Israa A. Mohammed Jumaah Jumaah, Shatha A. Demerchi, Abdulrahman Ahmed Mahmood

Hookah Smoking in Incidence with Asymptomatic Gout

Introduction

Hookah smoking in incidence with asymptomatic gout. This study links hookah (water pipe) smoking to asymptomatic gout, showing a significant increase in serum uric acid levels among smokers. Explore the health risks.

Abstract

Water pipe smoking (WPS) has become very popular worldwide, especially among young people. Its widespread use makes it a risk factor for various diseases. In this study, we hypothesized that water pipe smoking is a cause of asymptomatic gout and prostate cancer and affects salivary pH and serum magnesium (Mg) levels. The study was conducted with 80 participants (60 in the hookah smoking group and 20 in the control group) in Kirkuk, Iraq. Serum uric acid, magnesium (Mg), prostate-specific antigen (PSA), and saliva pH were tested and analyzed for both groups. The result was a significant increase in serum uric acid concentration without any notable changes in saliva pH, serum PSA, and serum magnesium levels. Also, based on tabular data using the Pearson correlation coefficient, a significant positive correlation between waterpipe smoking and serum uric acid levels was examined, but a significant negative correlation between serum PSA and serum Mg levels was assessed. Finally, we also observed small changes in serum uric acid, serum PSA, and serum magnesium levels over extended period (less than 5 years or ≥ 5 years) among waterpipe smokers.

Review

This study addresses a highly relevant public health concern regarding the widespread use of water pipe smoking (WPS) and its potential health ramifications. The authors hypothesized that WPS contributes to asymptomatic gout and prostate cancer, and affects salivary pH and serum magnesium levels. The core finding presented is a significant increase in serum uric acid concentration among water pipe smokers, alongside a positive correlation between WPS and uric acid levels. This finding warrants further investigation given the known link between hyperuricemia and gout. However, no significant changes were observed in saliva pH, serum PSA, or serum magnesium levels in relation to WPS exposure, despite the initial hypotheses. While the study attempts to investigate multiple biomarkers, several aspects require critical consideration. The claim of "Asymptomatic Gout" in the title is not directly supported by the abstract's results, which only report elevated serum uric acid (hyperuricemia). Hyperuricemia is a risk factor, not a diagnosis of asymptomatic gout itself, which implies a clinical assessment of individuals with elevated uric acid but no acute gout attacks. Furthermore, the hypothesis included prostate cancer, but the abstract only discusses PSA levels without reporting on actual cancer incidence, making the conclusion regarding prostate cancer speculative at best. The sample size of 80 participants (60 smokers, 20 controls) is relatively small, which may limit the generalizability of the findings and the statistical power to detect subtle but clinically significant changes. The reported negative correlation between serum PSA and serum Mg levels is also presented without clear explanation regarding its relevance to the primary hypotheses or its clinical implications in the context of WPS. To enhance the robustness and clarity of the findings, several improvements are suggested. Future work should clearly differentiate between hyperuricemia and asymptomatic gout, ideally including clinical follow-up for gout incidence. Expanding the sample size and recruiting participants from diverse geographical locations would strengthen the generalizability of the results. The methodology concerning the assessment of prostate cancer risk needs to be more thoroughly detailed, moving beyond just PSA levels if cancer incidence is part of the hypothesis. Finally, a more comprehensive discussion of the clinical implications of the observed negative correlation between serum PSA and serum Mg, and the "small changes" over time, would significantly benefit the paper. Despite these points, the study offers an initial contribution to understanding the health effects of water pipe smoking, particularly highlighting a potential link to hyperuricemia that merits further epidemiological and clinical research.

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