The Prevalence of Smoking (Cigarette and Waterpipe) among University Students in Some Arab Countries: A Systematic Review.

BACKGROUND: Tobacco use among university students remains the most alarming problem worldwide. This study aims to systematically review the previous literature for determining the prevalence of smoking (cigarette and waterpipe) among university students in some Arab countries. METHODS: We electronically searched articles from MEDLINE, PubMed, EMBASE, Google Scholar and Google for the period from April 2018 to June 2019. We conducted a systematic review of eligible studies published in English between 2006 and 2019, for assessing cigarette and waterpipe smoking among university students. The studies were all cross-sectional according to eligibility criteria and contained 469 studies19 meet the inclusion criteria from 12 countries of (Yemen, Kingdom of Saudi Arabia (KSA), Kuwait, Bahrain, Jordan, Lebanon, Tunisia, Egypt, Palestine, Syria, Libya and United Arab Emirates (UAE). RESULTS: the study included a total of participants (N=45,306) (33,450 Males vs 11,856 Females). The overall highest rate of current smoking among students was in Egypt (46.7%), Kuwait (46%) and KSA (42.3%). The smoking prevalence among males was significantly higher than females in Yemen (36.3% vs 28.0%,p<0.001), Bahrain (27.0%vs 4.2%, p<0.001), Tunisia (38.4% vs 3.4%, P<0.001), Egypt (61.2% vs 18.9%, P<0.001),  Palestine (52.7% vs 16.5%, p<0.001), Syria (26.1% vs 9.5%, p<0.001), KSA (32.7%vs5.9%,P<0.001), and Jordan (54.3%vs11.1%, P<0.005) and (56.9%vs11.4%, P<0.005). Another study in Yemen was significantly higher among women than man (15.7% vs 10.3%, p<0.001). The highest waterpipe smoking rates among gender was in KSA (36.4%-36.3%). For cigarette smoking, the highest rates were in Libya (80.2%), Jordan (80%) and KSA (70.7%). The highest smoking rates among males were in Egypt (61.2%), Jordan (56.9%-54.3%) and Palestine (52.7%), for females the highest rate was in Yemen (28.0%). CONCLUSION: The prevalence of smoking cigarette and waterpipe appears to be alarmingly high among university students in Arab countries. The results were different among students, due to the nature of the region and the different customs, traditions, lineage and multicultural from country to another.

Knowledge and factors related to smoking among university students at Hodeidah University, Yemen.

INTRODUCTION: Tobacco smoking, especially among university students, remains a significant issue worldwide. This survey aims to investigate and evaluate the smoking behavior and smoking-related knowledge and their relationship in students of Hodeidah University, Yemen. METHODS: A cross-sectional study was performed among students at Hodeidah University. Using a global youth tobacco survey and a global health professional survey, data were collected from three colleges (Commerce and Economics, Engineering, and Medicine) from April to June 2017, from 420 randomly chosen students. RESULTS: The smoking prevalence among university students was 33.1% (cigarettes 13.6%, waterpipe 9.3%, and 10.2% for dual cigarettes and waterpipe use), with a higher rate of smoking among males than females (36.3% vs 28.0%, p<0.001). The percentage of individuals participating in the three types of smoking among males and females, respectively, were 18.9% vs 5.0% for cigarettes, 1.9% vs 21.1% for waterpipe, and 15.4% vs 1.9% for dual cigarettes and waterpipe use, with a student mean age of 21.93 ± 2.55 years. The regression outcome revealed that year of study was highly associated with smoking (OR=0.87, 95% CI: 0.85-0.89, p<0.001). Age (OR=0.96, 95% CI: 0.94-0.99, p<0.05), residence (OR=1.05, 95% CI: 1.00-1.09, p<0.05) and family income (OR=1.03, 95% CI: 1.00-1.06, p<0.05) were also significant predictors of smoking. CONCLUSIONS: According to this study, most of the male students were cigarette users, while female students were waterpipe users. The prevalence of waterpipe use among females, as opposed to males, is an issue of concern. Policy makers may need to initiate anti-smoking programmes in Yemeni universities.

Smoking prevalence, attitudes and associated factors among students in health-related Departments of Community College in rural Yemen.

INTRODUCTION: Tobacco smoking is a global concern and tobacco use is rising among the youth in Arab countries, such as Yemen, especially among university students. This study aims to examine the prevalence, attitudes and associated factors of smoking among college students in the rural area of Hajja, Yemen. METHODS: A cross-sectional descriptive study was conducted at a community college in the Hajja province between August and December 2016. The data were collected from three health related departments (Nursing, Laboratory, and Assistant doctor). A questionnaire based on the Global Health Professional Survey and the Global Youth Tobacco Survey was answered by 380 randomly selected students. RESULTS: Logistic regression analyses indicated that sex (OR=0.4, 95% CI: 0.2-0.8, p<0.05), family income (OR=2.0, 95% CI: 1.2-3.3, p<0.05), and residence (OR=0.2, 95% CI: 0.1-0.5, p<0.001), were statistically significant predictors of smoking. Smoking for peer pressure, recreation and proving manhood were all found to be highly significant (p<0.001). The results also revealed that smokers had more negative attitudes towards allowing children to smoke in the future and allowing smoking in the household (p<0.001). CONCLUSIONS: Compared to similar studies on the general population, the prevalence of smoking among college students in the rural area was lower. An indication of a growth in tobacco use can be concluded, accordingly, the need for anti-smoking programmes to prevent students from initiating smoking is required.

Thrombotic obstruction of bileaflet mechanical prosthetic heart valves: early diagnosis and management.

BACKGROUND: Thrombosis of mechanical prosthetic heart valves (TMPHV) is one of the major complications that accounts for the highest morbidity and mortality related to Bileaflet Mechanical Prosthetic Heart Valves (BMPHV). MATERIALS AND METHODS: During the last six years we had ten cases of bileaflet mechanical valve thrombosis. All patients had undergone emergency surgical interventions except one who developed systemic embolization and massive brain insult immediately after admission for surgery and died two months later. We divided the patients in two groups, first group includes five patients who came in acute pulmonary edema and emergency operation was done either to replace the thrombosed BMPHV (in two) or successful thrombectomy was achieved (in three) and all of them have survived. The second group (four patients) presented with cardiogenic shock and required emergency femoro-femoral bypass. Two patients survived after thrombectomy and the other two could not come off bypass after changing the TMPHV and in spite of Intra-aortic balloon pump, they died 24 and 48 hours after the procedure. All patients received intravenous heparin on admission. Preoperative i.v. Streptokinase was given in two cases, of which one required thrombectomy and the other had valve replacement and died 24 hours later. RESULTS: Early diagnosis and operation still had the best results in TMPHV though thrombolytic therapy was successful in few reported early presented cases. All patients who had thrombectomy of the TMPHV have survived without any morbidity. Follow up of survived patients ranged between two months and six years with a mean of 24.1 months. It is worth attempting thrombectomy of the thrombosed BMPHV rather than re-replacement which carries higher morbidity and mortality, because of the longer ischemic arrest during operation which further depletes the energy of the myocardium. CONCLUSIONS: Though this is a small number of patients to make a definite conclusion, thrombectomy was more feasible in CarboMedics Prosthetic Heart Valves, since its in situ rotation that allows reorientation of its leaflets and declotting of valve hinge to be performed.