BackgroundSmoking is a major preventable cause of morbidity and premature death worldwide. Both varenicline and nicotine replacement therapy (NRT) help achieve smoking cessation. However, limited evidence exists regarding whether combination of varenicline and NRT is more effective than either alone. The aim of this research was to investigate the efficacy and safety of varenicline combined with NRT.MethodsA systematic search of MEDLINE, EMBASE, ClinicalTrial.gov, and Cochrane Library was conducted in November 2014. Two authors independently reviewed and selected randomized controlled trials. The quality of the studies was evaluated by the Jadad score. We carried out meta-analysis of both early (abstinence rate assessed before or at the end of treatment) and late (assessed after the end of the treatment) outcomes.ResultsThree randomized controlled trials with 904 participants were included in this meta-analysis. All three were comparing combination therapy with varenicline therapy alone. The late outcomes were assessed in 2 of the 3 trials. Both the early and late outcomes were favorable for combination therapy (OR = 1.50, 95 % CI 1.14 to 1.97; OR = 1.62, 95 % CI 1.18 to 2.23, respectively). However, this significance diminished after eliminating a study with pre-cessation treatment using nicotine patch. The most common adverse events were nausea, insomnia, abnormal dreams, and headache. One study reported more skin reactions (14.4 % vs 7.8 %; p = 0.03) associated with combination therapy.ConclusionsCombination therapy is more effective than varenicline alone, especially if pre-cessation treatment of nicotine patch is administrated. Adverse events of combination therapy are similar to mono-therapy except for skin reactions.

1 Total (95% CI) Total events Heterogeneity:Chi z = 9.29, df = 4 (P = 0.05); I z = 57% Test for overall effect: Z = 3.00 (P = 0.003)

Lycium barbarum polysaccharide (LBP) has traditionally been used in Chinese medicine as a chief ingredient of L. barbarum (wolf berry/goji berry) for the treatment of various diseases with the symptoms of frequent drinking and urination. This study was conducted as a randomized, controlled clinical trial. A total of 67 patients with type 2 diabetes (30 in control group and 37 in LBP group) were enrolled in this prospective, randomized, double-blind study (administration at 300mg/day body weight). In order to observe the hypoglycemic and lipid-lowering activity of LBP in patients with type 2 diabetes after dinner, various tests were conducted between control and LBP intervention groups in 3 months. Although, the study had small sample size and short follow-up, significant findings were observed. The results of our study indicated a remarkable protective effect of LBP in patients with type 2 diabetes. Serum glucose was found to be significantly decreased and insulinogenic index increased during OMTT after 3 months administration of LBP. LBP also increased HDL levels in patients with type 2 diabetes. It showed more obvious hypoglycemic efficacy for those people who did not take any hypoglycemic medicine compared to patients taking hypoglycemic medicines. This study showed LBP to be a good potential treatment aided-agent for type 2 diabetes.

The paper entitled "The impact of COPD and smoking history on the severity of Covid-19: A systemic review and meta-analysis." published in Journal of Medical Virology on 15 April, 2020 1 . The results revealed the pooled OR of COPD and the development of severe , while the OR of ongoing smoking was 1.98 (Fixed effect model, 95% CI: 1.29-3.05). However, in the sensitivity analysis, by excluding each study one by one showed that the study from W. Guan 2 was a major source of heterogeneity.After excluding this study, the effect of smoking on the severity of Covid-19 became insignificant with the OR of 1.55 (95% CI: 0.83-2.87). The authors identified 7 studies 2-8 with data on smoking history and severity of Covid-19. The searching for English and Chinese database was up to 22 March, 2020.In this letter, the author used the keywords "smoking", "tobacco", "smoker", "Covid-19", "novel coronavirus" and "SARS cov-2" to search PubMed on 16April, 2020. One new study published by R. Wang 9 was identified. The updated meta-analysis was performed by RevMan Ver. 5.3. The pooled OR of the fixed effect model was 2.16 (95% CI: 1.45-3.22). The heterogeneity was smaller than that of the original analysis (I 2 : 39% vs. 44%). The sensitivity analysis excluding the study from W. Guan 2 revealed a pooled OR of 1.89 (95% CI: 1.10-3.24) ( Figure 1). The heterogeneity increased in the sensitivity analysis (I 2 =48%). The new study from R. Wang 9 contributed a positive effect to the meta-analysis (OR: 3.93, 95% CI: 1.30-11.93) and resulted in the statistical significance. The study from W. Guan 2 contributed to most of the cases in the meta-analysis (1,085 out of 1,851 cases). By excluding this study, the results were more robust.This article is protected by copyright. All rights reserved. Accepted ArticleThe possible mechanisms linking smoke to the outcome of Covid-19 were under study. A recent review 10 suggested smokers are vulnerable to respiratory infection because of impaired immunity. Smoking can upregulate angiotensin-converting enzyme-2 (ACE2) receptor, the known receptor for the severe acute respiratory syndrome (SARS)-coronavirus, and also possible for SARS-CoV-2 causing Covid-19.The results of the updated meta-analysis further confirmed the impact of smoking history on the severity of Covid-19.

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