There has been a significant increase in electronic cigarette (e-cigarette) use since its introduction in 2007. Ironically, there remains very few published literature on the respiratory complications of e-cigarettes. The use of personalized vaporizers or commonly known as “vaping” has started to overtake standard e-cigarette. Its dynamic vaporizer customization makes it challenging to assess long-term health effects. Case reports on the pulmonary complications of e-cigarettes are limited to bronchiectasis, eosinophilic pneumonia, pleural effusion, and suspected hypersensitivity pneumonitis. Diffuse alveolar hemorrhage (DAH) is bleeding into the alveolar spaces of the lung secondary to disruption of the alveolar-capillary basement membrane. We report a case of young male presenting with subacute respiratory failure. He was later found to have diffuse alveolar hemorrhage syndrome that is likely induced by aggressive vaping. This adds up to the rising concern on the possible serious complications of this innovative technology designed as a safer alternative to traditional cigarettes.

/pdf/diffuse-alveolar-hemorrhage-induced-by-vaping-4ksriece8c.pdf

Diffuse Alveolar Hemorrhage Induced by Vaping

BACKGROUND The age of patients with pulmonary arterial hypertension (PAH) has increased, with registries now reporting mean ages of 50 to 65 years old. Limited data exist on age-related differences in hemodynamic and functional assessments in PAH. METHODS Adults with PAH in the Pulmonary Hypertension Association Registry were divided into 3 groups (18–50, 51–65, and >65 years old). Analysis of variance and chi-square testing were used to assess for baseline differences. Linear regression was used to examine the association of age with continuous hemodynamic and functional variables. RESULTS A total of 769 patients with mean age of 56 ± 16 years were included. Older patients had more connective tissue disease–associated PAH and less drug-associated PAH. In linear regression models, each year of increased age was associated with shorter 6-minute walk distance (−3.37 meters; 95% CI, −3.97 to −2.76), lower mean pulmonary arterial pressure (−0.21 mm Hg; 95% CI, −0.27 to −0.15), and lower pulmonary vascular resistance (−0.06 Wood units; 95% CI, −0.09 to −0.04). Pulmonary arterial compliance, cardiac index, right ventricular stroke work index, and percent predicted 6-minute walk distance were unrelated to age; resistance-compliance time was negatively related to age (−3 milliseconds per year; 95% CI, −4 to −2). CONCLUSIONS Relative to their pulmonary vascular resistance, older patients have lower pulmonary artery compliance and worse right ventricular performance. Based on these findings, we suspect that age influences right ventricular loading conditions and the response of the right ventricle to increased afterload.

Age-related differences in hemodynamics and functional status in pulmonary arterial hypertension: Baseline results from the Pulmonary Hypertension Association Registry.

Diagnostic complexity is an important contextual factor affecting a variety of medical outcomes. Existing measurements of diagnosis complexity either rely on crude proxies or use fine-grained measures that employ indicators from proprietary data that are not readily available. Hence, the study of this important construct in fields such as medical informatics has been hampered by the difficulty of measuring diagnostic complexity. This article presents a novel approach for conceptualizing and operationalizing diagnostic task complexity as a multi-dimensional construct, which employs the readily available International Classification of Diseases codes from medical encounters in hospitals and uses Analytic Hierarchical Process methodology. We demonstrate the reliability of the proposed approach and show that despite using a relatively simple procedure, it is able to predict readmission rates just as well as (or even better) than some of the sophisticated measures that have been used in recent studies (namely, the LaCE score index).

https://journals.sagepub.com/doi/pdf/10.1177/1460458218824708

The use of analytic hierarchy process for measuring the complexity of medical diagnosis

Risk stratification to predict early mortality among patients with pulmonary arterial hypertension (PAH) was introduced in the 2015 ESC/ERS guidelines [1]. It is a comprehensive assessment based on...

Pulmonary arterial hypertension: assessing risk to improve prognosis

A Canonical Correlation Analysis of the Relationship between Clinical Attributes and Patient-Specific Hemodynamic Indices in Adult Pulmonary Hypertension

The Complexity of Characteristics, Diagnoses, and Treatment of Older Patients with Pulmonary Hypertension☆☆☆

Seronegative type i autoimmune pancreatitis with immunoglobulin g4-related disease triggered by the pfizer-biontech covid-19 vaccine

Endoscopy Training in the Age of Artificial Intelligence: Deep Learning or Artificial Competence?

The use of electronic cigarettes (e-cigarettes) in the United States has steadily increased since their introduction into the market in 2007. These devices deliver nicotine through the vaporization of a liquid which contains a vehicle (propylene glycol or glycerin), artificial flavoring, and nicotine. The combustion of these liquids creates a vapor containing particulates, multiple chemicals, and nicotine. The long-term safety of these products is unknown. Studies in healthy, non-smoking volunteers and smokers with no clinical pulmonary disease have demonstrated that the inhalation of e-cigarette vapor has minimal short-term effects on pulmonary function. The exposure of cell cultures to e-cigarette liquid or aerosols has been shown to reduce cell viability, induce cytokine production, and cause oxidative stress. The exposure of animals (mice and rats) to e-cigarette aerosols induces inflammatory responses in the lungs and delays the clearance of bacterial and viral challenges. There are a small number of case reports of patients developing acute pulmonary toxicity following the use of e-cigarettes. Two patients have developed lipoid pneumonia following the use of e-cigarettes for 3 and 7 months. Finally, several studies suggest that patients with chronic lung disease who switch from tobacco cigarettes to e-cigarettes can have improvement in lung function (asthmatics) and a reduction in the number of exacerbations (chronic obstructive pulmonary disease). Clearly, the public and the medical profession need more information about the long-term complications associated with the use of e-cigarettes and their benefit in smoking cessation efforts. Keywords: electronic

/pdf/electronic-cigarettes-and-lung-toxicity-ynvrjtses5.pdf

Terrance Rodrigues

Papers

The Complexity of Characteristics, Diagnoses, and Treatment of Older Patients with Pulmonary Hypertension☆☆☆

Seronegative type i autoimmune pancreatitis with immunoglobulin g4-related disease triggered by the pfizer-biontech covid-19 vaccine

Endoscopy Training in the Age of Artificial Intelligence: Deep Learning or Artificial Competence?

Electronic cigarettes and lung toxicity

Final analysis of a prospective tandem colonoscopy study to determine proximal colon polyp miss rate among gastroenterology trainees