Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016–2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.
Objectives: To: 1) describe patterns of use of high flow nasal cannula therapy (HFNC); 2) examine differences between patients started on HFNC and those started on non-invasive ventilation (NIV); and 3) explore whether patients who failed HFNC therapy were different from those who did not. Design: Retrospective analysis of data collected prospectively by the Paediatric Intensive Care Audit Network (PICANet). Setting: All paediatric intensive care units (PICUs) in the United Kingdom and Republic of Ireland (n=34). Patients: Admissions to study PICUs (2015-16) receiving any form of respiratory support at any time during PICU stay. Interventions: None. Measurements and Main Results: Eligible admissions were classified into nine groups based on the combination of the first-line and second-line respiratory support modes. Uni-and multivariate analyses were performed to test the association between PICU and patient characteristics and two outcomes: a) use of HFNC versus NIV as first-line mode, and b) HFNC failure, requiring escalation to NIV and/or invasive ventilation (IV). We analysed data from 26,423 admissions; HFNC was used in 5,951 (22.5%) at some point during the PICU stay. HFNC was used for first-line support in 2,080 (7.9%) and post-extubation support in 978 admissions (4.5% of patients extubated after first-line IV). HFNC failure occurred in 559/2080 admissions (26.9%) when used for first-line support. Uni-and multivariate analyses showed that PICU characteristics as well as patient age, primary diagnostic group 4 and admission type had a significant influence on the choice of first-line mode (HFNC or NIV). Younger age, unplanned admission and higher admission severity of illness were independent predictors of HFNC failure. Conclusions: The use of HFNC is common in PICUs in the UK and Republic of Ireland. Variation in the choice of first-line respiratory support mode (HFNC or NIV) between PICUs reflects the need for clinical trial evidence to guide future practice.
This study suggested that whole grain consumption more than 7 times/week was consistently associated with reduced risk of breast cancer.
Nearly four fifths of influenza-related PICU admissions occurred in children with high-risk conditions, highlighting the burden of severe influenza in this vulnerable population Further research is required to explain sex and ethnic group differences in PICU mortality among children admitted with influenza.
ObjectiveInpatient Hospital Episode Statistics (HES) ethnicity data are available but not always collected and data quality can be unreliable. This may have implications when assessing outcomes by ethnicity. An alternative method for assigning ethnicity is using naming algorithms. We investigate if the association between ethnicity and cancer incidence varied dependent on how ethnic group was assigned.DesignPopulation-based cancer registry cohort study.SettingYorkshire, UK.ParticipantsCancer registrations from 1998 to 2009 in children and young people (0–29 years) from a specialist cancer register in Yorkshire, UK (n=3998) were linked to inpatient HES data to obtain recorded ethnicity. Patients’ names, recorded in the cancer register, were matched to an ethnic group using the naming algorithm software Onomap. Each source of ethnicity was categorised as white, South Asian (SA) or Other, and a further two indicators were defined based on the combined ethnicities of HES and Onomap, one prioritising HES results, the other prioritising Onomap.OutcomesIncidence rate ratios (IRR) between ethnic groups were compared using Poisson regression for all cancers combined, leukaemia, lymphoma and central nervous system (CNS) tumours.ResultsDepending on the indicator used, 7.1%–8.6% of the study population were classified as SA. For all cancers combined there were no statistically significant differences between white and SA groups using any indicator; however, for lymphomas significant differences were only evident using one of the ‘Combined’ indicators (IRR=1.36 (95% CI 1.08 to 1.71)), and for CNS tumours incidence was lower using three of the four indicators. For the other ethnic group the IRR for all cancers combined ranged from 0.78 (0.65 to 0.94) to 1.41 (1.23 to 1.62).ConclusionsUsing different methods of assigning ethnicity can result in different estimates of ethnic variation in cancer incidence. Combining ethnicity from multiple sources results in a more complete estimate of ethnicity than the use of one single source.
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