One cannot be allowed to self-learn on patients:Dr K K Aggarwal

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Doctors must be morally, ethically, and legally correct

New Delhi, 28th February 2018: Informed consent is an integral and crucial part of medical treatment today. It is not only a procedural requirement, but also a legal requirement. Not taking consent is gross negligence. Consent must be taken before starting a treatment or a procedure.

The patient must be well informed, consent needs to be in micro detail, cost needs to be explained and your competence to manage complications needs to be addressed. There is no learning curve in today’s era. Every learning must be under supervision. One cannot be allowed to self-learn on patients.

Addressing the faculty of King George Medical University, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Doctors must not just be scientifically correct but also be morally, ethically, and legally correct. The Montgomery and Bawa Gaba case in the UK have revolutionized the way medical practice needs to continue in India. Patients are educated and need to know all aspects of their treatment including the possibilities of complications and their repercussions. Patients and/or their legal heir need to be informed at every level. We are the custodians of their faith and the same should not be put on trial.”

The lecture was organized by the surgical faculty and was attended and co-addressed by Dr Vinita Das, Acting Vice Chancellor and Dr Abhinav Sonkar, Head of the department of surgery.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Difference of opinion and errors of judgments are not negligence. If two experts differ, it becomes a case of difference of opinion. Experts therefore should stop giving their decisive expert opinion on a case. My mantra is: Whatever you think and do, you document; and whatever you document you preserve as per legal requirement.”

The patient should be informed of every possible complication that may occur during this treatment, however rare they might be; even a complication rate as low as 0.1% might be 100% for that particular patient. No surgery can be called as a ‘minor’ surgery.

It is the inability to manage complications that leads to violence. As doctors we SERVE our patients and the community and provide

•                    Service which we have professionally trained for, which is

•                    Excellent i.e. anticipated

•                    Responsible, give our 100% to the patients and take responsibility

•                    Value – Group; each member of the group knows the duties of another, so no gap in service may result

•                    Enthusiasm: A positive happy atmosphere

Can accidental drowning occur medically?

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Dr KK Aggarwal

Recipient of Padma Shri

Actor Sridevi died of accidental drowning in her hotel bath tub after losing consciousness, according to the forensic report by the Dubai govt. on Monday. However, the report, which carries the stamp of the “Ministry of Health UAE” and the director of preventive medicine, Dubai, Dr Sami Wadie, does not state the cause of unconsciousness.

Can accidental drowning occur medically? Yes. Medical conditions can cause accidental drowning. Seizure disorders, which can be first-onset episode, can cause accidental drowning. Alcohol and/or use of illicit drugs increases risk of accidental drowning as it may affect balance, coordination and judgment. Stroke, syncopal attack (heart attack) or undetected primary cardiac arrhythmia are other factors that can cause accidental drowning. A gasping patient with ventricular arrhythmia will end up with drowning.

If there are no signs of struggle, then ‘accidental drowning’ can be a medical opinion. It is up to the police to accept this opinion or find it as a case of ‘homicidal drowning’ and investigate any foul play.

Some salient facts on accidental drowning

Drowning is the third most common cause of accidental death. A victim of drowning can be revived by cardiopulmonary resuscitation (CPR) with rescue breathing. Prolonged resuscitation, up to many hours, has been known to revive patients with hypothermia and cardiac arrest.

Antemortem drowning can be identified by the presence of fine, white, leathery, copious froth or foam tinged with blood at the mouth and nostrils (Froth is of lasting nature and large in quantity), cadaveric spasms in hands, diatoms in tissues from brain, liver and bone marrow of long bones, presence of water in stomach and intestines, voluminous water logged lungs along with fine froth in lungs and air passages.

A bathtub drowning is a major cause of death in a bathtub. The bathtub is the most common site of seizure-induced drowning; hence, patients with epilepsy should be advised to take showers instead of baths. Heart attack leading to syncope and subsequent falling in the tub can cause drowning. Besides the causes discussed above, mutations in the cardiac ryanodine receptor (RyR)-2 gene, which is associated with familial polymorphic VT in the absence of structural heart disease or QT prolongation, have been identified in some individuals with unexplained drowning. Concomitant trauma, paralysis, heart attack or hypothermia, which can lead to rapid exhaustion or cardiac arrhythmias are other factors for accidental drowning. Duration of submersion >5 minutes is the most critical factor.

Several studies have reported incidents of bath tub drowning with varying medical histories as follows:

  • A total of 268 victims were found unconscious or dead during tub bathing. After postmortem examination, the manner of death was judged as natural cause in 191 (71.2%) and accidental drowning in 63 (23.5%) cases. Drowning water inhalation, which was confirmed in 72% of victims, was absent in the others. Whereas, inhalational findings were more frequent in victims with other backgrounds such as alcohol intake, mobility disturbance, and history of epilepsy (Am J Forensic Med Pathol. 2013 Jun;34(2):164-8).
  • In a series of 14 cases of suicide by drowning in the bath in the Bristol area, England between 1974 and 1996, six cases had evidence of concomitant alcohol or substance use. Seven cases had a past psychiatric history and a history of previous deliberate self-harm. Most drowned at home, face down, fully clothed (Med Sci Law. 1999 Oct;39(4):349-53).
  • A retrospective review of 92 deaths in the bathtub in Maryland found 71.7% incidence of bathtub drowning; 28.3% were the absence of bathtub drowning. Three leading contributory causes of death were cardiovascular disease, drug/alcohol-related death, and seizure disorder in both groups More than triple overlapped drowning-related signs (history of recovery from the water, foam in the air way, watery fluid in the sphenoid sinuses, hyperinflated lungs and watery fluid in the stomach contents) could be beneficial for the diagnosis of a bathtub drowning. (Forensic Sci Int. 2015 Aug;253:64-70).
  • In a retrospective analysis of 245 bathtub death cases between 1971 and 1988 carried out in the Institute of Legal Medicine in Hamburg, 66 cases proved to be natural deaths, 76 were classified as suicides, 39 as accidents and 13 as homicides, while 51 fatalities remained unclear with respect to one of these groups. About 50% of the victims were alcoholized.  (Arch Kriminol. 1991 Jul-Aug;188(1-2):35-46).

Dr KK Aggarwal

Padma Shri AwardeeVice President CMAAOGroup Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Cleft lip/palate can be corrected with minimal scarring

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Cleft lip/palate can be corrected with minimal scarring

It is one of the most common birth defects

New Delhi, 27 February 2018: India has more than 72,000 children and adults with unrepaired cleft lip or cleft palate, as per a study. This number significantly highlights the unmet need for cleft lip and/or palate (CL/P) care in India. Apart from this, infants in low and middle-income countries face significant barriers to treatment, leading to prolonged disfigurement, social stigma, speech impairment as well as trouble of feeding food that can result in malnutrition and death.

Cleft lip and palate are openings or splits in the upper lip, the roof of the mouth (palate) or both. These occur when facial structures that are developing in an unborn baby don’t close completely.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Cleft lip palate are among the most common birth defects. Although they occur as isolated birth defects mostly, they are also associated with many inherited genetic conditions or syndromes. However, these conditions can be corrected. In most babies, a series of surgeries can restore normal function and achieve a more normal appearance with minimal scarring.Normally, the tissues that make up the lip and palate fuse together in the second and third months of pregnancy. In babies with this condition, the fusion never takes place or occurs only part way, leaving an opening (cleft).”

Some signs and symptoms of submucous cleft palate may include difficulty with feeding; difficulty swallowing, with potential for liquids or foods to come out the nose; nasal speaking voice; and chronic ear infections.

Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “Cleft lip may be detected with ultrasound beginning around the 13th week of pregnancy. The goals of treatment for cleft lip and cleft palate are to improve the child’s ability to eat, speak and hear normally and to achieve a normal facial appearance.”

While many cases of cleft lip and cleft palate can’t be prevented, the following tips can lower the risk.

  • If you have a family history of cleft lip and cleft palate, tell your doctor before you decide to conceive. He/she may refer you to a genetic counselor who can help determine your risk of having children with cleft lip and cleft palate.
  • Take prenatal vitamins. If you’re planning to get pregnant soon, ask your doctor if you should take prenatal vitamins.
  • Don’t use tobacco or alcohol. Use of alcohol or tobacco during pregnancy increases the risk of having a baby with a birth defect.

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