Dr K K Aggarwal

Safety of on–duty doctors

Jail inmates beat doctor to death in Gopalganj: A doctor, Bhudev Singh, died in Patna Medical College, hours after he was beaten up by some inmates of a district jail in Gopalganj district of Bihar on Sunday.

The crashed air ambulance carrying the patient violated air norms: The air ambulance that crashed in Faridabad killing 10 people including two medical residents and one male nurse last Wednesday seriously violated the government’s air safety rules and regulations that ban medical evacuation in single–engine aircraft. The aircraft was carrying a patient from Patna who had slipped into coma. “Operations with single–engine aeroplanes shall be conducted only on domestic sectors except for medical evacuation flights,” the relevant clause of the CAR clearly says. Single–engine aircraft cannot handle sudden emergencies.

These two headlines in the newspaper open up a new debate regarding the safety of practicing doctors. Both incidents occurred while on duty. It’s time for the medical associations in India to fight for the safety of the on–duty doctors.

Treating doctors are uninformed and give consent to travel in whatever arrangements are made for them. They are made to travel in ill–equipped ambulances, ill–fitted aircrafts, and in vehicles who rush their travel violating all traffic rules. The travel is often unsafe from all standards. We must raise our voice and fight for our rights.

I met one of the journalists who told me the sequence of events. One of the jail inmates, who happens to be a politician in Bihar, wanted a doctor to sign a false certificate declaring that the jail inmate was sick and was unfit to be transferred to another jail. When the doctor denied on merit that he would not give a false certificate, he was beaten up by the politician and his accomplices and the doctor ultimately died.

Is it what the doctors have to pay today for being truthful? I think a nationwide protest should be held and such politicians should be punished.

I reproduce below an email that I received today from a colleague, regarding this incident. “Dear Dr Aggarwal, I was shocked to hear the morning new on TV today – “Doctor who was sent to examine the inmates in Bihar jail was beaten to death by inmates.” The reason – he refused to issue a false medical certificate. I am sure lots of hue and cry will be raised by the media, public and also the medical associations. No one will reach the bottom of such incidents. The basic reason behind all these incidents is dereliction of duty by someone who is in–charge.

• Will the Jail Superintendent accept the responsibility for not providing security to the doctors?
• Will someone tell me if an armed constable was posted to regulate the entry of patients (inmates) in the dispensary?
• Will the CMO and Director of Health explain and accept the responsibility for sending the doctor to such place which was a high security risk without verifying the facilities and security for him?

This is pure apathy of the administration and it is this culture that is responsible for all the incidents of manhandling of doctors everywhere. All the above individuals need to explain and those who are responsible should be dismissed from service and cases filed against them for dereliction of duty. Dr RS Bajaj, Consultant Pediatrician, Rohini.”

NIH stops clinical trial on combination cholesterol treatment

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped a clinical trial studying a blood lipid treatment 18 months earlier than planned. The trial found that adding high dose, extended–release niacin to statin treatment in people with heart and vascular disease, did not reduce the risk of cardiovascular events, including heart attacks and stroke.

Participants were selected for AIM–HIGH because they were at risk for cardiovascular events despite well–controlled low–density lipoprotein (LDL or bad cholesterol). Their increased risk was due to a history of cardiovascular disease and a combination of low high–density lipoprotein (HDL or good cholesterol) and high triglycerides, another form of fat in the blood. Low HDL and elevated triglycerides are associated with an increased risk of cardiovascular events. While lowering LDL decreases the risk of cardiovascular events, it has not been shown that raising HDL similarly reduces the risk of cardiovascular events. During the study’s 32 months of follow–up, participants who took high dose, extended–release niacin and statin treatment had increased HDL cholesterol and lowered triglyceride levels compared to participants who took a statin alone. However, the combination treatment did not reduce fatal or non–fatal heart attacks, strokes, hospitalizations for acute coronary syndrome, or revascularization procedures to improve blood flow in the arteries of the heart and brain.

The AIM–HIGH trial, which stands for Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health, enrolled 3,414 participants in the United States and Canada with a history of cardiovascular disease who were taking a statin drug to keep their LDL cholesterol low. Study participants also had low HDL cholesterol and high triglycerides, which meant that they were at significant risk of experiencing future cardiovascular events. Niacin, also known as Vitamin B3, has long been known to raise HDL and lower triglycerides. Eligible participants were randomly assigned to either high dose, extended–release niacin (Niaspan) in gradually increasing doses up to 2,000 mg per day (1,718 people) or a placebo treatment (1,696 people). All participants were prescribed simvastatin (Zocor), and 515 participants were given a second LDL cholesterol–lowering drug, ezetimibe (Zetia), in order to maintain LDL cholesterol levels at the target range between 40–80 mg/dL.
Researchers began recruiting participants in early 2006. The study was scheduled to finish in 2012. The average age of the participants was 64 years. Pre-existing medical conditions included coronary artery disease (92 percent); metabolic syndrome, which is a cluster of risk factors for heart disease (81 percent); high blood pressure (71 percent); and diabetes (34 percent). More than half of participants reported having a heart attack prior to entering the study.

The rationale for the AIM–HIGH study was based in part on a large number of observational studies that consistently showed that low HDL cholesterol increases the risk of cardiovascular events in men and women, independent of high LDL cholesterol. In addition, previous small clinical studies showed that relatively high residual cardiovascular risk exists among patients with cardiovascular disease, low HDL cholesterol, and high triglycerides despite intensive management of LDL cholesterol.

Making the Kailash–Mansarovar Yatra safe Preventing mountain sickness

1. An altitude over 3,000 meters (9,843 feet) is usually defined as high altitude.
2. Acute mountain sickness (AMS) depends on the elevation, the rate of ascent and individual susceptibility.
3. Most visitors suffer from some symptoms that will generally disappear through acclimatization in several hours to several days.
4. Symptoms are worse at night and include headache, dizziness, lethargy, loss of appetite, nausea, breathlessness and irritability. Difficulty sleeping is another common symptom, and many travelers have trouble sleeping for the first few days.
5. AMS can be very serious, with the most serious symptoms being High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE), which can be fatal. Symptoms of HAPE include weakness, shortness of breath, even at rest, impending suffocation at night, and a persistent productive cough with white, watery, or frothy fluid. Symptoms of HPCE may include headache, ataxia, weakness, hallucinations, psychotic behavior, coma and loss of memory. Both approach and strike at night and can be fatal! Immediate descent is the surest treatment.
6. A gradual ascent allows the body to acclimatize to higher altitudes and the decreased oxygen supply.
7. The formula is to give a night halt between 7000 to 10,000 feet; night halt for every 1500 feet climb and full day halt for every 3000 feet climb thereafter.
8. Medication also helps to prevent AMS.
9. One should avoid exercise in the first few days. Attempt to do only half of your activities on the first day while your body is working to acclimatize to higher altitude oxygen conditions.
10. No alcohol in the first few days.
11. No smoking.
12. Drink enough water each day so that your urine runs clear.
13. Make sure you get enough calories. Low cal diets at high altitudes can sabotage health. A well nourished body can adjust to changes better than an undernourished one can. One should take high carb diet.
14. One should avoid taking tranquilizers and sleeping pills. These will depress the respiratory drive and limit oxygen intake.
15. Prophylactic drugs are acetazolamide, nifedipine etc.