Morning MEDtalks with Dr KK Aggarwal 27^th June 2018

PLASTICS AND THERMOCOL PRODUCTS BANNED IN MAHARASHTRA from 23^RD JUNE 2018

Maharashtra State Government has enforced the Maharashtra Plastic and Thermocol Products (Manufacture, Usage, Sale, Transport, Handling and Storage) Notification, 2018 Notification No. Plastic-2018/C.R. No. 24/TC-4 dated 23.03.2018 which was issued by the Environment Department with effect from 23.06.2018 thereby banning the use of plastic bags with handle and without handle, and the disposable products manufactured from plastic & thermocol (polystyrene) such as single use disposable dish, cups, plates, glasses, fork, bowl, container, disposable dish/ bowl used for packaging food in hotels, spoon, straw, non-woven polypropylene bags, cups/ pouches to store liquid, packaging with plastic to wrap or store the products, packaging of food items and food grain material etc.

Components of informed consent

Every doctor has a legal and ethical responsibility to provide adequate information to the patient so that he or she canprocess the information and make appropriate decisions.

1. No procedure can be undertaken without the patients agreement
2. The patients consent must be voluntary and competent
3. Must disclose material facts relevant to decision making (diagnosis, proposed treatment, risks and benefits of the treatment, alternative treatments along with their risks and benefits, and the risks of refusal)
4. Must answer truthfully, if asked, about the number of similar procedures or cases performed, and disclose success rates.
5. Must disclose, even without inquiry, any financial conflict(s) of interest.
6. Inform of all personnel involved in their care and their respective roles, including residents, students, and equipment representatives.
7. Inform of any reasonably foreseeable additional procedures that may be necessary for a successful outcome
8. Communicate in terms patients and their families can understand.
9. Use comprehensible language, offer educational material, and use interpreters when necessary
10. Document the content of informed consent sessions
11. Failure to provide the necessary, relevant information in a way that truly communicates with the patient may constitute ineffective, and therefore non-existent, consent.
12. Battery action: an action for a "touching" to which the patient did not agree. A claim of battery may be made, even if the procedure is technically successful.
13. Negligent nondisclosure: The patient says he or she did sign the consent form, but was not thoroughly and comprehensibly made aware of the nature of the proposed procedure and its risks. There are four elements that must be shown:

Duty

Breach of duty: 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.

The plaintiff must 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.

14. 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.

IPC Rule to know: Section 269 in The Indian Penal Code

269. Negligent act likely to spread infection of disease danger­ous to life.—Whoever unlawfully or negligently does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both.

Cyclospora in Wisconsin

Reports of parasitic infections from Cyclospora have been linked to Del Monte brand pre-cut fresh vegetables, despite the national companys initial recall on June 8, according to Food Safety News. Infection has been confirmed in 144 people, according to an update posted June 21 by the CDC. The main state hit by the Cyclospora outbreak is Wisconsin.

Cyclospora cayetanensis is a foodborne and waterborne parasitic cause of diarrheal illness in children and adults. Humans are the only natural hosts. Cyclospora can occur as a locally acquired infection, among travelers, or in patients with HIV/AIDS. C. cayetanensis is most frequently reported in Latin America, the Indian subcontinent, and Southeast Asia.

Oocysts of C. cayetanensis passed in the stool are shed in a noninfective form and require several days before they become infectious, so person-to-person transmission is not likely. A low infectious dose (10 to 100 organisms) is probably sufficient for infection.  Cyclospora infection is characterized by anorexia, nausea, flatulence, fatigue, abdominal cramping, diarrhea, low-grade fever, and weight loss.

The diagnosis of cyclosporiasis is established via stool microscopy; oocysts can be detected by modified acid-fast staining of stool, in which oocysts appear light pink to deep purple (diameter 8 to 10 microns). trimethoprim-sulfamethoxazole (TMP-SMX; one double-strength 160 mg/800 mg tablet orally twice daily for 7 to 10 days) is the treatment.

B Complex deficiency in alcoholics

At the NIMHANS examination for DM Addiction Medicine, we were discussing the issue of dietary insufficiency of B complex vitamins (especially thiamine) and as you mentioned in your blog today- folic acid deficiency among alcohol dependent patients.  Shouldn’t the alcohol beverages be fortified with B Complex, such that one drink can make up for the daily requirement of B Complex of an alcoholic? That way at least the huge health costs of complications due to vitamin B deficiency in alcoholics will be spared! (Dr Smita Deshpande)

Diabetes update

In youth with impaired glucose tolerance or recent-onset type 2 diabetes neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body’s ability to make insulin, according to June 25 in Diabetes Care. 

Components of informed consent: Watch https://www.facebook.com/drkkaggarwal/videos/1878828148805146/

Participate in survey on Inflammatory bowel disease

https://docs.google.com/forms/d/1SAbiZpxKIqt6bWixE3J-1ZB7VPH-Z530tmAgseQLK4g/edit

Cutting of trees in Delhi

Stepping into the raging controversy over felling of thousands of trees in south Delhi for redevelopment of government housing projects, the Delhi high court on Monday stayed any further tree-cutting till July 4, when it will hear the matter next.

It’s a request

Even as state-run hospitals have failed to provide proper services, guardian minister of Nagpur, Chandrashekhar Bawankule, had suggested that private hospitals should share the patient load by reserving 20% beds for poor.

Dr K K Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO