Dr. Ankur Sethi MD Paediatrics, Atlanta Hospital, Ghaziabad

The winter season brings a nip and chill in the air and the onset of various woes associated with it. The cold air gets heavier leading to greater hanging of these pollutants at the breathing height. The viruses in this changing weather happily proliferate and add to the sufferings of the population.

Children are always the worst sufferers of these changes leading to a multitude of problems. Owing to their delicate systems, low immunity and narrow airway tracts children are especially prone to various ailments.

Adverse Respiratory Effects

Upper Respiratory



Acute Pulmonary Hemorrhage



Sudden infant death syndrome

Changes in lung function

Asthma/Bronchospasm/ Allergies

can be pictured as a pyramid shown here.

Everyone is affected by the adverse health effects of winter and pollution to some extent. And these problems are increasing with each passing year.

While most people think of only pneumonia and asthma as a result of these factors, there are other ailments which can occur.

Use of biomass and solid fuels for household cooking and heating is associated with increase in acute respiratory infections – the leading cause of death in children under 5 years.

Indoor air pollution with environmental tobacco smoke is linked to acute otitis media.

Outdoor exposure to ozone is linked to bronchospasm and asthma attacks in some children.

Exposure to indoor moulds is associated with acute pulmonary hemorrhage among infants.

High exposure to particulate and second hand smoke is associated with sudden infant death syndrome (SIDS).

Thus, environmental health problems contribute very significantly to “burden of disease” in childhood. According to World Health Report, besides under nutrition, and safe water supply, air pollution is the third most important factor contributing to poor health.

Reasons why children are more vulnerable

Higher Exposures because they spend more time outside

Inhale more pollutants per kilogram of body weight than do adults

Because airways are narrower, irritation can result in proportionately greater airway obstruction.

Interventions Recommended:

We expect the government and administration to shoulder all the responsibility for preventing these problems. No doubt, major policy changes with respect to industrial and vehicular pollution, burning of leaves and garbage, transport and infrastructure planning falls in their domain. But, as individuals we can take certain steps to decrease these problems:

Make efforts at individual and family level to avoid increasing pollution at home and surroundings.

Properly clothe children and protect them from exposure to cold winds.

Avoid visits to over congested places, where exposure to infections from others is common.

Wash hands frequently and especially after contact with someone who has running nose or cough and fever.

Avoid exposure to smoke of any kind especially in indoor environment.

Provide proper nutrition for optimal growth and development.

Last, but very important, properly and timely immunization of children with all available vaccines. 

Seek early consultation with your pediatrician at the onset of any significant illnesses in the children.

Bruised, battered and beaten, a tired nation stares back at me. “What’s wrong?” I ask concerned.

“We can’t take being pushed, pulled and pummeled every moment of the day!” cries the nation, “Either it’s a lynching mob stringing up someone, or government agencies being manhandled by a meddlesome centre, or currency snatched out of the hands of the poor!We are tired!”

“Broaden your vision!” I tell the nation sternly, “Look at what is floating there above the clouds, dwarfing even Trumps New York statue! Look at the world record it has created, and yet you say, you are fatigued and tired? Raise your eyes and see the loftiness of our achievements!”

“Farmers are committing suicide!Riots and morchasfor more reservations break the fibre that holds us together!” cries the tired voice.

“Imagine the speed of the bullet train!” I reply, “Picture the world looking at us enviously, as this technological marvel races from city to city and back!”

“Look at the speed of those motorbike riders and scooterists!” whispers the nation, “All of them riding on pavements or on the wrong side of the road in your biggest cities, knowing no policeman will stop them, as today the mobs rule!”

“Just imagine our country,” I said proudly, “a nation which will have one single diet followed by all the people, where fruits and vegetables will be our only food. One nation, one diet! What a picture of culinary unity we will be to all the world!”

“Hear the poor!” whispers the nation, “As their pangs of hunger are replaced by forces of misguided communal anger! As drinking water pleas get exchanged for one religion for all! Where, a roof over their heads is forgotten, for mandir or masjid! Where local leaders who can’t repair potholes rush to construct religious structures elsewhere!”

I look at the nation, as it stares back at me helplessly, “Read how we are becoming the fastest progressing nation!” I cry, “That soon, we will replace half the world or more, the way we are going!”

The nation shakes its head and staresaghast at me, “Progress for whom?” asks the nation, “For a people who by then will be too petrified to speak up? With courts filled with judges, who have been handed their verdicts beforehand? With police instructedwith which community to arrest and whomto free?”

I look menacingly at the nation and say severely, “You need to broaden your vision!”

“I have been broadened to breaking point!” sighs the nation, “And any more stretching, will tear apart the delicate threads that bind me as one unitedcountry!”

I laugh mirthlessly as I salute the statue and the train, steadying myself, as I feel the seams of my nation rupturing under me..! 

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Last night I flew back home. While meeting friends in New York, many would tell me how they longed to visit India, “But your flights are so long!” they groaned, “Seventeen long hours! How, do you manage?” Well I’ve managed pretty well, I must say, and quite often have been upgraded to business class, which meant luxury seating and extravagant service, otherwise I’ve found myself occupying a whole row of empty seats where I could stretch out and read or sleep.

This time, as usual I prayed, yes prayed for a comfortable flight!

“We couldn’t get you a window seat dad!” said my daughter after they checkedme in online. When I reached my seat, I saw that the guy next to me had a shoulder and muscles to match that stretched across his seat into mine, and since mine mentally had already lost battle with his, would be kept imprisoned on one third of the seat.

“Didn’t you hear my prayers God?” I moaned as I sat and felt my shoulders ache.

“You slept like a baby!” said Ibrahim Alfaqieh, my broad shouldered Jordanian neighbor.

“Did I?” I asked.

“Well we’ve just landed!” he said with a smile.

I’d slept the whole flight through! And yes ‘like a baby’ as Ibrahim had mentioned.

And that’s when I realized that God’s answers to prayers are different from what we perceive His solutions to be. I asked for a good seat, He gave me good sleep!

A few years ago, when I got into full time writing, our family suddenly needed finance for a medical problem. I knew I had to make money quickly, and decided on three ways. One, a ‘friend’ wanted to sell his house. I asked him, what he expected to get. He told me, and I asked whether, I could help sell it, using ingenious, out of the box ways, and pocket anything extra I made, “You can’t Bob!” he said, “I’ve already told you a very high figure. But do try!”

I did. I made a handsome profit. But the ‘friend’ with his money and with what I was entitled todisappeared to New Zealand. I was then called to design a doctor’s clinic since that was a field, I had been in. The doctor, showed me his clinic. I worked on the design, and suddenly got a call from him, saying he was buying a ready-made already designed clinic.

Two deals falling flat, and the third one, also a business deal, went kaput!

“Why didn’t you allow me to make that much needed money?” I cried out in prayer, and then lo and behold found the money was not needed as the medical problem had disappeared.

“Sleep my child!” whispered a God above, “Don’t worry if your window seat didn’t work, I just increased your sleep dosage..!” 

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On that Night of Terror ten years ago, I was just a few feet away as hundreds died! The Press Club where I was spending that evening and finally the whole night, along with the Editor of the Trinity Mirror is situated a few hundred feet from both the CST station where innocents were mercilessly gunned down, and the Madam Cama hospital where others were ruthlessly shot point blank that night, and a kilometer from the Taj Hotel where mass executions took place. As gunshots receded, we heard the sound of the lone jeep which sped down the road outside, and which carried the three brave officers who became lifeless bodies in a few minutes.

I saw photographers running in, unloading ghastly pictures of the bloodied railway station, where terrified men, women and children, in crouching positions, behind sad, pathetic remnants of their baggage were mowed down by the machine guns of Kasab and his accomplice.

I was hardly a few feet away, and it was only providence that did not allow these terrorists from walking towards the bright lit Mumbai Press Club, where we would have all been sitting ducks for slaughter.

But I believe there’s a reason we scribes were spared; and that, to tell the world, “Never Again!”

Never again should such carnage take place, where both poor and wealthy were targeted and killed, even as they looked at their bloodied selves with lifeless eyes, asking ‘Why?”

Yes why? What made Kasab and gang to willingly sail stormy seas, risk their lives from Navy and Coast Guard, strut through strangers and walk fearlessly into four different locations to kill, and be killed?

Why? Well, evidence gathered, shows they had been fed with scenes of atrocities and conditioned to believe that injustice of a high magnitude was being inflicted on their community in our country. In their minds, they repaid hate with hate. And that is how terrorism thrives; on the wheels of hate!

Those wheels are turning now. With no thought of the damage this can do to our nation, hate is being used as a tool to win elections. Anger, harnessed to create the right atmosphere for violence, and with violence comes injustice as we have seen time and again.

I was hardly a few feet away when the carnage took place. Why, were we spared? I believe, to warn the nation today, that this atmosphere being cunningly created will lead ultimately to more innocents losing life, limb and loved ones!

You can stop it! By stopping such leaders from spreading their messages of animosity, and by you yourself, learning to speak and act without hurting others who do not worship as you do!

Lifeless eyes, from the Taj, CST station, Leopold Café and the Jewish House, plead silently, “Not again..!” 

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By Dr Vipul Gupta

Pediatric strokes even though rare, is one of the leading causes of significant morbidity and mortality. In comparison to stroke occurring in adults, children present differently with unique risk factors that often optimizes the outcomes. As the risk factors for pediatric stroke vary from that in adults, the cases are often diagnosed at later stages, or remain misdiagnosed.

According to the data reported in various International journals, mortality rate of children suffering from stroke under the age of 15 years is around 25% and the remaining will have a recurrence or will have persistent neurological disorders, difficulty in learning or seizures.  Unlike adults where the risk factors are predominated by diabetes, hypertension and atherosclerosis, pediatric risk factors are more diverse and larger in number.

However the instances of pediatric stroke are under reported and may be more than we realize. This is attributed to the fact that the symptoms mimic other diseases that lead to misdiagnosis and hence delay in its treatment. With recent advancements in the field of neurointervention, the survival rates of pediatric stroke (also suffering from congenital heart ailments, sickle cell disease or other blood disorders) has doubled due to improved intervention and awareness.

What is pediatric stroke?

Stroke is caused by the occlusion or rupture of arteries and veins in the brain and can be ischemic or hemorrhagic or both. Ischemic strokes are more commonly caused due to arterial blockage, but can also happen with venous blockage. When the blockage leads to rupturing of the blood vessels causing bleeding it is termed as hemorrhagic stroke. Ischemic stroke in adults accounts for 85% of all strokes whereas only 50% are attributed in the case of pediatric stroke.

Children are also vulnerable to a mini stroke (Transient Ischemic attacks – TIA) when the blood supply to the brain is interrupted for a very short time. Usually the symptoms subside immediately after TIA, but the chances for a stroke to occur within the next 24 hours doubles.

What are the symptoms?

As stroke can happen at any age, from infancy to adulthood, the age determines the appropriate treatment option for the neurointerventionist. It is thus often misdiagnosed due to the fact that the effects of stroke or its symptoms are not noticeable.

Strokes are first detected when the problems arise with their learning and development. Most noticeably there may be problems with movements in only one side of the body. Seizures are the most common symptom in infants upto 28 days old and in children upto 18 years may experience weakness or paralysis on one side of the body, facial drooping, speech problems and headaches. These symptoms are most commonly associated with ischemic strokes. Symptoms for hemorrhagic strokes include vomiting, seizures and occasional headaches.

The effect of stroke depends on the area of occurrence of stroke in the brain and the amount of damaged caused. People having larger strokes can be permanently paralyzed on one side of their body or lose their ability to speak. But some having small strokes may only have temporary problems like weakness of an arm or leg. With timely intervention most of the cases are recoverable completely.

Who is at more risk?

The risk factors and reasons for pediatric stroke are distinct and varied including malformations in the blood vessels and other congenital abnormalities.

Ischemic stroke is the leading cause pediatric stroke and the risk factors include –

1.    Congenital heart ailments - Heart disorders cause up to 25 per cent of ischemic strokes in children. They can be a result of congenital heart disease, an abnormality present since birth or acquired heart disease. Stroke is not usually the first sign of heart disease. Often heart disease has been diagnosed before the child has a stroke.

2.    Congenital Blood Disorders – also known as prothrombotic disorders, the condition causes the blood to thicken and clot faster. Sickle cell Disease (SCD) is another inherited condition that affects the development of RBC and changes its shape from round to sickle. Though rare, it can also cause bleeding in the brain blood vessels. Other conditions include leukemia, Anemia, and autoimmune disorders.

3.    Arterial Malformation – stroke can occur due to irregular formation of arteries in the brain. Being congenital, children born with this condition often go undetected until the symptoms of stroke are persistent. Such kids need regular monitoring for recurrent strokes.

Hemorrhagic strokes attributes to 50% of the cases of pediatric stroke and the main reason is Arterio-Venous Malformation (AVM). It is a rare malformation of the arteries and veins where the high pressure blood pumped from the heart to the brain directly move to the veins that passes blood at relatively low pressure. This change in pressure causes rupturing of the vessels thereby causing bleeding.

How is it treated?

The treatment for hemorrhagic stroke focuses on stabilizing the child by controlling the blood pressure, body temperature and prevents shortness of breath before treating the hemorrhage. The surgical options include microsurgery to clip the aneurysm or remove the abnormal vessels.

The treatment for ischemic stroke works on to reduce the damage to the brain and prevent another stroke. Doctors prescribe blood thinner and also monitor reflexes, eye movements, speech skills, swallowing and other body functions. Also how the child is processing to and reacting to light, pictures, sound and touch. 

Dr Vipul Gupta is the Director, Neurointervention, Agrim Institute for Neuro Sciences, Artemis Hospital