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CASE PRESENTATION

CASE PRESENTATION. Dr. Rajya Shree Nyachhyon Kunwar Seti- ART, Dhangadi, Nepal. Patient descrition. Migrant worker 26 years old male Unmarried Literate Consumes alcohol (everyday) and has smoking habit. Complain of:. High-grade fever continuous – 4 weeks

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CASE PRESENTATION

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  1. CASE PRESENTATION Dr. Rajya Shree Nyachhyon Kunwar Seti- ART, Dhangadi, Nepal

  2. Patient descrition • Migrant worker • 26 years old male • Unmarried • Literate • Consumes alcohol (everyday) and has smoking habit

  3. Complain of: • High-grade fever continuous – 4 weeks • Associated with headache, cough dry initially followed by productive • Altered sensorium and mooning, slurring of speech and unable to walk due to left sided of the body weakness -1 day

  4. History of present illness • For the above complain treated in India for typhoid fever and malaria but no improvement • Got deteriorated, so brought to home town for care and support • VCT done in Nepal (Tikapur) found positive and was referred to Seti- ART CLinic

  5. Physical examination • General condition- poor • GCS- E2 V3 M4 • Vital signs normal • Chest- BL VBS, Creps and wheezes present • CVS, PA- normal • CNS- Reflex and tone increased in left side, Power in left limbs 2/5, Planter bilateral upgoing

  6. Investigations • Blood picture, Urine RME , RFT, LFT- NAD • HBsAG, Anti-HCV, VDRL- negative • CSF: TC- 540/mm3, DC- L (90%) and N (10%), Protein 3+, sugar 64mg%, AFB- not seen, Gram stain- negative • CD4 count- 69

  7. CXR-PA View

  8. Treatment • IV fluids • NG tube for feeding • Urethral Catheterization • IV Antibiotics (Inj. Ceftriaxone 2gm IV BD), Tab. Cotrimoxazole Ds • Anti-Tubercular Treatrment (Isoniazide, Rifampicin, Pyrizinamide,Ethambutol)

  9. After one week of treatment • Patient oriented to time, place and person • GCS 15/15 • Vital sign normal • Fever subsided • Discharged on oral medication, advised for physio-therapy and proper nutrition • Plan to start ARV after 2 months of ATT

  10. Challenges in Nepal • Difficult to estimate no. of PLHAs due to inadequate surveillance mechanism and poor data keeping although - 15,945 has been recorded (NCASC,June 2010) but no. estimated is quite high (70,000) • Late presentation of case- due to lack of awareness and knowledge, lack of health facility, not well equipped, and lack of medical professional

  11. Poor expenditure in Health by Government • Stigma and discrimination not only in family, community but also in HOSPITALS

  12. THANK YOU

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