Hookah smoking and lung cancer in the Kashmir valley of the Indian subcontinent.

BACKGROUND: The literature about the causal relationship between lung cancer and tobacco smoking mostly concerns cigarettes. Hookah smoking is popular in the Kashmir valley of the Indian subcontinent, and is generally believed to be innocuous because of the passage of the smoke through water before inhalation. OBJECTIVE: To determine the relationship of hookah smoking to lung cancer in Kashmir. MATERIALS AND METHODS: In a case-control design, 251 cases of lung cancer and 500 age-matched controls were studied. A predefined questionnaire was administered through a personal interview regarding various smoking and dietary patterns and the results compared through statistical analyses. RESULTS: There were 194 (178 current) ever-smokers amongst the cases and 223 (134 current) amongst controls. Smokers had a 4.2 times risk of lung cancer compared to non smokers (OR 4.23, 95% CI 3.0-5.96, p < 0.0001). There were 120 hookah smokers amongst the cases and 100 amongst the controls and hookah smokers were nearly six times at risk for lung cancer as compared to nonsmokers (OR 5.83, (95% CI 3.95-8.60, p < 0.0001). Cigarette smokers were commoner amongst cases (46 vs 64 in controls; OR 3.49, 95% CI 2.18-5.60, p=0.000). The severity of smoking was associated with a higher risk of lung cancer (Chi-square 72.1, p 0.000).The practice of changing water of the hookah after each session proved non-existent. CONCLUSION: Hookah smoking is associated with a significantly higher risk for lung cancer in Kashmiri population, with about 6 fold elevated risk as compared to non-smoking controls.

A "Near-Miss Lethal Accident Case" in MR Suit of a Tertiary Care Hospital.

A "near miss" is an unpleasant event that did not result in injury, illness, or damage but had the potential to do so, but for a fortunate break in the chain of events. We present a near-miss case which occurred in the MR suite of a tertiary care hospital. Although the MR is considered a very safe procedure, if MR safety guidelines are not adhered to, adverse and catastrophic events to the extent of patient deaths are known to have occurred. It is hoped that this incident will prompt hospitals to document and follow MR safety protocols for patient and staff safety. Although MRI is an extremely safe procedure rarely MR adverse incidents have resulted in serious physical injury or even death. The incident is an eye opener regarding potential adverse events lurking in the relatively safe MR environment and provides an opportunity to rectify the inadequacies in MR safety.

Experience with oral mexiletine in primary erythromelalgia in children.

Primary erythromelalgia is characterized by burning pain, redness, and warmth in the extremities. We present two cases of primary erythromelalgia both of whom presented with a history of several months of severe burning pain in both hands and feet. Both patients had received multiple pain medications with no improvement in symptoms. Pain was relieved by putting affected parts in ice cold water, which resulted in immersion injury of the affected parts. Both patients stopped taking part in school and social activities. We tried oral mexiletine, a class Ib antiarrythmic agent, in view of its reported role in various chronic painful conditions. Dramatic improvement was observed with its use. Both patients improved after several weeks of use, and there were fewer soaking episodes. We observed no adverse effects with mexilitine therapy.