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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; 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

For updates follow at www.twitter.com/DrKKAggarwal     www.facebook.com/Dr KKAggarwal

    Health Videos …

eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

25th February 2013, Monday

Doctors discriminated in UK?

Case 1: If an Indian doctor does it

An Indian doctor Dr Bala Kovvali, was jailed in UK for 2 1/2 years for failure to send a 42-year-old seriously ill diabetic man with ketoacidosis (DKA) to hospital hours before he died. He misdiagnosed him as ‘depressed with a headache'. As per the complaint the patient Mr. Fellows became thirsty in the week before he died.

He was charged with failing to carry out adequate clinical assessment, not sending him to ER in time and missing the diagnosis of DKA. The patient was non diabetic but suffered from anxiety and depression. He gave history of excessive thirst.

Case 2: If a UK doctor does it

The case regards to several years ago a UK senior anesthetist. During a surgery of a boy for pyloric stenosis, the surgeon asked the anesthetist to inject air into the NG tube to check the integrity of the incision. The anesthetist injected air into the IV cannula instead repeatedly (a total of 40 ml of air!) The child died of air embolism. The only punishment he had was GMC warning. He was back to work within few months of the incident.

View: Both situations ended up with the patients’ death. In the first case, the doctor was jailed, while in the second, only a warning was given. Just because one is an Indian and the other is a UK doctor. In fact the case in the Indian doctor was an error of Judgment. But, the UK case was of reckless negligence. Injecting air in the IV line comes under “never events”.

The issue is based on the material provided by Dr Vivek Chhabra from UK.

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA (blog.kkaggarwal.com)

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    Constipation Update

What is the role of endoscopy in constipation?

Colonoscopy can identify lesions that narrow or occlude the bowel. Colonoscopy is preferable in constipated patients with anemia, rectal bleeding, hemoccult positive stools, obstructive symptoms, recent onset of constipation, weight loss, a change in stool caliber, or rectal prolapse because of the ability to visualize the entire colon.

Dr K K Aggarwal
  eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal on

An orange a day keeps stroke away

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    Photo Feature (from the HCFI Photo Gallery)

HCFI in association with East Delhi Morning Walkers Association organized a health checkup camp on 17th Feb 2013

Dr K K Aggarwal
    National News

436 killed in clinical trials last year

NEW DELHI: As many as 436 people died last year due to serious adverse events (SAE) during clinical trials. Investigations are now on to ascertain how many of the deaths were caused by drugs administered to the trial subjects. Union health minister Ghulam Nabi Azad said on Friday that deaths could be due to life-threatening diseases such as cancer, heart failure and stroke or side-effects of the drugs or their administration to critically or terminally-ill patients. "Such deaths are investigated to arrive at the causal relationship, if any," Azad said in parliament. In 2011, 438 cases of SAE were reported, of which 16 were found to be due to clinical trials. The previous year, 668 cases of SAE were reported, of which 22 were caused due to trials. The union health ministry says there were alleged irregularities in nine cases of clinical trials during the last three years. According to the ministry report, tribal persons were included in one case of phase IV trial of Human Papilloma Virus (HPV) vaccine, granted to an NGO, on April 22, 2009, to conduct trials in Khammam district, Andhra Pradesh and Vadodara district, Gujarat. (Source: TOI, Feb 23, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)


All about child sexual abuse

  1. Sexual abuse occurs primarily in preadolescent children.
  2. It’s more often in girls.
  3. Perpetrators are usually males.
  4. They are known to the victims.
  5. Most of the complaints that are possible indicators of sexual abuse are nonspecific.

For comments and archives

    Valvular Heart Disease Update

What are the most common causes of significant mitral regurgitation in the elderly?

The causes are mitral valve prolapse and ischemic heart disease.

Surgery for severe chronic mitral regurgitation is recommended for young asymptomatic patients with early evidence of left ventricular dysfunction but the same is not indicated in patients over age 80 to proceed with surgery unless symptomatic.

(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)

    From the Desk of Vice President (Elect) IMA (Dr KK Aggarwal)

Left ventricular systolic dysfunction in prosthetic heart valves

Patients with prosthetic heart valves may develop left ventricular systolic dysfunction with or without heart failure.

  • Preoperative left ventricular dysfunction that persists or partially improves
  • Perioperative myocardial infarction
  • Progression of other valve disease
  • Complications of the prosthetic valve
  • An unrelated disorder such as coronary heart disease or hypertension

Prosthetic endocarditis

Infective endocarditis and other infections such as valve abscess can occur with prosthetic valves. Transesophageal echocardiography is superior to standard transthoracic echocardiography for the detection of valvular vegetation, ring abscesses, and other complications, particularly with mitral prostheses.

Systemic embolization in prosthetic valve

  • Systemic embolization can result from valve thrombosis (even when nonobstructed), vegetations, or left atrial thrombus, particularly in patients with atrial fibrillation.
  • Transesophageal echocardiography is preferred method for evaluation.
  • The frequency of systemic embolization is 0.7 to 1.0 percent per patient-year in patients with mechanical valves who are treated with warfarin.
  • In comparison, the risk is 2.2 percent per patient-year with aspirin and 4.0 percent with no anticoagulation; patients with mitral valve prostheses are at twice the risk of those with aortic valve prostheses.

Prosthetic valve obstruction

  • When, in a newly symptomatic patient, there is an unexpected rise in transprosthetic gradient from a baseline determination or from established normal values for valves of that type and size, the possibility of critical obstruction should be considered.
  • Causes of obstruction include thrombus, pannus, and vegetation. The clinical manifestations include dyspnea, heart failure, and, with thrombus formation, systemic embolization.

Prosthetic valve thrombosis

Prosthetic valve thrombosis which can lead to valvular obstruction, occurs with equal frequency in patients with bioprosthetic valves and in those with mechanical valves who are treated with anticoagulants. The reported annual incidence of PVT ranges from 0.03 to 5.7 percent; higher rates are observed in patients with mitral prostheses (in some reports) and/or subtherapeutic anticoagulation.

For comments and archives

    International News

(Contributed by Dr Monica and Brahm Vasudev)

Bad air may worsen post-MI outcomes

Greater exposure to air pollution may increase the risk of dying among patients recovering after an MI, researchers found. (Source: Medpage Today)

Physicians who dress the part inspire confidence

When it comes to inspiring the confidence of the family members of intensive care patients, clothes, it seems, make the clinician. First impressions are particularly important in the intensive care unit (ICU), where physicians rarely are able to establish long-term relationships with patients and their families, Selena Au, MD, from the University of Calgary and Alberta Health Services-Calgary Zone, Canada, and coauthors write in an article published online February 18 in JAMA Internal Medicine. (Source: Medscape)

Carbapenem-resistant Enterobacteriaceae: new precautions

Citing increased reports of carbapenem-resistant Enterobacteriaceae (CRE), the Centers for Disease Control and Prevention (CDC) has expanded guidelines aimed at preventing the spread of these difficult-to-treat, multidrug-resistant organisms. The guidelines were made available via a CDC Heath Advisory published online February 14, 2013. (Source: Medscape)

Hydroxyethyl starch for blood volume linked to renal failure

Intravenous use of hydroxyethyl starch to increase blood volume and revive critically ill patients is not only not associated with decreased mortality but, when questionable research is excluded from review, is associated with a significant increase in risk for death and acute kidney injury, according to a study published in the February 20 issue of JAMA. (Source: Medscape)

Telomere length linked to common cold risk

Among healthy adults, shorter T-cell telomere length is associated with an increased risk of developing an upper respiratory infection after exposure to rhinovirus, according to results from a study published in the February 20 issue of JAMA. (Source: Medscape)

  Twitter of the Day

@DrKKAggarwal: Today's Health Question Does memory impairment means onset of (cont) http://tl.gd/l4gtj6

@DrKKAggarwal: To live in joy allow experience to flow through you with loving awareness and without clinging or aversion.

    Spiritual Update

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

Persist in your efforts and you will be successful

All success stories are stories of great failures. The only difference is that every time they failed, they bounced back. This is called failing forward, rather than backward. You learn and move forward. Learn from your failure and keep moving.

The third avtara of Vishnu, the boar, signifies the same. The answer is persistence in your objectives.

For comments and archives

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

What are the side effects of using gonadotropins?

  • Ectopic (tubal) pregnancies. While ectopic pregnancies occur in 1-2% of spontaneous pregnancies in the general population, in gonadotropin cycles the rate is slightly increased. Ectopic pregnancies can be treated with medications or surgery.
  • Adnexal torsion (ovarian twisting). In less than 1% of gonadotropin cycles, the stimulated ovary can twist on itself, cutting off its own blood supply. Surgery is required to untwist or remove the ovary.
  • Adverse pregnancy outcomes. Although the vast majority of pregnancies are entirely normal, recent studies suggest the possibility that complications during pregnancy may be increased slightly. Pregnancy-associated hypertension and abruption of the placenta may be increased.
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Rational use of blood


Blood components are various parts of blood like red blood cells, platelets, granulocytes and plasma separated from one another by conventional blood bank method of centrifugation because of their different specific gravities.

Cellular components

  • Red blood cells (RBC) or packed red cells (PCV)
  • Leukocyte depleted red cells
  • Platelet concentrate
  • Platelet apheresis
  • Leukocyte depleted platelet concentrate
  • Lekocyte apheresis

Plasma components

  • Fresh frozen plasma
  • Cryoprecipitate
  • Cryo-poor plasma

For comments and archives

    An Inspirational Story

No one will ever know

Karen, Judy and I were the last ones back in the school room after lunch. We put our metal lunch boxes on the shelf above the coat hooks, which were mostly empty. All of the other sixth graders were already outside, playing marbles or hop scotch or jumping rope, since it was a pleasant spring day.

"Look what I found this morning in the storage cupboard when I was getting out some art supplies for Mrs. Eiffler."
With a conspiratorial grin on her face, Karen held up a wooden box filled with short pieces of chalk in every color of the rainbow.

"Wow! What fun it would be to write on the chalkboard while everyone is outside." Judy's eyes twinkled with anticipation.

"But Mrs. Eiffler doesn't want us writing on the chalkboard," I responded, already feeling guilty, although we had not yet done a thing.

"Don't be such a 'fraidy cat', Janet. No one will ever know," said Karen, reaching into the box and drawing out a piece of chalk.
"Right. Everyone is outside, so we're safe. No one will tell on us." Judy was already drawing a house with sure strokes.

I reluctantly joined my friends in the artwork, wanting to be part of what was going on, but afraid of being caught. I knew well that we were breaking not one, but two class rules. The second rule was that no one was allowed to stay inside at noon without a written excuse from home if the weather was nice.

Trying various colors, we drew houses, trees and three-dimensional boxes. It was fun! All the time we were watching the clock, knowing that our fun would be over if anyone walked into the room.

Then Judy had an idea. "We're all right-handed. Let's see who can write their name best using their left hand."

Judy and Karen picked up their chalk and started writing. I chose a white piece from the box and wrote my name. The handwriting was a bit shaky, but no one would doubt that it said "Janet."

"I think Judy is the winner," said Karen. "Hers is the best."

"We'd better get this board cleaned off before Mrs. Eiffler comes back," said Judy, eying the clock. She picked up an eraser and began erasing our handiwork from the board.

Everything came off . . . but my name!

In disbelief, I looked at the chalk I held in my sweaty hand. On closer examination, it wasn't chalk at all. I had picked up a small piece of white color crayon which was mixed in with the pieces of chalk.

My stomach churned and my knees felt weak. What would Mrs. Eiffler do to me?

My mother had a saying: "Fools names and fools faces always appear in public places." I never understood fully what it meant before. Now I did! I was a fool, and there was my name in crayon to prove it. And the teacher would be returning soon.

"Quick, let's get some wet paper towels," said Judy, springing into action. After vigorous rubbing, my name still remained.

"I think I saw a can of cleanser by the sink in the coat room," I said as I raced to find it. Precious minutes were ticking away.

We rubbed and my name came off all right, but in the process of removing it, we left an abrasion on the chalkboard.
Listening for footsteps coming down the hall, we dried the scrubbed area as much as we could with more paper towels and fanned it with a book to remove every tell-tale trace of wetness.

We were just slipping into our desks as the bell rang and the other students began entering the room. The teacher walked in soon afterward.

Mrs. Eiffler never asked about abrasion and maybe never noticed it. But I did. Every time I walked past the marred surface of the chalkboard, I remembered. Oh, how I remembered.

The lesson I learned that day is one I never forgot, even though over forty years have passed since the event. "No one will ever know" is never true. Even if no one else found out, Jesus knew and I knew. Sometimes living with a guilty conscience is punishment enough.

For comments and archives

  Cardiology eMedinewS

Diabetes and Increased Risk of Heart Attack Death Linked Read More

Dabigatran noninferior to warfarin for extended VTE therapy: RE-MEDY published Read More

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ACIP strengthens pneumococcal vaccine guidance Read More

FDA warns about codeine following tonsillectomy Read More

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    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 rabies be transmitted to the doctor/assistants conducting postmortem of a person died of rabies?

As per Centre for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR), no confirmed case of rabies has ever been reported in persons who performed a postmortem examination of people or animals, although contact with decedents with confirmed or suspected rabies can cause anxiety. Even from living patients with rabies, human-to-human transmission has been documented only rarely (in cases of organ or tissue transplantation).

Both CDC and the World Health Organization (WHO) have stated that the infection risk to health-care personnel from human rabies patients is no greater than from patients with other viral or bacterial infections. In addition, rabies post-exposure prophylaxis (PEP) is available for exposed personnel. Nevertheless, because of the nearly universal fatal outcome from rabies, both CDC and WHO recommend that all personnel working with rabies patients or decedents adhere to recommended precautions. Even the minimal risk for rabies virus transmission at autopsy can be reduced by using careful dissection techniques and appropriate personal protective equipment, including an N95 or higher respirator, full face shield, goggles, gloves, complete body coverage by protective wear, and heavy or chain mail gloves to help prevent cuts or sticks from sharp instruments or bone fragments.

Participation in the autopsy should be limited to persons directly involved in the procedure and collection of specimens. Previous vaccination against rabies is not required for persons performing such autopsies. PEP of autopsy personnel is recommended only if contamination of a wound or mucous membrane with patient saliva or other potentially infectious material (e.g., neural tissue) occurs during the procedure.

    IJCP Special

Dr Good Dr Bad

Situation: A patient with fever and joint pain came with rash.
Dr Bad: It’s a drug allergy.
Dr Good: This looks like Chikungunya.
Lesson: Rash is present in 30% of cases with Chikungunya.

Make Sure

Situation: A patient with dengue fever developed shock.
Reaction: Oh my God! Why was the blood pressure 90/80 ignored?
Lesson: Make sure that a pulse pressure of less than 20 is not ignored; it is an impending sign that the patient is going into shock.

  Quote of the Day (Dr GM Singh)

Flattery is telling the other person precisely what he thinks about himself. Dale Carnegie

    Legal Question of the Day ((Ex)Prof. M C Gupta, Advocate & Medico-legal Consultant)

Q. A patient comes to a doctor and says he has ingested 40 tablets of diazepam. The doctor suggests gastric lavage. The patient refuses and also asks the doctor not to perform the procedure even if he becomes unconscious. What should the doctor do?


  1. The patient has obviously committed a crime (attempted suicide). The doctor knows he can be saved. If he does nothing and the patient dies, the doctor can be sued.
  2. The doctor should immediately inform the police and ask them to come immediately and should seek their advice what to do in the circumstances. He should also inform his relatives etc. telephonically, if possible.
  3. The fact that the person has come to a doctor shows implied consent for treatment.
  4. As a matter of fact, the patient here can be assumed of not being in his full senses and hence his refusal of treatment does not have much value and cannot be taken as a valid, voluntary and conscious refusal of consent. The doctor can commence treatment with reasonable force.
  5. In view of the above, consent can be obtained under the doctrine of parens patriae; 1-2 more persons (besides the doctor himself), such as another accompanying person, staff or some other adult, may act as parens patriae.
  6. The doctrine of parens patriae [Latin, Parent of the country] is a doctrine that grants the inherent power and authority of the state to protect persons who are legally unable to act on their own behalf.

    The parens patriae doctrine has its roots in English Common Law. In feudal times various obligations and powers, collectively referred to as the "royal prerogative," were reserved to the king. The king exercised these functions in his role of father of the country.

    In the United States, the parens patriae doctrine has had its greatest application in the treatment of children, mentally ill persons, and other individuals who are legally incompetent to manage their affairs. The state is the supreme guardian of all children within its jurisdiction, and state courts have the inherent power to intervene to protect the best interests of children whose welfare is jeopardized by controversies between parents. This inherent power is generally supplemented by legislative acts that define the scope of child protection in a state.

    The state, acting as parens patriae, can make decisions regarding mental health treatment on behalf of one who is mentally incompetent to make the decision on his or her own behalf, but the extent of the state's intrusion is limited to reasonable and necessary treatment.
  7. However, the doctor must take care to keep and preserve properly documented records.
    Mind Teaser

Read this…………………

A 73-year-old male patient with cancer is in the hospital for pain control and rates his pain as a 12 on a numeric pain rating scale of 0 to10. Thirty minutes after administering IV pain medication, the patient reports no pain relief. The pain management nurse calls the physician for additional orders for pain medication. The nurse's actions demonstrate:

1. analgesic titration
2. empathy
3. independence
4. patient advocacy

Yesterday’s Mind Teaser: Which nonpharmacologic intervention is difficult to use with older adults who are cognitively impaired?

1. Aromatherapy
2. Distraction
3. Guided imagery
4. Heat application

Answer for Yesterday’s  Mind Teaser: c. Guided imagery

Correct answers received from: Dr shashi saini, Dr. P. C. Das, Dr. Bharat Bhushan Aggarwal, Dr Kanta Jain, Dr RImpi Singla, Muthumperumal Thirumalpillai, Dr.K.Raju, Dr Pankaj Agarwal, Dr. Thakor Hitendrsinh G,

Answer for 23rd February Mind Teaser: c. I will take my medication at breakfast

Correct answers received from: Dr. Bharat Bhushan Aggarwal

Send your answer to ijcp12@gmail.com

    Laugh a While (Dr GM Singh)

Work Load

Salesman: This computer will cut your workload by 50%.
Office Manager: That's great, I'll take two of them.

    Medicolegal Update

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

Medical fasting

  • Various blood tests require a fasting of up to 12–16 hours so that a baseline normalcy of blood can be established.
  • The patient is asked to remain in a fasting state for medical reasons: surgery or other procedures of diagnostic or therapeutic intervention that require anesthetic. The presence of food in a person's system can cause complications when they are anesthetized; medical personnel strongly suggest that their patients fast for several hours before the procedure.
  • Some animal studies show that fasting every other day while eating double the normal amount of food on non–fasting days led to better insulin control, neuronal resistance to injury and health indicators similar to mice on calorie restricted diets.
  • Patient refusal of nutrition and hydration in terminal illness: "within the contexts of adequate palliative care, the refusal of food and fluids does not contribute to suffering among the terminally ill" and might actually contribute to a comfortable passage from life: "At least for some persons, starvation does correlate with reported euphoria."
  • In homeopathic medicine, fasting is seen as a way of cleansing the body of toxins, dead or diseased tissues, and giving the gastrointestinal system a rest. During fasts, water, fruit and vegetable juices are usually taken on choice.

For comments and archives

    Public Forum

(Press Release for use by the newspapers)

Guidelines about Eating

Malnutrition and wrong dietary habits have been identified as major risk factors for ill health, including heart attacks. Most people below the poverty line suffer from malnutrition due to lack of calories, proteins and vitamins in their food. In the affluent society, overeating or eating wrong food results in over nutrition, a form of malnutrition leading to heart blockages.

In this context Heart Care Foundation of India has formulated guidelines about eating, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India & National Vice President-Elect IMA.

These include:

  • Eat only when you are hungry.
  • Do not eat for pleasure, social obligations or emotional satisfaction.
  • Eat at a slow pace
  • Eat less; dinner less than lunch.
  • Take small mouthfuls each time, chew each morsel well, swallow it and only then take the next morsel.
  • Do not eat while watching television, driving a car or watching sports events. The mind is absorbed in these activities and one does not know what and how much one has eaten.
  • Do not talk while eating and never enter into heated arguments. The stomach has ears and can listen to your conversation. It will accordingly send signals to the mind and heart.
  • Plan and decide in advance what and how much food you will be eating.
  • Use low fat or skimmed mild dairy products. For cooking, use oils which are liquid at room temperature.
  • Do not take red meat and if you are a non-vegetarian, you may take poultry meat or fish.
    Readers Response
  1. Sir, Rabies is 100% fatal,  easily preventable, yet each year, twentyn thousand dies a horrible death  from rabies, that means one death from  rabies every thirty minutes,more tham fifteen million persons are bitten,  one person every two seconds,     man hours lost due to dog bite is  thirty eight million days,annual medical costs for treatment of dog bites exceeds Rs four billion  to the tax payer,  mortality and morbidity  from dog bite and rabies   exceeds that from  Japanese Encephalitis ,  yet rabies is not a notifyable disease. The annual incidence of animal bites is high, 1.7% and it was more in rural areas (1.8%), children (2.6%) and poor/low income group (75%). The main biting animal was dog (91.5%), mostly stray (63%), followed by cat (4.7%).(Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India). All because of a flawed illogical, unscientific, stray dog population control policy accepted by Govt of India. On the other hand, a bunch of so called  dog lovers have held the nation to ransom,  by preventing the removal of stray dogs  from public places, as is done in all civilized countries that have eliminated deaths from rabies.  These so called dog lovers, mostly live in secure houses and travel by cars, and so are never exposed to  the dangers of dog bite faced by the vulnerable sections of society, the workers, school children, elderly out on walks, and so on. It is high time the professional associations like the Indian Medical Association ( IMA), the Association of Physicians of India (API), the  Indian Association of Pediatrics IAP)  jointly brought pressure on the Ministry of Health for the adoption of a   logical , scientific  policy for the control of stray dog population,  and the elimination of rabies  from the great country. The present policy does justice to neither to animal nor to man. Dr Rozario  Menezes, GOA
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