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Morning Medtalks with Dr KK Aggarwal 9th June 2018

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Dr KK Aggarwal    09 June 2018

Clinical

  1. Can ageing be reversed: Ageing process will be reversible, according to two genetic engineers in just published book The Death of Death. Nanotechnology, turning bad genes into healthy ones, eliminating dead cells from the body, repairing damaged cells, treatments with stem cells and printing vital organs in 3D can work by lengthening the telomeres.  Telomeres become damaged and shortened with the passage of time, a process that speeds up in the event of toxins entering the body – smoking, alcohol and air pollution are among elements that reduce the length of telomeres, thus accelerating ageing. https://www.thinkspain.com/news-spain/30425/death-will-be-optional-and-ageing-curable-by-2045-say-genetic-engineersnews@thinkspain.com@thinkspain

IMANDB Seminar: Dr OP Yadava, Dr KK Aggarwal, Dr Vikas Ahlawat, Dr Anand Prakash, Dr Maj Prachi Garg

 

Minimal Invasive Bypass Surgery: Alternative approaches to the performance of standard CABG ("still heart" surgery), in which both cardiopulmonary bypass and cardioplegia are used, include: elimination of both CPB and cardioplegia; or elimination of cardioplegia only ("beating heart" surgery). In addition, sternotomy may also be avoided, replacing it with smaller incisions. Techniques 1 or 2 are often, but, not always combined with the use of smaller incisions. These varied approaches are collectively referred to as "minimally invasive" techniques.

Surgery through smaller incisions (minimal access) and totally endoscopic "robotic" surgery requires utilization of specialized instruments or computer-enhanced tele-manipulation system.

Saphenous vein and radial artery harvest can also be accomplished through small incisions using video-based surgical techniques, decreasing the morbidity associated with leg and forearm incision (pain, infection) and permitting more rapid recovery.

Three alternative techniques have emerged for MID CABG, which differ in the use of CPB.

With MID CABG through a limited anterior thoracotomy with CPB, antegrade and retrograde cardioplegia are delivered to produce optimal myocardial protection. The surgeons can work on an empty, decompressed heart in a still and bloodless field, leading to enhanced myocardial protection and better access and freedom to manipulate and expose the entire heart, which is necessary for multi-vessel CABG. This technique is now very rarely used.

MID CAB without CPB is performed through a limited anterior thoracotomy and is best suited to approach anterior coronary vessels, most commonly the left anterior descending artery as well as lateral (obtuse marginal) coronary targets. In this procedure, the left internal mammary artery is anastomosed to the LAD and lateral grafts are typically fashioned as Y or T grafts off the LIMA with either saphenous vein or additional arterial grafts. These procedures may be performed through direct access, endoscopically, or robotic-assisted.

Multi-vessel minimally invasive CABG can be performed either through a small thoracotomy or totally endoscopic either on the beating or arrested heart with comparable outcomes to conventional CABG and advantages of minimally invasive access.

Hybrid MID CABG (no CPB) with LIMA to LAD and percutaneous coronary intervention with drug-eluting stents to treat residual significant CAD. This emerging therapy is particularly attractive in patients with significant co-morbidities.

NIH:

Women in early pregnancy who have high levels of a certain thyroid hormone may be at greater risk for gestational diabetes, compared to women who have normal levels of the hormone, according to researchers at the National Institutes of Health. Their study appears in the Journal of Clinical Endocrinology and Metabolism.

The researchers found that pregnant women with the highest levels of the thyroid hormone triiodothyronine (T3), were more than four times more likely to develop gestational diabetes, compared to women with lower levels of the hormone. T3 is produced from the related hormone thyroxine (T4). The researchers also found that a high T3/T4 ratio — which indicates a high conversion rate from T4 to T3 — was strongly associated with a higher risk for gestational diabetes. Their findings suggest that screening pregnant women for thyroid disease early in pregnancy could help identify women at high risk for

Expense in Income Tax

  1. The amount of any Bad Debt or part thereof which is written off as irrecoverable in the accounts of the assessee for the previous year [sec 36]

 WMA Recommendations (draft)

  1. National medical associations should work with their governments to cultivate national guidance on safety of biosimilars.

National medical associations should advocate for delivering biosimilar therapies that are as safe and effective as their reference products.

National medical associations should lobby against allowing insurers and health funds to promote biosimilar and reference medicine’s interchangeability and automatic substitution, that can be to the detriment of patients.

Physicians must ensure that patient medical records accurately reflect the biosimilar medicine that is being taken.

Physicians shouldn’t prescribe a biosimilar to patients already showing success with the reference medicine.

Physicians should raise awareness of the issues surrounding biosimilars and promote clearly delineated labelling of biosimilars.

  

Legal

A dermatologist, Dr. Windell Davis-Boutte, who can be seen on video dancing to the hip-hop song “Cut It” while performing a surgical procedure was suspended by the Georgia medical board, which said her continued practice poses a threat to the public health, safety, and welfare.

Do LAWYERS FALL UNDER THE PURVIEW OF CONSUMER PROTECTION ACT: In the matter titled as “D. K. Gandhi versus M. Mathias”, the State Commission of Consumer Disputes Redressal Forum, Delhi, held that services rendered by a Lawyer would not come within the ambit of Section 2(1)(o) of the Consumer Protection Act, 1986, as the client executes the power of attorney authorizing the Counsel to do certain acts on his behalf and there is no term of contract as to the liability of the lawyer in case he fails to do any such act. The State Commission held that it is a unilateral contract executed by the client giving authority to the lawyer to appear and represent the matter on his behalf without any specific assurance or undertaking.

However, this verdict of the State Commission was reversed by the National Consumer Disputes Redressal Commission in the Revision Petition titled as D. K. Gandhi versus M. Mathias claiming lawyers are rendering a service. They are charging fees. It is not a contract of personal service and that there was no reason to hold that they are not covered by the provisions of the Consumer Protection Act, 1986. It was held that though a Lawyer may not be responsible for the favourable outcome of a case as the result/outcome does not depend upon only on lawyers’ work, but, if there was deficiency in rendering services promised, for which consideration in the form of fee is received by him, then the lawyers can be proceeded against under the Consumer Protection Act.

However, the said judgement of the NCDRC has now been stayed by the Hon’ble Supreme Court in the matter titled as “Bar of Indian Lawyers vs. D. K. Gandhi”. The said case is still pending adjudication before the Hon’ble Supreme Court of India.

Thus, the question whether the lawyers are covered under the Consumer Protection Act or not is pending before the Hon’ble Supreme Court of India.  However, as on date, the lawyers do not fall under the purview of Consumer Protection Act. 

Weather

 Heat wave conditions were observed at many parts of West Rajasthan

Maximum Temperature Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at many parts of Jammu & Kashmir; at some parts of Rajasthan and West Madhya Pradesh; at one or two parts of Himachal Pradesh and Bihar; above normal (1.6°C to 3.0°C) at many parts of Sub-Himalayan West Bengal & Sikkim and Gujarat; at some parts of Haryana and Assam & Meghalaya; at one or two pockets of Gangetic West Bengal. Yesterday, the highest maximum temperature of 47.0°C was recorded at Churu (West Rajasthan) over plains of the country

Temperatures Recorded at 1430 Hours IST of Today, the 08 th June, 2018 o Temperatures more than 40.0°C is observed at most parts of Rajasthan; at many parts of Punjab, Haryana and Delhi and at one or two pockets of Jammu division, West Madhya Pradesh, Gujarat region and Saurashtra & Kutch (Annexure 3). o Temperatures recorded at 1430 hours of today have risen by 3-6°C at some parts of Kerala and Assam & Meghalaya and at one or two pockets of Konkan & Goa and Tamilnadu & Puducherry by 1-3°C at many parts of Marathwada; at some parts of Punjab and rest Northeastern states and at one or two pockets of Jammu & Kashmir, Haryana, West Rajasthan, Jharkhand, Chhattisgarh, Odisha, Gangetic West Bengal, Andhra Pradesh and Rayalaseema

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