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eMedinewS is now available online on www.emedinews.in or www.emedinews.org
  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 & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos…
Nobility of medical profession Video 1 to 9 Health and Religion Video 1 to 7
DD Take Care Holistically Video 1 to 9 Chat with Dr KK On life Style Disorders
Health Update Video 1 to 15 Science and Spirituality
Obesity to Towards all Pathy Consensus ALLOVEDA: A Dialogue with Dr KK Aggarwal
  Editorial …

19th December 2012, Wednesday

Biggest Cardiology Stories of 2012 from Heart Wire

Acute coronary syndromes

  1. The year 2012 has been a relatively quiet year for ACS, with the main trial in the field (TRILOGY ACS) showing a neutral result.
  2. Results coming in with new drugs such as rivaroxaban and vorapaxar showed reduced ischemic outcomes. We might not need aspirin anymore in ACS patients.
  3. While both rivaroxaban and vorapaxar cause increased bleeding when given on top of aspirin and clopidogrel, aspirin is probably the worst culprit here.
  4. And most cardiologists are reluctant to give three antithrombotic agents together, so there is strong feeling that the next direction we may have to follow is to drop aspirin.
  5. There is a great future for the new anticoagulants in ACS without aspirin.
  6. WOEST study, although not in ACS patents, suggested aspirin was not needed in stent patients receiving clopidogrel and an anticoagulant.
  7. One highlight this year in ACS was STEMI subgroup of RIVAL. Radial access was associated with a 2.2% reduction in death/MI or stroke and a 1.9% reduction in all-cause mortality when compared with femoral access. This should be practice changing.
  8. DEFER trial in STEMI patients should answer the question of whether we should open up the artery only with a balloon and aspiration catheter and put a stent in later (4 to 16 hours) or just put the stent in there when you open the artery.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

Stool softeners, like docusate, act as surfactants to increase the amount of water in stool. A small number of RCTs evaluating docusate have not shown consistent benefit for constipation-related symptoms compared with psyllium or placebo. The evidence that exists suggests that docusate offers little benefit for constipation (Am J Gastroenterol 2005;100:S1-S4).

Dr K K Aggarwal
    eMedinewS Audio PostCard

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

Carotid neck ultrasound the only way to check regression of heart blockages

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela 2012

Children from various schools participated with great enthusiasm in learning the technique of CPR 10 - hands-only cardio pulmonary resuscitation.

Dr K K Aggarwal
    National News

Dear Colleague, Let’s celebrate New Year by learning CPR-10 and saving the life of a person

Watch English or Hindi Video @http://emedinews.in/videos/cpr/index.html

Dr K K Aggarwal

Most virulent form of dengue outbreak alarms national capital

NEW DELHI: Delhi is seeing an outbreak of the most dangerous and virulent form of dengue virus this season. Genetic analysis of the virus strains in circulation in India has shown that the national Capital is seeing a massive circulation of dengue virus serotype 2 that causes hemorrhagic fever, triggering a high mortality rate. An analysis of the type 2 strain has shown that the virus has also mutated. Dr A C Dhariwal, chief of India's National Vector Borne Disease Control Programme, told TOI that the genetic analysis of the virus strain conducted by the National Centre for Disease Control (NCDC) has found that it is of genotype 4 that didn't exist earlier. Dr Dhariwal said, "Type 2 strain of dengue is known to result with severe manifestations of the disease. On the other hand, we have seen a completely new genotype this season." Dr Shobha Broor, head of microbiology at the All India Institute of Medical Sciences (AIIMS), added, "This year Delhi is seeing an outbreak of type 2 dengue virus which is the most dangerous type. Chandigarh too is facing a similar type 2 outbreak. Genotype tells us how the virus is changing. Since genotype 4 hasn't occurred earlier, the population in Delhi is more susceptible to getting infected and they aren't naturally protected against this particular type," Dr Broor said.

Dr Broor said since the population in Delhi has not been exposed to genotype 4 before, they don't have antibodies that protect them and hence their body does not have immunity against xenotype 4. Dr Broor added, "In 1996, Delhi saw an outbreak with a dengue virus with genotype 2. Last year, Delhi saw an outbreak of a virus with genotype 3. This year, we have tested 12 samples and all turned out to be type 2 strain. “Dengue is caused by four viruses, namely, DENV 1, 2, 3 and 4." Based on the serotype and genotype data available with us now, we have instructed states to prepare for the next high transmission season which usually starts in July and goes onto October. Delhi has already put in place a task force to combat dengue," Dr Dhariwal said. (Source: TOI, Dec 18, 2012)

For comments and archives

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

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

    Valvular Heart Disease Update

What are the risk factors for calcific aortic stenosis in the elderly?

Risk factors associated with calcific aortic stenosis in elderly adults are similar to those for atherosclerosis.

(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)

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Tx-related AML not as deadly if Tx was taxane

Cancer therapy-related acute myeloid leukemia (AML) has a poor prognosis, but in breast cancer patients who had been treated with taxanes, overall survival of the therapy-related cancer was similar to that seen in women treated for de novo AML, researchers suggested at the annual meeting of the American Society of Hematology. (Source: Medpage Today)

For comments and archives

Fatal strokes strike distressed seniors

Depression, stress, and a negative outlook on life among older individuals appears to predict their risk of dying from a stroke, a longitudinal study showed. (Source: Medpage Today)

For comments and archives

Most advanced thought-controlled robotic arm unveiled

Using a sophisticated brain-computer interface, a woman paralyzed from the neck down learned to control a robotic prosthetic arm with her thoughts and perform several activities of daily living. With training, she rapidly learned to use the robotic arm to reach and grasp items and made significant gains in upper limb function. She learned to do maneuvers "with coordination, skill and speed almost similar to that of an able-bodied person," according to the research team. "This is a spectacular leap toward greater function and independence for people who are unable to move their own arms," senior investigator Andrew B. Schwartz, PhD, professor, Department of Neurobiology, University of Pittsburgh School of Medicine, Pennsylvania, said in a statement. "This technology, which interprets brain signals to guide a robot arm, has enormous potential that we are continuing to explore. Our study has shown us that it is technically feasible to restore ability," he added. The achievement is detailed in a paper published online December 16 in the Lancet. (Source: Medscape)

For comments and archives

Protecting patient data on mobile devices: New HHS guidance

With patient data increasingly transferred via smartphones, laptops, and tablets, physicians and other healthcare providers are facing increasing challenges in keeping the data safe. Now there's help from the US Department of Health and Human Services (HHS), which opened an online portal December 12 with tips, fact sheets, posters, and videos to help providers lock down private information. The initiative, "Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information," is available at on HHS' HealthIT Web site. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: Heart patients should be more cautious during Xmas time In the emergency room, heart attacks can be both over... http://fb.me/1r6xUJueE

    Spiritual Update

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

Why should not doctors be given impunity while treating their patients?

Error of judgment is not a crime. All judges whether in lower court, High Court or Supreme Court are given impunity for rendering their decisions. We have never heard a High Court judge being challenged in Supreme Court for giving a wrong decision.

For comments and archives

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

What is hydrosalpinx?

The embryo travels through the tube into the uterus .When it reaches the uterus, it can implant into the uterine wall and develop into a baby. However, an old infection can cause the tubes to fill with fluid and enlarge (dilate). When this happens, the tube is called a hydrosalpinx.

    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

How long can blood be stored?

The whole blood can be stored up to 35 days, in CPDA anti coagulant solution in refrigerated conditions at 4° – 6° C. But, in reality, the demand is so much that blood hardly remains stored for such a long period and is used much before expiry.

    An Inspirational Story

Unique human flaws

An elderly Asian woman had two large pots, each hung on the end of a pole, which she carried across her neck.

One of the pots had a crack in it while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full.

For two years, this went on daily with the woman bringing home only one and a half pots of water. The perfect pot was proud of its accomplishments. The poor cracked pot was ashamed of its own imperfection and miserable that it could only do half of what it had been made to do.

After 2 years of what it perceived to be bitter failure, it spoke to the woman: “I am ashamed of myself because this crack in my side causes water to leak out all the way to your house.”

The old woman smiled, “Did you notice that there are flowers on your side of the path, but not on the other pot’s side?”

“That’s because I have always known about your flaw so I planted flower seeds on your side of the path, and every day while we walk back, you water them. For two years I have been able to pick these beautiful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house.”

Moral: Like the pots, we all have our own unique flaws. But it’s the cracks and flaws we each have that make our lives together so very interesting and rewarding.

For comments and archives

    Cardiology eMedinewS

Chantix may up heart risk, FDA warns Read More

Physician fatigue not a factor in PCI outcome Read More

    Pediatric eMedinewS

Metformin reduces blood glucose and BMI in obese children Read More

More not better: Single vs double UCB transplant Read More

    IJCP Special

Dr Good Dr Bad

Situation: A pregnant lady was suspected to have DVT.
Dr. Bad: Go for MRI.
Dr. Good: Go for complete Doppler sonography test.
Lesson: A study published in BMJ from France has shown that a single negative complete Doppler sonography can conclusively rule out deep vein thrombosis in pregnancy.

Make Sure

Situation: A patient died after consuming six pegs of alcohol.
Reaction: Oh my God! Why was he allowed to consume six pegs?
Lesson: Make sure that no patient is allowed binge alcohol i.e. consuming more than six pegs in a day or five pegs at a time.

  Quote of the Day (Dr GM Singh)

In Life, in every moment, something new happens; something that you never expected, something that you were waiting from a long while to happen and something you were expecting to happen.

    Legal Question of the Day (M C Gupta)

Q. My father was treated in a private hospital. We spent Rs. 3 lakh on treatment. He expired. I sent a request to the hospital by registered post to supply me a copy of the indoor case record including operation notes. There was no response. I then sent two reminders. After second reminder, the hospital asked me to send Rs. 1000/- towards photo-copying charges. Is such demand legal? Is the hospital not supposed to supply the record within 72 hours?


  1. There is no law that the hospital has to supply a copy of records within 72 hours.
  2. The law you are referring to is Regulation 1.3 of the Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002, commonly referred, in short, as “Code of Ethics Regulations, 2002”, reproduced below:

    “1.3 Maintenance of medical records:

    1.3.1 Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India and attached as Appendix 3.

    1.3.2. If any request is made for medical records either by the patients/authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.”
  3. Please note that Annexure-3 consists of a half a page note maintained by the doctor as his own [personal side memoire]. It is not the official hospital record.
  4. Please also note that the medical council has jurisdiction only upon doctors and not hospitals. In other words, medical council rules and regulations do not apply to hospitals.
  5. There is nothing illegal in asking you to pay reasonable charges for the supply of records. Depending upon the number of pages, Rs. 1000/- may not be deemed in law to be an unreasonable amount.
  6. When you sent the first request to supply the record, you should have offered to pay necessary charges or, better still, asked them the charges and enclosed the same along with your request.
    Mind Teaser

Read this…………………

An intravenous pyelogram reveals that Paulo, age 35, has a renal calculus. He is believed to have a small stone that will pass spontaneously. To increase the chance of the stone passing, the nurse would instruct the client to force fluids and to

A. Strain all urine.
B. Ambulate.
C. Remain on bed rest.
D. Ask for medications to relax him.

Yesterday’s Mind Teaser: Thrombus formation is a danger for all postoperative clients. The nurse should act independently to prevent this complication by:

A. Encouraging adequate fluids
B. Applying elastic stockings
C. Massaging gently the legs with lotion
D. Performing active-assistive leg exercises

Answer for yesterday’s Mind Teaser: D. Performing active-assistive leg exercises

Correct answers received from: Dr Bharat Bhushan Aggarwal, Dr Shagufta Moin, Dr Mohan, Dr Prabha Sanghi, Dr PC Das, Dr Jainendra Upadhyay,
Dr Pankaj Agarwal, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Arpan Gandhi, Dr BK Agarwal, Dr Chandresh jardosh.

Answer for 17th December Mind Teaser: C. Keep legs elevated on 2 pillows while sleeping

Correct answers received from: Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

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Photos and Videos of 3rd eMedinewS – RevisitinG 2011 on 22nd January 2012

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    Laugh a While (Dr GM Singh)

Late for work

Hugh came into the office an hour late for the third time in one week and found the boss waiting for him.

"What's the story this time? Hugh?" he asked sarcastically. "Let's hear a good excuse for a change."

Hugh sighed and said, "Everything went wrong this morning. The wife decided to drive me to the harbor. She got ready in 10 minutes, but then the ferry didn't turn up. Rather than let you down, I swam across the river, ran over the mountain, borrowed a bicycle and cycled the 20 miles through the glen to this office."

"You'll have to do better than that. Hugh," replied the boss, disappointed. "No woman can be ready in 10 minutes."

    Medicolegal Update

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

What are resuscitative injuries?

Doctor should always document resuscitative injuries in detail in case of death

The injuries produced in human body during resuscitation pose difficulty in interpretation of injuries noted at postmortem examination or in inquest paper by the investigating law enforcement agency. Before proceeding to make an interpretation, the doctor conducting the autopsy should know if there has been an attempt for resuscitation and who did it and for how long. He should also know about the methods used in a particular case and whether all these have been documented in the clinical sheets or not. Resuscitative attempts may lead to skeletal, cardiac and abdominal viscera injuries. The investigating police officer should make a note on the basis of statements taken from the relative and doctors who attended the deceased and the same should be enclosed in inquest paper before handing them over to the autopsy surgeons.

  • The method generally used for life saving attempts by non–medical persons who are near the critical patient is mouth–to–mouth respiration and manual chest massage may causes contusions. • Resuscitation in hospitals includes bag and mask intubations, endotracheal tube, obdurate airways used for respiratory ventilation.
  • Mechanical methods like Thumper, active compression–decompression device and defibrillators are used in resuscitation. Closed chest cardiac massage along or with interspersed abdominal compression is also used for resuscitation.
  • The injections and closed–chest cardiac massage and other resuscitation procedures may result in the fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral hemothorax, tension pneumothorax, rupture of kidney and of spleen.
  • Fractures of ribs and/or sternum were found in 40% of cases, the frequency increasing with age. The number of fractured ribs ranged up to 16, mainly 3–8 ribs was fractured. Fractures of the 1st and 8th to 12th ribs were very rare.
  • The common site of rib fractures after heavy blunt thoracic injuries was found in the dorsal region.
  • The injuries which are received or inflicted on body prior to death are called antemortem injuries and may or may not be contributing factors in causing death or they may have occurred due to other reasons such as resuscitation/transport of sick/ill person for medical care called artifacts.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

More women than men die from severe heart attack in hospitals

Winter months are heart attack months, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Men and women have about the same adjusted in-hospital death rate for heart attack — but women are more likely to die if hospitalized for a more severe type of heart attack.

According to a report in Circulation, journal of the American Heart Association:

  • Women are twice as likely as men to die if hospitalized for a type of heart attack known as ST-elevation myocardial infarction (STEMI).
  • Women are also less likely to receive appropriate and timely treatment for heart attack.
  • Women with STEMI have a 12 percent higher relative risk for in-hospital death compared to men.
  • Compared to men, women are 14 percent less likely to receive early aspirin; 10 percent less likely to receive beta blockers; 25 percent less likely to receive reperfusion therapy (to restore blood flow); 22 percent less likely to receive reperfusion therapy within 30 minutes of hospital arrival; and 13 percent less likely to receive angioplasty within 90 minutes of hospital arrival.
  • Women admitted with a STEMI are about twice as likely to die in the first 24 hours of hospitalization as men.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 20815 people since 1st November 2012.

Hands only CPR Training is based on the following CPR Mantra: Quote” Within 10 minutes of death, earlier the better, at least for the next 10 minutes, longer the better, compress the center of the chest of the dead person effectively and continuously with a speed of 10x10 (100 per minutes).” Unquote

    Readers Responses
  1. Dear Sir, nice postings by you. Regards: Dr Prisha
    Forthcoming Events
Dr K K Aggarwal

4th eMedinews Revisiting 2012

(a day long single hall medical conference on 2012 happenings, followed by doctors of the year 2012 awards)

Sunday 20th January 2013, Maulana Azad Medical College Auditorium

Dilli Gate Delhi


Dr KK Aggarwal
Padmashri and Dr B C ROY National Awardee President

Dr Veena Aggarwal
Executive Editor IJCP Group
Organizing Chairman

Dr Pawan Gupta
Past President IMA Haryana
Organizing Secretary

4th eMedinewS Revisiting 2012

The 4th eMedinewS–revisiting 2012 conference is being held at Maulana Azad Medical College, New Delhi on Sunday January 20th 2013.

The one–day conference will revisit and discuss all the major advances in medicine in the year 2012. There will also be a live webcast of the event. An eminent faculty will speak at the conference.

There is no registration fee. All delegates will get Registration Kit, Attractive gifts, Certificates. Morning snacks and lunch will be provided.

Register at: www.emedinews.in/


4th eMedinewS Doctor of the Year Awards

Nominations invited for 4th eMedinewS Doctor of the year Award in plain paper. Nominated by 2 professional colleagues along with details of your contributions in the year 2012.

pls send his/her Biodata at: emedinews@gmail.com

    eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

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  Playing Cards

  Dadi Ma ke Nuskhe

  Personal Cleanliness

  Mental Diseases

  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

  First Aid Basics

  Dil Ki Batein

  How to Use

  Pesticides Safely

    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