UNSOLVED obscure GI bleeding

szuhanchen

有個病人今天已經因為GI bleeding 反覆入院多次，胃鏡大腸鏡小腸鏡都做過多次、CTA, RBC scan, capsule endoscope都做過，臨床症狀也是明顯的tarry stool和Hb, Plt consumption
Hema方面已詢問過相關性但被初步排除、rheuma中ANA, Comb test和C3是有異常，但沒有找到相關的paper 應該要繼續往這方面深入survey嗎?

TinyNotes

@szuhanchen 能不能提供更多的lab data資訊，包括hema和Rheuma相關的?
有沒有其他出血傾向的表現? 瘀血? 紫斑?
如果懷疑是Rheuma相關，有沒有其他相關的症狀能夠符合criteria?

dinhthaihoang

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Cách tham gia
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Điều kiện và điều khoản
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vapecig

Should e-cigarettes be smoked in a smoking room?

In recent years, "electronic cigarettes" and "heated cigarettes" have been attracting attention as the next generation of cigarettes. Although these cigarettes are actually different in nature, they are often treated similarly, and few people have a clear understanding of the differences between them.

However, the "Revised Health Promotion Law" will be fully enforced from April 2020, and if you do not understand the difference between the two, you may be in violation of the law.

Therefore, this article explains the differences between e-cigarettes and heated cigarettes, an overview of the Revised Health Promotion Law, and whether e-cigarettes should be smoked in smoking rooms. We will also introduce recommended smoking machines.

The differences between e-cigarettes and heated cigarettes

At first glance, electronic cigarettes and heated cigarettes may seem very similar, but there are actually significant differences between the two. Let's take a look at an overview of each below.

What is an electronic cigarette?

An electronic cigarette is a product that uses electricity to heat a liquid containing flavoring (liquid) in a cartridge and inhale the vapor generated by the heating.

E-cigarettes differ greatly from heated cigarettes in that they do not use tobacco leaves. For this reason, e-cigarettes are officially classified as "tobacco-like products.

Currently, e-cigarette factories from China do not contain nicotine. Liquid containing nicotine is treated as a drug and is subject to the Pharmaceuticals and Medical Devices Act (Yakki Hou), which requires a permit before it can be sold.

What are heated cigarettes?

Heated cigarettes are products in which tobacco leaves or processed tobacco leaves are electrically heated and the resulting vapor is inhaled. By not burning the tobacco leaf, the amount of tar is reduced and the amount of harmful substances other than nicotine is said to be low.

The number of users of heated cigarettes has increased due to the expectation that heated cigarettes will have less impact on the health of the smoker and those around him or her compared to cigarettes.

However, the vapor from heated cigarettes contains nicotine and other harmful substances, and it is not yet known whether they are actually less harmful than paper cigarettes. According to the Ministry of Health, Labor and Welfare, a survey on heated cigarettes announced that some products have detected the same level of nicotine in the mainstream smoke of heated cigarettes as that of paper cigarettes(*).

What is the Revised Health Promotion Law?

In April 2020, the revised Health Promotion Law came into full effect, changing the rules regarding smoking. The four major rules established by the revised law are: "no smoking indoors in principle," "no entry to smoking areas for people under 20 years old," "establishment of smoking rooms that meet technical standards," and "mandatory posting of signs in smoking rooms.

The most significant change is that smoking is now prohibited "indoors" in principle. Since smoking is allowed indoors in some restaurants, these establishments are now required to post signs at their entrances to make it clear that smoking is allowed. Defacing such signs, as well as posting confusing signs, is also prohibited, and if applicable, may result in penalties.

Thus, the revised Health Promotion Law sets stricter restrictions on smoking.

Should e-cigarettes be smoked in a smoking room?

As explained earlier, the revised Health Promotion Law sets stricter restrictions on smoking.

So, you may be wondering what to do when you smoke an e-cigarette. Many people may be wondering whether e-cigarettes must also be smoked in a smoking room.

This chapter explains whether electronic cigarettes should be smoked in smoking rooms or not.

E-cigarettes are not subject to regulation because they are "tobacco-like products.

E-cigarettes are not regulated under the revised Health Promotion Law. As explained in the introduction to e-cigarettes, e-cigarettes are treated as "tobacco-like products" that do not use tobacco leaves.

The rules may be changed again in the future, but as of January 2022, smoking e-cigarettes outside of a smoking room will not be a legal problem.

Heated cigarettes, on the other hand, are subject to the revised Health Promotion Law. Because heated cigarettes contain nicotine, smoking outside of designated areas is subject to penalties.

Although e-cigarettes are not regulated, it cannot be said that they do not pose a health hazard. In the United States, where health hazards believed to be caused by e-cigarettes have been reported, it is recommended that people refrain from using all e-cigarettes (*1).

Ideally, smoking should be done in a smoking room, as they are easily mistaken for heated cigarettes.
Under the revised Health Promotion Law, smoking e-cigarettes outside of a smoking room is not subject to regulation. However, even though it is not regulated, it is undesirable to smoke e-cigarettes anywhere.

For example, people may not be able to tell the difference between e-cigarettes and heated cigarettes and may misunderstand that they are heated cigarettes, which may lead to trouble. Also, you may be warned by store clerks or other staff.

Above all, considering the danger of the substances emitted when smoking, it is good manners to smoke in a smoking room as much as possible, even with e-cigarettes. It is important to choose a smoking location that does not disturb the surrounding environment.

If your office does not have a smoking room, a large installation work is not necessary if you use a smoke separator.

If a new smoking room is to be installed in an office that does not currently have a smoking room, extensive construction work will be required. If you cannot afford the time, effort, and cost of such construction work, why not install a "smoking separator that meets technical standards" that meets the requirements set forth in the revised Health Promotion Law?

Smoke separators are machines that inhale tobacco smoke and absorb and decompose harmful substances through filters in order to prevent passive smoking. Once installed, the smoke is not diffused into the room and clean air can be maintained.

Compared to installing a new smoking room to separate smoking and non-smoking areas, installing a smoke separator is less expensive.

If you are considering a smoke-free unit, Clean Air Scandinavia's smoke-free cabins are a good choice.

If you are considering installing a smoke-free unit, Clean Air Scandinavia's smoke-free cabins are a good choice. These cabins are capable of collecting almost 100% of tobacco particles, which are usually considered difficult to collect, and can meet the standards of the revised Health Promotion Law just by installing them.

The environmental standard stipulated by the Ministry of Health, Labor and Welfare sets the dust level in a smoking room at 0.15 mg/m3 or less, but a smoke-free cabin can be much lower than this standard.

When installing a smoke-free cabin, standards are set for TVOC values, suspended dust concentration, and wind velocity at the opening surface, and periodic measurements and report storage are required (*). Clean Air Scandinavia's smoke-free cabins meet these standards and can be used with peace of mind.

Installing a smoke-free cabin in your office will help eliminate harmful smoke and keep the room clean at all times. Smoke-free cabins can be installed anywhere indoors with a power supply of about 100 V, so they can also make the best use of limited space.

Clean Air Scandinavia offers products according to the number of users, so you can choose the one that best fits the situation at each business location. They can be installed wherever you prefer, and there is no installation cost. If you are considering separating smoking and non-smoking areas in your office, please contact us.

Conclusion

With the full enforcement of the revised Health Promotion Law, regular and frequent smokers must be careful where they smoke. Although electronic cigarettes are not subject to the regulation, they are easily mistaken for heated cigarettes, so it is better to smoke in a smoking room if possible.

If there is currently no smoking room in the office, it is advisable to set up a smoking room as much as possible. However, the major disadvantage of building a smoking room from scratch is that it is time-consuming and costly, and there is a possibility that the Health Promotion Law will be revised after March 2025, five years after it came into effect.