Feras Hawari

The acute effects of waterpipe smoking on lung function and exercise capacity in a pilot study of healthy participants

Abstract Context: Waterpipe tobacco smoking (WTS) has gained popularity, but its physiologic effects have not been extensively studied: rather, studies have focused on WTS’s chronic effects or have evaluated limited respiratory/cardiac parameters. Objective: We sought to characterize in a more detailed manner the acute effects of WTS on lung function and exercise capacity. Method: We recruited 24 healthy WTS males. We used a pilot single-group pre-test (abstained from WTS for ≥48 h) post-test (within 0.5 h of a 45-min WTS session) design. We performed spirometry, diffusing lung capacity and time-limited CPE testing (CPET; cycloergometer; 2-min 20-Watt warm-up and 25-Watt increase every 2-min for 10 min). Results: Mean age was 20.4 years; Post-WTS, the following significant changes were observed: CO level increased from 3.7 ppm to 24.4; oxygen consumption decreased (from 1.86 L/min to 1.7); baseline respiratory rate increased (from 17.7 breath/min to 19.7); forced expiratory flow over the middle half of the forced vital capacity decreased (from 5.51 L to 5.29); and perceived exertion (measured by Borg scale) at mid and peak exercise increased. Baseline resting systolic blood pressure, pulse pressure, and pulse pressure product increased post-WTS (from 118.9 mmHg to 129.2; from 45.3 mmHg to 55.6; and from 9.9 mmHg/min to 11.1 post-WTS, respectively). During exercise, a decrease in oxygen pulse was observed post-WTS (from 10.89 ml/beat to 9.97), while the heart rate-oxygen consumption relationship increased post-WTS (from 3.52 beats/ml/kg to 3.91). Conclusion: Acute WTS appears to induce impairment in lung function and exercise capacity. Larger studies are warranted to further characterize the nature and extent of such impairment.

Ethnicity and waterpipe smoking among US students

OBJECTIVES To examine the effect of ethnicity on waterpipe smoking among college students. DESIGN A cross-sectional study utilized data from University of Houston students through an online survey (n = 2334) from March to April 2011. The survey included questions on demographic characteristics (sex, age, race/ethnicity), tobacco use experience, risk perception, social acceptability and popularity. Multivariate logistic regression was used to determine predictors of waterpipe use with three outcomes: ever-use vs. no use, past-year use vs. no use and past-month use vs. no use. RESULTS Half of the sample had previously smoked tobacco using a waterpipe, approximately a third in the past year and 12.5% in the past month. Significant predictors included Middle Eastern ethnicity, Middle Eastern friend, past cigarette or cigar use. Perception of harm was associated with less use in the ever-use model, while perceived addictiveness, social acceptability and popularity of waterpipes were predictors in all models. CONCLUSION Our findings underscore the importance of developing culturally appropriate interventions to control waterpipe smoking among Middle Eastern Americans and those of Indian/Pakistani descent to curb further spread in US society, and highlight the importance of developing interventions that target the perceived addictiveness, social acceptability and popularity of waterpipe smoking.

Predictors of ICU Admission in Patients with Cancer and the Related Characteristics and Outcomes: A 5-Year Registry-Based Study

Objective:To identify factors predictive of admission of patients with cancer to an ICU. In addition, the study aimed to describe the characteristics and outcomes, both short-term and long-term, of patients with cancer admitted to the ICU. Design:Retrospective case-control study, utilizing the institution’s cancer registry. Setting:Comprehensive cancer center. Patients:Patients with cancer. The case group consisted of patients who required ICU admission during the study period, whereas the control group consisted of patients who did not require ICU admission. Intervention:None. Measurements and Main Results:The patient characteristics and outcomes were recorded. Univariate and multivariate analyses were conducted to determine factors associated with ICU admission. The registry included 10,792 patients, and among those, 2,439 patients (22.6%) required ICU admission after a median of 10.1 months (interquartile range, 3.28–25.2). The following factors were associated with ICU admission: hematologic malignancy (odds ratio, 1.51; 95% CI, 1.26–1.81), chemotherapy (odds ratio, 1.74; 95% CI, 1.48–2.03), advanced cancer (odds ratio, 2.57; 95% CI, 1.44–4.60), and smoking (odds ratio, 1.38; 95% CI, 1.20–1.61). The most common ICU admission diagnoses were sepsis (21.5%) and respiratory insufficiency/failure (25.7%). The ICU mortality was 36.5%, whereas the 1-year and 5-year survival rates were 22.8% and 14.2%, respectively. Conclusion:In a comprehensive cancer center, about one fourth of the patients required ICU admission. Addressing modifiable risk factors associated with ICU admission is essential to potentially reduce ICU admissions and improve long-term survival.

Adverse Drug Events in Critically Ill Patients With Cancer Incidence, Characteristics, and Outcomes

Objective: To determine the incidence, characteristics, and outcomes of adverse drug events (ADEs) in critically ill patients with cancer. Methods: This was a 5-month prospective observational study. Patients who were admitted to the adult medical/surgical oncology intensive care unit (ICU) were evaluated for any drug-related adverse events during their ICU stay. An ADE was defined as injury or patient harm resulting from medical intervention related to a drug. Results: The incidence rate of ADEs was 96.5 per 1000 patient days and 35.3 per 100 ICU admissions. Of the reported ADEs, 57 (64.8%) were serious/life threatening, 30 (34.1%) were significant, 1 (1.1%) was fatal, and 14 (15.9%) of all ADEs were considered preventable. The most common drug classes associated with ADEs were antidiabetics, antibiotics, and analgesics/sedatives. The length of stay and presence of renal or respiratory failure were significantly associated with an increased number of ADEs. The length of stay and female sex were significantly associated with the likelihood of developing an ADE. Conclusion: Critically ill patients with cancer are at high risk of developing ADEs. Strategies that reduce the incidence and severity of ADEs are essential to improve the outcomes of this patient population.

Adverse drug events resulting in admission to the intensive care unit in oncology patients: Incidence, characteristics and associated cost

Purpose: Describe the incidence, characteristics and cost of adverse drug events that necessitate admission to the intensive care unit in oncology patients. Methods: This was a prospective observational 5-months study at a medical/surgical intensive care unit of a comprehensive teaching cancer center. Patients admitted to the intensive care unit were screened to determine whether the admission was due to an adverse drug event. The adverse drug events were characterized based on the suspected medication, system involved and preventability. Patient demographics, length of stay, mortality and the total patient charges during their intensive care unit stay were recorded. Results: During the study period, 249 patients were screened and an adverse drug event was the primary cause of 57 (22.9%) admissions. The most common medications associated with an adverse drug event requiring intensive care unit admission were antineoplastics (n = 37), analgesics (n = 9) and anticoagulants (n = 4). Ten adverse drug events were considered preventable. The average length of stay for patients with adverse drug events resulting in intensive care unit admission was 6.2 days ±9.8 (SD) and the mortality rate was 28.1%. Hematological malignancy was independently associated with adverse drug events resulting in intensive care unit admission. The average patient charges for the intensive care unit stay was US

Characteristics and Outcomes of Acinetobacter baumannii Infections in Critically Ill Patients with Cancer: A Matched Case-Control Study

11,692 ± 17,529 (SD), which corresponded to about US

Cigarette smoking among Jordanian adults

1.5 million in annual patient charges for a 12-bed intensive care unit at a cancer institution. Conclusions: Adverse drug events resulting in intensive care unit admission in oncology patients are common and often associated with significant morbidity, mortality, and cost.

High-dose colistin for microbiologically documented serious respiratory infections associated with carbapenem-resistant Acinetobacter baummannii in critically ill cancer patients: a retrospective cohort study

AIM To describe the characteristics and outcomes of Acinetobacter baumannii (AB) infections in critically ill cancer patients and to evaluate the impact of AB on mortality and length of stay (LOS). RESULTS In a 4-year case-control study of critically ill cancer patients, we identified 161 patients with AB infections and 232 matched patients who were treated in the intensive care unit (ICU) during the same time period, but had no AB cultures. The case and control groups were matched for APACHE II, age, gender, type of malignancy, and mechanical ventilation. Most AB isolates were carbapenem-resistant (n=142, 88.2%). The majority of positive cultures were collected from the respiratory tract (58%) and blood (21.8%). The median ICU LOS and mortality rate for patients with AB infections were higher than those for the control group (12 days [IQR 6-23] vs. 3 days [IQR 1-7], p<0.0001 and 73.3% vs. 61.5%, p=0.015, respectively). AB infection was independently associated with ICU LOS and mortality: OR 1.108 (95% CI, 1.077-1.139), OR 1.658 (95% CI, 1.017-2.703), respectively. CONCLUSION AB infections in critically ill cancer patients were independently associated with increased mortality and increased ICU LOS. Measures to improve the outcomes of critically ill cancer patients infected with AB are necessary.

The effect of habitual waterpipe tobacco smoking on pulmonary function and exercise capacity in young healthy males: A pilot study

The objectives were to determine the rate of cigarette smoking and correlates of its use among a sample of Jordanian adults (N = 600). A survey-based, cross-sectional study was conducted with a convenient sample. Logistic regression was used to determine predictors of being a cigarette smoker. Approximately half of the population (45%) had smoked a cigarette in the past month, 40% in the past week, and 36% in past 24 hours. These findings underscore the magnitude of the smoking problem in the Jordanian population and the urgent need for effective interventions. Future research should focus on developing interventions that incorporate the predictors identified.

Predictors of Intention to Quit Cigarette Smoking among Jordanian Adults

Abstract Background: Recent studies suggested that high doses of colistin are necessary in the treatment of serious infections. However, few studies have evaluated such treatment. The objective of this study was to evaluate the effectiveness and nephrotoxicity of high-dose colistin in critically ill patients with respiratory infections associated with carbapenem-resistant Acinetobacter baumannii (CRAB). Methods: This was a retrospective cohort study of critically ill cancer patients who received high-dose intravenous colistin for treatment of CRAB-related respiratory infections. Patients received colistimethate sodium 9 million IU/day or an equivalent dose, adjusted for renal function. Treatment effectiveness was evaluated by determining the microbiological clearance, recurrent and new CRAB-related infections, and mortality in the intensive care unit (ICU). Nephrotoxicity was defined according to the RIFLE (risk, injury, failure, loss, and end-stage kidney disease) criteria. Results: A total of 89 patients met the inclusion criteria. Microbiological clearance was observed in 51 (66.2%) subjects who had at least 2 follow-up cultures (n = 77). In patients who achieved microbiological clearance, recurrent and new CRAB-related infections occurred in 3 (5.9%) and 9 (17.6%) subjects, respectively. Fifty-seven patients (64%) died in the ICU. Thirty-five (39.3%) subjects developed nephrotoxicity according to the RIFLE criteria, which was classified as risk in 4 (11.4%) subjects, injury in 8 (22.8%) subjects, and failure in 21 (60%) subjects. Conclusions: In critically ill cancer patients, high-dose colistin was associated with microbiological clearance in about two-thirds of the subjects with CRAB-related respiratory infections but mortality was high. A significant portion of patients developed nephrotoxicity while receiving colistin therapy.