Second day on the wards. \u00a0I split the female ward with Dr. Diana (the physicians here go by their first names, signing the same way in their charts) and was actually able to get through my half, including a new admission, who was a 32 yo female with LLQ abdominal\/pelvic pain. \u00a0She had had an ultrasound but the report said she needed to have a repeat once her bladder was full. \u00a0Unfortunately, but the time this occurred, the ultrasound machine was down, which is evidently a not uncommon occurrence here.<\/p>\n
<\/p>\n
Our other new admission here was also very interesting. \u00a0When I first met her, \u00a0I thought the young 17 yo female girl had nephrotic syndrome due to her facial congestion\/edema. \u00a0However when I asked Dr. Diana, she said that it was a condition known as EMF, endomyocardial fibrosis. \u00a0Evidently EMF was first discovered in Uganda in 1940 and is a form of restrictive cardiomyopathy.\u00a0 Here\u2019s the paragraph on Epidemiology for this condition:<\/p>\n
<\/p>\n
EPIDEMIOLOGY \u2014 EMF was first recognized in Uganda during the 1940s and accounts for as much as 20 percent of cardiac cases sent for echocardiography in that country in contemporary series. Although accurate epidemiologic data are lacking, EMF is estimated to the most common form of restrictive cardiomyopathy worldwide<\/p>\n
<\/p>\n
According to the physicians here, the hallmark sign is abdominal edema without pedal\/lower extremity involvement.\u00a0 I actually saw 2 patients today with this.\u00a0 The second was also a known EMF patient who shows up at the hospital once a month for paracentesis.\u00a0 She had stick-thin legs and an extremely swollen belly, just as described.<\/p>\n
<\/p>\n
We did an EKG on the patient, which was very interesting for 2 reasons. \u00a0Evidently the Ugandan physicians\u00a0\u00a0do not learn EKGs in medical school (more on their training later, it\u2019s actually very impressive). \u00a0Dr. Diana had seen 3 in med school. \u00a0I walked her through the diagnosis \u2014 unfortunately the patient had Mobitz II 2nd degree heart block as well as very prolonged QT syndrome. \u00a0She\u2019s not doing well at the moment. \u00a0After reading about it, EMF patients are treated like diastolic restrictive heart failure patients, which is very difficult. \u00a0The true treatment is surgery, for which we have to refer her to the main hospital in Kampala. \u00a0However she is too unstable at the moment to make the 2 hour journey over rough roads.<\/p>\n
<\/p>\n
The second reason the EKG experience was so interesting was that in placing the EKG leads. \u00a0None of the nurses knew how to do it and turned to me to do it! \u00a0Although I know about reading them, I don\u2019t know much about actually placing them. \u00a0Luckily there was a British medical student present who walked me through it.\u00a0Those were the 2 most interesting tidbits from today: \u00a0EMF and EKGs. \u00a02 more days on female ward and then it\u2019s off to Murchison\u2019s Falls for the weekend. \u00a0More to follow\u2026<\/p>\n","protected":false},"excerpt":{"rendered":"
Second day on the wards. \u00a0I split the female ward with Dr. Diana (the physicians here go by their first […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-15","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/15","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/comments?post=15"}],"version-history":[{"count":0,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/15\/revisions"}],"wp:attachment":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/media?parent=15"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/categories?post=15"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/tags?post=15"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}