Report and photos compiled by Rithy Chau, Telemedicine Physician Assistant at SHCH On Tuesday, September 16, 2003, Ratanakiri Provincial Hospital (RPH) staff with their Telemedicine(TM) Partners from Sihanouk Hospital Center of HOPE (SHCH) in Phnom Penh, Cambodia and the TelePartners from Boston, USA, began the sixth TM clinic. The patients were examined by clinicians from RPH and their data were transcribed along with digital pictures of the patients, then transmitted and received replies from their TM partners in Boston and Phnom Penh. SHCH staff (Rithy Chau, PA-C and Somontha Koy, RN) were present during the clinic hours to assist in recording and translating H&P (from French/Khmer into English) and to monitor and facilitate the data transmission and communication. There were five doctors and a medical assistant (or PA) participating in this month TM clinic along with Pharmacist Ly Channarith and RPH Director, Tha Bunthak, who managed and directed the clinic. There were six new cases and one follow up patient from the May 03 clinic present. All their data and photos were transmitted. Another new case (PH#00035) was added in this month clinic and was seen by Dr. Tha Bunthak. The data for this patient was transmitted on Friday, September 19, to be included in this month clinic website publishing. [Please note that some of the patients’ data collected, transcribed, and communicated were done by the RPH staff and were left in its crude form so as for viewers to understand the challenge of medicine practiced in remote, rural setting of Cambodia. The CamShin satellite was operating smoothly the entire time during this month TM clinic.] The following day, Wednesday, September 17, 2003, the TM clinic opened again to send the rest of the cases and receive the same patients for further evaluations, treatments and management. Clinicians from SHCH discussed briefly case by case with the local (RPH) telemedicine staff concerning each patient’s treatment and management using information/replies received from the TM partners that morning. In the afternoon, the local medical staff would then followed up with the agreed plan of treatment and management with each patient seen. Finally, the data of the follow-up for patient treatment and management would then be transcribed and transmitted to the PA Rithy Chau at SHCH who compiled and sent for website publishing. The followings detail e-mails and replies to the medical inquiries communicated between TM clinic at RPH and their TM partners in Phnom Penh and Boston :
-----Original Message----- Dear All, Please be informed that the next TM clinic at the Ratanakiri Provincial Hospital will be held On Tuesday, September 16 at 8:00AM local time for one full day. The data of the patients are expected to entered and transmitted to those of you in SHCH and partner (Boston) that evening. Please try to make your replies by noontime the following day, Wednesday 17 September.The patients will be asked to return that afternoon on Wednesday to receive treatments and plan of follow-up or refer. Thank you for your cooperation and service. Best regards, Channarith
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Tuesday, September 16, 2003
-----Original Message----- Dear All, This is our first patient for September 03 TM clinic. There will be 6 more sending to you. Thank you, Channarith
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Ratanakiri Provincial
Hospital Telemedicine Clinic with Patient: PN#0005, 37F, Village I
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-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH
Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. PN0005-37F: I, too, have a problem right now with allergic rhinitis, nighttime cough and signs of reflux. I agree that I would continue the Cetirizine and add the Omeprazole 20mg 2 po BID until next month. An exposure history should be done here to find the triggers for her allergic rhinitis. She should avoid eating late at night and to put rocks or wood under the posts of the bed, so her head is always elevated. Thanks. Jennifer _________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
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-----Original Message----- It sounds like GERD may be the cause of her symptoms and it is not surprising she still has symptoms 3 months later on cimetidine therapy-- If GERD is the cause, even with aggressive therapy it may take 4-6 months to see improvement. I would change to omeprazole 20 bid and add cimetidine at night. I would also emphasize avoiding mints, chocolates, coffee and fatty foods and not eating 3-4 hours before sleep. Can probably stop anti-histamine Rx. Have you tried albuterol inhaler? asthma can present with similar symptoms. Her symptoms can also be caused by heart failure therefore manifesting mainly when laying down at night. An echo to rule-out that possibility may be warranted now given her h/o ?heart disease.
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-----Original Message----- Dear All, This is patient SM#00029 for September 03 TM clinic. There will be more pictures sending to you. Thank you, Channarith
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Do you Yahoo!? Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: SM # 00029, 52 Y.O, Ochum
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-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. SM00029-52F: I will ask Dr. Cornelia to comment here because I cannot read the US report clearly. The doctors in Boston may not read French either. I see on the US that there may be a mass in the liver. Is this cystic? Are we considering a liver abscess? I will review this case with Dr. Cornelia and give an answer soon. So, more to come with case SM00029. Thanks. Jennifer _________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
-----Original Message----- From: sihosp@online.com.kh [mailto:sihosp@online.com.kh] Sent: Wednesday, September 17, 2003 2:12 PM To: kirihospital@yahoo.com Subject: Telepartners-session, 17 September 2003 Dear Gentlemen: I have spoken to Dr. Cornelia concerning patient #00029 who presents with the liver problem. She suggests that the SHCH team bring down all of the US pictures of the liver for review by the Radiology Dept. here. The question in our minds is a liver abscess. There is not mention of whether this mass in the left lobe of the liver is cystic or solid. There is also no mention of what the other structures in the abdomen look like- gall bladder, pancreas, bile ducts, etc. If this is a liver abscess that needs drainage there, can a bleeding time be gotten and the patient undergo liver puncture with US help? Is there someone skilled in this procedure to do it? The other thing that could be done is having the patient come down and get another US-abdomen and pelvis here. This does not mean that we would do any procedure on her beyond this. The first step is to send the pictures for review. I think if we think that this might be a liver abscess, I would suggest keeping her on Ceftriaxone 1gm Q12h and Metronidazole 500mg Q8h IV. Please do a rectal exam!!!! Thanks. Jennifer
-----Original Message----- Dear Ratanakiri TeleMedicine Clinic, Thank you for the opportunity to contribute to the care of Ms. Ochum. I am sorry to hear she has been feeling sick. I hope I can contribute some ideas to her care. 1) Request for more information. Can you please send me some more information? Does she have diarrhea? What is the hematocrit? Is it possible to get a stool study, to look for ova & parasites? The ultrasound image sent to me is normal, except for cholelithiasis, which is unlikely to be related to her illness. The image sent to me does not show a liver cyst, nor a tumor. The ultrasound report suggests a tumor, but does not mention a cyst. Why does your assessment say there is a liver cyst and a liver tumor? 2) Possible diagnosis if no more information can be provided. With the information I already have, I can make a guess. She may have parasites, or hepatitis and liver cancer. The clinical scenario suggests hepatitis and liver cancer, but the normal SGPT goes against a diagnosis of hepatitis. 3) Treatment recommendation. Ampicillin, ceftriaxone, and gentamicin should be stopped. These antibiotics will not help, and they may be harmful. The hyoscine is not necessary, but if it helps her symptoms it should be okay, as it is unlikely to do harm. Paracetamol should be used as little as possible. It will not help her, except to relieve symptoms of pain and fever, and could be harmful. If it helps her pain it should be okay to use it. If there really is a liver cyst, then she may have entamoeba or echinococcus, and these can be treated. We really need a stool test to look for parasites. It is also possible that she has schistosomiasis. A test for schistosome eggs in urine and stool would be useful. The treatment for entamoeba is 10 days of metronidazole 750 mg three times daily, followed by a course of paromomycin. The treatment for echinococcus is a prolonged course of albendazole or mebendazole. The treatment for schistosomiasis is 60 mg/kg of praziquantel. 4) Other material. The chest x-ray is normal. 5) Conclusion. I’m sorry I could not be more helpful. It is really necessary to get more information before we can be sure. In particular, a complete blood count, more details about the ultrasound, and stool and urine tests as discussed above. Yours truly,
Danny Pallin,
MD, MPH
tel:
617-525-6614
-----Original
Message----- Thanks Dr. Pallin. Feel free to call me with any questions or comments. Kathy
-----Original Message----- Dear All, This is patient SC#00030 for September 03 TM clinic. Only two pictures with this case. Thank you, Channarith
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Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: SC#00030, 54F, Village IV
Please send all replies to kirihospital@yahoo.com and cc: to tmed_rithy@online.com.kh . The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH
Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. SC-00030, 54F: It is not clear to me about the colitis diagnosis. How was she treated and did she improve? Was she supposed to be on a special diet? I also don’t know if you mean that her hard stools are increasing or diarrhea is now happening. It is not clear to me that her problem is in the stomach. Pain from the large bowel can radiate to the epigastric area. Has she had blood in the stool? I find it unacceptable that a rectal exam on this patient and all of the GI patients seen this session has not been done. This is very important to do. US of the abdomen will not show things well in the bowel. Did she have a barium enema in Vietnam? If so, what was the result? I don’t disagree to treat possible H. pylori eradication, but I feel that she likely has another problem in the large bowel and this should be worked up if your therapy with regimen #2 for H. pylori does not help her. Thanks. Jennifer _________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
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-----Original Message----- Dear Dr. Siphal, Thank you for allowing me to participate in this woman's care. While I agree that treatment for possible H.Pylori eradication would be helpful, there are several aspects of her case which are concerning. She is 54 yo, has a moderate anemia, and 2 months of epigastric pain with anorexia, mild weight loss and low grade temps. Given your report of the abdomenal US showing only microcalculi, is it safe to assume that her liver/gallbladder and stomach/epigastric area were also imaged but unremarkable? -- obvious things like neoplasms, GI abscesses, gallstones could be seen -- however, U/S doesn't always image the pancreas very well. Was her stool guaiac'd? I think the next definitive study would be an upper endoscopy, especially to r/o malignancy (given her age and demographics), severe gastritis, PUD, or even parasitic infestation of the GI/hepatobiliary system. If possible, blood tests for SGOT/SGPT, albumen, bilirubin, lipase, vit B12 and potentially even Hep B/C serologies would be helpful. If she has true ulcer disease she'd need to be on PPI for at least a couple of months to allow healing. If that is unhelpful abdomenal imaging via CT scan should be done as a last effort of diagnosis. Do you have any further information about her history of "colitis" and how it was diagnosed? Has she ever had a colonoscopy? As an aside, with renal calculi and anemia, it would be good to check her kidney function, and make sure she does not have chronic renal insuffficiency. I hope this helps. If possible, let me know how she does with any follow-up. Best, Dr. Jonathan Crocker Bulfinch Medical Group MGH
-----Original Message----- Good Morning Dr. Crocker: Here is your first case. The attachments above contain the patient's physical exam, photo and an ultrasound. Please feel free to contact me with any questions or comments. I will need your response no later than 8:00PM. Many thanks, -------------------------------------------------
Kathy Kelleher-Fiamma
-----Original Message----- Dear All, This is patient NH#00031 for September 03 TM clinic. Only one picture with this case. Thank you, Channarith
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Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: NH#00031, 52F, Village III
Please send all replies to kirihospital@yahoo.com and cc: to tmed_rithy@online.com.kh . The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. NH00031-52 F: I agree to use H. pylori eradication, regimen #2 x 14 days that you have listed. Is she still smoking? If still symptomatic in the next months, would recommend upper endoscopy. Thanks. Jennifer _________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
-----Original Message----- From: Cusick, Paul S.,M.D. [mailto:PCUSICK@PARTNERS.ORG] Sent: Wednesday, September 17, 2003 12:07 AM To: 'kirihospital@yahoo.com' Cc: 'tmed_rithy@online.com.kh' Subject: Patient: NH#00031, 52F, Village III I agree completely w/ treatment to eradicate H. Pylori and to institute low acid diet. She may require maintenance therapy w/ antiacids or ranitidine or cimetidine. In addition, efforts to stop smoking will likely decrease symptoms of dyspepsia. Paul Cusick MD
-----Original Message----- Dear All, This is patient SP#00032 for September 03 TM clinic. There will be more pictures to be sent. Thank you, Channarith The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: SP#00032, 30F, Village I
Please send all replies to kirihospital@yahoo.com, and cc: to tmed_rithy@online.com.kh. The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH
Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. SP00032- 30F: You feel that this woman may have a toxic thyroid nodule. This is reasonable. I would not use Atenolol for this condition because it is a selective beta blocker. The more appropriate drug is propranolol and I would use 10mg po BID. Propranolol delays thyroid release from the thyroid, blocks conversion of T4 to T3, which is the more active form of thyroid hormone, and works better with the sympathetic nerve effects of hyperthyroidism. I think she should have thyroid tests done and until we have a clear policy about this, we have to deal with each patient on a case by case basis. Yes, send blood down for testing. Thanks. Jennifer _________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
-----Original Message----- Dear All, This is patient MP#00033 for September 03 TM clinic. There will be more pictures for this patient. Thank you, Channarith
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Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: MS# 00033 12 years old, Female, Village one
Please send all replies to kirihospital@yahoo.com and cc: to tmed_rithy@online.com.kh . The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. MP00033-12F: The presentation, EKG and CXR point to pulmonary hypertension and this could be in connection with congenital heart disease. It is very helpful to be more precise on the cardiovascular exam. You mention a systolic murmur, but nothing about location, accepted grade, radiation, associated heart sounds, pulses, jugular venous pressure, etc. This is very important to understand if this patient may have atrial or ventricular septal defect versus mitral disease. Please remember that mitral stenosis is associated with a diastolic murmur and one should be able to know the difference between this and mitral regurgitation. The Heart Center should be the place that the patient goes for assessment. She may well be a candidate for heart operation, but not if she has severe pulmonary hypertension. Thanks. Jennifer _________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
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-----Original Message----- This child almost certainly has a heart defect, but difficult for me to diagnose exactly at this distance! The chest XRay shows mild cardiomegaly but with a prominent pulmonary artery; the lung vascularity doesn't look increased so she may have well have pulmonary hypertension. The physician tells us she is clubbed although I wasn't sure on the image (although the images are really beautiful!). The ECG shows right axis deviation and right ventricular hypertrophy. So my differential diagnosis would be : 1) Rheumatic Heart Disease (eg Mitral Stenosis + mitral regurgitation) just because it must still be common in Cambodia. 2) Eisenmenger VSD (becuase she has a history since a baby) and because there is clubbing .....but usually there shouldn't be much murmur. 3) Possibly an Atrial Septal Defect, but I would have expected more vascularity on the CXR. In summary, she needs to see a pediatric cardiologist. Congratulations to the physician there for his excellent report and the beautiful images he transmitted, and congratulations to Partners Telemedicine. Best Wishes, Michael de Moor, MD, FACC Chief, Pediatric Cardiology MassGeneral Hospital for Children Boston, USA.
-----Original Message----- Thanks again Dr. de Moor. If possible, I will need your recommendations by 8:00pm Best regards, Kathy
-----Original Message----- Thanks again Dr. Haver. As always, please feel free to contact me with any questions or comments. ------------------------------------------------- Kathy Kelleher-Fiamma
-----Original Message----- Dear All, This is the last case of September 03 TM clinic, patient TD#00034. Only two pictures with this patient. Thank you, Channarith The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
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Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: TD#00034, 55F, Village II
Please send all replies to kirihospital@yahoo.com and cc: to tmed_rithy@online.com.kh. The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
-----Original Message----- From: Jennifer Hines [mailto:jghines@hotmail.com] Sent: Wednesday, September 17, 2003 7:57 AM To: kirihospital@yahoo.com Subject: RE: Telepartners--SHCH Dear Gentlemen: I have listed my comments and recommendations below for all 7 of your patients. I hope that these answers are helpful and return to you before sundown (just kidding). I am at home answering these questions because of telesurf problems at the hospital. Interesting medical references will have to be sent later. TD 00034-55F: This woman likely is having HA from uncontrolled HTN. I do not see that she has significant EKG changes beyond perhaps, LVH. Her heart rate is already in the 60’s, so choosing a beta blocker has to be carefully monitored. I don’t believe that using only one antihypertensive agent in this patient will control her BP. I would use Atenolol 25mg QD, ASA 500mg ¼ po QD and consider HCTZ 25 mg QD. I would also encourage the use of paracetamol and I would not put an older patient on diazepam at all. This is controlled substance in this country and is addictive. We should not support it use here. Please remember to take more history about the HA, using the seven elements of the history of present illness (HPI)-location, quality, quantity, associated symptoms, alleviating things, aggravating things and timing. These should be kept in mind for all patients for all symptoms. Please make sure to treat the potassium and will have to watch this closely if HCTZ is going to be used. Thanks. Jennifer ________________________________________________________________ Send and receive larger attachments with Hotmail Extra Storage. http://join.msn.com/?PAGE=features/es
-----Original Message----- Dear All, This is a specil case after September 03 TM clinic,Patient PH#00035.There will be more photos to be sent for this patient. Thank you for your coorperation. Best regards, Channarith Do you Yahoo!? Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: PH#00035, 38F, Village III
Please send all replies to kirihospital@yahoo.com and cc: to tmed_rithy@online.com.kh. The information transmitted in this e-mail is intended only for the person or entity to which it is addredded and may contain confidential and/or priviledged material. Any review, retransmission, dissemination or other use of or taking of any action in reliance upon, this information by persons or entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the sender and delete material from any computer.
-----Original Message----- From: tmed_rithy [mailto:tmed_rithy@online.com.kh] Sent: Friday, September 19, 2003 1:35 PM To: Channarith Ly; Bunthak Tha Cc: Ruth Tootill; Somontha Koy; Bernie Krisher; Gary Jacques; Jennifer Hines; Cornelia Haener; Rithy Chau Subject: FW: Reply for patient SM#00029
Dear Dr. Lin/Channarith, As I wrote this morning to you concerning patient SM#00029, I got mixed upwith the special case. This patient SM#00029 was diagnosed withhepatomegaly with fever and jaundice possibly related to liver cancer (not cervical cancer). She can come for a second opinion on her condition at SHCH. As for the lady with pelvic mass (PH#00035), Dr. Cornelia has said that she possibly has cervical cancer which requires a radiotherapy treatment at Norodom Sihanouk Hospital (Russian Hosp). She may have to spend about 6 weeks in PP for the actual treatment itself and there will be many side effects and complication from radiotherapy tx. The patient needs to know this before she comes to PP. If you want to refer her for further evaluation, Norodom Sihanouk Hosp is the best place to send her any way. Sorry about the confusion. Thanks, Rithy Wednesday, September 17, 2003 Follow-up Report for Ratanakiri TM ClinicOne follow up patient from May clinic returned for this month TM. The other 6 (and one special case) patients seen were new to the TM clinic at Ratanakiri Provincial Hospital (RPH). Their data were transmitted and received replies during this month TM clinic. Per advice sent by Boston TelePartners and Phnom Penh Sihanouk Hospital Center of HOPE, the following patients were managed and treated per local medical staff: [Please note that in general the practice of dispensing medications at RPH for all patients is limited to a maximum of 7 days treatment with expectation of patients to return for another week of supplies if needed be. This practice allows clinicians to monitor patient compliance to taking medications and to follow up on drug side effects, changing of medications, new arising symptoms especially in patients who live away from the town of Banlung and/or illiterate. One new patient diagnosed with dyspepsia and UTI and another (June 03) follow up case with much improved symptoms of dyspepsia and HTN/IHD was seen at this month TM clinic, but their data were not included for transmission due to time constraint.] Patient PN#0005, 37F, Village IFinal assessment: 1) GERD 2) Allergic Rhinitis This patient was prescribed with medications (to be bought at the market) as follows:
Patient SM#00029, 52F,Ochum VillageFinal assessment: 1) Hepatitis? 2) Liver abcess vs. cancer? This patient was prescribed with medications from RPH pharmacy (otherwise indicated) as follows: 1. Albendazole 200mg 2 tab po bid x 28 days (hold until finalized between RPH and SHCH staff) 2. Paracetamol 500mg 1 tab po q8h prn pain 3. Hyoscine 20mg 1 amp IM or IV q 8h prn cramp/spasm -----Original Message----- From: tmed_rithy [mailto:tmed_rithy@online.com.kh] Sent: Friday, September 19, 2003 1:35 PM To: Channarith Ly; Bunthak Tha Cc: Ruth Tootill; Somontha Koy; Bernie Krisher; Gary Jacques; Jennifer Hines; Cornelia Haener; Rithy Chau Subject: FW: Reply for patient SM#00029 Dear Dr. Lin/Channarith, As I wrote this morning to you concerning patient SM#00029, I got mixed up with the special case. This patient SM#00029 was diagnosed with hepatomegaly with fever and jaundice possibly related to liver cancer (not cervical cancer). She can come for a second opinion on her condition at SHCH. As for the lady with pelvic mass (PH#00035), Dr. Cornelia has said that she possibly has cervical cancer which requires a radiotherapy treatment at Norodom Sihanouk Hospital (Russian Hosp). She may have to spend about 6 weeks in PP for the actual treatment itself and there will be many side effects and complication from radiotherapy tx. The patient needs to know this before she comes to PP. If you want to refer her for further evaluation, Norodom Sihanouk Hosp is the best place to send her any way. Sorry about the confusion. Thanks, Rithy Patient SC#00030, 54F, Village IVFinal assessment: 1) PUD 2) Nephrolithiasis 3) Parasitic infection This patient was prescribed with medications from RPH pharmacy (otherwise indicated) as follows: 1. Amoxicillin 500mg 2 cap po bid x 14d 2. Tinidazole 250mg 2 tab bid x 14d 3. Omeprazole 20mg 1 po bid x 14d (available at market) 4. Albendazole 200mg 2 po bid x 5d (available at market) 5. Mult Vit 1 po qd 6. FeSo4 1 po qd If symptoms do not improve in one month, may consider sending for endoscopy. Patient NH#00031, 52F, Village IIIFinal assessment: 1) GERD 2) PUD This patient was prescribed with medications from RPH pharmacy (otherwise indicated) as follows: 1. Amoxicillin 500mg 2 cap po bid x 14d 2. Tinidazole 250mg 2 tab bid x 14d 3. Omeprazole 20mg 1 po bid x 14d (available at market) After eradication of H. pylori, may continue with either Omeprazole 1 po qd or Cimetidine 400mg 1 po bid for 1.5 months. If symptoms do not improve in one month, may consider sending for endoscopy. Patient SP#00032, 30F, Village IFinal assessment: 1) Toxic Goiter (hyperthyroidism?) This patient was prescribed with medications from RPH pharmacy (otherwise indicated) as follows: 1. Propranolol 10mg po bid 2. Multi Vit 1 po qd Regularly observe heart rate. Draw blood on 9/18/03 to take to SHCH for TSH and free T4 evaluation. Patient MP#00033, 12F, Village IFinal assessment: 1) ASD vs. VSD? 2) MVP 3) Cardiomegaly Patient may possibly be referred to Calmette Cardiac Center in Phnom Penh for further work-up on her cardiac problems. Patient TD#00034, 55F, Village IIFinal assessment: 1) HTN 2) Dyspepsia 3) Ischemic Heart Dz 4) Insomnia
This patient was prescribed with medications from RPH pharmacy (otherwise indicated) as follows: 1. Atenolol 50mg ½ tab po qd 2. HCTZ 50mg ½ tab po qd 3. ASA 500mg ¼ tab po qd 4. Para 500mg 1 tab po q6h prn Check HR and K+ in one month. Advise patient on diet and exercise to reduce her dyspepsia symptoms and follow up next month.
Patient PH#00035, 38F, VillageIIIFinal assessment: 1) Cervical Cancer with possible metastasis Patient may be treated with palliative care or be referred to Norodom Sihanouk Hospital in Phnom Penh for further evaluation. The next Ratanakiri TM Clinic will be held on Tuesday and Wednesday, October 14-15, 2003
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Musculoskeletal:
PE:
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PE:
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Rectal:
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