Morning Medtalks with Dr KK Aggarwal 6th June 2018


Dr KK Aggarwal    06 June 2018


  1. Women with early-stage HER2 negative, lymph node negative, breast cancer (1-5 cm) who would currently be treated with chemotherapy could skip the toxic treatment, a major international study TAILORx published in the New England Journal of Medicine suggests. This applies to cancers with a mid-range recurrence score (11 to 25) on a widely used gene marker test. Roughly 70 per cent of women who fit this patient profile could be spared chemotherapy.
  2. Can a man remain conscious during CPR: A man undergoing cardiopulmonary resuscitation, or CPR, exhibited signs of conscious awareness for 90 minutes before the medical team stopped the life-sustaining procedure, according to a new case presented Monday at the annual European Anaesthesiology Congress in Copenhagen, Denmark. (Views: The answer is yes, it happens in thump resuscitation when done in CHB)

Public health

  1. Mayo Clinic: “Potassium is an extremely important mineral, as supported by the recent Dietary Guidelines for Americans and the Food and Drug Administration designation that K+ is a ‘nutrient of public health’ concern because of its general underconsumption across the US population.”
  2. Harvard: “High salt intakes increase blood pressure, ultimately leading to heart disease; high potassium intakes can help relax blood vessels and decrease blood pressure. Our bodies need far more potassium each day than sodium…”
  3. Cleveland Clinic: “Researchers found that heavy salt consumption was linked to a 20 percent increased risk of death, while high potassium intake offered a 20 percent risk reduction.”
  4. The index case: is the first documented or suspected patient in the onset of an epidemiological investigation. The index case may bring awareness of an emerging outbreak.
  1. Never ignore the first case of any new illness
  2. If you get two or more similar cases in the same family or area get concerned
  3. If you note sudden death/s of any animal or bird ring the bell
  4. Human to human transmission will occur from house hold contacts or treating healthcare workers
  5. The term primary case can only apply to infectious diseases that spread from human to human, and refers to the person who first brings a disease into a group of people.
  6. "Patient Zero" is used to refer to an individual identified as the first carrier of a communicable disease in a population (the primary case), or the first incident in the onset of a catastrophic trend.
  7. A known or suspected patient zero may be informally referred to as an index case for the purpose of a scientific study, such as the one-year-old boy who thought to be the source of the largest Ebola virus outbreak in history.


PTI: Over-crowded wards and overtime duty of doctors are not excuses to justify medical negligence, the Delhi State Consumer Disputes Redressal Commission has observed, while asking Safdarjung hospital here to pay Rs 11.05 lakh to a man whose wife died due to its deficient service. The commission directed the hospital, to ensure that an adequate number of doctors or specialists remain on duty irrespective of the fact that a particular day is a working day or a holiday.

  1. Negligent nondisclosure — Negligent nondisclosure cases are typical negligence cases, and as such, there are four elements that must be shown

Duty – The duty is the requirement that a physician act as a minimally competent, similarly trained, reasonable physician in similar circumstances would act when disclosing information.

Breach of duty – Breach of duty is failure to meet the minimal standard of care.

Injury – The injury is the harm that befalls the patient.

A causal relationship – A causal relationship between the breach and the harm is shown when the patient reasonably declares that he would have refused to undergo the procedure had he or she known the true nature of the risks.

If all four elements are proven to the jury, the physician is liable for the tort of negligent nondisclosure.

Typically, the proof of all four elements lies in the testimony of the plaintiffs expert witness, who must present the following information

Define the duty – The details that constitute an appropriate informed consent discussion are defined.

Identify the breach – The details that were wrongly omitted are defined.

Clarify the harm – The injuries that were suffered are defined.

Identify alternatives – The alternatives that a reasonable patient might have selected instead are defined. These may include a different procedure, a different physician, or a different facility. The plaintiff then adds that he or she, being a reasonable patient, would have refused to consent to the procedure originally offered (Uptodate).


  1. ‘Need to follow basic minimum standards’: Medical colleges need not be given a second chance to rectify their defects if they do not bother even to follow the “basic minimum standards of medical education,” the Supreme Court held. In a recent judgment, a Bench of Justices L. Nageswara Rao and M.M. Shantangoudar interpreted Regulation 8 (3) (1) (a) of the Establishment of Medical Colleges Regulations of 1999.
  2. Regulation 8 (3) (1) provides that a medical college, which failed the Medical Council of India (MCI) inspection, should be given an opportunity to redeem itself and seek a re-inspection. But even to seek this re-inspection, the errant college should satisfy certain minimum standards. This means that the college cannot afford to have more than 30% deficiency in faculty or residents and the bed occupancy should not be less than 50%. The court held that this “prescription of standards for availing an opportunity to seek re-inspection is not ultra vires” of Regulation 8 or the Indian Medical Council Act.
  3. The National Eligibility cum Entrance Test (NEET) witnessed a marked fall in the cut-off this year compared to last year. The Central Board of Secondary Examination (CBSE) announced the results.  The cut-off this year decreased from 131to 119, out of a total of 720. The decrease has been attributed to the complexity of the question paper this year.

Vedic Medicine (Dr Mukta)

लघूनि हि द्रव्याणि वाय्वग्निगुणबहुलानि भवन्ति; पृथ्वीसोमगुणबहुलानीतराणि, तस्मात् स्वगुणादपि लघून्यग्निसन्धुक्षणस्वभावान्यल्पदोषाणि चोच्यन्तेऽपि सौहित्योपयुक्तानि, गुरूणि पुनर्नाग्निसन्धुक्षणस्वभावान्यसामान्यात्, अतश्चातिमात्रं दोषवन्ति सौहित्योपयुक्तान्यन्यत्र व्यायामाग्निबलात्; सैषा भवत्यग्निबलापेक्षिणी मात्रा||६||

Charak Samhita 5/6

There are two types of dietary items one is those which are light and are easy to digest and the others are heavy and difficult to digest.

Light food articles are predominant in Agni (fire) and Vayu (air) mahabhoot and heavy articles are predominant in prithvi (earth) and Jala (water) mahabhoot.

Due to the basic nature of the Mahabhoota the light food articles increases the Agni and hence can be taken up to the level of satiety, but the heavy food articles decrease the Agni and hence causes diseases when taken in excess amount.

Financial Health

Allowable expenses: Expenditure on In-house Scientific Research:

  1. Revenue expenditure related to business is an allowable expenditure.
  2. Capital expenditure (other than cost of land) related to business is wholly an allowable expenditure.
  3. Any expenditure (other than cost of land or building) incurred on In-house R&D facility approved by prescribed authority, shall be allowed as deduction at the rate of 200% of such sum.

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