Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

J&J to pay Rs 74.5 lakh to the first victim of faulty hip implant

If the faulty device had not been found, then the entire blame would have gone to the doctors

The Central drug regulator, DCGI, has instructed Johnson and Johnson (J&J) to pay a compensation of over Rs 74.5 lakh to the first patient from Maharashtra affected by the companyís faulty hip implants.

The State-level committee, headed by Dr RK Arya Director Sports Injury Centre at Safdarjung hospital looked into the patientís issue and forwarded its recommendation to the central expert committee along with various documents including the disability certificate issued by a medical authority in Mumbai. The compensation amount was arrived at by a committee through a formula that was devised to calculate the expenses in each patientís case.

J&Jís Articular Surface Replacement (ASR) hip implant had failed in certain patients, allegedly leading to leaching of metals in the patientsí blood, causing the hip joint to deteriorate. In 2010, the company had announced a voluntary recall of 93,000 ASR hip implant systems across the world, saying 12% of them had failed over five years.

The company has announced plans to pay at least $2.47 billion, and has since settled many lawsuits while others remain stuck in litigation at various levels. Of the over 4,000 patients fitted with the ASR implant in India, just about 844 have been traced by the company till date.

We all need to inform the patients about the possibility of device failure or malfunction so that the fault does not come on the doctors, in case this happens as it did in this case.

And, in this case if the fault had not been traced to the implant itself, then consumer complaints would have been filed against doctors for medical negligence.

All doctors should report any malfunction of any device or disposable in the interest of the profession.

Morning Medtalks with dr KK Aggarwal

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Management of acute heart attack

1.ECG diagnosis should be done within 10 minutes of suspected heart attack

2.Activate heart attack network including cath lab

3.Single-call patient transfer protocols

4.In-field bypass of non-PCI centers

5.Minimize first contact to device time for patients who are treated with primary PCI

6.Minimise first contact to thrombolysis time for those who are treated with fibrinolysis and then transfer early to PCI enabled center

7.Written, updated heart attack management protocols

8.Audit treatment delays, reperfusion rates, and false activation rates

9.Maximum contact to device time of =120 minutes (ideal =90)

10.Consider fibrinolytic therapy if this timeline cannot be achieved.

11.Door-inĖdoor-out time =30 minutes when transferring to another hospital

12.Fitts contact to needle time =30 minutes when fibrinolysis is considered

13.Routine rapid transfer to PCI centers after fibrinolysis, immediate PCI for patients with failed reperfusion, and routine angiography with or without PCI within 24 hours after successful fibrinolysis

14.When access to cardiac catheterization is available within 120 minutes of first contact do not go for fibrinolysis or a combination of fibrinolysis and glycoprotein inhibitor

15.In heart attacks with cardiogenic shock and multivessel disease, non-culprit lesion PCI is not recommended during primary PCI

16.Routine upfront thrombectomy is not recommended during primary PCI

17.Transradial access is better than transfemoral access in primary PCI provided it can be performed by an experienced radial operator.

18.The use of unfractionated heparin is recommended for procedural anticoagulation in primary PCI.

19.The use of bivalirudin is preferred over UFH or low molecular-weight heparin for procedural anticoagulation in primary PCI who have a history of heparin-induced thrombocytopenia or a very high risk of bleeding.

20.Fondaparinux is not recommended for procedural anticoagulation in primary PCI.

21.It is not recommended that IV or intracoronary GPI be routinely used for primary PCI.

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Feeling tired and sleepy despite drinking several cups of coffee? Go to a closed room, stretch your shoulder and scream out loud. Repeat this a few times and you will feel energetic and fresh. This is known as power posture therapy and has become popular over the years.

While there are various holistic therapies for the treatment of depression, stress and anxiety, wellness experts are constantly looking at unique ways to approach lifestyle ailments. Power posture is one such cure. However, there are different ways to use this technique. It can be done with or without shouting or by forceful action of hands, legs and other body parts. But each action should be accompanied with positive thoughts.....read more

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