Ghada Radwan

Background:The reasons for the worldwide sex disparity in the incidence of hepatocellular carcinoma (HCC)
remain elusive. We investigated the role of multiple pregnancies on the associations between viral hepatitis C (HCV)
infection and HCC risk among Egyptian women.
Methods:We used data collected from blood specimens and questionnaires administered to female HCC cases
and controls in Cairo, Egypt, from 1999 through 2009. HCV infection was defined as being sero-positive for either
anti-HCV antibodies or HCV-RNA. Using logistic regression models we calculated odds ratios (OR) and 95% confidence
intervals (CI) to estimate the associations between being HCV positive and HCC risk, and how it is modified by the
number of pregnancies, after adjustment for other factors, including hepatitis B status.
Results:Among 132 confirmed female cases and 669 controls, the risk of HCV-related HCC increased with the number
of pregnancies. Women infected with HCV had higher risk for HCC if they had more than five pregnancies, as
compared to those who had five or fewer pregnancies (adjusted OR (95% CI): 2.33 (1.29-4.22)). The association of
HCV infection with HCC risk was significantly greater among the former (21.42 (10.43-44.00)) than among the latter
(6.57 (3.04-14.25)).
Conclusion:Having multiple pregnancies increases the risk of HCV-related HCC among Egyptian women, raising
questions about the roles of estrogens and other pregnancy-related hormones in modulating HCV infection and
its progression to HCC.
Keywords:Hepatocellular carcinoma, Hepatitis C, Epidemiology, Pregnancy, Women’shealth

Waterpipe smoking is increasing worldwide.
Nevertheless, little is known about nicotine dependence
in tobacco smokers who use waterpipes.
OBJECTIVE:To assess evidence of dependence among
non-cigarette smoking waterpipe smokers in Egypt.
METHODS: A total of 154 male exclusive current waterpipe smokers were enrolled for the present study. We
adapted the Fagerström test for nicotine dependence and
the Reasons for Smoking (RFS) scales and related these
to smoking behavior.
RESULTS:The mean age of the subjects was 47±
14 years, the mean age at smoking initiation was 22±
9 years, and average daily consumption was 4± 8 hagars
(tobacco units). The time to the first smoke of the day
(P <0.001), smoking even when ill (P =0.003), time to
tobacco craving (P <0.001), and hating to give up the
first smoke of the day (P =0.033) were each significantly associated with the number of hagars smoked per
day. The RFS subscales of addictive smoking, smoking
to relieve negative affect, and smoking for stimulation
were also associated with these variables.
CONCLUSION: The overall findings suggest that waterpipe smokers exhibit many of the same features of nicotine dependency attributed to cigarette smokers.
KEY WORDS: waterpipe smoking; nicotine dependence;
FTND; RFS; Egypt

Setting: Cairo and Giza governorates of Egypt 33
Objective: Particulate matter under 2.5 microns in diameter (PM2.5
) arises 34
from diverse sources, including tobacco smoke from cigarettes and 35
waterpipes, and is recognized as a cause of acute and chronic morbidity and 36
mortality. Our study aimed to measure PM2.5
in workplaces with different 37
intensities of smoking and varying levels of smoking restrictions 38
Design: We conducted an air sampling study to measure PM2.5
levels in a 39
convenience sample of indoor and outdoor venues in 2005-6. 40
Results: 3,295 individual measurements were collected at 96 venues with a 41
calibrated SidePak instrument. Compared to indoor venues where tobacco 42
smoking was banned (PM
2.5 levels of 72-81ug/m
3
), places offering waterpipes 43
to patrons of cafes (478 ug/m
3
) and Ramadan tents (612 ug/m
3
) had much 44
higher concentrations, as did venues such as public buildings with poor 45
enforcement of smoking restrictions (range: 171-704 ug/m
3
). Both the number 46
of waterpipe smokers and the number of cigarette smokers observed at each 47
venue contributed significantly to the overall burden of PM
2.5
. 48
Conclusion: Such data will support smoke-free policies and programs aimed 49
at reducing environmental tobacco exposure specifically and improving air 50
quality generally, and will provide a baseline for monitoring the impact of 51
tobacco control policies. 52
Key words: particulate matter, indoor air quality, smoking

Background: Hepatocellular carcinoma (HCC) is a major contributor to cancer incidence and mortality.
HCC is a highly fatal disease and is the third leading cause of death from malignancy worldwide. The aim of the study
was to determine long-term survival and prognostic factors predictive of the overall survival of HCC patients at the
National Cancer Institute (NCI), Cairo University. Patients and methods: A prospective study was conducted on a
cohort of 212 HCC patients attending to the medical oncology clinic at the National Cancer Institute (NCI) during the
period from July,1, 2007 till August, 31,2008 and they were followed up by phone till November 7th, 2010. Results:
The study revealed that 1-year, 2-year, 3-year survival rates of HCC patients were 26.9%, 9.4%, 5.0% respectively,
and median overall survival was 6.3 months (95% CI 5.4-7.2). Multivariate analysis revealed that independent
predictors of poor survival were pretreatment presence of extrahepatic metastasis and ascites, and not receiving
radiofrequency ablation (RFA) as a treatment modality. Conclusion: The study concludes that most HCC patients at
NCI presented at a late stage and their survival was poor. Preserved liver function, non-metastatic presentation of the
hepatic tumor and receiving RFA as a treatment modality are associated with good survival of HCC patients.
[Maissa K Noaman, Nargis A Labib, Ghada N Radwan, Othman M Mansour, Manar M Moneer and Inas A Elattar
Prognostic Factors for Survival of Patients with Hepatocellular Carcinoma in National Cancer Institute, Cairo
University. Journal of American Science 2011; 7(9):831-839]. (ISSN: 1545-1003).

Avian influenza (H5N1) (AI) is becoming a serious public health threat in Egypt. The
current study aimed to assess the existing knowledge, attitudes, and various practices
regarding AI in household backyard poultry breeders residing in Fayoum Governorate,
in rural Egypt.
Material and methods
Of the 149 cases confirmed to date in Egypt, 51 have been fatal. This study was
implemented in El Gendy and Manshat Abdllah villages in Fayoum Governorate. The
latter village is the one in which a case of AI was confirmed in February 2007. A group
of 150 women aged 15 years and above were recruited. A structured Arabic
questionnaire was used to collect data.
Results
All interviewed women (N= 150) had heard about AI. TV\radio was the common
source of information (83.3%). Nearly all interviewed women knew that AI is
transmitted from birds to humans (99%). Most of the participants (490%) correctly
identified saliva, nasal secretions, feces, and contaminated vehicles as the modes of AI
transmission. The knowledge regarding biosecurity measures (470%) and measures
of prevention (490%) was generally good. More than 90% of the interviewed
housewives agreed that AI is a serious disease that can be prevented, and that sanitary
precautions during breeding and food preparation practices are effective measures for
prevention of AI infection. Protective measures such as the use of gloves and masks,
which minimize the risk of transmission of AI from poultry to humans, were seldom used
by housewives in all their breeding, slaughtering, and cooking practices. However,
washing hands either with water or with soap and water was reported by the vast
majority of the respondents (490%).
Conclusion and recommendation
There was a good level of knowledge and favorable attitude of the study participants
regarding AI; however, practices appear to be inadequate to achieve full protection
against AI. Comprehensive and multidisciplinary interventions should be widely used to
enhance the complex behavior change process among the village residents

Waterpipe smoking is popular in many parts of the world. Micronuclei (MN) evaluation in the exfoliated
oral cells of smokers is a non-invasive technique for evaluation of possible tobacco harm. We aimed to
assess whether MN levels are higher in waterpipe smokers than in never smokers. We examined oral
smears of 128 adult male waterpipe smokers and 78 males who never smoked tobacco in rural Egypt. The
total number of MN per 1000 cells per subject, and the number of MN-containing cells per individual were
compared. We observed a higher level of total MN in waterpipe smokers (10±4) than in never smokers
(4±2,p< 0.001). A similar difference was found for the mean number of affected cells per individual
(8±3 vs. 4±1.62,p< 0.001). MN levels were not significantly dose related. This study is among the first
to assess the association between waterpipe smoking and a cytogenetic measure of tobacco harm. The
twofold increase in MN level is consistent with previous reports of MN in cigarette smokers. More research
is needed to determine if such MN levels are predictive of future health consequences

al., 1996; Wu, Hudmon, Detry, Chamberlain, &
Spitz, 2000), and with length of previous abstinence
among current smokers (Comings et al., 1996; Spitz
et al., 1998). However, it is not accepted universally
that DRD2 modulates smoking behavior, given that
some studies found no association (Bierut et al.,
2000; Johnstone et al., 2004; Singleton et al., 1998).
Two recent meta-analyses reported contradictory
findings. Li, Ma, and Beuten (2004) reported higher
prevalence of the A1 allele in smokers than in
nonsmokers, and Munafo` et al. (2004) found no
effect of DRD2 on any measures of smoking.
However, most studies were carried out in Whites,
and Munafo` et al. (2004) recommended further
investigation of molecular mechanisms of tobacco
dependence in other populations.
In response to the need for such information, we
extended our previous study of smoking behavior
among Egyptian male smokers to search for possible
influences of genetic variations in DRD2. Egypt has
the highest cigarette consumption rate in the Middle
East and North Africa region. In 1997, smoking
prevalence among adults was estimated to be 43.4%
in males and 4.7% in females (Nassar, 2003). This is
the first study in Egypt to investigate the possible
associations of DRD2 genotypes with tobacco use
and addiction