Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
President, Heart Care
Foundation of India
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)
Dear Colleague, 25th October
Can DMC enquire into subjudice cases?
The reference is DMC/F.14/DC/Comp.289/2006/ dated 21st March, 2006, where in DMC wrote to MCI as under. (Ref. No. : MCI-211(2)(538)/2005-Ethics/25996 dated 9th March, 2006): The complaint of Shri Balbir Singh r/o. Village Pochanpur, P.S. Dwarka, New Delhi, against doctors of Deen Dayal Upadhayay Hospital, Hari Nagar, forwarded by Medical Council of India, was examined by Delhi Medical Council. On perusal of the complaint, it is observed that the matter is subjudice; hence it will not be appropriate to examine the same.
Comments: This judgment needs rethinking as most of the cases to DMC may be forwarded by the consumer courts. In India one may be filing cases simultaneously in different courts and the same is not prohibited.
What is Bolum test? Dr KK Aggarwal
The stringent standards regarding disclosure laid down in Canterbury, as necessary to secure an informed consent of the patient is not accepted in the English courts. In England, standard applicable is popularly known as the Bolam Test, first laid down in Bolam v. Friern Hospital Management Committee  2 All.E.R. 118. McNair J., in a trial relating to negligence of a medical practitioner, while instructing the Jury, stated thus:
(i) A doctor is not negligent, if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. Putting it the other way round, a doctor is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view. At the same time, that does not mean that a medical man can obstinately and pig-headedly carry on with some old technique if it has been proved to be contrary to what is really substantially the whole of informed medical opinion.
ii. When a doctor dealing with a sick man strongly believed that the only hope of cure was submission to a particular therapy, he could not be criticized if, believing the danger involved in the treatment to be minimal, did not stress them to the patient.
iii. In order to recover damages for failure to give warning the plaintiff must show not only that the failure was negligent but also that if he had been warned he would not have consented to the treatment.
As per Supreme Court of India: Bolam test is applicable in India in all respects.
Obama Declares H1N1 a National Emergency
President Obama has upped the ante in the battle to control the H1N1 flu by declaring it a national emergency, the second such declaration since the flu first emerged last spring.
The White House said the proclamation, will allow public health agencies as well as doctors and hospitals to bypass certain requirements, but details about how that will transfer into clinical practice are not clear. The proclamation notes that the declaration is a precautionary measure, given that the rapid increase in illness across the Nation may overburden health care resources and that the temporary waiver of certain standard Federal requirements may be warranted in order to enable U.S. health care facilities to implement emergency operations plans. At least one extraordinary step, FDA permission to use the investigational antiviral peramivir to treat patients who are critically ill with H1N1 was also announced.
Last April, in the early days of the H1N1 outbreak, Homeland Security Secretary Janet Napolitano, speaking for the administration, declared a public health emergency. That declaration freed up supplies of oseltamivir (Tamiflu) and zanamir (Relenza) from the national stockpile. As per CDC director Thomas Frieden, H1N1 has thus far claimed more than 1,000 American lives, a death toll that includes about 100 children. Moreover, 46 states are reporting widespead flu activity.
When should platelets be transfused in dengue?
A: Significant spontaneous bleeding through intact vascular system doest not occur until the platelet count is 5000 or less. (NEJM 1962; 266:905-909, CCIM Haematol 1978; 7:523-539).
Previously, the platelet count of 10000 was considered to be indication for prophylactic platelet transfusion. However, in the 4 randomized transfusion trials comparing prophylactic transfusion triggers of 10000 versus 20000 showed no difference in hemorrhaging risk. (TRANS MCD REV 2004; 18:153-167). In dengue, platelet transfusions are rarely given but may be warranted in patients with severe Thrombocytopenia (less than 10000/mm3) and bleeding).
What is the treatment for plasma leakage in DHF?
A: To prevent or reverse hypovolumic shock fluid resuscitation is required. In patients with established intravascular fluid loss IV fluid, transfusion is recommended. As per WHO guidelines, the patient should receive 20 ml of DNS per kg body weight per hour until the pulse pressure is more than 20 and the urine output normalizes. (Formula of20)
What is the best test for dengue hemorrhage fever?
A: SGOT. Elevated SGOT levels are noted earlier than other tests. A Thailand study showed that normal SGOT levels for first three days of illness is a strong negative predictor of dengue hemorrhage fever. (J INFECT DCS 1997; 176:313)
What are the indications of admission of patients with dengue?
A: Blood Pressure lowers than 90/60 mmHg
Platelet count less than 50000
Evidence of bleeding other than petechiae
Hematocrit more than 50%
Have a headache and don't know why? It could be high levels of air pollution.
A study from the densely populated Santiago Province of Chile - a region surrounded by the Coastal and Andes mountains and, therefore, geographically prone to air pollution - found increased hospital admissions for migraines and other headaches on days of elevated air pollution readings. The study is reported in the American Journal of Epidemiology.
DVT may not be the cause of all VTE
New research raises doubts about the long-held medical dogma that dangerous blood clots in the lungs, known as pulmonary emboli, originate from clots in the deep veins of the legs or other parts of the lower body, which then break up and travel up through the body. A study appearing in the October issue of the Archives of Surgery found that 85 percent of trauma patients with pulmonary emboli showed no sign of deep vein thrombosis, or blood clots in the lower extremities. The lead author of the study, Dr. George Velmahos, chief of the division of trauma, emergency surgery and surgical critical care at Massachusetts General Hospital and professor of surgery at Harvard Medical School in Boston, said the findings also cast doubt on the use of filters to prevent the clots from traveling.
Gabapentin for neuropathy may not be the only solution
A single pill containing the pain relievers tramadol and acetaminophen is as effective as the drug gabapentin for treating diabetes-related nerve pain, according to study findings presented Tuesday at the 20th World Diabetes Congress in Montreal. In general, gabapentin is regarded as a first-line therapy for diabetic neuropathy.
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Medinews Doctor of the Year Award
IJCP group on 10th Jan 2010 will award Medinews Doctor of the Year Awards 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. Nominations are invited for the same on email. It will be an annual event. Jury will consist of eminent doctors.
DMC Election Update
The whole day yestaerday was busy with SMS and counter SMS from the DMA political groups regarding the DMA seat election for the DMC. emedinewspaper sources have heard that both have filed complaints with the local police. We will keep reporting on this issue as we get both the versions. In the mean time all the nominee from the medical colleges have been eleected. Only 4 nominated members from Delhi Government are remaining. Over a period of time once all 21 members are elecetd we will publsih a small write up on every member on a daily basis.