Alcohol : benefits vs risk

Firdaus Khan

There is consensus that non drinkers should not start and the ones who drink can continue provided they do so in moderation and in absence of contraindications, said Dr. KK Aggarwal, President, Heart Care Foundation of India. People tend to consume more alcohol in winter and near the New Year.

Persons who have been lifelong abstainers cannot be easily compared with moderate or even rare drinkers. Recommending alcohol intake to them even if they would agree to drink is not justified. The diseases that moderate alcohol use prevents (such as coronary heart disease, ischemic stroke, and diabetes) are most prevalent in the elderly, men, and people with coronary heart disease risk factors. For these groups, moderate alcohol use is associated with a substantial mortality benefit relative to abstention or rare drinking.

For young to middle-aged adults, especially women, moderate alcohol use increases the risk of the most common causes of death (such as trauma and breast cancer). Women who drink alcohol should take supplemental folate to help decrease the risk of breast cancer. Men under the age of 45 may also experience more harm than benefit from alcohol consumption. In this age group, moderate alcohol use is unlikely to provide any mortality benefit, but consumption of less than one drink daily appears to be safe if temporally removed from operation of dangerous equipment. For individuals with established contraindications to alcohol use, even this level of alcohol use is dangerous.

Men can tolerate more alcohol than women. The ideal therapeutic dose of alcohol is around 6 grams per day. Medically safe limits are 10 grams in one hour, 20 grams in a day and 70 grams in a week.

Beware of winter drinking

Winter is the month of high alcohol intake. Moderation is the key provided we understand what moderation is, said Dr. KK Aggarwal, President, Heart Care Foundation of India. He was interacting with the public at the Heart Care Foundation of India stall being put up at the ongoing India International Trade Fair, Pragati Maidan in the Ministry of Health & Family Welfare pavilion.

Healthy middle-aged women can have up to one and men up to two drinks a day without increasing the risk of the abnormal heartbeat called atrial fibrillation. More than three drinks increase the risk. Atrial fibrillation is a common disease of today. It occurs in about 1 percent of people up to the age of 80 and it can cause significant symptoms in those who have it. In atrial fibrillation, the two upper chambers of the heart (atria) beat irregularly and faster than they should. Blood can pool in the atria, leading to formation of clots that can block a major artery to the brain, causing a stroke.

Higher intakes of alcohol can cause elevation in the risk for atrial fibrillation. In a Harvard study of 35,000 women, all above 45 years, none had atrial fibrillation or any other heart condition at the start of the study. Over an average follow-up period of 12.4 years, 1.9 percent of the women who had one drink or less a day developed atrial fibrillation, compared to 1.8 percent of those having one to two drinks a day and 2.9 percent of those having two or more drinks a day. There is a 40 to 50 percent increase in the incidence of atrial fibrillation at about three drinks a day. Drinking more than six drinks in a day can precipitate sudden death. Drinking more than 5 drinks in one hour can precipitate sudden death or a heart attack.

Avoid unnecessary injections : World AIDS DAY

HIV, Hepatitis B and Hepatitis C can all be transmitted through blood and blood products and or by sexual route. Keeping in mind World AIDS Day KK Aggarwal, President, Heart Care Foundation of India cautioned that getting injections from unqualified health care workers can spread HIV / AIDS. The spread of HIV in India is primarily restricted to the southern and north eastern regions of the country. In India, the main factors which have contributed to its large HIV infected population are extensive labor migration, low literacy level in certain rural areas resulting in lack of awareness and gender disparity. According to Dr. KK Aggarwal, President, Heart Care Foundation of India :

Transmission

In order to pass HIV from one person to another, HIV-infected internal fluid from one person needs to get into the bloodstream of another person. HIV is usually transmitted through: Sharing needles, unprotected anal, vaginal, and sometimes oral sex, and from mother to infant before or during delivery and while breast-feeding.

HIV can spread through unprotected sexual contact with multiple partners, blood products, mother to baby (before or during, or through breast milk) and sexual intercourse (vaginal and anal). In the genitals and the rectum, HIV may infect the mucous membranes directly or enter through cuts and sores caused during intercourse (many of which would be unnoticed). Vaginal and anal intercourse is a high-risk practice.

The mouth is an inhospitable environment for HIV (in semen, vaginal fluid or blood), meaning the risk of HIV transmission through the throat, gums, and oral membranes is lower than through vaginal or anal membranes. There are however, documented cases where HIV was transmitted orally, so it cannot be stated that getting HIV-infected semen, vaginal fluid or blood in the mouth is without risk. However, oral sex is considered a low risk practice.

An injection needle can pass blood directly from one person's bloodstream to another. It is a very efficient way to transmit a blood-borne virus. Sharing needles is considered a high-risk practice.

It is possible for an HIV-infected mother to pass the virus directly before or during birth, or through breast milk. Breast milk contains HIV, and while small amounts of breast milk do not pose significant threat of infection to adults, it is a viable means of transmission to infants.

Effective strategy to prevent HIV

Becoming educated about HIV and understanding the facts about transmission are the first, and perhaps most important way to prevent the spread of HIV.

Abstaining from sex particularly with multiple sexual partners and needle sharing is the most effective way for people to protect themselves from HIV and other sexually transmitted diseases. However, when abstinence is not an option for people, using barrier protection such as latex condoms (male or female) is the next best thing.

Three stages of prevention

Firstly, everyone should take steps to avoid contracting the infection,

Secondly, an infected person who does not know that he is infected should be made aware of his condition through symptoms or thorough examination and

Finally, the already infected persons should be made aware of the need for prevention of other diseases and be aware that he can infect others.

The most effective ways to prevent HIV Infection

Not having sex – whether vaginal, anal, or oral

• Sex only between two mutually monogamous, uninfected partners who do not share needles or syringes with anyone.

• Not injecting non prescribed drugs

• Not sharing needles or syringes for any reason (when injected illegal drugs, medications, vitamins, or steroid; tattooing; or body piercing)

• Not engaging in activities that involve exchange of blood, semen, vaginal fluids, or breast milk.

Ways to reduce the risk of HIV Infection

Using a latex condom the right way every time during vaginal, anal, or oral sex.

• Not using drugs or alcohol, which can impair judgment.

• Cleaning needles and syringes with chlorine bleach and water if more effective prevention is not available.

• Using barrier protection (e.g. latex gloves) when coming into contact with blood.

A new weapon of war, HIV kanya, HIV blood transfusions after kidnapping, HIV positive syringes for extraction of money.

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.

Needle stick injury

The average risk of seroconversion 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.

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.

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.

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 a 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.

Infected blood with hepatitis C, hepatitis B and HIV together is the most deadly weapon ever possible.