Common adverse events of electronic cigarettes compared with traditional nicotine replacement therapies: A systematic review and meta-analysis.

ISSUES: Established literature suggests that electronic cigarettes (EC) are more effective than traditional nicotine replacement therapies (NRT) as a smoking cessation aid, but the factors that mediate this difference remain poorly understood. We examine how adverse events (AE) associated with EC use relative to NRTs differ, with the view that differences in AEs experienced may drive differences in use and compliance. APPROACH: Papers for inclusion were identified via a three-tiered search strategy. Eligible articles involved healthy participants and compared nicotine ECs to non-nicotine ECs or NRTs and reported frequency of AE as an outcome. Random-effects meta-analyses were conducted to compare the likelihood for each of the AEs between nicotine ECs, non-nicotine placebo ECs and NRTs. KEY FINDINGS: A total of 3756 papers were identified, of which 18 were meta-analysed (10 cross-sectional and 8 randomised controlled trials). Meta-analytic results found no significant difference in the rates of reported AEs (i.e., cough, oral irritation, nausea) between nicotine ECs and NRTs, and between nicotine and non-nicotine placebo ECs. IMPLICATIONS: The variation in the incidence of AEs likely does not explain user preferences of ECs to NRTs. Incidence of common AEs reported because of EC and NRT use did not differ significantly. Future work will need to quantify both the adverse and favourable effects of ECs to understand the experiential mechanisms that drive the high uptake of nicotine ECs relative to established NRTs. CONCLUSIONS: There is inconclusive evidence on the incidence of AEs experience when using ECs compared to NRTs, possibly given the small sample size of studies.

Global prevalence of heated tobacco product use, 2015-22: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Heated tobacco products (HTPs) are electronic devices that heat process tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on world-wide HTP use prevalence. This meta-analytic review estimated the prevalence of HTP use by country, World Health Organization (WHO) region, year, sex/gender and age. METHODS: Five databases (Web of Science, Scopus, Embase, PubMed and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post-modern HTP device market entry (2015). A random-effects meta-analysis was used to estimate overall prevalence for life-time, current and daily HTP use. RESULTS: Forty-five studies (n = 1 096 076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for life-time, current and daily HTP use was 4.87% [95% confidence interval (CI) = 4.16, 5.63], 1.53% (95% CI = 1.22, 1.87) and 0.79% (95% CI = 0.48, 1.18), respectively, across all years (2015-22). Life-time HTP use prevalence significantly increased by 3.39% for WPR [0.52% (95% CI = 0.25, 0.88) in 2015 to 3.91% (95% CI = 2.30, 5.92) in 2019] and 5.58% for EUR [1.13% (95% CI = 0.59, 1.97) in 2016 to 6.98% (95% CI = 5.69, 8.39) in 2020]. Current HTP use increased by 10.45% for WPR [0.12% (95% CI = 0, 0.37) in 2015 to 10.57% (95% CI = 5.59, 16.88) in 2020] and 1.15% for EUR [0% (95% CI = 0, 0.35) in 2016 to 1.15% (95% CI = 0.87, 1.47) in 2020]. Meta-regression revealed higher current HTP use in WPR [3.80% (95% CI = 2.88, 4.98)] compared with EUR [1.40% (95% CI = 1.09, 1.74)] and AMR [0.81% (95% CI = 0.46, 1.26)] and for males [3.45% (95% CI = 2.56, 4.47)] compared with females [1.82% (95% CI = 1.39, 2.29)]. Adolescents had higher life-time HTP use prevalence [5.25% (95% CI = 4.36, 6.21) than adults [2.45% (95% CI = 0.79, 4.97)]. Most studies scored a low risk of sampling bias due to their nationally representative sampling. CONCLUSION: The prevalence of HTPs use increased in the EUR and WPR between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period.

Isolated superior mesenteric artery traumatic injury following body height fall across a log.

This case outlines a 71-year-old male falling from body height horizontally across a log with isolated superior mesenteric artery vascular injury, a rarity in minor blunt force trauma. A computed tomography abdomen and pelvis with contrast was ordered revealing active contrast blush arising from a major mesenteric vessel consistent with active arterial bleeding. Bowels and solid intra-abdominal organs were spared from any injuries. He underwent an emergency laparotomy following immediate resuscitation. The bleeding was controlled with clamping of the proximal and distal segments of the superior mesenteric artery (SMA). A severed branch of SMA was identified and ligated to stop the haemorrhage. The patient's recovery was uncomplicated, and he was discharged home on post-operative day 8. This case report highlights a unique mechanism of injury causing a rare injury pattern, emphasizing the importance of early recognition and definitive surgical intervention.

Chronic mesenteric ischemia: Diagnosis & management.

Background: With rising rates of atherosclerotic disease and obesity worldwide, the prevalence of chronic mesenteric ischemia (CMI) has been progressively rising. Prompt diagnosis and early intervention are crucial to avoid bowel loss and mortality in optimising long-term outcomes for patients and achieving symptom relief. Objectives: This article aims to summarise relevant literature on CMI, enabling primary care physicians to make a timely diagnosis and intervention, improving outcomes of patients with CMI. Discussion: CMI is often mistaken for more common pathologies due to its non-specific history and physical examination findings. A missed diagnosis can end up in acute mesenteric infarction and bowel perforation which can cause severe morbidity and mortality. Thus, a thorough gastrointestinal disease work-up ruling out other conditions may be required. CT angiogram is the gold standard non-invasive investigation for confirming a CMI diagnosis. Referral to vascular surgery with early surgical intervention through angioplasty and stenting is crucial for improving patient outcomes. Long-term follow-up of patients through routine consultations and serial non-invasive imaging can monitor for recurrence and disease progression.

Non-medical use of pharmaceutical opioids with and without other illicit substance use: Trends from two repeated nationally representative Australian surveys.

Background: Due to concerns over the public health impact of increasing opioid use, Australia up-scheduled codeine in 2018, requiring codeine-containing pharmaceuticals to be prescription-only. We examined pre-post changes in the prevalence and correlates of non-medical use of pharmaceutical opioids (NMUPO) and other illicit substance use (ISU). Methods: We conducted a cross-sectional analysis of 45,463 participants aged 14 or above in the Australian National Drug Strategy Household Surveys (NDSHS) 2016 and 2019. Participants were categorized based on their past 12 months NMUPO and ISU patterns. Correlates examined included socio-demographic, psychological (Kessler 10), health and behavioral variables. Results: The overall prevalence of any NMUPO decreased from 3.56% in 2016 to 2.65% in 2019, and the prevalence of codeine use from 2.98% to 1.49%. No significant changes were observed in the use of other types of painkillers (e.g. oxycodone and fentanyl) between 2016 and 2019. The overall decrease in NMUPO primarily occurred among people who used NMUPO only and did not use other illicit drugs. Older adults were more likely to report NMUPO only. Younger age, higher psychological distress, risky alcohol use, and daily smoking were associated with both NMUPO and illicit drug use. Conclusions: A comparison of cross-sectional data from two time-points showed that the prevalence of NMUPO use among people who used NMUPO exclusively was lower post-up-scheduling of codeine in Australia. However, NMUPO use did not reduce among people who used both NMUPO and other illicit drugs. Public health interventions are needed to reduce opioid-related harm in those who also used other illicit drugs.

A systematic review of randomized controlled trials and network meta-analysis of e-cigarettes for smoking cessation.

AIM: E-cigarettes, or nicotine vaping products, are potential smoking cessation aids that provide both nicotine and behavioural substitution for combustible cigarette smoking. This review aims to compare the effectiveness of nicotine e-cigarettes for smoking cessation with licensed nicotine replacement therapies (NRT) and nicotine-free based control conditions by using network meta-analysis (NMA). METHODS: We searched PubMed, Web of Science and PsycINFO for randomised controlled trials (RCTs) that allocated individuals to use nicotine e-cigarettes, compared to those that used licensed NRT (e.g., nicotine patches, nicotine gums, etc), or a nicotine-free control condition such as receiving placebo (nicotine-free) e-cigarettes or usual care. We only included studies of healthy individuals who smoked. Furthermore, we identified the latest Cochrane review on NRT and searched NRT trials that were published in similar periods as the e-cigarette trials we identified. NMA was conducted to compare the effect of e-cigarettes on cessation relative to NRT and control condition. Cochrane risk-of-bias tool for randomized trials Version 2 was used to access study bias. RESULTS: For the e-cigarette trials, our initial search identified 4,717 studies and we included 7 trials for NMA after removal of duplicates, record screening and assessment of eligibility (Total N = 5,674). For NRT trials, our initial search identified 1,014 studies and we included 9 trials that satisfied our inclusion criteria (Total N = 6,080). Results from NMA indicated that participants assigned to use nicotine e-cigarettes were more likely to remain abstinent from smoking than those in the control condition (pooled Risk Ratio (RR) = 2.08, 97.5% CI = [1.39, 3.15]) and those who were assigned to use NRT (pooled RR = 1.49, 97.5% CI = [1.04, 2.14]. There was a moderate heterogeneity between studies (I2 = 42%). Most of the e-cigarette trials has moderate or high risk of bias. CONCLUSION: Smokers assigned to use nicotine e-cigarettes were more likely to remain abstinent from smoking than those assigned to use licensed NRT, and both were more effective than usual care or placebo conditions. More high quality studies are required to ascertain the effect of e-cigarette on smoking cessation due to risk of bias in the included studies.

Gateway or common liability? A systematic review and meta-analysis of studies of adolescent e-cigarette use and future smoking initiation.

BACKGROUND AND AIMS: Studies have consistently found a longitudinal association between e-cigarette use (vaping) and cigarette smoking. Many have interpreted such association as causal. This systematic review and meta-analysis evaluated the plausibility of a causal interpretation by (1) estimating the effect of adolescent vaping on smoking initiation, adjusted for study quality characteristics, (2) evaluating the sufficiency of adjustment for confounding based on the social development model (SDM) and the social ecological model (SEM) and E-value analyses and (3) investigating sample attrition and publication bias. METHODS: Systematic review and meta-analysis of longitudinal studies that examined the association between e-cigarette use at baseline and smoking at follow-up. Participants were non-smokers aged < 18 at baseline. RESULTS: Meta-analysis of 11 studies showed a significant longitudinal association between vaping and smoking [adjusted odds ratio (aOR) = 2.93, 95% confidence interval (CI) = 2.22, 3.87]. Studies with sample sizes < 1000 had a significantly higher odds ratio (OR = 6.68, 95% CI = 3.63, 12.31) than studies with sample sizes > 1000 (OR = 2.49, 95% CI = 1.97, 3.15). Overall, the attrition rate was very high (median = 30%). All but one study reported results from complete sample analysis, despite those dropping out having higher risk profiles. Only two studies comprehensively adjusted for confounding. The median E-value was 2.90, indicating that the estimates were not robust against unmeasured confounding. CONCLUSIONS: There is a longitudinal association between adolescent vaping and smoking initiation; however, the evidence is limited by publication bias, high sample attrition and inadequate adjustment for potential confounders.