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المؤلفون: Erin D. Michos, Ankur Kalra, Tariq Jamal Siddiqi, Urvish K Patel, Izza Shahid, Muhammad Usman, Jawad Ahmed, Muhammad Shahzeb Khan
المصدر: BMJ Evidence-Based Medicine
مصطلحات موضوعية: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Population, Context (language use), 030204 cardiovascular system & hematology, Nicotine, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, education, Mechanical ventilation, education.field_of_study, Smokers, business.industry, SARS-CoV-2, Smoking, COVID-19, General Medicine, medicine.disease, medicine.anatomical_structure, business, Cytokine storm, Respiratory tract, medicine.drug
الوصف: Although it is well established that cigarette smoking is associated with morbidity and mortality in several respiratory infections, data from recent studies suggest that active smokers are underrepresented among patients with COVID-19. This has led to claims that a ‘smoker’s paradox’ may exist in COVID-19, wherein smokers are protected from infection and severe complications of COVID-19. We aimed to review and summarise existing literature in this context. Electronic databases were searched for articles that reported prevalence of smokers among patients with COVID-19 or studied any association of smoking with outcomes among patients with COVID-19. We identified several biases and knowledge gaps which may give the false impression that smoking is protective in COVID-19. As of now, the data supporting smoker’s paradox claims are limited and questionable. Plausible biologic mechanisms by which smoking might be protective in COVID-19 include an anti-inflammatory effect of nicotine, a blunted immune response in smokers (reducing the risk of a cytokine storm in COVID-19) and increased nitric oxide in the respiratory tract (which may inhibit replication of SARS-CoV-2 and its entry into cells). On the other hand, smoking may worsen susceptibility and prognosis in COVID-19, in a manner similar to other respiratory infections. The claims of a protective effect must be viewed with extreme caution by both the general population as well as clinicians. Further investigations into the interaction between smoking and COVID-19 are warranted to accurately assess the risk of contracting COVID-19 among smokers, and progression to mechanical ventilation or death in patients suffering from it.
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المؤلفون: Abdul Wahab Arif, Dorothy M. Davis, Richard A. Krasuski, Muhammad Zain Farooq, Izza Shahid, Erin D. Michos, Muhammad Shahzeb Khan, Safi U. Khan, Pankaj Kumar
المصدر: BMJ Supportive & Palliative Care. :bmjspcare-2020
مصطلحات موضوعية: Oncology (nursing), business.industry, Ethnic group, Medicine (miscellaneous), Cancer, General Medicine, 030204 cardiovascular system & hematology, Logistic regression, medicine.disease, 03 medical and health sciences, Medical–Surgical Nursing, 0302 clinical medicine, Quality of life, Heart failure, medicine, College education, Marital status, 030212 general & internal medicine, business, Health statistics, Demography
الوصف: BackgroundIncreasing utilisation of hospice services has been a major focus in oncology, while only recently have cardiologists realised the similar needs of dying patients with heart failure (HF). We examined recent trends in locations of deaths in these two patient populations to gain further insight.MethodsComplete population-level data were obtained from the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics database, from 2013 to 2017. Location of death was categorised as hospital, home, hospice facility or nursing facility. Demographic characteristics evaluated by place of death included age, sex, race, ethnicity, marital status and education, and a multivariable logistic regression analysis was performed to analyse possible associations.ResultsAmong 2 780 715 deaths from cancer, 27% occurred in-hospital and 14% in nursing facilities; while among 335 350 HF deaths, 27% occurred in-hospital and 30% in nursing facilities. Deaths occurred at hospice facilities in 14% of patients with cancer, compared with just 8.7% in HF (p=0.001). For both patients with HF and cancer, the proportion of at-home and in-hospice deaths increased significantly over time, with majority of deaths occurring at home. In both cancer and HF, patients of non-Hispanic ethnicity (cancer: OR 1.29, (1.27 to 1.31), HF: OR 1.14, (1.07 to 1.22)) and those with some college education (cancer: OR 1.10, (1.09 to 1.11); HF: OR 1.06, (1.04 to 1.09)) were significantly more likely to die in hospice.ConclusionDeaths in hospital or nursing facilities still account for nearly half of cancer or HF deaths. Although positive trends were seen with utilisation of hospice facilities in both groups, usage remains low and much remains to be achieved in both patient populations.
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