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Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



You can download back issues from www.emedinews.in

20TH  December Sunday

Dear Colleague,

                  Medical community unaware about choking games  

There is a game being played by some teenagers that involves cutting off oxygen to the brain to induce a natural high. Although the choking game may not be as prevalent as other [risky behaviors] like drugs, the lead author of a paper appearing in Pediatrics points out a seriously low level of awareness among members of the medical community.  This raises concerns, because a recent CDC report estimated that IN US ALONE about 85 deaths from 1995 to 2007 were likely caused by participation in choking games, and several incidences of brain injuries have been reported.

 The fainting game is a loose term that covers activities designed to induce a partial or complete loss of consciousness brought about by the intentional deprivation of oxygen to the brain for a period of time. There are two distinct methods used to achieve oxygen deprivation:  strangulation and self-induced  hypocapnea.

The term game is used because these activities have typically been pursued by children as recreation; the practice among adults appears to be uncommon and generally in the different context of the pursuit of erotic asphyxiation.

In strangulation a ligature such as a belt or rope around the neck, or hands or arm pressure on the neck compresses the internal carotid artery. 


The second mechanism requires hyperventilation (forced over breathing) until symptoms of hypocapnia such as tingling, light-headedness or dizziness are felt, followed by a breath-hold. This alone is enough to cause a blackout but it is widely believed that the effect is enhanced if lung air pressure is increased by holding the breath "hard", that is forcing exhalation while allowing no air to escape or by a bear-hug by an assistant. These later actions may augment the effects of hypoxia by approximating the valsalva maneuver, causing vagal stimulation.  

Dr KK Aggarwal




 (Dr Brahm and Monica Vasudeva)
Postmenopausal women taking antidepressants may be at higher risk for stroke, death.
According to a study published in the Dec. 14/28 issue of the Archives of Internal Medicine, postmenopausal women who take anti depressants face a small but statistically significant increased risk of a stroke. In a study based on data from the Women'S Health Initiative Study on 136,293 women aged 50 to 79, who were followed for an average of six years, Harvard Medical School researchers found that antidepressant users were 45 percent more likely to have a stroke than women not taking the medications.

Radiation overexposure from CT scans more widespread
A new research has shown a wide variation in radiation dose for the most common CT scan like abdomen, pelvis, and chest. Many patients receive 13 times more radiation than others for the same type of scan.

Depending on the part of the body being scanned, each CT exposes a patient to an amount of radiation equal to between 30 and 440 chest X rays. In the US 72 million CT scans are performed a year and that could lead to 29,000 excess cancers and 15,000 excess deaths a year in the future.

In that study, published in the Archives of Internal Medicine, researchers at the National Cancer Institute found that people may be exposed to up to four times as much radiation as estimated by earlier studies.
Meanwhile, the second study, appearing in the same journal, of over 1,000 patients at four hospitals, showed that one woman out of 270 and one man out of 600 would suffer from cancer after undergoing a single heart scan at age 40.

Emergency [departments] have a habbit of sending patients to the CT scanner before they see a doctor.In the National Cancer Institute study, the authors predicted that lung cancer will be the most common radiation related cancer followed by colon cancer and leukemia.

Doctor, are you sure I am suffering from pneumonia?
I have heard once about a doctor treating someone with pneumonia and finally he died of typhoid.
Do not worry; it would not happen to me. If I treat someone with pneumonia he will die of pneumonia.

Rabies Tip
In India, neural tissue vaccine is still used for postrabies exposure treatment in public sector, which though effective, has serious side effects. Indian J. Pediatr. 2003 Mar.;70(Suppl. 1): S11 S16.

Funny clinical notes (Dr. Minakshi)
While in ER, she was examined, X rated, and sent home.

Health Tips ( Dr Prachi Garg)
What Causes Urinary Tract Infections in Women?
Bacteria can enter the urinary tract
1. Wiping from back to front after a bowel movement.
2. Having sex.
3. Holding urine for too long.
4. Being diabetic.
5. Having a kidney stone or other factor that makes it difficult to urinate. 6. Producing less estrogen, such as after menopause.
7. Having recently had a catheter inserted.

News and Views ( Dr G M Singh)

The current guidelines suggest that drugs of choice for mild to moderate migraine are analgesics, including aspirin, ibuprofen, and paracetamol. The fixed combination of aspirin, paracetamol, and caffeine appears more effective than single substances. Opioids have limited efficacy in the treatment of acute migraine headache and should generally be avoided.

Clinicians should consider prophylactic treatment of migraines when attacks occur 2 or more times per month. Beta blockers, calcium channel blockers, and valproic acid are effective prophylactic treatments, whereas there is less evidence of efficacy for lamotrigine and gabapentin.

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emedinews: revisiting 2009
IJCP Group is organizing emedinews: revisiting 2009, conference on 10th Jan 2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts (Dr KK Aggarwal (revisiting 2009), Dr Naresh Trehan (whats new in cardiac surgery), Dr Ajay Kriplani (surgical cure for obesity and diabetes), Dr Praveen Chandra (left main stenting), Dr Harsh Mahajan (PET Scan), Dr Kaberi Banerjee (all about infertility), Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephrology update), Dr. Ambrish Mithal from Medanta on Diabetes, Dr Vanita Arora (ECG arrhythmias), Dr Subramanium (Co Q 10 a new modality), Dr Neelam Mohan (Paed. Hepatology), and Dr. Sanjay Chaudhary on Eye Update etc) will deliver lectures.
CME will be followed by lively cultural evening (guest performances by noted singers Shabani Kashyap, Vipin Aneja and top singers of our medical profession Dr Praveen Khillani, Dr and Dr Mrs Subramanium, Dr Lata Tandon, Dr Arti Pathak, Dr Sanjay Chugh (on the drum), Dr Sudipto Pakrasi, Dr Harjeet Kaur, Dr Ramni Narsimhan, Dr Yash Gulati (Anchor) Dr Reshma Aggarwal (Anchor), doctors of the year award, dance and dinner. For registration mail 
emedinews@gmail.com. We have crossed 1200 registrations.

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Letters to the editor
1. Dear Sir, I would like to take the opportunity to share on this forum the medical condition of patients which are suffering from H1 N1 critically ill and are ventilator supported.

We have in the month of December 2009 shifted 8 ventilator supported patients from one hospital to another for reasons such us: Unable to manage patients with H1N1, no isolation facility, unable to manage patients with ARDS and patients relative unable to pay the ICU charges. Some very interesting facts: chest infection presents like ARDS.  All the patients required the following ventilator settings: FiO2 – 100 %; PEEP – 18-20 mmH20; I:E ratio inversed 2:1 or 3:1; Airway pressures – 60 and even more in some cases; none of the patients were septicemic and the blood pressure was maintained and no inotropic supports were required. All of them were below 40 years of age. Dr Satish Bhardwaj;grskb@yahoo.com

2. Sir, I use a formula for the diabetics in my practice., and it seems to work well. So I thought of humbly sharing it. Sir, all my patients of Diabetes on OHA or insulin are educated about a formulae of 3 for control of episodes of probable hypoglycemia at the beginning itself. As I work in a rural area, SMBG is a luxury here so I teach my patients to recognize signs of low blood sugar and then to take these counter measures to avoid any catastrophy till they reach any qualified health care provider for further assessment. In case of symptoms of - tremors, palpitations, sweating, shakiness, anxiety, extreme hunger, ghabrahat, tiredness, dizziness, blurring of vision, slurring speech, difficulty concentrating, inappropriate behavior, TAKE ANY ONE: 3 biscuits of glucose or 1/3 glass of glucose drink or 3 bricks of chocolate or 3 teaspoons of sugar mixed in a 1/3 glass of milk or 1/3 glass of RICE BROTH (a very commonly prepared semi liquid solution of boiled rice in my location, even more commonly available than chocolate!). It is also instructed to repeat the dose after 15 minutes (3X5) if no improvement is seen. Yours sincerely: Prashant Rampal

3. Dear Dr KK Aggarwal, I usually go through your medinews regularly, it is very informative educative. The latest one  on dharma artha and mokha is enlightening. GOD BLESS YOU. Keep it up. Dr Talwars



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