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Infectious Disease Department Shadowing at Hospital 108, Hà Nội

7/10/14

Although we have not learned pathology yet, listening to cases in the infectious disease department made us excited for the upcoming year. We had the opportunity to see cases such as mumps and measles, both of which are rare in the United States.

Case 1: Mumps

27 y.o. male who presented with enlarged parotids, left testicular swelling on day 11, mild fever for 2 days, and headache. Patient had elevated salivary amylase. The physicians ruled out bacterial infection because the neutrophil and WBC count was normal, there was no redness or inflammation of the parotids, and they weren’t able to squeeze mucous out of the glands. They treated the patient with supportive therapy: administering fluids and applying ice/heat to the neck or testicular area. One of the biggest concerns the doctors had was infertility. Other possible complications include encephalitis and meningitis.

Case 2: Measles

Patient presented with rash that spread from the head to trunk and finally to limbs (itchiness, redness that usually appears on days 3-5), continuous fever of 104 degrees Fahrenheit (without chills), headache, sore throat, runny nose, and dry cough. Some potential complications include pneumonia, meningitis, and rarely encephalitis. Like mumps, treatment for measles was supportive therapy: reduce fever and headache, administer fluids, and prescribe antibiotics to prevent infection due to weakened immune system.

Unlike the US where all children must be vaccinated to attend school, some of the patients were not. In fact, in Ha Noi, there has been an upsurge of measles recently because up to 80% of patients were not vaccinated, according to the National Institution of Hygiene and Epidemiology. Once vaccinated for measles, a patient will have life-long immunity.

 

Infectious Disease Department Shadowing at Hospital

Infectious Disease Department Shadowing at Hospital

 

 

 

 

Cardiology Department Shadowing

7/9/14

At hospital 108, we were scheduled to shadow various departments each day. Today was our first day: cardiology. We attended the morning meeting with the cardiologists and went on rounds with the attending, Dr. Son.

During our tour of the cardiology patient rooms, Dr. Son led us to a patient who likely was suffering from Brugada Syndrome. He told us that Brugada is a rare disease with higher prevalence in southeast asian countries. This particular patient presented with recurrent syncope during the night, and EKG showed slight ST elevations. After ruling out the usual suspects, the patient received sodium channel blockers. His ST wave heightened tremendously, Which Dr. Son said helped support the diagnosis of Brugada Syndrome. Dr. Son told us that Brugada is usually diagnosed when patients reach middle age. Unfortunately the only thing the doctors could do was install an ICD in the patient, which is not covered by insurance, thus costing the patient upwards of $10,000 dollars out of pocket. For some in Vietnam, this could mean years and years of salary. Other devices, like pacemakers, are covered by insurance.

Another case we saw was a patient with Wolf-Parkinsons White syndrome, a disorder where an abnormal cardiac electrical conduction pathway stimulates the ventricles to contract prematurely.  The patient’s EKG clearly showed a delta wave with shortened PR interval.  To treat this patient the doctor will perform catheter ablation tomorrow in order to destruct the additional electrical pathway—a procedure with over 95% success rate!

After lunch, we were invited back into the catheter lab and met the head of interventional radiology. We learned about the various IR services offered at the hospital including  angiography/angioplasty, ablation, and bypass graft. While at the lab, we had a chance to witness a Transjugular intrahepatic portosystemic shunt procedure (TIPS). As we watched the interventional radiologist perform the procedure, we also discussed the pathophysiology and anatomy. Our ability to draw knowledge during our first year courses and being ableto apply it to the clinical setting made our shadowing experience invaluable. We look forward to seeing more cases tomorrow.

Cardiology Department Shadowing at Hospital 108, Hà Nội

Cardiology Department Shadowing at Hospital 108, Hà Nội