Evaluation of the prevalence of waterpipe tobacco smoking and its related factors in Tehran, Islamic Republic of Iran

This study is designed to evaluate the prevalence of waterpipe tobacco smoking and its related factors among Iranian adults. This is a cross-sectional study carried out during 2013/14 in Tehran, Islamic Republic of Iran, among 1830 citizens aged over 15 years. Sampling was through Stratified multistage cluster sampling with proportional allocation within strata. Global Adult Tobacco Survey [GATS] questionnaire for waterpipe consumption was used for data gathering. Data were statistically analyzed by SPSS software. The prevalence of current waterpipe tobacco smoking was 17.6% .Waterpipe use prevalence in men was significantly more than women [24.2% vs. 11.3%]. Multivariate analysis showed that age, sex, cigarette consumption, waterpipe consumption at home and ignorance of safety issues significantly influenced current waterpipe smoking [P = 0.001]. Thus, prevalence of waterpipe smoking in Iranian adults is high and significant. Tackling waterpipe smoking should be considered in tobacco control programmes. However, further studies in this field are needed

Burden of obstructive lung disease study in Tehran: research design and lung spirometry protocol

Chronic obstructive pulmonary diseases [COPD] are planned to rank fifth in burden of disease and third with respect to mortality by 2020. Carrying out research regarding different aspects of COPD is mentioned as important health priorities by academic institutions and governments. The burden of lung disease [BOLD] Initiative was designed a decade ago to develop robust models that can be used to estimate the prevalence and current and future economic burden of COPD. The goal of the present project is to describe the prevalence and determining the causes and risk factors of COPD in the population of Tehran city. This cross sectional study follows a stratified cluster sampling strategy with proportional allocation within strata. The target population is all noninstitutionalized inhabitants, aged 18-40 in one group and over 40 in another, who inhabit in Tehran city. The stratification of the sample according to the 22 municipal districts of Tehran is incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. For each cluster, a team of three members approaches the index household, which is specified through the aforementioned random selection of clusters, and continues the enumeration in 10 neighbor households in a systematic manner. As a study protocol, there are no specific results to present; our purpose is to share our design with the scientific body. We expect that findings from the BOLD study in Tehran will show the status of COPD and its causes in the community

Relationship between XPD Lys 751 Gln polymorphism and colorectal cancer risk: a case-control study in a population-based study

In our study, we analyzed the allelic frequency of XPD Lys751Gln polymorphism of the XPD gene and the correlation between its variant alleles with colorectal cancer in patients and control groups. Human cells are routinely exposed to mutagenic and carcinogenic aromatic amines via smoking, pollution areas and other sources. These chemicals can form DNA adducts in vivo and thus lead to DNA damage. Amongst the known genetic polymorphisms of the DNA-repair genes the xeroderma pigmentosum group D [XPD, also known as ERCC2] has been the most extensively studied most commonly. This study has examined the relationship between the XPD Lys 751 Gin polymorphism and colorectal cancer in 88 patients and their 88 age and sex-matched controls. Genomic DNA from peripheral whole blood was extracted using Miller method to determine the genotype of subjects with RFLP-PCR analysis. This study shows cancer patients have more of the heterozygous genotype [XPD Lys 751 Gin] compared to control group. However the results are not statistically significant. Furthermore, colorectal cancer was less common in individuals with recessive homozygous genotype [P< 0.0001]. This study suggests that individuals with heterozygous polymorphism [Lys/Glri] may have an increased susceptibility to colorectal cancer compared to other polymorphisms [Lys/Lys and Gin/Gin]

Behavior and knowledge of Iranian professional athletes towards smoking

This study aimed to assess the rate of tobacco consumption among professional athletes in Iran and assessing their knowledge and attitude in this regard. A total of 738 athletes from 10 different types of sports were evaluated. Athletes were all members of the priority leagues. After obtaining consent from the Physical Education Organization and coordination with the related federations, athletes were asked to fill out the standard questionnaire. All understudy subjects were males. The mean age was 28.4 +/- 2.7 yrs. The mean age of initiation of sport in these subjects was reported to be 12.3 +/- 4.01 yrs. A total of 178 [24.6%] subjects had experienced cigarette smoking and 308 [42.3%] had experienced hookah smoking. Sixty four subjects [9%] were current smokers. The mean score of knowledge about hazards of smoking was 5.6 +/- 0.9 among those who had experienced smoking. This score was 7.9 +/- 0.5 among those with no smoking experience [P=0.04]. Rate of smoking among professional athletes is lower than general population average. So participation in organized sports may be a protective factor against tobacco use in people

Efficacy of harm reduction programs among patients of a smoking cessation clinic in Tehran, Iran

Background: Recently, harm reduction programs have been used to reduce mortality and morbidity among smokers. The main objective of this study was to evaluate the effect of harm reduction programs on the smoking patterns of subjects who presented to a smoking cessa-tion clinic in Tehran, Iran

Methods: This observational study was conducted between September 2008-September 2009 on 132 patients who were unable to quit smoking. Patients were enrolled by the first come first service method. During the study period, subjects were assigned to either group or individual visits every 15 days in conjunction with the use of nicotine gum. The main objective of this study was to evaluate at the third and sixth months of follow-up: the number of smoked cigarettes, level of expired carbon monoxide [CO], and numbers of nicotine gum used. Data were analyzed by the Wilcoxon rank, Fisher's exact, and Pearson's chi-square tests and SPSS version 17 software

Results: A total of 87.1% of the subjects were males. We noted decreases in the number of cigarettes smoked daily and the level of expired CO, whereas the amount of nicotine gum used significantly increased during the time interval between the first session and the third and sixth month follow-up visits [p<0.001 for all variables]. During the follow up sessions, 64.4% of subjects reduced the number of cigarettes they smoked daily by at least 50% and 12.9% of subjects quit smoking

Conclusion: Behavioral and pharmacological therapy in harm reduction programs result in a decrease in the number of cigarettes smoked daily and a reduction in the amount of expired CO. Therefore, these methods can be beneficial in achieving complete smoking cessation

Correlation between the pulmonary artery pressure measured in echocardiography and pulmonary artery diameter in the ct-scan of patients suffering from interstitial lung disease

Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required

Efficacy of nicotine patch in combination with trazodone in smoking cessation

Treatment for tobacco dependency involves a combination of behavioral therapy, antidepressants, and nicotine replacement therapy. This study was conducted in order to compare the outcome of smoking cessation by using each of the four forms of nicotine replacement therapy [NRT] among participants using Trazodone tablet 50 mg. In this non-randomized quasi-experimental study the efficacy of four mentioned forms of nicotine replacement therapy [NRT] including patches, gums and microtabs and two forms of NRT together was evaluated. Smoking cessation while using Trazodone was also studied. All the smokers who referred to the smoking cessation clinic of Iranian National Research Institute of Tuberculosis and Lung Diseases [NRITLD], Tehran, Iran from Oct. 2005 to Oct. 2007 entered the study. They attended 4 weekly sessions followed by 2 sessions in the next 12 months. A total of 286 subjects participated in this study. Trazodone was prescribed for them and 253 used at least one form of NRT. There were 181 [74.6%] males. The mean age was 42.43 +/- 13.4 yrs. Thirty three cases selected nicotine patches, 99[39.4%] used nicotine gums, 64[25%] chose microtabs and 57[23%] preferred using two types of NRT simultaneously. A total of 152 participants [60%] quit smoking at the fourth session. At the fourth session, it was proved that nicotine patches had the highest success rate and were most efficient for quitting smoking [94%]. Also, after 6 and 12 months follow-up it was found that nicotine patches were most effective for abstinence. Nicotine patches used in combination with Trazodone tablets could result in higher success rates for smoking cessation

relation between air pollution and cardiorespiratory admissions in Tehran

Air pollution is a major horror in many cities in Iran especially in Tehran. The cost of traffic congestion in the capital is put at two billion hours of time wasted each year. Tehran has also recorded SO[2] levels four times the standard prescribed by the World Health Organization. Tehran is the capital of the Islamic Republic of Iran with almost 11 million inhabitants [one sixth of the country's population], and is the most densely populated city of the country. The purpose of this research was to investigate the effects of air pollution on cardiorespiratory system. We assessed the relationship between the levels of air pollutants and emergency visits for asthma and cardiovascular diseases in Tehran, Iran. Two research questions investigated in this study were as follows: a] Which criteria elements of hazardous toxic air pollution were associated most strongly with the level of hospital admissions for cardiorespiratory conditions? b] What proportion of the variation in hospital admissions for cardiorespiratory conditions was explained by variations in levels of air pollution? During a 12-month period [from April 2004 to March 2005], the concentrations of 5 air pollutants [CO, NO[2], O[3], SO[2] and PM[10]] were measured in four stations located in north, west, south and central part of Tehran. The level of air pollution was calculated according to PSI [Pollution Standard Index]. Based on the results obtained during the study period, concentration of CO was reported as "above standard" on most of the days, leading to an "unhealthy" situation. 51.9% of measurements were made at PSI 300. For ozone [O[3]], all measurements were at standard conditions, PSI

Tobacco smoking pattern: cigarette vs. hookah

Smoking causes 5.2 million deaths annually in the world of which 70% occur in developing countries. Hookah smoking is increasing around the world especially in the Eastern Mediterranean Region including Iran. This study was carried out to evaluate the pattern of tobacco smoking in both forms of cigarette and hookah smoking. A cross- sectional study was conducted among a random population in the main squares of Tehran in 2006. The sample size consisted of 2053 people in the age range of 10 to 80 years. Non-Probability Sampling method was used. Questionnaires designed and adapted according to WHO and IUATLD questionnaires given to these people. Forty-six percent of the sample had experienced hookah smoking. The prevalence of occasional hookah smoking in the previous year was 45%, while 10% of the participants used hookah at least once a week, 17.9% at least once a month and 17.1% at least once a year;47.2% of participants had experienced cigarette smoking. Prevalence of daily cigarette smoking was 22.7%; 22.7% of current smokers and 25.01% of non-smokers consumed hookah at least once a week. Prevalence of hookah smoking is very similar among cigarette smokers and non-smokers. In this study the prevalence of cigarette smokers was more than national data and the rate of cigarette and hookah smoking among women was higher than that of other studies in this realm. These issues need to be further investigated and more serious studies are required in this regard

Knowledge regarding nutrition, attitude and practice of smokers and non-smokers

Generally, non-smokers have healthier lifestyles compared to smokers. Typical foods eaten more by nonsmokers are fruits and vegetables, whereas smokers eat more meat and fat and drink more alcoholic beverages. We aimed to compare nutritional knowledge, attitude and practice [KAP] of smokers participating in smoking cessation clinics with their non-smoker family members. Two hundred twenty-six smokers and 260 non-smokers aged 18 years and over were compared in a cross-sectional study. A Likert type KAP questionnaire including 36 items was used. Knowledge and attitude scores were compared between smokers and non-smokers using the Mann-Whitney test. Practice patterns were compared by the Chi-square test. Differences were significant at p =0.05 The mean age of male smokers and non-smokers were 38.5 +/- 11 and 33.5 +/- 14 years respectively and in women these rates were 42 +/- 10.4 and 31.3 +/- 15 yrs. respectively [p<0.0001]. In males, the mean percentage of knowledge in nonsmokers was higher than smokers [2.41 vs. 1.85] and the average score of attitude in smokers was less than that of nonsmokers [37.5 vs. 37.9; the differences were not significant]. Sixty [26.5%] smokers and 93 [35.8%] non-smokers reported having regular physical activity [p=0.005]. In women, the mean percentage of knowledge in non-smokers was higher than smokers [3.37 and 2.93 respectively; the difference was not significant]. Attitude score of female non-smokers was higher than smokers [40.3 vs. 37.1; p=0.001]. Among female non-smokers, 68 [46.9%] reported daily meat consumption; this rate for female smokers was 41 [56.2%; p=0.001]. Female non-smokers consumed daily breakfast more than female smokers [107, 73.8% vs. 35, 47.9%; p=0.001]. Our data showed a significant difference in nutritional KAP between smokers and non-smokers

Epidemiologic status of tuberculosis in Golestan Province

After Sistan and Balouchestan, Golestan province is ranked second in terms of TB prevalence in Iran. Therefore, a 5-year study was conducted to evaluate the alterations of TB epidemiologic indices in this province. This was a trend study. All patients suffering from various forms of pulmonary tuberculosis [smear positive, smear negative, extrapulmonary and miliary] during 1999-2003 in Golestan province were studied. Alterations of TB epidemiologic indices were evaluated by using Chi-square test. Out of a total of 3,417 registered TB patients during 1999-2003 in the Center for Communicable Disease Control in Golestan, 2,773 [81%] were available and entered the study; 47% were male. 62.7% of patients had smear positive, 16.4% had smear negative, 20.7% had extrapulmonary and 0.1% had miliary tuberculosis. The overall incidence of all forms of TB during the study period was 36 in 100,000 and no significant difference was detected while assessing the alterations of this index during the study period. Incidence of TB had an increasing trend among children; its prevalence among 0-14 year old females was higher than males during the study period. Although Golestan province is not adjacent to the provinces with high TB prevalence, it is ranked second in terms of incidence and prevalence of TB and various factors such as immigration can affect TB epidemiologic indices. An independent study is required to evaluate the distribution of TB among different ethnic groups

Phase II trial of celecoxib in combination with paclitaxel and carboplatin in advanced non-small cell lung cancer

Prostaglandins [PGs] can enhance tumor growth and metastasis by stimulating angiogenesis and invasiveness, in addition to apoptosis and immune surveillance. Microtubule-interfering agents induce cyclooxygenase-2 [COX-2] and PG biosynthesis and this might reduce the efficacy of paclitaxel. Preclinical studies suggest that treatment with a selective COX-2 inhibitor may augment the antitumoral effects of chemotherapy. Thus, we designed a phase II trial to evaluate the efficacy of the combination of paclitaxel, carboplatin and celecoxib in advanced non-small cell lung cancer. Thirty-seven patients were enrolled in this trial. The inclusion criteria were: chemotherapy-na‹ve advanced NSCLC [non-resectable locally advanced stage IIIA, stage IIIB and IV], age > 18 yrs. and performance status [PS] of 0-2 [ECOG]. All patients were given paclitaxel [200 mg/m[2]] and carboplatin [AUC 6] on day 1, every 21 days and celecoxib [400 mg] daily. Most of the patients were male and the mean age was 58 yrs. Old. Performance status 0, 1, and 2 were 8.2%, 40.5% and 51.3%, respectively. Four patients were in stage IIIA [10.8%], 12 patients in stage IIIB [32.4%] and 21 [56.8%] in stage IV. The overall response rate was 54%. Time to progression and median overall survival were 5.7 and 9 months, respectively. Only one patient had grade 3 anemia. There was no grade 4 cytotoxicity. Three patients had cytotoxic drug allergy. Based on this study, adding 400 mg celecoxib to the standard regimen [paclitaxel plus carboplatin] does not enhance time to progression and overall survival compared to historical data. Thus, we recommend combining higher dosage of celecoxib with other targeted agents in phase I/II trials

Fiberoptic bronchoscopy: correlation of cytology and biopsy results

Fiberoptic bronchoscopy is a diagnostic method for respiratory diseases. At present, its diagnostic yield has been increased by different cytologic and histologic procedures by convention. This study was conducted to evaluate the concordance and agreement between cytologic and histologic findings in conventional diagnostic bronchoscopic methods [washing and biopsy] for lung malignancies. This was a cross-sectional study performed on 2076 cases of bronchial biopsy and bronchial washing between 1996 and 2003. Of 2163 patients who underwent fiberoptic bronchoscopy after omitting 87[4%] cases due to unsatisfactory specimens, 2076 cases were studied including 832 [36.9%] females and 1244 [63.1%] males in the age range of 2 to 100 years, [mean age 57.7 +/- 16.3 yrs]. Male to female ratio was 1.5. Malignancy was diagnosed in 657[31.6%] biopsy and 283[13.6%] cytology specimens. Two hundred and sixty-five cases had malignant lesions according to both bronchial biopsy and bronchial washing; therefore, Kappa coefficient in both methods was 46.7% [P value = 0.000]. Concordance rate was 77.4%. Ninety-seven point three percent of malignant cases were diagnosed by biopsy and 41.9% by cytology. Cytology contributed to an additional diagnostic rate of 2.6%. Kappa agreement is classified as fair and although there is a very good concordance between the two sampling techniques, the diagnostic yield of cytology for malignancy must be improved by combination of multiple assays

CT-guided percutaneous fine-needle aspiration biopsy of pulmonary lesions

Transthoracic CT-guided percutaneous fine-needle aspiration biopsy [FNAB] has become a well- established diagnostic technique and been useful in differentiating malignant and benign pulmonary lesions. 505 patients [311 men and 194 women] aged 7-90 years old [mean age 56.2 years] with pulmonary lesions underwent CT-guided transthoracic fine-needle aspiration biopsy. Cytopathologic evaluation of FNAB samples was performed in all patients. In addition, each case was reviewed for complications, including pneumothorax and hemoptysis. Data were analysed using SPSS software for windows ver. 11.5. FNAB samples were adequate for diagnosis in 410 [81.2%] of 505 patients. Two hundred and forty-nine lesions [60.7%0] were malignant, and 161 [39.3%] were benign or atypical. Thirty-four [6.7%] patients had pneumothorax out of which none of them required thoracostomy tube placement. Additionally, hemoptysis was noted in 9 [1.8%] patients and follow-up was carried out. No further complications were reported. CT-guided FNAB of pulmonary lesions can yield well-established diagnoses and it can be useful in the management of patients with suspected lung cancer