Abdominal fat can impact brain health and cognition in high Alzheimer’s risk individuals

The impact of abdominal fat on brain health and cognition is generally more pronounced in middle-aged men at high risk of Alzheimer’s disease as opposed to women, according to researchers at Rutgers Health.

In middle-aged individuals with a family history of Alzheimer’s disease, the amount of fat in their abdominal organs (pancreas, liver, and belly fat) is related to their brain volumes and cognitive function, according to the study published in the journal Obesity. The study was written by Sapir Golan Shekhtman, a Ph.D. student at the Joseph Sagol Neuroscience Center at the Sheba Medical Center in Israel and led by Michal Schnaider Beeri, director of the Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center at Rutgers Brain Health Institute.

The research, conducted on 204 healthy middle-aged Alzheimer’s-dementia offspring, investigated fat depots in the pancreas, liver and abdomen measured with MRI.

“In middle-aged males at high Alzheimer’s disease risk-but not females-higher pancreatic fat was associated with lower cognition and brain volumes, suggesting a potential sex-specific link between distinct abdominal fat with brain health,” said Beeri, who is the Krieger Klein Endowed Chair in Neurodegeneration Research at BHI and a faculty member of the Rutgers Institute for Health, Health Care Policy and Aging Research.

Obesity is a risk factor for lower cognitive functioning and higher dementia risk, with different associations between sexes.

The research findings highlight the importance of investigating the interrelationships of fat depots, brain aging and cognition in the context of sex differences.

Additionally, the study challenges the conventional use of body mass index (BMI) as the primary measure for assessing obesity-related cognitive risks. The researchers said BMI poorly represents body fat distribution and does not necessarily account for sex differences.

“Our findings indicate stronger correlations compared to the relationships between BMI and cognition, suggesting that abdominal fat depots, rather than BMI, is a risk factor for lower cognitive functioning and higher dementia risk,” said Shekhtman.

These research findings open new avenues for targeted interventions and further exploration of sex-specific approaches in understanding and mitigating the impact of abdominal fat on brain health, Shekhtman noted.

Reference:

Golan Shekhtman S, Boccara E, Ravona-Springer R, Inbar Y, Zelicha H, Livny A, Bendlin BB, Lesman-Segev O, Yore I, Heymann A, Sano M, Mardor Y, Azuri J, Schnaider Beeri M. Abdominal fat depots are related to lower cognitive functioning and brain volumes in middle-aged males at high Alzheimer’s risk. Obesity (Silver Spring). 2024 Feb 27. doi: 10.1002/oby.24004.

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Sarcoidosis tied to greater risk of developing venous thromboembolism: Study

Chronic inflammation has been increasingly identified as a potential risk factor for VTE. While research on this topic is ongoing, it is essential to note that limited data is available on the risk of VTE in patients with sarcoidosis. This condition affects the immune system and causes granuloma formation.

According to a study published in Chest, sarcoidosis is associated with a higher long-term risk of VTE (pulmonary embolism or DVT, and each of these individually).
Using Danish nationwide registries, patients aged 18 or older with a recent diagnosis of sarcoidosis (having attended two or more inpatient/outpatient visits between 1996 and 2020) and without a prior history of VTE were matched based on age, gender, and comorbidities. The primary goal of this study was to determine the incidence of VTE.
Key findings from the study are:
• 14,742 patients with sarcoidosis and 58,968 matched individuals of median age, 44.7 years were included.
• The median follow-up duration was 8.8 years.
• Absolute 10-year risks of outcomes for patients with sarcoidosis vs the background population for VTE, pulmonary embolism and DVT was 2.9% vs 1.6%, 1.5% vs 0.7% and 1.6% vs 1.0%, respectively.
• In multivariable Cox regression, sarcoidosis increased the rate of all outcomes in the first year after diagnosis (VTE: hazard ratio [HR], 4.94;) and after the first year (VTE: HR, 1.65) compared with the background population.
• These associations persisted when excluding patients with a history of cancer and censoring patients with incident cancer during follow-up.
• Three-month mortality was not significantly different between patients with VTE with and without sarcoidosis, with adjusted HR of 0.84
In this nationwide cohort study, it was observed that individuals with sarcoidosis had a significantly higher risk of developing venous thromboembolism (VTE) in the long run compared to a control group matched for relevant factors.
Reference:
Yafasova, A., Fosbøl, E. L., Gustafsson, F., Krintel, S. B., Kristensen, S. L., Schou, M., Petersen, J. H., Sun, G., Rossing, K., Doi, S. N., Køber, L., & Butt, J. H. (2024). Long-term risk of venous thromboembolism in sarcoidosis: a nationwide cohort study. Chest. https://doi.org/10.1016/j.chest.2024.01.042

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Telehealth as safe as visit to clinic for abortion pills, finds study

Researchers have found in a new study that Telehealth medication abortion is effective, safe and comparable to published rates of in-person medication abortion care. The large national study finds that video visits, texting and mailing pills are all effective, as the U.S. Supreme Court considers limiting access to telemedicine abortion.

Medication abortion can be delivered safely and effectively through telemedicine, according to new research from UC San Francisco that comes as the U.S. Supreme Court is about to hear a case that could severely restrict access to one of the two pills that are used to induce abortions.

Researchers analyzed data from more than 6,000 patients who obtained abortion pills from virtual clinics in 20 states and Washington D.C. between April of 2021 and January of 2022. They found there were no serious adverse events 99.8% of the time, and that abortions did not require follow-up care 98% of the time. This is similar to what has been found for patients who receive medication abortion at clinics or doctor’s offices.

The findings appear Feb. 15, 2024, in Nature Medicine.

Medication abortion, which now accounts for more than half of all abortions, involves taking two pills – mifepristone followed by misoprostol – and extensive research supports its safety and efficacy. Demand for the pills has increased since more than two dozen states banned or restricted abortion following the June 2022 decision by the Supreme Court to overturn Roe v. Wade, which guaranteed a constitutional right to abortion.

On March 26, the Supreme Court is scheduled to hear arguments over whether the U.S. Food and Drug Administration (FDA), which approved mifepristone in 2000, should roll back rules that in recent years have made the medication more widely available. In 2021, the agency removed the in-person dispensing requirement, allowing health care providers to have abortion pills sent through the mail after an online consultation. Telehealth abortion now accounts for nearly 10% of all U.S. abortions.

“This research confirms that the FDA followed science in allowing patients to get medication abortion through telehealth and the mail,” said the study’s first author, Ushma Upadhyay, PhD, MPH, a public health scientist with Advancing New Standards in Reproductive Health (ANSIRH) at UCSF.  “Our findings make it abundantly clear that the case at the Supreme Court is simply an attempt to restrict access to abortion care, even in those states where it’s legal.”

Telemedicine promotes privacy and access

The researchers also compared video visits to secure text messaging, and found they were about equally safe and effective. The authors concluded that telehealth protects patient privacy while making abortion more accessible. This has become increasingly important as abortion clinics have closed in states that restricted abortion and wait times have increased elsewhere.

“Since the COVID-19 pandemic, telemedicine has become the new frontier in health care, including for medication abortion,” said Upadhyay, who is a professor of Obstetrics, Gynecology & Reproductive Sciences at UCSF. “A ruling against this method and the FDA’s rigorous science review process would be a huge blow to the American public and make this essential health service harder to get.”

The study has already been cited in the amicus brief submitted to the Supreme Court supported by more than 300 leading reproductive health researchers. 

Reference:

Upadhyay, U.D., Koenig, L.R., Meckstroth, K. et al. Effectiveness and safety of telehealth medication abortion in the USA. Nat Med (2024). https://doi.org/10.1038/s41591-024-02834-w

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Increased consumption of plant-based food and limiting meat may improve heart health, finds study

Plant-based diets are becoming popular in Germany and Western countries because of sustainable lifestyles, animal welfare, and health concerns. A flexitarian diet, which emphasizes plant-based foods while allowing for small amounts of meat and processed meat products, attracts followers who primarily cite health benefits as their motivation.

According to a BMC Nutrition study, a flexitarian diet is associated with lower cardiovascular risk than an omnivorous diet.

More data on CVD risk factors’ relationship with flexitarian diets must be collected. This study included 94 healthy participants aged 25-45 years, who were divided into three groups: long-term flexitarians (FXs), vegans (Vs), and omnivores (OMNs). Metabolic biomarkers, body composition, blood pressure, arterial stiffness ( measured by pulse wave velocity, PWV) and metabolic syndrome (MetS) severity were measured. Dietary intake, diet quality, and physical activity levels were also assessed.

Key findings from the study are:

· Compared to omnivores, Flexitarians and vegans had more beneficial insulin levels, triglycerides, total cholesterol, and LDL cholesterol.

· Flexitarians had the most favourable MetS-score results based on BMI and waistline and better PWV values compared to vegans and omnivores.

· FXs and Vs had higher intake rates of vegetables, fruit, nuts/seeds and plant-based milk alternatives.

Diet impacts CVD risk. Meat and processed meat intake correlate with an unfavourable risk profile.

Study limitations include cross-sectional design, small sample size, and potential recall bias.

Study strengths include well-controlled design, homogeneity, and additional CVD risk indicators such as MetS scores and PWV.

This study highlights that plant-based diets improve blood lipid profiles and have higher diet quality. The results of this study demonstrate the beneficial impact of a flexitarian diet on CVD risk parameters.

Reference:

Bruns, A., Greupner, T., Nebl, J. et al. Plant-based diets and cardiovascular risk factors: a comparison of flexitarians, vegans and omnivores in a cross-sectional study. BMC Nutr 10, 29 (2024). https://doi.org/10.1186/s40795-024-00839-9

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Study identifies blood biomarkers to predict risk of CVD in patients with rheumatoid arthritis

Rheumatoid arthritis impacts approximately 2 million people in the United States and is associated with increased risk of cardiovascular disease. However, assessing cardiovascular risk is difficult in patients with rheumatoid arthritis because standard clinical assessments based on factors like age, cholesterol, and smoking status tend to underestimate cardiovascular risk in individuals with rheumatoid arthritis.

In a new study published in the Journal of the American Heart Association, a research team led by physicians at Mass General Brigham with expertise in rheumatology and cardiovascular disease identified six blood biomarkers that are associated with cardiovascular risk in patients with rheumatoid arthritis and whose measurements improved the researchers’ ability to predict a future increase in arterial inflammation. The biomarkers hold the potential to clinically assess an individual patient’s risk of cardiovascular disease, but more research is needed to determine whether they are associated with cardiovascular events such as heart attack or stroke.

“We think these biomarkers might improve our ability to predict risk and intervene early to help our patients,” said first author Daniel H. Solomon, MD, MPH, chief of the Section of Clinical Sciences in the Division of Rheumatology and Matthew H. Liang Distinguished Chair at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “The idea is that if we measure biomarkers that are specific to rheumatoid arthritis, we might be able to better identify those at highest risk of cardiovascular events.”

To identify rheumatoid arthritis-specific biomarkers of cardiovascular risk, the researchers assembled a panel of 24 candidate biomarkers that had been previously shown to be associated with rheumatoid arthritis and systemic inflammation. Then, they measured the concentration of these biomarkers in 109 patients with rheumatoid arthritis who were taking part in a randomized clinical trial (the TARGET Trial) to compare the efficacy of two different treatments for rheumatoid arthritis at preventing cardiovascular disease. The researchers measured the biomarkers at the beginning of the study and six months later, imaging the patients’ arteries at each time to assess their arterial inflammation—an indicator of cardiovascular risk.

“Arterial inflammation can predict future cardiovascular disease risk,” said cardiologist and co-author Ahmed Tawakol, MD, the director of Nuclear Cardiology and co-director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. “If you take a snapshot of a person’s blood vessels, the more inflammation that is measured there, the greater the likelihood the person will have progression of their disease, and the greater likelihood that they will have a stroke or a myocardial infarction.”

Six of the 24 biomarkers were associated with increased cardiovascular risk and using them in predictive models improved the researchers’ ability to predict increases in arterial inflammation compared to standard clinical indices such as the Framingham Risk Score, which is based on factors such as age, sex, cholesterol, blood pressure, diabetes, and smoking.

“This is an important step towards using blood samples to measure changes in cardiovascular risk with the treatment of rheumatoid arthritis,” said Solomon.

The study showcases the strength of ongoing collaborations between Brigham and Women’s Hospital and Massachusetts General Hospital, said Solomon and Tawakol, who trained together as residents at the Brigham around 30 years ago. “Having two really great institutions collaborating in the same organization meant we could leverage the strengths of the respective institutions and teams,” said Solomon.

Now, the team is working to test these biomarkers in a larger and more long-term cohort of rheumatoid arthritis patients, the Brigham and Women’s Rheumatoid Arthritis Sequential Study (BRASS), which has been following over 1,000 patients with rheumatoid arthritis since 2003. This follow-up study will allow the researchers to not only test associations between the biomarkers and arterial inflammation, but also assess whether the biomarkers can predict future cardiovascular events such as heart attack or stroke.

Reference:

Daniel H. Solomon, Olga Demler, Pamela M. Rist, Leah Santacroce, Ahmed Tawakol, Jon T. Giles, Katherine P. Liao and Joan M. Bathon, Biomarkers of Cardiovascular Risk in Patients With Rheumatoid Arthritis: Results From the TARGET Trial, Journal of the American Heart Association, https://doi.org/10.1161/JAHA.123.032095.

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Elevated Lp(a) independently associated with long-term MACE among individuals with and without baseline ASCVD: JACC

A recent study unveiled a crucial link between Lipoprotein(a) [Lp(a)] levels and the risk of atherosclerotic cardiovascular disease (ASCVD). The findings were published in the Journal of the American College of Cardiology and explored the intricate relationship between Lp(a) and major adverse cardiovascular events (MACE).

The study was conducted across two medical centers in Boston, Massachusetts, analyzed data from over 16,000 individuals that spanned nearly two decades to determine the association between Lp(a) levels and the incidence of MACE among patients with and without pre-existing ASCVD. This research utilizing Cox proportional hazards modeling and categorized participants into Lp(a) percentile groups and evaluated their risk of MACE, including nonfatal myocardial infarction (MI), nonfatal stroke, coronary revascularization or cardiovascular mortality.

The results from the analysis found that out of the 62% of patients with baseline ASCVD, the individuals in the 71st to 90th percentile Lp(a) group expressed a notable 21% increased hazard of MACE, close to those in the 91st to 100th percentile group. Also, among the remaining participants without established ASCVD, there was a progressive increase in MACE risk with rising Lp(a) levels, with the individuals in the highest percentile group facing a sharp 93% relative risk increase. These findings challenge conventional risk assessment paradigms suggests that the optimal Lp(a) threshold for gauging cardiovascular risk may differ based on the individuals in the primary or secondary prevention cohorts. 

Reference:

Berman, A. N., Biery, D. W., Besser, S. A., Singh, A., Shiyovich, A., Weber, B. N., Huck, D. M., Divakaran, S., Hainer, J., Kaur, G., Blaha, M. J., Cannon, C. P., Plutzky, J., Januzzi, J. L., Booth, J. N., III, López, J. A. G., Kent, S. T., Nasir, K., Di Carli, M. F., … Blankstein, R. (2024). Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease. In Journal of the American College of Cardiology (Vol. 83, Issue 9, pp. 873–886). Elsevier BV. https://doi.org/10.1016/j.jacc.2023.12.031

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Both GA and conscious sedation reasonable anaesthetic approaches for patients undergoing endovascular thrombectomy

Endovascular thrombectomy (EVT) is established as the standard treatment for managing patients with acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). However, the ideal anesthetic approach during EVT remains undetermined.

A study published in the International Journal of Stroke concluded that the choice of anesthetic modality for AIS patients undergoing EVT did not seem to impact their 3-month neurological outcomes. However, regarding successful reperfusion rates, GA was superior to CS. Additionally, patients in the GA group were at a higher risk for developing hypotension and pneumonia. More research is needed to provide additional evidence. 
This systematic review and meta-analysis determined the optimal anesthetic modality for AIS patients undergoing EVT by examining current randomized controlled trials (RCTs).
Researchers evaluated databases Medline (via PubMed), EMBASE, Web of Science, and the Cochrane Library for RCTs comparing general anesthesia (GA) and conscious sedation (CS) in AIS patients undergoing EVT. The primary outcome was a favourable functional outcome at 90 days post-intervention. Review Manager software (RevMan V.5.3) was used for data analysis.
Key findings from the study are:
• Eight RCTs with 1199 patients were included.
• There was no significant difference between these two groups in the rate of functional independence with a risk ratio of 1.10
• Compared with the CS group, the GA group attained a higher successful recanalization rate with an RR of 1.14
• Patients in the GA had higher rates of hypotension and pneumonia incidence with RR of 1.87 and 1.38, respectively.
They said, ‘This systematic review and meta-analysis examined the clinical outcomes of conscious sedation versus general anesthesia during endovascular thrombectomy. Pooling data from eight randomized clinical trials, most of which were single-centre and European studies, the study found no significant difference in 3-month functional outcomes between the two groups. However, the general anaesthesia group had a higher rate of successful reperfusion but also higher rates of periprocedural hypertension and pneumonia. The meta-analysis suggests that both conscious sedation and general anesthesia are reasonable options for patients undergoing endovascular thrombectomy. Centre experience and patient characteristics are also important factors in decision-making.’
Reference:
Jia Y, Feng Y, Ma Y, et al. Type of anaesthesia for endovascular therapy in acute ischemic stroke: A literature review and meta-analysis. International Journal of Stroke. 2024;0(0).
doi:10.1177/17474930241228956

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Does intraoperative wound irrigation prevent surgical site infection after laparotomy? Study sheds light

Germany: A randomized clinical trial suggests that intraoperative wound irrigation with polyhexanide solution should not be recommended as standard clinical practice in open clean-contaminated surgical procedures in patients undergoing laparotomy.

In the study published in JAMA Surgery, the researchers did not find a significant difference in the rates of surgical site infection (SSI) between intraoperative wound irrigation with polyhexanide compared to saline or no irrigation in 689 patients undergoing laparotomy.

Postoperative SSI is the most common type of hospital-acquired infection across all income and development settings following gastrointestinal surgery. Surgical site infections increase costs, mortality and morbidity rates and prolong hospital stay. Intraoperative wound irrigation is used worldwide as a preventive measure, although evidence supporting this practice is lacking.

To fill this knowledge gap, Tara Catharina Mueller, Technical University of Munich, Munich, Germany, and colleagues aimed to investigate whether intraoperative wound irrigation with polyhexanide is effective in reducing surgical site infection within 30 days after open gastrointestinal surgery compared to saline or no irrigation.

For this purpose, they performed IOWISI, a multicenter, 3-armed, randomized clinical trial in 12 university and general hospitals in Germany from 2017 to 2021 with 30-day follow-up. Patients and outcome assessors were blinded to the intervention.

Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were the inability to provide consent and a clean laparoscopic procedure. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis.

Patients were allocated in a 3:3:1 ratio to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure.

Among the 689 patients included, 402 were male and 287 were female. The median age was 65.9 years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102).

The study’s primary endpoint was surgical site infection within 30 postoperative days, according to the definition of the US Centers for Disease Control and Prevention.

The study led to the following findings:

  • The procedures were classified as clean-contaminated in 8% of the cases.
  • The surgical site infection incidence was 11.8% overall, 10.6% in the polyhexanide arm, 12.5% in the saline arm, and 12.8% in the no irrigation arm.
  • Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23 versus HR, 1.19).
  • The incidence of serious adverse events did not differ among the 3 groups.

“Based on the present results, intraoperative wound irrigation with polyhexanide cannot be recommended as standard clinical practice in open clean-contaminated (level of contamination II) visceral surgical procedures,” the researchers wrote.

“More clinical trials are warranted to assess the potential benefit of polyhexanide intraoperative wound irrigation in colorectal, contaminated (level of contamination III) and septic (level of contamination IV) procedures,” they concluded.

Reference:

Mueller TC, Kehl V, Dimpel R, et al. Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net. JAMA Surg. Published online February 21, 2024. doi:10.1001/jamasurg.2023.7985

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Alleged delay in treatment lead to paralysis, seizures: Consumer Court absolves Max Hospital, Cardio-Diabetologist of medical negligence

New Delhi: The Delhi State Consumer Disputes Redressal Commission has absolved Max Super Speciality Hospital, a Senior Consultant Physician & Cardio-Diabetologist and others in a case alleging medical negligence over the delay in admitting a patient and not providing timely medical treatment resulting in paralysis on the left side of his body and ongoing seizures.

The commission, led by Justice Sangita Dhingra Sehgal delivered the decision on 12th January 2024 noting that the complainant failed to establish negligence or deficiency in service on the part of Max Super Speciality Hospital and no lackadaisical approach of the treating doctors were found.

The case, initiated on October 3, 2017, concerned Colonel Gulati who alleged deficiency in service and medical negligence by Max Super Speciality Hospital and its doctor. Gulati, a retired officer from the Indian Army, visited Max Super Specialty Hospital, Shalimar Bagh, complaining of disorientation and loss of control in his left hand. The hospital conducted a CT scan, revealing bleeding inside the brain and changes in brain tissue density. Further investigations, including MRI and Venography, were recommended.

He underwent a CT scan that revealed a critical condition requiring immediate attention and admission for treatment/surgery. However, despite repeated requests from the patient’s family, the hospital staff allegedly took no action, leading to a seizure in the reception area. The complainant became unconscious in a wheelchair outside the Emergency Room. After a four-hour delay, the hospital eventually admitted him, resulting in paralysis on the left side of his body and ongoing seizures.

Aggrieved, the patient filed a complaint with the consumer court alleging negligence, deficient services, and financial losses, and sought relief from the commission, including a lump sum of Rs 75,00,000 for income loss, Rs 10,00,000 for mental harassment, and legal costs of Rs 1,00,000, among other demands.

The Opposite Parties (Max Super Speciality Hospital (OP1), the doctor- a Senior Consultant Physician & Cardio-Diabetologist (OP2), the Medical Superintendent (OP3) and OPD Coordinator (OP4) of Max Hospital), in their joint written statement, refuted all allegations in the Complaint. They argued that the Complainant was attempting to shift blame, asserting that he arrived late, around 11:00 am, in the OPD, and underwent consultation with the doctor. The NCCT Scan revealed minimal traces of Subarachnoid Hemorrhage (SAH), leading to the recommendation for admission under the neurology team at the hospital.

The Opposite Parties claimed that proper medical measures were taken per protocol, and there was no negligence by the operating doctors. They allege that the Complainant concealed his medical history, including Paraesthesia in both Upper Limbs, and was already undergoing treatment for it. They argue that the SAH trace was minimal, confirmed by tests on 01.10.2017, and call for the complaint’s dismissal due to the suppression of material facts.

The Complainant filed a rejoinder to counter the Opposite Parties’ written statement. Both parties submitted evidence through affidavits and presented their written arguments.

The Commission perused the material available on record and heard the counsel for the contesting parties. It referred to Seema Garg & Anr. vs. Superintendent, Ram Manohar Lohia Hospital & Anr to discuss the extent of Medical Negligence in the instant case.

Deliberating the case, the Commission found that the complainant did not challenge the competency of the operating doctor, indicating no lack of competence on the part of the medical staff. Medical records demonstrated that the hospital promptly advised admission upon detecting abnormalities in the CT scan. It noted;

“On perusal of the abovementioned OPD sheet, we find that upon examination, the Opposite Party no. 2 advised the Complainant (patient) to go through a CT scan of the brain along with other tests such as CBC, KFT, PLS, LFT and STSH in order to determine the treatment to be followed in case of any emergency. Furthermore, we discover that after reviewing the CT scan report, which revealed a minimal trace of SAH, the Opposite Party no. 2 immediately advised the Complainant to be admitted under the supervision of a Neurosurgeon at Opposite Party no. 1 hospital, Dr. Kumar and the Complainant was admitted at around 3:30 p.m. on 01.10.2015, where further treatment was advised to the Complainant.”

“Even though the Complainant has not spared a word against the operating doctor in his complaint and has challenged the delay in admitting him to the hospital, but has failed to bring on record any substantial evidence, oral or documentary, in support of his contentions. It is further noted that the Complainant failed to establish that there was any breach of duty or omission to do something which a reasonable man would do or would abstain from doing or that the treatment which was given to the Complainant was not acceptable to the Medical Profession at that specific time period and also failed to examine any Expert Witness in support of his case”

The Consumer body further found that the complainant chose the hospital’s Out-Patient Department (OPD), designed for diagnosis and minor treatments, where immediate admission was not required. It observed;

“It was found that the Complainant had chosen Out-Patient Department (OPD) of Opposite Party No. 1 Hospital which is specifically designed for diagnosis, treatment, and care without requiring admission, catering to minor treatments and follow-up appointments. Additionally, in instances where patients face severe issues, they opt for the Emergency Ward, ensuring priority treatment for immediate medical attention.”

Subsequently, the commission ruled that there was no evidence supporting the allegations of negligence against Max Super Speciality Hospital, and the complaint was dismissed on the grounds of insufficient proof. It held;

“in view of the above discussion, we do not find any lackadaisical approach of the treating doctors of the Opposite Party no. 1 Hospital as no substantial evidence has been filed by the Complainant in order to show that the Opposite Parties have delayed the treatment of Complainant due to which, the Complainant has suffered seizure in reception area of the Opposite Party no. 1 Hospital. Additionally, this Commission cannot presume that the allegations in the complaint are inviolable truth even though they remained unsupported by any evidence.”

“Since there exists no evidence to substantiate the submission of the Complainant, we are of the view that there exists no Negligence on part of the Opposite Parties in the present case. Consequently, the present Complaint stands dismissed, with no order as to costs.”

To view the original order, click on the link below:

https://medicaldialogues.in/pdf_upload/max-hospital-no-medical-negligence-233352.pdf

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Private Medical Colleges Wrongfully Denied Admission to Medical Aspirants, HC Directs State to Pay Rs 20 Lakh Compensation each

Mumbai: The Bombay High Court bench recently directed the State Government to pay Rs 20 lakh compensation to three medical aspirants, who were denied admission to medical courses around 12 years ago due to irregularities in the admission process in private medical colleges.

Altogether four aspirants approached the HC bench. All of them were aspiring to pursue medical course and therefore they had appeared in the Common Entrance Test (CET) conducted by the Association of Management of Unaided Private Medical and Dental Colleges, Maharashtra (AMUPMDC) in 2012.

Even though they cleared the exam, due to the irregularities conducted by various medical institutes/colleges, they could not get admitted to medical courses although the students less meritorious than them managed to get admission.

Consequently, the State set up a committee to examine the irregularities. The Committee gave its report and recommended strict action against the institutions/officials who were involved in the irregularities.

Some of the students challenged the admission process before the Bombay HC back in 2013 and after the matter was dismissed by the HC, it reached the Supreme Court. The Apex Court on 2nd September 2014 directed the State Government to compensate the students by paying a sum of Rs 20 lakh towards public law damages and further directed the State to take action against the officers involved in the irregularities which resulted into meritorious students being denied admission.

The four medical aspirants who approached the Bombay HC bench in 2015 were not the petitioners before the Supreme Court. However, based on the Supreme Court’s directions, they approached the HC bench seeking similar relief i.e. Rs 20 lakh compensation on account of public law damages.

It was submitted by the petitioners that they were similarly placed to students who had approached the Supreme Court and therefore the relief granted by the Apex Court should also be granted to them. 

They further submitted that identical relief had been granted to other students who could not get admission for the academic year 2012-2013. The petitioners informed the Court that pursuant to the letter by the State, they had already submitted all the documents including the undertaking but they did not receive Rs 20 lakh compensation.

On the other hand, the State submitted that the petitioners were not before the Supreme Court and therefore they could not seek the relief by filing the plea before the HC bench. Therefore, the State submitted that the petitioners were not entitled to public law damages of Rs 20 lakh and urged the Court to dismiss the plea.

While considering the matter, the bench noted, “Therefore, in our view, if the Petitioners are similarly placed as those who were before the Supreme Court then the Respondent No.6 cannot deny the relief of payment of Rs.20,00,000/- to each Petitioner.”

The HC bench noted that in March 2019, the State had paid Rs 20 lakh to one of the petitioners for the lost opportunity. Referring to this, the bench observed, “If that be so, we failed to understand as to how Respondent No.6-State can submit that since the other three Petitioners were not before the Supreme Court they are not entitled to sum of Rs.20,00,000/-. This stand of Respondent No.6-State is contrary to their own act of making payment of Rs.20,00,000/- to Petitioner No.2. Therefore even on this count, the Respondent No.6-State is not justified in denying payment of Rs.20,00,000/- to other Petitioners.”

Further, the Court took note of the fact that in March 2015, the State issued a letter to the other three petitioners and sought certain documents to process and make the payment as per the Apex Court’s directions.

“We are informed by the Petitioners that they have complied with the said requisition by filing an undertaking and various documents namely Aadhaar card, bank details etc. However, the Petitioners have not received the payment of Rs.20,00,000/- till today. There is no justification given by Respondent No.6-State for having issued such communication and the Petitioner having complied with why the payment was not made from 2015 onward till today. Therefore on this count also, the stand taken by the Respondent No.6-State to deny the payment is contrary to their own stand. However since in the petition there is no averment on the Petitioners having complied with the requisition, we direct Petitioner Nos.1, 3 and 4 to once again file the documents requisitioned by Respondent No.6 vide letter dated 9th March 2015 so that the claim can be processed,” the Court noted at this outset.

Therefore, the bench directed three of the four petitioners to file the details sought via letter dated 9th March 2015 within a period of two weeks and directed the State to process the claim. 

“The Respondent No.6-State is directed to process the claim and make payment of Rs.20,00,000/- each to Petitioner Nos.1, 3 and 4 within a period of eight weeks from the expiry of two weeks as (i) per above,” directed the bench.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/bombay-hc-wrongful-denial-of-admission-233429.pdf

Also Read: 40 years after death of patient, HC upholds conviction of doctor

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