A rare case of vasculitis in cystic fibrosis: A clinical case.

Introduction: Cystic fibrosis is known to cause serious complications, such as recurrent pulmonary infections, pancreatic insufficiency, and other symptoms related to exocrine gland dysfunction. A rare manifestation of the disease is discussed in this case of a 24-year-old female diagnosed with cystic fibrosis, a purpuric rash was documented during pulmonary infection flares. Skin biopsy shows a leukocytoclastic vasculitis eruption along with infection. Treatment options are limited and not well established. Our patient received a treatment based on colchicine 1mg per day with a total response. The patient was observed during two consecutive pulmonary infection flares separated by a few months, and a total remission without recurrence was found. Conclusion: Considering its efficacy and safety, further scientific research about colchicine and vasculitis in cystic fibrosis should be aimed at in order to define a strong consensus between the disease and this treatment option.

The impact of textual and pictorial warnings on tumbac (waterpipe tobacco) boxes on the motivation and intention to quit waterpipe smoking in Lebanon: a cross-sectional study.

Few published studies have examined the impact of waterpipe tobacco pictorial health warnings worldwide but none of these papers assessed the motivation and intention to quit among Lebanese waterpipe smokers. To examine factors associated with the motivation and intention to quit waterpipe smoking (WS) in Lebanon, particularly the impact of textual vs. pictorial warnings on tumbac boxes. A cross-sectional study was conducted between January and May 2018, involving 520 participants. Having smokers at work (OR = 0.92) and increasing number of waterpipes per week (ORa = 0.94) were associated with decreased motivation to quit WS. Thinking that shocking images on tumbac packages would have more effect than textual warnings (ORa = 2.96) and those who would change the tumbac if the company decides to change the look of the box with shocking images about health damage (ORa = 1.98) were significantly associated with increased motivation to quit WS. Having a high motivation (ORa = 2.61), thinking that using shocking images on tumbac boxes can have more effect than textual warnings (ORa = 2.12), those who stopped smoking because of the warnings (ORa = 2.62), those who would choose pictorial warnings alone (ORa = 2.11), and both pictorial and textual warnings (ORa = 3.41) on tumbac packages were associated with higher intention to quit WS in two months. Pictorial and textual warnings on tumbac packs were associated with higher intention and motivation to stop WS. Public health education programs for this purpose seem warranted.

Factors associated with smoking cessation success in Lebanon

Objective: The objective is to assess factors associated with the success rate of smoking cessation among Lebanese smokers in a smoking cessation center. Methods: A cross-sectional data study, conducted between March 2014 and March 2016 in an outpatient smoking cessation center with 156 enrolled patients. The patient’s nicotine dependence and motivation to quit smoking were evaluated according to the Fagerstrom Test for Nicotine Dependence and Richmond tests respectively. Results: The number of packs smoked per year decreased the odds of smoking cessation success (p=0.004, ORa=0.982, CI 0.97-0.994), while the compliance with the offered treatment increased the odds of success by 7.68 times (p<0.001, ORa=7.68, CI 3.438-17.187). Highly dependent and highly motivated smokers had more success in the quitting process compared to those with a lower dependence and motivation respectively. Conclusion: Our findings showed that many factors can influence smoking cessation, an experience described as difficult, most significantly the number of packs per year and compliance with the smoking cessation treatment. Moreover, although these outcomes are not representative of the entire Lebanese population, we believe that health authorities could utilize these results when implementing upcoming smoking cessations programs. All attempts at cessation should have a goal of reducing the number of packs smoked per year to improve the chances of ceasing into the future (AU)

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Saliva cotinine and exhaled carbon monoxide levels in natural environment waterpipe smokers.

The purpose of this study is to evaluate the variations in exhaled CO and saliva cotinine in natural environment waterpipe smokers and compare them with cigarette smokers and absolute nonsmokers. Three groups were included in the study: nonsmokers (n = 20), waterpipe smokers (n = 15), and cigarette smokers (n = 20). A questionnaire was completed for each participant, exhaled CO was measured before and after waterpipe or cigarette smoking, and saliva cotinine was measured immediately after. We excluded from our study mixed smokers of both waterpipe and cigarettes. Mean values of saliva cotinine in waterpipe and cigarette smokers were very close: 77.8 ng/ml (SD = 110.4) and 87.1 (SD = 82.7) respectively. The weight and height of the persons as well as the size of the waterpipe bottle affected saliva cotinine. However, in waterpipe smokers, CO increased by 300% after 1 h of smoking, while in cigarette smokers, it only increased by 60%. In nonsmokers, exhaled CO was similar to environmental CO (10.2 ppm). The results of our study confirm that waterpipe device water does not filter nicotine and that the smoker him- or herself, by the frequency and the depth of inhalation, controls smoke inhalation. Like cigarette smokers, waterpipe smokers are exposed to harmful substances, such as CO, which was found to be quite high. The levels of expired CO and salivary cotinine could be good tools to detect exposure to waterpipe smoking.