Do not treat mild hypertension with low risk for heart disease

The benefit from antihypertensive therapy is unproven in patients with mild hypertension and no preexisting cardiovascular disease. 

A meta-analysis combined four placebo-controlled trials adding together 8912 patients with mild hypertension and no preexisting cardiovascular disease.

Up to 5 years of follow-up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of heart attacks.

Low-risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Can Apollo docs be booked in 304A when DMC says no negligence?

Six doctors of Apollo Hospital have been booked for causing death by negligence of a 70-year-old man in 2009 as per police.

According to the hospital, there is no medical negligence. The patient had multiple pre-existing co-morbid conditions including uncontrolled diabetes, heart and kidney disease. Appropriate care and treatment was provided by a competent multidisciplinary team but the patient, sadly, succumbed to his illness.

The Delhi Medical Council also ordered that the patient was duly treated as per established norms.

A case has been filed with police station on May 31 over an order of Saket court.

The patient, complainant’s father, was admitted to the hospital on March 6, 2009 with perianal abscess with diabetes and CAD. He was on blood thinners.

Allegations

·         After remaining in the hospital for 27 days, the patient died on April 1, 2009, due to gross, grave, reckless and culpable criminal negligence of the accused, who had vision, reasonable foresight and complete knowledge and awareness of the consequences of their acts, but showed thorough disregard and indifference.

·         There was unreasonable delay in conducting surgery for drainage of perianal abscess.

·         The surgery was performed after an unjustified delay of 20 hours from the time of admission.

·         Blood thinners were discontinued prior to surgery and were not restarted again. This contributed to a heart attack on March, 27, 2009 as per the allegation.

·         Anemia was not corrected on time.

·         Hyponatremia, very low albumin and plasma proteins and blood gases were not managed at all.

·         Had proper diagnosis been made in time the heart attack could have been prevented.

Charges: The hospital and the doctors now face charges under sections 304-A (causing death by negligence), 465 (forgery) and 471 (using forged document as genuine).

Defense

·         The patient was in sepsis at the time of admission. 

·         He had other co-morbidities which needed to be stabilized.

·         The patient was evaluated by the cardiologist, nephrologist and anesthetist.

·         After the patient had been pre-operatively evaluated, stabilized, he was taken up for surgery under high-risk consent.

·         Debridement was done everyday till debridement was necessary; hence, the blood thinners were not given for this period.

eMedinews Comments

·         Once the state medical council has cleared, the person can appeal the order in MCI. Till then, the police should not take any cognizance.

·         Difference of opinion, error of judgment is not negligence.

·         To be a criminal negligence, the act has to be willful, grossly negligent and reckless, which would have been observed by the state medical council if that was the case.

·         Stopping blood thinners is a normal practice for 5-7 days before any surgery.

·         Being on blood thinners does not guarantee that a person will not get a heart attack.

·         Death does not mean negligence or a criminal negligence.

·         If two experts differ, the benefit of doubt should go to the doctor and not the patient.

·         These types of case hurt doctors and make them practice defensive practice, which in long run is not in the interest of the patients.

Breaking News: New SARS like illness in Middle East

Advisory

Consider the possibility of MERS-CoV infection in travelers with fever, cough, shortness of breath, or breathing difficulties, or other symptoms suggesting an infection, and with a recent history of travel in the Middle East.

Facts about the disease

·         A novel coronavirus, Middle East respiratory syndrome coronavirus (MERS-CoV), causing severe respiratory illness emerged in 2012 in Saudi Arabia.

·         Additional cases have been detected subsequently in Saudi Arabia, other Arabian Peninsula countries, Tunisia, Germany, the United Kingdom, France, and Italy.

·         Real-time reverse-transcriptase polymerase chain reaction is the test of choice applied to lower respiratory secretions.

·         Individuals presenting with an acute respiratory infection, suspicion of pulmonary parenchymal disease, history of travel to the Arabian Peninsula or neighboring countries within the past 14 days, and no other explanation for the clinical syndrome are considered patients under investigation.

·         There is currently no treatment recommended for coronavirus infections except for supportive care.

·         The United States Centers for Disease Control and Prevention recommends the use of standard, contact, and airborne precautions for the management of hospitalized patients with known or suspected MERS-CoV infection.

·         There is no licensed vaccine for MERS-CoV.

Precautions

·      Avoid close contact with people suffering from acute respiratory infections

·      Frequent handwashing, especially after direct contact with ill people or their environment.

·      Adhering to food safety and hygiene rules such as avoiding undercooked meats, raw fruits and vegetables (unless they have been peeled), and unsafe water

·      Avoid close contact with live farm animals or wild animals.

·      Travelers to the Middle East who develop symptoms either during travel or after their return should seek medical attention and share their history of travel.

·      People with symptoms of acute respiratory infection should practice cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands) and delay travel until they are no longer symptomatic

AMA Declares Obesity a Disease

Although policies adopted by AMA have no legal standing, decisions are often referenced in influencing governmental bodies. This decision could have implications for provider reimbursement, public policy, patient stigma, and International Classification of Diseases coding.

Obesity is a pathophysiologic disease. There is a treatment for this disease; it involves behavioral modifications, medications and surgeons.

It’s like hypertension. Obesity is a disease. It's very, very, very clear that even though not every hypertensive gets a stroke and not every obese person suffers the complications, this does not change the fact that obesity is a disease.

Others feel that it’s more like smoking. Smoking isn't a disease. Smoking can cause disease such as lung cancer and emphysema in the same way that obesity can lead to diabetes and hypertension.

In other AMA actions, a policy that supports banning the marketing and sale of high-energy drinks to anyone younger than 18 years was adopted.

Also accepted was a policy that supports letting students have sunscreen at school without restrictions.

Can reducing MBBS course to three years be the answer?

One of the suggestions is to make MBBS a 3-year course on primary care with all subjects taught but with the intention of providing primary GP medical care.

For example, have only six months of basic anatomy in primary program and those who want to enter surgery get another three years of education with one year of anatomy classes linked to surgery. Why should every one learn all about advanced medicine including anatomy or physiology in MBBS?

Complete skeletal anatomy should be taught only to those who opt for orthopedics post MBBS. Same is true for advanced eye anatomy.

One can have basic MBBS course in every district in the country. For postgraduation they may have to enter a medical college.

In the US also, some universities have shortened medical school programs from four years to three.

Three-year programs generally are offered as an incentive for students to pick primary care, in order to prevent shortages of primary care doctors. Rather than having to spend two years taking basic courses and two years of doing clinical work in different specialties to determine their preferred fields, students in accelerated programs finish in three years because they spend only one year doing clinical work as they already have chosen primary care.

In nursing also, we have two courses: Basic Nursing and BSc Nursing. A similar experimentation can be done in MBBS.

Premarital sex is marriage

If any unmarried couple of the right legal age “indulges in sexual gratification,” this will be considered a valid marriage. They could be termed “husband and wife,” as per a Madras High ruling.

As per the court if a bachelor has completed 21 years of age and an unmarried woman 18 years, they have acquired the freedom of choice guaranteed by the Constitution.

As per the court “Consequently, if any couple choose to consummate their sexual cravings, then that act becomes a total commitment with adherence to all consequences that may follow, except on certain exceptional considerations.”

As per the judgment marriage formalities such as the tying of a mangalsutra, the exchange of garlands and rings or the registering of a marriage are only to comply with religious customs for the satisfaction of society.

As per the order either party to a relationship could approach a Family Court for a declaration of marital status by supplying documentary proof for a sexual relationship.

As per the order if after having a sexual relationship, the couple decided to separate due to difference of opinion, the ‘husband’ could not marry without getting a decree of divorce from the ‘wife’.

The judge was of the opinion that a valid marriage did not necessarily mean that all the customary rights pertaining to the married couple are to be followed and subsequently solemnized.

Comments: A documentary proof is necessary to prove that you have a sexual relationship between two partners. Like a DNA test of the child, a consent by the partner while undergoing an abortion etc. 

When will the Dr. B.C. Roy National Awards recommence?

The present Government and the Health Ministry along with the Board of Governors, Medical Council of India has been sitting on the Dr. B.C. Roy National Award file for the last 5 years.  

The last awards were given on 1st July, 2008 by the then President Smt. Pratibha Singh Patil.  

For the medical fraternity, Dr. B.C. Roy National Awards are the highest award, which a doctor can aspire for.  Each year, 15 to 20 awards were distributed. But, for reasons unknown to the medical fraternity, the Government and MCI are sitting on the file.  I have personally filed an RTI application in both MCI and Health Ministry but with no response.

It appears that the present Government is not medical fraternity friendly.  

• No further Dr. B.C. Roy National Awards have been given since 2008.  
• The Government is thinking of allowing AYUSH doctors to register under Allopathic Medical Register.
• The Clinical Establishment (Registration and Regulation) Act 2010 was passed by the Parliament without taking the medical fraternity into confidence.
• There is a proposal to introduce half-baked medical courses in competition to Allopathic MBBS without any basis.
• The Government is not making medical doctors at par with Civil Services by bringing in the concept of Indian Medical Services along the lines of IAS, IRS.
• The Government dissolved the Medical Council of India on the plea that there was a rampant corruption in the Council. If this is so, then why were the Coal and IT Ministries not dissolved and brought under the Administrative Control?