Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr.Asad~M[MRCP~UK] Nirav Valand Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY You solved the missing link by telling me that patient is Hypothyroid 👇

Nirav Valand Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr.Asad~M[MRCP~UK] Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY Both occur in ESKD with Hypothyroidism

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Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr. Fred C. Semitala Nirav Valand Joseph Ogavu Gyagenda DathanMD Andrew .D. D.Ddamulira Bbaale Jipson ACCESS SCHOOL OF NURSING AND MIDWIFERY Dr. Nicholus Mavine Felix Bongomin, MD MSc Dr Otile Jacob Dr. FRANCO 🇺🇬🇺🇬 I am Dr. Katende Dr. Asuman Lukwago Dr. Tamale Henry Duke Dr. Eve Nakato Thank you very much.
Two out of 3 from cART are not exerting their antiretroviral effect because of the commonest NRTI-resistance (M184V/I mutation reduce susceptibility to FTC by >200 & ABC by 3 fold).
Viral failure ➡️immunological failure (⬇️CD4 count)➡️Clinical Failure

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr. Fred C. Semitala Nirav Valand Joseph Ogavu Gyagenda DathanMD Andrew .D. D.Ddamulira Bbaale Jipson ACCESS SCHOOL OF NURSING AND MIDWIFERY Dr. Nicholus Mavine Felix Bongomin, MD MSc Dr Otile Jacob Dr. FRANCO 🇺🇬🇺🇬 I am Dr. Katende Dr. Asuman Lukwago Dr. Tamale Henry Duke Dr. Eve Nakato ➡️Virological Failure/Clinical Failure
➡️TDF replaced with ABC
➡️Patient’s current ART consists of ABC/FTC/EVF
➡️With this regimen patient went into Virological & Clinical Failure
⛔️Check for M184V mutation, M184V mutant HIV1 offer high resistance to (FTC) & low resistance (ABC)

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr. Fred C. Semitala Nirav Valand Joseph Ogavu Gyagenda DathanMD Andrew .D. D.Ddamulira Bbaale Jipson ACCESS SCHOOL OF NURSING AND MIDWIFERY Dr. Nicholus Mavine Felix Bongomin, MD MSc Dr Otile Jacob Dr. FRANCO 🇺🇬🇺🇬 I am Dr. Katende Dr. Asuman Lukwago Dr. Tamale Henry Duke Dr. Eve Nakato ➡️The single tablet regimen bictegravir/FTC/tenofovir alafenamide (B/F/TAF) is a guideline-recommended as a replacement regimen.

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr. Fred C. Semitala Nirav Valand Tariq Mir Joseph Ogavu Gyagenda DathanMD Andrew .D. D.Ddamulira Bbaale Jipson ACCESS SCHOOL OF NURSING AND MIDWIFERY Dr. Nicholus Mavine Felix Bongomin, MD MSc Dr Otile Jacob Dr. FRANCO 🇺🇬🇺🇬 I am Dr. Katende Dr. Asuman Lukwago Dr. Tamale Henry Duke Dr. Eve Nakato DX HIV ART resistance,

1. Do HIV viral load testing,
2. Do HIV drug resistance for the given regimen
3. Switch regimen as per guidelines
4. Monitor progress...

Congratulations 🎉👏
to ST JULIANA SCHS

How can we watch these matches , share us the link

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Tariq Mir Dr.Asad~M[MRCP~UK] Nirav Valand Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY Ichthyosis

Uraemic xerosis

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Tariq Mir Nirav Valand Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY Wouldn’t wish to link it to dialysis/ESKD , doesn’t look like Xerosis … More inclined toward #Ichthyosis_Vulgaris . More history on time of onset . For now he needs emollients.
Compare with Makerere Clinical Case Report case

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr. Fred C. Semitala Nirav Valand Tariq Mir Joseph Ogavu Gyagenda DathanMD Andrew .D. D.Ddamulira Bbaale Jipson ACCESS SCHOOL OF NURSING AND MIDWIFERY Dr. Nicholus Mavine Felix Bongomin, MD MSc Dr Otile Jacob Dr. FRANCO 🇺🇬🇺🇬 I am Dr. Katende Dr. Asuman Lukwago Dr. Tamale Henry Duke Dr. Eve Nakato But Professor, current recommendations include the discontinuation of EFV by CDC and replacement with DLG—why wasn't this change made?

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Tariq Mir Dr.Asad~M[MRCP~UK] Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY Ddx would be - xerosis another would be ichthyosis vulgaris.

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr. Fred C. Semitala Nirav Valand Tariq Mir Joseph Ogavu Gyagenda DathanMD Andrew .D. D.Ddamulira Bbaale Jipson ACCESS SCHOOL OF NURSING AND MIDWIFERY Dr. Nicholus Mavine Felix Bongomin, MD MSc Dr Otile Jacob Dr. FRANCO 🇺🇬🇺🇬 I am Dr. Katende Dr. Asuman Lukwago Dr. Tamale Henry Duke Dr. Eve Nakato Wild guess on Mutations 😆: K65R — ⬇️TDF & ABC effectiveness but ⬆️ susceptibility to AZT if QI51 isn’t in the eqn. L74V + M184V — ABC less effective but ⬆️ susceptibility to AZT. For EFV we check out K103N or Y181.
Predicted : K65R,K103N, M184V+L74V

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Tariq Mir Dr.Asad~M[MRCP~UK] Nirav Valand Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY In our setting, the 2-most common dermatological conditions in hemodialysis Patients are CKD-associated Pruritus & Uremic xerosis.

The latter is
*more common in pigmented patients *manifests with hyperpigmented excoriative patches

The former usually causes evident skin lesions

Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Tariq Mir Dr.Asad~M[MRCP~UK] Nirav Valand Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY Xerosis➡️ Ichthyosis.

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Robert Kalyesubula,MD, FISN(USA), PhD-FRCP(London) Dr. Oriba Dan Langoya Dr.Asad~M[MRCP~UK] Nirav Valand Dr. Hassan Sharif MUMSA Arua Clinic Bbaale Jipson Asasira Ignatius M.D, Dr Mugumya Sabastian Dr. FRANCO 🇺🇬🇺🇬 Dr. Martha ACCESS SCHOOL OF NURSING AND MIDWIFERY ➡️Looks like ‘Ichthyosis vulgaris’
➡️Genetic/Hereditary ichthyosis vulgaris manifest during early childhood - ⬇️filaggrin
➡️Acquired Ichthyosis affects adults only with ESKD/HIV/Leprosy/Lymphomas & Sarcoidosis.
➡️Risk ⬆️if ESKD patient is on Cimetidine/Vit B
🔺Acquired Ichthyosis