Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-Mail: drkk@ijcp.com, Website: www.ijcpgroup.com
emedinews is now available online on www.emedinews.in or www.emedinews.org
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


Dear Colleague

18th March 2010, Thursday

Preoperative evaluation of healthy patients

The preoperative evaluation of a healthy patient should include

  1. A screening questionnaire

  2. A history of exercise tolerance

  3. Recording Blood pressure and pulse

  4. History and physical examination, if one of the above is abnormal, in patients over 60 years, or in those undergoing major surgery

  5. Pregnancy test for women who may be pregnant

  6. Hemoglobin (Hb) and packed cell volume (PCV) if expected major blood loss and for patients 65 years or older undergoing major surgery

  7. Serum creatinine if major surgery, hypotension is expected, nephrotoxic drugs will be used, or the patient is above age 50

  8. Routine ECG has a low likelihood of changing perioperative management in the absence of known cardiac disease. Nevertheless, detecting a recent MI is important since it is associated with high surgical morbidity and mortality. ECG should be done.

    A In men older than 45 years and Women older than 55 years

    B. In patients with known cardiac disease

    C. When clinical evaluation suggest a cardiac disease

    D. In patients at risk for electrolyte abnormalities, such as diuretic use

    E. Presence of systemic disease associated with possible unrecognized heart disease, such as diabetes mellitus or hypertension

    F. in patients undergoing major surgical procedures.

  9. Chest x–ray for patients over 50 years undergoing major surgery, or those with suspected cardiac or pulmonary disease (if done in last six months, no need to repeat)

  10. Other specific tests only if the clinical evaluation suggests a likelihood of disease.

    Preoperative patient questionnaire


Do you feel unwell?

  1. Have you ever had any serious illnesses in the past?

  2. Do you get any more short of breath on exertion than other people of your age?

  3. Do you have cough?

  4. Do you wheeze?

  5. Do you get any chest pain on exertion?

  6. Do you have any ankle swelling?
  7. Have you taken any medicinal drug in the last three months (including excess alcohol)?

  8. Do you suffer from any allergies?

  9. Have you ben given any anesthetic in the last two months?

  10. Have you or your relatives had any problems with a previous anesthetic?

  11. What is the date of your last menstrual period?
    (Wilson, ME, Williams, MB, Baskett, PJ, et al, Br Med J 1980;1:509 )

Dr KK Aggarwal
Chief Editor

News and Views

Diagnostic Yield of Elective Coronary Angiography Low

Nearly two–thirds of those who undergo cardiac catheterization when they do not have diagnosed heart disease receive a clean report, suggesting that the expensive procedure, which exposes the patient to substantial amounts of radiation, may be overused, according to a study published in the New England Journal of Medicine. Investigators studied more than two million people who underwent cardiac catheterization. The investigators suggested doctors should be less willing to order an angiogram for symptom-free patients, a group that made up 30 percent of the study sample.

High Fat, Meat Consumption Associated With Elevated Diabetes Risk

As per a study in Diabetes Care, foods high in meat and fat confer an increased risk for diabetes in all ethnic groups, whereas the effects of other dietary patterns vary by gender and ethnicity. After following 29,759 Caucasians, 35,244 Japanese Americans, and 10,509 Native Hawaiians ages 45 to 75 for 14 years and examining their diets, researchers found that high fat and meat consumption was associated with elevated diabetes risk among all ethnic groups in men, and also, albeit to a lesser degree, in women.

FDA Adds Boxed Warning To WinRho SDF

FDA, a boxed warning has been added to WinRho SDF (Rho(D) immune globulin intravenous), a drug used to treat immune thrombocytopenic purpura or ITP. The warning says that cases of intravascular hemolysis have been seen in patients being treated with WinRho SDF, and some cases have been fatal. The warning also states that patients should be closely monitored for at least eight hours after WinRho SDF is administered to look for signs of intravascular hemolysis.

FDA announces review of ACCORD data

FDA will conduct a full review of findings from a study which concluded that neither aggressive lipid–lowering therapy nor tight blood pressure control reduced cardiovascular events in persons with diabetes.The ACCORD study investigated the addition of fenofibrate to statin therapy. It was this add–on therapy that appears to have triggered the FDA review. The addition of fenofibrate did not reduce cardiovascular events, the study found, although there was a non–significant trend toward a benefit in a subset of patients.

Uteroglobin test may identify asthma patients unresponsive to steroids

Asthma patients who will be unlikely to gain control of symptoms with inhaled corticosteroids might be identified with a blood test. A plasma protein called uteroglobin appeared elevated enough in patients unresponsive to inhaled corticosteroids that a blood test might be feasible. Such patients can be treated with other contrller drugs like montelukast. The study was presented at the American Academy of Allergy, Asthma & Immunology annual meeting.

Anti HIV drug effective in AIDS

An analogue of an anti–AIDS drug might prove effective in protecting against bouts of emphysema or chronic obstructive pulmonary disease. The drug, UK–484900 mitigates the role of interleukin–13, a factor in the cascade of molecular events that produces airway hyper–responsiveness. It blocks the impact of IL–13 in a mouse model of emphysema and CPOD, researchers believe that it might UK–484900 might be useful in human disease, Dr Robert Townley, of Creighton University in Omaha reported at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

Urine Test may predict prostate biopsy results

According to a study presented at the 2010 Genitourinary Cancer Symposium (GUCS) in San Francisco, California, PCA3 (prostate cancer gene 3) assay may foretell whether a prostate biopsy would reveal malignancy. The assay measures the PCA3 gene, which is overexpressed in prostate cancer. The study found that men who had higher PCA3 scores were more likely to have a positive biopsy result and thus prostate cancer. Higher PCA3 scores were associated with a higher biopsy Gleason score of more than 7. The PCA3 assay is approved in Europe and marketed as Progensa, but is not FDA approved yet. It is useful in guiding biopsy decisions in men who have raised PSA levels but who also have one or more prior negative biopsy results, despite the PSA results. (2010 Genitourinary Cancers Symposium (GUCS): Abstract 5. Presented March 5, 2010)

New Indian treatment for COPD

OCID 2987 is a selective phosphodiesterase 4 inhibitor with good safety window and represents a novel inhibitor to treat COPD and asthma, said Shridhar Narayanan, PharmD, senior vice president–biology at Orchid Research Laboratories in Chennai. In his poster presentation at the annual meeting of the American Academy of Allergy, Asthma & Immunology, Narayanan said that OCID 2987 is currently in regulatory toxicology studies.

Conference Calendar

Difficult Airway Management (DAM) (Target Audience – Doctors only)
Date: March 22, 2010
Venue: V Block, No: 70 (Old No: 89) Fifth Avenue Anna Nagar, Chennai, Tamil Nadu.

What’s New

Preoperative management

A randomized trial in patients undergoing elective vascular surgery found that fluvastatin (initiated at least 30 days before surgery) decreased myocardial ischemic events.
(Schouten O, Boersma E, Hoeks SE, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009;361:980.)

Cancer Alert

Unhealthy drinking screening

A single question, "How many times in the past year have you had [5 for men, 4 for women ] or more drinks in a day?", had moderately good sensitivity and specificity for screening primary care patients for unhealthy drinking. Screening is considered positive for the response ‘at least once’. [Smith PC, Schmidt SM, Allensworth–Davies D, et al. Primary care validation of a single–question alcohol screening test. J Gen intern Med 2009;24:783. ]

Quote of the Day

When we talk to God, we’re praying. When God talks to us, we’re schizophrenic. (Jane Wagner)

Diabetes Fact

Higher doses of vildagliptin (50 or 100 mg daily) are associated with significant reductions in A1C compared with placebo.

Public Forum (Press Release)

Living environment, the most important influence on health

Environment influences the health outcome of a family said Dr. K K Aggarwal, President, Heart Care Foundation of India and Editor eMedinewS.

  1. The noise levels of the area one lives determine the blood pressure and the anxiety levels. People living near the main roads or the airport have higher blood pressures.

  2. The air pollution levels decide the age of the lungs.

  3. The company of the people one lives with has been described as the most important factor in Vedic literature. The so–called ‘satsang’ decides one’s behavior and culture.

  4. As per a study at the Ohio State University published in Urban Studies looking at the data on 8,782 people in 373 Chicago neighborhoods, the neighborhood had a major influence on how much exercise one does. The researchers found that people who live in neighborhoods with higher levels of poverty lower levels of education, and more families headed by women were less likely than others to exercise. Neighborhood–related factors that influenced exercise levels included: amount of trust among neighbors, perceived violence in the community and beliefs that neighbors help each other. The study also found that neighborhood was more important for women than men in determining exercise levels. Neighborhood characteristics were more important than a person’s income in determining exercise levels.

Question of the day (Dr G M Singh)

Does heart rate affect blood pressure?

Q. When doctors interpret a blood pressure reading, should they also consider the heart rate?

I am a 78–year–old man and have had high blood pressure (under control) for more than 40 years. I frequently monitor my blood pressure at home, resting for five minutes before I take the reading. My blood pressure is often higher when my heart rate is close to its usual resting rate (about 50 beats per minute) and lower when my heart is beating faster than that. Can the body’s demands that cause higher blood pressure be partially satisfied by a faster heart rate?

A. Knowing that your blood pressure at home is under consistent control is more important than getting isolated readings at the doctor’s office. You are also resting before taking the reading, and this is important to avoid spuriously high readings that happen when someone rushes around, and then sits down quickly to take a blood pressure reading.

Heart rate and blood pressure are intimately related. Nerves and hormones constantly monitor and balance the heart rate and blood pressure. It is true that an isolated increase in blood pressure can drop the heart rate a little. But the reflexes that control blood pressure and heart rate are not simple. Sometimes, both heart rate and blood pressure can fall simultaneously, as happens with a typical fainting episode. Often, both heart rate and blood pressure rise together, such as when you exercise, get angry, or have an overactive thyroid.

Note your heart rate along with blood pressure, and take that information to your doctor every time you see him or her. Heart rate trends can provide useful data on your cardiovascular health. A consistently low heart rate, can indicate that some medicines might not be good for you. A consistently high heart rate can suggest that the thyroid be checked. (Source: Dr Richard Lee, Associate Editor, Harvard Heart Letter)

eMedinewS Try this it Works

Mnemonic check list for diabetes

S ight (annual eye examination)
U rine albumin
G lycosylated hemoglobin
A therosclerosis (aspirin and lipids; palpate arteries)
R educe weight (diet and exercise) and Remove footwear (monofilament testing; foot examination)

Dr Good Dr Bad

Situation: A diabetic came for an Echo test.
Dr Bad: Get 2D Echo done.
Dr Good: Get 2D tissue Doppler Echo done for diastolic functions of the heart.
Lesson: Diabetes mellitus affects the systolic and diastolic functions of the left ventricle (LV). There may be some limitations associated with the use of parameters of LV systolic function, such as ejection fraction or fractional shortening, in assessing the contractile properties of the LV. IMP is increased in asymptomatic, normotensive patients with DM despite normal LV ejection fraction. An increased IMP may be an early sign of diabetic cardiomyopathy in asymptomatic diabetic patients without hypertension. (J Diabetes 2009;1:50–6.)

Make Sure

Situation: A 20–Year–old girl suffering from dysmenorrhea wanted an analgesic for her pain.
Action: Give her Nimesulide
Make sure to remember that nimesulide is as effective as other analgesics in combating pain in gynecological conditions.

Medi Finance Indirect Tax


  • Complete liberalization of pricing and payment of technology transfer fee and trademark, brand name and royalty payments.

  • External Commercial Borrowings to be available for cold storage or cold room facility, including for farm level pre–cooling, for preservation or storage of agricultural and allied produce, marine products and meat.
Punjab & Sind Bank
Central Bank of India

Laughter the best medicine

Actual medical record

On the second day the knee was better and on the third day it had completely disappeared. .

Formulae in Critical Care

Corrected CSF white blood count
Formula: Subtract 1 WBC for every 1,000 RBCs

Milestones in Orthopedics

David L. MacIntosh, a renowned name in spots medicine, pioneered the first successful surgery for the management of the torn anterior cruciate ligament (ACL) of the knee. This common and serious injury in skiers, field athletes, and dancers invariably brought an end to their athletics due to permanent joint instability. Working with injured football players, Dr MacIntosh devised a way to re–route viable ligament from adjacent structures to preserve the strong and complex mechanics of the knee joint and restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.

Mistakes in Clinical Practice

QOD (every other day) Mistaken for QID and QD Write "every other day".

Lab test (Dr Navin Dang)

To monitor treatment for ovarian cancer or to detect recurrence, the blood test recommended is CA – 125. Other related tumor markers are BRCA – 1 and BRCA –2

SMS of the Day (Dr Ingole)

"Root cause of suffering in this world is attachment!"

List of Approved drug from 1.01.2009 to 31.10.2009

Drug Name


Approval Date

Imidacloprid 10% + Moxidectin 1.0% & 2.5% Topical solution (Veterinary) Each pippette contains: (a) 0.4ml, 1.0ml, 2.5ml, 4ml of 10% Imidacloprid and 1.0% moxidectin (b) 0.4ml, 0.8ml of 10% Imidacloprid and 2.5% moxidectin

For the treatment and prevention of flea infestations, prevention of heartworm disease and treatment of infections with gastrointestinal nematodes in dogs and cats.


(Advertorial section)


Zen Immune Power – a known immunity booster with ability to help reduce absorption of aluminum from the GI tract and enhance excretion through kidneys and is a key to eliminate aluminum toxicity and the related systemic involvement.

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 or emedinews@gmail.com

eMedinewS–PadmaCon 2010 

Will be organized at Maulana Azad Medical College, New Delhi on July 4, 2010, Sunday to commemorate Doctors’ Day. The speakers, chairpersons and panelists will be doctors from NCR, who have been past and present Padma awardees.

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.

NATIONAL SEMINAR ON STRESS PREVENTION (17–18 April). Over 400 registrations already done.

A Stress Prevention Residential Seminar cum spiritual retreat with Dr KK Aggarwal and Experts from Brahma Kumaris will be organized from April 17–18, 2010.

Co–organizers: eMedinews, Brahma Kumaris, Heart Care Foundation of India, IMA New Delhi Branch and IMA Janak Puri Branch, IMSA (Delhi Chapter)

Venue: Om Shanti Retreat Centre, National Highway 8, Bilaspur Chowk, Pataudi Road, Near Manesar.

Timings: On Saturday 17th April (2 pm onwards) and Sunday 18th April (7 am–4 pm). There will be no registration charges, limited rooms, kindly book in advance; stay and food (satvik) will be provided. Voluntary contributions welcome. For booking e–mail and SMS to Dr KK Aggarwal: 9811090206, emedinews@gmail.com BK Sapna: 9811796962, bksapna@hotmail.com

Also, if you like emedinews you can FORWARD it to your colleagues and friends. Please send us a copy of your forwards


Heart Care Foundation of India
Jointly with

eMedinewS, World Fellowship of Religions, Delhi Medical Council,
Delhi Medical Association,
IMSA (Delhi chapter) and MAMC takes pleasure to cordially invite you to

A lecture by
World renowned Dr Sanjiv Chopra, M.D., MACP
Faculty Dean for CME, Medical School, Harvard Boston, USA
"Leadership for the 21st Century –Ten Tenets of Leadership"
Saturday March 20, 2010

MAMC Auditorium, Maulana Azad Medical College, Delhi Gate.

Dr KK Aggarwal
Padma Shri Awardee 2010

Dr Sanjiv Chopra is Professor of Medicine and Faculty Dean for Continuing Medical Education at Harvard Medical School, and Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston, Massachusetts. He has four books to his credit. His books have been translated into several languages including Portuguese, Japanese, Italian and Czech. He has given a number of Keynote addresses on the topic of Leadership – "Leadership for the 21st Century: The Ten Tenets of Leadership" to wide acclaim in the United States and several countries abroad

Learning Objectives

  • Discuss the qualities of great leaders.
  • Elucidate that often the spark of leadership arises from a negative and somewhat jolting personal experience.
  • Emphasize that we can all lead and can do so at many different levels
  • Explore what made or makes many leaders – historical and contemporary – so effective.

Entry Free by prior registration only
For registration call; 9810301261, 9971994518
e-mail: drkk@ijcp.com, drkakroo@gmail.com

Readers Responses

  1. Resp Aggarwal sir, Congratulations on being selected as chairman of IMSA. I would very much like to know more about it and to get actively involved with its activities: Dr Ravi Wankhedkar, Consulting Surgeon & Coloproctologist, Member–Maharashtra Medical Council, Chairman–IMA AMS Maharashtra, Chairman–IMA Rural Health Comt, Maharashtra, Hon Asso Prof of Surgery, SBH Govt Med College, Dhule

  2. Dear Dr.KK.Aggarwal sir, let this new Ugadi brings auspicious blessings on you and your emedinews family. "ohm swasti r bhavatu; shanti r bhavatu; poornam bhavatu; mangalam bhavatu; ohm sarvae janaa ssukhino bhavantu":Dr. C. Srivivasa Raju, National Joint Secretary – Sri Sidhardh E.N.T.Hospital, Eluru