Morning glory

This summer is two hot. The flower of Morning glories are opening in early morning
and are fading at late morning, taken at a.m.9:00, as you can see the following photos.

Morning glory

Morning glories begin to blooming in the fence of my clinic.

Morning glory

Morning glory＝朝顔（日本語）＝牽牛（中文）.
The flower usually opens in the morning and closes in the afternoon.
It was first introduced to Japan by the Japanese mission to China in 
early 8th centuries as a drug (The seeds contain alkaloids and use as 
a laxative).

Fireworks in Ube city

Time: 2010 July 24. Saturday  pm 8:00~9:00
Taken Photos from near-side of the faculty of Engineering, Yamaguchi University

Korle Bu Teaching Hospital, University of Ghana Medical School (2)

Time: 1987.11.10
Place: Korle Bu Teaching Hospital, University of Ghana Medical School.

1) From the top of the ward

2) in the ward. From left; Dr. Nakano, Dr. Archampong and the attaché of 

    Japanese embassy.

3) The recovery room

4) the consultation room for children

Pediatric consultation

measuring of the body weight of infant

Korle Bu Teaching Hospital. University of Ghana Medical School(1)

Time: 1987.11.10
Place: Korle Bu Teaching Hospital. University of Ghana Medical School

The entrance of Korle Bu Teaching Hospital. 

University of Ghana Medical School

Korle Bu Teaching Hospital

Dr. Archampong(Dean of Medical school) and nurses

Accra, Ghana

View Larger Map
Stay period : November 8~11, 1987.
Place : Accra, Capital, Republic of Ghana

To enter Ghana, be required the certification of yellow fever vaccine.



WHO recommendation:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yellow Fever
Country requirement: a yellow fever vaccination certificate is required from all travellers 

over 9 months of age.

Malaria
Malaria risk due predominantly to P. falciparum exists throughout the year in the 

whole country. Resistance to chloroquine and sulfadoxine-pyrimethamine reported.
Recommended prevention: Mosquito bite prevention plus atovaquone-proguanil 

chemoprophylaxis doxycycline or mefloquine (select according to reported resistance pattern)

Rabies
Rabies risk: High risk. pre-exposure immunization recommended for travellers and other 

people for whom contact with domestic animals particularly dogs and other rabiesvectors is likely.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

before the arrival to Kotoka International Airport

in the street of Accra

Marriot hotel. noisy room conditioner.

Rainy season

From June to July is a rainy season（梅雨 ）in Japan, Korea and eastern china.

Rice seedling

The backyard of my Clinic is the small land for rice.
Today, rice seedlings are done by automatic rice transplanter machine.

Measles: An epidemic of Measles in Yamaguchi, 1991.

1) An epidemic of Measles in Yamaguchi Prefecture:
---In the past, an epidemic of Measles was noted in 1991(the peak was May) in
---Yamaguchi Prefecture (Population=1,560,000).

--------------------------- Reported numbers of Measles in Yamaguchi from 1991~1993.

---------Since then, no epidemics were occurred, except for small outbreaks, 

--------- in Yamaguchi prefecture.

2) The complication of Measles:

----Here, an example of the Measles's cases, who were hospitalized at Yamaguchi

--- University Hospital in 1991, with;

--------------- i) Pneumonia: 17 cases ( one case needed artificial ventilation)

-------------- ii) Encephalomyelitis: 5 cases

------------- iii) Croup: one case

------------- iv) Febrile convulsion: one case

Measles: 16 year old

~~~~~~~~~~~~~~~~~~
Measles: 16 year old boy
~~~~~~~~~~~~~~~~~~
He received Measles vaccine at 1 year old. So in this case, vaccine immunity
was disappeared.


1991.
January 14: started fever
----------15: high fever
----------16: high fever
----------17: Skin rash appeared from face, then upper trunk and extrimity.
----------18: Hospitalization. WBC 2,700(44%band. 22%seg, 20%lym.14% mon)，
--------------- CRP=3.3mg/dl
----------19: high fever, cough. Skin rashes appeared all over the body.
---------------------------------------But conjunctivitis was not severe.
---------------------------------------taken the photos;
-----------------------------1) Face:

-----------------------------------2) chest;

------------------------3) chest: enlarged

----------------------4) Koplik's spot: not so clear one.

----------------- January 20th:  skin rash of the arm.

        
------------------January 26:  skin pigmentation of arm. 10 yen coin for reference.

Measles:4 year old

Here show the case of Measles : 4 year old.

-----------Day 1:  fever start

ーーーーDay 2:  fever, cough and nasal discharge.

ーーーーDay 3:  Koplik spot appeared at night.

ーーーーDay 4:  Skin Rash appeared at Face.

ーーーーDay 5:  Rash from upper trunk and extremity to lower. 

------------------- WBC 7,000(Lym39%, Mon9%, Seg 45% ,Band7% ), CRP 0.43mg/dl.

ーーーーDay 6:  peak of Rashes.

ーーーーDay 8: no fever.  WBC 5,900(Atypical cells 36%, Lym 44%, Mon2%, Band5%, ーーーーーーーーーEos4%)

ーーーーDay 9: skin pigmentation.

Measles

I have seen no patients with Measles since 1999. In April, 1997, I opened
my clinic and only 3 infants with Measles until 1999.



What is Measles?

1) Etiology:  Measles virus

2) A typical case of measles begins with fever, cough, runny nose, red eyes, 

------- and sore throat.  2~3 days after, tiny white spots (Koplik’s spots) may

------- appear inside the mouth.

------- 3~5 days after, a red or reddish-brown rash appears. 

------- The rash usually begins on a person’s face at the hairline and 

------- spreads downward to the neck, trunk, arms, legs, and feet. 

------  When the rash appears, a person’s fever may spike to more than 

------- 104 degrees Fahrenheit.

------- After a few days, the fever subsides, the rash fades and 

------- skin pigmentation appear.

3) Clinical course of Measles:

麻疹＝Measles, 体温=Body Temperature, 発疹=skin rash，

コプリック斑=Koplik's spots,  結膜炎=conjunctivitis

はなかぜ=nasal congestion，せき=cough

4) Complications: 

------ i)  Pneumonia:  frequently in infant. usually, caused by bacteria

-------------------------such as H. influenzae or streptococcus pneumoniae.

------ ii) Otitis media: freuently in infant and toddler.

------ iii) Croup: acute laryngitis.

------ iv) Measles encephlo-myelitis: 6~15 year old are at risk.

---------- usually occur in recovery phase. Urinary and walking disturbance

---------- are the early sigh. Don't worry . Most cases recover without of 

-----------neurological sequerae

------ v)  Encephlitis:  1/1,000

------ vi) keratitis:  infant in the countries with vitamin A deficiency

------ vii) SSPE:  vary rare

Here, show the old photos of Measles:

1) high fever, cough, eye dischrges and skin rash:

2) Koplik's spot: look like candida infection.

3) skin pigmentation.

Hepatitis A vaccine

Hepatitis A virus is transmitted by the fecal-oral route (An object contaminated with
the stool of a person with hepatitis A is put into another person's mouth.)

I recommend the persons who travel or live in the countries of Central America,
South America, Mexico, Asia (except for Japan), Africa, and Eastern Europe.
→ more information
➞ http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-a.aspx

Hepatitis A vaccine:  
----------------1) inactivated Hepatitis A virus, which are cultured the cells , 
------------------ derived from the kidney cells of African green monkey. 
------------------ manufactured by Kaketsuken.1-6-1 Okubo, Kumamoto-shi, 
------------------ Kumamoto 860-8568, Japan.
----------------2) more than 16 year old.
----------------3) 3 times(0, 2~4 weeks and 6-month)0.5ml subcutaneously or 
                             intramuscularly.
                            　　　　　　　

Tetanus vaccine

~~~~~~~
Tetanus
~~~~~~~
Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles,
usually all over the body. It can lead to "locking" of the jaw so the victim cannot
open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases.
Several vaccines are used to prevent tetanus among children, adolescents, and adults
including DTaP, Tdap, DT, and Td(Centers for Disease Control and Prevention)

Etiology: The bacteria(Clostridium tetani) live in soil and grow in oxygen free
----------- environment. The bacteria enter the body from the injured skin, such as 

-----------car accidents and skin incision site.

American Society for Microbiology, Microbe Library.

Vaccine:  Tetanus toxoid,
------------- 0.5ml, subcutatenously or intramuscularly.

------------- 2 times(3~8 weeks interval)

In childhood, Tetanus vaccine are administered 4 times as DTaP and again at 

11 year old as DT vaccine.  However, after 10 years the antibody titer against

Tetanus is declined.  This is the reason why doctors administer Tetanus vaccine

in the case of deep skin injuries.

Tunis, Tunisia(2)

Time stayed : November 21~24, 1987
Place : Tunis(capital), Tunisia
Major languages: Arabic (official); French
Monetary unit: Tunisian dinar


1) from Hotel (November 23, 1987)

2) the center of Tunis:

3) Sidi Bou Said is a town, which is located only 20 km from Tunis.
---------- The walls of houses is white and the window is Tunisian blue