Validation of an Arabic version of an instrument to measure waterpipe smoking behavior.

OBJECTIVES: Reliable and valid measures of waterpipe smoking are essential to study its health effects. The purpose of this study was to examine the reliability and validity of an Arabic translation of Maziak questionnaire that assesses various aspects of waterpipe smoking in epidemiological studies. STUDY DESIGN: A cross-sectional study. METHODS: This questionnaire was translated, back translated, and culturally adapted to the local Arabic dialect. Construct and convergent validity were assessed in a sample of 119 daily waterpipe smokers (WPS) and 30 occasional WPS, defined as smoking at least one waterpipe per week but less than daily from Beirut and Doha (mean age = 52.4 years, males = 61.7%). Construct validity was assessed by comparing the smoking behavior of daily and occasional WPS. Convergent validity was assessed by correlating daily smoking intensity ('number of waterpipe smoked per day') with 'number of waterpipe smoked yesterday' and by correlating lifetime smoking exposure (waterpipe-year) calculated by multiplying number of waterpipe smoked per day × duration of waterpipe smoking with alternate measures obtained graphically (graphical waterpipe-year) or adjusted (adjusted waterpipe-year). Criterion validity was assessed by correlating daily smoking intensity and lifetime smoking exposure with serum cotinine level. Test-retest reliability was analyzed by re-administering the questionnaire to 30 daily and 30 occasional WPS after 2 weeks. RESULTS: Smoking intensity, patterns of use, and willingness to quit differed significantly between daily and occasional WPS. Daily smoking intensity correlated strongly with the number of waterpipe smoked yesterday (rs = 0.68, P < 0.001), but not in the occasional WPS (rs = 0.13, P = 0.70). Waterpipe-year correlated very strongly with adjusted waterpipe-year and graphical waterpipe-year (rs = 0.98, P < 0.001 and rs = 0.92, P < 0.001, respectively). Waterpipe-year, daily smoking intensity, and number of waterpipe smoked yesterday, correlated weakly but significantly with serum cotinine levels (rs = 0.243, P = 0.01; rs = 0.359, P < 0.01 and rs = 0.387, P < 0.01, respectively). The type and pattern of waterpipe use items showed high test-retest reliability with near perfect agreement (k > 0.9), the sharing and intention to quit waterpipe items had substantial agreement (k > 0.6), and the intent to quit item showed moderate agreement (k > 0.4). CONCLUSION: The questionnaire showed strong reliability, face validity, construct and convergent validity, and a weak but statistically significant criterion validity. Maziak questionnaire is valid and reliable for assessing waterpipe smoking patterns, intensity, and willingness to quit.

Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT.

AIM: To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. MATERIALS AND METHODS: One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below -950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. RESULTS: Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01-1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. CONCLUSION: Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax.

Outcomes of hospitalisation for right heart failure in pulmonary arterial hypertension.

The aim of this study was to examine the causes and outcomes of hospitalisation in patients with pulmonary arterial hypertension (PAH). 205 consecutive hospitalisations occurring between 2000 and 2009 in 90 PAH patients were studied. The leading causes for hospitalisation were right heart failure (RHF; 56%), infection (16%) and bleeding disorders (8%). For patients with RHF, in-hospital mortality was 14% overall, 46% for patients receiving inotropes and 48% for those admitted to the intensive care unit. The predictors for in-hospital mortality were the presence of connective tissue disease (CTD) (OR 4.92), systolic blood pressure <100 mmHg (OR 4.32) and Na ≤ 136 mEq · L(-1) (OR 4.29). Mortality after discharge was 13, 26 and 35% at 3, 6 and 12 months, respectively. World Health Organization functional class prior to admission, renal dysfunction, Charlson comorbidity index, and the presence of CTD were all predictors of mortality after discharge. Hyponatraemia and low systolic blood pressure upon admission and underlying CTD are the main prognostic factors for in-hospital mortality in patients with PAH admitted for RHF. The short-term outcomes after discharge are poor and remarkably worse in patients with underlying CTD or renal impairment. Early recognition of these factors may guide decisions regarding more aggressive therapy, including consideration for lung transplantation.