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Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

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)



14th December Monday

Dear Colleague,

Can one state medical council examine complaints of hospitals from other states?

The Delhi Medical Council examined a reference from Directorate of Health Services, seeking an inquiry on a complaint of Smt. S M from Indrapuram, New Delhi. The council opined that

"Even though late Master Shaunak Mishra had received initial treatment at Sarvodaya Hospital, Vaishali, Ghaziabad and Fortis Hospital, Noida, the scope of this enquiry is only confined to the issue of medical negligence, if any committed at Indraprastha Apollo Hospital where late Master Shaunak (referred hereinafter as the patient) was subsequently shifted on 23.9.2008 and expired on 25.9.2008."

(Ref DMC/DC/F.14/Comp.549/2009/30th June 2009)

Dr KK Aggarwal



 Signs That You Have Cataract symptoms (From Dr Prachi Garg):
1. Vision that appears foggy or cloudy; as if there's a film over the eye.
2. Inability to see colors as vividly as before.
3. Seeing double.
4. Problems seeing well at night.
5. Seeing an aura or halo surrounding lights.
6. Increased sensitivity to glaring lights.
7. Difficulty in differentiating shapes or similar colors.

Humor (krishan13629@yahoo.co.in)
Santa: I think that girl is deaf.
Friend: How do u know?
Santa: I told I Love her, but she said her chappals are new

Dr Good Dr Bad

Situation:  A CAD patient came with fasting sugar value of 115 mg%.
Dr Bad:  it is normal
Dr Good:  you need lifestyle management as it can increase your risk of future heart attack
Lesson:   There is a graded rise in cardiovascular risk with increasing degrees of glucose intolerance below the definition of overt diabetes.

Make Sure

Mistake: A 4 year old girl with rickets was unresponsive to high doses of vitamin D.
Reaction: Oh my god! Why was she not given alfacalcidol?
Make Sure that all children receive alfacalcidol who are unresponsive to calcium/vitamin D therapy. Alfacalcidol, has been found to be effective in refractory cases of rickets in numerous studies.

Clinical tip

Vitamin C is necessary for collagen formation, proper immune function and as a tissue antioxidant. Altern. Med. Rev. 2004 Nov.;8(4):359 377.

5 things pregnant women should know about swine flu ( Dr G M Singh)
1. It put you and your baby at risk.
2. The vaccine can protect you.
3. Go on the offensive.
4. See your doctor if you feel ill.
5. Don't panic.

Why human insulin: Insulin is a polypeptide hormone having two chains of amino acids linked by disulfide bridges. There are minor differences in the amino acid composition of the molecule from species to species. These differences make the insulin from other species antigenic and the antibodies formed inhibit the action of injected foreign insulin. Pork insulin differs from human insulin by only one amino acid residue and has low antigenicity. Human insulin produced by recombinant DNA technology in bacteria is being used to avoid antibody formation. (Dr Surrinder Singh)

Stress and Depression Could Worsen Childhood Asthma ( Dr Soni Verma)

Depressed kids with asthma exhibit a deregulation of the autonomic nervous system along with increased airway compromise. Children with asthma and high depression symptoms show a preponderance of parasympathetic over sympathetic nervous system reactivity in the ANS. This imbalance within the ANS could explain the increased airway resistance in depressed asthmatic children. The depressed children consistently showed greater parasympathetic activation along with decreased sympathetic activation in response to the emotional provocations - a pattern that would have a detrimental effect on the airways. (The Journal of Allergy and Clinical Immunology 09 July)

 Letter to the editor

In one of the previous issues one reader ( Probably Dr T M Aggarwal) enquired if Coagulochek was available in India. It is availbale through 'Roche' at a cost around Rs.16000-20000. I happen to see the same at Roche Stall in CSI meet held in Cochin. Local contact number of Delhi Representative is 09871112938. Dr S K Gupta MD, Cfm(France) Sr Consultant Max Balaji Hospital.

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medinews: revisiting 2009
IJCP Group is organizing emedinews: revisiting 2009, conference on 10th Jan 2010 at Maulana Azad Auditorium. It will be attended by over 1500 doctors. Topics will be happenings in the year 2009. There is no registration fee however advanced registration is required.  Top experts (Dr KK Aggarwal, Dr Naresh Trehan, Dr Praveen Chandra, Dr Harsh Mahajan, Dr Kaberi Banerjee, Dr N K Bhatia, Dr V Raina, Dr Ajit Saxena, Dr S C Tewari, Dr Vanita Arora etc) will deliver lectures. CME will be followed by lively cultural evening (guest performances by noted singers Shabani Kashyap, Vipin Aneja and top singers of our medical profession), doctors of the year award, dance and dinner. For registration mail 
emedinews@gmail.com. We have crossed 1200 registrations.

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Also if you like emedinews you can FORWARD it to your email addresses

 Eye care snippets by Dr. Narendra Kumar:  ANATOMY & PHYSIOLOGY OF THE EYE

Comparable to a camera, the eye has an outer protective layer, sclera; a middle vascular layer, choroid; and an inner photosensitive layer, retina. The fibrous layer consists of sclera and cornea. The sclera resists the intraocular pressure and supports the attachment of extra-ocular muscles. The cornea lies into the central visible portion of sclera, and is transparent and avascular, and receives its nutrition by diffusion from the surrounding area. Due to its converging power, the cornea bends light entering the eye and focuses it on the retina. The vascular layer, choroid, is continuous with the iris and the ciliary body, and the three structures together are known as the uveal tract. The photosensitive layer, retina, contains rods and cones, and nerve cells which extend into the optic nerve. The fovea, a point on the retina, has a high concentration of rods and no cones.

A transparent structure behind the pupil, the crystalline lens, changes its shape when the ciliary muscle acts during the process of accommodation. It is held in place by suspensory ligaments. Anterior chamber is the space between cornea and iris; posterior chamber is the space between iris and lens, and vitreous chamber is the space between lens and retina. While anterior and posterior chambers are filled with a watery fluid (aqueous humour), the vitreous chamber is filled with a gel-like fluid (vitreous humour). The six extra-ocular muscles (four straight and two oblique), attached to sclera, rotate the eyeball which is richly supplied with blood and nerves, and lies in a bony cavity of the skull, called the orbit. The lids (upper and lower) provide protection to the eyeball in front. On the inner side, lids are covered by a mucous membrane, the conjunctiva, which also covers the exposed part of sclera. The lacrimal gland secretes tears. The globe is 25 mm in diameter, the cornea 12 mm, the pupil 3.5 mm (under average light), and the optic disc 1.5 mm.

Nerve supply. Seven pairs of cranial nerves control and carry information to and from the eyes. 2nd optic nerve carries electric impulses from the retina to the brain. 3rd oculomotor nerve controls eye movement, accommodation and pupillary constriction. 4th trochlear nerve controls the muscle that moves the eye to look down and in. 5th trigeminal nerve transmits signals for corneal sensitivity. 6th abducens nerve controls the muscle that moves the eye to look in an outward direction. 7th facial nerve controls the muscles that close the lids and produce facial expressions. 8th acoustic nerve carries signals of loud noises to which eyes or lids respond.

Emmetropia and ametropia. The cornea bends light entering the eye and focuses it on the retina. If a person requires no correction to see clearly in the distance, s/he is called emmetropic. When a person requires lenses to see clearly in the distance, s/he is called ametropic. If the light falls short of the retina, the person is called myopic and if the light falls behind the retina, the person is called hypermetropic. The hyperope, with sufficient accommodation, can bring the image into focus, but the myope cannot (although s/he can improve vision by squeezing lids together to create a small opening and increased depth of focus).

Accommodation and presbyopia. Accommodation is a process of contraction of the ciliary muscle by which lens of the eye is forced to bulge forward, resulting in increased power, to allow focus clearly on objects situated at near distances.  A hypermetropic person spends lot of energy by exercising accommodation in order to keep things in focus.  As he gets older and begins to lose his ability to accommodate, he may find it difficult to see clearly after a long day's work.  Small amount of concentrated near work increases his difficulty in accommodating. Presbyopia is the name given to the age-related loss of accommodation. The ability to focus closely may be completely lost by the age of sixty.

Binocular vision and strabismus. Binocular vision is the fusion, in the brain, of two images one from each eye, resulting in a single stereoscopic perception. If fusion is disrupted by a Maddox rod in front of one eye, the eyes drift (heterophoria). An outward turning is called exophoria; and an inward turning, esophoria. In the absence of fusion, there is no binocular vision. In heterotropia or strabismus, the eyes are not straight. An outward turning is called exotropia; and an inward turning, esotropia. In childhood strabismus, two separate images reaching the brain cause diplopia. Since the condition of double vision is intolerable, the brain ignores image from one eye (suppression), and with passage of time vision in the ignored eye does not develop (amblyopia). If amblyopia is detected early, it is possible to use the affected eye by occluding the other (better) eye. To correct strabismus, however, lenses, orthoptics or surgery (or all together) may be needed.

Glaucoma. Aqueous maintains a constant pressure within the eyeball, which can be measured with the tonometer. The average range of normal intraocular pressure is from 12 mm Hg to 22 mm Hg. Estimating intraocular pressure, examining optic disc and recording visual field are the steps to diagnose glaucoma, which requires life-long treatment with drugs. Surgery is done when the condition cannot be controlled by drugs. 





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