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This study was carried out to evaluate the relationship between narghile smoking and serum concentration of serotonin and endorphin and some blood hematological indices in males. Group of smokers composed of 50 voluntary, and control group composed of 36 healthy voluntary. This study was conducted on adults man that ages between (18-25 years). The markers measured in this study were serum serotonin and endorphin and hematological indices (platelets, hematocrit, hemoglobin, and white blood cells). This study showed a significant decrease (P<0.05) in levels of serum serotonin, endorphin and blood platelets, and a significant increase (P<0.05) in levels of in blood hematocrit and hemoglobin and a non-significant increase of white blood cells (P>0.05) in smokers as compared with healthy persons


Introduction
A hookah is also known as a water pipe, shisha, narghile, argile or goza."hubble-bubble" or "hubblybubbly" is the more informal term used by some [1].Tobacco use is responsible for about 5 million deaths per year.Tobacco use is the 2nd major leading cause of death and is currently responsible for the deaths of one in tenadults' across the world.Shisha is familiar to about 1 billion people throughout the world and is daily used by more than 100 million men and women in Africa, Asia and several Mediterranean countries.The shisha had been smoked for at least 400 years.At present,Shisha is becoming an increasingly popular way of tobacco use worldwide [2,3].Water pipe (WP) smoking is growing as an alternative to cigarette smoking, especially in younger age groups.A majority of smokers mistakenly believe that WP smoking is a social entertainment practice that leads to more social behavior and relaxation and that this type of smoking is safe or less harmful than cigarette smoking [4].

The Structure and Function of the Waterpipe (Narghile)
The narghile is a tobacco-smoking instrument.It is composed of a bowl at the top, a body, a pipe with amouthpiece, and a glass bottle at the base of the instrument to hold the water.Tobacco is burned in the top bowl of the narghile by burning coal embers nextto the tobacco.Suction through the mouthpiece draws the smoke through the water in the glass bottle and then into the mouth and the lungs of the smoker [5].Contrary to common impressions, the narghile does not protect smokers from the tar in the smoke [6].Narghile smoke contains an increased concentration of tar and volatile carcinogens.This is supported by a recent study on the composition of the smoke aerosol of the Narghile water pipe.Narghile smokers are also exposed to carbon monoxide (CO), which is generated by incomplete burning of carbon fuels.By combining with hemoglobin, carboxyhemoglobin (COHB) is formed, reducing the oxygen-carrying capacity of the blood [7,8].Serotonin (5-hydroxytrayptamine; 5-HT) is a neurotransmitter widely synthesized in the central nervous system (CNS) and is also found in gastrointestinal mucosa cells and blood platelets.It is an intermediate product of tryptophan metabolism and is located primarily in the enterochromaffin cells of intestine, serotonergic neurons of the brain, platelets of the blood and is well established as a neurotransmitter in the central nervous system.Platelets serve as the major reservoir of serotonin in the bloodstream [9][10][11].Endorphins are endogenous opioid biochemical compounds.They are polypeptides produced by the pituitary gland and the hypothalamus in vertebrates, and they resemble the opiates in their abilities to produce analgesia and a sense of well-being.In other words, they might work as"natural pain killers" [12].

Aim of the study:
This study was done to detect if there was an alteration in serum concentration of serotonin and endorphin and some hematological indices in persons smoking narghile alone and with cigarettes.

Subjects and Methods:
This study included 86 person(50smokers, and 36 healthy persons), and the age was ranged between (18-25 years for these two groups).This study was conducted from September, 2016 till March 2017 inTikrit city.Instruments used was Enzyme Linked Immunesorbent Assay (ELISA) for measuring of serotonin and endorphin.Coulter Counter (Autoanalyzer) was used for estimation of platelets, hemoglobin, hematocrit and white blood cells.

Discussion
The results showed a significant decrease in the levels of serum serotonin, endorphin and blood platelets count and a significant increase in hemoglobin and blood hematocrit, white blood cells was increased in a non-significant value, these in whole smoker persons (narghile and cigarette smokers) as compared with non-smokers.However; Saiem Al-Dahr [3] mentioned that there was a significant increase of hemoglobin, hematocrit, and white blood cells and a non-significant decrease of platelets.Alsalhen [13] explain the increase in white blood cells count which may be a marker of exposure to oxidants, the inflammatory response to oxidants.Kremer [14] mentioned that smoking will further reduce serotonin levels, thus exacerbating the dependence on nicotine in subjects with a more transcriptionally efficient transporter gene.In this study there was a significant decrease in concentrations of serum serotonin and endorphin and blood platelets count and a significant increase in hemoglobin and blood hematocrit, white blood cells was increased in a non-significant value, these in whole smoker persons as compared with narghile smokers only.Malone [11] showed that the cigarette smokers had significantly lower concentrations of serotonin and the serotonin metabolite 5hydroxyindoleacetic acid (5-HIAA), and higher serotonin1A (5-HT 1A ) receptor density, thus, smoking mayeventually impair serotonin function.Saiem Al-Dahr [3] noted that blood platelets, hemoglobin and white blood cells were significantly increased in cigarette smokers as compared with narghile smokers and with non-smokers (cigarette smokers showed a significant highervalue than shisha smokers).Serotonin concentration is highly positive correlated with platelets count (r= .643,p=0.0001) and a highly negative correlated with hemoglobin and hematocrit (r=.942, p=0.0001) and (r=.958, p=0.0001) respectively.Also endorphin concentration is highly positive correlated with platelets count(r= .707,p=0.0001) and a highly negative correlated with hemoglobin and hematocrit (r=.930, p=0.0001) and (r=.950, p=0.0001) respectively.This results of correlation may be due to increase of oxidants of smoking which lead to decrease synthesis of platelets, serotonin and endorphin and increase hemoglobin and hematocrit levels.

Figure ( 1 )
Figure (1): The association between serum serotonin and blood platelets in whole smokers.

Figure ( 2 )
Figure (2): The association between serum serotonin and blood hemoglobin in whole smokers.

Figure ( 3 )
Figure (3):The association between serum serotonin and hematocrit in whole smokers.

Table ( 1): Distribution of samples
1-Human Serum Serotonin AssaySerotonin was determined by ELISA kit (IBL international GmbH, Hamburg, Germany).Enzyme immunoassay for the in vitro diagnostic quantitative determination of Serotonin in human serum, plasma, platelets, urine.Further the test can be used for research of tissue homogenates and cell culture supernatants.2-HumanSerumBeta-EndorphinAssayEndorphinwas determined by ELISA kit (USCNLIFE, for research use only).This immunoassay kit allows for the use in vitro quantitative determination of human Beta-Endorphin, β-EP concentrations in cell culture supernates, serum, plasma and other biological fluids.3-HaematologicalParametersAssayCoulter counter(Autoanalyzer, Bayer, Germany)was used in the determination of platelets (Plt), hemoglobin (Hb), hematocrit (Hct), and white blood cells count (WBC).