Conbercept efficacious in short-term treatment of Diabetic Macular Edema with or without Diabetic Nephropathy

Diabetic macular edema (DME) is a common complication of diabetes, and when coupled with diabetic nephropathy (DN), it poses additional challenges to management. In a recent retrospective study, researchers aimed to evaluate the therapeutic effects of conbercept on DME patients with and without DN.

This study was published in the International Journal Of Ophthalmology by Zhu YZ and colleagues.

The study included 54 patients diagnosed with DME, categorized into two groups: those with DN (25 eyes) and those without DN (29 eyes). Various parameters, including fasting blood glucose, HbA1c, microalbumin/creatinine, serum creatinine, central macular thickness (CMT), best corrected visual acuity (BCVA), and retinal hyperreflective foci (HF), were assessed before and during treatment. Optical coherence tomography (OCT) was utilized to evaluate ellipsoidal zone (EZ) and external limiting membrane (ELM) integrity.

The key findings of the study were:

  • Significant differences were observed between the two groups in fasting blood glucose, HbA1c, serum creatinine, urinary microalbumin/creatinine, and estimated glomerular filtration rate (eGFR).

  • EZ and ELM continuity were worse in the DME+DN group.

  • BCVA was significantly better in the DME group compared to the DME+DN group throughout treatment. CMT and HF values were higher in the DME+DN group and decreased with treatment in both groups over time.

  • The mean number of injections at 6 months was higher in the DME+DN group compared to the DME group.

Conbercept demonstrated significant efficacy in the short-term treatment of DME, with or without DN. It improved BCVA, CMT, and reduced HF counts. However, treatment efficacy was better in DME patients without DN. These findings highlight the potential of conbercept in managing DME, particularly in patients without DN. Further research is warranted to validate these results and explore long-term outcomes.

Reference:

Zhu YZ, Dou ZZ, Wang WY, Ma QY, Yi WD, Yao NN, Liu YC, Gao XD, Zhang Q, Luo WJ. Intravitreal injection of conbercept for diabetic macular edema complicated with diabetic nephropathy

DOI:10.18240/ijo.2024.02.12

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Surgical remission of Cushing’s disease tied to higher risk of developing autoimmune disease

Researchers have found in a new study that Surgical emission of Cushing’s disease tied to higher risk of developing autoimmune disease. 

ln a study of more than 250 persons undergoing surgical therapy for Cushing’s disease (CD) or nonfunctioning pituitary adenomas (NFPAs), the researchers found that patients who achieved remission of CD were more likely than those with surgically treated NFPAs to develop new-onset autoimmune disease within 3 years after remission.

The study is published in Annals of Internal Medicine.

CD results from excessive production of corticotropin (ACTH) by a pituitary adenoma, which causes hypercortisolemia. Transsphenoidal surgery (TSS) is the first-line treatment for most hypersecreting pituitary adenomas. After TSS for CD, adrenal insufficiency occurs once the ACTH-secreting tumor is removed, the signs and symptoms of hypercortisolemia typically improve over time but steroid withdrawal symptoms may develop after remission of CD. In addition, the development of new autoimmune disease in patients after CD remission has been observed, but research is limited.

Researchers from Harvard Medical School identified 194 persons with CD and 92 persons with NFPA, frequency-matched for age and sex, who underwent pituitary surgery. The authors found that persons with CD who achieved remission were more likely than those with surgically treated NFPAs to develop new-onset autoimmune disease within 3 years after remission.

The cumulative incidence was 10.4 percent. According to the authors, higher prevalence of adrenal insufficiency and the lower nadir serum cortisol levels in the CD group suggest that the postoperative adrenal insufficiency might have contributed to the development of autoimmune diseases. They also note that patients with CD who have a family history of autoimmune disease should be carefully monitored after achieving remission. In addition, the authors add that higher doses of early postoperative glucocorticoid replacement might be associated with decreased risk for development of autoimmune disease. These findings have implications for the understanding of the natural history of autoimmune disease and its relationship to cortisol fluctuations.

Reference:

Dennis Delasi Nyanyo, , Masaaki Mikamoto, Francesca Galbiati, Autoimmune Disorders Associated With Surgical Remission of Cushing’s Disease, Annals of Internal Medicine, https://doi.org/10.7326/M23-2024.

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Are body temperature and depression linked? Science says, yes

People with depression have higher body temperatures, suggesting there could be a mental health benefit to lowering the temperatures of those with the disorder, a new UC San Francisco-led study found.

The study, publishing today in Scientific Reports, doesn’t indicate whether depression raises body temperature or a higher temperature causes depression. It’s also unknown whether the higher body temperature observed in people with depression reflects decreased ability to self-cool, increased generation of heat from metabolic processes or a combination of both.

Researchers analyzed data from more than 20,000 international participants who wore a device that measures body temperature, and also self-reported their body temperatures and depression symptoms daily. The seven-month study began in early 2020 and included data from 106 countries.

The results showed that with each increasing level of depression symptom severity, participants had higher body temperatures. The body temperature data also showed a trend toward higher depression scores in people whose temperatures had less fluctuation throughout a 24-hour period, but this finding didn’t reach significance.

The findings shed light on how a novel depression treatment method might work, said Ashley Mason, PhD, the study’s lead author and associate professor of psychiatry at UCSF Weill Institute for Neurosciences. A small body of existing, causal studies has found that using hot tubs or saunas can reduce depression, possibly by triggering the body to self-cool, for example, through sweating.

“Ironically, heating people up actually can lead to rebound body temperature lowering that lasts longer than simply cooling people down directly, as through an ice bath,” said Mason, who is also a clinical psychologist at the UCSF Osher Center for Integrative Health. “What if we can track the body temperature of people with depression to time heat-based treatments well?”

“To our knowledge, this is the largest study to date to examine the association between body temperature – assessed using both self-report methods and wearable sensors – and depressive symptoms in a geographically broad sample,” added Mason. “Given the climbing rates of depression in the United States, we’re excited by the possibilities of a new avenue for treatment.”

Reference:

Ashley E. Mason et al, Elevated body temperature is associated with depressive symptoms: results from the TemPredict Study, Scientific Reports (2024). DOI: 10.1038/s41598-024-51567-w.

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Use of SGLT-2 inhibitors for HF management safe and well tolerated in adult congenital heart disease patients: Study

USA: A recent study showed that sodium-glucose transporter 2 inhibitors (SGLT-2i) use appears safe and well tolerated in a small cohort of the adult congenital heart disease (ACHD) population, including patients with complex congenital heart disease.

The findings, published in the International Journal of Cardiology Congenital Heart Disease, add to the literature on the SGLT-2i use in patients with ACHD. According to the authors, the study is the first to evaluate SGLT-2i in a complex ACHD cohort that included patients with single ventricle circulation.

“We found that SGLT2i initiation was well tolerated during short-term follow-up,” the researchers wrote. “Specifically, there was no significant worsening of renal function or reduction in blood pressure after initiation of SGLT-2 inhibitors in a heterogenous group of ACHD patients.”

SGLT2 inhibitors have shown efficacy and safety in heart failure (HF) patients. However, evidence is limited on the use of SGLT-2i in adult congenital heart disease patients with heart failure. To fill this knowledge gap, Ahmed Kheiwa, Loma Linda University, Loma Linda, CA, USA, and colleagues sought to evaluate the safety of this therapy in a small cohort of ACHD patients.

For this purpose, they performed a retrospective, single-centre analysis of 18 patients (>18 years of age) with ACHD and an HF diagnosis who were initiated on an SGLT2 inhibitor. Patient characteristics, including vital signs, concomitant medications, laboratory values, echocardiograms, and clinical outcomes, were obtained as a part of standardized clinical care at an ACHD program before and 2–6 months after initiation of SGLT-2i.

The primary outcome was to demonstrate the safety of SGLT-2i initiation via potential changes in systolic blood pressure, serum creatinine, and serum sodium.

The study revealed the following findings:

  • Of the 18 patients, 11 had moderate complexity congenital heart disease, while 7 had great complexity congenital heart disease.
  • Post initiation, there were no significant differences in systolic blood pressure (121.8 ± 20.8 mmHg to 114.4 ± 14.9 mmHg), creatinine level (0.85 ± 0.18 mg/dL to 0.89 ± 0.18 mg/dL), and sodium level (138.7 ± 2.9 mMol/L to 138.0 ± 2.2 mMol/L).
  • There was a statistically significant weight decline (78.9 ± 22.9 kg to 76.0 ± 23.0 kg) but without a statistically significant change in NT-pro NBP (1358.2 ± 2735.0 pg/mL to 601.6 ± 786.1 pg/mL).

The researchers report that the use of SGLT-2i in their small cohort of patients with heterogenous ACHD appears safe and well tolerated.

“The safety and potential efficacy of SGLT-2i in patients with adult congenital heart disease will require further evaluation in large-scale prospective multicenter studies,” they concluded.

Reference:

Kheiwa, A., Ssembajjwe, B., Chatta, P., Nageotte, S., & Abramov, D. (2024). Safety of SGLT-2 inhibitors in the management of heart failure in the adult congenital heart disease patient population. International Journal of Cardiology Congenital Heart Disease, 100495. https://doi.org/10.1016/j.ijcchd.2024.100495

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Novel oral intragastric expandable capsules can revolutionize weight loss management in obese patients: Study

China: A recent study published in Diabetes, Obesity and Metabolism has shed light on the safety and efficacy of intragastric expandable oral capsules in adults with overweight or obesity.

The 24-week trial comprising overweight/obese participants showed that 2.24 g of twice-daily intragastric expandable capsules taken before meals led to a clinically meaningful reduction in body weight compared with placebo, with mild gastrointestinal adverse events. 

Obesity is a chronic disease in which body weight exceeds a certain threshold because of the accumulation of adipose tissue, potentially leading to cardiovascular disease, type 2 diabetes, mood disorders, and even malignancy. Among several weight loss therapies, the most common are lifestyle and diet modifications but fail in the long term. Anti-obesity pharmacotherapies have shown efficacy in weight reduction, but side effects occur.

The increasing population of overweight/obese individuals urgently calls for multiple choices of weight management pharmacotherapies. Therefore, Xiaohui Guo, Department of Endocrinology, Peking University First Hospital, Beijing, China, and colleagues aimed to assess the safety and efficacy of 2.24 g intragastric expandable capsules twice per day versus placebo for weight management in adults with overweight or obesity in a double-blind, placebo-controlled study.

The study included adults with a body mass index (BMI) of at least 24 kg/m2 and no more than 40 kg/m2. A total of 280 participants were recruited from six hospitals in China and were assigned in a ratio of 1:1 to receive 2.24 g oral intragastric expandable capsules or placebo for 24 weeks.

Coprimary endpoints were the percentage change from baseline in body weight and the rate of weight reduction of ≥5%, assessed using the full analysis set and per protocol set.

Intragastric expandable capsules comprised two naturally derived components, food-grade carboxymethylcellulose cross-linked with citric acid, producing a three-dimensional polymer matrix that rapidly absorbs water and occupies the volume of the small intestine and stomach, when orally administered with water before a meal, subsequently producing satiety.

The study led to the following findings:

  • At baseline, the mean body weight was 81.8 kg, and the mean BMI was 29.4 kg/m2. The mean body weight change at week 24 was −4.9% with intragastric expandable capsules versus −1.9% with placebo [estimated treatment difference (ETD) −3.0%] using the full analysis set and −6.1% versus −2.5% (ETD −3.6%), respectively, using the per-protocol set.
  • The percentage of participants who had weight loss exceeding 5% was 45.0% in the intragastric expandable capsule group versus 19.7% in the placebo group (ETD 25.3%) in the full analysis set and 55.9% versus 26.2% (ETD 29.6%), respectively, in the per-protocol set.
  • Waist circumference significantly decreased at week 24 (intragastric expandable capsules vs. placebo: −5.6 ± 8.3 cm vs. −2.9 ± 4.8 cm).
  • The most common adverse events associated with the use of intragastric expandable capsules were gastrointestinal disorders (intragastric expandable capsule vs. placebo, 25.0% vs. 21.9%), and most were mild and transient.

In the 24-week trial, including participants with obesity or overweight, 2.24 g twice daily intragastric expandable capsules led to a clinically meaningful reduction in body weight compared with a placebo.

“Our study proved the efficacy of once-daily oral intragastric expandable capsules, in combination with counselling for physical activity and diet, resulting in significantly higher weight reduction at week 24 compared with placebo, with mild gastrointestinal adverse events,” the researchers concluded.

Reference:

Lu D, Yuan Z, Guo X, Zhu L, Zhang F, Li X, Wang W, Lin H, Luo J. Efficacy and safety of intragastric expandable oral capsules in adults with overweight or obesity: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab. 2024 Jan 22. doi: 10.1111/dom.15418. Epub ahead of print. PMID: 38253466.

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Indian Pharmaceutical Market soars with 9.5% growth in January 2024: Pharmarack Report

New Delhi: The Indian Pharmaceutical Market (IPM) exhibited a robust growth of 9.5% in terms of value and 2.07% in units, reaching a total value of 16,234 Cr in January, 2024, according to a recent report by market research firm Pharmarack.

The Moving Annual Total (MAT) basis showed the market achieving 194,951 Cr with a 7.4% value growth. Significant growth was observed in Respiratory, Pain/Analgesics, Urology, Anti-Neoplastics, and Stomatologicals, with notable performances in Respiratory Therapy, particularly Anti-asthma and COPD combinations. The Pain/Analgesics therapy also exhibited positive attributes, possibly influenced by seasonal trends, while Monoclonal antibodies and Immunosuppressive agents contributed significantly to the Anti-neoplastics therapy.

In the realm of therapy performance, Cardiac treatments exhibited a commendable 11.75% growth in value, coupled with a 3.19% increase in units. Despite a slight dip in unit growth, the Cardiac therapy sector contributed significantly to the overall positive trend in the market. Anti-Infectives demonstrated robust performance, boasting an 11.66% growth in value and a 3.17% increase in units. This strong performance reflects a notable demand for infectious disease management. Gastrointestinal therapies displayed steady growth, recording a 10.28% increase in value and an impressive 7.34% growth in units, indicating a sustained demand for treatments in this category.

Anti-Diabetic therapies showcased positive value growth at 10.78%, though there was a slight decrease in unit growth at 2.39%. Respiratory treatments experienced a 4.02% growth in value, but a decline of -2.59% in unit growth, possibly influenced by specific market dynamics. Pain/Analgesics therapies exhibited consistent growth with a 10.62% increase in value and a 2.46% rise in units, indicating a stable demand for pain management solutions. Anti-Neoplastics emerged as a standout performer with an impressive 20.54% growth in value and a remarkable 24.49% increase in units, pointing to a rising demand for cancer-related treatments. Stomatologicals showcased positive growth with an 8.92% increase in value and a 1.37% rise in units, emphasizing the demand for oral health-related pharmaceuticals.

As per the report, the growth in January ’24 was primarily fueled by price (5.2%) and new products (4.3%). Major therapies such as Cardiac, Anti-infectives, Pain/Analgesics, Neuro/CNS, and Anti-neoplastics experienced substantial volume growth. Remarkably, considerable price growth was observed in Cardiac, Gastrointestinal, Respiratory, Vit/Min/Nutr, Pain/Analgesics, and Neuro/CNS therapies. The new product lever, especially in Anti-diabetic, Blood-related, Hormones, and Stomatologicals, played a crucial role in driving IPM growth.

The top corporates influencing the market included Sun+Ranbaxy, Abbott, Mankind, Cipla, and Zydus. Similarly, the top brands contributing to sales included Augmentin (GSK), Glycomet GP (USV), Manforce (Mankind), Foracort (Cipla), and Mixtard (Abbott*).

In terms of the zonal split in Jan ’24, the IPM exhibited a value skew of S-N-W-E and a unit skew of N-S-E-W. The West zone led with the highest unit growth of 5.5%, and Tamil Nadu and UP-west & Uttarakhand emerged as the highest contributing states. However, Telangana was the only state pan India demonstrating a dip (-5%) in Jan ’24.

In the acute/chronic split, all segments displayed healthy growth, with a stable cyclic trend in the chronic and sub-chronic segments. Acute and chronic therapies contributed an incremental value of ~500 Cr each to the IPM over the Same Period Last Year (SPLY). The acute portfolio, holding ~50% share, contributed 7527 Cr in Jan ’24, with an 8% value growth and 2% unit growth. Sun Pharma* maintained its 1st position, and Fresenius exhibited remarkable performance. In the chronic segment, contributing ~33% to the IPM value, recorded 5463 Cr, growing at 11% by value, with nine corporates sustaining their rank over Jan ’23. The sub-chronic category contributed 19% by value and 15% by units, recording sales of 3239 Cr, growing at 10% by value.

The Supergroup Gauger revealed the top 5 corporates in each therapy for Jan ’24, indexed based on overall therapy vs. corporate value growth. Sun* (Cardiac), Aristo (Anti-Infectives), Abbott* (Gastrointestinal), Cipla (Respiratory), and GSK (Pain/Analgesics) emerged as leaders, highlighting their market dominance. In the Indian/MNC Therapy Split, Indian corporates recorded a 10% value growth and a 2.5% unit growth, contributing ~84% across major therapies, while MNCs demonstrated a 6% growth in value, with vaccines being their leading contributor.

Regarding New Introduction Dynamics, in the last 12 months, new SKUs valued at 891 Cr contributed 0.9% to the IPM in Jan ’24. Alkem*, Mankind, Eris LS, Cipla, Sun Pharma, and Abbott* led in launching new introductions, contributing to 16% of the total NIs.

The top 5 therapies leading in new introductions were Anti-diabetic, Cardiac, Pain and Analgesics, Derma, and Neuro/CNS. The average brand value per NI across all supergroups was Rs. 0.30 Cr, with Vaccines (Rs 2.0 Cr/Brand), Antineoplastics (Rs 1.1 Cr/Brand), Blood Related (0.6 Cr/Brand), Gynecological (0.52 Cr/Brand), and VMN (0.50 Cr/Brand) showing relatively higher brand values per NI.

Jan ’24 witnessed one new subgroup launch, with only 4 subgroups crossing a turnover of more than 1 Cr, and 5 subgroups from the OAD Combinations.

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Real-time PCR for Mpox virus highlighted by ICMR

The Indian Council of Medical Research (ICMR) has showcased significant advancements in health research and technology, according to its Annual Report for 2022-23. Under the leadership of Dr. Rajiv Bahl, Secretary of the Department of Health Research (DHR) and Director General of ICMR, the report highlights crucial developments like the Real-time PCR for the Mpox virus and NextGen Sequencing techniques, marking a breakthrough in disease diagnosis and surveillance in India.

ICMR’s role extends beyond research, significantly influencing public health policy with the formulation of nine comprehensive guidelines and policies aimed at combating health hazards and promoting public health awareness. Notable policies include Tobacco Control in India 2022 and the National Injury Prevention strategy.

For more news & updates, check out the link given below:

https://medicaldialogues.in/

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PM Narendra Modi inaugurates AIIMS Jammu

Prime Minister Narendra Modi has inaugurated the All India Institute of Medical Sciences (AIIMS) Jammu. PM Modi also handed over appointment orders to around 1,500 new government recruits of Jammu and Kashmir.

During the event, the prime minister informed that 50 new degree colleges have opened up in Jammu and Kashmir. He added that the number of medical colleges in Jammu and Kashmir has risen to 12 today from four in 2014, there are over 1,300 MBBS seats as opposed to 500 in 2014, and more than 650 PG medical seats as opposed to none in 2014.

For the full story, check out the link given below:

PM Modi inaugurates AIIMS Jammu campus, now 1300 MBBS seats, 650 PG medical seats in JnK


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10 Early Signs of STDs You Shouldn’t Ignore – Dr Basavaraj S Kumbar

If you’ve had unprotected sex,
it’s important to remember that there’s more at stake than just pregnancy. Not using
protection increases the chances of getting sexually transmitted diseases
(STDs), which can vary from common infections like chlamydia and gonorrhoea to
more serious ones like HIV and herpes.

It’s essential to know that not all STDs
show immediate symptoms. That’s why it’s smart to regularly get tested to catch
any surprises early on. Looking after your sexual health means more than just
avoiding pregnancy – it’s about protecting yourself and your partner from
potential infections.

Sexually transmitted diseases
(STDs) are a big worry because they can harm your health in many ways. While
some infections cause symptoms like itching, pain, or strange discharges,
others don’t show any signs right away.

This means you might not even realize
you have something wrong inside you. It’s really important to get tested
regularly to catch any problems early.

The symptoms of these infections can
vary a lot, from sores and painful urination to unusual discharge and swollen
lymph nodes. If left untreated, STDs can cause serious issues like trouble
getting pregnant, damage to your organs, or even cancer. So, it’s not just
about you – it’s about taking care of your health and thinking about your
future self.

10 Early Signs of STDs You Shouldn’t Ignore

  1. Unusual
    Discharge:     Keep an eye out for any unusual discharge from the genital
    area. Discharge that is different in colour, consistency, or odour than
    usual could indicate an STD like Chlamydia, Gonorrhoea, or Trichomoniasis.
  2. Genital
    Sores or Ulcers:     Pay attention to the presence of sores or ulcers on
    the genitals. These can be a sign of herpes or syphilis and should be
    examined by a healthcare professional promptly.
  3. Painful
    Urination:     If you experience pain or discomfort while urinating, it
    could be a symptom of various STDs, including Chlamydia, Gonorrhoea, or
    even a urinary tract infection (UTI) caused by an STD.
  4. Flu-Like
    Symptoms:     Feeling flu-like symptoms such as fever, fatigue, and body
    aches might be an early indication of HIV infection. If you’ve engaged in
    unprotected sex and experience these symptoms, it’s essential to get
    tested.
  5. Changes
    in Vaginal Discharge:     Women should be aware of any changes in vaginal
    discharge, such as increased volume, unusual colour, or foul odour. These
    changes could signal an infection like Bacterial Vaginosis,
    Trichomoniasis, or even a yeast infection caused by an STD.
  6. Pelvic
    Pain:     Persistent pelvic pain or discomfort, especially during
    intercourse, could be a symptom of various STDs, including Chlamydia,
    Gonorrhoea, or pelvic inflammatory disease (PID) caused by untreated
    infections.
  7. Visible
    Warts:     Warts appearing on the genital area could be a sign of Human
    Papillomavirus (HPV) infection. These warts may be flesh-coloured, raised,
    or clustered and should be evaluated by a healthcare provider.
  8. Itching
    or Burning:     Unexplained itching or burning sensations in the genital
    area could indicate an STD like Trichomoniasis or a yeast infection. These
    symptoms may also accompany other STD-related conditions.
  9. Abdominal
    Pain:     Persistent abdominal pain, particularly lower abdominal pain,
    could be a sign of a more serious STD-related complication, such as PID.
    Seek medical attention if you experience this symptom.
  10. Lack
    of Symptoms:     Remember that not all STDs present immediate symptoms.
    Some infections, such as Hepatitis B or HIV, may not show signs early on.
    Regular testing, especially after unprotected sex or with multiple sexual
    partners, is crucial for early detection and treatment.

Treatment and Prevention

Treatment and prevention methods
for sexually transmitted diseases (STDs) vary depending on the type of
infection. Antibiotics can effectively treat bacterial STDs, while viral
infections cannot be cured but can be managed with proper medical care. Vaccines
against hepatitis A, hepatitis B, and HPV offer an extra layer of protection
against certain infections.

Making smart lifestyle choices
like abstaining from sex, limiting sexual partners, practising mutual
monogamy,
and consistently using condoms significantly lower the risk of getting
an STD.
Untreated STDs can lead to serious health problems such as infertility,
organ
damage, illness, cancer, and the spread of other diseases. Routine
gynaecological check-ups are key for early detection of sexually
transmitted
diseases (STDs).

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.

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Faulty intubation during anaesthesia: SC slaps Rs 10 lakh compensation on Manipal Hospital

New Delhi: The Supreme Court recently directed Manipal Hospital to pay Rs 10 lakh compensation to the widow of a patient who developed hoarseness in his voice as a result of faulty insertion of a double lumen tube while administering anaesthesia.

While the District Consumer Court had granted Rs 5 lakh Compensation and the National Consumer Disputes Redressal Commission (NCDRC) upheld the same, the Supreme Court bench comprising Justices Hima Kohli and Ahsanuddin Amanullah enhanced the amount of compensation to Rs 10 lakhs.

“Having regard to the fact that the appellant expired during the pendency of the proceedings before the NCDRC, no useful purpose would be served in remanding the matter back for reappreciation of the evidence to arrive at a just and fair compensation. Instead, it is deemed appropriate to direct that the compensation awarded by the District Forum be doubled from ₹5,00,000/- (Rupees Five lakhs only) to ₹10,00,000/- (Rupees Ten lakhs only) with simple interest calculated @ 10% per annum from the date of filing of the claim petition till the amount is paid, subject to the adjustment of the amounts already released in favour of the deceased – appellant,” the Apex Court bench ordered.

The appellant approached the Supreme Court bench being aggrieved by the NCDRC order, which upheld the Karnataka State Commission order that confirmed the ruling of the District Consumer Court, Bangalore directing the hospital to pay Rs 5 lakh as compensation and Rs 5,000 as litigation expenses. However, the complaint against the concerned doctors was dismissed.

It was submitted by the counsel for the appellants that despite the deficiency of services being proved against the hospital and the deceased patient having claimed Rs 18 lakh as compensation with interest, the District Forum had suo moto arrived at a rough and ready figure of Rs 5 lakh payable as compensation without furnishing any reasons for arriving at the said figure.

The matter goes back to 2003 when the patient had undergone surgery on the left lung and after the surgery, he developed hoarseness in his voice. Even though the operating surgeon had assured the patient that the hoarseness could be due to the operation involving the complete removal of the tumor along with lymphnodes around the Recurrent Laryngeal Nerve and assured that the patient could regain his voice within 6-8 months with nebulization and voice therapy, the patient’s voice was not restored and remained hoarse all through. 

Subsequently, the appellant took opinions from two other expert doctors in the field and both doctors opined that there was subluxation of the left arytenoid process, which happened due to wrong intubation during the anaesthesia procedure at the hospital.

The appellant’s counsel argued that it is not in dispute that the surgery relating to cancer of the lung is a specialized surgery and requires a specialized anaesthetist. It was contended that even though the Head of the Department of Anaesthesia was to administer anaesthesia to the deceased patient, the same was administered by a doctor who was qualified but was a trainee anaesthetist in the Cardiac Anaesthesia Department.

While considering the matter, the NCDRC bench frowned on the delegation of such a critical duty on a trainee anaesthetist and treated the same as a breach of duty of care. After perusing the material on record, the NCDRC bench observed that the dislocation of the left Arytenoid was on account of the trauma caused leading to the paralysis of the vocal cord of the deceased-appellant and that the RLN injury does not cause dislocation of Arytenoid. The top consumer court opined that the paralysis of the left vocal cord of the deceased-appellant was attributed to the faulty insertion of the Double Lumen Tube in the course of administering anaesthesia to him for undergoing the surgery.

Meanwhile, the counsel for the hospital submitted that the District Forum erred in discarding the evidence of the doctors who stated that there was nothing wrong in giving anaesthesia through a double-lumen tube. He also sought to question the reliance placed by the District Forum on the testimony of two expert doctors produced by the deceased-appellant during the course of evidence.

However, the records revealed that the Hospital did not object to the said expert doctors deposing in the case, nor did the Hospital file an application for an expert appointed by the District Forum for giving an opinion in the instant case, argued the hospital’s counsel.

“Mere reliance on medical literature would not be sufficient to exonerate the Hospital from its duty of ensuring that the Head of the Department, Anaesthesia ought to have inserted the Double Lumen Tube. Instead, he was not available and the task was delegated to a trainee anaesthetist,” noted the bench.

Further, the Court also took note of the submission made by the appellant’s counsel that the deceased was working as an Area Sales Manager in the private sector and his career nosedived due to the hoarseness of his voice. The counsel submitted that the patient had virtually lost his voice and continued on the same post from the year 2023 onwards without promotion till he expired at the end of 2015. He was working on the same salary that was being paid to him at the time of his initial engagement i.e. Rs 30,000. per month.

Taking note of these facts, the Supreme Court bench observed, “…we are of the opinion that the District Forum ought to have taken all the aforesaid aspects into consideration for arriving at a rightful compensation payable to the deceased which in the instant case, has not been done.”

Therefore, the bench enhanced the amount of compensation from Rs 5 lakh to Rs 10 lakh and ordered, “As requested by learned counsel for the appellants, the amount awarded as above be released by the Hospital in favour of the widow of the deceased complainant … within a period of four weeks from today.”

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/supreme-court-rs-10-lakh-compensation-232650.pdf

Also Read: Not carrying out pre-operative investigations amounts to gross negligence: Consumer Court slaps Rs 10 lakh compensation

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