{"id":20,"date":"2013-05-15T19:23:24","date_gmt":"2013-05-15T19:23:24","guid":{"rendered":"https:\/\/inmedblogs.us\/jeffreywalden\/?p=20"},"modified":"2015-06-08T19:29:08","modified_gmt":"2015-06-08T19:29:08","slug":"caring-for-hiv-patients","status":"publish","type":"post","link":"https:\/\/inmedblogs.us\/jeffreywalden\/2013\/05\/15\/caring-for-hiv-patients\/","title":{"rendered":"Caring For HIV Patients"},"content":{"rendered":"

\"TB<\/a><\/p>\n

 <\/p>\n

Very busy day today: \u00a0I left our usual doctor\u2019s meeting\/teaching rounds expecting to see my half of the Male Ward patients that I had rounded on yesterday.\u00a0 However, the physician covering Female Ward called in sick and, since I had been on Female Ward last week, I was asked to cover for her.\u00a0\u00a0I was happy (and a bit nervous) to do so, but it was still a bit of a shock going from covering half of a ward to a whole ward, and basically a brand new set of patients at that.\u00a0 I was assigned my own medical student, and she was proved to be very helpful, recording while I interviewed the patients.<\/p>\n

 <\/p>\n

Of all the diseases encountered, HIV is by far the most prevalent.\u00a0 On any given day, half to two-thirds of any ward (except NICU) consists of HIV positive patients.\u00a0 Because of the stigma still associated with the disease, it undergoes two pseudonyms in the medical chart:\u00a0 CTRR and ISS.\u00a0 CTRR stands for Counseled, Tested, Resulted, and Reactive.\u00a0 If the patient returns negative, it simply reads CTR in the chart.\u00a0 ISS simply means Immunosuppressive Syndrome.<\/p>\n

 <\/p>\n

Caring for HIV patients \u2014 many of whom are extremely sick \u2014 has been one of the biggest challenges and changes from working in the US.\u00a0 Almost every person admitted to the hospital has a screening HIV test and the majority return positive.\u00a0 Once positive, they receive HIV counseling and are established in the outpatient HIV clinic once they are discharged from the hospital.\u00a0 Many of the patients we see here have Stage IV AIDS under the World Health Organization classification for HIV\/AIDS.\u00a0 Stage IV is the worst. Patients are started on anti-retrovirals if their CD4 count (the white blood cells which are attacked by the HIV virus) is under 200 or if they have a Stage IV AIDS defining illness.\u00a0 These include things like cryptococcus and toxoplasmosis.\u00a0 Several of the HIV patients that I rounded on today had CD4 counts below 50.\u00a0 We did see one patient with a CD4 count of 2 yesterday.<\/p>\n

 <\/p>\n

TB is another of the frequent opportunistic infections encountered here, and this includes extra-pulmonary TB including Potts disease (TB of the spine), hepatic TB, miliary TB, and lymphatic TB.\u00a0 Pulmonary TB is generally treated for 6 months here and extra-pulmonary for 9 months.\u00a0 The diagnosis is often tricky as it\u2019s very difficult to obtain sputum samples and, at least in HIV patients, sputum samples are often negative for acid-fast bacilli (the test for TB), so the diagnosis is made on a combination of radiographic and clinical findings.\u00a0 Another frequent opportunistic infection encountered here is diffuse candidiasis (a type of yeast causing pathologic disease).<\/p>\n

 <\/p>\n

All in all, the day was very tiring, as we had several new admissions as well as several \u201creviews\u201d sent from Outpatient Department.\u00a0 These are patients who may or may not warrant admission criteria and therefore the ward physician interviews and examines them and determines if they need to be hospitalized.\u00a0 After all this, I was very happy once all the work was done, and dealt with the fatigue the best way I know how:\u00a0 I went for a run.<\/p>\n

 <\/p>\n

Which, in and of itself, isn\u2019t that big a deal, but here it\u2019s a rather comic affair for the Ugandans to see a lone white person going for a run.\u00a0 The children become most the most excited and will yell out \u201cBye Mzungu!\u201d or \u201cRun Mzungu run!\u201d (making me feel rather Gumpish) and sometimes even join in with me for a few yards, laughing all the while.\u00a0 In general everyone, young and old alike, laugh when I run by, but it\u2019s good-natured.\u00a0 Sometime people on the road ahead of me will hear me coming and stop and gape at me until I\u2019ve passed.<\/p>\n

 <\/p>\n

An update on the boy with snakebite:\u00a0 He\u2019s being discharged tomorrow.\u00a0 He made a dramatic recovery after his skin infection antibiotic was increased and he was placed on anti-malarials.\u00a0 His leg looks great, and it definitely seems that it was a combination of cellulitis and malaria rather than snakebite. \u00a0At the end, it\u2019s been a very tiring but rewarding day.<\/p>\n","protected":false},"excerpt":{"rendered":"

  Very busy day today: \u00a0I left our usual doctor\u2019s meeting\/teaching rounds expecting to see my half of the Male […]<\/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-20","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/20","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=20"}],"version-history":[{"count":0,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/20\/revisions"}],"wp:attachment":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/media?parent=20"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/categories?post=20"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/tags?post=20"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}