Tuesday, June 23, 2009

Rare Diagnosis (2) - Fahr's Syndrome

Saw a really interesting case last week.

A middle-aged woman was brought by her husband who's worried that she might be suffering from dementia, although it seems a bit early onset for her age. Her behaviour and personality seems to be changing over the past few months, and frequent falls were also noted.

Examination revealed Parkinsonian features: Mask-like facial appearance, shuffling gait with postural instability and cog-wheel rigidity bilaterally. But besides that, she's also noted to have dysarthria, and mild choreoathetoid movement of the upper limbs. Mini-mental state examination score was suggestive of dementia, too.

A CT Brain was done for her and as follows:

Bilateral, symmetrical hyperdense lesions over internal capsule, basal ganglia and cerebrum. Impression is generalized extensive cerebral calcification.

What do you think it could be?

(Answer's in comment)

Related post:
Rare Diagnosis (1)

Saturday, June 20, 2009

Failed Contraception?

(Pic from Foto S.A)

Just to share a story:

A friend of mine did an educational community project during his final year as a medical student, which aimed to create awareness of contraception in a village (kampung).

They have prepared the presentation and booklets explaining on various types of contraceptives, which the primary emphasis is on barrier method - condoms, due to its cost-effectiveness and easiness-to-use.

But they encountered a problem - someone forgot to bring the plastic penis model for the demonstration use on how to put on the condom. As a result they had to improvise, which was to replace it with a banana bought locally (the end product is something like the pic shown above).

The presentation was uneventful. At the end of the project they distributed a few condoms to each family.

6 months later, they came back to the village for a statistical survey - to find out how much the pregnancy rate was controlled after the contraception introduced. And to their most suprise, the rate has not changed at all and there's even some increase as compared to before!

So to find out why, they did some home visits and they found something shocking and it's the most obvious reason of the failed contraception.

Apparently in every house there's one thing beside the bed - a banana with a condom on.
Their understanding is pregnancy won't occur with this "condomed banana" in the room!

This is a true story! ;)

Saturday, June 06, 2009

Rare Diagnosis - Leishmaniasis

We had an interesting case lately. A young patient presented with prolonged fever, hyperpigmented skin lesions and hepatosplenomegaly. Lab study showed pancytopenia. Based on the clinical presentation and there is history of travelling, the physician made a diagnosis of Kala-azar (visceral leishmaniasis) right before much investigation.
And bone marrow aspiration with trephine biopsy was then done - Leishman-Donovan bodies were seen and consistent with Leishmaniasis.

All I can say is I'm thrilled by the clinical acumen.
According to him this is by far only less than 5 cases in the state. What a rare case it is!

And just to share one more thing that I saw in the clinic, when I asked one diabetic patient whether he brought his glucose monitoring diary, this is what he showed me:

He made a graph of his glucose level! Believe me this is only 1/20 of the full length as he has been doing it for few years.

And guess what's his occupation? Ya, a maths teacher! ;)

Friday, June 05, 2009

Q Fever

Did a presentation on Q fever today. Just take out some points to share:

Q fever is a zoonotic disease caused by Coxiella burnetii, a pleomorphic, obligate intracellular Gram –ve coccobacillus., causing acute or chronic infection worldwide.

It's first recognized in 1935 by Derrick in Queensland, Australia but this is not the reason it's named so. "Q" stands for "Query" as it has been presenting as prolonged fever of ? cause before the organism identified.

Being one of the Rickettsial infections, Q fever appears rather atypical. You can think that it's Queer because it has no rash, has no vector, has negative Weil-Felix, its causative organism can survive outside for a long time and does not have Rickettsia as its genus name!

Q fever's symptoms are mainly prolonged fever, and commonly manifests as atypical pneumonia, granulomatous hepatitis, myocarditis or meningoencephalitis. Chronic infection leads to endocarditis (culture-negative).

Lab diagnosis is by detecting antibody level to phase I or II antigen with IFA/ ELIZA. Rx for acute infection will be T.Doxycycline for 10-21 days; whereas a longer course for chronic infection - Doxy with quinolones for 4 years OR Doxy with hydroxychloroquine for 1.5 to 3 years. Relapse rates of over 50% are seen despite Rx.

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