ABSTRACT
Background: The aim of the study was to determine the prevalence, knowledge, attitude and practices of shisha (waterpipe) smoking among physicians and surgeons in five main cities of Pakistan. Shisha smoking is becoming more popular in Pakistan, and as medical doctors (both physicians and surgeons) serve as role models for healthy behavior, they can greatly influence shisha use in public by the example they set, and by the education that they provide to their patients. Objective: To investigate and compare the knowledge, attitudes, and practices of shisha smoking among physicians and surgeons in Pakistan. Materials and Methods: A cross-sectional study was done in five major public medical universities of Pakistan. A self-administered questionnaire was used with some modification. Results: Out of 1000 distributed questionnaires, 786 doctors responded of which 51.4% were physicians and 48.6% were surgeons. Even though the vast majority (99%) of doctors agreed that shisha smoking is detrimental to health, almost 20% of surgeons and 13% of physicians reported using shisha daily. More physicians than surgeons had never used shisha, and more physicians were willing to quit, with the difference achieving statistical significance. The knowledge about shisha smoking was not uniform amongst the doctors, with physicians demonstrating significantly more knowledge as outlined in three areas (smoking causing increased risk of Sudden Infant Death Syndrome [SIDS], lung and heart disease). More physicians than surgeons agreed that doctors who use shisha are less likely to advise people against it; they also agreed that doctors should get training on cessation techniques. The majority of participants agreed that doctors are role models for patients. More physicians thought that smoking should be banned in public places and that tobacco sale to children and adolescents should also be banned. More surgeons than physicians agreed that shisha use is socially more acceptable than cigarette smoking. It was also noted that for the majority of doctors, there is no workplace policy in place regarding smoking. Conclusion: Social and recreational use of shisha is widespread among both physicians and surgeons (slightly higher among surgeons), despite being acknowledged by the majority as a health hazard. This is of concern as doctors are role models for patients, and doctors who smoke shisha raise public skepticism. Keeping in mind the health complications of this social practice, appropriate counter measures should be taken.
ABSTRACT
Aims: Acute Kidney Injury (AKI) is seen in 15% of hospitalized patients and a renal ultrasound (RUS) is often ordered to exclude an obstructive cause in the initial evaluation of AKI. This study was done to evaluate the usefulness of a RUS in patients with AKI in a developing country. Methods: This was a retrospective study on all patients who were referred to nephrology with AKI and had a RUS, over a one-year period at a tertiary care teaching hospital of Karachi, Pakistan. The patients’ charts were reviewed for clinical characteristics and the RUS findings were documented. Results: A significant number of patients did not have documented risk factors for obstruction based on the medical history. Hydronephrosis was found in 22.5% (25 out of 111) of patients, and in 14 of these cases, the etiology of the acute kidney injury was found to be obstructive uropathy. The presence of nephrolithiasis and/or benign prostatic hypertrophy was associated with and increased likelihood of finding hydronephrosis on RUS. Conclusions: We thus recommend doing a renal ultrasound in all cases of AKI due to the fact that most of the time in a developing country, an accurate history is not available, and the prevalence of stone disease and obstructive uropathy is high.