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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 …

16th October 2011, Sunday

Why it is important to consult a qualified doctor in emergency?

One should not ignore warning signals as “time is life” in medical science. The three cardinal warning signals are: anything which is unusual, anything which cannot be explained and any symptom appearing for the first time in life. Time is life is an old saying. In heart attack, time is muscle and in brain, time is brain.

Most acute emergencies will require emergent evaluation and treatment. Delay in treatment even of minutes can take away the life. In emergency one should not waste time to think, rush to a bigger hospital with full facilities and make sure that the person is attended to in time. Many hospitals may have ill equipped emergency departments or may have inadequately trained staff. In nursing homes the ER doctor may be from other systems of medicine.

Most quacks and unqualified medical practitioners will the diagnosis and a precious time will often be lost which may lead to high mortality and morbidity.

In emergency medicine, the ‘Golden Hour’ refers to the first hour following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. If bleeding can be stopped and person can be infused enough fluids within first hour, most trauma death can be avoided.

‘Platinum ten minutes’ refer to first 10 minutes after trauma and indicate the importance of starting first aid within ten minutes to reduce the chances of death.

Door to ECG Time: One should get an ECG within 10 minutes of chest pain. A prolonged door-to-ECG time is associated with an increased risk of clinical outcomes in patients with ST-elevation heart attack.

Door-to-Doctor Time in Stroke: In emergency department arrival to initial physician evaluation should be less than 10 minutes in stroke or the mortality will be high.

Door-to-neurologist time: In emergency department arrival to Paralysis Stroke Team Notification time should be less than 15 minutes.

Door to CT scan time is the time before which the CT should be done in suspected paralysis. In the emergency department arrival to CT Scan initiation in stroke should be less than 25 minutes.

Door-to-CT Interpretation in stroke should be <45 minutes.

Door to tPA time is the treatment window in paralysis: 80% of eligible paralysis patients presenting to the emergency department should be treated with tPA clot dissolving drug within 60 minutes.

Door-to-antibiotic time in community-acquired pneumonia (CAP) is the time to start antibiotics. All patients hospitalized with CAP should receive antibiotics within 4 hours of admission

Door-to-antibiotic time in meningitis (brain inflammation) of more than 6 hours is linked to high mortality (8.64 times).

Door-to-needle time in acute heart attack is the time before which the clot-dissolving drug should be given. In ST elevation heart attack, the door-to-needle time should be less than 30 minutes.

Door-to-balloon time in angioplasty: Primary percutaneous coronary intervention is now preferred for most patients if it can be performed by an experienced operator within 90 minutes from presentation to the emergency department.

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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

Why it is important to consult a qualified doctor in emergency?

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

18th MTNL Perfect Health Mela 2011 - Karva Chauth celebrated with a difference

A special Karva Chauth ceremony was observed as a part of MTNL Perfect Health Mela and was dedicated to HIV-AIDS prevention. The theme of the function was “Be Faithful to Your Partner”. A special screening of the movie was held interjected with HIV-AIDS messages.

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


Compensation package for clinical trial victims in the offing

NEW DELHI: India will soon quantify the amount of compensation to be paid by pharmaceutical companies, if a volunteer dies or gets injured during a clinical trial. On October 10, the Drug Technical Advisory Board (DTAB) gave its nod to the Central Drugs Standard Control Organization (CDSCO) to prepare a "compensation chart" or extensive guidelines that will specify the amount to be paid. Ethical committees of the company will have to decide the quantum of compensation on the basis of these guidelines. The compensation has to be paid by the trial's sponsor or its representative within 90 days of the death or injury to the victim or the next of h/his kin. In the first 30 days, the firm will have to prove to the ethics panel that the death or injury wasn't due to the drug, else it has to pay. (Source: TOI, Oct 14, 2011)

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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)

Absence of healthy bacteria in mouth may indicate cancer

Two bacterial species --Neisseria elongata and Streptococcus mitis -- were much more likely to be found in the mouths of healthy people than those with pancreas cancer. Scanning for levels of these two bacteria enabled the research team to accurately distinguish between cancer patients and healthy participants more than three-quarters of the time (80 percent). In reverse, levels of another species -- Granulicatella adjacens -- were higher among those with disease. (Gut)

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Transfusion not the best for anemia, age of stored blood important

University of Kentucky researcher Samy Selim at Saha Cardiovascular Research Center, have recently published a paper in the Journal Clinical Science suggesting that transfusion may not always be the best treatment for hospitalized patients with anemia. Results suggest the age of stored blood may be a factor in negative effects of transfusion. The paper said that plasma levels of sphingosine l-phosphate are strongly correlated with haemotocrit, but variably restored by red blood cell transfusions.

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Pioglitazone may reduce atherosclerotic plaque inflammation

Pioglitazone may reduce atherosclerotic plaque inflammation, independent of its glucose-lowering effects. In patients with impaired glucose tolerance or type 2 diabetes accompanied by carotid atherosclerosis, pioglitazone and glimepiride reduced fasting plasma glucose to a similar extent after four months of treatment, according to Nobuhiro Tahara, MD, PhD, of Kurume University in Japan in the October issue of JACC: Cardiovascular Imaging.

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    Twitter of the Day

@DrKKAggarwal: Divya Jyoti - An Inter Nursing School + College Health Festival 21st October, Friday, 2011: Divya Jyoti – an inter... http://fb.me/OjCfc62R

@DeepakChopra: Science vs. Spirituality: Deepak Chopra And Leonard Mlodinow Discuss 'War Of The Worldviews' http://huff.to/qDuasC via@huffingtonpost

    Spiritual Update

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

Lifestyle in Kartik Month

1. Kartik is a holy month.
2. Its known for Pitta aggravation in Ayurveda.
3. As per Ayurveda, if Pitta is imbalanced one should eat less pungent, sour and salty foods.

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    An Inspirational Story

(Ms Ritu Sinha)

Let the Light Shine

Bill was driving home one evening, on a two-lane country road. Work, in this small Midwestern community, was almost as slow as his beat-up Pontiac, but he never quit looking. Ever since the factory closed, he'd been unemployed, and with winter raging on, the chill had finally hit home.

It was a lonely road. Not very many people had a reason to be on it, unless they were leaving. Most of his friends had already left. They had families to feed and dreams to fulfill, but he stayed on. After all, this was where he buried his mother and father. He was born here and knew the country. He could go down this road blind, and tell you what was on each side, and with his headlights not working, that came in handy.

It was starting to get dark and light snow flurries were coming down. He'd better get a move on. You know, he almost didn't see the old lady, stranded on the side of the road. But even in the dim light of day, he could see she needed help.

So he pulled up in front of her Mercedes and got out. His Pontiac was still sputtering when he approached her. Even with the smile on his face, she was worried. No one had stopped to help for the last hour or so. Was he going to hurt her? He didn't look safe, he looked poor and hungry. He could see that she was frightened, standing out there in the cold. He knew how she felt. It was that chill that only fear can put in you. He said, "I'm here to help you ma'am. Why don't you wait in the car where it's warm? By the way, my name is Bill." Well, all she had was a flat tire, but for an old lady, that was bad enough. Bill crawled under the car looking for a place to put the jack, skinning his knuckles a time or two. Soon he was able to change the tire, but he had to get dirty and his hands hurt. As he was tightening up the lug nuts, she rolled down her window and began to talk to him. She told him that she was from St. Louis and was only just passing through. She couldn't thank him enough for coming to her aid.

Bill just smiled as he closed her trunk. She asked him how much she owed him. Any amount would have been all right with her. She had already imagined all the awful things that could have happened had he not stopped. Bill never thought twice about the money. This was not a job to him. This was helping someone in need, and God knows there were plenty who had given him a hand in the past. He had lived his whole life that way, and it never occurred to him to act any other way. He told her that if she really wanted to pay him back, the next time she someone who needed help, she could give that person the assistance that they needed, and Bill added "...and think of me".

He waited until she started her car and drove off. It had been a cold and depressing day, but he felt good as he headed for home, disappearing into the twilight. A few miles down the road the lady saw a small cafe. She went in to grab a bite to eat, and take the chill off before she made the last leg of her trip home. It was a dingy looking restaurant. Outside were two old gas pumps. The whole scene was unfamiliar to her.

The cash register was like the telephone of an out of work actor-it didn't ring much. Her waitress came over and brought a clean towel to wipe her wet hair. She had a sweet smile, one that even being on her feet for the whole day couldn't erase. The lady noticed that the waitress was nearly eight months pregnant, but she never let the strain and aches change her attitude. The old lady wondered how someone who had so little could be so giving to a stranger. Then she remembered Bill. After the lady finished her meal and the waitress went to get her change from a hundred dollar bill, the lady slipped right out the door. She was gone by the time the waitress came back. She wondered where the lady could be, and then she noticed something written on a napkin.

There were tears in her eyes, when she read what the lady wrote. It said, "You don't owe me a thing, I've been there too. Someone once helped me out, the way I'm helping you. If you really want to pay me back, here's what you do... “Don’t let the chain of love end with you."

Well, there were tables to clear, sugar bowls to fill, and people to serve, but the waitress made it through another day. That night when she got home from work and climbed into bed, she was thinking about the money and what the lady had written. How could she have known how much she and her husband needed it? With the baby due next month, it was going to be hard. She knew how worried her husband was, and as he lay sleeping next to her, she gave him a soft kiss and whispered in a soft, and low voice, "Everything's going to be all right; I love you Bill."

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    Fitness Update

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

Six weeks of weight training increases bone density

Osteoporosis or decreased bone density is a significant health problem in women and some men. Bone density, which decreases with age, is affected by bone loading, nutrition, and hormone status. Weight training is widely used as a method of preserving or increasing bone density. A study from Loyola Marymount University in Los Angeles found that bone density in the hip and spine increased by 2.7-7.7 percent in men but did not change in women, following a 24-week weight-training program that included squats and deadlifts. Weight training increases bone density more in men than women.

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    Malaria Update

AC Dhariwal, Hitendrasinh G Thakor, Directorate of NVBDCP, New Delhi

What the National Drug Policy of India says

What is the treatment of mixed infections?

All cases of mixed infection are to be treated as Pf as per the drug policy applicable in the area plus primaquine for 14 days.

There are various kinds of ACTs. All consist of an artemisinin derivative (artesunate, artemether, artether or dihydroartemisinin) combined with a synthetic antimalarial (amodiaquine, lumefantrine, mefloquine or sulfadoxine-pyrimethamine). The ACT used in Government health services, (artesunate + sulfadoxine-pyrimethamine (SP) is considered optimal in India, and which is therefore used. The dose is 4 mg/kg body weight of artesunate (AS) daily for 3 days, combined with 25mg/ kg of sulfadoxine + 1.25 mg of pyrimethamine (SP) on the first day. Strength of each artesunate tablet is 50 mg and each SP tablet contains 500mg sulfadoxine and 25mg pyrimethamine. ACT should be given only to confirmed P. falciparum cases found positive by microscopy or RDT. Other ACTs (see above) which have been duly registered and authorized for marketing in India may be used as alternatives to artesunate + SP, for example in cases with hypersensitivity to sulphonamides.

According to current WHO guidelines, ACTs can be given in the second and third trimester of pregnancy. In the first trimester, they should be avoided, given the still relatively scarce data on their safety, unless no other effective antimalarial treatment is available. The recommended treatment in the first trimester of pregnancy is quinine orally.

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    Medicine Update

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

What is the risk of transmission of the infection with hepatitis B from the carriers?

HBsAg–positive women who are pregnant should be counseled to inform their doctors so that hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine can be administered to their newborn immediately after delivery. HBIG and concurrent hepatitis B vaccine have been shown to be 95% efficacious in the prevention of perinatal transmission of HBV. Transmission of HBV from infected health care workers to patients has also been shown to occur in rare instances. The risk of infection after blood transfusion and transplantation of nonhepatic solid organs (kidneys, lungs, heart) from persons with isolated anti–HBc is low i.e. 0% to 13%. The risk of infection after transplantation of liver from HBsAg –negative, anti–HBc positive donors has been reported to be as high as 75% and is related to the HBV immune status of the recipients.

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    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Assessment of atherosclerosis risk: Triglycerides, cholesterol, HDL-cholesterol, LDL-cholesterol, Chol/HDL ratio. All of these studies find great utility in assessing the risk of atherosclerosis in the patient. Increased risks based on lipid studies are independent of other risk factors, such as cigarette smoking.

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    Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

What are the implications of reduction in emphasis upon teaching of FMT at the UG level as proposed by the MCI?

This needs to be looked at from two angles by posing, and answering, the following questions:

Q1. Will the quality of FMT (Forensic Medicine & Toxicology) as a medical discipline suffer if FMT course content and teaching hours are reduced at the undergraduate level?

Ans. I think it will suffer to some extent. It is possible to argue that a high quality MD course in FMT can still be conducted in spite of the low importance given to this subject at the undergraduate level. Such argument can be countered by saying that meritorious students are unlikely to opt for postgraduation in FMT if their minds are not made to appreciate at the UG stage that it is an important subject.

Q2. Will the performance of doctors as regards duties related to FMT in their day to day work suffer if FMT course content and teaching hours are reduced at the undergraduate level?

Ans. The answer is certainly in the affirmative. Fresh MBBS graduates joining state medical service are often required to perform autopsies. Likewise, I have seen ophthalmologists etc. in state service given the duties of performing autopsies. The quality of MLC and autopsy reports is a crucial factor in investigation of crime and maintenance of law and order. The importance and responsibility of doctors to the society in this regard is rarely impressed upon doctors during their student days. An adequate knowledge of the subject is therefore desirable not only in the interest of the discipline itself but also in the interest of society at large.

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    IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim of Rs. 2 lakhs has used a cumulative bonus of Rs. 40000 after 8 years. How much can he claim in the next year.
Dr. Bad: Same as 2.4 lakhs.
Dr. Good: It will be 10% less.
Lesson: Incase of claim under the policy in respect of insured person who has earned the cumulative bonus, the increased percentage will be reduced by 10% of claim of sum insured on the next renewal. However, basic sum insured will be maintained and will not be reduced.

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Make Sure

Situation: A 14 year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.
Reaction: Oh My God! Why was aspirin given!
Lesson: Make sure to remember that aspirin is contraindicated in children.

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    Quote of the Day

(Dr GM Singh)

Ants are creatures of little strength, yet they store up their food in the summer.


Pull the plug: To stop something. To bring something to an end.

    Mind Teaser

Read this…………………

Banana and lemon sign is seen in which fetal anomalies:

a. Neural tube defect
b. Hydrops fetalis
c. Twins
d. IUD
e. Down syndrome

Yesterday’s Mind Teaser: The most accurate and clinically useful measurement of portal vein pressure is

a) Hepatic venous pressure gradient (HVPG)
b) Direct measurement of portal pressure
c) Splenic pulp pressure
d) Wedged hepatic vein pressure

Answer for Yesterday’s Mind Teaser: a) Hepatic venous pressure gradient (HVPG)

Correct answers received from: Dr Anil Kumar Jain, Dr Chandresh Jardosh, Dr K Raju, Muthumperumal Thirumalpillai, Neelam Nath, Dr Jainendra Upadhyay, Jayaraman TP, Anil Bairaria.

Answer for 14th October Mind Teaser: d) Application of cyanoacrylate glue
Correct answers received from: Dr Anil, Dr Kavita, Dr Kartar, Dr Neena, Dr yash, Dr Tirath, Dr kesar,
Dr Trisha.

Send your answer to ijcp12@gmail.com

   Laugh a While

(Dr GM Singh)

Teacher: What’s your father?
Boy: I.C.S in summer and P.C.S in winter.
Teacher: What's that?
Boy: Ice cream seller in summer and Pakoda chat seller in winter.

    Medicolegal Update

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

Immunization death Ideal containers/preservative for viscera postmortem examination

  • For preservation of viscera, clean, wide-mouthed glass bottles fitted with glass stoppers of one liter capacity should be used. Rubber inserts should preferably not be used under caps.
  • 20-30 ml of blood taken from femoral artery or vein by per skin puncture should be collected in 60ml screw-capped bottles or in plastic capped tubes/10 mg of sodium or potassium fluoride per ml of blood should be added in blood for preserving blood.
  • 20-30 ml of urine is obtained from direct puncture of the bladder during the postmortem examination with a syringe and needle and should be collected in 60 ml screw-capped bottles or in plastic capped tubes and preservative 20-30 mg of thymol blue or boric acid or acetic acid should be added as preservative.
  • Saturated sodium chloride solution (common salt.) for all the visceral samples for chemical/toxicological examination
  • If there is an associated history of death due to acid intoxication, then all the samples should be preserved in rectified spirit.

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    Public Forum

(Press Release for use by the newspapers)

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Karva Chauth celebrated with a difference at MTNL Perfect Health Mela

A special Karva Chauth ceremony was observed as a part of MTNL Perfect Health Mela and was dedicated to HIV-AIDS prevention. The theme of the function was “Be Faithful to Your Partner”.

A HIV-Prevention message was also released on the occasion “ABC of HIV Prevention – Where ‘A’ stands for Abstinence (no-premarital sex), ‘B’ for Being faithful to your partner and ‘C’ for use Condoms if you cannot.

Over 500 ladies from various segments of the society participated in a special nail art show by Bharti Taneja’s Alp.

A special screening of the movie Rascal was held, interjected with HIV-AIDS messages.

Giving the details, Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Perfect Health Mela said that the ongoing Perfect Health Mela will end on 23rd October and from 19th will be open to general public where exhibitions, checkups, competitions and non-stop entertainment will be provided at NDMC Grounds Laxmibai Nagar, New Delhi.

The Mela is being organized by Heart Care Foundation of India and World Fellowship of Religions jointly with Health Department, Government of Delhi, MCD and NDMC from October 14 to 23, 2011.

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  1. Many many thanks for your emedinews. It is very useful. God bless all your good works. Regards and best wishes. Dr Bellarmine Mascarenhas, Coimbatore.
    Forthcoming Events

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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