Paragonimiasis

This is mainly for one of my former partners, as I am trying to get her to include some tropical medicine in her DENs (doctor’s educational need) for her next appraisal.

This is the chest radiograph of the patient with atypical haemoptysis. I have zeroed in on the most badly affected area of the lung for you to see what is going on.

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With the eye of faith, can you see a sort of honeycomb arrangement where the lung flukes live? They are about a centimetre by half a centimetre and roam about in the tissue, before releasing their eggs into the sputum. This lady complained of asthma, and indeed did have some localised wheeze. But this could have been caused by allergy to the parasites, known as Loeffler Syndrome.

I saw her for follow up today after an extended course of praziquantel, and she is doing fine, much improved. She isn’t spitting blood, but is still complaining about her back pain. The lateral film of her chest showed moderately severe osteoarthritis of the spine, so I doubt we will be able to fix that as dramatically.

Congenital abnormalities

First of all, let me reassure you, there are no photographs associated with this posting. Not appropriate, but if someone thinks they can help, contact me and we will discuss privately.

As a GP in Leicester, I didn’t see many children with severe abnormalities. Specialist services scooped them up and sorted them out as best they could. I’ve seen a couple of children with congenital heart disease, one severe and one quite mild, but the cost of investigations and assessments prior to a surgical opinion is prohibitive. Child’s Dream is an organisation which may take on a child with a congenital problem – see http://www.childsdream.org/

Today I saw a 17 day old baby born at home with no hands or feet. Her mother had brought her in for her first vaccination (BCG). A visiting obstetrician thought that the problem could have been caused by amniotic bands, cutting off the blood supply to the end of the limbs. Or a cardiovascular calamity occurring when the hands and feet are developing (at 6-8 weeks gestation). The mother said that she had taken no medication, traditional or western, during the entire pregnancy. She had two other children, both normal.

I am just thinking what a challenge helping this child would be in our NHS, never mind in a resource-poor setting like the border. We just try our best, with the help of St Jude (a medallion given to me by one of my former patients), the patron saint of lost causes.

Lunch – an improvement on yesterday

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The lady who operates the restaurant told us that she has plans to renovate the site, put in some wooden flooring and make it look more upmarket. However she leases it from the Thai government and is concerned about upgrading the property using a loan, and then being evicted. She used to own another site across the road, but she sold that to her uncle who needed space to run his vehicle repair operation. The site is on uneven ground, quite a slope, but she doesn’t want to use concrete. Teak looks better. She told us that business had slowed down over the past few years, but with her cash flow she could recoup her investment in about six months. Anyone interested in financing her?

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Premature baby doing well

I posted a photograph of high tech neonatal care, a tiny prem baby having phototherapy, last week. He is doing fine, as evidenced by these photographs:

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I like the way the woman’s image on mum’s tee shirt seems to be looking at the baby, all swaddled up.

Getting more adventurous for lunch

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This is a salad of greens, Chinese cabbage, tomatoes, onions, garlic, white radish and bean sprouts, mashed together in a pestle with a mortar, with added crab, toasted cashews, lime and sweet vinegar.

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But take a look at the maggot on the cut surface of the lime! Well, it’s all protein, isn’t it?

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Catfish spine penetrating injury continued

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Catfish spine injury

Catfish spine injury

This is coming along nicely. Less swelling. The gauze wick did its job over the weekend, no more pus, no odour. The occlusive dressing has caused the skin to discolour and top layer has peeled off, but a dry dressing will sort this out. Our microbiologist tells me that the germ causing this has not been described in Myanmar before (once in Thailand) so we might write it up for a journal. I like the idea of doing the dressing change inside a polythene bag, to reduce contamination.