Tobacco use by university students,Lebanon, 2001

Aims The objective was to determine the prevalence of smoking [cigarettes and/or narghile (i.e. water‐pipe)] among university students and to examine multiple correlates. Design Cross‐sectional. Setting Beirut, Lebanon. Participants A proportionate random sample of 1964 students from public and private universities in Beirut, Lebanon. Measurements Participants completed a self‐administered anonymous questionnaire that included demographic and scholastic items and health behavioral aspects, including smoking, alcohol, physical activity, weight control measures and seat belt use. Findings The overall prevalence of smoking was 40% (21.1%, 7.6% and 11.3% of the students were smoking only narghile, only cigarettes and both cigarettes and narghile, respectively). Regression analyses showed that males, those of non‐Lebanese origin, pursuing undergraduate degrees, performing risky weight control measures and drinking excessive amounts of alcohol had increased odds of smoking cigarettes. Also, age, high level of paternal education and field of study were significant predictors. Narghile smoking was significantly higher among males who drank excessive alcohol. Conclusions The authors advocate a collaborative effort to alleviate the consequences of smoking among university students.     

The Effects of Stabilization and Mckenzie Exercises on Transverse Abdominis and Multifidus Muscle Thickness,Pain, and Disability: A Randomized Controlled Trial in NonSpecific Chronic Low Back Pain

[Purpose] This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.Key words: Chronic low back pain, Stabilizaton exercises, Muscle thickness     

Clinical and laboratory findings in Iranian children with cyclic neutropenia

Cyclic neutropenia is a rare immunodeficiency syndrome, characterized by regular periodic oscillations in the circulating neutrophil count from normal to neutropenic levels through 3 weeks period, and lasting for 3-6 days. In order to determine the clinical features of cyclic neutropenia, this study was performed. Seven patients with cyclic neutropenia (3 males and 4 females), who experienced neutropenic periods every 3 weeks (5 with severe and 2 with moderate neutropenia), were investigated in this study. They had been referred to Iranian Primary Immunodeficiency Registry during 23 years (1980-2003). The range of patients' ages was from 7 to 13 years (median 11 years). The median age at the onset of the disease was 12 months (1 month- 2 years) and the median age of diagnosis was 2 (1.5-5) years, with a median diagnosis delay of 1 year (2 months- 5 years). Neutropenia was associated with leukopenia (3 patients), anemia (3 patients), and thrombocytopenia (1 patient). Patients were asymptomatic in healthy phase, but during the episode of neutropenia suffered from aphthous ulcers, abscesses and overwhelming infections. The most commonly occurred manifestations were: otitis media (6 cases), oral ulcers (5 cases), abscesses (4 cases), pneumonia (3 cases), diarrhea (3 cases), oral candidiasis (3 cases), cutaneous infections (2 cases), and periodontitis (2 cases). One of these patients subsequently died because of recurrent infections. Unusual, persistent or severe infections should be the initiating factors to search for an immune deficiency syndrome such as cyclic neutropenia, because a delay in diagnosis may result in chronic infection, irretrievable end-organ damage or even death of the patient.     

Racial Differences in Disease Activity and Quality of Life in Patients with Crohn’s Disease

Background

The existing literature on racial differences in Crohn’s disease (CD) activity and quality of life (QOL) is limited and extrapolated from surrogate measures.

Aim

The aim of our study was to compare objective markers of disease activity and QOL over time by race.

Study

A clinical data repository of inflammatory bowel disease (IBD) patients at University of Maryland, Baltimore IBD Program, was used. CD patients from 2004 to 2009 were included if they had greater than or equal to two clinic visits with disease activity and QOL scores during the study period. Differences in disease activity and QOL were compared by race over time.

Results

A total of 296 patients with CD met inclusion criteria; of these, 19 % (56/296) were African Americans (AA) and 81 % (240/296) were Caucasian. Baseline disease activity and QOL scores did not differ by race (p > 0.05). Caucasians had a steady decline in disease activity and increase in QOL. AA experienced a similar pattern of change in disease activity and QOL scores over time; however, the declines were not statistically significant between groups. At each time point post-baseline, disease activity and QOL scores were similar between races.

Conclusion

We found that Caucasian and AA patients with CD had similar disease activity and QOL scores at initial presentation and over time. Thus, AA do not represent a more severe subgroup of CD patients to treat. These findings have important implications for clinicians that care for patients with CD.     

Comparison between molecular epidemiology, geographical regions and drug resistance in Mycobacterium tuberculosis strains isolated from Iranian and Afghan patients

The aim of this study was to determine the prevalence of drug-resistant tuberculosis (TB) and its associated risk factors. The susceptibilities of Mycobacterium tuberculosis isolates were tested against four first-line antituberculous drugs and were typed by spoligotyping. Spoligotyping of M. tuberculosis strains resulted in 95 different patterns that were divided into three evolutionary groups (1-3). Eighty-six (90%) of the isolates had unique patterns that were reported for the first time. Interestingly, 9.4% of the strains belonged to the Beijing family. Multidrug resistance (MDR) was seen in group 1 of the evolutionary scenario. All M. tuberculosis isolates belonging to the Beijing family were associated with a resistance pattern. MDR was much higher in bacteria isolated from Afghan TB patients residing in Iran.     

Vaccination and skin test studies on the children of leprosy patients

In an attempt to achieve maximal skin-test positivity to leprosin A in children of leprosy patients living in Baba Baghi Leprosy Sanatorium in Iranian Azerbaijan, two new vaccines have been employed. Children without scars of previous BCG and without response to leprosin A were given a vaccine containing 10(8) viable units of BCG Glaxo plus 10(7) killed Mycobacterium vaccae per dose (vaccine B). Children with BCG Pasteur (Teheran) scars but without response to leprosin A were given a vaccine containing 10(8) killed M. vaccae alone (vaccine D). Eight years later skin testing was repeated, and both new vaccines were found to have significantly increased the numbers of children responding to leprosin A above the level that would have been expected had they received BCG Pasteur alone. This increase was due in large part to increases in the proportions of individuals responding to group i (common mycobacterial) antigens, and known as category 1 responders. The use of suspensions of killed M. vaccae in conjunction with BCG may represent a considerable advance in inducing protection from multibacillary leprosy in close contacts of leprosy patients if leprosin A positivity is truly a correlate of protective immunity. A comparison, using the same criteria, with the other proposed vaccines for leprosy would be very interesting.     

Celiac disease in Middle Eastern and North African countries: A new burden?

Celiac disease(CD) is now recognized as a common disorder among Middle Eastern(ME) and North African(NA) populations.The aim of this review is to assess the available data regarding CD in the ME and NA and to compare this information with that of Western countries.A literature review was performed using the electronic databases PubMed and Medline(1950-2008) as search engines,and “celiac disease“ was used as a Mesh term.The search was limited to ME and NA countries.The prevalence of CD in ME and NA countries...     

Enteric Nervous System in the Small Intestine: Pathophysiology and Clinical Implications

The digestive system is endowed with its own, local nervous system, referred to as the enteric nervous system (ENS). Given the varied functions of small intestine, its ENS has developed individualized characteristics relating to motility, secretion, digestion, and inflammation. The ENS regulates the major enteric processes such as immune response, detecting nutrients, motility, microvascular circulation, intestinal barrier function, and epithelial secretion of fluids, ions, and bioactive peptides. Remarkable progress has been made in understanding the signaling pathways in this complex system and how they work. In this article, we focus on recent advances that have led to new insights into small intestinal ENS function and the development of new therapies.     

Current Concepts of HBV/HCV Coinfection: Coexistence,but Not Necessarily in Harmony

Hepatitis B and hepatitis C are important causes of chronic liver disease globally. Although HBV/HCV coinfection is not uncommon, its epidemiology is poorly defined. Numerous studies provided evidence that coinfection accelerates liver disease progression and increases the risk of hepatocellular carcinoma. By applying new cell culture models to examine the interaction of both viruses, investigators concluded that HBV and HCV replicate in the same hepatocyte without interference. The roles of innate and adaptive immunity in determining the viral replication and disease outcomes still need rigorous investigation. To date, no standard-of-care recommendation exists for HBV/HCV coinfection. Pegylated interferon and ribavirin combination therapy demonstrated similar efficacy in suppressing HCV RNA in coinfection and HCV monoinfection. However, HBV reactivation during therapy can be a challenge. Future clinical trials evaluating the addition of a nucleoside/nucleotide analog for selective patients with HBV/HCV coinfection are essential for successful management of HBV/HCV coinfection.