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  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

 

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  Editorial …

18th July 2011, Monday

Can donors with high risk behavior donate blood?

It has been established that donors with high–risk behavior, such as those having multiple sex partners, intravenous drug users, commercial sex workers, men who have sex with men (MSM), lead to greater chances of spread of transmissible infections such as HIV and other blood–borne infections in the recipients.

Can men who have sex with men donate blood is a much debated issue. Some countries do not allow blood donations from men who have sex with men, while some have now started to accept. The United States, Canada including most countries in Europe have imposed a lifetime ban on blood donations from men who have sex with men. On the other hand, countries like Spain, New Zealand, and Australia accept blood from these donors but after a gap of one year since their last sexual contact. The CDC guidelines state that MSM cannot donate organ/s for five years after the last sexual encounter.

In February 2009, an article in the British Medical Journal discussed the advantages and disadvantages of whether MSM should be allowed to donate blood. The UK independent Committee on the Safety of Blood, Tissues, and Organs stresses upon the Blood Services to ensure that patients who require blood transfusion be given blood that is safe and also, they should not discriminate against donors without any cause. The right of recipients to receive safe blood should take priority over the asserted rights of donors to donate blood. And that the major duty of blood collection centres and transfusion services is to provide safe blood in sufficient quantities to the recipients. The policy excludes MSM from donating blood to protect the blood supply from infections transmitted through blood transfusions.

The National Blood Service of England and North Wales holds the view that accepting blood donations from individuals in groups that are at high risk of carrying HIV and other blood–borne diseases would cause an increase in the risk for transmission of these diseases, an unacceptable state of affairs. Data from the Health Protection Agency data suggest that men who have ever had oral or anal sex with men are at extreme risk of being affected by HIV.

All donors are screened for these blood–borne infections; however, there is a long "window" between infection and antibodies being detectable. This window period can be very long (months) for HIV. New Zealand and Spain uses tests for HIV RNA or for the p24 antigen, which have shorter windows. But these tests are not required for blood screening in the UK or in India. Also, tests often yield false–negative results and the accidental release of blood that tests positive, for transfusion.

If the condition of exclusion is removed or done away with, this can increase the risk of transfusion of HIV–infected blood by 5–fold. Also, changing deferral to 1 year from the last homosexual contact would increase the risk by 60%.

Those in favor of a lifetime ban on blood donation from MSM put forth the case that the risk for transmissible infection is too huge. The prevalence of HIV infection in MSM is 60–times greater than in the general population, 800–times greater than in first–time blood donors, and 8000 times greater than in repeat blood donors. Moreover, screening of blood is not often reliable due to the large window period.

However others argue in favor of only one year limit. Firstly because other high–risk groups such as drug users and female sex workers are allowed to donate blood after 1 year has passed from the last high–risk behavior. Secondly changing the criterion to 12 months from the last male–male sexual contact with a new partner would result in only 1 more unit of HIV–positive blood out of 1.5 crore units processed. Thirdly, Australia has a policy of deferring all high–risk categories for a period of one year and the American Association of Blood Banks since 1997 and American Red Cross since 2006 support 1–year deferral for all high-risk categories. The current view is that a one year behavior free interval can be considered for the donor.

All donors should be made aware about the various high risk behaviors e.g. heterosexual or homosexual promiscuity, intravenous drug abuse, etc. They should also be educated about the window period during which though they have not yet developed detectable antibodies, but may still be carriers of HIV infection. Donors, if they are practicing a high risk behavior, should be asked to self–exclude themselves from blood donation.

Donations from donors at high risk of infection with HIV or other blood–borne diseases should be excluded. This is of great importance. A Confidential Unit Exclusion (CUE) approach can be used in donors who practice high risk behavior but are under pressure to donate blood. The donor can indicate to the physician after the donation, in confidence, to dispose of the collected blood and not use it for any patient.

It is importance to keep in mind that while donors may fight for their rights to donate blood, the rights of the recipients take precedence. Recipients have the right to know the extent of safety of the blood they are receiving as well as the right to know the high risk behaviors of the donor.

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Dr KK Aggarwal
Group Editor in Chief

 
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Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Can donors with high risk behavior
donate blood?

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    Photo Feature (from the HCFI Photo Gallery)

National Conference on Insight on Medicolegal Issues

Dr Anil Goyal, was was felicitated at the National Conference on Insight on Medico legal issues.

 
Dr K K Aggarwal
 
    National News

National Conference on Insight on Medico Legal Issues – For the First time any conference was posted live on Facebook & Twitter

http://blogs.kkaggarwal.com/?p=1134
http://twitter.com/#!/search/medicolegal
https://www.facebook.com/pages/Insight–on–Medicolegal–Issues/247091668637671

An exclusive varsity for nursing courses

Bangalore: To fight chronic shortage of doctors, specially in rural areas, the government is planning to set up a dedicated university for paramedical and nursing courses. Medial education minister S A Ramdas has formed a 14–member committee, headed by Narayana Hrudayalaya chairman Dr Devi Shetty, to identify the location fo....more

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology: Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

 
    International News

(Dr Monica and Brahm Vasudev)

Mum was right about good posture!

Have you ever thought why your mother always told you to stop slouching and sit up straight’? She knows that poor posture not only makes a bad first impression, but can also make you physically weaker, according to a new research. Scott Wiltermuth, assistant professor of management organization at the USC Marshall School ....more

Shocking images don’t deter smokers

The shocking images of smokers’ lungs and tumors on cigarette packs hardly have any effect on the majority of addicts, according to a new research. 28 younger persons who had been smoking for quite a number of years and an equal number of non–smokers participated in the study. ....more

Google ‘killing’ our memory: Study

NEW YORK: Internet searches are making information easy to forget, as more people rely on their computers as a type of "external memory," a study of Harvard University students found. About 60 Harvard students were asked to type 40 pieces of trivia, such as "An ostrich's eye is bigger than its brain," into computers, and were ....more

Doctors frequently make mistakes with young athletes’ ECGs

An analysis of preparticipation screening electrocardiograms (ECGs) for young athletes suggests that cardiologists frequently make mistakes when interpreting the results. Such mistakes could lead to high ....more

 
    Fitness Update

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

Encouraging facts about organic food

All the facts, even if they don’t show a marked benefit for your health, encourage the consumption of organic food, as this produce has come into little or no contact with nitrates or pesticides, and appears to contain useful ....more

 
    Twitter of the Day

@DrKKAggarwal: #AJCC New MRI protocol refines CAD risk assessment–An MRI protocol for carotid plaque delivered a more clinically… http://fb.me/QvcWhiPw

@DeepakChopra: #CosmicConsciousness Desire is a wave of potential. Orgasm is transcendence into pure potential. Baby is the potential becoming actual

 
    Spiritual Update

The art of controlling anger

Cynicism is one of the recognized major risk factors for causation of coronary artery disease (blockages in the channels supplying blood to the heart). Anger, jealousy and irritability form the triad responsible for this. Anger is the enemy of peace, knowledge and devotion. According to Ayurveda ....more

 
    An Inspirational Story

(By Erma Bombeck – written after discovery of her terminal cancer)

If I had my life to live over

I would have talked less and listened more. I would have invited friends over to dinner even if the carpet was stained and the sofa faded. ....more

 
    Pediatric Update

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

Causes of hepatomegaly in neonates and children

Infections: TORCH infections, hepatitis viruses and EBV and malaria.
Metabolic: Galactosemia, lipid storage disorders, e.g. Gaucher’s disease. ....more

 
    Did You Know

(Dr Uday Kakroo)

In ancient times strangers shook hands to show that they were unarmed.

 
    Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Albumin

Albumin is an important protein present in the blood plasma. It prevents fluid from leaking out of blood vessels. Also it transports substances such as hormones, vitamins, drugs, and ions like calcium. Albumin ....more

 
    Contrary Proverbs

(Mr Vipin Sanghi)

Absence makes the heart grow fonder. BUT Out of sight, out of mind.

 
    IJCP Special

Dr Good Dr Bad

Sitaution: A patient with severe sepsis was advised recombinant human activity protein C. ....more

Make Sure

Situation: A 19–year–old boy came to the clinic with complains of rectal pain, tenesmus and bleeding per rectum. He gave the history of anorectal intercourse. Rectal culture was positive for Chlamydia trachomatis. ....more

 
    SMS of the Day

(Ritu Sinha)

In matters of self–control as we shall see again and again, speed kills. But a little friction really can save lives. Daniel Akst

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Doctors should totally avoid efforts to "cover up" any medical fact

  • Doctors should totally avoid special efforts to "cover up" alleged medical negligence or unintentional wrong doing or medical accident.
  • It is a standard accepted universal fact that "Medicine is not mathematics but is a science of uncertainty and an art of probability. One thing that makes medicine so difficult is that there is no such thing as the average man can understand the intricacies. We can only say the reading is ‘within the range of normal’. Medicine is a biological science with the variability inherent in body physiology with the variability inherent in biological matters.
  • Forensic medicine is not an exact science as a mathematical calculation hence while making a forensic opinion it is required to deliberate that unexpected results are produced due to biological variations in case to case, there is an element of uncertainty and absolute proof is a rarity in any medical care delivery.
  • Doctors should bear in mind the essential difference between probability and proof. They should be reasonable in their opinions and should not overstate the likelihood of a relationship between cause and effect.
  • The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds in the court of law. He should be aware of professional and scientific viewpoints which might differ from his, and should be familiar with the latest scientific literature in relation to the subject involved.
  • The doctor in the court of law may clarifying his testimony by means of photographs, maps, diagrams, charts, X–rays, skeletons, models, slides, films, tapes, etc., when they are properly verified.
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    Mind Teaser

Read this…………………

(Dr GM Singh)

The Infectious Disease Society of America has defined cystitis as:

a. More than 105 bacteria per millilitre
b. More than 103 bacteria per millilitre
c. Less than 105 bacteria per millilitre
d. Less than 107 bacteria per millilitre

Yesterday’s Mind Teaser: buckDROPet

Answer for Yesterday’s Mind Teaser: Drop in the bucket.

Correct answers received from: Dr.Suhail Khuroo, Dr. B. B. Aggarwal, Dr Suneera, Dr.K.Raju, Dr Neelam Ohri, Dr Rashmi Chhibber, Dr Chandresh Jardosh, Dr. Chetana Vaishnavi, Dr U Gaur , Dr Anil Bairaria, Dr. B.V.Sai Chandran, Dr Rakesh Bhasin, Dr. H.L. Kapoor, Dr Vijay Kansal

Answer for 16th July june Mind Teaser: I over–ate
Correct answers received from: Dr. H.L. Kapoor,  Dr.Deepali Chatterjee, Dr. B.V.Sai Chandran

Send your answer to ijcp12@gmail.com

 
    Medi Finance Update

(Dr GM Singh)

Who can nominate and be a nominee?

Only an individual investor can make a nomination. Kartas of HUFs, power of attorney holders, partnership firms and other non–individual investors cannot nominate. Similarly, nominees can only be individuals, including minors and NRIs. NRI nominees will be subject to exchange controls at the time of transmission of units. In case the nominee is a minor, the age of the minor and the details of the guardian have to be provided.

 
   Laugh a While

(Sudesh Nirwan)

Searching these keywords on Google ‘How to tackle the wife?’

Google search result, ‘Good day sir, Even we are searching’.

 
    Drug Update

List of Approved Drug From 01–01–2011 to 30–06–2011

Drug Name
Indication
DCI Approval Date
S (+) Etodolac 300mg + Thiocolchicoside 8mg Tablet
For the treatment of patients with acute painful musculoskeletal conditions
05.01.11
 
    Public Forum

(Press Release for use by the newspapers)

Get your Press release online (English/Hindi/Audio/Video/Photo)

Monsoon and Dengue at your doorstep

Trying to ward off mosquitoes with bed nets is of little use as the dengue mosquitoes are most active during the daytime said Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, President Heart Care Foundation of India. ....more

 
    Readers Responses
  1. Hello Dr Aggarwal, Here's a link to my story on the HT scoop about sex change of babies in Indore. It highlights how media cooks up news when there is none. Many doctors have also commented on the story. It would be great if it can be included in your newsletter so that more doctors get to read about it. Also, my concern is that doctors have to stand up if they get victimised by such media campaigns and challenge the fake stories. In this case, seven doctors are being threatened with cancellation of licences for no fault of theirs. Please read the story at
    http://www.thehoot.org/web/home/story.php?storyid=5379&mod=1&pg=1&sectionId=5&valid=true
    I am sure there won’t be any copyright problem if you do plan to use the story if you could just give credit to the hoot website. Regards, Manu Moudgil
 
    Forthcoming Events

September 30th to October 2nd, 2011, Worldcon 2011 – XVI World Congress of Cardiology, Echocardiography & Allied Imaging Techniques at The Leela Kempinski, Gurgaon (Delhi NCR), INDIA

from Sept 29, 2011: A unique & highly educative Pre–Conference CME, International & national icons in the field of cardiology & echocardiography will form the teaching faculty.

...more

………………………………………………………………

Medifilmfest (1st International Health Film Festival in Delhi)

October 14–23, 2011, As part of 18th MTNL Perfect Health Mela 2011
(Screening of films October 14–17, Jury Screening at Jamia Hamdard University Auditorium October 18–19, award winning films at TalKatora Stadium October 19–23, 2011)
Organized by: Heart Care Foundation of India, World Fellowships of Religions, FACES, Bahudha Utkarsh Foundation and Dept of Health and Family Welfare Govt of NCT of Delhi

...more

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