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.

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.