History Of Tobacco Smoking Research Articles

Determinants of Dietary Pattern & Non Communicable Diseases among Adult Population of Districts Kohat & Nowshera KP

Aim: To estimate the burden of non-communicable diseases and to assess the dietary pattern along with important relevant determinants among adult population of district Kohat & Nowshera Khyber Pukhtunkhwa Pakistan Study Design: A descriptive cross sectional study Place & Duration: This study was conducted in Kohat & Nowshera Districts of Khyber Pukhtunkhwa Pakistan; from June to December 2022. Methodology: A total of n=385 male adults was selected and a structured questionnaire was used to collect relevant information regarding demographic, dietary, behavioral determinants. Finally data was analyzed and presented in form of text and tables. Results: Results showed that 55.71% had age above 37 years; 28.31% were illiterate; 25.71% had monthly income more than 45000/ PKR; 60.78% were married; and 82.08% were employed. Moreover, 30.39% were current tobacco smoking; and 24.68% had positive history of past tobacco smoking. Furthermore, 44.94% prefer high caloric; 40.78% vegetables; 45.19% meat; 63,38% fresh fruits; and 18.70% & 21.30% prefer too much sugar and salt in food respectively. Furthermore; hypertension, malnutrition, eye problems and cancer were found among 22.60%, 59.74%, 7.01% & 2.08% respectively. Conclusions: It was concluded that common non-communicable diseases were present in the studied male adults and showed strong relationship with dietary pattern along with demographic, epidemiological and socio-economical determinants. Moreover, effective and efficient policies and strategies were needed to reduce the double burden of non-communicable disease and its associated complications. Keywords: Prevalence, Determinants, Diet, Vegetables, Overweight, Obesity, Tobacco, Adults

Preoperative Prediction of Sinonasal Inverted Papilloma-associated Squamous Cell Carcinoma (IP-SCC).

Sinonasal inverted papillomas (IP) can undergo transformation into IP-squamous cell carcinomas (IP-SCC). More aggressive treatment plan should be established when IP-SCC is suspected. Nevertheless, inaccuracy of the preoperative punch biopsy results to detect IP-SCC from IP raises the need for an additional strategy. The present study aimed to investigate significant clinicoradiological remarks associated with IP-SCC than IP. Postoperative surgical specimens obtained from patients with confirmed IP or IP-SCC at a single tertiary medical center from 1997 to 2018 were retrospectively evaluated. Patients' demographic and clinical characteristics, preoperative in-office punch biopsy results, and preoperative computed tomography (CT) or magnetic resonance images were reviewed. Univariate and multivariate analyses were performed to assess the odds ratio (OR) associated with IP-SCC. The area under the curve (AUC) in the receiver Operating Characteristic (ROC) curve was calculated in the prediction model to discriminate IP-SCC from IP. The study included 44 IP-SCC and 301 patients with IP. The diagnostic sensitivity of in-office punch biopsy to detect IP-SCC was 70.7%. Multivariate analysis showed that factors significantly associated with IP-SCC included tobacco smoking >10PY (adjusted-OR [aOR]: 4.1), epistaxis (aOR: 3.4), facial pain (aOR: 4.2), bony destruction (aOR: 37.6), bony remodeling (aOR: 36.3), and invasion of adjacent structures (aOR: 31.6) (all p < 0.05). Combining all significantly related clinicoradiological features, the ability to discriminate IP-SCC from IP reached an AUC of 0.974. IP patients with a history of tobacco smoking, facial pain, epistaxis, and bony destruction, remodeling, or invasion of an adjacent structure on preoperative images may be at higher risk for IP-SCC. 3 Laryngoscope, 133:2502-2510, 2023.

Abstract A077: Are anthropometric measures associated with prostate cancer in Nigerian men?

Abstract Purpose/Objective(s): Despite prostate cancer (PCa) being a public health problem globally, much remains unknown of its etiology. Though obesity is a probable risk factor for prostate cancer measurable by anthropometric indices, its impact on PCa development with other risk factors has not been explored among Nigerian men. This study was designed to test the hypothesis that anthropometric indices are higher in prostate cancer patients compared to age-matched healthy controls. Materials/Methods: The study was a case-control study conducted in four tertiary hospitals in Nigeria. The cases were newly diagnosed prostate cancer patients, while the controls were age-matched healthy men confirmed to be cancer-free with normal PSA. Patients with weight loss (self-reported) in the past month, ECOG ≥3, and uncontrolled comorbidities (diabetes and hypertension) were not eligible. Socio-demographics (age, marital status, ethnicity, the highest level of education, occupation, and employment status) and clinical history (high-fat diet, physical activity, cigarette smoking, alcohol, family history of prostate cancer, and Gleason score [for cases]) using an interviewer-administered questionnaire, and anthropometric measures (weight, height, body mass index, waist circumference, hip circumference, and waist-hip ratio [WHR]) physically measured were obtained from all participants. The socio-demographics and the clinical history were compared between cases and controls using a chi-square test. The comparison of the anthropometric measures between the groups and their correlation with Gleason's score were determined using a t-test. Results: Seventy-three prostate cancer cases (PCa) and seventy-three age-matched healthy controls (Co) were recruited for the study. The mean age was 64.20 years (SD = 6.184). Only the mean WHR was of significant difference between the PCa and the Co (0.98 [SD=0.07] PCa: 0.93 [SD=0.06] Co, p=&amp;lt;0.0001). Forty-three (58.9%) of the cases had high-grade diseases (Gleason Score 8-10). No significant association was found between anthropometric indices and the disease grade. PCa and Co groups differ by regular exercise (32PCa [43.8%]:47Co [64.4%]; p=0.013), family history of PCa (14PCa [19.2%]:2Co [2.7%]; p=0.001), tobacco smoking (28PCa [38.4%]:15Co [20.5%]; p=0.018), and alcohol consumption (57PCa [78.1%]:43Co [58.9%]; p=0.013). Conclusion: Patients with PCa had higher WHR and were more likely physically inactive, have a family history of prostate cancer, smoke tobacco, or drink alcohol. PCa in Nigerian men are predominantly high-grade, and there was no association between Gleason grade and anthropometric indices. Citation Format: Kehinde O. Adeyinka. Are anthropometric measures associated with prostate cancer in Nigerian men? [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A077.

Individual approach in treating patients with pulmonary and tracheobronchial tuberculosis, with a long history of tobacco smoking and decompensated diabetes mellitus

Introduction. At the end of 2020, the clinical cure rate in all registration groups of patients with pulmonary tuberculosis was 48.2 %. There is now ample evidence that additional risk factors influence the more severe course of pulmonary tuberculosis and reduce the effectiveness of standard anti-tuberculosis therapeutic programs. Diabetes mellitus and tobacco use are among the significant risk factors. Complementing standard TB therapeutic programs with nicotine addiction and diabetes mellitus treatment programs with the formation of an individual comprehensive patient treatment plan will increase the effectiveness of TB treatment. Thus, the goal of this work is to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.The aim of the work was to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.Materials and methods At the Central TB Research Institute the patient underwent a comprehensive examination, including mandatory, additional and facultative methods of investigation. Based on the findings, the patient underwent complex treatment: antituberculosis chemotherapy, correction of carbohydrate metabolism disorders using oral antidiabetic drugs, nicotine replacement therapy according to the selected scheme, taking into account the degree of nicotine addiction.Results and Discussion Against the background of complex treatment, by four months of therapy the following was achieved: knockdown of systemic inflammatory reactions, cessation of bacterial excretion, compensation of diabetes mellitus. X-ray examination revealed closure of a large decay cavity, resorption and consolidation of focal infiltrative changes. There was regression of infiltrative changes of trachea and bronchi. The patient completely stopped using tobacco due to nicotine replacement therapy.Conclusion This clinical example demonstrates the high effectiveness of an individualized approach to the treatment of tuberculosis, including the need for an individualized regimen of anti-tuberculosis therapy, adequate compensation for diabetes mellitus, and the implementation of relevant smoking cessation techniques among smokers with pulmonary tuberculosis.

Cannabis Use in Patients Seen in an Academic Radiation Oncology Department

PurposeCannabis use rates are increasing in the United States. Patients with cancer use cannabis for many reasons, even without high-quality supporting data. This study sought to characterize cannabis use among patients seen in radiation oncology in a state that has legalized adult nonmedical use cannabis and to identify key cannabis-related educational topics. Methods and MaterialsCannabis history was documented by providers using a structured template at patient visits in an academic radiation oncology practice October 2020 to November 2021. Cannabis use data, including recency/frequency of use, reason, and mode of administration, were summarized, and logistic regression was used to explore associations between patient and disease characteristics and recent cannabis use. A multivariable model employed stepwise variable selection using the Akaike Information Criterion. ResultsOf 3143 patients total, 91 (2.9%) declined to answer cannabis use questions, and 343 (10.9%) endorsed recent use (≤1 month ago), 235 (7.5%) noted nonrecent use (>1 month ago), and 2474 (78.7%) denied history of cannabis use. In multivariable analyses, those ≥50 years old (odds ratio [OR], 0.409; 95% confidence interval [CI], 0.294-0.568; P < .001) or with history of prior courses of radiation (OR, 0.748; 95% CI, 0.572-0.979; P = .034) were less likely, and those with a mental health diagnosis not related to substance use (OR, 1.533; 95% CI, 1.171-2.005; P = .002) or who smoked tobacco (OR, 3.003; 95% CI, 2.098-4.299; P < .001) were more likely to endorse recent cannabis use. Patients reported pain, insomnia, and anxiety as the most common reasons for use. Smoking was the most common mode of administration. ConclusionsPatients are willing to discuss cannabis use with providers and reported recent cannabis use for a variety of reasons. Younger patients new to oncologic care and those with a history of mental illness or tobacco smoking may benefit most from discussions about cannabis given higher rates of cannabis use in these groups.

Pollutant Levels at Cooking Place and Their Association with Respiratory Symptoms in Women in a Rural Area of Delhi-NCR

Household air pollution resulting from biomass and coal stoves is implicated in more than one-third cases of annual deaths from chronic lung diseases worldwide and nearly 3% of lung cancer deaths. This burden is borne largely by poor women in the developing countries. We carried out a study to evaluate its association with respiratory symptoms in women in a rural area. The study was carried out using a standard questionnaire, in 92 households including 174 women. The data on respiratory symptoms in women, kitchen type and location in households, type of fuel used for cooking, permanent ventilation in kitchen, presence of exhaust, history of tobacco smoking and indoor pollution level were obtained. Spirometery of participants was conducted. The indoor particulate matter (PM10, PM2.5 and PM1) and volatile organic compounds (VOCs) were measured in each home. The households were divided into two groups according to the location of the kitchen. In 46 households (Group A) women had a separate room as kitchen for cooking with good ventilation and exhaust conditions; and in the remaining 46 households (Group B) cooking was done in the living area. Seventy (76.1%) households used biomass fuel for cooking and heating (37; 80.4%, in Group A versus 46; 100% in Group B). The proportion of women with respiratory symptoms for one year or more was significantly high in Group B compared to Group A (13.0% versus 3.1% p = 0.01). The households which did not have a separate kitchen (Group B) had higher particulate matter and VOCs concentration. This study contributes to the growing evidence of adverse impact of indoor air pollution from biomass combustion on health of females. Results of the study demonstrated significantly high particulate matter (PM2.5), in households not using a separate room for cooking with biomass fuel.

Smoking and Its Prognostic Effect on Survival in Patients with TP53 Mutated MDS

INTRODUCTION: Smoking is an established risk factor for myelodysplastic syndrome (MDS). While smoking has been shown to be correlated with TP53 mutation in multiple solid malignancies, and TP53 mutated MDS has been shown to have poorer survival, there is a paucity of data on the prognostic effect of smoking on survival in patients with TP53 mutated MDS. To further characterize this, we performed a retrospective study to investigate the relationship between smoking and survival in patients with TP53 mutated MDS. METHODS: After IRB approval, a total of 127 patients with MDS who were treated at Thomas Jefferson University Hospital from January 2016 to February 2020 were included in the study. All diagnoses were reviewed by a hematopathologist and TP53 mutation status was confirmed by in-house next generation sequencing. Patient data was collected from the date of MDS diagnosis until death or date of last follow up. Ever-smokers were defined as any patient with a history of tobacco smoking or current smokers, while non-smokers were defined as those with no history of tobacco smoking as documented in the electronic medical record. Data was also collected on revised international prognostic scoring system (R-IPSS) scores. Univariate associations were compared between variables of interest and smoking status. The Wilcoxon rank-sum test was used to assess difference between continuous variables and the chi-squared test was used to assess difference between categorical variables. RESULTS: Median overall survival (mOS) for the entire study cohort was 2.63 years (95% CI 2.10-4.29). In patients with TP53 mutations (n=35) we saw no survival difference between ever-smokers (0.64 years; 95% CI 0.30-1.19) and non-smokers (0.79 years; 95% CI 0.49-not reached), p=0.96. Overall, smokers had a shortened mOS (2.22 years; 95% CI 1.31-3.06) compared to never-smokers (4.30 years; 95% CI 2.62-7.61), trending towards significance with p=0.053. After stratification by smoking status, Caucasian smokers showed significantly reduced mOS (2.22 years; 95% CI 1.19-3.38) compared to non-smokers (5.65 years; 95% CI 3.23-7.8; p<0.05). Analysis looking at patients with high/very high risk R-IPSS scores also showed reduced survival for ever-smokers (0.64 years; 95% CI 0.53-0.88) compared to non-smokers (0.97 years; 95% CI 0.49-not reached), trending towards significance with p=0.06. For the whole cohort, high and very high risk IPSS-R scores (mOS 0.64; 95% CI 0.56-0.97) showed significantly reduced mOS compared to low and intermediate scores (mOS 4.49; 95% CI 2.8-7.74) with p<0.001. TP53 mutated MDS also showed decreased survival with mOS 0.64 years (95% CI 0.5-0.97) compared to mOS 4.49 years (95% CI 2.8-7.74) for wild type TP53 with p<0.001. CONCLUSION: We found no survival difference between ever-smokers and non-smokers in patient with TP53 mutated MDS. However, we did find a convincing trend towards poorer survival in ever-smokers compared to non-smokers in all patients, with a statistically significant reduction in survival in the Caucasian subgroup. Although there was no survival difference in the TP53 mutated cohort, the overall survival difference in the cohort as a whole suggests that smoking may play a role in more aggressive disease. Given the short survival time for TP53 mutated MDS, further studies with higher power may be required to distinguish survival differences. Future studies should also assess the impact of smoking on other cytogenetic and molecular subgroups of patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Systemic aftermaths of tobacco addiction on the physiological composite of human secretome and the prognostic potential of U2AF26 in oral cancers

ObjectivesTobacco chewing and smoking practices have been a common trend among human populations. Tobacco addiction is a commonly known etiology for oral cancers. The study showcases a clinical case (I_5; a 36y male) with a chronic inflamed persistent oral lesion and positive addiction history of tobacco chewing & smoking to screen out a prognostic target for oral malignancy. MethodTwo-dimensional gel electrophoreses (2DE), using the depleted serum proteome of I_5 and healthy control, were performed for resolving the complex protein repertoire of the secretome. MALDI-TOF-MS and in-silico peptide analyses were used for characterizing the 2DE protein spot of interest. The relative real-time PCR, used for validation of the modulations in the expression of the gene of interest, involved oral cancer (n = 14) and pre-cancer lesions (n = 9). The adjacent normal tissues (encircling oral diseased lesions) and healthy oral epithelia were used as the controls. ResultsThe comparative analysis of 2DE profiles uncovered substantial disparities between the depleted secretome of the case (I_5) and the control. The qualitative differential spot ‘a’ (absent in I_5 but present in healthy control) corresponding to HNCUP U2AF26-III was found to down-regulate in the serum proteome of OSCC cases (both tobacco addicts & non-addicts) compared to healthy non-addicts. Also, the expression of the nccpU2AF26 showed significant down-regulation in oral-precancerous and cancerous samples in comparison with the healthy oral epithelia while the expression levels were found to be significantly up-regulated when lesions were compared with their adjacent normal tissues. ConclusionsThe serum proteome of a chronic tobacco addict deficits in multiple proteins constituting the physiological human secretome. The U2AF26-III may function as a prognostic biomarker and therapeutic target for oral malignancies. Also, a non-canonical transcript (nccpU2AF26) lacking exon 3 and 4 was identified to be present in normal oral epithelia and POLs, highlighting the need for rigorous analyses of the role(s) played by U2AF26 non-canonical isoform(s) in the genesis of oral precancer and cancer lesions.

Trauma recidivism is pervasive and is associated with mental and social health opportunities

IntroductionRecidivism after orthopedic trauma results in greater morbidity and costs. Prior studies explored the effects of social and medical factors affecting the frequency of return to the hospital with new, unrelated injury. Identification of mental, social and other risk factors for trauma recidivism may provide opportunities for mitigation. The purposes of this study are to determine the rates of subsequent, unrelated injury noted among orthopedic trauma patients at a large urban trauma center and to evaluate what patient and injury features are associated with greater rates of trauma recidivism. We hypothesize higher rates of new injuries will be related to ballistic trauma and other forms of assault, alcohol and recreational drug use, unemployment, and unmarried status among our trauma patients. MethodsA series of 954 skeletally mature patients at a level 1 trauma center over a 5 year period were included in the study. All were treated operatively for thoracolumbar, pelvic ring, acetabulum, and/or proximal or shaft femoral fractures from a high energy mechanism. Retrospective review of demographic, injury, medical, and social factors, and subsequent care was performed. Trauma recidivism was defined as returning to the emergency department for treatment of any new injury. A backward stepwise logistic regression statistical analysis was used to identify independent predictors of recidivism. ResultsMean age of all patients was 41.2 years, and 73.2% were male. 136 patients (14.3%) returned with a new injury within a mean of 21 months. These trauma recidivists were more likely to sustain a GSW (22.1% vs 11.4%, p = 0.001). They had higher rates of substance use, including tobacco (57.4% vs 41.8%, p = 0.001) and recreational drugs (50.7% vs 34.4%, p = 0.001), and were less likely to be married (10% vs 25.9%, p<0.001). Mental illness was pervasive, noted in 56.6% of patients with new injury (vs 32.8%, p<0.001). Medicaid insurance was most common in the trauma recidivist population (58.1% vs 35.0%, p = 0.001), and 12.5% were uninsured. Completing high school or more education was protective (93% non-recidivist (vs 79%, p = 0.001). Sixty-nine patients (50.7%) were repeat trauma recidivists within the study period. Independent predictors of new injury included recreational drug use (OR 1.64, p = 0.05) and history of assault due to GSW or other means (OR 1.67, p = 0.05). History of pre-existing mental illness represented the greatest risk factor for trauma recidivism (OR 2.55, p<0.001). DiscussionNew injuries resulting in emergency department presentation after prior orthopedic trauma occurred in 14.3% and were associated with history of assault, lower education, Medicaid insurance, tobacco smoking and recreational drug use. Mental illness was the greatest risk factor. Over half of patients with these additional injuries were repeat trauma recidivists, returning for another new injury within less than 2 years. Awareness of risk factors may promote focused education and other interventions to mitigate this burden. Level of EvidenceLevel 3 retrospective, prognostic

Factors Associated With the Development of Tinnitus and With the Degree of Annoyance Caused by Newly Developed Tinnitus.

Objectives:Tinnitus is highly prevalent, but only a few risk factors for developing tinnitus are known and little is known about factors associated with the degree of annoyance of new-onset tinnitus. Longitudinal analysis can reveal risk factors associated with the development of tinnitus and might lead to targeted prevention. The aim of this study is twofold. (1) To identify risk factors that are longitudinally associated with the odds of developing tinnitus 5 years later. (2) To identify factors that are cross-sectionally associated with tinnitus annoyance in adults with new-onset tinnitus.Methods:Baseline, 5-year, and 10-year follow-up data of participants in the Netherlands Longitudinal Study on Hearing (NL-SH) were used. The NL-SH is a web-based prospective cohort study, which started in 2006 and includes both normal hearing and hearing-impaired adults aged 18 to 70 years at baseline. The NL-SH uses an online digit-triplet speech-in-noise test to asses speech recognition ability in noise, and online questionnaires on various aspects of life. At follow-up, participants are asked (1) if they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0 to 100 numeric rating scale. We investigated whether demographic (age, sex, living arrangement, educational level), lifestyle (history of tobacco smoking, alcohol use), health (asthma, severe heart disease, hypertension, history of stroke, osteoarthritis, rheumatoid arthritis, epilepsy, multiple sclerosis, and migraine), hearing (speech recognition ability in noise, hyperacusis, and occupational noise exposure), and psychological variables (distress, somatization, depression, and anxiety) were potential risk factors for new-onset tinnitus, or associated with annoyance caused by new-onset tinnitus. Generalized estimating equations were used to longitudinally analyze the association between potential risk factors and new-onset tinnitus measured 5 years later. A multivariable association model was constructed using a forward selection procedure with p < 0.05 for model entry. Linear regression analysis was used to cross-sectionally analyze the association between potential factors and tinnitus annoyance in new-onset tinnitus. For this purpose, a multivariable association model was constructed using a forward selection procedure with p <0.05 for model entry.Results:In total, 734 participants without tinnitus at baseline were included, from which 137 participants reported to suffer from new-onset tinnitus 5 or 10 years later. Risk factors for new-onset tinnitus were history of smoking (odds ratio 1.5, 95% confidence interval [CI] 1.0 to 2.2, p = 0.027) and higher levels of somatization (odds ratio 2.0, 95% CI 1.2 to 3.3, overall p = 0.024). Factors associated with the degree of tinnitus annoyance were increased levels of anxiety (β = 11.6, 95% CI 2.3-20.8, overall p = 0.035) and poor speech recognition ability in noise (β = 13.5, 95% CI, 4.4 to 22.6, overall p = 0.014).Conclusions:Higher levels of somatization and a history of smoking were found to be risk factors for new-onset tinnitus 5 years later. Anxiety and poor speech recognition ability in noise were associated with higher degrees of tinnitus annoyance in new-onset tinnitus. Somatization deserves to be addressed in future research and clinical practice as it might provide part of a model for the development of chronic tinnitus.

BLUE FINGERS, EOSINOPHILIC LUNGS: ACUTE EOSINOPHILIC PNEUMONIA FOLLOWING COVID-19 INFECTION

BLUE FINGERS, EOSINOPHILIC LUNGS: ACUTE EOSINOPHILIC PNEUMONIA FOLLOWING COVID-19 INFECTION

Bronchodilators in Tobacco-Exposed Persons with Symptoms and Preserved Lung Function

BackgroundMany persons with a history of smoking tobacco have clinically significant respiratory symptoms despite an absence of airflow obstruction as assessed by spirometry. They are often treated with medications for chronic obstructive pulmonary disease (COPD), but supporting evidence for this treatment is lacking.MethodsWe randomly assigned persons who had a tobacco-smoking history of at least 10 pack-years, respiratory symptoms as defined by a COPD Assessment Test score of at least 10 (scores range from 0 to 40, with higher scores indicating worse symptoms), and preserved lung function on spirometry (ratio of forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ≥0.70 and FVC ≥70% of the predicted value after bronchodilator use) to receive either indacaterol (27.5 μg) plus glycopyrrolate (15.6 μg) or placebo twice daily for 12 weeks. The primary outcome was at least a 4-point decrease (i.e., improvement) in the St. George’s Respiratory Questionnaire (SGRQ) score (scores range from 0 to 100, with higher scores indicating worse health status) after 12 weeks without treatment failure (defined as an increase in lower respiratory symptoms treated with a long-acting inhaled bronchodilator, glucocorticoid, or antibiotic agent).ResultsA total of 535 participants underwent randomization. In the modified intention-to-treat population (471 participants), 128 of 227 participants (56.4%) in the treatment group and 144 of 244 (59.0%) in the placebo group had at least a 4-point decrease in the SGRQ score (difference, −2.6 percentage points; 95% confidence interval [CI], −11.6 to 6.3; adjusted odds ratio, 0.91; 95% CI, 0.60 to 1.37; P=0.65). The mean change in the percent of predicted FEV1 was 2.48 percentage points (95% CI, 1.49 to 3.47) in the treatment group and −0.09 percentage points (95% CI, −1.06 to 0.89) in the placebo group, and the mean change in the inspiratory capacity was 0.12 liters (95% CI, 0.07 to 0.18) in the treatment group and 0.02 liters (95% CI, −0.03 to 0.08) in the placebo group. Four serious adverse events occurred in the treatment group, and 11 occurred in the placebo group; none were deemed potentially related to the treatment or placebo.ConclusionsInhaled dual bronchodilator therapy did not decrease respiratory symptoms in symptomatic, tobacco-exposed persons with preserved lung function as assessed by spirometry. (Funded by the National Heart, Lung, and Blood Institute and others; RETHINC ClinicalTrials.gov number, NCT02867761.)

Abstract P219: Effect Of Hypertension On Clinical Recovery After Stroke Thrombectomy

Title: Effect of hypertension on clinical recovery after stroke thrombectomy Objective: Our goal was to identify what vascular risk factors for stroke affect outcomes after mechanical thrombectomy. Methods: We retrospectively reviewed stroke thrombectomy patients at our comprehensive stroke center from June 2013 to August 2016. Patients were determined to have atrial fibrillation, hypertension, diabetes, or hyperlipidemia based on historical information pre-treatment or based on hospital records during their index hospitalization. All patients in our series achieved recanalization after thrombectomy defined as a Thrombolysis in cerebral infarction (TICI) score of 2b or higher. Our endpoint was mild to moderate disability at 90 days defined by the modified Rankin Scale (mRS) score of 2 or less. We performed a univariate analysis on the above covariates affecting clinical outcome and studies all variables with a p-value of &lt; 0.2 in a multivariate analysis to determine which independent variables affected outcome. Multi-variate analyses were performed separately for males and females. Results: We reviewed 288 stroke patients that underwent thrombectomy. The mean age was 69±15; NIHSS was 17±6; 36% (104 of 288) received t-PA and 42% (121 of 288) had a modified Rankin Score of &lt; 2. 42.7% (123 of 288) were females. From the entire group, 47.5% (137 of 288) had atrial fibrillation, 29% (83 of 288) had diabetes mellitus 68% (197 of 288) had hypertension, 38.5% (111 of 288) had hyperlipidemia and 16% (47 of 288) had a history of tobacco smoking. After considering positive univariates from above, our multivariate logistic regression model identified that not having hypertension [ OR 2.32, CI 1.01-5.41, p=0.05 ] predicted better outcome post thrombectomy procedure for males after a successful recanalization. Conclusion: Our analysis suggests that, for males, the odds of a positive outcome after a successful thrombectomy procedure is positively influenced when the patient is not hypertensive. No traditional risk factor appeared to influence the outcome in females. Further prospective study is required to validate these findings.

Tobacco Use and Response to Immune Checkpoint Inhibitor Therapy in Non-Small Cell Lung Cancer.

Tobacco is a known risk factor for lung cancer, and continued tobacco use is associated with poorer outcomes across multiple lung cancer treatment modalities including surgery, chemotherapy and radiation therapy. Less is known about the association of tobacco use and outcomes with immune checkpoint inhibitors (ICIs), which are becoming an important part of the treatment landscape in lung cancer, both in metastatic and curative settings. We reviewed the literature on the association of tobacco and tumor biology as it relates to immunotherapy. We also reviewed the association of tobacco use on outcomes among phase III randomized clinical trials involving ICIs in non-small cell lung cancer (NSCLC). We identified that patients with a smoking history may have a greater benefit with ICI treatment compared to never smokers in both treatment-naïve (HR 0.82, 95% CI 0.69–0.97, vs. HR 1.06, 95% CI 0.81–1.38) and pre-treated (HR 0.79, 95% CI 0.70–0.90 vs. 1.03, 95% CI 0.74–1.43) settings. In trials where smoking status was further defined, ex-smokers appear to demonstrate greater benefit with ICI therapy compared to current smokers (HR 0.78, 95% CI 0.59–1.01 vs. 0.91, 95% CI 0.72–1.14). We conclude by offering our perspective on future directions in this area of research, including implementation of standardized collection and analysis of tobacco use in clinical trials involving ICI therapy in lung cancer and other disease sites, and also evaluating how tobacco may affect toxicities related to ICI therapy. Based on our review, we believe that a patient’s history of tobacco smoking does have a role to play in guiding treatment decision making in patients with lung cancer.

Cannabis consumption is associated with lower COVID-19 severity among hospitalized patients: a retrospective cohort analysis

BackgroundWhile cannabis is known to have immunomodulatory properties, the clinical consequences of its use on outcomes in COVID-19 have not been extensively evaluated. We aimed to assess whether cannabis users hospitalized for COVID-19 had improved outcomes compared to non-users.MethodsWe conducted a retrospective analysis of 1831 patients admitted to two medical centers in Southern California with a diagnosis of COVID-19. We evaluated outcomes including NIH COVID-19 Severity Score, need for supplemental oxygen, ICU (intensive care unit) admission, mechanical ventilation, length of hospitalization, and in-hospital death for cannabis users and non-users. Cannabis use was reported in the patient’s social history. Propensity matching was used to account for differences in age, body-mass index, sex, race, tobacco smoking history, and comorbidities known to be risk factors for COVID-19 mortality between cannabis users and non-users.ResultsOf 1831 patients admitted with COVID-19, 69 patients reported active cannabis use (4% of the cohort). Active users were younger (44 years vs. 62 years, p < 0.001), less often diabetic (23.2% vs 37.2%, p < 0.021), and more frequently active tobacco smokers (20.3% vs. 4.1%, p < 0.001) compared to non-users. Notably, active users had lower levels of inflammatory markers upon admission than non-users—CRP (C-reactive protein) (3.7 mg/L vs 7.6 mg/L, p < 0.001), ferritin (282 μg/L vs 622 μg/L, p < 0.001), D-dimer (468 ng/mL vs 1140 ng/mL, p = 0.017), and procalcitonin (0.10 ng/mL vs 0.15 ng/mL, p = 0.001). Based on univariate analysis, cannabis users had significantly better outcomes compared to non-users as reflected in lower NIH scores (5.1 vs 6.0, p < 0.001), shorter hospitalization (4 days vs 6 days, p < 0.001), lower ICU admission rates (12% vs 31%, p < 0.001), and less need for mechanical ventilation (6% vs 17%, p = 0.027). Using propensity matching, differences in overall survival were not statistically significant between cannabis users and non-users, nevertheless ICU admission was 12 percentage points lower (p = 0.018) and intubation rates were 6 percentage points lower (p = 0.017) in cannabis users.ConclusionsThis retrospective cohort study suggests that active cannabis users hospitalized with COVID-19 had better clinical outcomes compared with non-users, including decreased need for ICU admission or mechanical ventilation. However, our results need to be interpreted with caution given the limitations of a retrospective analysis. Prospective and observational studies will better elucidate the effects cannabis use in COVID-19 patients.

The Plasma Oxylipidome Links Smoking Status to Peripheral Artery Disease.

Peripheral artery disease (PAD) is prevalent among individuals with a history of tobacco smoking. Although oxidation of lipids may contribute to atherogenesis in vascular disease, enzymatically and nonenzymatically produced oxidized lipids can have varying and contrasting physiological effects. The underlying mechanisms of atherogenic vulnerability can be better elucidated with the recent advances in oxylipidome quantification using HPLC-MS/MS technology. In a randomized, controlled clinical trial, the plasma oxylipidome was analyzed in participants living with PAD by smoking status (n = 98) and in nonsmoking comparators without chronic disease (n = 20). Individuals with PAD had approximately a four-fold higher level of total plasma oxylipins versus the comparator. Cessation of smoking in individuals with PAD was associated with significantly lower levels of linoleic acid-derived TriHOMEs, greater levels of omega-3 fatty acid-derived oxylipins, and greater levels of nonfragmented oxidized phosphatidylcholines (OxPCs). Individuals living with PAD but without a history of smoking, exhibited higher levels of the putative atherogenic fragmented OxPCs versus individuals who currently or previously smoked. These data implicate the plasma oxylipidome in PAD and that smoking cessation is associated with a less inflammatory profile. Furthermore, fragmented OxPCs may play a more significant role in the pathophysiology of PAD in individuals without a history of smoking.

Nontender white papule of the areola in a middle-aged female

A 46-year-old female presented to dermatology for an asymptomatic skin lesion on her left nipple, present for 1 year. She reported occasional irritation and redness of her bilateral areolae, relieved with topical petrolatum. Her regular medications included clobazam, amlodipine, fluoxetine, levonorgestrel, and triamterene-hydrochlorothiazide. She had a short history of light tobacco smoking, which she had quit 20 years prior. Physical examination revealed a solitary nontender white 6-mm papule without purulence or a punctum, arising centrally from the left nipple (Fig 1).

Estimation of Salivary Copper, Zinc, Iron, and Copper-to-zinc Ratio in Oral Submucous Fibrosis Patients: A Case–control Study

The present study was conducted to test the salivary levels of Cu, Zn, Fe, and Cu/Zn ratio in oral submucous fibrosis (OSF) patients. Thirty-eight patients, aged 18-60 years who were clinically diagnosed with OSF, were considered as cases (group A). Thirty-eight patients without any signs of OSF were considered as controls (group B). History of tobacco habits, both smoking and chewing, was recorded. Salivary trace elements were analyzed using atomic absorption spectrometry and a differential pulse anodic stripping voltmeter (DPASV). Statistical Package for the Social Sciences (SPSS, Version 23; Chicago Inc., Illinois, USA) was used for analysis of data. Significant differences were noted between cases and controls. While Zn and Fe levels were decreased in cases, copper levels and copper/zinc ratio were enhanced in OSF affected individuals. Trace elements in saliva showed significant difference between OSF cases and healthy counterparts and are thus regarded as possible predictors for diagnosis of oral submucous fibrosis. The current study results clearly suggest an interaction of trace elements with OSF. Trace elements in saliva can be considered as a reliable, noninvasive diagnostic marker in OSF patients. Early diagnosis of these lesions can facilitate the provision of prompt treatment by the clinicians, for successful reversal and treatment.

Prevalence of hypertension in Shenzhen, China: a population-based, cross-sectional study

ObjectiveHypertension (HTN) is an important public health issue worldwide, associated with the rapid economic development and urbanisation over the last decades. This is especially the case in Shenzhen, which has...

Prevalence of Tobacco Smoking and Its Association With Disease Severity Among Patients With Psoriasis in China: A Cross-Sectional Study.

IntroductionTobacco smoking is associated with the onset and severity of psoriasis, and understanding the prevalence of tobacco smoking among patients with psoriasis is critical due to its high physical and mental influence and heavy disease burden. However, evidence on the association between tobacco smoking and psoriasis severity is still limited in China.ObjectivesThe objective of this study was to examine the prevalence of tobacco smoking and explore the association between tobacco smoking and diseases severity among patients with psoriasis.MethodsA total of 4,529 patients with psoriasis in 200 selected hospitals were recruited in China between January 2020 and September 2021. Detailed information covering demographic feature, tobacco smoking, and psoriasis history were collected through an electronic questionnaire, and clinical data were extracted from the health information system (HIS). SAS 9.4 was used for data analysis, and a p-value of <0.05 was considered statistically significant.ResultsThe prevalence of tobacco smoking was 30.8%, with 24.6% for current smoking. The average Psoriasis Area and Severity Index (PASI) score for patients with psoriasis was 9.4, with male patients having a higher PASI score than female patients. The odds ratio (OR) of former tobacco smoking prevalence was 1.5 [95% confidence interval (CI): (1.0–2.3)] for PASI score (3.0–7.0), 2.2 for PASI score (7.1–13.0), and 4.2 for PASI score >13, when compared with patients with PASI score < 3.0. Similarly, the OR of current tobacco smoking prevalence was 1.8 [95% CI: (1.5–2.2)] for PASI score (3.0–7.0), 1.9 for PASI score (7.1–13.0), and 3.1 for PASI score >13, when compared with patients with PASI score <3.0. The Spearman correlation analysis indicated that both tobacco smoking intensity and smoking duration were positively correlated with psoriasis severity (p < 0.05).ConclusionThe prevalence of tobacco smoking was high, especially among male patients with psoriasis and those with senior high education. Tobacco smoking was positively associated with psoriasis severity; moreover, both smoking intensity and smoking duration were positively correlated with the severity of psoriasis in a dose-dependent fashion.