The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review

Abstract Background The objective of this study was to systematically review the medical literature for the prevalence of waterpipe tobacco use among the general and specific populations. Methods We electronically searched MEDLINE, EMBASE, and the ISI the Web of Science. We selected studies using a two-stage duplicate and independent screening process. We included cohort studies and cross sectional studies assessing the prevalence of use of waterpipe in either the general population or a specific population of interest. Two reviewers used a standardized and pilot tested form to collect data from each eligible study using a duplicate and independent screening process. We stratified the data analysis by country and by age group. The study was not restricted to a specific context. Results Of a total of 38 studies, only 4 were national surveys; the rest assessed specific populations. The highest prevalence of current waterpipe smoking was among school students across countries: the United States, especially among Arab Americans (12%-15%) the Arabic Gulf region (9%-16%), Estonia (21%), and Lebanon (25%). Similarly, the prevalence of current waterpipe smoking among university students was high in the Arabic Gulf region (6%), the United Kingdom (8%), the United States (10%), Syria (15%), Lebanon (28%), and Pakistan (33%). The prevalence of current waterpipe smoking among adults was the following: Pakistan (6%), Arabic Gulf region (4%-12%), Australia (11% in Arab speaking adults), Syria (9%-12%), and Lebanon (15%). Group waterpipe smoking was high in Lebanon (5%), and Egypt (11%-15%). In Lebanon, 5%-6% pregnant women reported smoking waterpipe during pregnancy. The studies were all cross-sectional and varied by how they reported waterpipe smoking. Conclusion While very few national surveys have been conducted, the prevalence of waterpipe smoking appears to be alarmingly high among school students and university students in Middle Eastern countries and among groups of Middle Eastern descent in Western countries

Boston Keratoprosthesis Type II: Indications, Techniques, Outcomes, and Management

Implantation of a keratoprosthesis device is indicated for the visual rehabilitation of patients with corneal blindness in whom a standard corneal allograft would likely fail. The Boston keratoprosthesis type I device is a collar button-shaped device, composed of polymethyl methacrylate and titanium, whereas the type II device has an additional anterior extension that allows for implantation through surgically closed eyelids. The type I device is used in patients with intact eyelids, normal blink, and adequate tear film. The type II device is reserved for patients with abnormal lid function and tear secretion, forniceal foreshortening, and ocular surface keratinization. Herein, we focus on the indications, preoperative assessment, surgical technique, and postoperative care for the Boston keratoprosthesis type II and provide advice on management of complications