One of the signs of nation’s development is the advancement of infrastructural projects and architectural designs. We have learned so much in Japanese architecture making metal buildings that are proven to withstand the test of time and nature such as the killer quakes. It is good the third world country like the Philippines is adapting to the demand of our era. It might require some serious amount of financial investment but for sure, it will turn out to be practical in the long run.

I have a 28-year-old friend who works in a call center. He has been in and out of the hospital due to complaints of difficulty breathing, chest pain and easy fatigability. He does not smoke and drinks occasionally. He has been re-admitted due to the same symptoms and this time he needs to be placed on oxygen to aide his breathing. Chest CT scan revealed diffused interstitial pneumocystis and they are suspecting HIV.
He has been referred to an Infectious Disease Specialist but since his mother was there all the time, the doctor cannot expound on my friend’s sexual activity. Well, we have known his sexual preference for the longest but it is really hard to break the news to his mother. Hearing his unsafe sexual activity, which according to him, is common in the call center place and the gym, it is not really impossible for him to catch the disease.
The IDS doctor requested for a sputum staining to test for Pneumocystis Carinii Pneumonia infection and unfortunately the test is not available in the hospital where he is admitted. Respitory discharge needs to be submitted and be brought to a hospital that cater the Indirect Fluorescent Antigen study or IFA which is 97% reliable in confirming PCP. PCP is common among HIV positive patients. It is a kind of pneumonia caused by bacteria called Pneumocystis jiroveci which is classified as fungal pneumonia. It is the most common opportunistic infection among HIV positive patients.
The first signs of PCP are difficulty breathing, fever, and a dry cough which are the spot on signs manifested by my poor friend.
Upon admission he has been placed on IV antibiotics such as Meropenem and Fluconazole (which is actually an antifungal medicine). He is also on antibiotic pill Cotrimoxazole Bactrim Forte. My online research agrees that Trimethoprim-sulfamethoxazole (TMP-SMX) has been shown to be as effective as intravenous pentamidine and more effective than other alternative treatment regimens
HIV can only be passed from person to person through body fluids, such as blood, semen and vaginal fluid. Children born to infected mothers can also become infected during pregnancy. HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.
It takes around ten years on average for someone with HIV to develop AIDS.
The most common ways HIV is passed are:
There are various ways a person can become infected with HIV:
• Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection.
• Contact with an infected person’s blood: If sufficient blood from somebody who has HIV enters someone else’s body, then HIV can be passed on in the blood.
• Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world this is no longer a significant risk, as blood donations are routinely tested for HIV.
• Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared.
• From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.
Source: www.avert.org
I do not understand but he has not been placed on ELISA which is the definitive test for HIV infection but I have secretly discussed the matter with my friend. detects HIV antibodies in a person’s blood. It is necessary to wait at least 3 months which is called the window period after the last possible exposure before having an HIV antibody test, to be certain of an accurate result.
I just do not know how he could come out to his parent which is badly needed. He is worried about the stigma that he needs to face if his health condition also becomes known to the public.
I hope that it is not PCP.

Working in a hospital that specializes in cardiac cases, it always a learning experience for me taking on new cases. Like being assigned to a patient who broke her left should and was diagnosed close fracture humeral head, left. I learned from the ortho-surgeon that it is not being operated on. Instead, an arm-sling will just be in place at all times and the patient will be on anti inflammatory medications for a long time. It is different from the aircast-airsport-ankle-brace that is being used on some who has dislocated or snapped ankles.

It is shocking to learn about the death of the Jackass star Ryan Dunn from a car crash last Sunday in Pennsylvania. Dunn, 34, was with an unidentified passenger who also died in the fatal accident. While police are still investigating the cause of the mishap and they are suspecting intoxication as the cause of it since Dunn has posted on his twitter account a photo of him and his friends having some sort of alcoholic beverages. The car was set on fire.
While I hope that the cause was not due to DUI, we hope that he availed of a motorhome insurance to leave something for his family.

Ever since I cut my hair short, I get constant praises that my new hairdo looks good and it chopped off some 10 years of my actually age. While it is taking me some time to fix my hair everyday, I am planning to keep it this short. I am thrilled by the admiration that I get from my colleagues. It is the more natural than any anti aging products ever concocted

I have my hand-me-down BlackBerry for almost a year now. I decided to stick with it since it does not give me any problems. But I guess, like any other thing on this earth, its battery has reached its wear-and-tear condition. I cannot afford to get an original battery for a replacement so I settled for what they call “Class A”. There are mobile batteries that really work compatibly with your cell phone. Just be patient in scouting for one.

This is a case of a 69 year-old female who was flown in from the Federated States of Micronesia due to chief complaint of difficulty breathing.
The problem started about three months prior to admission when she started to complain of chest heaviness accompanied by difficulty breathing and shortness of breath. She has been admitted in a local hospital in her country and was diagnosed to have COPD or Chronic Obstructive Pulmonary Disease and was discharged after being stable.
COPD is a progressive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time. (source NHLBI)
After a month, she was re-admitted due to left sided pleuritic pain and was diagnosed with Community Acquired Pneumonia. She was responsive to IV antibiotics and manifested clinical improvements hence discharged.
Until ten days after being discharged, she complained of bilateral chest discomfort associated with shortness of breath and easy fatigability with positive 2-3 pillow orthopnea. She was then referred to our institution suspecting Coronary Artery Disease, congestive heart failure, to consider pulmonary embolism and pulmonary carcinoma.
The patient cannot speak English and only through her husband we could learn what is troubling her.
She was able to tolerate pulling urine flow of about 2.3 to 2.8 per session which is the target until her last session where her blood pressure drop down to 80s systolic. After pulling about 800cc of fluid, she became unstable. Dopamine drip was started on her to bring her BP up and he was brought back to her room for further evaluation.
Since she is anuric or does not produce urine, she was also referred to a kidney specialist called the nephrologist for dialysis three times a week.
She has been referred to a pulmonologist who ordered for a chest CT scan which revealed normal findings. Then, doctors suspected reproductive cancer involvement which prompted to think of referral to an Obstetrician Gynecologist. Considering ovarian cancer and multiple myeloma, the nehprologist request to run some tests on her such as the CA-125 and Serum protein electrophoresis.
According to medicine.com CA 125 is a protein that is a so-called tumor marker or biomarker, which is a substance that is found in greater concentration in tumor cells than in other cells of the body. In particular, CA 125 is present in greater concentration in ovarian cancer cells than in other cells.CA stands for cancer antigen measured through blood sample
The result was insignificant but the Serum protein electrophoresis particularly the gamma globulin proteins test was particularly high. This test measures the types of protein in the fluid (serum) part of a blood sample.
Serum proteins are classified as albumin or globulins. Albumin is the protein of highest concentration in the serum. It carries many small molecules, but is also important for keeping fluid from leaking out from the blood vessels into the tissues that is why it is called the gate keeper.
Increased gamma globulin proteins may indicate:
• Multiple myeloma
• Chronic inflammatory disease (e.g., rheumatoid arthritis, SLE)
• Hyperimmunization
• Acute infection
• Waldenstrom’s macroglobulinemia
• Chronic liver disease
Patient also started to complain of back pain. The nephrologist suggested to refer the patient to a haematologist of a blood disease specialist. The following day, the haematologist ordered for a bone marrow biopsy through bone marrow aspiration. The patient was placed on side lying position assuming a shrimp or fetal position to open the spinal cord. Through bone marrow aspiration a small amount of bone marrow fluid and cells are collected through a needle put into a bone. The bone marrow fluid and cells are checked for problems with any of the blood cells made in the bone marrow this time biopsy was made. Blood disorders such as leukemia, certain anemias, or problems that affect the bone marrow, such as multiple myeloma or polycythemia vera can be determined and staged.
The sample was sent to another hospital as we do not have the facility to perform such as test. Two days went on and the result came in Thursday morning and it was confirmed that the patient has Multiple myeloma is which is a cancer of the plasma cells in bone marrow. Plasma cells help the body’s immune system fight disease by producing proteins called antibodies. In multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone.
The growth of these bone tumors makes it harder for the bone marrow to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding. (source medline.com)
The haematologist said that patient’s case had less than 40% survival and the insurance will no longer cover expenses for such a case. Nevertheless, the specialist wanted to start her on oral chemotherapy ASAP.
But things happened so quickly. That night, the patient complained on difficulty breathing, also she has been placed on non-invasive ventilator (NIV) she was so restless that she kept on pulling the face mask. We have instructed her husband to convince her to keep the face mask in place to help her breathe. The patient progressively became restless that she pulled everything including her IV line. Her acid-blood gas revealed respiratory acidosis and sodium bicarbonate needed to be pushed through IV line. The bedside nurse then was trying her hardest to tame the patient and to insert a new IV line. She went out to get help from a fellow nurse but when she came back, the patient was pulseless. She immediately performed chest compression and instructed the other nurse to sound a code. Efforts to revive her failed. She was pronounced dead at 1:35 in the morning.
Final diagnosis was: Acute Cardiorespiratory Failure, COPD, Chronic Renal Failure (End Stage Renal Disease), Multiple Myeloma.

I surely miss my long lost love. Well, he is not actually lost. He is in Japan right now and chose to settle there with a significant other. Geez! I am not ranting about his new found love, I just wish that I focused into taking up IT course as business intelligence software is really big here and abroad. At first I wanted to be a journalist because I enjoyed writing since high school but since I am always on my computer, I think developing my liking for the technicalities of the computer age would be a smart idea.

I just created an account on Twitter and I started to follow local and international celebrities. It is interesting to know that apart from food, fashion and travel, most of them are trying to squeeze in physical workouts to make sure that they are in the pink of health and of course constant eye candies. Some of them have gone to suboxone treatment detox centers centers to make sure that they will start afresh. I hope that I have the time and resources to focus on my physical well being.

It is really heart breaking to learn that the person that you cared for for how many days will be gone in a blink of an eye or someone you are just talking to the other day just lost his or he life to something tragic. Well, what do we know? As the bible says, death will come like a thief in the night that is why it is imperative that we have life insurance guaranteed issue to protect us from the world’s uncertainties.