Ebube Christopher Mbah

Background: Water pipe smoking (hookah, shisha, narghile) is increasingly popular worldwide, particularly among adolescents and young adults. Misconceptions about its health risks persist despite growing evidence of its harmful cardiovascular effects. Objective: This scoping review aims to map the existing literature on public perceptions and misconceptions about water pipe smoking and its cardiovascular health implications, with the goal of informing awareness efforts and policy interventions. Methods: Following the PRISMA-ScR guidelines, we systematically searched, charted, and summarized 96 peer-reviewed studies published between 2000 and 2024 in major databases. Studies were included if they addressed public perception, knowledge, or cardiovascular outcomes related to water pipe use. Data were synthesized descriptively to highlight key themes and evidence gaps. Results: Most included studies (52%) were observational, with a regional focus on Middle Eastern and South Asian populations (67%). Common misconceptions included beliefs that water filtration reduces harm and that water pipe smoking is safer than cigarettes. Evidence shows significant exposure to harmful substances such as carbon monoxide, nicotine, heavy metals, and carcinogens, with reported associations with cardiovascular outcomes including atherosclerosis, myocardial infarction, and hypertension. Social acceptability, flavored tobacco, and weak regulation in low- and middle-income countries further promote its use. Conclusions: Water pipe smoking poses substantial cardiovascular risks that are poorly understood by the public. This scoping review highlights the need for culturally sensitive health education, robust public health campaigns, and stronger policy enforcement. Future research should adopt standardized reporting methods to better characterize long-term cardiovascular impacts, dual tobacco use patterns, and policy effectiveness.

Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease primarily affecting upper and lower motor neurons. Although cerebrovascular disease (CVD) and ALS have traditionally been studied as distinct entities, a growing body of evidence indicates meaningful epidemiological, pathophysiological, and clinical overlap between the two conditions. This narrative review synthesizes current evidence on the coexistence of ALS and cerebrovascular disease, examines shared mechanistic pathways, addresses diagnostic challenges, including stroke mimicry, considers clinical management implications, and identifies priorities for future research. A search of PubMed, Scopus, Web of Science, and EMBASE was conducted through February 2026 using the terms “amyotrophic lateral sclerosis,” “motor neuron disease,” “cerebrovascular disease,” “stroke,” “ischemic stroke,” “blood-brain barrier,” “neuroinflammation,” and “neurovascular coupling,” alone and in combination. Peer-reviewed original research, systematic reviews, meta-analyses, population-based studies, registry analyses, and expert consensus statements were included. Studies were assessed for methodological quality and relevance to the review objectives. This review is reported as a narrative synthesis. Population-based data demonstrate a bidirectional relationship between ALS and cerebrovascular events. ALS patients face an approximately 2.6-fold elevated risk of ischemic stroke, and prior cerebrovascular injury modestly increases subsequent ALS risk. Shared pathophysiological mechanisms include neuroinflammation with microglial M1/M2 polarization imbalance, pro-inflammatory cytokine cascades mediated via NF-κB signaling, oxidative stress and SOD1 pathway dysregulation, glutamate excitotoxicity, blood–brain barrier (BBB) dysfunction, and impaired neurovascular coupling. Diagnostic confusion arises because upper motor neuron–predominant ALS can closely mimic acute ischemic stroke. Concurrent cerebrovascular disease appears to accelerate functional decline and reduce survival in ALS. Resource-limited settings face compounded challenges from diagnostic misclassification, restricted EMG access, and limited specialist availability. The ALS–cerebrovascular overlap is clinically relevant, biologically plausible, and systematically understudied. Integrated multidisciplinary management, prospective longitudinal cohort studies, and linked registry analyses are urgently needed to clarify causal relationships, characterize shared disease mechanisms, and improve patient outcomes.

Atrial fibrillation (AF) is a major contributor to cardioembolic stroke. Anticoagulation, guided by CHA2DS2-VASc and HAS-BLED scores, is critical for secondary prevention, yet challenges persist in timing, patient-specific tailoring, and balancing efficacy with bleeding risk. This umbrella review synthesizes evidence on anticoagulation strategies for secondary prevention of cardioembolic stroke in AF patients. We searched PubMed, Scopus, Cochrane Library, Web of Science, and Embase for systematic reviews and meta-analyses (inception to May 2025) assessing oral anticoagulants (OACs) [vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs)] in AF patients with prior stroke or transient ischemic attack (TIA). Outcomes included recurrent stroke, systemic embolism, major bleeding, intracranial hemorrhage (ICH), and mortality. Quality was assessed using AMSTAR-2. Data were narratively synthesized, with quantitative metrics extracted where feasible. Eight reviews (2007–2025) were included, comprising 4–52 studies and 6893–94 656 participants. DOACs demonstrated superior efficacy over VKAs [apixaban odds ratio (OR) 0.79, 95% confidence interval (CI) 0.66–0.94], and VKAs outperformed antiplatelets (relative risk reduction 64%, absolute risk reduction 8.4%/year). DOACs showed lower major bleeding and ICH rates than VKAs, with apixaban exhibiting the most favorable safety profile (OR 0.71, 95% CI 0.61–0.81). Early versus delayed OAC initiation post-stroke improved efficacy (OR 0.68, 95% CI 0.55–0.84) with comparable safety. Identified knowledge gaps include optimal timing of OACs, outcomes in high-risk subgroups (elderly, renal impairment, and post-ICH), and cost-effectiveness. DOACs are superior to VKAs for secondary prevention of cardioembolic stroke in AF. However, individualized approaches are needed for timing and high-risk subgroups.