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  Address:  39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: http://www.ijcpgroup.com 

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)


Dear Colleague,                                                                                   24th October

Dengue 3 serotype on the rise

The current dengue epidemic in Delhi is serotype 3, the deadlist amongst the four sero types 1,2,3, & 4. Serotypes facilities are available in AIIMS and NICD. The results at AIIMS has shown the trend towards serotype 3. The second attack of dengue is more serious than the first one. 

 Should in the consent form rare complications be included

Case study: The Delhi Medical Council examined a representation from the office of DCP Headquarters, Delhi, forwarded by Govt. of NCT of Delhi wherein allegations of medical negligence were leveled by Shri Tej Singh against doctors of Indraprastha Apollo Hospital New Delhi in the treatment administered to complainant?s grandson late master Aditya Pal, resulting in his death on 26th October 2006. (DMCC/14/2/Comp. 281/2006/ dated 15th September, 2006)

Case: Master Aditya was suffering from Recurrent laryngeal Papillomatosis and was undergoing treatment at Apollo Hospital with laser resection by Dr. Rajiv Puri, a senior ENT consultant. The patient had undergone such procedures successfully on 25th Nov., 2004, 7th March, 2005, 2nd April 2005 and 25th July, 2005  by  the  same  surgeon.  On  3rd Oct 2005  also  the  same procedure was planned. The team first tackled the lesions above the tracheostomy and then went on to remove the remaining portion of the tumor, which was extending up to the carina. After few minutes of application of laser a flash occurred and flame was seen at tracheostomy, which was put out with water. A bronchoscope was introduced and the patient?s airway was found to have suffered Laser Burns. Following the accident, the procedure was stopped immediately and all necessary treatment including ventilator support was instituted and he was transferred to PICU. The mother of the child and other relatives were informed about the incident. The child remained in the PICU till 20.10.2005, where his clinical condition gradually improved. In view of the improved clinical condition, the child was transferred to the ward in accordance with the ICU protocol of the hospital. During the stay in the ward, changing of tubes/lavaging of airway were done by taking the child to PICU. Tracheostomy suction was done in the ward itself whenever necessary, as a part of the treatment protocol. However on 26.10.2005, the condition of the patient deteriorated when tracheostomy suction was found to be blood stained and volume was increasing. He was then shifted to PICU again for further aggressive management including ventilator support and in spite of all possible efforts; the child succumbed to his illness.

It has been observed that the preoperative, intraoperative and postoperative treatment provided to Master Aditya was fully in consonance with the known standard protocol of treatment in such cases. The laser equipment used was also in working order as per inspection report dated 09.11.2005.It was unfortunate that after having successful laser resection in four consecutive occasions, accidental fire occurred during the fifth session which resulted in laser burn of the airway of Master Aditya leading to secondary complications and he finally succumbed to them. After going through all the records and also examining the doctors associated with this case, the Council did not observe any negligence in the management of the entire episode.  The laser spark which occurred in the airway at the site of surgery and which caused burn injuries in the airway, although very rare, is known to occur with the incidence of 0.5% to 1.5% in the U.S.A. Post explosion treatment including treatment provided in the PICU and the ward was as per standard treatment protocol. 
However, it is felt that explicit/specific information about probability of such complications during such procedures should be made available to the patient in the consent form.  The same may be recommended to the Government for adoption in all Delhi Hospitals.
Editors Comments:  As on today we do not have to follow the US pattern of informing rare complications.  The supreme court of India has consciously preferred the 'real consent' concept evolved in Bolam and Sidaway in preference to the 'reasonably prudent patient test' in Canterbury, having regard to the ground realities in medical and health-care in India.
?But if medical practitioners and private hospitals become more and more commercialized, and if there is a corresponding increase in the awareness of patient's rights among the public, inevitably, a day may come when we may have to move towards Canterbury. But not for the present?. (Supreme Court of India)

Dr KK Aggarwal

Online course on TB, must for doctors: WMA
World Medical Association (WMA) has introduced a new online refresher course on tuberculosis (TB) for physicians around the globe with the concern that many were not provided with the basic knowledge about its diagnosis and treatment. The re-surfacing of TB as a serious global disease has necessitated doctors around the world to regain the basic knowledge they once had. The course provides basic clinical care information including the latest diagnostics, treatment and information about multidrug-resistant TB including how to ensure patient compliance. It is a public-private initiative led by Eli Lilly and Company.

Making of stem cells from adult cells
A new research has introduced a novel method that would accelerate the process of creating cells from human adult tissue without the use of embryonic cells. During the research, they closely monitored a naturally occurring process, called MET (mesenchymal to ephithelial cell transition), that pushes fibroblasts closer to a stem-cell-like state (connective tissue). The new method is far better than the conventional technique in transforming adult human cells into stem cells.

Migraine adds to hangover headaches
According to a latest research, people suffering from migraine are more vulnerable to alcohol-induced headaches. Scientists caused headache in rats through repeated stimulation of the brain?s dura mater followed by alcohol. These rats suffered increased pain sensitivity later, while no changes were observed in alcohol-induced sensitivity in the control groups. This result affirms the clinical observation that people with migraine are more susceptible to alcohol-induced headaches.

Metals that cure cancer
A latest research showed that cancerous cells have become resistant to the present most successful transition metal drug, Cisplatin. Drugs derived from ruthenium and osmium have a higher potential to treat colon and ovarian cancers than Cisplatin. Ruthenium and osmium are two transition metals whose compounds show a very high level of activity against ovarian cancer.

Study cautions about treatment method of fibroid
Uterine artery embolization, a procedure used to treat fibroids is not safe for a subsequent pregnancy. Fibroids cause menorrhagia or excessive bleeding. Doctors in UK examined outcomes of 215 pregnancies following uterine artery embolization treatment. Much higher rates of miscarriage, caesarean sections and heavy bleeding after delivery were observed with this procedure. According to the authors of the study, there has been a relatively lack of data of the long-term effects of this procedure. It is not offered as a first-time treatment, but, for some women, surgery and other treatments do not work. The study calls for caution in recommending the treatment.

Yoga is not asanas
Yoga is not asanas. The word YOGA means Union, which is when the body and mind work in symphony with each other. Therapeutic life style, is the new treatment modality in the cardiology scenario and includes interventions where the person is treated with drugs in conjunction with yoga, meditation, Pranayama, exercises and other life style interventions to shift one from sympathetic to para sympathetic mode and simultaneously controlling the blood sugar and lipid parameters apart from controlling the weight and the blood pressure. Yoga is an integral part of life style interventions.
Children & adolescents with congenital heart disease should avoid body piercing
No tattooing for heart patients

Children and teenagers with congenital heart disease should be strongly discouraged from getting a tattoo or piercing their ears or other body parts, because it could lead to a potentially deadly infection of the heart called endocarditis, said Dr. KK Aggarwal, President, Heart Care Foundation of India.
Infective endocarditis occurs when bacteria or fungi attaches and begins to grow on the valves of the heart. If left untreated, it can lead to a fatal destruction of heart muscle.
Most people are not aware that they should talk to their doctor before tattooing or piercing their body.

Many of the pediatric heart doctors also may not be aware that tattooing could lead to an infection of the heart.
Body art in the form of tattoos and piercing has become increasingly popular amongst children and teenagers, and is nowadays more socially acceptable.
Better knowledge and education about the link between body art and endocarditis is required in order to provide guidelines for doctors and patients.

Most experts today strongly discourage all forms of body art.  For those who cannot be dissuaded, the recommendation is to give antibiotics prior to tattooing or piercing, "with strong advice for prompt treatment of any signs of subsequent infection.

Heart risks detected by age 7 in overweight kids
Children at risk of future obesity should be examined for body mass index rebound. BMI rebound is the age at which body mass index (BMI) reaches its lowest point before increasing through later childhood, adolescence and adulthood.
An earlier BMI rebound age is associated with adverse risk factors for heart disease as measured at age 7: higher BMI, higher systolic and diastolic blood pressures, higher serum insulin and leptin levels, higher left ventricular mass and left atrial size.
 Early BMI rebound age for children is lower than 4.4 years for boys and 4.2 years for girls.  Normal values are 4.4 to 6.6 years for boys and 4.2 to 5.7 years for girls. All children who start gaining weight between 3-4 years should be classified as a high risk for future diabetes and heart disease.

You can advertise in emedinews

emedinews is a new venture of IJCP Group and is the first emedical newspaper of the country, mailed to 50000 subscribers everyday consisting of medical doctors, pharma product managers, hospitals, nursing homes and health policy makers. Advertisement opportunities are available. One can advertise with a singe insertion or with 30 insertions in a month. For details contact drkk@ijcp.com.

Medinews Doctor of the Year Award
IJCP group on 10th Jan 2010 will award 20 Medinews  Doctor of the Year Award to eminent doctors who have done outstanding work in the year 2009. The award will be a part of day long CME: MEDINEWS 2009 ? Revisiting 2009. The award will carry a citation, shawl, coconut kalash, scenery and a memento.

Discounts for doctors
Roentgen-BLK Radiation Oncology Centre at BL Kapur Memorial Hospital, Pusa Road, New Delhi is equipped with state of the art Radiotherapy equipment viz. Trilogy TX linear accelerator, and HDR brachytherapy machine. The experienced team of radiation oncologists, medical physicists, and technologists offer techniques like Image Guided radiotherapy (IGRT), Intensity Modulated Radiotherapy (IMRT), Stereotactic Radiotherapy (SRT), and 3D Conformal Radiotherapy (3DCRT). Through emedinews we offer a discount of 25% on radiotherapy charges for Doctors and their kin from immediate effect. [Dr S Hukku, Chairman Roentgen-BLK Radiation Oncology Centre]

Dr Ashwini Dalmiya elected to DMC on the DMA seat

Dr A Dalmiya Honorary Secretry DMA was eleceted as the DMC member from DMA seat, said Dr Naresh Chawla President DMA. Dr U C Bansal was the Election Commisioner. The election was held at DMA hall Daryaganj.  



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