Smoke Inhalation Research Articles

56P Long-time second-hand smoking as an independent prognostic factor in female patients with small cell lung cancer: A Chinese cohort study using propensity score matching

Background: Small cell lung cancer (SCLC) generally occurs in men, mainly related to smoking. However, the main risk factors of female nonsmoking patients with small cell cancer are unknown. This study aims to explore the clinical characteristics of female SCLC and the influence of two major risk factors: smoking and long-term second-hand smoke inhalation on the disease.

Epidemiological characteristics and outcome analysis of inhalation injury patients combined with burn area less than 30% total body surface area in a single center from 2008 to 2016

Objective: To explore the epidemiological characteristics and treatment outcomes of inhalation injury patients combined with burn area less than 30% total body surface area (TBSA) admitted to the First Affiliated Hospital of Naval Medical University. Methods: Retrospective observational study with performed on medical records of 266 inhalation injury patients combined with burn area less than 30% TBSA who were admitted to the First Affiliated Hospital of Naval Medical University from January 2008 to September 2016 and met the inclusion criteria. The gender, age, injured site, injurious factors of inhalation injury, degree of inhalation injury, combined total burn area, way of tracheotomy, time of tracheotomy, whether conducted mechanical ventilation or not, whether in intensive care unit (ICU) or not, microbial culture results of bronchoalveolar lavage, total hospitalization days, ICU days, mechanical ventilation days, and whether respiratory infections occurred or not. Single factor and multivariate linear regression analysis was used to screen out the risk factors impacting the total hospitalization days, ICU days, and mechanical ventilation days of patients. Single factor and multivariate logistic regression analysis was used to screen out the risk factors impacting respiratory infections of patients. Results: The 266 patients included 190 males and 76 females, with the majority age of above and equal to 21 and below 65 years (217 patients). Confined space was the major injured site. Hot air was the major factor of inhalation injury. Mild and moderate inhalation injuries were commonly seen in patients. The combined total burn area was 9.00 (3.25, 18.00) %TBSA. In 111 patients who were conducted with tracheotomy, the most were conducted before admitted to the First Affiliated Hospital of Naval Medical University. The total hospitalization days of patients were 27 (10, 55) days. The ICU days of 160 patients were 15.5 (6.0, 40.0) days. The mechanical ventilation days of 109 patients were 6.0 (1.3, 11.5) days. A total of 119 patients were diagnosed with respiratory infections, with 548 strains including 35 types of pathogens were isolated, mainly of Gram-negative bacteria. Single factor linear regression analysis showed age, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the total hospitalization days of patients (95% confidence interval (CI)=-0.397－0.001, -0.395－-0.053, 0.015－0.028, 0.009－0.263, 0.008－0.319, -0.419－-0.176, 0.242－0.471, 0.340－0.555, P<0.1). Multivariate linear regression analysis showed smoke inhalation, mechanical ventilation, and respiratory infections were the independent risk factors impacting the total hospitalization days of patients (95% CI=-0.384－0.082, 0.022－0.271, 0.261－0.506, P<0.05 or P<0.01). Single factor linear regression analysis showed injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, whether conducted mechanical ventilation or not, and whether respiratory infections occurred or not were the risk factors impacting the ICU days of patients (95% CI=0.053－0.502, 0.006－0.010, -0.018－0.457, -0.022－0.428, -0.575－-0.241, -0.687－-0.018, 0.132－0.486, 0.369－0.678, P<0.1). Multivariate linear regression analysis showed that no tracheotomy and respiratory infections were the independent risk factors impacting the ICU days of patients (95% CI=-0.414－-0.084, 0.278－0.601, P<0.01). Single factor linear regression analysis showed injured site, injurious factors of inhalation injury, combined total burn area, degree of inhalation injury, way of tracheotomy, and whether respiratory infections occurred or not were the risk factors impacting mechanical ventilation days of patients (95% CI=-0.565－-0.034, 0.145－0.946, 0.051－1.188, 0.001－0.009, 0.127－0.847, 0.436－1.162, -1.243－-0.229, 0.005－0.605, P<0.1). Multivariate linear regression analysis showed open space inhalation, smoke inhalation, severe inhalation injury, no tracheotomy, prophylactic tracheotomy, and respiratory infections were the independent risk factors impacting mechanical ventilation days of patients (95% CI=-0.588－-0.127, 0.138－0.560, 0.143－0.848, -0.909－-0.330, -1.008－-0.015, 0.007－0.519, P<0.05 or P<0.01). Single factor logistic regression analysis showed age, injured site, degree of inhalation injury, combined total burn area, way of tracheotomy, and whether conducted mechanical ventilation or not were the risk factors impacting respiratory infections of patients (95% CI=0.840－1.362, 0.641－1.044, 1.122－1.526, 1.028－1.661, 1.344－2.405, 1.460－2.612, 0.744－1.320, 0.241－0.424, 2.331－4.090, P<0.1). Multivariate logistic regression analysis showed prophylactic tracheotomy, no tracheotomy, and mechanical ventilation were the independent risk factors impacting respiratory infections of patient (95% CI=0.430－0.641, 0.290－0.511, 2.152－8.624, P<0.05 or P<0.01). Conclusions: The inhalation injury patients combined with burn area less than 30% TBSA are mainly young and middle-aged males. Confined space, smoke inhalation, mechanical ventilation, respiratory infection, and way of tracheotomy are influencing factors of the outcomes in hospital of inhalation injury patients combined with burn area less than 30% TBSA. Additionally, prophylactic tracheotomy shows its potential role in avoiding respiratory infection for patients with moderate or severe degree of inhalation injury.

Bilateral Lobar Lung Transplantation after Smoke Inhalation Injury - A Case Report

Introduction Pulmonary fibrosis due to smoke inhalation injury has to our best knowledge previously not been reported as an indication for lung transplantation (LTx). For small adult and pediatric recipients, lobar LTx can be an option to solve the issue with size mismatch with donors. Case Report A 41-year old woman developed pulmonary fibrosis due to smoke inhalation injury after a suicide attempt in 2013. After long term careful psychiatric evaluation, the patient was listed for LTx in 2017. Due to her short stature of 145 centimetres and underweight (BMI 16), finding matching organs was difficult. Her condition slowly deteriorated and early 2020, veno-arterial extracorporeal membrane oxygenation (vaECMO) was initiated. After eight days on vaECMO she was lung transplanted with bilateral lower lobes. By then she was severly underweight (BMI 14). The postoperative period was complicated with haemorrhage and severe respiratory failure. The patient developed multiple organ failure and an iatrogenic esophageal perforation was discovered. It initially measured 2 × 1 centimetres, increased to a maximum of 7 × 1 centimetres and was treated with endoluminal vacuum therapy (VAC). The foam sponge was replaced every three days, and after 2 months only a fibrin-coated surface remained and VAC was discontinued. Weaning from mechanical ventilation was not possible until after 4 months, which in part was caused by the treatment of the perforation. The patient was discharged with nutritional and respiratory support after 6 months in hospital. At a follow up visit 2 months later she was in good health, mentally stable and required neither non-invasive ventilation nor percutaneous endoscopic gastrostomy for nutrition. Summary This case report highlights a rare - if not unique - etiology of chronic respiratory failure leading to lung transplantation. Iatrogenic esophageal perforation occurred post LTx, previously always requiring major surgery, now treated successfully with VAC. Despite challenges both pre and post transplantation, the outcome was eventually successful.

Effects of Mosquito coil smoke (D-Transallethrin) on parenchyma of testis of adult Wistar Albino rats

Background: The use of mosquito coils has increased exponentially, especially in the under developed countries. Many researches have been conducted over the past few years to advocate both the possible risks and potential benefits. These coils and the inhalation of their smoke have been proved to cause upper and lower airway tract infections. But still the possible side effects of inhalation of these coil smoke on other organ systems of the body were unclear. Methods: Adult male Wistar rats were divided into two groups each containing eight rats. Group A was control group while group B was allowed to inhale mosquito coil smoke for four week. The experimental group was exposed to MCS for 8 hours / day. Histopathological analysis of testis was carried out. Results: Histopathological studies of rats exposed to MCS revealed changes in parenchyma of testis. Decrease in the height of germinal epithelium and diameter of seminiferous tubules and increase in and vascular congestion was observed. Conclusion: The results of present study suggest that allethrin based mosquito coil smoke has harmful effects on testis

Quantification of the Lung Deposition Load of Smoke Particles by Plastic Type with the Lung Deposition Load Index (LDLIn)

Many fire-related casualties are caused by smoke inhalation. The particulate matter in smoke is deposited on the walls of the respiratory system, and adversely affects the human body through the respiratory and circulatory systems. In order to estimate the adverse effects of smoke particles on the human body, it is reasonable to consider the quantity of harmful substances from smoke particles that are absorbed by each region of the respiratory tract rather than the mass concentration of smoke particles in the air. This is because the absorption amount is a consequent factor that depends on a wide variety of other factors and is not solely determined by the causative factor, that is, the mass concentration in the air. In this study, the lung deposition loads of smoke particles from plastics, such as LDPE, PA66, PMMA, and PVC were quantified using the lung deposition load index (LDLIn), and the results were compared with the findings of conventional particulate matter (PM) mass concentration indices, such as PM2.5 mass and PM10 mass. The LDLIn value was calculated from the number of smoke particles generated during a fire that were deposited in each region of the respiratory tract for the given combustion materials and fire conditions. Herein, the LDLIn quantified the lung deposition load by reflecting the surface area concentration by particle size as well as the deposition characteristics in the respiratory tract according to particle size and breathing conditions. Even at the same PM mass concentration index value, each material and fire condition resulted in different LDLIn values according to the change in concentration distribution by particle size. The LDLIn values also varied depending on the breathing conditions.

Classification of Critical Levels of CO Exposure of Firefigthers through Monitored Heart Rate.

Smoke inhalation poses a serious health threat to firefighters (FFs), with potential effects including respiratory and cardiac disorders. In this work, environmental and physiological data were collected from FFs, during experimental fires performed in 2015 and 2019. Extending a previous work, which allowed us to conclude that changes in heart rate (HR) were associated with alterations in the inhalation of carbon monoxide (CO), we performed a HR analysis according to different levels of CO exposure during firefighting based on data collected from three FFs. Based on HR collected and on CO occupational exposure standards (OES), we propose a classifier to identify CO exposure levels through the HR measured values. An ensemble of 100 bagged classification trees was used and the classification of CO levels obtained an overall accuracy of 91.9%. The classification can be performed in real-time and can be embedded in a decision fire-fighting support system. This classification of FF’ exposure to critical CO levels, through minimally-invasive monitored HR, opens the possibility to identify hazardous situations, preventing and avoiding possible severe problems in FF’ health due to inhaled pollutants. The obtained results also show the importance of future studies on the relevance and influence of the exposure and inhalation of pollutants on the FF’ health, especially in what refers to hazardous levels of toxic air pollutants.

Numerical Simulation of Alternative Smoke Control Approach in a High-Rise Building

Smoke inhalation is a major cause of death in fire accident. Three quarters of building fire casualties were the result of excessive smoke inhalation, even with the presence of a control system. One of the main reasons to a high percentage of fatality is poor circulation and exhaustion of smoke. A proposed system, including an integrated ACMV exhaust with additional louver, will be simulated and compared with the current conventional approach, the fixed pressurization system. The purpose of this study is to determine the effectiveness of the newly proposed approach to smoke exhaustion. Results showed that the path of obscuration for the conventional system in the room displayed a lowered value of 8.77 %, as compared to 9.71% for the integrated ACMV system, due to the greater propagation of smoke out of the room. The results are in agreement as there is a noticeably faster subsiding of hot air temperature at the corridor for the integrated ACMV system than that of the conventional system, after the peak temperature spread of 115 seconds. The current study concluded that the proposed integrated ACMV system with additional louver is more effective for smoke control than the conventional design.

Radiation Injury

Since the development of x-rays in the late 19th century, radiation has increasingly been used for diagnostic imaging and various industrial purposes. The human health consequences of radiation exposure can range from minor asymptomatic exposures to the development of potentially fatal acute radiation sickness depending on the characteristics of the exposure. This review provides an overview of radiation injury, including historical perspective and principles of toxicity; assessment and stabilization (bedside evaluation, supportive care, and empirical therapy); diagnosis (estimation of radiation dose, laboratory assessment, biodosimetry and bioassays, smoke inhalation, and psychiatric sequelae); treatment and disposition (hematologic acute radiation illness, countermeasures and antidotes, gastrointestinal symptoms, fluid and electrolyte management, surgical intervention, local radiation injury, psychiatric treatment, radiation exposure during pregnancy, palliative care, and disposition); and outcomes (carcinogenesis, noncancer effects). Tables include the characteristic of common radioactive isotopes, common radiation dose equations and conversions, prescribing information for colony-stimulating factors, recommended antimicrobial prophylaxis and treatment regimens, and radioisotope decorporation or blocking agents. Figures show types of ionizing radiation, comparison of radiation contamination and exposure, patterns of early lymphocyte response based on radiation dose, the relationship between time to onset of vomiting and radiation dose, and a sample body chart for documentation of radiation contamination. This review contains 5 figures, 5 tables, and 82 references. Key Words: radiation, radiation exposure, radiation sickness, diagnostic imaging, pregnancy, carcinogenesis, toxicity, acute radiation syndrome (ARS)

Management of Poisoning and Drug Overdose

Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.

Histological Changes in Proximal and Distal Convoluted Tubules of Kidney of Albino Rats after Exposure to Mosquito Coil Smoke Inhalation

Objective: To evaluate the effects of the mosquito coil smoke (MCS) inhalation on histology of proximal (PCT) and distal (DCT) convoluted tubules of kidney in Wistar Albino rats. Methods: This study was approved by the Ethical Committee of PGMI, Lahore. 24 Wistar rats were selected and randomly divided into 3 groups, each containing eight animals. Group A was control; Group B and C were experimental groups and were exposed to mosquito coil smoke inhalation for 8 hours/day for two and four weeks respectively. Kidney tissue of albino rats was dissected, examined and analyzed histologically. Results: The results of MCS inhalation in histological sections of group B and C showed marked cellular necrosis and vacuolization in PCT (proximal convoluted tubule) of the kidney as compared to the group A. protein cast was absent in PCT of all groups. DCT (distal convoluted tubules) in group B and C showed marked necrosis, vacuolization and protein cast. Necrosis was more marked in group C treated with mosquito coil smoke for 4 weeks. Conclusion: The results indicate that pyrethroids in mosquito coil smoke though considered least toxic pesticides, are very harmful. Exposure of pyrethroids can induce adverse changes in tubules of kidney. Key Words: MCS Mosquito Coil Smoke, Pyrethroids, PCT Proximal convoluted tubules, DCT Distal convoluted tubules. How to Cite: Siddique N, Ahmed M, Ilyas M, Jabeen R, Jawad A.H, Iqbal Z. histological changes in proximal and distal convoluted tubules of kidney of albino rats after exposure to mosquito coil smoke inhalation. Esculapio.2020;16(04):87-91.

TISSUE CHANGES OBSERVED IN EASTERN BOX TURTLES (TERRAPENE CAROLINA CAROLINA) FOLLOWING A PRESCRIBED FIRE.

Necropsies were performed on five eastern box turtles (Terrapene carolina carolina), found in an area recently subjected to an early-season prescribed fire, to determine whether mortality was burn related. External injuries primarily consisted of burns to exposed extremities and carapacial scutes which ranged from two burned scales to >80% of the shell. Internally, there was no evidence of smoke inhalation, but multiorgan and multifocal inflammation may have contributed to mortality.

Tobacco smoke exposure enhances reward sensitivity in male and female rats.

Systemic administration of the tobacco smoke constituent nicotine stimulates brain reward function in rats. However, it is unknown if the inhalation of tobacco smoke affects brain reward function. These experiments investigated if exposure to smoke from high-nicotine SPECTRUM research cigarettes increases reward function and affects the rewarding effects of nicotine in adult male and female Wistar rats. Reward function after smoke or nicotine exposure was investigated using the intracranial self-stimulation (ICSS) procedure. A decrease in reward thresholds reflects an increase in reward function. In the first experiment, the rats were exposed to tobacco smoke for 40min/day for 9days, and the rewarding effects of nicotine (0.03-0.6mg/kg) were investigated 3weeks later. In the second experiment, the dose effects of tobacco smoke exposure (40-min sessions, 1-4 cigarettes burnt simultaneously) on reward function were investigated. Tobacco smoke exposure did not affect the nicotine-induced decrease in reward thresholds or response latencies in male and female rats. Smoke exposure lowered the brain reward thresholds to a similar degree in males and females and caused a greater decrease in latencies in females. There was a positive relationship between plasma nicotine and cotinine levels and the nicotine content of the SPECTRUM research cigarettes. Similar smoke exposure conditions led to higher plasma nicotine and cotinine levels in female than male rats. These findings indicate that tobacco smoke exposure enhances brain reward function but does not potentiate the rewarding effects of nicotine in male and female rats.

Mortality Associated with Bushfire Smoke Inhalation in a Captive Population of the Smoky Mouse (Pseudomys fumeus), a Threatened Australian Rodent.

A mortality event of nine threatened smoky mice (Pseudomys fumeus) occurred in January 2020 at a captive breeding facility in southeastern Australia that was affected at the time by hazardous levels of bushfire smoke, despite being more than 20 km from the nearest fire. Pathologic and clinical observations indicated smoke inhalation was the cause of death. All animals had significant pulmonary lesions, notably pulmonary edema and congestion, and moderate amounts of dark brown to black pigmented intracellular and extracellular particles from <0.5-2.5 µm in diameter were observed in the central or hilar region of the lungs of four of six animals examined histologically. Deaths occurred between three and 30 d after exposure to smoke and, for seven animals in outdoor acclimatization enclosures, were associated with very high ambient temperature (>40 C). Similar mortalities did not occur in co-located parrots, suggesting differing species sensitivity to smoke inhalation. Our findings highlight the potential for smoke to be an underdiagnosed cause of mortality in free-ranging wildlife during bushfires and for bushfires to affect wildlife populations outside of burnt areas, including in unburnt refugia. Conservation interventions for wildlife after bushfires should consider and, where possible, mitigate the risk of animals dying due to increased respiratory demand following smoke inhalation injury.

Association of uteroglobin-related protein 1 with smoke inhalation injury severity.

ObjectiveTo evaluate serum uteroglobin-related protein 1 expression early after smoke inhalation injuries and its association with the severity of inhalation injury in burned patients.MethodsSmoke or chemical inhalation injury is associated with morbidity and mortality. The consequences of inhalation result from an inflammatory response. Uteroglobin-related protein 1 is an anti-inflammatory protein and may improve lung inflammation. We hypothesized that uteroglobin-related protein 1 levels could reflect disease severity and predict outcome in patients with inhalation injury. Sixteen patients diagnosed with acute respiratory distress syndrome secondary to smoke inhalation injury were prospectively included in the study. Plasma was collected upon intensive care unit admission and within 24 hours of the inhalation injury. Bronchoscopies were carried out in all patients to assess the severity of inhalation injury within 72 hours. Uteroglobin-related protein 1 plasma levels were determined in duplicate with enzyme-linked immunosorbent assay.ResultsThe mean age was 23 ± 5 years, and the inhalation injury distribution was as follows: three of grade 1, four of grade 2, and nine of grade 3. The level of uteroglobin-related protein 1 was related to inhalation severity (grade 1: 0.389 ± 0.053 arbitrary units versus grade 2: 0.474 ± 0.0423 arbitrary units versus grade 3: 0.580 ± 0.094 arbitrary units; p = 0.007).ConclusionPlasma levels of uteroglobin-related protein 1 are associated with the degree of lung inhalation injury.

Characteristics of patients with carbon monoxide poisoning due to smoke inhalation and pre-hospital factors related to intensive care unit admission of these patients: a nationwide observational study

This study aimed to investigate the pre-hospital clinical status of patients with carbon monoxide (CO) poisoning by smoke inhalation and the pre-hospital factors associated with these patients’ admission to the intensive care unit (ICU). In this observational study from January 2016 to December 2018, the National Fire Agency’s first aid activity log on patients with smoke inhalation was matched with National Emergency Department Information System’s patient data with CO poisoning and further analyzed retrospectively. Multiple logistic regression analysis was conducted to identify the relevant pre-hospital associative factors for the decision to admit a patient with CO poisoning to the ICU. Of the 4422 patients with CO poisoning included in the study, 358 (8.09%) were admitted to the ICU. In such patients transported by pre-hospital emergency medical services, age (odds ratio [OR], 1.020; 95% confidence interval [CI], 1.010–1.029), verbal (OR, 3.564; 95% CI, 2.390–5.315), pain (OR, 4.011; 95%CI, 2.661–6.045), unconsciousness (OR, 5.728; 95% CI, 2.708–12.113), SBP (OR, 0.979; 95% CI, 0.969–0.989), HR (OR, 1.011; 95% CI, 1.004–1.018), SpO2 (OR, 0.965; 95% CI, 0.946–0.985), O2 supply (OR, 1.725; 95% CI, 1.143–2.603), use of nasal prongs (OR, 0.504; 95% CI, 0.281–0.905), and intentional inhalation (OR, 2.282; 95% CI, 1.659–3.139) were independently associated with ICU admission. Our study demonstrated that age, mental change, SBP, HR, SPO2, O2 supply, use of nasal prongs, and intentional inhalation in patients with CO poisoning were associated with their ICU admission.

Role of fibreoptic bronchoscopy in early diagnosis of inhalational burns in patients with facial burns

Introduction: Inhalation burn is a major cause of mortality in burn patients. Early diagnosis of smoke inhalation injury (SII) is imperative in the management and prevention of burn injury. The gold standard modality for the diagnosis of SII is fiber-optic bronchoscopy (FOB). Materials and Methods: This prospective, observational study included thirty patients and was conducted from November 2016 to May 2018. Patients with thermal burns sustained &lt; 72 h with facial burns, age group 18–60 years, were included in the study. Results: FOB was done in thirty patients. About 26.67% of patients had closed space injuries. Singeing of scalp hair/eyebrows was present in 46.67% of patients. Singeing of nasal vibrissae/mustache was present in 56.67% of patients. Eversion of eyelids and lips was present in 33.33% and 50% of patients, respectively. Hoarseness of voice, edema of tongue, and tachycardia were present in 16.67%, 50%, and 66.67% of cases, respectively. On auscultation, 26.67% patients had basal crepts. In the chest X-ray, 16.67% of patients had pulmonary edema. Forty percent of patients had arterial hypoxemia and acidosis at the time of arrival. About 56.67% of patients were proved bronchoscopically to have features of SII. Conclusions: FOB has significant value in evaluation, prediction of prognosis, and management of SII when performed within 72 h of burns.

Therapeutic effects of hyperbaric oxygen: integrated review.

Hyperbaric oxygen therapy refers to inhalation of pure oxygen in a closed chamber. Hyperbaric oxygen has a therapeutic effect in numerous pathological conditions, such as decompression sickness, arterial gas embolism, carbon monoxide poisoning and smoke inhalation, osteomylitis, osteoradionecrosis and wound healing. Hyperbaric oxygen therapy is used for treating underlying hypoxia. This review indicates the action of hyperbaric oxygen on biochemical and various physiological changes in cellular level. Narrative review covers the current indications and contraindications of hyperbaric oxygen therapy. The review also focuses on the therapeutic effects of hyperbaric oxygen pretreatment and precondition in different pathological conditions. The complications and side effects of hyperbaric oxygen therapy are discussed.

Protective effect of lobelia and hops mixture against cigarette inhalation toxicity in female rats

Background/Aim Cigarette inhalation is dangerous for the health of both nonsmokers and smokers. It is the most important cause of death. The current study is important for studying the protective role of lobelia (Lobelia inflata) and hops (Humulus lupulus) against the toxic effects of smoking inhalation in adult female rats. Materials and methods This study was performed on 24 female rats divided into four groups (six each) including control group (G1), cigarettes inhalation group (G2), mixture of lobelia and hops inhalation group (G3), and mixture of herbal plants plus cigarettes inhalation group (G4). Female rats were exposed to inhalation of a mixture of lobelia and hops or cigarettes separately or mixed for 4 weeks with a concentration of 4.4 mg/kg for each dose. At the end of the experiment, serum samples and whole blood were used for biochemical and hematological investigation as well as histological examination on liver, kidney, lung, and cardiac tissue. Results The cigarette-treated rats showed significant increases (P&lt;0.05) in levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, protein, urea, and creatinine, whereas a significant decrease (P&lt;0.05) in albumin level was estimated. The exposure to the mixture of herbal plants only showed normal levels of liver and kidney biomarkers in comparison with the control group. However, the combination of cigarette plus mixture of herbal plants inhalations revealed normal levels of liver and kidney parameters after 4 weeks of inhalation. Histological studies showed morphological alterations in all vital organs of rats in cigarette inhalation-treated group, whereas normal histological examination in group of rats treated with cigarette plus mixture of herbal plants inhalations. Conclusion These findings concluded that exposure to cigarette inhalation in female rats activated harmful effects to the vital organs; this toxicity can be improved by exposure to mixtures of herbal plants from lobelia (L. inflata) and hops (H. lupulus).

Effects of repeated adolescent exposure to cannabis smoke on cognitive outcomes in adulthood.

Cannabis (marijuana) is the most widely used illicit drug in the USA, and consumption among adolescents is rising. Some animal studies show that adolescent exposure to delta 9-tetrahydrocannabinol or synthetic cannabinoid receptor 1 agonists causes alterations in affect and cognition that can persist into adulthood. It is less clear, however, whether similar alterations result from exposure to cannabis via smoke inhalation, which remains the most frequent route of administration in humans. To begin to address these questions, a rat model was used to determine how cannabis smoke exposure during adolescence affects behavioral and cognitive outcomes in adulthood. Adolescent male Long-Evans rats were assigned to clean air, placebo smoke, or cannabis smoke groups. Clean air or smoke exposure sessions were conducted daily during adolescence (from P29-P49 days of age ) for a total of 21 days, and behavioral testing began on P70. Compared to clean air and placebo smoke conditions, cannabis smoke significantly attenuated the normal developmental increase in body weight, but had no effects on several measures of either affect/motivation (open field activity, elevated plus maze, instrumental responding under a progressive ratio schedule of reinforcement) or cognition (set shifting, reversal learning, intertemporal choice). Surprisingly, however, in comparison to clean air controls rats exposed to either cannabis or placebo smoke in adolescence exhibited enhanced performance on a delayed response working memory task. These findings are consistent with a growing body of evidence for limited long-term adverse cognitive and affective consequences of adolescent exposure to relatively low levels of cannabinoids.

ATS Core Curriculum 2020. Pediatric Pulmonary Medicine.

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine, in a 3- to 4-year recurring cycle of topics. These topics will be presented at the 2020 International Conference. Below is the pediatric pulmonary medicine core, including pediatric hypoxemic respiratory failure; modalities in noninvasive management of chronic respiratory failure in childhood; surgical and nonsurgical management of congenital lung malformations; an update on smoke inhalation lung injury; an update on vaporizers, e-cigarettes, and other electronic delivery systems; pulmonary complications of sarcoidosis; pulmonary complications of congenital heart disease; and updates on the management of congenital diaphragmatic hernia.