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Dr KK Aggarwal

From the Desk of Editor in Chief
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; Member 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

19th June, 2010, Saturday

Sudden Cardiac Death (Excerpts from IMSA Workshop at Moolchand Medcity)

Dear Colleague

a. Sudden cardiac arrest is cessation of cardiac activity which gets revived after resuscitation. On the other hand, Sudden Cardiac Death is unsuccessful sudden cardiac arrest.

b. About 4–5 lakh in the US; 7 lakh in Europe and approximately 20 lakh people die in India every year directly due to Sudden Cardiac Death. In India, majority of them die before reaching the hospital and 75% of them can be revived if chest compression cardiac resuscitation (CCCR) is taught to all.

c. Three clinical phases occur after a sudden cardiac arrest. These are:

1. Clinical phase: which lasts 0–5 minutes where ventricular fibrillation is the main electrical activity and the treatment of choice is defibrillation followed by CCCR.

2. Hemodynamic phase: which lasts 5–10 minutes. Ventricular fibrillation persists and the patient, in addition, has hemodynamic instability. These patients require effective two minutes of CCCR before defibrillation is attepted followed by two minutes of CCCR again.

3. Metabolic phase: phase beyond 10 minutes. Only hypothermia system can work here.

d. 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.

e. 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.

f. Only 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.

g. While giving defibrillation, one should 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 two minutes.

h. Do not waste more than 10 seconds to check pulse or breathing before starting CCCR.

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

j. Even second's delay matters. Therefore, CCCR should be started without delay.

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

l. When giving cardiopulmonary resuscitation involving breathing–chest compression cycles, the ratio should be 30 compressions: 2 breaths. This ratio should not be more than five cycles in two minutes

m. 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.

n. 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.

Dr KK Aggarwal
Padma Shri Awardee and Chief Editor


Photo Feature (From HCFI file)

Television Stars in Perfect Health Mela

Global popularity of television programs has gone up by many folds recently. Consequently, the star quotient of television actors has augmented even more. Heart Care Foundation of India (HCFI) made the most of the fame of the television stars by inviting them to Perfect Health Mela (PHM) venue. Owing to presence of a TV stars such as Smriti Irani of "Kyuki Saas ……" fame, the purpose of the PHM was met successfully, this because their presence ensured participation of community at large.

Dr k k Aggarwal

In the photo: Ms. Smriti Irani, during Perfect Health Mela 2007, Also in the photo: Padma Shri & Dr BC Roy Awardee Dr KK Aggarwal, President HCFI

International Medical Science Academy Update (IMSA): New Vaccine Update

Cholera vaccine

A modified killed whole–cell oral bivalent vaccine (containing 01 and 0139 serotypes) showed promise as a safe, effective and affordable vaccine for endemic regions in a phase 3 trial. Additional follow up is needed to establish durability of protection.


Sur D, Lopez AL, Kanungo S, et al. Efficacy and safety of a modified killed–whole–cell oral cholera vaccine in India: an interim analysis of a cluster–randomised, double–blind, placebo–controlled trial. Lancet 2009;374:1694.

Rs 2 cr fine set on anti-internship students (Source: ENS and agencies)
Making internship of two years compulsory for medical students, Maharashtra Government has decided to increase fine up to Rs two crore for refusing to do so.  As per Medical Education Department the Government spends huge amount on medical students in the state run colleges. So, it expects the students to serve the state for two years. The Government has raised the fine from Rs 15 lakh to Rs 50 lakh for MBBS students and Rs two crore for students completing super-speciality courses for refusing to serve for the state. The norms would be mentioned in the bonds signed by students while taking admission. Compulsory internship would be implemented from next academic year. Medical Education Minister Vijaykumar Gavit had proposed that two-year internship should be made compulsory, failing which a fine of Rs two crore should be imposed.

Mnemonic of the Day (Dr Prachi)

IBD: extraintestinal manifestations (A PIE SAC)

Aphthous ulcers

yoderma gangrenosum
Erythema nodosum

clerosing cholangitis
Clubbing of fingertips

News and views

Inexpensive drug to stop sight loss shown to be effective

A relatively inexpensive, but unlicensed drug to help prevent severe sight loss in older people has been shown to be safe and effective, finds a study published online in the British Medical Journal. Bevacizumab (Avastin) is licensed as a treatment for bowel cancer, but it is widely used "off label" as a considerably cheaper alternative to the approved drug ranibizumab (Lucentis) to prevent wet age related macular degeneration (AMD) and several large trials comparing the two drugs are now underway. The researchers support its immediate implementation in healthcare systems whose budgetary limitations prevent patients’ access to ranibizumab. In the majority of countries in the world, where either no treatment or inferior therapies are available to patients with wet AMD, the appropriate use of bevacizumab, a highly cost effective intervention, would have an immediate impact in reducing incident blindness from this condition. Wet AMD is the leading cause of visual loss in people over the age of 50 in Europe and North America. Visual loss is a result of progressive loss of light sensitive cells at the back of the eye due to damage from abnormal, leaking blood vessels. Sufferers do not go blind, but find it virtually impossible to read, drive, or do tasks requiring fine, sharp, central vision.

Cardiovascular events trigger FDA review of ARB

Data from two clinical trials wherein patients with type 2 diabetes taking the blood pressure medication olmesartan had a higher rate of death from a cardiovascular cause compared to patients taking a placebo, is being reviewd by the FDA. The olmesartan arm of the 4,447–patient Randomized Olmesartan and Diabetes Microalbuminuria Prevention Study (ROADMAP) reported 15 cardiovascular deaths vs 3 in the placebo arm. Also, 10 cardiac deaths among patients taking olmesartan vs 3 in the placebo group were noted in the Olmesartan Reducing Incidence of End Stage Renal Disease in Diabetic Nephropathy Trial (ORIENT) study (with 566 patients). FDA has not concluded that Benicar increases the risk of death. FDA currently believes that the benefits of Benicar in patients with high BP continue to outweigh its potential risks."

Monoclonal Antibodies: Short–term therapy for long–term treatment of chronic viral infections?

Monoclonal antibodies are the largest class of biotherapeutic drugs. They may also induce a long–lasting and protective antiviral immune response similar to that achieved by vaccination when given to infected organisms to blunt the propagation of pathogenic viruses. These results obtained in mice by the "Oncogenése et Immunothérapie" group at the Institut de Génétique Moléculaire de Montpellier (CNRS/Universités Montpellier 1 and 2), have been published on 10 June in PLoS Pathogens. The findings appear encouraging for the treatment of certain severe and chronic viral infections.

Guidelines for the new pneumococcal vaccine: AAP

New recommendations from the American Academy of Pediatrics (AAP) provide guidelines for transition from the 7–valent pneumococcal conjugate vaccine to the 13–valent version (Prevnar 13) for the prevention of Streptococcus pneumonia. The vaccine is recommended to be used in healthy children up to 4 years of age and for high–risk children up to ~6 years of age. The new vaccine will be administered in four doses, at ages 2, 4, 6, and 12 to 15 months. These recommendations are published online in May 24, 2010 issue of Pediatrics.

  • Children who completed the 4–dose course with the 7–valent vaccine: 13–valent vaccine single supplemental dose is recommended for healthy children 14 to 59 months and high–risk children 14 to 71 months.

  • Children who completed the 4–dose course with the 7–valent version: 13–valent vaccine single dose may be given to children aged 6 to 18 years who are at a high–risk of invasive pneumococcal disease because of sickle cell disease, anatomic or functional asplenia, HIV infection or another immunocompromising condition, or presence of a cochlear implant or cerebrospinal fluid leak.

  • Children ≥ 2 years and who are at high risk of invasive pneumococcal disease should also receive the 23–valent pneumococcal polysaccharide vaccine at least eight weeks after their last dose of the 13–valent vaccine. A second dose of the 23–valent vaccine is recommended five years after the first for children with sickle cell disease, anatomic or functional asplenia, HIV infection, or other immunocompromising conditions.

New Drugs (Dr G M Singh)

  • Agriflu (influenza A and B (seasonal flu) vaccine)

  • Berinert (C1 inhibitor (human))

  • Budesonide inhaled (first–time generic for Pulmicort)

  • Cervarix (human papillomavirus vaccine (recombinant))

  • Influenza A H1N1 2009 Vaccine (GSK) (influenza A H1N1 2009 (swine flu) vaccine)

  • Ketorolac ophthalmic (first–time generic for Acular)

  • Lansoprazole (first–time generic for Prevacid)

  • Valacyclovir (first–time generic for Valtrex)

  • Vibativ (telavancin)

  • Votrient (pazopanib)

  • Zenpep (pancrelipase)

Interesting Tips in Hepatology & Gastroenterology

(Dr Neelam Mohan, Consultant Pediatric Gastroenterologist, Hepatologist, Therapeutic Endoscopist & Liver Transplant Physician, Sir Ganga Ram Hospital, Delhi)

Yesterday, I wrote on "How much liver does a recipient needs?" Today I shall address the following issues

What test does a living related donor undergo ?

Living related transplant programme always concentrates a lot on the safety of the donor. Therefore a battery of tests are performed on the donor to assess his/her fitness for undergoing surgery and also to assess adequacy of graft.

  • Blood tests: These include CBC,LFT, RFT coagulation profile, blood sugars, lipid and thyroid profile, serological tests like HBs Ag, HCV Ab, HIV, CMV IgG.)

  • CT Scan Abdomen: An initial plain CT scan is done to rule out fatty liver. An LAI (liver attenuation index) of > 6 is acceptable.

  • Pulmonary function tests, ECHO, ECG, mammography, Pap smear, urine R/E.

  • Ultrasound abdomen including pelvis.

  • CT Scan triphasic abdomen with volumetry to assess vascular pattern and volume of various lobes of liver

  • MRCP to look for the ductal pattern.

  • Besides this, consultation is obtained from Cardiologist, Hepatologist, Pulmonologist, Anesthetist, Gynecologist and Psychiatrist

Tomorrow I shall write on 'Advantages & disadvantage of living related liver transplantation over cadaveric transplantation.'

Forensic Legal Medicine ( A new series)

Medicolegal work in British India (Dr Sudhir Gupta MBBS (Gold Medal), MD, DNB, MNAMS (Associate Professor Forensic Medicine & Toxicology AIIMS)

The early incidence of custodial death and its certification by medical practitioners were reported in Madras in 1678. When a drunken soldier, Thomas Savage, abused his senior officer, he was tied to the cot and he died. Surgeons, John Waldo (surgeon) and Bezaliel Sherman (second surgeon) inspected the body and issued the first death certificate in British India. The first medicolegal autopsy was performed in India by Dr Edward in 1693; however, the first medicolegal case report of injury was documented in the form of medicolegal report by Dr Edward Buckley in 1695 in British India.

Conference Calendar

Basic Assessment and Support in Intensive Care (BASIC)
The Chinese University of Hongkong (CUHK) Accredited Target Audience – Doctors Only
Date: June 19–20, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

Quote of the Day

"Always bear in mind that your own resoution to succeed is more important than anything." Abraham Lincoln

Question of the Day

What are the common causes and characteristics of foot lesions in diabetes mellitus? (Dr Sharad Pendsey, Nagpur)

The common causes and characteristics of foot lesions in diabetes mellitus are:

Extrinsic factors

  • Poorly fitting footwear

  • Barefoot walking

  • Falls/accidents

  • Objects inside shoes

  • Thermal trauma

  • Injury by sharp objects

  • Home surgery

  • Nail pathologies

Intrinsic factors

  • Limited joint mobility

  • Bony prominences

  • Foot deformities

  • Neuroarthropathy

  • Plantar callus

  • Scar tissue

  • Fissures

eMedinewS try this it works

Medicine that’s easier to swallow

For patients who can’t swallow pills, break or crush the pills. To do this
use a:

  • Hammer

  • Screwdriver

  • Pestle and mortar

  • Coffee grinder. The coffee grinder works best. It grinds any pill into a fine powder, which the patients can then sprinkle onto any palatable food.

Advertising in eMedinewS

eMedinewS is the first daily emedical newspaper of the country. One can advertise with a single insertion or 30 insertions in a month.

Contact: drkk@ijcp.com emedinews@gmail.com


eMedinewS–revisiting 2010

The second eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, cultural hungama and live webcast. Suggestions are invited .


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Dr Good Dr Bad

Situation: A patient with inflammation was on regular follow–up.
Dr. Bad: Do sequential ESR.
Dr Good: Do sequential CRP.
Lesson: As the patient’s condition worsens or improves, the ESR changes relatively slowly but the CRP concentrations changes rapidly.

Make Sure

Situation: A known patient of NIDDM on oral hypoglycemics presents with hyperglycemic crisis. Reaction: Oh, my God! I did not manage the patient aggressively.
Lesson: Make sure that patients with impaired glucose tolerance (IGT) or NIDDM are fully evaluated for complications at the first visit. Present approach to therapy of NIDDM is characterized by approach to therapy of NIDDM is characterized by proactive shifts to agents that may be combined or prescribed in maximal doses to achieve normal or near normal glycemia from the time of diagnoses of NIDDM or IGT, in order to prevent complications.

Humor Section

IMANDB Joke of the Day

A man said to his doctor, "I think there’s something wrong with me; I’ve got a pain here, one over there…" he went on and on about his symptoms.

Everytime he paused for breath the doctor said, "Fine! Fine! Go on, go on!"
When he’d finally finished the story, the doctor said, "You know, you’ve got a disease that was supposed to have been extinct long ago."

Funny Definitions

Bacteria………………Back door to cafeteria

Formulae in Clinical Practice




Healthy Weight Range (Pounds)














































Milestones in Gabapentin

1997: Bipolar Disorder: Gabapentin is used in the treatment of bipolar disorder but with controversial efficacy. First suggested by Young LT et al.


Lab Test (Dr Arpan Gandhi and Dr Navin Dang)

Laboratory Tests for Inflammatory Bowel Disease.

Tests that may be ordered to rule out other causes of diarrhea and inflammation include: Stool culture to look for bacterial infection O & P (Ova and parasite) to detect parasites, Clostridium difficile to detect toxin created by bacterial infection; may be seen following antibiotic therapy. Fecal occult blood to look for blood in the stool and Celiac disease tests.

List of Approved drugs from 1.01.2009 to 31.10.2009

Drug Name


DCI Approval Date

Ropivacaine HCl Inj.2/5/7.5/10mg

For the production of local or regional anesthesia for surgery and for acute pain management.



Public Forum (Press Release for use by the newspapers)

Do not ignore joint pain

Joint pains need immediate diagnosis and proper treatment said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

Checklist for joint pain:

Which joint hurts, and which parts of the body are affected?
Did the pain just begin or, you’ve felt it before?
Did the pain start severely or slowly, and is it persistent or fluctuates?
Are there any recent injuries, fevers or illnesses?.
What makes the pain feel better, and what makes it feel worse?
Are there any other accompanying symptoms, including numbness or stiffness?
What are the times of the day when the pain is better, and times that it feels worse?

Any joint pain which improves with exercise, is more in the morning, is associated with joint deformity, should be reported to doctors immediately.

(Advertorial section)

Forthcoming eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

12th September: BSNL Dil ka Darbar – A day-long interaction with top cardiologists of the city.
8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from
8 AM to 5 PM

30th October, Saturday: eMedinewS Update from 8 AM to 5 PM

29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama

30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to 10 PM

31st October, 2010, Sunday: Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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If you like eMedinewS you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards.

Readers Responses

  1. Dear Friends, I would like to respond with reference to the sub–query – Which are the aspects of the current national programme that promote mental health of PLHIV, and which are the ones that require improvement?

    The National Mental Health Programme (NMHP) has the mandate to provide free mental health services to all clients. It is in this perspective that we have initiated linkages between the National AIDS Control Programme (NACP) and the mental health programme. More details on the NMHP is available at http:// india.gov.in /sectors /health_family/ mental_health.php. The counsellors of Integrated Counselling and Testing Centres (ICTCs) and staff of Community Care Centres (CCCs) have been sensitised about where to refer clients in need of mental health services for free treatment along with contact numbers. However, there is a shortage of mental health professionals, and mental health care is not accessible to all. Capacity building of the NACP staff on the mental health issues is the need of the hour to improve the quality of life of PLHIV. With Regards: Dr Rajesh K. Sood, Department of Health and Family Welfare, Kangra

  2. Dear Editor, Thanks to Anupam Sethi Malhotra for pointing out that ‘most complex problems do have a solution’. There’s need to look for answers to the other–than–medicine problems of adequate supply of safe drinking water, uninterrupted electric supply, reasonably priced healthy food–stuff, dependable transport system, affordable dwelling units, removal of encroachments from public land, and measures to slow down rapidly increasing population: Dr Narendra Kumar, kumars@vsnl.com

  3. Dr KKA, Today’s issue is very good. Info on HPV vaccine by Dr Harish Pemde is important. Revelation on irrational use of medicines given by Dr Vivek Chhabra is shocking. I will be more scared in future to visit an unknown doctor. And most interesting seems to be the beneficial effect of Pumpkin Extract on diabetics. What about pumpkin eaten as vegetable in Indian Homes? By the way what is pumpkin––Laukee or Kashifal? Vinod Varshney http://scimedia.blogspot.com

    eMedinewS Respond: Pumpkin (Cucurbita ficifolia) is called Kaddu in common parlance

  4. Dear Doctor, National Conference on Evidence based Healthcare to be held at Srinagar (Kashmir) during 18–19 September, 2010. Dr Syed Amin Tabish, amintabish@Gmail.com
  5. Sir, It was interesting to know the benefits of pumpkin in diabetes. Pumpkin can, at best, be an adjunct to standard therapy (insulin and/ or hypoglycemics). People should not be think that they can switch to "pumpkin therapy" altogether. I personally know some patients who have attempted this "pumpkin therapy" with poor outcome. It is an experimental therapy and people should not go for it without discussing with their doctor. Dr. Puneet Kumar,Kumar Child Clinic, Dwarka,New Delhi