HCFIe-Medinews A Service of IJCP Publications Pvt. Ltd.WFR
Address: 39 Daryacha, Hauz Khas Villege, New Delhi, India. e-Mail: drkk@ijcp.com , Website: www.ijcpgroup.com

Dr K K Aggarwal

Dr KK Aggarwal
Dr BC Roy Awardee
Sr Physician and Cardiologist,
Moolchand Medcity
President, Heart Care
Foundation of India
Gp Editor-in-Chief,
IJCP Group
Delhi Medical Council
Director, IMA AKN Sinha Institute (08-09)



1st December Tuesday 

Dear Colleague,


 Avoid unnecessary injections, finger prick blood donation camps and beware of new kidnappers weapon: a syringe with HIV, Hepatitis B and hepatitis C positive blood

Tuesday 1st December 2009 New Delhi: DMA released HIV AIDS points if importance in a session moderated by DR KK Aggarwal President Heart Care Foundation of India. The experts were Dr S C Sharma Willington Hospital, Dr Nalin Nag Apollo Hospital, Dr Naresh Chawla and DR Ashwini Dalmiya.

1. Over 200 diseases can be transmitted from exposure to blood; the most serious infections are hepatitis B virus, hepatitis C virus and HIV. HIV, Hepatitis B and Hepatitis C all can be transmitted through blood and blood products and or by sexual route. Though the prevalence of HIV is only 0.3% in the general population the same of hepatitis CV is up to 5%.

2. New weapons of war are HIV kanya, HIV blood transfusions after kidnapping, HIV positive syringes for extraction of money and infected hepatitis C, hepatitis B and HIV combined blood (most deadly weapon ever possible).

3. The average risk of sero conversion after a needle stick injury is about 3 per 1000 with no prophylaxis. This risk is reduced at least 80 percent when post exposure prophylaxis (started within 3 hours) is administered in a timely fashion.

4. Infection is high with hollow needle, high bore needle and if the needle is inserted in the artery or the vein.

5.  Prior to the widespread use of hepatitis B vaccine among health care workers, the prevalence of hepatitis B virus markers was higher among health care workers  than the general public. In 1991 the guidelines came that all health care workers be offered hepatitis B vaccine. This strategy has been highly successful in reducing hepatitis B virus infection among health care workers with a 95 percent decline in the incidence of hepatitis B infection among them.

6. 30% of HIV positive patients are also co infected with HCV and 10% with chronic hepatitis B infection.

7.  IV drug users acquire hepatitis C virus before HIV infection while men who have sex with men typically are infected with HIV before they acquire hepatitis C virus infection.

8.  Hepatitis B virus is the most infectious of the three blood borne viruses. It  gets transmitted by percutaneous and mucosal exposures and HUMAN BITES.  Hepatitis B can be transmitted by FOMITES such as FINGER STICK BLOOD SUGAR CHECK, multi dose medication vials, jet gun injectors, and endoscopes.

9. Hepatitis B virus can SURVIVE ON COUNTER TOPS FOR SEVEN DAYS and remain capable of causing infection.

10. The prevalence of HCV infection among health care worker is similar to that of the general population. Testing of health care workers for hepatitis c virus HCV should be performed after needle sticks, sharp injuries, mucosal, or non intact exposure to hepatitis C virus positive blood.

11.  The average incidence of sero conversion to hepatitis C virus after unintentional needle sticks or sharps exposures from an hepatitis C virus positive source is 1.8 percent (range, 0-7 percent).

12. Transmission of hepatitis C virus can occur from infected fluid splashes to the conjunctiva

13. Hepatitis C virus can survive on environmental surfaces for up to 16 HOURS.

14.  The first step after being exposed to blood or bodily fluids is to wash the area well with soap and water. EXPRESSING FLUIDF BY SQUEEZING the wound will not reduce the risk of blood borne infection.

15  Give Hepatitis B Vaccine to all unvaccinated persons after exposure to blood.  If the exposed blood is positive for HBV and the exposed person is unvaccinated treatment with hepatitis B immune globulin is recommended.

16. As per CDC do not use preventive post exposure HIV drugs when exposure occurred more than 72 hours prior or when intact skin was exposed or when the bodily fluid is urine, nasal secretions, saliva, sweat, or tears, and is not visibly contaminated with blood.

17.  Give 2 to 3 drugs for 4 weeks

18.  PRECAUTIONS are important during the first three months after exposure, when most people who are infected with HIV become antibody positive.

19.  Precautions include abstaining from sexual intercourse or using condoms every time.

20. Condoms reduce, but do not completely eliminate, the chances of transmitting hepatitis B, hepatitis C, or HIV infection to others.

21. Women exposed to blood or body fluids from a person known to be infected should avoid becoming pregnant during this time.

22. Individuals exposed to HIV infected fluids should not donate blood, plasma, organs, tissue, or semen during the follow up period.

23.  Breast feeding women should stop breastfeeding due to the risk of passing the infection to their child.

24. On Saturday, April 4 09, 52 year old Johnson Aziga was found guilty of murder by a Montreal jury for not sharing his HIV status with sexual partners, two of whom later died from AIDS-related illnesses. According to prosecutors, this marks the first case in Canada, and possibly the world, where  an HIV positive individual has been convicted of murder for failing to inform partners of his status. Aziga, a former government research analyst from Uganda, was found guilty. He infected seven women; four other partners did not contract the virus. The Crown argued that Aziga infected the women with slow acting poison that destroyed immune system: leading to their cancers and to their deaths. The sex was not considered consensual because the women were not aware he was HIV positive.

 Dr KK Aggarwal



Aspirin May Prevent Prostate Cancer Recurrence
The use of anti clotting drugs, including aspirin, appears to lower the odds that cancer will recur in men undergoing radiation treatment for prostate cancer. "We found that taking an anticoagulant lowers the risk [of recurrence] by almost half" says Kevin S. Choe, MD, PhD, a radiation oncologist at the University of Chicago. The anti clotting medications, or anticoagulants, studied were Coumadin, Plavix, and aspirin.

Oral Contraceptives May Help Treat Asthma
Treatment with oral contraceptives may benefit premenopausal women with asthma, even if their asthma symptoms are not strongly linked to their monthly menstrual cycles. In a small but rigorously designed study, researchers from the University of Alberta confirmed that fluctuating levels of the sex hormones estrogen and progesterone have a direct impact on markers of airway inflammation.

Reducing childhood deaths from diarrhoea
The report, Diarrhoea: why children are still dying and what can be done, lays out a seven point plan that includes a treatment package to reduce childhood diarrhoea deaths and a prevention strategy to ensure long term results. The seven specific points are:
1. fluid replacement to prevent dehydration;
2. zinc treatment;
3. rotavirus and measles vaccinations;
4. promotion of early and exclusive breastfeeding and vitamin A supplementation;
5. promotion of hand washing with soap;
6. improved water supply quantity and quality, including treatment and safe storage of household water; and
7. community wide sanitation promotion.

Treatment with ORS and zinc tablets
WHO and UNICEF recommend treating diarrhoea with low osmolarity ORS and zinc tablets, which decrease the severity and duration of the attack. These treatments are simple, inexpensive and life saving. Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost effective interventions for reducing child deaths from this neglected killer.

Improving water and sanitation
Yet despite the known benefits of improving water supply and sanitation, some 88 per cent of diarrhoeal diseases worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people were not using improved sanitation facilities, and nearly 1 in every 4 people in developing countries was practicing open defecation.

Early PSA Rise Predicts Mortality
A rising PSA value within 18 months after radiation therapy predicts an increased risk of prostate cancer metastasis and mortality, data from a large retrospective study showed.  Early biochemical failure predicted more than a 25% decline in five year survival compared with failure after 18 months. In a multivariate analysis, time to PSA failure trumped Gleason score, tumor stage, age, and PSA doubling time as a predictor of cancer specific mortality, according to a presentation at the American Society for Radiation Oncology meeting.

Now we can use the simple criteria from this study, which is widely available for anyone who has PSA testing, to identify men who have a greater than 25% chance of dying from prostate cancer in the next five years, Dr  Mark K. Buyyounouski,  of Fox Chase Cancer Center in Philadelphia, said in a statement.

Antibiotics Top Cause of Drug Induced Liver Failure
Antimicrobial agents are the most common cause of drug induced liver failure, with most cases ending in death or transplant.
A prospective analysis of some 1,200 cases of acute liver failure found that half of those caused by drugs were associated with anti tuberculosis, antifungal, sulfa drugs, and other antibiotics, according to Adrian Reuben, MBBS, of the Medical University of South Carolina in Charleston. Herbal supplements, anticonvulsants, and statins also were relatively common causes of drug induced liver injury (DILI).

Only 27% of DILI patients in acute liver failure recovered spontaneously, Reuben said. About 40% had successful transplants, while another 30% died either waiting for transplant or were too ill to be wait listed.   Overall, 66% of patients with DILI associated liver failure survived.

Vasculitis in Children and Adolescents: Clinical Presentation, Etiopathogenesis, and Treatment

The childhood vasculitides are a group of diseases affecting small to large blood vessels. The two most common conditions are Henoch Schonlein purpura (HSP) and Kawasaki disease (KD). HSP is diagnosed on the basis of typical clinical findings and is mostly a self limiting disease. KD is the most common vasculitis in infants and the development of coronary artery aneurysms is the major complication. Early treatment with intravenous immunoglobulin and aspirin (acetylsalicylic acid) is required to minimize this risk. All other vasculitides are very rare in children and include anti neutrophil cytoplasmic autoantibody (ANCA) associated vasculitis, polyarteritis nodosa and Takayasu disease.
The etiology of all these vasculitic diseases is generally unknown and, therefore, no specific treatment is available. The more rare vasculitides are generally much more severe, often needing treatment with high doses of corticosteroids and immunosuppressant agents such as cyclophosphamide, azathioprine, and mycophenolate mofetil.

Are alcohol drinks that contain caffeine safe.

US FDA has given 30 manufacturers of such drinks 30 days to show the agency why their products are safe and under what authority they think they can sell those products. The agency has asked manufacturers of caffeinated alcoholic beverages to provide FDA with the data necessary to demonstrate that caffeine can be safely and lawfully added to alcoholic beverages, FDA Principal Deputy Commissioner Dr. Joshua Sharfstein said during a morning teleconference. Currently, the FDA has approved caffeine only as an addition to soft drinks. The consumption of caffeinated alcoholic beverages has been associated with increased risk of serious injury to oneself and others as a result of driving while intoxicated, sexual assault and other dangerous behavior. The concern is that caffeine stimulates people to drink more.

Dark Chocolate May Improve Metabolic Stress Response
Eating a few pieces of dark chocolate every day may improve the metabolic response of people who report feeling highly stressed. Anxiety and stress can cause various changes in physical and emotional states in humans, and in the longer term can also lead to serious health consequences. Consuming two portions of 20g of dark chocolate every day for up to 14 days has been shown to reduce the amount of stress hormone cortisol and catecholamines in the urine. 


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1. Dr. Jayaseelan Past National President IMA passed away on 27.11.09 morning. May his soul rest in peace

2. Father of Dr Alok Bhandari (WT branch ) passed away. May GOD give the courage to the family to bear the loss. (You can send condolance sms at 9811081892)

 Letters to the editor

Does tanning in a tanning bed cause less damage than natural sunlight? DR. G M Singh

emedinews comments: It does not matter whether you get it from the sun or from artificial sources such as sun lamps and tanning beds. Ultraviolet radiation is linked to skin cancers (including basal cell carcinoma, squamous cell carcinoma, and melanoma) and to other sorts of skin damage, particularly premature skin aging (photoaging).  UV radiation is one part of the spectrum of light that reaches the earth from the sun. At the UV end of the spectrum, the wavelengths are too short to be visible to the naked eye. They range in length from 100 to 400 nanometers (nm, or billionths of a meter) and are classified, from the longest to the shortest, as UVA (320 to 400 nm), UVB (290 to 315 nm), and UVC (100 to 280 nm). UVA rays, which penetrate deep into the skin, are responsible for tanning. UVB rays damage superficial skin cell layers, causing sunburn. UVC rays, the shortest, are considered harmless, since most UVC light is absorbed by ozone in the upper atmosphere and thus does not reach the earth. Of the UV solar radiation that does reach the earth, up to 95% is UVA, and about 5% is UVB. For years, scientists believed UVB rays were the most harmful, because sunburn is linked to melanoma, the deadliest form of skin cancer. But since the late 1980s, we've learned that UVA rays also increase skin cancer risk, and they are the main cause of photoaging.

Tanning beds use fluorescent bulbs that emit mostly UVA, with smaller doses of UVB. The UVA radiation is up to three times more intense than the UVA in natural sunlight, and even the UVB intensity may approach that of bright sunlight. In 2002, a National Cancer Institute study found that use of an indoor tanning device was associated with a 50% increase in the risk of basal cell carcinoma and a more than 100% increase in the risk of squamous cell carcinoma. In 2007, the International Agency for Research on Cancer concluded that people who started indoor tanning before age 35 had a 75% greater risk of developing melanoma. Since 2003, UV radiation from any source has been listed by the U.S. National Toxicology Program as a known carcinogen (cancer causing substance). Currently, many government agencies caution against tanning. Meanwhile, the tanning industry makes claim that tanning is a good way to stimulate production of vitamin D, a hormone that is essential to bone health and has been linked to a reduced risk for several cancers. But you can get all the vitamin D you need in a daily vitamin D supplement, which offers all the benefits without any of the risks to your skin. (Source: Harvard Women's Health Watch)


Is there a limit on Lantus dose (e.g., to divide the dose if more than 100 units)? Dr. G M Singh


emedinews comments: There are studies where it has been advised ton be given in divided doses.

Dear Sir: Kindly let me know whether being allopathic doctor can prescribe Ayurveda drug to our patient or still will be quack practice as noted by Honorable Supreme Court. I will be highly thankful for details if you please provide in this regard. DR S Paul; spaulpat@gmail.com
Emedinews comments: when ever you want to prescribe any drug, go to PUBMED and study it. If clinical trials are there and the drug has been researched the allopathic way, it no more remains a pure Ayurveda or homeopathic tincture drug and can be prescribed.

Funny clinical notes (Dr. Minakshi)
The patient is tearful and crying constantly. She also appears to be depressed.

Clinical tip
Vitamin A is required for epithelial and bone formation, cellular differentiation and immune function. Altern. Med. Rev. 2004 Nov.;8(4):359 377.

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medinews: revisiting 2009

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