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Dr K K Aggarwal

What is the difference between TB infection and TB disease?

By Dr K K Aggarwal
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In most people who breathe in TB bacteria the body s immune system is able to fight the TB bacteria and stop them from multiplying. This is called TB infection. People who are infected with TB do not feel sick do not have any symptoms and cannot spread TB. If an infected person s immune system cannot stop the bacteria from multiplying the bacteria eventually cause symptoms of active TB which is called TB disease. Only 10 of all people with TB infection may suffer from the TB disease. People with conditions like HIV diabetes mellitus malnutrition and those on treatment with immunosuppressant drugs anti cancer corticosteroids etc are at a greater risk of developing TB disease once infected.

National IMA (membership 2.2 lacs) and eMedinewS (readership 1 lac) recommendations to Justice Verma

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1. The word penis should not be used (use male sex organs) anywhere in the law

2. The work vagina, labia majora should not be used anywhere in the law (Female sex organs)

3. Under the influence of alcohol and drugs the punishment should be different and treatment added. For rarest of the rare case death sentence can be added. People with abnormal sexual urges should be treated.  

4. We must sensitize the parents, teachers and schools to identify red flag signals of an abnormal personality trait in children (present in up to 10% of children) so that they do not indulge in sexual offences later

5. Chemical castration is not acceptable to medical profession, is not safe, not health friendly is temporary and lead to corruption

6. Medical profession should help training all policemen in CPR and first aid

7. Every PCR van should be a mini ambulance also. One can post a paramedic in it for RTA and assault cases

8. Private hospital should be allowed to examine rape victims and guidelines should be pasted in every Emergency room

9. We need to define, issuing of medical bulletin, guidelines

10. Transfer to other country there should be a clear cut national policy and decide by a panel of treating doctors in consultation with Govt. health officials

 11. Sick RTA or assaulted patients should b shifted to a nearby hospital (govt. or private) so that medical services are available within ten minutes and stabilized within one hour.

12. Forensic examination lab should be strengthened and should give results in time bound manner.

13. Most sexual assault cases occur in slum areas. Efforts should be made to create awareness in these areas

14. All accused should be compulsorily be tested for sexually transmissible illnesses and victims be considered for STI, HIV and pregnancy prevention treatments

15. All health care professionals to have compulsorily short term training in counselling, empathy, communication, etiquette as part of medical education.

Drafted by Dr KK Aggarwal for National IMA and eMedinews based on proceedings of a seminar organised by IMA and inaugurated by National President IMA, Dr K Vijaykumar.

 

 

 

Pre-exposure prophylaxis against HIV

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In addition to counseling on consistent condom use, pre-exposure prophylaxis with tenofovir-emtricitabine should be given to HIV-uninfected adults who are at high risk for sexually-acquired HIV and are committed to medication  adherence and close follow-up. The drug combination is available in India. All high-risk patients should ask their doctors for the same.

In July 2012, the US FDA approved the combination for pre-exposure prophylaxis among confirmed HIV-negative individuals at high risk for sexually-acquired HIV infection.

Specific high-risk populations include the following:

  • Men who have unprotected anal sex with men and have multiple or anonymous sex partners
  • Heterosexual individuals who have multiple sex partners in areas of high HIV prevalence
  • Partners of HIV-infected individuals who have not achieved viral suppression

Several trials have demonstrated a reduction in the risk of HIV infection by 48 to 75 percent with daily use of the above combination compared with placebo.

The combination drug should be given once daily and continued for as long as the risk of infection persists. If a decision is made to prescribe the drug it should be dispensed as a 90-day supply, renewable only after HIV testing.

Prior to initiation of pre-exposure prophylaxis, all patients should have HIV antibody testing to be certain that they do not have unsuspected chronic HIV infection.

Condoms are highly effective in preventing HIV transmission without the risk of systemic side effects and are an important aspect of any HIV prevention strategy.