Morning MEDtalks with Dr KK Aggarwal 11th August 2018

How is compensation calculated in a medical negligence claim?

The General Principle of English Law: Compensation is broadly divided into two categories, general damages (representing physical and psychological injuries) and special damages (representing financial losses).

General Damages: Physical and psychological injuries are valued based on guidelines in a book called the Judicial College Guidelines.

1. Tetraplegia £284,610 to £354,260
2. Severe psychiatric injury generally £48,080 to £101,470
3. Complete loss of sight in one eye £43,200 to £48,080
4. Female infertility £15,750 to £32,210
5. Severe bowel injury £39,090 to £61,140
6. Above knee amputation of one leg £91,910 to £120,530
7. Moderate chronic regional pain syndrome £24,580 to £46,040
8. Loss of or serious damage to two front teeth £7,650 to £10,010
9. Significant facial scarring £7,990 to £26,380

Special Damages: This represents financial losses incurred as a result of the negligence.

1. Loss of earnings: Lost wages as a result of an injury may be recovered. As can other earnings such as bonuses and salary increases.
2. Care and assistance: If someone looked after you (e.g. help with bathing, getting dressed, etc.), or carried out your chores/duties (e.g. cleaning, shopping, looking after children, etc.), as a result of an injury.  Also, if you require professional care as a result of your injuries.
3. Accommodation and adaptation costs: If your injury means you need a new property or adaptations to your existing property
4. Travel expenses: Mileage and parking costs (e.g. going to medical appointments).
5. Treatment costs: If you require treatment these costs may be recovered on a private basis, even if you would not have had paid for private treatment yourself.
6. Medication costs: Medication costs may be recovered. Also, the costs of medical aids, such as prostheses, may be recovered.
7. Funeral costs
8. Miscellaneous costs: Any other financial losses incurred. For example: the cost of a holiday which you were unable to go on, or cancelled theatre tickets.

Past and future financial losses may be recovered if you are permanently unable to work, or require care for the rest of your life, or require regular future treatment.

Low acetyl-L-carnitine a biomarker for major depression?

A study published online July 30 in the Proceedings of the National Academy of Sciences, which included 116 participants, showed that both men and women with major depressive disorder (MDD) had significantly lower levels of acetyl-L-carnitine than their counterparts who did not have the mental disorder. The degree of LAC deficiency reflected both the severity and age of onset of MDD. Larger acetyl-L-carnitine decreases were found in those with treatment-resistant depression and a history of childhood trauma.

LAC is an endogenously produced molecule critical for hippocampal function and several behavioral domains.

Notification of patient overdose deaths reduces clinician opioid prescriptions

Clinicians were more likely to reduce the number and dose of opioid drugs they prescribed after learning that one of their patients had died from an overdose from a controlled substance than those not notified. Physicians who received a letter from the chief deputy medical examiner informing them of the overdose death of one of their patients reduced the number of opioids prescribed by 9.7% in the three months following the intervention (Science, August 10, 2018).

Tips for care of contact lens

1. Wash your hands with soap and water. Dry them well with a clean cloth before touching your contact lenses every time.
2. Don’t sleep in your contact lenses, unless prescribed by your eye doctor.
3. Keep water away from your contact lenses. Avoid showering in contact lenses, and remove them before using a hot tub or swimming.
4. Don’t “top off” solution. Use only fresh contact lens disinfecting solution – never mix fresh solution with old or used solution.
5. Replace your contact lens case at least once every three months.
6. Give your eyes a rest.
7. Disinfect the night before planned wear, if you wear contact lenses sporadically.
8. Decorative lenses must be prescribed and fitted by an eye care professional. 
9. Never use lenses that have not been approved by the FDA

(Source: AAO, August 1, 2018)

FDA expands recall of valsartan due to cancer concern

The US FDA has expanded the list of drugs being recalled that contain valsartan. The FDA initially announced a valsartan recall in July after lab tests discovered that some drugs could have been tainted with a substance NDMA linked to higher risk of cancer. The drug had previously been recalled in 22 other countries. The expanded recall includes some drugs that contain valsartan and hydrochlorothiazide. N-nitrosodimethylamine or NDMA, the impurity the lab tests found, is considered a possible carcinogen. It is an organic chemical that has been used to make liquid rocket fuel and can be unintentionally introduced through certain chemical reactions. It is a byproduct from the manufacturing of some pesticides and fish processing.

The recalled medicine is linked to a manufacturer in China. The substances were supplied by Zhejiang Huahai Pharmaceuticals, based in Linhai, in eastern China, which said it notified authorities as soon as it identified the impurity.

Supreme Court fines PIL with Rs 25000/-

Reepak Kansal vs Union of India, Writ Petition (Civil) No. 826/2018 filed for demanding a direction to the Centre as well as the States to formulate a policy or issue guidelines for doctors and hospitals conducting Cesarean deliveries. 

The petition alleged flagrant violations and abuse of health norms due to the lack of such policy, claiming that several private hospitals and maternity homes often conduct unnecessary C-sections. 

The three-Judge Bench of the Honble Supreme Court of India has simply dismissed the said petitioner vide order dated 03.08.2018 saying that the said petition is an attempt to abuse the process of the Court. And a cost of Rs. 25,000/- has been imposed on the petitioner. 

Nanodrugs

Nanoparticles may be the way to deliver oral medication, including an insulin pill to control diabetes. Nanoparticles, which are ten thousand times smaller than the head of a pin, were studied as a way to deliver an oral dose to targeted areas. The findings at the University of Utah Health were published in the journal ACS Nano.

Around the globe

1. Antihypertensive therapy to lower elevated blood pressure (BP) decreases the risk for dementia and Alzheimers disease (AD) in older adults, and the benefits may be gained by several different drug classes (Alzheimers Association International Conference (AAIC) 2018).
2. Higher high-density lipoprotein cholesterol (HDL-C) could be a marker of HDL dysfunction rather than cardioprotection in postmenopausal women, a new Multi-Ethnic Study of Atherosclerosis (MESA) analysis suggests
3. Higher BMI is likely to cause higher blood pressure and higher left ventricular mass index, researchers conclude from Avon Longitudinal Study of Parents and Children (ALSPAC) study.
4. An FDA advisory committee voted 17-1 Wednesdayto recommend approval of omadacycline, a next-generation tetracycline-class antibiotic, for treatment of acute bacterial skin and skin structure infections (ABSSSI).
5. Encouraging people to eat a wide variety of foods to ensure they meet all their dietary needs may be associated with eating a greater variety of both healthy and unhealthy foods. A diverse diet may increase food consumption and the prevalence of obesity (American Heart Association [AHA] consensus statement).
6. Dipeptidyl peptidase 4 (DPP-4) inhibitors - vildagliptin and linagliptin - are associated with an increased risk of bullous pemphigoid. DPP4 inhibitors should be used “cautiously in patients with initial high risk for bullous pemphigoid - elderly patents and those with disabling neurological diseases. Clinicians prescribing DPP4 inhibitors should be aware of the association and stop the medication if bullous pemphigoid develops (JAMA Dermatology, August 8, 2018)

Video to watch: What are the normal CRP levels? https://www.youtube.com/watch?v=NdxJliwBqHQ 

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO