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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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Special issue – HIV/AIDS

  From the desk of editor in chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 
  Editorial ...

2nd December, 2010, Thursday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

HIV-AIDS revisiting 2010

  • We approach the fourth decade of HIV-AIDS devastating pandemic.
  • 30 million people have died of this disease.
  • More than 33 million people, including 2.5 million children, are now living with HIV.
  • In the 1980s, a young adult diagnosed with AIDS typically survived less than one year. Today, a similar person can expect to live up to age 70 or beyond if he or she is diagnosed with HIV infection early, has access to and receives appropriate therapy, and can tolerate the drugs and their side effects.
  • About 30 antiretroviral drugs and drug combinations are now available to suppress HIV infection.
  • The onslaught of new infections is still unacceptably high — 2.6 million in 2009 alone.
  • In 2010, NIH-supported researchers reported a number of important advances related to HIV prevention strategies. These strategies include vaccines, topical gels (microbicides) with anti-HIV activity, pre-exposure prophylaxis with antiretroviral drugs, and behavioral and social science interventions.
  • An effective vaccine is a critical goal in HIV prevention. A large study conducted in Thailand provided the first signs that a vaccine actually could prevent HIV infection, albeit in a relatively small
    percentage of those vaccinated.
  • In another major step toward development of an effective vaccine, NIH-sponsored researchers discovered several potent human antibodies that can stop most known HIV strains from infecting human cells in the laboratory.These antibodies could be used to design HIV vaccines, or could be further developed to treat HIV infection. The novel techniques used in this research may accelerate HIV vaccine research as well as the development of vaccines for other infectious diseases.
  • Another significant milestone for HIV prevention came in July 2010, when the Centre for the AIDS Programme of Research in South Africa (CAPRISA) reported that a vaginal gel containing the antiretroviral drug tenofovir reduced the risk of male-to-female sexual transmission of HIV by approximately 40 %. NIH funding provided the training and research infrastructure for this study.
  • Pre-exposure prophylaxis or PreP involves giving uninfected people antiretroviral drugs as a possible means of preventing HIV infection. Just last week, the published results of the NIH-sponsored iPrEx study indicated that a daily dose of an oral antiretroviral drug cut the risk of HIV infection by > 40 % among men who have sex with men (www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx).
    The study found even higher rates of effectiveness, up to 73 %, among those participants who adhered most closely to the PrEP regimen. Ongoing research will determine whether PrEP can work in other at-risk populations, including women and heterosexual men.
  • Other studies funded by NIH are exploring the possible benefits of frequent testing for HIV among high risk groups and linking those infected with the virus to care. The idea is that earlier detection might curb HIV transmission by enabling infected people to take steps to avoid passing the virus along to others. In addition, it may benefit infected people themselves because of growing evidence that a patient who receives early HIV treatment lives longer than those who begin treatment later in the course of their disease. (Source NIH)
Dr KK Aggarwal
Editor in Chief
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  HIV/AIDS Update

FAQs

1. What are other AIDS related illnesses?
Ans. Other AIDS related illnesses include Toxoplasma, Cryptococcus, PCP (Pneumocystis carinii pneumonia) and Organ Lymphoma.

2. When to do CD4 count?
Ans. CD4 count is a must in all patients at the time of diagnoses.

  • If < 350: treatment must be started irrespective of symptoms.
  • If the count is 350 – 500: treatment is started if there is AIDS–related illness.

3. Should viral load be tested in every patient?
Ans. Not at the time of diagnosis. But, after 6 months of treatment, viral load should be done as it helps to diagnose early resistances.

4. Should HIV treatment be started in pregnancy?
Ans. Yes, at 14 weeks if HIV test is positive.

5. How do we treat concurrent infections: HIV, Hepatitis B and Hepatitis C?
Ans. If a patient has concurrent infection, always treat all of them together; do not treat one particular infection.

HIV – The Rule of 3

Look for 3 infections
In any patient with high–risk behavior look for
1. Hepatitis B
2. Hepatitis C
3. HIV

Suspect HIV if
1. Unexplained fever, diarrhea, weight loss or anemia
2. Presence of opportunistic infection like discriminated TB
3. High risk behavior with or without sexually transmitted illnesses

Confirmation of HIV
3 testing using either rapid test or ELISA test from the same laboratory using 3 different types of kits to detect HIV antibodies. If even one of them is negative, one should not be labeled as HIV positive.

Window period
Once the virus enters the body it takes 3 weeks for the antibodies to get detected. This period of 3 weeks is called "Window Period". During this period the person is infectious, asymptomatic but antibodies are not detectable by available testing.

3 basic tests for the evaluation of HIV
1. Confirmation of HIV by 3 different kits
2. CD4 count
3. Viral load

3 methodologies of assessment
1. Clinical
2. Immunological with CD 4 count
3. Virological involving viral load, bDNA (branched DNA testing) and RT-PCR (reverse transcription-polymerase chain reaction)

Stability of treatment
A CD4 count is said to be stable on treatment when 3 consecutive tests have confirmed the same. These tests should be done at 3 weeks interval.

Viral Load
A significant change in viral load is when there is a 3–fold change.

3 ways of follow up
1. Total lymphocytic count/CD4 count
2. Viral load in the blood
3. Clinical suspicion and early diagnosis of opportunistic infections

CD count after immunization
After any routine immunization, one should not do CD count for 3 weeks.

 
  Quote of the Day

(By Dr GM Singh)

"Be nice to people on your way up, Because you are bound to need them on your way down. "

 
    Photo Feature (from the NET)

(Contributed by Dr Mukul Tiwari)

Weird X-rays

Bizarre X-rays

X-ray is one of the most useful medical advancements in history. But as these images show they can also reveal some of the most gruesome and bizarre results.  This X-ray shows a knife (upper right) in the chest cavity.

 
Dr K K Aggarwal
 
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

I–T Department introduces new number for taxpayers

Taxpayers will now have to procure a new number for filing returns and making any communication with the Income Tax Department. The unique Document Identification Number (DIN), on the lines of numbers like PAN (Permanent Account Number) and TAN (Tax Deduction and Collection Account Number), will be quoted on "every" income tax–related communication, including the returns to be filed next year for the financial year 2010–11. According to the new guidelines brought out by the Central Board of Direct Taxes (CBDT), the DIN will be mandatory "in respect of every notice, order, letter or any correspondence" with the department, by the taxpayers. "The DIN will be generated by the I–T Department and will be useful, essentially, for error–free filing of tax returns, claiming refunds and other communication with the department by the assesses," a senior Finance Ministry official said. (Source: The Hindu, Nov 29, 2010)

HC stays the MCI orders against the IMA

The Delhi HC has  granted stay against the MCI orders suspending the licence to practice for 6 months in respect of the President and Secretary of the IMA.

 
    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC, http://www.isfdistribution.com)

Obesity costs higher than what they appear

The United States spends $160 billion a year on obesity–related medical costs — twice what it paid only a decade ago, a McKinsey study indicates. Although the medical bill could double by 2018, McKinsey says the pandemic’s total economic burden is at least $450 billion a year in the U.S. — almost three times the direct medical costs. In other countries too, the indirect costs far exceed the direct ones.

(Dr Monica and Brahm Vasudev)

Binge drinking may increase risk for heart attack, heart disease

The French habit of drinking wine almost daily is less taxing to the heart than the Irish custom of downing an equivalent amount of beer on one or two nights a week, according to a study published Nov. 23 in the British Medical Journal. American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition on November 19, 2010.

Potassium citrate may help prevent, treat osteoporosis precipitated by western diet

The Western acidic diet contribute to the development of osteoporosis. A study has shown neutralizing diet–induced acid production with potassium citrate significantly and safely increased subjects’ bone density vs. placebo.

Childhood waist circumference correlated with pulse pressure and future risk of heart trouble

Children with a high waist circumference had significantly higher pulse pressures compared to children with a normal waist circumference. Body mass index did not show such a correlation.

Early urine test may help predict increased risk for pre–eclampsia

After analyzing urine samples obtained from patients before the 20th week of pregnancy, researchers found a panel of five proteins that correctly predicted pre–eclampsia with 92% accuracy.

Moderate drinking help kidney transplant patients

According to research presented during the American Society of Nephrology’s 43rd Annual Meeting and Scientific Exposition moderate drinkers were 67 % less likely to develop diabetes and 44 % less likely to die than those patients who abstained from alcohol, drank sporadically, or drank heavily. For study purposes, moderate drinking was defined as one or two drinks per day.

Weekend admissions increase risk of death in ESRD

People with end–stage renal disease (ESRD) who go into the hospital on weekends are 17% more likely to die than if they are admitted on a weekday, according to research presented during the American Society of Nephrology’s 43rd Annual Meeting and Scientific Exposition.

 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

A young couple married for last 4 months has visited an infertility specialist for treatment. They are under great stress. How should we counsel them?

Firstly we have to ascertain that there are no gross medical problems in the couple. We have to ensure that there is no problem in performing regular intercourse. The lady’s menstrual cycle should be regular. Once this is ascertained the couple should be reassured that the chances of getting pregnant per month in a healthy couple is about 15–20%. The fertile period should be explained which is usually between day 12 and day 18 of a regular menstrual cycle. Infertility will only be defined once they are unable to conceive after trying for more than a year. The couple should be able to return in 6 months if conception does not occur. A basic semen analysis may also be done.

For queries contact: banerjee.kaberi@gmail.com

 
    Pediatric Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

How do you clean a child’s teeth?

Keep your baby’s mouth clean by gently brushing the gums and teeth with water and a soft infant toothbrush or gauze. Once your baby has 8 teeth, you can start using a child–sized toothbrush for daily cleanings.
Brush your child's teeth 2 times a day. Start by using a fluoride-free toothpaste. When your child is able to spit and not swallow the toothpaste (usually around 2 to 3 years old), you should continue brushing his or her teeth using a pea-sized amount of fluoride toothpaste

 
    Medicolegal Update

Dr Sudhir Gupta, Asso Professor, Forensic Medicine & Toxicology, AIIMS

No Narcoanalysis without valid consent, rules Supreme Court of India

The most exhausting/frustrating and laborious parts of a criminal investigation are extracting information from an uncooperative accused persons and suspects by investigators in India as well as abroad. Since no individual should be forcibly subjected to any of these techniques of interrogation in question, whether in the context of investigation in any criminal cases or otherwise. The narcoanalysis test began to be used with a presumption that it provides a simply, nonviolent method of finding out the truth. In a world where until quite recently, torture was employed in criminal cases, perhaps narcoanalysis is a simple, civilized way of conducting criminal investigation.

  • The Supreme Court of India said that so–called narcoanalysis, brain mapping and polygraph tests cannot be conducted on any person without their consent.
  • The apex court further said the confession of guilt during the course of the tests can’t be treated as evidence in court.
 
  Important Judgement

In the High Court of Judicature at Bombay Bench at Aurangabad Writ Petition No. 3090 OF 2009

Dr. Pravin Rajendra Suryawanshi and others Vs. The union of India and others

DATE: 12TH AUGUST, 2010.
PER COURT:

  1. Heard learned counsel for the parties.
  2. We have perused the notification issued by the Ministry of Health and Family Welfare, New Delhi, dated 20th February, 2009 and affidavit in reply filed by respondent No.6The Maharashtra University of Health Sciences, Nashik, along with "Annexures R1 to R4". We have also perused the communication made by Dean, MGM Medical College, Aurangabad, dated 21.09.2008. The petition is pending since April 2009. Notices were issued. The petitioners were protected under the order dated 15th June, 2009.
  3. Considering the submissions advanced by the learned counsel for the parties, documents placed on record, prima facie we find that the petitioners have made out a case for consideration of this Court. Hence, following order:

Order

  • Rule.
  • The petitioners eligible, and entitled to discharge their duties as Lecturers/Professors and are entitled to the benefits accrued in accordance with law, until further orders.
  • Liberty is granted to the contesting parties to move, in case, there is any change in the circumstances or policy of the Central Government or M.C.I.

Sd/Sd/ (K.K. TATED, J.) (NARESH H. PATIL, J.)

 
    DMC order

DMC/DC/F.14/Comp.647/2010/ 21st July, 2010

Delhi Medical Council makes the following observations:–

It is noted that Dr. BSS is registered with DMC with MBBS and DNB (Family Medicine) qualification. However, in the letter pad he has been suffixing to his name qualification of MBBS, DNB (M.D.), Family MED (Diplomate National Board of India), and in the letter head of medical certificate in question, he has been suffixing MBBS, DNB (M.D.), D.N.B. Final (MED), D.N.B. Final (PAED), DNB (Family Medicine) (Diplomate National Board of India), in violation of Regulation 1.4.2. of Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations, 2002 which mandates that "Physicians shall display as suffix to their names only recognized medical degrees or such certificates/diplomas and memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements". The Delhi Medical Council observes that there is no recognized registerable medical qualification with the nomenclature DNB (M.D.) or D.N.B. Final (MED), D.N.B. Final (PAED), (Diplomate National Board of India). The Executive Committee, therefore, directs Dr. BSS to refrain, forthwith, from suffixing incorrect and misleading nomenclature of degrees to his name.

 
    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

Hypokalemia

  • Hypokalemia or decrease in serum potassium is seen usually in states characterized by excess K+ loss, such as in vomiting, diarrhea, villous adenoma of the colorectum, certain renal tubular defects, hypercorticoidism, etc.
  • Redistribution hypokalemia is seen in glucose/insulin therapy, alkalosis (where serum K+ is lost into cells and into urine), and familial periodic paralysis.
  • Drugs causing hypokalemia include amphotericin, carbenicillin, carbenoxolone, corticosteroids, diuretics, licorice, salicylates, and ticarcillin.
 
ijcpgroup
ijcpgroup
nuspera
IJCP
Docconnect
    Medi Finance Update

Personal Accident Individual

Exclusion

  • Cost of spectacles, contact lenses, and hearing aids.
  • Any dental treatment or surgery which is a corrective, cosmetic or aesthetic procedure, including wear and tear, unless arising from disease or injury and which requires hospitalization for treatment
 
    Drug Update

List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications under Section 26a of Drugs & Cosmetics Act 1940 by the Ministry of Health and Family Welfare

List of drugs prohibited for import

Fenfluramine and Dexfenfluramine

 
    IMSA Update

International Medical Science Academy (IMSA) Update

The US Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends a supplemental dose of PCV13 for healthy children aged 14 through 59 months who were fully immunized with PCV7 and for children younger than 71 months with medical conditions that increase the risk of pneumococcal disease who were fully immunized with PCV7 and 23-valent pneumococcal polysaccharide vaccine.

 
    IJCP Special

Dr Good Dr Bad

Situation: A smoker wanted to know his risk of lung cancer after quitting.
Dr Bad: It will become zero within a month.
Dr Good: There will always be some risk.
Lesson: In people who quit smoking, risk of lung cancer gradually falls for 15 years before it levels off and remains about twice that of someone who never smoked.

Make Sure

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for C. pneumoniae infection.
Reaction: Remember to start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10-14 days reverses the increased risk of atherosclerosis. Sero-epidemiological studies have shown a strong association between C. pneumoniae infection and atherosclerosis in patients with cardiovascular disease.

 
    Lighter Side of Reading

An Inspirational Story

The Forwarding 7%

Written by Regina Brett, 90 years old, of the Plain Dealer, Cleveland, Ohio

To celebrate growing older, I once wrote the 45 lessons life taught me. It is the most requested column I've ever written. My odometer rolled over to 90 in August, so here is the column once more.

  1. Life isn't fair, but it's still good.
  2. When in doubt, just take the next small step.
  3. Life is too short to waste time hating anyone.
  4. Your job won't take care of you when you are sick. Your friends and parents will. Stay in touch.
  5. Pay off your credit cards every month.
  6. You don't have to win every argument. Agree to disagree.
  7. Cry with someone. It's more healing than crying alone.
  8. It's OK to get angry with God. He can take it.
  9. Save for retirement starting with your first paycheck.
  10. When it comes to chocolate, resistance is futile.
  11. Make peace with your past so it won't screw up the present.
  12. It's OK to let your children see you cry.
  13. Don't compare your life to others. You have no idea what their journey is all about.
  14. If a relationship has to be a secret, you shouldn't be in it.
  15. Everything can change in the blink of an eye. But don't worry; God never blinks.
  16. Take a deep breath. It calms the mind.
  17. Get rid of anything that isn't useful, beautiful or joyful.
  18. Whatever doesn't kill you really does make you stronger.
  19. It's never too late to have a happy childhood. But the second one is up to you and no one else.
  20. When it comes to going after what you love in life, don't take no for an answer.
  21. Burn the candles, use the nice sheets, wear the fancy lingerie. Don't save it for a special occasion. Today is special.
  22. Over prepare, then go with the flow.
  23. Be eccentric now. Don't wait for old age to wear purple.
  24. The most important sex organ is the brain.
  25. No one is in charge of your happiness but you.
  26. Frame every so-called disaster with these words 'In five years, will this matter?'
  27. Always choose life.
  28. Forgive everyone everything.
  29. What other people think of you is none of your business.
  30. Time heals almost everything. Give time time.
  31. However good or bad a situation is, it will change.
  32. Don't take yourself so seriously. No one else does.
  33. Believe in miracles.
  34. God loves you because of who God is, not because of anything you did or didn't do.
  35. Don't audit life. Show up and make the most of it now.
  36. Growing old beats the alternative -- dying young.
  37. Your children get only one childhood.
  38. All that truly matters in the end is that you loved.
  39. Get outside every day. Miracles are waiting everywhere.
  40. If we all threw our problems in a pile and saw everyone else's, we'd grab ours back.
  41. Envy is a waste of time. You already have all you need.
  42. The best is yet to come...
  43. No matter how you feel, get up, dress up and show up.
  44. Yield.
  45. Life isn't tied with a bow, but it's still a gift."

Its estimated 93% won't forward this. If you are one of the 7% who will, forward this with the title '7%'. I'm in the 7%. Friends are the family that we choose.

………………………………

Mind Teaser

Read this…………………

JJJJOOOOHHHHNNNNSSSS  

Yesterday’s Mind Teaser: " little LARGE little LARGE little little little LARGE "
Answer for yesterday’s Mind Teaser:
"A little on the large side"

Correct answers received from: Dr Anurag Jain, Dr Chandresh Jardosh, Dr Muthumperumal Thirumalpillai

Answer for 30th November Mind Teaser: "An afterthought"
Correct answers received from: Dr Muthumperumal Thirumalpillai, Dr Vijay Kansal, Dr Kalpana Mohan, Dr K P Rajalakshmi, Dr Meera Rekhari

Send your answer to ijcp12@gmail.com

………………………………

Laugh a While
(Contributed by Dr G M Singh)

Aspirin
A man walks into the pharmacy and asks the pharmacist, "Do you have any acetylsalicylic acid?" "Do you mean aspirin?" asks the pharmacist. "That's it! I can never remember that word!"

 
    Readers Responses
  1. Dear Sir, Emedinews always keeps me updated in spite of my busy schedule. Thanks so much for your endeavor. Yesterday's special edition on HIV/AIDS was very informative and gave a quick recap of the subject. I particularly found the Rule of 3 to be very interesting....a very innovative way to remember important points about the disease. Regards: Dr Prachi
 
    Public Forum

(Press Release for use by the newspapers)

Campaign 100: Just compress it

Gasping, gurgling, moaning or any other noisy breathing increases the chances for survival when someone is suffering sudden cardiac arrest. Gasping is a sign that there's still blood flow to the brain, and the person can be saved even though the heart has stopped said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

First aid involves starting compressing the chest, 100 times a minute.

A Phoenix study of 1,218 cases published in Circulation showed better survival when abnormal breathing -- gasping -- was noted. After gasping one may have 4-5 minutes before the breathing stops and these 4-5 minutes are crucial. Gasping is present in 40% of the cases of sudden cardiac arrest. After timely CPR, as many as 39 percent of the gaspers will survive as compared to 9.4 percent of the non-gaspers. If no CPR is done, 21.1 percent for gaspers and 6.7 percent of non-gaspers survive.

 
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 08–09, 2011.

January 08, 2011, Saturday, 6 PM – 9 PM – Opening Ceremony, Cultural Hungama and eMedinewS Doctor of the Year Awards. For registration contact – emedinews@gmail.com

January 09, 2011, Sunday, 8 AM – 6 PM – 2nd eMedinewS revisiting 2010, A Medical Update

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