Background: In this systematic review and meta-analysis, we aimed to explore the association between cardiac injury and mortality, the need for intensive care unit (ICU) care, acute respiratory distress syndrome (ARDS), and severe coronavirus disease 2019 (COVID-19) in patients with COVID-19 pneumonia. Methods: We performed a comprehensive literature search from several databases. Definition of cardiac injury follows that of the included studies, which includes highly sensitive cardiac troponin I (hs-cTnl) N99th percentile.The primary outcome was mortality, and the secondary outcomes were ARDS, the need for ICU care, and severe COVID-19. ARDS and severe COVID-19 were defined per the World Health Organization (WHO) interim guidance of severe acute respiratory infection (SARI) of COVID-19. Results: There were a total of 2389 patients from 13 studies. This meta-analysis showed that cardiac injury was associated with higher mortality (RR 7.95 [5.12, 12.34], p b 0.001; I 2 : 65%). Cardiac injury was associated with higher need for ICU care (RR 7.94 [1.51, 41.78], p = 0.01; I 2 : 79%), and severe COVID-19 (RR 13.81 [5.52, 34.52], p b 0.001; I 2 : 0%). The cardiac injury was not significant for increased risk of ARDS (RR 2.57 [0.96, 6.85], p = 0.06; I 2 : 84%). The level of hs-cTnI was higher in patients with primary + secondary outcome (mean difference 10.38 pg/mL [4.44, 16.32], p = 0.002; I 2 : 0%). Conclusion: Cardiac injury is associated with mortality, need for ICU care, and severity of disease in patients with COVID-19.
BACKGROUND Indonesia forest fire in 2015 emitted a huge amount of pollutants into the air. This study was aimed to assess the health consequences of forest fire smoke in healthy residents in Riau during forest fire disaster in 2015.
METHODS This cross-sectional study was performed in healthy residents who lived in Pekanbaru, Riau Province, Sumatera, for at least 6 months during forest fire disaster in 2015, and data were taken in October 2015. Questionnaires consisting of respiratory and non-respiratory symptoms were collected. Lung function was assessed by spirometry (MIR II Spirolab™ spirometer, Medical International Research, Italy) and exhaled carbon monoxide (CO) was assessed using piCO+ Smokerlyzer®. Heart rate at rest and oxygen saturation in the room air were measured using Onyx 9591 Pulse Oximeter®.
RESULTS A total of 89 subjects were mostly female (75.3%), housewife (37.7%), nonsmoker (86.5%) with mean age of 38.9 years old. The non-respiratory and respiratory symptoms were reported in 84.7% and 71.4% subjects, respectively. Lung function was impaired in 72.6% subjects, mostly with mild obstruction and mild restriction. Exhaled CO was highly detected over normal values (mean [standard deviation] = 32.6 [9.97] ppm) with predicted carboxyhemoglobin (COHb) of 5.74 (1.56).
CONCLUSIONS Forest fire smoke exposure increased the respiratory and nonrespiratory symptoms among healthy individuals, which showed impairment in lung function, exhaled CO, and predicted COHb. Long term health effects on healthy individuals exposed to forest fire smoke warrant further evaluation.
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