Going together: ethical considerations for trainees in global surgery.
PMID: 32449453 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - May 25, 2020 Category: Tropical Medicine Authors: Doe M, Bua E Tags: Trop Doct Source Type: research

Can outpatient total hip arthroplasty be safely performed in the Caribbean? A case report.
Abstract Over the past decade, outpatient total hip arthroplasty has been performed successfully with increasing frequency in the United States. The principles for success have been the focus of many recent publications. Despite this, there remains scepticism among surgeons as to the generalisability of outpatient arthroplasty. In the Caribbean basin, our challenges are different from those faced in the high-resource world, but increased patient demand, the shift towards value-based healthcare and the natural evolution of the procedure is likely to result in hip arthroplasty transitioning into the outpatient setti...
Source: Tropical Doctor - May 25, 2020 Category: Tropical Medicine Authors: Mencia MM Tags: Trop Doct Source Type: research

Septic arthritis of knee due to Burkholderia pseudomallei: a case report.
We report such a case with septic arthritis of the knee, diagnosed on the basis of a positive pus culture. After being treated by arthrotomy and surgical debridement followed by a combination of intravenous ceftazidime (acute phase = three weeks) and oral doxycycline and co-trimoxazole (eradication phase = five weeks) for two months, the patient recovered completely with no recurrence. PMID: 32437295 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - May 21, 2020 Category: Tropical Medicine Authors: Parija D, Kar BK, Das P, Mishra JK, Agrawal AC, Yadav SK Tags: Trop Doct Source Type: research

Peripheral symmetrical gangrene due to severe Plasmodium falciparum malaria: a case report.
We present a patient with severe Plasmodium falciparum malaria of seven days' duration who developed an altered sensorium of one day. During hospital admission, peripheral symmetrical gangrene of hands and feet followed, despite normal limb vasculature. PMID: 32437296 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - May 21, 2020 Category: Tropical Medicine Authors: Durdana S, Rizwan A Tags: Trop Doct Source Type: research

Clinical profile of symptomatic congenital cytomegalovirus infection: cases from a tertiary hospital in north India.
Abstract We retrospectively analysed the records of nine infants with polymerase chain reaction proven congenital cytomegalovirus (CMV) infection, of which 66% were born preterm. Microcephaly was a universal finding, followed by hepatosplenomegaly in 89%, while chorioretinitis was seen in only 44% cases. The mean age at diagnosis was 3.5 months. Neuroimaging was abnormal in 78%, with ventriculomegaly being the most common finding followed by T2/FLAIR white matter abnormalities, periventricular cysts and intracranial haemorrhage. PMID: 32437297 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - May 21, 2020 Category: Tropical Medicine Authors: Bhattacharya D, Panigrahi I, Chaudhry C Tags: Trop Doct Source Type: research

Utility of anthropometric indicators in predicting osteoporosis in ambulant community dwelling rural postmenopausal women from southern India.
Abstract Osteoporosis is characterised by low bone mineral density (BMD) and is a significant public health problem in India. This cross-sectional study was done to assess the relationship between various anthropometric measures and BMD in 308 rural dwelling South Indian postmenopausal women. Anthropometric variables such as weight, body mass index (BMI), waist circumference (WC), hip circumference (HC) and neck circumference (NC) were measured. BMD was assessed by dual-energy X-ray absorptiometry (DXA) scan at the lumbar spine (LS) and femoral neck (NOF). The mean age ± SD of study participan...
Source: Tropical Doctor - May 16, 2020 Category: Tropical Medicine Authors: Sridharan K, Cherian KE, Kurian ME, Asha HS, Paul TV, Kapoor N Tags: Trop Doct Source Type: research

Clinical profile and predictors of mortality among the referred neonates at a tertiary care centre in north India: a prospective observational study.
Abstract The National Family Health Survey (NFHS-4) shows encouraging improvement in infant and under-five mortality rates in India. However, the neonatal mortality rate (NMR) still remains high as India contributes to about one-fifth of global deaths. This prospective study was conducted from 15 January to 30 April 2016 to examine the clinical profile and predictors of mortality among referred neonates at our centre. Among 301 neonates, prematurity (40%) was the most common indication for referral followed by need for ventilation (38%) and birth asphyxia (28%). Approximately 73% neonates were referred within 24&t...
Source: Tropical Doctor - May 7, 2020 Category: Tropical Medicine Authors: Singh J, Dalal P, Gathwala G Tags: Trop Doct Source Type: research

Prevalence of intestinal parasites and associated factors among children from child centres in Bahir Dar city, northwest Ethiopia.
Abstract Data concerning the burden of parasites among populations living in overcrowded circumstances have paramount importance for the success of interventions aimed at eliminating such disease. A cross-sectional study was therefore conducted from February to May 2019 among 217 children at child centres in Bahir Dar city. Data were collected using a structured questionnaire and stool samples were processed for parasitological investigation. A total of 53 (24.4%) children were infected with at least a single species of intestinal parasite. Giardia lamblia (7.8%) was the most frequent, followed by Hymenolepis nana...
Source: Tropical Doctor - May 7, 2020 Category: Tropical Medicine Authors: Abebaw A, Alemu G, Ayehu A Tags: Trop Doct Source Type: research

Change in schistosomiasis-related liver disease with repeated praziquantel treatment in school children in rural Zambia.
Abstract Repeated praziquantel treatment for schistosomiasis is an effective method to reduce disease burden. Ultrasonographic methods were used to assess the severity of schistosoma mansoni-related liver disease and demonstrate improvement following treatment. We compared data from 733 children in 2010 and 972 children in 2018 to determine the effect of repeated praziquantel treatment on prevalence of liver disease. Three age groups were compared across three liver disease classifications (normal, mild, severe). From 2010 to 2018, there was a significant reduction in prevalence of severe liver disease in all age ...
Source: Tropical Doctor - May 1, 2020 Category: Tropical Medicine Authors: Strahan R, McAdam D, Paul E Tags: Trop Doct Source Type: research

Transvaginal laparoscopic appendectomy using innovative submucosal tunnels: a conducive modification for improving hybrid NOTES access and its critical appraisal.
Abstract Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required addition...
Source: Tropical Doctor - April 29, 2020 Category: Tropical Medicine Authors: Jategaonkar PA, Yadav SP, Gupta D Tags: Trop Doct Source Type: research

Mucor as a cause of surgical site infection.
We present such a case after intramedullary nailing of the femur and discuss its presentation and management. PMID: 32349607 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - April 29, 2020 Category: Tropical Medicine Authors: Negi R, Kaushik R, Singh S, Punia RS Tags: Trop Doct Source Type: research

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal.
Abstract The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had su...
Source: Tropical Doctor - April 28, 2020 Category: Tropical Medicine Authors: Jaiswal LS, Pandit N, Sah B, Prasad JN Tags: Trop Doct Source Type: research

Microbiological profile of chronic osteomyelitis with special reference to anaerobic osteomyelitis in a tertiary care hospital of coastal Karnataka.
Abstract Chronic osteomyelitis is a relapsing, persistent, low-grade inflammation of bone caused by various infectious agents. The present study, conducted over a two-year period, on specimens received from cases of chronic osteomyelitis was, to determine the frequency of isolation of aerobic and anaerobic bacteria and to analyse their antimicrobial susceptibility pattern. Specimens were processed for Gram stain, aerobic and anaerobic culture, and were identified according to standard techniques. Significant growth was observed in 102/204 specimens, in which aerobic growth was observed in 62 (60.8%) and anaerobic ...
Source: Tropical Doctor - April 28, 2020 Category: Tropical Medicine Authors: Shenoy PA, Vishwanath S, Bhat SN, Mukhopadhyay C, Chawla K Tags: Trop Doct Source Type: research

COVID-19 and orthopaedic surgeons: the Indian scenario.
This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in orthopaedic surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties. PMID: 32316857 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - April 21, 2020 Category: Tropical Medicine Authors: Jain VK, Vaishya R Tags: Trop Doct Source Type: research

Rhabdomyolysis due to hypothyroidism without any precipitating factor.
We report as such the first manifestation of hypothyroidism. PMID: 32316858 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - April 21, 2020 Category: Tropical Medicine Authors: Varalakshmi DB, Ram R, Siva Kumar V Tags: Trop Doct Source Type: research

Safety measures for conducting exercise oxygen consumption, VO2, tests in developing countries.
Abstract Measurements of rate of oxygen consumption (VO2) recorded during controlled exercise is used to assess cardiovascular health in test individuals. In low- or middle-income countries, where Mycobacterium tuberculosis is common and older VO2 systems are in use, three specific preventative measures should be in place to prevent the transmission of tuberculosis. These include: (1) disinfecting reusable plastic masks and rubber tubing with bleach solution; (2) limiting maximum exposure of test individuals to Cl2 gas to
Source: Tropical Doctor - April 21, 2020 Category: Tropical Medicine Authors: Rowe MF Tags: Trop Doct Source Type: research

Important points on black oesophagus.
PMID: 32299287 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - April 16, 2020 Category: Tropical Medicine Authors: Gurvits GE Tags: Trop Doct Source Type: research

Acquired auditory neuropathy spectrum disorder after malaria treated with quinine.
Abstract Auditory neuropathy spectrum disorder (ANSD) can cause significant hearing impairment; it occurs when there is intact outer hair cell function in the inner ear, with a dyssynchronous neural response, thought to be due to dysfunction of the inner hair cells (IHCs), the synapse of the IHCs and the auditory nerve, or of the auditory nerve itself. This case report describes the onset of ANSD in a Malawian child after severe malaria treated with quinine. Diagnosis of ANSD was made by confirming the presence of otoacoustic emissions, together with the absence of auditory brainstem response and absent acoustic r...
Source: Tropical Doctor - April 14, 2020 Category: Tropical Medicine Authors: Brough H Tags: Trop Doct Source Type: research

Haemocholecyst related to gallbladder malignancy.
Abstract A haemocholecyst is a clot-filled gallbladder caused by bleeding into its lumen. It is a rare entity with fewer than 50 cases reported in the English literature. Preoperative diagnosis is often not possible even with good quality cross-sectional imaging. Here, we present a case of a gallbladder mass, whose nature was only made clear at operation, where a hugely enlarged gallbladder was found filled with blood clots. There was neither liver infiltration nor regional lymphadenopathy. The clinical status of the patient demanded simple cholecystectomy. Histopathological examination, however, revealed a gallbl...
Source: Tropical Doctor - April 14, 2020 Category: Tropical Medicine Authors: Ray S, Ghosh R, Khamrui S, Kumar Das A, Saha S, Kumar D Tags: Trop Doct Source Type: research

Recurrent arthritis: an unusual diagnosis.
Abstract Musculoskeletal complaints may be the initial manifestation of childhood leukaemias. When these symptoms predominate at the onset, a diagnosis of one of several rheumatic diseases may be entertained. Where blood tests are normal, no bone marrow examination would normally be indicated. The use of immune-suppressing medication, such as steroids, may lead to diagnostic delay or misdiagnosis. PMID: 32281521 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - April 11, 2020 Category: Tropical Medicine Authors: Sesama M, Bhaskar V, Meena M, Narang M, Aggarwal A, Kotru M Tags: Trop Doct Source Type: research

Overdosage of Calcarea phosphorica causes severe hypocalcaemia in a toddler.
Abstract A four-year-old girl presented with accidental ingestion of 200 tablets of Calcarea phosphorica. Although she was asymptomatic, she was found to have marked hypocalcaemia with a prolonged QTc interval on electrocardiogram. She was successfully treated with intravenous calcium, followed by oral maintenance. PMID: 32237955 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - April 1, 2020 Category: Tropical Medicine Authors: Bhattacharya D Tags: Trop Doct Source Type: research

Aetiology of acute diarrhoea and antimicrobial usage among children aged under five years at health centres in Bahir Dar, Ethiopia.
Abstract The aetiology of diarrhoea with Cryptosporidium species and pathogenic bacteria has not been identified in the Ethiopian primary healthcare system. Thus, antibiotic consumption for unconfirmed pathogenic diarrhoea is not infrequent. A total of 344 children aged
Source: Tropical Doctor - March 29, 2020 Category: Tropical Medicine Authors: Abera B, Hailu T, Beza L, Mulu W, Yizengaw E, Kibret M Tags: Trop Doct Source Type: research

Clinical outcome of severe sepsis and septic shock in critically ill children.
Abstract Information concerning the clinical outcome of severe sepsis and septic shock among the burden of tropical infections in children is limited, particularly in low-income settings.  We conducted a prospective consecutive cohort study in all children aged 1 month to 16 years needing paediatric intensive care between 1 January 2017 and 31 December 2018.  Demographic details, presenting symptoms and duration, associated co-morbidity and organ dysfunction were recorded. Clinical and laboratory parameters discriminating between survivors and non-survivors were evaluated.  Most presented with respi...
Source: Tropical Doctor - March 26, 2020 Category: Tropical Medicine Authors: Shah S, Kaul A, Jadhav Y, Shiwarkar G Tags: Trop Doct Source Type: research

Ascites: an unusual presentation of eosinophilic gastroenteritis in a child.
Abstract Eosinophilic ascites, owing to serosal involvement, is a very rare manifestation of eosinophilic gastroenteritis in children, especially when it occurs with muscular involvement in the absence of mucosal disease, which may be confirmed by endoscopic ultrasonography. An 11-year-old girl, presenting with massive eosinophilic ascites and colicky abdominal pain with peripheral eosinophilia, raised IgE levels and positive skin prick test, had such investigation which confirmed the presence of muscle layer thickening of both stomach and small bowel. She responded well to steroids and montelukast. PMID: 321...
Source: Tropical Doctor - March 16, 2020 Category: Tropical Medicine Authors: Menon Vengalil J, Venkatesh V, Bhatia A, Rana SS, Lal SB Tags: Trop Doct Source Type: research

Environment and psychosocial factors are more important than clinical factors in determining quality of life of HIV-positive patients on antiretroviral therapy.
Abstract Assessing quality of life (QOL) outcome helps to show the effect of antiretroviral therapy (ART) on the subjective perception of its benefits among patients with HIV. A cross-sectional assessment of QOL, using the World Health Organization WHOQOL-HIV, on 204 HIV patients taking ART in western India showed patients with HIV on ART as having the best QOL score in the spiritual domain and the worst in the environment domain. Patients who are single, highly educated, of higher occupational status, with no HIV-positive children, not undergoing frequent hospital admissions, with access to a counsellor for suppo...
Source: Tropical Doctor - March 5, 2020 Category: Tropical Medicine Authors: Desai KT, Patel PB, Verma A, Bansal RK Tags: Trop Doct Source Type: research

Pituitary macroadenoma secondary to Hashimoto's thyroiditis: inadvertent diagnosis in a pre-pubertal girl.
We report a prepubertal girl with Hashimoto's thyroiditis who was inadvertently diagnosed to have a pituitary macroadenoma based on neuroimaging. PMID: 32106779 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - February 27, 2020 Category: Tropical Medicine Authors: Bhattacharya D, Kumar R, Yadav J Tags: Trop Doct Source Type: research

Pyrexia of unknown origin in HIV-negative adults from Himachal Pradesh (India): will you suspect disseminated histoplasmosis?
Abstract Histoplasmosis is usually clinically suspected only in people who reside in, are migrants from or are travelling to endemic areas such as North America. Immunocompetent patients with a low level of exposure typically have either subclinical or mild and self-limiting infection. The most common risk for the development of progressive disseminated form is HIV infection. We recently managed two patients with disseminated histoplasmosis, presenting with prolonged fever, significant weight loss, pallor and hepatosplenomegaly. Both were HIV-negative and lived in Himachal Pradesh (India), a region that was consid...
Source: Tropical Doctor - February 25, 2020 Category: Tropical Medicine Authors: Arora N, Shukla S, Vijaykumar D, Suri V, Kumar R, Pannu AK Tags: Trop Doct Source Type: research

Microbiological profile of pathogens in spontaneous bacterial peritonitis secondary to liver cirrhosis: a retrospective study.
Abstract Spontaneous bacterial peritonitis (SBP) is an acute bacterial infection of ascitic fluid without an obvious source. The prevalence of SBP in patients with cirrhosis is in the range of 10%-30%. With increasing use of antibiotics, there is a gradual shift in the causative flora of SBP from Gram-negative bacteria to Gram-positive and, more importantly, to drug-resistant bacteria. The aim of this retrospective study on 721 cases was to identify the prevalence of various organisms causing SBP along with their drug sensitivity and resistance patterns. A prevalence of 38.2% culture positivity was observed in our...
Source: Tropical Doctor - February 18, 2020 Category: Tropical Medicine Authors: Mittal H, Wyawahare M, Sistla S Tags: Trop Doct Source Type: research

Indication-specific pricing of drugs: a utopian idea, a pragmatic proposition or unrealistic in economically constrained settings?
Abstract The concept of indication-specific pricing (ISP) of drugs means that the cost of a drug will vary depending on the reasons for its use. ISP is a novel concept and its beneficial or detrimental effects are unknown. Experience from richer countries suggests that it is fraught with many administrative, ethical and regulatory challenges. It seems, though, that prices of some drugs have been set using this model. The barriers, real and potential, to the implementation of ISP in low- and middle-income countries are discussed. Implementation of ISP is impractical in such environments because of the large impover...
Source: Tropical Doctor - February 9, 2020 Category: Tropical Medicine Authors: Meher BR, Padhy BM Tags: Trop Doct Source Type: research

Neurological complications during treatment of liver abscess: think of metronidazole toxicity.
We describe a young man who was receiving metronidazole for an amoebic liver abscess and developed encephalopathy and seizures. Brain magnetic resonance imaging showed characteristic bilateral symmetrical cerebellar dentate hyperintensities. PMID: 32019474 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - February 4, 2020 Category: Tropical Medicine Authors: Arora N, Wasti KP, Babbar N, Saroch A, Pannu AK, Sharma N Tags: Trop Doct Source Type: research

Low-cost management of mushroom poisoning in a limited-resource area: a 12-year retrospective study.
Abstract Amatoxin poisoning is the main cause of death from accidental ingestion of poisonous mushrooms and a mortality rate of 27.3% has been reported in Thailand. Symptoms of mushroom ingestion are often confused with food poisoning; thus, gastroenteritis is not recognised as the first phase of poisoning. Our study assessed the efficacy of N-acetylcysteine (NAC) as a treatment for amatoxin poisoning. We retrospectively analysed 74 medical records over 12 years. The majority (70/74) were treated successfully with NAC; death in the remaining 4 (5.4%) patients was attributed to late presentation in three and advanc...
Source: Tropical Doctor - January 21, 2020 Category: Tropical Medicine Authors: Jongthun R, Hemachudha P, Wacharapluesadee S, Hemachudha T Tags: Trop Doct Source Type: research

Treatment outcomes of adults with new onset pulmonary tuberculosis in Pretoria, South Africa.
Abstract A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization's six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment s...
Source: Tropical Doctor - January 19, 2020 Category: Tropical Medicine Authors: Nkoane MA, Adefolalu AO, Ogunbanjo GA Tags: Trop Doct Source Type: research

Characteristics and outcomes of HIV-exposed infants in Homa Bay County, Kenya, 2015.
We present the findings of a retrospective review of HIV-exposed infants (HEI) who sought early infant diagnosis services in the county throughout 2015. HEI who were breastfed>6 months, had replacement feeding and did not receive prophylaxis were 2-6 times more likely to be HIV-positive. PMID: 31948336 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - January 16, 2020 Category: Tropical Medicine Authors: Gitonga LK, Boru WG, Muthoni L, Odhiambo J, Ransom J Tags: Trop Doct Source Type: research

Three cases of an unusual cause of haematemesis: black oesophagus.
We report a case series of three patients of acute oesophageal necrosis who presented to us with symptoms of acute upper gastrointestinal bleeding and improved with conservative management. PMID: 31937203 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - January 14, 2020 Category: Tropical Medicine Authors: Shah J, Savlania A, Bush N, Mandavdhare HS, Singh H, Sharma V Tags: Trop Doct Source Type: research

Acute encephalopathy followed by delayed myelopathy: A rare presentation of organophosphate poisoning.
We report a rare delayed manifestation of organophosphorus poisoning in the form of pure motor spastic paraparesis due to dorsal myelopathy. A possibility of delayed manifestations of toxicity should be considered in individuals presenting with features suggestive of myelopathy and a previous history of organophosphate exposure. PMID: 31928153 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - January 12, 2020 Category: Tropical Medicine Authors: Agarwal A, Garg D, Goyal V, Vy V, Singh MB, Srivastava MP Tags: Trop Doct Source Type: research

New simple low-cost surgical approach to complex jejuno-ileal atresia.
We report our experience of staged operations in the surgical treatment of complex jejuno-ileal atresia. Our study examined transgastric deflation of the proximal segment and feeding jejunostomy through the distal segment as a first stage followed by a definitive restoration of continuity secondarily at a tertiary centre over a period of three years. A cohort of 21 cases were studied. None suffered with intestinal perforation or volvulus. Tube plugging was seen in three patients who were relieved by flushing. Tube replacement was not required. One patient developed necrotising enterocolitis and died. Sepsis was seen in thr...
Source: Tropical Doctor - January 8, 2020 Category: Tropical Medicine Authors: Pan P Tags: Trop Doct Source Type: research

Expectant management of retained abnormally adherent placenta complicated by uterine prolapse after vaginal delivery.
We present a case of an expectantly managed PAS following a spontaneous preterm vaginal birth. The patient developed puerperal uterine prolapse with the placenta in situ, a previously unreported complication, but this was successfully reduced manually. PMID: 31914867 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - January 8, 2020 Category: Tropical Medicine Authors: Ngene NC, Siveregi A Tags: Trop Doct Source Type: research

The role of pyridostigmine in recovery from motor paralysis in a snakebite patient with an allergic reaction to anti-snake venom.
Abstract A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all fou...
Source: Tropical Doctor - January 6, 2020 Category: Tropical Medicine Authors: Ahuja V, Chander A, Sawal N Tags: Trop Doct Source Type: research

Acute exogenous lipoid pneumonia presenting as spontaneous air leak following accidental baby oil aspiration.
Abstract Exogenous lipoid pneumonia (ELP) is an uncommon cause of respiratory distress. The practice of oil massage and oil instillation into the nostrils is common in the Indian subcontinent. Accidental aspiration of baby oil may lead to significant chemical pneumonitis. This presentation may vary from subtle to severe respiratory distress requiring intensive care management. Spontaneous air leaks are rare in acute ELP. We successfully managed a six-month-old girl presenting with mineral oil-induced ELP and air leaks. However, these children require long-term follow-up, as a small proportion may evolve into chron...
Source: Tropical Doctor - December 26, 2019 Category: Tropical Medicine Authors: Williams V, Ezhumalai G, Thakur A, Bansal A, Jayashree M Tags: Trop Doct Source Type: research

Incarcerated complete rectal prolapse managed by Altemeier's procedure.
We present the case of a 54-year-old male patient who presented with incarceration and was managed successfully with Altemeier's procedure. PMID: 31852358 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - December 18, 2019 Category: Tropical Medicine Authors: Pandit N, Yadav TN, Awale L Tags: Trop Doct Source Type: research

Home grown: the development and structure of urological training in the Caribbean.
This article reviews the history, development and structure of urology training in the English-speaking Caribbean. PMID: 31842708 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - December 16, 2019 Category: Tropical Medicine Authors: Persaud S, Douglas L, Aiken W, Morrison B, Goetz L Tags: Trop Doct Source Type: research

Incidence and predictors of direct-acting antiviral treatment failure in Turkish patients with chronic hepatitis C genotype 1b infection.
Abstract Evaluation of the incidence and predictors of failure of direct-acting antiviral treatment for hepatitis C virus genotype 1b patients is important. Our retrospective cohort study assessed 172 Turkish patients who had received a full course of such treatment and could be checked for sustained virologic response. The overall treatment failure rate was 2.9% (5/172), all of whom relapsed. In three of these cases with sequencing data available, all had NS5A resistance-associated substitution. Multivariate analysis revealed that a 1 mg/dL increase in pre-treatment total bilirubin level was associated wit...
Source: Tropical Doctor - December 6, 2019 Category: Tropical Medicine Authors: Cabalak M, Bal T, Onlen Y, Demir M Tags: Trop Doct Source Type: research

Cystic echinococcosis: a 10-year experience from a middle-income country.
This study aims to elucidate the presentation, treatment and outcomes of the disease in Pakistan. A review of charts of 225 patients (median age = 42.3 years) with CE admitted at Aga Khan Hospital, Karachi during 2007-2017, was carried out. Abdominal pain was present in 34.7% followed by fever in 26.2%. There were 142 (63.1%) cases of hepatic cysts and 55 (24.4%) of pulmonary hydatid cysts. Combined surgical and medical therapy was given to 130 (57.8%) patients. Surgery only was performed in 23 (10.2%) patients, medical therapy only was given to 35 (15.6%) patients, and puncture, aspiration, injection and rea...
Source: Tropical Doctor - December 5, 2019 Category: Tropical Medicine Authors: Butt A, Khan JA Tags: Trop Doct Source Type: research

Hospital based serological evidence of rickettsial diseases and assessment diagnostic tests of pyrexia of unknown origin.
Abstract The present study examined hospital-based serological tests of rickettsial infections and assessment for diagnosis of pyrexia of unknown origin (PUO). Blood samples were tested for Weil Felix antigens, ELISA for scrub typhus group and polymerase chain reaction (PCR) to detect the presence of DNA of spotted and scrub typhus group with the help of specific oligonucleotide. We tested 450 patient samples and found 101 Weil Felix-positive with 15 having ≥320 titres. IgM ELISA identified 32 (7.1%) positive cases. Positive PCR was seen in 13 (2.9%) samples, being only 40.1% of those testing positive for ELISA...
Source: Tropical Doctor - December 5, 2019 Category: Tropical Medicine Authors: Muzaheed, J Fatani A, D Divakar D, Rathod S, S Aloahd M Tags: Trop Doct Source Type: research

Crimean-Congo haemorrhagic fever in a middle Anatolian city: five years of experience.
Abstract We evaluated the epidemiological features and main risk factors of Crimean-Congo haemorrhagic fever (CCHF) in Corum, where the disease is endemic, by retrospectively analysing the medical records of all patients diagnosed with CCHF over five years. Diagnosis was made by the detection of virus RNA via reverse transcription polymerase chain reaction or by demonstrating IgM antibody of CCHF virus with an ELISA blood test. Of 399 patients, 22 (5.5%) patients died but we could show that the rates of incidence and mortality have decreased over the years. Early referral to health facilities, increased awareness ...
Source: Tropical Doctor - December 1, 2019 Category: Tropical Medicine Authors: Tumturk A Tags: Trop Doct Source Type: research

Splenic infarct with scrub typhus: a rare presentation.
Abstract Scrub typhus has a variety of clinical presentations ranging from asymptomatic to fever with chills, myalgias, hepatitis, gastric ulcerations and pancreatitis, all being attributed to disseminated vasculitis, with splenic infarction being a rare presentation. A 26-year man, a resident of north India, presented with an acute febrile illness and abdominal pain, computed tomography scan of the abdomen was suggestive of a splenic infarct. After ruling out other aetiology, a positive IgM (ELISA) for scrub typhus led to treatment with oral doxycycline, following which the patient was discharged symptom-free. Ra...
Source: Tropical Doctor - December 1, 2019 Category: Tropical Medicine Authors: Goyal MK, Porwal YC, Gogna A, Gulati S Tags: Trop Doct Source Type: research

Scrub typhus and leptospirosis in rural and urban settings of central India: a preliminary evaluation.
Abstract Scrub typhus and leptospirosis are bacterial zoonotic diseases reported from different parts of India, whose prevalence in Chhattisgarh is unknown. Our study was carried out to delineate the prevalence of these illnesses there and to assess the clinical profiles of rural and urban patients. A total of 169 patients with acute febrile illnesses (AFI) was enrolled in our study from May to December 2018, of whom 35 (20.7%) tested positive for scrub typhus and only one tested positive for leptospirosis by respective IgM ELISA. Scrub typhus seropositivity was higher in rural patients (25.0%) than in urban (18.1...
Source: Tropical Doctor - November 28, 2019 Category: Tropical Medicine Authors: Vikram K, Agarwala P, Bhargava A, Jain Y, Jagzape T, Wasnik P Tags: Trop Doct Source Type: research

A novel use of pneumococcal urinary antigen detection kits to identify Streptococcus pneumoniae cultures misidentified by the VITEK-2 system.
Abstract Streptococcus pneumoniae infections continue to be an important cause of morbidity and mortality in low-and middle-income countries. Differentiating S. pneumoniae from viridans group streptococci is essential to ensure appropriate antibiotic therapy. Conventional microbial identification tests can often misidentify the two groups. We used a common pneumococcal urinary antigen test to identify S. pneumoniae that were misidentified by the VITEK 2. The performance of the test was similar to the pneumococcal latex agglutination test. PMID: 31771427 [PubMed - as supplied by publisher] (Source: Tropical Doctor)
Source: Tropical Doctor - November 26, 2019 Category: Tropical Medicine Authors: Khan S, Hydrose SP, Chandran S, Dinesh K, Kumar A Tags: Trop Doct Source Type: research

Hotspots of H1N1 influenza in India: analysis of reported cases and deaths (2010-2017).
Abstract Influenza A (H1N1) caused significant mortality and morbidity globally. We identified the hotspots for H1N1 influenza in India using cases and deaths reported in the Integrated Disease Surveillance Program between 2010 and 2017. A total of 114,667 cases and 8543 deaths were reported from across India, at an overall case fatality rate of 7.5%. While Maharashtra accounted for 21% of cases and 31% of deaths, Delhi and Gujarat were ranked the highest based on the population-adjusted ranks for morbidity and mortality, respectively. The current analysis identified states and union territories in western India (...
Source: Tropical Doctor - November 26, 2019 Category: Tropical Medicine Authors: Chatterjee P, Seth B, Biswas T Tags: Trop Doct Source Type: research

A model for surgical volunteerism: a qualitative study based in Cambodia.
Abstract Medical volunteerism continues to attract many doctors from high-income nations to low- or middle-income countries (LMIC). In spite of the wealth of positive experiences of these volunteers documented in the literature, there is little evidence concerning the impact and effectiveness of their activity. We documented our model of five-year experience in the delivery of hand surgery in Cambodia, attempting a qualitative approach with attempts to understand the perceptions of local and volunteer surgeons. We conducted independent qualitative interviews with five visiting and 12 Cambodian surgeons who partici...
Source: Tropical Doctor - November 20, 2019 Category: Tropical Medicine Authors: Cheok S, Dong C, Lam WL, Gollogly J, Rajaratnam V Tags: Trop Doct Source Type: research