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Category : All ; Cycle : October 2011
Medical Articles
This Diwali remember – What you burn is what you breathe!
As sure as Diwali is a festival of lights, sweets, gaiety, splendor & fireworks, it is also one of deafening noise, blinding light, risky fire & suspended particles. And this has direct effects on our health & environment. When the entire nation looks forward to Diwali as a celebration of life, patients suffering from Asthma & COPD (Chronic Obstructive Pulmonary Disease) begin readying there lifesavers – Inhalers, nebulizers or whatever gives them a breath of life. For these people Diwali is not a festival of light & gaiety but that of smoke, coughing & wheezing.

Fireworks are sources of some of the highly toxic inhalants produced during Diwali celebrations. Firecrackers are “power packed” with potassium nitrate, carbon & sulfur. Apart from this they also contain toxic contents like copper, cadmium, lead, manganese, magnesium, zinc, sodium, potassium, and aluminum powder & barium nitrate. When ignited, the crackers burst allowing these powerful chemicals to come in contact with atmosphere and the smoke thus generated contains increased amounts of carbon monoxide, carbon dioxide, nitrogen dioxide, hydrocarbons, hydrogen sulfide & particulate matter which worsen the quality of Diwali air. The suspended particles hog like a thick blanket reducing visibility and suffocating the atmosphere. In fact studies have demonstrated that during Diwali festival the concentration of sulfur dioxide increased by 10 times & that of nitrogen dioxide, PM10(Particulate matter of size less than 10 microns) & TSP(Total Suspended Particles) increased by 2 to 3 times. The Overall air pollution during Diwali increases by about 200 %. The biggest culprits among firecrackers are the colour sparkles (“Phuljari”), “Anar”, “Chakri”, Fire pencils, Snake tablets & “Hydrogen” bomb.

A special mention may be made of PM10. With the average PM10 charge, we inhale millions of fine particles with each breath. The larger particles( 5 to 10 microns) are filtered in the nose & throat, smaller particles (3 to 5 microns) arrive in the bronchial tube, bronchi (2 to 3 microns), bronchioles (1 to 2 microns) & in alveoli (0.1 to 2 microns) & finally in the blood. These particles can no longer be coughed up & as deposits lead in long term to inflammation, particularly in asthmatics, & also with healthy people, although they may not notice the immediate irritant effects.

When we inhale such a highly toxic and polluted air during Diwali, how can escape from its ill effects? The harmful oxides present in the Diwali fumes come into contact with the moisture while passage from the nostrils to the lungs & form acids which cause immense damage to the body.

The Diwali smoke potentially leads to development of various respiratory ailments like –Allergic bronchitis, acute exacerbation of bronchial asthma & COPD (Chronic Obstructive Pulmonary Disease), allergic rhinitis, laryngitis, sinusitis, pharyngitis, common cold, acute eosinophilic pneumonia, reactive airway dysfunction syndrome, etc.

Children, pregnant women, asthmatics & senior citizens are highly prone to these potentially harmful effects of Diwali smoke.

Here is a list of precautions that need to be followed during Diwali celebrations.

Precautions to be followed by asthmatics:

1. Stay away from people burning crackers.

2. Keep the inhalers and other medicines ready beforehand (both maintenance & reliever medications).

3. Consult your doctor and start maintenance dose of inhalers a few days before the festival & continue the same two days after Diwali.

4. In severe cases rescue medications need to be taken & if not relieved contact your doctor immediately.

5. Better do not venture out in the evening of Diwali. Stay in company of friends and family members in house.

6. If need to venture outside use masks (N95 masks have been technically recommended).

7. Consult your doctor regarding pulmonary vaccination in advance.

8. Stay away during colouring and white washing of house before Diwali because these also act as “triggers” of an asthma attack.

9. If possible plan a visit to some hill-station / ecoclean place (which is not much crowded) during Diwali festival.

Precautions to be followed by every one of us during Diwali festival:

1. Avoid /decrease the firework celebrations & play “ecosafe” Diwali.

2. Enjoy Diwali with lamp, lanterns & diyas.

3. Fireworks if carried out should be done in open grounds, away from residential areas & during fixed time limits.

We should remember that one person’s idea of fun could be an asthma patient’s nightmare. Asthma patients have as much right as us to stick around and enjoy Diwali. And ultimately for our own benefit we should not forget that “what we burn is what we breathe”, this Diwali.

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Home Oxygen Therapy
The following article shares the information of home oxygen therapy in question answer format which can be understood by every body. In today’s era home oxygen therapy is advicated in many lung diseases and we all need to know about it.


Everybody Needs Oxygen:

Oxygen is essential for life. One of the reasons why life exists on earth and not on mars or on moon is because earth’s atmosphere contains 21% of oxygen.Our lungs inhale the atmospheric air through the nose. In the lung, there are air sacs (about 30 crores of them) called alveoli, which transfer oxygen into blood. Of course we all know that blood carries oxygen from lungs to every little organ, tissue and cell of the body.

Lungs with severe Disease can’t perform well:

Lungs have a very remarkable reserve capacity to withstand the onslaught of disease. But when the extent of lung disease is large, the lungs are unable to perform well and thus are unable to transfer enough oxygen in blood. These include disease like chronic bronchitis & emphysema caused by tobacco smoke, diffuse interstitial pulmonary fibrosis, chronic persistent severe asthma and some cases of lung cancer.

When is home oxygen prescribed?

Normally arterial bloods (‘the good blood’) contain about 90 units of oxygen (90mmHg in scientific term. But in some of the diseases as mentioned earlier, inspite of all the drugs (eg. Antibiotic & other medicines like bronchodilators) the lungs may be unable to sustain an oxygen level of 90 units in blood. As disease advance & physiological derangement worsens the blood oxygen level may fall to less than 60 units! At this point the person suffer from sustained breathlessness, aggravated further even by slightest of the activity like shaving, combing hair, walking a few steps, eating etc.,

What are the effects of low oxygen in blood?

Low oxygen in blood is called Hypoxia by doctor. Apart from producing breathlessness, rapid breathing
Palpitation anxiety, the person will also experience intense lethargy, fatigue (tiresomeness) initability, incoherent talk etc., low oxygen also increase the work load on the heart which eventually in unable to perform it’s pumping action well. What is most important to remember is that low oxygen levels in blood eventually affect the quality of life & length of life span.

What is Home Oxygen?

In the earlier year oxygen was given to patients only in the hospitals, later, several well-planned scientific studies showed that quality & quantity of life can be improved dramatically by using oxygen at home.

How long should one use Oxygen?

This question will basically be answered by the concerned doctor, but generally use of oxygen at home is life long.

How many hours in a day?

There were several scientific studies on this issue & expert finally concluded that Oxygen for 8 hours is good, Oxygen for 15 hours is better but Oxygen for 24 hours is best.

How can I get oxygen at home?

There are three way of using oxygen at home:

A) OXYGEN CYLINDERS: You are familiar with its appearance & use. An average cylinder runs about 48 hrs if you use at 2 liters per minutes, but may get exhausted sooner if you use at the rate of 4 liters per minutes.

Advantages: The only advantage of Oxygen cylinder is the easy availability & low initial investment ( refundable deposit of Rs. 5000/- to 1000/- : Cylinder refilling Rs.350 Per cylinder:rent for cylinder Rs. 5/- Per day: Transportation charges (eg Auto )Rs. 50/- to 100/- each time.

1. Need for frequent refilling
2. Hassles of transporting
3. Explosion hazards
4. Un predictability (you never know when the cylinder gets exhausted.
5. Huge expenditure ( appox. Rs. 70000/- per year) in the long run.

B) OXYGEN CONCENTRATOR: Are machines, which run on electricity, & has very specialized high efficiency compressors, to extract oxygen from atmosphere & concentrate to 95% pure gas. Its weight about 22 Kg & has caster wheels for easy mobility.
1) Safe, silent, Efficient & convenient
2) No recurrent Expenditure
3) No frequent hassles of transportation
4) Low maintenance cost

1) Expensive Rs. 60000/-
2) Needs Electricity (although can run on car battery or inverter)

C) LIQUID OXYGEN: Packed in small tanks, the size of a large thermos flask. One refilling can run for almost 2 to 3 day.

Handy, portable, easy to use

1) Very expensive (exact cost known)
2) Not available in India

What about the mask etc:

Oxygen can be used through either a soft nasal prongs or a face mask

Nasal Prongs: Are easy to put on, light, convenient & more acceptable it allows you to eat, drink & talk.

Face mask: uncomfortable to wear for long hours. Ideally suited for use at nights.

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Public Private Mix in treatment of Tuberculosis
The article discusses the role Public Private Mix in treatment of Tuberculosis in current scenario especially in a country like India.

Accountability is a fundamental principal of TB control.

In many countries, significant proportion of patients with TB first consult Private health practitioners.

Characteristics of poor management of TB patients in private sector:

1. Diagnosis by chest xray without smear examination.
2. Overuse of unnecessary and expensive tests.
3. Under treatment.
4. Over treatment.
5. No supervision.
6. No follow up of late patients.
7. Inappropriate monitoring of treatment by Chest Xray.
8. Inadequate treatment records.
9. No reporting.

There is no one means to achieve coordination between public and private sectors in all countries. The various approaches to strengthening the coordination between public and private sectors include the following:

1. Competition:

Well organised out patient chemotherapy, especially if provided free of charge, will attract asymptomatic cases from far and wide.

2. Exclusion:

-Exclude the private sector.
-Ban over the counter sale of anti tubercular drugs.

3. Contracting:
Public sector can contract TB control services to private groups.

4. Engagements:

-Actively engage private sector in TB care.
-In many countries, public health programmes & professional groups such as National Chest Societies, collaborate to establish standards of care that apply to both public and private sectors & revise medical colleges curricula to reflect these consensus standards.
-The following services should be made free:
*Lab services
*transportation of specimens
*referral to public sector
*free medications

5. Reporting:

Include making compulsory the following:
-Active surveillance of laboratories.
-Reporting of bacteriologiocaly confirmed patients.
-Monitoring of these patients.

Role of NGOs:

1. Educate private practitioners to adopt RNTCP (Diagnostic & treatment policies, treatment referral).
2. Provide diagnostic & treatment services to which private patients can be referred.
3. Provision of outreach workers in community for follow up of late patients.
4. Assisting in recording and reporting of cases.
5. Act as links with Chest Physicians, Paramedics, etc.

Government has recently introduces a 5 pronged programme for involvement of NGOs in RNTCP which includes the following 5 levels:

level 1: Outreach services, Education
level 2: DOT treatment
level 3: Hospital services
level 4: Microscopy centres
level 5: Model treatment services/centres

This carries a great relevance in today's scenario when we are striving hard to fight against Tuberculosis.

The take home message is involvement of all in providing health care services in tuberculosis.

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Dengue in 3 month old male boy
Deepak,3 month old male baby, of middle soccioeconomic class persented to us with poor feeding and irritable behavior. Born to nonconsaguinious marraige ,by NVD, CIAB, with unevevntfull 3 month home staying,

Baby put on broad spectrum antibiotics and relavant investigation sent. All parameters are normal except leucopenia.
Since baby in delhi (Dengue zone)so we send sample for Dengue NS1 as cause for letharginess. we surprise by knownig it is postive. It is repated twice for confirmation it postive again.

Local epidemics / disease pattern must be kept in mind for any unusual presentation even in small baby.

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Seizure in Normal child
A 8 yrs. Male (AMIT)boy with perfectely all right condtion, visit to own school as usual days . At 2:20 pm in class room he is complainng of headache. School teacher call the maother and send boy back home. At home he developed seizure(GTCS).

Amit's mother rushes to hospital ,in ER Amit vomit out. Doctor on duty just give antiemetic injection and loading with inj phenytoin for controloing vomiting and convulsion . After 2 hrs in hospital ,boy become unconciouss . Amit's mother by seeing all this catastrophic events rushes to our hospital where urgent CT done ,we find large Internal bleed ,Neurosugeon call send and urgent drinage done

Baby finally discharge with diagnosis of AV Malformation with rupture.

Don't Ignore any headache with seizure

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पापेनैव नृणाम् वाणी भवेत कटुक भाषिणीम्
दैन्य मात्सर्य परमा शुभाशुभ विवर्जिता
The पाप (deep seated (unconscious, subconscious and conscious) prejudices, envy, jealousy, contempt, hatred, arrogance, fanaticism, dogmatism, selfishness, lust, frustration, depression, fear, anxiety, guilt complex, inferiority complex etc.) vitiate our communication and make it scalding; with no concern for the benevolent or disastrous effect on the other/s.

Exact source is not known.

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ऐसे माझेनि नामघोशे
नाही करिती विश्वाची दु:ख्खे

अवघे जगचि महासुखे
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कही एकाधेनि वैकुंठा जावे
ते तिही वैकुंठचि केले आघवे
ऐसे नामघोष गौरवे
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ज्ञानेश्वरी 9 वा अध्याय

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अनित्यानि शरीराणी विभवो नैव शाश्वताः
नित्यम सन्निहितो मृत्यू कर्तव्यो धर्म संग्रह:

The physical body and the material possessions are inconstant,impermanent and ephemeral; while the death is a constant and close companion; so (let us) practice DHARMA (i.e. practice the innate conscience; with topmost priority).

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When our speech (and behavior) is generated by brazen lust, meanness, vested interests, prejudices, viciousness, vengeance, rage, helplessness, ignorance, irresponsibility, foolishness of falling prey to antisocial propaganda; or in short; our superficiality and pettiness; it is likely to be detrimental to the individual and social life.

Hence we MUST exercise the freedom; to; not express it! The laws and consensus ought to ensure such freedom! In absence of such freedom; we MUST exercise our freedom on our own; to practice NAMASMARAN and express the holistic perspective, policies, motivation and implementation conducive to individual and universal blossoming

However; if we interpret the “freedom of expression” as “freedom to express; to serve our superficiality and pettiness”; especially with the help of our position, power, newspaper, TV Channels, radio, cinema, drama, advertisements, internet etc; then the masses; who do not have such means to express; are bound to resort to violence; often indiscriminate; towards self or others.

This is exactly what is fueling the violence; in the form of suicides, crimes, fanaticism, fascism, racism, riots, terrorism, proxy wars etc (AND ALSO CORRUPTION). This violence will continue and in fact escalate; if we do not heed; and simply go on making hue and cry about so called “freedom of expression”; in news papers, radio, TV or internet!

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न तु अहं कामयेत राज्याम् न स्वर्गम न पुनर्भवम
कामयेत दुक्खतप्तानाम प्राणीनां आर्तिनाशनम

I don't desire heaven, kingdom or liberation. I want to eradicate the pain of suffering living beings.
A Treating Healer......OR.....A Teaching Healer......!!!

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