CD117 Tips

HIV, which is short for Human Immunodeficiency Virus, penetrates your body and directly attacks your immune system. In this process, the virus weakens your body's natural defense mechanism against diseases and infections. A compromised immune system makes the body prone to minor infections, which healthy people would generally overcome. The virus itself doesn't cause any physical symptoms. It only serves to ease the entry of other bacteria and viruses into the body.

The following are some of the ways HIV affects your body:
1. Immune system - The human immunodeficiency virus destroys CD4 cells, the white blood cells that help the immune system ward off foreign substances. If left unchecked, HIV can develop into AIDS. During such time, the virus may damage the immune system to an extent that it wouldn't be able to ward off minor infections that a healthy immune system would. A person with HIV could thus suffer from fever, chills, sweats, shortness of breath, white spots in the mouth, fatigue, skin rash and weight loss from time to time.
2. Respiratory system - As HIV develops into AIDS, the body can contract infections such as pneumocystis pneumonia (PCP), tuberculosis and Kaposi's sarcoma. These conditions lead to serious respiratory problems. PCP is found to be one of the most common infections among people with HIV. 85% of the people would develop the infection if the condition is left untreated.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Stress is a major factor that leads to various complications in most of the health conditions. Hence, it is essential to deal with stress because doctors emphasize that if you can manage your stress, then you are already halfway through the treatment. But with HIV building up in your body it can be challenging to stay stress-free.

Effect of stress on HIV patients
Evidence has been found after extensive research that death may increase at times by 22% when an HIV patient starts taking lots of stress. So you can guess from the number what a huge impact stress has on HIV. Some other studies had brought to light a different angle of the effect caused by stress on HIV. It is said that the CD4 count and viral load increases by many folds in patients who have HIV and are under stressful conditions which have made them fall into the clutches of depression.

Steps that can be taken to curb stress-

1. As the first step, you must identify the reasons or factors that are leading you to take the stress. These factors may be straightforward ones and something from your day-to-day activities. For instance, some might feel depressed about consuming too many medicines for HIV on a daily basis while some others might feel stress out because of the financial strain imposed by the disease. Sometimes the stress results from emotional reasons like departing from a loved one or being separated from the mainstream life.
2. Once you have identified the reason behind your stress, you must put in some effort to get back to your daily routine and make your day organized. Mostly, it happens that people tend to extend their hours of regular activities and mess up with their biological clock. This should be avoided. Always keep fixed hours for your sleep, work and other activities. Add appropriate physical activities and proper diet to your routine which will help with your general health and help with managing stress.
3. You must also learn to handle your emotions. Seek help in this case by attending counseling sessions with trained professional, especially when it comes to managing your sex life. Talk to your doctor and get all your questions answered because sometimes lack of knowledge leads to the development of doubts which lead to anxiety and then depression. And most importantly, spend time with your loved ones to obtain complete stress relief. This is one of the best methods to have a positive outlook on life while suffering from HIV.

So, while under treatment for HIV make an effort to avoid stress entirely to improve the situation. Follow the advice of your doctor, take the necessary medications and adopt lifestyle changes to lead a happy life.

In case you have a concern or query you can always consult an expert & get answers to your questions!

You are about to go on stage to face an audience. Palms sweaty, heart racing and a fear gripping your in such a way that your feet or tongue refuse to move? Relax. You are having a bout of stage fright. The first and most comforting thing to know is that the biggest and most popular performers and speakers also go through a bout of nervousness before their big show. And yet, when you see them on stage, you'll not detect an ounce of it. You can be that person too.

Why do you experience stage fright? Being the center of attention among an audience focused only on you can trigger thoughts of a bad or unconvincing performance resulting in loss of reputation, mockery and a perception of failure. The physical response your body has to this is called "fight or flight" syndrome which is a natural process designed to protect you.

So how do you face the situation and get better of it? Here are a few steps to get you there:

• Self-hypnosis / Hypnotherapy for stage fright: Imagine if you believed that you are a master public speaker and can feel calm and confident during every performance! A self-hypnosis or hypnortherapy session allows you to reach out into the recesses of your subconscious mind and harness its power to handle stressful situations like a stage performance. You may have heard the common adage of - You are what you believe; and this therapy proves it. The process will help you visualize your actual performance and link it with positive, encouraging and enjoyable images which will replace your anxiety with confidence. You can either visit a consultant or buy a CD online.
• NLP (Neuro Linguistic Programming) for stage fright: NLP was created in the 1970s by Richard Bandler and John Grinder in California as a connection between neurological process, linguistic and behavioural patterns learnt through experience or programming. NLP claims to cure everything from phobias to depression to even the common cold. Though not scientifically proven, NLP uses a set of mental exercises to allow you to change your perception and blockages and hesitation into positive actions. Similar to hypnosis, it'll allow you to program yourself to believe and practice for a positive outcome in order to achieve it.
• Add the wow factor: Anyone giving you their time deserves to leave with a 'wow'. Add facts, figures or moves that'll give them that. Add 'your' touch and style to it.

HIV, which is short for Human Immunodeficiency Virus, penetrates your body and directly attacks your immune system. In this process, the virus weakens your body's natural defense mechanism against diseases and infections. A compromised immune system makes the body prone to minor infections, which healthy people would generally overcome. The virus itself doesn't cause any physical symptoms. It only serves to ease the entry of other bacteria and viruses into the body.

The following are some of the ways HIV affects your body:

1. Immune system - The human immunodeficiency virus destroys CD4 cells, the white blood cells that help the immune system ward off foreign substances. If left unchecked, HIV can develop into AIDS. During such time, the virus may damage the immune system to an extent that it wouldn't be able to ward off minor infections that a healthy immune system would. A person with HIV could thus suffer from fever, chills, sweats, shortness of breath, white spots in the mouth, fatigue, skin rash and weight loss from time to time.

2. Respiratory system - As HIV develops into AIDS, the body can contract infections such as pneumocystis pneumonia (PCP), tuberculosis and Kaposi's sarcoma. These conditions lead to serious respiratory problems. PCP is found to be one of the most common infections among people with HIV. 85% of the people would develop the infection if the condition is left untreated.

Related Tip: Bananas Have the Potential to Prevent HIV Infection

AIDS also termed as Acquired Immuno Deficiency Syndrome is a serious condition affecting people worldwide. Caused by HIV (Human Immunodeficiency Virus), the retrovirus is known to attack the CD-4 cells (T-cells) wreaking havoc on the immune system. As a result, the body's ability to fight various diseases (including the HIV infection) gets affected.

An important point to be noted is that HIV infections do not always result in AIDS. The virus triggers an HIV Infection that gradually develops into AIDS. In fact, an HIV infected person can lead a normal life (AIDS do not occur) through timely diagnosis and treatment. In this article, we will discuss the essential steps that can play a pivotal role in HIV prevention.

HIV and AIDS Prevention
For an effective preventive measure, one should first understand the mode of spread of the HIV infection and AIDS.

For the transmission of the HIV infection, certain fluids such as the semen, vaginal secretions, or the blood of the infected person must enter the body of a healthy person. This transmission can take place in many ways, the most common of which include:

• Transfusion of the infected blood into a healthy person.
• Having unprotected sex with an HIV infected person.
• From the infected mother to the fetus or from the lactating mother to the baby (through breastfeeding).
• Sharing of needles can also play a pivotal role in the transmission of the HIV infection.

Having mentioned the various modes of transmission of the HIV infection, a little alertness and certain precautionary measures can work wonders to prevent the spread of this life-threatening disease.

• No matter how much you trust and love your partner, never go for unprotected sex. In addition to preventing unwanted pregnancies, condom also acts as a protective shield safeguarding one from the HIV infection and other STDs (sexually transmitted diseases). Also if you are suffering from HIV infection or AIDS, make sure your partner knows about the same. Keeping them in the dark will only complicate things further.
• It is a safe practice to get the donor blood tested before a transfusion.
• Always ensure that the needle you are using is new or properly sterilized.
• A pregnant woman should be extra careful. A small negligence can cause her and the baby dearly. Be in regular touch with your attending physician and get all the necessary medications and treatments done.
• For some people who are more susceptible to the HIV infection, a drug known as TRUVADA ( a combination of emtricitabine-tenofovir) can be highly effective. However, the drug is not advisable for people with Hepatitis B or renal problems. A person already HIV- infected may also not benefit from this drug.
• An HIV- infected should undergo regular health checkups and screenings to avoid any further complications and aggravation of the condition.

An HIV or AIDS patient is a normal human being like us. Don't isolate them or treat them as untouchables. Let them also live with dignity and pride. In case you have a concern or query you can always consult an expert & get answers to your questions!

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

1. Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
2. Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
3. Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
4. Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
5. Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
6. Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one’s health.

Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

HIV is a systemic disease which affects all parts of the body. The oral cavity also has some tell-tale symptoms which indicate HIV / AIDS. A careful examination and detailed history of symptoms is essential. In some cases, the oral manifestations could be the area where HIV is suspected. This can help in reducing morbidity and improves prognosis. The oral lesions that occur in HIV patients can vary and differ significantly in children and adults. While there are a variety of oral lesions in HIV-infected individuals, listed below are some common infections seen in HIV patients. These are a combination of fungal, viral and bacterial infections.

1. Candidiasis: Candida is an opportunistic fungus that is normally present in the oral cavity and with reduced immunity of HIV, recurrent bouts of the infection begins to show up. It can be in the form of regular thrush which is whitish and cannot be scraped off (pseudomembranous candidiasis), hyperplastic candidiasis (white patches which can be scraped off) or erythematous (reddish patches). Candida can involve any part of the oral mucosa including the pharynx and the palate.
2. Herpes Simplex: This is the most common viral infection seen in patients with HIV/AIDS. There could be primary or secondary infection of herpes virus, especially inside the mouth and the vermillion border of the lips.
3. Herpes zoster: This virus, when already present in the body, can be reactivated with HIV/AIDS and with oral herpes. The distinction with herpes simplex is from their distribution. These are unilateral, along the distribution of the maxillary or mandibular nerve. The lesions appear both on the facial skin and the oral mucosa. While the facial ones break open and form crusts, the mucosal ones coalesce to form larger lesions.
4. Hairy Leukoplakia: This is present in about 20% of asymptomatic HIV patients. Onset of hairy leukoplakia is an indication of rapid progression of HIV with increased CD4 counts. The typical lesion is a non-movable, hairy lesion along the side of the tongue and can spread to the top and the undersurface of the tongue. There are large amounts of Epstein-Barr virus (EBV) identified from biopsies of hairy leukoplakia.
5. Cytomegalovirus: If the ulcers have a necrotic base with a halo surrounding it, it is CMV infection, usually seen on any oral mucosal surface.
6. Periodontal disease: This is one of the bacterial infections that manifests itself in HIV patients. It can take two forms such as Linear Gingival Erythema (LGE) which can subsequently lead to Necrotizing Ulcerative Periodontitis (NUP). The oral hygiene is generally good with minimal plaque and there is rapid bone loss and soft tissue reddening and swelling. The, mouth, therefore is certainly a window to one’s health.

Diagnosing HIV with Western Blot Test-

It is a series of blood screenings are performed to test for HIV. The enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA), is the first test that your healthcare provider will order to screen for HIV. ELISA, like the Western blot test, detects HIV antibodies in your blood. Antibodies are proteins your immune system produces in response to the presence of foreign substances, such as viruses. If you test positive for HIV on the ELISA test, your provider will order the Western blot test to confirm HIV infection. 

Spread of HIV infection from a woman who has transmits HIV to her child during pregnancy, childbirth (labor and delivery), or breastfeeding (breast milk) is called as ‘Mother to child’ transmission (MTCT) of HIV. It is also termed as the perinatal transmission of the HIV infection or ‘vertical’ transmission. In the absence of medical intervention, perinatal transmission rates are very high, between 20-45% in different parts of the world. In various regions of the African subcontinent a large number of HIV infected children are present. It is a major cause of deaths in teens and adolescents in that region. Almost 90% of all HIV infected children live in the sub-Saharan Africa. In some districts of AP, Karnataka, Maharashtra and TN that were highly HIV-prone, we have several HIV infected children and adolescents. The virus replicates in the body and affects the immune system. Due to decreased immunity, various opportunistic infections enter the body and cause AIDS-related symptoms. Prevention of HIV infection in infants and young children is now a high priority and has been the rallying point for enhanced prevention efforts. MTCT HIV infection can be prevented with adequate measures by way of Anti-retroviral treatment (ART). All expecting mothers who are HIV infected should have access to the preventive medical services throughout the gestation period, during labor and also during breastfeeding. 

Proper provision of resources with skilled staff and awareness programs can help in avoiding new infection cases. Breastfeeding is the primary source of transmission of infection from mother to child. Basically, once ART is started in an HIV infected pregnant woman that should continue forever. With proper ART course, chances of MTCT are near Zero. At the Unison Medicare & Research Centre; which is India’s first fully comprehensive clinic for HIV Care and infectious Diseases, during last decade, not a single MTCT has occurred after treating more than 160 such HIV infected mothers. Even prior to that MTCT rate was lower than 1%. Our motto has been making the mothers virally suppressed commensurate with the global principle of “Undetectable = Untransmittable”! In fact, now more and more HIV infected couples have been coming forward for an elective pregnancy. Even HIV un-infected children orphaned by AIDS or living with sick caregivers are at the great risk of emotional and physical abuse, which in turn increases the child’s vulnerability to HIV infection. 

Reduction of risks to these vulnerable children is of great importance and various programs are being implemented for the welfare of orphans and vulnerable children. Various risk factors that are implicated in the transmission of HIV infection from mother to child are as follows: 

1. Increased viral load 
2. Genital tract viral load 
3. Reduced CD4 cell count 
4. Unprotected sexual intercourse with infected partner 
5. Smoking, Substance and drug abuse 
6. Deficiency of Vitamin A and other essential nutrients 
7. Presence of other Sexually transmitted diseases (STDs) 
8. Pre-term delivery 
9. Placental disruption 
10. Invasive monitoring of the fetus 
11. Breast feeding In most cases, HIV will not cross through the placenta from mother to baby. 

In an otherwise healthy mother, risk of child getting infected is low. Prenatal visits shouldn’t be increased until a complication arises. The physician should observe symptoms of AIDS and pregnancy-related complications on a regular basis. HIV may be the direct cause or a marker of a complex interaction of related medical and social conditions that affect pregnancy. Most HIV positive women are usually asymptomatic and have no major obstetrical problems during their gestation period. They should receive similar obstetric antenatal care as the HIV-negative women, unless indicated by the need to provide specific treatment for HIV related conditions. There is no evidence of a need to increase the number of antenatal visits, provided there are no complications of the HIV infection, although additional counselling sessions may be required to reassure the mother and family. 

Care of the HIV positive woman during pregnancy should include ongoing counselling and support as an integral part of the management. Invasive diagnostic procedures, such as chorionic villus sampling, amniocentesis or cordo-centesis should be avoided wherever possible, due to a possible risk of infection of the fetus.

Patient present to us with Obesity, hirsuitism, irregular/delayed cycles, anovulation & Infertility. TVUSG shows peripherally placed multiple follicles with hyperthicosis of stroma & large ovaries. PCOD drilling is indicated in Clomiphen resistant PCOD, where weight reduction & metformin had been tried sufficiently (for six months) in the past. In the past, wedge resection by Laparotomy was routine practice for fertility enhancement. Today laparoscopic PCOD drilling has become very popular fertility enhancing surgery. As compared to Gonadotrophin (pure FSH) injections i.e. ART with super ovulation, PCOD drilling had following advantages: 60-70% Ovulation rate, 40-50% Pregnancy rate, reduced abortion & OHSS following drilling, reduced requirement of CC.HMG/FSH/hCG following drilling. Effect of drilling lasts for nine months. According to the size of ovary 4 to 8 punctures should be made on both ovaries. 

Benefits of Laparoscopy Surgery:

1. Shorter Hospital stay.
2. Earlier return to your routine work.
3. Cosmetically vary small scar.
4. Less pain after operation.
5. Best fertility enhancement & Fertility results following Laparoscopy.
6. Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
7. The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.  

Pre-operative Check Lists:

1. Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S.etc.); Pelvic Trance vaginal USG report. S.FSH, S.L.H. & S.TSH.
2. Specific Investigations for Infertility (Endocrine, Blood, Genetic, Husband’s Semen report etc. If the couple is infertile.)
3. Operation planned from 4th to 10th day of Menstrual Cycle
4. Enema & preparation/shaving of local parts.

No. Of Cuts on Abdomen:
Three cuts: One of 5 mm and second & third of 3 mm size.

Average Stay in Hospital:
4 to 6 hours. (DAY CARE SURGERY)

Average Duration of Surgery:
10 to 20 minutes

Average Blood loss during Surgery:
10-30 cc.

Average time after operation to resume normal activities/work:
Within 24 hours.

Anesthesia:
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery) 

Operative Procedure:

Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside. 

Performing Laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. One incision is made inside sthe navel, and another two are usually made near the bikini line. The first incision allows a needle to be injected into the abdomen so carbon dioxide gas can be pumped inside the cavity of the abdomen, which helps to keep intestines & omentum up and away from organs. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. 

Cystic Ovary is lifted with suction irrigation cannula from one port and High frequency needle is used to puncture the ovarian surface perpendicularly from opposite side port. No. Of punctures are decided on the base of the size of enlarged ovaries. Haemostasis is checked & Ringer lactate poured over ovaries after Drilling.

Post-operative Course:

Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free. Patient can take fluids 3-4 hors after laparoscopy & light food after 4-6 hours. She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.

Most of the patients can walk normally without support and can take normal diet 6-8 hours after the laparoscopy. She can be discharged on the same day of the operation. Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room. Patient can do her normal activity within 24 hours after laparoscopy.

Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy. Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately. Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.

In case you have a concern or query you can always consult an expert & get answers to your questions!