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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 …

30th July 2011, Saturday

Sudden cardiac death

How is sudden cardiac death different from sudden cardiac arrest?

Sudden cardiac arrest is cessation of cardiac activity, which can be revived after resuscitation. On the other hand, sudden cardiac death (SCD) is unsuccessful sudden cardiac arrest.

How common is sudden cardiac death?

About 4-500,000 people in US, 700,000 in Europe and 2 million in India die every year directly due to SCD. In India, majority of them die before reaching the hospital; about 75% of them can be revived if chest compression cardiac resuscitation (CCCR) is taught to all.

What are the three clinical phases after a sudden cardiac arrest?

  1. Clinical phase: Lasts 0 - 5 minutes; ventricular fibrillation is the main electrical activity and the treatment of choice is defibrillation followed by CCCR.
  2. Hemodynamic phase: Lasts 5–10 minutes; ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective 2 minutes of CCCR before defibrillation is attempted followed by 2 minutes of CCCR again.
  3. Metabolic phase: Phase beyond 10 minutes. Only hypothermia system can work here.

How is cardiac arrest treated in the first 5 minutes?

The first 5 minutes after cardiac arrest is the clinical phase. In this phase, ventricular fibrillation is the main electrical activity. The treatment of choice is defibrillation followed by CCCR.

How is cardiac arrest that presents between 5-10 minutes of the arrest managed?

The second 5-10 minutes of cardiac arrest is the hemodynamic phase. Ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective 2 minutes of CCCR before defibrillation is attempted followed by two minutes of CCCR again.

What is the management of cardiac arrest that presents after 10 minutes of the arrest?

The patient, after 10 minutes of arrest, is in the metabolic phase. Only hypothermia system can work here.

What is chest compression cardiac resuscitation (CCCR)?

CCCR involves compressing the chest with a speed of 100 per minute. The mantra is to push as hard and as fast as possible. Each compression should lower the sternum by 1.5 to 2 inches, should be continuous and allow full recoil of the sternum. One person can effectively carry out chest compression for only 1–2 minutes. After that fatigue will invariably set in. Therefore, it is important to switch resuscitations between available bystanders.

Is CCCR effective in children?

CCCR is more effective in adults. In other conditions like children, unwitnessed cardiac arrest and non cardiac arrests, one may have to do complete cardiac pulmonary resuscitation involving breathing and chest compression cycles.

How to defibrillate in sudden cardiac arrest?

While defibrillating, use the maximum Jules available in the machine. After defibrillation, one should not wait to watch for the rhythm but continue CCCR uninterrupted for the next 2 minutes.

How long should one wait before starting CCCR?

Do not waste more than 10 seconds to check pulse or breathing before starting CCCR. Even a second’s delay matters. Therefore, CCCR should be started without delay.

What is the role of soda bicarb in CCCR ?

In basic cardiac resuscitation, injection adrenaline, atropine, endotracheal tube, soda bicarb etc have no role.

Who should lead the CCCR?

When multiple rescuers are available, the person highest trained should become the leader, direct and take over the first 2 minutes of the resuscitation cycle.

What should be the compression to breathing ratio in CPR?

When giving CPR involving breathing-chest compression cycles, the ratio should be 30 compressions: 2 breaths. This ratio should not be more than 5 cycles in two minutes.

How effective should be breathing in CPR?

One should not push more than 50% of the tidal volume in each breath. Don’t push air into the stomach as it will impair hemodynamics. If the respiratory rate is more, it will also impair hemodynamics.

What is the significance of gasping respiration in CPR or CCCR?

Agonal/gasping respiration is ineffective respiration and should be an indication for cardiac resuscitation. In fact, gasping is the sign that your resuscitation is likely to be successful.

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Dr KK Aggarwal
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Sudden cardiac death

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National Conference on Insight on
Medico Legal Issue

Dr N P Singh, was felicitated at the National Conference on Insight on Medico legal issues.


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


Gastroenteritis & hepatitis now major worries

MUMBAI: It's not mosquitoes but contaminated water that seems to be driving Mumbaikars to doctors this monsoon. The city has registered one of the highest incidence of gastroenteritis, a worrying fact that has been worsened by a spurt in hepatitis virus-caused jaundice in the city. In the May-June period, 10 patients succumbed to jaundice-related complications; six of them were pregnant women. "Gastroenteritis has been the worst disease this monsoon, with many patients coming in with kidney failure and lung injury. It has been the reason for the bulk of ICU admissions," said Hinduja Hospital intensivist Dr Khusrav Bajan. He ruled out antibiotic resistance as the reason for the surge; instead, he said, it is possibly because of mutation in microorganisms causing gastroenteritis. On Thursday, the civic body's daily health statistics showed that over 50 new patients with gastroenteritis were admitted to various civic hospitals, taking the total of these inpatients to 179. (Source: TOI, Jul 29, 2011)
For comments and archives

Now, Mumbai posting for postgraduate docs

Mumbai: The postgraduate doctors will now have to do their year-long bonded service in the civic healthcare centres instead of a rural stint. This move, said BMC officials, will give a boost to the healthcare system in the suburbs. "Earlier, the list of postgraduate and super-specialty doctors was given to the central government, who took the decisions on their postings in rural areas," said Manisha Mhaiskar, additional municipal commissioner (health). "Now, we have decided to post these doctors in our own peripheral and specialty hospitals," she said. (source: The Times of India, July 28th, 2011)

For comments and archives

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)

New guidelines address hypothyroidism dangers in pregnancy

Hypothyroidism during pregnancy is harmful to maternal and fetal health and to the child's future intellectual development, according to new guidelines of the American Thyroid Association (ATA) reported online July 25 in Thyroid. The new recommendations address the diagnosis and management of thyroid disease during pregnancy and the postpartum period. The new guidelines include 76 specific recommendations highlighting the role of thyroid function tests, hypothyroidism, thyrotoxicosis, iodine, thyroid antibodies and miscarriage/preterm delivery, thyroid nodules and cancer, postpartum thyroiditis, recommendations on screening for thyroid disease during pregnancy, and areas for future research. (Source: Medscape Medical News)
For comments and archives

Score predicts blurry coronary CT scans

A simple tool can help identify patients with a greater likelihood of having an uninterpretable major coronary segment on coronary CT angiography, researchers found. The uninterpretable risk score includes seven factors -- diabetes, hypertension, chronic obstructive pulmonary disease (COPD), sedentary lifestyle, body mass index, age, and history of atrial fibrillation, according to Thomas Vanhecke, MD, of Genesys Regional Medical Center/Ascension Health in Grand Blanc, Mich., and colleagues. The area under the receiver operating characteristic curve for the score was 0.59 in a development cohort and 0.68 in a validation cohort, the researchers reported online in Circulation: Cardiovascular Imaging. The score "may aid in appropriate patient selection for coronary CT angiography and avoiding radiation exposure in those likely to have an uninterpretable study," they wrote.
(Source: Medpage Today)
For comments and archives

Adding HbA1c May Improve Cardiovascular Risk Prediction In Diabetes Patients.

A report from the Women's Health Study and the Physician's Health Study II suggests that adding HbA1c measurements can improve risk prediction and lead to downward classification of some diabetics. For comments and archives

  Fitness Update

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

Exercise reduces depressive symptoms

The 2008 Physical Activity Guidelines for Americans were established by the Federal Government to encourage Americans to be more active. A new study published in the journal Medicine & Science in Sports & Exercise, the official journal of the American College of Sports Medicine, uses the Guidelines to demonstrate yet another health benefit of exercise. Adults who engaged in two hours and thirty minutes of moderate intensity exercise per week, as recommended by the Guidelines, were significantly less likely to be depressed. The University of South Carolina study, which took place over a time period of ten years, surveyed a total of 9580 men. Each participant completed a questionnaire on depression. Then, they were divided into four groups depending on their level of physical activity per week: inactive, low, medium, and high. Physical activity was determined by a questionnaire, and the rankings were established based on the physical activity requirements set by the 2008 Physical Activity Guidelines; the medium group met the guidelines, and the high group exceeded them. There were a total of 727 men exhibiting depressive symptoms, and data analysis showed that the light and medium physical activity groups were 24 percent and 51 percent less likely to be depressed as compared to their inactive counterparts. Interestingly, there was no statistical difference in depressive symptoms in the two most active groups.

For comments and archives

  Twitter of the Day

@DrKKAggarwal: #DNBindia: Today’s vishkanya: Hepatitis B, C and HIV positive sexually active girl. Dr K K Aggarwal

@DeepakChopra: Some physicists say that multiple universes with identical copies of us exist around us in a different branch of the quantum wave function

    Dr KK Answers

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

Dr KK Answers: How long does the hepatitis C virus last on the surface?

The hepatitis C virus can survive on environmental surfaces for at least 16 hours but not 4 or 7 days.

For comments and archives

    Spiritual Update

Are we all related to each other?

Vasudhaiva Kutumbakam is a Vedic saying, which literally means “The whole world is but one family” . It is one of the most ancient Vedic teachings coming from Rig-Veda. Today, in the era of rapid industrialization and globalization, people have started understanding and talking about this concept. The full statemen.... more

For comments and archives

    An Inspirational Story

(Dr GM Singh)

Dad’s Blessings

A young man was getting ready to graduate from college. For many months he had admired a beautiful sports car in a dealer's showroom, and knowing his father could well afford it, he told him that was all he wanted.

As Graduation Day approached, the young man awaited signs that his father had purchased the car. Finally, on the morning of his graduation, his father called him into his private study. His father told him how proud he was to have such a fine son, and told him how much he loved him. He handed his son a beautifully wrapped gift box. Curious, but somewhat disappointed, the young man opened the box and found a lovely, leather-bound Bible, with the young man's name embossed in gold. Angry, he raised his voice to his father and said "With all your money, you give me a Bible?" and stormed out of the house, leaving the Bible.

Many years passed and the young man was very successful in business. He had a beautiful home and wonderful family, but realized his father was very old, and thought perhaps he should go to him. He had not seen him since that graduation day. Before he could make arrangements, he received a telegram telling him his father had passed away, and willed all of his possessions to his son. He needed to come home immediately and take care of things.

When he arrived at his father's house, sudden sadness and regret filled his heart. He began to search through his father's important papers and saw the still new Bible, just as he had left it years ago. With tears, he opened the Bible and began to turn the pages. And as he did, a car key dropped from the back of the Bible. It had a tag with the dealer's name, the same dealer who had the sports car he had desired. On the tag was the date of his graduation, and the words PAID IN FULL.

How many times do we miss Spirit's blessings and answers to our prayers because they do not arrive exactly as we have expected?

For comments and archives


(By Ritu Sinha)

Back seat driver: People who criticize from the sidelines, much like someone giving unwanted advice from the back seat of a vehicle to the driver.

    Pediatric Update

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

What is viral croup?

Croup (laryngotracheobronchitis) is the most common upper respiratory obstruction in childhood, with peak incidence at 2 years (range 6 months to 6 years). It is also called as acute laryngotracheitis, or laryngo-tracheobronchitis. Most children with croup have an uncomplicated course, and only a small percentage who require urgent care require hospitalization. Croup is recurrent in a small number of patients.

For comments and archives

    Infertility Update

(Dr Kaberi Banerjee, Dr. Kaberi Banerjee, Infertility and IVF Specialist, Max Hospital)

What are the important vaccinations required for women before beginning treatment for infertility?

Some important vaccines are Measles, mumps, rubella (MMR), Varicella, Influenza, Tetanus-diphtheria-pertussis (Tdap) or Tetanus-diphtheria (Td), Pneumococcus, Hepatitis A, Hepatitis B, Meningococcus. Immunization should also be done for adult female scheduled for ages 19 to 45 years.
For comments and archives

    Gyne Update

(Dr Maninder Ahuja, Secretary General IMS)

Use of Bisphosphonates and incidence of esophageal cancer

Conflicting studies are coming up regarding use of bisphosphonates and incidence of esophageal cancer. The FDA is looking into all these studies and till the issue is resolved following care should be taken by the physicians prescribing these drugs for osteoporosis treatment and prevention: "While the FDA continues its investigation, the agency is advising physicians to instruct patients to carefully follow the directions for taking oral bisphosphonates, as esophagitis and other esophageal events have been reported for patients using the drugs incorrectly. Esophagitis and esophageal irritation are potential precursors of cancer.”

Patients should be told to take their bisphosphonate with a full glass of water first thing in the morning after they wake up. They should not eat or drink anything or lie down for at least 30 to 60 minutes afterward, according to the FDA. Reclining after taking the drug can cause it to wash back up the esophagus.

For comments and archives

  GP Pearls

(Dr Pawan Gupta)

Sublingual immunotherapy is better option than S/C route. A trial of the same on 100 children (6-12 years age) suffering from house dust mite produced 100% result in 70 patients. No result in 3 patient and 2 patients reported side effect of vomiting and throat irritations. The sub lingual route is safe, simple and effective

  Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Hemoglobin electrophoresis:

  • Find each type of hemoglobin in the blood. This can be used to diagnose certain types of anemia (such as thalassemia).
  • Check treatment for diseases that have abnormal types of hemoglobin in the blood.
  • Help couples find out how likely they are to have a child with certain forms of anemia that can be passed from a parent to a child (inherited).
For comments and archives
    IJCP Special

Dr Good Dr Bad

Situation: A 1-year-old child is brought with a complaint of ‘not putting on weight’, vague symptoms and with positive Mantoux test.
Dr Bad: Take a multivitamin syrup.
Dr Good: Start anti-TB drugs.
Lesson: Any child below 2 years of age with positive Mantoux test has active TB unless proved otherwise and is at high risk for developing TB meningitis and military TB.

For comments and archives

Make Sure

Situation: An hypertensive with obstructive sleep apnea was not responding to CPAP.
Reaction: Oh my God! Why was anti hypertensive drug not started?
Lesson: Make sure that all hypertensives with OSA are given anti HT drugs in addition to CPAP. In a randomized crossover trial of 23 patients with OSA and systemic hypertension, an antihypertensive medication (valsartan 160 mg per day) lowered the mean 24-hour blood pressure significantly more than CPAP therapy alone (Am J Respir Crit Care Med 2010;182(7):954-60).
For comments and archives

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  Quote of the Day

(Dr GM Singh)

It is the province of knowledge to speak and it is the privilege of wisdom to listen. Oliver Wendell Holmes

    Medicolegal Update

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

DNA tests are run at least twice, both independent of each other

No two people, except identical twins, have the same DNA structure

  • DNA testing is done by taking DNA extracts from biological sample putting them into a gel matrix and then using probes to help extract certain markers. Human being has a unique signature that lives within every cell of our body. This signature is commonly known as DNA.
  • Testing can be done on DNA to help determine parentage, ancestry, presence of genetically based diseases and to help identify someone who may have been present at a crime scene
  • Most DNA tests are run at least twice, both independent of each other. This not only builds upon the credibility of the test but also helps ensure that no wrong data or incorrect marker analysis was performed on the first test. If any discrepancies are detected between the two tests then a new sample is used and the entire test is performed again to understand where the discrepancy may lay.
  • We get our DNA from our biological mother and biological father. Each of them contributes 50% of our chromosomes that will make up our DNA – this same DNA will stay with us for our entire lives without change. This is the very reason that makes DNA such a great choice for uniquely identifying a person.
  • Questions may arise as to how accurate DNA tests are. After all, in the past blood tests can not been as accurate as we might have hoped. They often left a bit of uncertainty or could not be conclusive in many areas. But thanks to the uniqueness of DNA almost all of these doubts can be taken away.
  • Modern testing procedures and rules for DNA analysis mean that with rare exception DNA testing results can be guaranteed to be more than ninety percent accurate for most paternity, forensic and genetically based disease analysis. However human error can come into play. A lab may mistakenly switch samples or key in data incorrectly. All of these factors are possible, but also are very rare in occurrence. If there is ever any doubt as to the authenticity or correctness of a test it can simply be performed again to confirm accuracy in another or same lab

For comments and archives

    Mind Teaser

Read this…………………

A 30-year-old man has 6/5 vision each eye, unaided. His cycloplegic retinoscopy is +1.0 D sph. at 1 meter distance. His complaints are blurring of newsprint at 30 cm. that clears up in about two minutes. The most probable diagnosis is:

1 Hypermetropia.

2 Presbyopia.

3 Accommodative inertia.

4 Cycloplegia.

Yesterday’s Mind Teaser: One of the following statements regarding the investigations for UTI is True.

a. Urine culture should not be routinely obtained at the first prenatal visit
b. Screening for asymptomatic bacteriuria is not recommended during pregnancy
c. Presence of secretory IgA has been found to be correlating with the UTI
d. Urine dip for nitrites and leukocytes esterase should be routinely used for diagnosis

Answer for Yesterday’s Mind Teaser: d. Urine dip for nitrites and leukocytes esterase should be routinely used for diagnosis

Correct answers received from: Dr Madhulika Sharma, Dr.K.Raju, Dr Neelam Nath, Dr Anil Bairaria, Dr. B. B. Aggarwal

Answer for 28th July Mind Teaser: 1. Trachoma
Correct answers received from: Dr K.Raju, Dr Rahul Sharma, Dr.Sukanta Sen, Dr S K Verma, Dr Sunit Lokwani, Dr.K.V.Sarma, Dr. B. B. Aggarwal

Send your answer to ijcp12@gmail.com

    Medi Finance Update

(Dr. GM Singh)

To bring to your notice our Income Tax Act, 1961 also considers humane side of our life and also gives deduction for contributions made for financing our country’s infrastructure development. So, in case if you pay your medical insurance premium, incur expenditure on the medical treatment of a “dependant” handicapped, donate to specified funds for specified causes, contribute in monetary form to political parties or electoral trusts, take a loan for pursuing higher education or if you are an individual suffering from “specified” diseases, then all this too can help you effectively plan your tax obligations, thus optimally reducing your tax liability. Moreover, take into account the urge to buy your dream home by taking a loan, the Act also extends tax saving benefits to you.

    Laugh a While

(Dr GM Singh)

A man dies and goes to Heaven. He gets to meet God and asks God if he can ask him a few questions. "Sure," God says. "Go right ahead." "OK," the man says. "Why did you make women so nice?"
God says, "So you would like them." "OK," the guy says. "But how come you made them so beautiful?" "So you would LOVE them," God replies.
The man ponders a moment and then asks, "But why did you make them such airheads?" God says, "So they would love you back!"

    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name


DCI Approval Date

Iloperidone Tablets 1mg/2mg/4mg/6mg/8mg /10mg/12mg

For the acute treatment of adults with schizophrenia.


    Public Forum

(Press Release for use by the newspapers)

Get your Press release online (English/Hindi/Audio/Video/Photo)

The 5 Cs of five-a-day in selecting fruits and vegetables

The current recommendation is to eat 5 or more servings of fruits and vegetables daily to prevent cancer and heart disease. Fruits and vegetables contain vitamins, minerals, phytochemicals, and antioxidants and are low in calories. Those with the most color – dark green, red, yellow, and orange – have the most nutrients. Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "Cs" which can be incorporated in the five-a-day diet. As per Ayurveda, one should mix all seven colours and six tastes when choosing fruits and vegetables.

As per the USDA Food Guide Pyramid, one should take 5 to 9 servings of fruits and vegetables every day. Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease. Fiber-containing grain products, fruits and vegetables also reduce the risk of some cancers, said Padma Shri and Dr B C Roy national Awardee Dr KK Aggarwal President Heart Care Foundation of India and MTNL Perfect Health Mela.

A serving size is: one medium-size fruit, 1/2 cup raw or cooked fruits or vegetables, 180 ml fruit or vegetable juice, 1/2 cup cooked or canned legumes (beans and peas), 1 cup raw leafy vegetables, 1/4 cup dried fruit.

  • 5 servings mean 2 fruits and 3 vegetables
  • 7 servings means 3 fruits and 4 vegetables
  • 9 servings means 4 fruits and 5 vegetables

Tips for safe eating

  1. Snack with raw vegetables instead of potato chips.
  2. Add fruits in breakfast.
  3. Eat salads when you go out for lunch.
  4. Prefer juice instead of the usual coffee, tea or soda.
  5. Wash fruits and vegetables with water and scrub with a dish brush when appropriate.
  6. Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
  7. Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
  8. Avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been kept at an improper temperature
  9. Wash cutting boards with hot water, soap and a scrub brush to remove food particles.
  10. Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too.

For comments and archives

    Readers Response
  1. Dear Sir I deeply appreciate your medical news and the presentations: Dr Anupama
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & National Icons in the field of Cardiology & Echocardiography will form the teaching faculty.



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