Skin Grafting procedure to treat burns and other wounds began as early as 800 B.C. Modern organ transplant procedures began in the early 1900s. In 1936, an Ukranian doctor Yu Yu Voronoy transplanted the first human kidney, using an organ from a deceased donor. The transplant was successful but Voronoy’s patient died shortly after as a result of organ rejection which was the cause for many failures in the early years of transplant technology.

The first successful kidney transplant by surgeons at Boston’s Peter Bent Brigham Hospital in 1954 worked because the recipient and donor were genetically identical twins. In 1960, British immunologist Peter Medawar won the Nobel Prize for his studies in acquired immune tolerance that lead to the development of anti-rejection drugs, allowing patients to receive organs from non-identical donors. The awareness for organ transplants like Kidney, Liver, Pancreas and eye has lead to the increased number of such transplants. Apart from blood and these organs , banked human tissues include:

1. Bone- frozen, freeze-dried, and de-mineralized

2. Corneas

3. Heart valves

4. Tendons

5. Skin

6. Hematopoietic tissues, bone marrow and cord blood.

7. Dura mater, ear ossicles, and cartilage.

Importance of skin donation:

The skin is the largest organ in the body. The functions of skin are

1. Skin acts as a barrier to bacterial invasion.

2. Prevents loss of body proteins and fluids

3. As an organ in temperature regulation.

Early burn wound closure is crucial for survival of patients with large burn wounds. Burn wound infection leading to systemic sepsis is the single most major cause of death in burn patients. Burn wound is a devastating trauma that affects the patients physically, psychologically, socially and economically. Patients with burn size up to 40-50% of total body surface area (TBSA) can usually be treated with auto grafts obtained from the unburnt areas of the patient. Auto graft will be insufficient in larger burn size or in patients without available donor areas. Hence the skin donors are very  essential to save the lives of burn injury patients.

Skin Autograft donors can be : Living or Cadaver

1 .Living skin donation has the following features:

1. The donor has to undergo investigations for preoperative evaluation.

2. A surgical procedure under suitable anesthesia for harvest of graft.

3. Hospitalization is required for at least 2 days.

4. Donor site healing time and wound site pain of about 10-14 days.

5.  Only 15 to 20% of total body surface can be harvested at a time.

6. The other alternative is to procure split thickness skin grafts from a cadaver donor and preserve them for use in future.

2 .Cadaver skin donation:

The concept of skin donation after death is not new and the first skin bank was established in USA around 1950. The  benefits of use of autograft  on full thickness burn wounds are

1. Effective control of protein and fluid loss from wounds.

2. Reversal of hyper metabolic state with improvement in nutritional status.

3. Augmentation of immunological response.

4. Control of wound infection and improvement in the wound bed making it ready for acceptance of precious skin auto grafts.

5. Immediate pain relief and general feeling of well being.

6. Excellent biological wound cover till the auto graft donor sites become ready for taking of skin again.

7. Important information regarding skin donation

8. Only a thin layer of skin from thighs and back is taken.

9. No disfigurement! No bleeding!

10. No blood matching is required.

11. Can donate skin up to 24 hrs following death of a person.

12. Helpline numbers are available.

13. Hospital’s doctor’s team will come within 2 hours of your call.

14. Skin will be harvested in about 45 minutes.

Who can donate skin?

A person above 18 yrs of age, not having transmissible diseases like hepatitis, HIV, skin cancer or skin diseases can donate skin. Even an old person with wrinkled skin can also donate. Skin can be harvested up to 12 hours and with precautions even up to 24 hours after death if the body is kept in a cold storage. The skin quality must be good.

Who cannot donate skin?

Persons harboring transmissible infections such as Hepatitis B, Hepatitis C and HIV cannot donate skin. Skin from people suffering from skin cancer, persons who died of septicemia with damaged skin e.g. scleroderma, pemphigus should not be taken. The skin must be free of tattoos.

Why skin donation?

Skin is usually donated to patients suffering from burn injuries, diabetic wounds and to trauma patients requiring coverage of raw areas. It covers the exposed body and prevents the entry of bacteria. Controls the loss of protein, heat and fluid from the body. Gives the patient enough time to develop his own skin available for covering the wounds. The applied skin acts as a biological dressing for the patient.

Stored Donor skin graft is useful in the following clinical situations

Poor general condition of patient with high risk for surgical procedures. Insufficient auto graft donor sites especially in patients with major burn injuries. Risk of increase in the size of wound due to addition of donor site wound to the actual burn area and its associated complications unhealthy recipient bed and general status of the patient when skin graft procedure may be associated with graft loss. When the expected duration for harvesting skin graft from the same donor sites is more than 3 weeks.

Legal requirements:

1. Death certificate from the competent authority

2. Consent form signed by the next of kin.

Xenografts (from other species e.g. pig-skin) are not commercially available in many countries. Biosynthetic skin substitutes (artificial skin) are extremely expensive and unaffordable for most of the burnt patients in developing countries. Their availability is also uncertain. The only cost effective and definite alternative is skin allograft obtained from a human donor and stored in Skin Banks. The efficacy of skin allograft in the management of burn wound was realized in 1881.

These skin substitutes provide temporary but long term wound closure, with potential to save life of patients with large burn. The skin allograft transplant differs from organ transplantation as the skin grafts are used to provide temporary long term protection and are not expected to survive in the recipient permanently as transplanted organ. This means that neither ABO blood group nor HLA matching is required for allograft skin transplantation. So any human being can be a donor for anyone else.

Organization of a Skin Bank:

Permission for establishing a skin bank with procurement of deceased donor skin allograft has to be obtained from appropriate authority of the government. Though skin is an organ, split thickness skin graft (STSG) is considered as a tissue. The following protocols are prepared.

1. Defining the eligibility criteria.

2. Communication and response details.

3. Readiness of equipment and response team.

4. Skin procurement protocol.

5. Transport equipment & protocol.

6. Deposition and information routine.

7. Homograft and serological processing protocol.

8. Storage method and quality control.

9. Procedure for requisition and disbursement of homograft.

10. Record keeping.

Protocol preparation in relation to the following criteria

1. Response to donation call

2. Procurement of deceased donor skin allograft with consent of the next-of-kin.

3. Microbiological studies.

4. Viability testing of donated skin.

5. Preservation methods.

6. Awareness campaign

An ongoing awareness program is essential for success of the skin donation campaign. Brochures, posters, flip charts and power point presentations, educational films, articles in print media, television interviews and radio talks, guest lectures in social service organizations and in educational Institutions on a regular basis will create an awareness among the public. Development of burn survivor community and their interaction with the public will be more effective.

The skin bank team consists of: counselor, contact person,response team including surgeon, assistant, helper, supervising consultant, Microbiologist or biochemist, record keeper

Skin graft procurement:

Standard protocol for graft harvesting methods has to be followed. With shortest delay possible after death (it can be procured up to 24 hours after death if the body is preserved in cold storage) skin should be harvested. Prolonged delay may cause bacterial and fungal colonization of the donor skin.

1. The procedure takes about one hour and conducted with aseptic precautions in operation theater.

2. Skin is harvested from both thighs and back of the deceased person.

3. There is no bleeding as blood circulation stops at death.

4. The thighs are covered with dressing before handing over the body to relatives.

5. About 10 cc of blood of the deceased is collected at the same time for serological testing.

6. The grafts are transported to the skin bank in Phosphate buffered saline in glass containers placed in ice box along-with blood sample for serology and the microbiologist is informed.

7. Counseling responsibility is by the consultants and residents of department of surgery.

8. Extend the counseling outside the hospital in the community as well.

9. Participation of voluntary organizations may be useful in skin donation awareness.

Microbiological analysis:

1. Microbiological analysis of deceased donor skin allograft is carried out on regular basis

2. Appropriate protocols must be followed in the donor area cleaning.

3. Protocol for graft harvesting techniques.

Equipment required:

1. Instruments for skin graft procurement including dermatome.

2. Refrigerator and Incubator.

3. Ultra-cool refrigerator for -70 degree C temperature.

4. Laminar flow cabinet with air conditioners.

5. Universal power supply.

6. Laboratory articles, reagents, chemicals, furniture.

7. The cost of consumables for procuring skin donation including the cost of serological testing has to be worked up.

Storage and disbursement of homograft:

Initially the harvested skin is stored in 50% Glycerol for two hours at 4-6  degrees C for 2 hours. Then it is checked for any infection and the put in 85% Glycerol for 3 hours at 33 degrees C in a shaking incubator. Then the skin is kept in a freezer at 8 degrees C for 4-6 weeks until the serological reports are available. After 4-6 weeks the graft is transferred to a bio-safety cabinet and made into smaller uniform strips. The skin is then preserved in 85 per cent glycerol in a temperature of 4 degrees and it is ready for use. The treated cadaveric skin has a shelf-life of four to five years. The stored graft is checked every 3 months for bacterial or fungal infections. The stored graft is used for treating patients with damaged skin due to burns or injuries.

The future of Skin banking:

1. Augment the awareness in the medical fraternity regarding skin donation.

2. Participation of teaching institutions, peripheral hospitals and private hospitals for counseling

3. Participation of voluntary organizations in the awareness campaign.

4. The facility for skin banking should ideally be available in every medical college hospital

5. Several collection centers can be affiliated to each skin bank facility.

6. Training in standardized graft procurement protocol can be provided to available personnel.

7. Establishment of Tissue Bank Association to ensure the quality in functioning of skin banks.

Further research to improve the quality of skin  is necessary. Recently introduced Glyaderm (preserved acellular dermal substitute), a science of Bi-layered skin restoration technology will benefit the patients in future.

Also Read: ORGAN DONATION-INDIA STRUGGLING WITH SHORTAGE OF ORGANS FOR TRANSPLANTATION

Dr.N.Mariappan- Chennai.
Consultant Plastic surgeon
Mob:9901043568

The post Skin donation and skin banking- it has high benefit to the mankind. appeared first on Health Vision.

Tobacco use in India – An evil with many faces. Global Adult Tobacco Survey (GATS), a global standard for systematically monitoring adult tobacco use and tracking key tobacco control indicators reported a steep decline in tobacco consumption in India in its second survey report published on June 23, 2017. India is the world’s largest democracy, the second largest consumer and third largest producer of tobacco. Tobacco control results from India take on a global significance in terms of impact on total mortality and disease burden. In the last five years, the country has witnessed a number of legal battles between the government and the tobacco industry with favourable results on tobacco control. Despite tremendous resistance and litigation from the tobacco industry, the Ministry of Health imposed an 85% pictorial warning on tobacco packets from 1st April 2016.

Dual tobacco use in India:

A dual tobacco user uses both smoking and smokeless forms of tobacco. According to GATS India 2009- 2010, the prevalence of dual tobacco use was 5.3% (men 9.3%; women 1.1%), amounting to 42.3 million adults.

Indian Initiatives:

No tobacco day is celebrated by organising public marches, demonstration programmes, big banners, advertising campaigns through educational programs, direct oral communication with common public to encourage them to stop smoking. Meetings are organised for involved campaigners, marches, public debates, anti-tobacco activities, public art, health camps, rallies and parades, implementing new laws to restrict smoking in particular areas and many effective activities.

Individuals from different region of the country, non-profit and public health organizations get participated very actively in the campaign celebration to get global success and involves in distributing placards, posters display having latest theme and information related to the bad effects of tobacco use or its product smoking. Taxes on various tobacco products in India were hiked with the aim to discourage use of any form of tobacco.

Voice of Tobacco Victims (VoTV), a campaign led by doctors and tobacco victims, played a pivotal role in the getting gutka/smokeless tobacco banned. (https://vovindia.org). The 360-degree campaign involved legal battle, advocacy, media, and research. The VoTV network reached several medical societies and hundreds of individual doctors to increase engagement in tobacco control advocacy. Tobacco victims with their grit and determination declared- “This is what tobacco did to us, we want to save others”.

Summary of GATS 2 Survey 2017: Pattern of Tobacco

1. 6% of adults aged 15 and above (267 millions) used tobacco in any form

2. 199 million use smokeless tobacco; 100 million smoke tobacco and 32 million smoke as well as chew tobacco.

3. The most commonly used tobacco products are Khaini (a type of smokeless tobacco) 85 million users and Bidi (hand rolled cigarette) 67 million users.

4. 199 million users live in rural area and 68 million in urban

Significant changes compared to GATS 1 (OCTOBER 2010)

1. 17% relative decrease in tobacco prevalence

2. Tobacco use among 15-24 year olds showed relative reduction of 33% and for 15-17 year olds there was a 54% reduction.

3. The age of initiation of tobacco use increased by 1 year (17.9 to 18.9).

4. While there was a decrease in second-hand smoke exposure in public places (6%) and at home (13%), there was no decrease in workplaces.

5. 9% (83 % to 92%) more believed that second-hand smoke is harmful

6. 7% (89% to 96%) more believed that smokeless tobacco is harmful

 Areas of concern that remain still

1. 68% of smokers, 17% of Bidi smokers, and 50% of smokeless Tobacco users purchase loose Tobacco.

2. 30% of those who work indoors are exposed to second-hand smoke

3. 23% adults are still exposed to SHS at public places.

4. Nearly 10% of people still notice some form of tobacco advertisement.

5. Despite the Gutka ban, 51 million people were still able to buy Gutka.

We must commend Government of India for the commitment to Tobacco Control. We also recognize the efforts of several national/international NGOs, academic institutions and civil society activists who have contributed to this impressive result. GATS 2 demonstrate that the tobacco control strategies in India are going in the right direction. For continuing improvement, the country needs further strengthening of policies, particularly enforcement of tobacco control laws. Comprehensive national smoke-free laws protect over 1.4 billion people, or only 20% of the world’s population. Every person should be able to breathe tobacco-smoke-free air. Smoke-free laws are popular, protect the health of non-smokers, do not harm business and also encourage smokers to quit smoking or use of tobacco in any form.

Dr.N.Mariappan

Plastic surgeon, Chennai.

Ph: 9901043568

E-mail: drn_m@hotmail.com

The post Tobacco use in India – An evil with many faces appeared first on Health Vision.

2. More than 6 million global deaths are the result of direct tobacco use while around 890 000 are the result of non-smokers being exposed to second-hand smoke. Of the more than 6 million tobacco-related deaths every year across the world, one- sixth occur in India alone.

3. Total tobacco-related deaths are expected to reach 8 million by 2030. The Global Youth Tobacco Survey (GYTS) estimates doubling of deaths from smoking because of the increase in smoking among young girls compared with adult females, the high susceptibility of smoking among never smokers, high levels of exposure to second hand smoke, and pro-tobacco indirect advertising.

4. Around 80% of the world’s 1.1 billion smokers live in low-and middle income countries.

Second hand smoke (passive smoking) is the exposure of non-smokers to smoke that fills restaurants, offices or other enclosed spaces from tobacco products – cigarettes, Bidis and water pipes. About 34,000 non-smokers die from heart disease each year from exposure to second hand tobacco smoke in USA and is a leading cause of heart disease in non-smokers, your children, partner and friends.

1. In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer.

2. In pregnant women there is a high risk of complications during delivery. it causes low birth weight of the new-born babies. Infants have higher risk for sudden infant death syndrome (SIDS).

3. Almost half of children regularly breathe air polluted by tobacco smoke in public places. In 2004, children accounted for 28% of the deaths attributable to second-hand smoke. Children exposed to tobacco smoke are more likely to have ear infections and asthma.

4. Second-hand smoke causes more than 890 000 premature deaths per year.

Third hand smoke is residual nicotine and other chemicals left on indoor surfaces by tobacco smoke. People are exposed to the chemicals by touching contaminated surfaces or breathing in the off gassing from these surfaces.

Dr.N.Mariappan

Plastic surgeon, Chennai

Ph: 9901043568

E-mail: drn_m@hotmail.com

The post Be aware of Killer Tobacco appeared first on Health Vision.

Cigarette Smoking – Risks to Human Health and Environment. There are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer

 Direct risks to human health

1. Cancers of the Lungs, Oesophagus, Throat and Larynx are common in smoking population. Smoking is also associated with cancers of the bladder, pancreas, lips, kidney, uterus and cervix.
2. Autoimmune disorder: Smoking suppresses the body’s immune system.
3. Rheumatoid arthritis and Crohn’s disease are common and causes periodic flare-ups of autoimmune diseases.
4. Type 2 Diabetes: Smokers are 30% to 40% more likely to suffer from type 2 diabetes compared to non-smokers.
5. Premature deaths: Smoking leads to premature death because of the associated health risks including respiratory, cancer and vascular diseases.
6. Lung Disease: Apart from lung cancer, smoking can also contribute to chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis.
7. Heart attack and stroke: Smoking narrows blood vessels and restricts blood circulation to the heart; brain and other critical organs. Smokers are vulnerable to heart attack and stroke.
8. There is an increase in the risk of likelihood of blood clotting in the legs and lungs.
9. Complications for pregnant women: Risks of developing complications during birth. They may also experience a wide range of congenital disorders
10. Chewing tobacco: Is not a healthier alternative to smoking; it can increase your risk of mouth cancer, throat cancer and cancer of the oesophagus (food pipe). Teeth become more vulnerable to tooth decay and tooth loss.

Environmental hazards include:

1.  Health dangers of second hand smoke
2. Cigarette butts and the contamination of waterways
3. Deforestation
4. Generation of huge amounts of toxic waste
5. Air pollution through industrial production
6. Soil and land pollution through farming and from cigarette butts
7. Smoke air pollution
8. Impact on aquatic fish
9. Health impacts on pets.
10. Forest fires (Wild fires).

Dr.N.Mariappan

Plastic surgeon

Ramagondanahalli

Whitefield, Bangalore –560066

Ph: 9901043568

E-mail: drn_m@hotmail.com

The post Cigarette Smoking – Risks to Human Health and Environment appeared first on Health Vision.

World AIDS day is celebrated on 1st December of every year with the aim to raise the public awareness about HIV/ AIDS. 2017 marks the 29th anniversary of World AIDS Day. Acquired Immuno-Deficiency Syndrome (AIDS) is a pandemic disease caused by Human Immuno-deficiency Virus (HIV) infection. Government organizations, non-governmental organizations, civil society and health officials take part in the celebrations by organizing speeches or forums and discussion related to the AIDS. Between 1981 and 2007 around 25 million people died because of the HIV infection. In the year 2007, around 2 million people of which at least 270,000 children were infected with this epidemic disease, even after the anti retroviral treatment (ART) were made available at many places.

Using a slogan “Everybody counts”- World Health Organization is advocating for access to safe, effective, quality and affordable HIV services, medicines, diagnostics, other health commodities for all people who need them. Universal Health Coverage (UHC) means that all people receive health services they need without experiencing financial hardship, including access to the full range of HIV services AIDS originated in the 19th and 20th century in the west and central region of Africa. There is no cure for it, the course and severity of the disease can be lessened by regular treatment. The disease was first recognized in 1981, but identified by the name of AIDS on 27th of July in 1982. HIV virus attacks the T-cells of immune system of the human body and causes the disease known as AIDS. The infection can be easily transmitted from one person to the other directly through mucous membrane, blood, or body fluids like blood, semen, vaginal fluids, and breast milk of infected persons.

History of World AIDS Day celebrations:

World AIDS Day was first visualized in the month of August, 1987 by Thomas Netter and James W. Bunn, public information officers for the AIDS Global Programme at the WHO (World Health Organization) in Geneva, Switzerland. Dr. Jonathan Mann, Director of the AIDS Global Programme, approved the idea and recommended the observance on 1st of December in the year 1988. The official announcement for World AIDS Day was declared in the year 1995 by The President of United States of America and has become the most recognized international health day celebration. The Joint United Nations Programme on HIV/ AIDS, also known as the UNAIDS, was promoted worldwide in the year 1996. World AIDS campaign was launched by the UNAIDS in 1997 to focus on AIDS programs, better communications, disease prevention and disease awareness learning for the whole year. In the beginning, the World AIDS Day themes were focused only on the children as well as the young people, and were later recognized as a family disease as any person of any age group can be infected with HIV. In 2007, symbolizing by an iconic display of AIDS Ribbon by White House marked the beginning of the World Aids Day celebrations, which offers the key opportunity to the health organizations to increase the awareness among people, make the most possible access to the treatment and discuss the preventive measures. A simple red ribbon is one of the most widely recognized symbols of HIV and AIDS and is the global symbol for solidarity with HIV-positive people and those living with AIDS.

TEN facts regarding HIV/AIDS- (WHO Fact sheet, Updated May 2017):

Fact 1: Human immuno deficiency virus infects cells of the immune system with progressive deterioration of the immune function, and breaks down the body’s ability to protect against infections and other diseases. AIDS is the most advanced stage of HIV infection, defined by association of any of more than 20 opportunistic infections or related cancers.
Fact 2: HIV can be transmitted through the following ways: Unprotected sexual intercourse (vaginal or anal) or oral sex with an infected person; Transfusions of contaminated blood or blood products or transplantation of contaminated tissue; Sharing of injecting equipment (needles, syringes) and solutions contaminated with virus; contaminated surgical and tattooing equipments and other sharp instruments ; transmission between a mother and her baby during pregnancy, childbirth and breastfeeding.
Fact 3: An estimated 36.7 million (34.0–39.8 million) people were living with HIV in 2015, and 1.8 million (1.5–2.0 million) of these were children. The vast majority of people living with HIV are in low- and middle-income countries. An estimated 2.1 million (1.8–2.4 million) people were newly infected with HIV in 2015. An estimated 35 million people have died from HIV-related causes so far, including 1.1 million (940 000–1.3 million) in 2015.
Fact 4: Combination antiretroviral therapy prevents HIV from multiplying in the body. Effective ART treatment results in a reduction in viral load (the amount of virus in the body), greatly reducing the risk of transmitting the virus to sexual partners. If the reproduction of HIV stops, then the body’s immune cells are able to live longer and provide the body with protection from infections. If the HIV +ve partner in a couple is on effective ART, the chances of sexual transmission to the HIV negative partner can be reduced by as much as 96%. Expanding the coverage of HIV treatment contributes to HIV prevention efforts.
Fact 5: As of mid-2016, 18.2 million people were receiving ART worldwide; More than 16 million affected population lives in low-and middle-income nations. In 2016, WHO released the second edition of the “Consolidated guide-lines on the use of anti-retroviral drugs for treating and preventing HIV infection” with recommendations to provide lifelong ART to all children, adolescents and adults, including all pregnant and breastfeeding women living with HIV, regardless of CD4 cell count. WHO has expanded earlier recommendations to offer pre-exposure prophylaxis of HIV (PrEP) to selected people at substantial risk of acquiring HIV; and alternative first-line treatment regimens are also recommended.
Fact 6: HIV testing can help to ensure treatment for people in need: Access to HIV testing and medicines should be dramatically accelerated in order to reach the goal of ending AIDS by 2030. HIV testing reach is still limited, an estimated 40% of people with HIV (over 14 million) remain undiagnosed and their infection status is unknown. WHO recommends innovative HIV-self-testing and partner notification approaches to increase HIV testing and diagnostic services.
Fact 7: An estimated 1.8 million children are living with HIV: According to 2015 statistics, most of these children live in sub-Saharan Africa and were infected through transmission from their HIV-positive mothers during pregnancy, child-birth or breast-feeding. Nearly 150 000 children (110 000–190 000) were newly infected in 2015.
Fact 8: Elimination of mother-to-child transmission is becoming a reality: Access to preventive interventions remains limited in many low and middle income countries. In 2015, almost 8 out of 10 pregnant women living with HIV (1.1 million) received anti-retroviral treatment worldwide. In 2015, Cuba was the first country declared by WHO, as having eliminated mother-to-child transmission of HIV and syphilis. In June 2016, Armenia, Belarus and Thailand were validated for eliminating mother-to-child HIV transmission.
Fact 9: HIV is the greatest risk factor for developing active TB disease: In 2015, an estimated 1.2 million (11%) of the 10.4 million people who developed TB worldwide were HIV +ve and approximately 390 000 deaths were reported. The WHO African Region accounted for around 75% of the estimated number of HIV-related TB deaths
Fact 10: Comprehensive prevention package of services include:

HIV testing and counseling:

Correct and consistent use of female or male condoms;
Get treated for sexually transmitted infections (STI);
Promotion of safer sexual practices, such as avoidance of penetrative sex,
Voluntary medical male circumcision in 14 priority countries;

Avoid injecting drugs, or if you do, always use sterile needles and syringes; ensure that blood or blood products for transfusion are tested for HIV; start antiretroviral therapy immediately, if you have tested positive for HIV, for your own health and to prevent HIV transmission to your sexual or drug using partner or to your infant, if you are pregnant or breastfeeding; Use pre-exposure prophylaxis prior to engaging in high risk behavior; Get post-exposure prophylaxis if there is the risk that you have been exposed to HIV infection in both occupational and non-occupational settings.

Objectives of world AIDS day:

(1) To guide the member states for globally increasing the prevention and control measures for HIV/AIDS.

(2) Offer technical support for the plan for prevention, care, and treatment for HIV/AIDS including, testing, and counseling of mothers for transmitting the infection to the child, STI control and antiretroviral therapy.

(3) To increase the awareness in people about the antiretroviral medicines and therapies that can help fight against HIV/AIDS.

(4) Involve the peer groups in the campaign for getting the most effective result.

(5) Encourage more students from the schools, universities and social structures to contribute in the competitions organized for the cause of AIDS.

(6) To decrease and control the number of patients infected by HIV/AIDS and to encourage the peer groups for use of condom and safe sex practices.

World AIDS Day celebration is the focal point of the World AIDS Campaign, which is active all year round. It has become one of the most recognized international health days and a key opportunity to raise awareness, commemorate those who have passed on, and celebrate victories, such as increased access to treatment and prevention services.

(1) Many health education campaigns are organized to help increased awareness in the people and promote the day.

(2) Anti-discrimination activities are launched on that day.

(3) AIDS Memorial Quilt project is organized in USA, to remember the people died of AIDS-related conditions. Friends and family members of deceased AIDS sufferers construct quilt panels, and are displayed all over the USA.

AIDS Awareness Months:

Different governments and organizations have declared different months as AIDS Awareness Month. The most popular choices are October and December. December is chosen to coincide with World AIDS Day. AIDS Day celebrations in India is on Friday, 1st of December, 2017.

Signs and Symptoms of HIV/AIDS:

A person with HIV/AIDS has the following signs and symptoms: fever, chills, Sore throat, and sweats during night, enlarged lymph glands, weight loss, tiredness, weakness, Joint pain, muscle ache, and red rashes. HIV virus cause damages to the immune system and the infected person does not feel any symptoms and appears healthy. This makes the disease difficult to identify early and cure completely. In the late stage of HIV infection the virus weakens the immune system to fight against infection and the person develops illness with AIDS and show the following features: Blurred vision, fever (above 100°F), weight loss, tuberculosis, pneumonia, permanent tiredness, night sweats, diarrhea (persistent, chronic), swollen glands, white spots on the tongue and mouth, shortness of breath, Kaposi sarcoma, cancers of the lungs, cervix, rectum, liver, head and neck and the lymphomas (cancer of immune system).

Early detection:

The U.S. Centers for Disease Control and Prevention recommends that all people should get tested for HIV as part of their regular medical care. National HIV Testing Day (NHTD) was first observed on June 27, 1995.The Federal theme for 2017 is “Test Your Way. Do It Today”.

United States Preventive Services Task Force (USPSTF) recommends HIV testing:
As part of regular medical care for people 15 to 65 years old.
For all pregnant women.
For people younger than 15 and older than 65 if they have a high risk for
HIV, such as for people who engage in high-risk behavior.

Diagnosis:

HIV is diagnosed when antibodies to HIV are found in the blood by ELISA test and confirmed by Western blot method. Rapid antibody tests give results right away, but positive results needs to be confirmed by the ELISA or Western blot test. HIV is diagnosed only after two or more positive ELISA tests are confirmed by one positive Western blot assay. The tests can be done on the same blood sample. ELISA test results are available in 2 to 4 days and Western blot method takes 1 to 2 weeks.[Normal Person has a CD4 cell count between 500 and 1500 ; people living with HIV, usually in pretty good health have a count over 500]. AIDS is the last and most severe stage of HIV infection. The definition of AIDS include all HIV infected individuals with CD4+ cell count less than 200 cells cells/µL of blood (CD4 < 14 %) and those with certain HIV-related conditions and symptoms. Opportunistic infections are common in people with weakened immune systems and susceptible to Pneumo-cystis pneumonia, Kaposi’s sarcoma and a variety of other illnesses associated with decreased immunity (The US Centers for Disease Control and Prevention).

Treatment Overview:

The most effective treatment for HIV is antiretroviral therapy (ART), a combination of several medicines that aims to control the amount of virus in your body. Guidelines to be followed for a healthy living with HIV infection include:

(1) Keep immune system strong by nutritious diet, quit smoking, and learn to avoid infection.

(2). Monitor your CD4+ (white blood cells) counts to check the effect of the virus on your immune system.

(3) Counseling to handle the strong emotions and stress that follow diagnosis of HIV.

(4). Modify lifestyle to reduce stress so that you can manage the HIV illness better.

The Indian Systems of Medicine in AIDS treatment (AYUSH):

Multiple medical systems such as Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) have existed for centuries before the rise of biomedicine. AYUSH system focuses on “vital force”- when reduced exposes the patient susceptible to infections or disorders. Vital force is the overall body and mind health of the person with emphasis on a more holistic moral and lifestyle choice.

Ayurvedic AIDS Treatment:

AIDS is primarily a disease of low ojas (immunity) according to Ayurveda. Ojas provides the physical and mental strength to resist disease. Rasayana is a branch of Ayurveda which specifically deals with increasing immunity and vitality through the use of various herbs, minerals and Ayurvedic techniques and practices. After initial detoxification, the strength, immunity and vitality of the patient are increased through rasayanic therapies. Ayurvedic treatment, Diet and Lifestyle modifications:

(1) The first step is to give emotional and moral support to the patient.

(2) The patient needs easily digestible, nourishing food, and be engaged in fruitful activities.

(3) Ayurveda help in preventing AIDS by strengthening the body’s defense system by herbs and Achara Rasayana (behavioral medicine). Amla (Emblica officinalis), Bala (Sida Cordiolia), Haritaki (Terminalia Chebula), Nirgundi (Vitex nirgundo) and Amrita (Tinospora Cardifolia) are the herbals effective in the prevention of AIDS.

(4) Ayurvedic tonic and rasayanas (rejuvenators) should be given to strengthen the system, boost immunity levels and stimulate appetite. After gaining some strength, shodhana techniques (elimination/ purifying) are used to expel toxins from the body through enemas, purgation, steam bath, and emesis.

(5) A nourishing diet along with medicated ghee preparations and soups is recommended. Spicy, oily and acidic foods are to be avoided. Chyavanprash (health Supplement), raktavardhak (Blood purifier) and triphala (three fruits) are recommended for AIDS patients.

Yoga and Naturopathy:

Naturopathy can be defined as a drugless, noninvasive, rational and evidence-based system of medicine imparting treatments with natural elements based on the theories of vitality, toxemia and the self-healing capacity of the body, as well as the principles of healthy living, and uses the body’s innate capacity to cure diseases. Long term Naturopathy and yogic lifestyle modifications in HIV +ve patients on ART show increase in the CD4 count. Improper diet, sedentary lifestyle, addiction, and behavioral attitudes like anxiety, phobia are the negative lifestyle methods altered by this method of treatment. Naturopathy and yoga is recommended as a strong adjuvant in the treatment of HIV-positive individuals.

Unani System of Medicine:

Qillat-e-Manaat (immunity power) was in use for long before the discovery of the immune system or the development of germ theory. Treatment: Unani physicians agree that an imbalance of the human blood causes HIV infection; Supportive treatments include: 1) Cupping (Hijama) given to alleviate pain 2) Maqqavi Azae- Raeesa advia tonics to support vital organs and immunity and 3) Ilajbil-giza special diet therapy.

Siddha principles of treatment of HIV etiology:

HIV is taught as “vettai noi” or ‘theivu noi”. Primary treatment is with Rasa Gandhi Melugu, a mercury preparation with some additional 40 drugs. Other drugs like Kodiveli, (Plumbago zeylanica Linn, belonging to the family Plumbaginaceae), Panai vellam (palm jaggery), Garlic, Sukku (dry ginger), Melagu (wax), and Thippili (Indian long pepper or piperum longum) are also added into a form of melugu. Rasam (mercury) and Kandhagam (sulphur) are used as broad spectrum antibiotics. Diet and medications that enhance body immunity are the important components of the treatment.
Homeopathy place emphasis on the supposed miasm (susceptible constitutional types) when treating patients. They identify the miasm based on the symptoms that are presenting at the time, rather than on the diagnosis of a particular disease such as HIV which is considered a mixed miasm disease, with different miasms presenting at different times depending on the characteristics of the patient. The prescription of medications is based only on a patient’s presenting symptoms, not on the presence of the virus.

Limitations:

AYUSH-based treatments need additional research to examine specific formulations that hold promise of enhanced immunity and possible inter-actions between traditional formulations and ART.

End AIDS by 2030:

“The 2030 Agenda for Sustainable Development was adopted with a promise to leave no one behind. Nowhere is this more important than in tackling AIDS. Supporting young, vulnerable and marginalized people will change the course of the epidemic.”- Secretary-General Ban Ki-moon.

UNAIDS issued new “Fast-Track: Ending the AIDS epidemic by 2030” strategy on November 18, 2014).The fast track approach aims at 90 percent of people who live with HIV will know their status, 90 % of known HIV +ve positive people will be on treatment, and 90 % of people on treatment will have their viral load suppressed, and making them less likely to transmit the virus by 2020. And by 2030, AIDS will no longer be a threat to public health.

1. More health workers, ready for anything: We need 7.2 million additional doctors, nurses and midwives worldwide. Unless we invest in the global health workforce, the number will grow to 12.9 million by 2035.

2. Focus on “key populations”. Members of populations of sex workers, men who have sex with men, transgender people and drug users (Injectable) are being marginalized and stigmatized. Their isolation and high risk behaviors mean these groups have much higher HIV prevalence rates than others and they suffer the bulk of new infections. LET’S END IT: End isolation, End stigma, End HIV transmission.

3. Rock-solid health systems: Strong health systems with strong foundation built on governance, financing, technology, research, service delivery, and the adequate health workforce (human resources) are essential to address HIV epidemic.

4. Strange bedfellows, unexpected results: Global health needs more innovative and strong partnerships to end the HIV epidemic.

5. ARVs to treat and prevent: In 2011, U.S. scientist Myron Cohen discovered that treating HIV positive patients with their immune systems still strong, anti-retroviral therapy lowers the risk of transmitting the virus and proved the concept of treatment as prevention. More health workers and strong health systems to support community based testing campaigns; counseling, provider- initiated testing, and self testing are crucial for effectiveness of the program and to achieve the Sustainable Development Goals.

Harvest the benefits:

Extensive research and huge investments were made in the field of AIDS over the past decades; the world needs to harvest the benefits of enormous efforts and money spent on AIDS-related conditions. A 90% decrease in the annual number of HIV infections and AIDS-related deaths is expected by 2030. It is possible to save lives, prevent new infections and reduce the cost of therapy by the Fast-Track approach. Avoiding AIDS-related deaths and new infections are the priorities. Achieving these targets will generate economic benefits of 15 times the investment needed for fighting AIDS related issues. It also reduces the financial burden spent on antiretroviral therapy. This will strengthen the health systems by establishing critical infrastructure to focus on other priorities, such as emerging chronic diseases and outbreaks of highly infectious diseases.

Dr.N.Mariappan
Department of Plastic and Reconstructive Surgery

Vydehi Institute of Medical Sciences & research centre,

Whitefield, Bangalore – 66

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