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1.
Pulm Med ; 2020: 6175964, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32850151

RESUMO

Although pulmonary fibrosis can occur in the absence of a clear-cut inciting agent, and without a clinically clear initial acute inflammatory phase, it is more commonly associated with severe lung injury. This may be due to respiratory infections, chronic granulomatous diseases, medications, and connective tissue disorders. Pulmonary fibrosis is associated with permanent pulmonary architectural distortion and irreversible lung dysfunction. Available clinical, radiographic, and autopsy data has indicated that pulmonary fibrosis is central to severe acute respiratory distress syndrome (SARS) and MERS pathology, and current evidence suggests that pulmonary fibrosis could also complicate infection by SARS-CoV-2. The aim of this review is to explore the current literature on the pathogenesis of lung injury in COVID-19 infection. We evaluate the evidence in support of the putative risk factors for the development of lung fibrosis in the disease and propose risk mitigation strategies. We conclude that, from the available literature, the predictors of pulmonary fibrosis in COVID-19 infection are advanced age, illness severity, length of ICU stay and mechanical ventilation, smoking and chronic alcoholism. With no proven effective targeted therapy against pulmonary fibrosis, risk reduction measures should be directed at limiting the severity of the disease and protecting the lungs from other incidental injuries.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Fibrose Pulmonar/complicações , Comportamento de Redução do Risco , Sobreviventes/estatística & dados numéricos , Fatores Etários , Alcoolismo/complicações , Humanos , Tempo de Internação/estatística & dados numéricos , Pandemias , Respiração Artificial/efeitos adversos , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Tabagismo/complicações
2.
PLoS One ; 15(8): e0237723, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857771

RESUMO

PURPOSE: This study investigated nicotine dependence as an independent risk factor for upper aerodigestive tract (UADT) cancers, including lung and head and neck cancers (HNC). The study aimed to isolate the direct effect of nicotine dependence, independent of tobacco smoking. METHODS: A case-control study with a total of 4957 participants was conducted in Ontario, Canada, of which 2964 categorized as either current or former smokers were used in the analysis. Nicotine dependence of ever-smokers (2360 UADT cases and 604 controls) was measured using the Fagerström Test for Nicotine Dependence. Using mediation analyses and adjusted logistic regression models, we decomposed the direct effect of nicotine dependence and the mediated effect of smoking duration to quantify the risks of lung and HNC. The role of human papillomavirus (HPV) and cancer subtypes were assessed. RESULTS: Most individual nicotine dependence behaviours showed positive associations with lung cancer with approximately 1.8 to 3.5-fold risk increase, and to lesser extent with 1.4 to 2.3-fold risk for HNC. Nicotine dependence is partially accountable for increased risks of lung cancer (OR = 1.20, 95%CI = 1.13-1.28) and HNC (1.12, 95%CI = 1.04-1.19). Nicotine dependence had a greater effect on the risk of HPV-negative oropharyngeal cancer (OR = 3.06, 95%CI = 1.65-5.66) in comparison to HPV-positive oropharyngeal cancer (OR = 1.05, 95%CI = 0.67-1.65). The direct effects of nicotine dependence remained significant after accounting for cumulative tobacco exposures. CONCLUSION: Nicotine dependence increases the risks of lung and HNC cancers after accounting for tobacco smoking, suggesting potential toxic effects of nicotine. These results are informative for the safety consideration of nicotine exposures.


Assuntos
Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias Pulmonares/epidemiologia , Nicotina/efeitos adversos , Tabagismo/epidemiologia , Idoso , Estudos de Casos e Controles , Feminino , Neoplasias de Cabeça e Pescoço/etiologia , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tabagismo/complicações
3.
Artigo em Inglês | MEDLINE | ID: mdl-32668758

RESUMO

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the "cold call" following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.


Assuntos
Registros Eletrônicos de Saúde , Neoplasias , Medidas de Resultados Relatados pelo Paciente , Abandono do Hábito de Fumar , Tabagismo , Aconselhamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Uso de Tabaco , Tabagismo/complicações , Tabagismo/terapia
4.
Rev. méd. hondur ; 88(1): 27-32, ene.- jun. 2020. tab, map
Artigo em Espanhol | LILACS | ID: biblio-1128540

RESUMO

Antecedentes: Aproximadamente un sexto de la población mundial tiene el hábito de fumar para una prevalencia de 24%. La OMS considera que, de no cambiar las tendencias durante el siglo XXI, el tabaco será responsable de la muerte prematura de mil millones de personas. Objetivo: Determinar la prevalencia del consumo de tabaco y la medición de desigualdades socioeconómicas en la población Lenca, Municipio de Intibucá, Intibucá, Honduras, 2015. Métodos: Estudio descriptivo transversal con análisis de asociación. Se aplicó formulario estructurado para recolectar datos generales, sociodemográficos y tabaquismo, previo consentimiento informado. Dependencia al tabaco fue evaluada con test Faguerström. Se prepararon bases de datos en Epi-info-7 y SPSS-18. Se calcularon razones de disparidad (OR). Resultados: De un total de 602 entrevistados,se identificaron 167 fumadores para una prevalencia de consumo de tabaco de 27.7%. El 76.6% (128) de fumadores tuvo dependencia baja a nicotina y 23.4% (39) dependencia moderada. La media de ingreso familiar mensual fue USD$193 en fumadores y USD$168 en no fumadores. El 40.1% (67) de fumadores gastó mensualmente en tabaco un mínimo de USD$95. No se encontró relación entre consumo de tabaco e ingreso familiar mensual (OR=0.87, IC95% 0.7-1.0) ni con analfabetismo (OR=1.20, IC95% 0.7-2.0). Discusión: No se observaron diferencias significativas entre consumo de tabaco y las variables socioeconómicas, se encontró una elevada prevalencia de consumo de tabaco en esta población en relación con otros estudios realizados en el país. Los resultados apoyan la necesidad de políticas enfocadas en prevención del tabaco en indígenas...(AU)


Assuntos
Humanos , Masculino , Feminino , Grupos Étnicos/classificação , Uso de Tabaco , Tabagismo/complicações , Disparidades nos Níveis de Saúde
10.
Respir Investig ; 58(5): 387-394, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32381453

RESUMO

BACKGROUND: The data on smoking cessation treatment outcomes for smokers with chronic obstructive pulmonary disease (COPD) are limited. The present study assessed the effectiveness of smoking cessation interventions at our clinic. METHODS: Data from a prospective registry of a 3-month smoking cessation program were evaluated. The primary outcome, smoking cessation, was defined as the complete abstinence from smoking between the 8-week and 12-week clinic visits. Pulmonary function and health-related quality of life using St. George's Respiratory Questionnaire (SGRQ) were assessed at baseline and at the end of the program. RESULTS: Out of the 155 COPD patients with nicotine dependence (female/male = 39/116; mean age, 67.2 ± 9.8 years; mean forced expiratory volume in 1 s (FEV1), 59.7 ± 21.1% predicted), 107 participants completed the program. Among the completers, 74 achieved smoking cessation. In the multivariate analysis, mental disorders (odds ratio [OR] 3.678, 95% confidence interval [CI]: 1.182, 11.445), higher exhaled carbon monoxide (CO) level (OR 1.080, 95% CI: 1.013, 1.151) and lower FEV1/forced vital capacity (FVC) (OR 0.958, 95% CI: 0.923, 0.995) were negatively associated with successful smoking termination. Significant changes in pulmonary function were found in quitters but not in continuous smokers (increases in FEV1 by 0.09 L/s [95% CI: 0.03, 0.15] and peak expiratory flow by 0.23 L/s [95% CI: 0.01, 0.44]). SGRQ total scores improved significantly in both quitters (-5.4 [95% CI: -8.4, -2.5]) and continuous smokers (-7.0 [95% CI: -11.6, -2.5]). CONCLUSION: In the program completers, the exhaled CO levels, FEV1/FVC ratio, and presence of mental disorders were significantly associated with program success or failure in COPD patients with nicotine dependence.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Abandono do Hábito de Fumar , Tabagismo/complicações , Tabagismo/terapia , Idoso , Monóxido de Carbono/metabolismo , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/metabolismo , Qualidade de Vida , Inquéritos e Questionários , Tabagismo/metabolismo , Tabagismo/fisiopatologia , Capacidade Vital
11.
Artigo em Inglês | MEDLINE | ID: mdl-32384731

RESUMO

Tobacco treatment is increasingly recognized as important to cancer care, but few cancer centers have implemented sustainable tobacco treatment programs. The University of California Davis Comprehensive Cancer Center (UCD CCC) was funded to integrate tobacco treatment into cancer care. Lessons learned from the UCD CCC are illustrated across a systems framework with the Cancer Care Continuum and by applying constructs from the Consolidated Framework for Implementation Research. Findings demonstrate different motivational drivers for the cancer center and the broader health system. Implementation readiness across the domains of the Cancer Care Continuum with clinical entities was more mature in the Prevention domain, but Screening, Diagnosis, Treatment, and Survivorship domains demonstrated less implementation readiness despite leadership engagement. Over a two-year implementation process, the UCD CCC focused on enhancing information and knowledge sharing within the treatment domain with the support of the cancer committee infrastructure, while identifying available resources and adapting workflows for various cancer care service lines. The UCD CCC findings, while it may not be generalizable to all cancer centers, demonstrate the application of conceptual frameworks to accelerate implementation for a sustainable tobacco treatment program. Key common elements that may be shared across oncology settings include a state quitline for an adaptable intervention, cancer committees for outer/inner setting infrastructure, tobacco quality metrics for data reporting, and non-physician staff for integrated services.


Assuntos
Continuidade da Assistência ao Paciente , Neoplasias , Tabagismo , Implementação de Plano de Saúde , Humanos , Neoplasias/complicações , Análise de Sistemas , Tabaco , Tabagismo/complicações , Tabagismo/terapia
12.
Med Hypotheses ; 140: 109762, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388390

RESUMO

On March 11, 2020, the World Health Organization declared the coronavirus outbreak a pandemic. Since December 2019, the world has experienced an outbreak of coronavirus disease 2019 (COVID-19). Epidemiology, risk factors, and clinical characteristics of patients with COVID-19 have been reported but the factors affecting the immune system against COVID-19 have not been well described. In this article, we provide a novel hypothesis to describe how an increase in cellular adenosine triphosphate (c-ATP) can potentially improve the efficiency of innate and adaptive immune systems to either prevent or fight off COVID-19.


Assuntos
Trifosfato de Adenosina/imunologia , Infecções por Coronavirus/imunologia , Sistema Imunitário , Pneumonia Viral/imunologia , Idoso , Apoptose , Betacoronavirus , Comorbidade , Citocinas/imunologia , Feminino , Humanos , Interferons/imunologia , Masculino , Modelos Teóricos , Pandemias , Prognóstico , Fatores Sexuais , Fumar , Linfócitos T/imunologia , Tabagismo/complicações
16.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32253889

RESUMO

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.


Assuntos
Terapia Comportamental/métodos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Fumar/terapia , Tabagismo/terapia , Adolescente , Adulto , Idoso , Aconselhamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Estudos Prospectivos , Fumar/efeitos adversos , Fumar/psicologia , Inquéritos e Questionários , Tabagismo/complicações , Tabagismo/diagnóstico , Tabagismo/psicologia , Adulto Jovem
17.
Medisan ; 24(2)mar.-abr. 2020. ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1098397

RESUMO

Se describe el caso clínico de un paciente de 51 años de edad con antecedente patológico personal de ser un fumador empedernido, el cual acudió al Cuerpo de Guardia del Hospital Provincial Docente Dr. Joaquín Castillo Duany de Santiago de Cuba por presentar disnea asociada a cifras elevadas de tensión arterial y livedo reticular en la cara anterior abdominal. Debido al cuadro clínico y a los resultados de los exámenes complementarios, fue trasladado a la Unidad de Cuidados Intensivos, donde posteriormente se le diagnosticó pancreatitis aguda grave, tras realizar una laparotomía exploratoria y hallar zonas isquémicas en las asas intestinales. El paciente mantuvo una evolución tórpida y falleció a causa de una disfunción múltiple de órganos.


The case report of a 51 years patient with personal pathological history of being a heavy smoker is described, who went to the emergency room of Dr. Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba due to a dyspnea associated with high figures of blood pressure and livedo reticularis in the abdominal anterior face. Due to the clinical pattern and the results of the complementary tests, he was referred to the Intensive Cares Unit, where later on he was diagnosed serious acute pancreatitis, after an exploratory laparotomy where ischemic areas in the intestinal loops were found. The patient maintained a torpid clinical course and he died because of a multiple dysfunction of organs.


Assuntos
Pancreatite/diagnóstico , Insuficiência de Múltiplos Órgãos , Tabagismo/complicações , Hipertensão , Unidades de Terapia Intensiva
18.
Reumatol. clín. (Barc.) ; 16(2,pt.1): 103-109, mar.-abr. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194328

RESUMO

OBJECTIVE: Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA. METHODS: This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ). RESULTS: A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000). CONCLUSION: Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle


OBJETIVO: Minimizar la discapacidad y mejorar la función física hasta sus niveles óptimos sigue siendo un desafío en el tratamiento de la artritis reumatoide (AR). El objetivo es identificar los factores que conducen a la discapacidad en la AR. MÉTODOS: Se trata de un estudio multicéntrico egipcio de corte transversal llevado a cabo en 215 pacientes con AR que asisten a nuestras clínicas de reumatología para pacientes internados y ambulatorios durante 4 meses, desde abril a julio de 2017, que aceptaron participar en el estudio; 170 pacientes eran de hospitales de la Universidad de El Cairo y 45 de hospitales de la Universidad de Zagazig. Registramos una serie de posibles factores de riesgo que incluyen factores demográficos, clínicos, serológicos y terapéuticos. La evaluación de la discapacidad de los pacientes se realizó utilizando HAQ modificado (MHAQ). RESULTADOS: Se encontró una correlación positiva significativa entre MHAQ y diferentes marcadores de actividad además de la puntuación de edad y depresión (p < 0,001). El analfabetismo representó un puntaje MHAQ más alto (p = 0,001). Se encontró un MHAQ más alto en pacientes con cardiopatía isquémica (p < 0,05). Los pacientes con erosiones en los rayos X tuvieron puntajes de MHAQ significativamente más altos. Las subluxaciones también representaron puntuaciones más altas de MHAQ (p = 0,000). CONCLUSIÓN: El envejecimiento, el analfabetismo, la actividad de la enfermedad, las erosiones, las subluxaciones, la depresión y la cardiopatía isquémica se relacionaron con una mayor discapacidad. El buen control de la actividad de la enfermedad que a su vez reduce las erosiones y las subluxaciones es obligatorio. La detección de la depresión y el uso adecuado de antidepresivos es de gran valor. Se recomienda la detección y profilaxis adecuada de la cardiopatía isquémica controlando los factores de riesgo modificables como la obesidad, la dislipidemia, la hipertensión, el tabaquismo y el estilo de vida sedentario


Assuntos
Humanos , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/terapia , Avaliação da Deficiência , Escala de Gravidade do Ferimento , Luxações Articulares/prevenção & controle , Isquemia Miocárdica/prevenção & controle , Egito , Fatores de Risco , Isquemia Miocárdica/complicações , Estudos Transversais , Obesidade/complicações , Dislipidemias/complicações , Hipertensão/complicações , Tabagismo/complicações , Comportamento Sedentário
20.
Am J Physiol Lung Cell Mol Physiol ; 318(5): L1004-L1007, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32233791
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