Morning Medtalks with Dr KK Aggarwal 8th April


Dr KK Aggarwal    08 April 2018

  1. Saliva testing of amyloid-β42 levels can help prevent Alzheimers disease. Elevated levels in persons at risk for developing AD are similar to levels in AD patients. AD is a neuroinflammatory process, begins 10 years prior to onset of cognitive deficits, NSAIDs, initiated a decade prior to the typical age of AD onset, may be effective in staving off these inflammatory effects in people whose Aβ42 concentrations are found to be high (Department of Psychiatry, University of British Columbia, Vancouver, Canada)
  2. CSIR has alleged that Hydroxy Urea treatment is not DCGI approved in Sickle Cell disease. Yearly > 5, 00,000 children are born with SCA (50% in India) . Hydroxy Urea is USFDA approved. As per uptodate Hydroxyurea reduces vaso-occlusive events such as pain episodes and acute chest syndrome in people with sickle cell disease. The most important mechanism is an increase in the level of fetal hemoglobin (HbF), which reduces sickle hemoglobin (HbS) polymerization, sickling, and vaso-occlusion.
  3. A warning about life-threatening bleeding linked to use of synthetic cannabinoids (fake weed or spice, Spice, K2, Joker, Black Mamba, Kush and Kronic) has been issued by US CDC. They are available in Indian market too.
  4. Apology should be the first thing to do. Confirming an incident of medical negligence in February, AIIMS said a corrective treatment was carried out & hospital has tendered a written apology to the patient. Instead of the scheduled operation AV fistula was performed on patient.
  5. The American Medical Association Code of Medical Ethics states in Opinion 8.121  "Physicians must offer professional and compassionate concern toward patients who have been harmed, regardless of whether the harm was caused by a health care error. An expression of concern need not be an admission of responsibility. When patient harm has been caused by an error, physicians should offer a general explanation regarding the nature of the error and the measures being taken to prevent similar occurrences in the future. Such communication is fundamental to the trust that underlies the patient-physician relationship, and may help reduce the risk of liability."
  6. Similarly, the Joint Commission standard states in RI. 1.2.2: "Patients and, when appropriate, their families are informed about the outcomes of care, including unanticipated outcomes." This standard envisions involving both the physician and the hospital in the disclosure of treatment outcomes, both when favorable and particularly when adverse. It does not, however, expressly require admission or apology. Some states have enacted legislative disclosure mandates for providers in the event of serious errors that harm patients. Furthermore, and perhaps most importantly, disclosure aligns with the ethical principle of patient autonomy that is important in modern-day health care. Patients should be given the information necessary to make health care decisions and to control what happens to them, before and after procedures.
  7. Atrial fibrillation is generally considered a progressive disease.
  8. Red cell transfusions are associated with increased surgical site infection rates among hospitalized patients. Compared with more liberal transfusion strategies, restrictive transfusion (at a lower Hb level) reduces the risk of SSI. (JAMA 2014; 311:1317)
  9. MOU has been signed by WHO & WMA to reaffirm and consolidate co-operation between the two organisations. The MOU include the realization of Universal Health Coverage for All.
  10. Rampant misuse and abuse of topical steroid creams is resulting in IADVL dermatologists warning against unusual increase in fungal ringworm infections across the country since the past five to six years.

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