Background and Aims: We hypothesized that the prevalence of electronic cigarette vaping among the medical student population is on the rise. Our aims were to assess the prevalence of electronic cigarette vaping among medical students in Saudi Arabia, to understand and analyze the reasons that led them to try it, and to investigate students’ perceptions towards electronic cigarette vaping. Methods: An anonymous, paper-based, cross-sectional questionnaire was distributed amongst 401 undergraduate medical students from years 1-5 at Alfaisal University in Riyadh, Saudi Arabia. Prevalence, intensity of e-cigarette use and reasons for it, relation of electronic cigarettes to cessation of tobacco smoking, and side effects were studied. Results: The prevalence of vaping was 49/401 (12.2%). There was a strong association between gender and vaping, with males being 3 times more likely to vape compared to females (χ2 (1) =13.62, P <.001). The three most common reasons for using electronic cigarettes were to enjoy the variability in flavours (61.4%, n = 30), to reduce or quit tobacco cigarettes (29.5%, n = 14), and to avert the public smoking ban (13.6%, n = 7). The three most common side effects experienced by users were coughing (26.7%, n = 13), dry mouth/throat (24.4%, n = 12), and dizziness (20%, n = 10). Conclusion: Use of the electronic cigarettes is not uncommon amongst medical students, mostly due to their appealing flavor variability. Further research is required to define long-term safety and side effect profiles, and to generate evidence-based guidelines concerning e-cigarette safety and efficacy for smoking cessation.

Unusual or unexpected effect of treatment Background: Pancreaticoduodenectomy (Whipple procedure) is an established surgical procedure for the treatment of carcinoma of the head of the pancreas. Modifications to this procedure include gastropancreaticoduodenectomy, which includes the removal of parts of the pancreas, duodenum, and stomach. Complications of surgery include fistula formation, failure of the anastomosis, and leak of pancreatic enzymes, which can be reduced by stenting the pancreatic duct. This report is of a rare complication of pancreaticoduodenectomy and describes a case of retrograde migration of a pancreatic duct stent into the biliary tract through the orifice of the hepaticojejunostomy. Case Report: A 50-year-old man with a history of gastric cancer, underwent gastropancreaticoduodenectomy. Surgery was complicated by displacement of the pancreatic stent to the biliary system, which resulted in postoperative obstructive jaundice and bile leakage from the hepaticojejunostomy between the hepatic duct and the jejunum. An endoscopy was performed and the stent was successfully retrieved. The patient recovered rapidly, the bile leakage resolved, the patient's jaundice resolved, and was discharged home with no further surgical complications. Conclusions: A case is reported of a rare early complication of pancreaticoduodenectomy in a patient with gastric cancer. Endoscopy successfully retrieved the pancreatic duct stent that had migrated into the biliary tract through the orifice of the hepaticojejunostomy.

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