Fruit-Flavored E-Cigarettes Linked to Increased Risk of Nocturnal Dry Cough

Although in vitro and animal studies have identified the pulmonary toxicity of electronic cigarette (ECIG) flavors, epidemiological evidence on their respiratory effects remains limited. This study explored the longitudinal association between exposure to flavored ECIGs and the occurrence of nocturnal dry cough among users using data from the Population Assessment of Tobacco and Health Study (2014-2019).
 A secondary analysis was conducted on 18,925 adults, totaling 38,638 observations, employing weighted-incidence estimates and generalized estimating equation models to assess both unadjusted and adjusted associations.
Findings revealed that the weighted incidence proportion (WIP) of nocturnal dry cough was significantly higher among current (WIP: 16.6%) and former fruit-flavored ECIG users (WIP: 16.6%) compared to non-ECIG users (WIP: 11.1%). Current users of fruit-flavored ECIGs had a 40% higher risk of reporting nocturnal dry cough compared to non-users (aRR: 1.40). Former ECIG users of multiple flavors and other flavors had a markedly increased risk of cough, with 300% and 66% higher risks, respectively (aRR: 3.33 and aRR: 1.66).
The significant association between fruit-flavored ECIG use and increased risk of nocturnal dry cough highlights a potential early indicator of respiratory inflammation and disease risk, raising concerns about the respiratory health impact of flavored ECIGs. Further studies are needed to assess the long-term implications of these findings on respiratory health.
 

Efficacy, safety, and feasibility of roxadustat as part of a dialysis organization

Recent research demonstrated that roxadustat successfully achieved and maintained average hemoglobin levels of 10.0 g/dL or higher in patients who are on dialysis. The incorporation of oral roxadustat within dialysis organizations demonstrated a significant degree of adherence to dosing protocols, with no new safety issues identified. The results of this study were published in the journal Hemodialysis International.

Eligible individuals were treated with open-label roxadustat, administered three times weekly for a total of twenty-four weeks, with the possibility of extension of  ≤ 1 year. The initial dosing regimen depended on the dosage of erythropoiesis-stimulating agents (ESAs) at the time of screening for patients who had been on ESAs for six weeks or longer, while it was based on body weight for those who had been on ESAs for less than six weeks. This study's primary efficacy endpoints were the percentage of patients with a mean hemoglobin (Hb) level of at least 10.0 g/dL, averaged throughout the time period from weeks sixteen to twenty-four, as well as the mean change in hemoglobin from the baseline to the average observed from sixteen to twenty-four weeks. Additionally, treatment-emergent serious adverse events (TESAEs) and treatment-emergent adverse events (TEAEs) were evaluated.

Among the 281 patients screened, 203 underwent treatment, and 201 were incorporated into the complete analysis set. In total, 166 patients completed the twenty-four week treatment duration, with 126 proceeding into the extension period. The mean baseline hemoglobin level was 10.4 g/dL, and 82.6% of the participants underwent in-center hemodialysis. From weeks sixteen to twenty-four, a mean hemoglobin level of 10.0 g/dL or higher was achieved by 84.6% of the patients. The mean change in Hb from baseline during this timeframe was 0.5 (1.0) g/dL. Adherence to the dosing regimen was recorded at 94%. Additionally, 3.0% of patients received a red blood cell transfusion at up to week twenty-four. TESAEs and TEAEs were reported by 25.6% and 71.4% of patients, respectively. The most commonly reported TESAEs included COVID-19 (n = 5; 2.5%), as well as pneumonia, acute myocardial infarction, and sepsis (each n = 4; 2.0%).

Thus, it can be concluded that roxadustat was able to effectively reach and uphold mean hemoglobin levels of ≥10.0 g/dL in patients on dialysis. The successful incorporation of oral roxadustat into dialysis protocols has been shown, signifying compliance with the recommended dosing schedule.

Stent on a string: a potential new gold standard for postureteroscopy ureteral drainage

A recent study indicated that stent on string (SOS) is a great alternative following ureteroscope (URS), particularly for patients without intraoperative complications, and they are typically inserted as a routine based on surgeon preference. These stents decrease pain, cost, dwell time, risks, and the suffering associated with prolonged stenting, and most patients are satisfied to remove them at home. While their use is currently limited in endourology practices, they are expected to become the standard for routine URS in the future. The findings of this study were published in the Journal of Endourology.

An extensive systematic review was carried out across several databases, utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. This review targeted studies published in English that involved patients of all age groups with SOS after undergoing ureteroscopy (URS) for the management of stone disease. A total of 22 studies (20 involving adults and 2 involving pediatric patients) were included from the 1210 records identified, including 8382 patients. Among these patients, 3427 (40.9%) had stent on string inserted and 434 (11%) were in the pediatric age group.

Study results showed that SOS presents several advantages, and when compared with stents without strings (SWOSs), they were implanted for a shorter period, with no significant differences in complications such as urinary tract infection or urinary symptoms. Moreover, SOS showed notable cost savings, decreased pain upon removal, and a high incidence of successful home removal, with more than 90% of patients indicating their readiness to remove their SOSs at home. However, it is important to consider the minor risk of stent dislodgment when deciding on SOS placement post-URS.

The above study demonstrated that SOS is an excellent option after URS, especially for patients who do not experience intraoperative complications. Surgeons typically insert these stents based on their preference as part of routine practice. The use of these stents reduces cost, pain dwell time, risks, and the discomfort associated with prolonged stenting. Many patients are happy to have them removed at home. The use of SOS is currently limited in endourology, it is anticipated that they will become the gold standard for routine ureteroscope in the future.

The correlation between chronic sinonasal inflammation and nasopharyngeal carcinoma

In a recent systematic review and meta-analysis, the presence of chronic sinonasal inflammation shows a significant correlation with nasopharyngeal carcinoma. Findings of this study were documented in the American Journal of Otolaryngology.

This meta-analysis involved a comprehensive search of four international databases from 1^st January 1973 to 28^th March 2022 for studies addressing sinonasal inflammation and NPC in adults (greater than 18 years old). Case-control, cohort, or cross-sectional studies were included that explored the association between a prior history of sinonasal inflammation and the risk of developing NPC. The incidence of nasopharyngeal carcinoma (NPC) in patients with prior sinonasal inflammation is the outcome.

A total of eight studies, comprising 8,245 individuals diagnosed with NPC and 1,036,087 individuals without NPC, were examined. The overall odds ratio for developing NPC following sinonasal inflammation was found to be 1.81 (95% confidence interval 1.73-1.89). Chronic rhinosinusitis (CRS) exhibited a stronger association with an increased risk of NPC, with an odds ratio of 1.78 (95% confidence interval: 1.68-1.90), in comparison to allergic rhinitis (AR) (odds ratio of 1.60; 95% confidence interval: 1.52-1.68).

Thus, it can be concluded that chronic sinonasal inflammation is strongly linked to nasopharyngeal carcinoma. It is important to thoroughly examine the cause-and-effect relationship and the potential effects of targeted screening using large-scale prospective studies.