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)



emedinews is now available online on www.emedinews.in and www.emedinews.org

5th January 2010 Tuesday 

Dear Colleague,

What is the Difference between Civil and Criminal Negligence?

The Supreme Court has dealt with and pointed out with reasons, the distinction between negligence in civil law and in criminal law. Their Lordships have opined that there is a marked difference as to the effect of evidence, viz. the proof, in civil and criminal proceedings.

In civil proceedings, a mere preponderance of probability is sufficient, and the defendant (accused medical practitioner) is not necessarily entitled to the benefit of every reasonable doubt; but in criminal proceedings, the persuasion of guilt must amount to such a moral certainty as convinces the mind of the court in the same way as a reasonable man would feel and be convinced beyond all reasonable doubt.

Where negligence is an essential ingredient of the offence, the negligence to be established by the prosecution must be culpable or gross and not the negligence merely based upon an error of judgement.

From a legal perspective, culpability describes the degree of one's blameworthiness in the commission of a crime or offense. Except for strict liability crimes, the type and severity of punishment often follow the degree of culpability.

The difference in civil and criminal negligence therefore is in the degree of the negligence: To establish civil negligence the conclusion can be arrived on the basis of balancing the facts of each case and trying to take a just decision based on the probabilities that are before the Judge. Whereas to establish criminal negligence the conclusion is also based on verification of facts, however, the same has to be established on a much higher degree resulting in a certainty beyond all doubts.

Suggested reading:Syad Akbar vs. State of Karnataka (1980) 1 SCC 30.

Dr KK Agarwal

Chief Editor



Vedanta: Three nice stories:

1.Once, all villagers decided to pray for rain, the day of prayer all people gathered and only one child came with an umbrella. That is call FAITH.


2.When you throw a baby in the air, the baby laughs because he knows you will catch him. That is TRUST.

3.Every night you go to bed. You have not assurance that you will wakeup next morning but you will have plans for tomorrow. That is HOPE.

Celebrate your life with faith, trust and hope.

News and Views: International AIDS Society Conference on HIV Pathogenesis and Treatment: Cape Town, South Africa, July 19-22, 2009

1. There are significant differences in the demographics of patients who have late presentation of HIV infection and those diagnosed earlier in the disease process. Of 54 late presenters, 13 (24%) were women compared with 26 of 251, or about 10% of the non late group (P<0.01) (Dr Jurgen van Lunzen, of the Universitatskilinkum Eppendorf in Hamburg, Germany). Late presenters tend to be older, they are more often women, and they are from high prevalence countries.

2. Family get-togethers can have a dark side, with asymptomatic children passing potentially deadly pneumonia germs to older relatives. Kids get colonized by strep and pneumococcus, and become carriers, they may not get sick from it, but the elderly are more susceptible to it. Seniors can shield themselves from the threat of pneumonia, however. People over 65 should get the pneumococcal vaccine: it lasts for six years. (Dec. 24 issue of the New England Journal of Medicine)

3. The risk that an untrained bystander can do harm by giving cardiopulmonary resuscitation, or CPR, to someone who collapses in public is almost vanishingly small. Dr. Thomas D. Rea, an associate professor of medicine at the University of Washington, and lead author of a report in the Dec. 21 online issue of Circulation said that there have been concerns expressed by laypeople and dispatchers that doing CPR might cause damage. Chances that you can injure someone who is not in cardiac arrest are very, very small, and those injuries are not serious. Rea and his colleagues used data on 1,700 adults who received CPR in the King County emergency response system between June 2004 and January 2007. 55 percent were in cardiac arrest and 45 percent were not. Nearly half of those not in cardiac arrest received CPR from bystanders. The data showed minor problems, discomfort or injuries in 9 percent to 11 percent of cases, but only four fractures, three due to chest compressions administered during CPR, one from repositioning the individual for CPR.

4. New study findings offer reassurance to pregnant women that paracetamol does not appear to raise the risk of birth defects. Some research, has suggested that the drug may be linked to a higher risk of a birth defect called gastroschisis. Gastroschisis refers to a defect in the abdominal wall that allows the intestines to protrude; it has been linked to aspirin use during pregnancy. In the new study, researchers analyzed data from a large U.S. study that included more than 11,600 children born with congenital defects such as spina bifida, cleft lip and various defects affecting the brain, heart, lungs, limbs and gastrointestinal system. They were compared with 4,500 children born with no major anomaly. Overall, the study found, there was no evidence linking mothers' paracetamol use in the first trimester to a heightened risk of any birth defect. In fact, women who took the medication to treat a first-trimester fever had a lower risk of certain birth defects, including gastroschisis, than women who did not treat their fevers with acetaminophen. (Dr. Marcia L. Feldkamp, of the University of Utah in Salt Lake City, in the January 2010 issue of the journal Obstetrics & Gynecology.)

5.Treating depression may help people with diabetes get their blood sugar under control. In a study of low-income minorities with poorly controlled diabetes, researchers found that antidepressant therapy was associated with improved long-term blood sugar control and reduced blood pressure.[ Diabetes Care, December 2009.]

Mistake to be avoided: The absence of rheumatoid factor doesn’t make arthritis truly seronegative.

Have a Food Allergy?  Possible warning signs (Dr Prachi Garg)
1. Skin that itches, turns red or develops a rash.
2. Watering, tearing eyes that may also itch.
3. Itching or congestion of the nose.
4. Diarrhea, abdominal pain, cramping or vomiting.
5. Swelling.


Dr Good Dr Bad

Situation: A patient on long term same dose oral anti diabetics developed hypoglycemia.

Dr Bad: Take more food

Dr Good: Get urine microalbumin test done

Lesson: In such a situation think of nephropathy. 50% of insulin is metabolized in kidneys


Smile is not a single word, it is a complete sentence:
Speak More In  Less Time

Emedinews pearl: Try This: To reduce the rare chance of septal perforation with corticosteroid nasal sprays direct the spray toward the lateral nasal wall and away from the septum.

 Is AID vaccine possible? (GM Singh)
The neutralizing HIV antibodies have been identified thus vaccine that can lead to formation of these neutralizing antibodies can lead to protection. Also the mechanism and protection of simian immunodeficiency virus (SIV), (a virus similar to HIV in Chimpanzees) has been identified and one can apply same principle for Human immunodeficiency virus (HIV).

Make Sure
A patient with diabetes shows deteriorating kidney function
Oh My God! His HBAIC is very high?
Make sure that strict glycaemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Finance Tip: Knowing about Will

1.What is the importance of writing a Will?
A:For the security of the family it is necessary to write a Will in advance.

2. Where should it be registered?
A: The same should be registered at the same place where properties are registered. For registration it may require a stamp paper (Rs. 100/-).

3. How many witnesses are required?
A: The Will should be registered in the presence of two witnesses one out of whom preferably should be a doctor.

4. What is the main point for including a doctor as the witness?
A: Most of the disputes on properties will later on are to prove that the person at the time of writing the Will was of sound mind.

5.Why it is advised that while writing the Will one should video record it?
A: For 100% security it is better to video record the Will so that if there is a dispute one can prove that the executor was a person of sound mind.

Mile Stone:
Granisetron is used in the treatment of chemotherapy-induced nausea and vomiting. It is a transdermal elective 5-hydroxytryptamine3 (5-HT3) receptor antagonist with less or no affinity for other serotonin receptors. Chemotherapy induces vomiting, and mucosal enterochromaffin cells release serotonin during chemotherapy, which stimulates 5-HT3 receptors. The 5-HT3 antagonists prevent serotonin from binding to 5-HT3 receptors, hence prevents nausea and vomiting. It was approved by FDA in September 2008.

Laughter the best medicine
A little girl attending the school clinic started crying as the doctor approached her.
" I am only going to take your pulse" the doctor explained.
" But don't I need it"? sobbed the little girl.

Question of the day
How does one classify ulcerative colitis?

Ulcerative colitis is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon.
It almost invariably involves the rectum and may extend in a proximal and continuous fashion to involve other portions of the colon.
Different terms are used to describe the degree of involvement.
1. Ulcerative proctitis refers to disease limited to the rectum.
2. Distal colitis or proctosigmoiditis refers to the inflammatory process that extends into the mid-sigmoid colon, usually reachable by the 60 cm flexible sigmoidoscope.
3. Left-sided ulcerative colitis refers to the disease that extends to the splenic flexure.
4. Extensive colitis refers to disease extending beyond the splenic
5. Flexure but sparing the cecum.
6. Pancolitis refers to when the inflammatory process extends beyond the splenic flexure to the cecum.

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1 As a Strong Immunity Booster and Immuno Modulator.
2.Helps in Enhacing the Excretion of Aluminium from our body, and Relieve Smptoms of Aluminium Toxicity.
3.Helps in Prevention of Complications of Long Standing Diabetes Mellitus.
4.Helps in Various Allergic Disorders.
5.Helps Improve the Integrity of Joints, Bones, Tendons and Muscles.
6.Helps Prevention of Plaque Formation in Blood Vessels. Reduces LDL and 
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10.Helps Improve Memory Loss in old age and Study Concentration in School
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11.Helps Improve Nocturnal Enuresis in Children and Urinary Incontinence in
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12.Rejuvenates the Body Metabolism and Provides a feeling of Well Being.

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 (what's new in cardiac surgery), Dr Anupam Sibal (A decade of successful liver transplants in India), 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?), Dr Rohina Handa ( Whats new in rheumatology), Dr Ajay Kumar ( Fatty Liver), Dr P K Julka (Whats new in oncology), Mr.  B.N.S Ratnakar, 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 Khilnani, 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.

1. PSB & Aviva is proud to be associated with Emedinews: Revisiting 2009. To know more about us, please visit our stall on day of the conference. http://avivaindia.com/

2. Kindly enjoy  tea and coffe at NESTLE counter

3. Refresh yourself with mineral water, coke and other related drinks, soda at COKE counter.

4.  Silicic Acid is available as Sodium Meta Silicate in U.S.A and is being Launched in India During the  IJCP  Emedinews revisiting 2009 Conference at New Delhi on January 10th,2010.

Update about the conference
1. The conference starts at 8am at MAMC. Kindly collect your registration kit before that. The kit has pen, pad, folder, key chain, watch, lunch and dinner coupons.
2. Enjoy the soft drinks at the COKE counter round the clock and tea coffee at the NESTLE counter.
3. There will be no lunch time. Rice Kari, Puri Aloo will be available 9-5pm non stop, eat any time and attend the seminar.
4. Dinner will be cocktails, soft drinks, snacks and chhat party 5-9pm
5. Cultural hangama will be non stop 5-9pm
6. We have over booked the registrations. Facility for webcast and plasma TV out side the auditorium will be available.
7. The CME will be accredited for 9 DMC credit hours.
8. The program details are available at www.emedinews.org or www. emedinews.in

emedinews-revisiting 2009 Program

8.00   AM  -  8.30 PM   Dr KK Aggarwal  Revisiting the year 2009
8.30   AM  -  8.45 AM   Dr Neelam Mohan, Advances in Paedatric Diseases ( Non Liver)
8.45   AM  -  9.00 AM   Dr S C Tewari, Nephroprotection
9.00   AM  -  9.15 AM   B.N.S Ratnakar (GM CBI), Presentation
9.15   AM  -  9.45 AM   Dr Ambrish Mithal, Newer treatments in diabetes
9.45   AM  -  10.00AM   Dr Harish Parashar, Aluminium Toxicity
10.00 AM  -  10.30AM   Dr N K Bhatia, Screening for TTI
10.30 AM  -  10.40AM   Anshu Gupta, Probiotics Update
10.40 AM -   11.10AM   Dr Praveen Chandra, Indications of Cardiac Interventions            11.10 AM -   11.25AM   Dr Sanjay Chaudhary, What's new in Lasik
11.25 AM -   11.55AM   Dr Naresh Trehan, What's New in Cardiac Surgery
11.55 AM -   12.10PM   PSB-AVIVA, Presentation
12.10 PM -   12.40PM   Dr Anupam Sibal, A Decade of Succesful Liver Tansplant in India
12.40 PM -   1.10 PM    Dr Ajay Kriplani, Current Trends in the Management of Morbid Obesity
1.10   PM -   1.40 PM    DR Vanita Arora, Common Arrhythmias
1.40   PM -   2.10 PM    Dr N Subramanium, Current Concept in Male Infertility
2.10   PM -   2.40 PM    Dr V Raina, Molecular Genetics
2.40   PM -   3.10 PM    Dr Kaberi Banerjee, IVF: Where We Stand Today?
3.10.  PM -   3.25 PM    Anil Chopra (Bajaj Capital), Mutual Funds
3.25   PM -   3.40 PM    Dr Praveen Khilnani, Whats New in Critical Care in Past Decade?
3.40   PM -   4.10 PM    Dr Ajit Saxena, Erectile Dysfunction and Male Infertility
4.10  PM  -   4.20 PM    Dr Ajay Kumar, Whats New in Gastroenterology
4.20  PM -    4.30 PM    Dr Rohini Handa, Whats New in Rheumatology
4.30  PM -    4.40 PM    Dr P K Julka, Whats New in Oncology
5.00  PM Onwards Cultural hangama and awards


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 Letters to the editor

1. Dr Aggarwal: Congratulations u r doing  a great Job. We r proud to have a guide like u. Best wishes for a wonderful new year. (Dr Ashish Mahobia, Raipur , Chattisgarh)

2. Respected Sir, Continuously updating and upgrading the medical knowledge is imperative for any medical profession. And it seems the idea of CMEs is of immense benefit with regards to the same. Sir, I have a few humble submissions to make. Rgarding the mandatory policy for attaining 30 CME hours per year for the purpose of re-egistration, are there any plans of esteemed Delhi Medical Council to make CME attendance/certificates from internet sites viz "medscape" or any such Indian site in future viz "emedinews", applicable for re-egistration purposes?  It is my humble submission that 30 hours of CME per year for a doctor registered under DMC and residing at another state may prove to be quiet taxing with regards to the void in patient care and closing the OPD during the traveling and CME days. Moreover financial implications for traveling to Delhi (especially for those residing in rural areas, where the earnings are very meager) may also put immense strain on the doctor. Any mode of CME which can be attained through the above means at the place of stay,  and given due cognizance for registration purposes will be highly appreciated by the minority of doctors practicing outside Delhi anywhere in the country and would be a lifesaver. (Prashant)

3. Dear Dr K.K. Aggarwal: I heartily congratulate you for the initiative taken by you for the first of its kind medical newspaper. The articles are very informative with all the information about medical world on a single page in a very concise form. I request you to take up the issue of portable Ultrasound machines on a priority basis and give it wide publicity among the members. Dr Vinod Khetarpal. GN-5, Shivaji Enclave, New Delhi 110027, Mobile 9811054945. 



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