Tobacco smoke exposures and fertility-related outcomes among females seeking fertility care, and the interaction with N-Acetyltransferase 2 (NAT2)..

Cigarette smoke contains thousands of harmful substances and is one of the leading preventable causes of mortality and morbidity in the United States. Past studies examining tobacco smoke exposures on fecundability and pregnancy outcomes are inconsistent. NAT2 is an important enzyme in the metabolism of xenobiotic substances found within tobacco smoke. This preconception cohort study examines associations between active smoking and secondhand smoke exposure (SHSe) on fecundability and spontaneous abortion (SA), and explores a possible interaction with NAT2 acetylator status. A total of 223 women seeking fertility care were followed for up to 2.3 years. Preconception tobacco smoke exposures were collected by questionnaires and verified by urinary cotinine. SHSe at home and work was measured using the questionnaire (never, rarely (once/week), often (1-6 times/week), daily for each location) and then combined and categorized as low or high SHSe. NAT2 was genotyped to determine acetylator status (rapid vs slow). Pregnancy outcomes (SA vs live birth) were collected on 72 women. Cox proportional hazards regression was used to estimate fecundability ratios (FR) and 95% confidence intervals (CI), and logistic regression to estimate odds ratios (OR) and 95% CIs for the association of active smoking and SHSe on fecundability and SA, respectively. Full models were adjusted for age, BMI, assisted conception, gravidity, marital status, alcohol use and race. Overall, no significant effect of tobacco smoke exposure on fecundability was established. Though statistically insignificant, the effect of smoking on fecundability was stronger among slow NAT2 acetylators. Smokers (OR: 6.28; 95% CI 1.31, 37.9) and nonsmokers with high SHSe (OR: 3.20; 95% CI 0.87, 12.7) had increased odds of SA (ptrend= 0.02), compared to nonsmokers with low SHSe. Among nonsmokers, women with high SHSe had higher odds of SA (OR: 4.30; 95% CI 1.14, 19.1) than women to low SHSe. No significant interaction with NAT2 was reported. Despite wide CIs, results suggest that active smoking and high levels of SHSe may increase in the risk of SA among women seeking fertility care. This dissertation has clinical implications for patient care, and points to biological mechanisms by which tobacco smoke may affect fertility and pregnancy outcomes

Healthcare Workers Hospitalized with COVID-19: Outcomes from the Burden of COVID-19 study at the University of Louisville Center of Excellence for Research in Infectious Diseases [CERID]

Introduction: On March 6, 2020, the current ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also known as COVID-19 reached the commonwealth of Kentucky. Within days the first cases of infection and hospitalization were identified among healthcare workers (HCW) in Kentucky, other states in the U.S., and around the world. There is little information available regarding the impact of COVID-19 on the HCW population within this area. The objective of this study is to describe the baseline characteristics of hospitalized HCWs infected with COVID-19. Methods: Data collection was performed as part of a retrospective study of patients hospitalized with COVID-19 in any of nine acute care hospitals in Louisville. COVID-19 infection was confirmed using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Descriptive statistics were performed on clinical and epidemiological characteristics of hospitalized patients with COVID-19 who had indicated healthcare as their occupation. Results: Of the 700 adults hospitalized with COVID-19 from March 7 through July 1, 2020, 23 were HCWs. The mean age was 51 years and 78% were female. The majority of hospitalized HCWs had comorbidities including obesity (70%), hypertension (57%), hyperlipidemia (35%) and diabetes (26%). Common symptoms reported were fever (70%), dyspnea (78%), cough (78%) and fatigue (57%). Nine HCWs (39%) were admitted to the intensive care unit (ICU) and 6 (26%) developed acute respiratory distress syndrome (ARDS). Two (9%) patients developed a new, serious arrhythmia, two sustained cardiac arrest (9%), and two (9%) died in-hospital. Conclusions: Older adult HCWs with underlying health conditions such as obesity and hypertension were more likely to be hospitalized and have severe in-hospital complications. One HCW death due to COVID-19 was identified in this small population. These findings can help to identify and strengthen approaches to protect HCWs from SARS-CoV-2 infection and from long term effects of COVID-19

Epidemiology and Outcomes of Hospitalized Adults with SARS-CoV-2 Community-Acquired Pneumonia in Louisville, Kentucky

Background: During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 community-acquired pneumonia (CAP) has been the primary cause of hospitalization. The objective of this study was to evaluate the clinical characteristics and outcomes of 1,013 patients hospitalized with SARS-CoV-2 CAP from September 2020 through March 2021 in Louisville, Kentucky. Methods: This was a retrospective observational study of 1,013 patients hospitalized with SARS-CoV-2 CAP at eight of the adult hospitals in the city of Louisville from September 2020 through March 2021. Patients with 1) a positive reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate on chest imaging were defined as having SARS-CoV-2 CAP. Data were abstracted from each hospital’s electronic health record. Descriptive statistics were performed on clinical and epidemiological characteristics of hospitalized patients with SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. Data were analyzed by descriptive and inferential statistics using R version 3.4.0. Results: Of the 1,013 patients hospitalized with SARS-CoV-2 CAP, the median age was 65 years, 53% were males, 24% reported their race as African American or Black, and 6% identified as Hispanic. The most frequent comorbidities were hypertension (73%), obesity (56%), and diabetes (43%). At the time of admission, 60% required supplemental oxygen. The mortality rate was 19% for the total population and 45% for the 359 patients admitted to the intensive care unit (ICU). For each comorbidity, the proportion of hospitalized patients with SARS-CoV-2 CAP was significantly different from the Louisville population (P Conclusions: The elderly, males, and patients with a history of coronary artery disease, cerebrovascular disease, chronic obstructive pulmonary disease, hypertension, diabetes, renal disease, or obesity are overrepresented among hospitalized patients with SARS-CoV-2 CAP compared to the Louisville population. These patients are also more likely to require ICU care and experience worse clinical outcomes, with death occurring in approximately one in every five hospitalizations