Dokter Blog: from the desk of Rahajeng Tunjungputri

Medicine et cetera by @ajengmd

RNT Discussion 2012: Identification of Protozoa

This lecture is a part of the Parasitology 1 course of the Faculty of Medicine Diponegoro University.

Images belong to their respective owners, and used for educational purposes only.
The slides can be viewed by clicking here 

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RNT lecture 2012 Worms of the large intestine

This lecture is a part of the Parasitology 1 course of the Faculty of Medicine Diponegoro University.
Images belong to their respective owners, and used for educational purposes only.
The slides can be viewed and downloaded by clicking here 

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Neglected people, unseen diseases

This article was published in The Jakarta Post 15 May 2011


– Rahajeng Tunjungputri, Contributor, Nijmegen

Most of us cannot imagine that there are hidden diseases that affect billions of the world’s population that have been neglected for so many years. Nevertheless, as hard as this may be to believe, this is indeed the case with neglected tropical diseases (NTDs)…

click here to read full article on The Jakarta Post

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Identification PPT for Parasitology Students

For students,

The following is now available on slideshare:

And a very informative video on Schistosomiasis, this is the last of 3 videos:

Wish you all the best for your exams!


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Trematodes presentation

The short version of the powerpoint presentation of trematodes we use for response discussion was just uploaded. This only consists selected (and most important) slides.

You can click the pic below (or click here) to see the presentation on slideshare.

There is an interesting case report on trematode infection on NEJM:

Do Hyun Park, M.D., Ph.D.
Hyun-Young Son, M.D.
University of Ulsan College of Medicine
138-736, Seoul, South Korea

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results of liver-function tests were abnormal, showing elevated levels of aspartate aminotransferase (350 IU per liter), alanine aminotransferase (352 IU per liter), alkaline phosphatase (204 IU per liter), {gamma}-glutamyltransferase (434 IU per liter), total bilirubin (6.4 mg per deciliter [109 µmol per liter]), and conjugated bilirubin (3.9 mg per deciliter [67 µmol per liter]). The white-cell count was also elevated (13,000 per cubic millimeter), and there was eosinophilia (27%). A computed tomographic scan of the abdomen showed dilatation of the common bile duct without definite filling defects. Given our concern that the patient might have acute cholangitis, a duodenoscopy was performed, and a prominent major papilla was discovered. After cannulation of the common bile duct, numerous leaf-shaped worms popped out (see video) and were subsequently identified as Clonorchis sinensis (also called Opisthorchis sinensis). The patient was given praziquantel and had a quick and uneventful recovery. The clinical manifestations of clonorchiasis tend to reflect the worm burden and the duration of infection. Clonorchis may persist in the biliary tree for decades, and prolonged infestation is associated with the development of cholangiocarcinoma. Acute cholangitis and pancreatitis are rare but important complications of C. sinensis infestation.

Good luck for your exams!
Images used in the presentations are not mine, no copyright infringement intended.

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Parasitology Identification 1


Dear Students,

Due to request of the parasitology tutorial I had with my student groups today, I decided to share this with you. Not the file itself obviously, but as usual, it is now available for your viewing pleasure and your studying on Slideshare.

Today we spent about 1 hour in class for “practice-exam” and discussion about these parasites.

Please study, and good luck for your exams. I wish you nothing but the best!

For the powerpoint slides click here



Some extra pics from today’s session:

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What do you expect from your teachers?


I’ve always loved writing. It hasn’t always brought me positive result. Sometimes I envy people in other countries where they have a little bit more freedom of speech in medicine. And that you don’t have to be old first to share your experience and opinions.

I found a blog of a medical student: with a post titled as “The Deal” by Lucia Li.

She basically states what the medical students expect from the doctors, and what they are willing to give back to the doctors who teach them. Some points there, from a student perspective they ask the followings from the doctors who teach them:

“Don’t ignore us — no-one likes to be ignored. We’re here to learn, we want to learn. show some interest in our education and we’ll likely love you forever.

Remember who we’re going to be — doctors. That means, however many years down the line, we’re going to be your house-officers, your registrars. It’s in your interest to teach us and contribute to our elevation from ignorance/ incompetency.

Remember who we currently are — students. We want to learn. About lots of different things.

Challenge us — ask us questions to get us thinking. It helps us to identify the important things to learn. It also may spark a lasting interest in that specialty…

But, hey, this is a two-way bargain. What can we, the students, offer in return?

And then they offer the teachers what they can do in return

What should we, the students, do?

Mind our manners — We will appreciate the fact that you have given time out of your busy schedule for us.

We’ll make use of your efforts — If I’m going to be taught by someone who I know will ask me questions and challenge me, I will certainly try to do some reading beforehand so I understand more of what you’re teaching. In short, it is only right that we reciprocate the interest you have taken in our education with an interest in improving our own.

Give feedback — if you have taught me well, I will make try to show my appreciation by thanking you when I leave clinic or telling the course organisers. But, the best feedback we can give you…

Be excellent doctors — being taught well by a good doctor has two benefits. The first being the imparting of medical wisdom. The second being the setting of a role model; a good doctor, explaining things as they go along, engaging with me as well as their work, always inspires me to do that same. Learn more, try harder.”

And here, I’d like to make my own personal points. I am still a student, and as a doctor I know I will continue being a student for a very long time (for my residency, for my research). On the other hand, I also teach, which I only started very recently, which gives me great pleasure and a fresh perspective on students and teaching.

From what I experience, I know that still being a student can help me learn how to be a good teacher. I observe my own teachers, learn what is for me an exciting and great learning experience. I love it when my teachers stimulate me to think and answer questions in the class instead of just bombarding me with information because it helped me form my pattern of thinking in a logical way. I love it when they can capture my interest and award me with extra information. I love it when I realize that after a class I gain new knowledge and insight. I love it when the teachers engage personally with us and interested in what we have learned so far. I love it when the teachers give feedback about our assignments and our efforts in working on those assignments. I love it when the ultimate goal is to help us understand the subjects. I love it when they have time to teach us even though they are very busy, and focused on us during the class. I love it when they are interested and enthusiastic about what they teach, because it makes us understand the importance of learning them. I love it when they appreciate me and my efforts. I love it when they inspire!

I only very recently started as assistant lecturer. And when I have discussion with my students, I know that I ask them to do “at least” the followings. I want them to be focused in class. I want them to be prepared before meeting me, because then we can engage more in the discussions. I want them to understand the fundamentals: why we think in certain ways, why certain things are very important, what is the “big picture”, what’s the underlying principle and philosophy of the things we learn, what I want them to learn specifically for the exams and also what they still have to remember for the rest of their lives as doctors. I want them to be able to learn how to think, and what to think about. I want them to start a class with focus and attention because there’s new information I’d like to share with them. I want them to do their assignments and do them well because I also prepare myself to give feedback on their assignments. I want them to read, because I also read and there are items in the reading material that I’d love to discuss with them. I want to share new things with them, because I don’t want them to be bored with the learning session. I want them to share their opinions, their questions and answers. I want them to be interested and to always want to do better.

So, what do you expect from your teachers?

— Rahajeng

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Videos of worm in intestine!!!

Dear all,

This images may be disturbing for general audience, although medical students and doctors in particular may find this intriguing. It’s important to remember why and how parasitic diseases cause so much burden, and hopefully these videos can help us to understand that.

I had a great time watching these videos with the parasitology students today.

Video 1:


Video 2:

12 year old girl presented with anemia and anorexia. Colonoscopy was performed.


Video 3:

Case report: A 46-year-old woman presented with a history of 3 days of pruritus in the anal area and 1 day of excretion of tapelike materials. During the year before presentation, she had reported intermittent colicky abdominal pain and loose stool, which had been attributed to irritable bowel syndrome. Laboratory evaluation was unremarkable, with no evidence of anemia. Colonoscopy revealed a long, moving tapeworm, Diphyllobothrium latum, located in the terminal ileum and extending to the sigmoid colon. D. latum is a fish tapeworm that can infect humans after they consume infected undercooked or raw fish. The patient had a history of eating raw fish and recalled eating raw trout most recently 2 months before presentation. She was treated with a single dose of praziquantel. After administration, the abdominal pain resolved, but she continued to have intermittent loose stool.

Jae Hak Kim, M.D.
Jin Ho Lee, M.D.
Dongguk University College of Medicine
Goyang, South Korea



Video 4:

A lady came in complaining of pain in her lower abdomen and she was suffering from severe bloating. Ultrasound was inconclusive, so exploratory surgery was performed.

The videos were available from and I did not make them. No copyright infringement intended.



Other source:

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Medicine is a growing field, and information presented here is reflective of the time of posting. Please refer to your physician for direct medical consultation. My views do not reflect those of my employers. --
Regards, Rahajeng

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