Author : Chuen-Tat Kang  [*]

Individual Scientist and Researcher

Abstract

Medical journals are seldom touched by the scientific professionals that worked in non-related field of study.  However, using nephrological journals to solve the health issues independently may be rare without relying on medical doctors and professionals that charge very high cost of medical consultation.  For those patients potentially have been affected by renal diseases particularly related to diabetic nephrology, then it is recommended to assist oneself by taking additional initiatives to understand more about the health problem by summarising the content of independent nephrological research as below, not only able assist the patient affected but also helping the nephrology professionals to cure the renal diseases faster with proper care of diets.

FORMATION OF RENAL STONE – 3 THEORETICAL POSSIBILITIES

In the nephrological study, one of the aspects that interested the scientists and the public will be the mechanism of kidney stone formation that could affect people randomly among us.  Established theories predicted the chemicals composed in the colloid materials, crystals and inhibitor substances from the fluid consumed in daily diets maybe the major contributors to the constituents of the kidney stones, but more scientific evidences are required to justify the theories.[1]  In the exploration of inhibitor substances or “crystal poison”, growth rate of stone maybe reduced by the presence of pyrophosphate.[2]  Other potential inhibitory substances could be diphosphonate EHDP.[3]  Crystal formation of kidney stones due to existing colloid material and crystal nature of the solution consumed are more widely accepted theories, where the material of colloid could be pisolitic calcium oxalate calculi.[4]

DIABETES MELLITUS AND RENAL DISEASE

Although there seemed no direct correlations between diabetes mellitus or high blood glucose level and the fatal renal disease, certain conditions of the kidneys could affect the seriousness of kidney problems.  Such relationships are also synonymous to diabetic nephropathy, Kimmelstiel-Wilson lesion, diabetic renal disease or diabetic glomerulosclerosis.[5]  Three different mechanisms have been proposed for the linkage between the kidney and diabetes mellitus (1) arteriolosclerosis and arteriosclerosis (2) acute and chronic pyelonephritis (3) diabetic glomerulosclerosis per se.  Protein deposits on the endothelial aspects have confirmed the correlations.[6]  Initial changes are also found in the capillary basement membrane and mesangium that accumulate matrix and membrane-like material, leading to true nodule formation in lobular centre in nodular diabetic glomerulosclerosis.[7] 

IMMUNOLOGICAL RESPONSES IN RENAL SYSTEM

Subsets of T-cells will normally function as suppressor cell to modulate the progression and rate of immune response in renal system although the mechanism of regulation in the quantity and quality of antibody response is not very well understood.  There are various factors that determine the glomerular localization of immune complexes, inclusive of the role played by glomerular C3 receptors.[8]  The degree of injury caused by the immune complexes of antigen with immunoglobulins to interact with various effector mechanisms, could also be determined.  The effector mechanism could be vasoactive amines, the coagulation system, complement and kinin systems, and with cells having receptors for Fc portion of immunoglobulins and to activated C3.[9]  Larger sources of immune complexes with IgG and complement, maybe cleared by reticuloendothelial system (RES) rapidly, remaining smaller complexes and those without complement may persist in the circulation longer.[10] 

NEPHRONOPHTHISIS AND RENAL MEDULLARY CYSTIC DISEASE – CLINICAL MANIFESTATION

Prior to the detection and diagnosis of nephronophthisis-cystic renal medulla complext, there exist health problems among the patients.[11]   In the typical 110 cases of analysis, polyuria, enuresis and polydipsia dominated 80%.  This include urinary concentrating defects or diminishing urinary concentration ability, abnormal urinalysis without protein, blood and formed elements in the urine of certain patients, renal salt or sodium wasting where kidney fails to handle sodium or other salts normally, aminoaciduria with the urinary excretion of typical amino acids like proline etc.[12]  Frequency of 60% cases are detected with anemia and hypertension hat may lead to weakness and pallor.[13]  Another 40% of the reported cases are mainly confined to children and adolescents with disordered bone growth or metabolism and parathyroid gland pathology-related hyperplasia.[14]  Vomiting, signs of azotemia, bleeding and convulsions constituted 10% of the abovementioned reported cases.

PROTEINURIA AS INDICATOR OF RENAL DISEASE

It was undeniable that progression of kidney failure is inexorable once a degree of renal damage has occurred, leading to the hypothesis that maladaptive response happens in the remaining nephrons that may cause eventual destruction by common pathogenic mechanism.[15]  There are also many clinical observations depicting a strong correlation between the rate of chronic renal failure (CRF) and a quantity of proteinuria, with severity of proteinuria linked to faster rate of progression of CRF and poor renal outcome.  Those presenting with nephritic syndrome had a worse prognosis than those presenting with less proteinuria.[16]  The rate of progression of CRF could be predicted by the severity of proteinuria, signifying the relationships between proteinuria and the development of renal scarring.  Those with decreasing proteinuria symptom possessed higher cumulative renal survival rate than those patients with higher or constant rate of proteinuria.[17]  

DIABETIC NEPHROPATHY[18]

One of the major cause of illness and death of diabetes is nephropathy.  However, associated cardiovascular disease especially among non-insulin-dependent diabetes mellitus (type II diabetes, NIDDM) patients may cause excess mortality of diabetes, besides the end-stage renal disease (ESRD) that lead to proteinuric insulin-dependent diabetes mellitus (type I diabetes, IDDM) and NIDDM as well.[19]  In a typical studies done between 1933 and 1952 in a cohort of 1030 IDDM patients, 40% higher relative mortality has been encountered in patients with proteinuria, whereas patients without proteinuria had a significantly lower relative mortality.[20] 

MICROALBUMINURIA AND DIABETIC NEPHROPATHY

Microalbuminuria is defined as urinary albumin excretion between 300 mg per 24 hours (or 200 mg/min) and 30 mg per 24 hours (or 20mg/min) regardless of urine collection method after consensus was obtained on early diabetic nephropathy at a conference.[21]  Similar clinical definition of diabetic nephropathy could be applied in insulin-dependent diabetes mellitus (type I, IDDM) and also non-insulin dependent diabetes mellitus (type II, NIDDM), when persistent albuminuria has been the hallmark among diabetic nephropathy patients in concurrent with additional valid criteria such as diabetic retinopathy without laboratory evidence of urinary tract or kidney other than diabetic glomerulosclerosis.[22]  In the development of diabetic nephropathy, there  exists formation of new glomerular macromolecular pathway and loss of glomerular charge selectivity on the determination of ration for immunoglobulin G : immunoglobulin GA, that may partially lead to microalbuminuria.[23]  Typical clinical experimentation apply filtration fraction to reflect the glomerular pressure because the glomerular hydraulic pressure  cannot be measured in humans.

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During the 18th century proteinuria was detected as one of the symptom in diabetic patients. Only until year 1836 then it was postulated that albuminuria could be an indication of serious nephron or renal diabetic related disease.[24]  This observation has further been justified in current findings where elevated urinary albumin excretion was diagnosed in both IDDM and NIDDM patients.  The amount of albumin filtered and the amount reabsorbed by the tubule cells could determine urine albumin excretion.  Alteration of size and charge-selective properties of glomerular capillary membrane may change glomerular pressure and flow that affect the diffusive and convecting driving forces for transglomerular passage of protein.[25]   

DIFFERENT DIABETIC ASSOCIATED URINARY TRACT COMPLICATIONS WITH TREATMENT

Bladder dysfunction like neurogenic bladders are very common among diabetes patient with typical statistics of 25% cases among non-insulin-dependent diabetes mellitus (type II diabetes, NIDDM) and approximately 26-87% among patients of insulin-dependent diabetes mellitus (type I diabetes, IDDM).[26]  Typical therapy maybe : (a) possible incision of the internal sphincter (b) 10-50 mg of bethanechol, three times a day in cholinergic therapy (c) long term intermittent or indwelling catheterization (d) ensure actual bladder emptiness with repetitive scheduled voiding every 3 to 4 hours.  The probability of urinary tract infections among diabetic patients are comparatively higher than non-diabetics, that could be caused by fungus with counts greater than 104/mL on catheterized specimen in typical primary infection.[27]   

POTENTIAL APPLICATION OF HERBAL MEDICINES IN THE TREATMENT OF DIABETIC NEPHROPATHY

As in chronic kidney diseases, diabetic nephropathy was believed to be treated using traditional herbal medicines effectively by applying indigenous systems of healthcare in poorer sections of the society in the developing world, and such alternative treatment has become more popular in the developed countries.[28]    Although traditional native medicines are relatively cheap and easily prepared compared to modern medical care that requires adherence to good manufacturing practice (GMP), the nephrotoxic potential of herbal remedies in diabetic nephropathy inclusive is being increasingly recognized.[29]  There are various ways where herbal toxicity that may develop in the following situations, further worsening the health of diabetic patients of nephron problems, namely (a) incorrect identification leading to substitution of an innocuous herb with unknown toxicity (b) consumption of unknown toxic in herbs etc.[30]   

FUNCTIONS OF ANGIOTENSIN II BLOCKERS IN THE PREVENTION OF DIABETIC NEPHROPATHY

There are various chemicals that act as agents to inhibit the rennin-angiotensin system could be used to reduce the risks of diabetic nephropathy and other types of renal diseases especially the type 2 diabetes.[31]  In typical Irbesartan and Diabetic Nephropathy Trial (IDNT), each selected patient had received either amlodipine (10 mg daily), irbesartan (300 mg daily) or placebo, with blood pressure to be controlled equal or less than 135 / 85 mm Hg using antihypertensives except angiotensin converting enzyme (ACE)-inhibitors or angiotensin II receptor blockers, and calcium channel blockers.[32]  Irbesartan was found to be effective in reducing the risk of a doubling of the serum creatine concentration by 33%, reducing the risks of end-stage renal disease by 23% with proteinuria reduction by 33%, with lower level of similar risks reduction in amlodipine group and placebo.

GROWTH HORMONE EFFECTS IN DIABETIC-INDUCED RENAL DISEASES

When the number of disaccharide units increased in the blood circulation systems, caused by the assembly of carbohydrate units, this will lead to the thickening and increasing permeability of diabetic basement membrane due to interference in the packing of the collagen helices into fibrils.  Such problems may also be due to excess growth hormone in addition to insulin deficiency and glucose excess.[33]  When growth hormone is elevated, such insulin antagonist mobilizes free fatty acids and inhibit glucose utilization at the phosphofructokinase step, as growth hormone levels are high with wide fluctuation in uncontrolled diabetics.  The growth hormone may also caused hypertrophied kidneys in diabetic human or animal.  Together with the effects of insulin deficiency, ultimate basement membrane thickening may occur in the absence of leukocyte and phagocyte.[34]   

DIETARY PROTEIN INTAKE AND EFFECTS ON THE RENAL FAILURE PROGRESSION

Animal body’s protein intake may be used to predict the dietary effects in the renal diseases among humans, where the restrictions on protein consumption are beneficial in the renal function preservation.[35]  The experimental results suggest in chronological order that semi-defatted fish meat, defatted pork diet, followed by equivalent group of control casein diet and fully defatted fish meat diet, able to ameliorate renal insufficiency progression in Imai rats, with beneficial effects from oils derived from fish rather than protein.  In other experiments applying vegetable protein, lower renal plasma flow and a lower glomerular filtration rate were observed among kidney patients.[36]  Chronic intake of high amounts of fish protein was related to a lower risk of microalbuminuria in type I diabetic patients.[37]  

NUTRIENT ADMINISTRATION FOR DIABETIC-INDUCED ACUTE RENAL FAILURE (ARF)

Oral feedings should be encouraged for tolerable patients with initial 40g/day of high quality protein is given to meet the daily protein requirement of about 0.6g/kg body weight per day, that may be increased to 0.8g/kg per day for blood urea nitrogen (BUN) level of 100 mg/L or lower.[38]  Small amount of enteral nutrient maybe helpful to maintain kidney’s function, prevent sepsis development from intestinal bacteria, limit bacterial translocation from gut etc.[39] 

CHRONIC KIDNEY DISEASES AND DIET

Care need to be taken in food consumption for patients affected by Chronic Kidney Diseases (CKD), especially foe those in the morbid states.[40]    Recommendation in the restriction of salt intake is less than 6g/day, with estimated salt intake (g/day) = urinary sodium (mEq/day)¸17. Restriction of protein intake is suggested around 0.6-0.8g/(kg×day), good particularly for stage 3-5 CKD, with Maroni’s formula applied.  Estimated protein intake (g/day) = [urea nitrogen in urine (g/day) + 0.031 g/kg x body weight (kg) ] x 6.25.  Total calcium concentration corrected for albumin is proposed to be maintained at 8.4-10 mg, with corrected Ca concentration is calculated by special formula.  Corrected Ca concentration (mg/dL) = measured Ca concentration (mg/dL) + [4 – serum albumin concentration (g/dL)], when the serum albumin concentration is less than 4 g/dL.  Obesity is also recommended with BMI being less than 25 kg/m2, with standard body weight (kg) = [height (m)]2 x 22.[41]     

CHRONIC RENAL DISEASE AND INORGANIC COMPOUNDS

Inorganic compounds, mainly derived from phosphorus, aluminum, magnesium etc, may be used to define uremic toxins that have been implicated strongly in the pathogenesis with uremic state alterations, although more attention is being placed on organic compounds.[42]  Serum phosphorus will be able to maintain in the normal range of 3.5-4.5 mg per deciliter until the glomerular filtration rate falls below 25% of normal even with renal tubular reabsorption of phosphorus occur.[43]  Aluminum, as the 5th most common element in earth crust, found around 4 mg Aluminum / liter of municipal water, with systemic aluminum elimination approximately 15 mg/day.[44]  Other element like magnesium may be cleared fractionally with increment as the renal function falls progressively.

CONCLUSION

Proper independent research among patients affected by renal problems may be possible with self-study, by following routine habit of reading especially among non-medical professionals.  This will assist the patients to cure themselves faster and more effectively rather than over-relying on costly medical advice with potential treatment errors not usually aware by persons outside the area of nephrological medical professions.

References

[*] GJS Intellectual Company Australia, community legal researcher.  Address : PO Box 6263, Dandenong, Victoria VIC 3175, Australia.  Mobile : +61-(0)405421706   E-mail : chuentat@hotmail.com

1.  Pyrah LN :  (1979) Renal calculus. Springer-Verlag; 1979; United Kingdom; page 18-20 

2.  Fleisch H, Bisaz S :  Mechanism of calcification : role of collagen, pyrophosphates and phosphatase.  Am. J. Physiol.; 1962; 200:1296

3. Fraser D, Russell RG, Pohler O, Robertson WG, Fleisch H :  The influence of disodium, ethane-1-hydroxy 1,1-diphosphonate (EHDP) on development of experimentally-induced urinary stones in rats.  Clin. Sci.; 1972; 42:197 

4. Murphy BT, Pyrah LN :  The composition, structure and mechanisms of the formation of urinary calculi.   J. Urol.; 1961; 57:949

5. Mandal AK : Electron Microscopy of the Kidney in Renal Disease and Hypertension.  Plenum Publishing Corporation; 1979; USA

6.  Churg H, Grishman E : Ultrastructure of glomerular disease : A review.  Kidney Int.; 1975; 7:254

7.  Churg J, Dachs S : Diabetic renal disease : Arteriosclerosis and glomerulosclerosis : In kidney Pathology Decennial. 1966-1975 (S. C. Sommers, ed); Appleton, New York; 1975, page 503

8.  Gerfand MC, Frank MM, Green I : A receptor for the third component of complement in the human renal glomerulus.  Journal of Experimental Medicine; 1975; 142:1029-1034

9.  Wilson CB,  Dixon FJ : Immunopathology and glomerulonephritis.  Annual Review of Medicine; 1974; 25:83-89

10. Wilson CB, Brenner BM, Steir JH : Immunologic Mechanisms of Renal Disease; Churchill Living Stone Inc, 1979; United States of America

11. Gardner K : Cystic Diseases of the Kidney.  John Wiley and Sons Inc.; 1976; United States of America; page 176

12. Mongeau JG, Worthen HG : Nephronophthisis and medullary cystic disease.  Am J Med.; 1967; 43:345-355

13. Strauss MB (1971) Microcystic disease of the renal medulla.  In Strauss, MB, Welt, LG. (ed) : Disease of the kidney. Boston Little Brown; 1971; page 1259-1273

14. Axelsson U, Odlund B : Cystic disease of the renal medulla and its possible relation to juvenile nephronophitis.  Acta Med Scand; 1968; 183:275-280

15. Harris KPG : Proteinuria : implications for progression and management.  In Chapter 5 of Nahas AM : Mechanisms and clinical Management of Chronic Renal Failure. 2nd Edition; Oxford University Press; United States of America; 2000; page 146

16. Cameron J, Turner D, Ogg C, Chantler C, William D : The long term prognosis of patients with focal segmental glomerulosclerosis.  Clinical Nephrology; 1978; 10:213-218

17. Locatelli F, Marcelli D,  Comelli M, et. al. : Proteinuria and blood pressure as causal components of progression to end stage renal failure. Nephrology, Dialysis and Transplantation; 1996; 11:461-467

18. Brenner BM. (ed) : Brenner and Rector’s : The Kidney.  Volume II Fifth Edition; W. B. Saunders Company; 1996; United States of America; page 1864

19. Deckert T, Poulsen JE, Larsen, M : Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death and complications.  Diabetologia; 1978; 14:363

20. Borch-Johnsen K, Andersen PK, Deckert T : The effect of proteinuria on relative mortality in type I (insulin-dependent) diabetes mellitus.  Diabetologia, 1985; 28:590

21. Mogensen CE, Chachati A, Christensen CK, et. al. : Microalbuminuria : An early marker of renal involvement in diabetes.  Uremia Invest; 1986; 9:85

22. Deckert T, Parving HH, Andersen AR, et. al. :    Diabetic nephropathy – A clinical and morphometric study.  In Eschwege, E. (ed) : Advances in Diabetic Epidemiology; Elsevier Biomedical Press; 1982; Amsterdam of Netherland; page 235

23. Deckert T,  Kofoed-Enevoldsen A, Vidal P, et. al. : Size and charge selectivity of glomerular filtration in type I (insulin dependent) diabetic patients with and without albuminuria.  Diabetologia; 1993; 36:244

24. Bright  R : Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urine.  Guys Hosp rep.; 1836; 1:338

25. Brenner BM, Bohrer MP, Baylis  C, Deen WM : Determinants of glomerular permselectivity : Insights derived from observations in vivo.  Kidney Int.; 1977; 12:229

26. Schiff HI : The neurogenic bladder in diabetes.  N.Y. State J. Med.; 1982; 82:922

27. Glodberg PK, Kozinn PJ, Wise GJ, et al : Incidence and significance of candiduria. JAMA; 1979; 241:582

28. Vivekanand JHA : Herbal medicines and chronic kidney disease.  Nephrology; 2010; 15:10-17

29. Luyckx VA, Naicker S.: Acute kidney injury associated with the use of traditional medicines.  Nat. Clin. Pract. Nephrol.; 2008; 4:661-71

30. Isnard B, Peray G, Boumelou A, Le Quintree M, Vanherweghem JL :  Herbs and the kidney.  Am. J. kidney Dis.; 2004; 44 : 1-11

31. Lewis J, Lewis EJ : Fight to prevent end-stage renal disease.  In Raz I, Skyler JS, Shafrir E : Diabetes From Research to Diagnosis and Treatment.  Mrtin Dunitz United Kingdom, page 142

32. Lewis EJ, Hunsicker LG, Clarke WR, et. Al.: Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to Type 2 diabetes.  N Engl J Med; 2001; 345 : 851-60

33. Wardle EN : Renal Medicine – Guidelines in Medicine Volume 2.  MTP Press Limited; 1979; United Kingdom

34. Anderson J, Oakley-Pyke-Taylor (Editor) : The kidney in diabetes.  Clinical Diabetes; 1968; Oxford Blackwell; United Kingdom

35.Liang XM, Otani H, Zhou Q, Tone Y, Fujii R, Mune M, Yukawa S, Akizawa T : Various Dietary Protein Intakes and Progression of Renal Failure in Spontaneously Hypercholesterolemic Imai Rats.  Nephron Experimental Nephrology, April 2007; 105 : e98-e107

36. Kontessis P, Jones S, Dodds R, Trevisan R, Nosadini R, Fiorett OP, Borsato M, Sacerdoti D, Viberti G : Renal, metabolic and hormonal responses to ingestion of animal and vegetable proteins.  Kidney Int.; 1990; 38 : 136-144

37. Mollsten AV, Dahlquist GG, Stattin EL, Rudberg S : Higher intakes of fish protein are related to a lower risk of microalbuminuria in young Swedish type I diabetic patients.  Diabetes Care; 2001; 24 : 805-810

38. Druml W, Mitch WE : Chapter 9 – Nutritional management of Acute Renal Failure.  In : Brady HR, Wilcox CX (editor) : Therapy in Nephrology and hypertension.  WB Saunders-Elsevier Science Limited; 2003; United States; page 73-86

40. Anonymous : Chapter 17 : Modification of lifestyle and diet.  Clinical and Experimental Nephrology; Tokyo; June 2009: 13; 3:228-231

41. Springer, Japanese Society of Nephrology 2009, DOI 10.1007/s110157-009-0148-8

42. Alfrey AC : Phosphate, Aluminum and Other Elements in Chronic Renal Disease. In : Schrier RW, Gottschalk CW (Editor) : Diseases of the kidney. Fourth Edition; Volume III; Little, Brown and Company Inc; USA; page 3371

43. Slatopolsky E, Robson AM, Elkan I, et al : Control of phosphate excretion in uremic man.  J. Clin. Invest.; 47:1865; 1968

44. Alfrey AC : Dialysis encephalopathy syndrome.  Annu. Rev. Med. 2:93, 1978

This modern dentistry is more important to specfic areas of world like USA as studies reveal that 70% of US kids are infected with serious dental infections like ECC ( Early childhood caries ) which is caused mainly due to lack of children dental care. Kids dental care should be given higher priority as studies shows that more than half of children ages from 5 to 17 have atleast one dental cavity or dental filling. Pediatric dentistry is the most discussed part in modern dentistry. Pediatric dentistry also known as pedodontics or paedodontics. As the name describes pediatric dentistry deals with kids dentistry or child dental treatments and dental care. Recent studies shows that 40 percent children have dental cavities when they reach kindergarten. This modern dentistry is more important to specfic areas of world like USA as studies reveal that 70% of US kids are infected with serious dental infections like ECC ( Early childhood caries ) which is caused mainly due to lack of children dental care. Kids dental care should be given higher priority as studies shows that more than half of children ages from 5 to 17 have atleast one dental cavity or dental filling.Its a fact that kids in US lack dental care when all US towns are having all kinds of pediatric dentistry services. You can find good pediatric dentist with all specilized pediatric dentistry services in every town. All these town pediatric dentists are specialized in child psychology and management.

Pediatric dentistry is the most discussed part in modern dentistry. Pediatric dentistry also known as pedodontics or paedodontics. As the name describes pediatric dentistry deals with kids dentistry or child dental treatments and dental care. Recent studies shows that 40 percent children have dental cavities when they reach kindergarten. This modern dentistry is more important to specfic areas of world like USA as studies reveal that 70% of US kids are infected with serious dental infections like ECC ( Early childhood caries ) which is caused mainly due to lack of children dental care. Kids dental care should be given higher priority as studies shows that more than half of children ages from 5 to 17 have atleast one dental cavity or dental filling.Its a fact that kids in US lack dental care when all US towns are having all kinds of pediatric dentistry services. You can find good pediatric dentist with all specilized pediatric dentistry services in every town. All these town pediatric dentists are specialized in child psychology and management.

Quotations can also be the price, which is used to quote for some product or a service. Quotations are basically ‘a set of words’ or a short note identifying a certain source of information. Punctuations are used to indicate quotations.

Sources for Quotations:

Quotations are normally taken from books, speeches, interviews, articles or even from movies. Quotations are a popular form of practice of quoting or a passage that has been cited. Good orator skills and speeches with inspiration provide an excellent source for quotations.

Usage of Quotations:

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Famous quotations particularly which inspire people are complied in books and various websites online. Quotations can be of many forms and are categorized according to their genre or their usage.

M any people also use quotations as email signatures as well. Politicians or motivational speakers often use quotations to explain their intentions. Many a times, quotations are used, complied and printed to provide inspiration for the readers.

Misinterpretation of Quotations:

A s quotations can be from any language, translation always has the risk of misinterpretation. Like many other things, quotations have also been misinterpreted which can lead to a lot of confusion.

Famous Compilations of Quotations

As reliability is important in the world of quotations, famous and trustworthy sources of quotations include the Oxford Dictionary of Quotations, The Yale Book of Quotations, The Columbia Dictionary of Quotations, The Macmillan Book of Proverbs, Maxims, and Famous Phrases .

Social networking is a popular medium for its accessibility and convenience; therefore, this form is a common way of sharing of quotations. However, internet is often used to wrongly credit quotations from unknown people to famous personalities to gather attention.

Copyright laws can be different as per the location but the basic criterion remains the same. EU Copyright Directive is a good example of copyright law concerning quotations. In spite of all the concerns, the amazing world of quotations has inspired and helped millions around the world and will continue to do so.

Hello, Dr. Snodgrass!

Hello, Chomp! I am so glad you could drop by.

Me too. I thought it might be fun to turn the tables today and have you answer some questions for me about human dentistry.

Well, that does sound like a good idea.

I know a lot of things about animals, but when it comes to human dental facts and dental history, there is so much to learn.

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That’s true. Did you know, for example, that dentistry is an ancient craft dating back thousands of years?

Wow. I was not aware of that.

Some of the earliest dentists were the ancient Egyptians, who made fillings out of resin and malachite. They also held loose teeth together with gold wire.

Is that something like the braces you use on crooked teeth today?

Yes, braces serve much the same function.

When was the first toothbrush invented?

That is not so easy to answer and you have to go far back into history. The first toothbrushes were nothing more than twigs, which early humans chewed on to fray the ends. Then they used the frayed wet end of the twig to clean their teeth.

Very inventive!

Yes, and it’s not even an exclusively human trick. Our primate cousins in the wild have also been observed improvising homemade toothpicks out of twigs.

So different animals have more in common than I thought.

That’s the truth, Chomp. All we have do to is look carefully at humans and their fellow animals to see remarkable similarities.

And some impressive differences.

Of course. It is our similarities that help us respect each other, and our differences that keep us interesting.

That’s a neat way to look at things, Dr. Snodgrass.

Thanks, Chomp. Well, I’m especially busy today, because I’ve got some new young patients coming for their first dental exam. I must go for now.

Sure thing, Dr. Snodgrass. Thanks for teaching me a little dental history.

You’re welcome, Chomp. It’s always a pleasure. Come back soon!

For more information about Hermitage Pediatric Dentist Snodgrass-King, go to http://snodgrassking.com

First of all, recognition of the phenomenon of embryo formation. Early in Sman dpyad zla ba’i rgyal po, and Rgyud bzhi 1,000 years ago, there was full recognition of this problem, pointing out that the opportune time for fertilization is about 12 days after menstruation. Earlier or later than that will not be fertile. This is the most precise and earliest record in traditional Chinese medicine. In the books, it also points out that a woman will easily tire, suffer a withered complexion, have a distended chest, and an uneasy or painful waist before menstruation. At the peak of the fertilization period, a woman has higher libido.

Tibetan medicine claims that an embryo involves the merger of the father’s semen and mother’s blood. This idea is an excellent Chinese medicine diagnosis at the time when there was no microscope to observe these matters. Based on this idea, Tibetan medicine also stresses the importance of both the father’s semen and mother’s blood. Abnormality of either, such as diseased rlung, mkhris pa, or badkan, will result in infertility. When there is a rough appearance, abnormal color or degree of concentration, and abnormal smell, no embryo will be formed. This is both correct and scientific. In the old society, people used to blame the female side for infertility, so it is scientific that Tibetan medicine seeks the reasons for infertility equally in either the man or woman.

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Tibetan medicine also pointed out that there should be “five origins” for embryo formation, namely, earth, water; fire, wind and space. It is coincident that traditional Chinese medicine activity also emphasizes that, in the formation of embryo, the “water is accepted in the 4th month, fire accepted in the 5th month, metal accepted in the 6th month, wood accepted in the 7th month and earth accepted in the 8th month”.

However, the “five origins” of Tibetan medicine is different to the “five dements” of TCM. The earth in TCM is the ground-earth for embryo development, and the space of Tibetan medicine offers a room for the embryo to stay and develop. Both systems maintain that all five factors should be harmonious to ensure normal development.

you clink to interested informationhttp://net.zoosnet.net/LR/Chatpre.aspx?id=NET39826137

Manager is the person has to know all the tasks that are performed during the clinical trials. From start to finish, it is better if he presents a visual media of the procedures that must be made. All processes, from beginning to end has been designed according to the work flow in mind. This will help to improve efficiency and create opportunities for best practices in clinical trials.

Management should have an understanding of project progress and the skills or knowledge to make assessments throughout the project, so if ever there are problems, he or she can implement the return required to be able to get to a timely conclusion. Punctuality is very important for getting high-quality results for the project. Other than this group work and dedication also needed for getting best results. Each and every time if you perform a task you have to make comparison of previous results and also the consequences of it to avoid later issues. Clinical trial supply Asia is also most important factor which cannot be avoided. All clinical products must meet the quality and must pass all the legal quality criteria for acceptance in world market. For this purpose better quality management is a must for all best practices in clinical trials.

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According to industry analysts and consultants, outsourcing may be disadvantageous, no matter how simple the task may be. Even if t is justified or not, clinical trials could be affected because the director, who is directly responsible for the focus is divided into several processes, as well as concerns about the language barrier and other concerns. Businesses rely on best practices for the improvement depends on a variety of techniques to determine a company’s competitiveness on the market.

To increase performance, make the process much simpler but still want to get the best results, it is important to use the legal system or software. The objective is to minimize errors and provide consistent results. In addition, the work done at the time must be without any hassle. With the use of these systems, process efficiency maximized while identifying risks and barriers that may prevent clinical trials to proceed as planned. One of the most useful tools is the management system work flow. This system offers more control and for the benefit of safe operations.

Organizing the work flow is a major task and need proper planning. The goal for the company is to use best practices and technologies so that the process can be faster, more efficient, reliable and very intuitive. It is crucial to take advantage of these tools and processes so that clinical trials will not suffer because of the methods and systems obsolete.

Find More Clinical Trials Articles

i.e. tongue, gums, buccal mucosa (inner side of cheek) and palate
(area behind the tonsils)

Eighty-five percent of oral cancers are linked to tobacco use. People who use both tobacco and alcohol are at greater risk for developing these cancers than people who use either tobacco or alcohol alone. The other risk factors are poor oral hygiene and Human papilloma virus (HPV) infection. There are certain stages before development of frank cancer which present as White patches (leukoplakia) in the mouth, which do not get rubbed off or Red patches (Erythroplakia). There is a condition which is called submucous fibrosis (SMF) when person cannot fully open the mouth, whole of inner lining of cheek tissues turns white and hard due to effect of Gutkha. In this condition, person is very prone for development of cancer in future.

More than 5 million children inIndiaare addicted to gutkha, a smokeless tobacco product that is a key driver behind the country’s soaring oral cancer rates. People who are at risk for oral cancers should get annual check ups and learn to reduce their risk. They should also discuss how often to have checkups.

Decrease in mouth opening or pain during opening of mouth.
Changes in colour – red, brown, white or black spots / patches in the mouth
Raised growth, swelling or lump
A sore or ulcer which does not heal
Bleeding
Tingling, burning or numbness in tongue or lip
Pain anywhere in the mouth
Painful, sensitive or loose teeth
Difficulty in swallowing or talking

            Submucous Fibrosis – Inability to open the mouth fully

            Erythroplakia (Red Patches)

            Leukoplakia (White Patches)

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The earlier cancer is detected there are very high chances of cure and complete recovery. It is important to realize that many cancers today are curable.

High risk individuals should be examined 1st by trained surgical oncologist. Subsequent check up can be done, every 2 – 3 monthly or during annual check ups.

by each and every one of us will go a long way in detecting cancer at the early stage. One can stand in front of large mirror and look for the following : -

Change in colour of gums, lips and cheeks, White, Brown or red patches, ulcer, sore or scab, thickening in any part of the oral cavity.
Look for any lump, swelling or any other abnormality.
If a person cannot open the mouth fully then endoscopic examination should be done.

If you find anything abnormal, record it on a notebook and report it to your doctor. In case everything is normal, RELAX!

The advantage of early detection of cancer is that it can be cured by only surgery or radiotherapy resulting in good functional and cosmetic outcome with decreased cost.

Oral Cancers mouth examination is must for both the sexes.This is most important for all of us because it is through these annual check ups that we can find out about the status of our health. Annual Health check up should also include cancer check up which includes the following :

General Body Check up including Mouth Examination
Dental Check up
Breast Examination
Pap smears
Mammography
Pelvic Examination
Colon & Rectum Examination

General Body Check up including Mouth Examination
Dental Check up
Colon & Rectum Examination
Testicles Examination
Prostate Examination
Prostate Specific Antigen (PSA)

Avoid Tobacco and Tobacco Products like gutkha, paan, khaini, surti, beedi, cigarette
Avoid Alcohol
Maintain Good oral and dental hygiene

All smokers and tobacco chewers need several counselling sessions to leave the habit and ensure they do not start taking tobacco, after quitting it, best helped by dedicated tobacco cessation clinics at specialised cancer hospitals.

Depending on the type of cancer (diagnosis) and how far it has spread (staging) it is treated with surgery, radiotherapy, chemotherapy and often various combinations of these. It is therefore important that, if someone you know, develops a cancer, he / she should go to a comprehensive or dedicated cancer care superspeciality hospital with NABH ACCREDITATION, where a correct diagnosis, staging and planned treatment can be carried out along with good rehabilitation team including speech and swallowing therapist, physiotherapist and prosthodontics dental surgeon. Oral Cancer Cases which were being labelled as inoperable due to lack of surgical skills earlier are very much operable with good results.

Complete diagnostic check up to confirm or rule out cancer.
Staging work up to find out the stage of the disease.
Tumour Board evaluation by a group of cancer experts to plan the standard treatment as per National / International protocols
Treatment of cancer at dedicated cancer centres specially NABH Accredited hospitals, where all modalities of diagnosis and treatment are available under one roof.
Faith in self, God and the treating team
Positive attitude and the will to fight cancer

A panel of cancer experts i.e. Surgical Oncologists, Radiation Oncologists, Medical Oncologists, Gynae Oncologists, Paediatric Oncologists, Onco-pathologists, Radiologists and Imaging experts, get together to review and plan suitable modality or modalities of treatment.
Treatment is need driven and not doctor driven.
Patients get the choice of surgery or radiotherapy, if the results are same by both modalities.
Patients are saved from unnecessary surgeries, if the surgeries cannot be performed.
Patients get complete treatment. This prevents recurrence due to incomplete treatment.
Chances of cure / improvement in quality of life are much higher because of right and optimum treatment.
Patients are saved from Medical shopping and get expert opinion under one roof by spending one consultation fee only. 

High end Technology and infrastructure
Highly trained team of oncologists
Very high standards of treatment
Patient safety and confidentiality
High Survival rates
Environment and legal compliances
Continuous surveillance of systems by Quality Council of India

To fight against this menace of oral cancer, we need to stop usage of tobacco, we need to be aware of warning signs / symptoms so that early detection is possible leading to cure than this disease. This can be achieved at cancer specialist NABH hospitals with high success. 

More Cancer Articles

Pain which you might feel when you touch, push, or bite food with teeth
 High receptiveness of the tooth to heat and cold
Inflammation near the tooth
Discoloration of the tooth or broken tooth

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Endodontic treatment or Root canal therapy offers a lot of distinct advantages such as :

Complete elimination of pain, swelling and numbness that results from swelling
Removal of microbial infection in future
Preservation of the affected tooth in the mouth for a longer period of time

Listed below are some of the disadvantages and risks  related with this procedure.

Occurrence of bruises at the anesthetic injection site
Post-operative pain
Files or other instrumentation may get broken inside the tooth
Certain obstructions may  arise which could make it impossible to completely instrument canals (e.g. calcification)
It would become impossible to complete the root canal treatment due to certain unexpected findings.  such as cracks, within the tooth
There are chances that secondary infections may develop following the root canal treatment Numbness could accompany  pain and swelling.
 Fracture of the tooth following endodontic treatment is yet another risk which we cannot rule out.

Track record as well as remedies not really simply employs different vocabularies, yet these people in addition have diverse sets involving rules and also procedures intended for making expertise statements. Also some thing because apparently easily technical since the form involving citation can easily pose large barriers for you to crossing disciplinary edges, Intended for instance, suggestions inside medical journals reflect a great fully several conceptual framework connected with facts production from footnotes within a historical publication. Pertaining to historians, footnotes usually are a space in which usually evidence claims might be examined and contested, whilst a reference inside a health-related article legitimates a claim.

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An applied history associated with medicinal drugs will be an equity casualty regarding this professional separation. Pertaining to, if, as social as well as cultural healthcare historians insist, healthcare circumstances are generally contingent, those who rely on current understandings of sickness components to be able to make clear before disease incarnations are generally ipso facto suspect. Throughout an otherwise laudatory endorsement regarding a book proposal on this history connected with a psychiatric syndrome, the actual late medical historian Roy Porter wrote that “a historical study ought to be able to stand individually of any epidemiological payoff”.

Because regarding the particular hybrid nature involving collaborative histories involving medicinal drugs these issues tend to be exacerbated, restricting the actual possible venues intended for publication regarding scholarship. The editors involving North American as well as British academic medical history journals solicit as well as publish cultural and also social studies regarding medicine, whilst they will routinely reject applied history submissions. Likewise, editors in addition to referees connected with health-related journals are usually unlikely for you to publish applied historical studies. This form that a submission must take and also what are generally considered acceptable data; restrict the particular publication associated with applied health-related history within health-related journals. What historians typically look at as information along with the narrative form in that they will convey it cannot easily be accommodated inside the platform associated with what healthcare journals think about an acceptable contribution.

If a history involving medication uninformed by biomedical know-how will be untenable, then health-related research uninformed by historical context is actually incomplete. The particular challenge remains, as it has been intended for decades, connected with how to help create a collaborative environment to bring these two strands together. Perhaps the actual beginning involving an answer resides within an educational energy that exposes academic historians for you to both patients’ care and health-related science in addition to that gives physicians with the training to be able to appreciate the extent to which in turn treatment along with research take place within historically specific cultures and contexts. Such a hard work could be this foundation for exciting in addition to productive collaborations between physicians and historians.

More History Of Medicine Articles

Forensic accounting is a rapidly growing area of accounting concerned with the detection and prevention of financial fraud and white-collar criminal activities. George A. Manning in his book “Financial Investigation and Forensic Accounting” defines Forensic Accounting as the science of gathering and presenting financial information in a form that will be accepted by a court of jurisprudence against perpetrators of economic crimes. The integration of accounting, auditing, and investigative skills yields the specialty known as Forensic Accounting which focuses very closely on detecting or preventing accounting fraud. “Forensic”, according to the Webster’s Dictionary means, “Belonging to, used in or suitable to courts of judicature or to public discussion and debate.” The word accounting is defined as “a system of recording and summarizing business and financial transactions and analyzing, verifying, and recording the results.” The term ‘forensic accounting’ refers to financial fraud investigation which includes the analysis of accounting records to prove or disprove financial fraud and serving as an expert witness in Court to prove or disprove the same. Thus, basically, the forensic accounting is the use of accounting for legal purposes.

The forensic accounting can be traced back as far as 1817 to Meyer v. Sefton, a Canadian case that allowed an ‘expert witness’ to testify in court. The term ‘forensic accounting’ was first published in an article in 1946 “Forensic Accounting- Its Place in Today’s Economy” authored by Maurice E. Peloubet, a partner in Price Waterhouse. He stated that, “during the war both the public and industrial accountant have been and now engaged in the practice of forensic accounting”. Many scholars have traced the roots of investigative accounting to his work. Interest in forensic accounting spread through the United States and England early in the twentieth century. One of the first institutions to use the services of such investigative accountants was the IRS. The story of Al Capone the famous mobster being caught on a tax evasion scheme is well-known. The FBI decided to use forensic accountants and employed nearly 500 such agents during World War II. As a profession, forensic accounting continued to grow during the latter half of the century, as GAAP and tax laws became widespread and mandatory.

Forensic Accounting is a fast emerging field in the “World of Accounting”. Although it has been around for a long time, it has become increasingly popular and much relevant today in view of global financial crisis due to the downfall of the Lehman Brothers and its ripples felt across the globe. Thus, a new avatar of Accountant has emerged known as Forensic Accountant. Although Investigative Accounting has been around for years, it has only recently begun to transform into a new branch of accounting, hence Forensic Accounting. Forensic accountants unlike traditional accountants, look beyond the numbers, put their nose and eye deep into the financial books, records and data to uncover fraud, hidden assets, siphoned funds and the like. The word forensic is defined as the application of scientific knowledge to legal problems and legal proceedings. The word accounting is defined as “a system of recording and summarizing business and financial transactions and analyzing, verifying, and recording the results.” By combining these two definitions it can be concluded that forensic accounting utilizes his regular accounting principles & practices in legal situations. Forensic Accounting is like the bridge which connects accounting system to legal system. Thus, we can say that the forensic accounting is an accounting that is used in a court of law. One of the most notable legal situations in the recent past would be the Enron scandals; where large numbers of American forensic accountants were employed. The wave of financial crisis primarily caused by corporate malfeasance and fraudulent financial activities eroded public trust and investor confidence in financial reports and audit services and need was felt to look beyond the conventional accounting function which only fulfilled the compliance requirements i.e. company’s books of accounts are kept in accordance with rules & regulations. In view of the increasing number of financial frauds committed by conspiracy with complex accounting records manipulation, it was felt that a new tribe of Accountant is needed to detect the financial fraud in companies with his accounting, auditing, and investigative skills and also assist in legal matters. This area of accounting came to be known as ‘forensic accounting’. There is a global awareness to fight the cases of financial frauds. Though many strategies have been formulated and many actions have been taking to fight against it, the problem still persists. One of the major hindrances in fighting financial crime cases is lack of quality forensic analysis of the financial statements and records due to lack of forensic accounting professionals. This author who had been an investigating officer during his tenure with Delhi Police in number of major cases of financial crimes have faced this dearth of quality forensic accounting experts who could have come handy in timely & accurate investigation of the intricate financial crimes and unearth the complex modus operandi adopted by the fraudsters who are themselves in some cases highly qualified financial professionals. The reason why there has been rampant increase in white collar financial crimes because they think that they can get away with it with impunity and the greatest deterrent to thwart the criminal act is law enforcement. However, the conviction rate in the financial fraud cases was very low due to weak law enforcement which is attributable to weak litigation support in prosecution process. Without full support of accounting expert, prosecutors often fail to prove and provide strong evidence to put fraudsters behind bar. Here, the Forensic accounting can play an important role here by providing accounting or financial information or other evidentiary inputs for legal purposes. To achieve the aim, forensic accountant besides having financial accounting expertise, should also have proven skill in law, scientific investigative technique, interpersonal and communication skills etc.

The Western Countries are utilizing the forensic accounting expertise to address the financial fraud cases. United States and Canada are pioneers in development & implementation of Forensic Accounting. The Canadian Institute of Chartered Accountant recently recognized Investigative and Forensic Accounting as an accounting specialty. The CICA has started granting its members to use the designation initials CAIFA who complete three years post qualification experience as a CA with Diploma in Investigative and Forensic Accounting (DIFA) from the University of Toronto. The CA-designated specialist in investigative and forensic accounting (CAIFA) combines the well-recognized and respected attributes of the CA – in particular integrity, understanding of business, and financial acumen – with an in-depth knowledge and experience in investigative and forensic accounting. The CA-designated specialist in investigative and forensic accounting (CAIFA) combines the well-recognized and respected attributes of the CA – in particular integrity, understanding of business, and financial acumen – with an in-depth knowledge and experience in investigative and forensic accounting. This is accomplished through a profession-endorsed certification process that has ongoing experience and education requirements. The CAIFA tells litigation lawyers, law enforcement professionals, the courts and other legal forums that the designated holder is well positioned to practise in areas such as fraud and economic loss quantification, including:

· investigating and analyzing financial evidence;

· testifying as an expert witness ;

· becoming involved in criminal investigations and uncovering financial evidence in employee or insurance fraud cases;

· Investigating in the rapidly evolving area of computer and Internet fraud.

However in India, this branch of accounting has not got its due recognition even after alarming increase in the complex financial crimes and lack of adequately trained professionals to investigate and report on the complex financial crimes. The task of Forensic Accountants is handled by Chartered Accountants who apart from handling traditional practice of auditing as required under the Companies Act, 1956 or Income Tax Act are called upon by the law enforcement agencies or the companies or private individuals to assist in investigating the financial crime or scam. The CA or CWAs in India are best suited for this profession due to their financial acumen acquired during their rigorous training which can be further honed by introducing post qualification degree or diploma in Investigating and Forensic Accounting similar to one introduced by CICA. The CA or CWA who acquire post qualification in Investigative & Forensic Accounting can use the designation CA-IFA or CWA-IFA and be legally recognized as the Forensic Accounting Experts to handle the investigation of financial crimes and give expert testimony in the Court of Law. However, no efforts has so far been made by the ICAI and ICWAI, the two leading statutory accounting professional bodies to move in this direction and set up a institute which can offer the post qualification diploma in Investigative and Forensic Accounting to its members.

However, growing financial fraud cases, recent stock marker scams, failure of non financial banking companies, phenomena of vanishing companies and plantation companies and failure of the regulatory mechanism to curb it has forced the Government of India to form Serious Fraud Investigation Office (SFIO) under Ministry of Corporate Affairs which can be regarded the first step of Government of India to recognize the importance and advance the profession of forensic accountants. The SFIO is a multidisciplinary organization having experts from financial sector, capital market, accountancy, forensic audit, taxation, law, information technology, company law, customs and investigation. These experts have been taken from various organizations like banks, Securities & Exchange Board of India, Comptroller and Auditor General and concerned organizations and departments of the Government. However, the main important law enforcement agency involved directly in combating white-collar crimes is the Police, CBI, DRI etc. There is a total lack on the part of these law enforcement agencies to train their investigators in this specialized part of investigating white-collar crimes involving forensic accounting. The investigation of the major financial crimes is handled by ordinary investigating officers who after spending some time in investigation of conventional crimes are shunted to the economic offence wing and they are expected to handle the financial crime cases involving complex & intricate financial records which is required to be analyzed to unearth crime or unique MO adopted by the white collar criminal. The result is obvious, the case dies its natural death and the criminals roam free as the IO given his lack of specialized knowledge & qualification fails to properly investigate the financial crime to its logical conclusion. On the other hand if we look at the western countries particularly USA, the law enforcement agencies of which like DEA, FBI, CIA has well marshaled its pool of special agents having forensic accounting backgrounds that are the backbone of the bureau’s financial crimes and terrorism financing units and investigate with professional acumen, the complex financial crime like money laundering, internet crimes, financial institution fraud and other economic crimes. Today, there are more than 600 FBI agents with accounting backgrounds. Thus, it is highly imperative on the part of law enforcement agencies in India that they follow the suit and engage specialist forensic accountant on its roll whose engagements relating to criminal matters typically arise in the aftermath of financial fraud.

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1) The Companies Act, 1956:

a) Section 235 and 237: There are provisions in Companies Act (Section 235 and 237) which empowers the Central Government to inspect the books of accounts of a company, to direct special audit, to order investigation into the affairs of a company and to launch prosecution for violation of the Companies Act, 1956. Books of accounts and other documents of the companies are inspected by the officers of the Directorate of Inspection and Investigation and the Registrars of Companies. These inspections are designed to find out whether the companies conduct their affairs in accordance with the provisions of the Companies Act, 1956 to see whether any unfair practices prejudicial to the public interest are being resorted to by any company or a group of companies and to examine whether there is any mismanagement which may adversely affect any interest of the shareholders, creditors, employees and others. Wherever inspection reports disclose any information that may be of interest to other Departments or agencies like the Ministry of Commerce and Industry, Central Board of Direct Taxes, Enforcement Directorate, State Government or Provident Fund Authorities, such information is passed on to them. If an inspection discloses a prima facie case of fraud or cheating, action is initiated under provisions of the Companies Act, 1956 or the same is referred to the Central Bureau of Investigation.

b) Provisions of Sick Industrial Companies Act incorporated into the Companies Act, 1956: The Section 424A(5) of the Companies Act, 1956 empowers National Company Law Tribunal (NCLT) to examine as preliminary issue whether the company is a sick industrial company u\s 2(46AA). Thus even before examining the viability of the scheme of revival proposed by the company, NCLT can check the genuineness of the reference made to it. Thus, inquiry by operating agency will only be to enable NCLT to decide the viability of the scheme and to assess whether the company has the ability to revive on its own. Further, Section 424B of the Companies Act, 1956 empowers the tribunal to make such inquiry as it may deem fit for determining whether any industrial company has become a sick industrial company. Further, the Tribunal may, if it deems necessary or expedient so to do for the expeditious disposal of an inquiry, require by order any operating agency to enquire into the scheme for revival and make a report with respect to such matter as may be specified in the order. Operating agency is group of experts consisting of persons having special knowledge in banking & industry in which sick industrial company is engaged and includes public financial institution, State level institution, scheduled bank or any other any other person as may be specified by general or special order as its agency by the Board. Thus, Forensic Accountant can be part of operating agency and investigate whether the reference made by the company is genuine or the accounts are manipulated or fabricated to suit the scheme of reference made to NCLT to declare it as sick company and thereby siphon public funds.

2) SEBI Act, 1992:

The share market is highly volatile and the brokers indulge into various unfair and fraudulent trade practices like synchronized share trading, manipulate and fabricate the books of accounts and cheat the gullible investors. Regulation 11 C of the SEBI Act, 1992 empowers the SEBI to direct any person to investigate the affairs of intermediaries or brokers associated with the securities market whose transactions in securities are being dealt with in a manner detrimental to the investors or the securities market. Thus fraudulent and unfair trade practices of the brokers or market intermediaries are investigated by the investigator appointed by SEBI which require the broker or market intermediary to furnish information, books of accounts, registers, documents or records etc. which is analyzed by the investigator to find out any manipulation, fraudulent practice or otherwise of the broker. Thus, Forensic Accountant can play a lead role in assisting the SEBI to unearth the complex share related frauds perpetrated by the brokers.

3) The Insurance Act, 1938:

Section 33 of the said Act empowers the IRDA to direct any person (“Investigating Authority”) to investigate the affairs of any insurer. The investigating authority may seek assistance of the auditor (or actuary or both) who shall be the Chartered Accountant within the meaning of Chartered Accountant Act, 1949 for the purpose of assisting him in any investigation. The books of account, registers and other documents are taken by the investigating authority in its custody to analyze it to find out the manipulations or fabrication in the books of accounts. Thus, Chartered Accountants plays a front role as an Forensic Accountant and aid in the investigation conducted into the affairs of the insurer as per the provisions of Insurance Act, 1938.

4)  The Prevention of Money-Laundering Act, 2002:

Section 3 of the Prevention of Money Laundering Act, 2002 defines the offence of money laundering as involvement of a person in any process or activity connected with the proceeds of crime and projecting it as untainted property. The three important stages in the money laundering process are:

· Placement: Physical disposal of cash acquired from illegal sources by depositing the cash in domestic banks or other kinds of financial institutions.

· Layering: Working through complex layers of financial transactions to distance the illicit proceeds from their source and disguise the audit trail.

· Integration: Making the wealth derived from crime appears legitimate.

Forensic Accountant can often be involved in the following antimony laundering activities:

· Investigating and analyzing financial evidence to establish a suspicious transaction;

· Developing computerized applications to assist in the analysis and presentation of financial evidence;

· Communicating their findings in the form of reports, exhibits and collections of documents that assist the banks in submission of the suspicious transaction reports to the regulator; and

· Assisting in legal proceedings, including testifying in court as an expert witness and preparing visual aids to support trial evidence.

5)  The Companies (Auditor’s Report) Order, 2003:

CARO, 2003 requires the auditor to report to the effect that if a substantial part of fixed assets have been disposed off during the year, whether it has affected the going concern status. In order to carry out the duties, the auditor has to draw a corollary and reference to the section 293 Companies Act, 1956, AS 24 (‘Discontinuing Operations’) and to AAS 16 (Going Concern) and thereafter make his observations on this matter. It also requires the auditor to report on Frauds i.e.; if any fraud on or by the company has been noticed or reported during the year.

An expert witness is a witness, who by virtue of education, training, skill, or experience, is believed to have knowledge in a particular subject beyond that of the average person, sufficient that others may officially (and legally) rely upon the witness’s specialized (scientific, technical or other) opinion about an evidence or fact issue within the scope of their expertise, referred to as the expert opinion, as an assistance to the fact-finder. Expert evidence is evidence given to a court or tribunal by a person, skilled and experienced in some professional or technical sphere, of the conclusions he has reached on the basis of his knowledge, from facts reported to him or discovered by him by tests, measurements or similar means. It is commonly given by, for example, doctors, chemists, surveyors, architects, accountants and the like. In a Scottish case, Davie v Edinburgh Magistrates (1953) , it was said that the function of an expert witness “…is to furnish the judge with the necessary scientific criteria for testing the accuracy of his conclusions, so as to enable the judge to form his own independent judgment by the application of those criteria to the facts proved in evidence” .

Expert witnesses have a different status from ordinary witnesses when giving evidence at a Court or other judicial or quasi-judicial tribunals. The evidence of the “expert” differs from that of the ordinary witness who testifies as to facts observed, in that the expert is permitted to express his/her opinion on a matter that has occurred in the past, or may occur in the future which have not been actually observed by the expert, who is providing evidence. The relevance and weight which the Court or tribunal will attribute to such an opinion within the total evidence which is adduced is a matter for the Court or tribunal.

An expert, unlike other witnesses, is allowed, because of his special qualifications and/or experience, to give opinion evidence. It is for his opinion evidence that he is called, not for his view of the facts or circumstances of the dispute, although his interpretation of the facts is often necessary in order to explain and/or justify his conclusions.

The tradition and law relating to the status of the experts as witnesses dates back to English Courts around 1550. However, the first recorded use of an accountant as an expert witness was in Meyer V. Sefton, 2 Stark. 274 (1817). The use of Forensic Accountant testifying as an expert witness in the Court of law is becoming increasingly prevalent today in view of the rapid increase in the financial fraud cases. In court cases where the knowledge of an expert can help to better explain the facts in issue or relevant facts, an “expert witness” may be called upon to give expert testimony.

Section 45 of the Evidence Act which makes opinion of experts admissible, lays down that when the Court has to form an opinion upon a point of foreign law, or of science, or art, or as to identity of handwriting or finger impressions, the opinions upon that point of persons specially skilled in such foreign law, science or art, or in questions as to identity of handwriting, or finger impressions are relevant facts. However, neither the Indian Evidence Act nor there is any seminal judicial pronouncements which clarifies as to when, how and under what circumstances, the testimony of Forensic Accounting Expert would be admissible or inadmissible.

In order, to bring the evidence of a witness as that of an expert it has to be shown that he has made a special study of the subject or acquired a special experience therein or in other words that he is skilled and has adequate knowledge of the subject. The Cost Accountant or Chartered Accountant can be considered as an expert to give testimony within the meaning of Section 45 of the Evidence Act. Moreover, the draft of “The Companies Bill, 2008″ includes the definition u/s 2 (1) (zn) which interalia includes Cost Accountant and Chartered Accountant in the definition of “Expert” which can be also considered/extended for relying upon their testimony in the Criminal/civil cases by the court.

In USA, however, the admissibility of the Forensic Accounting Expert testimony is supported by the Judicial Pronouncements and Federal Rule of Evidence. Over the years, the US Supreme Court has delivered several decisions clarifying its standards for the admission of expert testimony:

In Frye v. U.S., the Court stated that expert testimony will be admitted if based on a methodology “generally accepted” by the scientific community.

In Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993) the Court concluded that the trial judge must act as a gatekeeper for expert testimony, considering several nonexclusive factors applicable

to the testimony’s reliability and relevance, including:

· Whether the theory or technique has been or can be tested,

· Whether the theory or technique has been subjected to peer review or publication,

· The known or potential rate of error, and

· Whether the theory or technique is generally accepted in the relevant scientific community.

Although Daubert focused on the admissibility of scientific expert testimony, its progeny have had a great impact on Financial Expert testimony. In Kumho Tire Co. V. Carmichael, 526 U.S. 137 (1999), the Court made clear that the gatekeeper function applies to all expert testimony, not just scientifically-based testimony.

Rule 702 of the Federal Rules of Evidence effectively codifies the Supreme Court’s decisions in “Daubert” and “Kumho”. Rule 702 provides that if the Court finds that scientific, technical or other specialized knowledge “will assist the trier of fact to understand the evidence or to determine a fact in issue,” and if the Court finds that the witness is qualified as an expert “by knowledge, skill, experience, training, or education,” then the Court may permit the witness to testify — so long as the witness’ testimony is based on “sufficient facts or data,” the testimony “is the product of reliable principles and methods,” and the witness has “applied the principles and methodology reliably to the facts of the case.

Further, concerning determinations of nonscientific expert testimony reliability, financial expert testimony (which includes Forensic Accountant Testimony) in particular, the Advisory Committee on the Federal Rules of Evidence and the Standing Committee on Rules of Practice and Procedure (“Committee”) which proposed amendments to the texts of Rules 701, 702, and 703, specifically observed:

“Some types of expert testimony will not rely on anything like a scientific method, and so will have to be evaluated by reference to other standard principles attendant to the particular area of expertise. . . . The expert’s testimony must be grounded in an accepted body of learning or experience in the expert’s field, and the expert must explain how the conclusion is so grounded. “Whether the testimony concerns economic principles, accounting standards, property valuation or other non-scientific subjects, it should be evaluated by reference to the ‘knowledge and experience’ of that particular field.”

Therefore, under the Federal Rules of Evidence, a judge will permit an accountant to testify as an expert witness only if the judge decides that:

The accountant’s testimony will help the jurors or judge understand the evidence or determine a fact in issue.

The accountant is qualified as an expert by knowledge, skill, experience, training, or education.

The accountant can show that his or her testimony (a) will be based on sufficient facts or data and (b) will be the product of reliable principles and methods that have been applied reliably to the facts of the case. (These requirements are often referred to in shorthand as “qualification, reliability, and fit.”)

Thus, under the rule announced in Daubert v. Merrill-Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993) and expanded in Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999), the courts must ensure that experts-scientific and otherwise-will offer testimony that is methodologically sound and relevant to the facts of the case before admitting their expert testimony.

Challenges to financial expert testimony have skyrocketed in recent years. Since Daubert v. Merrell Dow Pharmaceuticals, Inc. (1993), an increasing number of testifying experts have been subjected to challenges by opposing counsel in an attempt to prevent the experts from testifying (Journal of Forensic Accounting: 1524-5586/Vol.IV(2003), Page-113). Figlewicz and Sprohge in their article, “The CPA’s Expert Witness Role in Litigation Services: A Maze of Legal and Accounting Standards,” offer ten guidelines to help avoid legal challenges:

1. Know the relevant professional standards.

2. Apply the relevant professional standards.

3. Know the relevant professional literature.

4. Know the relevant professional organizations.

5. Use generally accepted analytical methods.

6. Use multiple analytical methods.

7. Synthesize the conclusions of the multiple analytical methods.

8. Disclose all significant analytical assumptions and variables.

9. Subject the analysis to peer review.

10. Test the analysis-and the conclusions-for reasonableness.

Now the various investigation agencies such as Police, CBI etc. are taking the help of CA/CWA as a Forensic Accountant and using their report as evidence in the cases of criminal/civil nature. Whether the aforesaid principles/guidelines laid down by the two US Supreme Court Judgments incorporated into Federal Rules of Evidence would be followed by Indian Courts or not will become clear in the due course of time.

However, the fact is that though till today there is general acceptance of admissibility of scientific evidence and expert’s opinion in Indian Courts, there is no special law with respect to this which lays down criteria, principles or guidelines in clear terms with regard to when the expert opinion would be admissible and when it will not as is the case under the US federal law. Section 45 of the Indian Evidence Act is insufficient in this regard. However, in case of doubt, the principles laid down by US Supreme Court can be adhered to. In conclusion, one should understand that it is ultimately for the Court Of Law to decide as to who is qualified as an expert by knowledge, skill, experience, training or education, who may testify thereto in the form of an opinion or otherwise if:

1. The testimony is based upon sufficient facts or data,

2. The test is the product of reliable principles and methods, and

3. The witness has applied the principles and methods reliably to the facts of the case

However, no doubt, with the rapid increase in the cases involving misappropriation of funds, manipulation of books of accounts, banking fraud cases, Securities scams etc. involving complex financial transactions, the Forensic Accountants and admissibility of their testimony needs to be elucidated and these would be determining factors for deciding the fate of these cases. The involvement of Forensic Accountant in financial fraud cases and his testimony will not only take these cases to logical conclusion but also will go a long way ahead to put a curb on these menace of white collar offences.

Neeraj Aarora

(Advocate)