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BMC Public Health Jul 2024Smoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments,...
BACKGROUND
Smoking significantly contributes to the mortality rates worldwide, particularly in non-communicable and preventable diseases such as cardiovascular ailments, respiratory conditions, stroke, and lung cancer. This study aims to analyse the impact of smoking on global deaths, and its association with mortality across the main income groups.
METHODS
The comprehensive analysis spans 199 countries and territories from 1990 to 2019. The study categorises countries into four income groups: high income, upper middle income, lower middle income, and low income.
RESULTS
The findings underscore the profound impact of global tobacco smoking on mortality. Notably, cardiovascular disease mortality is notably affected in both upper-middle-income and high-income groups. Chronic respiratory disease mortality rates show a significant impact across all income groups. Moreover, stroke-related mortality is observed in the lower-middle, upper-middle, and high-income groups. These results highlight the pervasive influence of smoking prevalence on global mortality, affecting individuals across various socioeconomic levels.
CONCLUSION
The study underscores the critical implications of smoking on mortality rates, particularly in high-income countries. It emphasises the urgency of targeted interventions in these regions to address the specific challenges posed by tobacco smoking on public health. Policy recommendations include implementing prohibitive measures extending to indoor public areas such as workplaces and public transportation services. Furthermore, allocating funds for research on tobacco and health, is imperative to ensure policymakers are consistently informed about emerging facts and trends in this complex domain.
PubMed: 38965521
DOI: 10.1186/s12889-024-19336-6 -
BMC Pulmonary Medicine Jul 2024SARS-CoV-2 is a systemic disease that affects endothelial function and leads to coagulation disorders, increasing the risk of mortality. Blood levels of endothelial...
BACKGROUND
SARS-CoV-2 is a systemic disease that affects endothelial function and leads to coagulation disorders, increasing the risk of mortality. Blood levels of endothelial biomarkers such as Von Willebrand Factor (VWF), Thrombomodulin or Blood Dendritic Cell Antigen-3 (BDCA3), and uUokinase (uPA) increase in patients with severe disease and can be prognostic indicators for mortality. Therefore, the aim of this study was to determine the effect of VWF, BDCA3, and uPA levels on mortality.
METHODS
From May 2020 to January 2021, we studied a prospective cohort of hospitalized adult patients with polymerase chain reaction (PCR)-confirmed COVID-19 with a SaO2 ≤ 93% and a PaO/FiO ratio < 300. In-hospital survival was evaluated from admission to death or to a maximum of 60 days of follow-up with Kaplan-Meier survival curves and Cox proportional hazard models as independent predictor measures of endothelial dysfunction.
RESULTS
We recruited a total of 165 subjects (73% men) with a median age of 57.3 ± 12.9 years. The most common comorbidities were obesity (39.7%), hypertension (35.4%) and diabetes (30.3%). Endothelial biomarkers were increased in non-survivors compared to survivors. According to the multivariate Cox proportional hazard model, those with an elevated VWF concentration ≥ 4870 pg/ml had a hazard ratio (HR) of 4.06 (95% CI: 1.32-12.5) compared to those with a lower VWF concentration adjusted for age, cerebrovascular events, enoxaparin dose, lactate dehydrogenase (LDH) level, and bilirubin level. uPA and BDCA3 also increased mortality in patients with levels ≥ 460 pg/ml and ≥ 3600 pg/ml, respectively.
CONCLUSION
The risk of mortality in those with elevated levels of endothelial biomarkers was observable in this study.
PubMed: 38965511
DOI: 10.1186/s12890-024-03136-0 -
BMC Pulmonary Medicine Jul 2024In the tumor microenvironment (TME), a bidirectional relationship exists between hypoxia and lactate metabolism, with each component exerting a reciprocal influence on...
BACKGROUND
In the tumor microenvironment (TME), a bidirectional relationship exists between hypoxia and lactate metabolism, with each component exerting a reciprocal influence on the other, forming an inextricable link. The aim of the present investigation was to develop a prognostic model by amalgamating genes associated with hypoxia and lactate metabolism. This model is intended to serve as a tool for predicting patient outcomes, including survival rates, the status of the immune microenvironment, and responsiveness to therapy in patients with lung adenocarcinoma (LUAD).
METHODS
Transcriptomic sequencing data and patient clinical information specific to LUAD were obtained from comprehensive repositories of The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). A compendium of genes implicated in hypoxia and lactate metabolism was assembled from an array of accessible datasets. Univariate and multivariate Cox regression analyses were employed. Additional investigative procedures, including tumor mutational load (TMB), microsatellite instability (MSI), functional enrichment assessments and the ESTIMATE, CIBERSORT, and TIDE algorithms, were used to evaluate drug sensitivity and predict the efficacy of immune-based therapies.
RESULTS
A novel prognostic signature comprising five lactate and hypoxia-related genes (LHRGs), PKFP, SLC2A1, BCAN, CDKN3, and ANLN, was established. This model demonstrated that LUAD patients with elevated LHRG-related risk scores exhibited significantly reduced survival rates. Both univariate and multivariate Cox analyses confirmed that the risk score was a robust prognostic indicator of overall survival. Immunophenotyping revealed increased infiltration of memory CD4 + T cells, dendritic cells and NK cells in patients classified within the high-risk category compared to their low-risk counterparts. Higher probability of mutations in lung adenocarcinoma driver genes in high-risk groups, and the MSI was associated with the risk-score. Functional enrichment analyses indicated a predominance of cell cycle-related pathways in the high-risk group, whereas metabolic pathways were more prevalent in the low-risk group. Moreover, drug sensitivity analyses revealed increased sensitivity to a variety of drugs in the high-risk group, especially inhibitors of the PI3K-AKT, EGFR, and ELK pathways.
CONCLUSIONS
This prognostic model integrates lactate metabolism and hypoxia parameters, offering predictive insights regarding survival, immune cell infiltration and functionality, as well as therapeutic responsiveness in LUAD patients. This model may facilitate personalized treatment strategies, tailoring interventions to the unique molecular profile of each patient's disease.
Topics: Humans; Lung Neoplasms; Prognosis; Tumor Microenvironment; Adenocarcinoma of Lung; Lactic Acid; Male; Female; Middle Aged; Biomarkers, Tumor; Aged; Hypoxia
PubMed: 38965505
DOI: 10.1186/s12890-024-03132-4 -
BMC Infectious Diseases Jul 2024The clinical benefit of coronavirus disease 2019 (COVID-19) treatments against new circulating variants remains unclear. We sought to describe characteristics and...
Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals, or no treatment: a retrospective cohort study.
BACKGROUND
The clinical benefit of coronavirus disease 2019 (COVID-19) treatments against new circulating variants remains unclear. We sought to describe characteristics and clinical outcomes of highest risk patients with COVID-19 receiving early COVID-19 treatments in Scotland.
METHODS
Retrospective cohort study of non-hospitalized patients diagnosed with COVID-19 from December 1, 2021-October 25, 2022, using Scottish administrative health data. We included adult patients who met ≥ 1 of the National Health Service highest risk criteria for early COVID-19 treatment and received outpatient treatment with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or no early COVID-19 treatment. Index date was defined as the earliest of COVID-19 diagnosis or early COVID-19 treatment. Baseline characteristics and acute clinical outcomes in the 28 days following index were reported. Values of ≤ 5 were suppressed.
RESULTS
In total, 2548 patients were included (492: sotrovimab, 276: nirmatrelvir/ritonavir, 71: molnupiravir, and 1709: eligible highest risk untreated). Patients aged ≥ 75 years accounted for 6.9% (n = 34/492), 21.0% (n = 58/276), 16.9% (n = 12/71) and 13.2% (n = 225/1709) of the cohorts, respectively. Advanced renal disease was reported in 6.7% (n = 33/492) of sotrovimab-treated and 4.7% (n = 81/1709) of untreated patients, and ≤ 5 nirmatrelvir/ritonavir-treated and molnupiravir-treated patients. All-cause hospitalizations were experienced by 5.3% (n = 25/476) of sotrovimab-treated patients, 6.9% (n = 12/175) of nirmatrelvir/ritonavir-treated patients, ≤ 5 (suppressed number) molnupiravir-treated patients and 13.3% (n = 216/1622) of untreated patients. There were no deaths in the treated cohorts; mortality was 4.3% (n = 70/1622) among untreated patients.
CONCLUSIONS
Sotrovimab was often used by patients who were aged < 75 years. Among patients receiving early COVID-19 treatment, proportions of 28-day all-cause hospitalization and death were low.
PubMed: 38965495
DOI: 10.1186/s12879-024-09576-7 -
BMC Geriatrics Jul 2024We aimed to investigate the impact of sarcopenia and sarcopenic obesity (SO) on the clinical outcome in older patients with COVID-19 infection and chronic disease.
OBJECTIVE
We aimed to investigate the impact of sarcopenia and sarcopenic obesity (SO) on the clinical outcome in older patients with COVID-19 infection and chronic disease.
METHODS
We prospectively collected data from patients admitted to Huadong Hospital for COVID-19 infection between November 1, 2022, and January 31, 2023. These patients were included from a previously established comprehensive geriatric assessment (CGA) cohort. We collected information on their pre-admission condition regarding sarcopenia, SO, and malnutrition, as well as their medical treatment. The primary endpoint was the incidence of intubation, while secondary endpoints included in-hospital mortality rates. We then utilized Kaplan-Meier (K-M) survival curves and the log-rank tests to compare the clinical outcomes related to intubation or death, assessing the impact of sarcopenia and SO on patient clinical outcomes.
RESULTS
A total of 113 patients (age 89.6 ± 7.0 years) were included in the study. Among them, 51 patients had sarcopenia and 39 had SO prior to hospitalization. Intubation was required for 6 patients without sarcopenia (9.7%) and for 18 sarcopenia patients (35.3%), with 16 of these being SO patients (41%). Mortality occurred in 2 patients without sarcopenia (3.3%) and in 13 sarcopenia patients (25.5%), of which 11 were SO patients (28%). Upon further analysis, patients with SO exhibited significantly elevated risks for both intubation (Hazard Ratio [HR] 7.43, 95% Confidence Interval [CI] 1.26-43.90, P < 0.001) and mortality (HR 6.54, 95% CI 1.09-39.38, P < 0.001) after adjusting for confounding factors.
CONCLUSIONS
The prevalence of sarcopenia or SO was high among senior inpatients, and both conditions were found to have a significant negative impact on the clinical outcomes of COVID-19 infection. Therefore, it is essential to regularly assess and intervene in these conditions at the earliest stage possible.
PubMed: 38965468
DOI: 10.1186/s12877-024-05177-w -
BMC Cardiovascular Disorders Jul 2024Heart failure (HF) is a chronic condition characterized by significant impairment of the cardiovascular system, leading to a decline in health-related quality of life,...
BACKGROUND
Heart failure (HF) is a chronic condition characterized by significant impairment of the cardiovascular system, leading to a decline in health-related quality of life, recurrent hospitalizations, and increased mortality risk. It poses a substantial challenge for modern medicine, particularly when patients fail to adhere to therapeutic recommendations. The primary aim of this study was to evaluate the level of adherence to therapeutic guidelines among patients with HF and identify factors influencing adherence levels.
METHODS
The study comprised 105 HF patients admitted to the cardiology department. A diagnostic survey approach was utilized, employing the Adherence in Chronic Diseases Scale (ACDS) along with a self-developed questionnaire.
RESULTS
The findings revealed that 39.05% of participants exhibited a moderate level of adherence to therapeutic recommendations, while 34.29% reported high adherence and 26.67% displayed low adherence. Most of the patients (n = 66) had a rather good level of knowledge. Factors such as higher education (p < 0.001), engagement in mental work (p = 0.001), favorable socioeconomic status (p < 0.001), being in a stable relationship (p < 0.001), and residing with family (p < 0.001) were associated with increased adherence levels. The multivariable linear regression model indicated significant (p < 0.05) independent predictors that positively influenced the ACDS score, including being in a relationship, widowhood, and average or poor financial situation. Conversely, factors such as obesity and respiratory diseases were associated with a decrease in the ACDS score (p < 0.05).
CONCLUSIONS
This study underscores the moderate adherence level to therapeutic recommendations among HF patients. Sociodemographic factors including education level, relationship status, occupation, financial stability, and living arrangements significantly impact adherence. Conversely, patients with obesity, respiratory conditions, or frequent HF-related hospitalizations demonstrate lower adherence. Patient education emerges as a pivotal factor influencing adherence. Tailored interventions targeting these factors could enhance adherence and optimize HF management outcomes.
PubMed: 38965456
DOI: 10.1186/s12872-024-04001-y -
BMC Cancer Jul 2024Lung cancer still ranks first in the mortality rate of cancer. Uric acid is a product of purine metabolism in humans. Its presence in the serum is controversial; some...
BACKGROUND
Lung cancer still ranks first in the mortality rate of cancer. Uric acid is a product of purine metabolism in humans. Its presence in the serum is controversial; some say that its high levels have a protective effect against tumors, others say the opposite, that is, high levels increase the risk of cancer. Therefore, the aim of this study was to investigate the potential causal association between serum uric acid levels and lung cancer.
METHODS
Mendelian randomization was used to achieve our aim. Sensitivity analyses was performed to validate the reliability of the results, followed by reverse Mendelian analyses to determine a potential reverse causal association.
RESULTS
A significant causal association was found between serum uric acid levels and lung cancer in East Asian and European populations. Further sublayer analysis revealed a significant causal association between uric acid and small cell lung cancer, while no potential association was observed between uric acid and non-small cell lung cancer, squamous lung cancer, and lung adenocarcinoma. The sensitivity analyses confirmed the reliability of the results. Reverse Mendelian analysis showed no reverse causal association between uric acid and lung cancer.
CONCLUSIONS
The results of this study suggested that serum uric acid levels were negatively associated with lung cancer, with uric acid being a potential protective factor for lung cancer. In addition, uric acid level monitoring was simple and inexpensive. Therefore, it might be used as a biomarker for lung cancer, promoting its wide use clinical practice.
Topics: Humans; Uric Acid; Mendelian Randomization Analysis; Lung Neoplasms; White People; Asian People; Polymorphism, Single Nucleotide; Asia, Eastern; Europe; Genetic Predisposition to Disease; Biomarkers, Tumor; Risk Factors; East Asian People
PubMed: 38965453
DOI: 10.1186/s12885-024-12576-0 -
Scientific Reports Jul 2024If a mutated gene with heterozygous advantage against malaria, e.g., hemoglobin S (HbS) gene, is introduced in a small tribe, the gene (allele) frequency (f) increases...
If a mutated gene with heterozygous advantage against malaria, e.g., hemoglobin S (HbS) gene, is introduced in a small tribe, the gene (allele) frequency (f) increases until it reaches a steady state value (f) where the total mortality from malaria and sickle cell disease is a minimum. This is a classic example of balanced-polymorphism named malaria hypothesis. In a previous in silico study, assuming realistic initial conditions, it has been shown that the f is around 14%, far less than the f observed in certain parts of Africa, 24%. It seems that the malaria hypothesis, per se, could not explain such a high f, unless it is assumed that malaria and HbS gene can provide protection against other diseases. Using Monte-Carlo simulation, the current study was conducted to examine the effect on f of five scenarios was examined. The studied scenarios consisted of different combinations of mortality of other diseases and the possible amounts of protections conferred by malaria and HbS gene against the diseases. Taking into account other diseases causing mortality in the population makes the f rate of change steeper over generations. f is an increasing function of the amount of protection conferred by HbS gene against other diseases. The effect of protection provided by malaria against other diseases on f, is however, variable-depending on the amount of protection conferred by HbS gene against other diseases, it may increase or decrease f. If malaria and HbS gene provide protections of 1.5-fold and threefold against other diseases, respectively, the f is around 24%, the amount reported in certain tribes of Africa. Under certain scenarios, the f attained is even higher.
Topics: Humans; Malaria; Hemoglobin, Sickle; Anemia, Sickle Cell; Gene Frequency; Monte Carlo Method; Computer Simulation; Genetic Predisposition to Disease
PubMed: 38965406
DOI: 10.1038/s41598-024-66289-2 -
Communications Biology Jul 2024The costs and benefits of group living are also reflected in intraspecific variation in group size. Yet, little is known about general patterns of fitness consequences...
The costs and benefits of group living are also reflected in intraspecific variation in group size. Yet, little is known about general patterns of fitness consequences of this variation. We use demographic records collected over 25 years to determine how survival and reproductive success vary with group size in a Malagasy primate. We show that female reproductive rates of Verreaux's sifakas (Propithecus verreauxi) are not affected by total group size, but that they are supressed by the number of co-resident females, whereas mortality rates are significantly higher in larger groups. Neither annual rainfall nor the adult sex ratio have significant effects on birth and death rates. Hence, these sifakas enjoy the greatest net fitness benefits at small, and not the predicted intermediate group sizes. Thus, independent fitness proxies can vary independently as a function of group size as well as other factors, leading to deviations from optimal intermediate group sizes.
Topics: Animals; Female; Reproduction; Male; Genetic Fitness; Strepsirhini; Population Density; Sex Ratio
PubMed: 38965399
DOI: 10.1038/s42003-024-06484-z -
Scientific Reports Jul 2024Arterial stiffness (AS) and chronic kidney disease (CKD) are common in the older population. AS results in increased pulsatile pressure, elevated pulse pressure (PP),...
Arterial stiffness (AS) and chronic kidney disease (CKD) are common in the older population. AS results in increased pulsatile pressure, elevated pulse pressure (PP), and is linked to hypertension. PP is a surrogate for AS. The kidney has low vascular resistance mechanisms, presumably making it vulnerable to the increased pulsatile pressure and hypertension associated with AS. The aims of this study were to investigate the impact of PP elevation on incident CKD (glomerular filtration rate < 60 ml/min/1.73 m) and all-cause mortality. The data was collected from the general population cohort study "Good Aging in Skåne". Cox proportional hazard regression models adjusted for age, sex, diabetes, and smoking habits were used to investigate the impact of three levels of PP elevation on incident CKD (n = 2693) and all-cause mortality (n = 5253). For PP < 60 mmHg, the median survival time was 18.7 years (event incident CKD) and first quartile survival time (event all-cause mortality) 15.4 years. Elevated PP ≥ 80 mmHg was associated with incident CKD (hazard ratio 1.59, CI 1.28-1.97), but not all-cause mortality. Our results suggest that a finding of PP ≥ 80 mmHg in older age should raise concern of kidney function.
Topics: Humans; Sweden; Male; Female; Renal Insufficiency, Chronic; Aged; Blood Pressure; Hypertension; Glomerular Filtration Rate; Incidence; Aged, 80 and over; Middle Aged; Proportional Hazards Models; Risk Factors; Vascular Stiffness; Cohort Studies
PubMed: 38965357
DOI: 10.1038/s41598-024-66458-3