A cytokine super cyclone in COVID-19 patients with risk factors: the therapeutic potential of BCG immunization

The seventh human coronavirus SARS-CoV2 belongs to the cluster of extremely pathogenic coronaviruses including SARS-CoV and MERS-CoV, which can cause fatal lower respiratory tract infection. Likewise, SARS-CoV2 infection can be fatal as the disease advances to pneumonia, followed by acute respiratory distress syndrome (ARDS). The development of lethal clinical symptons is associated with an exaggerated production of inflammatory cytokines, referred to as the cytokine storm, is a consequence of a hyperactivated immune response aginst the infection. In this article, we discuss the pathogenic consequences of the cytokine storm and its relationship with COVID-19 associated risk factors. The increased pro-inflammatory immune status in patients with risk factors (diabetes, hypertension, cardiovascular disease, COPD) exacerbates the Cytokine-storm of COVID-19 into a ‘Cytokine Super Cyclone’. We also evaluate the antiviral immune responses provided by BCG vaccination and the potential role of ‘trained immunity’ in early protection against SARS-CoV2.     

Population-based analysis of obesity and workforce participation

Objective: To describe the relationship between obesity class and workforce participation and the influence of demographic, socioeconomic, and comorbid disease states on this relationship using population‐based Canadian data. Research Methods and Procedures: Responses from 73, 531 adults surveyed in the Canadian Community Health Survey 2000 to 2001 who provided complete information regarding variables of interest were analyzed. Workforce participation was defined as individuals reporting that they held and were present at a job or business in the week before survey administration. The association between obesity and workforce participation was explored using logistic regression after adjusting for demographic, socioeconomic, and obesity‐related comorbidities. Results: In univariate analysis, obese individuals had lower odds of participating in the workforce. In the fully adjusted model, increasing obesity was associated with decreasing odds of workforce participation, with Class I, II, and III obesity having odds ratios (95% confidence interval) of 0.94 (0.89 to 0.99), 0.85 (0.77 to 0.94), and 0.66 (0.57 to 0.78), respectively. Obese individuals were also less likely to be employed and more likely to be absent from work. Discussion: Obesity is associated with lower workforce participation. This association appears to be independent of associated comorbidity and sociodemographic factors. These results indicate that the economic impact of obesity alone on workforce productivity is larger than previous reports suggest.     

Health Benefit Costs and Absenteeism Among Employed Patients With Acromegaly

ObjectiveAcromegaly is associated with increased morbidity and mortality. Limited data are available on these patients’ utilization and costs of health care. This study assessed the impact of acromegaly on employees’ health benefit (direct and indirect) costs and absenteeism.MethodsA retrospective analysis was conducted of drug and medical claims and employer data (from January 2010 to April 2019) of patients with an acromegaly diagnosis and matched controls from a U.S. employee database. Patient claims were tracked for 12 months postdiagnosis (or matched) date. Outcomes were analyzed using separate 2-part regression models, controlling for clinical, demographic, and job-related variables.ResultsForty-seven patients with acromegaly and 940 controls were identified. Cohorts were similar in most demographic and job-related variables. Patients with acromegaly had a significantly higher Charlson comorbidity index score and higher incidence of claims for several comorbidities. Acromegaly drugs represented 16.3% of the acromegaly cohort’s total costs. Total health benefit costs were $54 821 higher (P < .05) for patients compared with controls, with direct costs representing 79.8% of the difference. Total indirect costs were higher for patients with acromegaly, with short-term and long-term disability comprising most of the difference between the acromegaly and control groups. Patients with acromegaly had significantly more short-term disability days than controls, but total sick days were similar for the 2 groups.ConclusionThe presence of acromegaly was associated with increased direct and indirect employee health benefit costs and increased work absenteeism.