Randomized Clinical Trial of Antioxidant Therapy Patients with Septic Shock and Organ Dysfunction in the ICU: SOFA Score Reduction by Improvement of the Enzymatic and Non-Enzymatic Antioxidant System.

BACKGROUND AND AIM: Here, we assess the effect of adjuvant antioxidant therapies in septic shock patients with organ dysfunction and their effect on the enzymatic and non-enzymatic antioxidant systems. METHODS: Randomized clinical trial run between 2018 and 2022. One hundred and thirty-one patients with septic shock were included in five groups with 25, 27, 24, 26 and 29 patients each. Group 1 received vitamin C (Vit C), Group 2 vitamin E (Vit E), Group 3 n-acetylcysteine (NAC), Group 4 melatonin (MT) and group 5 no treatment. All antioxidants were administered orally or through a nasogastric tube for 5 days as an adjuvant to standard therapy. RESULTS: All patients had multiple organ failure (MOF) and low Vit C levels. Vit C therapy decreased CRP, PCT and NO3-/NO2- but increased Vit C levels. The SOFA score decreased with MT in 75%, Vit C 63% and NAC 50% vs. controls 33% (p = 0.0001, p = 0.03 and p = 0.001 respectively). MT diminished lipid peroxidation (LPO) (p = 0.01) and improved total antioxidant capacity (TAC) (p = 0.04). Vit E increased thiol levels (p = 0.02) and tended to decrease LPO (p = 0.06). Selenium levels were decreased in the control group (p = 0.04). CONCLUSIONS: Antioxidants used as an adjuvant therapy in the standard treatment of septic shock decrease MOF and oxidative stress markers. They increase the TAC and thiols, and maintain selenium levels.

Investigation of the Formal Pathogenesis of Green Liver Discoloration in Organically Reared Female Bronze Turkeys (Melleagris gallovapo).

Green liver discoloration (GL) in fattening turkeys is suspected to be a multifactorial disease complex with a compromised immune system as the key factor. This study aimed to identify the formal pathogenesis of GL and to investigate possible nutritional influences. A total of 360 Bronze turkey hens out of 10 flocks from 5 fattening farms were necropsied for detection of GL during 2 consecutive trials on 2 examination dates each (70th to 75th and 120th to 127th day of fattening, respectively). At each examination date, hematological and clinical chemistry analyses, as well as determination of vitamin E and selenium concentrations in the liver, were carried out in 6 hens with (if applicable) and 6 hens without GL, representing a total of 130 individuals. Raw nutrient, energy, amino acid, bulk and trace element, and vitamin E and D3 concentrations were analyzed in feed samples for each of the five feeding phases during each trial. The results of the hematological analyses, clinical chemistry analyses, and determination of vitamin E and selenium liver concentrations were statistically evaluated between: (i) individuals with and without GL, and (ii) individuals from flocks with and without turkeys with GL. At both fattening stages, the occurrence of GL was characterized by an inflammatory reaction. A subacute inflammatory reaction was detected in the early fattening stage, indicating a viral cause of the disease. In the late fattening stage, acute inflammation indicated a bacterial cause of the disease. The results of the feed sample analyses of the different flocks were generally quite homogeneous. However, the nutrient and energy content of the feed likely contribute to GL pathogenesis.

Protective Effect of Olive Oil Microconstituents in Atherosclerosis: Emphasis on PAF Implicated Atherosclerosis Theory.

Atherosclerosis is a progressive vascular multifactorial process. The mechanisms underlining the initiating event of atheromatous plaque formation are inflammation and oxidation. Among the modifiable risk factors for cardiovascular diseases, diet and especially the Mediterranean diet (MedDiet), has been widely recognized as one of the healthiest dietary patterns. Olive oil (OO), the main source of the fatty components of the MedDiet is superior to the other "Mono-unsaturated fatty acids containing oils" due to the existence of specific microconstituents. In this review, the effects of OO microconstituents in atherosclerosis, based on data from in vitro and in vivo studies with special attention on their inhibitory activity against PAF (Platelet-Activating Factor) actions, are presented and critically discussed. In conclusion, we propose that the anti-atherogenic effect of OO is attributed to the synergistic action of its microconstituents, mainly polar lipids that act as PAF inhibitors, specific polyphenols and α-tocopherol that also exert anti-PAF activity. This beneficial effect, also mediated through anti-PAF action, can occur from microconstituents extracted from olive pomace, a toxic by-product of the OO production process that constitutes a significant ecological problem. Daily intake of moderate amounts of OO consumed in the context of a balanced diet is significant for healthy adults.

Updated Organic Composition and Potential Therapeutic Properties of Different Varieties of Olive Leaves from Olea europaea.

Olea europaea L. folium merits further exploration of the potential of its substrates for therapeutic supplements. Quantitative and qualitative analyses were conducted on samples of Madural, Verdeal, and Cobrançosa elementary leaves and leaf sprouts (mamões) collected in the region of Valpaços, Portugal. Organic analysis assessed the moisture content, total carbohydrates, ash, protein, and fat contents, total phenolic content (TPC), vitamin E, and fatty acid (FA) profiles. Moisture content was determined through infrared hygrometry and TPC was determined by a spectrophotometric method. Concerning organic analysis, all leaf samples showed similar moisture content, though Cobrançosa's leaf sprouts and Verdeal's elementary leaves had slightly lower contents. Meanwhile, these cultivars also showed a higher TPC, α-tocopherol isomer, and fatty acid composition (FAC). FAC in all samples exhibited higher contents of PUFA and SFA than MUFA, with a predominance of linolenic and palmitic acids. Organic analyses of Cobrançosa's leaf sprouts and Verdeal's elementary leaf extracts allow for the prediction of adequate physiological properties regarding neuroinflammatory, neurobehavioral, metabolic, cardiovascular, osteo-degenerative, anti-ageing, pulmonary, and immunological defense disorders. These physiological changes observed in our preliminary in silico studies suggest an excellent nutraceutical, which should be borne in mind during severe pandemic situations.

Supplementation With Carotenoids, Omega-3 Fatty Acids, and Vitamin E Has a Positive Effect on the Symptoms and Progression of Alzheimer's Disease.

BACKGROUND: Preliminary work by our center has reported behavior and functional benefits in patients with Alzheimer's disease (AD) following targeted micronutritional supplementation. OBJECTIVE: To build on the existing exploratory research and investigate the impact of these micronutrients on the natural progression of AD in a randomized controlled trial. METHODS: Patients with mild-moderate AD consumed daily 1 g fish oil (of which 500 mg DHA, 150 mg EPA), 22 mg carotenoids (10 mg lutein, 10 mg meso-zeaxanthin, 2 mg zeaxanthin), and 15 mg vitamin E or placebo for 12 months in a double-blind, placebo-controlled, randomized clinical trial. Carotenoids, ω-3FAs, and vitamin E were quantified in blood. Carotenoids were also measured in skin. AD severity was measured using the mini-mental state examination and dementia severity rating scale tools. Behavior, mood, and memory were measured using an informant-based questionnaire. RESULTS: Following 12 months of supplementation, the active group (n = 50) compared to the placebo group (n = 27), demonstrated statistically significant improvements in skin carotenoid measurements, blood carotenoids, ω-3FAs, and vitamin E concentrations (p < 0.05, for all). The active group also performed better in objective measures of AD severity (i.e., memory and mood), with a statistically significant difference reported in the clinical collateral for memory (p < 0.001). CONCLUSION: Exponential increases in the prevalence of AD and its relentless progressive nature is driving the need for interventions that help to ameliorate symptoms and improve quality of life in AD patients. Given the positive outcomes demonstrated in this trial, this combined micronutrient dietary supplement should be considered in the overall management of AD.

Protective effect of nutrition and supplements on COVID-19 management

In March 2020, an infection caused by SARS-CoV-2 termed COVID-19, was declared by WHO, as a world pandemic having affected 54.1 crores individuals across 230 countries to date (23rd June 2022). The infection is caused due to a fast-mutating virus that can best be controlled through one's immune system and strengthening the same is a challenge currently. Enriching immunity has persistently been a matter of study and conclusive results depict that nutritional status has a tremendous impact on strengthening immunity. Both macro-and micronutrients play a significant role in developing a strong immune response. Most of the mediators of immune response like cytokines, interferons, and antibodies along with surface markers such as MHC, toll-like receptors, membrane transporters, etc., are all proteinaceous, and hence an adequate protein intake is vital for ideal immune response. The fermentation of dietary fiber by the microflora in the gut leads to the generation of short-chain fatty acids known to be anti-inflammatory. Poor status of nutrients such as vitamin A and zinc have been reported to be related to not only the increased rate of infection risk but also higher levels of oxidative stress as well as inflammation. Both these factors down regulate the immunity and thereby lower the recovery rate. These nutrients mediate the immune signalling pathways including the transcription of factors as NFkB and Nrf-2 and reduce the generation of cytokines as IL-6 which are associated with reducing inflammation. Nutrients like vitamin D besides working on immunity also play a substantial contribution in preventing infection as they modulate the surface receptors, thereby hindering the entry of viruses into the host cells. This article is aimed at emphasising the vital significance of nutritional status in enhancing the immune system and preventing infection during the current pandemic.

Vitamin D to prevent COVID-19 or other acute respiratory infections: phase 3 randomised controlled trial (CORONAVIT)

IntroductionVitamin D deficiency associates with susceptibility to COVID-19 and other acute respiratory infections (ARI).ObjectiveTo determine whether a ‘test-and-treat’ approach to vitamin D replacement in the general population reduces incidence of COVID-19 or other ARI.MethodsWe randomly assigned 6200 UK adults to receive an offer of a postal vitamin D test with postal provision of a 6-month supply of higher-dose vitamin D (3200 IU/d, n=1550) or lower-dose vitamin D (800 IU/d, n=1550) to those with 25(OH)D <75 nmol/L vs no offer of vitamin D testing or supplementation (n=3100). The primary outcome was the proportion of participants experiencing at least one test- or doctor-confirmed ARI of any cause at 6 months. Secondary outcomes included incidence of COVID-19.Results2958/3100 adults randomised to intervention accepted the offer of testing, of whom 2690 (90.9%) had 25(OH)D <75 nmol/L and received vitamin D supplements (1356 higher-dose, 1334 lower-dose). 72 adults in the higher-dose offer group, 86 in the lower-dose offer group and 132 in the no offer group experienced at least one ARI of any cause during follow-up (odds ratio [OR] for higher-dose vs. no offer 1.05, 95% CI 0.78–1.40;OR for lower-dose vs. no offer 1.27, 0.96–1.68). COVID-19 was diagnosed in 32 adults in the higher-dose offer group, 48 in the lower-dose offer group and 68 in the no offer group (OR for higher-dose vs. no offer 0.90, 0.59–1.37;OR for lower-dose vs. no offer 1.37, 0.94–1.99).ConclusionsIn adults with a high baseline prevalence of vitamin D insufficiency, a test-and-treat approach to vitamin D replacement did not reduce risk of all-cause ARI or COVID-19.Please refer to page A209 for declarations of interest related to this .

Success and Challenges of Telemedicine in the Care of Pediatric Heart Transplant Patients During the COVID-19 Pandemic: OJNI

Background: During the COVID-19 surge and shutdown of New York City from March 2020 through May 2020, we transitioned to telemedicine to provide routine and urgent care to our pediatric heart transplant patients. The effectiveness of telemedicine in this population has not been described. Methods: A retrospective cohort study was conducted at the Children’s Hospital at Montefiore.  Electronic health records of all pediatric heart transplant patients who received care from January 3, 2020, to August 31, 2020 were queried. Data collected included frequency of telemedicine visits, in person, and emergency room visits, hospitalizations, immunosuppression levels requiring adjustment, and out-of-window patient follow-up. The proportion of immunosuppression levels out of range was compared among four identified groups by chi-square analysis. Results: During the shutdown period (March 13, 2020, to May 12, 2020) there were 54 telemedicine visits: 61% routine and 39% urgent. Five (24%) urgent telemedicine visits justified an in-person follow-up: three clinic visits, two ED visits, one patient hospitalized.  During the post-shutdown period 1 (May 13, 2020, to June 20, 2020) when in person visits resumed, nine patient visits were out of window for routine follow-up, with a median of six weeks delayed.  Immunosuppression levels were not therapeutic in 29% of patients in the pre-shutdown period (January 3, 2020, to March 18, 2020) compared to 46% during the post-shutdown period 1 (p=0.06). By post-shutdown period 2 (June 12, 2020, to August 31, 2020), out of range immunosuppression levels had returned to pre-shutdown out of range levels (25% of patients) with a p=0.6. The percent of immunosuppression levels out of range between post-shutdown period 1 and post-shutdown period 2 was statistically significant (p=0.04). Conclusion: Telemedicine can be utilized to stay connected to patients when routine in person care is disrupted.  The higher percentage of patients with immunosuppression levels out of range seen during post COVID-19 shutdown period 1 reinforces the importance of routine immunosuppression level surveillance.

Significance of nuts in strengthening immune system during COVID-19

Viral infections are contagious and deadly. Many viral attacks in the past decades including COVID-19 have turned into pandemics and cost millions of lives. Treatment to virus is difficult as they transform themselves into many variants. Thus, an intelligent way of keeping oneself out of the trouble is through better nutrition that enhance immune responses. Foods that provide high quantities of nutrients are vegetables, fruits and nuts. They are rich in fibres, fats, protein, vitamins, minerals and plant bioactive compounds like phytosterols, polyphenolics, flavonoids, etc. Many studies and randomised control trials have proven their therapeutic effects and health promoting capacities. These compounds interfere with the pathways of metabolic mechanisms in the human body and work by either providing a protective scope or by destroying any harmful incomings into the body;that would disrupt the homeostasis. In this article, nuts and their nutritive components that administer healthy benefits are discussed. Almonds, cashew nuts, pistachios, peanuts, chestnuts and Brazil nuts are examined and reviewed here. The nutritional composition of these nuts and their mechanism to offer medicinal properties are explained in detail. Apart from nutritional values, these nuts are rich source of antioxidants that confer anti-inflammatory and immunomodulatory features. These activities enhance the immune responses by activating the defense mechanisms. Apart from the intake of highly nutritious diet, practising social distancing, isolation and better sanitation procedures are highly beneficial to avoid the severity of the viral attacks.

Face Mask Embedded with Nanoemulsion for Reducing Facial Skin Adverse Effects Caused by Prolonged Wearing the Mask during COVID-19 Management

Background: Wearing a facemask is one of the precautionary measures for preventing coronavirus disease spread, which causes many facial skin adverse effects. Vitamin-E (TPGS) and olive oil have an efficient effect on skin moistening. Therefore, in this study, face-masks embedded with NE;prepared using olive oil and TPGS, were developed to reduce the long-wearing face mask adverse effect. Methods: Box-Behnken design was used to develop NE formulations which were physically evaluated to select the most stable formulation. Fibroblast cell lines (3T3) were used to examine NE efficacy on dermal cell proliferation and in vitro cytotoxicity possibilities. Face-masks were also examined for 6 hr wearing dermal compatibility on healthy participants. Results: The formulated NE didn’t significantly affect cell proliferation nor had a toxic effect on dermal cells (p<0.05). More than 60% of the respondents were satisfied with masks containing NE. Conclusion: In particular, a face mask embedded with the preparaed selected NE formula could produce emollient feelings during application without retarding the breathing or causing any irritant sensation. © 2022, Association of Pharmaceutical Teachers of India. All rights reserved.

A Critical Review of Diet Supplementation: The Rationale, Concerns and Guiding Principles in Modern Healthcare

There has been a massive surge in the intake of dietary supplements in recent years, with millions of people taking the "magic pills " worldwide, either with the hope of achieving general well-being, treat specific disease, or retard the aging process. Supplementing the diet with multivitamins and minerals (MVMs) has revolutionized modern healthcare, with many "experts " claiming such drugs have a critical role to play in the prevention and treatment of many health conditions. Many are of the opinion that since dietary supplements are mere extracts from certain foods and herbs, so unlike drugs, have no significant side effects, are "all natural, " and are therefore "safe " for a non-medical prescription. The association of the deficiency of some MVMs, such as vitamins C, D, and Zinc, with the increased incidence and progression of COVID-19, has also strengthened the argument in favor of routine diet supplementation. The objectives of this article are to investigate the health and therapeutic claims attributed to some dietary supplements, their safety concerns, and their possible role in modern healthcare. A review of related online free-full articles written in the English language published from 2000 to 2021 was done. While the pharmacokinetics and pharmacodynamics of some dietary supplements are clearly understood and established, others are still shrouded in serious confusions and safety concerns, especially for long-term use. Until more evidence is available, routine intake of dietary supplements should be discouraged, except there are clear medical indications. Rather, all people should ensure they get their required nutrients from whole foods.

The diabetogenic effects of chronic supplementation of vitamin C or E in rats: Interplay between liver and adipose tissues transcriptional machinery of lipid metabolism.

AIM: The chronic administration of vitamin C and E can differentially disrupt hepatic insulin molecular pathway in rats. Hence, this study evaluated their effects on lipogenesis in the liver and adipose tissue and investigated the possible involvement of microRNA (miR)-22/29a/27a in the induced impaired glucose tolerance. MAIN METHODS: Wistar rats were orally supplemented with vitamin C (100, 200, and 500 mg/kg) or vitamin E (50, 100, and 200 mg/kg) for eight months. KEY FINDINGS: Vitamin C or E at the highest doses significantly altered liver weight and index, serum and hepatic lipids, adiponectin, and liver enzymes; besides their reported unfavorable effect on glucose homeostasis. Vitamin C and E negatively affected peroxisome proliferator-activated receptor coactivator-1 (PGC-1α), sterol regulatory element-binding protein (SREBP)-1c/-2, miR-22/29a/27a expression, and adipose perilipin 1 to different extents, effects that were supported by the histopathological examination. SIGNIFICANCE: The current study provides a deeper insight into the findings of our previous study and highlights the detrimental effects of chronic vitamins supplementation on lipid metabolism. Overall, these findings emphasize the damage caused by the mindless use of supplements and reinforce the role of strict medical monitoring, particularly during the new COVID-19 era during which numerous commercial supplements are claiming to improve immunity.

E-cigarette or Vaping Product Associated Lung Injury (EVALI) Presenting As Cardiac Arrest.

E-cigarettes or vaping products became available in the market in 2004. Since then, their use has rapidly increased in all sections of society. They have been increasingly used as a "safer" alternative for combustible cigarettes and as an aid toward smoking cessation. Over time, the acceptability of e-cigarettes in public spaces increased. Lack of regulatory control also led to a rapid rise in the rate of e-cigarette/vaping product users. We report a case of a 35-year-old female who recently switched from conventional cigarettes to e-cigarette usage, and who presented to the emergency department after an out-of-hospital cardiac arrest. She was found to have bilateral extensive nodular ground-glass opacities on a CT angiogram of the chest. She needed non-invasive ventilation and was initially started on broad-spectrum antibiotic treatment for possible pneumonia. Due to a worsening clinical status, e-cigarette or vaping product associated lung injury (EVALI) diagnosis was considered, and she was started on parenteral steroid therapy, leading to rapid recovery in respiratory status. With a tapering course of steroid therapy and cessation of e-cigarette use, there was complete clinical and radiological recovery. This case highlights that EVALI can have varied clinical presentations, and the diagnosis should be considered in anyone who presents with an acute cardio-pulmonary decline and a concomitant history of e-cigarette use.

General overview on SARS-CoV-2 and potential role of natural compounds as antiviral drugs targeting SARS-CoV-2 proteins. (Special issue.)

Purpose: The novel coronavirus disease namely COVID-19 is a viral disease induced by severe acute respiratory syndrome coronavirus (SARS-CoV-2). The cases were first reported in Wuhan, China, by the end of 2019 and subsequently spread worldwide. The virus can be transferred through direct or indirect contact and leads to several manifestations;the most common are fever, dry cough, pneumonia, and acute respiratory distress syndrome (ARDS). COVID-19 has caused massive human and economic losses, posing an ongoing threat. Understanding the current situation and developing a treatment which can be both safe and effective has become essential. In this regard, natural products could be an important resource in the development of treatment for COVID-19, as they have contributed to the treatment of other viruses in the past. This review aims to understand the cellular machinery of SARS-CoV-2 and to identify its drug targets.

Boosting the immune system with functional compounds during the COVID-19 pandemic: a review

Background: More than 1 year has passed since the outbreak of the COVID-19 pandemic. Nutrition and its role in boosting the immune system have been a hot topic during the previous year in the light of the COVID-19 pandemic. An effective medicine for COVID-19 has not been introduced and public vaccination has not gained an acceptable speed in the world;therefore, preventive measures, protocols adherence, and a robust immune system are crucial. The aim of this study was to evaluate the role of food in boosting the immune system during the Covid-19 pandemic.

THE IMPACT OF OLDER ADULTS' LIVING ENVIRONMENT ON THEIR HEALTHY AGING IN PLACE DURING THE COVID-19 PANDEMIC

Keywords: older adults, private home, cohousing, assisted living, healthy aging, COVID-19 pandemic THE IMPACT OF OLDER ADULTS' LIVING ENVIRONMENT ON THEIR HEALTHY AGING IN PLACE DURING THE COVID-19 PANDEMIC The World Health Organization (WHO) declared the novel Coronavirus [SARS-CoV-2], which causes COVID-19, a respiratory disease, a public health emergency on March 11, 2020 (Government of Canada, 2021;Nascimento, 2020). The research question was, "how does older adults' living environment promote their healthy aging in place during the COVID-19 pandemic?" LITERATURE REVIEW Multiple factors, including an individual's composition, physical environment, social interaction, independence, cognitive/mental health, mobility, transportation, services such as recreational opportunities, healthcare and information work together to impact older adults' healthy aging (Bigonnesse, 201 7;Puplampu, Matthews, et al., 2020). Healthy aging is a multidimensional construct that indicates the older adult is doing well;it can be defined as promoting and optimizing the health of an older adult by managing chronic diseases, ensuring cognitive, physical, and mental health, facilitating social engagement and resilience, independence, safety, support and services from the community (Batsis et al., 2021;Government of Canada, 201 6;Lock & Belza, 201 6;Pac et al., 2019). Housing for older adults plays a key role in their healthy aging, which became apparent during the COVID-19 pandemic as long-term care facilities in Canada became high-risk settings and sources of outbreaks and deaths (Public Health Agency of Canada, 2020).

Toxicity of food supplements as an adjuvant for COVID-19 treatment or prevention

Commercially available food supplements, especially vitamins and minerals, are be-coming increasingly popular in the era of COVID-19 pandemic. Sales of food supplements increased dynamically because of the belief that they could be more effective than conventional antiviral or corticosteroid drugs as well as missing the specific medical therapy for preventing or treating this disease. The greatest interest is associated with immune-related nutrients and antioxidant agents, including vitamin C, vitamin D, vitamin E, selenium (Se), and zinc (Zn). These are currently under clinical investigation for possible application in the prevention and management of COVID-19. This review summarizes postulated mechanisms of commonly used supplements suggested reducing the duration and severity of viral infections by improving immune response. Their toxicity in the context of potential adverse effects is also discussed. Whether these molecules and the amount could hurt patients with COVID-19 are research questions worth evaluating. Considering both efficacy and safety, evidence supporting larger intakes of specific nutrients with immune-boosting and/or antioxidant properties needs further research. Until relevant responses are provided, age and gender related tolerable upper intake levels for vitamins and minerals should be considered to avoid weight gaining as an additional risk factor of developing complications during the disease course, besides the risk of inappropriate doses associated with toxicity. Herein, high-quality information respecting specific nutrients proposed to have positive effect against COVID-19 is disseminated and certain research gaps are addressed, requiring the research on the health effects of supplements to be tightly correlated to age, nutritional status, wellbeing and particular to existing co-morbidities.

Modeled Respiratory Tract Deposition of Aerosolized Oil Diluents Used in Δ9-THC-Based Electronic Cigarette Liquid Products.

Electronic cigarette, or vaping, products (EVP) heat liquids ("e-liquids") that contain substances (licit or illicit) and deliver aerosolized particles into the lungs. Commercially available oils such as Vitamin-E-acetate (VEA), Vitamin E oil, coconut, and medium chain triglycerides (MCT) were often the constituents of e-liquids associated with an e-cigarette, or vaping, product use-associated lung injury (EVALI). The objective of this study was to evaluate the mass-based physical characteristics of the aerosolized e-liquids prepared using these oil diluents. These characteristics were particle size distributions for modeling regional respiratory deposition and puff-based total aerosol mass for estimating the number of particles delivered to the respiratory tract. Four types of e-liquids were prepared by adding terpenes to oil diluents individually: VEA, Vitamin E oil, coconut oil, and MCT. A smoking machine was used to aerosolize each e-liquid at a predetermined puff topography (volume of 55 ml for 3 s with 30-s intervals between puffs). A cascade impactor was used to collect the size-segregated aerosol for calculating the mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD). The respiratory deposition of EVP aerosols on inhalation was estimated using the Multiple-Path Particle Dosimetry model. From these results, the exhaled fraction of EVP aerosols was calculated as a surrogate of secondhand exposure potential. The MMAD of VEA (0.61 µm) was statistically different compared to MCT (0.38 µm) and coconut oil (0.47 µm) but not to Vitamin E oil (0.58 µm); p < 0.05. Wider aerosol size distribution was observed for VEA (GSD 2.35) and MCT (GSD 2.08) compared with coconut oil (GSD 1.53) and Vitamin E oil (GSD 1.55). Irrespective of the statistical differences between MMADs, dosimetry modeling resulted in the similar regional and lobular deposition of particles for all e-liquids in the respiratory tract. The highest (~0.08 or more) fractional deposition was predicted in the pulmonary region, which is consistent as the site of injury among EVALI cases. Secondhand exposure calculations indicated that a substantial amount of EVP aerosols could be exhaled, which has potential implications for bystanders. The number of EVALI cases has declined with the removal of VEA; however, further research is required to investigate the commonly available commercial ingredients used in e-liquid preparations.