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Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



26th November Thursday 

Dear Colleague,

 DMC Update

It is unfortunate that the New Delhi Medical Council till now has not been constituted. The Council is still awaiting officially the names of four nominated members from the Government. Last three monthly council meetings were held with an assumption that it was the last meeting of the old council.

Some many important decisions to be taken by the council are pending. The points raised in the Council regarding reducing the reregistration charges, waiving off charges for senior citizen doctors and whether a person practicing in Delhi, Noida and Faridabad, requires three registrations or one registration, all have been deferred for discussion by the new council when formed.

Couple of questions which the Council Clarified

1. Medical records are the property of the patient and they (patients/relations) can have access to the same anytime they want.
2. As per Medical Council of India, if a patient or the relations demand medical records, they need to be made available within 72 hours (to them).
3. If the patient or relations ask for originals, even they may require to be given to the patient or relations and a photocopy of the same then need to be kept by the medical establishment with an acknowledgement from the patients/relations.

Professional Negligence versus Professional Deficiency versus Professional Misconduct

These are the three definitions which must be understood by all of us as well as the experts who are being called to expertise a report or a complaint.

1. Professional Deficiency is an act of omission or commission ending in a loss to the patient or to his or her family. Here, the case is decided on the Bolam's principles where it is judged whether or not the doctor has acted by providing an average degree of skill, care or service. Any deficiency in the service is not a medical negligence and also is not professional misconduct. Professional deficiency is liable for compensation under Consumer Protection Act and the same is paid by the insurance company under the Indemnity Insurance.

2. Professional misconduct is well defined in Medical Council of India Rules and is punishable by the Council in the form of warning or suspension of practice for a specific period. Few examples of professional misconduct are sexual relationship with a patient, female foeticide, advertisement by doctors etc. etc.

3. Medical negligence is an act of negligence which can be filed in the Criminal Court for prosecution as well as in the Civil Court for compensation. The examples are operating under the influence of alcohol with resultant harm, operating a wrong limb or the wrong person etc. Medical negligence as well as professional misconduct may not be covered by the insurance company.

When an inquiry is held, in the report of the experts it is very important not to intermix these definitions as it may have serious medico legal implications.  

 Dr KK Aggarwal




News to use

1. Extreme temperatures and heavy air pollution boost heart attack risk. December 15 issue of the Journal of Cancer
2.      A study published in the Journal of American College Cardiology has shown that obesity is  a major risk factor for left arterial enlargement which increases risk of arterial fibrillation, stroke and death.
3.      A low fat diet results into long term improvement in mood as per a study in November issues of Archives of Internal Medicine.
4.      Man who regularly do moderate exercise may have a low risk of death in prostate cancer including aggressive fast growing tumors as per a study published in November issue of Journal of Urology.
5.      Recent studies have shown that people at risk of type 2 diabetes can prevent onset of diseases by losing 5 to 7% body weight.
6.      People with pre diabetes have increased risk of developing type 2 diabetes, heart disease and stroke.
7.      Hepatitis B vaccination may protect for more than two decades, according to a study published in the Journal of Infectious Diseases November Edition.
8.      Eating high fiber diet can reduce pot bally obesity as per a study published in American Journal of Clinical Nutrition.
9. Both obesity and hypertension are independent risk factors for left arterial enlargement. Enlarged left arterial in turn is a  risk factor for arterial fibrillation.  In a study published in November issue of Journal of American College of Cardiology, doctors have shown that obesity is the most destructive of the two. It is also related to the magnitude of change in left arterial volume especially in persons who were both hypertensive and obese.

10.  Just lowering blood pressure will not be enough for reducing left arterial volume unless one also reduces the weight also.

Statins May Stave Off Gallstones ( Dr Soni Verma)
Long term use of cholesterol lowering statins appears to reduce the incidence of gallstones. All statins provide the protective effect and that the effect increases with higher doses. To prescribe a statin should center on its known benefits in cardiovascular disease, with gallstones a side issue. (Nov. 11, 2009, Journal of the American Medical Association)

Benefits of Exercise 30 Minutes a Day
The lack of awareness is greatest among men about benefit of minimum 30 minutes of exercise a day. By doing at least 30 minutes of moderate physical activity each day, one can reduce rates of chronic health problems. Physical activity is important for protecting against a large number of chronic diseases, including cardiovascular disease, some cancers, diabetes and some cognitive disorders. (Duke University, Sept. 24, 2009)


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Letters to the editor

1. The father of our nation, Mahatma Gandhi had told long ago"do not see, do not hear and do not talk bad" The GURU of our cme's group DR.K.K.AGGARWAL as per his knowledge and experience says in addition to we have to follow " DO NOT EAT, READ, DO AND THINK BAD". DR.G.M.SINGH

2. Respected Dr. K K Aggarwal Sir: history of optometry was good article; please convey my thanks to Dr. Narendra Kumar for reminding us the brief history of optometry. Pl start similar topics on all medical branches. Dr. Pramod Lokegaonkar

3.  Congratulation Kissu, your articles are very informative and uptodate, even beats some of the articles we see here in the USA. Keep up the good work of educating all of us in the field. Amal(Dolly)

4. I would like to conclude the controversy regarding intra cardiac adrenaline that it is not to be practiced at all in any condition be it anaphylaxis or be it cardiac arrest. I am not aware of any literature or reference published in 21st century supporting intra cardiac adrenaline. I have definitely heard of doctors who have lost their jobs / license to practice after giving intra cardiac adrenaline in the UK NHS. However, if you do not have Intravenous access than one can give adrenaline via another intravascular and easy route which is intra osseos route (even in adults, though hardly practiced in India for reasons I do not know, may be lack of availability of intra osseous needles of adult size) and of course via tracheal route in an intubated position (dose: 3mg diluted in 10-20ml of sterile water) as practiced by Intensivists & Emergency Physicians. Dr Vivek Chhabra, MD, Emergency Physician - Certified Provider - ALS - Resuscitation Council (UK) and Australian Resuscitation Council 2007

5.  Thanks Dr K. K. Aggarwal for this highly appreciable initiative. The intra arterial thiopentone problem is a real hazard for we anesthetist. Mostly happens with "short GA cases where iv is secured in OT only with no iv drip. So always have a running iv line for iv thio injection because blood column rise in drip will alert you about intra arterial cannulation. If still it happens than do not remove that cannula from artery in panic. Instead inject excessive saline through that cannula to dilute the already injected thiopentone. Thanks. Dr GIRISH CALLY. @ 919810031679

6.  DCI approved drugs: This was the best article so far. GKGupta

7. Sir: Thanks for your quick response. Point is well made and taken but I still have not seen availability of 2mg IR Alprazolam. Instant release above 0.5 mg is rare. Even SR preparations of 2mg is difficult to find. But point is made. Suman

Dr Good Dr Bad

Situation:   A patient with chronic anemia has hemoglobin of 4 mg/dl.

Dr Bad:  The patient needs whole blood transfusion
Dr Good:  The patient needs packed red cell transfusion

Lesson:  In chronic anemia, packed red cell transfusion is the treatment of choice, as the hemoglobin level can be raised without overloading the circulation.

Phosphorus Levels May Predict Heart Disease (Dr Prachi Garg)
Elevated blood levels of phosphorus are associated with a higher risk of heart disease. US researchers studied the link between phosphorus levels and coronary artery calcification (CAC) in nearly 900 healthy adults in the Spokane Heart Study, a long term investigation of heart disease risk factors. CAC is an early sign of hardening of the arteries. At the start of the study, 28 percent of participants had CAC. After six years of follow up, another 33 percent had developed CAC, and the level of CAC increased among those who already had the condition. The association between phosphorus levels and CAC was strong even after the researchers adjusted for other factors. (Society of Nephrology, news release, Nov. 5, 2009)

Red, processed meats linked to prostate cancer (Dr Prachi Garg)
Men who eat a lot of red meat and processed meats may have a higher risk of developing prostate cancer than those who limit such foods. Researchers at the National Cancer Institute found that among more than 175,000 men they followed for nine years, those who ate the most red and processed meats had heightened risks of developing any stage of prostate cancer, or advanced cancer in particular. The findings, reported in the American Journal of Epidemiology, add to a conflicting body of research on meat intake and prostate cancer risk. Because studies over the years have come to different conclusions, experts generally consider the evidence linking red and processed meats to the disease to be limited and inconclusive.

Health Tip: Keep a Health Journal

The American Academy of Family Physicians suggests your journal include the following:
1. Any injuries you have had or illnesses for which you have been treated.
2. Any time you were hospitalized, including when and why.
3. Any allergies you have to foods, medications, household items, pollens, etc.
4. Any past surgeries or procedures.
5. All prescription and over the counter medications, vitamins or supplements taken. Be sure to include the dose and how often you take them.
6. Diseases, illnesses or health conditions that have affected immediate family members.

Folate Levels in Pregnancy Tied to ADHD in Offspring
Low folate levels during pregnancy are associated with higher odds for attention deficit/hyperactivity disorder in offspring aged 7 to 9, new research has found. The findings seem to support the long held belief that folic acid levels in expectant mothers influence their children’s nervous system development. The researchers also found that children of mothers with low folate levels had notably smaller head circumference at birth, which may indicate a slower rate of prenatal brain growth. The study was released online Oct. 28 in advance of publication in an upcoming print issue of the Journal of Child Psychology and Psychiatry.

Funny clinical notes (Dr. Minakshi)
The patient refused autopsy.

A doctor, a lawyer and a manager were discussing the relative merits of having a wife or a mistress. The lawyer says: "For sure a mistress is better. If you have a wife and want a divorce, it causes all sorts of legal problems."

The doctor says: "It's better to have a wife because the sense of security lowers your stress and is good for your health."

The manager says: "You're both wrong. It's best to have both so that when the wife thinks you're with the mistress and the mistress thinks you're with your wife - you can go to the office and do some work.

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