Abstract

<b>Background:</b><b> </b>High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality education and fewer occupational opportunities, faced by ethnic minorities. <b>Objective:</b><b> </b>This study examined the protective effect of years of schooling—used as a proxy for educational attainment—on diabetes mellitus (DM), overall and by ethnicity. Based on the MDRs framework, we hypothesized that the protective effect of education would be weaker for Latino individuals compared to non-Latinos. <b>Methods:</b><b> </b>Data were drawn from the 2012 wave of the Understanding America Study (UAS), a nationally representative, internet-based panel. The outcome of interest was self-reported doctor diagnosis of DM. Logistic regression models were used to assess the association between educational attainment and DM, with an interaction term to explore differences between Latino and non-Latino individuals. Models were adjusted for age, sex, employment, immigration status, and marital status. Findings were presented as adjusted odds ratios (OR), p-values, and 95% confidence intervals (CIs). <b>Results:</b><b> </b>Higher educational attainment was associated with lower odds of DM in both Latino and non-Latino individuals (p < 0.001). An interaction between education and ethnicity (p < 0.05) indicated that the protective effect of education was weaker for Latino individuals compared to non-Latinos. <b>Conclusion:</b><b> </b>The findings align with the MDRs framework, which suggests that the health benefits of education are not equally distributed across ethnic groups. For Latino individuals, structural barriers such as lower educational quality and labor market discrimination may limit the protective effect of education against DM. While education is a key determinant of health, its unequal returns contribute to ethnic health disparities. Policymakers must address structural inequalities in education and employment that disproportionately affect ethnic minorities. Tackling these disparities through multi-sector policy interventions will require bipartisan political support.

Abstract

<b>Background:</b> Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. <b>Objectives:</b> This study introduces the rationale, design, methodology, and participants of the SMOKES Study (Study of Measurement of Knowledge and Examination of Support for tobacco control policies), which is conducted to evaluate tobacco use, tobacco-related knowledge and attitude, as well as support for tobacco control policies among college and university students. <b>Methods:</b> The SMOKES Study was designed to address significant gaps in literature by focusing on college and university students in a non-Western context. A multi-center, cross-sectional design was employed to collect data from a diverse sample of college and university students across different geographical provinces in Iran. The survey instrument incorporated a range of measures covering socio-demographic characteristics, university-related variables, family tobacco use status, personal tobacco consumption behaviors (including detailed assessments of cigarette, hookah, and electronic cigarette use), and attitudinal as well as knowledge-based assessments related to vaping. Support for tobacco control policies is also measured. Data were collected using an online survey that included self-administered questionnaires, enabling access to a large diverse sample. This study may be used to determine the prevalence of ever and current use of cigarettes, electronic cigarettes, and hookah, as well as examining the correlates of single, dual, and poly-tobacco use. The study also aims to assess the role of social determinants, attitudes, and ethnic/geographic differences in shaping these outcomes. <b>Results: </b>The study sample consisted of 2403 college and university students, including undergraduates enrolled in different academic programs from all faculties and disciplines. Participants were drawn from universities across 15 provinces, and 11 ethnic groups, ensuring a heterogeneous sample with respect to socio-demographic background, ethnicity, and institutional affiliation. This diversity enhances the generalizability of the findings and allows for the exploration of subgroup differences in tobacco use patterns and policy support. <b>Conclusions:</b> The SMOKES Study offers a framework for examining tobacco-related knowledge and the acceptability of tobacco control policies among a key part of the population, being college and university students. By providing detailed insights into the prevalence and correlates of tobacco knowledge, attitude, use, as well as the tobacco control policy support, the study lays the groundwork for tailored public health interventions and more effective tobacco regulation strategies particularly for college campuses in a non-Western setting.

Abstract

<b>Background:</b><b> </b>Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. Despite this, few studies have systematically examined the explanatory mechanisms that might clarify why menthol-flavored tobacco is linked to poorer cessation outcomes among participants in tobacco cessation programs. <b>Aims:</b><b> </b>This study aimed to investigate the potential mechanisms by which menthol tobacco use is associated with lower quit rates across three types of smoking cessation interventions. <b>Methods:</b><b> </b>Participants were randomized into one of three smoking cessation interventions: in-person (CEASE), self-help, or online/hybrid programs. Smoking abstinence was assessed three months post-intervention as the primary outcome. Secondary analyses explored whether demographic, socioeconomic, or behavioral factors mediated the association between menthol use and quit rates across the intervention arms. <b>Results:</b><b> </b>Menthol tobacco use was significantly associated with lower quit rates (p < 0.01). This association was not explained by demographic, socioeconomic, health, or addiction-related factors. While menthol use was associated with lower education and employment levels, demographic characteristics, physical or mental health, or addiction did not explain the effect of menthol on tobacco cessation. These findings suggest that the lower quit rates observed among menthol users cannot be attributed to any third factors assessed in this study. <b>Conclusions:</b><b> </b>Menthol tobacco use independently predicts lower quit rates, and the mechanisms behind this disparity remain unclear. The consistent findings across different intervention types highlight the need for further research to uncover the underlying pathways and to design targeted strategies to improve cessation outcomes for menthol users.

Abstract

<b>Background: </b>Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. <b>Objective: </b>To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. <b>Methods: </b>Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. <b>Results:</b> In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, <i>p</i> < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, <i>p</i> < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, <i>p</i> < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, <i>p</i> < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, <i>p</i> < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, <i>p</i> < 0.05). No other factors, including demographic variables (e.g., age), socioeconomic status (e.g., education, marital status), substance use profiles (e.g., cigarette packs per week, NRT use), or nicotine dependence, were significant predictors of cessation success. <b>Conclusion:</b> Baseline self-reported anxiety/depression and depressive symptoms play a critical role in reducing the likelihood of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program. These findings underscore the importance of addressing mental health challenges as part of tobacco cessation interventions to enhance their efficacy. Future research should explore targeted strategies for integrating mental health support into cessation programs to improve outcomes for underserved populations.

Abstract

<b>Background</b><b>:</b> Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the poverty-to-income ratio (PIR), and CMD indicators—including obesity, diabetes, and cardiovascular disease (CVD)—among men and women using data from the National Health and Nutrition Examination Survey (NHANES). <b>Methods</b><b>:</b> This cross-sectional study utilized NHANES data (1999-2018), adjusting for race/ethnicity and age. SES was operationalized using PIR, with CMD outcomes (obesity, diabetes, and CVD) as dependent variables. Generalized linear models (GLM) were employed to evaluate the main effects of SES on CMD, with gender included as a moderator. <b>Results</b><b>:</b> Higher SES was associated with lower overall CMD risk. However, the protective effects of SES were more pronounced in women than in men for all outcomes. These findings suggest that gender-specific pathways may mediate the relationship between SES and CMD. Women may derive greater health benefits from higher SES due to factors such as reduced stress exposure, healthier behaviors, and increased healthcare utilization. Conversely, the weaker association observed in men may reflect differences in social hierarchy sensitivity, responses to unemployment, or other contextual factors. <b>Conclusion</b><b>:</b> The findings highlight the importance of gender-specific considerations when addressing SES-related disparities in CMD outcomes. Policies and interventions aimed at reducing CMD burden should account for these gender differences to promote equitable improvements in cardiometabolic health. Further research is needed to unravel the mechanisms driving these differences and to inform targeted strategies.

Abstract

<b>Objective: </b>To examine racial/ethnic differences in the associations of family socioeconomic status (SES), neighborhood SES, and inhibitory control with body mass index (BMI) in 9-10-year-old children using data from the Adolescent Brain Cognitive Development (ABCD) study. <b>Methods: </b>This cross-sectional study included a diverse sample of children aged 9-10 years, representing non-Latino White, Black, Latino, Asian, and Other racial/ethnic groups. BMI was the primary outcome. Key predictors were family SES, neighborhood SES, and inhibitory control. Multivariable regression models were stratified by race/ethnicity to identify group-specific associations. <b>Results: </b>Race/ethnic groups differed in<b> </b>psychosocial correlates of childhood BMI at age 9 and 10. Among non-Latino White children, higher family income (B = -0.086, p < 0.001), higher parental education (B = -0.069, p < 0.001), and living in a married household (B = -0.079, p < 0.001) were associated with lower BMI. Additionally, the presence of healthy food options in the zip code (B = -0.030, p = 0.032) was linked to lower BMI, while lack of planning (B = 0.032, p = 0.030) was associated with higher BMI. For non-Latino Black children, positive urgency (B = -0.068, p = 0.022) was negatively associated with BMI, while other factors such as family SES and neighborhood SES did not show significant associations. For Latino children, higher family income (B = -0.093, p = 0.001) and parental education (B = -0.099, p < 0.001) were associated with lower BMI. In this group, male gender (B = 0.043, p = 0.033) was associated with higher BMI. Among Asian children, higher family income (B = -0.199, p = 0.006) and parental education (B = -0.144, p = 0.037) were significantly associated with lower BMI. For children in the "Other" racial/ethnic category, higher family income (B = -0.101, p = 0.023), living in a married household (B = -0.076, p = 0.026), and higher median income in the zip code (B = -0.083, p = 0.013) were associated with lower BMI. In this group, male children had lower BMI compared to females (B = -0.089, p = 0.001). <b>Conclusion: </b>The findings highlight substantial racial/ethnic differences in the psychosocial and socioeconomic correlates of BMI in children. There is a need for tailored interventions that target social determinants of childhood high BMI. One size does not fit all.

Abstract

<b>Background:</b><b> </b>Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported outcome measures in this context are in line with more objective outcome measures.<b> </b><b>Aims:</b><b> </b>This study aimed to validate self-reported quit rates using the Fagerström Test for Nicotine Dependence (FTND) as a gold standard outcome measure for evaluation of the effectiveness of the CEASE smoking cessation intervention compared to a self-help approach among low-income, underserved adult smokers. <b>Methods:</b><b> </b>A quasi-experimental design was employed to evaluate this community-based intervention. Although participants were initially assigned to three groups, this report focuses on two arms that show the major difference in the efficacy of the program: (1) the self-help group (reference; Arm 1) and (2) the in-person CEASE group (Arm 2). Outcomes included successful quitting, assessed through self-reports, and changes in FTND scores. To examine the concordance between these measures, we tested whether changes in FTND scores fully explained the relationship between the intervention and self-reported quitting. Potential confounders included demographic, socioeconomic, and health-related variables. Data were analyzed using regression and structural equation modeling (SEM). <b>Results:</b><b> </b>The majority of participants were Black Americans, followed by White individuals and those of other racial backgrounds. The CEASE intervention (Arm 2) demonstrated effectiveness in reducing nicotine dependence (measured by FTND) and increasing self-reported quit rates compared to the self-help group. Importantly, changes in FTND scores fully explained the effect of the CEASE intervention on self-reported quitting, highlighting the program’s impact on addiction severity. <b>Conclusion:</b><b> </b>Successful quitting measured using self-report is in line with the decline in nicotine addiction severity among low-income racial minority populations. CEASE holds promise as a scalable solution to address smoking disparities in underserved communities.

Abstract

<b>Background: </b>Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults. <b>Objectives:</b> This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites. <b>Methods:</b> Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status. <b>Results:</b> Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education. <b>Conclusion:</b> AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.

Abstract

<b>Background: </b>The rising concerns surrounding climate change have drawn attention to its potential impact on health, particularly among vulnerable groups such as children and older adults. Despite extensive research on health consequences, limited studies have explored the connection between extreme heat exposure and tobacco use initiation among adolescents in the United States. <b>Objectives:</b> This study examines the relationship between extreme heat exposure and the initiation of tobacco use in adolescents, using data from the Adolescent Brain Cognitive Development (ABCD) study. It also evaluates the mediating roles of major depressive disorder (MDD) and childhood behavioral problems. <b>Methods:</b> Data from 11,878 participants in the ABCD study were analyzed to explore the link between extreme heat exposure (independent variable) and tobacco use initiation (dependent variable). Covariates included age, sex, and race/ethnicity, while MDD and behavioral problems (measured using the Child Behavior Checklist, CBCL) were assessed as potential mediators. Structural equation modeling (SEM) was applied for analysis. <b>Results:</b> The findings indicated a significant association between extreme heat exposure and an increased likelihood of tobacco use initiation in adolescents aged 9 to 15. MDD and behavioral problems partially mediated this relationship. <b>Conclusions:</b> These results underscore the importance of targeted interventions aimed at mitigating the impact of extreme heat on adolescent health, including its influence on tobacco use initiation. Addressing mental health and behavioral challenges could help reduce these risks. Future longitudinal research is needed to confirm these findings and evaluate the efficacy of strategies to protect vulnerable youth populations.

Abstract

<b>Background: </b>The dual use of e-cigarettes and combustible cigarettes poses significant public health concerns due to the compounded risks associated with the use of both products. Understanding the predictors of dual use can inform targeted interventions and tobacco control strategies aimed at reducing nicotine dependence and health risks among adults.<b> </b><b>Objective: </b>This study aims to identify the sociodemographic predictors of dual use of e-cigarettes and combustible cigarettes among U.S. adults using baseline data from the Population Assessment of Tobacco and Health (PATH) Study.<b> </b><b>Methods: </b>We analyzed baseline data from the PATH Study, focusing on adult participants who reported the use of both e-cigarettes and combustible cigarettes. Logistic regression models were used to identify the associations between dual use and key sociodemographic variables, including age, gender, race/ethnicity, and education level.<b> </b><b>Results: </b>The analysis revealed that dual use of e-cigarettes and combustible cigarettes was predominantly observed among young, female, non-Latino, White, and highly educated adults. Younger adults were more likely to engage in dual use compared to older age groups. Females showed higher rates of dual use compared to males. Non-Latino White individuals were more likely to be dual users than individuals from other racial/ethnic backgrounds. Additionally, higher educational attainment was associated with increased dual use, contrary to traditional smoking patterns.<b> </b><b>Conclusion: </b>The findings highlight specific demographic groups that are at higher risk of dual use of e-cigarettes and combustible cigarettes, particularly younger, highly educated, non-Latino White females. These insights suggest the need for tailored public health interventions that address the unique needs and behaviors of these populations. Future research should explore the underlying motivations and contextual factors contributing to dual use to enhance the effectiveness of tobacco control policies and cessation programs.

Abstract

<b>Objective: </b>This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. <b>Methods:</b> Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents. <b>Results:</b> A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders. <b>Conclusions:</b> The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.

Abstract

<b>Objective</b>: aortic root enlargement (ARE) and descending thoracic aorta dilatation (DTAD) in combined aortic valve and ascending aorta replacement surgery (AV+AAR) are postoperative concerning issues. This retrospective observational analysis studies surgical factors which could determine those complications. <b>Methods</b>: 236 patients underwent AV+AAR. Mean-time follow-up by trans-thoracic echocardiography (TTE) and computer tomography (CT) was 44.7 ± 21.2 and 38.2 ± 18.4 months respectively. In long-term follow-up, outcome variables are: ARE equal/more than 10% of the preoperative TTE data and DTAD equal more than 5% of preoperative CT measurement at the same thoracic vertebrae axial slice. <b>Results</b>: ARE and DTAD appear strictly related to the discrepancy between prosthetic valve and straight vascular prosthesis diameters (p = 0.024), while there is not significant difference (log-rank = 0.917) related to aortic valve surgery type (replacement or repair). Considering diameter difference (DD) between vascular and aortic valve prosthesis, patients were subsequently grouped into two sections: L5 group, in which DD was less/equal than 5 mm, and M5, in which DD was more/equal than 5 mm. ARE was found in 30.8 % of L5 patients and only in 14.7 % among M5 patients (log-rank = 0.026). We have also observed descending thoracic aorta dilatation in 34.2 % of L5 and in 12.1 % of M5 (log-rank = 0.023). <b>Conclusions</b>: According with our data, difference between vascular prosthesis and aortic valve prosthesis equal/more than 5 mm is a protective factor against ARE and DATD.

Abstract

Authors describe autoptic findings of two cases whose COVID-19 diagnosis was supported by laboratory data. Both patients were Caucasian individuals of middle age (one male, 47 years old; the other a female aging 36 years) that were considered as previously healthy. Clinically they died from cardiorespiratory insufficiency while being treated in intensive care units. None of them was intubated and blood oxygen levels (SpO2) decreased below 90% only during the agonal phase. Myopericardial changes were visible from a macroscopic point of view, with hemorrhagic and necrotic areas involving pericardium. Fresh hemorrhage and severe hyperemia were both signs of vascular damage and extravasation leading to acute myocardial injuries. Lymphocytic presence was disparate and not constant.

Abstract

<b>Background:</b> Prolonged decline in the ability of the kidney to regulate acid–base balance, eliminate waste products, and manage water homeostasis and entered chronic phase, toxic metabolic accumulates and erythropoietin secretion by the kidney is decreasing and causes hematological changes including decrease of HCT, MCV, RBCs and platelet counts. Hemodialysis became a practical treatment for kidney failure and is the most common method used to treat advanced and permanent kidney failure. Anemia is one of the most common complications in hemodialysis patients<b>. Objectives:</b><b> </b>The study aimed to evaluate the prevalence of anemia among hemodialysis patients and investigate the variations of hematological parameters among anemic hemodialysis patients in the Tripoli region. <b>Materials and Methods:</b> The present study was conducted on 250 renal failure patients, attending Tripoli Center for dialysis and 100 normal healthy subjects. The study Ethical Committee of the medical centers and the Libyan Academy of graduate studies reviewed and approved the study design and patient consent statements were taken from each patient. Information's about the patients were recorded in a questionnaire. A blood sample of 5 ml was drawn by venous puncture from each normal healthy individual and hemodialysis patient. 2.5 ml of the blood sample was collected in K-EDTA tubes for the hematological examinations and another 2.5 ml of the blood sample was collected in a plain tubes for biochemical tests (serum urea, creatinine, and uric acid concentrations). The hematological parameters (RBCs count, Hb, HCT, MCV, MCH, MCHC, WBCs count, differential count of WBCs, and Platelets count) were determined using an automated hematology analyzer Sysmex (K- 4500) machine. The data were compared using GraphPad Prism version.9. The statistical significance of differences between groups was evaluated with the independent t-test. A P-value of <0.05 was considered significant for all statistical tests. <b>Results:</b> The results showed that the prevalence of anemia among hemodialysis patients was 89.8%. The degrees of anemia were 17% severe, 71.66% moderate, and 11.34% mild anemia. The types of anemia were 13.36% microcytic hypochromic, 82.59% normocytic hypochromic, and 4.05% macrocytic hypochromic anemia. RBCs, WBCs &#x26; platelets counts, Hct, MCHC, and Lymphocytes % showed a significant (<i>P<0.01</i>) decrease, and MCV was a significant (<i>P<0.01</i>) increase in the anemic hemodialysis patients compared with the healthy individuals. But, a significant (<i>P<0.05</i>) decrease in MCH was observed in the anemic hemodialysis patients when compared with the healthy individuals. A significant correlation was observed between RBCs and their indices with most of the hematological parameters. A significant (<i>P<0.01</i>) negative correlation was observed between serum urea with Hb, and RBCs count and Hct. While, a significant (<i>P<0.01</i>) positive correlation was recorded between uric acid with platelets count. A significant (<i>P<0.05</i>) positive correlation was observed between gender with platelets count, while, a significant negative correlation was recorded between gender with serum urea (<i>P<0.01</i>), creatinine, and uric acid, and Hb (<i>P<0.05</i>). A significant (<i>P<0.01</i>) negative correlation was observed between blood groups with serum uric acid. A significant (<i>P<0.01</i>) positive correlation was observed between durations of hemodialysis with RBCs count and Hb, while, a significant (<i>P<0.05</i>) negative correlation was recorded between durations of hemodialysis with body weight, and MCHC. <b>Conclusion</b>: It can be concluded that a higher prevalence of moderate, normocytic hypochromic anemia among hemodialysis patients. Also, results showed a significant variation in hematological parameters among the anemic hemodialysis patients. So, hemodialysis patients advice to examine the hematological parameters and treated from anemia if detected.

Abstract

Exercise is an important factor of rehabilitation in heart failure patients, improving several indicators of disease prognosis and functional capacity. The aim of the present study was to examine the effect of a cardiorespiratory rehabilitation program on the physical and mental fatigue, general health and anxiety in patients suffering from heart failure. Thirty-one patients with heart failure [(M±SD) age: 67.59±7.60 years] participated in a cardiorespiratory rehabilitation program. The program included aerobic exercise on cycle ergometers and muscle strengthening for 3 months (12 weeks), 3 times/week. Before and after the program, patients' fatigue, general and mental health were assessed using the following self-reported questionnaires: a) Fatigue Assessment Scale (FAS), b) Goldberg's General Health Questionnaire (GHQ-28) and c) Spielberger's Anxiety Questionnaire. Data analysis showed a statistically significant tendency of reduction in social dysfunction (from 1.99±0.42 to 1.75±0.45, p=0.05), while anxiety (from 27.10±7.61 to 26.40±4.35) showed no change (p>0.05).Also, evaluating the changes in the health level after attending the program, there was a trend of improvement in physical activity and functioning with the appearance of fewer physical symptoms (from 1.38±0.43 to 1.24±0.31, p=0,13). These results show that exercise can contribute to increasing the general well-being of these patients and reducing feelings of helplessness, making them able to cope with their daily activities and tasks.

Abstract

<b>Background: </b>Cigarette smoking is one of the 10 greatest contributors to global death and disease. Cigarette smoking is the most common type of tobacco use. In average, to date 47.5% of men and 10.3% of women are current smokers. Tobacco continues to be the second major cause of death in the world. It consists of many chemicals, including cytotoxic, carcinogenic and free radicals, therefore it affects many organs if not all. <b>Objective:</b> The aim of this study is to assess the extent of adverse effect of cigarette smoking on blood pressure, liver function, and hemoglobin concentration in male population on the West Coast of Libya. <b>Methods:</b> This study was conducted on (200) healthy male subjects, their ages ranged from 15 to 85 years. They were divided into four groups; 50 non-smokers as control group (age between 15-35 years), 50 smokers (age between 15-35 years), 50 non-smokers as control group (age between 36-84 years) and 50 smokers (age between 36-84 years). The blood was collected in EDTA tubes to test the Complete blood count (CBC) and in plain tubes for biochemical assay (activities of liver enzymes). The Blood pressure of subjects was measured directly after sample collection. <b>Result</b>: The blood pressure among the group of age 36-84y was significantly higher (<i>P < 0.05</i>) when compared between the smokers and the nonsmokers group, while among the group of age 15-35 was not significant. The results of liver enzymes activities among the group of age 36-84y showed that ALT and ALP were significantly high (<i>P <0.05</i>) in the smoker group when compared with the nonsmoker group, while serum AST was not significant (<i>P>0.05</i>). However, among the group of age between 15-35 years, the results showed that statistically significant differences (<i>P<0.05</i>) were observed in ALT and AST activities for the smoker group when compared with the nonsmoker group. Regarding RBCs count and hemoglobin concentration among both of groups (age between 15-35 &#x26; 36-84 years), the results showed that a significant difference in mean RBCs count and hemoglobin concentration were noted between the smokers and the nonsmokers. <b>Conclusion</b>: It can be concluded that exposure to cigarette smoking leads to an increase the blood pressure. Cigarette smoking can lead to an increase in liver enzymes activities, RBCs count and Hb concentration.

Abstract

An arrhythmia, or abnormal heart rhythm, usually means that the heart is beating too fast, too slowly, or irregularly. Few people do not feel discomfort when they notice that their heart is beating faster or irregularly or if they feel their heart pounding in their throat. Arrhythmia is an abnormal heart rhythm. The heart is controlled by a conduction system that transmits electrical impulses. This causes the heart to beat. This system works automatically, so outside of human will. The heart generally works rhythmically throughout life.

Abstract

<b>Introduction:</b> Stroke is associated with high mortality. It is the main neurological cause of mortality and the most important cause of disability worldwide. In the year 2007, Stroke was the third cause of admission at the Korle-Bu Teaching Hospital, and the number one cause of death. <b>Objective:</b> To determine the probability of survival (case-fatality rates) of stroke patients admitted at the Korle- Bu Teaching Hospital during the period 2007. <b>Method:</b> A Retrospective descriptive study of Surgical/Medical Emergency, SME and the Medical wards admissions and discharges from 1st January 2007 to 31st December, 2007. <b>Results:</b> A total of 250 hospitalized stroke patients were identified, of which 68(27%) were from the SME and 182(72%) from the medical wards. The mean age (SD) was 57.6(14.7) and 52% were males. Case fatality rate was 52% at the SME versus 35% at the Medical wards) whilst the risk of death in males expressed as risk ratio (RR) was 2.1, (95% CI 0.70-5.6) vs. RR=1.3, (95% CI 0.73-2.5) in females and the median survival time was 2days (95% CI 1.5-2.4) versus 7 days (95% CI 6.3-7.6) at the SME and Medical respectively. The type of admission and stroke outcome was significant P=0.01 (95%CI 0.02-0.14). <b>Conclusion:</b> Stroke was associated with high mortality. The risk of dying from stroke was higher at the SME Findings were independent of stroke subtype, stroke onset and any associated co-morbidities.

Abstract

Alterations in the cardiac electrical system are the cause of morbidity and a wide variety of symptoms – from mild to those requiring urgent intervention – because of the risk of sudden cardiac death. The most prevalent of these types of electrical disturbances is atrial fibrillation, the incidence of which is growing as the average age of the human being increases. Among many other electrical heart alterations is one I describe in this document: "The presence of short PR and QTc intervals together in the same ECG tracing”. <b>Methods: </b>A cardiac calibrator was used by four different cardiologists in blinded fashion to document a distinct ECG pattern, that of a short PR and QTc intervals together in the same ECG tracing from more than 2.500 cases assessed for this condition (more than two thousand five hundred cases evaluated since 2.007 to date). <b>Results:</b> Here we describe the clinical features of 330 patients with a documented short PR and QTc intervals together in the same ECG tracing along with descriptions of their symptoms and ancillary investigations. <b>Conclusions:</b> ECG tracing must be studied carefully in patients with suggestive symptoms before declaring normal an ECG tracing with certain defined characteristics.