Bladder cancer: often undetected for a long time | Symptoms & Treatment

Bladder cancer is one of the most insidious types of cancer. A malignant tumor can grow in the bladder unnoticed for years. A urologist explains how to identify the disease early on.

People in this country get fose bladder cancer more than 29,000 times a year. It is insidious that the tumor hardly causes any clear symptoms in the early stages. Pain is also rare.

What is bladder cancer? Bladder cancer, a so-called bladder carcinoma, is a malignant tumor in the urinary bladder.

Symptoms: Beware of blood in the urine

The symptoms by which bladder cancer can still be recognized is explained by Professor Dr. Christian Wülfing, head of urology at the Asklepios Clinic Altona. “The most common thing is blood in the urine,” said the press spokesman for the German Society for Urology.

Those affected should therefore always consult a doctor if their urine turns red or brown. Painful urination can also be a sign of bladder cancer. In the advanced stages of the cancer there is usually pain in the abdomen and kidney area.

According to the urologist, an early detection test such as the urine test “NMP22”, which is supposed to detect a substance that is increasingly formed by tumors in a urine sample, has so far not been very reliable.

causes: Smoking is the number one risk factor

It is still unclear why tumors develop in the urinary bladder and urinary tract. Scientific studies have been able to prove some factors that increase the risk of developing bladder cancer, writes the German Cancer Aid in its guide.

The biggest risk factor for bladder cancer is “clearly” smoking, according to Professor Dr. Wülfing. Passive smoking also increases the risk, because the carcinogenic substances in cigarette smoke are filtered out of the blood by the kidneys and enter the bladder with the urine, where they damage the mucous membrane. Experts estimate that around 30 to 70 percent of all bladder cancers are due to smoking.

Chemical substances that cause bladder cancer

During certain professional activities, employees are exposed to certain chemical substances such as aromatic amines and aniline dyes, which can increase the risk of bladder cancer. According to the German Cancer Aid, the following are at risk:

  • Chemical workers
  • painter
  • car Mechanic
  • Employed in rubber processing
  • Employees in the steel and leather industry
  • Hairdressers
  • Dental technician

Bladder cancer is a recognized occupational disease in these industries. There are now improved safety precautions for handling such substances in the workplace. But many people also come into contact with carcinogenic substances in their private everyday lives. Chemical hair dyes are suspected of increasing the risk of bladder cancer.

Other risk factors for bladder cancer are:

  • chronic bladder infections
  • Bladder stones and indwelling catheters
  • Taking pain medication with the active ingredient phenacetine
  • Infectious diseases such as schistosomiasis that have persisted for many years

Men are more likely to develop bladder cancer

According to the German Cancer Aid, men get sick more than twice as often Bladder cancer like women. That is because men smoke more. But the number of new cases among women is increasing, “probably because the proportion of female smokers has also increased over the past 30 to 40 years,” explains the urologist.

treatment depends on the tumor stage

The doctor can determine whether a suspicion of bladder cancer is justified by analyzing the urine, palpation and ultrasound examinations, cystoscopy and an X-ray contrast image of the kidneys and urinary tract. The majority of bladder tumors are recognized at a stage in which they are still growing on the surface and can be surgically removed.

“This is usually followed by an endoscopic operation in which tissue from the tumor is ‘peeled off’ via a cystoscopy,” says Professor Dr. Wülfing. This method is also called transurethral bladder tumor resection – TURB for short.

Even with one chemotherapy or radiation therapy of the urinary bladder Krebs treated in the early stages. If it is already advanced, however, the bladder must be removed. Then the patients get a bladder replacement and a so-called urostoma is placed. The urostoma is an artificial urine discharge through the abdominal wall, through which the urine is then excreted.

If the bladder cancer is detected late, it can affect the muscle and lymph tissue. If this is the case, even a bladder removal will no longer help and the cancer will be fatal. In Germany around 4,000 people die each year from a tumor in the urinary bladder.

Important NOTE: Under no circumstances does the information replace professional advice or treatment by trained and recognized doctors. The contents of t-online.de cannot and must not be used to make independent diagnoses or to start treatments.

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Constant headache? What’s behind the throbbing in the head

Everyone knows headaches. Too much stress at work, lack of sleep, but also your period can make your head pound uncomfortably. Most of the time the pain goes away. However, if you repeatedly suffer from headaches, you should consult a doctor.

200 different headache types

It can press, pound or be perceived as piercing or stabbing: a headache has many faces. According to experts, there are around 200 different types of headache. In about 90 percent of the cases it is a primary headache, i.e. an independent disease. Tension headaches and migraine count among them. Secondary headaches occur as a result of a previous illness, such as a flu-like effect.

Headache: Sometimes the brain needs water

Most of the time, the trigger for a headache is harmless. After exercise or on hot days, the head is usually buzzing due to a lack of fluid. The brain consists of 70 percent water and quickly becomes aware of the loss of fluid. If you refill the water reservoir, the throbbing also subsides.

Stress leads to tension headaches

A cramped sitting posture, for example at the computer, can tense the neck muscles and lead to tension headaches that constrict the head like “a helmet that is too tight”, as many people concerned describe. Stress is also a common trigger for tension headaches. Anyone who unconsciously bites their teeth together for a long time while concentrating must also expect headaches. Doctors speak of chronic tension headaches when they occur on 15 or more days a month over a period of three months.

Migraines plague many women during their period

Women often have during their Menstruation struggling with a headache. These are caused by fluctuations in the female hormone balance. It is even more uncomfortable when the menstrual period leads to real migraine attacks. These occur like attacks and are usually characterized by unilateral pain.

Migraines are accompanied by severe nausea, vomiting, and sensitivity to noise and light, among other things. An estimated 10 to 15 percent of the population suffer from migraines. Many women who have migraines mainly during their period therefore take the pill.

If you have a headache, also think about your eyes

If headaches occur more frequently in people who wear glasses, they often indicate a change in their eyesight. If glasses and contact lenses are adjusted to the current values, the headaches often subside. But diseases of the eye can also lead to headaches.

When to see a doctor immediately with a headache

Green star or an attack of glaucoma leads to severe headaches due to the increased intraocular pressure, which is accompanied by reddening of the eyes and painful hardening of the eyeball. The optic nerve is in acute danger. A doctor must be consulted immediately to prevent going blind.

In general, those affected should always consult a doctor as soon as possible if the headache occurs suddenly and with an intensity that is not known.

Speech-impaired headache: It can be a stroke

If the headache is accompanied by dizziness, symptoms of paralysis, numbness, visual or speech disorders, a stroke be the trigger. On the other hand, severe headaches that develop within a few hours and are accompanied by stiff neck and fever can be a Meningitis indicate. This inflammation can occur when a bacterial infection of the sinuses or ears spreads to the meninges.

If bacterial meningitis is left untreated, life-threatening swelling of the brain occurs, as the German Migraine and Headache Society (DMKG) warns. Ticks can also trigger meningitis. The so-called early summer meningo encephalitis (FSME) is triggered by viruses and not bacteria.

Take pain medication as briefly as possible

Anyone who is briefly plagued by headaches can take painkillers in addition to adequate fluid intake, exercise in the fresh air and relaxation. However, these should only be used for a short time. The rule of thumb is: As short as possible and as little as necessary.

The DMKG recommends taking painkillers for a maximum of ten days a month and a maximum of three days in a row. Because the preparations all have side effects when used continuously. In addition: In too high a dosage, painkillers can also lead to headaches. If the headache occurs again and again or with a previously unknown intensity, you should see a doctor.

Important NOTE: The information is in no way a substitute for professional advice or treatment by trained and recognized doctors. The content of t-online.de cannot and must not be used to make independent diagnoses or to start treatments.

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NHL goalkeeper Philipp Grubauer from Colorado injured

Regungslos lag Philipp Grubauer with outstretched arms and legs on the ice. The Rosenheimer’s face was contorted with pain, the NHL goalie from the Colorado Avalanche clearly needed help. Grubauer drove in Edmonton on both sides of the ice, leaning on a skid, dragging his injured left leg.

It is a heavy blow for the Denver franchise, and also for the German national goalkeeper, who has given no less than the title as a goal (“We want the thing”). Grubauer suffered the injury in the first play-off quarter-final against the Dallas Stars (3: 5) in a parade without opposing influence. There is no diagnosis yet, but the scenes suggest that it got him a little worse.

“Time will tell how long he will be out. I have no idea at the moment, but I do not assume that he will be on the ice tomorrow, “said Avalanche coach Jared Bednar on Saturday:” Hopefully he will be fit again as soon as possible. “Colorado needs its German keeper . Grubauer, 2018 Stanley Cup winner with the Washington Capitals, is a bank and the undisputed number one. He has appeared seven times since the league was restarted, with the Avalanche winning five. His catch quota was 92.2 percent, the goal average was 1.87 per game.

As so often, a seemingly harmless situation led to the goalkeeper’s break. 3:06 minutes were played in the middle third with a score of 1: 3 when Stars striker Denis Gurjanow pulled away, Grubauer fended off the shallow shot with the so-called “kick save” with his right leg and injured his left.

Groin, knees, ankles, Grubauer could have been hit in many places. “There was a tweak somewhere,” said Bednar in a press conference, “you saw what I saw. He couldn’t go on. ”That alone is“ bad news ”. The head coach couldn’t say anything more at first. The second game against the stars will continue on Monday at Rogers Place. The Czech Pavel Francouz (30) will start in Grubauer’s place on the bench Michael Hutchinson (30) from Canada.

“Frankie has to do the job now,” said Bednar. When he was substituted on, Francouz saved 18 of 20 shots. “It was hard for him to get in that way. He hadn’t played for a while and our team wasn’t good, ”said the head coach and criticized the lack of support:“ We let him down. ”In the championship round, Grubauer is one of three remaining German NHL professionals. The others are Thomas Greiss and Tom Kühnhackl from the New York Islanders, but in contrast to Upper Bavaria, they hardly play a role.

Goalkeeper Greiss is still waiting for his first appearance since the league restart. Striker Kühnhackl was allowed to play three times in the qualifying round, in the round of 16 against Washington (4: 1) the two-time Stanley Cup winner was last regularly deleted from the squad. The Islanders start their series against the Philadelphia Flyers on Monday (local time).

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Special Projects – Twenty Years Together

The economic program of the first acting and then President Vladimir Putin was then extremely worried by most analysts. As such, there was no economic election program; in the Address to Voters, the topic of the economy was practically ignored (except for the fight against poverty). Throughout 2000 and at the beginning of 2001, the rumors about what would be the “Putin program” did not stop.

In particular, there was a discussion about whether the new president would prefer the liberal “German Gref program” from the Center for Strategic Research or the “Victor Ishaev program” – a protectionist development of a group of economists of the Russian Academy of Sciences. Formally, the choice was not made. The government of Mikhail Kasyanov, which included German Gref (in the status of minister) and Alexei Kudrin (deputy prime minister and minister of finance), implemented the first option, plus the achievements of the assistant to the president Andrei Illarionov.

It is possible to reconstruct Putin’s actual economic program for 2000-2001 according to the then fundamental decisions of the government and the president. In the tax sphere, this is a reduction in the level of nominal taxation from 60–65% of GDP to 40–45%, repayment of external debt (including the Paris Club), joining the World Trade Organization, a deficit-free budget, lowering the Bank of Russia refinancing rate and the fight against inflation, the creation of a mechanism for maintaining federal budget revenues to smooth out oil price fluctuations (stabilization fund).

In addition, the government was then loyal to the idea of ​​gradually strengthening the ruble (from 32 rubles / $ in 2000 to 10 rubles / $) and abandoning the control of capital flows (one of the first important actions in 2000 was to reduce the rate of sale foreign exchange earnings from 75% to 50%, the Central Bank insisted on 100%).

Solutions for the industrial sector include the consolidation of the public sector, the active attraction of direct foreign investment, the reform of the energy system, the privatization of railways and parts of oil assets, the strengthening of Gazprom’s business and the construction of a pipeline system bypassing Ukraine.

The ultimate goal of the program was to achieve rates of economic growth above 4% of GDP in order to increase real disposable incomes of the population, reduce the number of poor and create a middle class.

Poverty rate

The longest announced in this unofficial and mostly liberal plan was the reform of RAO UES of Russia – ten years. Almost everything else usually fit in four to five years. Almost everything then claimed was somehow implemented and implemented, but three to four times slower than anticipated.

This is actually the main pattern in the “Putin program” – it cannot be said that any initial plans were canceled (the exception is the privatization of Russian Railways). But their unpredictably slow implementation by the time any effect was achieved already made it possible to forget that this was not a natural course of things, not slow progress, but the implementation of the president’s program. He did not back down from the program. He consistently and steadily carried it out together with the entire economy at a speed that no one had expected at the time of planning.

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Nadezhda Babkina appeared in public after a serious illness

Nadezhda Babkina has been at home for 24 hours. The 70-year-old singer was discharged from the hospital, where she spent a month, on the eve of May Day. Nadezhda Georgievna decided to record a video for her fans, first introduced to the public after a serious illness.

Nadezhda Babkina left the hospital on April 30. The queen of Russian song was met by beloved Eugene Gore. Now the singer is at home, in a circle of relatives. All this time, while doctors fought for the artist’s life, the public sent health rays to their favorite. Ordinary Russians, friends of the star, as well as colleagues in show business did not hide that they prayed for Babkin.

The celebrity decided to appear before the public a few hours after discharge. She recorded a video in which she thanked everyone and called on to take care of herself and loved ones. Seems to be, Babkina not yet fully recovered from a serious illness. In the frame, she sits in an armchair. She is wearing a burgundy tracksuit.

“My dears, I am so glad that I can communicate with you and say the most sincere words of gratitude. Yes, I have passed the test. I don’t want to pass this to anyone. But who knows where this infection is and where it is attached to. You don’t have to find out “You just need to clearly follow the rules that were invented for us. My good ones, let’s take care of each other, understand, compassion and sympathy. The test is very difficult and difficult,” the vocalist addressed the subscribers.

The disease has changed Nadezhda Babkina

She noted that was able to get out thanks to folk love and prayers. “A terrible situation. But all the time I heard you call me, speak, support. I sincerely love you all, because my life is connected with you. I’m at home, recovering. I am grateful to the doctors who were always there,” added the artist. At the end of the appeal, she wished all health and sent a kiss.

Fans are very happy that their idol is finally at home. However, they note that the disease hit their pet hard.

“I’ve lost weight somehow. It seems that you’ve gotten very well,” “Do not be sick anymore. We were very worried about you!” , “Love you very much! “,” God, how poor I am, poor thing. Get better, please, “write excited followers.

Recall that Nadezhda Babkina was urgently hospitalized on April 1 in one of the capital’s clinics. The leader of the “Fashion sentence” was taken away from the apartment in the center Moscow in serious condition. Doctors diagnosed her with “bilateral pneumonia.” For a long time, the singer was in intensive care, she was introduced to a medical coma. After the singer regained consciousness, she ate through a special probe and breathed using a tracheostomy tube.

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Abolition of flogging and the death penalty for minors in Saudi Arabia

La Croix: Saudi Arabia has announced the abolition of flogging and the death penalty for minors. What is the real reach of these announcements?

Stéphane Lacroix: Regarding flogging, it is not an abolition, it does not disappear from Saudi law. Articles in the local media make it clear that its removal, and its replacement by other sentences such as prison or a fine, only apply in the context of the ta’zir. But flogging remains possible for hudud.

The hudud are these punishments explicitly provided for in the Koran for certain crimes: stoning or flogging for fornication for example, amputation for theft or the death penalty for apostasy. They are considered “Wanted by God” : the reform announced here does not concern them.

Flogging is only removed as part of the ta’zir, that is, offenses, of a lower category, the sentence of which is left to the discretion of the judge.

→ READ. In Saudi Arabia, the crown prince does the cleaning around him

As for the abolition of the death penalty for minors, nothing has yet filtered out the elements of language that will be used to justify it in Islamic terms. In both cases, it should be noted that these are only announcements from the pro-government human rights commission, not official statements. They may be test balls, intended to adjust the shot according to the reactions.

What is the goal of the Crown Prince, Mohamed Ben Salmane?

S. L.: Undoubtedly to “smooth” the image of Saudi Arabia, in a difficult context for him by touching only on the part of the law which is within his competence. Islamically speaking, this decision is not problematic and should not anger the most conservative.

In practice, however, his decision could amount to a real reduction or even a de facto suppression of flogging. Indeed, the hudud, especially for the most serious crimes, are much less applied than the ta’zir.

Muslim law provides very difficult conditions to meet and the accused benefits from doubt. So that a woman is convinced of zina (fornication or adultery), she must have been seen committing a sexual act by four witnesses. Even in Saudi Arabia, there have been no known cases of stoning for several decades, and when I had worked on this, no one had been able to tell me when it was last.

Some predominantly Muslim countries retain these punishments in their law, but do not apply them. And even when it could be, political intervention may well prevent it. Apostasy was not retained against blogger Raif Badawi (imprisoned since 2012 for “insulting Islam” and sentenced in May 2014 to a thousand lashes and ten years in prison as a sentence of ta’zir, Editor’s note). The authorities may have intervened to avoid him, considering that his execution would have damaged the image of the country.

At the same time, we learned of the death in prison – presumably for lack of care – of Abdallah al-Hamid, the founder of the Saudi Association for Civil and Political Rights. Don’t the announcements also aim to conceal the reality of the current repression?

S. L.: The conjunction of these different events is sadly telling. Abdallah al-Hamid was a major figure on the Saudi intellectual and political scene. Professor of literature and poet, he originally belonged to the Islamist movement, like many in his generation, before breaking away from it.

In the 2000s, he animated a platform of intellectuals bringing together Islamists as liberals, people from the left, but also Shiites, defending the principle of a constitutional monarchy with an elected Parliament. In his books, he criticized Wahhabism as an ideology in the service of an authoritarian state.

Imprisoned six times, he embodies everything that Mohamed Ben Salmane does not want: a civil society, critical voices. The crown prince sees reform only from above, within an ultra-authoritarian framework. I’m not saying it has no effect on society. But his vision is the opposite of the democratic reform that Abdallah al-Hamid demanded.

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strawberry producers are struggling

Gariguette, Ciflorette, Mara des bois … Strawberries usually brighten up spring tables. But in March, during the first weeks of containment imposed by the Covid-19 health crisis, consumers shunned them, plunging producers into a bad patch.

→ LIVE. Coronavirus: the latest news in France and worldwide

The closure of restaurants and markets has made it impossible to sell early crops. Part of the production – from 20 to 30% – has been destroyed. “We distributed several tons, to hospitals, the food bank, firefighters”, testifies Bruno Vila, strawberry producer in Perpignan (Pyrénées-Orientales).

Highlight French strawberries

On the stalls of the large distribution, the Spanish strawberries sat enthroned while the French producers threw. We asked the bosses of large and medium-sized areas to highlight the asparagus and strawberries from local producers “, explains Jérôme Despey, secretary general of the FNSEA and president of the Hérault chamber of agriculture.

Little by little, the market has recovered but producers’ revenues remain precarious. “Sales improved significantly in early April. Supermarkets are now promoting the French origin of products. But we are far from having made up for our losses “, notes Bruno Vila.

Peak direct sales

Those who, like Olivier Cozon, producer of fruit and vegetables in the Hérault, have long wagered on direct sales are now making a splash. “We have been delivering baskets for fifteen years. Eight hundred people are chasing us right now! We currently deliver 500 baskets per week, instead of a hundred in normal times, ” explains the producer, who heads a farm with around ten permanent employees.

The arms are missing

If the production flow is now in working order, another problem arises: the lack of manpower for collection. “Half of the workforce is local, the other half usually come from Poland, Spain, Portugal and Morocco. Some workers still managed to cross the Spanish border in early April, but now no exceptions are possible “, notes Xavier Mas, president of the Fraises de France association.

→ READ. Coronavirus: agriculture lacks arms

In the south-east, where the harvest is early, producers were able to anticipate and bring in seasonal workers. “But in Val-de-Loire, Rhône-Alpes and central France, it looks complicated. We are at an impasse “, worries Xavier Mas. Launched at the end of March by the government, the platform for calling for volunteers, “arms on your plate” has already allowed producers to recruit, but the hiring conditions have some limits.

The call for volunteers

“We had a lot of volunteers, explains Hélène Suzor, in charge of the fruit and vegetable sector at the Hérault Chamber of Agriculture. This solidarity is very significant, but it faces a problem of sustainability. Each volunteer must be able to be released from his agricultural mission within seven days to resume his usual activity. This is therefore very worrying for producers who would prefer to be able to count on a sustainable workforce during the season. “

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Avalon Aardoom has to end short track career with heart defect


“It’s hard to bear that it was for me”: Avalon Aardoom can no longer hit the short track ice cream.
Image: Imago

When Avalon Aardoom was little, her heart beat 300 times a minute or more. Nevertheless, she wanted to be world champion in the short track. She was on the right track. But from one second to the next, all their dreams are destroyed.

Avalon Aardoom was in France, somewhere in the Pyrenees. On the way to one of those goddamned peaks when her body ended her skating career. It was summer, June, a few days ago, Avalon had traveled to France with the other Dutch national short trackers. It was supposed to be an ordinary training camp – and an ordinary training camp meant one thing for short trackers in summer: cycling until almost the thighs burst.

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Avalon passed out from the ergometer during the performance test before the training camp, but that didn’t matter. In December, a fall on the ice had shaken her brain once, and she had to stop for a few months. In addition, these performance tests were brutal, the other short trackers had to vomit, Avalon just fainted. She was extremely familiar with this.

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Is it true that nicotine users contract Covid-19 less?

Hello,

Numerous case studies demonstrate this unequivocal : smokers who get Covid-19 have a risk greatly increased to develop severe forms of the disease. In this work, we find that the proportion of smokers is two to four times higher in severely ill patients than in those with a moderate form of the disease.

On the other hand, several publications relayed since the beginning of April report a counterintuitive phenomenon: in several countries, the proportion of smokers infected with SARS-CoV-2 would be lower than the proportion of smokers at regional or national level. The Minister of Health, Olivier Véran, recently mentioned this data.

In France, works being published conducted on a limited number of patients at the Pitié-Salpétrière, as well as a study in a school environment in Crépy-en-Valois (prepublished this April 23), also reported this statistical trend.

Many potential limits

Note now that the link between smoking status and propensity to be infected does not appear in all research. So in a recent study published in the Jama, involving 5,700 New York patients hospitalized for Covid-19, the proportion of smokers was analogous to that observed in the regional population.

The first studies were met with skepticism, not without reason. Indeed, many of these works have sometimes significant biases.

First limitation present in all studies (with the exception of French studies): the age parameter of hospitalized patients. Indeed, a significant proportion of patients with severe forms of Covid-19 are over the age of 65. The prevalence of smokers decreases very strongly with age (for example, in France, 65-75 year olds smoke 2.5 times less than the general population).

In the study conducted at Pitié-Salpêtrière, taking into account the age and sex of the patients, smokers nevertheless appeared to be four times less likely than non-smokers to be Covid +. A rate observed both in hospitalized patients and in patients treated on an outpatient basis. However, in order to draw more solid conclusions, these results should have been put into perspective with the smoking profile of patients who usually attend this hospital, at the same periods in previous years.

Another parameter that seems to be excluded from most analyzes: the socio-economic profile of the groups studied, which can strongly influence the expected proportion of smokers. A limitation mentioned by the authors of the French study, who established their calculations “Assuming that the population studied who lives in a limited area around a Parisian hospital has the same smoking habits as the French population in general”, and who note that “Healthcare workers were overrepresented in the outpatient group due to routine workplace testing when they became symptomatic”. The study conducted at Crépy-en-Valois seems to take this parameter into account. And its results are consistent with the Pitié Salpêtrière study.

Third important pitfall: the quality of the information collected is not always there … far from it. In some studies used by epidemiologists to conduct their analyzes, the smoking status of the sickest Covid + patients was simply not informed. Commentators have also noted that one of these studies considered individuals to be “non-smokers” less than 30 packages per year – preventing any comparison with national statistics which relate to all cigarette consumers.

For its part, the study conducted at Pitié-Salpêtrière seems to consider as “former smoker” any person who had quit smoking at the time of his hospitalization … without mentioning the hypothesis that patients may have stopped smoking because of the first Covid-19 symptoms! A point which would considerably influence the results. Requested by CheckNews, Zahir Amoura, author of this work, has not yet commented on this point.

Is the phenomenon biologically plausible?

The interpretation of these statistics, as well as the extent of the associated phenomenon, are still questionable.

Researchers, however, have begun to explore the hypothesis of a direct causal link between smoking status and primary SARS-CoV-2 infection. The question arises indeed: from a physiological point of view, is it plausible that lungs exposed to tobacco are less permeable to this coronavirus? Could nicotine be involved in the phenomenon?

A possible link with the ACE2 receiver?

SARS-CoV-2 infects cells by binding to the ACE2 receptor, abundant on the surface, in particular, the cells of the mucous membranes and the alveolar pulmonary tissue. The expression of the gene corresponding to ACE2 is not identical in smokers and in non-smokers. Based on animal models, smokers have long been considered to express less ACE2 – which suggests a simple explanation for the phenomenon: less ACE2 induces a lower propensity for infection.

But recent data, which seem to be corroborated by new researchsuggest that in humans, smoking is associated with a higher expression of ACE2. A higher propensity for coronavirus infection would therefore be expected. The epidemiological observations mentioned above, suggesting a protective effect of tobacco, would therefore raise a paradox.

Several explanatory hypotheses have been formulated. Some authors have advanced that in all patients, infection with SARS-CoV-2 would decrease the availability of ACE2 receptors in the lungs. The biological processes that usually mobilize these receptors would be hindered, leading to various symptoms of the disease. People with more ACE2, even if they were infected, would develop fewer symptoms. However, this interpretation is challenged by the Crépy-en-Valois study, where the diagnosis of infection was made on a blood test, and not on a simple clinical assessment of symptoms.

According to other works, the nAChR nicotinic receptor could modulate the activity of ACE2. Could stimulating nAChR make infection through ACE2 more difficult? This fact is not yet proven. “The possibility of a reciprocal modulation between ACE2 and the nicotinic receptor is an interesting scientific question for which we have no answer”, insists Professor Jean-Pierre Changeux, co-author of a scientific article inviting this hypothesis to be explored.

La Pitié-Salpêtrière has announced the launch of several clinical trials in this direction. The first, conducted on caregivers, aims to compare the infection rate between a group carrying nicotine patches and a group carrying placebos patches. More trials need to be done on Covid + patients in hospital to assess whether nicotine affects the course of the disease – especially in smokers who are forced to quit as a result of hospitalization.

Nicotine and vaping: preliminary data not very encouraging

The return of associations of electronic cigarette users does not seem to go in this direction, however. According to the analysis of a questionnaire sent in early April to several thousand members of the AIDUCE and SOVAPE associations, the rate of patients suspected of being Covid + was similar whether or not there was nicotine consumption – around 2.5 %. “Although it concerns nearly 10,000 people, this citizen survey is inconclusive on a major protective effect of nicotine, note the associations in a press release. The first data show no major positive or negative effect of vaping when faced with the risk of contracting Covid-19 for vapers and their entourage. ”

Tobaccoologist Bertrand Dautzenberg, who had encouraged these associations to explore this hypothesis, notes on Twitter that the data was not collected under conditions “Respecting all the obligations of scientific studies”. He nevertheless considers that they are not showing strong signs of a beneficial effect of nicotine in reducing Covid-19 levels. ” He invites an analysis of the Health Database to further explore this hypothesis.

No reason to start smoking

The tobacco specialist recalls “That tobacco certainly brings a negative effect greater than that of a small benefit which is not confirmed at all”. “This leads to encouraging all doctors to advise and support smoking cessation for all smokers.” The authors of the Crépy-en-Valois study abound in this sense, recalling that tobacco is responsible for 75,000 deaths per year in France. “Smoking cannot therefore be offered as a way of protecting oneself against the new coronavirus”, they insist.

Unsurprisingly, this finding is similar to that of the authors of a review on the complications of Covid-19 related to smoking. “Risk factors for severe forms of Covid-19 (pulmonary and cardiovascular disorders, diabetes, etc.) are more common in smokers. Smokers with comorbidities should quit smoking by all means. ” They also observe that confinement can lead to social isolation and psychological distress that increase the need for smoking. [En outre], smoking is more prevalent among the economically less advantaged groups, and they are potentially more at risk for Covid-19. ”

For its part, the association Alliance contre le tabac urged the greatest caution with regard to speculative information in circulation. In the absence of more evidence, nicotine users, “Should not expect to be more protected than the population from the current epidemic”, she recalls. In addition, she advises non-smokers to use nicotine substitutes. A warning also formulated by the promoters of the Pitié-Salpétrière study or by the Minister of Health.

In summary

Although well publicized, epidemiological observations associating smoking and the risk of developing the symptoms of Covid-19 are difficult to interpret at this time. Under the hypothesis of a real cause and effect link, the biological mechanisms mentioned in the press are still hypothetical. None have yet been formally tested.

Listen to the weekly behind the scenes podcast of CheckNews. This week: Covid-19: what are the real figures for deaths in intensive care?

Jérôme Salomon, the Director General of Health, mentioned a mortality of 10% in intensive care of patients hospitalized for Covid-19. In this episode, Luc Peillon explains why this figure is largely underestimated.


Florian Gouthière

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Drug: Cannabis does not help most pain sufferers

WORLD ON SUNDAY: Pain patients in particular could benefit from cannabis, it said.

Jansen: Yes, supposedly. A new option for the seriously ill, for which one is grateful as a pain medic. I thought, well, let’s take care of it now. The patients were already there. Everyone had read about the new wonder drug somewhere. People said: I take three tablets a day, now I finally want holistic medicine. In normal times we have 300 to 400 patients a day in the house. The doctors could hardly hold their office hours in peace, they should constantly explain how to get cannabis.

WORLD ON SUNDAY: How did you manage that?

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