Sticky tape as a diagnostic device

On Friday at the hospital I was asked to see a patient who had a referral to the practice for a sticky tape test. The specimen collection team weren’t familiar with the test.

Rather than go into details on the interaction I had on Friday I thought I’d let you know about how a humble piece of sticky (or scotch) tape can help make a diagnosis.

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Enterobius vermicularis is better known as a pinworm. It causes Enterobiasis or pinworm infestation.

Pinworm usually affects children but can cause illness in adults especially institutionalised adults.

The disease manifests as itchiness around the anus and causes sleeplessness and restlessness.

The worm is transmitted via the faecal-oral route. Pinworm eggs get deposited on the skin around the anus and these get transferred to others, especially those who like to rim but more commonly as a result of poor toilet hygiene. It’s easy to understand why this is a disease common in childhood and why families become infested easily.

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Worms emerge at the anal verge a few hours after falling asleep. To make a diagnosis it’s best to get the worms and eggs as soon as the patient wakes up before any bathing or bowel movement. On waking, a short strip of sticky tape is applied to the skin close to the patient’s anus and applied to a glass slide. The slide can be sent into a pathology laboratory where it will be stained and examined using a light microscope.

Pinworm infestation gets treated with over-the-counter worming medications.

 

 

Raw milk and why I’m not sure it’s worth the risk

A couple of weeks ago I wrote a piece on Yummy Lummy about a meal Bron and I shared at Jamie’s Italian Canberra. In the middle of the post I ranted a little about the use of raw milk in some cheese, viz., bocconcini. As a clinical microbiologist with an interest in food, food safety and public health I’ve always appreciated the balance between taste and desires of food advocates and the need for safety. In that regard, Australia excels when it comes to using risk management principles to minimise harm to Australians. On balance and with some exceptions, raw milk is not permitted for commercial use in Australia. You can find the regulations at FSANZ.

A couple of days ago ProMED-mail posted a piece on unpasteurised milk in the USA. The ProMED-mail piece provides food for thought and some great references to excellent articles. To be fair, these articles relate to the USA and as I’ve stated, in Australia our regulatory process is very good.

For my money, I’d prefer pasteurised milk to be used at the small cost of some loss of flavour. For the raw milk devotees, I’m sorry but while your enthusiasm is great, in the greater public good, I think Australia should continue to tightly regulate diary products.

Dangers of Raw Milk: Minnesota Study Documents 1 in 6 Become Ill
Nonpasteurized Dairy Products, Disease Outbreaks, and State Laws—United States, 1993–2006
Raw or heated cow milk consumption: Review of risks and benefits

What do you think when you see CBR?

When anyone says CBR or whenever I read CBR two things come to mind.

Chemical Biological Radiological and the code for Canberra airport.

I’ve been involved in Chemical Biological Radiological related work since about 2000. It’s one the main things I work on in my current role. I’ve had an interest in biological warfare and terrorism, that is, countermeasures and response planning even before 2000. As a young microbiologist before studying medicine I was fascinated by the use of microorganisms as weapons.

So when I read or hear CBR my mind turns to

Clinically I think of

Now that I’ve lived in Canberra since 2007, I’ve come to know the Canberra airport very well and its code is CBR.

So what do you think I think of when I see this

2013-12-06 08.34.59 AEDT It's even being used as wallpaper on ACT Government PC monitors.

2013-12-06 08.34.59 AEDT It’s even being used as wallpaper on ACT Government PC monitors.

I don’t think Confident Bold Ready. When I see the bright yellow background and the stylised letters it sends my mind back to the 1970s and 1980s to this

So rather than make me think of Canberra as confident bold ready, the logo makes me look to the past. Apparently the ACT Government has budgeted $2.6 million for this work. I’m expecting Molly Meldrum to materialise and start spruiking Canberra.

For me, CBR is always going to mean Chemical Biological Radiological or Canberra airport.

Words that peeve me

I’ve just posted this page at another site. I’ll add to it from time to time.

https://drgarylum.squarespace.com/words-that-peeve-me/

Where does #manflu fit in this? The difference between a head cold and influenza

One of my pet peeves is when the media contracts a scientific or established official name into something very shorthand. In my mind it’s disrespectful to the people who investigated the microorganism and the disease. To be fair, it’s not something I’m going to sacrifice myself over, after all it’s just a peeve and nothing more. What is more annoying is when we see this creep into official writing, but again, it’s more peeve and annoyance and I have no real influence on anyone but myself.

So in this post I’ll accept manflu as a word but rather than use the common shorthand of flu I will always prefer influenza.

The Internet (Oh how I love the Internet) is replete with descriptions and short videos on manflu, all you need to do is go to YouTube and search manflu for some very funny video clips.

My concern today is the difference between the common cold and influenza. You hear it so often in the workplace. Someone takes a call from an ill colleague who has called in to say they have the influenza. The vast majority of people who call in sick have a common cold. When you’re infected with an Influenza virus you will know it.

The Royal Australian College of General Practitioners has in its emergency management planning a really nice table describing the difference. It references the Center for Disease Control and Prevention in the US.

Symptoms of influenza and the common cold

Symptom Influenza Common cold
Fever Often high, lasting 3 to 4 days Rare
Headache Frequent Rare
Aches and pains Common; can be severe Slight
Cough Common; can become severe Sometimes; mild to moderate
Sneezing Sometimes Common
Runny nose Sometimes Common
Sore throat Sometimes Common
Shivering Common Rare
Physical capacity Frequently bedridden Normal
Energy levels May show moderate to extreme signs of weakness A littler lower than usual
Complications Pneumonia, kidney failure and heart failure. Can be life-threatening Sinus or ear infection

Does manflu exist? Of course not. It’s just the common cold. That hasn’t stopped me tweeting about it though when I’m suffering :-)

CPAP and allergic rhinitis (aka hay fever)

I’ve been using continuous positive airway pressure (CPAP) for nearly twelve months for hypopnœas (more than 30 episodes of non-breathing for <10 seconds in duration each sleep cycle). While I don’t have sleep anpnœa (periods of non-breathing >10 seconds), my sleep physician recommended CPAP. All in all it’s been a good move. I sleep better and I don’t snore. I still don’t feel all that refreshed in the mornings but I do feel like I’m getting more sleep.

This is my first spring using CPAP. Spring in Canberra is something to behold. It’s beautiful every morning. The air is crisp, cold and fresh. The air is also full of pollen, pollen like you wouldn’t believe. It’s bad enough it’s cold and dry, but the beautiful cherry blossoms and other flowers bring with them so much pollen anyone who is afflicted with hay fever will know about it quickly.

For as long as I can remember I’ve had hay fever. On arriving in Canberra I changed from a Fluticasone to various non-sedating oral antihistamines with varying effect. Over the last year or so I’ve needed more powerful antihistamines. The ones that make me feel groggy all morning.

It’s been a revelation though sleeping with CPAP. The CPAP forces air in and I have no problems sleeping unlike the poor sleep I’ve experienced every spring. When I wake up though the symptoms return quickly and occasionally when I’m asleep I sneeze. I think having a humidifier attached to my CPAP machine helps a lot too.

My bedside CPAP set up. Yes, they're baby wipes to clean the mask every morning.

My bedside CPAP set up. Yes, they’re baby wipes to clean the mask every morning.

I’ve previously blogged about my CPAP experience

http://yummylummy.com/2012/11/11/cpap-shogun-japanese-restaurant-a-burger-with-a-difference/

http://yummylummy.com/2012/11/18/cpap-update-and-my-week-in-instagram/