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What We Need To Know More About Oral Cancer?

October 23rd, 2011 by admin

Indiais called the capital of Oral Cancer in the world because of its highest incidence. Oral cancer ranks no. 1 among men and no. 3 among women inIndia. Unfortunately, even young adults are being diagnosed with the disease because more and more children are using pan masala / Gutka and other tobacco products. Inspite of the fact that oral cancers are completely preventable, the incidence is rising at an alarming speed. Oral cancers account for 40% of the cancer in men and include cancers of : -

 

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. 

Author on various topics for Cancer, Radiation Oncology, Allied Services, Healthcare, Hospitals and Health Subjects.

For more information you can visit Cancer HospitalIndia

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Endodontic Treatment

October 23rd, 2011 by admin

Endodontic therapy or ‘Root canal therapy’ refers to  a series of treatments  prescribed for teeth that have been diagnosed with infection such as an abscess, irreversible pulpitis, chronic apical periodontitis, or are necrotic. In other words, an endodontic treatment or root canal treatment refers to the removal of the pulp. Endodontic treatment is a procedure in which inflamed, infected or necrotic nerve and blood vessel tissue are completely eliminated by operating upon the ‘pulp’ or hollow interior of the tooth. Following the endodontic procedure, the root canals are disinfected, enlarged and sealed to the root tips using a rubbery filling material. The access hole into the tooth is filled with either materials such as silver amalgam, composite resin, porcelain or gold. Endodontic treatment could be done in adult (permanent) or baby teeth. There are certain symptoms that would tell you that you urgently need a root canal treatment. This includes:

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.

 

The Mews Dental Studio,  http://www.themewsdentalstudio.co.uk is Southampton’s only Specialist dental referral centre specialising in Prosthodontics, Oral Surgery and Practice limited to Endodontics.

History of medicine

October 23rd, 2011 by admin

Latest facts regarding the substantial human being trials that happened during the Frosty War have got shocked both medical professionals and also the public. However testing during this period was in particular intense, at had been not an aberration. Using trail and also error as a means regarding gaining expertise, numerous tribe ethnicities acquired a data source involving medical understanding that was utilized to cure many conditions. The initial identified surgical procedure was performed inside Egypt since far back since 2750 BC. Christopher Freville says how the Edwin Smith Papyrus sheds many lighting on the level of progress associated with Egyptian medication. Although there was usually a combination in the unnatural element with standard Egyptian remedies, these were effectively used in the actual fields of public health, anatomy along with scientific diagnostics.

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.

 

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Forensic Accountant: Reliability & admissibility as Expert Witness

October 22nd, 2011 by admin

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)

Neeraj Aarora

Gastroenterology And Hepatology Hospitals in Bangalore at Low Cost

October 22nd, 2011 by admin

 

Gastroenterology And Hepatology Hospitals in Bangalore

 

Prevention, diagnosis and treatment of diseases of the digestive tract, liver and pancreatico-biliary system in children and adults is the core objective of the Centre of Medical and Surgical Gastroenterology at We Care India partner Hospitals Bangalore. The hospitals offer state of art endoscopic procedures for gastrointestinal bleed, gastrointestinal cancers, foreign bodies, obstructive jaundice, pancreatitis and feeding techniques. The gastrointestinal surgeons manage major gastro-intestinal surgical problems of the intestines, pancreas and hepatobiliary tract including cancers, many of them through minimal access surgery….

The Hepatologists and transplant surgeons at We Care partner Hospitals in Bangalore work as a team and have established India’s first Liver Centre. It is equipped with high-end technology to perform precise surgery in this newly developed modality of surgical treatment…. 

 

Comprehensive specialty care for diseases of the liver, pancreas and bile duct including Liver transplants. Treatment of major gastrointestinal surgical problems – including cancers, hepatobiliary and pancreatic diseases. Routinely performs Colorectal Surgery , Minimal Access Surgery ,Bariatric Surgery and Diagnostic & Therapeutic Endoscopies. Constantly involved in major research programs at the basic, applied, and translational levels to generate new knowledge that ultimately benefits patients…..

 

 

Major surgeries for benign and malignant conditions of oesophagus, stomach, intestines, liver and pancreas are carried out routinely. Minimally invasive Cholecystectomy, Appendectomy, Splenectomy and Intestinal Resections are also routinely performed. Surgery for Hiatus Hernia is another commonly performed procedure….

The other specialty of the centre of Gastrointestinal Surgery at We Care partner hospital is that complex Biliary reconstruction surgery for bile duct strictures is performed on par with any other centre in the world with excellent results. The Minimally Invasive Surgery Division at We Care partner hospital in Bangalore is one of the centers performing the largest number of laparoscopic procedures in the country, performing not only basic laparoscopic procedures but also most of the advanced laparoscopic procedures like laparoscopic esophageal surgery, gastric resections, colorectal surgery, pancreatic surgery and small bowel surgery. We have a state of the art Aida Touchscreen facility, and DVD recording facility and a newer version of the Harmonic Scalpel for bloodless surgery…..

 

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The Center for Liver Diseases and Transplantation at We Care India partner hospitals in Bangalore is equipped with the state-of-the-art technology for liver surgery using the laparoscopic Argon Beam Laser as well as Tissue Link™ in combination with other methods of liver resection like CUSA™ and Laparoscopic Vascular Stapling. Bloodless Liver Surgery is performed with high success rates…..

The Liver Transplant team at We Care Partner Hospitals in Bangalore uses the above general principles as well as prognostic indices that are under development for conditions such as fulminant hepatic failure, primary biliary cirrhosis and primary sclerosing cholangitis…..

 

With the use of advanced technology and surgical methods, patients now have more options than ever before for the treatment of hepatobiliary disease. We Care partner Hospitals in Bangalore for Liver Disease & Transplantation offers comprehensive specialty care for diseases of the liver, pancreas and bile duct. We emphasize on ongoing communication with referring physicians and incorporate them in the decision process of their patient’s medical management. Following treatment, we follow up our care with an organized discharge report to the referring physician. Our physicians are trained at the world’s most renowned centers in Hepatobiliary surgery and Liver Transplantation and are actively involved in clinical research and offer multiple studies in areas such as hepatocellular carcinoma, gastroenterology and viral hepatitis….

 

We Care partner hospitals center for Gastroenterology & Hepatology performs Bariatric surgery as a specialized treatment for obesity. Bariatric surgery is performed if other forms of fat reduction methods like exercise or diet control do not produce the desired results. Bariatric surgery involves reducing the size of the stomach, leading to lesser food intake and gradual weight loss….

 

With the use of advanced technology and surgical methods, patients now have more options than ever for the treatment of Hepatobiliary disease. We Care partner hospitals centre for Hepatobiliary surgery offers comprehensive specialty care for diseases of the liver, pancreas and bile duct….

 

Endoscopy is routinely performed at the Center for Medical and Surgical Gastroenterology, We Care India partner hospitals in Bangalore for the following conditions:

For patients who suffer from gastrointestinal bleeding ,both Banding / injection of esophageal varices and control of bleeding with adrenaline injection / argon plasma coagulation are routinely performed.

 

For patients for whom feeding is a problem either due to neurological disorders or altered consciousness levels, endoscopic placement of nasojejunaltube or PEG (Percutaneous Endoscopic Gastrostomy) tube is done……

 

 

Apollo hospital Bangalore is the first of its kind in South India and within the Apollo chain of the Hospitals to be equipped with comprehensive state of the art armamentarium under one roof….

 

Wockhardt Hospitals Bangalore has become one of the first super specialty hospital in South Asia to achieve accreditation from Joint Commission International (JCI), USA….

Manipal Hospital, situated on Airport Road, Bangalore is a landmark destination for quality and affordable healthcare. The 600 bed centrally air-conditioned hospital is the first tertiary care multi superspeciality referral centre in Karnataka….

At the core of what SPARSH Hospital is trying to do is to redefine the way healthcare has been practiced and managed historically. This for SPARSH Hospital is a continuous process. A continuous process of reinventing our processes and systems, of investing in technology, equipment and medical skills, of changing patient management and care, to create an institution where everyone working here feels like a stakeholder….

BGS Global Hospitals is a 500-bed health care centre offering multi-speciality care through global standard medical technology. To maintain, assist, and enhance life. To give back the will to live. To put back the joy into living. These are the principles that back Team BGS Global in ensuring patient delight. Relentless research, continuous learning and quality medical practice help us in achieving this….

 

 

 

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Send your query : Get a Quote

 

We have a very simple business model that keeps you as the centre.

Having the industry’s most elaborate and exclusive Patient Care and Clinical Coordination teams stationed at each partner hospital, we provide you the smoothest and seamless care ever imagined. With a ratio of one Patient Care Manager to five patients our patient care standards are unmatched across the sub continent.

 

 

Welcome to World Class Treatment and Surgery by We Care Health Services, India.
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The surgery and medical treatments offered by We Care Health Services at JCI Accredited / ISO Certified Hospitals are vast and varied; ranging from Heart Surgery in India, Cardiology to Cardio Thoracic surgery, Total Knee / Hip / Ankle / Shoulder Joint Replacement Surgery in India including ACL reconstruction Surgery to Birmingham Hip Resurfacing Surgery in India , Spine Surgery in India like Discectomy / Laminectomy Surgery, Cervical Decompression to Anterior / Posterior Spinal Fusion Surgery in India, Chemotherapy, Radiotherapy, Cancer surgery, Sterotactic Radiotherapy, Autologous / Allogenic Bone Marrow Transplant Surgery to Breast Cancer treatments, Near relative Kidney Transplant Surgery to Dialysis and Kidney Biopsy, Low Cost Liver Transplants Surgery, Hysterectomy (Vaginal / Abdominal) to Ovarian Cystectomy, Hernia repair Surgery to Cholecystectomy, Advanced Neurosurgery in India, Bariatric surgery, Gastric Bypass Surgery in India, Eye Surgery in India, Cornea Transplant, Cataract Surgery to LASIK Eye care Surgery, IVF, ICSI, Egg Donor to Surrogacy, Minimally Invasive surgery or Laparoscopic Surgery to Cochlear Implants, Breast Lift / Tummy Tuck, Face Lift to Low Cost Rhinoplasty Cosmetic Surgery, multi specialty Hospitals in India offering first world treatments with board certified highly qualified medical consultants in attendance at third world prices..

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IMRT, IGRT, VMAT: New Tools For Fighting Lung Cancer

October 21st, 2011 by admin

 

There are 25 Lakh cancer patients in the country. Ten lakh new cases are detected annually and 4 lakh people lose there lives to cancer. Cancer is now the third biggest killer in our country. Lung cancer is one of the most common cancers inIndia. It is the most common cause of cancer related deaths in men and the second most common cause of death in women (after breast cancer). Lung cancer alone is responsible for 13 Lakh deaths worldwide annually.

 

 

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Smoking, particularly of cigarettes, is by far the main contributor to lung cancer. Across the developed world, almost 90% of lung cancer deaths are caused by smoking. Passive smoking can also lead to lung cancer.

– Gases emitted by industries & vehicles are carcinogenic.

 

- Arsenic, nickel, chromium.

 

Smoker’s cough that persists or becomes intense.  
Increase in volume of sputum.  
Wheezing.  
Nonsmoker’s cough that persists for more than 2 weeks.  
Change in color of sputum.  
Blood in sputum.

 

 

More than 90% of the lung cancer cases are due to active and passive smoking and hence preventable. The earlier one stops smoking, better it is.

Prevention is the most cost-effective means of fighting lung cancer. While in most countries, industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of lung cancer, and smoking cessation is an important preventative tool in this process, especially in the youth.

 

 

Chest x-ray is the most easily available and cheapest modality for diagnosis of lung cancer which will show the tumor in the lung or in the air passage.

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CT scan is the most important modality because it not only shows the tumor but also gives information about the progression of the disease; whether the tumor is operable or not.
MRI and PET-CT may also help to know the progression of the tumor.

 

Treatment for lung cancer depends on the cancer’s specific cell type, how far it has spread, and the patient’s performance status. Common treatments include surgery, chemotherapy, and radiation therapy.

 

Surgery is the main modality of treatment for early lung cancer. If investigations confirm lung cancer, CT scan and often positron emission tomography (PET) are used to determine whether the disease is localized and amenable to surgery or whether it has spread to the point where it cannot be cured surgically.

 

Radiotherapy is used with curative intent in patients with lung cancer who are not eligible for surgery. This form of high intensity radiotherapy is called Radical Radiotherapy. Chemotherapy may be added concurrently with Radiotherapy to increase the efficacy of cell kill.

 

Radiotherapy for lung cancer has undergone dramatic changes in the last decade. is being used to target Lung cancer for the last ten years. But as we all know, lungs move during respiration and so the tumor target may be missed during Radiotherapy. This problem has now been overcome with the new technique of delivering IMRT, which is called . In IGRT, a low dose KV CT Scan is done before treatment and the position of the patient is corrected in all three dimensions if there is any shift from the original position.

 

devices are also available with the help of which we target the tumor only during a specific phase of respiration so that the Radiation Beam hits the tumor more precisely and normal tissues are spared of unnecessary Radiation. This is also known as gated or 4D Radiotherapy.

 

Another major breakthrough in the treatment delivery of IMRT and IGRT is . VMAT is a highly advanced and sophisticated treatment planning system which is available at very few select centers worldwide. Treatment planning with VMAT is far more precise and normal tissues receive only a fraction of Radiation as compared to older techniques. Another major advantage is that with VMAT, the treatment time is reduced from 25 to 30 minutes to just 2 to 5 minutes. Treatment with VMAT is thus not only faster but also more accurate with minimal side effects.

 

 

Chemotherapy is an important aspect of treatment of lung cancer. Most lung cancer patients require chemotherapy. The latest development is the treatment of lung cancer includes targeted therapies. These “targeted” therapies hit specific targets which are present on cancer cells. Hence, these therapies are considered superior than conventional chemotherapies as they kill specifically the target bad cells and spare the good (normal) cells.

 

 

Cancer Screening of high risk population.
Annual Health Check ups.
Complete diagnostic check up and staging work up to know the disease stage.
by a panel of cancer experts.
Integrated treatment at dedicated cancer centers with
Surgery by dedicated thoracic surgeons skilled in Lung cancer surgery.
Use of highly effective targeted chemotherapy under expert medical supervision.
Use of advanced Radiation techniques such as and
And most importantly, the because with the latest technology available,

Author on various topics for Cancer, Radiation Oncology, Allied Services, Healthcare, Hospitals and Health Subjects.

For more information you can visit Cancer HospitalIndia

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