Association of Electronic Cigarette Exposure on Cardiovascular Health: A Systematic Review and Meta-Analysis

Despite the growing use of electronic cigarettes (EC) in the Unites States, particularly among young people, and their perceived safety, current evidence suggests that EC usage may cause adverse clinical cardiovascular effects. Therefore, we aim to pool all studies evaluating the association of EC exposure with cardiovascular health. Medline, Cochrane CENTRAL, and Scopus were searched for studies from January 1, 2006 until December 31, 2022. Randomized and observational studies reporting cardiovascular outcomes, hemodynamic parameters, and biomarkers of platelet physiology, before and after acute or chronic EC exposure were pooled using a random-effects model. Overall, 27 studies (n = 863) were included. Heart rate increased significantly after acute EC exposure (weighted mean difference [WMD]: 0.76 bpm; 95% confidence interval [CI], 0.48, 1.03; P < 0.00001; I2 = 92%). Significant increases in systolic blood pressure (WMD: 0.28 mmHg; 95% CI, 0.06, 0.51; P = 0.01; I2 = 94%), diastolic blood pressure (WMD: 0.38 mmHg; 95% CI, 0.16, 0.60; P = 0.0006; I2 = 90%), and PWV (WMD: 0.38; 95% CI, 0.13, 0.63; P = 0.003; I2 = 100%) were also observed. Augmentation index increased significantly (SMD: 0.39; 95% CI, 0.11, 0.67; P = 0.007; I2 = 90%), whereas reduction in flow-mediated dilation (WMD: -1.48; 95% CI, -2.49, -0.47; P = 0.004; I2 = 45%) was observed. Moreover, significant rise in both soluble P-selectin (WMD: 4.73; 95% CI, 0.80, 8.66; P = 0.02; I2 = 98%) and CD40L (WMD: 1.14; 95% CI, 0.41, 1.87; P = 0.002; I2 = 79%) was observed. Our results demonstrate that smoking EC is associated with a significant increase in cardiovascular hemodynamic measures and biomarkers. Our findings can aid policymakers in making informed decisions regarding the regulation of EC to ensure public safety.

Towards The Future - Telerehabilitation In Stroke Care In Pakistanss

Stroke is the third leading cause of death globally. Pakistan, a low-middle income country (LMIC), reports approximately 350 000 new stroke cases annually, including 20 000 cases each year from Karachi, Pakistan’s largest city populated by 12 million people1. Telerehabilitation is a fairly new branch of telemedicine, defined as the provision of rehabilitation amenities by experts to the patient using telecommunication technology. It reduces hospital stay and expense, thus proving beneficial for both the patient and healthcare provider. Its use is more common in high-income countries (HICs) than LMICs. Popular systems like the Rehab@Home2 framework are examples of telerehabilitation models for patients suffering from stroke3. There is a shortage of literature to comprehensively comment on the impact of telerehabilitation on stroke patients in LMICs. However, telehealth in neurology, termed teleneurology, has the potential for advancement in the treatment of patients with neurological diseases in LMICs, as they have the highest incidence of neurological disorders. A paper proposed that establishing a teleneurology network for Sub-Saharan Africa consisting of transcontinental, inter-regional, intraregional, and national networks will allow neurologists and neurology residents from LMICs to consult with their counterparts in HICs, thus improving the overall quality of the healthcare system4. Pakistan only has 3.2% of the current GDP devoted to the health sector, leading to limited medical facilities nationwide. The outbreak of Covid led to an uplift in the growth of telehealth which encourages evolution in the future. However, this advancement in the use of telehealth has been hindered by several factors since its inception in 2003, including a lack of legal framework and laws for the establishment of new programs, lack of sustainable support from the government, deficiency of funds and resources for the organization of infrastructure, distant rural areas with poverty, low literacy rate, limited cell phone ownership, and internet access. The scarcity of qualified doctors and trained paramedics or nurses and lack of awareness is another significant impediment as depicted by a survey, which informed that 98.2% of doctors employed in the public health sector in Karachi recorded a paucity of training workshops or conferences for telemedicine5. Hence, measures to overcome these barriers like investments from HICs, training workshops from pioneers of the field, and healthcare professionals who can offer services in multiple languages are some of the factors that can aid in effectively introducing telerehabilitation for the masses.

Impact of racial, ethnic and gender disparities in Cardiology

Literature shows evidence of racial and gender biases in many sub-specialties of medicine including cardiology. Racial, ethnic, and gender disparities exist along the path to cardiology residency, beginning as early as medical school admissions. Approximately 65.62% White, 4.71% Black, 18.06% Asian, and 8.86% Hispanic are cardiologists, while there are a total of 60.1% White, 12.2% Black, 5.6% Asian, and 18.5% Hispanic people in the US in 2019, showing evident underrepresentation. Gender disparities have an inevitable role in the lack of a diverse cardiovascular workforce. According to a recent study, only 13% of practicing cardiologists in the US are women, even though the female population in the US is 50.52% as compared to 49.48%- of men. These disparities led to underrepresented physicians earning less than their similarly qualified counterparts, decreased equity, increased workplace harassment, and also results in patients facing unconscious bias from their physicians leading to deteriorated clinical outcomes. Implications in the field of research include the underrepresentation of minorities and the female population despite the increased burden of cardiovascular disease they face. However, efforts are underway to eradicate the disparities that exist in cardiology. This paper aims to increase awareness regarding the issue and inform future policies with the goal of encouraging underrepresented communities to join the cardiology workforce.

Amoebic versus pyogenic liver abscess

OBJECTIVES

To study the differences between the clinical presentation and complications of amoebic and pyogenic liver abscess. To correlate the diagnostic significance of Entamoeba Indirect Haemagglutination test (E.IHA) in establishing the diagnosis of amoebic liver abscess.

DESIGN

Open cohort observational study.

SETTING

Department of Medicine (Medical Unit II) Jinnah Postgraduate Medical Centre, Karachi.

PARTICIPANTS

Fifty two patients aged 13-70 years admitted in Medical Unit II and diagnosed to have liver abscess.

INTERVENTIONS

Group A comprised of patients clinically diagnosed to have amoebic liver abscess and received Metronidazole 500mg iv x 8 hourly for atleast 10 days or more if patient developed complications. Group B comprised of patients diagnosed to have pyogenic abscess and received Cefotaxime 1g iv x 8 hourly for the same duration or more if complicated (antibiotic reviewed in accordance with culture and sensitivity report).

MAIN OUTCOME MEASURES

Differences in the clinical presentation, complications and diagnostic parameters between the two groups of patients.

RESULTS

It was not possible to differentiate between amoebic and pyogenic liver abscess on clinical grounds, routine investigations and imaging techniques. Aspiration of pus, especially if the abscess was multiple, was most helpful in differentiating the two types of abscesses. Serological test of E.IHA was highly specific and sensitive for amoebic liver abscess.

CONCLUSION

Majority of liver abscesses in Karachi are due to Entamoeba Histolytica. Pyogenic abscess though less frequent, must be excluded by pus aspiration and culture and sensitivity. E.IHA is a good rapid method of discriminating between the two types of abscesses.