Hydatid disease, hepatic injury and hypertonic saline: a clinical conundrum.

Echinococcosis or human hydatid disease is a helminthic infection is caused by Echinococcus species. Classically, cystic echinococcosis is caused by Echinococcus granulosus sensu stricto, E. equinus, E. ortleppi and E. canadensis, though several other species have been implicated in hydatid disease. Echinococcus infection may lead to cystic disease of the liver, lungs and potentially other organs. Here we present a patient who had cystic disease of the lungs and liver. The patient initially experienced right upper quadrant pain and nausea, and later went on to develop a fever, cough and dyspnoea in the setting of hydropneumothorax. CT scan of the chest and abdomen revealed a large fluid collection at the left lung base and a large lobular complex fluid mass within the right lobe of the liver. Echinococcus titres were positive. The patient was commenced on albendazole; however, experienced significant derangement of liver enzymes within the following month. In light of this, the albendazole was ceased, and a hemi-hepatectomy was performed. During the hemi-hepatectomy there was some cyst content spillage, and subsequently a washout with hypertonic saline 3% was performed. This was followed by a course of praziquantel 1200 mg two times per day for 14 days. Repeat CT 6 months later demonstrated no evidence of recurrence.

Factors impacting the solo remote placement experiences of undergraduate James Cook University medical students: A mixed-methods pilot study.

OBJECTIVE: To determine the factors impacting the experiences of James Cook University medical students on solo placements in remote towns. DESIGN: This 2018 pilot study used an exploratory sequential mixed-methods approach to explore the recent solo remote placement experiences of James Cook University medical students. Qualitative interviews were performed initially to elicit context sensitive themes for the self administered survey. The survey went on to use Likert-scale questions in addition to pre-validated survey instruments. SETTING: Focus groups and interviews took place at James Cook University Medical School in Townsville in late 2018 after students returned from their rural rotation. Two telephone interviews were conducted for Year 6 students unable to attend the focus groups. PARTICIPANTS: James Cook University medical students in years 2, 4 and 6 students who experienced a solo placement in a remote (MMM 6 or 7) town during 2017 or 2018 were invited to be part of the study. Only Townsville-based students were involved. A total of 14 students participated in the focus groups (n = 14) and a further 31 students completed the survey (n = 31). MAIN OUTCOME MEASURE(S): Interviews identified themes negatively or positively impacting solo remote placement experience, while bivariate analysis identified factors associated with having an 'excellent' overall experience. RESULTS: Student interviews identified five main themes impacting student experience in remote communities: culture of the medical facility; quality and quantity of clinical experiences; quality of accommodation; placement length; and community infrastructure and services. Negative impacts could result in students experiencing social isolation. Students reporting an 'excellent' solo remote placement experience in the survey were more likely to have: felt very welcome in the community; felt the health staff supported them; heavily involved themselves in clinical activities; enjoyed the experiences remote communities can offer; positive rural career intentions; reported they 'bounce back during and after life's most stressful events'; and come from a rural or remote hometown. CONCLUSIONS: Solo remote placements provide medical students with opportunities to further knowledge, clinical capabilities, social experiences and careers, but can have negative aspects. However, negative aspects are often modifiable management issues or can potentially be avoided if prospective students are better informed of the challenges associated with remote communities.