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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 & 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 …

27th December 2012, Thursday

Can cardiac death occur after a blunt injury?

The postmortem report of Delhi police constable Subhash Tomar has reportedly stated that the cardiac arrest was precipitated by blunt injuries to his neck and chest.

Constable Tomar who died at RML Hospital in Delhi probably died of a heart attack. Whether or not he sustained some injuries from the protesting crowd, it cannot be denied that he was received in hospital in a state of cardiac arrest. He was revived for some time but ultimately succumbed to the consequences of cardiac arrest.

So can blunt injury precipitate sudden cardiac death? Commotio cordis is an event, which occurs as a result of a blunt, non-penetrating and often innocent-appearing blow to the chest wall directly over the heart. This induces instantaneous ventricular fibrillation leading to sudden cardiac arrest. The person collapses and stops breathing. It becomes crucial to act fast. Immediate cardiopulmonary resuscitation (CPR) and if available, use of automated external defibrillator (AED) will help revive the patient. If not, the outcomes are tragic with sudden cardiac death.

This incident again is a reminder of the fact that all of us need to learn CPR and act in time. A successful resuscitation is only possible if it is done by bystanders within 10 minutes of death, earlier the better.

Remember the CPR mantra “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 victim effectively and continuously with a speed of 10x10 i.e. 100 per minute.”

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

Register for 4th eMedinewS–revisiting 2012 conference

    Constipation Update

Chronic idiopathic constipation or functional constipation is a common condition affecting the GI tract, with a prevalence of between 4% and 20% (Ford AC, Suares NC. Effect of laxatives and pharmacological therapies in chronic idiopathic constipation: systematic review and meta-analysis. Gut 2011;60:209-18).

Dr K K Aggarwal
  eMedinewS Audio PostCard

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

Healthcare worker fatigue and patient safety

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

19th MTNL Perfect Health Mela 2012

Large number of students took active participation in the 19th MTNL Perfect Health Mela

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

Low-cost treatment ray of hope for kids with cancer

MUMBAI: Cancer treatment need not always be expensive. A new effort from Tata Memorial Hospital's paediatric department shows that low-cost treatment can help children afflicted even by the most worrisome of paediatric blood cancers called acute myeloid leukemia (AML). Dr Sripad Bhanavali, who heads the medical oncology department of Tata Memorial Hospital, said medicines helped cure 40% of AML cases, both in the West and in India. Bone marrow transplant is considered to be the best treatment option but is expensive at Rs 10 lakh. "It is not an option for people from lower socio-economic sections." For the last five years, his department has been working out a low-dose maintenance therapy for kids with AML. Over 100 kids have been a part of this study and the survival rate has increased to 67%. "Low-dose maintenance therapy is called metronomic therapy," said Dr Banavali, adding, "the metronomic dose for the entire year would work out to Rs 4,000 because the drugs are old and well-known ones." The department will publish the study shortly. But on Christmas day, the biggest cheer for cancer-afflicted children came from HOPE 2012, the department's annual event. "HOPE is our humble effort not only to help these children re-charge themselves, but also to give them a lifetime of beautiful memories which they can cherish," said Dr Banavali at the function held on Tuesday. Nearly 70% of the 2,000-odd paediatric patients treated at Tata Memorial Hospital annually get access to free treatment because of help from the hospital, government, charitable trusts, NGOs and donors. For the last couple of years, ImPaCCT Foundation set up by the hospital's volunteers and doctors has been helping families get funding without approaching multiple organizations. (Source: TOI, Dec 26, 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

Concurrent tricuspid valve surgery with chronic MR surgery

  • Tricuspid valve repair in patients with severe TR (Grade 1C).

(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)

Less is better for treating whiplash

Usual care worked as well as an intensive management program for patients with acute whiplash injury, according to results of a large randomized trial. Active clinical management that included physical therapy showed a small advantage over usual care after 4 months, as assessed by the Neck Disability Index (NDI). The advantage had disappeared by 8 months, and outcomes in the treatment groups remained similar at 12 months. (Source: Medpage Today)

For comments and archives

FDA OKs Gattex for short bowel syndrome

The FDA has approved teduglutide (Gattex) for use in patients with short bowel syndrome who require parenteral nutrition. (Source: Medpage Today)

For comments and archives

Serious surgical mistakes: At least 4000 annually in US

More than 4000 surgical "never events" occurred each year between 1990 and 2010 in the United States, according to the findings of a retrospective study of national malpractice data. Winta T. Mehtsun, MD, MPH, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues estimate that such errors cost the healthcare system millions of dollars each year in malpractice payments alone. The investigators published their findings online December 18 in Surgery. (Source: Medscape)

For comments and archives

FDA clears bio-seal after lung biopsy to reduce risk of collapsed lung

A device for sealing punctures left behind after lung biopsies are performed, the Bio-Seal Lung Biopsy Tract Plug System, made by Angiotech, has been cleared for marketing by the US Food and Drug Administration (FDA). It reduces the risk of the patient experiencing a collapsed lung after a lung biopsy has been performed, the FDA said in a press release. The product is made up of a syringe prefilled with a hydrogel, which has been solidified and then dried. This is attached to a slender wire, the stylet. (Source: Medscape)

For comments and archives

Hype or hope? Renal denervation hits the headlines

Renal sympathetic denervation for the treatment of resistant hypertension has been the subject of much media coverage this week, with the publication of one-year results from the Symplicity HTN-2 trial in the December 18, 2012 issue of Circulation by Dr Murray Esler (Baker IDI Heart and Diabetes Institute, Melbourne, Australia) and colleagues, showing 10- to 20-mm-Hg drops in blood pressure with the procedure. (Source: Medscape)

For comments and archives

    Twitter of the Day

@DrKKAggarwal: The “Ideal Dose” of Alcohol Prescriptionhttp://blog.kkaggarwal.com/2012/12/the-ideal-dose-of-alcohol-prescription/ …

@DeepakChopra: Are we living in a dream world? I tackle this timeless question fundamental to our understanding of reality. http://tinyurl.com/bww6543

    Spiritual Update

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

Never hurt the ego of a person

It is a well known Vedic fact that if you hurt the ego of a person, he will never forgive you, especially, if you have insulted or implicated him in character assassination, cast implications, financial embezzlement or in public, you call a woman as old or a man as impotent.

For comments and archives

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

How does contraception work?

Contraceptive agents are usually divided into those that are either hormonal or non hormonal. Most of the hormonal contraceptives work by changing a woman’s hormone levels to mimic a pregnancy, therefore preventing eggs from being able to be released from the ovary. In contrast, non hormonal contraceptive agents or devices work by preventing a man’s sperm from joining a woman’s egg.

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

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

Blood Donation - Gift of Liquid Love

The discovery of post transfusion Hepatitis in 1968 led to the mandatory testing of blood for Hepatitis B antigen (HbsAg).

    An Inspirational Story (Dr GM Singh)

The Most Important Question

During my second month of nursing school, our professor gave us a pop quiz. I was a conscientious student and had breezed through the questions, until I read the last one: "What is the first name of the woman who cleans the school?"

Surely this was some kind of joke. I had seen the cleaning woman several times. She was tall, dark-haired and in her 50s, but how would I know her name? I handed in my paper, leaving the last question blank. Before class ended, one student asked if the last question would count toward our quiz grade.

"Absolutely," said the professor. "In your careers you will meet many people. All are significant. They deserve your attention and care, even if all you do is smile and say hello".

I've never forgotten that lesson. I also learned her name was Dorothy.

For comments and archives

    Cardiology eMedinewS

Duration of ß-blockers post-MI Read More

Dalcetrapib in recent ACS Read More

    Pediatric eMedinewS

Appendicitis: CT scan vs ultrasound depends on hospital type Read More

FDA gives nod to Tamiflu for infants Read More

    IJCP Special

Dr Good Dr Bad

Situation: A 45–year–old male with community–acquired pneumonia came for a prescription.
Dr Bad: Start treatment with azithromycin and cefuroxime combination.
Dr Good: Start levofloxacin.
Lesson: In a meta–analysis that included 23 randomized trials, respiratory fluoroquinolones (levofloxacin, moxifloxacin, or gemifloxacin) were more likely to result in treatment success than the combination of a beta–lactam + a macrolide for the treatment of CAP that was mostly mild to moderate in severity (CMAJ 2008;179:1269–77).

Make Sure

Situation: A patient with pyogenic meningitis developed complications.
Reaction: Oh my God! Why were antibiotics not given when the meningitis was suspected?
Lesson: Make sure that first dose of antibiotics is given at the time meningitis is suspected.

    Legal Question of the Day (Dr MC Gupta)

Q. I am an orthopedician. I want to get training in musculoskeletal ultrasonography and use the ultrasound machine in my clinic? Will I face some legal problem?


  1. As a first step, you will have to get registered under the PC&PNDT Act, 1994, by submitting a proper application along with a non-refundable application fee of Rs. 25,000/-
  2. Then you will have to buy the machine.
  3. Then you will have to maintain records in a strict manner and will have to send a monthly report to the authorities as per the given proforma.
  4. Also, you will have to be prepared for surprise inspections of your clinic by the authorities.
  5. If you are comfortable with the above, you may go ahead.
  6. Two of my doctor clients have surrendered their PCPNDT registration because they did not find the restrictions worth it.
  Quote of the Day (Dr GM Singh)

Love does not claim possession, but gives freedom. Rabindranath Tagore.

    Mind Teaser

Read this…………………

Before a post- thyroidectomy client returns to her room from the OR, the nurse plans to set up emergency equipment, which should include:

A. A crash cart with bed board
B. A tracheostomy set and oxygen
C. An airway and rebreathing mask
D. Two ampoules of sodium bicarbonate

Yesterday’s Mind Teaser: When a post-thyroidectomy client returns from surgery the nurse assesses her for unilateral injury of the laryngeal nerve every 30 to 60 minutes by:

A. Observing for signs of tetany
B. Checking her throat for swelling
C. Asking her to state her name out loud
D. Palpating the side of her neck for blood seepage

Answer for Yesterday’s Mind Teaser: C. Asking her to state her name out loud

Correct answers received from: Dr Jaya, Manu Shankar, Dr Bharat Bhushan Aggarwal, Dr Shagufa Moin, Prabha Sanghi, Dr C Mohan, Dr Suresh Arora,
Dr Chetna Bansal, Dr Monica Gandhi, Dr Kanta Jain, Dr Arpan Gandhi, Dr (Maj. Gen.) Anil Bairaria, Dr pankaj Agarwal, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Thakor Hitendrsinh G, Dr Avtar Krishan, Dr B K Agarwal.

Answer for 25th December Mind Teaser: a. Flapping hand tremors

Correct answers received from: Pravin Lonsare, Dr Kanta Jain, Dr Arpan Gandhi, Dr Thakor Hitendrsinh G, Dr Avtar Krishan.

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Funny meanings...

Cigarette: A pinch of tobacco rolled in paper with fire at one end and a fool at the other!

    Medicolegal Update

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

Forensic anatomy and importance of larynx in postmortem examination

  • The larynx consists of a large ‘V’–shaped thyroid cartilage. Below the smaller cricoid cartilage, at the upper margin of the posterior wing of the thyroid on each side, are the superior horns or ‘cornuae’, which are connected by the thyrohyoid membrane to the greater horns of the hyoid bone, which lies immediately above.
  • The hyoid bone lies at the root of the tongue. The hyoid calcifies at variable times; the body is usually calcified, but the horns may calcify irregularly, both in space and time. In teenagers and young adults, they are usually cartilaginous and the joints mobile.
  • In middle and later life, the hyoid and thyroid horns calcify and become more brittle.
  • The cricoid cartilage is a modified upper tracheal ring but can also become partly calcified as age increases.
  • No meaningful ages can be placed on any calcification, but traumatic fractures can occur at any time except in children and most teenagers.
  • The pressure is mainly bilateral, so that the sides of the larynx are squeezed. Particularly vulnerable structures are the four ‘cornuae’ or horns, which protect backwards to maintain the patency of the airway around the glottis
  • Lateral pressure of the fingers can displace any of the four horns inwards, either by direct pressure or by pressure on the thyrohyoid membrane, which then drags the horns medially. In young persons, the horns are so pliable that they return to their normal position on release of the pressure but, variably beyond the third decade, they may be sufficiently calcified to fracture.
  • Though the hyoid bone has received most attention in publications as being the marker of violence to the larynx, in fact the thyroid horns are far more vulnerable. Simpson (1985) found that, in 25 successive deaths from manual strangulation, there were 22 fractures of thyroid horns but only one fractured hyoid.

For comments and archives

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    Public Forum

(Press Release for use by the newspapers)

Heart failure and snoring not a welcome combination

Two types of sleep-disordered breathing are common among patients with heart failure: snoring-related obstructive sleep apnea-hypopnea (OSAH) and snoring-unrelated Cheyne-Stokes breathing (CSB). They are collectively referred to as sleep-disordered breathing (SDB), said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

  • OSAH is characterized by reductions or cessations of airflow during sleep, despite ongoing respiratory effort. It is due to upper airway obstruction and clinically is associated with snoring.
  • CSB is characterized by cyclic crescendo-decrescendo respiratory effort and airflow during wakefulness or sleep, without upper airway obstruction. The decrescendo effort may be accompanied by cessation of respiration during sleep (central sleep apnea syndrome).

Patients who have heart failure and SDB can be asymptomatic or symptomatic. When OSAH is the predominant type of SDB, snoring and symptoms related to poor sleep quality (e.g. fatigue) are common. When CSB is the predominant type of SDB, symptoms due to CSB may be subtle or indistinguishable from those due to the underlying heart failure.

Night time angina and recurrent refractory arrhythmias (irregular heartbeats) may occur with either type of SDB. The evaluation of patients with heart failure should include questions about potential SDB symptoms.

Patients who report snoring, excessive daytime fatigue, or poor sleep quality may benefit from assessment via sleep lab. Sleep testing should also be considered in patients with heart failure who have night angina, recurrent arrhythmias, or refractory heart failure symptoms.

Patients who have heart failure and SDB likely have a poorer prognosis than patients who have heart failure without SDB. Optimization of the medical management of heart failure is the primary therapy for patients whose heart failure is complicated by SDB because it improves heart failure-related outcomes and may improve SDB. For patients who have heart failure complicated by SDB, positive airway pressure with CPAP machine improves cardiac function, blood pressure, exercise capacity and quality of life.

    Readers Responses
  1. Dear Sir, excellent newspaper. Regards: Dr Jyoti
    Forthcoming Events

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

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  Perfect Health Mela

  FAQs Good Eating

  Towards Well Being

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  Dil Ki Batein

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  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