eMedinewS
3rd February 2014, Monday

Dr K K AggarwalPadma 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; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); 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);
For updates follow at
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Dr. Ketan Desai Update

In one of the forums, a report of eMedinewS was challenged by some medical doctors.

In one of my editorials I had claimed that there are no active cases against Dr. Ketan Desai in any of the courts. His main disproportionate case was closed by the CBI.

Status of two pending cases about De Desai
1.  In the Lucknow High Court case, Criminal Revision no. 243 of 2012 in an order dated 27.11.2013 by Hon’ble Justice Arvind Kumar Tripathi  wrote – “His argument was completed. Now arguments in Criminal Revision 474 of 2012 is to be heard……. till then framing of charges against the Revisionist (Dr. Ketan Desai) shall remain deferred.”
Note: So far no charge have been framed by the competent Court against Dr. Ketan Desai.

2.  In another case from Delhi, in a order dated 02.1.2013 by the Hon’ble Supreme Court of India (Hon. Chief Justice, Hon. J. Chelameswar and Hon. Justice Vikramjeet Sen), the order says –
“Upon hearing the counsel, the court made the following orders:
  Exemptions allowed
  Issue notice
  Let the matter be heard along with SLP (CPC) No. 7591, 7592 of 2011.
  In the meantime, there will be stay on other proceedings……
  The registry is directed to put up a note as to whether the connected matters are ready for  final disposes. “
Note: This case relates to original case of Jatinder Pal Singh Versus CBI.

Some facts with eMedinewS
1.  In the main disproportionate asset case against Dr. Ketan Desai, CBI has submitted a closure report which was later on accepted by CBI court. In the case CBI ought to have investigated his family assets for the last 13 years. CBI also put special note on their website and invited any information regarding Dr Ketan Desai. CBI received more than 200 emails and examined them in the next two years. CBI could not find any benami property or unaccounted money leading to closure of the disproportionate asset case.

2.  As per eMedinewS information CBI had filed PE/regisistered 29 cases against him out of which 27 have been closed. The status of the rest two cases has been reproduced above.

3.  Out of these two cases, one of the cases of Jatinder Pal Singh Versus CBI, it was alleged that Dr. Ketan Desai was caught red-handed with Rs. 2 crores but in the seizure challan, a copy of which is available with eMedinewS, at the time of Dr. Ketan Desai’s arrest, only Rs. 53600 in cash were recovered. Gold 3.5 kg was also mentioned in the seizure challan. As per eMedinewS information and as per disproportionate asset closure report, the gold seized at the time of arrest of Dr. Desai was entered in his income tax books starting way back from 1997 and Dr. Ketan Desai had been paying wealth tax on the same.

4.  In the Lucknow case, as mentioned above, as per eMedinewS information, during one of the MCI investigations, 300 doctors were shown out of whom four doctors were found to have submitted a fake ration card as wrong proof of residence, three doctors have not submitted their F16 forms to income tax and another four doctors in subsequent investigation 1 ½ year later were not found to be staying in the campus. To the best of the knowledge of the eMedinewS, there was no allegation of corruption on the part of the then MCI President. The allegation by CBI which eMedinewS could understand was that if these 12 mistakes could have been found by the MCI inspectors team the college would not have got the permission.

5.  eMedinewS has also gone to the MCI history and found that way back in 2001, Delhi High Court had appointed an Administrator Mr. Jhingan who was in MCI for 1  year. Later another committee was constituted by the Supreme Court under Dr. P N Tandon which sat in MCI office for the next six years. From 2010 for 3 ½ years, there was Board of Governors which ran the MCI. None of them have been able to come out and proof corruption charges against Dr. Desai.

6.  eMedinewS is a medical newspaper and has nothing to do with Indian Medical Association or MCI or its office bearers. As an Editor of the eMedinewS, I am responsible to reproduce facts and figures which are not influenced by any forces. Myself and eMedinewS have been alleged by many in their writings but eMedinewS writes based on the facts available with it from time to time. If anyone has any specific allegation with a proof against Dr. Desai, the same can be forwarded to eMedinewS which, if found authenticated, will be published.

7.  My eMedinewS writing should not be taken as a view of IMA as though I am currently a Vice President of IMA, but as per constitution, Vice Presidents are assigned certain jobs. For me the job is to build IMA membership plan. A Vice President is also assigned to look after certain states and help in their functioning. All decision making in IMA is done by President and Honorary Secretary General in consultation with working committee and the Central Council where I represent only as a single vote. All correspondence regarding any IMA activity or against the procedure should be done with Honorary Secretary General and not with me as the capacity of Senior Vice President. However, if any clarification or issue needs to be raised on IMA platform, all my colleagues are free to approach me and I can put their point of view to the President of IMA or in the Working Committee of the Central Council for discussion. All my personal interactions with few of the members of the forum recently has been conveyed to IMA decision makers by me.

8.  Also I have rejoined as a member of the ethics committee recently. Any deliberations there are under code of discipline and even as an editor of emedinews can not be disclosed by me unless they are approved and put on the website. I am only one of the 17 members.

9.  I have been alleged of being silent on the issue. I was for want of collecting the above facts.

Dr K K Aggarwal
Editor eMedinewS

Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Ringtone – CPR 10 Mantra Hindi
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Eating foods in their natural form is always better

sprritual blog

An elephant is obese, eats sugarcane (ganna) and yet does not develop diabetes. I am sure if he is given 10% sugar drinks everyday or made to eat 30% sugar containing sweats, he would end up with diabetes. 

The natural form of sugarcane is eating ganna, the second form is ganne ka juice, third is gur (jaggery), fourth is shakkar and fifth is white sugar.

The more you eat foods in their natural form, more the health benefits you will get from that food.
Food is Brahmin and contains the same consciousness as you have. The food which is more refined will loses its consciousness and is not beneficial to the health. 

  Similarly, wheat flour with bran is better than flour without bran, which is better than suji, which is better than maida.  Maida is the final product and if taken every day, it can cause heart disease, diabetes and high blood pressure.

cardiology news

Girl and the Plants

A little girl was enjoying the beauty of the garden in her home. Her father had a good collection of rare and exotic plants. He grew them with tender care.

The girl was fascinated by a plant full of fine and fragrant flowers. She went near the plant and enjoyed its beauty and the fragrance of its fine flowers. Suddenly she noted that the plant was growing in a heap of filth. She could not tolerate the presence of dirt at the bottom of the plant with such fantastic flowers.

She conceived a plan to clean the plant. She pulled the plant with all her might and uprooted it. She then carried it to the tap and washed the shoot and roots in running tap–water till all traces of dirt were washed away. She then placed the plant on a clean stone and went away, thinking that she had done a great deed indeed.

Later her father came to the garden and saw the uprooted plant. Its flowers and leaves had wilted and the plant had almost died in the scorching sun. His little daughter ran to him to exhibit her achievement. 'I have cleaned it, Daddy, she reported innocently. It was placed in dirty soil. Now it is clean.

The father showed her how her treatment had almost killed the plant. He told her that he had collected the filthy soil and placed it to cover the plant’s roots as it was the best medium to grow that plant. It could grow up healthily and produce fine flowers only if grown in filthy soil. She was sad that the plant had suffered and withered by her cleaning. Flash: Pain, poverty and illness may cause agony in our life. Sight of successful persons may make us depressed and envious. A great gardener mixes the right soil for each plant. In the same way God provides each of us with the best environment required for optimum spiritual growth. But it may appear to be unpleasant to us and we may even complain to God about our plight.

News Around The Globe

6th International Conference "Recent Advances in Cardiovascular Sciences" 31st January &1st February, 2014

Dr. Grant N Pierce, Ph.D. Executive Director of Research, St. Boniface General Hospital, Winnipeg Dr. Grant N. Pierce, Ph.D. in Physiology, (University of Manitoba). After completing postdoctoral training at UCLA (1983-86), Dr Pierce obtained his first faculty appointment in the Dept. of Physiology, Faculty of Medicine at the University of Manitoba, Winnipeg, Canada. Dr. Pierce has published over 200 research manuscripts and written or edited 8 textbooks on a variety of topics concerning metabolism, nutrition and cardiovascular health. His research papers have been cited well over 5000 times. Dr. Pierce has served on the Editorial Boards of some of the best cardiovascular journals in the world and as Assistant Editor of Molecular and Cellular Biochemistry for more than 20 years. He is currently Co-Editor of the Canadian Journal of Physiology and Pharmacology. He has been invited to give over 150 lectures at meetings and Universities throughout the world. He has helped to organize more than 50 meetings all over the globe. In collaboration with several Faculties from the University of Manitoba, he initiated the Canadian Centre for Agri-food Research in Healthand Medicine (CCARM) at St. Boniface Hospital to investigate the health-related benefits of nutraceuticals and functional foods. Dr. Pierce is currently the Executive Director of Research at St. Boniface Hospital.

Topic: The Curious Case of the Effects of Trans Fats on Cardiovascular Health
Trans fats have been generally classified as detrimental to our cardiovascular health. These effects have been largely concluded from epidemiological evidence without detailed basic science work into the mechanisms of action of the fatty acids. Here we will contrast the effects of two different trans fats, elaidic acid, an industrially produced trans-fat, and the ruminant trans-fat, vaccenic acid on the vasculature and on cardiomyocyte viability during non-ischemic, ischemic and ischemia⁄reperfusion conditions. We will show data to support the conclusion that not all trans fats are deleterious to the heart and its vasculature. Whereas elaidic acid is toxic to cardiomyocytes and promotes atherosclerosis, vaccenic acid can have quite opposite effects. This work was supported through grants from CIHR and the Heart and Stroke Foundation of Canada.

How to learn urethral surgery in 2014? : Dr Gudio Barbagli, Arezzo, Italy

We are now living remarkable changes involving economy, politics, technology and world environment and medicine and surgery. These remarkable changes also involve the teaching and the learning of urethral surgery. Why? Because of the geographical differences in urethral stricture disease, internet and technological advancement in the quality of audio video transmission by streaming.

Any new generation should use at best the technological innovations that the evolution of science provides for them. Before 2014, there were only two ways to learn urethral surgery: one, from literature (evidence-based medicine, guidelines, and consensus conferences) and second by training in centers specialized in reconstructive urology. But there are only few centers in the world that are specialized in reconstructive urology. Also there is a restriction from the hospital to accept visitors and to permit the doctor to leave their work for many weeks. High cost of travel is another deterrent factor.

In a geographic analysis of male urethral strictures, there were significant regional differences in stricture etiology and location. Patients from US/Italy had more penile strictures (27 vs 5%) and fewer posterior urethral stenoses, while, patients from India had more traumatic and posterior strictures (BJU Int. 2013 Oct;112(6):830-4).

Urethral stricture disease presents important differences in etiology, length and treatment in different countries. Any developing country, where urethral stricture disease still remains one of the most important urological disease, should encourage the development of centers specialized only in reconstructive urethral surgery. Only specialized centers are able to provide the highest standards of care. India has only 1 center specialized in urethral surgery.

Take home messages
·  Encourage the development of centers specialized ONLY in reconstructive urethral surgery.
·  Take care of the geographical differences in urethral stricture disease.
·  Develop internet streaming training.

The world around is changing, be able to change your mind….

Jayaramdas Patel Oration: Skill assessment in urologic laparoscopic surgery: Dr Tadashi Matsuda, Osaka, Japan

Objective evaluation of surgical performance
· Proficiency level: Motion analysis of instruments. For this we measured the magnitude and direction of horizontal and vertical forces during each stroke of dissection.
· Competency level: Outcome analysis (complication, survival)
On-theater assessment by a preceptor has been performed for several years. But it suffers from subjectivity and bias. The competency of senior surgeons should be determined as laparoscopy is a newly developed skill. A new assessment system is required: objective, reliable, valid, fair and feasible.
The Endoscopic Surgical Skill Qualification (ESSQ) system in Japan is an inter-institutional, nation-wide assessment system. It is a system of surgical education and not a license till now.

ESSQ System Requirements in urology
·  Experience of >20 lap adrenalectomies/nephrectomies
· Formal application sponsored by two supervisors who have personal knowledge of the lap surgical skill of the applicant
· Attendance at a lap training course
· Two years of lap practice after completing a formal urologic training program of 6 years

ESSQ System Skill assessment is done by 2 referees randomly selected on an unedited videotape showing the whole procedure in a double blind fashion: adrenalectomy <2.5 hours, nephrectomy <3.5 hours.  If 2 referees accept, then qualify; if 1 or 2 disqualify, then judged by the committee. Reliable assessment of skill is a hard task. Committee decision is mandatory for final decision.

Assessment areas
·  Port placement
·  Establishment of surgical field
·  Plane & technique of dissection
·  Management of large vessels
·  Control of bleeding
·  Hand coordination

1-5 points deducted for a dangerous maneuver; Perfect: 75 points, if more 60 points, then pass. Qualified doctors are required to renew the qualification every 5 years. They are also required to report the perioperative data on the latest 20 consecutive cases.

Key points
·  Skill assessment is mandatory in surgical education.
· A variety of skill assessment methods have been devised.
· The Japanese Society of Endourology has developed the ESSQ system in urological laparoscopy and has run the system for 10 years.
· The major complication rate of urologic laparoscopic surgeries has decreased in Japan.

LUTS/BPH Progression: what predicts progression and can it be prevented? Dr Mark Speakman : UK

Which patients get worse? The factors

Symptoms

  1. Mod-Severe LUTS

Bother

  1. QoL >3

Flow rate

  1. <12mL/sec

Age

  1. 70yrs

Prostatic volume

  1. > 40cc

PSA

  1. > 1.4ng/mL

Residual volume

  1. >150mL

Inflammation

  1. +ve

The 4-yr CombAT data support the role of combination therapy in reducing risk of AUR, BPH-related surgery, BPH clinical progression and providing greater symptom benefit (Eur Urol 2010;57:123–31).

An emerging paradigm in the contemporary study of LUTS is that obesity increases and physical activity decreases risk of progression (J Urol. 2012 189(1 Suppl):S102-6). 

Complications of renal transplant: Dr Vikram S Dogra, Rochester, USA

The grey scale assessment should be followed by color Doppler technique.  The entire course of the renal artery and vein should be visualized with special attention paid to the anastomoses, usually at the external iliac artery and vein. An angle-corrected flow evaluation is done – maintain an angle <600 from the beam. Subsequently, a representative segmental renal artery waveform in the upper pole, midportion, and lower pole is evaluated with spectral Doppler and an RI is calculated.

Renal artery stenosis accounts for 75% of all vascular complications of allografts (10%). Usually occurs in the 1st year, but can present within 3 years; >50% occur at the site of anastomoses. End to end anastomosis had 3 times more risk of stenosis than end to side.
·         Severe hypertension refractory to medical therapy
·         Hypertension and the presence of an audible bruit over the graft
·         HT associated with unexplained gut dysfunction
Criteria for RAS: Peak systolic velocity ≥ 2.5 m/sec, AT>0.08 s, AI>1.5 ms (native kidney <300 cm/sec), ratio of PSV of main renal artery to external iliac artery of ≥1.8 and parvus tardus waveform.

Renal vein thrombosis occurs in about 5% of transplants; present between 3rd and 8th postop day.
·         Absent venous flow on Doppler
·         Reversed diastolic flow in the intra renal arteries
·         Dilated renal vein which contains the thrombus

Renal infarcts may involve either the whole transplant or a part of it. Most commonly occurs as a consequence of rejection.

Non vascular complications include all diseases that occur in a native kidney: hydronephrosis, renal stones, renal cell cancer, and emphysematous pyelonephritis.

Key Points
·         USG is the first modality to evaluate renal allograft for vascular complications.
·         Ultrasound helps in diagnosing vascular complications such as RAS, RVT.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

eMedinewS e–gifts to our readers

This is the age of smartphones. To improve usability and readability, eMedinewS has launched a mobile app of the newsletter for its readers. You can now also view eMedinewS on your smart phones or iPads.

The eMedinewS app is now available for free  emedinewsdownload.

The various icons for downloading are provided on the top of the newsletter. Choose the icon that is compatible with your device, whether emedinewsiPhone, emedinewsAndroid, emedinewsBlackberry, emedinewsiPad, emedinewsDesktop/Windows phone or emedinewsGSM
Click on the icon ‘e’ from the mail and download to install the app to the home screen of your mobile phone, iPad or Desktop. After you finish downloading, you will see an icon ‘e’ on the home screen of your device. That’s it.

Now you don’t need to type the address of the website in your web browser or log in to your email account every day to read the newsletter. Just click on the app and begin reading.

Rabies News (Dr. A K Gupta)

Does strain of virus used in rabies vaccine play a role in eliciting the required response?

Response to rabies vaccination is a unique mix of specificities to rabies virus antigens. Antibodies develop out of intrinsic host responses and in response to extrinsic factors such as the amount of antigen given, type of antigen, and route of exposure or vaccination. There may be substantial variation in the neutralizing activity and quantity of rabies virus neutralizing antibodies (RVNA) produced. Therefore, the strain of virus used in antirabies vaccine plays a role in eliciting the required response.

cardiology news

Do not ignore breakfast

Taking a good breakfast made of carbohydrates and lean protein, can help lessen cravings and hunger during the rest of the day, which can lead to significant weight loss.

A research by Dr. Daniela Jakubowicz, a clinical professor at Virginia Commonwealth University and an endocrinologist at the Hospital de Clinicas Caracas in Venezuela has shown that sedentary, obese women lost almost five times as much weight on the "big breakfast" diet as did women following a traditional, restrictive low–carbohydrate diet. While treating obese people we need to treat carb cravings and hunger.

On waking up in the morning, the body is primed to look for food. The metabolism is revived up, and levels of cortisol and adrenaline are at their highest. The brain needs energy right away, and if one doesn’t eat or eats too little, the brain needs to find another fuel source. To do this, it activates an emergency system that pulls energy from muscle, destroying muscle tissue in the process. Then when you eat later, the body and brain are still in high–alert mode, so the body saves energy from the food as fat.

Also the levels of the brain chemical serotonin are highest in the morning and the craving levels are at the lowest and you may not feel like eating. As the day wears on, serotonin levels dip, and you get cravings for chocolate or cookies, and such similar foods. If you eat these foods, your serotonin levels rise, and your body begins to associate good feelings with them, creating an addictive cycle.

The high protein, carbohydrate mix in breakfast gives the body the initial energy boost it needs in the morning. Throughout the rest of the day, the meals are made up of protein and complex carbohydrates, like vegetables. Because protein is digested slowly, you won’t feel hungry.

If you have to eat chocolate or candy, eat them in the morning because having them when serotonin levels are high, they won’t taste as good, and the brain won’t feel the same serotonin boost. This will eventually help cut down on cravings. Eating breakfast with high glycemic foods may be harmful. After eating cereal or a doughnut, the blood sugar and insulin levels spike. Once that blood sugar is used up, you’ll still have excess insulin circulating, which makes you hungry and makes you crave carbohydrates.

cardiology news

Total CPR since 1st November 2012 – 86083 trained

Media advocacy through Web Media

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press release

Act fast: You can reduce the Damage and Death from Heart Attack if…?

New Water–soluble aspirin and clot–dissolving drugs can stop most heart attacks in progress, reduce disability and save lives. They work best if given within one hour of when signs of heart attack begin to appear. It is therefore important to recognize the warning signs of a heart attack and act right away, said Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association…

Every year, over 24 lakh people die of heart attacks in India. About half of those deaths take place within one hour of the onset of warning signs and before the patient ever reaches a hospital, added Dr Praveen Chandra, Chairman, Interventional Cardiology at Medanta – The Medicity.

The 5 warning signs of a heart attack, which everybody must know are:

  1. Pain or discomfort in the jaw, neck or back.
  2. Feeling weak, lightheaded, or faint.
  3. Chest pain or discomfort.
  4. Pain or discomfort in the arms or shoulder.
  5. Shortness of breath

Act fast

  1. Take 300 mg water–soluble aspirin and chew it if a heart attack is suspected.
  2. Get yourself rushed to a nearest heart centre for clot–dissolving therapy.
  3. You may require an emergency angiography and angioplasty to remove the clot.
  4. If there is a cardiac arrest, the bystander should follow the CPR 10 mantra: "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute."

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 86083 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

emedipicstoday emedipics

Dr KK Aggarwal receives Harpal S Buttar Oration Award from Nobel Laureate Dr Ferid Murad

press release

Treating vitamin D deficiency in the country

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

A 31 year old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrance is normal and aduiogram shows a bilateral conductive deafness. Impedance audiometry. Shows as type of curve and acoustic reflexes are absent. All constitute part of treatment, except:

1. Hearing aid.
2. Stapedectomy.
3. Sodium Fluoride.
4. Gentamicin.

Yesterday’s Mind Teaser: A vascular necrosis can be possible sequelae of fracture of all the following bones, except:

1. Femur neck
2. Scaphoid.
3. Talus.
4. Calcaneum.

Answer for yesterday’s Mind Teaser: 4. Calcaneum

Correct answers received from: Abhay Naik, Dr Jainendra Upadhyay, Dr.BRIJESH SONI, Dr.K.Raju, Dr Chandresh Jardosh, Dr Tarun Gupta, Dr Avtar Krishan, drjella, Muthumperumal Thirumalpillai, Dr B K Agarwal, Dr.Sahadevudu Gelivi, DR.A.K.GAJJAR

Answer for 1st February Mind Teaser:2. Whole blood.

Correct answers received from:Dr Avtar Krishan, drjella.

Send your answer to ijcp12@gmail.com

indianoil
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centralbank
medicolegal update

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medical querymedical query

medicolegal update
medicolegal update

For crying out loud

With all the new technology regarding fertility, an 88–year–old woman was able to give birth to a baby recently. When she was discharged from the hospital and went home, various relatives came to visit.

"May we see the new baby?" one of them asked. "Not yet," said the mother. "I’ll make coffee and we can visit for a while first."

Another half hour passed before another relative asked, "May we see the new baby now?"

"No, not yet," said the mother. A while later and again the guests asked, "May we see the baby now?"

"No, not yet," replied the mother.

Growing impatient, they asked, "Well, when can we see the baby?"

"When it cries!" she told them.

"When it cries?" they gasped. "Why do we have to wait until it cries?"

"Because, I forgot where I put it."

medicolegal update

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medicolegal updatemedicolegal update

medicolegal update

Situation: In an STD clinic, a 23–year–old heterosexual male presenting with dysuria and uretheral discharge was prescribed azithromycin to cover a suspected Chlamydia trachomatis infection.
Reaction: Oh my God! Why didn’t you advise the same treatment for his partner also?
Lesson: Make sure sure to remember that in such cases, it is essential that both the partners are treated.

medicolegal update

I got the bill for my surgery. now I know what those doctors were wearing masks for. Jomes H.Boren

medicolegal update

Dr KK Aggarwal:Avoid chocolate for heartburn By Dr K K Aggarwal http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: In my stillness I am the eternal possibility… In my movement I am the cosmos

medicolegal update
  1. Dear Dr. K.K.Aggarwal, Hearty Congratulations for the Awards. with regards, Dr. Jayalakshmi

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