Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. n22,oe 80ECgrte rVpn soitdLn nuy(VL)ae fhsiaiaino deaths or (CDC Control hospitalization years Disease of (EVALI)cases 13-85 for Centre Injury from the Lung to Associated reported Vaping ALI. been or severe have to E-Cigarettes to morbidity similar 2800 lungs over significant quite the 2020, function, cause exposes In endothelial Smoking (ARDS) and generation. Syndrome epithelial younger on Distress the effects particularly Respiratory detrimental affected, Acute the among and interchangeably. mortality used (ALI) and often are Injury that Lung terms and two Acute Youth are Products Dokha Global Tobacco and Alternative WHO Midwakh of the products. concern Tobacco per growing Smokeless a various As and growth. increase and alarming an function (ATPs) is lung smokeless there world impaired Survey, use Tobacco to them the Adult of leads million in smoking 13 as which death of development, of worldwide, years) products causes (13-15 children tobacco leading million 24 the around with of alarming, one is Tobacco complications. informed severe first well potential be the its INTRODUCTION should is and physicians this ones that reviewed, emerging emphasize literature to and the wish existing We per both ATPs, date. as till of and severe reported clinical use knowledge protective injury Significant the moderately our lung lung about To disease. for ultra-short acute lung with months. criteria associated restrictive ventilation Midwakh three The severe prone of at with steroids, case achieved compatible compliance. of was were dose lung recovery extubation high radiological poor post a and to done to achieved tests due was ventilation spirometry response settings Mechanical Initial good ventilatory strategy. a walls. high and bronchial with met, erythematous was weeks ARDS with Midwakh two consolidation. patchy of hemorrhages for and attempt petechial required appearance report first bilateral glass computerized was We ground a revealed high-resolution with A following bronchoscopy chromium, cigarettes. pneumonia Injury. hours interstitial flexible cobalt, and Lung bilateral 24 A of shisha showed Associated (HRCT) within levels Vaping to chest or Injury harmful the compared E-Cigarettes of Lung to when to tomogram Acute content addition similar remarkably with tar In presentation presented and a adolescents. who nicotine smoking, amongst male, higher adolescent particularly has Midwakh 14-year-old UAE, Midwakh (ATPs). a in Products lead, Tobacco ATP and Alternative used of Iron consumption most cadmium, increase the alarming an of is one There is harmful. is form any in Tobacco Abstract 2020 5, September Medicine Dental of College Mohammed 3 2 1 Varughese of Angel review and Report Case -A literature East Middle emerging the An in (MALI): epidemic Injury Lung Acute associated Midwakh oamdBnRsi nvriyo eiieadHat cecsHma Bin Hamdan Sciences Health and Medicine of University Rashid Bin Mohammed East Middle Mediclinic Hospital City Mediclinic 3,4,5 Cmo Tsrnefo lcrncCgrte,Hoa rSih,Mdaho oh,and Dokha, or Midwakh Shisha, or Hookah Cigarettes, Electronic from range ATPs .Common 6. 3. xoueo ioiedrn dlsec rcidodhsdltroseet nbrain on effects deleterious has childhood or adolescence during nicotine of Exposure 1 uelPooboni Suneel , 2 ia Vinod Vijay , 1 1 | n ai Abusamra Rania and , rmal5 ttsi h S,wt gsranging ages with USA, the in states 50 all from ) 3 h rvlneo dlsetsoigis smoking adolescent of prevalence The . 3 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. epeetaptetwt RSdet ct ugijr eae oMdah oh smanufactured is Dokha Midwakh. to related injury lung acute to due ARDS with of patient (SpO2) saturation a Oxygen present We after. bpm (89% 121 L and walk 3.1 test a after). walk of DISCUSSION 98% before min was FEV1 bpm 6 and post-discharge normal walk 110 predicted), and of the months (91% predicted) rate before three (70% L heart 100% L at a 3.8 6.3 (with 3) of of obtained (DLCO) (figure FVC was capacity Chest with Diffusion reduced improved HRCT symptoms slightly significantly respiratory follow-up predicted), resolving has A with Spirometry recovery tolerance. normal, significant of effort showed dose post-discharge improving tapering months a and three critical on at of discharged features up was weakness, Follow patient global The minimal A L noted. respectively. 2.15 were %) being neuropathy Prednisone. (112.8 FEV1/FVC peripheral % and and 94.09 (FEV1), with myopathy and pattern second ventilatory illness (53.3%) one restrictive L in a 2.02 volume revealed %), expiratory and (46.8 Forced post-extubation extubation (FVC), days until capacity five requirements the ventilator vital done and scan the was forced collapse of Spirometry HRCT improvement lobe ventilation significant chest 14. prone lower a day of was repeat right on period there and prolonged A which a consolidation Subsequently, after initiated, lobe methylprednisolone. appearances. was lower glass of ground high-pressure left with dosage revealed 10, changes lung day which high interstitial On performed, developed the was results. kidneys he despite 2) microbiology his course, (figure required negative of of perfusion admission still the because PICU was balancing rationalized ventilation the episode, were diuretics this During Antibiotics and following administered, lungs. rehydrated day). were was and medications patient per anti-hypertensive The mg which discontinued. for (500 were failure azithromycin pre-renal anti-inflammatory oral (300 following and toxins hydroxychloroquine the and hypertension inhaled oral of day) mg/kg/day), course to day (15 18% per due five gram/day monocytes, ARDS mg a one 6% on with Prednisolone commenced Methyl Lymphocytes, pneumonitis was intravenous interstitial % patient medications; the of 5 the which diagnosis neutrophils, for including A % considered, with PCR was 71 keeping eosinophils. petechial viral of no in culture, differentiation inflammation, and secretions, count microbiology macrophages, bilateral airway cell negative of severe and had increase lavage PCR revealed Bronchoalveolar COVID-19 mild which beside injury. 5, walls lung fulminant bronchial day erythematous on and physiotherapy com- performed chest hemorrhages, was regular was furosemide admission, bronchoscopy his dose During Flexible low liters. of 4 chest infusion of Continuous the balance given performed. fluid of cumulative was ml/kg), crackles. Auscultation re- positive ˜5 and a administered. admission (Tv entry for were moderately ventilation upon menced air sedation for lung-protective ( gas decreased and criteria ultra-short Hg blockage bilateral blood the with Neuromuscular mm revealed arterial met managed 192 compliance. Initial patient was ratio lung The He PaO2/FiO2 poor ml). control radiographs, cause). Hg). 400 control-Assist on cardiogenic Volume mm volume infiltrates no on 42.3 Tidal (Bilateral center PCO2 8, ARDS our 77.9, he PEEP severe to (PaO2 %, hours, hypoxemia transferred 70 few relative was - vealed he a 40 ventilation, Within (FiO2 mechanical settings of 1). four hypoxia. (figure significant day to On appearance due ventilation interstitial ground-glass mechanical of and demonstrated and and which series oseltamivir, intubation (HRCT), consolidation a and required chest underwent patchy antibiotics the he rapidly with of broad-spectrum admission, with tomogram empirical pneumonia On computerized 2020 on Midwakh, high-resolution March smoking started Lancifolius). a in post underwent 19; (Conocarpus hours hospital leaves COVID 24 local tree including over investigations his Damas fever and crushed to cough, with presented breathlessness, healthy, mixed of and symptoms fit respiratory the developing previously is boy, this 14-year-old date. knowledge, to A our reported To ever EVALI. (MALI) to following Injury PRESENTATION ARDS similar Lung / CASE very Acute ALI presentation Associated of a Midwakh symptoms of smoking, and case Midwakh signs first with of presented session who single male, a adolescent 14-year-old a report We 2 < 0)o EP8and 8 PEEP on 200) Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. e ta.hglgtdvrosnwotoe htne ob tde nPdarcAueRsiaoyDistress Respiratory Acute Pediatric in studied be to need that and outcomes blockers new neuromuscular various of highlighted benefit al. patient. potential et injured the Lee lung with severe weakness the ICU-acquired in of glucocorticoids risk polyneuropathy systemic the and balance myopathy to illness had oxy- critical reduces to and due synchrony survival patient-ventilator weakness improved improves to (NMBA) leading agents consumption blocking gen neuromuscular regions of dorsal use by of ARDS, The reduction as severe recruitment with ml/kg and of to ventilation and 5 phase up of injury up to acute reaching distribution 4 lung FiO2 the was Ventilator-induced homogenous of in of volumes pressure more of especially tidal requirement matching, inspiratory useful with ventilation/perfusion low was peak ventilation better positioning the his lung enabling Prone ultra-protective ml/kg, despite to barotrauma. ap- 5 lungs avoid resort of to we the therapeutic required volume Thus of used H2O. tidal compliance cm set of 35 poor a beyond efficacy For case, the remarkable. our was pathophysiology, In 50% mmHg), ARDS 200–300 limited. of /FiO2 is understanding (PaO2 proaches much-improved mild as a hypoxemia (PaO2/FiO2 Despite populations severe of severity and 100,000 mmHg) to per 100–200 according (PaO2/FiO2 cases 2012 moderate from 30–80 of definition of 82% Berlin incidence almost per (SpO2 an in hypoxemia has condition persistent ARDS clinical had the have discharge some in at and improvement oxygen home tapering, an corticosteroid showed during steroids inflammatory relapsed the CDC, reduce to the steroids treated systemic per patients by As treated were E- EVALI E- with using response. case patients the our antibiotics, after to in pneumonitis to addition happened In chemical-induced as similar presentation, a initial quite of of were typical hours with 24-48 findings scans, products present EVALI vaping with CT with or distress Patients Cigarette including USA. respiratory the follow-up. severe findings, in the acute, outbreak during radiological (EVALI) watched Injury be and Lung to cigarette/Vaping-associated presentation has which clinical obstruction, airway airway The diffuse of the onset of obstruc- gradual or airway setting the single the by edema, followed in be laryngeal damage infection with could parenchymal secondary pulmonary associated agents and and were triggering edema/ARDS, exposure pulmonary the significant non-cardiogenic as following tion, disease, (BOOP), cases airway Fatal obstructive Pneumonia pul- syndrome, Organizing bronchopneumonia, multiple. dysfunction like Obliterans airways disorders reactive Bronchiolitis respiratory and disease, of and combinations lung spectrum these a interstitial of in on edema, leaves result monary effects may and the injury bark, lung reported. Nevertheless, fruits, inhalational been Toxic flowers, tobacco. never dried have to combustion leaves) spices, on tree herbs, system byproducts add Damas nervous the may the Central smokers (like and Midwakh plants carcinogens native these, lungs. to the enter addition quickly is In found content were lead. tar comparison depressants and its (CNS) in iron, and cigarettes higher cadmium, and respectively 193.33% shisha chromium, cigarettes to electronic cobalt, and compared and 128.57%, when tobacco, 218.07%, highest snuff the 170.76%, tobacco, were chewing cigarettes, products with tobacco UAE the can Midwakh in bowl in particularly The levels and an Gulf 1). Therefore, the (image inhalations; in students 2 small bowl increasing day. in a is a a session Midwakh through and times one Smoking smoked 20-25 stem, finish is Midwakh to a It smoking enough mouthpiece, up tobacco, flavor. a ends dry the individual of parts, enhance grams three to 0.5 has spices approximately and which contain herbs Midwakh, with called mixed pipe leaves, tobacco drying by 1 I stems omnyue T nUE etol oCgrteo vrl oac use tobacco overall on Cigarette to only next UAE, in ATP used commonly most the is .It 14 D eomnsflo pa - ek SO n hs -a) oeptet have patients Some x-ray). chest and (SpO2 weeks 1-2 at up follow recommends CDC . 14 . 12 9,10 yposlk og,soteso rah ee a ail osnwithin worsen rapidly can fever breath, of shortness cough, like Symptoms . TaiinlMdahppscnann les ec hs oiat can toxicants these hence filters; no contain pipes Midwakh .Traditional 11 hyas ecie h eouino nta ct nuoi obe to pneumonia acute initial of resolution the described also They . 17 oee,we ie ln ihseod,i a exacerbate can it steroids, with alone given when However, . 2 iwk oac rdcscnan amu eesof levels harmful contains products tobacco Midwakh . 3 13 . 18 I u ae tcudntb vie swe as avoided be not could it case, our .In < 15 16 ti iie notrectgre as categories three into divided is It . 0 mg om fARDS. of forms mmHg) 100 . 7 mn h dlsetadschool and adolescent the among , < 5)requiring 95%) 8 Nicotine . Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. tityoeigtecutystbcocnrllw a rvn AIeiei ntergo n protect and region and the education in health epidemic MALI public with it. REFERENCES a closely Appropriate prevent to work can attributable to laws products. generation. risks control pediatricians younger tobacco tobacco acute term and the country’s injury, discourage physicians long the lung to request identify obeying acute We parents to strictly of their pathophysiology Midwakh smoking. and the Midwakh on identify adolescents of studies to effects clinical studies ultra-short long-term such and effects and with research no ventilation long-term additional are Prone the recommend there We Steroids, though 2020, months of of three dose As at high for. achieved EVALI a watched recent was to the be recovery of to responded history mimic have Significant a case close on a diagnostic Our based settings. was was a USA. It lung-protective and posed exclusion the features. which of radiological in (MALI), diagnosis symptoms, a epidemic Injury and was signs Lung It presentation, Acute clinical period. associated of pandemic Midwakh COVID-19 the of during case challenge got first-ever which the report PICU, We the from hospital. discharge the upon from CONCLUSION post-discharge parameters months spirometry three within reduced discharge first normalized after significantly the almost months over had significantly 9-12 increased patient and 6MWT months Our the three after in at months walked up 12 distance followed appli- disability mean when potential functional The year with persistent strength. study had muscle One patients and ARDS. the function adult of in half outcomes that discharge term illustrated etc long pediatrics complications on to treatment studies cation dysfunction, numerous organ been residual have to There due morbidities new quality developed Health-related 23% and that status and (HRQOL) functional status nutrition development, life hypertension, neurocognitive of pulmonary weakness, of acquired risk PICU function, growth, pulmonary term long like (PARDS) Syndrome Esyd ey;Dlbla aa;E oce asa Ceia hrceiainadsft assess- safety and characterization .Chemical Maissam Kouche, El Sarah; problem—evidence Dalibalta, health Yehya; emerging Elsayed, an is among Medwakh 9. using use smoking Tobacco dokha Hajat of R, Ali pattern M, Al-Houqani and .Prevalence 8. E Mathew AV, Ranade S, Jayadevan M, Jayakumary 7. Otra fLn nuyAscae ihteUeo -iaet,o aig rdcs (2020, Products. Vaping, or E-Cigarette, of rep- Use nationally the use: with pipe Associated water Injury of Lung comparison of Cross-country Outbreak al. 6. et H, Fouad Y, school Song high and J, middle among Morton use tobacco 5. Current (CDC). Prevention and dangers Control the Disease about for warning Centers epidemic: 4. tobacco global the on Report Tar (WHO). and Organization Health Nicotine World of 3. Determination Dubai. Analytical in students al. school et high Begum among Ayesha dokha Mohammad, product Bassam, tobacco Mahboub, the 2. of Prevalence K. Wolff A, Crookes 1. eto oh:A mrigatraietbcopout cec fteTtlEvrnet 08Feb 2018 Environment. Total the of Science product. 7:e39189. tobacco alternative 2012; emerging ONE 15;615:9-14. An PLoS Emirates. dokha: of Arab ment United the ,2010 in Prev survey Cancer cross-sectional J large Pac a Asian from Emirates. Arab United Ajman, in 1547–1549. students ;11: health allied and medical cigarettes/severe-lung-disease.html eray2) eree uy1,22,fo https://www.cdc.gov/tobacco/basic from 2020, 12, Survey July Tobacco Retrieved Adult Global 25). The February from countries middle-income 23:419–27. and 2014; low Control Tob 13 (GATS). from 61:581–5. data 2012; resentative Rep Wkly Mortal Morb MMWR 2011. States, students—United 2011. WHO, Geneva: tobacco. (7): of 2018;42 Toxicology. Analytical of Journal Products. Tobacco Shisha and 496–502. Dokha Various in Levels 49(10):1349-52. Aug; 2014 Misuse. Use Subst 21 h -iuewl et(MT ep sesgoa hsclfnto,ie,ln n cardiac and lung i.e., function, physical global assess helps (6MWT) test walk 6-minute The . 19 ootsuycnutdo 1 ehnclyvniae eiti ainsconcluded patients pediatric ventilated mechanically 316 on conducted study cohort A . 4 22 . information/e- 20 . Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. Cadu ,Viy C nuaaS,e l umnr ucin nCide etltdfrAcute for Ventilated Children in Functions Pulmonary al. et SK, Angurana PC, Vaidya S, Chakdour 22. Acute Pediatric of Matte Disposition CM, Discharge Tansey and Morbidity MS, New Herridge al. 21. et NJ, Thomas RS, acute Watson pediatric G, my- of Keim survivors corticosteroid pediatric 20. Acute in outcomes T. clinical Deltombe J.H.Pertinent C.,Lee M., S.W.,Ong Dangoisse S.W.,Loh M., Lee Bisteau 19. J.M., Brucher A., Dive P., Hanson 18. agents blocking Neuromuscular M.J. Schultz M.C., Damasceno Esp´osito D.C., V.G., syndrome. Pereira distress respiratory A.S., acute Neto in distress position 17. respiratory Prone J.J. acute Marini and E., Carlesso injury P., Taccone lung L., Gattinoni acute of 16. Providers targeting Care Therapeutic P.A. Health Ward for T.J., Guidance Standiford Interim 15. Update: al et Pe- EH Vaping. Koumans and cigarettes TC, Electronic Jatlaoui of DA, Hazards Health Siegel of the Journal 14. of England Understanding New New The Farber Injury J. Lung Harold Acute Vaping-Induced 13. M.P.H. M.D., , Pulmonology Christiani medicine: C. Pulmonary David Injury: 12. Lung Inhalational Various Toxic in Rafeq: Metals Samaan Heavy Adegunsoye; of Deji Determination 11. Analytical al. et Hajjaj El Mohmmad Mahboub, Bassam 10. yoei eprtr alr.PdarCi aeMd21;Sep;19(9):e464-e471. 2018; Med 7;364(14):1293- Care Apr Crit Pediatr 2011 Failure. Med Respiratory J Hypoxemic Engl N syndrome. distress respiratory acute 304. after years 5 disability 2018;46:1731-8. Med Care Crit Survivors. Oct;7(19):513. Syndrome Med.2019 Distress Transl Respiratory Ann review. narrative a (PARDS): syndrome distress 20(11):1371-80. respiratory 1997; Nerve. three Muscle from patients. care evidence intensive current in 26;2(1):33. the opathy Jul of 2012; summary Care. A Intensive syndrome: Ann. distress trials. controlled respiratory 2013;188:1286–1293. randomized acute Med. with Care patients Crit. in Respir. J. Am. limits. and indications, Rationale, 2016;167:183–191. Res. (MMWR).2019; Transl. report Associated syndrome. weekly Use Mortality Product and Vaping, Morbidity or 2019 E-cigarette, States,October United 68(41);919–927 Suspected — with Patients Injury Lung for Caring and Evaluating 2020 Mar 3.1 Vol.41,Issue Review in diarics 382:960-962 2020; 5, March Medicine & Scientific of 2019 Journal 29, Biomedical June advisor Implications. Health Related and 2019;23(5):17829-17835 Research. Products, Technical Shisha and Dokha ´ ,TmisnG izGaao ,Coe ,e l Functional al. et A, Cooper N, Diaz-Granados G, Tomlinson A, 5 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. 6 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. 7 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. 8 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. 9 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. 10 Posted on Authorea 5 Sep 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159932488.88470346 — This a preprint and has not been peer reviewed. Data may be preliminary. 11