June 28  2015, Sunday
eMedinewS
editorial
Treatment of mild hypertension in low-risk patients
Dr KK Aggarwal There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease.

A meta-analysis combined four placebo-controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease (1). During 4 to 5 years of follow-up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low-risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail (2). Frail is defined as an inability to walk six meters in less than eight seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).

References
  1. Diao D, Wright JM, Cundiff DK, Gueyffier F. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.
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Blood Donation Camp conducted by Sathyamangalam IMA Tamilnadu
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Cardiology eMedinewS
  • A real-world study of more than 4000 patients seen in a blood-pressure clinic did not find a J-shaped relationship in which patients with a low diastolic blood pressure were at increased risk of dying from all causes or from cardiovascular causes. The study was presented at the European Society of Hypertension (ESH) 2015 Scientific Sessions.
  • The European Commission (EC) has approved edoxaban for high-risk patients with nonvalvular atrial fibrillation and for the treatment and prevention of deep-venous thrombosis (DVT) and pulmonary embolism (PE).
Pediatrics eMedinewS
  • A new study has found that frequent hand-washing with soap and nail clipping may cut the intestinal parasitic reinfection rate by more than half among school-aged children. The study is published online in PLoS Medicine.
  • Premature infants who underwent early screening for patent ductus arteriosus (PDA) had lower in-hospital mortality, but rates of other complications were inconsistent, suggested the results of a French population-based study published in JAMA.
Dr KK Spiritual Blog
Bhoot, Pret and Pishach

In mythology, ‘Bhoot’ means the memories of known people whose unfulfilled desires keep on disturbing us. ‘Pret’ means the memories of unknown people whose unfulfilled desires keep coming to our mind during sleep and disturbing us. These unfulfilled desires of unknown people are instances that we may have forgotten but still reach us through the cloud internet. When these memories start disturbing our day to day life, they are defined as Pishach.

Pret, Pishach and Bhoot are seen only by some people and not everyone. That means that their attachment will only be with those with whom their unfulfilled desires were linked to.

This attachment disorder where the unfulfilled desires of the deceased person keep on coming to our mind during day time, night and in our dreams can be understood by a computer IT model used by porn sites.

People who own porn sites develop software by which a specific program can get transferred to our computer and whenever we open these sites the program file gets embedded in our computer in a secret location in such a way that whenever we open the computer, the specific will appear on the desktop or will become the preferred sites whenever we open the internet. The specific site only will automatically open even if we do not wish to open it.

These files are difficult to delete unless the computer is reformatted or an experienced IT professional is able to delete these files.

The attachment disorders and the unfulfilled desires of the deceased persons can be compared to this technology and can be explained why those thoughts keep on coming in our mind. Not only the thoughts, even the images of people keep coming into mind and they are difficult to get deleted.
CPR Training Camp
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Make Sure
Situation: A 36–year–old truck driver had severe allergic rhinitis and came for treatment.
Reaction: Oh my God, why was he not prescribed azelastine nasal spray?
Lesson: Make sure to avoid oral antihistamines in persons who perform tasks like driving as they may cause sedation and drowsiness; instead prescribe azelastine nasal spray, which is effective and non–sedating.
Dr Good Dr Bad
Situation: A diabetic with A1c 6% had a BP of 130/88 mmHg.
Dr Bad: This is very good control of diabetes.
Dr Good: This is very good control but we also need to control BP.
Lesson: Cardiovascular morbidity can only be reduced with aggressive management of hypertension, cholesterol (LDL <100 mg/dL) and aspirin (75–150 mg/day) in patients with or at high risk for cardiovascular disease.
(Copyright IJCP)
eMedi Quiz
A patient has been allegedly bitten by cobra snake. The venom in such a bite would be:

1. Musculotoxic.
2. Vasculotoxic.
3. Cardiotoxic.
4. Neurotoxic.

Yesterday’s Mind Teaser: Mummification refers to:

1. Hardening of muscles after death.
2. Colliquative putrefaction.
3. Saponification of subcutaneous fat.
4. Desiccation of a dead body.

Answer for yesterday’s Mind Teaser: 4. Desiccation of a dead body.
Correct Answers received from: Dr Avtar Krishan, Dr Poonam Chablani, Dr K Raju, Dr K V Sarma, Dr Prabodh K Gupta, Daivadheenam Jella, Dr Sharavana, Dr G Madhusudhan, Dr Pandit Hantodkar, Dr K C Sharma.
Answer for 26th June Mind Teaser: 1. Pemphigus vulgaris.
Correct Answers received: Daivadheenam Jella, Dr Avtar Krishan.
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IJCP Book of Medical Records
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CPR 10
Total CPR since 1st November 2012 – 101090 trained
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.
Madan Singh, SM Heart Care Foundation Fund, Post CAG
Kishan, SM Heart Care Foundation Fund, Post CHD Repair
Deepak, SM Heart Care Foundation Fund, CHD TOF
Press Release
Air pollution can raise blood pressure

Breathing polluted air for even two hours can increase blood pressure, potentially raising the risk of cardiovascular disease in those exposed to smog, said Padma Shri, Dr B C Roy & DST National Science Communication Awardee, Dr K K Aggarwal, President Heart Care Foundation of India and Honorary Secretary General Indian Medical Association (IMA).

In susceptible patients, this small increase may actually be able to trigger a heart attack or stroke. In the study, which appeared in a recent issue of the journal Hypertension, researchers tested 83 people as they breathed levels of air pollution similar to those in an urban city near a roadway. The air pollution caused diastolic pressure, the lower number in a blood pressure reading -- to rise within two hours. Blood vessels were impaired for as long as 24 hours. Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function. If there is a high forecast for air pollution levels, then those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity.

Blood vessels were impaired for as long as 24 hours. Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function. If air pollution levels are forecasted to be high, those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity.
eIMA News
  • In a preliminary study of men with type 2 diabetes, the use of phosphodiesterase type-5 (PDE5) inhibitors was associated with reduced all-cause mortality, even in men who had a previous myocardial infarction (MI), during a 5-year follow-up. (ADA)
  • Vitamin D supplementation in Crohn's disease (CD) patients in remission is associated with short-term maintenance of intestinal permeability and improvement of markers of disease activity, according to researchers. In a June 9 online article in the United European Gastroenterology Journal, Dr. Raftery, of St. James's Hospital, Dublin, Ireland, and colleagues noted that although vitamin D supplementation appears to be of benefit in CD, few studies have examined possible mechanisms.
  • Despite fewer legal constraints than in the developing world, women and service providers in developed countries face barriers in relation to provision of abortion services and their lack of access to them, as reported in the Journal of Family Planning and Reproductive Health Care.
  • Chronically elevated blood pressure from young adulthood to middle age is associated with systolic and diastolic dysfunction in a group of healthy middle-aged adults, according to a new analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study.
TECOS: No Heart Failure with Sitagliptin in High-Risk Diabetic patients

In patients with type 2 diabetes and cardiovascular disease, the use of the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin (Januvia) did not increase risk of cardiovascular events in a large outcomes trial designed specifically to answer this question. There was no increase in the number of patients hospitalized for heart failure with sitagliptin, a critically watched secondary end point, given that other drugs in the class, most notably saxagliptin (Onglyza), showed an increase in heart-failure events in one study. "Given the size of our study, the long duration of follow-up, as well as the higher risk of our population, we feel that this very adequately addresses and puts to bed the question that there is any risk for heart failure with this drug," said Eric Peterson, MD, from Duke Clinical Research Institute, Durham, North Carolina, cochair of the TECOS executive committee. (ADA Medscape)

No CV Benefit with Lixisenatide in ELIXA, but Results Reassure

Lixisenatide (Lyxumia), an injectable glucagonlike peptide (GLP-1) agonist, did not show a benefit on cardiovascular outcomes in the 6000 high-risk patients with type 2 diabetes in the ELIXA trial. But in this FDA-required CV safety study, lixisenatide also did not cause any harm in these patients, who had recently suffered an acute coronary event. There was no difference between the lixisenatide and placebo arms in the primary composite outcome of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. "The effect of lixisenatide was neutral in ELIXA, and this should provide physicians and patients with some reassurance," said lead investigator, Marc Pfeffer, MD, of Brigham and Women's Hospital, Boston, Massachusetts. (ADA Medscape)

Hope Ahead? Varying Approaches Progress Artificial Pancreas

Conference attendees were treated to a progress report from several research teams developing "artificial-pancreas" systems. Incremental progress is steady; the remaining challenges include the prevention of hypoglycemia, which the systems have greatly reduced but not eliminated entirely, as well as postprandial glucose spikes resulting from delayed absorption of subcutaneously infused insulin. Scientists at the meeting also stressed that it will still be a few years before any of the systems in development are commercially available, likely around 2018. Nor do they represent a "cure" for type 1 diabetes but, rather, a "bridge" until such time as a cell-based cure is discovered. (ADA Medscape)

Weight Drops, Muscle Mass Stays: 5-Year 'Why WAIT' Success

Significant weight loss was achieved and maintained for up to 5 years in a real-world study of obese patients with type 2 diabetes who took part in a 12-week, intensive lifestyle intervention program, which emphasizes the preservation of muscle mass. The 53% of participants who lost at least 7% of their weight (about 23 pounds) with the program and kept it off for a year maintained this weight loss long term and saw improvements in certain cardiovascular risk factors in the 5-year follow-up. Osama Hamdy, MD, PhD, from the Joslin Diabetes Center, Boston, Massachusetts, reported the findings from the Weight Achievement and Intensive Treatment (Why WAIT) program here. The study was awarded the Michaela Modan Memorial Award for its major contribution to the understanding of type 2 diabetes. (ADA Medscape)

Four Diabetic Ketoacidosis Episodes Triple Risk of Early Death

In a cohort of adult patients with type 1 diabetes who were hospitalized with diabetic ketoacidosis (DKA), almost all patients survived the hospitalization, but they had an increased risk of early death. After one hospitalization for DKA, patients had a 10% greater risk of dying within 5 years, but after more than four hospitalizations for DKA, they had a 30% increased risk of dying within 6 years, reported Fraser W Gibb, MBChB, PhD, from the Edinburgh Centre for Endocrinology & Diabetes, Scotland. It was also "really quite striking" that the patients had a median age of 31 when they died after multiple DKA hospitalizations, and many died at home, often from "uncertain causes," he said. Session chair Kasia J Lipska, MD, MHS, from Yale University, New Haven, Connecticut, called the findings "very scary (and) sobering (ADA Medscape)

Condolence

We are very sad to convey that Dr V Satyamurty, a senior pediatrician of Kancheepuram town passed away on 26.06.2015 Friday morning while having his breakfast due to sudden cardiac arrest. His last rites and cremation took place on the same day itself. The members of IMA Kancheepuram paid homage at his residence.
IMA Branch Activity
WEAAD 2015
Neolife Foundation in association with Indian Medical Association UA has observed ‘World Elder Abuse Awareness Day’ on 15th June 2015 by organising various activities. Awareness at work places: Awareness regarding Elder Abuse, its impact and prevention of Abuse is carried out as an ongoing basis while helping and treating elders and others (13th June to 15th June 2015). More than 200 people participated in this activity including students, social leaders, senior citizen organizations and police Department. Pamphlets were also distributed, explaining the duty of youth, general public and health workers in identifying and preventing elder abuse. In Madhavendra Hospital, Advocacy progamme was also conducted for caregivers and health workers and invited them to join the mission of prevention of Elder Abuse. Posters and banners were displayed at Madhavendra Hospital, Neolife Health Centre, Ganga Mata Eye Hospital and market places like Gita Kutir Chouk to make aware the general public about Elder Abuse. Stall installation / Juice Distribution: To create awareness and to attract the crowd towards this awareness activity, a stall was installed on 15th June 2015, at the market place near Geeta Kutir. People were explained about Elder Abuse and its prevention. Simultaneously, public were distributed juices at the stall. We interacted with people, distributed pamphlets and invited them to join the mission of prevention of Elder Abuse. More than 300 people participated in this activity.
News
  • Patients with Parkinson's disease (PD) who exercise consistently have better health-related quality of life (HRQoL) and a slower decline in HRQoL than patients who do not exercise, suggests a new study presented at the 19th International Congress of Parkinson's Disease and Movement Disorders.
  • Tofacitinib, a drug commonly used to treat arthritis, could also be a potential new treatment for disfiguring skin condition vitiligo, suggests new research published in JAMA Dermatology.
  • Patients with lupus nephritis were younger than patients diagnosed with five other subtypes of glomerulonephritis in end-stage renal disease (ESRD), yet patients with lupus nephritis had the highest mortality rate, reported a study published online in the Clinical Journal of the American Society of Nephrology.
  • A new study suggests that the gastrointestinal symptoms of inflammatory bowel disease (IBD) may have more to do with a patient's level of perceived stress than with their level of intestinal inflammation. The findings are published in the American Journal of Gastroenterology.
  • Men with low-risk prostate cancer on active surveillance whose tumors are upgraded after a biopsy might not need to rush into surgery, suggests new research published in the July issue of the Journal of Urology.
Media
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Inspirational Story
Determining Your True Path

A master was strolling through a field of wheat when a disciple came up to him and asked, "I can’t tell which is the true path. What’s the secret?"

"What does that ring on your right hand mean?" asked the master. "My father gave it to me before dying." "Well, give it to me." The disciple obeyed, and the master tossed the ring into the middle of the field of wheat.

"Now what?" shouted the disciple.

"Now I have to stop doing everything I was doing to look for the ring! It’s important to me!"

"When you find it, remember this: You yourself answered the question you asked me. That is how you tell the true path: It is more important than all the rest."
Quote of the Day
First we make our habits then our habits make us. John Dryde
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Reader Response
Dear Sir, Thanks for the updation. Regards: Dr Kala
Wellness Blog
A Nine Modifiable Risk Factors for Heart Attack

The majority of known risk factors for heart attack disease are modifiable by specific preventive measures.

Nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, lack of adequate fruits and vegetables in diet and sedentary lifestyle. These account for over 90 percent of the population–attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10–year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years it begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. The Heart Care Foundation of India recommends walking 80 minutes in a day and with a speed of 80 steps per minute.
IMA Humor
A man speaks frantically into the phone, "My wife is pregnant, and her contractions are only two minutes apart!" "Is this her first child?" the doctor queries. "No, you idiot!" the man shouts. "This is her husband!"
Rabies News (Dr A K Gupta)
Are there any survivors of human rabies?

Till date only seven survivors have been recorded. These patients survived not due to any specific anti–rabies therapy but following intensive life support and excellent nursing care. These patients survived for variable periods with residual neurological deficits. All the survivors had paralytic form of rabies and majority had history of some anti–rabies vaccination in the past.
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