Straight from the Heart: Some Facts on Max-Fortis Cases

 Straight from the Heart: Some Facts on Max-Fortis Cases

IMA got an access to part inquiry reports in the Fortis and the Max case, respectively. Here are some excerpts which should also be known to the medical fraternity

Fortis case: IMA Notes Based on inquiry report

·         “The committee found that the patient was suffering from Dengue Shock Syndrome, not mere dengue fever”.

·         “The mortality is high ranging from 6 to 30%. Most deaths occur in children”.

·         “The Committee found that the family had to spent Rs. 15.00 lakh for emergency ICU treatment for 15 days, not for dengue fever”

·         “There is prima facie no evidence of negligence in the management of the child during her stay in the PICU.”

·         “It is unlikely that conducting MRI earlier would have affected the course of treatment.”

·         “There are no guidelines on how many consumables are to be used per day in a PICU patient. However, general guidelines state that a liberal use of consumables for example syringes, gloves etc. must be made to decrease the risk of hospital acquired infections in these patients.”

·         “After perusal of above statements, I am of opinion that the father of the baby Adya was well informed about the consequences of LAMA.”

·         “However, at the end of the complete documents in all cases, one original signature of the parents is there.”

·         “It is again reiterated, the consent for so-called LAMA was obtained from the parents of the victim at the strong insistence of the treating doctors who gave a professional opinion stating that the MRI Scan Report revealed irreparable brain damages. It is again repeated that the "cost of the treatment" was never a consideration or deterrent for the parents.”

IMA Comments

IMA is developing a LAMA policy so that these types of disputes do not occur when a case reaches a state of no recovery.

Max Case: Some excerpts from the government report

·         “.. report concluded that the hospital have not kept any proper temperature and vital sign monitor record of the period of comfort care provided to the live male newborn”

IMA Comments: Not keeping record is a misconduct and not a criminal offence.

·         “….committee also concluded that the staff nurses on duty were also at fault as they handed over the bodies of the newborns without any written direction from the pediatrician and they also missed the signs of life in the male newborn while handing over the 'body' to the attendants”

IMA Comments: The very fact they also missed signs of life confirms the newborn was clinically dead (when the brain is alive and heart can get revived later when the body temperature increases due to warmth. Clinical death period is 10 minutes in every death and up to 4 hours in hypothermia)

·         “WHEREAS, the committee also concluded that the hospital has entered the name of live male newborn baby in the still birth register.”

IMA Comments: This is a record keeping mistake and not criminal negligence.

About 90% of the estimated malaria cases in the Southeast region are from India

About 90% of the estimated malaria cases in the Southeast region are from India

India also needs a stronger malaria surveillance system to combat the disease

New Delhi, 02 December 2017: As per recent reports, India accounts for about 6% of the world’s new cases of malaria and 7% of deaths caused by the disease. India accounts for about 90% of the estimated number of malaria cases followed by Indonesia (9%) and Myanmar (1%) in the Southeast Asia region. The country has also been found to be one of the weakest in terms of malaria surveillance systems. Despite efforts at various levels, malaria remains an acute public health challenge in India.

Malaria is a life-threatening mosquito-borne blood disease caused by a Plasmodium parasite. It is transmitted to humans through the bite of the Anopheles mosquito. Once an infected mosquito bites a human, the parasites multiply in the host's liver before infecting and destroying red blood cells.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "Malaria is transmitted by the bite of a female anopheles mosquito. The mosquito bite occurs mainly between dusk and dawn. Five types of Plasmodium parasite can infect humans. They are found in different parts of the world. Some cause a more severe type of malaria than others. Malaria can also be transmitted through blood transfusion, or via sharing of contaminated needles. The behavior of the mosquitoes may differ. Some may prefer to rest indoors and feed indoors in the night. Some may prefer to rest and feed outdoors earlier in the day. Preventive therapy of malaria can be instituted during pregnancy in high risk areas. The malarial mosquito feeds every third day compared to the dengue mosquito, which feeds three times in a day.”

Symptoms of severe malaria include the following: fever and chills; impaired consciousness, prostration, or adopting a prone position; multiple convulsions; deep breathing and respiratory distress; abnormal bleeding and signs of anemia; and clinical jaundice and evidence of vital organ dysfunction.

Adding further, Dr Aggarwal, said, “Pregnant travelers should defer travel to areas where risk of malaria is high until after delivery. For non-immune pregnant women who cannot defer travel, chemoprophylaxis with chloroquine and mefloquine depending on travel to areas with chloroquine-sensitive or resistant malaria is recommended. Pregnant women from endemic areas, who due to prolonged exposure to malaria, have developed natural immunity benefit from chemoprophylaxis.”

Here are some tips to prevent malaria.

• Malaria mosquitoes grow in fresh water collected in the house. It is therefore important to not let water stagnate in your house and the surrounding areas. Mosquito cycle takes 7-12 days to complete. So, if any utensil or container that stores water is cleaned properly once in a week, there are no chances of mosquito breeding.
• Mosquitoes can lay eggs in money plant pots or in water tanks on the terrace if they are not properly covered. If the water pots for birds kept on terraces are not cleaned every week, then mosquitoes can lay eggs in them.
• Using mosquito nets/repellents in the night may not prevent malaria because these mosquitoes bite during the day time.
• Malaria mosquitoes do not make a sound. Therefore, mosquitoes that do not produce a sound do not cause diseases.
•  Wearing full sleeves shirt and trousers can prevent mosquito bites. Mosquito repellent can be helpful during the day. 

Air pollution causes millions of CKD cases globally each year

Air pollution causes millions of CKD cases globally each year

The estimated global burden of chronic kidney disease (CKD) attributable to air pollution (fine particulate matter (PM) less than 2.5 µm) is significant, amounting to more than 10.7 million cases per year.

The researchers used the Global Burden of Disease study methodologies to estimate the burden of CKD attributable to air pollution. Epidemiologic measures of the burden of CKD attributable to air pollution included years living with disability (YLD, meaning years living with kidney disease), years of life lost (YLL, meaning early death attributable to kidney disease), and disability-adjusted life years (DALY, a measure that combines the burden of living with the disease and the early death caused by the disease).

·         The global annual burden of incident CKD attributable to high PM2.5 levels was 10,784,514 (95% Uncertainty Interval: 7,821,109-13,857,623).

·         YLD, YLL, and DALYs of CKD attributable to high PM2.5 were 2,185,317 (1,418,442-

·         3,061,477), 7,897,941 (5,471,081-10,514,433), and 10,083,258 (7,064,399-13,323,685), respectively.

The study also found that burden of disease varies greatly by geography. India, along with Nigeria, Bangladesh and Pakistan had the high attributable burden of disease, exceeding 200 incident cases of CKD per 100,000 population.

India was also amongst the countries that reported highest DALYs that included Mexico, Central America, Southeast Asia and Northern Africa. DALYs per 100,000 were 366.71 (251.05, 498.01) in Nicaragua and 353.93 (260.05-449.24) in Mexico, compared to 44.59 (24.07-65.74) in the United States.

These findings were presented at the recently concluded ASN Kidney Week 2017 in New Orleans, Louisiana, USA.

Keeping BP, cholesterol, body weight, blood sugar within healthy limits, avoiding overuse of OTC painkillers, smoking, eating a healthy diet and exercising regularly are some of the ways to protect kidney health.

Air pollution has become a major threat to society today. Air pollution has been at an extremely high level, particularly in the Delhi-NCR region and continues to remain the ‘hazardous’ category.

Studies have shown that air pollution can damage the kidneys. A significant association between exposure to PM2.5 and risk of incident CKD, decrease in estimated glomerular filtration rate (eGFR)  and progression to end stage renal disease was reported online September 2, 2017 in the Journal of the American Society of Nephrology.

It’s now time perhaps to add air pollution (PM2.5) to the list of risk factors for chronic kidney disease and recommend avoiding or limiting air pollution exposure to the list of measures generally advised to prevent/delay chronic kidney disease.

It has become important to also note the air pollution levels in different areas in your city before venturing out to avoid exposure to pollution.

(Source: American Society of Nephrology News Release, November 4, 2017)

Increasing cases of piles in India to be blamed on unhealthy and sedentary lifestyle

Increasing cases of piles in India to be blamed on unhealthy and sedentary lifestyle Provided lifestyle changes are not made on time, it can cause complications and need surgical intervention New Delhi, 06 September 2017: One disease that is increasingly affecting about 10 million people in India every year is piles. The disease is spreading fast due to stress, insomnia, constipation, and increasingly sedentary life in the urban areas. Studies indicate that every second individual in the world comes across piles between 45 and 65 years of age. As per the IMA, what is alarming is that young people in their 20s are falling prey to this disease owing to bad lifestyle habits. Piles are hemorrhoids which become inflamed. Hemorrhoids are masses, clumps, and cushions of tissue in the anal canal. These are full of blood vessels, support tissue, muscle and elastic fibers. Although all of us have hemorrhoids, they become problematic only when the hemorrhoidal cushions become too big. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Piles is today become increasingly prevalent in urban areas thanks to faulty food habits, be it junk food, aerated drinks, or a low-fibre diet. Youngsters are becoming habituated to fast food, as it is convenient and easily available, and therefore, start experiencing symptoms right from an early age. Food that is not rich in fibre ruptures veins in the rectum and anus, causing inflammation of these areas. When this swelling and inflammation continue for a long time, it leads to piles. Although in majority of the cases, piles are not serious and go away on their own, they can even require surgical intervention if lifestyle changes are not made on time.” Some symptoms of piles include a hard lump around the anus consisting of coagulated blood, a feeling that the bowels are full even after a bowel movement, bright red blood after a bowel movement, itchiness around the anus, mucus discharge, pain while defecating, and soreness around the anus. Adding further, Dr Aggarwal, said, “It is important to consume a diet high in fibre such as salads, seasonal vegetables, and fresh fruits. Spices, junk food, and aerated drinks are better avoided. Some examples of high-fibre foods include oats, sesame seeds, radish, turnips, and papaya which help in preventing and curing piles. However, if piles continue despite all these precautionary measures, it is a good idea to consult a doctor.” Here are some tips to prevent piles. • Be physically active: About 20 to 30 minutes of moderate aerobic exercise such as a brisk walk can help stimulate your bowels. • Eat more fibre: Just as exercise, fibrous food also stimulates the bowels and therefore prevents constipation and piles. • Drink plenty of water: Staying hydrated helps the stool stay soft and staves off constipation. • Do not fight the urge: It is important to empty your bowels when you feel the urge to. Holding stools for a long time can make them go hard and dry inside the bowel.