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Drug: The Double Edged Knife (Part 12)
ISSUE 73
Front Page
Index

Feature

- Somalia and Survival in the Shadow of the Global Economy (Part 12)

Headlines

- Qatari Business Delegation Led by Sheikh Naef Visiting Somaliland

- KULMIYE Concedes April 14 Presidential Poll Results

- The NEC Thanks UK, Denmark and Switzerland For Their Help

- 5-Year-Old Child Savagely Tortured By Kidnappers

Health

- Drug: The Double Edged Knife (Part 12)

- Brucellosis (Human) General Introduction

International News

- You Asked Rageh Omaar

- Africa's Long-Distance Love Affairs

- Women Forced To Toil Abroad

- Young Somali Seeks Peace, Knowledge

- Samsam Saleh: 'Take yourself seriously'

- U.S. Deports Somali Judge Accused Of Human Rights Abuses

- Earliest Homo Sapiens Fossils Discovered In Ethiopia

- Africa Aid Event Delayed By Security Alerts

- Mt. Whitney Returns From Terrorist Hunt In Africa

- Added Forces Strengthen Horn of Africa Task Force

Peace Talks

- Renewed Fighting in Mogadishu, At Least Seven Killed

- Addo Hails Kibaki's Role in Peace Talks

- Call for a Human Rights-committed Interim Parliament

Editorial & Opinions

- President Rayale's Turn

- Ahmed Silanyo: The Man Who Saved Somaliland From Civil War

Mohamed H. Dahir (Chairman Pharmaceutical Association of Somaliland)

HIV AIDS (cont’d)

Laboratory Diagnostic Testing

Antibodies are not detectable in the serum until 4 to 12 weeks after initial infection with HIV-1. Two tests are commonly used to determine the presence of HIV-1 antibodies: (a) The enzyme linked immunosorbent Assay (ELISA) and (b) The western blot test. Elisa is 99% specific and 99% sensitive. False positive or negative occur rarely. Elisa is the initial screening test and it must be repeated before a western blot is performed. Western blot is more specific and costlier.

HIV RNA can be detected in all untreated patients at every stage of disease. To determine the viral load, the RNA is measured by PCR or (Polymeasure chain reaction test). A strong correction exists between viral RNA and CD4 cell count and stage of disease. These two parameters are used in conjunction to give a prognosis. RNA values change dynamically with antiretroviral therapy. A change of 0.5 log (three folds greater) is considered clinically significant. Reduction in viral load goes with decreased risk of viral progression. Each two fold reduction in decreased risk of viral progression. Each two fold reduction in viral load is associated with 27% decrease in risk of progression. Viral load testing is used routinely in clinical practice to monitor patients and determine the therapy.

Counseling

Pre-test and post test counseling is recommended. Counseling is "patient- centred" and takes cultural values into consideration. That includes sexual identity of patients. Counseling is an interactive process. Listening allows the counselor to act up on the information provided by the person (patient) being counseled.

Counseling takes the age, profession, economic status, learning skills, language, comprehension and style of communication into consideration. Visual aids, repetition of key points and usage of appropriate and explicit phrases help communication.

A psychological and travel history will reveal the risk behavior. Pretest counseling should provide detailed information on HIV transmission, risk behavior, risk reduction and the meaning of positive or negative test results. Post-test counseling should give test results and interpretation of these results. Assessment of the patients psyschologic support, referral for medical and psychologic follow -up should be made. Post-test counseling should include risk of transmission to partners, reduction of risk and partner notification

UNIVERSAL PROTECTION

PRECAUTION IN DEALING WITH HIV PATIENTS IN THE OPERATION THEATRE
  1. Hand washing: washing with soap reduces the risk of transmission of most infections including HIV. Strict adherence to washing procedure elementary but essential.
  2. Usage of gloves: A pair of disposable plastic gloves are necessary when ever there is a chance risk of coming into contact with patients body fluids or blood.
  3. Eye glasses, mask and cap: Eyes should be protected from splashes of blood or body fluids. Spectacles meant for eyesight may not be adequate protection. Disposable goggles are a practical solution. Some of these are autoclavable . The usefulness of cap and masks should not be under estimated in case of spillage.
  4. Foot wear: feet with cracks are an ideal port of entry while trading the contaminated fluids and floor. Disposable covering must be worn over the aseptic footwear.
  5. Impervious gown: An impervious gown or a plastic apron underneath the linen is of great help. 
  6. Needles and sharps: used needles must be disposed off by incineration. They should be deposited in thick walled, puncture resistant containers with polyethylene liners 5 ply cardboard boxes may be used as disposable containers. 
  7. Bending and reshaping of needles should be avoided. Risk of needle stick injury is higher while working in depths like chest or pelvis. Usage of hand to direct the needle must be avoided.
  8. Metal instruments: the instruments should be washed, after usage by gloved hand; soap and water initially and a 30 minute soaking in 2% glutaraldehyde. The blunt instruments should be autoclaved (double autoclaved) after usage sharp instruments are transferred to a fresh batch of 2% glutaraldehyde for 6 hours or hydrogen peroxide (10%) for complete distinction.
  9. Anaesthetic tubing: Same procedure as required for sharps. 

To be continued next week

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