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The introduction of a fixed 20-stick pack occurred over time in the early 20th century, rather than through regulation, and was due to commercial success

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The respiratory system also exhibited significant involvement, with symptoms such as tachypnea, dyspnea, and respiratory distress, while the cardiovascular system presented with hypertension, tachycardia, and a murmur in the left common carotid artery (Table 1) ( In terms of frequency, hypertension was the most common symptom, occurring in 41.38% (n = 12) of cases (in comparison, hypotension was reported in 13.79% (n = 4) of the patients), followed by right hemiparesis and facial nerve palsy, each observed in 31.03% (n = 9) of cases