Effect of narghile and cigarette smoking on newborn birthweight

OBJECTIVE

To assess the effect of narghile smoking on the weight of newborns.

DESIGN

Historical retrospective cohort.

SETTING

Six major hospitals in Greater Beirut, Lebanon.

POPULATION

Consecutive singleton newborns delivered from August 2000 to August 2003.

METHODS

Obstetric and nursery charts were reviewed to obtain information about maternal and neonatal variables. Information concerning initiation of smoking, dose of smoking, smoking habits during pregnancy, and socio-demographic characteristics was collected through interviews with mothers.

MAIN OUTCOME MEASURES

Low birthweight and newborn birthweight.

RESULTS

Exclusive narghile smokers constituted 4.4% (378/8592) of women. Multiparas were significantly more likely to smoke cigarettes and narghile. Mothers smoking narghile more than once per day were at 2.4 increased odds of having low birthweight infants compared with nonsmoking mothers (OR 2.4; 95% CI 1.2-5.0) after adjusting for confounding variables. No difference was noted between women smoking narghile in the first trimester and those initiating smoking in subsequent trimesters regarding low birthweight.

CONCLUSIONS

Narghile smoking more than once per day increases the odds of low birthweight by a 2.4-fold compared with nonsmokers, although to a lesser extent than cigarette smoking.

Terbutaline versus nifedipine for prolongation of pregnancy in patients with preterm labor

OBJECTIVE

To compare the effectiveness, safety, and possible adverse effects of terbutaline and nifedipine in prolonging pregnancy beyond 48 h.

METHODS

A randomized controlled trial was conducted with 174 pregnant women admitted with preterm labor randomized into 2 groups, which were given terbutaline (95 patients) and nifedipine (79 patients), respectively. Bivariate and multivariate analyses, using logistic regression, were used to analyze the data.

RESULTS

No statistically significant difference was found between the 2 groups in terms of prolongation of gestation to 48 h. The failure rate in terms of prolonging gestation for 24 h was found to be 12.6% for the terbutaline group and 10.1% for the nifedipine group, which was not found to be statistically significant (P value=0.61). Side effects were significantly more common in the terbutaline group, except for maternal hypotension.

CONCLUSION

Terbutaline and nifedipine appear to be equally effective in their tocolytic action. However, nifedipine did have the advantage of ease of administration. It also had significantly less effect on the fetal heart rate.

Level of health awareness of Saudi patients on renal replacement therapy

OBJECTIVE

To assess health awareness in patients on renal replacement therapy (RRT) in Saudi Arabia.

METHODS

This is a cross-sectional survey using a 22-item questionnaire in 143 randomly selected adult RRT patients [40 on hemodialysis (HD), 61 on peritoneal dialysis (PD) and 42 with renal transplant (TX)]. The study was carried out at King Abdul-Aziz Medical City, Riyadh in April 2006. The questionnaire was designed to evaluate patients' knowledge in 5 areas: 1. causes of renal failure, 2. biology of the kidneys, 3. symptoms of kidney disease, 4. therapeutic options available, 5. national kidney patients support facilities. The association between the level of awareness (the percentage of correct answers) to different demographic factors was assessed.

RESULTS

Three fifths of the patients had less than secondary education. The average mark for correct responses of all patients was 45.9% with a highest (58%) for the category on biology of the kidney and lowest (36.8%) for national kidney patients support facilities. The PD group had the highest score (54.4%) followed by HD (44.3%) and finally TX (35.1%).

CONCLUSION

The level of our patients; health awareness is lower than satisfactory. Level of education seems to be a contributory factor.

Use of warfarin and risk of urogenital cancer: a population-based, nested case-control study

BACKGROUND

Indirect evidence suggests that prolonged treatment with warfarin might be associated with a decreased incidence of urogenital cancer. We aimed to assess this association in a large population-based study.

METHODS

Beneficiaries of Saskatchewan Health who were eligible for prescription drug benefits and aged 50 years or over with no history of cancer since 1967 were enrolled into a nested, matched case-control study. 19 412 new cases of urogenital cancer diagnosed between Jan 1, 1981, and Dec 31, 2002, were identified by use of information from the Saskatchewan Cancer Agency registry. For each case, six controls, totalling 116 470, who were matched for age, sex, and time of diagnosis were selected randomly. Conditional logistic regression analysis was used to calculate adjusted incidence rates of urogenital cancer in relation to warfarin use.

FINDINGS

Compared with men who never used warfarin, men with 4 years of warfarin use had an adjusted incidence rate of 0.80 (95% CI [0.65-0.99]). For warfarin use 76-100% of the time, the adjusted rate ratios were 0.80 (0.66-0.96) during year 2 preceding diagnosis of prostate cancer, 0.76 (0.62-0.94) during year 3, and 0.67 (0.53-0.86) during year 4. No significant association was found between warfarin and risk of other urogenital cancers.

INTERPRETATION

Our results suggest that warfarin has an antitumour effect that is specific to prostate cancer. Further investigation, with more complete assessment of confounders and that addresses the effect of warfarin on mortality of prostate cancer, is warranted.

Risk of breast cancer in association with exposure to two different groups of tricyclic antidepressants

PURPOSE

In 2002, we reported an epidemiological study in which we found that some tricyclic antidepressants (identified as genotoxic in Drosophila Melanogaster) were associated with an increased risk of breast cancer, when exposure took place 11-15 years before the date of diagnosis. The implications of the results found lead us to carry out a separate case-control study, using the same source population, to validate the conclusions drawn from our previous study.

METHODS

We accrued 7330 breast cancer cases, diagnosed between 1981 and 2000, and 29 320 controls matched on age and time.

RESULTS

The association between exposure to genotoxic TCAs 11-15 years before diagnosis and the risk of breast cancer development was much weaker, as compared to what was reported in our previous study. The relative risk of breast cancer in women exposed to high doses of genotoxic TCAs 11-15 years before diagnosis was 1.17 (95%CI: 0.79-1.74), while in women exposed to high levels of non-genotoxic TCAs during the same period it was 0.95 (95%CI: 0.61-1.48).

CONCLUSION

In conclusion, we did not find supporting evidence for an increased risk of breast cancer among women exposed to TCAs up to 20 years in the past.

Application of lag-time into exposure definitions to control for protopathic bias

PURPOSE

To control for protopathic bias, some studies have incorporated the concept of lag-time into their exposure definition (time period before the index date that was not considered in assessing exposure). The objective of this study was to introduce a procedure to identify the best lag-time to be applied in studies where control for protopathic bias is required.

METHODS

We used data from a case-control study carried out to assess the association between exposure to proton pump inhibitors (PPIs) and risk of gastric cancer, using RAMQ databases. Exposure was defined as the number of defined daily doses of PPIs dispensed during the 5-year period prior to the index date (divided into four quartiles). Thirty-one different lag-times were applied (0-30 months) based on 1-month intervals. Logistic regression was used to estimate the matched odds ratio (OR) for each lag-time. The change point in the ln(ORs) was identified by applying a two-compartmental model and a segmented regression model.

RESULTS

A trend of decreasing ORs was found with the application of an increasing lag-time. As an illustration, the ORs for the 1st quartile of defined daily doses, when applying the 31 different lag-times, ranged between 3.52 when applying a 0 lag-time and 0.97 when applying a 30 months lag-time. Applying the two methods for the different lag-times showed that the ORs stabilized at around 6 months.

CONCLUSION

For the purpose of controlling for protopathic bias in pharmacoepidemiological studies, we have provided a method to assess the most appropriate lag-time that should be applied for the assessment of drug exposure.

Trauma epidemiology and outcome in a developing country: perspectives from a university teaching hospital in Beirut

This study aims at evaluating trauma care at the American University of Beirut Medical Centre (AUB-MC) and comparing it to the norms established by the Major Trauma Outcome Study (MTOS). From January 2001 until January 2003, data necessary to calculate probability of survival using the Trauma Injury Severity Score methodology were collected. M, W, Z, Ws and Zs statistics were calculated to compare outcome at AUB-MC to the MTOS dataset. A total of 873 patients were included in the study. W statistics was calculated at 0.35 with Z score for the overall sample of 0.081 indicating that there was no statistically significant difference in survival between this group and the MTOS group. In a developing country a hospital achieves trauma outcomes similar to the MTOS dataset. Further studies looking at trauma care in Lebanon as a whole are needed.

The effect of warfarin on the risk of prostate cancer

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Background: The anticancer activity of oral anticoagulants has been a matter of debate for several years. Recent evidence suggests that prolonged treatment with warfarin may be associated with a reduced incidence of newly diagnosed urogenital cancer during long-term follow-up of patients with venous thromboembolism. The aim of this study was to assess whether exposure to warfarin was associated with reduced risk of prostate cancer in a large population-based cohort. Methods: We conducted a matched case-control study nested within the population of beneficiaries of the Saskatchewan Prescription Drug Plan aged 50 years and older from 1981–2002 with no history of cancer since 1967. New cases of prostate cancer diagnosed between 1981 and 2002 were identified using the linked Saskatchewan Cancer Agency registry. Six controls per case matched on age, gender, and sampling time were randomly selected. The cumulative exposure to warfarin in the five years preceding the cancer diagnosis was assessed. Prescription counts were used to define warfarin exposure. Exposure in the year immediately preceding the cancer diagnosis was excluded to control for detection bias. Conditional logistic regression analysis was used to assess confounding by other drugs such as nonsteroidal anti-inflammatory medications. Results: Among 11502 cases and 69012 controls, 7.4% of cases and 7.1% of controls had a history of any warfarin use. Compared to men who had never used warfarin, adjusted odds ratio (OR) for prostate cancer among ever-users in the 5 year period was 0.94 (95% confidence interval (CI), 0.86–1.03). In those who accumulated 1, 2, 3 and 4 years of warfarin use, the adjusted ORs were 1.01 (95% CI, 0.89–1.16), 1.00 (95% CI, 0.82–1.23), 0.81 (95% CI, 0.60–1.09), and 0.80 (95% CI, 0.65–0.99), respectively (p-trend=0.03). Conclusion: Our results suggest that cumulative use of warfarin of at least 4 years may be associated with a reduced risk of prostate cancer. However, confounding by other determinants of prostate cancer associated with warfarin use is possible. Nonetheless, confirmation of these findings by prospective studies may provide the evidence necessary to consider the use of warfarin in prostate cancer prevention.

No significant financial relationships to disclose.

Use of antidepressants and risk of colorectal cancer: a nested case-control study

BACKGROUND

Animal studies suggest that selective serotonin reuptake inhibitors (SSRI) retard the growth of colorectal tumours, whereas tricyclic antidepressants increase the risk of colorectal cancer. We aimed to assess whether SSRI use was associated with a decreased risk of colorectal cancer, and tricyclic-antidepressant use with an increased risk of colorectal cancer.

METHODS

We did a population-based nested case-control study from Jan 1, 1981, to Dec 31, 2000, of people aged 5-85 years who were registered with Saskatchewan Health and eligible for prescription-drug benefit. Between Jan 1, 1981, and Dec 31, 2000, 6544 cases with colorectal cancer were identified from the Saskatchewan Cancer Agency registry and analysed for use of tricyclic antidepressants; between Jan 1, 1991, and Dec 31, 2000, 3367 cases with colorectal cancer were identified from the Saskatchewan Cancer Agency registry and analysed for SSRI use. For every case, four eligible controls matched for age, sex, and calendar time (ie, free of any cancer in calendar month of case diagnosis) were selected randomly by a statistician who used incidence density sampling. By use of conditional logistic regression, we assessed incidence-rate ratios of having colorectal cancer in association with use of antidepressants, analysing dose and time of use.

FINDINGS

A decreased risk of colorectal cancer was associated with high (ie, >6.0x10(-6) mol per day) daily SSRI dose during 0-5 years before diagnosis (incidence-rate ratio 0.70 [95% CI 0.50-0.96], p for trend=0.0172), adjusted for age, sex, use of non-steroidal anti-inflammatory drugs in the same period, and SSRI use during 6-10 years before index date (ie, date of diagnosis for a case and the same date for matched controls). No consistent relation was recorded for risk of colorectal cancer and use of tricyclic antidepressants.

INTERPRETATION

SSRI use might inhibit the growth of colorectal tumours through an antipromoter effect or direct cytotoxic effect. Further investigation is needed, with more complete assessment of confounders such as lifestyle factors (eg, diet), use of drugs, and comorbidity (eg, diabetes or inflammatory bowel disease) that might affect the occurrence of colorectal cancer.

Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting

OBJECTIVES

This paper examines the effect of household crowding on inter-pregnancy spacing and its association with socioeconomic indicators, among parous mothers delivered in an urban environment.

DESIGN

Cross sectional survey.

METHODS

Sociodemographic data were obtained on 2466 parous women delivering at eight hospitals in Greater Beirut over a one year period. Statistical methodology comprised Pearson chi(2) test and logistic regression analysis.

MAIN RESULTS

A significant inverse relation was observed between household crowding and socioeconomic status, defined as education and occupation of women and their spouses. Inter-pregnancy spacing increased with higher levels of crowding. Further analysis suggested that this positive association was confounded by maternal demographic characteristics.

CONCLUSIONS

These data have shown that household crowding, a correlate of low parental socioeconomic status, is associated with longer birth intervals. This association, however, seems to be largely explained by maternal age and parity.

Seroprevalence of hepatitis C virus and hepatitis B virus among dialysis patients in Bahrain and Saudi Arabia

Dialysis patients are at risk for contracting blood-borne infections, including hepatitis viruses (HBV and HCV). The aim of this study was to assess the prevalence of HBV and HCV infection among hamodialysis patients in Bahrain and Saudi Arabia. Study subjects comprised 81 Bahraini and 34 Saudi dialysis patients, and as control 7714 Bahraini and 2330 Saudi blood donors. Serologic markers of HBV (HBsAg, anti-HBc) and HCV (anti-HCV) were determined by EIA and confirmed by PCR (HBV) and RT-PCR (HCV). Higher prevalence of HCV (9.240% vs 0.300%, P <.001), HBsAg (5.88% vs 0.620%; P <.001), but not anti-HBc (1.7% vs 4.6%; P =.01) were seen in patients compared to controls, respectively. When compared to Bahrainis, higher prevalence of HBsAg (11.8% vs 3.7%) and anti-HCV (14.7% vs 7.4%) were seen among Saudi patients, respectively. Double HCV infection was frequent, and the most prevalent types were HCV1a/1b plus HCV4 in Bahraini, and HCV 2/2a plus HCV 4 among Saudi dialysis patients. Our results are the first report on viral hepatitis among dialysis patients in Bahrain, and the first to compare HBV/HCV rates among dialysis patients in the Eastern Arabian peninsula, and confirms other results that documented increased HBV and HCV infection among dialysis patients. Future studies aimed at assessing the status and to monitor the progress of viral hepatitis infection among dialyzed and transfused patients will have a strong impact on patient diagnosis, follow-up, and treatment.

Distribution of HLA class II (DRB1/DQB1) alleles and haplotypes among Bahraini and Lebanese Arabs

The genetic relationship between Bahraini and Lebanese Arabs in terms of HLA class II (DRB1 and DQB1) gene and haplotype frequencies was investigated in a group of 90 Lebanese and 52 Bahraini Arabs. Subjects of both sexes were unrelated and HLA-DRB1 and DQB1 genes were genotyped using the polymerase chain reaction-sequence specific primer (PCR-SSP) technique. Analysis of the HLA-DRB1 alleles showed that the DRB1*040101 and DRB1*110101 alleles were more common among Lebanese, whereas DRB1*030101, DRB1*130701/1327, and DRB1*160101 alleles were more common among Bahrainis. Similarly, of the 7 HLA-DQB1 alleles analyzed, the presence of DQB1*0201 was higher among Bahrainis, whereas DQB1*030101 was higher among Lebanese. The DRB1*160101-DQB1*050101 (23.08%) and DRB1*030101-DQB1*0201 (21.15%) haplotypes were more frequent among Bahrainis, while the DRB1*110101-DQB1*030101 (56.67%), DRB1*040101-DQB1*0302 (28.89%) and DRB1*040101/DQB1*030101 (25.56%) haplotypes were more frequent in Lebanese subjects. Our results underline significant differences between these two populations in HLA class II distribution, and provide basic information for further studies of MHC heterogeneity among Arab-speaking countries, and as a reference for further anthropologic studies.

Low socioeconomic status and neonatal outcomes in an urban population in a developing country

OBJECTIVE

To investigate the effect of low socioeconomic status indicators, specifically parental educational and occupational characteristics on neonatal health outcomes.

METHODS

Analysis of 3372 newborn infants admitted to five National Collaborative Perinatal Neonatal Network centers (1 February 2000 to 31 January 2002). Outcomes included birth weight, gestational age, admission to the neonatal intensive care unit (NICU) and length of hospital stay. The independent effects of mother's education and occupation as well as father's occupation on health outcomes were assessed by means of stepwise logistic regression analysis.

RESULTS

A total of 271 (8.0%) infants were of low birth weight, 306 (9.1%) were preterm, 410 (12.2%) had NICU admissions and 240 (7.1%) were hospitalized for more than a week. After adjusting for maternal gravidity, age, smoking during pregnancy and pregnancy-related complications, parental socioeconomic characteristics had no significant impact on low birth weight or preterm birth. NICU admission and prolonged hospitalization were significantly correlated with skilled, semi-skilled and unskilled paternal occupations. Illiterate mothers had nearly 3-5 times the risk of NICU admission and prolonged hospitalization.

CONCLUSION

Both father's occupation and mother's education play an important role as determinants of neonatal morbidity characteristics.

Arterial Stiffness Is Associated with Orthostatic Hypotension in Elderly Subjects with History of Falls

OBJECTIVES

To test the hypothesis that impaired hemodynamic orthostatic changes commonly observed in the elderly may be related to age-related increase in arterial wall stiffness.

DESIGN

Convenience sample of consecutive patients admitted for falls.

SETTING

Acute- and intermediate-care geriatric ward of a French hospital.

PARTICIPANTS

Fifty-seven elderly patients (46 women) consecutively admitted to a geriatric ward with a history of recent falls.

MEASUREMENTS

Orthostatic hypotension (OH) was assessed using blood pressure measurements in the supine position and 1, 2, and 3 minutes after standing. Arterial wall stiffness was assessed using upper-limb and aortic pulse-wave velocities, measured with an external pressure transducer connected to a computer.

RESULTS

OH was present in 18 patients with a mean age+/-standard deviation of 85.4+/-7.6 (5 men, 13 women) and absent in 39 patients aged 83.7+/-6.2 (6 men, 33 women). Upper-limb pulse-wave velocity was significantly higher, by 16%, in patients with OH than those without (9.91 vs 8.53 m/s; P<.02). Significant correlations were found between upper-limb pulse-wave velocity and systolic blood pressure changes after 1 minute of standing (r=0.263, P<.05) and maximal diastolic blood pressure change after standing (r=0.351, P<.01).

CONCLUSION

Upper-limb arterial wall stiffness was significantly greater in elderly patients with OH than in patients without OH and was significantly related to blood pressure changes after standing. These results highlight the possible role of age-related changes in the arterial tree in the hemodynamic response to orthostatic challenges.

Proxy reporting of quality of life using the EQ-5D

BACKGROUND

The economic evaluation of health interventions for older people is complicated by the difficulty in obtaining self-reports of quality of life from persons with cognitive impairments, physical impairments, or both.

OBJECTIVES

Using the EQ-5D (EuroQoL) measures, to assess: (1) agreement between subjects and proxies on subject's quality of life ratings at different points in time; (2) agreement between subjects and proxies on change of subject's quality of life ratings over time; and (3) subject and proxy characteristics related to agreement.

RESEARCH DESIGN

Prospective study of subjects visiting hospital emergency departments (ED). Data were collected at enrollment in the ED and at follow-up, 1 and 4 months after the ED visit.

SUBJECTS

The study comprised 231 pairs of cognitively intact patients aged 65 years or older and their primary caregivers.

MEASURES

Quality of life was measured using both components of the EQ-5D scale, the index score and the Visual Analogue Scale (VAS). Demographic characteristics and health status (physical and mental) were measured for both subjects and proxies. Subjects and proxies were interviewed either in English or French.

RESULTS

There was low to moderate agreement between subjects and proxies at different points in time (intraclass correlation coefficient [ICC] = 0.22 to 0.59), and between subject and proxy change scores over time (ICC = 0-0.50), on both the index score and the VAS. Better agreement between subjects and proxies was found at the 4 months follow-up, when the subject was less depressed, and when the proxy's native language was English.

CONCLUSIONS

Proxy EQ-5D responses, either for a specific point in time or for assessing change over time, may not be valid measures of self-reported quality of life among older medically-ill patients.

Attitudes towards prenatal diagnosis and termination of pregnancy among health professionals in Lebanon

OBJECTIVES

To assess the attitudes of health professionals in Lebanon towards prenatal diagnosis and termination of pregnancy, for a series of genetic, non-genetic and non-medical conditions.

METHODS

A total of 158 questionnaires were sent to geneticists, family doctors, pediatricians and obstetricians/gynecologists, that included information on sociodemographic variables and sets of questions and case scenarios, to which participants were asked to reply anonymously.

RESULTS

Responses from the 75 participants revealed that the type of specialty did not significantly influence their attitude. However, acceptance of termination of pregnancy was influenced by gender, age, marital status, religion and its importance in their daily life. In general, acceptance of termination of pregnancy in the case of mild or severe clinical conditions was comparable to that reported from European countries, but more favorable in the case of sex chromosome abnormalities. Acceptance of prenatal diagnosis for non-clinical conditions was, however, lower than that reported in Western nations.

CONCLUSION

The study provides a good basis for further studies with a larger number of respondents representing various geographical regions of the country.

Bone mineral density in beta - thalassemic Lebanese children

Osteoporosis has been described extensively in adult thalassemics. Fewer studies have been reported in thalassemic children. In this article, we measured the bone mineral density (BMD) of Lebanese beta-thalassemic children before institution of a balanced transfusion-chelation regimen, in comparison with that of healthy controls, and studied its correlation with various demographic and biological parameters. Both groups, controls and thalassemics were comparable with respect to age, sex, socioeconomic and regional distribution. On the other hand, thalassemics had a significantly lower height age (p<0.001), lower bone age (p=0.001), lower sexual maturation (p=0.004), lower absolute BMD values and larger negative BMD-Z scores (p<0.001). Within the thalassemic group, BMD correlated significantly with luteinizing hormone (LH) and follicle stimulating hormone (FSH), estradiol and testosterone values, as well as with the pretransfusion hematocrit, but not with other endocrine or bone metabolism parameters. We conclude that Lebanese beta-thalassemic children have a significantly lower BMD than their healthy counterparts due, in part, to their slower physical development. A major contributor seems to be the low-transfusion regimen followed by these patients, as well as the endocrine dysfunction which was detected in about 25% of them.

Identification of Chlamydia trachomatis DNA in human papillomavirus (HPV) positive women with normal and abnormal cytology

Insofar as infection with human papillomavirus (HPV) and Chlamydia trachomatis (CT) are associated with cervical intraepithelial neoplasia (CIN), the aim of this study was to assess the correlation of HPV and CT infection in patients with normal or abnormal cytology. Endocervical samples from patients (n=121; mean age 33.7+7.0) were assessed for HPV and CT DNA by PCR. While there was no statistically significant difference between HPV-positive (n=44) and HPV-negative (n=77) patients to age pregnancies, higher proportion of smokers, patients with multiple male sex partners, or with abnormal cytology was seen in HPV-positive vs. HPV-negative women, respectively. An infection rate of CT of 21/44 was seen in HPV-positive as compared to 11/77 in HPV-negative patients. Within HPV-positive patients, there was no significant difference between CT-positive and CT-negative patients with regards to the risk factors studied. Collectively, this suggests that a causal relationship between HPV and CT infection in the development of CIN disease.

Detection of human papillomavirus (HPV) genotypes in cervico-vaginal scrapes of women with normal and abnormal cytology

BACKGROUND

Certain types of human papillomavirus (HPV) are associated with cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma. The study addressed the expression and detection of HPV genotypes in cervical and vaginal specimens of women with normal and abnormal cytology by polymerase chain reaction (PCR), each woman serving as her own control.

METHODS

Study participants (127) were subgrouped into CIN-positive and CIN-negative, based on cytology screening, and endocervical and vaginal scrapes were collected by a gynecologist and placed immediately in saline. HPV DNA was assessed by PCR, and HPV genotypes were determined by hybridization of PCR products with type-specific biotinylated probes.

RESULTS

Of the 127 participants, 55 tested positive and 72 tested negative for HPV DNA. While there was no difference between the two groups with regards to age or to number of pregnancies, higher numbers of smokers and of women with multiple sexual partners and abnormal cytology were seen in the HPV-positive group (P < 0.001). HPV DNA was detected in the vaginal scrapes of all HPV-positive, but in none of the HPV-negative women (sensitivity and specificity = 1.0). Furthermore, the HPV genotype was the same in vaginal and endocervical specimens in all the HPV-positive women.

CONCLUSION

HPV detection by PCR, using endocervical or vaginal sampling, is a sensitive and highly specific test for the identification of HPV infection, in particular in women with cytomorphologically normal cervices.

Prevalence of antibodies against hepatitis C virus among blood donors in Lebanon, 1997-2000

Chronic hepatitis C virus (HCV) infection in many individuals is asymptomatic and the prevalence of antibodies to hepatitis C virus (anti-HCV) among blood donors in Lebanon is scarce. This study aimed to address the prevalence of anti-HCV in 8700 blood donors, the data obtained was compared to other world regions. Between 1997 and 2000, 8700 blood donors were screened for the presence of anti-HCV in their sera. Initially reactive specimens were retested in duplicate, and repeatedly positive samples were subsequently retested by a third generation microplate enzyme immunoassay. Of the 8700 blood donors screened, 51 were confirmed positive for anti-HCV, giving a prevalence rate of 0.6%. While there was no difference in anti-HCV prevalence in relation to age or gender, higher rates were seen in non-Lebanese compared to Lebanese subjects (6.17% vs. 0.48%, P < 0.001). None of the anti-HCV positive individuals had an identifiable risk factor for contracting HCV (intravenous drug user, prior transfusion, etc.), and their transaminases were comparable to anti-HCV-negative donors, suggesting that HCV-positive donors were asymptomatic. These results demonstrate low prevalence of anti-HCV among Lebanese blood donors, which was comparable to those established for Western countries.

Factor V R506Q mutation-Leiden: an independent risk factor for venous thrombosis but not coronary artery disease

BACKGROUND

A specific point G-A transition at nucleotide position 1691 in the factor V (FV) gene, FV-Leiden, was associated with increased risk of venous thromboembolism (VTE). Insofar as the association of FV-Leiden with coronary artery disease (CAD) remains poorly defined, the aim of this study was to determine the prevalence of FV-Leiden in a sample of 68 VTE patients, 69 CAD patients, and 192 randomly selected healthy subjects.

METHODS

Total genomic DNA was extracted from the peripheral blood of study subjects and was used for PCR analysis. The presence (or absence) of FV-Leiden was assessed by PCR using primers flanking the mutant site (nt 1691), followed by hybridization with wild-type ('G') and mutant ('A') biotinylated DNA probes; detection was by DNA enzyme immunoassay (DEIA).

RESULTS

While the prevalence of FV-Leiden in CAD patients was not statistically different from that of healthy subjects (14.5 % vs. 15.1 %; P=0.890, odds ratio 0.95; 95 % confidence interval 0.43--2.06), a significant increase in FV-Leiden prevalence was seen in VTE patients (70.6 % in VTE patients; P<0.001, odds ratio 13.4, 95 % confidence interval 6.9--25.8). Of the 48 VTE patients who tested positive for FV-Leiden, 42 were heterozygotes (G/A), while 6 were homozygotes (A/A) (allele frequency 0.397). All 10 CAD patients positive for FV-Leiden were heterozygote carriers (allele frequency 0.072). While gender was not a factor in FV-Leiden expression, higher prevalence in FV-Leiden was seen in younger (< or =45 years) VTE patients (38/51 vs. 10/17).

CONCLUSION

FV-Leiden is a major inherited risk factor for VTE, with a peak incidence in younger patients, but does not appear to play any role in CAD pathogenesis in the population studied.