eMedinewS 4th July 2013, Thursday

     Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10-13); National Vice President Elect Elect, Indian Medical Association; 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 & Hony. Visiting Professor (Clinical Research) DIPSAR

For updates follow at
www.facebook.com/Dr KKAggarwal

cpr10 Mantra The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

Ringtone - CPR 10 Mantra Hindi

Ringtone - CPR 10 Mantra English

From the Desk of Editor in Chief

We make IMA and we are responsible for our actions

It is we who make an association or an institution. If we say institution is bad that means we are bad. Of late we have seen a lot of people talking bad about Indian Medical Association. .....Read More

SRK and surrogacy

The month-long wait for details of actor Shah Rukh Khan's third baby, born with the help of a surrogate mother, is over. BMC officials have received a birth report with details that a baby boy was born on May 27 to parents listed as Shah Rukh Khan and Gauri Shah .....Read More

Sanjay Dutt and Uttarakhand Disaster

It is a real opportunity for people like Salman Khan and Sanjay Dutt to come forward and take a lead in helping people in Uttarakhand. Such charities always make an impact. .....Read More

Where is Aamir Khan Now?

Aamir Khan projected himself in his show Satyamev Jayate as a social reformer for the country and not only as an actor.

He ended up in controversies especially with the medical profession. He sat in an open debate in ABP News and said .....Read More

sprritual blog The spiritual prescription "I am sorry"

Two hardest words for a doctor to say: “I’m sorry.”

Most defense lawyers counsels doctors not to apologize to patients. Their view is that if you say you’re sorry for something, you are implicitly taking some degree of responsibility for whatever has happened or in other words you are pleading guilty. The complainant’s lawyers may use a doctor’s apology to the maximum extent possible to show the doctor knew what they did was wrong. The usual approach is to deny and defend. .......Dr K K Blogspot

cardiology news
pediatrics news
wellness blog

Drinking coffee prevents Parkinson’s disease

Nicotine present in the tobacco has been used for its medicinal value for quite some time for diseases like Parkinson’s disease and ...Read More


Situation: A 19-year-old male came with a history of substance abuse.
Dr. Bad: He is a drug addict.
Dr. Good: I need to take history of childhood maltreatment.
Lesson: Childhood maltreatment has an impact in juvenile and adulthood periods in the form of offending, mental health concerns Read More

press release

Longer CPR efforts may improve survival chances


Health risks from dead bodies are negligible (Dr K K Aggarwal)

The health risks of dead bodies are dangers related to the improper preparation and disposal of cadavers. ...Read More

Preventing electrical deaths in monsoon

Do not use 2 pin electrical appliances: they can be dangerous

In countries like India where 2-pin electrical appliances are still used, it is common to see 3-5 people dying every day due to electrocution in major cities. Most of these deaths are preventable. Like fire, electricity too is a good servant but a bad master. Therefore, it has to be used properly, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India. ...Read More

News Around The Globe

The Anuradha Saha case twist Update

The Kolkata High Court has ordered 17 Kolkata doctors including Former West Bengal Medical Council members including its President to stand trial for criminal conspiracy in 1988 Anuradha Saha Medical Negligence Case. As per the allegation, the council members conspired to shield the crime.


  • Criminal conspiracy: IPC Section 120b: Punishment of criminal conspiracy: (1) Whoever is a party to a criminal conspiracy to commit an offence punishable with death, 2 (imprisonment for life) or rigorous imprisonment for a term of two years or upwards, shall, where no express provision is made in this Code for the punishment of such a conspiracy, be punished in the same manner as if he had abetted such offence. (2) Whoever is a party to a criminal conspiracy other than a criminal conspiracy to commit an offence punishable as aforesaid shall be punished with imprisonment of either description for a term not exceeding six months, or with fine or with both.)
  • Screening offender: IPC Section 201: Causing disappearance of evidence of offence, or giving false information to screen offender.-- Whoever, knowing or having reason to believe that an offence has been committed, causes any evidence of the commission of that offence to disappear, with the intention of screening the offender from legal punishment, or with that intention gives any information respecting the offence which he knows or believes to be false, if a capital offence; if a capital offence.-- shall, if the offence which he knows or believes to have been committed is punishable with death, be punished with imprisonment of either description for a term which may extend to seven years, and shall also be liable to fine; if punishable with imprisonment for life; if punishable with imprisonment for life.-- and if the offence is punishable with 1(imprisonment for life), or with imprisonment which may extend to ten years, shall be punished with imprisonment of either description for a term which may extend to three years, and shall also be liable to fine; if punishable with less than ten years' imprisonment. if punishable with less than ten years' imprisonment.-- and if the offence is punishable with imprisonment for any term not extending to ten years, shall be punished with imprisonment of the description provided for the offence, for a term which may extend to one- fourth part of the longest term of the imprisonment provided for the offence, or with fine, or with both. Illustration A, knowing that B has murdered Z, assists B to hide the body with the intention of screening B from punishment. A is liable to imprisonment of either description for seven years, and also to fine.


today emedipics

Doctor Day Celebration

On the Occasion of Doctors Day, a CME was organized by IMANDB, eMedinewS and Heart Care Foundation of India on 29th June 2013 at IIC, New Delhi


  • Every council is quasi-judicial body with a role to give a judgment which is not only true but also looks to be true.
  • Council members are public servants and can be booked under Prevention of Corruption Act and also under various IPC sections.
  • Under Delhi Medical Council Act, all the enquiries under this section are judicial proceedings within the meanings of section 193, 219 and 228 of Indian Penal Code. Section 219 of the Indian Penal Code 1860 talks about Public servant in judicial proceeding corruptly making report, etc., contrary to law: “Whoever, being a public servant, corruptly or maliciously makes or pronounces in any stage of a judicial proceeding, any report, order, verdict, or decision which he knows to be contrary to law, shall be punished with imprisonment of either description for a term which may extend to seven years, or with fine, or with both”.

Hamstring Injury – Facts

Dr Sanjay Gupta, Consultant Sports Medicine, Moolchand Medcity

Dhoni is out of cricket for some time because of hamstring injury.

Hamstrings are a group of four muscles at the back of thigh. The word ham originally refers to the muscle behind the thigh and knee & string refers to tendons, and thus, the hamstrings are the string-like tendons felt on either side of the back of the thigh and knee. Partial rupture (also commonly k/a Pull or Strain) or total rupture of one or more of four hamstring muscles is termed as Hamstring Injury.

What causes this injury?: Hamstring injuries typically are caused by rapid acceleration activities when running or initiating running activity. Hamstring injuries are common in sports such as soccer, football, cricket and athletics.

What is the function of the hamstrings? The hamstring muscles actively bend (flex) the knee. They also act to straighten or (extend) the hip (as in the motion of moving the thigh backward). Surprisingly, these large muscles are not very active with normal walking or standing. However, they are extremely important in power activities such as running, jumping, and climbing.

How do you grade severity of Injury?

Grade 1: Up to 50% rupture of muscle fibres (recovery takes 2-3 weeks)
Grade 2: 50% to 95% muscle fibres rupture (recovery takes about 3-5 weeks)
Grade 3: 100% rupture (recovery takes 6 weeks or greater)

Symptoms and Signs: Quite often, a "pop" is heard or felt by the injured athlete. A variable amount of pain is experienced immediately. The athlete is usually unable to continue and oftentimes cannot even stand.
Examination of the individual with a hamstring injury reveals spasm, tightness and tenderness at back of thigh. With more severe injury, swelling and a black and blue or bruised appearance will follow. Tears and strains most often occur at the middle of the back of the thigh where the muscle joins its tendon or at the origin of the hamstring at the base of the buttocks (at the ischium).

How are hamstring injuries diagnosed? In most patients, imaging is not necessary. However, if imaging is done to more completely view the muscle, tendon, or bone involvement with the injury MRI gives the best views.

How are hamstring injuries treated? Most hamstring injuries heal without surgery. In rare cases, where there is a complete rupture at the ischium, or where significant piece of ischial bone is jerked away, surgery is necessary. Essentially, all other grade I-III tears are best treated without surgery. The goal of treatment is to restore muscle function and prevent scar formation. Initially, treatment consists of rest, ice, compression, and elevation (RICE). A short course of non-steroidal anti-inflammatory medication may be helpful. As soon as pain permits, it is important to begin a program of stretching and range-of-motion rehabilitation exercises because prolonged immobilization and inactivity results in muscle shrinkage (atrophy) and scar tissue (fibrosis).

Can hamstring injuries be prevented? There is no fool proof way to completely avoid hamstring injuries. However, the risks can be minimized by paying attention to the principles of muscle strength and flexibility. Individual flexibility should be maximized by a regular stretching program as well as a period of warm-up and stretching before the intended athletic activity.

What is the prognosis for hamstring injuries? The outlook is generally good, but can require a period of rest by avoiding running and athletic competition. The length required for recovery varies depending on the severity of the muscle injury.

National News

  • As per a report published in Circulation, less than 33% patients with high blood pressure and high cholesterol have adequate control of both conditions, which could reduce the risk of heart disease by 50%.
  • A large French retrospective analysis has shown that drinking tea or coffee was associated with a small but statistically significant reduction in systolic and diastolic blood pressure. Drinking tea and coffee was also associated with a significant reduction in pulse pressure and heart rate, although the heart-rate reductions were greater with tea. The study was presented at European Society of Hypertension Scientific Sessions.
  • A study published in JAMA states that people who are vegetarians ranging from vegans to those who ate meat once a week were 12% less likely to die within six years than their meat-eating peers.
  • According to the new rheumatoid arthritis treatment guidelines, methotrexate is recommended as first-line therapy; sulfasalazine or leflunomide can be substituted if there are contraindications to methotrexate.
  • Clinicians administer IV iron facilities only in facilities equipped for resuscitation if the patient experiences an allergic reaction.
  • In patients with cirrhosis twice a year ultrasound has more advantages over annual CT scan for ruling out liver cancer.

Osteoporosis Management Guidelines Updated for Women and Men

  • The National Osteoporosis Guideline Group (NOGG) has updated its 2009 guidelines on the diagnosis and management of osteoporosis in postmenopausal women and men at least 50 years of age in the United Kingdom. The new recommendations were published online June 17 in Maturitas.
  • Pharmacotherapies shown to lower the risk for vertebral fracture (and for hip fracture in some cases) include bisphosphonates, denosumab, parathyroid hormone peptides, raloxifene and strontium ranelate.
  • Generic alendronate is usually first-line treatment because of its broad spectrum of antifracture efficacy and low cost.
  • Ibandronate, risedronate, zoledronic acid, denosumab, raloxifene, or strontium ranelate may be appropriate therapy when alendronate is contraindicated or poorly tolerated.
  • Because of the high cost, parathyroid hormone peptides should be used only for patients at very high risk, especially for vertebral fractures.
  • Postmenopausal women may benefit from calcitriol, etidronate and hormone replacement therapy.
  • Approved treatments for men at increased fracture risk are alendronate, risedronate, zoledronic acid, and teriparatide.
  • Patients at increased risk for fracture should start alendronate or other bone-protective treatment at the onset of glucocorticoid therapy.
  • For postmenopausal women, approved pharmacotherapy for prevention and treatment of glucocorticoid-induced osteoporosis includes alendronate, etidronate, and risedronate; approved treatment options in both sexes are teriparatide and zoledronic acid.
  • Calcium and vitamin D supplementation is widely recommended for older persons who are housebound or live in residential or nursing homes and is often recommended as an adjunct to other treatments for osteoporosis.
  • Potential adverse cardiovascular effects of calcium supplementation are controversial, but it may be prudent to increase dietary calcium intake and use vitamin D alone rather than using both calcium and vitamin D supplementation.
  • Withdrawal of bisphosphonate treatment is associated with decreases in bone mineral density (BMD) and bone turnover after 2 to 3 years for alendronate and 1 to 2 years for ibandronate and risedronate.
  • Continuation of bisphosphonates without the need for further evaluation is recommended for high-risk individuals. When bisphosphonates are continued, treatment review, including renal function evaluation, is needed every 5 years.
  • If bisphosphonates are discontinued, fracture risk should be re-evaluated after every new fracture, or after 2 years if no new fracture occurs.
  • After 3 years of zoledronic acid treatment, the benefits on BMD density persist for at least another 3 years after discontinuation. Most patients should stop treatment after 3 years, and their physician should review the need for continuation of therapy 3 years later.
  • Persons with a previous vertebral fracture or a pretreatment hip BMD T-score of -2.5 SD or less may be at increased risk for vertebral fracture if zoledronic acid is discontinued.

Valvular Heart Disease Update

TEE is also more precise in determining which of the three scallops of the posterior leaflet are involved. Such information is of importance in planning mitral valve repair. In the relatively common association between prolapse and the vegetation of infective endocarditis, it can be difficult by transesophageal echocardiography to distinguish among the components of the prolapsing mass.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What are the emotional aspects related to ectopic pregnancy?

Ectopic pregnancy is a physically and emotionally traumatic experience. In addition to experiencing the loss of a pregnancy, women may fear the loss of future fertility. Feelings of grief and loss are normal. Sadness, anger, self–blame, guilt, and depression are part of the grieving process, and need to be acknowledged and expressed. It can be helpful to share these feelings in a support group, such as RESOLVE or SHARE, or through counseling.

Rabies Update (Dr. A K Gupta)

Can rabies be transmitted to a dog that has eaten the flesh of a dead rabid cow or buffalo?

Yes. The rabies virus after multiplying in the brain spreads to other organs of the body like the heart, muscles, skin, etc. So the dog can definitely get infected because the virus can spread through oral mucous membrane.

medicolegal update

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

Indian pharmacopoeia in British India

In British India, even after establishment of two English medical schools, the noted British John Forbes Royale wrote a very famous essay on "Antiquity of Read More

ijcp book of medical records
medicolegal update

Is fee splitting an unethical practice?

The medical profession today is accused of fee splitting. Many doctors, when asked, say that they are not clear about the law. The argument is when we are included under the Consumer Protection Act (CPA), and marketing of medical services is allowed, then why are commissions not Read More

dr good dr bad

Situation: Doctor, screen me for thyroid deficiency.
Dr. Bad: Get TSH, FT4 and FT3 test done.
Dr. Good: Get serum TSH done.
Lesson: The current recommendation is to do only serum TSH as the initial screening test. Read More

make sure

Situation: A patient on ACE inhibitor developed angioneurotic edema.
Reaction: Oh my God! Why was ACE inhibitor continued?
Lesson: Make sure that patients on ACE inhibitors are advised to watch for symptoms of urticaria and stop the drug immediately in case swelling of lip, face or tongue develops (Br J Clin Pharmacol 1999;48(6):861–5).

quote of the day

Education is the best friend. An educated person is respected everywhere. Education beats the beauty and the youth. Chanakya.

twitter of the day

Dr KK Aggarwal: Vegetarian diet and Soya Products help reduce BP http://bit.ly/14JxRjo #Health

Dr Deepak Chopra: Taking things personally is a result of the misperception that one is a person
http://bit.ly/14JxRjo #Health

emedinews humor

Top Secret Communications Center

When my son was in the Air Force, my wife and I visited quite often. On our first visit, we were allowed inside this top secret Communications Center, but everything in Read More

reader response

Dear Sir, emedinews is very informative newspaper. Regards: Dr Prisha

An Inspirational Story

If I knew it would be the last time that I'd see you fall asleep, I would tuck you in more tightly, and pray the Lord, your soul to keep.

If I knew it would be the last time that I see you walk out the door, I would give you a hug and kiss, and call you back for one more.

If I knew it would be the last time I'd hear your voice lifted up in praise, I would video tape each word, so I could play them back day after day. ............Read More

eMedi Quiz

Read this…………………

By which of the following mechanism do antiphospholipids antibodies cause hypercoagulable state....

A. Interference with coagulation cascade
B. Activation of endothelial cells
C. Oxidation-mediated injury of the vascular endothelium
D. All the above

Yesterday’s Mind Teaser: Dietary gluten intake postulated to be a possible etiologic factor in all the following dermatologic diseases except.......

A. Acne vulgaris
B. Psoriasis
C. Dermatitis herpetiformis
D. Recurrent aphthous stomatitis

Answer for yesterday’s Mind Teaser: A. Acne vulgaris

Correct answers received from: Dr P J Khalap, Dr BB Gupta, Abhay Naik, Dr Biji Anilkumar, Dr KV Sarma, Tukaram Pagad, Dr Pankaj Agarwal, Dr Avtar Krishan, Muthumperumal Thirumalpillai, Dr Avtar Krishan.

Answer for 2nd July Mind Teaser: B.10-20 mg/day

Correct answers received from: Dr BB Gupta, Abhay Naik, Dr K Raju, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

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Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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