There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted i...There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.展开更多
The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might pro</span><span style="font-family:Verdana;"&...The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might pro</span><span style="font-family:Verdana;">vide a </span></span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">reverse-gateway” from smoking traditional cigarettes to a less-harmful</span><span style="font-family:Verdana;"> alternative. But are users actually smokers? We developed an electronic on-line survey to gather data regarding e-cigarette usage in a target study population of pharmacy students. The survey was created using Google Forms to collect the responses anonymously. We surveyed medical-savvy healthcare students about their e-cigarette use, and whether or not their healthcare providers were aware of their e-cigarette use. Although nearly one-fourth of a convenience sampling of 134 pharmacy-student respondents (23.9%) reported using e-cigarettes, only 2.0% reported prior regular cigarette use, 28% used cartridges containing nicotine and only 11.2% had tried and wanted to quit. The majority (64.1%) reported that their healthcare providers did not ask about such use, and respondents did not volunteer this information. The results of this pilot survey reveal a significant e-cigarette use among health-aware pharmacy students, and they do not support the notion that the respondents do so to quit smoking. The observation that most of the students’ healthcare providers did not inquire about their e-cigarette use, coupled with the finding that users did not volunteer their vaping behavior</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> suggests that the information should be included when getting a medical history. Further research is needed to determine what behavioral factors may play a role in this type of decision-making among student healthcare professionals.展开更多
Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of tox...Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of toxins. However, the scientific evidence and the long-term health effects of e-cigarettes are limited. We describe a case of a 43-year-old man who had been smoking electronic cigarettes excessively for three days and presented with acute dyspnea, increased work of breathing and tachycardia. Subsequent chest x-ray revealed bilateral pleural effusions. In addition, the patient had a new oxygen requirement and was thus admitted with a diagnosis of pneumonia and bilateral pleural effusions. The case and the potential harmful effects of electronic cigarettes are discussed herein.展开更多
The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational pu...The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes.The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials.Daily use of ECs has implications in myocardial infarction(MI)with an odds ratio of 1.70 compared to healthy,nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62.Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions.Platelet aggregation,endothelial function,and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure.Though more studies need to be done on the topic of EC use and cardiovascular disease,the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes.ECs are toxic to human beings and their harmful effects cannot be overlooked.There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use.It will take decades to collect data for chronic EC use on long term sequelae,such as lung cancer.Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported.Due to undergoing investigations of possible harm and life threatening complications of EC use,we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies.A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage,frequency of use,and contents of ECliquid are just some of the vast complicating factors that limit the ability to effectively compare data.展开更多
Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping pr...Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI).Methods:Retrospective review of clinical characteristics,radiographs,and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio,Texas from 9/2019 to 6/2020 was performed.Results:We report 16 cases(15 men;median age,30 years[range 19-75])of EVALI with a history of vaping Tetrahydrocannabinol(THC),nicotine,or both.The most common presenting symptoms were tachycardia,dyspnea,cough,and fever.All patients required supplemental oxygen,including two who required noninvasive positive pressure ventilation,and five who required mechanical ventilation.All 16 patients had bilateral ground-glass opacities(GGO)with peripheral sparing on chest computerized tomography(CT).Cultures were negative,except for one patient who tested positive for rhinovirus.COVID-19 PCR was done in one individual which was negative.Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh(i.e.,without fixative)BAL in the majority of patients(N=12)with a mean lipid-saturation percentage of 78%[range,44%-100%]and the mean Colombo count of 194[range,101-359].Fifteen patients were treated with systemic corticosteroids.The median length of hospital stay was 10 days.At discharge,three patients required supplemental oxygen.Eight of those who had follow-up imaging showed resolution of GGO.One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate,with resolution of symptoms.Fourteen patients who were evaluated after discharge denied vaping post-discharge(two patients were not able to be contacted and did not keep follow-up appointments).Conclusions:Successful diagnosis and management of EVALI requires a high clinical suspicion,thorough evaluation to展开更多
[背景]近年来,青少年电子烟使用率不断上升,且电子烟相关肺损伤病例激增,引起各领域研究人员的关注。[目的]通过文献计量学及可视化分析探讨2013-2022年全球范围内电子烟或电子烟产品使用相关肺损伤(EVALI)的研究热点与趋势。[方法]选用...[背景]近年来,青少年电子烟使用率不断上升,且电子烟相关肺损伤病例激增,引起各领域研究人员的关注。[目的]通过文献计量学及可视化分析探讨2013-2022年全球范围内电子烟或电子烟产品使用相关肺损伤(EVALI)的研究热点与趋势。[方法]选用Web of Science核心数据库,获取2013-2022年全球EVALI相关的文献,从国家/地区、机构、作者、期刊、被引文献、关键词等方面进行统计,采用CiteSpace 6.2.R1绘制发文量趋势分析图、作者合作网络分析图、论文共被引聚类时间分布图、关键词聚类分析图等图谱,并对数据进行可视化分析。[结果]通过检索,2013-2022年间EVALI相关研究的文献共有888篇。发文量逐年增加,在2020年增幅明显,从2021年开始有所下降,但引用量逐年增加。发文量最活跃的国家是美国(631篇),欧美国家合作紧密且中心性更为突出,发文机构中加州大学系统以103篇居榜首。Rahman I (27篇)发表论文最多,中心度较高;Goniewicz M L被引文献最多;网络分析图显示作者间的合作相对较弱。American Journal of Respiratory and Critical Care Medicine(《美国呼吸与重症监护医学杂志》)是发文量最高的期刊(94篇)。被引次数前5名的文献均被引用超过300次。EVALI相关研究的高频关键词依次是nicotine(尼古丁,149次),exposure(暴露,118次)、oxidative stress(氧化应激,80次)等。共同引用网络中关键节点的聚类和聚类时间分布图表明青少年电子烟成瘾开始受到社会的广泛关注。从突现分析得到排名前25个关键词来看,对EVALI发病机制的研究重点逐渐从电子烟蒸气对肺产生的氧化应激损伤转向调味化学物质在肺损伤过程中发挥的氧化作用,目前该领域研究的兴趣主要是电子烟中各种化学物质以及加热元件对肺的损伤机制。[结论] EVALI正受到政府、医疗机构等领域研究人员的持续关注。多种电子烟成分如调味化学物展开更多
文章简单介绍了现代电子烟的发展背景、工作原理以及当下国内外的发展使用趋势。电子烟为控烟而生,但现在越来越多的证据表明电子烟会导致肺损伤。通过查阅国内外文献,对电子烟相关性肺损伤(e-cigarette or vaping product use associat...文章简单介绍了现代电子烟的发展背景、工作原理以及当下国内外的发展使用趋势。电子烟为控烟而生,但现在越来越多的证据表明电子烟会导致肺损伤。通过查阅国内外文献,对电子烟相关性肺损伤(e-cigarette or vaping product use associated lung injury,EVALI)的发病机制、临床特征、疾病诊治与预防进行了整理和分析。EVALI的发病机制尚不明确,现阶段仅能通过患者的电子烟使用史结合影像学与实验室检查的结果来进行临床诊断。患者在确诊后应立即停止使用电子烟并且依照临床表现进行相应的治疗,目前主要的治疗手段包括支持治疗、经验性应用抗菌药物治疗以及早期应用糖皮质激素治疗,出现呼吸窘迫或呼吸衰竭的患者则需住院进行治疗。各国卫生与教育机构应加强对青少年普及电子烟的危害与知识,并通过政策上对电子烟的限制来减少电子烟对群众健康所带来的危害。展开更多
文摘There has been a dramatic increase in medical complications related to synthetic cannabinoid (SC) use either by water pipe or vaping. The legalization of marijuana in an increasing number of states has also resulted in an increase in a number of complications related not just to marijuana, but in particular, to SC. As a result, there have been recent increased reports of acute pulmonary injury related to inhaled SC products. We describe that rarely endotracheal intubation with mechanical ventilation has been required to treat the acute respiratory distress syndrome (ARDS) and the diffuse alveolar hemorrhage (DAH) associated with the acute toxicity of SC inhalation. We describe the second reported case of successful utilization of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) in order to treat acute pulmonary toxicity caused by SC inhalation by a water pipe. While the exact pathophysiology of these interesting and recent pulmonary complications is unknown, the recent increase in exposure to SC via water pipe systems and vaping suggests that there will be many more cases of patients that will require ECMO as a form of life-saving therapy.
文摘The rise in “vaping”-associated deaths in the United States raises serious concerns. A justification for some level of risk is that e-cigarettes might pro</span><span style="font-family:Verdana;">vide a </span></span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">reverse-gateway” from smoking traditional cigarettes to a less-harmful</span><span style="font-family:Verdana;"> alternative. But are users actually smokers? We developed an electronic on-line survey to gather data regarding e-cigarette usage in a target study population of pharmacy students. The survey was created using Google Forms to collect the responses anonymously. We surveyed medical-savvy healthcare students about their e-cigarette use, and whether or not their healthcare providers were aware of their e-cigarette use. Although nearly one-fourth of a convenience sampling of 134 pharmacy-student respondents (23.9%) reported using e-cigarettes, only 2.0% reported prior regular cigarette use, 28% used cartridges containing nicotine and only 11.2% had tried and wanted to quit. The majority (64.1%) reported that their healthcare providers did not ask about such use, and respondents did not volunteer this information. The results of this pilot survey reveal a significant e-cigarette use among health-aware pharmacy students, and they do not support the notion that the respondents do so to quit smoking. The observation that most of the students’ healthcare providers did not inquire about their e-cigarette use, coupled with the finding that users did not volunteer their vaping behavior</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> suggests that the information should be included when getting a medical history. Further research is needed to determine what behavioral factors may play a role in this type of decision-making among student healthcare professionals.
文摘Electronic nicotine delivery systems also known as electronic cigarettes (or e-cigarettes) are marketed by their manufactures as a safer alternative to tobacco cigarettes because of potentially reduced delivery of toxins. However, the scientific evidence and the long-term health effects of e-cigarettes are limited. We describe a case of a 43-year-old man who had been smoking electronic cigarettes excessively for three days and presented with acute dyspnea, increased work of breathing and tachycardia. Subsequent chest x-ray revealed bilateral pleural effusions. In addition, the patient had a new oxygen requirement and was thus admitted with a diagnosis of pneumonia and bilateral pleural effusions. The case and the potential harmful effects of electronic cigarettes are discussed herein.
文摘The aim of this study was to review the most recent literature on the safety of electronic cigarettes(ECs)in the context of cardiovascular disease and in the context as a tool for smoking cessation and recreational purposes.The format of this review begins with relevant research from the basic sciences and follows through with a pertinent review of clinical trials.Daily use of ECs has implications in myocardial infarction(MI)with an odds ratio of 1.70 compared to healthy,nonsmokers and even worse risk for MI with dual use of combustible cigarettes together with EC with an odds ratio of 4.62.Studies measuring cardiac function with echocardiography reported both systolic and diastolic dysfunction along with reduced ejection fractions.Platelet aggregation,endothelial function,and hemodynamics during pregnancy were all but some of the pernicious cardiovascular implications of EC exposure.Though more studies need to be done on the topic of EC use and cardiovascular disease,the majority of studies considered in this review concluded some level of harm albeit in some instances less than that of traditional combustible cigarettes.ECs are toxic to human beings and their harmful effects cannot be overlooked.There is some favorable evidence of efficacy in smoking cessation though mixed with concern of chronic EC use.It will take decades to collect data for chronic EC use on long term sequelae,such as lung cancer.Though more and more reports of acute lung injury and hospitalizations related to EC use have been reported.Due to undergoing investigations of possible harm and life threatening complications of EC use,we cannot recommend ECs as safer or a more efficacious method of smoking cessation to traditional nicotine replacement therapies.A notable consideration for much of the literature reviewed are that standardization of EC use is difficult as device generation and battery voltage,frequency of use,and contents of ECliquid are just some of the vast complicating factors that limit the ability to effectively compare data.
文摘Objective:To describe the clinical features,proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage(BAL),and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury(EVALI).Methods:Retrospective review of clinical characteristics,radiographs,and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio,Texas from 9/2019 to 6/2020 was performed.Results:We report 16 cases(15 men;median age,30 years[range 19-75])of EVALI with a history of vaping Tetrahydrocannabinol(THC),nicotine,or both.The most common presenting symptoms were tachycardia,dyspnea,cough,and fever.All patients required supplemental oxygen,including two who required noninvasive positive pressure ventilation,and five who required mechanical ventilation.All 16 patients had bilateral ground-glass opacities(GGO)with peripheral sparing on chest computerized tomography(CT).Cultures were negative,except for one patient who tested positive for rhinovirus.COVID-19 PCR was done in one individual which was negative.Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh(i.e.,without fixative)BAL in the majority of patients(N=12)with a mean lipid-saturation percentage of 78%[range,44%-100%]and the mean Colombo count of 194[range,101-359].Fifteen patients were treated with systemic corticosteroids.The median length of hospital stay was 10 days.At discharge,three patients required supplemental oxygen.Eight of those who had follow-up imaging showed resolution of GGO.One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate,with resolution of symptoms.Fourteen patients who were evaluated after discharge denied vaping post-discharge(two patients were not able to be contacted and did not keep follow-up appointments).Conclusions:Successful diagnosis and management of EVALI requires a high clinical suspicion,thorough evaluation to
文摘[背景]近年来,青少年电子烟使用率不断上升,且电子烟相关肺损伤病例激增,引起各领域研究人员的关注。[目的]通过文献计量学及可视化分析探讨2013-2022年全球范围内电子烟或电子烟产品使用相关肺损伤(EVALI)的研究热点与趋势。[方法]选用Web of Science核心数据库,获取2013-2022年全球EVALI相关的文献,从国家/地区、机构、作者、期刊、被引文献、关键词等方面进行统计,采用CiteSpace 6.2.R1绘制发文量趋势分析图、作者合作网络分析图、论文共被引聚类时间分布图、关键词聚类分析图等图谱,并对数据进行可视化分析。[结果]通过检索,2013-2022年间EVALI相关研究的文献共有888篇。发文量逐年增加,在2020年增幅明显,从2021年开始有所下降,但引用量逐年增加。发文量最活跃的国家是美国(631篇),欧美国家合作紧密且中心性更为突出,发文机构中加州大学系统以103篇居榜首。Rahman I (27篇)发表论文最多,中心度较高;Goniewicz M L被引文献最多;网络分析图显示作者间的合作相对较弱。American Journal of Respiratory and Critical Care Medicine(《美国呼吸与重症监护医学杂志》)是发文量最高的期刊(94篇)。被引次数前5名的文献均被引用超过300次。EVALI相关研究的高频关键词依次是nicotine(尼古丁,149次),exposure(暴露,118次)、oxidative stress(氧化应激,80次)等。共同引用网络中关键节点的聚类和聚类时间分布图表明青少年电子烟成瘾开始受到社会的广泛关注。从突现分析得到排名前25个关键词来看,对EVALI发病机制的研究重点逐渐从电子烟蒸气对肺产生的氧化应激损伤转向调味化学物质在肺损伤过程中发挥的氧化作用,目前该领域研究的兴趣主要是电子烟中各种化学物质以及加热元件对肺的损伤机制。[结论] EVALI正受到政府、医疗机构等领域研究人员的持续关注。多种电子烟成分如调味化学物
文摘文章简单介绍了现代电子烟的发展背景、工作原理以及当下国内外的发展使用趋势。电子烟为控烟而生,但现在越来越多的证据表明电子烟会导致肺损伤。通过查阅国内外文献,对电子烟相关性肺损伤(e-cigarette or vaping product use associated lung injury,EVALI)的发病机制、临床特征、疾病诊治与预防进行了整理和分析。EVALI的发病机制尚不明确,现阶段仅能通过患者的电子烟使用史结合影像学与实验室检查的结果来进行临床诊断。患者在确诊后应立即停止使用电子烟并且依照临床表现进行相应的治疗,目前主要的治疗手段包括支持治疗、经验性应用抗菌药物治疗以及早期应用糖皮质激素治疗,出现呼吸窘迫或呼吸衰竭的患者则需住院进行治疗。各国卫生与教育机构应加强对青少年普及电子烟的危害与知识,并通过政策上对电子烟的限制来减少电子烟对群众健康所带来的危害。
