FIRST NATIONAL DAILY MEDICAL NEWSPAPER OF INDIA
28th November Saturday
Avoid unnecessary injections, finger prick blood donation camps and beware of new kidnapper's weapon: a syringe with HIV, Hepatitis B and hepatitis C positive blood
1. 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 their immune systems: leading to their cancers and to their deaths. The sex was not considered consensual because the women were not aware he was HIV positive.
2. 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%.
3. A new weapon of war, HIV kanya (HIV positive female), HIV blood transfusions after kidnapping, HIV positive syringes for extraction of money. Infected hepatitis C, hepatitis B and HIV, combined blood is the most deadly weapon ever possible.
4. The average risk of sero conversion after a needle stick injury is about 3 per 1000 with no prophylaxis. It is estimated that this risk is reduced at least 80 percent when post exposure prophylaxis (started within 3 hours) is administered in a timely fashion. 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. Recent studies suggest that 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. Hepatitis B virus is the most infectious of the three blood borne viruses. It gets transmitted by percutaneous and mucosal exposures and human bites. It has also been transmitted by fomites such as finger stick devices used to obtain blood for glucose measurements, multi dose medication vials, jet gun injectors, and endoscopes. The virus can survive on counter tops for seven days and remain capable of causing infection. Irecently saw an elderly male with hepatitis B where the source was a finger prick sugar detection camp.
7. 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. 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). Transmission of hepatitis C virus from blood splashes to the conjunctiva has been described. Hepatitis C virus has been demonstrated to survive on environmental surfaces for at least 16 hours but not four or seven days.
Dr KK Aggarwal
Corrigendum: Blood alcohol limits (correceted from yesterday column)
The 1994 Motor Vehicle Act has a provision for imprisonment for six months and or a fine of Rs. 2000 if a person is found drunk while driving. The definition accepted by the Courts is blood levels of more than 30 mg/dl which amounts to a blood alcohol concentration (BAC) of more than 0.030%.
With an alcohol concentration of less than 0.030%, the person behaves and reacts normally. In gradual manner, with the concentration is more than 0.030%, the person shows signs and symptoms starting from impaired judgment (BAC 0.030 to 0.06%), impaired reasoning (0.060 to 0.10%); reduced reaction time (0.11 to 0.20%); motor impairment (0.21 to 0.29%); bladder disturbances (0.30 to 0.39%) and brain damage ( >0.40%).
An equivalent alcohol is present in 44ml of 80 proof (40% weight/volume) whisky, 355 ml (5% weight/volume) beer and 148 ml of wine (12% /weight/volume). 44ml whisky therefore will actually have 17.74 ml of pure alcohol.
And 14 gm of alcohol (17.74 ml) will increase BAC by 0.02 to 0.05%. After drinking the BAC will normalize by 0.015% every hour. Therefore, after one peg of alcohol, it may take 1.5 to 3 hours for the blood alcohol levels to come back to Zero. When we are arranging alcohol party, we should nor serve more than 45 ml at a time and make sure that the person does not drive for the next three hours after a peg.