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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)



27th December Sunday

Dear Colleague,

           Can a post mortem examiner give a conclusive report about medical negligence?

In the matter of  "Police Station Hari Nagar seeking medical opinion on a complaint of Shri Sanjeev Malhotra, alleging medical negligence on the part of doctors of West End Nursing Home, in the treatment administered to complainantís wife late Sunita Malhotra, resulting in her death on 30.9.2008" the DMC opined " It is further noted with disconcert that in spite of repeated directions from the Delhi Medical Council, the post mortem conducting doctors, continue to make observations which are beyond the scope of post mortem. A post mortem must state:- 

(i) The post mortem findings should reflect about the cause of death either from a medical or legal standpoint and be restricted to the same; observation like "the life of the deceased could have been saved if proper timely medical management have been given", is inappropriate, as it is beyond the purview of post mortem examination.  

(ii) If the post mortem examiner feels that the case involves any issue of medical negligence, the same should be referred to the appropriate authority, in this case the Delhi Medical Council, where a medical specialist relating to the field to which the case pertains, can examine the same in detail based on his expertise and determine the matter conclusively and effectively. A post mortem examiner is competent in the field of forensic medicine and he should, therefore, refrain from giving a conclusive report about medical negligence.

D KK Aggarwal




How Dangerous is Aluminium?

The Normal human Body Requirements of Aluminium is 5-20 mg /day. But Most of the Antacids Containing Aluminium Hydroxide provide more than 80 mg of Aluminium. Routine Usage of such Antacids Causes Anaemia, Aphthous ulcers,   Osteoporosis , Pathological Fractures, Endogenous Depression, Loss of Memory and Urinary Incontinence, and Chronic Renal Failure.These are the Signs of Aluminium Toxicity. Sodium Meta Silicate, an Isomer of Silicic Acid is Known to Reduce the Aluminium Load on the body by Enhancing it's Renal Excretion.

 Is vinegar good for the arteries?

A. There is no evidence to this. However some studies in humans suggest hat daily doses of apple cider vinegar may help people with type 2 diabetes control their blood sugar.

Acetic acid gives vinegar its distinctive smell and sour taste. A synthetic cousin of acetic acid, EDTA is a chelating agent and is used in cases of lead, mercury, or iron poisoning. A dubious practice, chelation therapy, involves repeated administration of EDTA to clean out the arteries by dissolving cholesterol-filled plaque. This is based on wishful thinking, not science.

Apple cider vinegar is an ingredient in foods, sauces, and dressings. Taking too much can lower blood potassium levels. Straight apple cider vinegar can erode the enamel on your teeth. (Source Harvard Heart Letter)


Yoga Update

According to a study in the journal Spine (Sept. 1, 2009), yoga therapy can reduce pain and improve function in people with chronic low back pain (pain that lasts more than three months). The Spine study is the second of two randomized trials to test a specific form of yoga called Iyengar yoga.


Most yoga taught and practiced is hatha yoga, which combines: classic poses (asanas), controlled breathing, and deep relaxation or meditation. Iyengar is a type of hatha yoga that uses props such as blankets, blocks, benches, and belts to help people perform the poses to the fullest extent possible even if they lack experience or have physical limitations.

 Breast cancer update

1. A form of trastuzumab (Herceptin) with a chemotherapy like conjugate attached mprove outcomes in heavily pretreated metastatic breast cancer. Median progression free survival was 7.3 months with single agent trastuzumab-DM1 (T-DM1) in a Phase II study reported at the San Antonio Breast Cancer Symposium.

2. Postmenopausal breast cancer patients face an uncertain risk from use of vaginal estrogen preparations that raise systemic estradiol levels. [Wills S, et al: SABCS 2009; Abstract 806.]

3.In a new application of an old procedure, stellate ganglion block significantly relieved intractable hot flashes, night sweats, and sleep disturbances in postmenopausal breast cancer patients. [Haest K, et al: SABCS 2009; Abstract 809.]

4.High-dose vitamin D significantly reduced muscle and joint pain in breast cancer patients treated with the aromatase inhibitor anastrozole (Arimidex). [Rastelli A, et al, SABCS 2009; Abstract 803.]

 Take home messages from the Medicine Update 2009, MAMC

 Diabetes Mellitus and Metabolic Syndrome:

1.      Metabolic syndrome is much more common in Indians than Caucasians, since for the same BMI Indians have more body fat and less muscle mass than their Caucasian counterparts.

2.      Many young Indians with normal BMI suffer from CAD.

3.      Framingham scoring underestimates cardiovascular risk in Indians.

4.      Lower cut off of BMI and waist circumference is appropriate for Indians.

5.      Lifestyle modification is the one measure that scores in all sectors of diabetes and cardiovascular risk prevention in metabolic syndrome.

6.      As opposed to the 30 minutes a day exercise recommendation adopted in the west, Indians must be subjected to a 60 minutes-a-day exercise program. This includes 40 minutes of aerobic exercises and 10-20 minutes of resistance training for important muscle groups (gradually increase resistance to 5 kg). Such weight training can be done at any age.

7.      To prevent diabetes and metabolic syndrome from developing healthy lifestyle measures may be started as early as at 10 years of age.

8.      Combination of metformin with lifestyle modification has till date failed to show additional benefit over lifestyle modification alone in preventing DM in pre-diabetics. However larger trials are needed.

9.      Sibutramine and Orlistat are approved weight reducing agents for treating obese Indians not responding to treatment. Overweight women with PCOS may benefit from Metformin.

10.  Incretin therapy is a promising addition. Newer congeners of Exenatide may find use in pre diabetics who are overweight.

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 Mistake to be avoided
A patient on phone was asked to take Amlopress AT
He took amlopress 80 mg.

Dr Good Dr Bad
A patient with sickle cell anemia came with fever with chills and rigors
Dr Bad: Take anti malaria
Dr Good: you need further testing
Lesson: Sickle cell anemia patients are usually immune to malaria

Screening for Cancer (Dr Prachi Garg)
1. Mammogram to help detect breast cancer.
2.Pap test to screen for cervical cancer.
3.Colonoscopy or sigmoidoscopy to help detect colon cancer.
4.Chest X ray, CT scan or sputum cytology (microscopic examination of phlegm to screen for cancer cells) for lung cancer.

Funny clinical notes (Dr. Minakshi)
Both breasts are equal and reactive to light and accommodation.

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 emedinews: revisiting 2009

IJCP Group, Heart care Foundation of India and World Fellowships of Religions are  is organizing emedinews: revisiting 2009, day long conference on the top health happenings in the year 2009 on 10th Jan 2010 at Maulana Azad Auditorium. There is no registration fee however advanced information is required.  Top experts (Dr KK Aggarwal (revisiting 2009), Dr Naresh Trehan (whats new in cardiac surgery), Dr Ajay Kriplani (Current Trends in the Management of Morbid Obesity), Dr Praveen Chandra (The Indications of Interventional Treatment in Cardiology), Dr Kaberi Banerjee (IVF- Where We Stand Today?), Dr N K Bhatia (TTI infections), Dr V Raina ( molecular genetics), Dr Ajit Saxena (ED and male infertility), Dr S C Tewari (Nephroprotection), Dr. Ambrish Mithal (Diabetes), Dr Vanita Arora (ECG arrhythmias), Dr N Subramanium (Current concept in Male infertility ), Dr Neelam Mohan (Coeliac Disease), Dr. Sanjay Chaudhary (Eye Update), Dr Harish Parashar (aluminum toxicity), Dr Praveen Khillani (Whats new in field of critical care in past decade?), will deliver lectures.

CME will be followed by lively cultural evening guest performances by Shabani Kashyap, Vipin Aneja and perfomances by medical professional singers Dr Praveen Khillani, Dr Lalita and Dr N Subramanium, Dr Lata Tandon, Dr Arti Pathak, Dr Sudipto Pakrasi, Dr Harjeet Kaur, Dr Ramni Narsimhan, Dr Sanjay Chugh (on the drum), Dr Yash Gulati (Anchor) Dr Reshma Aggarwal (Anchor), doctors of the year award, dance and dinner. For registration mail emedinews@gmail.com. We have crossed 1200 registrations.



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