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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)



28th November Saturday

Dear Colleague,

 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.



5 Minutes of International Medicine from BMJ Group  (Sent by Dr N P Singh)

reoie gras (Gut 2009;58:1442)
1. Non alcoholic fatty liver disease is the most common form of chronic liver disease in both children and adults
2.  It is likely to become a serious public health problem worldwide
3.  It is closely associated with obesity and insulin resistance
4.  It includes a spectrum of diseases from simple fatty liver (steatosis) to fibrosis and cirrhosis
5.  It can take only 10 20 years for the disease to progress from its first signs to irreversible end stage disease
6.  There is no effective drug treatment, early diagnosis and lifestyle changes are key to stop disease progression
7.  Disease markers need to be developed to identify those most at risk. 

Some antidepressants better than others?

A recent review of 117 trials and 26,000 patients suggested that, among second generation antidepressants, escitalopram and sertraline were best, and sertraline seemed the best overall because it is cheaper. However, this editorial says that the conclusions may be wrong. 

A large practical study STAR*D (Sequenced Treatment Alternatives to Relieve Depression) found that which drug you give is less important than monitoring the patient and changing drugs if it is not working.
Source: Evidence-Based Mental Health 2009;12:98-100
Is everyone who gets migraines at an increased risk of a stroke?
Only the quarter of migraine sufferers who get an aura are at increased risk of stroke. Migraine with aura doubles a person's risk of having a stroke.   Migraine is also associated with an increased risk of transient ischaemic attacks and angina. It is not  clear whether this is true for all migraine sufferers or only those with aura.  

Migraine without aura is not  associated with an increased risk of stroke. Aura is a transient neurological disturbance before or during the headache. Sensitivity to light, visual blurring, and fatigue are common accompaniments to migraine but should not be confused with aura. People who have migraine with aura should have their other risk factors treated (smoking, blood pressure, cholesterol, and blood glucose)
Source: BMJ 2009;339:b4380

Refer rheumatoid arthritis
When you see a patient who you suspect of having rheumatoid arthritis (RA), do you refer straight away or wait a bit to do tests and see what happens?  The Canadian study stresses that early referral to a rheumatologist leads to better health outcomes for patients with RA. Nearly 60% of patients reviewed in this study waited more than three months to see a specialist. Those registered with a family doctor were more likely to have delayed referral. Specialists in other fields were better at referring on without delay. (Source: Annals of the Rheumatic Diseases 2009;68:1790-1791)

New test for Down's syndrome safe and sound

Pregnant women can have a range of prenatal tests for Down's syndrome (DS) to get a statistical risk score or can get a definitive result from an invasive test, chorionic villus sampling (CVS) at 9 to 12 weeks or amniocentesis at 15 to 20 weeks. The non-invasive tests do not give a definitive answer, and the invasive tests carry a risk of miscarriage. So it is a good news that a non invasive blood test is soon to be offered to pregnant women in the US that might provide a definitive diagnosis of DS in the first trimester at no risk to the fetus. (Source: Archives of Disease in Childhood 2009;94:823-826)

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Rabies management involves a three pronged approach including proper wound management, judicious use of antirabies serum and modern tissue culture vaccines. Indian J. Pediatr. 2003 Mar.;70 (Suppl. 1)S11 S16.

Dr Good Dr Bad

Situation:   A patient came with folate deficiency due to malabsorption.

Dr Bad:  Start 1 mg per day of folate

Dr Good:  Start high doses of folate

Lesson:   Folate deficiency is treated by replacement therapy. The usual dose of folate is 1 mg/day, by mouth, but higher doses (upto 5 mg/day) may be required for folate deficiency due to malabsorption.


An old man was on his death bed, and wanted to be buried with his money. He called his priest, his doctor and his lawyer to his bedside. "Here's $30,000 cash to be held by each of you. I trust you to put this in my coffin when I die so I can take all my money with me."

At the funeral, each man put an envelope in the coffin. Riding away in a limousine, the priest suddenly broke into tears and confessed, "I only put $20,000 into the envelope because I needed $10,000 to repair the roof of the church."

"Well, since we're confiding in each other," said the doctor, "I only put $10,000 in the envelope because we needed a new X-ray machine for the pediatrics ward at the hospital which cost $20,000."

The lawyer was aghast. "I'm ashamed of both of you," he exclaimed. "I want it known that when I put my envelope in that coffin, I enclosed a check for the full $30,000."

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