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Views : Kugan’s death: Myocarditis highly unlikely

Posted in Uncategorized by malaysiasms on April 11, 2009

This is a glaring example  of how the poor and marginalised can never get justice in Malaysia.

Malaysiakini

A Sad Doctor

I refer to the Malaysiakini report Kugan’s case: Unsettling questions remain and Blunt force trauma did not cause Kugan’s death.

Health Ministry Director-General Dr Mohd Ismail Merican may have breached the very medical ethics he is entrusted to protect as president of the Malaysian Medical Council.

custody1His press conference is clothed in medical terminology to confuse the layman as to the cause of A Kugan’s death and to try to shift the blame to somewhat natural causes. As a result, the perpetrators may escape the serious charge of murder.

Worse still he implies Dr Prashant S Ambekar relatively lack of experience had contributed to mistakes in his postmortem findings but this without calling Prashant to explain.

The anonymous armchair panel which he secretly constituted did not see the body or the wounds. They had only two postmortem reports to dwell on. Let me explain in simple language what it is all about.

Pulmonary edema (layman terms water in the lungs ) is the end result when the water collects in the lungs, literally clogging it and patient does not get enough oxygen to sustain his life and dies.
This will happen commonly in two situations.

1. The heart cannot pump the blood out of the lungs; or

2. Too much water is retained in the body when the kidney does not function and the heart is unable to cope with the extra load and it get fatigued. Doctors called it heart failure.

The first postmortem report by Dr Abdul Karim Tajuddin which certified death due to pulmonary edema was correct and it was also the finding of Prashant. But Karim did not go further than that; he did not ascertain why the patient had pulmonary edema.

Prashant did a more comprehensive postmortem and reported that the kidney tubules were almost completely blocked with myoglobin (a protein from muscle). This normally happens when the muscle breaks down due to crush injuries or extensive blunt trauma to the body.

It’s not necessary to have organ damage or skeletal fractures. Moreover, Prahant did not find anything abnormal with the heart; neither did Kugan have a heart attack or an infection.

Merican agrees that nothing was abnormal with the heart but claimed Kugan may have had myocarditis.

Myocarditis is an infection of the heart caused mostly by viruses and in seventy percent of those who die of myocarditis, postmortem findings can be negative so it can be applied conveniently to Prashant’s findings.

Myocarditis is relatively rare in Malaysia and I have seen less than five cases in healthy adults for the last 25 years in practice.

Studies in the US have shown that only 1.3% of sudden death is attributable to myocarditis, while 38% die to breakdown of muscles (rhabdomyolysis) after blunt trauma.
 
This is a glaring example  of how the poor and marginalised can never get justice in Malaysia.

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