End Of Rotation

Today was my last day of my pediatrics rotation. I spent it at the NICU, there were two babies delivered today during my stay at the NICU. Before saying goodbye to my residents, we bought "pansit" and "crispy pata" for their lunch as a way of saying thank you for a wonderful stay at the department of pediatrics. Next I will be assign to the Ophthalmology section, taking a look at those patients with eye problems. After signing out around 5 in the afternoon, I bade them goodbye and with a smile left the office. So another chapter has ended and another is about to start. Pleasant Day.

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Sunday Blues

Yesterday I had my last duty on my Pediatrics rotation. Ill be transfering to another department coming this Wednesday. The sad thing about yesterday is, I m the only intern on duty, what a way to spend my last day at Pediatrics, alone. :(. Anyways the day went like a breeze, spend my morning at the nursery then visited one of my friends at the ER. Although I m hospital alone yesterday, something made me smile. I catched a baby which broked the record being the heaviest. In one of my previous post, I mentioned a 9.8 pound baby which I catched and eventually he held the record being the heaviest. But dawn today I was astonished, we had a stat c-section around 1 in the morning, and the baby then came out was a big one. After being weighed, she was a 10 pounder. She was really big indeed, in terms of Filipino weights of newborns. I called her "Dumbo the 2nd", the first being the 9.8 pounder I catched days ago. Afterwhich I headed to the quarters, and took my sleep around 3 in the morning. Now I m awaiting lunch, then ill be homeward bound again. Pleasant Day.

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How To Survive A Heart Attack Alone

I got this informative power point presentation given to me by a senior doctor and I want to share it with you, maybe it wont be helpful now but it may give some help in the future. Here is the scenario:

Let's say it's 6.15pm and you're driving home (alone of course) after an unusually hard day on the job. You're really tired, and frustrated, stressed up and upset.

Suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw.You are only five miles from the hospital nearest your home. Unfortunately you don't know if you'll be able to make it that far

You ask yourself what to do? You have been trained in CPR, but the guy that conducted the course did not tell you how to perform it on yourself.

Since many people are alone when they suffer a heart attack, without help, the person whose heart is beating improperly and who begins to feel faint, has only about 10 seconds left before losing consciousness.

So here is what to do: Do not panic, but start coughing repeatedly and very vigorously. A deep breath should be taken before each cough, the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every 2 seconds without let-up until help arrives or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital. (this article was published on number 240 of journal of general hospital rochester)

Another added information to myself, hopefully it could also be beneficial on your part. Pleasant Day

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Medical Terminology

Anally......................Occuring Annualy
Antibody....................Against Everyone.
Artery......................The study of paintings.
Bacteria....................Back door to cafeteria.
Bandages................... The Rolling Stones
Barium......................What doctors do when patients die.
Benign......................What you be after you be eight.
Botulism....................Tendency to make mistakes.
Bowel.......................Letters like A, E, I, O, or U.
Cesarean Section............A district in Rome.
Catscan.....................Searching for Kitty.
Cauterize...................Made eye contact with her.
Colic.......................A sheep dog.
Coma........................A punctuation mark.
Congenital..................Friendly.
Cortizone...................The local courthouse.
D&C.........................Where Washington is.
Dilate......................To live long.
Diaphram....................A drawing in Geometry.
Enema.......................Not a friend.
Enteritis...................A penchant for burglary.
ER..........................The things on your head that you hear with.
Fester......................Quicker than someone else.
Fetus.......................A character in Gunsmoke.
Fibula......................A small lie.
Fibrillate..................To tell lies
Genital.....................Non-Jewish person.
Genes.......................Blue denim slacks.
G.I. Series.................World Series of military baseball.
Grippe......................What you do to a suitcase.
Hangnail....................What you hang your coat on.
Hemorrhoid..................A male from outer space.
Herpes......................What women do in the ladies room.
Hormones....................What a prostitute does when she doesn't get paid.
ICU.........................Peek-a-boo
Impotent....................Distinguished, well known.
Inpatient...................Tired of waiting.
Labor Pain..................Getting hurt at work.
Medical Staff...............A Doctor's cane.
Menopause...................Button on a VHS remote control.
Morbid......................A higher offer.
Minor Operation.............Somebody else's.
Nitrates....................Cheaper than day rates.
Node........................Was aware of.
Outpatient..................A person who has fainted.
Organ Transplant............What you do with your piano when you move.
Organic.....................Church music.
Pap Smear...................A fatherhood test.
Paralyze....................Two far-fetched stories.
Pathological................A reasonable way to go.
Pelvis......................Second cousin to Elvis.
Pharmacist..................Person who makes a living dealing in agriculture.
Plaster Cast................The drunk roadies backstage at a rock concert.
Platelet....................A small plate or platter.
Post Operative..............A letter carrier.
Protein.....................In favor of young people.
Recovery Room...............Place to do upholstery.
Rectum......................Damn near killed him.
Rheumatic...................Amorous.
Saline......................Where you go on your boyfriend's boat.
Scar........................Rolled tobacco leaf.
Scrotum.....................Small planet near Uranus.
Secretion...................Hiding something.
Serology....................Study of English Knighthood
Seizure.....................Roman emperor.
Surgery.....................A reason to get an uninterruptible power supply.
Tablet......................A small table.
Terminal Illness............Getting sick at the airport.
Testicles...................Found on an octopus.
Tibia.......................A small country in North Africa.
Triple Bypass...............Better than a quarterback sneak.
Tumor.......................An extra pair.
Urine.......................Opposite of you're out.
Vagina......................Heart trouble.
Varicose....................Real Close / Near by.
Vein........................Conceited.
Vulva.......................Automobile from Sweden.

Pleasant Day

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Systemic Lupus Erythematosus - a Self Killer

Yesterday I attended a case presentation at our hospital regarding the dreaded systemic lupus erythematosus or just known as SLE. The presentation area was filled with lots of people to listen to the case being presented by one of my residents. We also had a rheumatologists as a resource speaker.

The case being presented was a 15 year old female presenting with rashes. 2 weeks prior to her admission she already sought consult and was diagnosed then to have measles, the rashes however did not wear off. Eventually additional symptoms were added until she was admitted. She was referred to rheumatology department for SLE workup and through enough she was diagnosed to have SLE.

Systemic Lupus Erythematosus is an autoimmune disease that affects multiple organ systems.Normally, the immune system helps protect the body from harmful substances. But in patients with an autoimmune disease, the immune system can't tell the difference between harmful substances and healthy ones. SLE if not controlled can be fatal.

Symptoms of SLE usually vary from one person to another because it can affect different organ systems. The clinical criteria in diagnosing SLE usually involves 11 manifestations. This 11 are: malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder and a positive antinuclear antibody. A person should present at least 4 of the 11 given to be diagnosed to have SLE.

Steriods are the main stay in SLE treatment. Advances in research and medicine have decrease the number of fatalities from the dreaded disease. Treatment doesn't just involve medications but family support and patient education also proves important. Prognosis of patients with SLE have improved over the past few years. Hopefully in the future newer medications are discovered with lesser side effects and hopefully one day a cure can be found.

The picture above shows the typical malar rash found among SLE patients. Pleasant Day

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Osteoporosis - the Silent Epidemic

Osteoporosis is a disease in which the density and quality of bone are reduced, leading to weakness of the skeleton and increased risk of fracture, particularly of the spine, wrist, hip, pelvis and upper arm. In many affected people, bone loss is gradual and without symptoms or warning signs until the disease is advanced. Osteoporosis is a global problem which is increasing in significance as the population of the world both grows and ages. For these reasons, osteoporosis is often referred to as the "silent epidemic".

CLASSIFICATIONS

Primary Osteoporosis - caused by estrogen deficiency. It is much more common in women than men. Type I - is called "postmenopausal osteoporosis," typically occurring within 15 to 20 years of menopause. Type II - is caused by low calcium. Chronic calcium deficiency leads to decreased bone formation and fragile bones. Type ll osteoporosis usually occurs in people over 70 and is, therefore, called "senile osteoporosis."

Secondary Osteoporosis - is age-related osteopororosis generally seen in the elderly of both sexes, especially after age 70, due to long term remodeling inefficiency, dietary inadequacy and activation of the parathyroid axis with age

Unfortunately there are very few physical warning signs for osteoporosis until the disease has established itself. Broken bones or fractures after a minor bump or fall may mean you already have osteoporosis, and this is often the first sign of the disease.

Osteoporosis occurs when the body fails to form enough new bone, when too much of the old bone is reabsorbed by the body, or when there is an imbalance between Osteoclast and Osteoblast activity. The 2 essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. If calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, bone production and bone tissues may suffer. Calcium and phosphate may be reabsorbed back into the body from the bones, making the bones weaker. Both situations can result in brittle and fragile bones that can break easily.

TYPES OF THERAPY FOR OSTEOPOROSIS

Antiresorptive drugs, already available, slow the progressive thinning of bone.

Bone-building agents help to rebuild the skeleton and are now becoming available or are in the developmental pipeline

Non-pharmacological interventions are also very important in reducing the risk of fracture.

All of the above mentioned treatment strategies need to work hand in hand to prevent Osteoporosis from being such a pain. Pleasant Day

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Peed by a Newborn

Still in my NICU rotation with a new set of clinical clerks under me, I had 6 catches yesterday. All of them were still admissions of the previous duty but all of them gave birth during my tour of duty.

One of the highlights of yesterday's delivery, was a 9.8 pounder baby boy which was delivered via outlet forceps extraction. Among Filipino babies, the normal weight of a newborn is around 3 to 4 kilograms, but this babied weigh 4.3 kgs., big in terms of Filipino newborn weights. He was really heavy, and carrying him around could make your arms fatigue easily. At least all of us at the nursery, from my residents, nurses and my peers were happy to see such a bouncing big baby boy. All of us took turns in teasing the baby.

The last highlight of the day yesterday was my last baby catch. He was a term baby boy born around 6 pm. So after the delivery, we cleaned him up, offered oxygen, did some suctioning. Then just when he was to be clothed with new linen for him to be transported to the isolette, he gave out his first urine output, unfortunately he was facing me, so his pee went directly to my scrub suit. Talk about a happy moment, so I was there looking intensely at him and looking at the wet part of my scrub suit but he looked at me back and gave a soft cry. Just told my self, he is only a newborn and he doesn't now what he is doing to console myself. We had no admissions during the evening and had a good night rest last night. Pleasant Day

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Fully....Fully...

Still in my NICU rotation, a new bunch of clinical clerks had just started to rotate in pediatrics. So I oriented the clerk assigned to the NICU, things to do and what things to monitor. So again another duty has ended. Yesterday was guite tiring, had dinner at 2 in the morning. Talk about super late dinner, looks like I m already having early breakfast.

We only had a total of 5 admissions for my tour of duty. All were term babies, but one of their mothers arrived in the hospital fully dilalted. After having late dinner at 2 in the morning, I headed to the bed thinking that there won't be any more admissions for the rest of my duty. Then after being half asleep for an hour, my cellphone rang, the OB intern told me that they had a patient for admission but is still in the ER. So I stood up and headed to the ER to check the patient and get some history regarding her pregnancy. While talking to her, she told me that it was already her 5 pregnancy, so I told myself this labor won't last long. So after doing my routine interview, I sat down at the desk scribbled the data I got in a piece of paper, internal exam was again done on the patient, then I heard "Fully...Fully.." (patient is already fully dilated). Feeling the rushed I then jumped from the sit, grabbed my gear, informed my resident and then headed to the delivery room. Just in time, I had catched the baby. It was a healthy bouncing baby boy. After cleaning the baby, I carried it to the mother and she had her first glimpse of her baby boy.

Such joy filled me seeing mothers smile looking the their newborn. Pleasant Day

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Monday Morning Endorsements

Another Monday has dawned upon me, another start of the week. Woke up a little bit late, skipped breakfast and then on the way to the hospital. Took the same route to the hospital, but not so sure if the bus i rode was the same as that of yesterday. Same scenery, same rush, came in just in time for the morning endorsements with a pediatric consultant.

The people of yesterday's duty gave it the morning endorsements, they had a total of 10 admissions. Cases range from acute gastroenteritis, acute dyspepsia, to hemolytic uremic syndrome. Each case was discussed in detail from the history to the management. Certain in between questions were asked to the clerks, us interns and also to our residents by the consultant. The endorsement lasted nearly 2 hours then we returned to our respective posts.

Morning endorsements always give us the rush, not just your usual morning. Afraid to be scolded by the consultant, afraid that your history will have a lot of holes for the consultant to shoot at, afraid that you can't answer the questions being hurled at you. But in the end, after each endorsement, new lessons are learned, more than enough compared to the morning rush given by the daily morning endorsements.

Morning endorsements are best with a cup of coffee on the table. Pleasant day

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IUFD - A Heartbreaker

Another duty has ended and another from duty status has arrived. I started my duty yesterday at around 6 pm because I came from Laguna (a province here in the Philippines) for a medical mission. Upon arriving in the hospital, I texted my resident and told her I m already around and that I brought her some presents from the province. She replied and told me that no pregnant patient are currently waiting in the labor room. So there I was relieved, at least I still have time to rest from the medical mission. Then after an hour, pregnant patients started to be admitted, first was primigravid (first pregnancy), which was eventually delivered. Then another placenta previa (condition described in my previous post) came and a stat C-section was scheduled. So I entered the operating room and prepared the things for the baby.

After a few minutes, one of the NICU nurses called the operating room and told me that a term pregnant patient is in the ER and was fully dilated and was about to be brought to the deliver room. So I informed my resident about the admission, then one of the OB residents herd our conversation and interrupted us and told us that it was a case of IUFD (intrauterine fetal demise). So inspite of that we still prepared for the baby catch. Then the patient came, she was eventually delivered after a few minutes at the delivery room, and upon catching the baby, my heart was filled with a sudden remorse, he was there lying limp with no heartbeat. He was a mature infant lying motionless infront of us, if only the mother came to the hospital a few hours earlier then maybe we could have save the baby. Another mortality in front of me, another gloom in my tour of duty. According to the mother, few hours prior to coming to the hospital, she was contracting and she noticed that the baby stopped its movements, however inspite of this she still didn't consulted the hospital and waited a little bit more. If only she took the decrease in movement seriously maybe we could still have save her child. One of the OB residents said a small prayer infront of the baby and he was eventually wrapped and eventually sent to the morgue.

Another mortality, another heartbreak. :(

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Newborn Screening - A Must For Newborns

Since I m currently rotating in the NICU (neonatal intensive care unit) I want to write something that is routinely done in the NICU. I m talking about the Newborn Screening, its a test that is usually done after the first 24 hours of life of the newborn unless stated otherwise.

So what is "Newborn Screening"? Newborn screening is to test some congenital diseases that could be present in the newborn. It also provides early detection for such diseases so appropriate management can be done. It is usually done by getting blood samples from the heel of the newborn. In the Philippines, it was made a law last 2004 that all newborns should undergo newborn screening exams.

Usually in other countries the Newborn screening has a long list of diseases that it can detect at an early stage but here in the Philippines it only screens 5 congenital diseases that are proven to be common in the local setting. The five diseases are as follows each with a brief description:

Congenital Hypothyroidism - the thyroid hormone is generally low upon birth of the baby. If untreated it usually leads to growth restriction and mental retardation. With the Newborn screening its early detection would prompt early management and in that way avert the possible severe consequences that could happen to the baby

Phenylketonuria - is a genetic defect which leads to decrease in the enzyme phenylalanine hydroxylase. This enzyme is important for the conversion of the amino acid phenylalaine to the amino acid tyrosine. WIth this deficient, it could lead to poor brain development and could also cause seizures to the patient. Early detection is important for proper management.

Galactosemia - this is a metabolic disorder wherein one cannot metabolise the sugar galactose. This could lead to liver cirrhosis, renal failure and many more. With the help of Newborn screening it could detect it early and save lives.

Congenital Adrenal Hyperplasia - is an autosomal recessive disease which results in the failure to produce the steriod cortisol. This could lead to excessive production of sex steriods and this could affect the appearance of infants when they grow up. Early detection could avert this and proper management be started early

Lastly, G6PD Deficiency - is a hereditary disease wherein one lacks the enzyme G6PD (glucose-6 phosphate dehydrogenase). It is important in the metabolism of our red blood cells. Patient could bleed to death with this type of enzyme deficiency. Also one thing, patients affected with this usually has a long list of foods and meds to avoid. Early detection could be proven really helpful

So there you go, a simple heel prick and you could save your infant from disastrous consequences.

In the picture is the usual heel prick done to get a blood sample for the screening. Pleasant Day

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Wednesday Admission

Another from duty status, my duty hours are over just waiting for my log out time. Just wanna share my "benign" duty experience of duty. For my 24 hour tour of duty, I only had 1 admission to the NICU. Imagined that only 1 gave birth yesterday. Most of my yesterday was again spent on playing my cellphone and chatting with some of the NICU nurses. Can you imagined that, only 1 was admitted. During my whole stay at the hospital, this was the first time I had the number 1 on my admissions list. Wheeewww, talk about a really "benign" tour of duty. I even slept early around 10:30 pm and no pregnant patient was admitted during the wee hours of the morning. We had morning endorsements this morning with a pediatric consultant, it was also a breeze. I m now currently writing this entry. A few more hours then I m homeward bound again.

I was like this dog at my bed quarters last night. Pleasant Day

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Tuesday Slow-Mo

Tuesday was in slow-mo mode. I only had one catch for the whole day before going home in the afternoon. My lunch was a breakfast meal, filled with eggs and sausages. I spend my afternoon playing my cellphone and spent some time checking the cute babies in the nursery. There was this one baby which was born yesterday, he was a 9 pounder, a big baby in terms of weights of Filipino babies. When I looked at him he was in a deep sleep and under phototheraphy, due to mild jaundice (yellow discoloration). Before going home, I visited the street adjacent to the hospital with one of my peers, we both some snacks and drinks, squid balls and sago to be exact with 2 pieces of ice creams one for each of us. After eating, Packed may small bag then I m homeward bound again.

Time move like a turtle today. Pleasant Day

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Placental Relief

I had another Sunday duty yesterday, still rotating in the NICU (neonatal intensive care unit). There were around 2 deliveries in the morning and eventually it looks like a relaxing Sunday duty but unfortunately there was one pregnant patient still waiting in the delivery room. She was a 32 weeker (roughly around 8 months) still premature by age of gestation terms. So I checked out his chart and ask the clerk in charge who was doing the labor watch. After which I found out the she had total placenta previa or placenta previa totalis.

Placenta previa totalis is a condition wherein the placenta implants itself in the lower part of the uterus when in fact it should be located in the upper part of the uterus. It also cames ahead of the presenting part (the fetal head) which may cause severe bleeding when labor comes. Cases like this are usually for C-section. I asked to OB resident in charge and ask her about the plans for the patient, she told me that may be they will deliver the baby because she already experiencing recurrent bleeding. So I told myself, here we go again, another premature delivery. So I went out of the labor room, informed my NICU resident regarding the plans of the OB, and both of us were praying that hopefully she wont deliver.

After approximately 2 hours, I called the labor room to check out the progress of labor of the said patient and to my relief the clerk in charge told me that she would be sent back to her room. The abdominal contractions have stopped and the bleeding also was managed. Then I relayed the news to my resident which made us both smile and we had received a great relief.

Above are the types of placenta preview, and they could really be a pain in the ass (placenta previa partialis(partial) is not seen in the picture). Pleasant day

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Saturday Review

The skies here look like to rain but no rain drops are falling. My Saturday past by, highlight of the day is that we had a review session with one of our pediatricians. Topics being discussed were about growth and development, infectious diseases and connective tissue diseases. We were given questions to answer during the morning and the answers where discuss during our afternoon session. I had a hard time with the questions under growth and development, the topic that I hate in pediatrics, but for the rest of the questions under the different topics I had a great time answering them.

After answering questions I had lunch with my peers at a nearby pizza parlor. Ordered a mix of pizza, spaghetti and chicken. We also had good conversations regarding things happening at the hospital. After which we return to our review area for the answers to the morning questions. After checking, I was satisfied with my score but still has a lot of room for improvement. Then we made are goodbyes and I m homeward bound again. Tomorrow another duty day at the NICU. Hopefully I won't have any complicated cases tomorrow because it really breaks my heart seeing an infant die. Pleasant day.

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Teratoma Galore

Yesterday was my first duty at the NICU (neonatal intensive care unit). My role was to inform my residents of waiting pregnant patients that are to give birth. I was there looking at the different cute babies in the nursery. The night prior to my duty, the OB dept admitted a 28 year old twins which are premature by age of gestation (28 weeks) and it was noted the one of her twins had a possible teratoma near her buttocks. A teratoma is a tumor which has components coming from the three germ layers (mesoderm, ectoderm, endoderm).

She was admitted for tocolysis (control of labor) because she is not even near term. So the tocolysis went ok until my duty came when one of the OR (operating room) nurses called us at the NICU that the said patient is gonna have a stat cesarean section. So me, one of my clerks, and three of my resisdents all went down to the operating room to await the delivery of the twins. Before delivery, we discussed the possible things that might happen and what to do when the babies come out.

The C-section started and there we waited, the first of twin came out, he was normal lookoing although small due to prematurity, he gave a good cry which somehow made us a little relief. One of my residents catch the baby then I assisted her in giving neonatal resuscitation until he was stable. Then I was wondering why the second of twin took time to come out, then to my astonishment when I saw the 2nd of twin, there a was a huge tumor on his buttocks measuring probably 10x8 inches. whew that was huge, the tumor was bigger than the baby. Resuscitation was done and eventually he was intubated. Both babies were brought to the NICU then eventually after a 2 hours the baby with the teratoma eventually died. So again there I was, looking at him, telling my self a casualty in my very first NICU duty, what a day.

The baby that we catched just looks like the photo above. I have some pictures in my cellphone though. Same location of the tumor. By the way, teratoma came from the Greeks which meant "monstrous tumor" Pleasant Day

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Self Breast Exam - a cheap way of screening

During my clerkship, when I was in my community rotation, I did a research study among reproductive age woman on who among them practice self breast examination. Well I m glad with the results that many women in my research area were practicing self breast exam. But what is self breast exam? What are its benefits?

Self breast exam is where in a woman examines her breast with gentle palpation using her fingers to detect any abnormalities such as lumps, masses, and any dimpling. Its an essential and cheap way for breast cancer detection. It is usually done by standing in front of mirror and a woman raises one arm and palpates one breast to detect any abnormalities then does the same to the other breast. The ideal time to start self breast exam is when a woman reaches the age of 20 and is usually ideally done 1 week after the start of a womans period. Self breast examination accompanied by a regular check up with a doctor can catch breast cancer early and is essential in treating and defeating the dreaded disease.

Breast cancer is rampant not just in my country but all over the world. It is one of the top 3 leaders contributing to cancer deaths. Early detection with a simple breast exam could go a very long way. Detecting and capturing it early is proven to be vital in the prognosis of patients. Allocate a few minutes a day or maybe within a week doing self breast examination, its simple and can be proven beneficial.

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Tuberculosis at a glance

Tuberculosis is a highly rampant in my country, I meet a lot of patients having this type of disease, from the out patient department to those being admitted. Some have a beginning disease, others on treatment, and others are already in their advanced stages. But what is tuberculosis? What are its signs and symptoms? What are the treatment options? I ll be giving you tuberculosis at a glance,

Tuberculosis is caused by a nasty bacteria called Mycobacterium tuberculosis. It usually spreads via droplet inhalation. So when don't let a TB patient sneeze or cough in front of you... better watch out. It usually affects the lungs in most cases but there are also extrapulmonary sites where TB can occur. Extrapulmonary sites include the GI tract, spine, meninges etc.

Signs and symptoms of Tuberculosis include chronic cough (usually 2 weeks and above), back pain, weight loss, easy to fatigue, a lymphadenopathy, others may cough out blood (hemoptysis) and other systemic signs such as fever, malaise, pallor, etc. Signs and symptoms may vary from 1 patient to the other.

Treatment usually lasts for 6 months for pulmonary tuberculosis and could be longer for extrapulmonary tuberculosis. Multi drug regimen is usually its main stay because the bacteria could easily developed resistance. In my country, drugs are usually free against TB, however its still rampant due to some patients not complying to the drug schedule. That's way WHO launched DOTS (direct observed treatment short course) to strictly watched over patients so they would comply with the treatment schedule. TB is treatable and doesnt neeb to be a cause of morbidity. Hopefully one day, my country will be totatlly TB FREE.

Thats Tuberculosis in a glance

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The French Connection

Another tour of duty ended, yesterday I was stationed at the ER because one of my clinical clerks was absent. My tour of duty was filled with viral infections coming in from here and there. As usual I was given a ward census for the number of patients admitted under the pediatric service. While studying the cases listed in the census, I found an interesting case, a patient who was transfered to the ICU. She is a 13 year old female, who came in the other day due to difficulty of breathing. So she was tended to, but my other co-intern noticed that she was also presenting with lower extremity weakness and upper extremity weakness. She was eventually admitted. During my tour of duty yesterday she was transfered to the ICU for close monitoring. She was then referred to neurology service regarding her symptoms. A neurologist discuss the case with the relatives of the patient, her impression was to consider Guillain-Barre Syndrome. The syndrome was first reported by french guys during the early 1900's. Eventually the disease is name after them.
I visited her prior the her lunch, examined her extremities, she eventually could'nt lift her legs with slight strength on her upper extremities. Eventually she was not having difficulty of breathing, so I talked to her for a while, then left her on my way down to the ER. Skipped breakfast this morning, then we had a small group discussion regarding our "French connection" case". A few minutes from now, I m homeward bound again.


The "French Connection" can cause respiratory failure. Pleasant Day

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