Risk factors identification of COVID-19 patients with chronic obstructive pulmonary disease: A retrospective study in Punjab-Pakistan

Socio-demographic environmental and clinical factors influencing asthma control in community pharmacies of Lahore Pakistan

Asthma is a significant non-communicable disease affecting over 300 million people worldwide. This study aimed to evaluate the influence of socio-demographic, environmental, and clinical factors on asthma control among patients visiting community pharmacies in Lahore, Pakistan. A multicenter prospective observational study was conducted with 284 participants using a validated data collection tool. Data included demographics and potential confounders such as smoking, obesity, co-morbidities (e.g., allergic rhinitis, gastroesophageal reflux disease [GERD]), and adherence to treatment. Asthma control was classified into full, partial, and uncontrolled levels based on established guidelines. Statistical analyses, including chi-square tests and logistic regression, were performed to identify significant predictors. The results indicated that 53.5% of participants were female, 74.6% were aged above 40 years, and 42.3% were obese. A family history of asthma was reported in 55.6% of participants, while smoking was prevalent in 77.1%. Clinical co-morbidities, such as allergic rhinitis (49.3%) and GERD (50.7%), were notable. Participants who adhered to treatment (62.3%) and engaged in daily exercise (59.5%) exhibited significantly better asthma control. Multivariate analysis revealed that higher education, rural residence, and the absence of obesity were positively associated with asthma control, whereas passive smoking and prolonged asthma history had a negative impact. This study underscores the multifaceted nature of asthma management and the importance of addressing socio-demographic, environmental, and clinical factors. Improved asthma outcomes require targeted interventions, including promoting adherence to treatment plans, encouraging physical activity, and minimizing exposure to smoking and environmental allergens. The findings highlight the need for community-centered strategies to enhance asthma control and reduce its public health burden, particularly in middle-income countries like Pakistan.

Construction of Internet Plus Wound Care Service Quality Evaluation System Based on Donabedian and SERVQUAL Models-A Delphi-Analytic Hierarchy Process Study

The objective of this study was to develop an Internet Plus wound care service quality evaluation system within the context of digital and intelligent medical care services. We utilized the Donabedian and SERVQUAL models as the theoretical framework, establishing an initial evaluation system through a literature review and semi-structured interviews. This evaluation system was refined through two rounds of Delphi expert consultations, and the weights of each level of indicators were determined using the Analytic Hierarchy Process (AHP). The statistical results indicated a return rate of 100%, with authority coefficients of the experts at 0.898 and 0.906, respectively. The experts' opinions were relatively concentrated and consistent. After two rounds of consultations, the importance values of indicators exceeded 4.5 points, the variation coefficient was below 0.25, and the Kendall coordination coefficients for secondary and tertiary indicators were 0.163 and 0.131, respectively, all with p < 0.001. The final indicator system comprised 3 primary indicators, 10 secondary indicators, and 59 tertiary indicators, demonstrating strong scientific validity and reliability.

Insights into the epidemiology and clinical aspects of post-COVID-19 conditions in adult

ObjectivesWhile most individuals infected with COVID-19 recover completely within a few weeks, some continue to experience lingering symptoms. This study was conducted to identify and describe the clinical and subclinical manifestations of adult patients from the long-term effects of COVID-19.MethodsThe study analyzed 205 medical records of inpatients (age ≥ 16 years, ≥ 4 weeks post-COVID-19 recovery, and a negative SARS-CoV-2 status at enrollment) at Thong Nhat Hospital, Vietnam, from 6 September 2021 to 26 August 2022, using R language software.ResultsThe majority of patients hospitalized with long COVID-19 symptoms (92.68%) had normal consciousness. The most common symptoms on admission were fatigue (59.02%), dyspnea (52.68%), and cough (42.93%). In total, 80% of patients observed respiratory symptoms, primarily dyspnea, while 42.44% reported neurological symptoms, with sleep disturbance being the most common. Noticeably, 42.93% of patients experienced respiratory failure in the post-COVID-19 period, resembling acute respiratory distress syndrome.DiscussionThese findings provide crucial insights into the epidemiology, clinical, and subclinical aspects of post-COVID-19 conditions, shedding light on the prevalence of common symptoms and the demographic distribution of affected patients. Understanding these manifestations is vital for patient well-being, improved clinical practice, and targeted healthcare planning, potentially leading to better patient care, management, and future interventions.

Sarcoidosis in first- and second-generation immigrants: a cohort study of all adults 18 years of age and older in Sweden

BACKGROUND

There is a lack of studies on sarcoidosis among immigrants, which is of interest as there may be genetic and environmental characteristics affecting immigrants from certain countries. We aimed to study hazard ratios (HRs) of sarcoidosis in first- and second-generation immigrants, comparing them with native Swedes in the total adult Swedish population.

METHODS

We conducted a nationwide study of individuals ≥18 y of age. Sarcoidosis was defined as at least two registered diagnoses in the National Patient Register between 1 January 1998 and 31 December 2018. Cox regression analysis was used to estimate HRs with 99% confidence intervals (CIs) of first registration of sarcoidosis in first- and second-generation immigrants compared with native Swedes. The Cox regression models were stratified by sex and adjusted for age, comorbidities and sociodemographic characteristics.

RESULTS

In total, 6 175 251 were included in the first-generation study, with 12 617 cases of sarcoidosis, and 4 585 529 in the second-generation study, with 12 126 cases. The overall sarcoidosis risk was lower in foreign-born men (fully adjusted HR 0.63 [99% CI 0.57 to 0.69]) but not in foreign-born women (fully adjusted HR 0.98 [99% CI 0.90 to 1.06]). The overall risk was slightly lower in second-generation immigrants (HR 0.82 [99% CI 0.78 to 0.88]). Women from Asia exhibited a higher risk (HR 1.25 [99% CI 1.02 to 1.53)], while a potential trend was observed among women from Africa (HR 1.47 [99% CI 0.99 to 2.19]).

CONCLUSIONS

Sarcoidosis risk was lower in foreign-born men but not in women and also lower in second-generation immigrants.

Association between diet-derived antioxidants and asthma: Insights from the NHANES survey 2003-2018 and Mendelian randomization analysis

BACKGROUND

Many studies have reported correlations between diet-derived antioxidants and asthma. Nevertheless, the probable association between diet-derived antioxidants and asthma remains a matter of discussion.

OBJECTIVES

We explored the association between Diet-Derived Antioxidants and Asthma.

METHODS

We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to assess the relationship between diet-derived antioxidants and asthma and a two-sample Mendelian randomization (MR) study was employed to assess the causal associations between lifelong diet-derived circulating antioxidant levels and the risk of asthma.

RESULTS

Participants with asthma were more likely to be young-to-middle-aged females, smokers, have lower income, belong to non-Hispanic Black ethnicity, have a high school education, have a BMI over 30. The dietary intakes of vitamin C, zinc, selenium, and CDAI were negatively associated with asthma risk (Vitamin C: OR = 0.76, 95 % CI: 0.63-0.91, P = 0.032; Zinc: OR = 0.86, 95 % CI: 0.75-1.00, P = 0.046; Selenium: OR = 0.85, 95 % CI: 0.73-0.98, P = 0.004; CDAI: OR = 0.80, 95 % CI: 0.65-0.97, P = 0.027). There was a significant nonlinear relationship between the dietary intake of vitamin C, zinc, and selenium and the risk of asthma (Pnon-linear < 0.05). However, no causal link between circulating antioxidants and asthma risk was found in the MR analysis. Sensitivity analyses supported the robustness of the results.

CONCLUSION

In the observational study, we identified a negative correlation between the dietary intake of vitamin C, zinc, selenium, and CDAI and asthma risk, while our MR analyses did not find evidence to support a causal relationship between diet-derived antioxidants and the risk of asthma.

Latent profile analysis of dyspnea-related kinesiophobia in older adults with chronic obstructive pulmonary disease

BACKGROUND

Dyspnea-related kinesiophobia refers to restrictions or avoidance of activities due to fear of dyspnea and is prevalent among older adults with chronic obstructive pulmonary disease (COPD). Hence, there is a need to identify subgroups of dyspnea-related kinesiophobia among older adults with COPD to support the development of strategies to increase activity levels.

OBJECTIVE

The purpose of this study was to investigate dyspnea-related kinesiophobia among older adults with COPD, explore heterogeneity in kinesiophobia within subgroups of this population, and analyze the characteristics of different subgroups of kinesiophobia.

METHOD

This cross-sectional study was conducted from November to December 2023 in Fenyang City, Shanxi Province, China, via face-to-face questionnaire surveys of hospitalized adults with COPD aged over 60 years in four secondary or tertiary hospitals. The Breathlessness Beliefs Questionnaire (BBQ) was used to measure dyspnea-related kinesiophobia. Latent profile analysis was employed to classify the subgroups. CChi-square tests and binary logistic regression were used to examine the effects of sociodemographic factors, marital status, education, income, daily activities, general health, and COPD severity across different profiles.

RESULTS

A total of 384 older adults with COPD (Male N = 228, aged 60-88) were included in the study. Their average BBQ score was (39.15±5.59). Latent profile analysis identified two groups: 230 participants (59.9 %) in the low-level kinesiophobia group (C1) and 154 participants (40.1 %) in the high-level kinesiophobia group (C2). Multivariable stepwise binary logistic regression analysis revealed that older adults with COPD who engaged in exercise less than three days weekly reported an average monthly household income of <3000 CNY, unmarried status (including unmarried, divorced, or widowed), a Charlson Comorbidity Index (CCI) >1, more than three exacerbations within one year or with moderate (GOLD 2 Criteria)-severe (GOLD3) COPD were more likely to be the high-level kinesiophobia group (p < 0.05).

CONCLUSION

Dyspnea-related kinesiophobia manifests in two groups among older adults. Targeted interventions for different subgroups should be further developed to promote health and reduce nursing burdens.

Chronic Obstructive Pulmonary Disease Patients With Community-Acquired Pneumonia on Inhaled Corticosteroid Therapy: A Comprehensive Analysis of Risk Factors, Disease Burden, and Prevention Strategies

Background

Chronic obstructive pulmonary disease (COPD) patients commonly exhibit significant morbidity and experience a diminished quality of life. Since there has been no prior research on pneumonia in our study population, we carried out this study to learn more about the situation.

Methods

A retrospective analysis of 912 COPD patients with CAP who were receiving ICS treatment at the DHQ Hospital in Muzaffargarh, Punjab, Pakistan was conducted. Study began in February 2022 and ended in February 2023. Using multinomial logistic regression, the odds ratio and relative risk and Kaplan-Meier curves showed time-to-death and recovery by COPD status.

Results

Patients with COPD having a smoking history from 25 pack years and above had 22.791 higher odds of CAP (95% CI: 20.413-31.515), 21.527 higher odds of HTN (95% CI: 12.323-57.103), 16.955 higher odds of diabetes (95% CI: 22.954-29.331), and 13.964 higher odds of death in severity without COVID-19 vaccination (95% CI: 5.988-32.561) compared to patients with COPD having a smoking history from 10 to 15 pack years.

Conclusion

COPD patients with a shorter ICS duration had a lower CAP risk, and vice versa, while vaccinated patients had a less severe disease as compared to non-vaccinated patients.

Epidemiological analysis of influenza vaccination coverage in Pudong New Area, Shanghai (2013-2023): Implications for influenza vaccination strategies

Seasonal influenza remains a significant public health concern globally, with annual vaccinations as the most effectively preventive measure. This study examines influenza vaccination coverage rates across different age groups in Pudong New Area, Shanghai, China, from 2013 to 2023. This study extracted influenza vaccination data from the Shanghai Immunization Planning Information System (SIPIS) of the Center for Disease Control and Prevention Shanghai's Pudong New Area from 2013 to 2023. The analysis utilized weighted linear regression to compare vaccination rates over the study period. From 2013 to 2023, a cumulative total of 1,421,295 influenza vaccinations were administered in Pudong New Area, with the quadrivalent inactivated influenza vaccines (IIV4) and trivalent inactivated influenza vaccines (IIV3) comprising 56.8% and 42.9%, respectively. The overall average influenza vaccine coverage rate was 2.27% (95% CI: 2.26, 2.28). The 0-4 years group exhibited the highest average annual coverage rate of 22.52% (95% CI: 22.47, 22.57) among different age groups, in stark contrast to that of the 20-24 years age group, which had the lowest at 0.32% (95% CI: 0.31, 0.33). In terms of repeat vaccinations, a significant majority (86.87%) of recipients received only 1-2 doses, while just 13.13% received 3 or more doses. Although influenza vaccination coverage among preschool children in Pudong New Area is relatively high, it falls significantly short of WHO recommendations. Enhance the level of awareness of influenza vaccine among adults and provide a free influenza vaccination strategy for specific groups such as doctors, which is helpful to increase influenza vaccination rates among populations.

Impacts of travel duration on urban-rural resident free vaccination behavior: Chinese COVID-19 vaccine booster dose evidence

This study aimed to evaluate how the duration of travel affects the behavior of urban and rural residents regarding free COVID-19 vaccination, and provide scientific evidence for promoting free vaccination and building an immune barrier to cope with future epidemics. From August 3, 2022 to February,18,2023, A follow-up survey was conducted in urban and rural adults in four cities in China to collect information on socio-demographic factors, vaccination status and travel time for vaccination. Propensity score matching (PSM) analysis was deployed to measure the net difference of the enhanced vaccination rate between urban and rural residents in different traffic time distribution. A total of 5780 samples were included in the study. The vaccination rate of the booster dose of COVID-19 vaccine among rural residents was higher than that of urban residents with a significant P-value (69.36% VS 64.49%,p < .001). The traffic time had a significant negative impact on the COVID-19 booster vaccination behavior of urban and rural residents. There was a significant interaction between the travel time to the vaccination point and the level of trust in doctors. Travel time had a negative impact on the free vaccination behavior of both urban and rural residents. The government should optimize and expand the number of vaccination sites and enhance residents' trust in the medical system. This is crucial for promoting free vaccination and effective epidemic management in the future.

Association between birth weight and chronic obstructive pulmonary disease in the UK Biobank: a prospective cohort study

BACKGROUND

Birth weight has been reported to be associated with chronic obstructive pulmonary disease (COPD) in adulthood, but the results have not yet been determined. This study aims to analyse the potential association of birth weight with COPD risk in UK Biobank.

METHODS

We conducted a prospective analysis for participants without baseline COPD in UK Biobank. The HRs and 95% CIs were calculated by multivariable Cox regression models, and dose-response relationship was evaluated by restricted cubic splines. Besides, we also calculated the interactions for covariates and further analysed the joint effects.

RESULTS

A total of 251 172 participants with birth weight data were included in this study, and 5602 COPD cases were found during follow-up. According to Cox regression models, participants with the lowest quintile of birth weight (< 2.86 kg) had higher risk for COPD (HR=1.21, 95% CI 1.11 to 1.32). In addition, the dose‒response analysis showed a non-linear relationship between birth weight and COPD risk, which first decreased and then increased, and the interactions for age, passive smoking and maternal smoking were also found by stratified analysis. Furthermore, we also found the joint effects between COPD risk and maternal smoking in the lowest quintile group.

CONCLUSIONS

This study indicated that lower birth weight may increase the risk of COPD. The non-linear associations between birth weight and COPD risk for prospective cohort; as birth weight increased, the risk showed a trend of decreasing first and then increasing. Moreover, maternal smoking had a joint effect with low birth weight for COPD risk.

Evaluation of joint external evaluation to COVID-19 and other infectious diseases mortality outcomes in 96 countries

BACKGROUND

This study evaluated the effectiveness of Joint External Evaluation (JEE) scores with regard to coronavirus disease 2019 (COVID-19) and other infectious diseases performance in 96 countries. To propose a revised JEE tool, potential JEE indicators were also examined.

METHODS

JEE data from 2016-2019 were linked with outcomes such as COVID-19 fatality rates and infections, as well as mortality rates for other infectious diseases. We also examined potential indicators such as the Sustainable Development Goals (SDGs) and Universal Health Coverage index to propose enhancements to the JEE tool. Multiple regression analysis was used to assess these associations.

RESULTS

The average JEE score was 2.70 (SD=0.92) in 96 countries. Detection capabilities received the highest average score (3.23), while the other areas (2.30) section received the lowest scores. However, the analysis revealed that the JEE tool had limited predictive accuracy for COVID-19 outcomes. By contrast, the JEE scores showed a negative association with the performance of other infectious diseases. Notably, SDGs 2 (zero hunger), 4 (quality education) and 8 (decent work and economic growth) were strongly associated with better COVID-19 outcomes.

CONCLUSION

The JEE scores showed limited predictive value for COVID-19 mortality outcomes in 96 countries. The tool offers insights into health security, but needs revision to better handle future pandemics.

Investigating socioeconomic disparities of Kangaroo mother care on preterm infant health outcomes

Several studies have been conducted to examine the complicated relationships between various factors that influence Kangaroo mother care (KMC) for preterm infants. However, the extended socio-economic model has not been seen in any of the previous studies that looked into the factors related to KMC and how it affects the health outcomes of babies born before in our study population. This study examines the various dimensions of KMC implementation and its influence on the health outcomes of premature infants. The current cross-sectional study was carried out in South Punjab, Pakistan, covering both private and public KMC units in obstetrics and gynecology departments. The study included a sample size of 719 patients and was conducted during a period covering 21 September 2022 to 14 October 2023. Multinomial logistic regression analysis is employed to ascertain the factors by using SPSS-26 (SPSS Inc., Chicago, IL). The use of folic acid (OR: 1.44; 95% CI: 0.87-3.11) and factor anemia (OR: 8.82; 95% CI: 1.69-14.59) no significantly correlated with better health outcomes, while environmental toxin exposure had a negative impact (OR: 0.90). The findings underscore the need for comprehensive interventions and policies to bridge socioeconomic gaps, ensuring all preterm infants benefit from KMC.

The Complex Relationship Between Chronic Obstructive Pulmonary Disease With Cardiovascular Disease and Their Interactions With COVID-19 Vaccination: A Retrospective Study

BACKGROUND

Previously, most researchers explored the association between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). This study investigates the distinct influence of COVID-19 vaccination status on patients with both conditions.

OBJECTIVE

We investigate the relationship between COPD and CVD in a cohort of 838 individuals who presented with both conditions. Our aim is to understand how these conditions interact and how COVID-19 vaccination status affects patient outcomes.

METHODS

A retrospective analysis was conducted on 838 patients with COPD and CVD treated at DHQ Hospital in Muzaffargarh, Punjab, Pakistan, from November 2022 to April 2023. We employed multiple logistic regression and the Wilcoxon signed-rank test to assess the odds ratio and relative risk of COPD in patients with-CVD under various conditions. Additionally, we analyzed time-to-death and survival using Kaplan-Meier methods.

RESULTS

Findings reveal a 7.95 times higher risk of death in patients without COVID-19 vaccination compared with those who were vaccinated (95% CI, 6.12-10.33). Conversely, COVID-19-vaccinated patients exhibited a 0.221 times lower risk of recovery than their nonvaccinated counterparts (95% CI, 0.08-0.60). We also observed significant differences in time-to-death and recovery based on the presence of COPD and CVD, with vaccinated patients generally experiencing milder disease.

CONCLUSION

Our study assessed the impact of COVID-19 vaccination status on patient outcomes in patients with overlapping COPD and CVD. Individuals diagnosed with COPD and CVD display significant differences in terms of their probability of survival, with those who have received vaccinations.

Chronic obstructive pulmonary disease in East Africa: a systematic review and meta-analysis

Chronic obstructive pulmonary disease (COPD) is a common lung disease that causes restricted airflow and breathing problems. Globally, COPD is the third leading cause of death and low- and middle-income countries account for the majority of these deaths. There is limited information on COPD's prevalence in East Africa. Thus the purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of COPD in East Africa.A computerized systematic search using multiple databases was performed in search of relevant English articles from the inception of the databases to August 2023. All the authors independently extracted the data. R and RStudio software were used for statistical analysis. Forest plots and tables were used to represent the data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore, a meta-analysis of random effects models was used to estimate the overall pooled prevalence of COPD in East Africa. A funnel plot test was used to examine possible publication bias.The database search produced 512 papers. After checking for inclusion and exclusion criteria, 43 full-text observational studies with 68 553 total participants were found suitable for the review. The overall pooled prevalence of COPD in East Africa was 13.322%. The subgroup analysis found the COPD pooled prevalence in the different countries was 18.994%, 7%, 15.745%, 9.032%, 15.026% and 11.266% in Ethiopia, Uganda, Tanzania, Malawi, Sudan, and Kenya, respectively. Additionally, the subgroup analysis of COPD by study setting among community-based studies was 12.132% and 13.575% for hospital-based studies.According to the study's findings, approximately one of every seven individuals in East Africa has COPD, indicating a notably high prevalence of the disease. Thus governments and other stakeholders working on non-communicable disease control should place an emphasis on preventive measures to minimize the burden of COPD.

Prevalence of sexually transmitted infections (STIs) among first time visitors at STIs clinic in Hangzhou, China: Assessing the influence of the COVID-19 pandemic

BACKGROUND

This study assesses the prevalence of sexually transmitted infections (STIs) in first time visitors to the STIs clinic in Hangzhou, China, considering different genders, ages and symptoms. And also explores howthe COVID-19 pandemic has affected on STIs.

METHODS

From 2019 to 2023, 27,283 first time visitors were tested for nine distinct STIs, including Human Papillomavirus (HPV), Human Immunodeficiency Virus (HIV), syphilis, Herpes Simplex Virus type 2 (HSV-2), Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and vaginal Candida.

RESULTS

Symptomatic male and female visitors showed overall STI-positive rates of 39.27% and 59.20%, respectively(p < .001). The top three pathogens in both genders were HPV (47.56% and 56.71%), UU (29.21% and 56.47%), and HSV-2 (22.41% and 52.94%). Among asymptomatic visitors, the total STI-positive rate was 36.63% in males and 52.03% in females. Age-stratified analysis revealed higher STI rates in visitors ≤ 20 or >50 years, regardless of gender and symptoms. During the COVID-19 pandemic, symptomatic visitors showed lower positive rates for HPV, HIV, syphilis, and HSV-2, while Candida, UU, CT, NG, and multiple infections increased. Among asymptomatic visitors, HPV had the lowest positive rate, while NG and multiple infections increased during the pandemic.

CONCLUSION

STI prevalence is notably high, particularly in those aged ≤ 20 and >50 years. It emphasizes the need for enhanced health education, condom use, and vaccination. The COVID-19 pandemic impacting STIs through varied factors, such as reduced sexual activity and clinical service interruption.

Association of handgrip strength with nutritional status and clinical outcomes in hospitalized pediatric patients

BACKGROUND & AIMS

Malnutrition in children and adolescents is prevalent at hospital admission and the incidence increases with length of stay. Malnourished patients have loss of muscle mass and strength, compromising their functionality. Handgrip strength (HGS) is a nutritional marker understudied in pediatrics although it is capable of detecting nutritional deprivation before changes in body composition are observed. Therefore, this study aimed to evaluate the association between reduced HGS at hospital admission, compromised nutritional status and worse clinical outcomes of pediatric patients.

METHODS

Cohort study conducted with patients aged 6-18 years admitted to a pediatric ward. Nutritional status was assessed in the first 48 h of hospital admission using the z-score of height for age (H/A) and body mass index for age (BMI/A), percentile of mid-arm muscle circumference for age (MAMC/A) and the pediatric global subjective nutritional assessment (SGNA). HGS was measured using a digital dynamometer and considered reduced when the maximum value of three measurements was below the 5th percentile for sex and age. The clinical outcomes analyzed were length of hospital stay and frequency of readmission within 3 months after hospital discharge.

RESULTS

A total of 135 patients were evaluated (median age 10.9 years, 55.6% male) and 17.8% had reduced HGS. Patients with reduced HGS had lower H/A z-score (-0.50 vs 0.22, p = 0.012) and a higher frequency of reduced MAMC when compared to those with normal HGS (8% vs 13%, p = 0.007). Reduced HGS was not associated with malnutrition (OR = 0.63; 95%CI 0.23-1.77), prolonged hospital stay (OR = 1.89; 95%CI 0.72-4.92) or readmission to hospital 3 months after hospital discharge (OR = 1.82; 95%CI 0.67-4.93), in a model adjusted for the clinical condition.

CONCLUSION

Reduced HGS was not a predictor of malnutrition and clinical outcomes. However, it was associated with lower H/A Z-score and MAMC/A percentile values and can be used as a complementary measure in the nutritional status assessment of hospitalized pediatric patients.

Immunocompromised individuals are at increased risk of COVID-19 breakthrough infection, hospitalization, and death in the post-vaccination era: A systematic review

INTRODUCTION

Immunocompromised individuals have been shown to mount a reduced response to vaccination, resulting in reduced vaccine effectiveness in this cohort. Therefore, in the postvaccination era, immunocompromised individuals remain at high risk of breakthrough infection and COVID-19 related hospitalization and death, which persist despite vaccination efforts. There has been a marked paucity of systematic reviews evaluating existing data describing the clinical measures of efficacy of COVID-19 vaccination, specifically in immunocompromised populations. In particular, there is a scarcity of comprehensive evaluations exploring breakthrough infections and severe COVID-19 in this patient population.

METHODS

To address this gap, we conducted a systematic review which aimed to provide a summary of current clinical evidence of the effectiveness of COVID-19 vaccination in the immunocompromised population. Using PRISMA guidelines, we conducted a literature search on PubMed and the Cochrane database published between January 1, 2021 to September 1, 2022.

RESULTS

Our findings demonstrated that despite vaccination, immunocompromised patients remained at high risk of new breakthrough COVID-19 infection and severe COVID-19 outcomes compared to the general population. We found increased average relative risk (RR) of breakthrough infections in the immunocompromised population, including patients with cancer (RR = 1.4), HIV (RR = 1.92), chronic kidney disease (RR = 2.26), immunodeficiency (RR = 2.55), and organ transplant recipients (RR = 6.94). These patients are also at greater risk for hospitalizations and death following COVID-19 breakthrough infection. We found that the RR of hospitalization and death in Cancer patients was 1.08 and 2.82, respectively.

CONCLUSION

This demonstrated that vaccination does not offer an adequate level of protection in these groups, necessitating further measures such as Evusheld and further boosters.

Inhaled corticosteroids and Stenotrophomonas maltophilia in outpatients with chronic obstructive pulmonary disease: a retrospective cohort study

OBJECTIVES

Inhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease (COPD). However, ICS are associated with an increased risk of adverse effects.We aimed to determine whether an association between a lower respiratory tract culture with Stenotrophomonas maltophilia and increasing ICS dosing in patients with COPD exists.

DESIGN

An observational cohort study of outpatients with COPD in Denmark between 2010 and 2018.ICS exposure was categorised into four groups based on average daily consumption 1 year prior to inclusion: no use, low ICS dose (≤400 µg), moderate ICS dose (400-800 µg) and high ICS dose (>800 µg). Dose-response relationship was investigated by a multivariable Cox proportional hazards regression.

RESULTS

Of the total 22 689 patients, 459 had lower respiratory tract cultures positive for S. maltophilia. The HR of S. maltophilia increased with increasing daily ICS dose: low ICS dose HR 2.6 (95% CI 1.6 to 4.0), moderate ICS dose HR 3.0 (95% CI 1.9 to 4.6) and high ICS dose HR 5.7 (95% CI 3.8 to 8.5).

CONCLUSIONS

We found that ICS was associated with a high, dose-dependent increased hazard of S. maltophilia in outpatients with COPD. High dose users had a nearly six times increased hazard compared with non-users of ICS. When appropriate, attempts at de-escalating ICS treatment should be made.

Why do patients with DR-TB do not complete their treatment? Findings of a qualitative study from Pakistan

BACKGROUND

One of the major reasons for unsuccessful treatment outcomes among patients with drug-resistant tuberculosis (DR-TB) is the high rate of loss to follow-up (LTFU). However, in Pakistan, no qualitative study has been conducted to explore the perceptions of LTFU patients with regard to DR-TB treatment, the problems they face and the reasons for LTFU in detail.

METHODS

This was a qualitative study that involved semistructured, indepth, face-to-face interviews of 39 LTFU patients with DR-TB. All interviews were carried out in Pakistan's national language 'Urdu' using an interview guide in two phases: the first phase was from December 2020 to February 2021 among patients with extensively drug-resistant tuberculosis and the second phase from July 2021 to September 2021 among patients with multidrug-resistant tuberculosis.

RESULTS

The inductive thematic analysis of audio-recorded interviews generated the following four key themes, which were the major reasons reported by the participants of the current study to have led to LTFU: (1) patient-related factors, such as lack of awareness about the total duration of DR-TB treatment, fatigue from previous multiple failed episodes, lack of belief in treatment efficacy and perception of DR-TB as a non-curable disease; (2) medication-related factors, such as use of injectables, high pill burden, longer duration and adverse events; (3) socioeconomic factors, such as gender discrimination, poor socioeconomic conditions, non-supportive family members, social isolation and unemployment; and (4) service provider-related factors, such as distant treatment centres, non-availability of a qualified person, lack of adequate counselling and poor attitude of healthcare professionals.

CONCLUSION

In the current study, patients' perceptions about DR-TB treatment, socioeconomic condition, medication and service provider-related factors emerged as barriers to the successful completion of DR-TB treatment. Increasing patients' awareness about the duration of DR-TB treatment, interacting sessions with successfully treated patients, availability of rapid drug susceptibility testing facilities at treatment centres, decentralising treatment and using the recently recommended all-oral regimen may further decrease the rate of LTFU.