Mirna Waked

Water-pipe (narguile) smokers in Lebanon: a pilot study.

We carried out a comparative study to assess the demographic and social characteristics of water pipe (WP) smokers, the association with cigarette smoking and chronic respiratory diseases and the dependence profile on 4 groups: exclusive WP smokers, exclusive cigarette smokers, mixed smokers and absolute non-smokers. Cigarette smoking was statistically significantly higher in WP smokers than non-WP smokers; 36.5% of exclusive WP smokers smoked > or =7 WPs/week. Chronic respiratory disease and chronic bronchitis were reported more frequently in exclusive WP smokers than absolute non-smokers. WP smoking seems to be as great a risk factor as cigarette smoking for chronic respiratory disease.

Respiratory diseases and pesticide exposure: a case-control study in Lebanon

Study objective: To evaluate the odds of being exposed to pesticides in asthmatic adults. Design: A case-control study was performed in Lebanon. Setting: People were approached when consulting physicians as outpatients. Patients: Asthmatic patients and non-asthmatic controls in several Lebanese hospitals were interviewed. Main results: The study included 407 subjects from 10 medical centres. Any exposure to pesticides was associated to asthma (OR = 2.11 (1.47 to 3.02); p<10−4). Occupational use presented the highest association (OR = 4.98 (1.07 to 23.28); p = 0.02), followed by regional exposure (OR 3.51 (2.11 to 5.85); p<10−4). Results were confirmed by multivariate analysis, particularly for regional exposure (ORa = 2.78; p = 0.02) and house exposure (ORa = 2.17; p = 0.001). Conclusions: Results are comparable to those found in other studies; especially for occupational exposure. Pesticides toxicological effects may explain chronic respiratory symptoms and asthma associations found with all exposure types. Pesticide exposure was associated with asthma in Lebanese adults.

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.

Waterpipe dependence in university students and effect of normative beliefs: a cross-sectional study

Objectives The objective of this study was to measure the correlates, including normative beliefs, associated with waterpipe (WP) and cigarette smoking prevalence and dependence. Setting A cross-sectional study was carried out using a proportionate cluster sample of Lebanese students in 17 public and private universities. Participants Of the 4900 distributed questionnaires, 3384 (69.1%) were returned to the field worker. All available students during break times were approached, with no exclusion criteria. Primary and secondary outcome measures sociodemographic variables, detailed active and passive smoking, in addition to items of the tobacco dependence scales were all evaluated. Results Correlates to WP smoking were studying in a private university (adjusted OR, aOR=1.50 (1.26 to 1.79); p<0.001) and ever smoking cigarettes (aOR=1.80(1.44 to 2.26); p<0.001); friends’ and societal influence were found on smoking behaviour and dependence. Although the role of parents was not visible in decreasing the risk of smoking WP, their protective influence seemed more important on WP dependence (β=−1.09(−1.79 to −0.28); p<0.001), a behaviour that is considered more deleterious for health. Parents’ and friends’ disagreement with smoking had a protective effect on cigarette smoking and dependence (aOR<1; p<0.01), while thinking that idols and successful people smoke increased the risk of both cigarette smoking and dependence (aOR>1; p<0.01). Conclusions In conclusion, WP smoking and dependence are influenced by parents’ and friends’ opinions, and idols’ smoking status. Future research is necessary to further improve our understanding of motives for WP smoking and dependence.

Assessment of health risk behaviours among university students: a cross-sectional study in Lebanon

There are insufficient data concerning health risk behaviours of university students in the Middle East, particularly Lebanon. Our objective was to identify health risk factors among university students in Lebanon, focusing on preventable behaviours. A cross-sectional study was carried out, using a proportionate cluster sample of Lebanese students in public and private universities. A standardised questionnaire was distributed across university campuses. Data concerning socio-demographic characteristics, toxic substances consumption (including tobacco, alcohol and illicit drugs), nutrition and sedentarity behaviours, in addition to sexual behaviours, were collected. Among 3384 participants, 20% were current cigarette smokers, while 23% were current waterpipe smokers and 33.5% declared consuming alcohol. Higher rates were found for smoking and alcohol consumption in private versus public universities (p < 0.001). Participants also reported a very low consumption of fruits and vegetables. Moreover, 31% of boys and 8.6% of girls declared having regular sexual activity; among them, 41% of boys and 26% of girls declared using a condom regularly. Substantial proportions of university students in Lebanon adopt risky behaviours for health, particularly in private universities. Health-promotion activities should be established to decrease the occurrence of these behaviours and prevent their future adverse health outcomes.

Asthma, allergic rhinitis and eczema in 5–12-year-old school children across Lebanon

OBJECTIVES To determine the prevalence of asthma, allergic rhinitis and eczema in Lebanese children. STUDY DESIGN Descriptive cross-sectional study on children in public and private schools in Lebanon. METHODS Standardized written questionnaires were distributed to 5-12-year-old students at 22 schools. RESULTS In total, 3909 individuals were analysed. The prevalence of diagnosed asthma (4.8%) was low, while the prevalence of allergic rhinitis was 21.2% and that of eczema was 11.8%. Marked variations and differences were found across the governates in Lebanon, with the lowest prevalence of diagnosed asthma (1.8%) in Bekaa and the highest prevalence in Beirut (11.6%). CONCLUSION Asthma symptoms, rhinitis and eczema have medium prevalence in Lebanon compared with worldwide data. Compared with other countries in the Eastern Mediterranean Region, the prevalence of 12 months of wheezing, night cough and wheezing on exercise were highest in Lebanon, but were much lower compared with English-speaking countries. Further studies are needed to understand the environmental, climatic and socio-economic causes of these discrepancies.

Community- and healthcare-associated infections in critically ill patients: a multicenter cohort study

OBJECTIVE To compare the spectrum of infection, comorbidities, outcomes, and mortality of patients admitted to the intensive care unit (ICU) due to community-acquired or healthcare-associated severe sepsis. METHODS This prospective cohort study was conducted in three university medical centers in Lebanon from February 2005 to December 2006. Patients with severe sepsis were included and followed up until hospital discharge or death. RESULTS One hundred and twenty patients were included of whom 60% had community-acquired infections (CAI) and 40% had healthcare-associated infections (HAI). The most common infection in both groups was pneumonia. Hematologic malignancies were the only comorbidity more prevalent in HAI than in CAI (p=0.047). Fungal infections and extended-spectrum beta-lactamase (ESBL) organisms were more frequent in HAI than in CAI (p=0.04 and 0.029, respectively). APACHE and SOFA scores were high and did not differ between the two groups, nor did the proportion of septic shock, while mortality was significantly higher in the HAI patients than in the CAI patients (p=0.004). On multivariate analysis for mortality, independent risk factors were the source of infection acquisition (p=0.004), APACHE II score (p=0.006), multidrug-resistant Pseudomonas infections (p=0.043), and fungal infections (p=0.006). CONCLUSIONS Severe sepsis and septic shock had a high mortality rate, especially in the HAI group. Patients with risk factors for increased mortality should be monitored and aggressive treatment should be administered.

Surfactant protein D, a clinical biomarker for chronic obstructive pulmonary disease with excellent discriminant values

Biological markers can help to better identify a disease or refine its diagnosis. In the present study, the association between surfactant protein D (SP-D) and chronic obstructive pulmonary disease (COPD) was studied among subjects consulting for respiratory diseases or symptoms and was compared with C-reactive protein (CRP) and fibrinogen. A further aim of this study was to identify the optimal cut-off point of SP-D able to discriminate COPD patients. A case-control study including 90 COPD patients, 124 asthma patients and 180 controls was conducted. Standardized questionnaires were administered and lung function tests were performed. Biological markers were measured in blood samples according to standardized procedures. The association between SP-D and COPD was investigated using logistic regression models. Receiver-operating characteristic curves were used for threshold identification. SP-D levels above the median value were positively associated with COPD [adjusted odds ratio (OR)=3.86, 95% confidence interval (CI): 1.51–9.85, P=0.005). No associations with COPD or asthma were found for CRP or fibrinogen levels. Scores for COPD diagnosis in all COPD patients or ever-smoker COPD patients were identified (sensitivity, 76.4 and 77.8%; specificity, 89.3 and 88.5%, respectively). The results indicate that SP-D can differentiate COPD from other respiratory symptoms or diseases. Used with socio-demographic characteristics and respiratory symptoms, SP-D is able to discriminate COPD patients from controls, particularly among smokers.

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.

Surfactant protein D multimerization and gene polymorphism in COPD and asthma

A structural single nucleotide polymorphism rs721917 in the surfactant protein D (SP‐D) gene, known as Met11Thr, was reported to influence the circulating levels and degree of multimerization of SP‐D and was associated with both COPD and atopy in asthma. Moreover, disease‐related processes are known to degrade multimerized SP‐D, however, the degree of the protein degradation in these diseases is not clarified. We aimed to determine the distribution of multimerized (high molecular weight (HMW)) and non‐multimerized (low molecular weight (LMW)) species of serum SP‐D and their correlation with genetic polymorphisms and presence of disease in Lebanese COPD and asthmatic patients.