Is "hookah cafe" a tool to bypass smoke-free law?

Background In Turkey consumption of tobacco products in all indoor places are banned since 2009. Hookah and cigarettes which do not contain tobacco but used in a way to imitate the tobacco products are considered as tobacco products since 2013. The objective of this study was to determine hookah consumption in enclosed spaces of licensed hospitality establishments in Istanbul. Methods This is a cross-sectional study. There are 428 hospitality establishments licensed to offer hookah tobacco products in Istanbul. Seven districts which encompass 51.2% of all the licensed establishments were selected as the study area. Sample size was calculated as 141 establishments assuming a violation rate of 50%, margin of error of 0.05, confidence level of 95% and a 10% non-response. Establishments were selected through simple random sampling. Data were collected through direct observation and presences of hookah use, smoking, signage display were noted. Observations were carried out after 3:00 PM for 10 minutes. Results Of the 141 establishments 128 were accessed (90.8%). The majority were cafes (68.8%) and 3.1% had kids menu. Only 57.0% had existence of open terrace and 68.8% had extensions with removable panels. Of the establishments 15.6% had < 100 meters distance from formal education institutions. Among all 50.7% had no-smoking sign display, and of these only 61.5% were appropriate in terms of size and content. Violation for cigarette smoking and hookah use were 73.4% and 78.1%, respectively. In only four establishments health warnings were present on hookah bowls and two were appropriate in terms of size and content. Conclusions The absence of open terraces, lack of no-smoking signage, health warnings on hookah bowls, proximity to educational institutions and violations indicate problems with licensing and inspection procedures. Hookah premises without open spaces render detection of cigarette smoking impossible. There is a need to revise the methods of enforcement

Respiratory Depression Caused by Heroin Use

Summary Heroin is a semisynthetic narcotic analgesic and heroin abuse is common due to its pleasure-inducing effect. For the last 30 years heroin abuse has become an important worldwide public health problem. Heroin can be administered in many different ways as preferred. Heroin affects many systems including respiratory system, cardiovascular system and particulary the central nervous system. Overdose use of heroin intravenously can be fatal due to respiratory depression. In this letter, we wanted to engage attention to respiratory depression caused by heroin abuse and potential benefits of using naloxone. [TAF Prev Med Bull 2012; 11(2.000): 248-250

RELATIONSHIP BETWEEN LIVER BIOPSY AND NON-INVASIVE BIOCHEMICAL METHODS

William H. Craig - husbandhttps://stars.library.ucf.edu/cfm-ch-register-vol13/1182/thumbnail.jp

noninterventional, observational study

Background/Aims: The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients.Materials and Methods: Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest (R), aspartate aminotransferase-to-platelet ratio index(A-PRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies.Results: Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis.Conclusion: Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further