Patient Smoking Status Research Articles

Factors Associated with Unfavorable Clinical Presentations in Patients with Ruptured BrainArteriovenous Malformations

Rupture of brain arteriovenous malformations (bAVMs) carries potentially devastating consequences. For patients presenting with ruptured bAVMs, several clinical grading systems have been shown to predict long-term patient morbidity and may be taken into consideration when making clinical decisions. Unfortunately, use of these scoring systems is typically limited to their prognostic value and offer little to patients in therapeutic benefit. Tools are needed not only to predict prognosis for patients experiencing ruptured bAVMs but to gain insight into what characteristics predispose patients to poor long-term outcomes before they rupture. Our objective was to find clinical, morphologic, and demographic variables that correlate with unfavorable clinical grades on presentation in patients with ruptured bAVMs. We retrospectively reviewed a cohort of patients with ruptured bAVMs. Linear regression models were used to test whether Glasgow Coma Scale (GCS) and Hunt-Hess scores on presentation(outcomes) were associated with patient and arteriovenous malformation (AVM) characteristics (predictors) individually. GCS and Hunt-Hess were assessed following bAVM rupture for 121 brain cases. The median age at rupture was 28.5 years, and 62 (51%) were female. Smoking history was associated with worse GCS; current and past smokers had GCS scores 1.33 points lower on average than nonsmokers (95% confidence interval [CI] -2.59 to -0.07, P= 0.039) and had worse Hunt-Hess scores (0.42, 95% CI 0.07-0.77, P= 0.019). Associated aneurysms were associated with worse GCS (-1.60, 95% CI -3.16 to -0.05, P= 0.043) and trended towards worse Hunt-Hess scores (0.42 points, 95% CI -0.01 to 0.86, P= 0.057). Patient smoking status and presence of an AVM associated aneurysm were shown to have modest correlations with unfavorable clinical grades (Hunt-Hess, GCS) on presentation, with unfavorable clinical grades being associated with long-term patient prognosis following bAVM rupture. Further investigation using AVM-specific grading scales and external data are needed to determine the utility of these and other variables in clinical practice for patients with bAVM.

Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair.

Patients are often advised on smoking cessation prior to elective surgical interventions, but the impact of active smoking on paraesophageal hernia repair (PEHR) outcomes is unclear. The objective of this cohort study was to evaluate the impact of active smoking on short-term outcomes following PEHR. Patients who underwent elective PEHR at an academic institution between 2011 and 2022 were retrospectively reviewed. The National Surgical Quality Improvement Program (NSQIP) database from 2010 to 2021 was queried for PEHR. Patient demographics, comorbidities, and 30-day post-operative data were collected and maintained in an IRB-approved database. Cohorts were stratified by active smoking status. Primary outcomes included rates of death or serious morbidity (DSM) and radiographically identified recurrence. Bivariate and multivariable regressions were performed, and p value < 0.05 was considered statistically significant. 538 patients underwent elective PEHR in the single-institution cohort, of whom 5.8% (n = 31) were smokers. 77.7% (n = 394) were female, median age was 67 [IQR 59, 74] years, and median follow-up was 25.3 [IQR 3.2, 53.6] months. Rates of DSM (non-smoker 4.5% vs smoker 6.5%, p = 0.62) and hernia recurrence (33.3% vs 48.4%, p = 0.09) did not differ significantly. On multivariable analysis, smoking status was not associated with any outcome (p > 0.2). On NSQIP analysis, 38,284 PEHRs were identified, of whom 8.6% (n = 3584) were smokers. Increased DSM was observed among smokers (non-smoker 5.1%, smoker 6.2%, p = 0.004). Smoking status was independently associated with increased risk of DSM (OR 1.36, p < 0.001), respiratory complications (OR 1.94, p < 0.001), 30-day readmission (OR 1.21, p = 0.01), and discharge to higher level of care (OR 1.59, p = 0.01). No difference was seen in 30-day mortality or wound complications. Smoking status confers a small increased risk of short-term morbidity following elective PEHR without increased risk of mortality or hernia recurrence. While smoking cessation should be encouraged for all active smokers, minimally invasive PEHR in symptomatic patients should not be delayed on account of patient smoking status.

SOCIO-DEMOGRAPHIC PROFILE AND BODY MASS INDEX OF PATIENTS WITH PULMONARY TUBERCULOSIS AND THEIR TREATMENT OUTCOME IN A TERTIARY CARE CENTRE KERALA

Introduction: Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. Several socio-demographic factors contributing towards the increasing incidence and development of TB are age, gender, socioeconomic status, smoking, alcoholism, drug addiction, living conditions, literacy, family history, overcrowding, poor sanitation, poor ventilation, malnutrition, occupation. Primary Objectives: To evaluate the socio-demographic profile and body mass index (BMI) of patients with pulmonary tuberculosis and their treatment outcome. Secondary Objectives: 1. To assess the relationship between low SES and new smear positive PTB. 2. To assess malnutrition among diagnosed PTB patients. 3. To know how malnutrition and low SES affect the treatment outcome 4. To assess nutritional status of patients before and after treatment 5. To evaluate the relationship between co morbidity and treatment outcome. Methods: This is a prospective study done in 360 new sputum-positive pulmonary tuberculosis patients attending the department of respiratory medicine, GMC Kannur over 1 year. After full filling the inclusion and exclusion criteria data was collected and the results were organized and analyzed statistically. Results: The total sample size was 360. 29.2%, belonging to 41-50 years with the male preponderance of male: female ratio = 1.7:1. Regarding the socio-demographic profile, 93.3% were natives, and 72.2% were married. 81.9% belonged to the lower caste, 94.7% had nuclear families, with small-sized families of percentage 70, and most of them, 87.2% resided in pucca houses. The majority of cases had a primary level of education and the literacy rate was only 1.9%. 43.3% of Sputum-positive patients were from low SES. Malnutrition (BMI&lt;18.5Kg/m2) was seen in 58% of patients and there was a significant increase in BMI (p&lt; 0.001) after treatment completion. The majority of patients had DM (38.9%).There was statistically significant clearance in CXR after treatment completion (p &lt;0.001). It was found that DM, smoking and CXR shadows can lead to reduced sputum smear conversion and it was statistically significant with statistical significance as follows: DM – OR=0.367,95%CI of OR is 0.181-0.742, p-value- .004, CXR shadows: OR=0.190,95% CI of OR- 0.079-0.460, p value-0.001, current smokers: p value-0.006. Conclusion: In the current study, the majority of patients was having undernutrition (BMI&lt;18.5Kg/m2) and low SES. The nutritional status was improved after treatment completion. Sputum smear conversion at the end of 2 months, which is a key indicator of infectivity, was affected by patients smoking status, DM, and CXR shadow. Hence, education, awareness, smoking cessation, adequate nutritional support, DM control are necessary for control of TB and for achieving the national target.

Factors Affecting the Surgical Outcome in Nasal Septal Perforation Repair.

Nasal septal perforation (NSP) repair is challenging surgery considered in patients with symptomatic NSP intractable to conservative treatments. This study aimed to assess the success rate and identify factors affecting the surgical outcome of NSP by analyzing consecutive series of NSP repairs by a single surgeon. We enrolled 84 patients diagnosed with NSP and who underwent surgical repair of NSP by a single surgeon (Y.J.J.) between November 2007 and July 2022. Medical records were retrospectively reviewed regarding variables involving preoperative symptoms, rhinologic history, etiology, surgical techniques, and the outcome of surgery. In addition, features of NSP were objectively evaluated using computed tomography scans. The overall success rate of NSP repair was 64.3% (54 of 84). Nasal obstruction (79.8%), crusting (34.5%), and epistaxis (27.4%) were frequent preoperative symptoms. Iatrogenic injury from previous nasal surgery (70.2%) was the most common cause. The average size of NSP on preoperative CT was 9.53 ± 6.68 mm. Patients with incomplete NSP closure had significantly larger perforations (12.21 ± 7.92 mm) than those with successful closure (8.04 ± 5.41 mm) preoperatively (P = .005). Patients with smoking history (OR = 2.971, 95% CI 1.170-7.548, P = .020) and NSP repair with combined rhinoplasty (OR = 3.811, 95% CI 1.401-10.370, P = .007) were more likely to experience incomplete closure. Patients whose perforations were reinforced with interposition graft were more likely to result in successful repair (OR = 6.752, 95% CI 2.496-18.262, P < .001). The bilaterality of mucosal flap coverage, surgical approach, types of mucosal flap and interposition graft, perforation shape, mucosal thickness around perforation, and distance from the nasal floor were not significantly related to the surgical outcome. Significant factors affecting the outcome of NSP repair were patient's smoking status, combined rhinoplasty, application of interposition graft, and perforation size.

Cigarette smoking is linked to an increased risk of delirium following arthroplasty in patients suffering from osteoarthritic pain.

Postoperative delirium (POD) is a common postoperative complication, and the potential relationship between cigarette smoking and POD is still unclear. The current study evaluated the relationship between preoperative smoking status in patients suffering from osteoarthritic pain and POD after total knee arthroplasty (TKA). A total of 254 patients who had undergone unilateral TKA were enrolled between November 2021 and December 2022, with no gender limitation. Preoperatively, patients' visual analog scale (VAS) scores at rest and during movement, hospital anxiety and depression (HAD) scores, pain catastrophizing scale (PCS) scores and smoking status were collected. The primary outcome was the incidence of POD, which was evaluated by the confusion assessment method (CAM). A total of 188 patients had complete datasets for final analysis. POD was diagnosed in 41 of 188 patients (21.8%) who had complete data for analysis. The incidence of smoking was significantly higher in Group POD than in Group Non-POD (22 of 41 patients [54%] vs. 47 of 147 patients [32%], p < 0.05). The postoperative hospital stays were also longer than those of Group Non-POD (p < 0.001). Multiple logistic regression analysis showed that preoperative smoking (OR: 4.018, 95% CI: 1.158-13.947, p = 0.028) was a risk factor for the occurrence of POD in patients with TKA. The length of hospital stay was correlated with the occurrence of POD. Our findings suggest that patients who smoked preoperatively were at increased risk of developing POD following TKA.

Clinical implications of the concentration of alveolar nitric oxide in non-small cell lung cancer.

Clinical implications of the concentration of alveolar nitric oxide in non-small cell lung cancer.

MSR92 Racial and Smoking Status Disparities in Mediation Effects on Liraglutide-Associated Cardiovascular Outcomes: A Dynamic Path Analysis Using Leader Trial Data

Mediation analyses are useful to disentangle possible causal pathways from an exposure/treatment to its clinically relevant outcomes. Mediation effects are commonly presented in changes in hazard ratios obtained from Cox proportional hazard model analyses, yet the assumption of proportionality is however violated with a post-exposure mediator added into the analysis. Dynamic path analysis evolved more recently where the proportionality is not required and all time-varying mediators can be simultaneously modeled, thereby reflecting the complexity of mediators in causal pathways. We sought to apply dynamic path analyses for assessing the heterogeneity of mediation effects on liraglutide-associated major adverse cardiovascular event (MACE) outcome by racial and smoking status of patients.

Differential therapeutic benefit of platinum-doublet chemotherapies with ICIs based on the classification by combined with smoking status and PD-L1 expression in patients with advanced NSCLC.

e21131 Background: Chemotherapy combined with immune checkpoint inhibitors (Chemo-ICIs) has been the standard of care for advanced NSCLC patients. Smoking status is associated with PD-L1 expression and the TILs within tumor microenvironment, which leads to the efficacy of ICIs. It remains unclear how the combined with PD-L1 expression and smoking status affect the efficacy of Chemo-ICIs. Methods: We retrospectively reviewed advanced NSCLC patients without driver mutation (EGFR, ALK, ROS-1, BRAF) who received Chemo-ICIs from January 2019 to June 2021, and Chemo from January 2014 to December 2016 as a first-line therapy at the National Cancer Center Hospital, Tokyo, Japan. The additional benefit of ICIs to chemotherapy were evaluated by comparing the Chemo-ICIs group with Chemo group. Results: During study period, 225 patients received Chemo-ICIs and 133 received Chemo as a first line therapy. Overall response rate (ORR) and progression free survival (PFS) was significantly better in the Chemo-ICIs group than the Chemo group (ORR: 44.9% vs. 40.2%, p=0.01, and median PFS: 8.2 months vs. 6.2 months, P&lt;0.001). The median overall survival was 27.9 months in Chemo-ICIs and 20.4 months in chemo (P=0.14). In the subgroup analysis of PFS, the benefit of Chemo-ICIs compared to Chemo was not observed in never-smoker patients (8.9months vs 8.8months, P=0.27). In contrast, among smoker patients, Chemo-ICIs showed significant longer PFS compared to Chemo (7.5 months vs 5.7 months, P&lt;0.001). Next, patients received Chemo-ICIs were classified into six groups, based on the smoking status (never smoker or smoker) and PD-L1 expression (TPS: 0%, 1-49%, or 50%). Chemo-ICIs showed better PFS rate at 12 months in the smoker/ TPS ≥50% group (42.2% vs 25.0%, p=0.03), and the never smoker/TPS ≥50% group (75.0% vs 27.3%, p=0.05) compared with Chemo (Table). In patients with 1-49% TPS, compared to the Chemo group, significant PFS benefit of ICIs was observed only in smoker patients (42.2% vs 25.0%, p=0.003), not in never smoker patients (46.2% vs 27.3%, p=0.13). In patients with 0% TPS, although the additional benefit of ICIs to Chemo was not observed both in never and smoker patients, PFS rate at 12 months in never smoker (13.3%) was lowest among all six groups. Conclusions: Our study suggested that additional benefit of ICIs to chemotherapy could be predicted by combined with smoking status and PD-L1 expression.[Table: see text]

Clinical characteristics, response to poly (adenosine phosphate-ribose) polymerase inhibitors and platinum chemotherapy in patients with lung cancer harboring BRCA mutations.

e21036 Background: BRCA1/2 are tumor suppressor genes involved in DNA double-strand break repair. Tumors harboring BRCA1/2 pathogenic mutations (BPM) are highly responsive to treatment with poly (adenosine phosphate-ribose) polymerase inhibitors (PARPi) and exhibit increased sensitivity to platinum-based chemotherapy (platinum). Somatic BPM are found in 1-2% of all cases of non-small cell lung cancer (NSCLC), the majority of which are not associated with germline variants. While platinum remains the backbone of first-line treatment of NSCLC, PARPi have not demonstrated efficacy in treatment of NSCLC and testing for BRCA mutations in NSCLC is not routine. We present the clinical characteristics and outcomes of patients with NSCLC harboring BPM treated with platinum and PARPi as part of clinical practice at our center. Methods: We retrospectively evaluated the onco-genetic and pathology data bases for patients with locally advanced or metastatic NSCLC who were treated at Hadassah Medical Center (HMC), underwent somatic molecular or genetic testing, and were found to have somatic BPM (according to ClinVar or Varsom). We compared the clinical outcomes to a matched cohort (age, gender, smoking, and performance status) of non-BPM NSCLC patients treated at HMC. Results: Since 2013 we evaluated 642 patients with locally advanced or metastatic NSCLC using comprehensive somatic or germline molecular panels. Twenty-two patients were found to have somatic BPM of which, 18 (81.8%) were found to be carriers of corresponding germline BRCA1/2 variants. This included 14 (63.6%) carriers of classical Ashkenazi-Jewish variants (10 - BRCA2 617delT, 2- BRCA1 185delAG and 2- BRCA1 5382incC) and representing less than 1% of all BRCA1/2 carriers at HMC. Median age of diagnosis was 67 yeas old (range 40–78). Eleven (50%) patients had a history of smoking, and 8 (36.3%) patients had a history of other malignancies, mainly breast cancer. Pathology for all patients revealed adenocarcinoma and 8 (36.6%) patients had additional actionable mutations ( EGFR, ALK, BRAF or ERBB2). Sixteen (72.7%) patients were treated with platinum, with an objective response rate (ORR) of 75% and a median progression free survival (mPFS) of 14 months (range 4-29), compared to ORR of 45% and mPFS of 8.5 months (range 3-18) in a matched cohort of non-BPM NSCLC patients treated with platinum. Six (27.7%) patients were treated with second or third line PARPi with ORR of 83.3%, mPFS of 21 months (range 6-34). Median overall survival (OS) for the entire cohort was 28 months (range 4-103) with 8 (36.4%) patients surviving for more than 3 years. Conclusions: In this cohort, patients with NSCLC harboring BPM show a durable response to platinum and PARPi with prolonged OS. The results support testing BRCA1/2 in NSCLC patients and treatment with platinum and PARPi for patients with BPM.

Stem Cell Therapy Enriched Fat Grafting for the Reconstruction of Craniofacial Deficits.

Twelve subjects with at least two regions of craniofacial volume deficit were enrolled, and they underwent fat grafting with SVF-enriched or standard fat grafting to each area. All patients had bilateral malar regions injected with SVF-enriched graft on one side and control standard fat grafting to the contralateral side. Outcome assessments included demographic information, volume retention determined by CT scans, SVF cell populations assessed by flow cytometry, SVF cell viability, complications, and appearance ratings. Follow-up was 9 months. All patients had improvement in appearance. There were no serious adverse events. There was no significant difference in volume retention between the SVF-enriched and control regions overall (50.3% versus 57.3%, P = 0.269) or comparing malar regions (51.4% versus 56.7%, P = 0.494). Patient age, smoking status, obesity, and diagnosis of diabetes did not impact volume retention. Cell viability was 77.4% ± 7.3%. Cellular subpopulations were 60.1% ± 11.2% adipose derived stem cells, 12.2 ± 7.0% endothelial cells, and 9.2% ± 4.4% pericytes. A strong positive correlation was found between CD146+ CD31-pericytes and volume retention (R = 0.863, P = 0.027). Autologous fat transfer for reconstruction of craniofacial defects is effective and safe, leading to reliable volume retention. However, SVF enrichment does not significantly impact volume retention.

Association of smoking history extracted from electronic health records (EHR) using machine-learning methods and tumor characteristics in patients with lung cancer.

1559 Background: Though smoking is a major risk factor for lung cancer, it has been a challenge to collect patients’ smoking history information accurately from the EH due to data inconsistency and incompleteness. To address these challenges, we utilized a weak supervision methodology to automatically annotate smoking status of patients with lung cancer and correlated it with tumor characteristics. Methods: We analyzed 6,355 patients with lung cancer who underwent tumor profiling with MSK-IMPACT. In total, 14,555 unstructured clinical notes were extracted from EHR at the Memorial Sloan Kettering Cancer Center. The weak supervision methodology used a generative model for intermediate labels that were subsequently tuned by machine-learning classifier to generate the final labels. Clinical notes from a randomly sampled set of 564 patients were manually curated and used for performance assessment. The rest of the patients were split into training and validation datasets used for model training and hyperparameter tuning. Pack years were also extracted from clinical notes using Natural Language Processing. We next conducted multivariate analyses for primary and metastatic tumor samples separately to correlate smoking metrics with tumor characteristics including tumor mutation burden (TMB) and chromosomal instability, as inferred by the fraction of genome altered (FGA) after controlling for age at sequencing, gender, histological subtypes, ancestry, coverage and tumor purity. Results: The weak supervision classifier had almost perfect performance for 2-label classification model (ever smokers and never smokers) with macro F1-score: 97.7%, balanced accuracy: 97.1%, 97.1%, precision:98.4%, 98.4% and recall: 99.5%,94.6% respectively. For 3-label classification model (never smoker, former smoker, and current smoker), the macro F1-score was 79.8%; balanced accuracy: 97.1%, 86.7%, 71.2%, precision: 93.9%, 90.1%, 61.7%, recall: 96.1%, 93.3%, 46.0% respectively. Analyzing genomic data, we observed that smoking status (smoker vs. never smoker) and pack-years were associated with TMB in both primary and metastatic tumor samples (p&lt;2e-16). FGA was marginally associated with smokers compared to never smokers in primary tumor samples (p=0.06). Among smokers diagnosed with lung adenocarcinoma, significantly high FGA in primary tumor samples was observed in males compared to females after adjusting for pack-years and other variables (p= 3.3e-3). Conclusions: We demonstrated high performance of our approach for automated curation of smoking history from EHR. The genomic results confirmed distinct mutational patterns associated with smoking behavior in patients with lung cancer. We are currently exploring multimodal approaches by including chest CT images and “time of quitting” to improve performance of the 3-class model.

(416) Clinical Characteristics of Men with Sexual Dysfunction Visiting an Andrology Clinic: A Single-Center Study in Saudi Arabia

Abstract Introduction Previous studies that investigated the clinical characteristics of sexual dysfunction in men in Saudi Arabia are limited. This study aimed to explore the clinical characteristics of sexual dysfunction in men visiting an andrology clinic in Saudi Arabia. Objective This study aimed to explore the clinical characteristics of sexual dysfunction in men visiting an andrology clinic in Saudi Arabia. Methods This study is a retrospective single-center cross-sectional study. A random sampling method was used to recruit participants between March and September 2019. Descriptive statistics were used to describe patients’ characteristics. Continuous data were reported as mean ± SD. Chi-squared and multiple logistic regression were used to find the associations between patient's age (older and younger than 50 years) and clinical characteristics of the participants. Results In total, 21.3% participants had diabetes and 9.5% had hypertension. More younger males suffered from sexual problems (69.8%) compared to older males (30.2%). Also, 37.5% participants were overweight, while 25.3% had class I obesity. Most participants had normal follicle stimulating hormone, prolactin, testosterone, luteinizing hormone, and prostate specific antigen levels. Approximately 69.5% had vitamin D insufficiency. Among those older than 50 years, 80.2% had diabetes (P &amp;lt; 0.05). Younger smokers accounted for 79% of the population, with a significant association between patient's age and smoking status (P &amp;lt; 0.05). Patients younger than 50 years with normal A1C levels had a 2.5 times higher risk of having sexual problems (P &amp;lt; 0.00, confidence interval 1.63–3.91). Conclusions MSD may be considered to be caused by other nonorganic problems. There is a significant need to increase Saudi men's awareness of sexual medicine. Disclosure No

Smoker pseudo-paradox in ST-segment elevation myocardial infarction patients

Cigarette smoking is a preventable cause of cardiovascular morbidity and mortality. Despite the adverse effects of smoking, some studies have reported the term "smoker's paradox', meaning better outcomes in smokers following acute myocardial infarction. The aim of the present study was to evaluate the relationship between smoking status and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI). This was a registry-based cohort study of STEMI patients from Imam-Ali hospital, Kermanshah, Iran. Consecutive STEMI patients (July 2016-October 2018) were stratified by smoking status and followed for one year. Cox proportional models were used to estimate crude, age-adjusted, and full-adjusted hazard ratios with 95% confidence intervals (HR, 95%CI). Of 1975 patients (mean age 60.1 years, 76.6% male) included in the study, 48.1% (n=951) were smokers (mean age 57.7 years, 94.7% male). Crude and age-adjusted HR (95% CI) for the associations of smoking and mortality were 0.67 (0.50-0.92) and 0.89 (0.65-1.22), respectively. After adjusting for age, sex, hypertension, diabetes, body-mass index, anterior wall myocardial infarction, creatine kinase-MB, glomerular filtration rate, left ventricular ejection fraction, low-density lipoprotein cholesterol, and hemoglobin, smoking was associated with increased risk of mortality: HR (95% CI: 1.56 (1.04-2.35). In our study, smoking was associated with an increased risk of mortality. Although the smokers had a better outcome, this would be reversed after controlling for age and the other STEMI associated factors.

Global prevalence and effect of comorbidities and smoking status on severity and mortality of COVID-19 in association with age and gender: a systematic review, meta-analysis and meta-regression

A COVID-19 patient often presents with multiple comorbidities and is associated with adverse outcomes. A comprehensive assessment of the prevalence of comorbidities in patients with COVID-19 is essential. This study aimed to assess the prevalence of comorbidities, severity and mortality with regard to geographic region, age, gender and smoking status in patients with COVID-19. A systematic review and multistage meta-analyses were reported using PRISMA guidelines. PubMed/MEDLINE, SCOPUS, Google Scholar and EMBASE were searched from January 2020 to October 2022. Cross-sectional studies, cohort studies, case series studies, and case–control studies on comorbidities reporting among the COVID-19 populations that were published in English were included. The pooled prevalence of various medical conditions in COVID-19 patients was calculated based on regional population size weights. Stratified analyses were performed to understand the variations in the medical conditions based on age, gender, and geographic region. A total of 190 studies comprising 105 million COVID-19 patients were included. Statistical analyses were performed using STATA software, version 16 MP (StataCorp, College Station, TX). Meta-analysis of proportion was performed to obtain pooled values of the prevalence of medical comorbidities: hypertension (39%, 95% CI 36–42, n = 170 studies), obesity (27%, 95% CI 25–30%, n = 169 studies), diabetes (27%, 95% CI 25–30%, n = 175), and asthma (8%, 95% CI 7–9%, n = 112). Moreover, the prevalence of hospitalization was 35% (95% CI 29–41%, n = 61), intensive care admissions 17% (95% CI 14–21, n = 106), and mortality 18% (95% CI 16–21%, n = 145). The prevalence of hypertension was highest in Europe at 44% (95% CI 39–47%, n = 68), obesity and diabetes at 30% (95% CI, 26–34, n = 79) and 27% (95%CI, 24–30, n = 80) in North America, and asthma in Europe at 9% (95% CI 8–11, n = 41). Obesity was high among the ≥ 50 years (30%, n = 112) age group, diabetes among Men (26%, n = 124) and observational studies reported higher mortality than case–control studies (19% vs. 14%). Random effects meta-regression found a significant association between age and diabetes (p < 0.001), hypertension (p < 0.001), asthma (p < 0.05), ICU admission (p < 0.05) and mortality (p < 0.001). Overall, a higher global prevalence of hypertension (39%) and a lower prevalence of asthma (8%), and 18% of mortality were found in patients with COVID-19. Hence, geographical regions with respective chronic medical comorbidities should accelerate regular booster dose vaccination, preferably to those patients with chronic comorbidities, to prevent and lower the severity and mortality of COVID-19 disease with novel SARS-CoV-2 variants of concern (VOC).

Total Joint Arthroplasty Patient Demographics Before and after COVID-19 Elective Surgery Restrictions.

In 2020, the COVID-19 pandemic caused cessation of non-emergent total joint arthroplasty (TJA, referring to total hip and total knee arthroplasty) operations between mid-March and April 2020. The purpose of this study is to analyze effects and potential disparities in access to care due to the COVID-19 restrictions. A database was used to examine demographics of patients undergoing TJA from May-December 2019 (Pre-COVID-19) and May-December 2020 (Post-COVID-19 restrictions). Categorical covariates were summarized by reporting counts and percentages and compared using Fisher exact tests. Continuous covariates were summarized by reporting means and standard deviations. Two-sample t-tests were used for continuous covariates. Equality of TJA counts by year were tested using a test of proportions. There were more TJA procedures performed during the post-COVID-19 period in 2020 vs pre-COVID19 (1151 vs. 882, p<.001). There was an increase in the relative percentage of THAs vs. TKAs performed in 2020 vs 2019 (26.9% vs 18.8%, p<.001), and an increase in patients with Medicaid with a decrease in private insurance (p=.043). The average length of stay was shorter in 2020 with a greater percentage of TJAs performed outpatient ( p<.001). There were no differences in patient sex, race, BMI, smoking status, or age between the two periods. A relative increase in THA procedures, an increase in patients with Medicaid and decrease in private insurance, and a decreased length of stay were seen post COVID-19 restrictions. These trends may reflect pandemic-related changes in insurance status as well as the growing shift to same-day discharge.

Long-term outcomes in patients with immune checkpoint inhibitor induced pneumonitis

IntroductionImmune checkpoint inhibitors (ICI) have improved outcomes for patients with many malignancies. However, these treatments are associated with immune-related adverse events, including pulmonary toxicity (pneumonitis). Pneumonitis is associated with significant...

EFFECTS OF SMOKING IN UROTHELIAL CARCINOMA OF BLADDER UNDERGOING RADIAL CYSTECTOMY

The current study was designed to evaluate the impact of smoking status and cessation in bladder carcinoma patients undergoing radial cystectomy. A prospective study was conducted in the Department of Urology and Radiation Oncology of Shifa International Hospital, Islamabad and MMDC, Multan from January 2022-January 2023. A total of 190 patients with urothelial carcinoma of the bladder undergoing radial cystectomy were included in the study. Smoking history was noted for each patient before radial cystectomy. This history included smoking status, quantity, duration, and cessation in patients with former smoking history. The mean age of patients was 65.3 years. Among 190 patients, 87 were former smokers, 65 were current, and 38 were non-smokers. 58 patients (30.5%) had a pathological tumor stage 3. Multivariate analysis showed that duration of smoking, smoking cessation, and cumulative smoking exposure were predictors of tumor staging. Patients with more than 30 years of smoking were at higher odds of developing advanced tumor stage. Similarly, increased cumulative exposure was associated with greater odds of high tumor stage (p&lt;0.001). Duration of smoking cessation had an opposite relationship with the odds of advanced tumor (p=0.001). Based on the results, it can be concluded that the current smoking status and cumulative smoking exposure are directly associated with disease development and recurrence in urothelial carcinoma of bladder patients. Smoking cessation has the opposite relationship respectively.

Effect of Smoking Cessation on Left Ventricular Ejection Fraction after Acute ST Elevation Myocardial Infarction.

Acute Myocardial Infarction (AMI) is the leading cause of global mortality. Moreover, Left Ventricular Ejection Fraction (LVEF) is the most important predictor of post-AMI mortality. Thus, the present study aimed to investigate the relationship between smoking cessation and LVEF following one year from the STEMI. The present study was a part of the Kermanshah STEMI Registry and included 825 smokers admitted to Imam Ali Hospital, Kermanshah, Iran, with AMI during a 2-year study period. Data collection was performed using the standardized case report form by the European Observational Registry Program (EORP). Moreover, multiple logistic regression was used to compare LVEF between the patients who had quit smoking post-AMI and those who were still smokers after one year. Also, one-to-one Propensity Score Matching (PSM) was used to reduce the assessment error and selection bias, increase the result accuracy, and minimize the effects of confounders on the LVEF-smoking relationship. Following one year after AMI, 219 (26.55%) patients had quit smoking, while 606 (73.45%) still smoked. Using the PSM, a total of 168 ex-smokers were matched to 168 current smokers. Moreover, it was shown that LVEF was higher in current smokers compared to ex-smokers. However, the difference was not significant. Also, multiple logistic regression showed that the Odds Ratio (OR) of LVEF reduction was insignificantly higher in ex-smokers (OR=1.13; 95% CI: 0.98-1.29) compared to current smokers. Multivariate regression analysis found similar results even after the application of PSM (OR = 1.02; 95% CI: 0.82-1.22). Given the low rate of smoking cessation after MI, physicians are recommended to ask about the smoking status of MI patients at each office visit or re-admission and strongly recommend quitting smoking.

Clinical Significance of Gastrointestinal Symptoms in Hospitalized Patients With Covid-19 Infection

Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection. &#x0D; Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated. &#x0D; Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively. &#x0D; Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.

The expression of HER2/neu in patients with lung cancer and its associated factors.

Lung cancer is the most common cause of cancer-related death worldwide in both sexes. Evidence suggests the role of genetic factors in lung cancer. Studying of such factors can help understand the cancer prognosis. Overexpression of the human epidermal growth factor receptor-2 (HER2/neu) protein is considered an important prognostic factor in breast cancer, but its role has not been confirmed in lung cancer. Therefore, the present study aimed to investigate the role of its expression in patients with lung cancer. In this cross-sectional study, patients aged >18 years who were referred to Afzalipoor Hospital, Kerman, Iran, from 2016 to 2017, and were diagnosed with lung cancer were enrolled into the study if they had a pathological sample of their cancerous lung. Their demographics were recorded, and the sample was sectioned and stained to measure HER2/neu gene expression according to DAKO instructions using heat-induced antigen retrieval (HIER) enzyme marker. The samples of 100 patients with lung cancer were evaluated (84% men and 16% women) with a mean age of 61.34 years (standard deviation of 12.51 years). HER2/neu expression was significantly associated with the type of cancer and was highest in adenocarcinoma and zero in small cell carcinoma (P < 0.001), but not with patients' sex, age, smoking status and family history of cancer (P > 0.05). These results emphasized the overexpression of HER2/neu in different types of lung cancer, which can be used further for therapeutic purposes. The results showed that HER2/neu was overexpressed not only in adenocarcinoma but also in other types, like squamous cell carcinoma. Therefore, all subtypes of non-small cell lung carcinoma should be considered for anti-HER2 therapies, and further research is required for small cell lung carcinoma.