This paper presents investigation of lungworm disease outbreaks that is based on retrospective examination of cases recorded between 1994 and 2000 on a government beef cattle breeding centre in the state of Pahang, peninsular Malaysia. The breed of cattle on the centre was Nelore and the mean population over a 7-year period (from 1994 to 2000) was 1612. All animals were allowed to graze on pasture and mixed grazing was practiced on the farm. The routine de-worming programme was performed using levamisole and ivermectin from 1994 to 1998 and abamectin in 1999 and 2000 on 1 to 3-month-old calves and an annual dose given to the adult cattle. Nelore was introduced into the farm in 1991, three years before the first outbreak from Brazil where Dictyocaulus viviparus infection had been reported. No lungworm infection had been observed in the farm prior to the animal introduction. Within the 7-year period, 36 fatalities occurred and the annual mortality rate due to lungworm infection was 0.31%. The highest rate was recorded in 1997. Among the total 36 deaths, about 75% of deaths occurred in calves aged between 6 months and 12 months, 67% were males and 33% were female cattle. The highest number of deaths (19%) occurred in the month of November. In conclusion, D. viviparus infection may have been introduced into a tropical climate along with consignments of cattle from lungworm endemic areas resulting in fatal disease outbreaks for a few years following the animal's initial introduction.
Coughing is an important reflex mechanism which enhances the clearance of secretions and particulates from the airways, however repetitive muscle strain due to prolonged coughing may cause the uncommon complication of stress fracture of the ribs. The following is an unusual case of cough induced multiple rib fractures associated with subcutaneous emphysema and pneumothorax which was missed in the emergency setting. Delayed diagnosis and treatment would have been avoided if this uncommon condition was considered as a possibility.
This article sets out to highlight the challenges and opportunities for medical education in primary care realised during the COVID-19 pandemic and now being enacted globally. The themes were originally presented during a webinar involving educationalists from around the world and are subsequently discussed by members of the WONCA working party for education. The article recognises the importance of utilising diversity, addressing inequity and responding to the priority health needs of the community through socially accountable practice. The well-being of educators and learners is identified as priority in response to the ongoing global pandemic. Finally, we imagine a new era for medical education drawing on global connection and shared resources to create a strong community of practice.