One Hookah session delivers 125 times the smoke of one cigarette

The health detriments of cigarette smoking are, by now, very well known to the general public. But what about hookah smoking? Though some people believe the myth that because hookahs employ a water bowl, it makes them safer by drawing the smoke through the water, a new study unveils some shocking discoveries about just how harmful hookah smoking is.

Hookahs are water pipes from which people can smoke specially made tobacco with flavors, including apple, mint, cherry, chocolate and watermelon. Use of the hookah – also known as narghile, argileh, shisha, hubble-bubble and goza – began centuries ago in Persia and India. It is typically used in groups, and users share the same mouthpiece as it is passed around.

Hookah delivers 10 times carbon monoxide of single cigarette

Although cigarette smoking rates are beginning to fall, researchers from this latest study – published in the journal Public Health Reports– note that more people are using hookahs to smoke tobacco. University Of Pittsburgh School Of Medicine researchers say their study shows that such smokers are taking in a large load of toxins. To conduct their research, the team conducted a meta-analysis, which is a mathematical summary of previously published data. The benefit of a meta-analysis is that it produces more precise estimates based on available data.

In total, the researchers reviewed 542 scientific articles that were relevant to cigarette and hookah smoking. From this, they narrowed the articles down to 17 studies with enough data to make reliable estimates on toxicants inhaled from cigarettes or hookahs.

Their research revealed that one hookah session delivers about 125 times the smoke, 25 times the tar, 2.5 times the nicotine and 10 times the carbon monoxide of a single cigarette.


  1. University of Pittsburgh news release, accessed 14 January 2016
  2. as on 17/01/2016 at 12:07Pm.
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On March 30th, 2016, posted in: Blog by

One-hour diagnosis of heart attack possible with troponin T test from Roche

Novel strategy shortens time to heart attack diagnosis drastically, enabling faster start of treatment of patients and better use of healthcare resources.

Results from the TRAPID-AMI1 clinical study have been published online by the Annals of Emergency Medicine, confirming a novel approach for a more rapid diagnosis of heart attack in patients with acute chest pain. The strategy is based on the cardiac troponin T high-sensitivity test from Roche and reduces the observation time needed to rule-in or rule-out a heart attack from 3-6 hours to just 1 hour. It is well established that a fast and reliable diagnosis of heart attack is critical because every hour of delay from the onset of symptoms to treatment increases the mortality risk.

Every minute counts:

A heart attack, or acute myocardial infarction (AMI), is a common cardiac event in which the blood supply to an area of the heart muscle is interrupted, causing the muscle cells to die. Prompt treatment is essential as every 30 minutes of delay increases the relative risk of mortality by 7.5 % in patients with AMI. Patients with chest pain and other symptoms suggestive of AMI account for approximately 10-20% of all emergency room consultations and every 43 seconds, someone in the United States will have a heart attack.

Troponin is a heart muscle protein that is released into the blood stream during a heart attack. A limitation of the earlier generations of blood tests was the time required to detect the troponin release, sometimes requiring up to six hours with less sensitive troponin tests. The mortality rate of heart attacks is highest within hours of onset, so an early diagnosis and initiation of treatment greatly impacts outcome and potentially saves lives. The European Society of Cardiology adopted this accelerated diagnostic concept at their annual meeting held in London (UK) in August 2015. Their new clinical practice guidelines (2015 ESC NSTEMI) now support the 1-hour diagnostic algorithm with high-sensitive troponin testing validated in the TRAPID-AMI study.


  1. Acronym for: Cardiac troponin T–hs (high sensitivity) assay for RAPID rule-out of Acute Myocardial Infarction
  2. Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T, Mueller, C. et al.,Annals of Emergency Medicine, doi: 10.1016/j.annemergmed.2015.11.013, published online 12 January 2016.


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On March 30th, 2016, posted in: Blog by

Swine flu in Pakistan

By Dr Asif Javed Butt

Influenza or flu in humans is caused by influenza viruses A, B and C. Influenza virus B is exclusive to humans whereas other two are not human specific. Influenza virus C can infect humans, dogs and pigs whereas Influenza virus A has many strains and many of them infect both humans and other animals. H1N1 strain which causes swine flu and H5N1 strain which causes bird flu are more famous ones.

Some forms of H1N1 strain of influenza A are endemic to pigs and some to humans and only occasionally it can transfer from pigs to humans. Only 50 cases of zoonotic swine flu have been identified since first known case in 1958. Infected humans can infect others via airborne droplets. The 2009 H1N1 virus was not zoonotic swine flu, as it was not transmitted from pigs to humans, but from person to person through airborne droplets.

Right from the start of 2016, in addition to common cold and other forms of influenza, H1N1 swine flu is also on the rise in Pakistan. Although not declared an epidemic, according to media reports it has killed more than 19 people mostly in Multan, Lahore and Sargodha districts. In general Symptoms include fever; cough, sore throat, watery eyes, body aches, shortness of breath, headache, weight loss, chills, sneezing, runny nose, coughing, dizziness, abdominal pain, lack of appetite and fatigue. Because these symptoms are not specific to swine flu, a differential diagnosis of probable swine flu requires not only symptoms, but also a high likelihood of swine flu due to the person’s recent and past medical history.

The U.S. Centers for Disease Control and Prevention (CDC) recommends real-time PCR as the method of choice for diagnosing H1N1. The oral or nasal fluid collection and RNA virus preserving filter paper card is commercially available in some countries. This method allows a specific diagnosis of novel influenza (H1N1) as opposed to seasonal influenza.

To prevent spread of swine flu, don’t touch your nose, mouth or eyes during some common symptoms of flu. Frequently wash your hands especially after coughing or sneezing, stay at home if you are ill, avoid large gathering when swine flu is common in season, avoid close contact with sick people, and do regular exercise. Patients of swine flu, their attendants, and health care providers should use face mask. Vaccines are available for different kinds of swine flu. The U.S. Food and Drug Administration (FDA) approved the new swine flu vaccine for use in the United States in September 2009.  Studies by the National Institutes of Health show a single dose creates enough antibodies to protect against the virus within about 10 days. Although general influenza vaccines are being used for a while now, availability of swine flu specific vaccines in Pakistan is not known.

Antiviral drugs can make the illness milder and make the patient feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within two days of symptoms). Beside antivirals, supportive care at home or in a hospital focuses on controlling fevers, relieving pain and maintaining fluid balance, as well as identifying and treating any secondary infections or other medical problems. The CDC recommends the use of oseltamivir (Tamiflu) or zanamivir (Relenza) for the treatment and/or prevention of infection with swine influenza viruses; however, the majority of people infected with the virus make a full recovery without requiring medical attention or antiviral drugs. The virus isolated in the 2009 outbreak was found to be resistant to amantadine and rimantadine.

The most common cause of death is respiratory failure. Other causes of death are pneumonia, high fever (leading to neurological problems), dehydration, electrolyte imbalance and kidney failure. Fatalities are more likely in young children pregnant and the elderly.

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On March 30th, 2016, posted in: Blog by