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Mwanamke atumia ARV miaka tisa bila ukimwi; Fidia Yake Sawa na 2.5 Billion Tsh.!!

Discussion in 'Habari na Hoja mchanganyiko' started by Steve Dii, Dec 16, 2007.

  1. Steve Dii

    Steve Dii JF-Expert Member

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    Source link: Mwananchi.

    SteveD.
     
  2. D

    Dotori JF-Expert Member

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    Mimi ninaona tatizo ni system failure. Mtu kuanzishiwa dawa za kurefusha maisha inabidi apitie hatua zifuatazo:
    1. Apimwe na kuthibitika ameambukizwa
    2. Mgonjwa huanzishiwa Dawa pale CD4 zinapopungua na kufukia 200-300 kutegemea cut off point ya nchi.
    Vile vile wakati mgonjwa anaendelea na matibabu, CD4 levels zinatakiwa kuwa-monitored kila baada ya miezi 3-4.
    Kwa nchi zilizoendelea, Viral load hupimwa angalau mara moja kwa mwaka.
    Inashangaza kwa miaka yote tisa, hakuna aliyeweza kuona mapungufu haya.
    Madawa haya ni makali na ndio maana yanahitaji close monitoring.
    Mama huyu ana haki ya kumshtaki Daktari huyu kwa kutokuwa makini. Sio tatizo la bahati mbaya, ila kuna uzembe ulifanyika.
     
  3. YournameisMINE

    YournameisMINE JF-Expert Member

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    Hizo HAART(highly active antiretrovirus therapy) ni meds kali sana na zipo kwa combos. Hii kesi imetokea Worcester na sio Boston( magazeti ya bongo bwana).
    Tatizo mama ni M-spanish, kwa stereotype tokana na presenting s & s akaonekana ana ngoma. Kama mtu ana chest pain si unapima kujua(kujua ni resp or cardio), kama ni kucheck TB, PCP na kolokolo nyingine. Dr, aliangalia historia tu na ku-prescribe madawa.
    Dotori, upo sahihi.........protocol hapa ni: ( a) kama ni symptomatic b) asymptomatic na CD4 plus less than 200 c) asymptomatic with CD4 plus count 200-350........hizo zote tatu unaweza kutibu au ku-offer therapy d) asymtomatic with CD4 plus count greater than 350, ni ushauri kwa mgonjwa kwamba kuanza mapema ni vyema.

    Viral load kuanzia 10000- greater than 100000.....risk inaongezeka, muhimu sana kujua in the course of therapy. Sasa huyu bwana sijui alikuwa anafanya nini!?? maybe taking advantage of pt's knowledge deficits, sijui ma-nurse nao walikuwa wapi??.

    Huyu Dr, kweli mzembe...........lakini si shangai hasa mgonjwa akiwa ni minority. Mtu anaweza kusema ooooh mbona dr naye ni mchina!!, ukweli ni kwamba, tena hao ndio wabaya kweli kweli maana wapo greedy na wanaangalia $$$ sign tu.
     
  4. K

    Kithuku JF-Expert Member

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    Mimi nadhani kuna tatizo linahitaji utafiti zaidi. Pengine baada ya kutumia dawa kwa miaka 9 amepona, ndio maana ameonekana hana tena hiyo HIV, au mnadai hilo haliwezekani? Hii kwangu ni fursa ya kiutafiti, ningeshauri wataalamu warudi wakawapime tena wale wagonjwa waliotumia hizo ARV kwa miaka 9 na zaidi, si ajabu wakakuta wengine wengi tu waliopona, na hii ikawa habari kubwa kwenye fani ya tiba! Au mnasemaje wakuu? Wataalamu wa tiba mlioko kwenye hii foramu hebu jibuni changamoto hii: haiyumkiniki huyo mama alipona hiyo HIV?
     
  5. D

    Dotori JF-Expert Member

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    Not possible, kwa kutumia ARVs unaweza kupunguza kiasi cha virusi ulivyonavyo mwilini "Viral load" na kuwa "negligible", lakini ukipima antibodies (Kinga za mwili) lazima zitaonyesha ulishawahi kuambukizwa. This means that the HIV testing will never be negative even you have negligible viral load.
    Natumai maelezo haya yatakusaidia.
     
  6. K

    Kithuku JF-Expert Member

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    Bado maelezo hayajanisaidia. Nadhani hizo unazosema "antibodies" zinazalishwa na mwili kutokana na kuwepo kwa virus wa HIV mwilini. Maana yake ni kwamba kama hamna HIV, hizo antibodies nazo hazizalishwi, kama HIV load ni kubwa na production ya antibodies inakuwa kubwa pia. Natumia logic tu hapa, ambayo ndiyo inayoongoza hypotheses formulation kabla mtu hajaingia kufanya research ku-test hiyo hypothesis. Kwa hiyo assumption yangu ni direct proportionality between antibody production and HIV load in the blood. Kama ni kweli ARV zinapunguza viral load kama unavyosema, inamaanisha pia zinapunguza antibody production, kwa hiyo zitaendelea kupungua hadi kwenye hatua ya kuwa undetectable (ambayo huko maabara ndiyo inaitwa "negative" au siyo?). Kwenye hesabu tunge-state hivi (kwenye conclusion tunapomalizia ku-derive hii expression): "as HIV load tends to zero, so does antibody production tend to zero, and HIV test result tends to negative".

    Utanisamehe kubishana na wewe (yawezekana u mtaalamu wa fani ya tiba, kwa maelezo yako), lakini kwa taaluma yangu ya utafiti na falsafa, naona bado kuna jambo ambalo ama halijafanyika, lau kama lilishafanyika sina habari nalo. Je kuna mtafiti aliye-approach hii issue kwa mantiki niliyoainisha hapo juu? Na kama yupo (au wapo) ni nani, na matokeo yalikuwaje? Waweza kutuwekea reference hapa ili sisi tulio wadadisi zaidi tuweze kujisomea?
    Asante.
     
  7. D

    Dotori JF-Expert Member

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    Nitakutafutia references for further reading
     
  8. K

    Kithuku JF-Expert Member

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    Dotori,

    Thanks, nasubiri hizo references.
     
  9. K

    Kithuku JF-Expert Member

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    Ndugu Dotori bado nasubiri hizo references ulizoniahidi. Katika falsafa tunaamini kuwa hakuna kweli za kudumu (absolute facts don't exist), kwa hiyo hayo uliyonijibu kwamba ati "CORRECT" mengine ukayaita "NOT TRUE", inaweza ikapatikana proof nyingine kuonesha kwamba ni kinyume chake. Na kuonesha Falsafa ilivyo sahihi, historia pia imethibitisha haya. Kumbuka kuwa falsafa ndiye muumbaji wa sayansi. Kabla ya enzi ya Galileo Galilei (aliishi kati ya mwaka 1564 na 1642), iliaminika na kukubalika kwamba ni FACT kuwa jua huizunguka dunia, na kauli kinyume cha hapo iliitajwa na wanasayansi wa kipindi hicho kwamba ni UONGO (kama ulivyosema "NOT TRUE"), lakini sasa wanasayansi kote ulimwenguni wanakubaliana na kinyume chake. "FACTS" nyingi za akina Isaac Newton na John Dalton zilikuja badilika sana baada ya mafikara na tafiti mpya za kina Albert Einstein na Ernst Rutherfold. Kwa hiyo bado miye naamini hayo unayotueleza kuhusu antibodies na HIV na vitu vinavyofanana hivyo, bado hazijawa absolute facts wala hazitakuwa, maana elimu inaendelea, utafutaji wa knowledge unaendelea, na mojawapo ya fursa za kutafuta knowledge zaidi ni huyo mama aliyetibiwa HIV kwa miaka 9 na sasa "amepona". Kwa kuwa hadi sasa hakuna ushahidi kwamba alikuwa HIV negative alipoanza dawa, sioni mantiki ya kupinga huu uwezekano kwamba HIV ilikuwako mwilini mwake na sasa haipo. Nakushauri ndugu Dotori, hebu jiruhusu kufikiri beyond the books you have read, utaiona hii potentiality ninayozungumzia, it is a research opportunity, na nitashangaa sana kama madaktari wenye MD zao na wanasayansi-uhai (biological scientists) wenye PhD zao hawataiona hii waichangamkie. Kuna mwenzetu humu ndani ana signature inayosema wasomaji wa vitabu ni wengi lakini watu wenye kufikiri (thinkers) ni nadra kupatikana. Madaktari wetu, jitoeni humo, msikariri tu kwamba ati kitu kikiwa hivi basi chatibiwa vile, hapana! Twahitaji kutumia kila nafasi inayopatikana ya kuboresha ujuzi uliopo.

    Kwa hiyo changamoto yangu kwa madaktari wa matibabu (nadhani ndo kiswahili cha medical doctors, au?), nawachagiza mje na ushahidi hapa unaoonesha huyo mwanamke hakupona HIV! Mie hypothesis yangu ni kuwa alipona baada ya kutumia dawa kwa miaka 9, na inawezekana wako wengine waliopona hivyo, kwa hiyo ningekuwa katika nafasi yenu ningeandika pendekezo (proposal) ya kufanya utafiti wa ku-test hiyo hypothesis. Haya miye sio daktari, lakini hoja yangu ndio hiyo, nawachagiza madaktari wa tiba walete majibu ya kuridhisha. Karibuni.
     
  10. YournameisMINE

    YournameisMINE JF-Expert Member

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    Kithuku,
    Simple, kwanza HIV ni RNA viruses. Hiyo story nyingine ndefu. Antibodies zinakuwepo baada ya infection nyingi wether bacterial or virus, maana yake ni kwamba body ina-recognize infection hiyo. Ktk issue ya HIV ukisema kwamba ni negligible maana yale ni kwamba viral load ni ndogo kuweza kuleta madhara lakini ipo incase kwamba ukiacha medication basi inaweza kuwa balaa. Ni kama Hepatitis C au B once you have it then its for life, ni suala la management tu ili isiwe full swing.......viral load ya ngoma ikiwa chini ya let say 2000mm3, basi ni poa lakini si kwamba huna tena.

    Well, sidhani kama hiyo inatosha lakini inaweza kutoa idea.
    Thanx.
     
  11. D

    Dotori JF-Expert Member

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    Nashukuru Ndugu Kithuku kwa maelezo na changamoto zako.
    Naomba kwanza niombe radhi kuwa mie sio mtaalamu wa Falsafa. Ila ninachofahamu ni kuwa wakati mwingine medical science na philosophy haviendani.
    Kwanza, Tukianzia kwa huyu mama, Hii ni typical case of mismanagement. Makosa hufanyika katika utabibu (Refer to case ya MOI), lakini Daktari husika kama angekuwa makini alikuwa na nafasi ya kugundua kuwa alim-diagnose wrongly huyu mama. Kwani mgonjwa wa UKIMWI kama nilivyosema awali anatakiwa kuwa monitored regularly. Vipimo vingeonyesha normal CD4 range na kwa kuwa hakuwa na HIV basi the viral load ingekuwa negative au negligible.
    Pili, Viral diseases are not treatable. Most are self limiting. Hakuna dawa inayoua vizuri. "Viruses have to strictly depend on living cells for replication. The narrow margin between the therapeutic dose of antiviral agents and lethal dose to the cells themselves is one of the major problems encountered in the development of viricidal drugs". Dawa zilizopo zinatumia mechanisms zifuatazo:
    1. Kuzuia virusi visiingie ndani ya cells.
    2. Kama vikiingia, basi dawa inazuia visizaane
    3. Na kama vikizaana, dawa zinazuia visitoke ndani ya cells
    Body defense mechanisms ndio inayoclear the infection.
    Tatu, Virusi vya HIV vinashambulia kinga za mwili ambazo zinapaswa kukulinda dhidi ya maradhi na hivyo kuhurusu magonjwa nyemelezi (Opportunistic infections) kushambulia.
    Kama nilivyosema awali, mtu anapopatwa na infection yoyote ile, body defense mechanisms tend to mount an attack(Create antibodies). Whether the infection has been resolved or not, the antibodies will retain the memory of this attack or infection. Kwa wataalamu wanaweza kujua kama hii ni recent infection au past infection kwa kuangalia aina ya antibodies in circulation, IgM huashiria recent infection na IgG past infection.
    IgM huwa ni short lived and IgG tend to persist. Kinachopimwa katika HIV ni IgG.Therefore is one is infected, he/she is infected for life

    Natumai maelezo haya yatasaidia kukuelewesha zaidi.
    http://www.bmj.com/cgi/reprint/322/7297/1290
    http://www.avert.org/testing.htm
    http://www.forbes.com/home/feeds/afx/2007/06/28/afx3868315.html
    http://www.natap.org/2005/newsUpdates/090805_09.htm
     
  12. K

    Kithuku JF-Expert Member

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    Ndugu Dotori,

    Nashukuru kwa maelezo yako na hizo reference ulizoniwekea nitazisoma halafu nitarudi hapa.

    Ila nadhani hiyo statement ya kwamba medicine na philosophy haviendani nadhani umepitiwa kidogo, ama umejisahau tu, nataka kuamini kwamba ni kwa bahati mbaya. Umesahau kwamba taaluma yenyewe msingi wake uliwekwa na philosopher maarufu Hippocrates aliyeishi kati ya mwaka 460 na 470 BC, na hata kiapo mnachoapa madaktari (Hippocratic oath) ni yeye aliyekianzisha. Huyu Hippocrates alitumia misingi ya kifalsafa (philosophical principles) kuijenga taaluma hiyo mnayoifurahia hii leo. Misingi mikuu ya falsafa ni Ethics, Aesthetics, Epistemology, Logic na Metaphysics, kama una nafasi angalia tu kwa kifupi hata kwenye web misingi hii inahusu nini, na utagundua kwamba taaluma ya utabibu ndicho inachohitaji, na ndicho matabibu maarufu wa zamani (wa kihistoria tuseme) walichosimamia. Wapo kina Galen, Avicenna (au Ibn Sina, alikuwa mwarabu huyu, tofauti na wenzie wengi ambao walikuwa wagiriki), na philosophers wengine wengi ambao ndio walioweka misingi ya kuiweka taaluma yenu hapo ilipo. Hata Akina Aristotle na Socrates wamechangia mengi sana katika medicine. Kwa hiyo ndugu yangu Dotori falsafa ndio mzazi wa sayansi zote na elimu yote ulimwenguni, ikiwemo hiyo ya tiba, na nyingine kama uhandisi, sheria, uchumi, utawala, Eli-Mungu (Theology), sema chochote utakuta misingi ya falsafa ndani yake.

    Narudia kushukuru, nikishamaliza kusoma hizo rejea ulizoniwekea hapo nitarudi, usinichoke ndugu yangu, maana kujua vitu ni starehe ya pekee. Nafurahi kukutana na watu ambao wako tayari kushughulika na changamoto za kiakili, na kufanyia akili zetu mazoezi ya kufikiri na kupambanua.

    Asante.
     
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