Oral and Maxillofacial Injuries Associated With E-Cigarette Explosions: A Systematic Review and Management Guidelines Proposal.

PURPOSE: E-cigarettes have become increasingly popular devices used to consume nicotine in recent years. There is a growing body of evidence regarding the risk of spontaneous explosion of these devices causing burn and projectile injuries. The primary purpose of this review was to summarize all injuries to the oral and maxillofacial region secondary to explosion of e-cigarettes. The secondary purpose was to propose an initial management algorithm for such injuries based on the findings in the literature. This review also aims to test the hypothesis that e-cigarette explosive injuries to the oral region were associated with an increased risk of intubation and surgery and examine whether any other injury pattern was associated with an increased risk of intubation or surgery. METHODS: A cohort study based on identifying cases in the literature was conducted to summarize injuries to the oral and maxillofacial region and examine the associations between injury types and location and management. A literature search of the major biomedical databases was conducted in September 2022 using terms such as e-cigarette, explosion, blast, trauma, and burn, among others, which yielded 922 studies. Nonclinical studies, review articles, and studies without injuries to the facial region were excluded. Study subjects were recorded for demographics, device characteristics, injury mechanism, injury location, management, and complications. Chi-squared analysis was used to determine if the predictor variables of type of injury (burn or projectile) and its associated location (ocular, facial, or intraoral for burns and facial thirds for projectile) were associated with the outcomes of intubation and surgical management. The collected data were then used as a guide to propose an initial management algorithm for these injuries. RESULTS: Twenty eight studies, including 20 case reports and 8 case series met the inclusion criteria. A total of 32 explosions of e-cigarettes to 32 patients caused 105 recorded injuries to the facial region. Projectile injuries made up 73.3% (n = 77) of all facial injuries, while burn injuries made up of 26.7% (n = 28). There were 14 (43.8%) patients who suffered both projectile and burn injuries. Burn injuries mostly involved the face (64.3%, n = 18), oral cavity (25%, n = 7), and eye (10.7%, n = 7). The majority (81.8%, n = 63) of projectile injuries occurred in the lower facial third. There were 20 (62.5%) patients who suffered a bone or tooth fracture. Management of injuries involved surgery in 62.5% (n = 20) of patients, which included open reduction and internal fixation of fractures, dental extraction, bone and skin grafts, and ocular surgery. A complication rate of 44.4% (n = 8) was observed across studies that reported on follow-up. There was no statistically significant association between explosive injury to the oral region and intubation or surgical management. There was also no other statistically significant association between any other injury type and location with intubation or surgical management. CONCLUSIONS: E-cigarettes are at risk for spontaneous combustion that can cause serious oral and maxillofacial injuries, particularly to the lower facial third and commonly requiring surgical management. Safety of these devices should be improved through increased user education and regulation.

The Impact of COVID-19 on First Nations People Health Assessments in Australia.

The COVID-19 (coronavirus disease 2019) pandemic has the potential to worsen existing health inequalities faced by Aboriginal and Torres Strait Islander peoples in Australia. We aimed to assess the impact of the pandemic on First Nations people health assessments using an interrupted time series model utilizing data extracted from the Australian Medicare Benefits Schedule database. Additive triple exponential smoothing was used to model health assessments undertaken between January 2017 and December 2019. The model was used to predict health assessments between January 2020 and June 2020 with 95% confidence (P < .05). There was no significant difference between observed and predicted First Nations people health assessments in January, February, and June 2020. However, we found a statistically significant decrease in health assessments in March (16.5%), April (23.1%), and May (17.2%) 2020. The proportion of total health assessments delivered via telehealth was 0.5%, 23.6%, 17.6%, and 10.0% for March, April, May, and June 2020, respectively. The decrease in total First Nations people health assessments compounds the risk of poorer health outcomes in this population already vulnerable due to a high burden of chronic disease and considerable social, economic, and health inequalities. Strategies to improve the delivery of telehealth for First Nations people must be considered.

Radiological findings of e-cigarette or vaping product use associated lung injury: A systematic review.

INTRODUCTION: Chest radiology provides an opportunity to better understand the diagnostic characteristics of e-cigarette or vaping product use associated lung injury (EVALI). This systematic review aimed to summarize the radiological findings associated with EVALI reported in the literature. METHODS: This systematic review was conducted in accordance with PRISMA guidelines. Electronic searches of MEDLINE®, CINAHL, Embase® and CENTRAL were conducted in February 2020. Included were all English-language studies reporting radiological findings of EVALI. Data was synthesized using descriptive statistics. RESULTS: Thirty studies comprising 184 participants were included. Mean patient age was 24.5 years old. The majority (n = 141, 76.6%) of included patients were male. The most common radiological features reported on chest x-ray were bilateral infiltrates (n = 64, 41.3%) and ground glass opacities (n = 17, 11.0%), and on chest CT were bilateral infiltrates (n = 62, 36.9%), bilateral ground glass opacities (n = 56, 33.3%), subpleural sparing (n = 29, 17.3%), pleural effusions (n = 14, 8.3%), and centrilobular nodularity (n = 13, 7.7%). Of patients with follow-up data reported (n = 81), only 28.4% (n = 23) had complete resolution of symptoms or radiological findings. CONCLUSION: Chest radiology is the cornerstone of diagnosis and monitoring of EVALI. A wide variety of radiological findings highlight the need for standardisation of terminology in the radiological descriptions of EVALI. Common findings included bilateral infiltrates and ground glass opacities. Higher quality evidence is warranted to help develop evidenced-based guidelines for the diagnosis and management of EVALI.

Larval growth predicts the recruitment success of a coral reef fish.

While growth rates of pelagic larvae have been argued to be one of the principal determinants of the recruitment success of temperate marine fishes, it is not known if this is the case in the tropics. Here, we use larval growth histories derived from otoliths of a Caribbean reef fish to show that monthly variation in the intensity of settlement and recruitment of pelagic juveniles onto reefs is positively correlated with variation in growth rates 1-2 weeks after larvae begin feeding. Our results suggest that the processes thought to underlie recruitment of marine fishes in temperate regions may also operate in the tropics and contrasts with current research on the causes of recruitment variability in coral reef fishes, which emphasises the role of larval transport.

Marine biodiversity in the Caribbean: regional estimates and distribution patterns.

This paper provides an analysis of the distribution patterns of marine biodiversity and summarizes the major activities of the Census of Marine Life program in the Caribbean region. The coastal Caribbean region is a large marine ecosystem (LME) characterized by coral reefs, mangroves, and seagrasses, but including other environments, such as sandy beaches and rocky shores. These tropical ecosystems incorporate a high diversity of associated flora and fauna, and the nations that border the Caribbean collectively encompass a major global marine biodiversity hot spot. We analyze the state of knowledge of marine biodiversity based on the geographic distribution of georeferenced species records and regional taxonomic lists. A total of 12,046 marine species are reported in this paper for the Caribbean region. These include representatives from 31 animal phyla, two plant phyla, one group of Chromista, and three groups of Protoctista. Sampling effort has been greatest in shallow, nearshore waters, where there is relatively good coverage of species records; offshore and deep environments have been less studied. Additionally, we found that the currently accepted classification of marine ecoregions of the Caribbean did not apply for the benthic distributions of five relatively well known taxonomic groups. Coastal species richness tends to concentrate along the Antillean arc (Cuba to the southernmost Antilles) and the northern coast of South America (Venezuela-Colombia), while no pattern can be observed in the deep sea with the available data. Several factors make it impossible to determine the extent to which these distribution patterns accurately reflect the true situation for marine biodiversity in general: (1) highly localized concentrations of collecting effort and a lack of collecting in many areas and ecosystems, (2) high variability among collecting methods, (3) limited taxonomic expertise for many groups, and (4) differing levels of activity in the study of different taxa.

Invasion of the Indo-Pacific blenny Omobranchus punctatus (Perciformes: Blenniidae) on the Atlantic Coast of Central and South America

We examined 308 specimens of the Indo-Pacific blenniid Omobranchus punctatus deposited in four museum collections, and analyzed data on their collection locations to assess its invasion on the Atlantic coast of Central and South America. This species occurs in shoreline estuarine and marine habitats in the Indo-West Pacific. Previous sampling and recent records in the Tropical West Atlantic from 1930 to 2004 produced 20 records for: Panamá, Colombia, Venezuela, Trinidad and Brazil. In this work, we provide data on 17 new records for the Gulfs of Venezuela and Paria in Venezuela, as well as four records for Maranhão and Pará states in NE Brazil. The temporal pattern of collections (1930 - 2009) and the proximity of most localities to ports and zones of ship traffic indicate that O. punctatus was initially introduced to the Atlantic by ships travelling from India to Trinidad. Within Brazil the introduction is linked to shipping connected to petroleum platforms. In Maranhão and Pará the introduction may have occurred as a result of fish sheltering in fouling on hulls of ships moving between ports around the mouth of the Amazon River. Alternatively, the spread of this species along of the American coast may reflect the expansion of the range of O. puntactus through larval dispersal in northward flowing currents. We recommend monitoring of this introduced species, and studies of its ecology in West Atlantic areas.

Nós examinamos 308 espécimes do blenídeo Omobranchus punctatus, de origem Indo-Pacífica, depositados em coleções de quatro museus. Os dados de distribuição foram analisados com o objetivo de avaliar a invasão das águas costeiras do Oceano Atlântico nas Américas do Sul e Central. Em sua área de distribuição original, O. punctatus ocorre em ambientes marinhos e estuarinos. Amostragens datadas de 1930 e de 2004 produziram 20 registros da espécie no Atlântico Oeste tropical, incluindo amostras do Panamá, Colômbia, Venezuela, Trinidade e Brasil. Neste trabalho nós apresentamos 17 novos registros em áreas da Venezuela e nordeste do Brasil. O padrão temporal dos dados (1930-2009) e a proximidade da maioria das áreas de amostragem a regiões portuárias indicam que a espécie foi inicialmente introduzida no Atlântico pela água de lastro de navios navegando na rota India-Trinidade. No Brasil, a introdução parece estar associada ao movimento de navios em torno das plataformas de petróleo. No Maranhão e no Pará, a introdução está associada ao movimento de navios entre os portos próximos à foz do rio Amazonas. Alternativamente, a expansão de área desta espécie ao longo da costa da América pode ter acontecido através de dispersão larval, acompanhando as correntes em direção ao norte. Nós recomendamos o monitoramento desta espécie, bem como o desenvolvimento de estudos sobre sua ecologia em ambientes do Atlântico ocidental agora ocupos por ela.