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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


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  Editorial …

18th September 2011, Sunday

Azharuddin’s son Ayazuddin a victim of missed resuscitation
during the Golden Hour?

Ayazuddin (19), son of former cricketer and Moradabad MP Mohammad Azharuddin, died on 16th October (2011) five days after being critically injured in a road accident in Hyderabad. He was critically injured when his 1000 CC Suzuki skidded on the Outer Ring Road at Puppalguda on Sunday. His cousin died on the same day.

Ayazuddin suffered a cardiac arrest on his way to the hospital. He responded to resuscitation and was later operated on to stop the bleeding from his lung and kidney. His kidneys were also damaged. Commuters on the route alerted the police and a patrol vehicle from a nearby police station arrived soon. The police team failed to get an ambulance and had to take the profusely bleeding cousins in their patrol vehicle to the hospital, losing an hour in the process.

Medically the lesson is that opportunity to save him was list as the precious first hour was missed of resuscitation. The "Golden Hour" concept emphasizes the increased risk of death and the need for rapid intervention during the first hour of care following major trauma. Rapid intervention improves the outcome of injured patients (obstructed airway, tension pneumothorax, severe hemorrhage).

Death in road traffic accident can be a part of trimodal distribution of mortality (death at the scene; death 1 to 4 hours after injury; and death weeks later, generally in an intensive care setting) or bimodal distribution (death at the scene or within the first 4 hours).

The current thinking is that relatively few patients die after the first 24 hours following injury. The large majority of deaths occurs either at the scene or within the first four hours after the patient reaches a trauma center. This is true only when the patient gets medical care within the first hour. The care involves fluid resuscitation and control of the bleeding.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Azharuddin’s son Ayazuddin a victim of missed
resuscitation during the Golden Hour?

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

17th MTNL Perfect Health Mela 2010

‘Anmol’ – a festival organised for children with special needs. Special children are not disabled but differently abled. In the Photo:Students performing aerobics.

Dr K K Aggarwal
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter


Spurt in dengue cases due to rain, stagnant water

NEW DELHI: Six new cases of dengue were reported in the city on Friday, taking the total number of cases to 144. Two people have succumbed to the disease this season. MCD health officials said that heavy rains and stagnation of water can lead to spurt in the cases of mosquito–borne disease which has been relatively under control. Cases of malaria and chikungunya have also increased. "The dengue cases have gone up to 144. Four people have been diagnosed positive for chikungunya and 745 malaria cases have been reported so far, including patients who are from other states," said Dr V K Monga, Chairman of the MCD Health Committee. (Source: TOI, Sep 17, 2011)

For comments and archives

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    International News

(Dr Monica and Brahm Vasudev)

Anti–nausea drug linked to arrhythmias

A drug used to treat nausea and vomiting caused by chemotherapy may trigger dangerous and possibly lethal changes in heart rhythms, the FDA warned Thursday. The drug, ondansetron (Zofran), may increase the risk of "developing prolongation of the QT interval of the electrocardiogram, which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes," the FDA said. In a warning issued to clinicians, the FDA said that patients at greatest risk include those with "underlying heart conditions, such as congenital long QT syndrome, (and) those who are predisposed to low levels of potassium and magnesium in the blood" as well as patients who are taking other medications also associated with QT prolongation. Ondansetron is a 5–HT3 serotonin receptor antagonist, commonly prescribed to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, and surgery. (Source: Medpage Today)

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EASD: No microvascular benefit with intense BP, glucose control

Aggressively lowering blood pressure and blood glucose together won’t provide any microvascular benefits to type 2 diabetes patients, researchers said here. In an analysis of data from the ACCORD trial, neither intense glycemic management nor intense blood pressure control reduced the risk of a composite of microvascular outcomes, Patrick O'Connor, MD, of HealthPartners Research Foundation in Minneapolis, reported during an oral session at the European Association for the Study of Diabetes meeting here. (Source: Medpage Today)

For Comments and archives

ESGO: Ultrasound allows early ovarian cancer diagnosis

Ovarian cancer screening with transvaginal ultrasound has shifted the balance of detection to early–stage disease and improved survival, according to a study reported here. Early–stage tumors have accounted for about 70% of cancers diagnosed through the Kentucky–based program. Patients with screen–detected ovarian cancer had an estimated five–year survival of 88%, as compared with 40% to 50% for unscreened patients in two different cancer registries. Diagnostic accuracy has improved with the integration of an imaging–based morphology index for assessing tumor growth potential, Edward J. Pavlik, MD, reported at the European Society of Gynecological Oncology meeting. (Source: Medpage Today)

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Grief triggers clotting factors

A surge in inflammatory and prothrombotic factors following the death of a loved one may help explain the elevated cardiovascular risk present at this most stressful of times, a prospective study suggested. For instance, among a group of newly bereaved adults the mean neutrophil count –– possibly representing catecholamine– and cortisol–induced inflammation –– was 4.34 × 109/L compared with 3.79 × 109/L in a similar group of nonbereaved individuals (P<0.001), according to Geoffrey Tofler, MD, of the University of Sydney in Australia, and colleagues. The bereaved also had increased platelet activation as shown by higher median levels of platelet/granulocyte aggregates (383 × 106/L versus 343.5 × 106/L, P=0.02), the researchers reported online in the European Journal of Cardiovascular Prevention & Rehabilitation. Acute bereavement has been linked with a heightened incidence of cardiovascular events, but the reasons underlying this have not been elucidated.

For comments and archives

  Fitness Update

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Alzheimer’s brains found to have lower levels of key protein

Researchers have found that a protein variation linked by some genetic studies to Alzheimer’s disease is consistently present in the brains of people with Alzheimer’s. In further biochemical and cell culture investigations, they have shown that this protein, known as ubiquilin–1, performs a critical Alzheimer’s–related function: it "chaperones" the formation of amyloid precursor protein, a molecule whose malformation has been directly tied to Alzheimer’s pathology.

"What we saw here is that in all 20 of the Alzheimer’s brains we examined the ubiquilin–1 protein level was lower, and that's completely new," said University of Texas Medical Branch at Galveston assistant professor José Barral, co–author of a paper on the study now online in the Journal of Biological Chemistry. "Our experiments looked at the consequences of decreased ubiquilin–1, and showed that it’s necessary for the proper handling of amyloid precursor protein."

APP has been a major focus of Alzheimer’s investigators for almost two decades, ever since scientists identified it as the source of so–called "protein plaques," abnormal aggregations of proteins nearly always found in the brains of Alzheimer’s victims. Ubiquilin–1’s significance was revealed after the UTMB researchers established ubiquilin–1’s status as a chaperone protein for APP.

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  Twitter of the Day

@DrKKAggarwal: : #DNB India: Rapid reduction in body temperature can be accomplished by cool or tepid (20ºC), not cold, bathing,… fb.me/YfLKi7j4

@DeepakChopra: My intent: deep belly breathing! #30daysyoga.

    Dr KK Answers

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Can heart patients take Viagra group of drugs Vardenafil and tadalafil?

Tadalafil has the advantage of a longer duration of action. Both drugs and sildenafil potentiate the BP lowering response to nitrates. This interaction lasts 24 hours with vardenafil and up to 48 hours with tadalafil. Tadalafil, vardenafil and sildenafil are contraindicated with concomitant nitrate use.

For comments and archives

    Spiritual Update

You can be obese even with normal weight

Normal weight can be a risk factor for heart disease: A man’s risk of developing high blood pressure rises along with his weight, even when it’s within normal range.

For comments and archives

    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

A young girl, whose father is no more, joined internship and on the very first day an incident occurred causing death due to mismatched blood transfusion. A magisterial inquiry held that three persons were guilty—the intern, the house surgeon and the lab technician. A case under 304A has been filed against them. What defence does she have? Can she escape liability on the ground that she was an intern and not a fully registered medical practitioner?

  • There is nothing like a fully or partially registered medical practitioner. An intern who is registered as a medical practitioner under section 25 of the IMC Act, 1956, is a registered medical practitioner in real terms. The Act nowhere says that his responsibilities, duties and liabilities are different or lesser compared to those registered under section 15.
  • However, in practical terms, the judge may give lighter punishment if the crime is proved. Young age; being just a fresh intern who had barely spent one day as a doctor; being an unmarried girl whose father is no more; lack of malafide; being the first day on job; lack of adequate supervision; heavy load of work in a govt. hospital––all these can be pleaded as attenuating factors while determining punishment which can be as light as just a fine for which not even a minimum amount is mentioned in section 304A.

For comments and archives

    An Inspirational Story

(Ms Ritu Sinha)

One day, when I was a freshman in high school, I saw a kid from my class was walking home from school. His name was Kyle. It looked like he was carrying all of his books. I thought to myself, "Why would anyone bring home all his books on a Friday? He must really be a nerd." I had quite a weekend planned (parties and a football game with my friend’s tomorrow afternoon), so I shrugged my shoulders and went on. As I was walking, I saw a bunch of kids running toward him. They ran at him, knocking all his books out of his arms and tripping him so he landed in the dirt. His glasses went flying, and I saw them land in the grass about ten feet from him. He looked up and I saw this terrible sadness in his eyes.

My heart went out to him. So, I jogged over to him and as he crawled around looking for his glasses, and I saw a tear in his eye. As I handed him his glasses, I said, "Those guys are jerks. They really should get lives." He looked at me and said, "Hey thanks!" There was a big smile on his face. It was one of those smiles that showed real gratitude. I helped him pick up his books, and asked him where he lived. As it turned out, he lived near me, so I asked him why I had never seen him before. He said he had gone to private school before now. I would have never hung out with a private school kid before. We talked all the way home, and I carried his books. He turned out to be a pretty cool kid. I asked him if he wanted to play football on Saturday with me and my friends. He said yes. We hung all weekend and the more I got to know Kyle, the more I liked him, and my friends thought the same of him. Monday morning came, and there was Kyle with the huge stack of books again. He just laughed and handed me half the books.

Over the next four years, Kyle and I became best friends. When we were seniors, we began to think about college. Kyle decided on Georgetown, and I was going to Duke. I knew that we would always be friends, that the miles would never be a problem. He was going to be a doctor, and I was going for business on a football scholarship.

Kyle was valedictorian of our class. I teased him all the time about being a nerd. He had to prepare a speech for graduation. I was so glad it wasn’t me having to get up there and speak. Graduation day, I saw Kyle. He looked great. He was one of those guys that really found himself during high school.

He filled out and actually looked good in glasses. He had more dates than I had and all the girls loved him. Boy, sometimes I was jealous. Today was one of those days. I could see that he was nervous about his speech. So, I smacked him on the back and said, "Hey, big guy, you’ll be great!" He looked at me with one of those looks (the really grateful one) and smiled. "Thanks," he said. As he started his speech, he cleared his throat, and began.

"Graduation is a time to thank those who helped you make it rough those tough years. Your parents, your teachers, your siblings, maybe a coach…but mostly your friends. I am here to tell all of you that being a friend to someone is the best gift you can give them. I am going to tell you a story."

I just looked at my friend with disbelief as he told the story of the first day we met. He had planned to kill himself over the weekend. He talked of how he had cleaned out his locker so his Mom wouldn't have to do it later "Thankfully, I was saved. My friend saved me from doing the unspeakable." I heard the gasp go through the crowd as this handsome, popular boy told us all about his weakest moment. I saw his mom and dad looking at me and smiling that same grateful smile. Not until that moment did I realize it’s depth.

Never underestimate the power of your actions. With one small gesture you can change a person’s life. For better or for worse. God puts us all in each other's lives to impact one another in some way. Look for God in others.

For comments and archives

    Medicine Update

(Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity)

Tooth decay in children

Tooth decay develops when a child’s teeth and gums are exposed to any liquid or food other than water for long periods. The most common way this happens is when parents put their children to bed with a bottle of formula, milk, juice, soft drinks, sugar water, or sugared drinks. It can also occur when children are allowed to drink from a sippy cup, suck on a bottle, or breastfeed for long periods during the day or night.

For comments and archives

    Infertility Update

(Dr. Kaberi Banerjee, Infertility and IVF Specialist)

Under the aegis on AOGD

Infertility is still an enigma to us. The most advanced technique gives a pregnancy rate of at best 50–60% per attempt. Definitely there is lot more to be understood. We are hosting a Conference on 8th – 9th of October at Le’ Meridian, New Delhi on Current Practices and Recent Advances in ART (CUPART 2011). We have invited a very respectable panel of International and National faculty whose experiences will be a wealth of knowledge to us.

Organizing Chairperson – Dr Kaberi Banerjee

Day – 1 Interesting Highlights

Workshop – Only limited seats, first come first basis

Sperm preparation techniques in IUI, Sperm Preparation Techniques for various sperm samples in IVF and ICSI, Sperm Cryopreservation and Banking, ICSI and the Micromanipulator, Ultrasound – The Stethoscope of the Fertility Expert, Slow Freezing and Vitrification, Embryo Culture Media and Preparation

Faculty: Alok Teotia, Srikanth Yatnale, Shubhangi, Deene Vishnukanth, and many more

Inauguration & Welcome Address by Chief ICMR New Delhi at 7.00pm followed by Shaan – e– Hindustan – Sufi Night with Adil Hussaini, Hyderabad & Fellowship Dinner

For Registration Pls Contact: Address: E –23 Ayurvigyan Nagar New Delhi – 110049

For details contact +91 9871250235

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

International Normalized Ratio

The International Normalized Ratio (INR) is used to monitor the effectiveness of blood thinning drugs such as warfarin (Coumadin). These anti–coagulant drugs help to inhibit the formation of blood clots. They are prescribed on a long–term basis to patients who have experienced recurrent inappropriate blood clotting.

For comments and archives

    IJCP Special

Dr Good Dr Bad

Situation: A patient with mild hearing impairment wanted to know if passive smoking was harmful.
Dr Bad: It’s not harmful.
Dr Good: Avoid it.
Lesson: Second–hand tobacco smoke exposure may boost risk of hearing loss. Passive exposure is linked to significantly elevated risk of hearing loss in the low–to–mid frequencies for never smokers and former smokers. (Fabry DA, et al. Secondhand smoke exposure and the risk of hearing loss. Tob Control 2010;20(1):82–5)

For comments and archives

Make Sure

Situation: A patient on 10 units of insulin developed hypoglycemia with 11 units of insulin.
Reaction: Oh my God! Why was additional insulin given?
Lesson: Make sure that insulin dose is calculated correctly. The formula is 1500/total daily dose. The value will be the amount of sugar fluctuation with one unit of insulin.

For comments and archives

  Quote of the Day

(Dr. GM Singh)

Some people come into our lives and quickly go. Some stay for a while, leave footprints on our hearts, and we are never, ever the same.


It’s anyone’s call: A competition where the outcome is difficult to judge or predict.

    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Ante mortem and postmortem injury

One major difference between an ante mortem and a postmortem injury is the presence of signs of bleeding

  • The injury received in the body prior or before death is called antemortem injury. These injuries may be a contributing factor in the death or even its cause. But, they may also have occurred many days/months or years ago.
  • During an autopsy, the autopsy surgeon assesses the age of antemortem injuries, as well as distinguishing them from postmortem injuries—that is, injuries occurring after death. Postmortem injury can come from various sources such as deliberate mutilation of a body by a murderer following a homicide, predation by wild animals, or careless handling in the mortuary. Postmortem injuries can cause confusion over the manner and cause of death.
  • One major difference between an antemortem and a postmortem injury is the presence of signs of bleeding. While the person is still alive, the blood is circulating and any injuries such as cuts or stabs will bleed. After death, the body usually does not bleed. However, there are exceptions. For instance, when a person drowns, their body usually floats face down and these results in the head becoming congested with blood.
  • If the cadaver receives a head injury by colliding with blunt object/force, then there could be some evidence of bleeding. Scalp wounds sustained after death may also leak some blood. It can be especially difficult to distinguish between injuries inflicted in the very last few minutes of life and those caused postmortem. If the person collapses, there may be areas of laceration to the head and scalp which may be very hard to interpret.
  • After death, the blood stays liquid in the vessels and no longer clots. Careless handling of a cadaver may produce some postmortem bruising which may need to be distinguished from antemortem bruising. Blood also tends to pool under gravity after death, causing a bruised appearance in the lower limbs, arms, hands, and feet known as lividity or discoloration. Some of the smaller vessels may even hemorrhage under the pressure of this pooled blood. These bruises could be confused with ante–mortem bruising.
  • Recent research has focused on improved techniques for distinguishing between an antemortem and a postmortem injury by analyzing damaged tissue. Antemortem injuries show signs of inflammation, while postmortem injuries do not. Some research suggests that tissue from ante mortem injuries contains a chemical involved in inflammation leukotriene B4 (LTB4). Postmortem injuries were found to have no LTB4. This could help the doctor for assessment of the injuries more accurately.

For comments and archives

    Mind Teaser

Read this…………………

Which of the following is not true regarding ERCP in benign injuries of biliary tract?

a) ERCP should be the initial investigation in all cases of injuries to the bile duct to define the extent of injury.
b) ERCP is of value if there is a incomplete stricture.
c) ERCP is helpful if it is a Type A or Type D injury.
d) ERCP is of no use if clinically or radiologically the bile leak has stopped.

Yesterday’s Mind Teaser: : Which of the following is least to occur as gallbladder primary?

a. Adenocarcinoma
b. Squamous cell carcinoma
c. Lymphoma
d. Carcinoid tumour

Answer for Yesterday’s Mind Teaser: c. Lymphoma

Correct answers received from: Dr Anil Kumar Jain, Dr K Raju, Dr Chandresh Jardosh, Dr Neelam Nath, Anil Bairaria, Dr Jainendra Upadhyay, Dr Gunjesh kumar, Dr Shirish Singhal, Dr Anil Kumar Jain.

Answer for 15th September Mind Teaser: a. Chile
Correct answers received from:Dr Priya, Dr Shishir, Dr Tarun, Dr Vikas, Dr Varun.

Send your answer to ijcp12@gmail.com

    Laugh a While

(Dr GM Singh)

Senior personal ads

MINT CONDITION: Male, 1932, high mileage, good condition, some hair, many new parts including hip, knee, cornea, valves. Isn’t in running condition, but walks well.

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name


DCI Approval Date

Lipid Based Amphotericin–B Gel 0.1%

Indicated in the treatment of cutaneous and mucocutaneous mycotic infections caused by candida (Monilia) species.


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online http://hcfi.emedinews.in (English/Hindi/Audio/Video/Photo)

Poor dental hygiene can cause heart disease

Chronic poor oral health and tooth loss is associated with modest increases in future heart blockages and paralysis said Padmashri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

This effect persists after adjustment for known cardiovascular risk factors.

In a study of 1203 men with 2 years follow up published in the journal circulation in 2008 among men less than 60 years of age there was a significant dose-dependent increase in the risk of coronary heart disease (hazard ratio 2.12) comparing the highest versus the lowest category of radiographic bone loss (marker of chronic periodontiti).

Mechanisms how chronic periodontitis predisposes to heart blockages include adverse effect of systemic inflammation on endothelial function, intermittent bacteremia may contribute to systemic inflammation including and release of bacterial endotoxins of oral origin into the bloodstream induced by gentle chewing.

Treatment helps. In randomized trial published in 2007 in New Eng J of Medicine, in 120 patients with severe periodontitis, intensive dental therapy was associated with a significant improvement in endothelial function at six months.

For comments and archives

    Readers Response
  1. Dear Sir, regarding the Spiritual update "Seva, Simran & Satsang: The Basic Spiritual Prescription" Everyday soul detoxification therapy! I m delighted: Regards: Minie Mehta
  2. Hats off to u sir for serving mankind medicaly nd spritualy as well: Regards Ashok Agarwal
    Forthcoming Events

International Heart Protection Summit (IHPS–2011)

Organized by Ministry of Health & Family Welfare Govt. of India & ASSOCHAM September 28th, 2011 at Hotel Ashok, Chanakyapuri, New Delhi
President: Dr. H.K. Chopra, Intl. President: Dr. Navin C. Nanda, Scientific Chairman: Dr. S.K. Parashar, Org. Secretary: Dr. O.S. Tyagi,
For Registration & Details: Contact – Mob. 9971622546, 8010222883,
E–mail: agnideep.mukherjee@assocham.com; sandeep.kochhar@assocham.com,


18th MTNL Perfect Health Mela

Date: 14th–18th October
Different locations in Delhi
19th–23rd October
Venue: NDMC Ground, Opp. Indira Nari Niketan Working Girls Hostel
Near Philanji Village, Laxmibai Nagar, New Delhi
Theme: Science Behind Rituals


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    Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta