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Abstract
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In their article, Works and Stack1 presented e‐cigarette or vaping product‐use‐associated lung injury (EVALI)--a disease process obtained from smoke inhalation with electronic delivery systems, which pathophysiology is similar to chemical pneumonitis but often presents with a pneumonia‐like picture. Their case presented unique significant leukocytosis and profound weight loss associated with the course of the illness.
The chemical composition of e‐cigarette vapor and liquid may contain various substances as nicotine, propylene glycol, glycerin, acetone, formaldehyde, nitrosonornicotine, nitrosamine, metals, flavoring substances, particulate matters (PM1‐2.5‐10), vitamin E acetate, etc.2 E‐cigarettes can also be used as a route of administration of cannabis/synthetic‐cannabinoids (soluble synthetic cannabinoid receptor agonists [SCRAs] called "Spice," ie, APINACA [N‐(1‐adamantyl)‐1‐pentyl‐1 H‐indazole‐3‐carboxamide] and AB‐FUBINACA [N‐[(1 S)‐1‐(aminocarbonyl)‐2‐methylpropyl]‐1‐[(4‐fluorophenyl)methyl]‐1 H‐indazole‐3‐carboxamide]), as well as methamphetamine, 3‐4‐methylenedioxymethamphetamine‐MDMA, synthetic cathinones (eg, mephedrone, 3,4‐methylenedioxypyrovalerone‐MDPV, methylone, ketamine, cocaine), and opioids (eg, heroin, fentanyl and derivatives, tryptamines, or 2,5‐dimethoxy‐4‐bromophenethylamine‐NBOMe).
Approximately 15% of people vaping cannabis have used SCRAs via this route. Most of the EVALI cases (82%) reported vaping cannabis products, usually cannabis oils that contained tetrahydrocannabinol (THC), and 84% of users who vaped THC oil reported purchasing it from informal sources such as friends, street dealers, and from the internet.
The most probable causes of the EVALI outbreak are thought to be vitamin E acetate, which has been added to vaping products as a diluent, or THC‐derivatives.4 However, the harm of the other new‐psychoactive‐substances (NPS) in e‐cigarettes may be underdiagnosed due to the lack of comprehensive screening methods for NPS detection in biological samples...
Language: en |