Ebenezer Israel

Comparison of Cigarette and Water Pipe Smoking Among Female University Students in Egypt

This study investigated behavioral and sociodemographic factors associated with tobacco use among female university students patronizing water pipe cafes in Cairo, Egypt. We interviewed two groups of female university student smokers (100 and 96 students from a public and a private university, respectively). The interviews took place in nine water pipe cafes near the two universities. A logistic regression model was developed to analyze the relationship between tobacco-related knowledge and beliefs and the choice between smoking water pipe or cigarettes. Among these smokers, 27% smoked cigarettes only, 37.8% smoked water pipe only, and 35.2% smoked both types of tobacco. Most of the water pipe smokers (74.1%) preferred this method because they believe it to be less harmful than smoking cigarettes. More than half of the subjects were encouraged to start smoking by other females (56.6%). Curiosity was a significant factor for initiation (OR = 2.8, 95% CI = 1.3-6.2, p<.01). We found no significant differences between water pipe and cigarette smokers regarding current age, age at initiation, quit attempts, knowledge about the hazards of smoking, wanting to be fashionable, or smoking with friends. About one in four (23.7%) attempted to quit, with health cited as a major reason. An urgent need exists for correction of the misperception among this study population that water pipe smoking is safe and less harmful than cigarette smoking.

Investigation of an outbreak of bloody diarrhea: Association with endoscopic cleaning solution and demonstration of lesions in an animal model

UNLABELLED OUTBREAK INVESTIGATION: An outbreak of diarrhea, bloody diarrhea, and abdominal cramps occurred among persons undergoing flexible sigmoidoscopy at a branch clinic of a local health center. Illness was associated with use of sigmoidoscopes cleaned by one clinic assistant and appeared to be caused by 2% glutaraldehyde disinfectant solution left in the instruments after cleaning. ANIMAL STUDIES In subsequent animal studies, colonic instillation of 2% glutaraldehyde solutions caused bloody diarrhea and a distinctive pattern of mucosal damage; similar changes were seen in a review of pathologic samples from other human cases of glutaraldehyde disinfectant-associated diarrhea. CONCLUSION Our data indicate that improper endoscopic reprocessing can result in serious illness and underscore the importance of adequate training and quality control in this area.

Genotoxic effects of waterpipe smoking on the buccal mucosa cells

Waterpipe smoking is popular in many parts of the world. Micronuclei (MN) evaluation in the exfoliated oral cells of smokers is a non-invasive technique for evaluation of possible tobacco harm. We aimed to assess whether MN levels are higher in waterpipe smokers than in never smokers. We examined oral smears of 128 adult male waterpipe smokers and 78 males who never smoked tobacco in rural Egypt. The total number of MN per 1000 cells per subject, and the number of MN-containing cells per individual were compared. We observed a higher level of total MN in waterpipe smokers (10 +/- 4) than in never smokers (4 +/- 2, p < 0.001). A similar difference was found for the mean number of affected cells per individual (8 +/- 3 vs. 4 +/- 1.62, p < 0.001). MN levels were not significantly dose related. This study is among the first to assess the association between waterpipe smoking and a cytogenetic measure of tobacco harm. The twofold increase in MN level is consistent with previous reports of MN in cigarette smokers. More research is needed to determine if such MN levels are predictive of future health consequences.

Nondaily, light daily, and moderate-to-heavy cigarette smokers in a rural area of Egypt: A population-based survey

INTRODUCTION Understanding tobacco use among nondaily and light daily cigarette smokers is needed because they are dissimilar from other smokers and may require specific prevention efforts. METHOD We compared three groups of adult male smokers in rural Egypt: light daily and nondaily smokers versus moderate-to-heavy daily smokers. Data were obtained from a household survey in 2003 in six randomly selected villages in the Nile Delta region of Egypt. There were 7,657 adult participants, of whom 48.6% were male and 51.4% were female. Among them, 1,401 males (37.6%) and 5 females (0.1%) were self-identified as current cigarette smokers; further analysis focused on males. We restricted data analysis to those who reported a stable pattern of 3+ years of smoking. There were 42 nondaily smokers. Daily smokers were subdivided into two groups: light daily smokers (who smoked no more than 10 cigarettes/day; n = 223) and moderate-to-heavy daily smokers (who smoked at least 11 cigarettes/day; n = 769). RESULTS We found statistically significant differences between these groups on nearly every measure: nondaily smokers tended to be younger and unmarried, but they also had higher levels of education and professional occupations compared with the other smokers. Nondaily and the light daily smokers were more likely than moderate-to-heavy smokers to be planning to quit and to have self-efficacy for quitting, and they were less likely to be smoking in the presence of their wife and children at home. DISCUSSION Further understanding of nondaily and light daily smokers may aid in tailoring specific interventions.

NURSING HOME OUTBREAK OF INFLUENZA A (H3N2) : EVALUATION OF VACCINE EFFICACY AND INFLUENZA CASE DEFINITIONS

OBJECTIVES Describe an outbreak of influenza A (H3N2); provide an analysis of vaccine efficacy; measure the sensitivity, specificity, and positive predictive value of 3 clinical case definitions of influenza. SETTING A nursing home in Washington County, Maryland. The outbreak involved 52 residents (attack rate = 47.7%) and at least 10 of 140 employees (minimum attack rate = 7.1%). RESULTS Twenty-five residents exhibited a 4-fold or greater increase in titer to influenza A/Sichuan/2/87. Vaccine efficacy was measured at -7.1%, suggesting that the influenza vaccine in 1988/1989 did not offer optimal protection against influenza A infection for the institutionalized elderly. CONCLUSIONS The outbreak was a clear indicator of the need for rapid diagnosis. With the use of rapid diagnostic tests, influenza A could have been detected in time to use amantadine.

Assessment of tobacco dependence in waterpipe smokers in Egypt.

SETTING Waterpipe smoking is increasing worldwide. Nevertheless, little is known about nicotine dependence in tobacco smokers who use waterpipes. OBJECTIVE To assess evidence of dependence among non-cigarette smoking waterpipe smokers in Egypt. METHODS A total of 154 male exclusive current waterpipe smokers were enrolled for the present study. We adapted the Fagerström test for nicotine dependence and the Reasons for Smoking (RFS) scales and related these to smoking behavior. RESULTS The mean age of the subjects was 47 ± 14 years, the mean age at smoking initiation was 22 ± 9 years, and average daily consumption was 4 ± 8 hagars (tobacco units). The time to the first smoke of the day (P < 0.001), smoking even when ill (P = 0.003), time to tobacco craving (P < 0.001), and hating to give up the first smoke of the day (P = 0.033) were each significantly associated with the number of hagars smoked per day. The RFS subscales of addictive smoking, smoking to relieve negative affect, and smoking for stimulation were also associated with these variables. CONCLUSION The overall findings suggest that waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers.

DRD2/ANKK1 TaqI polymorphism and smoking behavior of Egyptian male cigarette smokers.

Little is known about the genetic contribution to cigarette smoking and nicotine addiction in Egypt. The dopamine D2 receptor gene contains a TaqI repeat fragment length polymorphism creating two alleles with functional significance, DRD2*A1 and DRD2*A2. We investigated the relationship between these alleles and tobacco use in a study of 389 Egyptian male current smokers (mean age = 40 years; SD = 12). Participants were interviewed in 2004 on their smoking behaviors and quit attempts, and were given the Fagerström Test for Nicotine Dependence (FTND). Blood samples were obtained and genotyped for DRD2 A1and A2 alleles. The frequencies of A1/A2, A1/A2, and A2/A2 genotypes were 6%, 29%, and 65%, respectively. We found no statistically significant association between genotype and age at onset of smoking, years of smoking, FTND score, or average number of cigarettes smoked per day. DRD2 genotype was associated with the number of cigarettes smoked in the past 48 hr (42.2 in A1 carriers vs. 37.6 in A2, p = .03), the previous quit duration (28% in A1 vs. 40% in A2 quit for more than 1 month, p = .05), and the depth of inhalation (82% in A1 vs. 72% in A2 inhaled the smoke deeply, p = .03). Logistic regression analysis including DRD2 genotype, FTND score, age at smoking initiation, marital status, and education as predictors showed that maximum duration of quit time was associated with FTND score (p = .003), DRD2 genotype (p = .01), marital status (p = .03), and age at smoking initiation (p = .04). These findings suggest a modest association between DRD2 genotype and quitting behavior in male cigarette smokers in Egypt.

Evaluation of Papanicolaou Stain for Studying Micronuclei in Buccal Cells Under Field Conditions

OBJECTIVE To compare Papanicolaou (Pap) and May-Grünwald Giemsa (MGG) stain as 2 techniques for staining for buccal mucosal cells to detect micronuclei (MN) infield studies. STUDY DESIGN Eighty cytologic smears (2 per individual) were taken from the buccal mucosa of 40 cigarette smokers recruited at a rural village in Egypt. Forty smears were stained with Pap stain and 40 with MGG stain. All were assessed for cellularity and scored for MN. RESULTS Pap stain was faster and easier to process and transport in the field study than was MGG stain. Regarding MGG smears, bacteria and cell debris masked the MN as compared to Pap smears, in which the fixative destroyed the bacteria and made the cell boundaries clearly demarcated. Using Pap stain, MN were seen easily in transparent cytoplasm. CONCLUSION Pap stain is the preferred method infield studies for scoring and detecting MN in cells of buccal mucosa.

Congenital syphilis in Maryland, 1989-1991: the effect of changing the case definition and opportunities for prevention.

Background The reported incidence of congenital syphilis in the United States rose dramatically during the 1980s. Although lack of prenatal care has been associated with congenital syphilis, little has been published regarding missed opportunities for prenatal intervention. Goal of this Study To determine whether congenital syphilis increases in Maryland between 1989 and 1991 resulted from a true increase in congenital syphilis incidence or a change in the surveillance case definition, and to describe missed opportunities for prenatal intervention. Study Design This was a retrospective cohort study. Results When the revised case definition was used, a 473% increase in the number of cases was seen. Among infants who met the revised definition, 45% of mothers had received no prenatal care. Among those whose mothers had received prenatal care, opportunities to intervene were missed for 53%. Conclusions Although a true increase in congenital syphilis incidence occurred before 1990, the increase reported in Maryland between 1989 and 1991 was primarily due to the change in case definition. Many cases of congenital syphilis could have been prevented with early and adequate prenatal care.

Lyme disease surveillance in Maryland, 1992

The incidence of Lyme disease (LD) reported to the Maryland Department of Health and Mental Hygiene during 1992 was 6.5/100,000 population, ranging from 29.3 cases/100,000 on the Eastern Shore (74.4% of all cases) to no cases in the mountains of western Maryland. Among the 317 reported patients, 44.4% gave a history of tick exposure and 78.9% had positive serologic test results. For the 187 (59.0%) patients meeting the Centers for Disease Control and Prevention (CDC) surveillance case definition, erythema migrans (EM) occurred in 69.5%, with arthritic (26.7%), neurologic (13.4%), and cardiac (2.1%) manifestations being less frequent. Patients not meeting the surveillance case definition were significantly more likely to have influenza-like symptoms, a smaller rash, and arthralgia. Patients meeting the CDC criteria were more likely to have an onset during the major transmission season in the summer (odds ratio (OR): 2.1; confidence interval (CI): 1.2 to 3.6) since this was the time when most (115/130) patients with EM were detected. Positive serologic results were more likely (OR: 2.2; CI: 1.2 to 4.2) in those not meeting the case definition. The treatment given to patients thought to have LD was almost always that recommended in the literature and there was no difference between treatment prescribed for patients meeting and those not meeting the case definition. These data show that physicians in Maryland are treating many patients for LD who are clinically diagnosed as having LD (e.g., febrile patients with flulike symptoms, patients with arthralgias or erythematous rashes < 5 cm in size) and who have positive serologic test results but who do not meet the CDC surveillance case definition. These patients and the large number of unreported patients being seen and treated for LD or tick bites must be added to the overall burden of LD in the state.