Direct measurement of toxicants inhaled by water pipe users in the natural environment using a real-time in situ sampling technique.

While narghile water pipe smoking has become a global phenomenon, knowledge regarding its toxicant content and delivery, addictive properties, and health consequences is sorely lagging. One challenge in measuring toxicant content of the smoke in the laboratory is the large number of simplifying assumptions that must be made to model a "typical" smoking session using a smoking machine, resulting in uncertainty over the obtained toxicant yields. In this study, we develop an alternative approach in which smoke generated by a human water pipe user is sampled directly during the smoking session. The method, dubbed real-time in situ sampling (RINS), required developing a self-powered portable instrument capable of automatically sampling a fixed fraction of the smoke generated by the user. Instrument performance was validated in the laboratory, and the instrument was deployed in a field study involving 43 ad libitum water pipe use sessions in Beirut area cafés in which we measured inhaled nicotine, carbon monoxide (CO), and water pipe ma'ssel-derived "tar." We found that users drew a mean of 119 L of smoke containing 150 mg of CO, 4 mg of nicotine, and 602 mg of ma'ssel-derived "tar" during a single use session (mean duration = 61 min). These first direct measurements of toxicant delivery demonstrate that ordinary water pipe use involves inhaling large quantities of CO, nicotine, and dry particulate matter. Results are compared with those obtained using the Beirut method smoking machine protocol.

Volatile aldehydes in the mainstream smoke of the narghile waterpipe.

Very little is known about the quality and quantity of toxicants yielded by the narghile, a subject of increasing importance as this method of tobacco smoking has become popular all over the world. This study is concerned with the identification and quantification of volatile aldehydes in the gas and particle phases of mainstream narghile smoke generated using a popular type of flavored ma'ssel tobacco mixture. These compounds were analyzed based on a modified version of the Environmental Protection Agency compendium method TO-11A. Using a standardized smoking machine protocol consisting of 171 puffs, 2.6s puff duration and 17s inter puff interval, the average yields of formaldehyde, acetaldehyde, acrolein, propionaldehyde and methacrolein were 630, 2520, 892, 403, and 106 microg/smoking session, respectively. The results showed that none of the aldehydes identified in this study are found in the particulate phase of the smoke, except for formaldehyde for which the partitioning coefficient was estimated as Kp = 3.3 x 10(-8) microg/m3. Given previously reported lung absorption fractions of circa 90% for volatile aldehydes, the yields measured in this study are sufficient to induce various diseases depending on the extent of exposure, and on the breathing patterns of the smokers.

Electronic Cigarette Smoke Impairs Normal Mesenchymal Stem Cell Differentiation.

Electronic cigarettes (e-cigarettes) are promoted as low-risk alternatives to combustible cigarettes. However, the effects of chronic inhalation of potential toxicants emitted by ecigarettes remain largely unexamined. It is conceivable that smoking-induced chronic diseases result in cellular injury, in the absence of effective repair by stem cells. This study evaluates the effect of cigarette and e-cigarette aerosol extracts on the survival and differentiation of bone marrow-derived mesenchymal stem cells (MSCs). MSC growth and osteogenic differentiation were examined after exposure to smoke extracts. Data revealed detrimental effects of both cigarette and e-cigarette extracts on MSC morphology and growth. Levels and activity of alkaline phosphatase, an osteogenic marker, decreased and induction of osteoblastic differentiation was impaired. Both smoke extracts prevented osteogenic differentiation from progressing, evident by decreased expression of terminal osteogenic markers and mineralization. Elevated levels of reactive oxygen species (ROS) were detected in cells exposed to smoke extracts. Moreover, decreased differentiation potential was concomitant with severe down-regulation of Connexin 43 expression, leading to the loss of gap junction-mediated communication, which together with elevated ROS levels, could explain decreased proliferation and loss of differentiation potential. Hence, e-cigarettes present similar risk as combustible cigarettes with respect to tissue repair impairment.

Investigation of mainstream smoke aerosol of the argileh water pipe.

A first-generation smoking machine and protocol have been developed in order to study the mainstream smoke aerosol and elucidate thermal-fluid processes of the argileh water pipe. Results using a common mo'assel tobacco mixture show that, contrary to popular perceptions, the mainstream smoke contains significant amounts of nicotine, "tar" and heavy metals. With a standard smoking protocol of 100 puffs of 3 s duration spaced at 30-s intervals, the following results were obtained in a single smoking session: 2.25 mg nicotine, 242 mg nicotine-free dry particulate matter (NFDPM), and relative to the smoke of a single cigarette, high levels of arsenic, chromium and lead. It was found that increasing puff frequency increased the NFDPM but had little effect on nicotine delivery, while removing the water from the bowl increased by several-fold the nicotine, but had little effect on NFDPM. It was also found that the charcoal disk heat source contributed less than 2% of total particulate matter (TPM), and that characteristic temperatures of the tobacco varied from 450 degrees C nearest the heat source to 50 degrees C furthest away, indicating that the NFDPM is likely a result of devolatilization rather than chemical reaction, and will thus differ significantly in composition from that of cigarette smoke.

Third degree tears and episiotomy.

OBJECTIVE: To investigate the relation of episiotomy to third degree perineal tears, and to detect the rate, indications and risk factors of both episiotomy and third degree perineal tears. METHODS: Between 1994 and 1999, 17,559 singleton vaginal deliveries were retrospectively investigated to find frequency, risk factors and relation of episiotomy to third degree Perineal tears. To avoid the affect of confounding factors, we analyzed a sub-sample that included only vertex presentation with spontaneous occipito-anterior vaginal deliveries. RESULTS: The incidence of episiotomy was 39%. Third degree tears occurred in 1% of the deliveries with episiotomy in 0.2% of the deliveries without episiotomy. Third degree tears were more commonly occurred in primiparae, instrumental deliveries, episiotomy, and birth weight more than 4 kg. After stratification for birth weight and parity, no relation between episiotomy and third degree tear was found. CONCLUSION: In uncomplicated deliveries, no significant relation between third degree perineal tear and episiotomy was found.

Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity.

To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Ala Hospital, Jordan were compared. Data included parity, gestational age, infant birthweight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction (caput, jaundice, cephalohaematoma). Serous neonatal morbidity was rare for both groups.

A study on particles and some microbial markers in waterpipe tobacco smoke.

Waterpipe smoking is becoming increasingly popular worldwide. Research has shown that cigarette smoke, in addition to hundreds of carcinogenic and otherwise toxic compounds, may also contain compounds of microbiological origin. In the present study we analyzed waterpipe smoke for some microbial compounds. Both of the two markers studied, viz 3-hydroxy fatty acids of bacterial lipopolysaccharide (LPS) and ergosterol of fungal biomass, were found in waterpipe tobacco, in amounts similar as previously found in cigarette tobacco, and in smoke. Waterpipe mainstream smoke contained on average 1800 pmol LPS and 84.4 ng ergosterol produced per session. An average concentration of 2.8 pmol/m(3) of LPS was found in second hand smoke during a 1-2-h waterpipe smoking session while ergosterol was not detected; corresponding concentrations from smoking five cigarettes were 22.2 pmol/m(3) of LPS and 87.5 ng/m(3) of ergosterol. This is the first time that waterpipe smoking has been shown to create a bioaerosol. In the present study we also found that waterpipe smoking generated several polycyclic aromatic hydrocarbons, carbon monoxide, and high fraction of small (<200 nm) particles that may have adverse effects on human health upon inhalation.

The value of treating the male partner in vaginal candidiasis.

OBJECTIVE: To determine whether treatment of the sexual partners of women with vulvo-vaginal candidiasis with oral Ketoconazole can affect the cure and recurrence rate of candida vaginitis. METHODS: A total number of 144 women with vaginal candidiasis were treated with Ketoconazole 400 mg daily for 7 days, and half the male partners were treated with Ketoconazole 400 mg daily for 7 days. All women had physical follow-up examination, and mycological cultures were obtained at one week and four weeks after the start of treatment. The incidence of predisposing factors or of a recurrence history did not differ between treatment groups. Chi-square test was used to determine the significance of difference between the two groups with or without simultaneous treatment of the male partners. RESULTS: In the control group (untreated partners) 53 of 72 patients were cured after one week, with a cure rate of 74%, compared to 57 of 72 patients (treated partners) with a cure rate of 79%. The recurrence rate in the control group (untreated partners) 4 weeks after the start of treatment was 28 of 53 (53%), compared to 35 of 57 (61%) in the (untreated partners) group. No significant statistical difference was found in the cure and recurrence rates for both groups. CONCLUSION: Simultaneous treatment of the male partners with Ketoconazole did not influence either cure rate or recurrence rate in women with vaginal candidiasis.

Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity

To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Alia Hospital, Jordan were compared. Data included parity, gestational age, infant birthweight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction [caput, jaundice, cephalohaematoma]. Serious neonatal morbidity was rare for both groups