Sunday, November 30, 2008

Questions and answers about HIV transmission

What are the main routes of HIV transmission?
These are the main ways in which someone can become infected with HIV:
1.Unprotected penetrative sex with someone who is infected.

2.Injection or transfusion of contaminated blood or blood products, donations of semen (artificial insemination), skin grafts or organ transplants taken from someone who is infected.

3.From a mother who is infected to her baby; this can occur during pregnancy, at birth and through breastfeeding.

4.Sharing unsterilised injection equipment that has previously been used by someone who is infected.

Can I become infected with HIV through normal social contact/activities such as shaking hands/toilet seats/swimming pools/sharing cutlery/kissing/sneezes and coughs?

No. HIV is not an airborne, water-borne or food-borne virus, and does not survive for very long outside the human body. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.
Can I become infected with HIV from needles on movie/cinema seats?

There have been a number of stories circulating via the Internet and e-mail, about people becoming infected from needles left on cinema seats and in coin return slots. These rumours appear to have no factual basis.
For HIV infection to take place in this way the needle would need to contain infected blood with a high level of infectious virus. If a person was then pricked with an infected needle, they could become infected, but there is still only a 0.4% chance of this happening.
Although discarded needles can transfer blood and blood-borne illnesses such as Hepatitis B, Hepatitis C and HIV, the risk of infection taking place in this way is extremely low.
There is a wide spread belief among 'negative' people that HIV positive persons will try deliberately to spread the disease.There is no factual basis for this belief.

Is there a risk of HIV transmission when having a tattoo, body piercing or visiting the barbers?
If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission. However, people who carry out body piercing or tattooing should follow procedures called 'universal precautions', which are designed to prevent the transmission of blood borne infections such as HIV and Hepatitis B.
When visiting the barbers there is no risk of infection unless the skin is cut and infected blood gets into the wound. Traditional 'cut-throat' razors used by barbers now have disposable blades, which should only be used once, thus eliminating the risk from blood-borne infections such as Hepatitis and HIV.

Am I at risk of becoming infected with HIV when visiting the doctor or dentist?
Transmission of HIV in a healthcare setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient. These procedures are called universal precautions for infection control. They are designed to protect both patients and healthcare professionals from the transmission of blood-borne diseases such as Hepatitis B and HIV.

Can I get HIV from a mosquito?
No, it is not possible to get HIV from mosquitoes. When taking blood from someone, mosquitoes do not inject blood from any previous person. The only thing that a mosquito injects is saliva, which acts as a lubricant and enables it to feed more efficiently.

Can I become infected with HIV through biting?
Infection with HIV in this way is unusual. There have only been a couple of documented cases of HIV transmission resulting from biting. In these particular cases, severe tissue tearing and damage were reported in addition to the presence of blood.

Can HIV be transmitted outside of the body?
Whilst HIV may live for a short while outside of the body, HIV transmission has not been reported as a result of contact with spillages or small traces of blood, semen or other bodily fluids. This is partly because HIV dies quite quickly once exposed to the air, and also because spilled fluids would have to get into a person's bloodstream to infect them.
Scientists agree that HIV does not survive well in the environment, making the chance of environmental transmission remote. To obtain data on the survival of HIV, laboratory studies usually use artificially high concentrations of laboratory-grown virus. Although these concentrations of HIV can be kept alive for days or even weeks under controlled conditions, studies have shown that drying of these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within a few hours.
Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, the real risk of HIV infection from dried bodily fluids is probably close to zero.

Does circumcision protect against HIV?
There is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen. Male circumcision probably has little or no preventive benefit for women.

If I am taking antiretroviral drugs and have an 'undetectable' viral load, am I still infectious?
Even if your tests show that you have very low levels of HIV in your blood, the virus will not have been totally eradicated and you will still be capable of infecting others. Some drugs do not penetrate the genitals very well and so do not disable HIV as effectively there as they do in the blood. This means that while you may have little active virus showing up on blood tests, there may still be quite a lot of HIV in your semen or vaginal fluids. Transmission may be less likely when you have a low viral load, but it is still possible so you should always take appropriate precautions.
Click here if you want to know more

World AIDS Day December 1

Take the Lead. Pledge your Leadership to stop AIDS in India

World AIDS Day is just around the corner!! Take the Lead and Pledge your Support for World AIDS Day, December 1st.

Stand up. Make a difference.
If you are in India, you can TEXT us your pledge by doing the following:

SMS "PLEDGE" to the number: 56070
If you are not in India you can submit your video or written pledge to us.

Click here to learn more
Pass on the pledge to your friends!!! You can forward the SMS to your friends.
To know more about World AIDS Day events in India click here

Tuesday, November 25, 2008

Non-Medical reasons for referring a Patient-Part 1

You may think that if a patient is referred to a higher medical centre[with better facilities] from a smaller hospital it is purely due to medical reasons. Many a time it is not.
Today I was confronted with such a referral.

It was near the end of my working day. Four men came in to my consultation room wanting some advice regarding a patient admitted under another Physician in a small hospital nearby. She was diagnosed to have Dengue fever and had been referred to higher centre.

They had brought all the patients records.I went through the clinical notes and lab charts.She was not in a critical condition.But the doctor treating her had asked them to take her to Hi-tech hospital in the nearest City.
One of the men,whom I know before asked, 'Is there a hospital in this town which can manage such cases?'
'Yes, even the Hospital in which the patient is currently admitted may be able to take care of such cases. Dengue fever patients need constant monitoring,that is all.If there is a fall in blood pressure or bleeding they may need blood transfusions'.I said.
'Then why the referral?' He asked.
I asked them what the treating doctor told them about patient's condition.They revealed that the doctor had told them that the patient has a serious life threatening infection. The patient can be said to be out of danger only after 3-5 days.
'Would you have accepted death of the patient if it had happened in that hospital?'
I asked. 'If patient died there in spite of all the recommended treatment methods you would definitely would not accept it and will raise voices against the doctor and the hospital.You would have asked the doc why he did not refer the patient to better centre'.

[Most probably stones will be thrown and the doc manhandled, which is now the fashionable thing in Kerala.I did not say that aloud.Did not want to give them ideas]

'On the other hand if the patient died in the big hi-tech City hospital you will accept it as your fate and will be satisfied with yourself that you have done enough.That is the reason for the referral.So it will better for you to take the patient to the City',I concluded.

Their faces showed indecision.They went out of my room to discuss among themselves as I saw my last patient for the day.I thought they will not come back again.But they trooped in to my room once more. I did not expect what they asked.

'Can you treat the patient in your hospital?

I did not know what to say.My hospital was slightly better equipped than the hospital in which the patient is admitted currently.I wanted to take up the challenge.10 years ago I might have jumped at the opportunity. But age and bitter experiences have changed me a lot..[as explained in my earlier posts 30vs40 part 1]. I wanted time to decide.
'Let me see the patient and decide.Bring her to the hospital tomorrow morning'.I replied

Tomorrow they may or may not come.If they come I may take up the challenge.
To know what happened to that patient click here.

Thursday, November 20, 2008

Life and Death

Today I realised how thin is the line between life and death.

It was late afternoon.My appointments in outpatient department in my hospital was running late by more than an hour[as usual]. The coffee I ordered to keep me awake was unduly late in coming.
In walked an elderly, thin and ill looking gentleman.The chart showed me he was 74. He was accompanied by an innocent looking girl. The girl did the talking.She said her grand father is feeling tired and is having no appetite for the last few days. He is also not sleeping much.She attributed it to him taking care of his ailing wife who is admitted in a state of coma in the same hospital with a massive stroke few days ago.
He was pale, eyes sunken, all skin and bones.I asked him what was troubling him. He was hard of hearing.So I raised my voice and asked again.He said he had no appetite nor he is able to sleep.He told me about is wife.He said the wife is showing some improvement and there is still hope that she will become conscious one day.

I examined him quickly still thinking why the coffee is not on my table yet.His pulse was little weak,blood pressure and heart sounds ok.They have already done some blood tests. It showed he is anemic and also having mildly elevated blood sugar.

I thought everything is due to anemia. So I raised my voice to tell him about his sugar free, green leafy vegetable rich diet.He asked me whether he can take rice both at lunch time and at dinner.I said yes,but he did not hear it.He suddenly slumped in his chair,his face becoming more pale and his hands rigid.His breath was just a gasp.I called him loud and tried to feel his now absent pulse.The grand daughter was screaming with fright and asked what was wrong.
I with help of the nurse carried that frail man on to the examination couch.He was taking gasping breath but no heart sounds.I started cardiac resuscitation by rhythmically thumping his chest with the proximal part of my palms.I asked the nurse to take the young girl out and to bring help immediately in form of a stretcher to take the patient to the ICU.The nurse went to telephone to dial but I yelled at her to run to the emergency department for help.

For me it seemed it took a long time for the orderlies to come with the stretcher but actually they came in 3 minutes.I was continuing my cardiac resuscitation till I reached the ICU.
In the ICU the nurses put an IV line and stuck the electrodes of the cardiac monitor on his chest.I looked at the monitor.There was no activity.It was asystole or Cardiac standstill,a form of cardiac arrest which is difficult to reverse. I shouted orders one by one. A male nurse was continuing the Chest thump and I could hear a rib creak.I called out to be careful. By that time breathing had almost stopped.I called out for an endo tracheal tube to be put into the wind pipe. A nurse handed me the laryngoscope and another the endo tracheal tube.I could put in the tube with the help of the scope properly with in seconds.Now his breathing is taken care of as the nurse started pumping oxygen into his lungs with the ambu bag.

The male nurse was still continuing the cardiac resuscitation on the chest.I called out for more iv drugs to be given.
'Defib' I shouted.
The machine to give electric shock to the heart to try to make it come alive was ready.
'360 joules', I ordered and put the pads on that thin chest, asked everybody to stay away and pressed the button.The patient jerked and the smell of burned skin came into my nose. 'Give me more jelly on the pad', I shouted.
I looked at the monitor.It showed a flurry of activity as the cardiac resuscitation continued.It raised my hopes.I ordered more drugs to be pushed IV. But slowly the line in the monitor became flat.
'Defib' once more I shouted.This time a nurse did that as I watched the patient jerking again receiving the shock. This time there was not much activity in the monitor screen. The electric shock was repeated again and again, the jerking of the lifeless body continued and the monitor showed the flat line of death.

I looked at my watch. It was 30 minutes ago that this man asked me if he can eat rice both at lunch and dinner time.But it seemed a long long time ago.. And meanwhile he had passed the line between life and death.

Now I had a few live patients to see and I was already so late. I asked my junior, the resident medical officer to do the paper work and the rest of the formalities.

When I reached the OP, the coffee was there on my table, already cold.By then I was fully awake and so I ignored the coffee. As the next patient came to sit on the chair that was just now vacated by the life of that old man, I realised how thin is the line between life and death.

Wednesday, November 19, 2008

Is homeopathy good for Chickenpox?

Is homeopathy good for Chickenpox?
Many people ask this question to me.I will tell them my experience.

A Staff Nurse working in my Hospital came to me with the typical rash of Chickenpox.The eruption started only that morning. I told her it is chickenpox and in most of the cases it wont create any problem.It is a self limiting[meaning will subside by itself] viral infection.She asked about the anti viral treatment.I told her with treatment the recovery is faster by few days especially if started on the day of the eruption of rash.As she did not have much leave she opted for anti viral treatment[Acyclovir]. She recovered fast and was back to work in 8 days.

About 4 weeks later the Nurse came again to me with her mother who had healing and active rashes all over her body.She had secondary bacterial infection of her skin as a complication of Chickenpox.She was exhausted and dehydrated.Her mother developed rashes 10 days ago.She was taking homeopathic treatment, but was suffering badly. She was advised salt free diet and other dietary restriction. I gave her treatment for skin infection due to bacteria and few symptomatic remedies,asked her to take salt normally and reassured her.It took another 10 days for her mother to become all right again.
At that time the Nurse's sister a College student was shown to me with early chickenpox rash.I again gave her the option of just taking symptomatic medicines or taking anti viral medicines also.She did not opt for anti virals. Her illness had an uneventful course and she recovered completely in 12 days.
Chickenpox is self limiting and usually do not produce any complications in young persons.Anti viral therapy reduces the number of eruptions and increases the speed of recovery.Anti viral therapy is a useful option in those who want to recover fast.

Homeopathy do not have any additional proven benefit in management of Chickenpox.But severe diet restriction along with some stronger homeopathic medicines are found to increase the number of eruptions and increase the exhaustion and fatigue in patients, there by delaying the recovery.
Chickenpox in older people may cause complications.Such patients may have to be looked after carefully.
For more authentic information on Chickenpox visit here

Monday, November 17, 2008

It seemed they all want her to die

She is 21 years old.She is my patient for the last few days.She is sick, really sick, probably spending her last days under my care.
The family is around her.Her widowed mother,her Uncles,her grand mother etc.They are taking care of her in the usual loving and caring way as any other family will do. But some how for me it seemed they all want her to die.

Why? Because she is an HIV positive person.After being treated for various illnesses symptomatically the real reason for her problem, her positive status was revealed only few days ago.She was immediately referred to the nearest Government facility treating such patients.
The family took her home instead.After 2 days her Uncles came to me.They wanted some treatment but did not want hospital admission.

'Let me first see her condition and decide I said.
They brought her soon.Her condition was really poor.I explained to the relatives. I told them it may be better to take her to a Higher centre with better facilities.They flatly refused. I realised then that I am her last hope.
It seemed they all wanted her to die.

I am trying my level best.But she may be fighting a losing battle.

The follow up of this patient can be read in my posts in December and January

Saturday, November 15, 2008

World Diabetes Day

Today November 14th is the World Diabetes Day.
World Diabetes Day (WDD) is the primary global awareness campaign of the diabetes world. It was introduced in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to the alarming rise in diabetes around the world. In 2007, the United Nations marked the Day for the first time with the passage of the United Nations World Diabetes Day Resolution in December 2006, which made the existing World Diabetes Day an official United Nations World Health Day.

World Diabetes Day is a campaign that features a new theme chosen by the International Diabetes Federation each year to address issues facing the global diabetes community. While the themed campaigns last the whole year, the day itself is celebrated on November 14, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922

No Child Should Die of Diabetes
This is the campaign theme this year.

Diabetes and children
Diabetes is one of the most common chronic diseases to affect children. It can strike children of any age, even toddlers and babies. If not detected early enough in a child, the disease can be fatal or result in serious brain damage. Yet diabetes in a child is often completely overlooked: it is often misdiagnosed as the flu or it is not diagnosed at all.

Every parent, school teacher, school nurse, doctor and anyone involved in the care of children should be familiar with the warning signs and alert to the diabetes threat.

Know the diabetes warning signs
Frequent urination
Excessive thirst
Increased hunger
Weight loss
Lack of interest and concentration
Blurred vision
Vomiting and stomach pain (often mistaken as the flu)
*In children with type 2 diabetes these symptoms may be mild or absent.

Type 1 and type 2 diabetes.

Diabetes is a chronic, potentially debilitating and often fatal disease. It occurs as a result of problems with the production and supply of the hormone insulin in the body. The body needs insulin to use the energy stored in food. When someone has diabetes they produce no or insufficient insulin (type 1 diabetes), or their body cannot use effectively the insulin they produce (type 2 diabetes).

Type 1 diabetes is an autoimmune disease that cannot be prevented. Globally it is the most common form of diabetes in children, affecting around 500,000 children under 15. However, as a result of increasing childhood obesity and sedentary lifestyles, type 2 diabetes is also increasing fast in children and adolescents. In some countries (e.g. Japan), type 2 diabetes has become the most common form of the disease in children.

Globally, there are close to 500,000 children under the age of 15 with type 1 diabetes.
Every day 200 children develop type 1 diabetes.
Every year, 70,000 children under the age of 15 develop type 1 diabetes.
Type 1 diabetes is increasing in children at a rate of 3% each year
Type 1 diabetes is increasing fastest in pre-school children, at rate of 5% per year.
Finland, Sweden and Norway have the highest incidence rates for type 1 diabetes in children.
Type 2 diabetes has been reported in children as young as eight and reports reveal that it now exists in children thought previously not to be at risk.
In Native and Aboriginal communities in the United States, Canada and Australia at least one in 100 youth have diabetes. In some communities, it is one in every 25.
Over half of children with diabetes develop complications within 15 years.
Global studies have shown that type 2 diabetes can be prevented by enabling individuals to lose 7-10% of their body weight, and by increasing their physical activity to a modest level.
Type 2 diabetes in children is becoming a global public health issue with potentially serious outcomes.
Type 2 diabetes affects children in both developed and developing countries.

Diabetes is a deadly disease. Each year, almost 4 million people die from diabetes- related causes. Children, particularly in countries where there is limited access to diabetes care and supplies, die young.

Diabetic Ketoacidosis (DKA), a build-up of excess acids in the body as a result of uncontrolled diabetes, is the major cause of death in children with type 1 diabetes. With early diagnosis and access to care, the development of severe DKA should be preventable.
Insulin was discovered more than 85 years ago. Today children in many parts of the world still die because this essential drug is not available to them.
Children with diabetes should monitor their blood sugar regularly to help control their diabetes. This monitoring equipment is often unavailable or not affordable.
In Zambia, a child with type 1 diabetes can expect to live an average of 11 years. In Mali, the same child can expect to live for only 30 months. In Mozambique the child is likely to die within a year.
The World Diabetes Day campaign in 2008 aims to:

Increase the number of children supported by the IDF Life for a Child Program.
Raise awareness of the warning signs of diabetes
Encourage initiatives to reduce diabetic ketoacidosis and distribute materials to support these initiatives.
Promote healthy lifestyles to help prevent type 2 diabetes in children.


from International Diabetes Federation

Sunday, November 2, 2008

Featured blog post

My post How I got interested in HIV/AIDS was featured in Desipundit. Thank you for the recognition.