 (58-71); 1176 female (43.8%) were included. An UIA was detected in 214 subjects with an incidence of 10.6% (6.0%) in females (males). Determinants for UIA were female sex (OR 2.00, 95%CI 1.45-2.77, p < 0.001), hypertension (OR 1.48, 95%CI 1.08-2.04, p = 0.015), smoking (OR 1.41, 95%CI 1.03-1.95, p = 0.036), and BMI (OR 0.95, 95%CI 0.91-0.98, p = 0.004). Among subjects with UIA, 9.4% with a BMI > 25 had multiple aneurysms, compared to 21.6% with BMI ≤ 25 (p = 0.012). This study suggests that a high BMI exhibits a protective effect on UIA incidence and the development of multiple aneurysms. Additionally, the data confirms established risk factors for UIA development, such as female sex, hypertension, and smoking.

Effect of Valproate Coprescription on Clozapine Pharmacokinetics in Clinical Practice

Abstract Background Sodium valproate has been coprescribed with clozapine for seizure prophylaxis and for augmentation in treatment-refractory schizophrenia. However, the effect of valproate on clozapine metabolism and on the incidence of clozapine-related side effects is unclear. Methods We compared clozapine dose and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in smokers and nonsmokers of both sexes in samples submitted for clozapine therapeutic drug monitoring, 1996–2017 in relation to valproate coprescription. Results There were 1217 (665 patients) and 3823 (1600 patients) samples from nonsmokers and from smokers, respectively, who were coprescribed valproate and clozapine. Data from 9774 (5065 patients) and 15,465 (7298 patients) samples from nonsmokers and from smokers, respectively, for whom drugs other than valproate were coprescribed were used as controls. Valproate coprescription in nonsmokers was associated with an increase in average plasma clozapine of 22.5%, suggesting moderate inhibition of clozapine metabolism, but there was no marked effect of valproate coprescription on plasma clozapine in smokers. In all the valproate-treated groups (male and female smokers and nonsmokers), the median plasma norclozapine concentration and the median plasma clozapine-to-norclozapine ratio were significantly lower and higher, respectively, as compared with the controls. Mixed-effects models showed a significant dose-response effect of valproate on lowering the plasma norclozapine concentration and on increasing the plasma clozapine-to-norclozapine ratio. Implications Given the complexity of the effect of valproate coadministration on clozapine pharmacokinetics and the possibility that the toxicity of clozapine may be enhanced in the presence of valproate, the use of these drugs in combination must now be questioned in all patients and not only in women of childbearing age.

Risk factors for cardiometabolic multimorbidity: an analysis of 4 million participants from May Measurement Month 2017-2019

Abstract Background Cardiometabolic multimorbidity (CMM), defined as the presence of two or more cardiometabolic conditions, presents a significant global challenge due to aging populations and a growing prevalence of cardiometabolic diseases. However, evidence regarding the risk factors for CMM is scarce, particularly in low- and middle-income countries. May Measurement Month (MMM) is the largest annual global campaign collecting data on blood pressure (BP) and cardiometabolic diseases. Purpose To determine the proportion of hypertension in people with CMM and risk factors associated with CMM, from the three MMM campaigns in 2017-2019. Methods A total of 3 397 746 participants (≥18 years) were included, arising from 103 countries. CMM was defined as having two or more of three cardiometabolic diseases: myocardial infarction, stroke, and diabetes. Hypertension was defined as a systolic BP≥140mmHg and/or diastolic BP≥90mmHg, using the average of the second and third of three readings and/or taking antihypertensive medication. A multivariable logistic mixed effects regression model was used to examine associations between CMM and potential risk factors, including age, sex, BMI category, smoking status, and alcohol consumption in the model, with random effects for country. Results Amongst all participants, 316 940 (9.3%), 62 731 (1.8%), and 28 491 (0.8%) had one, two or three cardiometabolic conditions, respectively, and 91 222 (2.7%) had CMM. The proportion with hypertension increased with an increasing number of cardiometabolic conditions: 29.6% in those with none, and 63.0%, 68.6% and 71.2% in those with one, two, or three conditions, respectively. In a fully adjusted model, females had 16% (OR = 1.16, 95% CI: 1.12-1.20, p-value &amp;lt;0.001) higher odds of having CMM than males (Figure). Increasing age was associated with higher odds of having CMM, the highest risk being found in participants ≥70 years. Participants who were underweight, overweight, or obese, were more likely to have CMM than those with a healthy weight. Of the risk factors studied, current smoking was associated with the highest odds for CMM, (OR = 12.8, 95% CI: 12.62-13.04, p-value&amp;lt;0.001) compared with not smoking. Participants consuming alcohol at least once per week had 74% lower odds (OR = 0.26, 95% CI: 0.25-0.27, p-value &amp;lt;0.001) of having CMM compared with those who never or rarely consumed alcohol (Figure 1). Conclusions The risk of CMM increases with female sex, older age, abnormal weight, and smoking. Additionally, CMM is associated with a higher likelihood of having hypertension. Efforts targeting high-risk populations with modifiable CMM related-risk factors are crucial for prevention of CMM.Figure 1.Risk factors for CMM

The evaluation of complete blood count parameters in the patients with idiopathic versus secondary cerebral venous thrombosis

Background: Several laboratory markers derived from a complete blood count (CBC) have been proposed as potential indicators for assessing the risk of cerebral venous thrombosis (CVT). However, limited and conflicting evidence exists regarding this association. This study aimed to evaluate the role of CBC parameters in CVT development and their link to disease characteristics. Methods: This case-control study included patients diagnosed with CVT between March 2018 and and March 2021. All participants with CVT were registered in the organized registry system at the Neurology Research Center of Shiraz University of Medical Sciences, Shiraz, Iran (CVT registry code: 9001013381). The control group consisted of age- and sex-matched individuals without systemic diseases. CBC results from the control group and the first recorded hospital CBC of the patient group were collected. Results: The study included 295 patients with CVT [49 with idiopathic CVT (iCVT) and 246 with secondary CVT (sCVT)] and 341 healthy individuals. Among the CVT group, 72.54% were women. Patients with CVT had higher red cell distribution width (RDW) and lower red blood cell (RBC) count, hemoglobin (Hb) levels, and hematocrit compared to the non-CVT group. In iCVT cases, male gender, RBC count, Hb levels, and hematocrit were notably higher compared to sCVT cases. Logistic regression analysis showed that female gender, smoking, and higher hematocrit values were associated with increased probability of iCVT. Conclusion: The study suggests that certain CBC parameters may serve as potential markers for assessing CVT risk and differentiating between iCVT and sCVT cases. Validation and further research are needed to explore the underlying mechanisms.March 2021.

How do Chinese young adult women initiate smoking and progress to become regular smokers? A qualitative study

ABSTRACT Objective The increasing prevalence of smoking among young adult women in China raises concerns about the associated health risks. This study aims to investigate the trajectory of smoking and its influencing factors among Chinese young adult women in order to gain a comprehensive understanding and reduce the prevalence of smoking. Methods Using purposive sampling, one-on-one interviews were conducted with 28 young female smokers aged 20–31 years between May 2022 and September 2022. Results The findings revealed that the trajectory of smoking among Chinese young adult women is divided into three stages: smoking initiation, maintenance of smoking, and becoming addicted to smoking. Participants were initially attracted to smoking due to factors such as the taste of tobacco, peer influence, stress in interpersonal interactions, and cigarettes marketed for women. As smoking behavior progressed, participants mentioned motivations including relieving negative emotions, experiencing relaxation and pleasure, shaping their personal image, and confronting discrimination and prejudice. Eventually, when they became addicted to smoking, the physical dependence on nicotine and the smoking habit prevented them from stopping. Conclusions Understanding the influence of these factors on women’s smoking behaviors is crucial for informing tobacco control policies and reducing tobacco use among women.

Determining the perceived risk of lung cancer and chronic obstructive pulmonary diseases (COPD) among hookah users in Iran.

Hookah consumption is harmful to human health and can cause various diseases. Developing lung cancer and other lung diseases are one of the health consequences of hookah consumption. Measuring the perceived risk for being diagnosed with these conditions among hookah users is necessary. Therefore, this study was conducted to determine the perceived risk of lung cancer and Chronic Obstructive Pulmonary Disease (COPD) in hookah users in Iran. This cross-sectional study was conducted with a descriptive-analytical approach on 340 hookah users between January-May 2023. These people were recruited through convenience sampling. The information on the perceived risk of participants was collected through a questionnaire on the perceived risk of lung cancer and COPD. Data were analyzed through descriptive tests and multiple linear regression tests. These analyses were performed using Stata statistical software version 17. The mean and standard deviation of the perceived risk for lung cancer was 8.41 ± 5.50 and for COPD was 8.51 ± 5.58 out of 20 possible scores. The results of multiple linear regression generally showed that the using other type of tobacco (β = 3.14, p < 0.0001), 2 or more use of hookah in past month (β=-3.41, p = 0.025), unskilled workers (β = 1.79, p = 0.017), married smokers (β=-1.31, p = 0.026), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables regarding to lung cancer perceived risk. In line with COPD the using other type of tobacco (β = 3.47, p < 0.0001), once a month use of hookah in past month(β=-3.74, p = 0.041) and twice or more use of hookah in past month (β=-4.82, p = 0.008), smokers in contemplation stage (β = 3.91, p < 0.0001), female smokers (β = 3.08, p < 0.0001), unskilled workers (β = 2.42, p = 0.007), negative attitude toward hookah (β = 0.46, p < 0.0001) were the predictive variables to COPD perceived risk. In general, the perceived risk of developing lung cancer and COPD among hookah users was low. Therefore, it is necessary to provide widespread information about the potential harm of hookah in causing lung cancer and COPD, at the community level.

Gender differences in e-cigarette knowledge, attitudes, and practice among adults in Bahrain: a cross-sectional study

IntroductionE-cigarettes smoking is a global health concern due to its associated risks and unexpected rise in e-cigarette smoking among adults and nonsmokers. This study aims to investigate gender differences in e-cigarette knowledge, attitude, and practice among adults in Bahrain.MethodsThe data was collected using an online questionnaire covering demographics, knowledge, attitude, and practice. Data were analyzed using SPSS software, reporting mean and SD for continuous variables, frequencies, and percentages for categorical variables. A chi-square test was conducted to assess the association between variables and gender with a significance level of p < 0.05.ResultsA total of 555 participants completed the questionnaire, with the majority being females (66.8%), with a mean age of 31 (SD 8.5). Among respondents, 23.2% were smokers with a higher percentage of male smokers 58.7% compared to female smokers 5.7%. E-cigarette smoking was prevalent among 18% of participants, with 86% of them being male e-cigarette smokers compared to 14% of female e-cigarette smokers. The chi-square test showed that there was statistical significance between males and females when it comes to knowledge and attitudes toward e-cigarette smoking (p = 0.000). Males have inadequate knowledge and positive attitudes toward e-cigarette smoking compared to females. There was no statistical difference in the analysis of practice between both genders.ConclusionE-cigarette smoking is very prevalent among adults in Bahrain, especially among males. Educational interventions and robust laws and policies should be implemented to address this issue and contribute to improving community health.

Associations of ambient particulate matter and household fuel use with chronic liver disease in China: A nationwide analysis

BackgroundLong-term effects of outdoor and indoor air pollution on chronic liver disease (CLD) remain unclear. Thus, the study was conducted to investigate the relationship between prolonged exposure to ambient particulate matter (PM1, PM2.5 and PM10) and household fuel usage with CLD. MethodsData from the China Health and Retirement Longitudinal Study (CHARLS) covering the years 2011 to 2020 were employed. In the cross-sectional analysis, 16,680 participants were included, while 12,969 participants were enrolled in the longitudinal study. The associations between various sizes of particulate matter and CLD were elucidated using logistic regression model and generalized linear-mixed models. Additionally, the additive effects of ambient particulate matter (PM) levels and the utilization of solid fuels for cooking were investigated, with a comparison of effect sizes between converted and non-converted fuel types. ResultsOver a 10-year follow-up period, 746 (5.75 %) individuals developed CLD. For a 1-year average concentrations, PM1, PM2.5 and PM10 were each linked to a 1.549 (95 %CI:1.522–1.576), 1.296 (95 %CI:1.276–1.317) and 1.134 (95 %CI:1.118–1.150) fold risk of incident CLD per 10 μg/m3 increase, respectively. A similar effect of PM concentrations over a 2-year period on CLD was observed. Moreover, simultaneous exposure to ambient PM and solid fuels is associated with an increased risk of CLD. Those who continue using solid fuels may face a higher risk of CLD compared to individuals who switch to cleaner cooking fuels. Female participants, smokers, and individuals with shorter sleep duration and multiple chronic diseases exhibited slightly stronger effects. ConclusionLong-term exposure to varying sizes of PM (PM1, PM2.5, PM10) has been linked to an elevated risk of CLD incidence. Co-exposure to ambient PM and solid fuels is associated with higher health risks.

Progressive T1 high-intensity plaques in carotid stenosis: Comparative MRI analyses in asymptomatic and symptomatic phases of low-grade stenosis

Background and PurposeCarotid artery stenosis, particularly the progression from asymptomatic to symptomatic lesions, is a key factor in cerebrovascular events. This study identifies predictors of symptom development in low-grade carotid stenosis (<50%), focusing on intraplaque hemorrhage (IPH) and dynamic plaque changes. Materials and MethodsWe conducted a retrospective study analyzing 30 cases of symptomatic low-grade carotid stenosis, using carotid MRI before and after symptom onset. Key measures included relative plaque signal intensity (rSI) and high-intensity plaque (HI plaque) volume. Stepwise regression analysis examined the influence of these factors on Symptomatic rSI, Symptomatic plaque volume, and NIHSS scores. ResultsSignificant increases were observed in rSI (1.32 ± 0.32 to 1.69 ± 0.25, p < 0.001) and HI plaque volume (296.4 ± 362.7 mm³ to 717.5 ± 554.9 mm³, p < 0.001) from asymptomatic to symptomatic phases. Past smoking (p = 0.008) and statin use (p = 0.04) were associated with higher Symptomatic rSI, while poor risk factor control (p = 0.03) was negatively associated. Female sex (p = 0.007) and current smoking (p = 0.009) were linked to smaller Symptomatic plaque volumes, while ischemic heart disease (p = 0.0002) and poor risk factor control (p = 0.002) predicted larger plaque volumes. Larger plaques were correlated with higher NIHSS scores (p = 0.002). ConclusionsIPH and plaque volume are key markers of progression in low-grade carotid stenosis. Poor control of cardiovascular risk factors and a history of ischemic heart disease contribute to plaque burden and stroke severity. Continuous monitoring and strict risk management are essential in reducing stroke severity in these patients.

The Indirect Effects of Negative Affect Reduction Motives on the Relationship Between Sex and Severity of Problems When Trying to Quit Among Black Adults Who Smoke

Background. African American/Black (hereafter referred to as Black) persons who smoke constitute a tobacco disparities group in the United States. Within the Black population, female smokers experience a disproportionate percentage of these disparities and are less likely to quit cigarettes than their male counterparts. Two factors implicated in female smokers’ relatively worse quit success are (1) motives to smoke to reduce negative affect and (2) expectancies that smoking will reduce negative affect. Objectives. The present study sought to test sex differences in these two clinically relevant cognitive constructs and evaluate the indirect effects of sex and severity of problems when trying to quit via smoking motives and expectancies for negative affect reduction among Black adults who smoke. Participants included 103 Black adults who smoke daily (72% male; Mage = 44.5 years, SD = 11.5 years). Results. Results revealed sex differences in both negative affect reduction motives and expectancies, as well as a partial indirect effect for sex on the severity of problems when trying to quit through negative affect reduction motives (a1b1 = 0.18, 95% CI [0.04, 0.38]) but not negative affect reduction expectancies (a2b2 = −0.01, 95% CI [-0.11, 0.09]) in a simultaneous model of indirect effects. Conclusions. These findings shed light on the complex relationship between race, sex, and severity of problems when trying to quit, particularly when complicated by smoking motives and expectancies. Current data should be considered when developing sex-specific, tailored smoking cessation interventions for Black women.

Smokers' Characteristics Associated with Successful Smoking Cessation Undergoing Pharmacotherapy in Slovenia.

Tobacco use is a major global health problem, contributing to premature death and disability. In Slovenia, the prevalence of smoking is higher than the EU average, emphasizing the need for effective tobacco control measures. The aim of this study was to identify the characteristics of patients most likely to benefit from pharmacotherapy for smoking cessation. We performed cross-sectional analysis of factors associated with successful smoking cessation using pharmacotherapy for Slovenian smokers. A total of 176 (24.6%) smokers with an average age of 50 years agreed to receive pharmacotherapy for their smoking cessation attempt and were enrolled in the study. Participants were followed up at 4-week intervals during treatment and for 24 weeks after completion of pharmacotherapy. Attempts to quit smoking with prescription medications were successful in 24.4% of those willing to try. Female smokers, older persons, those with more children, with a lower self-perception of health, a higher number of cigarettes per day and a higher nicotine dependence were more likely to attempt to quit smoking. However, the strongest predictors of smoking cessation success were lower nicotine dependence, which was tested using the Fagerström test for nicotine dependence, and higher adherence to pharmacotherapy. Nicotine dependence and adherence to pharmacotherapy are the strongest predictors of a successful smoking cessation attempt. Identification of potential responders, prescription of pharmacotherapy and follow-up are applicable in the primary healthcare setting.

Prognostic Factors for Outcome of Fusion Surgery in Patients With Chronic Low Back Pain - A Systematic Review.

Systematic review. This systematic review aims to identify prognostic factors, encompassing biomedical and psychosocial variables, linked to outcome of fusion surgery for chronic low back pain (CLBP) in single or two-level lumbar degenerative spinal disorders. Identifying these factors is crucial for decision making and therefore long-term treatment outcome. A systematic search (PROSPERO ID: CRD4202018927) from January 2010 to October 2022 was conducted, utilizing Medline, Embase, and the Cochrane Database of Systematic Reviews (CDSR, CENTRAL). Prognostic factors associated with various outcomes, including functional status, back and leg pain, health-related quality of life, complications, return to work, and analgesic use, were assessed. Risk of bias was determined using QUIPS, and the quality of evidence was evaluated using GRADE approach. Of the 9852 initially screened studies, eleven studies (n = 16,482) were included in the analysis. In total, 161 associations were identified, with 67 prognostic factors showing statistical significance (P < 0.05). Thirty associations were supported by two or more studies, and only eight associations were eligible for meta-analyses: female gender remained statistically significant associated with decreased postoperative back pain, but negatively associated with complication rates and functional status, and smoking with increased postoperative back pain. Only female gender and smoking were consistently associated with outcome of fusion for CLBP. Most of the included studies exhibited low to moderate methodological quality, which may explain the relatively weak associations identified for the assessed prognostic factors.

Resistance to anti-smoking messages related to the higher smoking stigma of Korean female smokers.

The degree of perceived smoking stigma can differ, based on various factors such as gender; this may influence the effect of smoking cessation interventions, including denormalization. This study investigates the gender differences in smoking stigma recognized by Korean smokers and explores the effect of these differences on the success of smoking cessation messages that aim to initiate an identity crisis among smokers. It aims to contribute to effective smoking cessation intervention strategies for female smokers. The smoker-gender Implicit Association Test (IAT) was used to measure gender-based smoking stigma; the test comprised photos of people smoking, with positive and negative descriptors. Participants were 120 smokers aged 19-35 years (60 males and 60 females). Participants' cognitive attitudes toward smoking and cessation intentions were assessed at baseline. To investigate the effect of social stigmatization on smokers, participants were asked to watch anti-smoking campaigns that stigmatized either smoking behavior or smokers' self-identity. Cognitive attitudes and cessations intention were used to show differences in gender and message conditions. The IAT D-score showed that female smokers perceived other female smokers significantly more negatively than they did male smokers, suggesting a higher level of smoking stigma. Female smokers in the socially stigmatizing condition reduced their negativity toward smoking less than those who were not stigmatized. Moreover, cessation intentions did not improve when female smokers received identity-threatening messages, indicating that female smokers tended to resist stigmatizing messages. These findings provide empirical evidence that the gender of Korean smokers is significantly related to differences in smoking stigma. The negative perception and resistance responses of female smokers shown in this study are consistent with the findings of previous studies on the stigma of substance use disorders and addiction. High smoking stigma can also be a risk factor in anti-smoking interventions, including health communication; therefore, these findings should be interpreted with caution.

Biological monitoring of exposure to benzene in water pipe smokers of rural Western Uttar Pradesh (India)

Aim: Present study was performed to investigate the possible human exposure to benzene through water pipe smoking, if any, in the selected rural population of Western Uttar Pradesh. Methodology: Urine samples from water pipe smokers of both the sexes were collected and analyzed for urinary concentration of phenol, creatinine and malondialdehyde employing standard methods. Results: The results showed that tobacco used by selected rural population contained traces of benzene in the range of 2.75 to 9.682µl ml-1. Analysis of urine samples for phenol, a major metabolite of benzene, showed its increased concentrations in water pipe smokers than non smokers. Further, the effects of age and gender differences on the excretion of phenol were also recorded. Female water pipe smokers were found to be more vulnerable to benzene exposure than male smokers. Intriguingly, alcoholic water pipe smokers were less vulnerable than the non-alcoholic smokers. Interpretation: It is concluded that respiratory, cardiac and haematological disorders caused by water pipe smoking might be attributed to long term benzene exposure amongst water pipe smokers. Large scale epidemiological studies are warranted in Indian rural population considering WHO (Framework Convention on Tobacco Control) regulations of water pipe smoking and tobacco products. Key words: Biological monitoring, Benzene, Oxidative stress, Phenol, Tobacco, Waterpipe smoking

Evaluating the cost-effectiveness of polygenic risk score-stratified screening for abdominal aortic aneurysm

As the heritability of abdominal aortic aneurysm (AAA) is high and AAA partially shares genetic architecture with other cardiovascular diseases, genetic information could help inform AAA screening strategies. Exploiting pleiotropy and meta-analysing summary data from large studies, we construct a polygenic risk score (PRS) for AAA. Leveraging related traits improves PRS performance (R2) by 22.7%, relative to using AAA alone. Compared with the low PRS tertile, intermediate and high tertiles have hazard ratios for AAA of 2.13 (95%CI 1.61, 2.82) and 3.70 (95%CI 2.86, 4.80) respectively, adjusted for clinical risk factors. Using simulation modelling, we compare PRS- and smoking-stratified screening with inviting men at age 65 and not inviting women (current UK strategy). In a futuristic scenario where genomic information is available, our modelling suggests inviting male current smokers with high PRS earlier than 65 and screening female smokers with high/intermediate PRS at 65 and 70 respectively, may improve cost-effectiveness.

Integrated multiscale analysis reveals complex gender-specific changes in lymphocytes of smokers

Environmental stressors induce specific physiological responses that can be measured in the blood, notably by morphological changes in lymphocytes. Tobacco being the best-known stress in terms of its impact on health, we studied the physiological properties of peripheral blood lymphocytes in a population of 33 healthy non-smokers and smokers. Proteasome amount, mitochondria energy levels, changes in membrane properties and cell and nuclear size were analyzed to obtain 28 parameters from two fluorescence-based techniques: flow cytometry and cell imaging. The results showed that none of the parameters alone identified gender and smoking status, but that statistical analysis of these parameters, whether or not combined with a third set of data, hematological data, can. Statistical analysis of selected parameters clearly discriminates between male and female samples, as well as smokers and non-smokers. Effects of tobacco smoke pollutants are more pronounced in female smokers than in other groups.

Lung cancer screening in never smokers.

Low-dose computed tomography (LDCT) lung cancer screening has been established in smokers, but its role in never smokers remains unclear. The differences in lung cancer biology between smokers and nonsmokers highlight the importance of a discriminated approach. This overview focuses on the emerging data and implementation challenges for LDCT screening in nonsmokers. The first LDCT screening study in nonsmokers enriched with risk factors demonstrated a lung cancer detection rate double that of the phase 3 trials in smokers. The relative risk of lung cancer detected by LDCT has also been found to be similar amongst female never smokers and male ever smokers in Asia. Majority of lung cancers detected through LDCT screening are stage 0/1, leading to concerns of overdiagnosis. Risk prediction models to enhance individual selection and nodule management could be useful to enhance the utility of LDCT screening in never smokers. With appropriate risk stratification, LDCT screening in never smokers may attain similar efficacy as compared to smokers. A global effort is needed to generate evidence surrounding optimal screening strategies, as well as health and economic benefits to determine the suitability of widespread implementation.

Early neurological deterioration in acute lacunar ischemic stroke: Systematic review of incidence, mechanisms, and prospects for treatment.

Cerebral small vessel disease (CSVD) causes between 25% and 30% of all ischemic strokes. In acute lacunar ischemic stroke, despite often mild initial symptoms, early neurological deterioration (END) occurs in approximately 15-20% of patients and is associated with poor functional outcome, yet its mechanisms are not well understood. In this review, we systematically evaluated data on: (1) definitions and incidence of END, (2) mechanisms of small vessel occlusion, (3) predictors and mechanisms of END, and (4) prospects for the prevention or treatment of patients with END. We identified 67 reports (including 13,407 participants) describing the incidence of END in acute lacunar ischemic stroke. The specified timescale for END varied from <24 h to 3 weeks. The rate of END ranged between 2.3% and 47.5% with a pooled incidence of 23.54% (95% confidence interval (CI) = 21.02-26.05) but heterogeneity was high (I2 = 90.29%). The rates of END defined by National Institutes of Health Stroke Scale (NIHSS) decreases of ⩾1, ⩾2, ⩾3, and 4 points were as follows: 24.17 (21.19-27.16)%, 22.98 (20.48-25.30)%, 23.33 (16.23-30.42)%, and 10.79 (2.09-23.13)%, respectively, with lowest heterogeneity and greatest precision for a cutoff of ⩾2 points. Of the 20/67 studies (30%) reporting associations of END with clinical outcome, 19/20 (95%) reported worse outcomes (usually measured using the modified Rankin score at 90 days or at hospital discharge) in patients with END. In a meta-regression analysis, female sex, hypertension, diabetes, and smoking were associated with END. END occurs in more than 20% of patients with acute lacunar ischemic stroke and might provide a novel target for clinical trials. A definition of an NIHSS ⩾2 decrease is most used and provides the best between-study homogeneity. END is consistently associated with poor functional outcome. Further research is needed to better identify patients at risk of END, to understand the underlying mechanisms, and to carry out new trials to test potential interventions.

Influence of Cardiovascular Risk Factors Among Patients with Covid 19 Infection and its Association with In-Hospital Outcome – A Multicentre Prospective Observational Study

Introduction: The global spread of COVID-19, first identified in Wuhan, China, in December 2019, has ignited an unprecedented ongoing global pandemic. Risk stratification of these patients is crucial to optimize the use of hospital resources. Several associations with adverse outcomes in COVID-19 patients have been identified, including factors that also predispose to cardiovascular disease (CVD), such as older age, male sex, hypertension, overweight and diabetes. In this context we designed this study to observe Association of Cardiovascular risk factors with patients infected with Covid 19 and it’s in-hospital outcome. Materials and Methods: In this prospective observational study total 408 adult patients who were reverse transcription polymerase chain reaction (Rt-PCR) positive for COVID-19 were included. They were admitted in Sarkari Karmachari Hospital, Kuwait Bangladesh Friendship Government Hospital and Dr. Sirajul Islam Medical College between June 2020 to June 2022. Patients with severe comorbidities like Acute myocardial infarction, Stroke, Acute kidney injury, malignancy and pregnant women were excluded from the study. Appropriate informed written consent was obtained. Demographic and clinical data were correlated with outcome. The statistical analysis was carried out using the Statistical Package for Social Sciences version 22.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Qualitative variables were expressed as frequency and percentage. Quantitative variables were expressed as mean ± standard deviation and median. Test of significance was performed by unpaired t-test for quantitative variable and Chi square test for qualitative variables. In addition, multivariate logistic regression analysis of possible risk factors was done to determine the association with outcome by calculating odds ratio with 95% confidence intervals. A p value &lt;0.05 was be considered as significant. Results: The mean age of participants was 45.2±13.4 years among them 263 (64.5%) were male and 145 (35.5%)were female. According to BMI maximum male 126 (47.9%) were normal weight group whereas maximum female 63(43.4%) were obese. Considering cardiovascular risk factors among male and female Smoking were 160 (60.8%) vs. 38 (26.2%), Hypertension were 105 (39.9%) vs. 65 (44.8%), Diabetes Mellitus were 71 (27.0%) vs 55 (37.9%), Dyslipidemia were 69 (26.2%) vs. 36 (24.8%), Family history of CVD were 55 (20.9%) vs.20 (13.8%) and Clustering of risk factors (≥2 factors) were 117 (44.5%) vs. 74 (51.0%). Among the study population 81 (19.9%) needed oxygen therapy , 50 (12.3%) needed Non-invasive ventilation, 34 (8.3%) patients needed Mechanical Ventilation, Among the study subjects total 27 (6.61%) expired and maximum number of patients 15 (55.6%) were in 61-80 years age group. Regression analysis for the predictors of adverse in hospital outcome among the Cardiovascular risk factors showed Age (&gt;60yrs) (p= 0.034), BMI (&gt;25) (p= 0.026), Smoking (p= 0.041), Hypertension (p= 0.037) Diabetes Mellitus (p= 0.013), Dyslipidemia (p= 0.021) and Clustering of risk factors (≥2) (p= 0.012) were statistically significant contributors. Conclusion: In conclusion, this study shows that Age (&gt;60yrs), BMI (&gt;25), Smoking, Hypertension, Diabetes Mellitus, Dyslipidemia, clustering of risk factors (≥2) have greater risk of adverse outcomes including death from COVID-19. It is recommended that individuals with cardiovascular risk factors, especially older men and women, should be focus of public health measures and must be informed regarding increased risk of death in COVID-19. It is likely that with proper preventive and therapeutic interventions the higher risk of adverse outcomes in COVIDF-19 patients with cardiovascular risk factors can be mitigated. We need to be more vigilant in controlling CVD risk factors since it not only increases the morbidity of non-communicable diseases, but also poses to and worsens the outcome of communicable diseases. Bangladesh Heart Journal 2024; 39(2): 85–92

Lung function and health-related quality of life among adult patients following pulmonary TB treatment.

<sec><title>OBJECTIVES</title>Pulmonary TB (PTB) increases the risk of chronic lung complications, which are associated with increased morbidity and mortality. We determined the prevalence and predictors of post-TB lung disease and persistent symptoms in a resource-limited setting.</sec><sec><title>METHODS</title>Adults who completed PTB treatment underwent spirometry and completed the St. George's Respiratory Questionnaire (SGRQ), a questionnaire that assesses quality of life on symptom, activity, and impact. We performed multivariate analyses to calculate the X-adjusted prevalence ratio (PRadj) of abnormal spirometry and identify associated risk factors.</sec><sec><title>RESULTS</title>Among the 162 participants, 89 (54.9%) were male. The median age was 32 years, and 65 (40.1%) had HIV. Overall, 65 participants (40.1%) had abnormal lung function, with spirometric restriction seen in 29.0%, obstruction in 4.9%, and a mixed pattern in 6.2%. Smoking (PRadj 1.88, 95% CI 1.11-3.16; P = 0.02) and female sex (PRadj 1.81, 95% Cl 1.15-2.84; P = 0.01) were independent risk factors for abnormal lung function. The median SGRQ scores were higher in participants with cavitation (P < 0.001) or bilateral consolidation on initial chest X-ray (P = 0.01).</sec><sec><title>CONCLUSIONS</title>Lung function abnormalities, particularly spirometric restriction, are common in patients completing PTB treatment. Female sex and smoking status were associated with lung function abnormalities; therefore, additional studies to understand the underlying mechanistic pathways are warranted.</sec>.