Bhriguvanshi, Arpita

The journal retracts the article, “Effect Comparison of E-Cigarette and Traditional Smoking and Association with Stroke—A Cross-Sectional Study of NHANES” [...]

Introduction: Stroke is the second largest cause of death and third leading cause of disability worldwide. Some high-income countries have one in five lifetime cases and one in two in low-income countries. Due to the high stroke burden and aging population, better preventive and treatment approaches are needed. Recent research shows that stroke patients have a different gut microbiota than healthy people, suggesting a relationship between dysbiosis and stroke incidence and prognosis. Probiotics may improve stroke outcomes by strengthening the intestinal barrier and reducing inflammation. Hypothesis: Our study seeks to evaluate the potential benefits of probiotic supplementation in reducing the risk of ischemic stroke in healthy individuals as well as its impact on the prognosis of stroke patients, specifically in reducing gastrointestinal complications and improving gut microbiota balance (reduce dysbiosis). Methods: We conducted an umbrella meta-analysis of meta-analyses published in the last 10 years using PRISMA guidelines in PubMed. Using RevMan 5.4, we performed an inverse variance random effects model to calculate log (odds ratio) and converted it to pooled OR and 95% confidence interval to obtain a forest plot keeping alpha criteria 0.05. Heterogeneity and risk of bias assessment (by Newcastle-Ottawa Scale) were assessed. Results: While probiotic supplementation in healthy individuals did not significantly decrease the risk of ischemic stroke (OR 0.87 [95%CI 0.75-1.01]), it showed notable benefits in stroke patients. These positive effects included a substantial reduction in the odds of specific GI complications (constipation, diarrhea, gastric retention, esophageal reflux, vomiting, stress ulcers, and gastrointestinal bleeding) by 62% (0.38, 0.29-0.51), non-specific GI complications by 72% (0.28, 0.24-0.34), infection by 73% (0.27, 0.21-0.33) and a significant improvement in gut flora balance, reducing the odds of dysbiosis by 79% (0.21, 0.12-0.36). (p<0.00001) The inter-study heterogeneity was 91% with (p<0.00001, Chi 2 =128.76), a moderate risk of bias. Conclusion: Our umbrella meta-analysis highlights the potential benefits of probiotic supplementation in stroke patients, particularly in mitigating stroke-related GI complications and alleviating intestinal flora dysbiosis. These findings underscore the crucial role of gut-brain interactions in stroke and suggest that probiotics may serve as a promising component of stroke management.

Introduction: Tobacco use is a known risk factor for stroke and other cardiovascular diseases. However, the relationship between e-cigarette smoking and stroke is largely unknown. Hypothesis: This study aims to assess the effect of e-cigarettes among people who have had a history of stroke. Methods: A cross-sectional survey was performed using the NHANES database from 2015 to 2018 in the US population. We identified participants 18 or older with a history of stroke and their smoking habits (e-cigarette, traditional, and dual smoking). The chi-square test, unpaired t-test, and multivariable logistic regression models were used to examine the association of e-cigarette consumption among the stroke population. Results: Out of a total of 266,058 respondents, 79,825 were smokers [E-cigarette: 7,756 (9.72%); Traditional: 48,625(60.91%), Dual smokers: 23,444 (29.37%)] Overall prevalence of stroke was 5.41% (n=4194) amongst various types of smokers. Amongst females with stroke, the prevalence of e-cigarette use was higher compared to traditional smoking. (36.36% vs 33.91%; p<0.001) Mexican Americans (21.21% vs. 6.02%) and other Hispanics (24.24% vs. 7.70%) had a higher prevalence of e-cigarette use than traditional smoking. (p<0.001) E-cigarette smokers were having an early onset of stroke in comparison with dual and traditional smokers. (Median age in years: 48 vs. 50 vs. 59, respectively; p<0.001). Stroke was more prevalent amongst traditional smokers compared to e-cigarette and dual smokers (6.75% vs. 1.09% vs. 3.72% p<0.001). In multivariable logistic regression analysis, the odds of having a history of stroke were higher amongst e-cigarettes in comparison with traditional smokers. (aOR:1.15; 95%CI: 1.15-1.16; p<0.001). Conclusion: Although stroke was more prevalent in traditional smokers, e-cigarette smokers had early-onset and higher odds of stroke compared to traditional smokers. More prospective studies are needed to evaluate the long-term effects and safety of e-cigarettes to mitigate the risk of cardio and cerebrovascular disorders.

Introduction: Tobacco use is one of the most significant risk factors for stroke. Besides traditional cigarettes and combustible products, the use of e-cigarettes and electronic nicotine delivery products has been widespread among young adults in the recent era. Furthermore, the trend of vaping has increased over the last decade. However, the relationship between e-cigarettes and stroke is largely unknown. The aim of this study was to evaluate the prevalence and identify the relationship between e-cigarette smoking and stroke. Methods: A cross-sectional study was performed using the NHANES database of the US population. Adults with a history of smoking were considered in our study and divided into three groups, e-cigarette users, traditional, and dual smokers. The Chi-squared test, Wilcoxon rank-sum test, and multivariable logistic regression analysis were used to identify the prevalence and association of e-cigarette consumption and stroke. Results: Out of a total of 266,058 respondents from 2015 to 2018, we found 79,825 respondents who smoked e-cigarettes (9.72%) or traditional (29.37%) or dual smoking (60.91%). Stroke prevalence among e-cigarette smokers was 1.57%. Stroke was more prevalent among traditional smokers than among e-cigarette smokers. (6.75% vs. 1.09%; p < 0.0001) E-cigarette smokers had early onset of stroke in comparison with traditional smokers. (median age: 48 vs. 59 years; p < 0.0001). Among females with stroke, the prevalence of e-cigarette use was higher in comparison with traditional smoking (36.36% vs. 33.91%; p < 0.0001). Among the stroke population, the prevalence of e-cigarette use was higher among Mexican-Americans (21.21% vs. 6.02%) and other Hispanics (24.24% vs. 7.70%) compared with traditional smoking (p < 0.0001). The regression analysis found higher odds of stroke history among e-cigarette users than traditional smokers [aOR: 1.15; 95% CI: 1.15–1.16)]. Conclusion: Though stroke was more prevalent in traditional smokers, the incidence of stroke was early-in-onset and was strongly associated with e-cigarette use compared to traditional smokers. We have also identified vascular effects of e-cigarettes components as possible triggers for the stroke.