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Hi, everyone. Thanks for joining. Um, we're just gonna give it a few more minutes, maybe like two or three more minutes. Um, for more, for more people to join. Um, and then we'll get started. Ok, I think we'll make a start now. So I'll pass over to Ben, who's gonna be leading today's session. Ok. Let's have a look. Hello. Um, we're doing infectious diseases today. I, I don't know how much you guys have done on this, so we'll start reasonably simple and then, uh move up. So we're gonna do three things, do an infectious disease history. So how to take it and think about some of the important questions you need to ask. Um, go through an example for history taking diarrhea, basically doing what we've done in the infectious disease history and then got some slides on HIV. So what it is, um, how it's managed and then how you'd use that information for counseling. So all very ay focused today. So infectious disease history taking, obviously you will know the generic sort of set up for how to take a medical history, the presenting complaint, history, presenting complaint and the rest of the stuff. But after you've got an idea of what's going on, it's, you often need to sort of ask some specific questions relative to sort of the category of presenting complaints to like guy questions with G or things to do with the infection in this case. So I'm hoping people are gonna contribute and suggest some important things. You might want to ask someone after you suspect that they've got an infection. So that's basically ways that they might have got it or things like that. Can anyone put some in the chat? Some of the things they might go for? Yeah. Can be really basic. Can be anything. Travel history, Irene. Amazing. Yes. We're gonna have a slide on travel history in a second. That's completely right. Has anyone been in contact with them? Perfect. Yes. Khan. People around them have been ill again. Yeah. So two really important ones. One have they been abroad really important cos you get different stuff, uh, in different countries and you need to sort of broaden your net for what they might have and then contacts really important cos it's a really easy way of working out what someone's got close contacts again from very good, I think food they've eaten. That's really good. Kishan. Yes. So, anything different that they might have eaten and where they've got it from immunocompromised, either by medications or past medical history. Irene is on absolute fire today. That's completely right. And this is part of my uh next life IV drug user is perfect. So that's to do with contamination from blood really, isn't it? And that's really, really important. So you guys obviously know lots about this already. So age infants and elderly, that's a really good point. So an example of that, I guess would be in suspected meningitis where the age is really important in determining uh what organisms are most likely. So that's a really good 0.1 which I wrote down. Very good. Let's move on. You clearly know. Let's pass anyway. So we talked about travel and possible transmission while traveling. I'll go on to some of the other ones next. But seeing you, you guys are pretty good. What kind of things do you ask about? If someone says yes, I have been traveling, I've been on a tour of Eastern Africa. What kind of things would you ask them? So, they've been away to a different continent. What would you be interested in knowing? Let's see what we got. Yeah. Very good, Irene. Yeah, Khan. Ok. Fantastic. That's gone to the next slide. Do you know what you're talking about? So you need to work out what they've done? That's really easy. You ask, where did they go in? Which countries, which regions for? How long um what did they do whilst they were there? So, in each place, the place is important and then it's the exposure within the place which is important and there's these particular ones we ask about. So sort of specific animal exposure, I guess that's a bit more niche food intake. Good. Far has just said that um, needles or tattoos, so possible ways that they might have caught some blood borne uh diseases. And I guess that's also when we talk about needles, we're including sort of healthcare professionals in there. Fresh water swimming. Does anyone know why we ask about freshwater swimming? What's the common sort of example thing we ask about there? Um, and then sexual contacts, again, you'd ask about that anyway, even if they haven't been away. But again, that's important Campylobacter kitchen. So, is that for freshwater swimming? I'm not sure that was, wasn't what I had in mind I had more like the, er, parasitic infections in mind. Uh, but you might be right, just cos I'm, I'm not sure about that, but I'll check it after that will be one for me. And then, yeah, someone's mentioned already the precautions. So, did they find out what vaccines they were supposed to take if there were any, did they take them? And did they take any prophylactic medication? Um, so malaria prophylaxis uh can do that with Doxycycline, I think. But you can ask them what they were supposed to take and whether they took it and then other stuff familiar as well. Did they use like things like nets or were they exposed to mosquitoes? So, what did they do? Where did they go, what did they do? Any precautions they took? That's what's important for travel history. Let's keep going. Sexual history. So obviously a larger sexual history will be more a sort of OD or like a GU M style. Oy, if we're thinking in that way, but if we were just thinking about osk, but it's also relevant here. Um maybe just briefly finding out have you got any new sexual partners and just showing an awareness that that's something you're thinking about. Uh digging into lots of detail. Maybe it's not too relevant specific context. Someone's already mentioned fantastic protective factors. We went over just in the travel history and we've had that mentioned, who mentioned that? Was it Irene? I'm not sure Irene Irene did. Yeah. Predisposing factors. So that's within their past medical history and drug history. Are they on any medications or do they have any conditions that are making them more susceptible to infection things like, I guess uh HIV, which will go over later, right? So you're all, you know what you're doing now, let's move on. So let's just talk through a diarrhea history. Next presenting complaint. Sort of exactly what you'd imagine using elements of Socrates when you can, for things which aren't to do with pain can be really, really useful and it's a way of sort of keeping your head a bit together if you're a bit stressed. Um site obviously for diary is not that useful, but onset character associated symptoms. Is there all the time, uh, how severe it is? You know, it can be good, useful and it's really helpful to know these four questions at the top for if you're wanting to have an idea of what the organism might be. And then it's narrowing down on other questions around the diarrhea, the slides moving or no. Can you hear me speaking? What are you on presenting complaint or not? OK. Presenting complaint. That's, that's good. Or is that a yes to uh just hearing me speaking, stuck on risk factors for infectious diseases history. That's no good. That's not what we're after at all. Mm I'm not sure what I can do for that. Should I take it off for money? I think the handy, uh, let me put it off and on again and see if that works. Sure PDF present. Now, how's that? Is that showing presenting complaint? Yay? OK, great. So we talked about presenting complaint and you guys are able to explore that. So, after we've got an idea of what's going on, we then need to ask our travel, our infectious disease questions and you can ask all the ones who have just been over. But I've written out some of the really relevant ones for, for this. So obviously, food history and this is gonna be quite important. Um Again, sexual history is gonna be important. There are sexually transmitted conditions which will cause diarrhea contacts in the household really important and immunocompromised. Ok. So this is just when I'm looking at the nice guidelines, obviously, the majority of people who present to the GP or whatever have got diarrhea because they've got a viral infective course. OK. And the main thing that they need is to stay hydrated and rested. Um And it will go away within a week or so. These are some of the important things that you will be sort of raising your ear to think. Maybe this needs a slight escalation, not necessarily for admission, but maybe for taking a sample uh and sending it off to get cultured or something along those lines. So obviously, if they're syste systemically or really unwell, then you are gonna admit them. Um But things like recent hospitalization, antibiotic and PPI does anyone know what that question that, what those three questions are getting at together if someone's been in hospital or they've had antibiotic treatment or they're on a PPI what particular cause of diarrhea that's getting at CDF amazing um blood in the stools again. So that's for more of the invasive pathogens. So the ones which are going into the lining of the bowel, which are gonna be more likely to be uh treatable with antibiotics. Recent foreign travel, two weeks, plus of symptoms, contact of a known significant infection. So yeah, if any of these are coming positive, think about sending a specimen or escalating just the advice for infective diarrhea. So this was my OS station in year four. We had to take a history. It was basically exactly what I've just gone over. We had to take a history, um, for someone who hadn't got any of the particular, uh risk factors or like escalation criteria, you have to briefly do an abdominal exam and then tell them what to do next. And it's really quite simple stuff. So they need to stay really hydrated, Obviously, think about what's exacerbating their symptoms and just avoid them. So, really common sense and then think about the spread. So can they wash their hands in the bathroom? Uh Can they take some time off work or school until after the diarrhea is settled? Um It's really quite basic. So they're just having this knowledge that most of it doesn't need escalating and it doesn't need antibiotics. It will just resolve very good. I hope that's clear for everyone. We're now gonna move on to something that's slightly different HIV. So this is gonna later be about the things that you might consider telling patients and counseling. But just so that just to remember what HIV is for a more medically minded person. So it's an RNA virus which goes into cells through the CD four antigen, right? And that's important because that's expressed on T helper cells, which are really important in coordinating sort of humoral immune responses. What happens after infection is that there's initially really quick viral replication and then and a rapid decline in CD four cells. Because of that, there's then an immune response against that from the other T cells. CD eight cells and sort of the viral replication slows down and it becomes more chronic and then aids or acquired immunodeficiency syndrome is when the CD four count gets below 200. Or you can show that there's evidence of these opportunistic infections. So the immune system has been weakened so much that you start getting these infections that you wouldn't otherwise get, feel free to have a look at this after you get the slides and enjoy that in great detail. Let's keep going. How does it present? So, primary HIV infection is, yeah. So like a flu or glandular fever type presentation. So lymphadenopathy, sore throat, malaise myalgia. And during this time, like I said, on the left side, they've obviously got this rapid viral replication. So they're very infectious. As there's a sort of gradual immune response, you go into an asymptomatic phase where these symptoms resolve themselves and then as the CD four count continues to drop, uh and you go into the criteria for advanced HIV disease, which is what AIDS is more commonly referred to nowadays. Um Then you get these opportunistic infections or the malignancies as well. Um Nothing else to say about that. So, transmission is really important and it's really important um for counseling someone on HIV as well. Uh There's sort of a few main ways that you can get it. So obviously what most commonly is sort of associated with unprotected sexual activity. Um, but it can also be transmitted in a couple of other ways. So mother to child during pregnancy, birth or breastfeeding. So mothers with HIV have to take extra precautions during childbirth and breastfeeding. Yeah, then there's sort of more direct exposure to blood or open wounds. Um And I guess I'd put that in the category of sort of contaminated needles or instruments or blood products. So it's sort of sexual activity, mother to child and then sort of direct exposure, even if it's via sort of instruments or needles or whatever. What's really important is these two things at the bottom. I think there's, they, I don't know if any more but I think there used to be quite a lot of misconceptions about how it spread. So there's no, it's not like the fa cold or anything you can't transmitted via social interaction, um, by touching something that someone else has touched or anything like that. Um, and then really important, which we'll go over a little bit later if the person's been treated and stabilized on the treatment to the point that you can't detect the HIV viral. Uh, no, I can't see the sides again. I'll keep going if you can't detect the HIV viral load, um, then it can't be transmitted. Which slide are you stuck on? Er, guys, I'm very sorry about this. I don't know why it's, uh, why it's doing this. What are you saying right now? How HIV works to image. No. Oh, no. Ok. Well, it worked last time, so I'm gonna do it again. The rest stop. There we go. Is that transmission one? Yeah. Ok. All right. Is that testing? I hope so. So, the main test, uh, that would be, you say if you went into A&E or something, uh, it's called the fourth generation test and it looks at two things, the HIV antibody and the HIV antigen. Um the antigen is detectable 1 to 3 weeks after exposure and the antibodies are usually detectible 4 to 6 weeks after exposure. So the reason why that's really important to know is cos it means that if you have an asymptomatic patient who's been exposed to HIV, just testing them a couple of weeks later isn't enough. You need to test them at four weeks and at 12 weeks to make sure that you're, you can quite safely rule out that they've got been infected. Ok. So that's a really important 0.4 weeks and 12 weeks after a presumed infection. If someone has a positive test on one sample, then the test needs to be repeated with another sample before you can diagnose them because it's a really important diagnosis that you need to get. Right. I don't know how common it is, but I think there's some OSK stations where you have to counsel people about HIV testing. So this is maybe in an A&E or a GP practice where it's been brought up the idea of the HIV testing and you tell them and you need counselor about it. It's sort of quite common sense. So you need to tell them why you'd want to test it. Benefits of HIV testing. Obviously, the main benefit is that if you catch it early, you can treat it, uh, much better and you're less likely to develop these complications. Where would people go for their four slash 12 week testing? Irena, uh, it would just be back to where you're doing it. So, if it was in the GPI guess it would be rearranged often these things are also managed by specialist clinics, HIV clinics and then they'd be managing that. So it, it would just depend who was doing the test. Um, another important thing about HIV testing is they need to know how they're gonna get their results. So, ideally that would be face to face, but maybe they're being texted there and they need to know that they need to know about this window period and that's this 4 to 12 week thing. So they need to know they're gonna have to come for another and they might need some repeat tests. So just have a think about that. I think HIV testing is becoming more and more routine. Uh And so you might be less likely to get this as an ay but it's worth having a look at management of HIV. So, yeah, so the specialist HIV clinics largely um run the management. However, obviously you need to give immediate advice about sort of transmission. So that's gonna be safer sex. But also thinking about uh if there's any chance of transmitting it via needles or whatever else, it might be. So that should form part of your history, um antiretroviral therapy as a medical student. I guess you might not need to know loads of these details about all the different combinations of antiretroviral therapy. But just knowledge that it's a few drugs used at a time and a common combination is these nide reverse transcriptase inhibitors and protease inhibitors. Um You can go back onto the HIV slide later and see how those work. But it's a combination of drugs that's being used. Um monitoring. The two main things that are monitored are the viral loads. That's the, the amount of H IVR N and the CD four count to look at how your immune system is being affected. Uh They're initially monitored really regularly. So like every few weeks and then after the person's been stabilized on the treatment that might be reduced, the additional considerations are gonna be tailored to the actual patient depending on how severe the um infection is. But some things to bear in mind is sort of like antibiotic, prophylaxis. So, Cotrimoxazole, um there's other prophylactic medications, but Cotrim mama is the one I've written out for, I think Pneumocystis and you do like the CD four counts in the 200 more regular cervical smears for women. And then thinking about vaccines that they're up to date because obviously the persons can be more susceptible to more severe and avoiding live vaccines, good others. Um Yeah. So thinking about the mental side of it. So obviously, it's a long term condition and that's gonna cause or that might cause significant anxiety. They might need to be referred to counseling or support groups. Um Yeah, then it's the big issue of the requirements for contact tracing. So if the person is infectious, it's really important that they're sort of practicing safe sex techniques if, if they are still having sex and then also thinking about contacts in the past that they might have passed this on to HIV is one of the conditions where if you think someone is being put at risk um by your patient, then you can break confidentiality. So it's really, really important that that's explained in full and properly to the patient and that the all the precautions are being taken. Um There's no need to tell work unless you're in the armed forces or if you're working in healthcare, right? And that's just cos there's a risk about passing it on pregnancy. If we've got time, then we can talk about that, but not too relevant. And then yeah, telling him about opportunistic infections. Good. Next prognosis. Yeah, antiretroviral therapy has improved loads. It's really good now and if it's taking correctly and people can live a normal lifespan. So, equivalent to the normal population, the most important factor is early diagnosis and prognosis. Obviously, besides taking the medication correctly without the A RT, um, the CD four count will just gradually decline. Um and complications will develop which can be, well, we will be eventually fatal. So it's really important this A R team, right? These are some of the common opportunistic infections. So A CD four count over 500 is considered normal. So, between 515 100 depending on how much it's decreased, uh will sort of determine which opportunistic infections you're more likely to catch. Um So candar thrush, sort of atypical thrush um is between 205 100. We've also got shingles in here. So it's more likely to develop shingles. Um in a younger person, you might know that shingles really tends to develop in older people who are, are beginning to be immunocompromised just because of their age or whatever other reason. And then this Kaposi sarcoma, I don't know if you've ever seen it in real life or seen images of it. It's these sort of round uh red papules which are sarcomas, they're uh cancerous and they're caused by this H HV eight virus underneath. We got the sort of conditions you see with a CD four count between 102 100. Does anyone know not know what cryptosporiopsis causes? What, what infection that is? Oh, no, I've just seen from someone that you're still on the testing slide. I hope I oh Kishan on testing slide or not, didn't phase them, which is good. Yeah, you're completely right. That causes diarrhea. Um and Pneumocystis which I think some people have mentioned up in the had mentioned and you uh you talking about, right? So that's this really nasty respiratory infection and that was what we were giving the coach. So for on the other slide then aspergillosis. So it's like this fungal infection and invasive infection in the lungs. There's loads more of these, but these are some of the common ones that you might see on exam question. Ok. Right. We've got quite a bit of time. So I'm gonna go over briefly over pep and prep and then think about how you might explain HIV and then eos time. Um, so path is post exposure prophylaxis. Um And it's a combination of drugs that you can take after you think that you've been exposed to HIV. So Truvada, which is a combination of two drugs in itself which uh I'll remember when I see the next side and we'll take graph here, pronounced exactly like that. And it needs to be taken for 28 days. Ok. See, underneath, it needs to also be started within 72 hours. So reasonably strict criteria on how it needs to be taken, prep, preexposure prophylaxis. So this is for people who are known to be high risk of catching, of getting HIV. Um So Truvada, there we go. Tenofovir and I have been and are taken before the expected exposure and after. So there's two ways that it can be taken really if you think it's like this isolated um exposure and you don't want to be taking it long term, it can be done with three doses. So you need to take the dose 2 to 24 hours before the exposure, 1 24 hours after and then 1 24 hours after that. So 48 hours later, and you take a double dose on the one before the exposure. So it's a little bit complicated three doses in a 21 to 1 ratio. The other one, if there's repeated exposures um is just to take a dose every day and that works really well. Just a point uh for vagina sex, you need to do the option two, the single dosing every day. If it's taken correctly, it's 99% effective. So it works really well. Um Yeah, side effects. This is important. If you're doing counseling, you need an idea what the side effects might be. They're quite um nonspecific. So, nausea, headache, gi disturbance kind of covers most things. It can affect renal function and bone mineral density. So it needs monitoring. So again, if you're doing counseling on this, you need to let them know that they'll need to come back for some monitoring. And then you also need to think about sort of other precautions that need taken. Besides, obviously, this person is repeatedly exposing themselves to a sort of blood borne or sexually transmitted infection. So just having a consideration that other precautions needs to be taken, you need to think about D I taste testing. You need to think about HEP B vaccine, maybe HPV vaccine as well. So these are high risk groups. Very good explaining HIV. We've absolutely raced through this, so gonna have lots of time. Um Yeah, so Furano, what's really important when you're asked to explain a condition and what I think probably quite a lot of people fail on is just launching straight into the explanation of what you think you need to tell them. Uh That's really just the end of it. That's the second half of it. The first thing you need to do is find out about them and what's brought them in and what they understand. Um So I think about it like this in three sections. I think about it. I need to find out all about them. Um And the classic thing people say is because we haven't met before. Could you tell me what's brought you in and you need to take a really brief medical history um in the case of HIV counseling, which we'll talk about in a bit that will include maybe a sexual history or, um, a social history. So, start always best about the patient and getting up to speed with what's brought them in and what their sort of medical, medical, uh, history is. Then it's time for ice. The big thing asking about, what do they already know? What are their ideas, what are they worried about? Um, and what are they hoping to find out? What's a really nice thing to do in an AK is if you know what they're hoping to find out, if you ask about their expectations before you crack on, you can sort of directly reference that when you're telling them. So you can say, I know that you are concerned about uh how this is transmitted and whether it could be transmitted to your family members or whatever. Um And then explain in detail about transmission and it just shows that you're actually thinking about the person in front of you and link it back to them, which is really good. Yeah. And then obviously the third bit is um to tell them all the relevant info. So building on their understanding and explaining all the necessary information, uh it's written at the top uses here. Brief medical history, understanding concerns, explain and summarize. So if that helps you to remember boosters, then go for that, right. What have we got left? What is there left? There's not much left. There's this last slide explaining HIV, I read these four things. Out. So I think these are the, once you've done number one and number two from here, what information do you think is gonna be really important to tell them where you're gonna need to start with an explanation of what it is. So we've just looked at a slide which has lots of information about the CD four and co CXR receptors and integration with protea. You need to think about what's relevant to the patient in front of you. Um It's probably not gonna be all, it is not gonna be all that detail in nine out of 10 cases unless you happen to have a uh sort of immunologists. But then they should know anyway, um you need to tell them briefly what it is that it's a virus and that it attacks a certain type of immune cell called the CD four cell. And when the immune system becomes weakened, that can lead them susceptible to quite dangerous infections that you wouldn't get. So something like that, a brief explanation, transmission is really important so that it's transmitted through uh unprotected sexual sort of contacts, but also through different bloods and also through mother to baby. Hopefully you've worked out through your history, how they might have got it and then explained that to them and explained how to take precautions. There needs to be that known, told about contact tracing and issues around confidentiality. So the issue that if they are not contact, tracing anything as a risk that it's being spread, that confidentiality might need to be breached the treatment. So obviously, that will all be coordinated by a sort of specialized HIV clinic. Um So going into loads of detail about the different uh combinations of drugs they might need won't be necessary. But telling them that it is this antiretroviral therapy, there's a combination of drugs which are used. Um And the aim of treatment is to reduce the amount of HIV uh RNA in their system and I improve the, their immune system to the point that they're not getting these uh infections and directing them towards other support as well. And then tell me about the prognosis, which will be really important. So this has been diagnosed, um that who can expect to live a normal lifespan if taking uh the medications correctly, right? So that was really quick. That was all the things that I've been told to go through with you. So that means unless you have any extra things that you're wondering about that. The next thing I think is Aussies, but that will only be in four minutes. So you'll have four minutes to relax, I think, which is quite nice, very good. Which of you guys are wanting to stay for the uh Huskies. If you put a, the thing in the chart that's really handy for breaking people up later. Anesthesia says, yes, gift says, yes, Irene says, yes, Irene, you do wear them hero of infectious diseases today. I would really recommend that you do it. I mean, it cos obviously it's just an opportunity to, uh, practice the things that you're doing really soon with absolutely no pressure or nothing, but just being thrown off a bit, um, is such a good opportunity. I wish I did it when I was in four. Uh, I didn't, I know about it too much. Ok. Six of you. Right. Well, for the others, I'm not gonna share any more of my information today. I don't know who we've got as the I can see one. I we've got my good friend and colleague Isaac kind. I don't know if we got any of those. Let's have a look, Daer. Ok, Daniel's here and who is the final person? Why? Let's see if they're here? Why here as well? Ok. Amazing. So why don't we have uh brilliant. There's six people. That's perfect. So gift and Irene, why don't you go to Isaac's room? Um And Khan, why don't you go to uh Daniel's room and Ravi here and faze, I hope I said your name right? Faze. Why don't you go to the last room, Wira Room? And if anyone else changed their mind and wants to come in, then just join one of those rooms as you go. Does that sound good? I hope so. Gift you were at the top. So I think I sent you to Isaac's room. Yeah, gift and Irene. Oh, no. Anesthesia. I didn't. Uh, oh, no, no one got it. Why don't I put it in the chat? Hey guys, sorry. My wifi has been really up and down. So I just had to rejoin, um, if you're staying for the osteopro, as Ben said, just feel free to join any of the three breakout rooms. And the reason for that is because we can't actually allocate people to a room. Um, So yeah, depending how many of you are staying, I'd say try and have like three or four people in each room. Um But yeah, feel free to join any of those. And if the volunteers, if you can join your specific breakout session, there's I going to do a name on it. Um Yeah. Ok, good stuff. Well, you can try doing my, just do it. Yeah, it doesn't matter that much. No. Thank you so much, Ben. That was really great. Ok, good stuff. Thank you. Bye. Um And here's the link to the feedback form. If you guys can please fill it out, you'll get access to the slides after as well, laa if you're in this room, um you can join your breakout session. It has your name on it. Um It should just be on one of the buttons on the left hand side of your screen will say breakout rooms. No.