Allergic diseases, smoking, and environmental exposure among university students in Lebanon

Cesarean section and the risk of allergic rhinitis in children: a systematic review and meta-analysis

Multiple evidence indicates that perinatal factors make impact on immune development and affect offspring allergic rhinitis (AR) risk. In this systematic review and meta-analysis, we examined available published studies to clarify the relationship between cesarean section (C-section) and offspring AR in children. To explore the relationship between C-section, especially the special attention was paid to different cesarean delivery mode, and the risk of AR in children. Articles were searched using PubMed, Web of Science, EMBASE, Cochrane Library, China knowledge Network, Wanfang, and China Science and Technology Journal databases. A meta-analysis of 22 studies published before August 1, 2022, which included 1,464,868 participants, was conducted for statistical analysis with RevMan5.4. The correlation strength between C-section and offspring AR was determined by combining odds ratio (OR) and 95% confidence interval (95% CI). Meta-regression and subgroup analyses were used to explore potential sources of heterogeneity. Publication bias was detected using the funnel chart and Egger tests. Meta-analysis revealed that there was a significant correlation between C-section and children AR (OR = 1.19, 95% CI: 1.12-1.27, P < 0.001), especially C-section with a family history of allergy (OR = 1.82, 95% CI: 1.36-2.43, P < 0.001). Moreover, elective C-section (without genital tract microbe exposure) had the higher risk of offspring AR (OR = 1.24, 95% CI: 1.05-1.46, P = 0.010) compared with the whole study. Meta-regression demonstrated that sample size explained 38.0% of the variability between studies, and year of publication explained 18.8%. Delivery by C-section, particularly elective C-section and C-section with a family history of allergy can increase the risk of AR in children.

Scanning Electron and Atomic Force Microscopic Analysis of Erythrocytes in a Cohort of Atopic Asthma Patients—A Pilot Study

Background: Non-communicable diseases are often associated with chronic inflammation, placing patients suffering from these conditions at a higher risk of thrombosis and other complications. The pathophysiology of asthma and/or atopic asthma is also linked to chronic inflammation, which consequently may alter blood parameters including erythrocyte structure and function. Methodology: The objective of this study was to evaluate differences in erythrocytes between patients with atopic asthma (n = 30) and healthy individuals (n = 30) by evaluating routine haematological parameters; structures and axial ratios of erythrocytes using light microscopy; erythrocyte membrane elasticity using atomic force microscopy; and erythrocyte ultrastructure using scanning electron microscopy. Results: The haematological findings of healthy participants and patients suffering from asthma were within normal clinical ranges together with significantly higher levels of circulating monocytes (p = 0.0066), erythrocytes (p = 0.0004), haemoglobin (p = 0.0057), and haematocrit (p = 0.0049) in asthma patients. The analysis of eosin-stained erythrocytes by light microscopy showed more echinocytes, acanthocytes, and ovalocytes compared to controls and a significant difference in axial ratios (p < 0.0001). Atomic force microscopy findings showed reduced erythrocyte membrane elasticity in asthmatic erythrocytes (p = 0.001). Ultrastructural differences in erythrocytes were visible in the asthma group compared to controls. Conclusion: Altered erythrocyte ultrastructural morphology and a significant change in the haematological profile are evident in atopic asthma and may influence common complications associated with asthma. The impact of these changes on the physiological mechanisms of coagulation and the pathophysiology of asthma needs to be further elucidated.

Factors associated with wheezing among Lebanese children: Results of a cross-sectional study

BACKGROUND

In Lebanon, asthma is underdiagnosed due to low access to healthcare, particularly in rural areas, although asthma diagnosis in children is based mainly on clinical symptoms. Thus, wheezing might be more suggestive of undiagnosed respiratory diseases including asthma in Lebanese children. This study aimed to determine the factors associated with wheezing in Lebanese children without asthma diagnosis.

METHODS

This cross-sectional study was conducted between December 2015 and April 2016, enrolling a total of 1203 schoolchildren.

RESULTS

Out of 1500 prepared questionnaires, 1380 questionnaires were distributed in schools, and 1203 (87.17%) were collected back from the parents of children aged between 4-17 years old. The sample included 42 (3.5%) [95% CI 0.025-0.045] children with reported chronic wheezing. A multivariable analysis was performed taking the presence versus absence of wheezing in children as the dependent variable. The results showed that spraying pesticides at home (aOR=1.91), presence of humidity at home (aOR=2.21) and child reflux (aOR=2.60) were significantly associated with the presence of wheezing in children.

CONCLUSION

The findings of the study suggest that certain environmental factors, such as pesticides, humidity at home and reflux disease, might be associated with wheezing episodes in children. Those factors can be prevented through raising awareness by health care professionals.

Effect of waterpipe dependence on risk motives, attitudes and other health-related risky behaviors in Lebanese university students

Explore whether waterpipe dependence in young Lebanese adults would have any effect on modifying the association between risk conception, attitude, and other risky behaviors. A cross-sectional study was carried out using a proportionate cluster sample of Lebanese university students (3384 students). Waterpipe dependence was associated with higher association of alcohol dependence and cigarette dependence by 76.7% and higher excitement for dangerous behaviors by 7.1%. It was significantly associated with increased association of cigarette dependence and alcohol dependence by 66.8%, with the thinking of a behavior of being not dangerous by 239%, with having motives for risky behaviors by 74.1%, with ever having unsafe sex by 111.74%, and between having motives for risky behaviors and ever having unsafe sex by 61.95%. Waterpipe dependence was associated with higher motives, excitement, and perception of risk and risky behaviors, namely cigarette dependence, alcohol dependence, and unsafe sex. Moreover, it was associated with higher risky behavior interdependence.

Diet and asthma in Lebanese schoolchildren: A cross-sectional study

OBJECTIVES

The causes of the global increase in asthma in children are unknown. It has been hypothesized that diet is an important factor that may play a role in the pathogenesis of the disease. The objective was to evaluate the association between diet and current asthma among Lebanese children.

METHODS

A cross-sectional study was conducted on 1000 children recruited from public and private schools in Lebanon. Of the total enrolled participants, 107 children were diagnosed with current asthma and were analyzed. The food frequency questionnaire was used to assess participants' dietary habits.

RESULTS

The consumption of sweets ≥3 times weekly (ORa = 5.42), white bread ≥3 times weekly (ORa = 26.38), and olive oil daily (ORa = 9.80) were associated with higher odds of current asthma. Drinking carbonated beverages occasionally (ORa = 0.25) and ≥3 times per week (ORa = 0.03) was significantly associated with lower odds of current asthma. Adhering to Mediterranean diet (occasional, >3 times weekly and daily) was significantly associated with lower odds of current asthma compared to never consuming Mediterranean diet (ORa = 0.23 and ORa = 0.22, respectively). The occasional consumption of bread was significantly associated with higher odds of current asthma (ORa = 8.2), whereas daily consumption was significantly associated with lower odds (ORa = 0.336). Moreover, the occasional, ≥3 times weekly and daily consumption of meat were significantly associated with higher odds of current asthma (ORa = 9.6; ORa = 5.1 and ORa = 4.5), respectively. An occasional consumption of junk food was significantly associated with lower odds of current asthma (ORa = 0.044), whereas a daily consumption was associated with higher odds.

CONCLUSION

Adhering to certain diets might be associated with higher odds of current asthma.

Development of an asthma risk factors scale (ARFS) for risk assessment asthma screening in children

BACKGROUND

The study objective was to create asthma risk factors scale (ARFS) score that would be correlated with the increased risk of asthma in Lebanese children. This scale would eventually be used both to identify children at risk and assess early diagnosis of asthma.

METHODS

A case-control study (study 1) of 1276 children (976 controls and 300 cases) and a cross-sectional study (study 2) of 1000 children were conducted using a parental questionnaire. Children aged between 3 and 16 years were screened for possible enrollment. The ARFS was created by combining the following risk factors: child's exposure to pesticides, detergent mixing, alcohol, smoking and drug intake during pregnancy and breastfeeding, the actual paternal and maternal smoking status and history of asthma, and the types of food the child consumes.

RESULTS

There was a significant increase in the risk assessment screening for asthma per 15 points increments of ARFS (p < 0.001 for trend). The score category 0-14.99 best-represented control individuals (88.8% controls), while a score higher than 45 represented asthmatic children best (98.4% asthmatics). The positive predictive value (disease positive/all positive by scale) came out as 94.02%, whereas the negative predictive value (disease negative/all negative by scale) was found to be 90.47%. These results were confirmed in the second study sample.

CONCLUSION

The ARFS is a simple and easy-to-use tool, composed of 15 questions, for the clinician risk assessment of asthma in children, taking into account the environmental exposure, parental history of asthma and dietary habits of the child. Its value for asthma diagnosis remains to be confirmed in future prospective studies, especially in children with chronic respiratory symptoms.

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.

The AAA Risk Factors Scale: A New Model to Screen for the Risk of Asthma, Allergic Rhinitis and Atopic Dermatitis in Children

OBJECTIVE

To create an allergic disease risk factors scale score that would screen for the risk assessment of asthma, allergic rhinitis and atopic dermatitis (AD) in children from 3 to 17 years.

METHODS

This case-control study, conducted between December 2015 and April 2016, enrolled 1,274 children. The allergic disease risk factors scale was created by combining environmental, exposure to toxics during pregnancy and breastfeeding and parental history of allergic diseases.

RESULTS

Playing on carpets, male gender, child's respiratory problems or history of eczema before the  age of 2 years, and humidity significantly increased the odds of allergies in the child. Maternal waterpipe smoking, maternal history of rhinitis, history of asthma in the mother or the father, along with the maternal drug intake or alcohol consumption during pregnancy significantly increased the odds of allergies in the child. There was a significant increase in allergy diseases per category of the allergic disease risk factors scale (p < 0.001 for trend). Scores ≤2.60 best represented control individuals, while scores > 5.31 best represented children with allergic diseases.

CONCLUSION

Allergic diseases seem to be linked to several risk factors in our population of school children. Many environmental factors might be incriminated in these allergic diseases.

Predictors of past quit attempts and duration of abstinence among cigarette smokers

Objective: Despite the widespread awareness of the harms of smoking, millions continue to smoke around the world partly due to the difficulty it takes to quit smoking. Identifying the factors associated with making quit attempts is an essential pillar to reach successful quitting. The purpose of this study is to assess the factors associated with the past quit attempts and their past length of abstinence in a Lebanese sample of cigarette smokers.

Methods: This study was conducted between March 2014 and March 2015, involving 382 patients randomly chosen from 5 outpatient clinics in 5 hospitals in Lebanon. A standardized questionnaire was completed including socio-demographic characteristics, smoking behavior, chronic respiratory symptoms, Fagerstrom scale, Mondor scale, packaging perception, quitting behavior and readiness to quit ladder.

Results: Smokers who have chronic allergies (ORa = 2.45, p = 0.03), those who have ever stopped smoking for at least one month due to the warnings implemented on the packages (ORa = 4.6, p < 0.0001) and smokers with an intention to quit in 2 months (ORa = 2.49, p < 0.0001) had significantly more past quit attempts.

Results: Furthermore, longer quit attempts duration (more than 1 month) were significantly associated with low-nicotine dependent smokers (ORa = 0.56, p = 0.02), higher-motivated smokers (ORa = 1.85, p = 0.01), people with chronic allergies (ORa = 2.07, p = 0.02), smokers who have ever stopped smoking for at least one month due to the warnings (ORa = 3.72, p < 0.0001) and those with an intention to quit in 2 months (ORa = 1.98, p = 0.05).

Conclusion: The promoters of smoking cessation services should consider these factors when designing comprehensive tobacco control initiatives and in service planning.