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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 (March 10-13); 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

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    Health Videos …
eMediTube (videos), eMedipics, eMediSlide, eMediLaw
  Editorial …

9th June 2013, Sunday

All about death by hanging

  • Hanging is the simplest and yet highly effective method used by people who commit suicide.
  • It is the most common cause of suicide after poisoning in women and after gunshot injury in men.
  • Hanging accounts for 53% of suicides in males and 39% in females.
  • It has a high mortality rate up to 70%.
  • The materials required are easily available and of wide range and therefore it is difficult to prevent.
  • Hanging can be suspension hanging or drop hanging.
  • Suspension hanging is hanging of the body by the neck and drop hanging involves calculated drop to break the neck.
  • In suspension hanging, a person takes 10 to 20 minutes to die resulting into a painful death. Materials used are rope, bed sheet, shoe laces, telephone extension cables, thread of the chairs/mattresses.
  • Suspension hanging causes compression of carotid artery, jugular veins and the airway.
  • In suspension hanging, 5 kg of pressure is required to compress the carotid artery; 2 kg of pressure is required to compress the jugular veins and 15 kg of pressure is required to compress the airway. Unconsciousness occurs in 5 to13 seconds.
  • Full suspension is not necessary, even with partial suspension a person can die.
  • Near hanging is the term used for those who survive.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

  eMedinewS Audio PostCard

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

Proton–pump inhibitors to carry warning about C

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Excessive use of mobile phone can be injurious to your health

A press conference was organised by Heart Care Foundation of India on the occasion of World Environment Day.

Dr K K Aggarwal
    National News

Polio affected boy in Beed missed timely vaccine dose, say doctors

Aurangabad: The 11-month-old boy from Beed district in Maharashtra found infected with the vaccine derived polio virus (VDPV), type P2 might have missed his timely polio dose, as his family kept migrating from one place to another, feel doctors as reported in TOI. The child belongs to a closely-knit family of 19 from the Kanhapur village of Dharur taluka, located around 88 km from Beed town. The majority of villagers here are farmers or work as migrant labourers for sugarcane harvesting.

H V Wadgave, district reproductive and child health officer, Beed, said on Friday that that there was a gap of seven months between the first and the second polio doses administered to the child, instead of the ideal period of a month. The zero polio dose was given to the child on July 3, 2012; the first dose was administered on September 7, 2012, while the second dose was given to him on April 2, 2013.

The affected child's parents belong to the backward socio-economic class. The baby was delivered under normal conditions at the Primary Health Centre (PHC) in Hatta, in Hingoli district, where the zero polio dose was administered at birth. The child was diagnosed with fever on April 27, 2013 and suffered paralysis of left limbs on May 4, followed by convulsions. The other limbs were eventually paralysed, after which he was admitted to a private hospital in Ambejogai. Later on May 9, he was shifted to the Government Medical College, Latur.

A team of doctors from Delhi camped in Beed to further investigate the matter. The team visited Kanhapur to supervise the investigation process and chalk out a plan of action for the migratory population to complete the medical rights of its children.

A survey by the medics stated that 60% of the children in Kanhapur village were fully immunised. The village is equipped with 80% of ideal sanitation facilities. However, villagers were reluctant in using toilets due to water scarcity brought about by drought, coupled with myths and lack of awareness in the community. The village is completely dependent on tap water for drinking purposes. Open water sources and open defecation were common.

Around 42 children were surveyed by the medical team, out of whom 32 were found to have routine immunisation cards. Twenty-five were found to be completely immunised as per age, 16 were partially immunised, while a 15-day-old child was found to be unimmunised. "There was another two-month child from the family who was unimmunised as its parents were out of the district on labour work," Wadgave said.

Similar cases of partial immunisation have been found across the village, Wadgave said, since families are not aware about the next medical dosage due to constant migration. "This is a major issue for Beed district, as core families depend on labour work for livelihood and hence migrate to neighbouring districts or state," he added, "Getting the child immunised becomes difficult, because there is no system of tracking such migrants and then inform concerned health officers about administer medical doses on time."

A list of migrants should be obtained and planned in coordination with district authorities, PHCs or rural hospitals to provide benefits. The vaccination schedule is arranged depending on the number of beneficiaries in the neighbouring areas. A fixed schedule is planned for the district and vaccination camps are held every month in villages by a medical team. (Source: TOI, Jun 8, 2013)

For comments and archives

    Valvular Heart Disease Update

The most common cause of mitral regurgitation in the elderly are mitral value prolapse and coronary artery disease. Mitral stenosis is relatively uncommon in elderly adult. For patients who are symptomatic balloon valvotomy is the procedure of choice.

(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)

    Be Human Stop Child Abuse (Team IMA for CMAAO)


The differential diagnosis includes other types of genital injury, infection, dermatologic conditions, congenital conditions affecting the perineum, and conditions affecting the urethra or anus.

    International News

(Contributed by Dr Monica and Brahm Vasudev)

FDA panel loosens noose on Avandia

A panel of FDA advisers thinks it is time to ease restrictions on access to Avandia (rosiglitazone), a onetime multimillion dollar blockbuster drug brought low by reports that it increased the risk of heart attacks. (Source: Medpage Today)

Probiotics may help prevent antibiotic-related diarrhea ?

Probiotics are safe and effective for preventing Clostridium difficile–associated diarrhea (CDAD) in children and adults taking antibiotics, according to a systematic review published online May 31 in the Cochrane Database of Systematic Reviews. (Source: Medscape)

Better heart health brings lower stroke risk

Meeting American Heart Association/American Stroke Association criteria for at least average cardiovascular health may lower the risk of stroke, researchers found. (Source: Medpage Today)

JCV test 'useful but not sufficient' to gauge PML risk

A new report raises questions about the reliability of the test for JC virus (Stratify, Biogen Idec) to help determine risk for progressive multifocal leukoencephalopathy (PML) in patients with multiple sclerosis (MS) treated with natalizumab (Tysabri, Biogen Idec). (Source: Medscape)

Tumor features predict colon blockage

The likelihood of bowel obstruction among older patients with stage IV colon cancer depended on the site, grade, and histology of the tumor, a large retrospective analysis found. (Source: Medpage Today)

AASM calls for sleep apnea check in diabetes, hypertension

All patients with type 2 diabetes or hypertension should be evaluated for sleep apnea by a board-certified sleep medicine physician, the American Academy of Sleep Medicine (AASM) advised this week in a position statement. The AASM's position statement was announced at SLEEP 2013: Associated Professional Sleep Societies 27th Annual Meeting. (Source: Medscape)

    Twitter of the Day

@DrKKAggarwal: Lifestyle counseling can reduce heart disease An intensive effort to change lifestyle in people at high... http://fb.me/1bVkJ0I6l

@DeepakChopra: Infinite universes come & go in the vast expanse of consciousness like motes of dust dancing in a beam of light-Yoga Vasishth #God #Atheism

    Spiritual Update

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

All about depression

  1. Depression is a major public health problem and a leading predictor of functional disability and mortality.
  2. Optimal depression treatment improves outcome for most patients.

For comments and archives

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

What is ovarian tissue cryopreservation?

Doctors are experimenting with a procedure to freeze the tissues from a woman’s ovary. The ovaries produce eggs. In this procedure, doctors cut the tissue from one of your ovaries into thin slices. These slices are then frozen. After your cancer treatment, the doctors can place a slice of thawed ovarian tissue back into your body. The tissue does not need to go back where it came from in order to start producing eggs. You may need to be treated with fertility hormones in order for this tissue to produce an egg. Once the tissue produces an egg, your doctor will retrieve it and fertilize it in the laboratory. After your doctor places the subsequent embryo into your uterus, you may be able to get pregnant. There are some disadvantages to this procedure. You will need to have surgery several times. It also is dangerous if you have cancer of the ovary. If the tissue has cancer and is placed back in your body, the cancer could spread.

    An Inspirational Story

Doctor’s service!

A doctor quickly entered the hospital after being called in for an urgent surgery. He changed his clothes and went directly to the surgery block. He saw the boy’s father walking back and forth in the hall waiting for the doctor.

Once seeing the doctor, the dad yelled: “Why did you take all this time to come? Don’t you know that my son’s life is in danger? Don’t you have the sense of responsibility?”

The doctor smiled and said: “I am sorry, I wasn’t in the hospital and I came the fastest I could… now, I wish you’d calm down so that I can do my work.” “Calm down?! What if your son was in this room right now, would you calm down? If your own son dies now what will you do?” said the father angrily.

The doctor smiled again and replied: “I will say what is said in the Holy Bible ‘From dust we came and to dust we return, blessed be the name of God.’ Doctors cannot prolong lives. Go and intercede for your son, we will do our best by God’s grace.”

“Giving advice when we’re not concerned is so easy” murmured the father. The surgery took some hours after which the doctor went out happy, “Thank God! Your son is saved!” And without waiting for the father’s reply he carried on his way running. “If you have any question, ask the nurse.”

“Why is he so arrogant? He couldn’t wait some minutes so that I ask about my son’s state?” commented the father when seeing the nurse minutes after the doctor left. The nurse answered: “His son died yesterday in a road accident, he was in the burial when we called him for your son’s surgery.”

For comments and archives

    Cardiology eMedinewS

Atrasentan reduces albuminuria and cholesterol Read More

    Pediatric eMedinewS

Zinc supplements reduce diarrhea morbidity in young infants Read More

    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Can RIG be given locally to a healed wound?

Yes. If anti-rabies vaccination has not been started, then RIG can be given locally without disturbing the scab.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with insulin resistance developed MCA infarction.
Dr. Bad: Both are not related.
Dr. Good: They are related in terms of persistent arterial occlusions.
Lesson: A prospective, observational, longitudinal study in consecutive acute ischemic stroke patients presenting with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis concluded that high insulin resistance may be associated with more persistent arterial occlusions and worse long-term outcome after acute ischemic stroke thrombolysis (Diabetes Care 2011 Nov;34(11):2413-7).

Make Sure

Situation: An 18-year-old girl complained of purulent nasal discharge, nasal congestion, pain in the cheek and upper teeth for last 10 days. CT scan showed maxillary sinusitis.
Reaction: Remember to give macrolides.
Lesson: Make sure to remember that clarithromycin 500 mg twice-daily for 7 days is not only effective in maxillary sinusitis but also in other sinusitis.

    Quote of the Day (Dr GM Singh)

Worries are like a bird, let them fly over you. But do not give them a chance to build a ‘NEST’ on your head.'

    Legal Question of the Day (Dr MC Gupta)

Q. Suppose a hospital has only one ventilator and it is in use for a quadriplegic patient with almost no hope of survival. A young patient with high chances of survival is admitted later. What should the hospital do?


  1. This is a situation with conflict among various objectives:
    • The objective of not denying life- saving treatment to a serious patient admitted newly.
    • The objective of not denying life- saving treatment to a patient already admitted and under treatment in the hospital.
    • The objective of allocating available resources in a fair manner when there are many claimants.
    • The objective of not doing something, even if in the interest of the patient, which may be against law.
  2. The medical superintendent of the hospital should immediately contact another hospital where a ventilator may be available and should arrange for the new patient to be admitted there.
  3. If alternative arrangements for the new patient are not possible but he is likely to die in the absence of a ventilator, the following line of management is suggested:
    • A board of doctors (which means, in practice, 2 or more doctors, preferably including an anesthetist and intensive care specialist) should assess the two patients under discussion and should prepare a report, from a medical point of view, and give its recommendations in the circumstances, including its finding about the feasibility of using the single ventilator alternately between the two patients and thus partially help both.
    • Such report should be presented to the medical superintendent who should discuss with the hospital lawyer and try to implement it as per legal advice.
  4. Properly documented record must be kept regarding the medical condition and the consent/refusal etc. of any advice given to the patients or their relatives. It should be recorded, with proper authentication, that the condition of the patient is serious and has been explained to the relatives etc. and they have been advised to take the patient to some other hospital with better facilities including a ventilator.
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Photos and Videos of 4th eMedinewS – RevisitinG 2012 on 20th January 2013

Photos of Doctor’s Day Celebration

eMedinewS Apps
   Mind Teaser

Read this…………………

The pain management nurse follows the recommended protocol for preventing constipation when starting a patient on opioids by:

1. Adding bulk fiber to the diet.
2. Giving the patient enemas as needed.
3. Increasing fluids and exercise.
4. Using a bowel stimulant and stool softener.

Yesterday’s Mind Teaser: 4. Unilaterally

1. Bilaterally
2. Globally
3. Occipitally
4. Unilaterally

Answer for Yesterday’s  Mind Teaser: 4. Sodium bicarbonate via IV push.

Correct answers received from: Tukaram Pagad, Dr Anusha Sudhakar, Dr Ayyavoo ERODE, Dr Deepali Chatterjee, Dr Gajveer, Dr Jainendra Upadhyay, Dr Bharat Bhushan Aggarwal, Dr Arpan Gandhi, Dr Pankaj Agarwal, Dr Avtar Krishan Muthumperumal Thirumalpillai, Dr Chandresh Jardosh, Daivadheenam, Dr PK Sahu.

Answer for 7th June Mind Teaser: Location, quality, and onset

Correct answers received from: Dr Chandresh Jardosh, Daivadheenam, Dr PK Sahu.

Send your answer to ijcp12@gmail.com

   Laugh a While (Dr GM Singh)

A couple, desperate to conceive a child, went to their priest and asked him to pray for them. "I'm going on a sabbatical to Rome," he replied, "and while I'm there, I'll light a candle for you."

When the priest returned three years later, he went to the couple's house and found the wife pregnant, busily attending to two sets of twins.

Elated, the priest asked her where her husband was so that he could congratulate him. "He's gone to Rome, to blow that candle out" came the harried reply.

    Medicolegal Update

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

Exhumation of corpse – America

In America, corpses are exhumed when there is a need to identify a body or to establish cause of death like in the case of suspected homicide.

  • The remains of President Zachary Taylor were exhumed in 1991 to determine whether or not he had been poisoned, and the famous outlaw Jesse James’s grave was excavated to prove that it was his body in the coffin. In addition, archaeological investigations often involve exhumation.
  • Under modern law, courts usually do not allow exhumation unless there are substantial and compelling reasons to do so.
  • In a landmark U.S. Supreme Court decision Justice Cardozo stated, "The dead are to rest where they have been lain unless reason of substance is brought forward for disturbing their repose."
  • Three general principles govern the law of disinterment in the United States. First, it is presumed that a "decently buried" body should remain undisturbed where it was placed unless good reason is given to do so. Second, disinterment is considered the private concern of the immediate family and the cemetery. Third, if there is disagreement among the close relatives regarding a proposal for exhumation the matter is adjudicated by a court of equity. The court considers (in order of importance) the wishes and religious beliefs of the deceased (if these can be determined), the wishes of the spouse of the deceased, the opinions of other close relatives, and the policies and regulations of the cemetery when determining if exhumation should be allowed.
  • California Labor Code stipulates that if it is suspected that a person has died as a result of injuries sustained in the course of his employment, the investigating appeals board may require an autopsy and, if necessary, the exhumation of the body for the purposes of autopsy. However, in accordance with the rules of equity, the close relatives can, if they wish, prevent the state (i.e., California) from either exhuming the body or performing the autopsy.

For comments and archives

    Public Forum

Public Forum (Press Release for use by the newspapers)

Carbohydrates substitute to saturated fat not the answer

More than 20 prospective studies have addressed components of diet and the risk of heart disease, stated by Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India.

The type of fat consumed appears to be more important than the amount of total fat.

Trans fatty acids increase risk of heart disease while polyunsaturated and monounsaturated fats decrease risk.

There is controversy about whether it is optimal to substitute saturated fats with carbohydrate. An increase in carbohydrate tends to reduce the level of good high density lipoprotein (HDL) cholesterol in addition to total and low density lipoprotein (LDL) cholesterol. Thus, the reduction in heart disease risk may be less than predicted by the reduction of saturated fat alone.

Observational studies have consistently shown that individuals consuming diets high in vegetables and fruits (which are rich in antioxidant vitamins) had a reduced risk of heart disease.

Results of a number of randomized trials are now available and show largely no significant clinical benefits of antioxidant vitamins on heart disease.

Supplemental vitamin C, E, and beta carotene cannot be recommended in the primary prevention of CHD.

Taking supplements without clinical benefits could, in theory, increase the risk if individuals mistakenly avoid therapeutic lifestyle changes or drug therapies with proven benefits.

    Readers Responses
  1. Mobile jammers should be used in all medical establishment but an efficient intercom system should be installed so that important information can be conveyed to concerned person. Every body including heads should follow this rule. vivek kumar, varanasi
    Forthcoming Events

Enrollment for workshop

Heart Care Foundation of India under the aegis of Perfect Health Mela is organizing a series of skill workshops in the month of Oct as per the following programmes

Communication Skills 23rd October, Wednesday
8 am
Constitution Club of India
4 hours
Handling Media crisis Saturday 26th October
2 pm
Constitution Club of India
1 hour
Conflict Management 24th October Thursday
10 am
Constitution Club of India
2 hours
Organizational Behavior 24th October Thursday
8 am
Constitution Club of India
2 hours
Team Building 25th October, Friday
8 am
Constitution Club of India
2 hours
Time Management 25th October, Friday
10 am
Constitution Club of India
2 hours

The workshops will have experts interacting both theoretically and with practical demonstrations and interactions. If interested, kindly confirm your registration at rekhapapola@gmail.com. You can also forward this information to your interested friends and colleagues for a registration.

Dr KK Aggarwal
Padma Shri and Dr B.C. Roy National Awardee
President of Heart Care foundation of India

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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, Dr Usha K Baveja