Body burden of toxic metals and rare earth elements in non-smokers, cigarette smokers and electronic cigarette users.

Smoking is considered an important source for inorganic elements, most of them toxic for human health. During the last years, there has been a significant increase in the use of e-cigarettes, although the role of them as source of inorganic elements has not been well established. A cross-sectional study including a total of 150 subjects from Brasov (Romania), divided into three groups (non-smokers, cigarette smokers and electronic cigarettes smokers) were recruited to disclose the role of smoking on the human exposure to inorganic elements. Concentration of 42 elements, including trace elements, elements in the ATSDR's priority pollutant list and rare earth elements (REE) were measured by ICP-MS in the blood serum of participants. Cigarette smokers showed the highest levels of copper, molybdenum, zinc, antimony, and strontium. Electronic cigarette (e-cigarette) users presented the highest concentrations of selenium, silver, and vanadium. Beryllium, europium and lanthanides were detected more frequently among e-cigarette users (20.6%, 23.5%, and 14.7%) than in cigarette smokers (1.7%, 19.0%, and 12.1%, respectively); and the number of detected REE was also higher among e-cigarette users (11.8% of them showed more than 10 different elements). Serum levels of cerium and erbium increased as the duration of the use of e-cigarettes was longer. We have found that smoking is mainly a source of heavy metals while the use of e-cigarettes is a potential source of REE. However, these elements were detected at low concentrations.

Churg Strauss syndrome associated with montelukast--case report.

Churg-Strauss Syndrome (allergic granulomatous angiitis) is a rare systemic and pulmonary vasculitis. We report the case of a 62 years old female, non-smoker, with a 20 years history of moderate persistent asthma treated with Salmeterol/Fluticasone 50/500 microg bid for 5 years and supplemental Montelukast in the past 5 months. The patient was admitted in our hospital with fever, malaise, sensory deficits in the lower extremities, diffuse musculoskeletal and thoracic pain. Blood eosinophil was 38% of her total WBC, thoracic computed tomography evidenced ill-defined groundglass attenuation predominantly involving the lateral segment of the middle lobe. Pulmonary infiltrates with eosinophilia can be used to define eosinophilic lung diseases. We made the differential diagnosis of eosinophilic lung disease: acute or chronic eosinophilic pneumonias, allergic bronchopulmonary aspergillosis, Loffler syndrome, Churg-Strauss syndrome, bronchocentric granulomatousis, idiopathic hypereosinophilic syndromes. Bronchoalveolar lavage showed 14.6% eosinophils. Few days after hospital admission patient experienced nausea, vomiting and diarrhea. She underwent a digestive endoscopy, which showed eosinophilic enteritis according to colon biopsy. Nasal mucosa biopsy found granulomas. Anti-neutrophil cytoplasmatic antibody (ANCA) was positive at 1:20. She displayed more than four American College of Rheumatology (ACR) criteria for Churg-Strauss Syndrome (developed while she was receiving montelukast therapy). Discontinuation of Montelukast and association of oral prednisone (1 mg/kgc) induced rapid improvement of symptoms and rapid decrease of peripheric eosinophils (72 hours). This case report illustrates the importance of early diagnosis of Churg-Strauss syndrome and the possible pathogenic link between leukotriene receptor antagonist use and CSS development.

[Why do doctors smoke?]. / De ce fumeaza doctorii?

Smoking prevalence is decreasing in developed countries in the last decades. Nevertheless, there is a constant increase of morbidity and mortality of smoking-related diseases (COPD, asthma, respiratory infections, cardiac diseases, cancer). Then why do doctors smoke? Because they experimented in adolescence and college and the addiction developed fast, while information about smoking risks arrived too late. Five hundred questionnaires were distributed to 100 doctors and 400 students between March-April 2009; 50% were returned from the doctors and 90.5% from the students. We analyzed comparative the smoking status (60% non-smoking doctors and 56.9% non-smoking students. Mean age was 25.05 for doctors and 24.2 for smoking students. Mean starting age was 17.13 years, 17.78 respectively. They were asked about major components of cigarettes, main diseases induced by smoking, the effects of nicotine addiction, known laws and projects, the need for introducing in the university curricula of anti-smoking modules. 20% of the doctors and 14.5% of the students had a smoking-related disease. 52% of doctors and 57% of students supported forbidding smokingin public spaces, 13.7% of doctors and 88.9% of students supported the increase of cigarettes price, and only 48% of doctors and 47% of students suggested the need of help for smoking cessation. We noticed there are flaws in knowledge of extra pulmonary diseases in students as well as doctors. Most respondents had lacking, non-systematic information and 96% of doctors and only 69.6% of students consider useful tabaccology lectures. For stopping epidemic morbidity and mortality due to smoking related diseases, there is need for involving all those working in health programmes. For this, medical schools should do better in preparing specialists. We also consider it is time that all medical specialties should consider smoking cessation a priority, while the pneumologists should sustain a systematic and routine activity against smoking.