Georges Khayat

Lower Prevalence of Cigarette and Waterpipe Smoking, But a Higher Risk of Waterpipe Dependence in Lebanese Adult Women Than in Men

The objective of this study was to evaluate whether nicotine dependence was higher in Lebanese women smokers compared with men smokers. Data were taken from a national cross-sectional study. Lebanese residents aged ≥ 40 years were enrolled between October 2009 and September 2010. After informed consent, participants answered a standardized questionnaire about smoking behaviors and dependence (measured by the Fagerström-Test-Nicotine-Dependence for cigarettes and the Lebanon-Waterpipe-Dependence-Scale 11 for waterpipes): 1,066 males and 1,134 females were interviewed. 58.7% versus 42.9% of them, respectively, ever smoked cigarettes, while 6.9% versus 6.7% ever smoked a waterpipe (p < 0.001). Moreover, 57.5% in male versus 49.1% in female cigarette smokers (p = 0.041), 35.9% versus 51.6% in waterpipe smokers (p = 0.076), and 67.9% versus 43.6% in mixed smokers were tobacco dependent. A dose-effect relationship was observed with increased rates of women versus men with waterpipe dependence) and an increased odds of dependence among women in multivariable analysis (ORa = 2.28). Positive (smoking waterpipe for pleasure and conviviality) and negative (smoking waterpipe to relax nerves and improve morale) reinforcements were significantly more frequent in women, while no significant sex difference was observed for nicotine dependence or psychological craving. In exclusive waterpipe smokers, significantly higher respiratory diseases and symptoms prevalences were found in females compared with males. Women who smoke waterpipes should receive attention during tobacco health education and smoking cessation.

Prediction of the survival and functional ability of severe stroke patients after ICU therapeutic intervention

BackgroundThis study evaluated the benefits and impact of ICU therapeutic interventions on the survival and functional ability of severe cerebrovascular accident (CVA) patients.MethodsSixty-two ICU patients suffering from severe ischemic/haemorrhagic stroke were evaluated for CVA severity using APACHE II and the Glasgow coma scale (GCS). Survival was determined using Kaplan-Meier survival tables and survival prediction factors were determined by Cox multivariate analysis. Functional ability was assessed using the stroke impact scale (SIS-16) and Karnofsky score. Risk factors, life support techniques and neurosurgical interventions were recorded. One year post-CVA dependency was investigated using multivariate analysis based on linear regression.ResultsThe study cohort constituted 6% of all CVA (37.8% haemorrhagic/62.2% ischemic) admissions. Patient mean(SD) age was 65.8(12.3) years with a 1:1 male: female ratio. During the study period 16 patients had died within the ICU and seven in the year following hospital release.The mean(SD) APACHE II score at hospital admission was 14.9(6.0) and ICU mean duration of stay was 11.2(15.4) days. Mechanical ventilation was required in 37.1% of cases. Risk ratios were; GCS at admission 0.8(0.14), (p = 0.024), APACHE II 1.11(0.11), (p = 0.05) and duration of mechanical ventilation 1.07(0.07), (p = 0.046). Linear coefficients were: type of CVA – haemorrhagic versus ischemic: -18.95(4.58) (p = 0.007), GCS at hospital admission: -6.83(1.08), (p = 0.001), and duration of hospital stay -0.38(0.14), (p = 0.40).ConclusionTo ensure a better prognosis CVA patients require ICU therapeutic interventions. However, as we have shown, where tests can determine the worst affected patients with a poor vital and functional outcome should treatment be withheld?

Waterpipe Smoking and Dependence are Associated with Chronic Obstructive Pulmonary Disease: A Case-Control Study

Waterpipe (WP) smoking is gaining in popularity in the Lebanese population. Although WP smokers are potentially exposed to the same noxious substances found in cigarettes, popular belief considers WP smoking harmless. Our objective was to evaluate the association between WP smoking, dependence and COPD. We conducted a case-control study in two tertiary care hospitals. Cases were included if diagnosed as COPD by a chest physician and confirmed by a post-bronchodilator spirometry (FEV1/FVC<0.7); controls were included if free of any respiratory disease or symptom. After an oral informed consent, a standardized questionnaire was administered and spirometry results were collected by trained technicians. 211 COPD cases and 554 healthy controls were enrolled. In previous smokers, any type of smoking was associated with COPD: OR=28.3 (p<0.001) for cigarette smoking, OR=12.2 (p<0.001) for waterpipe smoking, and OR=41.9 (p<0.001) for mixed smoking. Lower odds ratios were found in current smokers: OR =19.6 (p<0.001) for cigarette smoking, OR=1.8 (p=0.299) for waterpipe smoking and OR=9.5 (p<0.001) for mixed smoking. However, assessing WP dependence by the validated LWDS-11 scale in current WP smokers, found an OR=15.0 (p=0.001) for the association between WP dependence and COPD. These results were confirmed by stratified and multivariate analysis, after adjustment for cigarette smoking and other potential confounding variables. This is the first study that looked at the relation between COPD and WP smoking, and that showed a high risk of COPD in ex-smokers of WP. In current smokers of WP, dependent individuals have an increasing risk of COPD, as much as cigarette smokers.

Correlates of COPD and chronic bronchitis in nonsmokers: data from a cross-sectional study

Purpose Our objective was to assess the prevalence of chronic bronchitis and chronic obstructive pulmonary disease (COPD) and their correlates among a Lebanese nonsmoker group. Material and methods A cross-sectional study was conducted between October 2009 and September 2010, using a multistage cluster sample throughout Lebanon including Lebanese residents aged 40 years and above with no exclusion criteria. Pre- and postbronchodilator spirometry measurements were performed and carbon monoxide level was measured in exhaled air. COPD was defined and classified according to the Global Initiative for Chronic Obstructive Lung Disease guidelines or according to the lower limit of normal (forced expiratory volume in 1 second/forced vital capacity postbronchodilator < 5th percentile of the healthy population having the same age and sex). Chronic bronchitis was defined by the declaration of morning cough and expectorations for more than 3 months a year over more than 2 years in individuals with normal spirometry. Results Out of 2201 individuals, 732 were never-smokers: 25 (3.4%) of them had COPD, and 86 (11.75%) fulfilled the definition of chronic bronchitis. Correlates of COPD included a childhood respiratory disease, house heated by diesel, and older age. On the other hand, correlates of chronic bronchitis included childhood respiratory diseases, living in southern Lebanon versus other regions, heating home by gas, older age, number of smokers at work, and lower height. Conclusion A substantial percentage of the nonsmoking population may exhibit chronic bronchitis or COPD. The significant correlates mentioned above should be taken into consideration in order to reduce the risk of developing such chronic and debilitating respiratory diseases.

Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

Background: Diagnosing chronic obstructive pulmonary disease (COPD) without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD. Methods: Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD), which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms. Results: We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%). The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity. Conclusion: In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.

Validation of the respiratory toxics exposure score (RTES) for chronic obstructive pulmonary disease screening

ObjectiveOur aim is to evaluate the validity of exhaled carbon monoxide (CO) and of a newly-created score as markers of Chronic Obstructive Pulmonary Disease (COPD).Materials and MethodsThe CO level was measured in a derivation subsample of a cross-sectional study and linked to COPD diagnosis; its predictors were evaluated, and a scale was constructed. It was evaluated in a validation subsample and in a clinical setting.ResultsIndividuals with COPD had higher CO levels than healthy individuals. CO level significant predictors were cigarettes per day, waterpipes per week, lower age, male gender, living close to diesel exhaust, heating home with the use of diesel, and having indoor family smokers. A score composed of CO predictors was able to significantly predict COPD (Ora = 4–7.5).ConclusionsCoupled with the clinical judgment of physicians, this scale would be an excellent low-cost tool for screening COPD, in absence of spirometry.

Validation de la version arabe de l’échelle de somnolence d’Epworth : étude multicentrique

OBJECTIVES The Epworth Sleepiness Scale (ESS) is a self-completion questionnaire developed in the English language and used for the evaluation of sleepiness. The objective of this study was to develop an Arabic version of ESS (AESS) and to investigate its reliability and the validity. METHODS The AESS was created according to the recommendations of the ISPOR Task Force for Translation and Cultural Adaptation with bilingual individuals. It was applied to 91 patients referred to three sleep Lebanese centers for suspicion of sleep-related breathing diseases, and to 166 controls in good health. AESS scores of 60 patients were compared to 60 matched controls according to their age, sex and body mass index. Reproducibility was tested in 30 controls. The treatment response was tested among 15 patients after one month of CPAP treatment. RESULTS Principal component analysis showed convergence towards only one latent factor. The AESS had a good internal consistency (Cronbachs alpha 0.76, intraclass correlation coefficient of 0.85 (IC95%: 0.76-0.92), Spearman 0.97, P<0.001). An increase in the severity of sleep apnea was accompanied by an increase in the score on the AESS (P<0.001). AESS scores improved significantly after CPAP. CONCLUSION The AESS, a reliable and valid instrument for the evaluation of daytime sleepiness, is a valuable tool for clinical practice and multicenter research.

The Lebanese Cigarette Dependence (LCD) Score: a Comprehensive Tool for Cigarette Dependence Assessment

BackgroundCigarette smoking induces dependence.PurposeThe primary objective of this work was to validate the use of the Fagerström test for nicotine dependence (FTND) in the Lebanese population, and to broaden it eventually by adding new items covering DSM-IV and ICD-10 dependence components.MethodsWe used data from two samples: a cross-sectional national study and a case–control study. A standardized questionnaire was administered, with items related to cigarette dependence: the FTND and the new Lebanon Cigarette Dependence (LCD) scale. For both tools, an exploratory factor analysis was performed on sample 1, while confirmatory factor analysis was performed on sample 2.ResultsAlthough the FTND test showed satisfactory psychometric properties, the LCD showed better validity and reliability, covered dependence concept better, and showed a higher correlation with the number of times the participant tried to stop smoking (r = −0.087; p = 0.029 versus r = −0.215; p < 0.001).ConclusionsFTND could be used in the Lebanese population; however, the LCD scale may be more useful.

Telomerase as a potential marker for inflammation and cancer detection in bronchial washing: a prospective study.

OBJECTIVES The diagnosis of lung cancer remains difficult especially in peripheral tumors, given the absence of relevant markers and of sensitive imaging techniques. Telomerase is a ribonucleotide enzyme responsible for the immortalization of cancerous cells and seems to increase in bronchial aspirates of lung cancer patients. The purpose of our study is to further investigate the value of telomerase measurement in bronchial aspirates as a diagnostic tool for lung cancer. DESIGN AND METHODS Random 82 bronchial aspirates were obtained from patients undergoing bronchoscopy to diagnose any lung illness including inflammation and cancer. Cytology examination, quantification of proteins by Bradford method, and telomerase activity measurement by quantitative Real-time PCR were performed. Out of 82 specimens, 11 were excluded because of hemolysis, absence of elements or lack of final diagnosis. ROC curve analysis was done. RESULTS A significant difference in telomerase activity average was noted between normal patients and those with inflammation and cancer. Discriminatory capacity of telomerase activity was: for cancer vs. non cancer, AUC =0.74 (95% CI: 0.62-0.84), sensitivity=78%, specificity=72%, Negative Predictive Value=87%, at cut-off >0.46 atmol/mg protein/20 min; for cancer vs. normal, AUC=0.87 (95% CI: 0.72-0.96), se=78%, sp=92%, NPV=71%, at cut-off >0.46; for cancer vs. inflammation, AUC=0.69 (95% CI: 0.55-0.80), se=74%, sp=70%, NPV=79%, at cut-off >1.03, and for inflammation vs. normal, AUC=0.76 (95% CI: 0.62-0.88), se=79%, sp=77%, NPV=59%, at cut-off >0. CONCLUSION Telomerase activity in bronchial aspirates is a promising diagnostic marker for lung cancer and inflammation detection.

A randomized double-blind controlled trial comparing three sedation regimens during flexible bronchoscopy: Dexmedetomidine, alfentanil and lidocaine

No standardized sedation protocol is available for flexible bronchoscopy (FB).