Trop Doct [journal]
- Ovarian dysgerminoma presenting as a pregnancy: case report. [JOURNAL ARTICLE]
- Trop Doct 2016 Jul 22.
A 32 year-old P4 G4 was referred from a rural hospital for fibroids in pregnancy. The pregnancy test was positive. An ultrasound scan reported a huge left extrauterine mass. The uterus was of normal size. There was no pregnancy demonstrated. A laparotomy was done through a midline incision. There was a huge left ovarian tumour occupying the pelvic/abdominal region right up to the xiphisternum. A left salpingo-oophrectomy was done. The post operative period was uneventful. The histopathological report confirmed the diagnosis of ovarian dysgerminoma FIGO stage 1A. She was referred to oncologists for adjvunt chemotherapy.
- Acute pancreatitis associated with scrub typhus. [JOURNAL ARTICLE]
- Trop Doct 2016 Jul 13.
Scrub typhus, or tsutsugamushi fever, is a zoonosis of rural Asia and the western Pacific islands. The causative organism, Orientia (formerly Rickettsia) tsutsugamushi, is transmitted to humans by the bite of a larval Leptotrombidium mite (chigger). Scrub typhus may have gastrointestinal presentations, such as acute acalculous cholecystitis, duodenal ulcer perforation, peritonitis and gastric ulceration. Acute pancreatitis with scrub typhus has been reported rarely. We report a patient of scrub typhus complicated by acute pancreatitis and acute kidney injury.
- Multiple eschars in scrub typhus: a case report. [JOURNAL ARTICLE]
- Trop Doct 2016 Jul 13.
Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from all the four eschars and from EDTA blood were positive for 56-kDa type-specific antigen which is specific for Orientia tsutsugamushi The patient recovered completely after 7 days of antibiotic treatment. He was from an area where scrub typhus was not observed previously. An eschar in an acute febrile patient from the "tsutsugamushi triangle" is a valuable sign in scrub typhus diagnosis. A search for multiple eschars in scrub typhus must be made by clinicians.
- Prevalence and clinical aspects of tungiasis in south-west Nigerian schoolchildren. [JOURNAL ARTICLE]
- Trop Doct 2016 Jul 8.
Tungiasis is highly prevalent in resource-poor communities in sub-Saharan Africa, but studies among schoolchildren are scanty. We assessed prevalence, parasite load and clinical aspects of tungiasis in schoolchildren in south-western Nigeria. A total of 545 schoolchildren was examined. Of these, 133 (24.4%; 95% CI, 20.9-28.2%) were infested with Tunga penetrans Boys showed a higher prevalence than girls (31% versus 18%, P < 0.0001); in those infested, the median number of lesions was two, with no gender difference (2 boys, interquartile range, 1-4; 2 girls; interquartile range, 1-4; P = 0.34). The maximum number of 44 lesions was found in a 14-year-old boy. Desquamation was present in 90.2%, followed by erythema (54.9%) and oedema (43.6%); 54.9% showed any chronic pathology and more one-third nail deformations. Our study indicates that tungiasis is an important health problem in rural Nigerian schoolchildren. Sustainable interventions are required to control the disease in this and similar communities.
- Zika virus infection and once again the risk from other neglected diseases. [Journal Article]
- Trop Doct 2016 Jul; 46(3):159-65.
Since the first cases of Zika were identified and reported in Brazil, the magnitude and consequences of the outbreak in the Americas have increased tremendously, leading the World Health Organization to consider Zika and its link with clusters of microcephaly a Public Health Emergency of International Concern. Only a previous large outbreak in French Polynesia was known and no neurological anomalies have been reported. Differences in African and Asian lineage and differences in genetic evolution of the Zika virus may possibly provide an explanation for the development of the recent outbreaks and their variable presentation. However, the similar clinical presentation between Zika and other diseases like Dengue and Chikungunya can support that Zika has been circulating and spreading inadvertently. This hypothesis gains strength when rates of laboratory confirmation diagnosis for Dengue are observed in Brazil and Colombia, two of the most affected countries by Zika virus (ZIKV) infection.The lack of attention and resources on neglected diseases supposes a huge risk that new lethal pathogens camouflage themselves to spread into large areas and populations.
- Editorial. [Editorial]
- Trop Doct 2016 Jul; 46(3):121.
- Changing clinical profile and factors associated with liver enzyme abnormalities among HIV-infected persons. [JOURNAL ARTICLE]
- Trop Doct 2016 Jun 24.
The spectrum of liver disease among HIV-infected patients is changing. In the era of antiretroviral therapy, opportunistic infections are diminishing and deranged liver function appears to be due usually to drug-induced liver injury, alcohol, non-alcoholic steatohepatitis (NASH) or chronic hepatitis B. To test this hypothesis, 98 HIV-positive patients with deranged liver function were compared with matched HIV-positive patients with normal liver function and likewise matched HIV-negative patients with normal liver function tests.
- Alpha-fetoprotein as a prognostic marker in acute liver failure: a pilot study. [JOURNAL ARTICLE]
- Trop Doct 2016 Jun 24.
Prognostic markers of acute liver failure (ALF) are based on clinical, laboratory or radiological parameters. Most of the biochemical markers are based on hepatic degeneration. We studied the impact of serial serum alpha-fetoprotein (AFP) levels, a marker of liver regeneration, on the outcome of the patients with ALF. AFP levels were estimated on days 1 and 3 of hospitalisation of 32 patients with ALF and the ratio (AFP day3/day1) was calculated. All subjects were categorised as group A (expired) or group B (survived). The AFP ratio was 0.84 + 0.15 in group A (n = 20) versus 1.55 + 0.70 in group B (n = 10); P < 0.001. However, the absolute initial AFP values were not associated with the outcome, favourable or unfavourable. We conclude that AFP levels change dynamically during ALF and have the potential to be used as a predictor of outcome in isolation or in combination with well-established prognostic markers.
- Is West Nile Virus infection associated with myasthenia gravis? [JOURNAL ARTICLE]
- Trop Doct 2016 Jun 24.
Myasthenia Gravis (MG) is an autoimmune disease which is characterised by disruption of signal transmission at neuromuscular junction. We aimed to search about a newly reported association between MG and West Nile Virus (WNV) infection.We searched WNV IgG by ELISA in serum samples of 50 available MG patients and 38 controls.None of the samples gave positive results for past WNV infection.No evidence of past WNV infection was found in our study population of MG patients. This may have been because MG has been showed to be related with neuroinvasive WNV, which none of our study subjects seem to have had based on their stories. New multicentre studies focusing on immunological mechanisms and held with larger groups or especially neuroinvasive disease patients can cast light onto the answer of this question.
- Medical traditions and chronic disease in Ethiopia: a story of wax and gold? [Journal Article]
- Trop Doct 2016 Jul; 46(3):122-5.
Effective medical care for non-communicable diseases (NCD) remains lamentably poor in Ethiopia and many low-income countries. Consequently, where modern medicine does not reach or is rejected, traditional treatments prevail. These are fragmented and esoteric by nature, and their understanding of illness is so fundamentally different that confusion proliferates when attempts are made to introduce modern medical care. Ethiopia is host to a variety of longstanding medical belief systems that coexist and function together, where modern medicine is often viewed as just another choice. This multiplicity of approaches to illness is accompanied by the Ethiopian custom of weaving layers of meaning, often contradictory, into speech and conversation - sometimes referred to as 'wax and gold', the 'wax' being the literal and the 'gold' the deeper, even hidden, meaning or significance. We argue that engagement with traditional belief systems and understanding these subtleties of meaning could assist in more effective NCD care.