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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)



Dear Colleague,                                                                                   26th October

What are the examples where Bolam Test had been cited in Indian Judgments?

In India, Bolam test has broadly been accepted as the general rule.
i.         In Achutrao Haribhau Khodwa v. State of Maharastra MANU/SC/0600/1996, the apex court held.
1. The skill of medical practitioners differs from doctor to doctor.
2. The nature of the profession is such that there may be more than one course of treatment, which may be advisable for treating a patient.
3. Courts would indeed be slow in attributing negligence  on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. 
4. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical  profession and the court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.  
5. In cases where the doctors act carelessly and in a manner, which is not expected of a medical  practitioner, then in such a case an action in torts would be maintainable.
ii.       In Vinitha Ashok v. Lakshmi Hospital MANU/SC/0583/2001, the apex court after referring to Bolam, Sidaway and Achutrao, clarified: A doctor will be liable for negligence in respect of diagnosis and treatment in spite of a body of professional opinion approving his conduct where it has not been established to the court's satisfaction that such opinion relied on is reasonable or responsible. If it can be demonstrated that the professional opinion is not capable of withstanding the logical analysis, the court would be entitled to hold that the body of opinion is not reasonable or responsible.
iii.      In Indian Medical  Association v. V.P. Shantha MANU/SC/0836/1995, the apex  Court held: The approach of the courts is to require that professional men should possess a certain minimum degree of competence and that they should exercise reasonable care in the discharge of their duties. In general, a professional man owes to his client a duty in tort as well as in contract to exercise reasonable care in giving advice or performing services.

Dr KK Aggarwal



Migraine sufferers may also be more prone to hangover headaches
U.S. researchers studied the effects of alcohol on a group of rats that experience recurrent migraines as well as a group of control rats that don't get the headaches. The study authors found that the rats with migraines experienced more pain four to six hours after ingesting alcohol than the control rats. The study was presented at the annual meeting of the Society for Neuroscience, held Oct. 17 to 21 in Chicago.

Just relax may actually work to help some women get pregnant
For years women seeking to get pregnant have been advised by friends and family to stop stressing about it. Alice Domar, who works at Harvard Medical School, found that women who took part in a stress management program while having a second round of assisted fertility treatment had a 160 percent greater pregnancy rate than women getting IVF alone.

The Importance of Folic Acid
Folic acid is particularly important for pregnant women, and should be taken, if possible, beginning at least three months before they become pregnant. The U.S. Centers for Disease Control and Prevention says this B vitamin can reduce the risk of major birth defects affecting the spine and brain by as much as 70 percent. Women who are pregnant or planning to become pregnant should take 400 micrograms of folic acid daily. It can be contained within a multivitamin, or as a separate supplement.

Alcohol reduces heart attacks or increases cancers
The benefits related to cardiovascular health have become well-known. A study released in mid-July, for instance, found that moderate alcohol consumption reduces the risk of cardiovascular disease in women by increasing the amount of "good" cholesterol in the bloodstream and reducing blood sugar levels. Many studies have linked a daily drink, most often wine, to reduced risk of dementia, bone loss and physical disabilities related to old age. Wine also has been found to increase life expectancy and provide potential protection against some forms of cancer, including esophageal cancer and lymphoma.
BUT experts with the American Cancer Society and the American Heart Association say that though these studies do show some benefits to moderate drinking, the health risks from alcohol consumption far outweigh the potential rewards. Drinking any alcohol at all is known to increase your risk for contracting a number of types of cancer. These include cancers of the mouth, pharynx, larynx, esophagus, liver, colon/rectum and breast.
There also are other health risks from moderate drinking, including liver damage and accidents caused by impaired reflexes.
The health benefits from drinking generally are related to the antioxidants and anti-inflammatories found in red wines and dark beers, but those substances can be found in a number of different fruits and vegetables.
For example, people can get resveratrol -- the antioxidant found in red wine that's believed to provide most of the drink's health benefits -- from drinking grape juice just as well as from drinking wine.
But for people who enjoy a glass of red wine or enjoy drinking, the key is to stick to the definition of moderation," she said.
Moderate drinking is defined as one drink a day for women and two drinks a day for men. What counts as one drink are:
1. 12 ounces of regular beer or wine cooler
2. 8 ounces of malt liquor
3. 5 ounces of wine
4. 1.5 ounces of 80-proof distilled spirits or liquor
Drinking anything more than that on a daily basis is known to lead to a host of health problems that can reduce your life expectancy.

Can Viagra be taken daily?
Daily sildenafil significantly improves penile blood flow and penile endothelial function indices without causing any relevant systemic effects. (Journal of Urology Oct 2009)

Doctor, please hurry. My son swallowed a razor-blade.
Do not panic, I am coming immediately. Have you done anything yet?
Yea, I shaved with the electric razor.

Concentrate all your thoughts upon the work at hand. The sun's rays do not burn until brought to a focus. Alexander Graham Bell

Never underestimate the power of stupid people in large groups.

You can advertise in emedinews
emedinews is a new venture of IJCP Group and is the first e medical newspaper of the country, mailed to 50000 subscribers everyday consisting of medical doctors, pharma product managers, hospitals, nursing homes and health policy makers. Advertisement opportunities are available. One can advertise with a singe insertion or with 30 insertions in a month. For details contact drkk@ijcp.com

Medinews Doctor of the Year Award
IJCP group on 10th Jan 2010 will award Medinews  Doctor of the Year Awards to eminent doctors who have done outstanding work in the year 2009. The award will be a part of day long CME: MEDINEWS 2009 Revisiting 2009. The award will carry a citation, shawl, coconut kalash, scenery and a memento. Nominations are invited for the same on email. It will be an annual event. Jury will consist of eminent doctors.

DMC Election Dispute Update

Dr. U C Bansal: Election Commissioner:  The election went peacefully. In the counting Dr. A Dalmiya was declared elected by 120 votes. After that Dr. V K Monga started fiddling with the ballots bundles and immediately after many supporters of Dr. H C Gupta barged into the counting arena and there were hue and cry and Dr. V K Monga reported that one bundle of ballots has been missing. There was manhandling at the counting area. The police present at the election process was made to intervene. As the results of election were already announced, the election process was completed and the results handed over to the DMA.

Dr. V K Monga Observer of Dr. H C Gupta: Out of 1679 votes confirmed and counted votes of Dr A Dalmiya were 780. Ten votes were invalid and 869 were in favour of Dr H C Gupta. While the other party wanted a recheck of counted votes to which we agreed, and while that was being done  the presiding officer himself took away a bundle of 100 votes which were lying in the tray of Dr H C Gupta.
 (Both versions are quote unquote, taken on telephone from them)

Letter to the editor

Dear Dr KK
Thanks for Dengue notes SGOT( AST) is revealing. Dangue panic/phobic/scare, syndrome needs a few words from you. Also some time count may be < 10,000 but there are say a clump of magakaryocytes in a few fields which is sufficient for reassuring patients; Micro scopic examination of PBF along with CBC by cell counter can not be ignored. Please comment. Dr Satish Chugh

Editors comments: I agree, dengue patients don?t die of platelet deficiency. As per international guidelines, unless the platelet count is less than 10000 and there is spontaneous active bleeding, no platelet transfusion is required. The cause of death in dengue is capillary leakage causing blood deficiency in intra vascular department, leading to multi organ failure. At the first instance of plasma leakage from intra vascular compartment to extra vascular compartment, one needs to give 20 ml per kg body weight per hour of fluid replacement to the patient till the difference between upper and lower blood pressure is more than 40 mmHg or the patient passes adequate urine. Giving unnecessary platelet transfusion to the patient can harm the individual. Dr. Aggarwal further said that in the city there is a panic amongst the family doctors and patients for running after getting platelet transfusion done. Remember the formula of 20 to understand the severity of dengue.

    1. Rise in pulse by 20
    2. Fall in upper Blood Pressure by 20 mmHg
    3. Pulse pressure lower than 20
    4. Rise in Hematocrit by 20%
    5. Platelet count less than 20,000
    6. More than 20 petechiae in the tourniquet test




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