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Published: February 21st 2012
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In my outpatient clinic last Friday morning, I saw about 15 patients with my team.
Tenof them had Tuberculosis in one form or another. So far, during the last 3 weeks, I have seen pulmonary TB, TB meningitis, TB peritonitis, TB tuberculoma, disseminated TB. I had always heard that syphilis was considered to be the "Great Imitator," but how it could eclipse Mycobacterium in its various forms is beyond me.
Due to the advent of multi-drug resistant TB in Mumbai, all patients diagnosed with this infection are started on AKT (Anti-Koch's therapy, as it is called here) immediately in the hospital setting. When they are stable for discharge, they return within 1-2 weeks for follow-up on their condition, where they receive an update on the sensitivities of their cultures. This follow-up is a great time to discuss whether the patient is dealing with a multi-drug resistant strain or not. If they are, then the treatment is adjusted at this appointment.
For the last 2 days, I have switched over to the Pediatrics side. The physician I rounded with this morning is named Dr. Vinand Deshmukh, and he is one heck of a domineering personality. He is that classic, confrontational,
in-your-face, academic clinician that is oft-alluded to and feared by medical students. It is amusing to watch him hound his residents as they meekly present their patients to him. It's an inevitable and perpetual "pimping" session that takes no prisoners, and boy, does he know his stuff. He even doggedly questioned his subjects about recent health care news pertinent to India. Needless to say, there were blank stares. He even went after me today. Clearly, I will be cut no slack in his presence. Since rounds were so intense, I did not have a chance to take very many photos today, but have no fear, I'll get them to you soon.
Interesting cases from the day:
1)
Kwashiorkor - young patient with distended abdomen, chubby cheeks, and pedal edema. For those who don't know, this is a diagnosis given to patients who have severely inadequate protein intake. Because of the lack of protein, fluid osmotically shifts out of the blood vessels and into the tissues, where it gives you the false impression that the child is well-fed. Food is carefully being administered to avoid the dreaded Refeeding Syndrome.
2)
TB Meningitis in a child with congenital hydrocephalus
3) A beastly congenital
dilated cardiomyopathy in a 2 month old child. One of the residents claimed to hear an S3. The kid's heart rate was 160 beats/min, so I have my doubts about that one :-)
4)
Spastic cerebral palsy - I am not sure exactly how to classify this as of now, but I will look it up. This kid was really interesting. His upper and lower extremities were so hypertonic (tightened) that I had to use a good amount of strength to extend his arms and legs. He had a great demonstration of multi-beat clonus in both ankles and he was hyper-reflexive bilaterally. However, at 17 months of age, he had absolutely NO control of his neck musculature. His neck was as floppy as a newborn's.
That's all I have for now. I promise the next one will be more entertaining!
In the meantime, take a look at how much fun I've been having! Yaaaaay!
Sunjay
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