Video reveals ignorance, not negligence: Doctors

Tribune (Excerpts) : A viral video shot inside Kashmir valley’s main tertiary care hospital showed a patient with his abdomen slit open and attendants pleading for help and alleging doctors of negligence. An inquiry was ordered immediately.

The complete picture of the video, however, reveals it was the ignorance of the attendants and not the negligence of the doctors.

The patient, suffered from wound dehiscence and also peritoneal carcinomatosis, a rare type of cancer that can develop when gastrointestinal cancer spread and cause tumours to grow in the thin layer of tissue that lines the abdomen and covers most of the abdominal organs.

In such cases once the wound gets opened a time gap is given for secondary suturing.

Dehiscence

Surgical wounds occasionally dehisce despite a carefully performed layered closure. Wound dehiscence typically occurs within the first postoperative week but can occur later in patients with underlying conditions associated with poor wound healing. Reasons for dehiscence include: High-tension areas (superior trunk, proximal upper extremities), Atrophic skin (advanced age, previously irradiated skin), Poor patient compliance with postsurgical instructions, Use of medications that inhibit wound healing, such as systemic corticosteroids, mechanistic target of rapamycin (mTOR) inhibitors (sirolimus, everolimus), or hedgehog pathway inhibitors (vismodegib, sonidegib), Poor circulation, Underutilization of deep, absorbable sutures to close the wound and development of infection

Surgical wounds healing by primary intention are approximately 5 to 10 percent healed after one week and 50 percent healed after one to two months, reaching a maximum of 80 percent of normal skin strength several months postoperatively.

Therefore, the wound must not experience significant stress in the first few weeks after surgery. Patients should be warned that the strength of the wound sutures may be overpowered even by mild activity. For trunk and upper extremity wounds, it is reasonable to limit patients to lifting no more than 15 pounds for two weeks after surgery, gradually increasing activity as tolerated. Aerobic activity such as walking is usually not an issue for wound healing and can be continued within a day or two of surgery. For lower extremity wounds, patients may need to elevate the extremity to decrease edema, which can also place significant stress on a healing wound.

Wounds that have dehisced after cutaneous procedures are usually allowed to heal by secondary intention. Patients should apply a thin layer of petrolatum by using a cotton tip applicator and cover the wound with nonadherent gauze. The dressing is changed daily until complete re-epithelization has occurred. Topical or systemic antibiotics are not needed in these situations unless there is overt evidence of soft tissue infection. [UPTODATE]

What is carcinomatosis: A condition in which cancer is spread widely throughout the body, or, in some cases, to a relatively large region of the body. Also called carcinosis.

Peritoneal carcinomatosis: Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity. This condition is often associated with disease progression and poor prognosis. The occurrence of peritoneal carcinomatosis (PC) has been shown to significantly decrease overall survival in patients with liver and/or extraperitoneal metastases from gastrointestinal cancer. Moreover, overall survival in patients with PC is generally only slightly influenced by systemic chemotherapy, so that the occurrence of PC is traditionally regarded by the surgeon as a terminal condition.

Exercising safely

1. Exercise can improve your sensitivity to insulin and help you build muscle and shed excess fat
2. First, consult your doctor before starting or changing a fitness routine. This is especially important if you are overweight or have a history of heart disease, peripheral vascular disease, or diabetic neuropathy.
3. For people who are 35 or older and who have had diabetes for more than 10 years, current guidelines recommend a visit to your doctor to discuss your plans before beginning a new exercise program.
4. Exercise tolerance test (also known as a treadmill test) may be needed to monitor the performance of your heart and your blood pressure during exercise.
5. In diabetics the best time to exercise is one to three hours after eating, when your blood sugar level is likely to be higher.
6. If you use insulin, its important to test your blood sugar before exercising. If the level before exercise is below 100 mg/dL, eating a piece of fruit or having a small snack will boost it and help you avoid hypoglycemia. Testing again 30 minutes later will show whether your blood sugar level is stable.
7. Diabetics should keep hard candy or glucose tablets with you while exercising in case your blood sugar drops precipitously.

When should you worry about fatigue?

1. If your fatigue gets worse or lasts longer than a week or two, its time to see your doctor.
2. Your fatigue might be related to an underlying illness or infection, especially if its accompanied by symptoms, such as a low-grade fever, shortness of breath, or loss of appetite.
3. Other reasons to see your doctor about fatigue are if you often wake up exhausted despite sleeping well, do not feel motivated to begin the day, or struggle to do activities that are ordinarily easy. These could be symptoms of a sleep disorder or depression.
4. It may also be a medication side effects, anemia, an underactive thyroid (hypothyroidism), or liver inflammation (hepatitis).
5. In most cases people bounce back from fatigue after some rest and a good nights sleep.

Dated: 24 th March, 2019

Current Temperature Status and Warning for next 24 hours

Heat Wave and Temperatures Observed Yesterday (Past 24 hours from 0830 hrs IST of 23 rd March to 0830 hrs IST of 24 th March, 2019)

Heat Wave:

.Yesterday, No heat wave conditions were observed.

Maximum Temperatures Recorded at 1730 Hours IST of 23 rd March, 2019:

• Maximum Temperature more than 40.0°C was recorded at isolated pockets over Vidarbha, Marathwada, North Interior Karnataka and Rayalaseema. (Annexure-1).
• Maximum temperature departures as on 23-03-2019: Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at a few places over Saurashtra & Kutch; above normal (1.6°C to 3.0°C) at most places over interior Karnataka and coastal Odisha; at many places over Rayalaseema, Tamilnadu & Puducherry, Coastal Karnataka, Kerala and Lakshadweep; at a few places over West Rajasthan, Gujarat Region, Madhya Maharashtra and Marathwada; at isolated places over Gangetic West Bengal. They were below normal (-1.6°C to - 3.0°C) at most places over East Uttar Pradesh; at many places over Andaman & Nicobar Islands, East Madhya Pradesh, interior Odisha, Assam & Meghalaya; at a few places over Jammu & Kashmir; at isolated places over Bihar, Jharkhand, West Madhya Pradesh and Chhattisgarh and near normal over rest parts of the country. (Annexure-2).

Yesterday, the highest maximum temperature of 42.1°C recorded at Anantapur (Rayalaseema) over the country.

Heat Wave Warnings for Next 24 hours(From 0830 hrs IST of 24 th to 0830 hrs IST of 25 th March 2019):-

.NIL