Smoking Patients Research Articles

Sex differences in the tumor promoting effects of tobacco smoke in a cRaf transgenic lung cancer disease model

Tobacco smoke (TS) is the leading cause for lung cancer (LC), and female smokers are at a greater risk for LC. Yet, the underlying causes are unknown. We performed whole genome scans in TS exposed wild type and histologically characterized tumor lesions of cRaf transgenic mice. We constructed miRNA-gene and transcription factor-miRNA/gene regulatory networks and determined sex-specific gene regulations by evaluating hormone receptor activities. We validated the findings from TS exposed cRaf mice in a large cohort of smoking and never-smoking LC patients. When compared to males, TS prompted a sevenfold increase in tumor multiplicity in cRaf females. Genome-wide scans of tumor lesions identified 161 and 53 genes and miRNAs, which code for EGFR/MAPK signaling, cell proliferation, oncomirs and oncogenes, and 50% of DEGs code for immune response and tumor evasion. Outstandingly, in transgenic males, TS elicited upregulation of 20 tumor suppressors, some of which are the targets of the androgen and estrogen receptor. Conversely, in females, 18 tumor suppressors were downregulated, and five were specifically repressed by the estrogen receptor. We found TS to perturb the circadian clock in a sex-specific manner and identified a female-specific regulatory loop that consisted of the estrogen receptor, miR-22-3p and circadian genes to support LC growth. Finally, we confirmed sex-dependent tumor promoting effects of TS in a large cohort of LC patients. Our study highlights the sex-dependent genomic responses to TS and the interplay of circadian clock genes and hormone receptors in the regulation of oncogenes and oncomirs in LC growth.

Internalized Stigma and Adherence to Treatment Among Outpatients with Mental Illness

Background: Treatment adherence, the key to therapy success and patients' quality of life, can be influenced by many factors in psychiatric patients, including self-stigma, alongside insight, illness duration, social support, health beliefs, personality, substance abuse, side effects, and life circumstances. Objectives: This study aims to identify factors, particularly self-stigma, affecting treatment adherence in stable psychiatric outpatients. Methods: A sample of 200 adult mental health patients in Arak, Iran, diagnosed with schizophrenia, bipolar disorder, major depressive disorder, or anxiety disorders, participated in this study. Self-stigma was assessed using the Internalized Stigma of Mental Illness (ISMI) scale, and treatment adherence was measured using the Drug Attitude Inventory (DAI-10). Data were analyzed using descriptive statistics, correlation, regression, and chi-square tests. Results: Among the 200 participants (73 men and 127 women, with an average age of 35.1 years), the average stigma score was 62.8. The mean DAI-10 score was 4.8, with 172 showing positive medication attitudes. Younger, smoking, and alcohol-consuming patients showed lower treatment adherence. Higher self-stigma correlated with lower adherence, but there were no significant associations with gender, marital status, diagnosis, or diagnosis duration. Conclusions: This study highlights the importance of addressing self-stigma as a barrier to treatment adherence in individuals with mental illnesses. Strategies to reduce self-stigma may improve treatment outcomes, especially among younger patients and those with substance use disorders. Further research is warranted to develop effective interventions for enhancing medication adherence in stable psychiatric outpatients.

Process and effect evaluation of a referral aid for smoking cessation counselling in primary care: Findings of a randomized controlled trial.

This study explored the use and effects of a smoking cessation referral in: 1) practice nurses (PNs), and 2) smokers. The use of evidence-based smoking cessation interventions (EBSCIs) can double the likelihood of a successful smoking cessation attempt. A referral aid was developed to aid Dutch PNs in primary care in deciding which smokers are the most suitable for EBSCI. Two different studies were conducted: 1) a randomized controlled trial with a process evaluation (n=82) and effect evaluation (n=285) among smoking patients recruited by PNs (n=73), and 2) a process evaluation among a subgroup of PNs (n=40) from January 2019 to September 2020. Overall, the response in both groups was low. PNs found the referral aid materials clear and understandable. Smokers had similar but (slightly) less-positive opinions. The smokers in both groups did not differ in the amount of discussion and use of EBSCIs, nor on smoking abstinence. Further research should assess how to better involve PNs and smokers when recruiting for an RCT and how to foster effective counselling. Additional research should also look deeper into barriers to referral of both PNs and smokers, and how to stimulate referral to EBSCIs best and help smokers to make a decision; for example by implementing a simplified strategy both within the primary care setting and outside, by involving other healthcare professionals or options outside healthcare such as the workplace and social domain. The study was registered at the Netherlands Trial Register (NL7020, https://www.trialregister.nl/trial/7020).

Expression of AhR-regulated miRNAs in non-small cell lung cancer in smokers and never smokers.

Smoking is a risk factor for non-small cell lung cancer (NSCLC). The most common subtypes of NSCLC are lung adenocarcinoma (LAC) and squamous cell carcinoma (SCC). The cigarette smoke contains aryl hydrocarbon receptor (AhR) ligands, such as benzo(a)pyrene (BaP). By activating the AhR, BaP can change the expression of many genes, including miRNA-encoding genes. In this study, we have evaluated the expression of few miRNAs potentially regulated by AhR (miR-21, -342, -93, -181a, -146a), as well as CYP1A1, a known AhR target gene, in lung tumor samples from smoking (n=40) and non-smoking (n=30) patients with LAC and from smoking patients with SCC (n=40). We have also collected macroscopically normal lung tissue >5 cm from the tumor margin. We compared the obtained data on the miRNA expression in tumors with data from The Cancer Genome Atlas (TCGA). We found that in 76.7% of non-smoking LAC patients, CYP1A1 mRNA was not detected in tumor and normal lung tissues, while in smoking patients, CYP1A1 expression was detected in tumors in almost half of the cases (47.5% for SCC and 42.5% for LAC). The expression profile of AhR-regulated miRNAs differed between LAC and SCC and depended on the smoking status. In LAC patients, the expression of oncogenic miRNA-21 and miRNA-93 in tumors was higher than in normal lung tissue from the same patients. However, in SCC patients from our sample, the levels of these miRNAs in tumor and non-transformed lung tissue did not differ significantly. The results of our studies and TCGA data indicate that the expression levels of miRNA-181a and miRNA-146a in LAC are associated with smoking: expression of these miRNAs was significantly lower in tumors of smokers. It is possible that their expression is regulated by AhR and AhRR (AhR repressor), and inhibition of AhR by AhRR leads to a decrease in miRNA expression in tumors of smoking patients. Overall, these results confirm that smoking has an effect on the miRNA expression profile. This should be taken into account when searching for new diagnostic and therapeutic targets for NSCLC.

Use of infrared thermography in patients undergoing primary amputation due to peripheral arterial obstructive disease.

Peripheral Arterial Disease (PAD) is highly prevalent and the final stage of the disease is the Critical Ischemia (CI) of the Lower Limbs (LL), culminating, in most cases, with amputation of the limbs as part of the proposed treatment. Infrared Thermography (IT) is an inexpensive method, painless, without emission of radiation and easy to manage, which aims to determine the temperature of the skin of the limb to be amputated, and could help the surgeon to evaluate the level of the lower limb amputation. To Evaluate Whether IT is a useful method to determine the level of lower limb amputation in patients with PAD and CI. Method: Prospective cohort study performed from April 2023 to November 2023, at the Unit of vascular surgery - Hospital de Base do Distrito Federal (Brasília-DF). It evaluated patients with PAD and CI that were in the preoperative period for lower limb amputation. All Patients Underwent IT evaluation standards protocols. The results showed a wider longitudinal thermal gradient in PAD smoking (S) patients compared to non-smokers. It was also observed that (S) patients with wide thermal gradients were more likely to undergo an above the knee amputation. Infrared thermography was a useful method in discriminating thermal differences in patients with PAD and CI could be employed in preoperative evaluation to choose the level of lower limb amputation. Smoking patients with greater longitudinal thermal gradients are more likely to undergo an above the knee amputations.

Impact of Implant Surface and Smoking on Peri-Implant Human Bone: What we Learned from The Last 20 Years?

The present review summarizes the findings from human histological studies conducted over the past 20 years at the University of Guarulhos, Brazil, examining the impact of various implant surface topographies and smoking on peri-implant bone response. Seven different implant surfaces were evaluated in 90 partially or completely edentulous individuals using a total of 123 micro-implants. Histometric parameters, including bone-implant contact (BIC%), bone area within the threads (BA%), and bone density (BD), were assessed after an 8-week healing period. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses were also performed. Results showed that treated surfaces, regardless of the treatment type, consistently demonstrated better histometric outcomes compared to machined surfaces. Anodized surfaces and those subjected to airborne particle abrasion, followed by acid etching, exhibited higher BIC% values than machined surfaces in smoker patients. Smoking reduced BIC% around anodized implants. The presence of inflammatory cells was observed adjacent to the peri-implant soft tissue on some treated surfaces. In conclusion, implant surface topography significantly influences early bone response under unloaded conditions, with treated surfaces promoting better human bone tissue response than machined surfaces. However, smoking negatively impacts peri-implant bone healing, emphasizing the importance of smoking cessation for optimal osseointegration.

Nail Clubbing

A 78-year-old smoker patient with COPD (GOLD 3E) is admitted for COPD exacerbation. The initial examination shows abnormal fingers and nails. The hyponychial angle is 195 degrees and there is a positive Schamroth sign. A diagnosis of nail clubbing is made. Because the association of nail clubbing and COPD is rare, the history is completed and reveals significant weight loss over the past few months. A -pulmonary CT-scan shows a peri-hilar mass, and biopsy confirms small cell lung cancer.

Reparative potential of bone tissue and associated influencing factors

The aim of the sthudy. To study the influence of general and local factors on the regenerative potential of bone tissue to optimize augmentation mechanisms in the treatment of jaw atrophy. The influence of general and local factors on the regenerative potential of the bone during the augmentation operation of the alveolar process (part) of the jaw in 68 patients was studied. The survival rate of dental implants and the incidence of complications after completion of dental rehabilitation in the long-term follow-up period (more than 5 years) were evaluated. 18 indicators were studied, which were evaluated by qualitative and quantitative methods. The study of the effect of indicators on regeneration was carried out using an accurate Fischer test for conjugacy tables. The assessment of the strength of the influence was calculated as the ratio of the chances of developing an unfavorable outcome of bone grafting and dental implantation. He highest chances of developing adverse outcomes were found in smoking patients with diabetes mellitus, high body mass index, low survival of bone walls, severe bone atrophy (5.6 and higher class according to Cawood & Howell), three-dimensional bone defect, in the absence of 3 or more bone walls, the presence of subcompensated and decompensated psychological state the patient. In the course of histological examination, the influence of these factors on the mechanisms of reparative osteogenesis morphologically manifested a lower degree of progress of regenerative processes and a lower degree of maturity of bone tissue. To reduce the chances of developing an unfavorable outcome, in the presence of negative general and local factors, it is not advisable to use dental implantation simultaneously with bone augmentation procedures. In order to reduce the pathophysiological impact of negative factors during sinus lifting, increase the proportion of autosteal material for potentiating the metabolic activity of bone tissue, as well as prescribe antioxidant, antihypoxant and membrane stabilizing therapy before surgery and in the early postoperative period.

Forecasting tobacco smoking recurrence in lung TB patients

Aim of study: Identify tobacco smoking (TS) recurrence predictors in lung TB patients. Маterials and Methods: In all, the results of over the phone consulting on to-bacco smoking cessation with 335 smoking TB pa-tients (age from 18 to 70). Inclusion criteria: tobacco smoking in the course of 3 years and longer. Exclusion criteria: psychic diseases and disorders, аlcohol or narcotic drugs’ addiction. Number of cigarettes per day, duration of TS, nicotine dependence (ND) degree based on Fagerstrom test, motivation for smoking cessation, and anxiety and depression markers by HADS score were defined in all the patients. The smoking patients were offered over the phone consulting throughout the first month of smoking cessation in case they cease (time for consulting sessions coordinated with patients). Effectiveness of cessation was evaluated after 6 months. The patients were aggregated into the following groups: those who successfully ceased smoking and have not smoked for 6 months and longer (Group 1), and those who resumed TS after treatment (Group 2). Data was statistically processed with the help of SPSS programme

Mechanistic Insights of hsa-mir-301a Regulation by Tobacco Smoke in Lung Squamous Cell Carcinoma: Evidence From Bioinformatics Analysis.

MicroRNAs play a significant role in the development of cancers, including lung cancer. A recent study revealed that smoking, a key risk factor for lung cancer, increased the levels of hsa-mir-301a in the tumor tissues of patients with lung squamous cell carcinoma (LUSC). The aim of the current study is to investigate the mechanism by which tobacco smoke increases hsa-mir-301a levels in LUSC tumor tissues using bioinformatics analysis. Bioinformatics tools and online databases, including The Cancer Genome Atlas (TCGA), LinkedOmics, and Encyclopedia of RNA Interactomes (ENCORI), were applied in this study. Our results showed a correlation between the upregulation of hsa-mir-301a in LUSC tissues and smoking exposure. However, no correlation was discovered between patients' smoking status and the expression level of the hsa-mir-301a host gene, SKA2, prompting us to investigate possible changes in microRNA processing under tobacco smoke exposure. In silico results using online platforms suggest that post-transcriptional processes, which involve the RNA-binding proteins DGCR8 and FUS, contribute to the elevation of mature hsa-mir-301a levels in smoking patients with LUSC. Our findings suggest that RNA-binding proteins play a key role in controlling the processing of hsa-mir-301a, indicating a complex regulation of hsa-mir-301a in the LUSC tissues of smokers.

Anesthetic Challenges during Endobronchial Brachytherapy: A Case Report.

Lung cancer is the leading cause of cancer death worldwide. It may present as airway obstruction in a patient with endobronchial masses. Endobronchial brachytherapy (EBBT) has been shown to provide palliative therapy. It is the insertion of a radioactive material near the mass to reduce tumor size, thereby improving airway obstruction. This is the first case of EBBT done in our institution during the COVID-19 pandemic. A 53-year-old male, 60 kg, ASA Physical Status 2 for hypertension, smoker, malignancy, and previous pulmonary tuberculosis patient, presented with a cough and dyspnea. An endobronchial mass almost obstructing the right mainstem bronchus was seen on a computed tomography (CT) scan. He was diagnosed with squamous cell carcinoma of the lung and underwent radiotherapy and erlotinib chemotherapy. On repeat CT scan, there was no noted decrease in the size of the mass. EBBT was suggested, and a multi-disciplinary team was formed for the planned procedure. Pulmonology, radiation oncology, and anesthesiology teams were identified, and thorough planning was done prior to the actual procedure. Three fractions of EBBT were done under sedation using midazolam, fentanyl, and dexmedetomidine infusion. Lidocaine spray and transtracheal block were also performed as adjuncts prior to sedation. The procedure went as planned, and points for improvement were discussed for subsequent fractions. Due to persistent cough and discomfort from the catheter, additional ipratropium nebulization for minimization of secretions, and oral dextromethorphan for cough suppression were incorporated. After each fraction, the patient was monitored post-procedure for any side effects both from the radiotherapy and anesthetic technique. Qualitative reduction in mass size was noted in subsequent fractions. The patient was able to complete 3 fractions and was advised to follow-up after a month. EBBT is an emerging palliative and treatment modality for lung cancer, especially for intraluminal masses. Anesthetic considerations will depend on each case's characteristics such as airway anatomy, patient comfort and capacity, and procedural requirements. Conscious sedation with topical anesthesia is an adequate and appropriate anesthetic option, especially in cases where severe airway obstruction may compromise ventilation if airway reflexes are blunted. A multidisciplinary approach with different services and stakeholders is important for the proper planning, execution, and management of such patients.

Prevalence and Severity of Periodontal Disease and its Association with Type-II Diabetes Mellitus and Smoking by Using Periodontal Screening and Recording: A Retrospective Study.

Periodontal screening recording (PSR) is considered a quick, reliable, reproducible valuable screening tool for periodontal disease. This study aims to find the prevalence and severity of periodontal disease and its association with self-reported diabetic status and smoking history of the patients by using PSR codes over a period of 2 years. This was a cross-sectional retrospective study in a dental hospital in Chandigarh. Data of 10,882 patients comprising self-reported history of smoking (893) and diabetes (725) patients were assessed for the prevalence of periodontal disease by using PSR codes. Pearson Chi-Square test was used for statistical evaluation of PSR codes data. Out of a total of 65,292 sextants assessed, the maximum and minimum reported PSR codes were 2 and 4, respectively. Gingivitis was found to be the most prevalent, followed by periodontitis and periodontal health in the total assessed population (P < 0.001). Mucogingival problems and complete edentulism were found to be more prevalent in posterior sextants in comparison to anterior sextants. Both self-reported smokers and type-II diabetes mellitus patients presented gingivitis as the most common clinical presentation, with the highest prevalence seen in the 55-74-year age group, which also comprised the group with maximum mucogingival problems and edentulism. This study gives an overview of patients' general oral health status and reflects the burden of periodontal disease in the Chandigarh region, thus contributing to the national oral health data.

Association between nontraditional lipid parameters and the risk of type 2 diabetes and prediabetes in patients with nonalcoholic fatty liver disease: from the national health and nutrition examination survey 2017-2020.

Nonalcoholic fatty liver disease (NAFLD) is a prevalent metabolic disorder strongly linked to type 2 diabetes mellitus (T2DM). Understanding the predictive value of lipid parameters in identifying abnormal glucose metabolism in NAFLD patients is crucial for early intervention. This study analyzed data from the National Health and Nutrition Examination Survey(NHANES) database (2017-2020) involving 1066 NAFLD patients. Participants were categorized into three groups: T2DM (n=414), prediabetes mellitus (pre-DM) (n=507), and normoglycemia (NG) (n=145). Traditional lipid parameters [triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)] and nontraditional lipid parameters [atherogenic index of plasma (AIP), residual cholesterol (RC), and non-high-density lipoprotein cholesterol (non-HDL-C)] were evaluated for their association with T2DM and pre-DM. Elevated TG levels were significantly associated with an increased risk of T2DM and pre-DM, whereas high HDL-C demonstrated a protective effect. Among nontraditional lipid parameters, increased AIP and RC were most strongly associated with T2DM risk, while high non-HDL-C was best associated with the development of pre-DM. Stratified analyses revealed that these associations were stronger in younger, non-obese, smoking, and female NAFLD patients. Nontraditional lipid parameters, particularly AIP and RC, show superior predictive value over traditional lipid parameters in identifying abnormal glucose metabolism in NAFLD patients. Incorporating these novel biomarkers into clinical practice could enhance early detection and prevention strategies for T2DM and pre-DM in this high-risk population.

Evaluation of Glycosylated Hemoglobin Levels and Effect of Tobacco Smoking in Periodontally Diseased Non-Diabetic Patients.

Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers. The study was conducted with 40 patients in the age range of 20-40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups. The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant. This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.

Effect of tobacco smoking on the periodontal health in Parsa, Nepal: A comparative cross-sectional study

Introduction: For ages, smoking tobacco has been a part of cultural practice in different parts of Nepal. For periodontal diseases, one of the important risk factors is tobacco smoking, mainly cigarette smoking. Objectives: This study was conducted to find out the relationship among tobacco smoking and periodontal disease by means of clinical attachment loss (CAL), plaque score, and gingival score in cigarette smoker patients in comparison with nonsmokers. Methodology: A comparative cross-sectional study was done among 300 patients who visited the Outpatient Department of Periodontics, M. B. Kedia Dental College, Parsa, Nepal. The patients were divided into two groups, cigarette smokers and nonsmokers. Oral cavity examination was done using plaque index, gingival index, and CAL. Mann–Whitney test was done to determine the relation between tobacco smoker and overall periodontal health. Results: The result shows that the overall median plaque score of the patients was 1.08, the gingival score of the patients was 1.22, and CAL was 2.04. Furthermore, there was statistical significance between periodontitis and cigarette smoking. Conclusion: The present study concluded that smoking has a negative effect on periodontium health. More duration of cigarette smoking habit had higher severity of symptoms when compared to nonsmokers.

Asthma–COPD overlap syndrome among smoker subjects with asthma: A cross-sectional study

This study aimed to assess the prevalence of asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) in asthmatic outpatients with smoking exposure (smokers or ex-smokers with ≥10 pack-year history) and to evaluate quality of life (QoL) and adherence among the study sample. This cross-sectional study was conducted at outpatient respiratory clinics in governmental hospitals in Jordan. Asthmatic outpatients were interviewed to assess their spirometric readings, patients’ adherence, and patients’ QoL [using the Mini Asthma QoL questionnaire (MiniAQLQ)]. The prevalence of ACOS was found to be 33% among asthmatic smoker patients in the outpatient setting (n = 65 out of 200 subjects with asthma-diagnosed patients recruited into the study). For subjects with ACOS, 47.7% of them were older than 60 years old. Smoking history for more than 30 years was prevalent among most subjects with ACOS (67.7%). The MiniAQLQ average score was found to be low (mean ± SD = 3.23 ± 1.01, score out of 7) and similarly for patients’ adherence to their treatment modalities (mean ±SD = 1.76 ± 1.2, score out of 6). A significant positive relationship between adherence to treatment and QoL was found among subjects with ACOS (correlation coefficient = 0.171, p-value = 0.018). In conclusion, a moderate prevalence of ACOS was estimated among asthmatic smoker patients. Low levels of QoL and adherence to treatment were significantly correlated.

Non-Smoker’s Cancer- Human Papilloma Virus (HPV) Induced Head &amp; Neck Squamous Cell Carcinoma (HNSCC)

Head and neck squamous cell carcinoma is recognized as 6th most common cancer worldwide. Etiological factors are generally cigarettes, alcohol consumption also tobacco products such as ghutka, pan masala and betel quid also triggers the development of OSCC. Among several causes of cervical malignancies which the second most carcinoma is the world, infection with some types of human papilloma virus (HPV) is thought to be the greatest cervical cancer risk factor. Over 150 subtypes of HPV have been identified; from which more than 40 types of HPVs are typically transmitted through sexual contact and infect the anogenital region and oral cavity. HPV is suspected as the principle causative factor for oral malignancy in non smoker and non-alcoholic patients. It was also reported to be associated with Head and neck squamous cell carcinoma in 1995. The recently introduced vaccine for HPV infection is effective against certain subtypes of HPV which are associated with cervical cancer, genital warts, and some less common cancers, including oropharyngeal cancer. The value of HPV vaccination for oral cancer prevention is still controversial and hypothetical; some evidence also supports the possibility that HPV vaccination may be preventive factor in reducing the incidence of oral cancer.

Educational intervention on the harmful effects of tobacco in smoking patients. Medical Clinic 33. Policlínico Luis Augusto Turcios Lima

Educational intervention on the harmful effects of tobacco in smoking patients. Medical Clinic 33. Policlínico Luis Augusto Turcios Lima

Modifiable risk factors for cardiovascular disease in Iraqi Kurdistan population: a large epidemiological study

Cardiovascular diseases (CVDs) are considered the leading factor of morbidity and mortality across the world. This study aimed to identify the modifiable risk factors of CVDs in the Kurdistan Region. In this retrospective cross-sectional study, the patients who visited and were diagnosed with any type of CVDs and treated in a main private cardiac center in Duhok governorate in Kurdistan Region were included between the years 2018 and 2023. The study found a similar percentage of male and female patients. The percentage of old patients was significantly increased from 18-19 to ≥70. The most preventable modifiable risk factors among cardiac patients were hypertension (86.17%), physical inactivity (60.59%), diabetes (40.15%), and dyslipidemia (56.31%). The less preventable modifiable risk factors were alcohol (4.01%) and cigarette smoking (14.43%). Males had a higher prevalence of cigarette smoking (24.63% vs. 4.38%; P&lt;0.0001) and female patients had a higher prevalence of hypertension (91.25% vs. 81.02%; P&lt;0.000), diabetes (44.43% vs. 35.80 %; P=0.0007) and dyslipidemia (59.15% vs. 53.43%; P=0.0257). In terms of family history of heart disease, the middle age group had a higher prevalence compared to younger and older age groups. Diabetes and cigarette smoking was more prevalent among older age groups, while dyslipidemia was more prevalent among younger and older age groups. Alcohol, physical inactivity, and hypertension were similar among age groups. Hypertension, diabetes, dyslipidemia, and physical inactivity were the most prevalent risk factors for CVDs in this region. The older patients had significantly higher rates of some of these risk factors.

TICRR serves as a prognostic biomarker in lung adenocarcinoma with implications in RNA epigenetic modification, DDR pathway, and RNA metabolism.

TOPBP1 interacting checkpoint and replication regulator (TICRR), a hub gene of the Cdk2-mediated initiation step of DNA replication, has been shown an essential role in tumorigenesis by accelerating the DNA replication of tumor cells. RT-qPCR was used to detect the mRNA expression of TICRR in LUAD tumors and adjacent normal tissues. The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database of LUAD were acquired to analyze the critical role of TICRR expression in survival prognosis and clinicopathology characters in LUAD. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and gene set enrichment analysis (GSEA) were performed using the R package. The correlation of TICRR expression with immune cellinfiltration, RNA epigenetic modification, DNA damage repair (DDR) pathway, and cell metabolism of LUAD was further explored to verify significant conclusions. TICRR was significantly upregulated in most cancer types, including LUAD, lung squamous cell carcinoma (LUSC), and others. Cox regression analysis indicated the overexpression of TICRR was associated with poor survival in several cancers. In LUAD, TICRR expression was positively correlated with tumor stage and was increased in smoking, male, and high tumor mutational burden (TMB) patients. Enrichment analysis revealed that TICRR could influence tumor proliferation and prognosis via activating pathways involving cell cycle, DNA repair, DNA replication, cysteine metabolism, oxidative phosphorylation, and ubiquitin-mediated proteolysis pathways. Interestingly, high TICRR expression correlated with DDR pathway signature (34 genes), 37 m6A/m5C regulated genes, and some metabolism-regulated genes. Silencing the TICRR gene affects cysteine metabolism and modifies cancer-related pathways, with decreased cell cycle and increased B/T cell receptor signaling. Our TICRR risk model accurately predicts LUAD patient prognosis, validated across GEO datasets, and is integrated with clinical characteristics via a nomogram, facilitating personalized treatment strategies and enhancing patient management. Taken together, TICRR has emerged as a promising prognostic biomarker in lung adenocarcinoma (LUAD), with implications in immune activation, cell cycle regulation, RNA modification, and tumor energy metabolism. These findings suggest that TICRR could serve as a viable therapeutic target and a reliable prognostic indicator for LUAD.