AFRO-NETS> RFI: Your clinical opinion (2)

["Dr. Ghermai Tesfasellase" <ghirmayt@eri.healthnet.org>]

RFI: Your clinical opinion (2)
------------------------------

Dear Dr. Koirala,

The case that you seem to a have a problem with is really a challenging 
one. When I read your e-mail message I felt very sorry and I thought 
that I forward my suggestions to you.

The environment in Nepal is very cold and highly degraded with bad 
weather specially this days of the year. All the clinical features seem 
to be originating from blood. Considering the existing features of the 
problem, and the laboratory findings, I suggest that you consider blood 
culture for some micro-organisms; blood film for haemoparasites. In Ne-
pal, Tuberculosis is highly prevalent and consider bacterial meningitis 
(especially Tbc meningitis) in your diagnosis regardless of the Hx of 
RA. 

Considering the emergent situation of the case I suggest that you put 
the patient on the following treatment regime: Rx Crystalline penicil-
lin, 3million units iv every six hours for five days; Dextrose 5% in 
saline, iv about 50 drops/minutes, Hydrocortisone 100mg iv or im every 
eight hours. Moreover, I suggest that you consider side-effect of the 
drugs that she was taking. Once I had such a case more than 11 years 
ago when I was working in a paediatric ward. I managed him with the 
above treatment regime and he was cured. Thus, just try this. I hope we 
shall come up with promising result. Now I am working in the Ministry 
of Health of the State of Eritrea.

Sincerely Yours,

Dr. Ghermai Tesfasellase
Head of International Co-operation Office
Asmara, Eritrea
Fax: +291-1-122-899
mailto:ghirmayt@eri.healthnet.org 

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