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Trop Doct [journal]
- The 'Malawi device': a durable, reusable, low cost device from own materials for emergency ventilation during percutaneous tracheostomy. [JOURNAL ARTICLE]
- Trop Doct 2014 Jul 10.
The use of a tracheostomy is routine in current intensive care practice to facilitate weaning patients requiring prolonged respiratory support from mechanical ventilation. Percutaneous tracheostomy has become an established technique with an acceptable risk profile in appropriately selected patients, and has the advantage that it can be performed at the bedside without the need for an operating theatre. This is particularly relevant in a resource-poor setting. Ideally, percutaneous tracheostomy requires the presence of two skilled persons; one to perform the tracheostomy while the other controls the airway and withdraws the endo-tracheal tube at the appropriate time. This is not always possible in a resource poor setting with limited manpower. Without two operators, it is possible for the tracheal tube to become displaced before the completion of the tracheostomy with potentially disastrous consequences. We describe a method by which the airway and ventilation can be maintained if accidental tracheal extubation occurs before completion of a percutaneous tracheostomy. The 'Malawi Device', a cheap and simple modification of readily available equipment, enables a single operator to maintain the airway and ventilate the patient when the above scenario occurs.
- Dengue epidemiological trend in Oman: a 13-year national surveillance and strategic proposition of imported cases. [JOURNAL ARTICLE]
- Trop Doct 2014 Jul 3.
Dengue fever has emerged as a major public health problem globally in the past three decades. A 13-year national surveillance data analysis was done to describe the epidemiology and its trend of dengue disease in Oman reported between 2001 and 2013. Laboratory-confirmed dengue virus infections reported were studied retrospectively during the study period. A total of 64 laboratory confirmed cases were reported. All the patients contracted the disease during their visit to South-East Asian countries, hence classified as imported cases. The majority of the cases were reported in the year 2012 (23.4%). The most important clinical characteristics were fever (90.6%), myalgia (35.9%) and rash/petechial rash (20.3%). Thrombocytopenia was seen in 31.2% of the study subjects. The mortality was nearly 4.6% and all other patients made a full recovery. The most effective measure for travellers is taking precautions to avoid mosquito bites.
- Massive intrathoracic lipoma: a report of two cases, one being congenital. [JOURNAL ARTICLE]
- Trop Doct 2014 Jun 30.
Massive intrathoracic lipomas are uncommon. Few cases have been reported worldwide. We report two cases, one of which was congenital. They were managed by thoracotomy and complete excision, with excellent outcomes.
- Maternal and neonatal complications of macrosomia. [JOURNAL ARTICLE]
- Trop Doct 2014 Jun 23.
This case control study, aimed at identifying complications of macrosomia, was conducted in two major hospitals of Yaoundé, Cameroon over a 6-month period from 1 October 2012. Maternity records were compared of births weighing ≥4000 g with those weighing between 3000 g and 3500 g. The main outcome variables were mode of delivery, low genital lacerations, Apgar score, birth injuries, postpartum haemorrhage and early neonatal death. Data were analysed using SPSS 18.0. Chi-square test or Fisher's exact test and t-test were used for comparison. P < 0.05 was considered statistically significant. Maternal complications observed were poor uterine contractions during labour, second-degree perineal tears, Caesarean section, instrumental delivery and postpartum haemorrhage. Neonatal complications were birth injuries, poor 5-minute Apgar score and early neonatal death. In our setting, macrosomia is associated with increased maternal and neonatal complications.
- Global warming and altitude malaria. [EDITORIAL]
- Trop Doct 2014 Jun 9; 44(3):125-127.
- The cost-effectiveness of orthopaedic clinical officers in Malawi. [JOURNAL ARTICLE]
- Trop Doct 2014 May 12.
BackgroundIn Malawi the orthopaedic clinical officer (OCO) training programme trains non-physician clinicians in musculoskeletal care. We studied the cost-effectiveness of this program.MethodsHospital logbooks were reviewed for data pertaining to activity in seven district hospitals over a 6-month period. The total costs were divided by the total effectiveness, calculated as disability adjusted life years (DALYs) averted.ResultsThe total cost-effectiveness of providing orthopaedic care through the OCO training programme was US$92.06 per DALY averted. The mean per hospital was US$138.75 (95% CI: US$69.58-207.91) per DALY averted which is very cost-effective when compared with other health interventions. Of the 837 patients treated 63% were aged <15 years and 36% were in the 'economically active' demographic of ages 15-74 years.ConclusionTraining of clinical officers in orthopaedic surgery is very cost-effective and allows transfer of skills into rural areas. The demographics suggest that failure to provide such care would have a negative economic impact.
- Ruptured ectopic pregnancy: the long and tortuous journey to the theatre. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 25.
Ectopic pregnancy is a common gynaecological emergency in Nigeria, West Africa. Here we present a case that brings to light some of the problems facing the health sector in reducing the high maternal mortality rate.
- A prospective study on distribution of eschar in patients suspected of scrub typhus. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 15.
Scrub typhus is an acute febrile illness caused by a tick bite infected with the bacteria Orientia tsutsugamushi. The clinical diagnosis is difficult as the symptoms are similar to other febrile illnesses such as dengue, typhoid, leptospirosis and so on. An eschar, if present, will narrow down the provisional diagnosis towards scrub typhus. There are no data on the preferential sites of tick bites in an Indian population. We present here the preferential sites of tick bites in a South Indian population of 123 cases positive for eschar. Geographically, clothing styles vary leading to the differences in the areas of skin exposed to the bite and thus the formation of eschars. Scrub typhus, if not treated, may lead to fatal complications. As scrub typhus is one of the most under-reported illnesses in the world, clinicians should look for the presence of an eschar in the preferential sites at least to narrow down the diagnosis and treatment.
- A unique case of facial burn superinfected with Dermatobia Hominis larvae resulting in a bilateral enucleation of the eyes. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 11.
We present a case of a female Ecuadorian patient who presented a deep facial burn injury complicated with a severe infestation of Dermatobia Hominis larvae. The burn injury was complicated by severe myiasis attributable to the poor management of the wound received at home, using tropical plants, which caused a secondary infection and severe necrosis of the tissue involving the forehead, cheeks, chin, scalp, nose, mouth and the eyes resulting in a bilateral enucleation and long inpatient hospital care.
- Retinal profile: a clinical indicator of severity in dengue fever in a suburban Indian environment. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 10.
PurposeTo study the retinal changes in subjects suffering from dengue fever and check if these changes can be taken as sufficient indicator of severity and progression of the disease.Patients/MethodsA detailed history was recorded of 118 patients on whom ocular examination, including direct ophthalmoscopy, indirect ophthalmoscopy and coloured fundus photography, was performed.ResultsForty-seven percent of patients were found to have posterior segment abnormalities. Retinal vein dilatation or tortuosity was the most common finding followed by changes in the optic disc (8.4% of patients) and background haemorrhage (6.7% of patients). With increasing severity of thrombocytopenia, the proportion of patients with retinal abnormalities increased. In patients with grade I thrombocytopenia, no fundal abnormality was found. In those with grade II thrombocytopenia, fundal abnormality was found in 13.63% patients, whereas in the grade III category it was 27.90%.ConclusionsSeverity of thrombocytopenia had a significant association with retinal abnormalities. Occurrence of fundus changes increases with an increase in severity of thrombocytopenia. Fundus changes were found in all patients with grade IV thrombocytopenia.