Daily use of smokeless tobacco: systemic effects

Article Abstract:

The use of smokeless tobacco is common among young adults in the United States. Lesions in the mouth are associated with the use of smokeless tobacco and it is known that long-term use adversely effects the overall well-being of users. Exposure to nicotine, related cardiovascular effects, and urinary mutagenicity (as a measure of the absorption of carcinogenic compounds) were compared between various forms of smokeless tobacco, such as oral snuff and chewing tobacco, and cigarettes in eight healthy men who smoked and had previously used other tobacco products. The levels of nicotine in the bloodstream were the same from smokeless and smoked tobacco. Since addiction to the use of tobacco is caused by nicotine, the use of smokeless tobacco can be as habit-forming as smoking. Similar effects on the cardiovascular system, as seen by increased heart rate and blood pressure, were observed from the use of chewing tobacco and smoking cigarettes. A smaller increase in heart rate and blood pressure was associated with the use of snuff. Increased heart rate and blood pressure requires the heart to work harder, which can lead to heart disease. With the use of any form of tobacco, the increased heart rate was seen throughout the day, not just at the time of use. An increase of epinephrine and norepinephrine was seen with the use of all tobacco products, indicative of increased activation of the nervous system, which is known to be caused by nicotine. The excretion of sodium in the urine was greater with the use of smokeless tobacco, probably because of the absorption of sodium from the smokeless tobacco, which contains sodium for taste. Increased sodium levels can lead to high blood pressure and heart disease. The absorption of chemicals, such as N-nitrosamines, was greatly increased with smoking cigarettes, slightly increased with the use of chewing tobacco but not increased with the use of oral snuff. Therefore, the use of smokeless tobacco causes the absorption of nicotine, sodium, and cancer-causing chemicals, which are known to have adverse effects on health. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Nicotine, Tobacco, Smokeless tobacco, Tobacco chewing

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Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial

Article Abstract:

Background: Cannabinoid use could potentially alter HIV RNA levels by two mechanisms: immune modulation or cannabinoid-protease inhibitor interactions (because both share cytochrome P-450 metabolic pathways). Objective: To determine the short-term effects of smoked marijuana on the viral load in HIV-infected patients. Design: Randomized, placebo-controlled, 21-day intervention trial. Setting: The inpatient General Clinical Research Center at the San Francisco General Hospital, San Francisco, California. Participants: 67 patients with HIV-1 infection. Intervention: Participants were randomly assigned to a 3.95%-tetrahydrocannabinol marijuana cigarette, a 2.5-mg dronabinol (delta-9-tetrahydrocannabinol) capsule, or a placebo capsule three times daily before meals. Measurements: HIV RNA levels, CD4+ and CD8+ cell subsets, and pharmacokinetic analyses of the protease inhibitors. Results: 62 study participants were eligible for the primary end point (marijuana group, 20 patients; dronabinol group, 22 patients; and placebo group, 20 patients). Baseline HIV RNA level was less than 50 copies/mL for 36 participants (58%), and the median CD4+ cell count was 340 x 10(super 9) cells/L. When adjusted for baseline variables, the estimated average effect versus placebo on change in log(sub 10) viral load from baseline to day 21 was -0.07 (95% CI, -0.30 to 0.13) for marijuana and -.0.04 (CI, -0.20 to 0.14) for dronabinol. The adjusted average changes in viral load in marijuana and dronabinol relative to placebo were -15% (CI, -50% to 34%) and -8% (CI, -37% to 37%), respectively. Neither CD4+ nor CD8+ cell counts appeared to be adversely affected by the cannabinoids. Conclusions: Smoked and oral cannabinoids did not seem to be unsafe in people with HIV infection with respect to HIV RNA levels, CD4+ and CD8+ cell counts, or protease inhibitor levels over a 21-day treatment.

Marijuana, Health aspects, Care and treatment, HIV infection, HIV infections, Cannabinoids, Author Abstract

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Severe hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts: natural history and predictors of outcome

Article Abstract:

Hyperbilirubinemia following the placement of a transjugular intrahepatic portosystemic shunt (TIPS) is a very serious condition that can lead to liver failure and death. Hyperbilirubinemia occurs when the breakdown of red blood cells increases blood levels of bilirubin. Researchers followed 232 patients who received a TIPS, which is usually used to treat variceal bleeding or ascites. Nineteen patients developed hyperbilirubinemia, and within 90 days, 95% had died or had to have a liver transplant. Only 17% of those who did not develop hyperbilirubinemia had that outcome.

Prognosis, Hyperbilirubinemia

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