eMedinewS22nd December 2013, Sunday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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)
For updates follow at
www.facebook.com/Dr KKAggarwal

CURB–65 pneumonia severity score

  • Confusion* (1 point)
  • Urea >20 mg/dL (7 mmol/L)** (1 point)
  • Respiratory rate >=30 breaths per minute (1 point)
  • Low systolic (<90 mmHg) or diastolic (<=60 mmHg) Blood pressure (1 point)
  • Age >=65 years (1 point)

Total Criteria Point Count:

CURB–65 Score

0 to 1 Points: Low severity (risk of death <3 percent). Outpatient therapy is usually appropriate.
2 Points: Moderate severity (risk of death 9 percent). Hospitalization should be considered.
3 to 5 Points: High severity (risk of death 15 to 40 percent). Hospitalization is indicated, and the patient should be assessed for possible intensive care unit admission, especially if the CURB–65 score is 4 or 5.

*Defined as an Abbreviated Mental Test Score <=8 or new disorientation to person, place, or time.

**Urea is blood urea nitrogen (BUN), expressed in mg/dL or serum urea concentration, expressed in mmol/L.


  1. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377–82.
  2. Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64 Suppl 3:iii1–55.
  3. Qureshi KN, Hodkinson HM. Evaluation of a ten-question mental test in the institutionalized elderly. Age Ageing. 1974 Aug;3(3):152–7.

Statins for CKD

New guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) workgroup recommend wider statin use among patients with chronic kidney disease.

A synopsis of 8 key recommendations regarding lipid management and monitoring in adults with CKD, including those receiving chronic dialysis or who have had kidney transplants was published online December 9 in the Annals of Internal Medicine.

  • A key recommendation was for treatment with statin or statin with ezetimibe of adults at least 50 years of age who have an estimated glomerular filtration rate (eGFR) less than 60 mL/minute per 1.73 m2 and who are not treated with chronic dialysis or kidney transplantation. This was a 1A level recommendation, based on the Study of Heart and Renal Protection (SHARP; Lancet. 2011;377:2181–2192).
  • Adults with dialysis–dependent CKD should not begin treatment with statins or statin/ezetimibe. (2A)
  • Patients already taking a statin at the time of dialysis should continue to do so. (2C)
  • Kidney transplant patients should receive statin treatment because their risk for coronary events is dramatically increased. (2B)
  • Adults aged 18 to 49 years who have an eGFR less than 60 mL/minute per 1.73 m2 but who are not treated with dialysis or kidney transplantation should be treated with statins if they are known to have coronary disease, diabetes, prior ischemic stroke, or an estimated 10–year incidence of coronary death or nonfatal myocardial infarction exceeding 10%. (2A)
  • Among persons with CKD, low–density lipoprotein cholesterol is an insufficient test for cardiovascular risk. Adults with newly diagnosed CKD should therefore undergo lipid profile testing. (1C)
  • However, follow–up measurement is not needed. (Not graded)
  • Adults aged 50 years or older who have CKD and an eGFR 60 mL/minute per 1.73 m2 or higher (GFR categories G1 – G2) should be treated with a statin. (1B)

cpr10 Mantra The CPR 10 Mantra is – "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 dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

cpr 10 mantra
VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Negative thoughts are absence of positive thoughts

sprritual blog

Darkness cannot be removed physically; it can only be removed by switching on the light or going into sunlight or lighting a fire. Similarly, negative thoughts are absence of positive thoughts.

In Bhagavad Gita also it has been said that the period of Uttarayana with longer days, the first half at full moon, in the presence of light or agni, one acquires more positive thoughts as compared in Dakshinayana before Amavasya or no moon or in absence of light.

Bhagavad Gita also says that whatever you think the whole life, you think at the time of death and if the at the time of death you have positive thoughts, you are likely to get Moksha. That may be the reason why in Hindu mythology it is said that just before the death, we should light a diya or chant in front of agni (fire) so that the dying person’s thoughts become positive.

In terms of computer language, it can be explained as – when you open a file repeatedly, it becomes a priority file and takes priority in the search engine as compared to other files.

cardiology news

Believe in Yourself

There may be days when you get up in the morning and things aren’t the way you had hoped they would be.

That’s when you have to tell yourself that things will get better. There are times when people disappoint you and let you down.

But those are the times when you must remind yourself to trust your own judgments and opinions, to keep your life focused on believing in yourself. There will be challenges to face and changes to make in your life, and it is up to you to accept them.

Constantly keep yourself headed in the right direction for you. It may not be easy at times, but in those times of struggle you will find a stronger sense of who you are.

So when the days come that are filled with frustration and unexpected responsibilities, remember to believe in yourself and all you want your life to be.

Because the challenges and changes will only help you to find the goals that you know are meant to come true for you.

News Around The Globe


  • Cancer immunology has been selected as the "Breakthrough of the Year" by the editors of Science, the flagship journal of the American Association for the Advancement of Science. According to the report published in the December 20 issue, immunotherapy marks an entirely different way of treating cancer — by targeting the immune system, not the tumor itself.
  • The US FDA has approved the first combo bronchodilator treatment indicated "for once–daily, long–term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD). The combination includes umeclidinium and vilanterol powder for inhalation (Anoro Ellipta, GlaxoSmithKline (GSK)/Theravance).
  • A music–based exercise program enhances cognitive function and decreases anxiety in older adults, as per new research published online November 7 in Age and Aging.
  • Endocrinologists have cautioned that patients who take over–the–counter supplements that promise to enhance thyroid function may get more than they bargained for. The supplements could contain unlabeled ingredients, including the active thyroid hormones T3 and T4, which could make patients hyperthyroid, increasing the risk of side effects such as high heart rate, sweating and anxiety.
  • Dutch investigators report in the journal Human Reproduction that overall, 79% of men had successful conception with cryopreserved semen after treatment for Hodgkin’s lymphoma compared with 74% of men without frozen semen, a nonsignificant difference.

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Rabies News (Dr. A K Gupta)

How common are animal bites and infections?

Only 15 to 20 percent of dog bite wounds become infected. Puncture wounds and hand wounds are more likely to become infected than scratches.

cardiology news

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

  • The prevalence and incidence of atrial fibrillation (AF) is increasing globally, and the arrhythmia is having a profound impact on patient disability and mortality, according to new study, published online December 17, 2013 in Circulation. Dr Sumeet Chugh (Cedars Sinai Medical Center, Los Angeles, CA) and colleagues analyzed the numbers from the Global Burden of Disease (GBD) database and observed that in total, 33.5 million individuals, or 0.5% of the world’s population has AF and this new epidemiological data on AF confirms the emergence of this condition as a global epidemic.
  • New research has shown that blood transfusion may be an independent risk factor for thrombosis and consequently ischemic events in patients of acute coronary syndrome. In the second Impact of Transfusion of Red Blood Cell on Platelet Activation and Aggregation Studied with Flow Cytometry Use and Light Transmission Aggregometry (TRANSFUSION–2) study, 33 patients had suspected ACS and were on dual antiplatelet therapy with aspirin and a thienopyridine (usually clopidogrel) and 28 had other heart disease and were taking either aspirin or no antiplatelet agent. Their cohort was high risk, they write; one–fifth had diabetes and 41% had renal insufficiency.
cardiology news

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

  • Dexmedetomidine is an effective, well–tolerated sedative for preterm and full–term neonates. Preterm neonates have decreased plasma clearance and a longer elimination half–life than term neonates. Constantinos Chrysostomou, MD, from the Cardiac Intensive Care Unit of Children’s Hospital of Pittsburgh, Pennsylvania, and colleagues present the results of their phase 2/phase 3 study in an article published online November 18 in the Journal of Pediatrics.
  • A maternal blood test measuring messenger RNA (mRNA) expression of hypoxia–induced genes may provide a noninvasive method to monitor the severity of fetal hypoxia/acidemia during pregnancy, according to research published online December 9 in BMC Medicine.
cardiology news

Winter blood pressure 5 mm Hg higher than summer blood pressure

The systolic (top number) and diastolic (bottom number) blood pressures rise and fall with change of season.

In a study by the Institute National de la Sante et de la Recherche Medicale of Paris and published in the journal Archives of Internal Medicine involving 8801 people aged 65 or older, average systolic blood pressure was five points higher during the winter than in summer.

Instances of high blood pressure (systolic blood pressure higher than 159, or diastolic higher than 94 mmHg) in the study were found in 33.4 percent of participants during winter but just 23.8 percent during summer.

The reason could be related to the baroreflex, a mechanism of blood pressure regulation that is modified in elderly subjects or a function of the sympathetic nervous system, which helps control involuntary actions such as stress response. A 5 mm change in blood pressure can explain why more heart patients die in winter.

cardiology news

Total CPR since 1st November 2012 – 80967 trained

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press release

Heart Attack Symptoms in Women and Older are Different

Maximum heart attacks occur in winter and the symptoms in the women and the elderly may be different, warns Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President, Heart Care Foundation of India.

Chest pain is still the most common sign of a heart attack in most women but women are more likely than men to have symptoms other than chest pain in heart attack.

These symptoms include pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness and palpitations.

Between 30 and 37% of women may not have chest discomfort during a heart attack.

Women are on an average nearly a decade older than men at the time of their initial heart attack.

Older people also are more likely to have heart attack without chest discomfort.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 80967 people since 1st November 2012.

The CPR 10 Mantra is – "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 dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

emedipicstoday emedipics

CPR cum Health Check up Camp by Punjab Kesari Varishth Nagrik 16th December 2013

press release

Depression linked to paralysis

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

An enzyme involved in the catabolism of fructose to pyruvate in the liver is:

1.Glyceraldehyde–3–phosphate dehydrogenase.

Yesterday’s Mind Teaser: All the following are related to legal responsibility of an insane person except.

1. Mc Naughten’s rule
2. Durham’s rule
3. Curren’s rule
4. Rule of nine

Answer for yesterday’s Mind Teaser: 4. Rule of nine

Correct answers received from: DR.A.K.GAJJAR, Yamini Alsi, Dr.K.Raju, Dr.K.V.Sarma, Muthumperumal Thirumalpillai, DR AVTAR KRISHAN, Tukaram Pagad

Answer for 20th December Mind Teaser: 3. Neisseria gonorrhoeae and Chlamydia trachomatis.

Correct answers received from: Yamini Alsi, Dr B K Agarwal, Dr.Bitaan Sen & Dr.Jayashree Sen, Dr Manjit Mohi,

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update
medicolegal update

Tech support: "Okay Colin, let’s press the control and escape keys at the same time. That brings up a task list in the middle of the screen. Now type the letter "P" to bring up the Program Manager."
Customer: I don’t have a P.
Tech support: On your keyboard, Colin.
Customer: What do you mean?
Tech support:"P" on your keyboard, Colin.

medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A known epileptic child died of a seizure while swimming.
Reaction: Oh my God! Why was he allowed to swim?
Lesson: Make sure that patients with uncontrolled epilepsy are not allowed to swim.

medicolegal update

The recipe for perpetual ignorance is: Be satisfied with your opinions and content with your knowledge. Elbert Hubbard

medicolegal update

Dr KK Aggarwal: Shorter the waist line, longer the life line http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Photons cannot be seen but make seeing possible #CosmicConsciousness

medicolegal update
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