Kidney not visualised after Hernia Operation: Hyderabad Hospital doctors slapped Rs 30 lakh compensation for allegedly removing kidney

Hyderabad: The Telangana State Consumer Disputes Redressal Commission recently directed two doctors from a private hospital in Secunderabad to pay Rs 30 lakh compensation to a patient for alleged wrongful removal of a kidney.

It was alleged by the Complainant that his left kidney was removed by them during the hernia operation in 2009. In this regard, the complainant referred to several investigation reports at the later stage mentioning that the left kidney was not visualized properly.

While considering the matter, the State consumer court applied the principle of res ipsa loquitor and noted that the treating hospital represented by its two doctors could not prove that the left kidney was not removed but had shrunk due to atrophy and the same is not visualized and in this regard, they could not submit any evidence also.

The case concerned the complainant who was diagnosed with stones in the bladder in the year 2007. Allegedly, the doctor at the hospital had left the operated portion open in order to ooze out the pus that was formed inside and subsequently, the outer portion was sutured, leaving open the inner portion, and after one month he was discharged.

Following this, in the year 2009, the patient developed hernia due to which he approached Poulomi Hospitals where he was admitted and underwent all the investigations done by the hospital and the ultrasound scan of the whole abdomen was also taken. As per the complainant’s submission, the report mentioned that both the kidneys of the complainant were normal in contour and echo texture, the size of the right kidney was also noted as 96 x 48 mm; left kidney size: 117 x 60 mm.

Consequently, on 20.07.2009, the doctors at the hospital performed the surgery for Hernia and on 31.07.2009, the patient was discharged from the hospital. However, the patient was in regular touch with the Urologist Dr Madhekar who had been prescribing the medicines regularly. Due to the ill health of the complainant, he was asked to rest for several days and was further advised not to take physical strain.

Meanwhile, his health condition was deteriorating and therefore in 2011, the complainant went to Calcutta to visit his father-in-law on 10.10.2011. However, he developed severe stomach pain and approached Dr. Sarkar at Arogya Maternity & Nursing Home. He was admitted to the hospital on 21.11.2011 and he was operated for hernia and a mesh was put in order to protect him from further pain, and during his stay, there were several investigations and scans done and the doctor had informed that his “left kidney was not well visualised”. 

At that time, the complainant allegedly realised that the treating hospital while conducting the hernia operation in 2009 had fraudulently in collusion with each other had removed his kidney without his knowledge, information and consent and the matter came to light only in 2011 when the doctor in Calcutta had informed him.

On 16.05.2022, the patient again developed severe stomach pain and thereafter he approached Kothagudem Area Hospital, who referred the patient to Medicare Diagnostic Centre for medical test, USG abdomen and pelvis. The concerned scanning report also revealed that the left kidney was not visualised. Again on 13.06.2012, the complainant visited Mamata Medical College Hospital, Khammam and the scan report there also revealed that the left kidney was not visible.

The Complainant alleged that he has been suffering since then due to fraudulent acts of the doctors at the treating hospital, who had fraudulently removed his left kidney.

Due to such culpable act of the opposite party, the complainant approached the AP State Human Rights Commission and registered a case which was referred to Kushaiguda Police Station, Cyberbad, who conducted investigations and inquiry and opined that the act committed by the doctors at the treating hospital was a deficiency of service and advised the complainant to approach Consumer Court and submitted the said report dated 4.2.2015.

It was alleged by the complainant that due to such fraudulent and deficient acts of the hospital doctors, the complainant had been suffering continuously since 2009. Due to this, the precious life of the complainant had been ruined, his life span was reduced and he developed several malfunctioning, his urinary system had also totally crippled his life due to which his marital status has also been affected and he has no children till date.

Approaching the consumer court bench, the complainant demanded a compensation of Rs 50 lakh with interest @ 24% p.a., from the date of complaint till the realization.

On the other hand, the doctors at the hospital pointed out that before coming to their hospital, the patient underwent treatment at Gandhi Hospital and underwent multiple surgeries. They also informed the consumer court bench that non-visualisation of the kidney does not necessarily mean that the kidney was removed. It was submitted that in case of atrophy of kidney, there is a possibility of non visualization of kidney and that there is no nexus between the surgery performed in 2009 and the alleged pain the complainant is suffering from.

Further, they pointed out that on the basis of the complaint made before the Human Rights Commission, the matter was referred to Kushaiguda police station and after conducting the inquiry, the concerned police found that there was no substance in the allegations made by the complainant.

It was further argued that to receive and kidney for transplantation, huge process and regulations are involved under the Special Act called “Organ Donation Act” and the donor of such kidney should be in a healthy condition whereas in the instant case, the complainant himself is suffering from stones in his kidneys and had underwent several surgeries for the same. Therefore, the question of removing the kidney does not arise.

Further, it was pointed out that to transplant the kidney from the donee to the donor both must be closely related and shall be in good health. The doctors further pleaded that after performing the PCNL for renal calculus and Hernia removal on 20.07.2009, an ultra scan was done on 28.07.2023 and the report categorically showed the presence of the left kidney admeasuring 123×63 mm and the same was allegedly shown to the complainant before his discharge.

It was further argued that since the complainant had not paid any consideration and availed the services under the Arogyasree Scheme, he does not fall into the category of Consumer and therefore, the complaint is not maintainable.

Referring to this contention, the consumer court noted that “It is a fact borne by record that the complainant has not paid any consideration to the opposite parties but the Government has paid the consideration on behalf of the complainant hence it implies that the complainant has paid the valid consideration and had availed the services of opposite party as a beneficiary as such he falls into the definition of ‘consumer’.”

While considering the allegations that the left kidney of the patient was fraudulently removed, the Consumer Court noted that when the complainant visited the hospital for treatment of hernia in 2009, both his kidneys were normal and the ultrasound scan dated 09.07.2009 revealed the same.

The Commission noted that the complainant’s case was based on the whole abdomen report dated 18.11.2011 of Medvue Medical Services, Kolkata and the USG Abdomen and Pelvis report dated 16.05.2012 of Medicare Diagnostics, Kothagudem, Ultra Sonography of Abdomen/Pelvis report dated 13.06.2012 of Mamata General & Super Speciality Hospital, Khammam and USG Abdomen and Pelvis report dated 18.07.2014 of Medicare Diagnostics, Kothagudem.

In all these reports, it was reported that the “left kidney not visualised”. Therefore, based on these documents, the complainant stated that when he visited the hospital, both his kidneys were normal and the doctors at the hospital while performing the Hernia operation had fraudulently removed his left kidney.

The Commission noted that the hospital doctors appeared and filed the written version but they failed to file any evidence affidavit nor any documents and had contended in the written version that in case of Atrophy of kidney, the kidneys will not be visible.

“In a medical negligence case, when negligence is alleged and the complainant has supported his allegations with documentary evidence, the burden shifts on the opposite party to prove that they were not wrong and have rendered their services diligently, but in the instant case the opposite party did not choose to file any evidence nor had put any efforts to prove that the kidney was not visualised due to atrophy,” noted the Commission.

Further, it noted that the doctors at the treating hospital had specifically stated that at the time of discharge from the hospital and ultrasound was done on 28..07.2009 to study the left lumbar region post-operation and the left kidney was well visible in the said report with a measurement of 123×62 mm. However, the Commission noted that “no such report is filed before this Commission”.

Observing that the Commission is not medical expert to analyse and conclude that in case of Atrophy, the kidney will shrink to the extent that it becomes invisible, the Commission noted that it was for the doctors at the treating hospital to furnish such proofs.

“A mere statement will not suffice, the same has to be established and proved with cogent evidence, the opposite party failed to substantiate their contention with sufficient evidence or medical literature. In the absence of the same an adverse inference can be drawn against the opposite parties that they might have certainly played some mischief with the complainant at the time of surgery for hernia in the year 2009,” mentioned the consumer court.

Meanwhile, the doctors at the hospital remained silent and to come to a truthful conclusion, the Commission sent the complainant for examination to the Gandhi Govt. Hospital at Secunderabad and instructed to examine the complainant and to report whether the left kidney of the complainant is visible or is removed by surgical intervention.

Accordingly, the Gandhi Hospital conducted the examination and sent a report on 19.07.2023. However, the Commission noted that the report was not conclusive in nature, because it was not supported with any pathology report nor the films of MRI etc. At one point the report mentioned that the left kidney “Not visualized” and at the same time it also mentioned that the left kidney has a calculus in it.

Therefore, the Commission held that the report by Gandhi Hospital cannot be relied upon. Meanwhile, the Commission noted that the doctors of the treating hospital, despite being aware of the fact that the complainant was sent for examination to Gandhi Hospital, did not choose to come forward and give any explanation.

At this outset, the Commission referred to the Supreme Court order in the case of CPL Ashish Kumar Chauhan Vs Commanding Officer and others, where the Apex Court relied on its earlier decisions invoked the principle of Res Ipsa loquitor. 

Applying the same principle, the Commission noted that the Complainant by producing the documents substantiated that his left kidney was not visualized and alleged that the same was removed by the doctors at the treating hospital without his consent during the surgery for hernia.

“These documents speak for themselves, in view of these documents the burden shifts on the opposite party to prove that the left kidney was not removed but had shrunk due to atrophy and the same is not visualized but no such evidence is forth coming from the opposite parties,” noted the Commission.

Holding them negligent, the Commission held,

“Therefore based on the above discussion and failure on the part of the opposite party to produce the crucial document ‘ultra scan’ dated 28.07.2009 and the silence of the opposite party in not coming forward with any sort of explanation supported with evidence and medical literature, all these acts and avoiding and escaping behaviour of opposite parties leads us to irresistibly conclude that the opposite parties under the guise of Hernia operation had illegally removed the left kidney of the complainant, the opposite party had taken undue advantage of the ignorance of the complainant and deceived him, thereby not only causing organ loss to the complainant but the complainant is forced to live with the fear, frustration and disappointment.”

While considering the issue of compensation, the Commission observed that “…strictly speaking the act committed by the opposite parties are criminal in nature.”

It noted that no amount of compensation will restore the loss suffered by the complainant,

“Since due to the act of the opposite parties, the life expectancy of the complainant has come down and he is forced to live with one kidney, what will the fate of the complainant be if unfortunately his right kidney fails.”

Therefore, the Commission ordered Poulomi Hospitals represented by Urologist Dr. Madhekar and another Dr. Behara to jointly and severally pay Rs 30 lakh as compensation and another Rs 25,000 as costs.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/telangana-state-commission-rs-30-lakh-compensation-228797.pdf

Also Read: Death after Anaesthesia administration during implant removal :Bengaluru Hospital, Doctors to Pay Rs 38 Lakh Compensation

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Owning pets helps to cope with loneliness and cognitive decline

In the past few decades, the number of individuals living alone has shown an upward trend. In 2021, the proportion of single-person households in the United Kingdom (UK) and the US reached 29.4% and 28.5%, respectively.

Loneliness is a potential mediator in the association of living alone with dementia among older adults. Contrary to living alone,10 pet ownership (eg, raising dogs and cats) is related to reduced loneliness.

To explore the association of pet ownership with cognitive decline, the interaction between pet ownership and living alone, and the extent to which pet ownership mitigates the association between living alone and cognitive decline in older adults.

A recent study in JAMA Network suggests that pet ownership can be associated with slower cognitive decline among older adults living alone. Slower rates of decline in verbal memory and verbal fluency among individuals living alone, but not among those living with others. Pet ownership offset the association between living alone and declining rates of verbal memory and verbal fluency.

Researchers designed a cohort study used data from waves 5 (June 2010 to July 2011) to 9 (from June 2018 to July 2019) in the English Longitudinal Study of Ageing. Participants included adults 50 years and older. Data were analyzed from April 1 to June 30, 2023. Pet ownership and living alone in wave 5. In waves 5 to 9, verbal memory and verbal fluency were assessed, and composite verbal cognition was further calculated.

The key findings of the study are

  • A total of 7945 participants included, the mean (SD) age was 66.3 (8.8) years, and 4446 (56.0%) were women. Pet ownership was associated with slower rates of decline in composite verbal cognition (β = 0.008 [95% CI, 0.002-0.014] SD/y), verbal memory (β = 0.006 [95% CI, 0.001-0.012] SD/y), and verbal fluency (β = 0.007 [95% CI, 0.001-0.013] SD/y).
  • Three-way interaction tests showed that living alone was a significant modifier in all 3 associations. Stratified analyses showed that pet ownership was associated with slower rates of decline in composite verbal cognition (β = 0.023 [95% CI, 0.011-0.035] SD/y), verbal memory (β = 0.021 [95% CI, 0.008-0.034] SD/y), and verbal fluency (β = 0.018 [95% CI, 0.005-0.030] SD/y) among individuals living alone, but not among those living with others.
  • Joint association analyses showed no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.

Researchers concluded that ” In this cohort study, pet ownership was associated with slower rates of decline in verbal memory and verbal fluency among older adults living alone, but not among those living with others, and pet ownership offset the associations between living alone and declining rates in verbal memory and verbal fluency. Further studies are needed to assess whether pet ownership slows the rate of cognitive decline in older adults living alone.”

Reference: Li Y, Wang W, Zhu L, et al. Pet Ownership, Living Alone, and Cognitive Decline Among Adults 50 Years and Older. JAMA Netw Open. 2023;6(12):e2349241. doi:10.1001/jamanetworkopen.2023.49241.

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Risk of young-onset dementia could be reduced by targeting health and lifestyle factors

Researchers have identified a wide range of risk factors for young-onset dementia. The findings challenge the notion that genetics are the sole cause of the condition, laying the groundwork for new prevention strategies.

The largescale study identified 15 risk factors, which are similar to those for late-onset dementia. For the first time, they indicate that it may be possible to reduce the risk of young-onset dementia by targeting health and lifestyle factors.

Relatively little research has been done on young-onset dementia, though globally there are around 370,000 new cases of young-onset dementia each year.

Published in JAMA Neurology, the new research by the University of Exeter and Maastricht University followed more than 350,000 participants younger than 65 across the United Kingdom from the UK Biobank study. The team evaluated a broad array of risk factors ranging from genetic predispositions to lifestyle and environmental influences. The study revealed that lower formal education, lower socioeconomic status, genetic variation, lifestyle factors such as alcohol use disorder and social isolation, and health issues including vitamin D deficiency, depression, stroke, hearing impairment and heart disease significantly elevate risk of young-onset dementia

Professor David Llewellyn of the University of Exeter emphasized the importance of the findings: “This breakthrough study illustrates the crucial role of international collaboration and big data in advancing our understanding of dementia. There’s still much to learn in our ongoing mission to prevent, identify, and treat dementia in all its forms in a more targeted way. This is the largest and most robust study of its kind ever conducted. Excitingly, for the first time it reveals that we may be able to take action to reduce risk of this debilitating condition, through targeting a range of different factors.

Dr Stevie Hendriks, Researcher at Maastricht University, said: “Young-onset dementia has a very serious impact, because the people affected usually still have a job, children, and a busy life. The cause is often assumed to be genetic, but for many people we don’t actually know exactly what the cause is. This is why we also wanted to investigate other risk factors in this study.”

Sebastian Köhler, Professor of Neuroepidemiology at Maastricht University, said: “We already knew from research on people who develop dementia at older age that there are a series of modifiable risk factors. In addition to physical factors, mental health also plays an important role, including avoiding chronic stress, loneliness and depression. The fact that this is also evident in young-onset dementia came as a surprise to me, and it may offer opportunities to reduce risk in this group too.”

Dr Janice Ranson, Senior Research Fellow at the University of Exeter, said: “Our research breaks new ground in identifying that the risk of young-onset dementia can be reduced. We think this could herald a new era in interventions to reduce new cases of this condition.”

Dr Leah Mursaleen, Head of Clinical Research at Alzheimer’s Research UK, which co-funded the study, said: “We’re witnessing a transformation in understanding of dementia risk and, potentially, how to reduce it on both an individual and societal level. In recent years, there’s been a growing consensus that dementia is linked to 12 specific modifiable risk factors such as smoking, blood pressure and hearing loss . It’s now accepted that up to four in 10 dementia cases worldwide are linked to these factors.

“This pioneering study shines important and much-needed light on factors that can influence the risk of young-onset dementia. This starts to fill in an important gap in our knowledge. It will be important to build on these findings in broader studies.’

Reference:

Hendriks S, Ranson JM, Peetoom K, et al. Risk Factors for Young-Onset Dementia in the UK Biobank. JAMA Neurol. Published online December 26, 2023. doi:10.1001/jamaneurol.2023.4929.

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High-sensitivity troponin HEART pathway allows earlier detection of acute myocardial infarction: JAMA

USA: A recent cohort study published in JAMA Network Open has suggested that the high-sensitivity troponin HEART pathway may allow earlier detection of acute myocardial infarction (AMI) and improve resource use.

The multicenter cohort study involved 17 384 emergency department (ED) patients with chest pain risk stratified with a HEART pathway incorporating conventional vs high-sensitivity (hs) troponin levels. The study revealed that the high-sensitivity troponin group demonstrated a higher rate of AMI diagnosis during the ED visit and a lower AMI diagnosis rate within 30 days after the visit, along with lower rates of revascularization, stress testing, and admission. Mortality was rare and similar across groups.

Patients presenting to the EDs with chest pain are routinely risk-stratified for major adverse cardiac events (MACEs) using the HEART (History, Electrocardiogram, Age, Risk factors, and Troponin) score pathway. The pathway incorporates risk factors, clinical features, initial serum troponin testing, and electrocardiography findings hs-troponin levels are suggested to improve risk stratification among patients with possible acute myocardial infarction.

Mackensie Yore, Veterans Affairs/University of California Los Angeles National Clinician Scholars Program, Los Angeles, and colleagues aimed to compare resource use and health outcomes among emergency department patients undergoing cardiac risk stratification with a HEART pathway using conventional vs high-sensitivity serum troponin.

The study was conducted at 16 Kaiser Permanente Southern California hospitals during hs-serum troponin assay uptake. It included 17 384 adult patients who presented to an emergency department with chest pain and were risk-stratified with a HEART pathway based on high-sensitivity troponin or conventional troponin.

The study’s main outcome was AMI detection in the ED and within 30 days.

The study led to the following findings:

  • Of the 17 384 patients (median age, 58 years; 56.2% were women), 12 440 were risk stratified with a HEART pathway based on conventional troponin, and 4944 were risk stratified with a HEART pathway based on high-sensitivity troponin.
  • Detection of AMI within 30 days was higher for the high-sensitivity troponin group than the conventional troponin group (5.8% versus 4.4%), while the 30-day all-cause mortality rate was unchanged (0.3% versus 0.4%).
  • In the emergency department, 4.6% of patients in the high-sensitivity troponin group received a diagnosis of AMI compared with 2.0% in the conventional troponin group.
  • Among those who did not receive a diagnosis of AMI in the emergency department, an additional 1.2% of patients in the high-sensitivity troponin group and 2.4% in the conventional troponin group received a diagnosis within 30 days.
  • Patients in the high-sensitivity troponin group had lower rates of healthcare use compared with the conventional troponin group, including admission (12.2% versus 15.0%), stress testing within 7 days (10.2% versus 12.8%), and coronary revascularization within 30 days (1.0% vs 2.0%).

“The findings indicate that the hsTn HEART pathway was linked with higher rates of ED AMI diagnoses and lower rates of AMI diagnoses after the index ED visit and within 30 days,” the researchers wrote.

The team added, “We also found less health service use for the hsTn group compared with the cTn group.”

“A high-sensitivity troponin algorithm may improve the ED evaluation of AMI, both catching AMI earlier and mitigating advanced testing and unnecessary admission,” they concluded.

Reference:

Yore M, Sharp A, Wu Y, et al. Emergency Department Cardiac Risk Stratification With High-Sensitivity vs Conventional Troponin HEART Pathway. JAMA Netw Open. 2023;6(12):e2348351. doi:10.1001/jamanetworkopen.2023.48351

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JIPMER Announces Conduction Of 1st Year Orientation Program For MD, MS, DM, MCH, MDS students

Puducherry: Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) has announced the conduction of 1st year postgraduate orientation program for MD, MS, DM, MCH, and MDS courses for the January 2024 batch. 

The postgraduate orientation program for the first-year postgraduate degree students admitted in the January 2024 session has been scheduled for 2nd January and 5th – 6th February 2024 in the NTTC Hall-1, JIPMER Academic Centre, JIPMER. Registration for the Programme will start sharp at 8.30 am on 2nd January 2024.

All the Heads of Departments are requested to circulate this among the first-year MD, MS, DM, MCh & MDS students who have joined in the first and second round of seat allotment and permit them to attend the program. The Heads should not post them on night duty before and during the program days and inform all unit heads to relieve the students on time, which will enable them to attend all sessions on time.

Also Read:AIIMS Jodhpur Invites Online Applications For PhD Admission January 2024 Session

The guide and PG dissertation topic details of the students as per the format given below to nttc.jipmer@gmail.com on or before 02.02.2024 need to be sent.

Sl. No.

Name of the resident

Name of the research guide

Proposed area of research/ topic (Optional)

The students are to come with a fully charged laptop, pen drive, and a hard copy of the PGRMC (Word Doc) form, which can be downloaded from the link mentioned in the notice below.

The Jawaharlal Institute of Postgraduate Medical Education & Research is a medical school located in Pondicherry. It is an institute of national importance (INI) and a tertiary care referral hospital. It is under the direct administrative control of the Ministry of Health and Family Welfare and the Indian Government, with autonomy to run its internal administration. The courses include undergraduate, postgraduate, super specialty, fellowships, PhD programs, post-basic diplomas, and certified courses.

To view the notice, click on the link below –

https://medicaldialogues.in/pdf_upload/circular-i-yr-pgo-for-md-ms-dm-mch-mds-jan-2024-batch-228823.pdf

Also Read:ICMR Announces ICMR-JRF 2023 Entrance Exam results

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2 international passengers held for allegedly carrying medicines worth Rs 80 lakh at IGI Airport

New Delhi: Two international passengers were apprehended for allegedly carrying medicines worth Rs 80 lakh at IGI Airport in New Delhi, an official statement issued by the Central Industrial Security Force (CISF) said on Tuesday.

According to CISF, the two persons identified as Md Raihan Fazal and Azeem Khan were planning to go to Kabul via Dubai on a flight.
“On 24.12.2023 at about 6:10 pm, on the basis of behaviour detection, CISF surveillance and intelligence staff noticed suspicious activities of two international passengers at Check-in area, Terminal-3 of IGI Airport. On suspicion, passengers later identified as Md Raihan Fazal and Azeem Khan bound for Kabul via Dubai by Air India flight No. AI-995 (STD-2020 hrs) were diverted to the random checking point for thorough checking of their 4 big-size trolley bags,” CISF said in a statement.
CISF said that the images of the bags after their screening raised suspicion and a physical check was done further, which led to the seizure of medicines.
“On screening their four trolley bags through the X-BIS machine, CISF personnel noticed suspicious images. On physical checking, a huge quantity of medicines of approximate value Rs 80 lakh were detected,” CISF said.
“On inquiry, the passengers could not produce supporting documents for carrying such huge quantity of medicines,” the central security force added.
CISF further mentioned that passengers along with detected medicines were handed over to Customs for further action in the matter.
Medical Dialogues team had earlier reported that Narcotics Control Bureau (NCB) Mumbai had successfully busted an international network involved in the illicit trafficking of pharma drugs from India to Australia.

Read also: International network involved in pharma drugs illicit trafficking busted, 3 held

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Medical infrastructure inadequate, Delhi HC directs Govt to submit report in four weeks

New Delhi: The Delhi High Court, during the hearing of a suo motu public interest litigation, expressed its concerns regarding the healthcare facilities in various government hospitals in the capital. The court noted that the medical infrastructure in the national capital is inadequate and there is a shortage of hospital beds.

The division bench, comprising acting Chief Justice Manmohan and Justice Mini Pushkarna, has directed the Delhi government to provide a status report outlining their plan for ensuring a sufficient medical infrastructure to cater to the increasing population of the city.

In an order issued on December 13, the court said “Learned counsel for GNCTD is directed to file a status report within four weeks. The status report will indicate as to how the GNCTD plans to ensure that the medical infrastructure keeps pace with the city’s population.”

Also read- Death Of 14 Year Old Due To Cancer: AIIMS, Safdarjung Hospital Deny Accusations Of Admission Denial

This directive was issued in response to a suo motu PIL initiated in 2017 concerning the issue of the availability of ICU beds and ventilator facilities in government hospitals in the city.

During the proceedings, amicus curiae advocate Ashok Aggarwal presented a newspaper report titled “Turned Away by three hospitals fourteen-year-old cancer patient dies.” The report was published by Hindustan Times on December 07.

Medical Dialogues team had also reported the incident where a 14-year-old girl suffering from blood cancer passed away at AIIMS on December 5 after being denied treatment at several Delhi hospitals. 

According to AAP leader Dilip Pandey, the girl was referred from the Delhi government’s Cancer Institute. Her relatives jostled around AIIMS and Safdarjung Hospital but couldn’t get a bed. As per the report, the minor’s family alleged that three government hospitals in Delhi refused treatment citing lack of medicines, beds or equipment.

However, AIIMS and Safdarjung Hospital had denied these allegations and termed them as “baseless”.

“Upon a reading of this report, it is apparent that medical infrastructure in the city of Delhi is inadequate and the number of hospital beds is insufficient. The demand is far in excess of the supply. The said report is taken on record,” the court observed.

The matter will now be heard on January 29, 2024.

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

https://medicaldialogues.in/pdf_upload/delhi-high-court-order-228767.pdf

Also read- AIIMS Nagpur Inaugurates Autopsy Complex

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DPP-4 inhibitors may Reduce Osteoporosis Risk among Diabetes patients

DPP-4 inhibitors may Significantly improve BMD and Reduce Osteoporosis Risk in Diabetes patients suggests a new study published in the Journal of Clinical Densitometry

Type 2 Diabetes Mellitus (T2DM) frequently coexists with osteoporosis and reduced bone mineral density (BMD). Dipeptidyl peptidase-4 inhibitors (DPP-4i), a class of antihyperglycemic agents, are commonly employed in T2DM treatment. However, the influence of DPP-4i on bone health remains unclear and debated. This meta-analysis is conducted to explore the relationship between the use of DPP-4i and changes in BMD, as well as the prevalence of osteoporosis among T2DM patients.

They conducted a comprehensive search in PubMed, Embase, and Cochrane Library and Web of Science databases for relevant studies published up until June 2023. Studies included in the meta-analysis were those investigating T2DM patients under DPP-4i treatment, and examining the effects on BMD and osteoporosis. Random-effects models and fixed-effect models were utilized to compute the pooled effects. Heterogeneity among the included studies was evaluated using I² statistics.

Results This meta-analysis incorporated a total of 10 studies, encompassing a combined population of 214,541 individuals. The results from this meta-analysis indicated an increase in BMD following DPP-4i usage (SMD 0.15, 95 % confidence interval 0.03-0.26). Additionally, the risk of osteoporosis was significantly reduced (OR 0.90, 95 % confidence interval 0.86-0.94) with very low heterogeneity, recorded at 0 % and 53.0 % respectively. No publication bias was detected in the funnel plot, and sensitivity analyses affirmed the stability of the study’s conclusions.

The results offer valuable insights into the positive impact of DPP-4i on bone health in T2DM patients, contributing to informed clinical decision-making. These findings may inform the development of more comprehensive T2DM management strategies that account for bone health.

Reference:

Huang L, Zhong W, Liang X, Wang H, Fu SE, Luo Z. Meta-Analysis on the Association Between DPP-4 Inhibitors and Bone Mineral Density and Osteoporosis. J Clin Densitom. Published online November 28, 2023. doi:10.1016/j.jocd.2023.101455

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Adenovirus Alert: ICMR cautions West Bengal Govt over deadly variant in kids

Kolkata: Indian Council of Medical Research (ICMR) has cautioned the West Bengal health department over the prevalence of a deadly variant of adenovirus among the children in Kolkata and its adjacent districts.

The revelation has been made following the recent findings of the ICMR- affiliated National Institute of Cholera and Enteric Diseases (NICED)- based on sample testing of persons for adenovirus. 

Also Read:Adenovirus-linked deaths underreported, West Bengal doctor claims children not getting beds

Of the 3,115 individuals tested for adenovirus, a total of 1,257 tested positive and the deadly variant was among 40 individuals, most of whom were children. Confirming the receipt of the alert, a senior official of the state health department said necessary precautions are being taken to tackle any emergency-like situation.

Adenovirus has taken an alarming shape in West Bengal at the beginning of the current financial year of 2023. As per the records of the state health department, as many 1,200 cases of adenovirus-positive persons were detected in the period between the end of December 2022 and the end of March 2023, mostly kids, and the total death figure being affected by it during that period stood at 19.

However, at that point of time there had been controversies over the death figure as doctors’ associations had accused the state health department of showing the figure as truncated.

At that point of time, the state government had even set up an eight-member task force to monitor cases of adenovirus-affected people and ensure proper treatment of them.

Medical Dialogues team had earlier reported that West Bengal was witnessing a spike in Adenovirus cases among children, a prominent doctor has slammed the state government for inadequate preparedness and lack of hospital beds for their treatment. Dr Manas Gumta, general secretary of the Association of Health Service Doctors, alleged that the West Bengal government “underreported” the number of deaths caused by infection of the virus. 

Also Read:Bengaluru registers surge in Adenovirus cases, health experts say no reason to worry

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Transcutaneous Auricular vagus nerve stimulation Effective in Treating Functional Dyspepsia

A recent study published in the The American Journal of Gastroenterology found that transcutaneous auricular vagal nerve stimulation (taVNS) is an effective therapeutic avenue for adults who suffer from functional dyspepsia (FD). FD is a condition marked by persistent upper abdominal discomfort that affects millions globally. This approach pf targeting the vagal nerve has remarkable effectiveness in modulating gastrointestinal motility, inflammation, and nociception.

The study randomly enrolled consecutive FD patients meeting Rome IV criteria. The patients were allocated to receive either 10-Hz taVNS, 25-Hz taVNS, or a sham treatment. Over a period of 4 weeks, participants underwent 30-minute sessions twice a day. The primary outcome measured was the response rate at week 4 that indicated a reduction of ≥5 points in the modified FD Symptom Diary score compared to baseline. Secondary outcomes included the rate of adequate relief and monitoring adverse events.

Among the total 300 patients enrolled, the participants in the V10 and V25 groups demonstrated significantly higher response rates (81.2% and 75.9%, respectively) compared to the sham group (47%). Both V10 and V25 groups also exhibited higher rates of adequate relief (85.1% and 80.8%, respectively) in contrast to the sham group (67%). Also, there was no statistically significant difference between the V10 and V25 groups in terms of response rates and adequate relief. The therapeutic effects of taVNS endured through weeks 8 and 12 of the follow-up period showed its lasting impact, while the adverse events were minimal and comparable across all groups (1%-3%).

This study is the first to demonstrate that a 4-week regimen of taVNS at 10 Hz or 25 Hz  which is both effective and safe for treating adult FD. The findings open new doors for non-invasive neuromodulation techniques in the context of gastrointestinal disorders that provides hope for those seeking relief from the burdens of functional dyspepsia.

Reference:

Shi, X., Zhao, L., Luo, H., Deng, H., Wang, X., Ren, G., Zhang, L., Tao, Q., Liang, S., Liu, N., Huang, X., Zhang, X., Yang, X., Sun, J., Qin, W., Kang, X., Han, Y., Pan, Y., & Fan, D. (2023). Transcutaneous auricular vagal nerve stimulation is effective for the treatment of functional dyspepsia: A multicenter, randomized controlled study. The American Journal of Gastroenterology. https://doi.org/10.14309/ajg.0000000000002548

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