Background: The rise of electronic nicotine delivery systems (ENDS) has introduced new challenges to tobacco control and regulation, particularly among young adults, raising questions about their safety. This umbrella review aimed to synthesise existing systematic reviews with or without meta-analyses to evaluate the health impacts of ENDS. Methods: We conducted a systematic literature search via the PICO strategy across multiple databases, focusing on e-cigarettes, ENDS and e-liquids, while excluding non-nicotine e-cigarette and nicotine replacement therapies (NRTs). Health outcomes include a range of clinical diseases and physiological changes. Quality assessment was performed via assessing the methodoligcal quality of systematic reviews 2 (AMSTAR-2), and the findings were synthesised narratively and in tables, prioritising the highest-rated reviews. The meta-analyses used R software (V.4.3) random effects models, and evidence quality was assessed via the Grading of Recommendations, Assessment, Development and Evaluation criteria. Results: Of the 5055 records, 69 systematic reviews were included. Systematic reviews have indicated increased risks of cardiovascular and respiratory diseases, mental health issues and substance abuse with ENDS use, especially among adolescents. Cardiovascular risk factors included increased heart rate (mean difference (MD) 1.41, 95% CI 0.81 to 2.01, I ² =91%) from 25 studies; increased blood pressure (MD for systolic blood pressure=0.51 mm Hg, 95% CI 0.26 to 0.75, I ² =89%; MD for diastolic blood pressure=0.59 mm Hg, 95% CI 0.35 to 0.83, I ² =82%) from 23 studies; endothelial dysfunction and increased platelet activity. Respiratory risk factors included reduced lung function and a higher incidence of asthma in nine studies (OR 1.30, 95% CI 1.1 to 1.55; I ² =43%) and chronic obstructive pulmonary disease. Mental health concerns, such as depression and suicidality, were also prevalent among adolescent ENDS users. Nine studies reported a negative effect of ENDS on periodontal health. Evidence of carcinogens has been found in the urinary examinations of ENDS users in some studies. The adverse events reported in seven randomised controlled trials with 2611 participants were similar between ENDS and NRT (RR 1.13, 95% CI 0.83 to 1.54, I ² =12%). Conclusions: Exposure to ENDS is harmful to various organ systems, especially cardiovascular and respiratory systems. Comprehensive regulatory measures and public health strategies are necessary to curb the use of ENDS, particularly among young people.

Gastric cancer (GC) is one of the most common malignancies throughout the world with late diagnosis and poor prognosis. The expression of programmed death-ligand 1 (PD-L1) in GC is attributed to immune evasion and tumor progression. PD-L1 positivity has both predictive and prognostic biomarker potential. Aiming to summarize a large amount of research and to provide a definitive conclusion to the conflicting results on the prognostic significance of PD-L1 expression in GC, we performed an umbrella review based on existing meta-analyses which were published recently (2016-2021) and indexed in the PubMed database. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in August 2021 to screen articles, and data extraction with quality assessment was performed on the selected meta-analyses. Review Manager (RevMan) 5.3 software was used to analyze the HR and OR with a 95% confidence interval (CI) among PD-L1 positive GC patients. We also assessed the between-study heterogeneity (I²). Forest and Funnel plots were obtained, and a P-value of <0.05 was considered statistically significant. A total of 567 articles were screened, and we selected three meta-analyses with a total of 40 studies conducted over a period of 14 years. In our umbrella review, a total of 8,419 GC patients with an average PD-L1 positivity of 39% were analyzed. We found that PD-L1 positivity in GC patients is associated with poor prognosis (pooled HR =1.44, 95% CI: 1.24-1.68, P<0.00001) having higher mortality reducing the chances of overall survival (OS). However, there are no significant differences in PD-L1 expression among different lymph node (LN) metastases (OR=1.31, 95% CI: 0.98-1.74, P=0.07) and tumor, node, and metastasis (TNM) stages (OR=1.13, 95% CI: 0.80-1.58, P=0.50). Early identification of PD-L1 expression may help tailor cost-effective and targeted immunotherapy among GC patients. More research is needed to further understand how PD-L1 affects LN metastasis and tumor invasion.

Digital innovation and its integration in various parts of lifestyle are inevitable as humans have started to evolve over time. Its integration in our health and various systems is irrefutable. In this position paper, we explore the various aspects of this important component of technology, discuss its evolution over time, discuss the various existing modalities, highlight the regulatory frameworks in India, and elaborate on the different ways it can be integrated in our country’s future health plans. We believe digital health is here to stay and play important role in shaping our lives in terms of our accessibility and other interactions related to health.

Coffee has long been popular worldwide. The rise in lifestyle-related diseases such as cardiovascular disease, diabetes, stroke, dementia, and others has motivated coffee usage and illness prevalence studies. Some studies show coffee consumers are at risk for such diseases, whereas others show its active components protect them. Policymakers and the public need a comprehensive umbrella review to make healthy choices and enjoy coffee. Coffee consumption and stroke, CHD, and dementia outcomes have been distinguished using the PICO search strategy in PubMed with a filter for meta-analysis. We included 10 years of investigations until October 2023. MeSH terms “coffee intake,” “stroke, dementia,” and “transient ischemic attack,” comparing stroke risk with coffee consumption were used. The study excluded case reports and non-human, non-English observational research. The stroke risk of coffee was examined using RevMan software. Coffee consumption’s stroke risk ratio (RR), 95% CI, and I2 were estimated. Forest plots with P values ≤ 0.05 are significant. The umbrella review includes 11 meta-analyses from 457052 papers, totalling 11.96 million individuals. Drinking up to 4 cups of coffee daily reduced stroke risk by 12% compared with not drinking any coffee (0.88 (CI of 0.84-0.92, I2 of 13%, P < 0.00001)). Coffee drinkers had a 1.19 risk ratio for cardiovascular diseases compared to non-coffee drinkers (CI: 0.99–1.38, I2 = 84%, P < 0.00001). The dementia risk ratio for caffeine users was 0.90 (95% CI: 0.82-0.97, I2 = 46%, P < 0.00001) compared with non-consumers. Our analysis covering 5.42 million individuals found that 4 cups of coffee consumed a day reduced stroke risk by 12%. Coffee may reduce ischemic and haemorrhagic strokes by preserving endothelium and antioxidants. Coffee may lessen dementia risk, according to our study’s 0.94 pooled risk ratio after sensitivity analysis. Heavy coffee drinkers had a greater CHD risk, as per our findings. Heavy coffee drinkers were more at risk.

Diabetes mellitus (DM) is an important cause of morbidity and mortality worldwide. DM patients develop both macrovascular and microvascular complications, erectile dysfunction (ED) being one of them. The risk of developing ED in DM patients as compared to those without DM is 3-4 times. Our study has reported the burden of ED in DM patients. Literature search was done by using PubMed and EMBASE databases for studies published from 1 January 2013 to 31 December 2013 by using terms such as diabetes, erectile dysfunction, and their synonyms. Pooled prevalence was calculated by using random effect model and Der Simonian-Laird method. Joanna Briggs Institute (JBI) Critical Appraisal scale for cross-sectional studies was used for assessing the study quality. Five hundred and sixty-seven studies were identified, out of which 10 studies were selected. The prevalence of ED in Type 2 DM patients in India was estimated 60.57% (95% CI: 48.84-72.30%). Prevalence of ED in DM patients is high in India. Stigma, stress, and phobia related to ED needs to be addressed. Screening, awareness, early diagnosis, and management for ED and DM will help in improving morbidity and mortality of the nation.