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Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives: Shisha smoking, one of the commonest methods of smoking tobacco among Arabs, increases the risk of cardiovascular and respiratory diseases. The objective of this study was to determine the prevalence of shisha smoking among male students of three colleges and to identify factors associated with shisha smoking. Methods : This cross-sectional study included 500 male students of three colleges (medicine, applied medical sciences and dentistry). Data were collected from 371 students using a self-administered questionnaire. Results : The overall prevalence of shisha smoking was 12.6% (8.6% shisha only and 4.0% both shisha and cigarettes). Thirty students (63.8% ) started shisha smoking at ages of 16 to 18 years. Seven students (15%) smoked shisha daily. Cafιs or restaurants were the favorite places for smoking (70.2% of students). There was a high prevalence of shisha smoking among students whose mothers had a secondary (19.1%) and higher (53.3%) education. Conclusions : There was a high prevalence of shisha smoking among university students. The majority of students started shisha smoking at a young age. Public health measures, including the banning of smoking in public places are recommended.

Heart failure (HF) is a rising global cardiovascular epidemic driven by aging and chronic inflammation. As elderly populations continue to increase, precision treatments for age-related cardiac decline are urgently needed. Here we report that cardiac and blood expression of IGFBP7 is robustly increased in patients with chronic HF and in an HF mouse model. In a pressure overload mouse HF model, Igfbp7 deficiency attenuated cardiac dysfunction by reducing cardiac inflammatory injury, tissue fibrosis and cellular senescence. IGFBP7 promoted cardiac senescence by stimulating IGF-1R/IRS/AKT-dependent suppression of FOXO3a, preventing DNA repair and reactive oxygen species (ROS) detoxification, thereby accelerating the progression of HF. In vivo, AAV9-shRNA-mediated cardiac myocyte Igfbp7 knockdown indicated that myocardial IGFBP7 directly regulates pathological cardiac remodeling. Moreover, antibody-mediated IGFBP7 neutralization in vivo reversed IGFBP7-induced suppression of FOXO3a, restored DNA repair and ROS detoxification signals and attenuated pressure-overload-induced HF in mice. Consequently, selectively targeting IGFBP7-regulated senescence pathways may have broad therapeutic potential for HF., (© 2022. The Author(s).)

Aflatoxin M1 (AFM1) is a salient metabolite that can be used to assess Aflatoxin B 1 (AFB1) exposure in humans and animals. The carcinogenic potency of AFB1 and AFM1 was severely reported. The aims of this study were (1) to survey the contamination level of AFM1 in the most traded infant powdered formula brands (IPF) ( n = 42) along with the AFB1 level in under 5's children food brands (biscuits, cornflakes, and cereals) ( n = 42) and (2) to assess the estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) of AFM1 among infants (0-12 months) in Lebanon. All of the samples were analyzed using ELISA technique. AFB1 was below detection limit in all of the children's food brands samples. Out of 42 IPF samples 9.5% were AFM1-positive in the range of 29.54-140.16 ng/L and exceeded the maximum tolerable limit (MTL) set by the European commission (25 ng/kg). The overall average contamination level was 5.72 ± 0.014 ng/L. The EDI of AMF1 for male was in the range of 0.37-0.78 ng/kg/b.w./day and 0.40-0.87 ng/kg/b.w./day for females. Similarly, the HQ calculation resulted in an average of 3.05 for males and 3.28 for females. MOE calculations were far lower from 10,000 in both genders which indicates a high risk of genotoxicity and carcinogenicity. Our findings show that AFM1's EDI, HQ and MOE scored high among Lebanese infants. As infants consume more IPF relative to their body weight, the persistence of IPF with high AFM1 levels threatens their health. Thus, infant's exposure risk to AFM1 in IPF should be a continuous focus of attention.

Myocarditis and pericarditis may constitute adverse reactions of mRNA coronavirus disease 2019 (COVID-19) vaccines. This study aimed to document these reactions and to assess the association with patient sex and age. This is as an observational retrospective study using a case-non-case design (also called disproportionality study) on inflammatory heart reactions reported with mRNA COVID-19 vaccines within the World Health Organization (WHO) global safety database (VigiBase), up to June 30, 2021. Results are expressed using reporting odds ratios (RORs) and their 95% confidence interval (95% CI). Of 716,576 reports related to mRNA COVID-19 vaccines, 2,277 were cases of inflammatory heart reactions, including 1241 (55%) myocarditis and 851 (37%) pericarditis. The main age group was 18-29 years (704, 31%), and mostly male patients (1,555, 68%). Pericarditis onset was delayed compared with myocarditis with a median time to onset of 8 (3-21) vs. 3 (2-6) days, respectively (P = 0.001). Regarding myocarditis, an important disproportionate reporting was observed in adolescents (ROR, 22.3, 95% CI 19.2-25.9) and in 18-29 years old (ROR, 6.6, 95% CI 5.9-7.5) compared with older patients, as well as in male patients (ROR, 9.4, 95% CI 8.3-10.6). Reporting rate of myocarditis was increased in young adults and adolescents. Inflammatory heart reactions may rarely occur shortly following mRNA COVID-19 vaccination. Although an important disproportionate reporting of myocarditis was observed among adolescents and young adults, particularly in male patients, reporting rates support a very rare risk, that does not seem to compromise the largely positive benefit-risk balance of these vaccines. Furthermore, this study confirmed the value of disproportionality analyses for estimation of relative risks among subgroups of patients., (© 2021 The Authors. Clinical Pharmacology & Therapeutics published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)

Background: and purpose. Complementary medicines (CM) use may result in untoward effects perioperatively. The study purpose is to identify CM pattern of use amongst elective surgery patients, and improve effectiveness of information collection relating to CM use., Materials and Methods: This is a prospective observational cohort study. CM questionnaire was administered alongside standard hospital forms at pre-admission clinic over eight weeks., Results: 992 patients attended pre-admission clinic; 317 patients were included in analysis. Introduction of CM questionnaire increased disclosure rate by 11.7% giving a total prevalence of 44.2%. CM use was significantly higher in females and in older patients. Top CM reported were vitamin D (12%) and omega-3 (12%). Majority of patients did not plan to withhold CM before surgery, and were not concerned about perioperative risks., Conclusion: Pre-admission clinics need to encourage CM disclosure. Patient education of potential risks and greater engagement of clinicians in patient assessment is required., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Muscle atrophy derived from excessive proteolysis is a hallmark of numerous disease conditions. Accordingly, the negative consequences of skeletal muscle protein breakdown often overshadow the critical nature of proteolytic systems in maintaining normal cellular function. Here, we discuss the major cellular proteolysis machinery-the ubiquitin/proteosome system, the autophagy/lysosomal system, and caspase-mediated protein cleavage-and the critical role of these protein machines in establishing and preserving muscle health. We examine how ordered degradation modifies (1) the spatiotemporal expression of myogenic regulatory factors during myoblast differentiation, (2) membrane fusion during myotube formation, (3) sarcomere remodeling and muscle growth following physical stress, and (4) energy homeostasis during nutrient deprivation. Finally, we review the origin and etiology of a number of myopathies and how these devastating conditions arise from inborn errors in proteolysis.

Background: Heart-type fatty acid binding protein (H-FABP) has been proposed as an early biomarker of myocardial infarction (MI). The authors aimed to undertake a systematic review and meta-analysis to estimate the early sensitivity and specificity of quantitative and qualitative H-FABP assays., Methods: The authors undertook a systematic search using electronic databases, citation lists and expert contacts to identify all diagnostic cohort studies of patients presenting with suspected acute coronary syndrome that compared H-FABP at presentation to a reference standard based on the Universal definition of MI. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis was conducted using Bayesian Markov chain Monte Carlo simulation., Results: The authors included eight studies of quantitative H-FABP and nine studies of qualitative H-FABP. The summary estimates of sensitivity and specificity were 81% (95% prediction interval 50% to 95%) and 80% (26% to 98%) respectively for the quantitative assays and 68% (11% to 97%) and 92% (20% to 100%) respectively for the qualitative assays. Four studies reported the sensitivity of troponin and H-FABP at presentation in which the combination was considered positive if either test was positive. The addition of H-FABP to troponin increased sensitivity from 42-75% to 76-97% but decreased specificity from 94-100% to 65-93%., Conclusion: H-FABP has modest sensitivity and specificity for MI at presentation but estimates are subject to substantial uncertainty and primary data are subject to substantial heterogeneity. H-FABP may have a role alongside troponin in improving early sensitivity but comparison with high sensitivity troponin assays is required.

Background: The aim of the study was to investigate variations in anti-infliximab (IFX) antibody (Ab) levels and clinical implications thereof in patients with inflammatory bowel disease (IBD)., Methods: A retrospective, explorative, single-center study of patients with IBD who developed anti-IFX Ab and in whom anti-IFX Ab were reassessed., Results: IFX was administered to 316 patients; anti-IFX Ab was determined in 180 patients and detected in 83 (46%). During ongoing IFX maintenance therapy, anti-IFX Ab disappeared at later reassessment in two-thirds of patients with clinical response after median 4 (3-5) infusions. In contrast, anti-IFX Ab persisted in all patients without clinical response. Anti-IFX Ab appeared pharmacologically active, as IFX levels were high when anti-IFX Ab disappeared (median 3.7 μg/mL, interquartile range [IQR] 2.8-5.5), while undetectable or low when anti-IFX Ab persisted (median 0 μg/mL, IQR 0-0). In 56 patients, anti-IFX Ab were assessed after IFX discontinuation. The proportion of patients with anti-IFX Ab gradually declined over time, with a few patients having anti-IFX Ab up to about 4 years after initial assessment. No variables were associated with anti-IFX Ab disappearance in multivariate analysis., Conclusions: Discontinuation of IFX is advisable in patients with inadequate response and repeat positive anti-IFX Ab measurements. Anti-IFX Ab can persist for years after discontinuation, which could impact efficacy and safety at retreatment. Continued IFX treatment may, however, be considered in patients with clinical response and a single positive anti-IFX Ab measurement, as anti-IFX Ab disappears in two-thirds of these during continued treatment., (Copyright © 2012 Crohn's & Colitis Foundation of America, Inc.)

A 26 year old woman with ulcerative colitis was treated with regular infliximab (IFX) infusions until gestation week 31, and gave birth to a healthy child at gestation week 37. Maternal IFX trough level was relatively high during the course of pregnancy. In the infant, therapeutic level of IFX was detectable at week 16 after birth, but not at reassessment at week 28. Anti-IFX antibodies were consistently below the detection limit in the patient and in the child. This case illustrates that IFX is transferred through the placenta to the embryo, and may result in therapeutic drug levels in the newborn child despite IFX discontinuation in third trimester 6 weeks prior to delivery. The half life of IFX appeared markedly longer in infants as compared to adults. The safety of IFX beyond the first trimester is unknown, and this case highlights the need for further investigations of maternal transfer of IFX as well as the risks associated with IFX administrations in the second and third trimester., (Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.)

Purpose: To determine inter-scan, inter-reader and intra-reader variability of trabecular structure analysis using flat-panel volume computed tomography (fp-VCT) in cadaver knee specimens., Methods: Five explanted knee specimens were imaged at three different time points using fp-VCT. Four parameters that quantify trabecular bone structure of the proximal tibia were measured by two observers at two different time points. Bland-Altman analysis was used to compute the inter-scan, inter-observer and intra-observer variability., Results: Inter-scan variability was low, with a mean difference of 0% and a standard deviation less than 8.4% for each of the four parameters. The inter-observer and intra-observer variability was less than 2.8% +/- 8.5%., Conclusion: Fp-VCT is a method for assessing trabecular structure parameters with low inter-scan, inter-reader and intra-reader variability.