Morning Medtalks with Dr KK Aggarwal


Dr KK Aggarwal    14 April 2018

The time has come for the doctors to fight for the rights of their patients

Prime Minister Narendra Modi has set an aim to increase the share of healthcare sector in the countrys gross domestic product (GDP) to 2.5 per cent as per Union minister Rajnath Singh. Will it happen?

The proposed Digital Health Information Security Act seeks to regulate the generation, collection, storage, transmission, access and use of all digital health data. This legislation covers within its ambit clinical establishments, insurance companies and employers that collect health information, and IoT, manufacturers of wearables and other entities that deal with digital health data. The draft legislation is open for comments until 21 April 2018. Will the associations take it as seriously as they took the issue of NMC?

Gurgaon Police has arrested two senior doctors, Cardiology consultant S S Murthy and medical superintendent V Nagarjuna, of Fortis on charges of negligence during treatment of a woman who had suffered a fatal cardiac arrest. They got bail. According to the charge-sheet filed in the case, Murthy had not given anti platelets medicines to Seema Ghai, who was admitted to the hospital after suffering a cardiac arrest on May 12, 2017.

 Aspirin has established benefit in patients with an ST elevation myocardial infarction (STEMI). The loading dose should be given as soon as possible to any patient with a STEMI, irrespective of treatment strategy. The loading dose is 150-300 mg of uncoated aspirin; the first tablet should be chewed or crushed to establish a high blood level quickly. There is no evidence that higher doses are more effective and they may lead to greater gastric irritation. In India the first aspirin tablet should contain 300 mg and be chewed. The recommended maintenance dose of aspirin is 75 to 150 mg/day.

HCFI recommendation: Aspirin (and a platelet P2Y12 receptor blocker) as soon as possible after presentation in acute MI.

Martin F.D Souza v. Mohd. Ishfaq, [2009) 3 SCC 1]: “An expert should be consulted in case of any doubt. Thus, in Smt. Indrani Bhattacharjee, Original Petition No.233 of 1996 decided by the National Consumer Commission on 9.8.2007, the patient was diagnosed as having `Mild Lateral Wall ischemia. The doctor prescribed medicine for gastro-entiritis, but he expired. It was held that the doctor was negligent as he should have advised consulting a Cardiologist in writing.”

Earlier, obtaining a minimum of 50 per cent marks in theory as well as practical separately were mandatory for passing the PG exams. Now in an MCI amendment in the Postgraduate Medical Education Regulations besides getting minimum 50 per cent marks cumulatively in all four papers for degree examinations and three papers in diploma examinations, a student has to obtain no less than 40 per cent marks in each theory paper. Obtaining of 50 per cent marks in practical examinations will be mandatory for clearing the examinations as a whole in the said degree or diploma examination.

The time has come for the doctors to fight for the rights of their patients. In US physicians recently joined patients with diabetes in a demonstration against the high cost of insulin.

The presence of bacteria in Gram stains of specimens collected from sterile sites should almost always be considered a significant finding. However, Gram stains of specimens from nonsterile sites must be interpreted with care.  So never ignore gram stain positive organisms in pleural fluid or CSF.

Fire in OT:  If an oxidizer (oxygen, nitrous oxide), fuel (alcohol-based prep solutions, surgical towels and drapes), and ignition source (electrosurgery unit [ESU]) are combined in a closed environment, then any spark may result in eruption of flames. Strategies to prevent and extinguish fires are based on separating and/or controlling these three elements of the "fire triad".  Normally each element is typically managed by different members of the surgical team (anesthesiologist, surgeon, or nursing staff) overall risks is a shared responsibility.

In an non OT situation in the 2011 AMRI fire was due to  flammable substances kept in the basement of the building to catch fire after a short circuit in the electrical system.

The US FDA is banning the sale in bulk volumes of dietary supplements that contain high levels of concentrated or pure caffeine after at least two deaths of otherwise healthy individuals. Teenagers looking for an energy boost, are inclined to mix high amounts of powdered or liquid caffeine into drinks they take before working out. But while a half cup of concentrated liquid caffeine can contain about 2,000 mg of caffeine, a single teaspoon of powdered pure caffeine can contain 3,200 mg. That’s equal to about 20 to 28 cups of coffee, a potentially toxic dose. Consumers are often directed to take micro-doses of such supplements, up to 1/64 of a teaspoon.

Maximum temperatures are recorded below normal over most parts of the country and the present synoptic conditions indicates, rise in maximum temperatures over Northwest, Central and West India by 2-4°C during next 4-5 days, however Heat wave conditions would not occur over any part of the country during next 4-5 days.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI


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