Morning MEDtalks with Dr KK Aggarwal 31st August 2018

Allegations of medical negligence against NEIGRIHMS doctor: An alleged case of medical negligence by a doctor from the Gyne department of NEIGRIHMS has come to the fore after relatives of a patient shot off a letter to the director of the institute, reported The Shillong Times, Aug 30, 2018. As per the complaint, the patient was admitted to the Gynecology department at NEIGRIHMS on August 6 with a swollen abdomen and mucus secretion but the doctor in charge, did not start treatment.

Allegedly, the blood tests showed hemoglobin level as only 7 gm but no blood was given to her and the doctor did not even come to see her. Her condition worsened and she had to be rushed to Nazareth Hospital where she was operated upon the same day. The relatives claimed that the decision to shift her to Nazareth Hospital proved to be a blessing as the doctors removed a 5 kg tumor from her body and cut off 3 ft of her intestine which saved her life. They sought the intervention of the Director in taking strict action against the doctor whose negligence nearly cost the patient’s life.

Wrong injection leaves one dead and 25 sick in the local government hospital in Datia in Madhya Pradesh, reported Asian Age, August 30, 2018. On Wednesday, a complaint was filed with the police in Datia that administration of “wrong” injections to some patients in the local government hospital led to death of one of them while leaving 25 others sick.

According to the police, relatives of the alleged victims of the medical negligence claimed that the patients were administered injections by some nurses in district hospital at Datia without going through their medical records and diagnosis. While one patient died just ten minutes after being given the injection, 25 others have fallen seriously ill, police said quoting the complaint.

Preliminary investigation by the hospital authorities revealed that normal water was used instead of distilled water for injection.

A once-daily ‘triple’ pill containing low doses of three antihypertensive drugs: Telmisartan (20 mg), amlodipine (2.5 mg) and chlorthalidone (12.5 mg) helped patients with mild to moderate hypertension, who needed either initiation (untreated patients) or escalation (patients on monotherapy) of antihypertensive therapy, meet their treatment targets compared with usual care, where patients received their doctors choice of the antihypertensive drug.

Seventy percent patients receiving triple pill achieved the BP targets of less than 140/90 mm Hg (or <130/80 mm Hg in patients with diabetes or chronic kidney disease [CKD]) vs 55% patients on usual care.

The maximum between-group difference was observed at six weeks after starting treatment, when 68% of those receiving the triple pill had achieved their target BP vs 44% of those receiving usual care. The average reduction in BP was 8.7 mm Hg for participants receiving the triple pill and 4.5 mm Hg for those receiving usual care. The benefits of triple pill were maintained until six months. Rates of serious adverse events were similar between the two groups (TRIUMPH trial).

Think before you prescribe. Triple therapy with NSAIDs, diuretics and an ACEI or ARB may be nephrotoxic. In a retrospective cohort study of almost 500 000 patients published in BMJ. 2013 Jan 8;346:e8525, the overall risk increased by 31% with the simultaneous use of these three drugs. The use of a double therapy combination containing either a diuretic or angiotensin-converting-enzyme inhibitor (ACE) or angiotensin II receptor blocker (ARB) with nonsteroidal anti-inflammatory drugs (NSAIDs) was not associated with an increased rate of acute kidney injury.

Since the observed risk was greatest at the start of treatment “first 30 days of use”, caution is warranted, especially during the initial few months of therapy. Monitor BP and serum creatinine when more than two anti-hypertensive drugs are used in combination with NSAIDs.

HFpEF is a systemic disorder associated with endothelial dysfunction and microvascular disease in the heart and other organs. As per the PROMIS-HFpEF trial, the first prospective multicenter, multinational study of coronary flow reserve in HFpEF (heart failure with preserved ejection fraction), microvascular dysfunction may be a promising composite risk marker and therapeutic target in heart failure with preserved ejection fraction (HFpEF).

Impaired coronary microvascular function is highly prevalent in HFpEF patients in the absence of unrevascularized macrovascular coronary artery disease (CAD) and is associated with NTproBNP (a marker of HF severity), systemic endothelial dysfunction and cardiac dysfunction (European Heart Journal, August 27, 2018).

PURE Diet Score recommends 7 foods, including dairy and meat. A diet quality score based on the PURE study, which advocates eating more of seven key functional foods (fruits, vegetables, nuts, legumes, fish, dairy and nonprocessed red meat) has been linked to lower mortality and cardiovascular events in three independent data sets.

“Yes, the inclusion of dairy and unprocessed meat does conflict with current Western guidelines, but we are not suggesting people consume outrageous amounts of these items — three servings of dairy and one and a half servings of unprocessed red meat per day are what our data suggest is beneficial,” said PURE investigator Andrew Mente, MD, Population Health Research Institute at McMaster University, Hamilton, Ontario, Canada.

Pioneering self-instructional AHA training kiosks provide hands-only CPR skills. More than 100,000 people have been trained in the life-saving skill ofhands-only CPR since the American Heart Association (AHA) launched its hands-only CPR training kiosk program in 2016. Thirty of these interactive devices have been placed in cities across the United States. The majority of the hands-only CPR training kiosks are located in high-traffic, public locations, such as airports.

Each kiosk has a touch screen that displays a brief instructional video about hands-only CPR, followed by a practice session and a 30-second test. With the help of a practice manikin, the kiosk gives precise training feedback about the depth and rate of compressions, factors that influence the effectiveness of CPR. The training session takes about 5 minutes.

Ayushman Bharat scheme website will start working from September 5. Union health minister JP Nadda informed that free health insurance Ayushman Bharat scheme website will start working from 5 September (Zee Business, August 27, 2018).

Deadly swine fever threatens Asia, warns FAO. The United Nations body, Food and Agriculture Organization (FAO) has warned about the rapid onset of the deadly African Swine Fever (ASF) in China detected in areas a thousand kms apart, posing an imminent threat to other Asian countries.

Although African swine fever has before been detected outside of Africa – including outbreaks in Europe and the Americas, dating back to the 1960s – its diverse geographical spread in China has raised fears that the disease will move across borders to South-east Asia or the Korean Peninsula, where trade and consumption of pork products is also high. The robust ASF virus can survive in extreme weather conditions, and even in dried or cured pork products.

There is no effective vaccine to protect swine from the disease. And, while the disease poses no direct threat to human health, outbreaks can be devastating with the most virulent forms lethal in 100% of infected animals.

African swine fever (ASF) is a highly contagious hemorrhagic disease of pigs, warthogs, European wild boar and American wild pigs. All age groups are equally susceptible.

Video to watch: TEDx Talk

Dr KK Aggarwal: Modern day doctor-patient relationship

https://www.youtube.com/watch?v=i9ml1vKK2DQ

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

President HCFI