September 5   2015, Saturday
Diagnosis of hypertension in childhood requires repeated BP measurements
Dr KK Aggarwal One needs to confirm presence of hypertension based on three blood pressure measurements at separate clinical visits.

Normative BP percentiles are based upon data on gender, age, height, and blood pressure measurements from the National Health and Nutrition Examination Survey and other population-based studies.

In a study published in Pediatrics 2013;131:e415, initial BP measurement was normal (below the 90th percentile), pre-hypertensive (systolic or diastolic BP between the 90th or 95th percentile) and hypertensive (systolic or diastolic BP =95th percentile) in 82, 13, and 5 percent of children.

At follow-up, subsequent hypertensive measurements were observed in only 4 percent of the 10,848 children who had initial hypertensive values. In the cohort, the overall prevalence of hypertension was 0.3 percent.
Heart Care Foundation of India (HCFI) trains school children on the importance of healthy eating, hygiene and sanitation
A physical activity program and nutrient supplementation interventions failed to improve cognitive function and lower the risk for mild cognitive impairment (MCI) or dementia, suggested two new studies published in JAMA.


In a meta-analysis of melanoma patients, the risk for sentinel lymph node (SLN) positivity was significantly lower in those with histologic progression than in those without, thus pointing that regression may be used to select those patients who would be the most appropriate for SLN biopsy. The study was published online September 2 in JAMA Dermatology.


According to a new study published in the journal Neurology, diabetes may be linked to the buildup of "tangles" in the brain, separate from Alzheimer's disease.

Infectious diseases

Positive topline results have been obtained from RECAPTURE 1 and 2, the pivotal Phase III studies evaluating the antibiotic ceftazidime-avibactam as a treatment for adult hospitalized patients with complicated urinary tract infections (cUTI), including pyelonephritis.

Sleep disorders
Obstetrics and Gynecology

A new study suggests that nocturnal enuresis, or bedwetting, may be an additional symptom that doctors can look for when assessing post-menopausal women for obstructive sleep apnea. The findings are published in the journal Menopause.
Cardiology eMedinewS
European Society of Cardiology (ESC) 2015 Congress Update
  • Findings from the OptiLink HF trial suggest that patients with heart failure who had a device that alerted physicians when it detected that fluid in the chest was above a certain threshold did not have fewer CV hospitalizations or improved survival during a mean follow-up of 23 months compared with other patients who received standard care.
  • Findings from the SERVE-HF trial suggest that the surprising mortality risk from central sleep apnea treatment in systolic heart failure (HF) appears real and more from sudden death than from chronic worsening.
  • The PATHWAY 2 trial showed that adding the diuretic spironolactone brings resistant hypertension under control for most patients, with better results than other antihypertensives in that setting.
Pediatrics eMedinewS

Physical fitness in childhood as measured by physical work capacity at 170 beats per minute (PWC170) has been associated with increased knee cartilage volume in adulthood, suggested a new study published in Arthritis Care and Research.


School age children who are born prematurely are more likely to have low mathematical achievement, thought to be associated with reduced working memory and number skills, suggested a new study published in the neurology journal Brain.
Pulmonary Embolism
Wells' Criteria for Pulmonary Embolism

Wells criteria determine if PE is either:
  • Unlikely (score ≤4)
  • Likely (score >4)
The Wells’ criteria include the following
  • Clinical symptoms of deep vein thrombosis (DVT) (3 points)
  • Other diagnoses are less likely than PE (3 points)
  • Heart rate >100 (1.5 points)
  • Immobilization three or more days or surgery in previous four weeks (1.5 points)
  • Previous DVT/PE (1.5 points)
  • Hemoptysis (1 point)
  • Malignancy (1 point)
Dr KK Spiritual Blog
The Science Behind Birth Of Krishna In A Jail Of Ignorance

Krishna represents Brahman or God consciousnesses or consciousness- the self. The birth of Krishna is synonymous with the process of self-realization. Normally desires and negative thoughts core our consciousness with ignorance. The journey to self-realization involves removal or shedding of this ignorance which can only be done by the eight spiritual principles as described by the Yoga Sutras of Patanjali.

And these are Yama (self control); Niyama (self-discipline), Asanas (bodily postures); Pranayama (control of breath), Pratyahara (withdrawal), Dharana (one pointed), Dhyana (contemplation) and Samadhi (self-realization).

These eight limbs or eight steps signify the journey of eight days after full moon falling on Rakshabandhan, a day celebrated to control one’s lust.

Ignorance is symbolized by a PRISON, which represents darkness; narrow-minded approach (small entry gate) and limitedness to everything (small room). The chain in the prison means the bondages to lust, greed, desires and ego.

Birth of Krishna in the prison means ‘self-realization out of ignorance’. It can only be acquired by adhering to the eight principles of Ashtang Yoga with Tapas (Abhyasa) or hard work. Krishna, born, as the eighth child of Devaki, represents tapas of eight limbs of yoga. The self-realization can only occur after the seven strips are successfully negotiated and the mind is purified in the process.

In the state of Samadhi, there is spontaneous birth of the self. In this state (sama = equal; dhi – intelligence) one controls equality and balances between good and the bad.

The symbolization is that, as Krishna was born, the chains that bound his father fell off; the doors that had been bolted flew open and the prison guards immediately went into sleep. Then Vasudeva, the father took Krishna and went to Gokul, by placing Krishna in a basket and walking across the Yamuna river, where at the same time Yashoda, consort of Nanda, had given birth to a female child.

The ‘chains’ here mean the bondage to the external world and the five senses. A self realized person is free of these bondages. The opening of gates symbolizes control over lust, desire, greed and attachments. Sleeping of the guard symbolizes, that in a self-realized state, one is totally cut off from the world. Everything else perishes and one gets detached.

The thunderstorm, the rain, and the fire, all represent the internal turmoil of uncontrolled desires and hatred. The moment Krishna’s feet touch the turbulent water, everything settles. The spiritual lesson is that by turning inwards and towards one’s pure consciousness any turbulent state of mind can be controlled.

While acquiring all that, one must control the ego and keep the desires inwards and not have egocentric desires. Controlling the ego is depicted as a snake sitting over the basket and guarding Lord Krishna.

The baby girl born at Gokul represents the Mayashakti, which was killed by Kansa (the ego of the body).

Controlling the desires and attachments is easy but controlling the Ego is the most difficult. That is what is represented by the fact that at the time of birth of Krishna, Kansa still remained alive. It took many years for Krishna (self realized state) to kill the ego (Kansa).

Acquiring a state of self-realization should not be the ultimate goal in life. After self-realization, if the ego is not controlled one can misuse one’s spiritual powers. The ultimate aim in life should then be to kill the ego, which is what Krishna ultimately did.
Scientific awareness on personal hygiene and prevention from obesity among school going children, Mount ABU Public School
Make Sure
Situation: A female patient complained of lower abdominal pain, fever and had uterine tenderness on bimanual palpation.
Reaction: Oh my God! You should do cervical swabs and consider starting antibiotics.
Lesson: Make sure to remember that women with such symptoms may have endometritis, which requires prompt diagnosis. It may respond to doxycycline and metronidazole.
Dr Good Dr Bad
Situation: A female with past history of DVT needed an oral contraceptive prescription.
Dr. Bad: Start OC patch (transdermal).
Dr. Good: You cannot be on OC.
Lesson: There is a possibility of an increased risk of venous thromboembolism in oral contraceptive patch users.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Successfully trained 113241 people since 1st November 2012 in Hands-only CPR 10
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
Strep Throat: A growing concern amongst parents in India

Strep throat is an infection caused by the Streptococcus group of bacteria and it is very common among kids and teens. The symptoms of strep throat include fever, throat pain and red, swollen tonsils. Strep throat often causes acute rheumatic fever, a disease that causes inflammatory lesions in connective tissue, especially that of the heart, joints, blood vessels, and subcutaneous tissue. Given this scenario, timely intervention and diagnosis are essential.

Strep throat usually requires treatment with antibiotics. Due to its contagious nature, the usual recovery time has been a few days to a week often making children miss school and important course work. However, according to a recent study published in the journal Pediatric Infectious Disease, children treated with amoxicillin for strep throat may return to school the next day without putting other children at risk for contracting the illness. If amoxicillin as a single dose is ingested by 5 PM (at least 12 hours before arrival at school the following day), a return to school the next morning should be permitted for return to school after diagnosis of strep throat. The dose of amoxicillin is 50 mg/kg/day.

All children treated with amoxicillin for streptococcal pharyngitis, if afebrile and improved, should be permitted to attend school after 12 hours of the initial dose. This recent development and way of treatment is extremely helpful in a country like India where the incidence of the infection is very high. It is estimated that about 6-10/1000 children suffer from rheumatic fever in the country.

Speaking about the issue, Padma Shri Awardee Dr KK Aggarwal, President Heart Care Foundation of India & Honorary Secretary General IMA said, "Timely diagnosis and proper treatment of Strep throat is extremely important given that it is highly contagious and can lead to rheumatic heart disease in children. People often confuse the symptoms of strep throat with those of the common flu and cough. However, all parents must take their children to a doctor even at the slightest doubt. This new treatment measure is revolutionary and can go a long way in containing the infection and reducing the recovery period amongst school going children."

Strep throat is spread by person-to-person contact with fluids from the nose or saliva. It commonly spreads among family or household members. Symptoms appear about 2 to 5 days after coming in contact with the streptococcus bacterium. They may be mild or severe. Common symptoms include:
  • Fever that may begin suddenly and is often the highest on the second day
  • Chills
  • Red, sore throat that may have white patches
  • Pain when swallowing
  • Swollen, tender neck glands
We wish Our Editor-in- Chief A Very Healthy and Happy Birthday. Today is Janmashthmi and 5th September. He was born on Janmasthmi and hence was named Krishan Kumar.
eIMA News
Increasing maternity leave from 3 months to 8 months
Dr Marthanda Pillai
President, IMA

Dear Sir

You have rightly raised a very important issue of increasing maternity leave to women to eight months in the latest eMedinewS. It definitely affects the services in the hospital as women constitute majority of staff in the hospitals. I feel eight months is not needed for any woman after pregnancy. Even in USA there is only month of maternity leave as far as my knowledge goes. No one is against the rights of women but at the same time their services are also essential for society, the hospital services in particular. It is better if women are given choices who work in hospitals whether they want three months or eight months without pay as no hospital can afford to pay full salary for eight months without any work. It is better to represent to the central government with facts and figures of role of women in hospital services and the essentiality of their services routinely.

Thanking you
Yours sincerely

Dr JP Reddy
IMA Nilagiri Nalgonda, Telangana
  • Survival at 3 years among patients who underwent endovascular abdominal aortic aneurysm repair was superior to patients who had open surgery in a statewide, population-based study from California (JAMA Surgery).
  • New-onset seizures are more common in atrial fibrillation, possibly linked by silent strokes, an observational study suggested (ECS).
  • Prof V Reggie Edgerton, senior author and a UCLA distinguished professor of integrative biology and physiology, neurobiology, and colleagues from University of California-Los Angeles report how a man paralyzed from the waist down has been able to move his legs voluntarily with the help of a "robotic exoskeleton" (bionic suit) (Medical News Today).
  • Polymorphisms in vitamin D-binding protein appear to modify the relationship between serum vitamin D and food allergy in young children (Journal of Allergy and Clinical Immunology).
  • The BENEFIT trial showed that for established Chagas disease cardiomyopathy, treating the parasite doesn't improve long-term cardiovascular outcomes.
  • CDC: Heart age tops actual age in the United States. According to a study published online September 1 in the most recent issue of the Morbidity and Mortality Weekly Report, a new and simpler way to express a person's risk for a heart attack or stroke still shows the nation to be heart unhealthy on average, but this metric may provide more motivation for patients to adopt healthier lifestyles.
Out-of-hospital CPR should last for at least 35 minutes
Patients with an out-of-hospital cardiac arrest should have CPR administered for at least 35 minutes, according to a Japanese study presented at the European Society of Cardiology Congress in London. The study, conducted by researchers at the Kanazawa University Hospital in Kanazawa, included data of 17,238 adults who received CPR by EMS personnel in the field in 2011 and 2012.

The team analyzed the duration of pre-hospital CPR and two endpoints: one month survival and one month favorable neurological outcome after cardiac arrest. The team found that the probability of survival declined with each minute of CPR, but up to that point, positive results were possible. 99.1 per cent of all survivors and 99.2 per cent of survivors with favorable neurological outcomes achieved return of spontaneous circulation within 35 minutes of EMS-initiated CPR. No patient with a CPR duration of 53 minutes or more survived one month after cardiac arrest. "The decision regarding when to stop resuscitation efforts is one of the biggest challenges for emergency medical services (EMS) personnel or clinicians. However, the appropriate duration of CPR is not clear," said lead researcher Yoshikazu Goto. "More than 99 per cent of survivals and favorable neurological outcomes were achieved by 35 minutes with minimal gains afterwards. CPR leads to absolutely no benefit from 53 minutes onwards," Goto said. (European Society of Cardiology)
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Inspirational Story
Learn to Appreciate

Once upon a time, there was a man who was very helpful, kind-hearted, and generous. He was a man who will help someone without asking anything to pay him back. He will help someone because he wants to and he loves to. One day while walking into a dusty road, this man saw a purse, so he picked it up and noticed that the purse was empty. Suddenly a woman with a policeman shows up and gets him arrested.

The woman kept on asking where did he hide her money but the man replied, “It was empty when I found it, Mam.” The woman yelled at him, “Please give it back, it’s for my son’s school fees.” The man noticed that the woman really felt sad, so he handed all his money. He could say that the woman was a single mother. The man said, “Take these, sorry for the inconvenience.” The woman left and policeman held the man for further questioning.

The woman was very happy but when she counted her money later on, it was doubled, she was shocked. One day while woman was going to pay her son’s school fees towards the school, she noticed that some skinny man was walking behind her. She thought that he may rob her, so she approached a policeman standing nearby. He was the same policeman, who she took along to inquire about her purse. The woman told him about the man following her, but suddenly they saw that man collapsing. They ran at him, and saw that he was the same man whom they arrested few days back for stealing a purse.

He looked very weak and woman was confused. The policeman said to the woman, “He didn’t return your money, he gave you his money that day. He wasn’t the thief but hearing about you son’s school fees, he felt sad and gave you his money.” Later, they helped man stand up, and man told the woman, “Please go ahead and pay your son’s school fees, I saw you and followed you to be sure that no one steals your son’s school fees.” The woman was speechless.

Moral: Life gives you strange experiences, sometime it shocks you and sometimes it may surprise you. We end up making wrong judgments or mistakes in our anger, desperation and frustration. However, when you get a second chance, correct your mistakes and return the favor. Be kind and generous. Learn to appreciate what you are given.
Quote of the Day
This is my simple religion. There is no need for temples; no need for complicated philosophy. Our own brain, our own heart is our temple; the philosophy is kindness. Dalai Lama
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Reader Response
  • Dear Sir, I am of view that maternity leave should be for nine months; last 3 months of pregnancy and 6 months thereafter. This will help mothers to feed their child for 6 months which is also a world-wide recommendation. Whether they are fully paid or not can be a matter of discussion to compensate for the time women are on maternity leave. Contractual arrangements can be done for short periods to meet the work demands. With kind regards: Dr Ashutosh Aggarwal, MD
  • Six month leave should be mandatory! Depending upon the child's status that can be extended to further three months but definitely without pay and leave to be considered as service! If men folk are involved then we have to give 'maternity' leave for medical men when their spouses give birth. This is my opinion! Dr S Kannan Meenakshisundaram, Villupuram.
  • Dear friends, I fear increasing maternity leave to 8 months will do more harm than good to the Nation. It is similar to providing free items. A better suggestion are to provide breaks and provide rooms for expressing breast milk/Creche etc. Muthuswami A.
Wellness Blog
Treatment of mild hypertension in low–risk patients

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 6 meters in less than 8 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).

  1. Diao D, Wright JM, Cundiff DK, et al. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;8:CD006742.
  2. Odden MC, Peralta CA, Haan MN, et al. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012;172:1162.
eIMA Quiz
Do women have more headaches than men?

A. No, they get equal numbers.
B. Yes, but not that many more.
C. Yes, and the headaches are more severe.
D. Yes, but men tend to get more painful kinds that last longer.
E. None of the above.

Yesterday’s Mind Teaser: What percentage of your diet should fat make up?

A. About 10 percent of your daily calories.
B. About 20 percent of your daily calories.
C. About 30 percent of your daily calories.
D. About 40 percent of your daily calories. E. There is no recommended amount of fat; you should strive to eat as little of it as possible.

Answer for Yesterday’s Mind Teaser: C. About 30 percent of your daily calories.

Answers received from: Dr Avtar Krishan, Daivadheenam Jella, Dr G Madhusudhan, VK Ramadesikan, Dr Ridu Kumar Sharma, Dr Bitaan Sen, Dr Jayashree Sen, Dr Poonam Chablani, Dr Raghvendra Chakurkar.

Answer for 3rd September Mind Teaser: c) It is related to duration of ulcerative colitis.

Correct Answers received from: Dr K Raju, Dr Poonam Chablani, Dr Shangarpawar, Dr Azhar Almas, Dr KV Sarma, Dr G Madhusudhan, Dr BR Bhatnagar, Daivadheenam Jella, Dr Raghvendra Chakurkar, Dr Avtar Krishan.
IMA Humor
Computer Gender

Why computers should be considered masculine
  • In order to get their attention, you have to turn them on.
  • They have a lot of data but are still clueless.
  • They are supposed to help you solve your problems, but half the time they ARE the problem.
  • As soon as you commit to one, you realize that, if you had waited a little longer, you could have had a better model.
Why computers should be considered feminine
  • No one but their creator understands their internal logic.
  • The native language they use to communicate with other computers is incomprehensible to everyone else.
  • Even your smallest mistakes are stored in long–term memory for later retrieval.
  • As soon as you make a commitment to one, you find yourself spending half your paycheck on accessories for it.
Rabies News (Dr A K Gupta)
A patient received two doses of modern vaccine (on days 0 and 3) and the dog was well on days 5 and 7 (third injection due, but not given). However, the dog dies on any day between 8 and 15. What should be done?

In case, day 0 and 3 injections were given and the dose due on day 7 was postponed because the dog was kept under observation but the dog dies between 8 and 15 days, three doses of vaccine must be given as close to the original dates of the schedule and all five injections must be completed by day 28.
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