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2010.09.23 20:30 |  診療  |  その他（一般）  |  その他（医療関連）  |  ミチバ  | 推薦数 : 2

お化けのQ熱

・標題の「お化け」は、Ｑの前の枕詞。（全然関係ないけど、この前おわった『ＧＭ～踊れドクター』の中で、若い研修医が、「あたりまえだのクラッカー」といったり、モンキーダンス踊っていたり・・・感動した）

・さて、Ｑ熱は、Coxiella burnetiiというリケッチア感染症ですが、職業性疾患としてもとらえる必要がありますね。（私、経験ないですけど）

とりあえず、Ｑ熱の概要をどうぞ↓

http://idsc.nih.go.jp/idwr/kansen/k02_g1/k02_09/k02_09.html

・さて、

Environmental and Occupational Medicineという教科書を少し引用します。

 リスクの高い職業は、農夫、酪農家、羊をあつかう労働者(sheep worker), 食肉処理業者、獣医、肉取扱業者(meat handler)、また、実験で羊を扱う人。（職業のうまい訳が見つからなくてすみません）

また、動物に接触していなくても田舎で働いている人、住んでいる人は感染のリスクが高いかもしれないと書いています。

・また、Ｑ熱は、ペットやレジャーでも、感染しますね。

猫のこと↓

 日本医師会の動物由来感染症ハンドブックｗｅｂ版

http://www.med.or.jp/kansen/animal/cat/02.html

 

・ガーデニングもリスクが高いみたいですね。Infections of Leisureという教科書には、庭には鳥や動物がやってきているということを書いています。で、下のような記述もあり、「ああ、なるほどね」と思いました。

A stray neighborhood cat giving birth in or near your garden immediately sets the stage for the possibility of Q fever.

（Coxiella　burnetiiは胎盤に多いので）

 

・ところで、Ｑ熱が、慢性疲労症候群や「ひきこもり」に関係しているのではないかといった記載を診たのですが、どこまで明らかになっているのでしょう？

 

以下日記

・本日は当直明け。当直中似たような患者さんがお二人来られました。ともに高血圧で、他医にかかっており、自宅で血圧測ったら高くて心配になったと。頭重感がするような、といった訴えでした。家庭血圧が簡単に測れるようになったのはよいですが、よくよく病気の説明をしていないと、数字を見て、それが気になってよけい「病気」になるということもあるでしょう。似たようなことは、パルスオキシメーターで測る酸素飽和度にもありますね。９６％でも、９８％でも変わらないのに、患者さんは、できるだけ１００％に近い数字を望まれる。そういう傾向があるので、以前は、積極的に患者さんにパルスオキシメーターをお勧めしてませんでした。（高かったし）まあ、最近は、欲しいと言われた方には、数字にこだわり過ぎないようにと説明して買ってもらいますが。

・本日は、10時過ぎに病院出て帰宅。一服後、内科学会のセルフトレーニング問題にとりくみました。時間をとってやりだすと面白いですね。こういう問題集がいっぱいあったら良いのに。やっていて、一発で分かる問題と、しっかり調べないと分からないもの、そして、何か、不適切問題じゃないかなというものがあります。でも、おもしろいや。（ＮＥＪＭで画像のクイズがありますね。あんなノリで内科学会も作ってくれればよいのに）

・14時過ぎに、次女と「みやま」（金光店）というラーメン屋に遅い昼食におでかけ。帰宅して、一服後また、お勉強。夕方は、三女を塾に送って、また、お迎えです。迎えが21時30分ころなので、それまで寝れません。早く寝たいのに。（ちなみに、配偶者はお泊りです）

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