PEP in practice

• PEP in practice
  28 year old lab technical got needle prick injury during sample collection attended for PEP in a teaching institution advised AZT+3TC+EFV, after the second day that client experienced confusion, abdominal pain, vomiting. Symptomatic management and counseling given by ART medical officer and advised to change regimen if the symptoms persist. But by day 12 DNA PCR done with negative PCR report PEP stopped.
  Is it wise to do like that?
  -NO!!
  -Change regime AZT to STV
  -Take EFV in empty stomach or in divided doses
  -At least ask to continue STV+LMV for 28 days
  
  Reasons:-
  · Any investigation can give false positive and false negative results-Not only PCR
  · Most of the reported studies with PCR and PEP not from our country, not from this virus subtype.
  · Even with PEP failure case slow progression was reported
  · Even with PEP failure case latency will be reduced which may be important in future if cure is available
  · Even with PEP failure case low viral load during window period might reduce transmission in case of unprotected sexual intercourse.
  · Too short duration of therapy might result in resistance to the future first line regime.


• My experiances with PEP

PEP for 2days, 7days, 14days and 6months(none of the guidelines about PEP in this world is supporing this commision of negligence).

Nevirapine as a PEP regime by OG post graduates(May get SJS).

PEP after 5 days of needle prick(More prone for resistant strain.

எவனா இருந்த என்ன எல்லாருக்கும் இந்த நெலம வருண்டா பிச்சகார பயலுகளா!!

35 yr old PLHA who is a politician referred to an ART centre who is on ART in that centre, from private after a long delay (several days) in unconscious condition last 4 days with h/o fever, head ache, vomiting for last 15 days, patient is on ART and ATT around last 2 months, treated in private with antibiotics. Patient is nil oral last 4 days with IV fluid of 1 bottle of NS in day one, 1 bottle of NS and DNS in day two. ART call over given, on examination ?Meningeal signs +, fever+, RS-clear. CT shows no space occupying lesion and patient on mannitol. Advised to do lumbar puncture after mannitol. But they want neurologist opinion to rule out ICT?? to do Lumbar Puncture. With requisition made by ART medical officer to the chief of that medical ward to do LP to save the patient by his own risk, the answer is “Our PG’s will do LP”. The next day, next day, the next day, AGAIN a requisition made by the ART MO. The answer is “we don’t want to do LP for HIV positive”, it’s the reason we asked for neurologist opinion. My patient is no more, but I am. Yes he expired with septicemia by bed sore.
“PLHA can die with brain herniation during LP, but not by BED SORE”
Yes, Again I murdered by my profession.
But the idiotic chief came back to ART centre with his relative for initiation of ART, and the PG asked me for a good HIV physician. IDIOTIC PHYSICIANS. (“Physicians fight each other to do LP” if the client is HIV negative or unknown status- which is highly dangerous, if the client is positive they are ready to give chance for a resident or neglect the procedure )

என்னத்த சம்பாரிச்சாலும் சாகும் போது உன்னக்கும் இந்த நெலம வருண்டா பிச்சகார பயலுகளா!!!

Professionaly we are killers!!

30 yr old female PLHA who is on treatment(STV+LMV+NVP) last 6 months in a ART centre came with complaints of breathlessness for the past 1 week came to ART centre referred to medicine department to rule out PCP(pneumonia) or lactic acidosis by a ART medical officer with notes in follow-up notebook. Notes contain RS-no crepts, no wheeze. The case was received by a post graduate student in the medicine department when he knows she is HIV positive she was sent back to home with the prescription of non-sense.
Prescription is
C.Doxycycline 100mg 1bd
T.Antacid 2 tds
T.Paracetamol 1 tds.
Yes I met the assistant professor, he asked me to admit the patient. But with the good counseling (“She is HIV patient she will die 200%”)by that post graduate, patient and attenders are absent in that place when I am back. EUTHANASIA without pain to the doctor.
YES, I MURDERED BY MY PROFESSION. We didn’t get back the patient.
STV&female-prone for lactic acidosis
Breathlessness- always rule out PCP in HIV clients.
Simply no use in getting any highly qualified degree without having professional ethics.