eMedinewS6th November 2013, Tuesday

Dr K K Aggarwal Padma 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
www.twitter.com/DrKKAggarwal
www.facebook.com/Dr KKAggarwal

Hospitals liable to pay major part of the compensation

Excerpts from the judgment

1. In Nizam Institute’s case, the Supreme Court of India directed the Hospital to pay the entire amount of compensation to the claimant even though the treating doctors were found to be negligent.

2. In R. V. Yogasakaran the New Zealand Court opined that the hospital is in a better position to disclose what care was taken or what medicine was administered to the patient. It is the duty of the hospital to satisfy that there was no lack of care or diligence. The hospitals are institutions, people expect better and efficient service, if the hospital fails to discharge their duties through their doctors, being employed on job basis or employed on contract basis, it is the hospital which has to justify and not impleading a particular doctor will not absolve the hospital of its responsibilities. (See also Errors, Medicine and the Law, Alan Merry and Alexander McCall Smith, 2001 Edn., Cambridge University Press, p. 12.)"

3. Even in the case of Savita Garg vs National Heart Institute, the Supreme Court of India while determining the liability of the Hospital, observed as under:

"15. Therefore, as per the English decisions also the distinction of "contract of service" and "contract for service", in both the contingencies, the courts have taken the view that the hospital is responsible for the acts of their permanent staff as well as staff whose services are temporarily requisitioned for the treatment of the patients. Therefore, the distinction which is sought to be pressed into service so ably by learned counsel cannot absolve the hospital or the Institute as it is responsible for the acts of its treating doctors who are on the panel and whose services are requisitioned from time to time by the hospital looking to the nature of the diseases. The hospital or the Institute is responsible and no distinction could be made between the two classes of persons i.e. the treating doctor who was on the staff of the hospital and the nursing staff and the doctors whose services were temporarily taken for treatment of the patients……………

16. Therefore, the distinction between the "contract of service" and "contract for service" has been very elaborately discussed in the above case and this Court has extended the provisions of the Consumer Protection Act, 1986, to the medical profession also and included in its ambit the services rendered by private doctors as well as the government institutions or the non-governmental institutions, be it free medical services provided by the government hospitals.

In the case of Achutrao Haribhau Khodwa v. State of Maharashtra, their Lordships observed that 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 tort would be maintainable. Their Lordships further observed that if the doctor has taken proper precautions and despite that if the patient does not survive then the court should be very slow in attributing negligence on the part of the doctor. It was held as follows: (SCC p. 635) ‘A medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor. The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. 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.

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. But 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.

Similarly, our attention was invited to a decision in the case of Spring Meadows Hospital v. Harjol Ahluwalia. Their Lordships observed as follows: (SCC pp. 46–47, para 9) ‘9…Very often in a claim for compensation arising out of medical negligence a plea is taken that it is a case of bonafide mistake which under certain circumstances may be excusable, but a mistake which would tantamount to negligence cannot be pardoned. In the former case a court can accept that ordinary human fallibility precludes the liability while in the latter the conduct of the defendant is considered to have gone beyond the bounds of what is expected of the skill of a reasonably competent doctor…’

4. "The hospital can discharge the burden by producing the treating doctor in defence that all due care and caution was taken and despite that the patient died.

5. " … the institute had to produce the treating physician concerned and has to produce evidence that all care and caution was taken by them or their staff to justify that there was no negligence involved in the matter."

6. "………Once an allegation is made that the patient was admitted in a particular hospital and evidence is produced to satisfy that he died because of lack of proper care and negligence, then the burden lies on the hospital to justify that there was no negligence on the part of the treating doctor or hospital."

7. "…in any case, the hospital is in a better position to disclose what care was taken or what medicine was administered to the patient. It is the duty of the hospital to satisfy that there was no lack of care or diligence. The hospitals are institutions, people expect better and efficient service, if the hospital fails to discharge their duties through their doctors, being employed on job basis or employed on contract basis, it is the hospital which has to justify and not impleading a particular doctor will not absolve the hospital of its responsibilities."

8. "Therefore, in the light of the rival legal contentions raised by the parties and the legal principles laid down by this Court in plethora of cases referred to supra, particularly, Savita Garg’s case, we have to infer that the appellant AMRI Hospital is vicariously liable for its doctors.

9. "It is clearly mentioned in Savita Garg’s case that a Hospital is responsible for the conduct of its doctors both on the panel and the visiting doctors. We, therefore, direct the appellant–AMRI Hospital to pay the total amount of compensation with interest awarded in the appeal of the claimant which remains due after deducting the total amount of Rs.25 lakhs payable by the appellants–doctors".

Reference

Supreme Court of India, Civil Appeal No.2867 OF 2012, Dr. Balram Prasad Vs. Dr. Kunal Saha; Civil Appeal No.692 of 2012 AMRI vs Dr. Kunal Saha; Civil Appeal No.2866 of 2012 Dr. Kunal Saha vs Dr. Sukumar Mukherjee & Ors; Civil Appeal No.731 of 2012 Dr. Baidyanath Haldar vs Dr. Kunal Saha and Civil Appeal No.858 of 2012 Dr. Sukumar Mukherjee vs Dr. Kunal Saha: V. Gopala Gowda, J.

CME clause is liable to get implemented

Repercussions of the Supreme Court Judgment

Excerpts from the Judgment

That the number of medical negligence cases against doctors, Hospitals and Nursing Homes in the consumer forum are increasing day by day. In the case of Paschim Banga Khet Mazdoor Samity Vs. State of West Bengal, (7 (1996) 4 SCC 37), Supreme Court of India has already pronounced that right to health of a citizen is a fundamental right guaranteed under Article 21 of the Constitution of India. It was held in that case

1. that all the government Hospitals, Nursing Homes and Poly–clinics are liable to provide treatment to the best of their capacity to all the patients.

2. The doctors, Hospitals, the Nursing Homes and other connected establishments are to be dealt with strictly if they are found to be negligent with the patients who come to them pawning all their money with the hope to live a better life with dignity.

3. The patients irrespective of their social, cultural and economic background are entitled to be treated with dignity which not only forms their fundamental right but also their human right.

4. "We, therefore, hope and trust that this decision acts as a deterrent and a reminder to those doctors Hospitals, the Nursing Homes and other connected establishments who do not take their responsibility seriously.

5. The central and the state governments may consider enacting laws wherever there is absence of one for effective functioning of the private Hospitals and Nursing Homes.

6. Since the conduct of doctors is already regulated by the Medical Council of India, we hope and trust for impartial and strict scrutiny from the body.

7. Finally, we hope and believe that the institutions and individuals providing medical services to the public at large educate and update themselves about any new medical discipline and rare diseases so as to avoid tragedies such as the instant case where a valuable life could have been saved with a little more awareness and wisdom from the part of the doctors and the Hospital.

Comments

1. Quoting above lines the cases of medical negligence will increase.

2. The compensation asked will also increase

3. Any adverse remarks or advisory by MCI or state councils will go in favor of huge compensation.

4. Even the poor will need the best of the care

5. CME clause is liable to get implemented

6. Rare diseases needs to be picked up and diagnosed

7. The councils may become more strict.

Reference

Supreme Court of India, Civil Appeal No.2867 OF 2012, Dr. Balram Prasad Vs. Dr. Kunal Saha; Civil Appeal No.692 of 2012 AMRI vs Dr. Kunal Saha; Civil Appeal No.2866 of 2012 Dr. Kunal Saha vs Dr. Sukumar Mukherjee & Ors; Civil Appeal No.731 of 2012 Dr. Baidyanath Haldar vs Dr. Kunal Saha and Civil Appeal No.858 of 2012 Dr. Sukumar Mukherjee vs Dr. Kunal Saha: V. Gopala Gowda, J.

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."


VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

sprritual blog

Life after Death – A Perspective from the Baha'i Faith

Humanity, it is the firm conviction of every follower of Baha’u’lIah, founder of the Baha’i Faith, is approaching today the crowning stage in a millennia–long process which has brought it from its collective infancy to the threshold of maturity –a stage that will witness the unification of the human race. Not unlike the individual who passes through the unsettled yet promising period of adolescence, during which latent powers and capacities come to light, humankind as a whole is in the midst Of an unprecedented transition. Behind so much of the turbulence and commotion of contemporary life are the fits and starts of a humanity struggling to come of age. Widely accepted practices and conventions, cherished attitudes and habits, are one by one being rendered obsolete, as the imperatives of maturity begin to assert themselves.

A recent survey of the world conditions appeals for "a complete reconceptualization of the relationships that sustain society. The deepening environmental crisis, driven by a system that condones the pillage of natural resources to satisfy an insatiable thirst for more, suggests how entirely inadequate is the present conception of humanity’s relationship with nature; the deterioration of the home environment, with the accompanying rise in the systematic exploitation of women and children worldwide, makes clear how pervasive are the misbegotten notions that define relations within the family unit; the persistence of despotism, on the one hand, and the increasing disregard for authority, on the other, reveal how unsatisfactory to a maturing humanity is the current relationship between the individual and the institutions of society; the concentration of material wealth in the hands of a minority of the world’s population gives an indication of how fundamentally ill–conceived are relationships among the many sectors of what is now an emerging global community."

Let’s then look at what the Baha’i teachings have say about how life begins, and what is death?

The immortal identity of the human being, namely the atman, ruh, or soul has its origin in the worlds of God. The individual has his or her beginning when the soul, coming from these spiritual worlds, associates itself with the embryo at the time of conception. The soul and the body, together, constitute the human being. The soul does not enter or leave the body and does not occupy physical space.

"Know, verily," Baha’u’llah says, "that the soul is a sign of God, a heavenly gem whose reality the most learned of men hath failed to grasp; and whose mystery no mind, however acute, can ever hope to unravel. It is the first among all created things to declare the excellence of the Creator, the first to recognize His glory, to– cleave to His truth, and to bow down in adoration before Him. If it be faithful to God, it will ‘reflect His light, and will, eventually, return unto Him. If it fails, however, in its allegiance to its Creator, it will become a victim to self and passion, and will, in the end sink in their depths.’

The soul's relationship with the physical body is akin to the reflection of light upon a mirror. (Dr AK Merchant)

cardiology news

MEANINGLESS GOALS

A farmer had a dog who used to sit by the roadside waiting for vehicles to come around. As soon as one came he would run down the road, barking and trying to overtake it.

One day a neighbor asked the farmer "Do you think your dog is ever going to catch a car?"

The farmer replied, "That is not what bothers me. What bothers me is what he would do if he ever caught one."

Many people in life behave like that dog who is pursuing meaningless goals.

News Around The Globe

News

  • The seventh edition of Indian Pharmacopoeia 2014, a book considered as a manual on drug standards was released by Union Health Minister Ghulam Nabi Azad, as reported by PTI, Nov 4. "There have been rapid changes in the standards of drug all over the world, stakeholders felt necessary to bring out new edition of the book as it would also help keep pace with the regulatory requirements," the Union minister said while releasing the book.
  • The collaborative task force of the American College of Chest Physicians (ACCP) and the American Thoracic Society has released its list of 5 recommendations in pulmonary care as part of the Choosing Wisely campaign at CHEST 2013: American College of Chest Physicians Annual Meeting. The list will be published in the ACCP’s journal Chest in 2014.
    • "Don’t perform computed tomography (CT) surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines."
    • "Don’t routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (Groups II or III pulmonary hypertension)."
    • "For patients recently discharged on supplemental home oxygen after hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia."
    • "Don’t perform chest computed tomography (CT angiography) to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D–dimer assay."
    • "Don’t perform CT screening for lung cancer among patients at low risk for lung cancer."
  • British researchers have reported that a new test (Triage, Alere, San Diego, CA) that measures the level of placental growth factor (PlGF) in the blood can help doctors determine with a high degree of accuracy if a woman will develop preeclampsia during her pregnancy. In a prospective multicenter study of 625 pregnant women presenting before 35 weeks’ gestation with suspected preeclampsia, low plasma PlGF (lower than the fifth centile for gestation) had very high sensitivity and very low negative predictive value for pinpointing those women who actually had the disorder and would need delivery within 14 days.
  • A dual–agonist compound that aims to boost two key gut hormones –– GLP–1 and GIP –– at the same time may offer better blood sugar and weight loss control than currently available single–hormone drugs, as reported in Science Translational Medicine.
  • According to a study from Central America, a single dose of human papillomavirus vaccine (HPV) achieved stable antibody levels at 48 months, suggesting that one dose of vaccine might afford adequate protection. Patients who received one dose of vaccine had geometric mean titers (GMTs) that were 5 (HPV 18) to 9 times (HPV 16) higher than those of non–immunized, seropositive women. Women who received two of the three scheduled doses had GMTs 14 to 24 times higher than those of the nonimmunized group.
  • A balloon colonoscope increases the detection rate of polyps and adenomas compared with standard colonoscopy (SC), catching numerous polyps and adenomas that SC missed when conducted in sequence, according to findings presented at the American College of Gastroenterology (ACG) 2013 Annual Scientific Meeting.

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Rabies News (Dr. A K Gupta)

How will you approach a case of irregularities in treatment schedule, e.g., if patients missed the doses as per the due dates, i.e. dose schedule is broken?

First three doses of modern rabies vaccine must be very timely and for the fourth and fifth dose, a variation of 1–2 days is permissible.

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Elsayed Soliman, MD, of Wake Forest School of Medicine in Winston–Salem, N.C., and colleagues have reported in JAMA Internal Medicine that although myocardial infarction is a known risk factor for the development of atrial fibrillation, the relationship might work the other way around, too. Among patients without a history of coronary heart disease, those with atrial fibrillation were 70% more likely to have an MI through an average of about 7 years of follow–up after accounting for other potential risk factors (HR 1.70, 95% CI 1.26–2.30). That risk was greatest among women (HR 2.16, 95% CI 1.41–3.31) and black individuals (HR 2.53, 95% CI 1.67–3.86).
  • Physicians are far more likely to order a VerifyNow (Accumetrics) platelet–function test for their patients with acute MI if the point–of–care assay is offered to them for free, but it only modestly influences their choice of antiplatelet agent and doesn’t have any effect on 30-day risk of events, including bleeding. The study presented at the TCT 2013 attempted to gauge the physicians’ inclination to use the test, not just whether the test performed as advertised and made a clinical impact. When physicians did order the test, which measures the aggressiveness of platelets and can help guide the choice of an ADP–receptor inhibitor, it was usually to switch the patient from clopidogrel to a more potent drug like prasugrel (Effient, Lilly/Daiichi–Sanyo) or, sometimes, ticagrelor (Brilinta, AstraZeneca). Much less often it was to raise the drug’s dosage to achieve a stronger antiplatelet effect.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • According to a cross–sectional observational study, the approach a physician uses to discuss vaccinations plays a significant role in whether or not parents choose to have their child vaccinated at that visit. The study recorded and analyzed 111 provider–parent vaccine discussions during health supervision visits. The study is reported online November 4 in Pediatrics.
  • Allergic esophagitis triggered by milk may not require complete avoidance, according to a small study that found most such patients could tolerate dairy if it was baked into bread or other foods. Nearly three–quarters of children who tried baked goods that contained milk had no signs of symptoms or inflammation in the esophagus as reported by Paul E. Hesterberg, MD, of Massachusetts General Hospital in Boston, and colleagues in the November issue of the Journal of Allergy and Clinical Immunology.
cardiology news

Eating junk food: It’s in the brain

When it comes to eating junk food, one may blame the brain. Addiction is a disease and the same has been proved by a study.

Two areas of the brain have to work together to give the self–control to reject unhealthy foods. California Institute of Technology researchers used MRI to scan the brains of volunteers as they looked at photos of dozens of types of foods and decided which ones they’d like to eat. They found significant differences in the brain activity between people who had self–control in terms of making food choices and those with no self–control.

An area of the brain called the ventromedial prefrontal cortex is involved in all value–based decisions. When ventromedial prefrontal cortex activity decreases, a person will probably reject an item, whereas increased activity means they’ll probably choose it.

The study published in the journal Science found that in people with no self–control, the ventromedial prefrontal cortex seemed to take into consideration only the taste of a food.

In people with good self–control, another area of the brain called dorsolateral prefrontal cortex becomes active and modulates the basic value signals so that the self–controllers also incorporate health considerations into their decisions.

The study showed that ventromedial prefrontal cortex is active during every decision and that the dorsolateral prefrontal cortex is more active when a person is using self–control.

cardiology news

Total CPR since 1st November 2012 – 71933 trained

Media advocacy through Web Media

X–ray can be normal in Pneumonia

The chest X–ray can be normal in the first 24 hours of pneumonia, said Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Pneumonia can be community–acquired or hospital–acquired. Community-acquired pneumonia is pneumonia that is acquired in the community by a person without a history of contact with a patient or a health care worker and can be treated with simple antibiotics.

But if a person develops pneumonia in 48 hours after getting admitted to hospital or after 48 hours of endotracheal intubation, it is called hospital–acquired pneumonia. This pneumonia needs treatment with combination of costly antibiotics.

Healthcare–associated pneumonia occurs in a non hospitalized patient but with extensive healthcare contact. Public must avoid visits to the hospitals to avoid this as once the pneumonia develops, it requires costly and aggressive antibiotics.

One should suspect healthcare-associated pneumonia if the patient in the last one month has received any intravenous therapy; has been going to a doctor for a wound care; has received intravenous chemotherapy; has visited a hospital setting or a hemodialysis clinic. It should also be suspected if the person was admitted to a hospital with acute care facilities in the last 3 months.

Uncomplicated community-acquired pneumonia (CAP) can be treated in a clinic as it has low mortality but patients with CAP who require admission have 37% mortality.

High–risk community–acquired pneumonia patients can be remembered by the formula CURB 65

C stands for confusion (anoxia)
U stands for urea more than 20 (pre renal azotemia)
R stands for respiratory rate more than 30 per minute (due to too low oxygen)
B stands for low blood pressure systolic less than 90 and diastolic less than 60 (due to CO2 retention)

Any patient of community–acquired pneumonia who does not respond within 72 hours should be treated as a high–risk patient. Pneumonia patients have low mortality if they have received pneumonia/flu vaccination in the past.

For community–acquired pneumonia treatment, one can treat only on the basis of clinical features and a chest X–ray. But in healthcare–associated pneumonia, sputum culture examination is also required.

Do not treat X–ray, breathlessness or cough as they may persist for a long period of time after treatment.

Cough in pneumonia may last for a week and X–ray may take 4 weeks to clear in normal individuals and 12 weeks in the elderly.

Repeat X–ray after one week of discharge is not necessary. However, follow up X-ray is required at 8 to 12 weeks to document resolution of pneumonia and to exclude underlying malignancy.

For simple health care-associated pneumonia, where multi drug resistance is not suspected: Treat with IV 2 g of ceftriaxone or Levofloxacin 750 mg daily or ampicillin sulbactam 3 g intravenous every six hours. The best bet is to give 750 mg Levofloxacin every day.

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 71933 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."

today emedipics

Large Number of people attended 20th MTNL Perfect Health Mela

press release

Vowel chanting produces aspirin in my body

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

The primary role of chaperones is to help in:

1.Protein synthesis.
2.Protein degradation.
3.Protein denaturation.
4. Protein folding.

Yesterday’s Mind Teaser: A 40–year–old lady delivered a full term baby. On examination of the baby, the neonatologist noted certain urogenital abnormality. He took the picture. The most likely diagnosis is:

1.Urogenital sinus.
2.Hypertrophied clitoris.
3.Miocropenis.
4.Vulval hematoma.

Answer for yesterday’s Mind Teaser: 2.Hypertrophied clitoris.

Correct answers received from: Narahari Kandakatla, Dr Arpan Gandhi, Dr. V.P. Thakral, Dr.K.V.Sarma, drmanishald, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr.K.Raju, DR AVTAR KRISHAN, Dr Kanta jain, Dr Prakash Khalap, Dr B K Agarwal, Khurshid Alam

Answer for 4th November Mind Teaser: 2.Decreased production of 2,3-bisphosphoglycerate.

Correct answers received from: DR AVTAR KRISHAN, Dr Kanta jain, Dr Prakash Khalap, Dr B K Agarwal

Send your answer to ijcp12@gmail.com



medicolegal update

Click on the image to enlarge

medicolegal update

An elderly husband and wife visit their doctor when they begin forgetting little things. Their doctor tells them that many people find it useful to write themselves little notes.

When they get home, the wife says, "Dear, will you please go to the kitchen and get me a dish of ice cream? And maybe write that down so you won’t forget?"

"Nonsense," says the husband, "I can remember a dish of ice cream."

"Well," says the wife, "I’d also like some strawberries and whipped cream on it."

"My memory’s not all that bad," says the husband. "No problem – a dish of ice cream with strawberries and whipped cream. I don’t need to write it down."

He goes into the kitchen; his wife hears pots and pans banging around. The husband finally emerges from the kitchen and presents his wife with a plate of bacon and eggs.

She looks at the plate and asks, "Hey, where’s the toast I asked for?"

medicolegal update
medicolegal update

Click on the image to enlarge

medicolegal update

Situation: A 62–year–old diabetic with coronary artery disease, on treatment for the same, came for follow up.
Reaction: Oh My God! Why didn’t you put him on antioxidants?
Lesson: Make Sure to add antioxidants to the prescription because of their free radical scavenging and other beneficial effects.

medicolegal update

Sunbeams out of the clouds. Faith out of all my doubt. Terri Guillemets

medicolegal update

Dr KK Aggarwal: Eating refined sugar can cause diabetes http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Why do you stay in prison When the door is so wide open –Rumi

medicolegal update
  1. Dr K K Aggarwal, Congratulations for good work n extensive respects n regards from public political side. DR B M ALUR,GADAG,Past President,Indian Medical Association,Karnatak State Branch,

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