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Trop Doct [journal]
- 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.
- A head within a head sign: a manifestation of healing nutritional rickets. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 7.
The epiphyseal perichondrium is calcified during the rachitic healing process and visible radiologically as 'a head within a head' around the proximal femoral epiphysis in young children. Seen in isolation, these radiographs can pose diagnostic dilemmas.
- Presence of accessory penis, colonic duplication and several other congenital anomalies in a child: a very rare association. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 4.
An accessory penis is a very rare anomaly. Only five cases have been reported thus far to our knowledge. We present the case of a child aged 2 years and 10 months who had a penis-like structure (containing phallus and glans) attached to the right buttock. Associated anomalies were a non-communicating type of colonic duplication, a paramedian stenosed anal opening, a horse-shoe kidney, posterior urethral valves, scoliosis of the lumbo-sacral spine, polydactyly and equino-varus deformity of the right foot. As far as we can tell, this is the first report of an accessory penis associated with colonic duplication and other congenital anomalies.
- Ophthalmomyiasis externa: three cases caused by Oestrus ovis larvae in Turkey. [JOURNAL ARTICLE]
- Trop Doct 2014 Apr 4.
Ocular involvement of parasitic infections includes external, internal and orbital ophthalmomyiasis. Oestrus ovis (sheep botfly) is the most common cause of ophthalmomyiasis externa. Living in warm climates, particularly in agricultural districts, is a risk factor. Although external ophthalmomyiasis can be treated by removal of the infecting larva(e) and topical drug treatment, the risk remains of its presence leading to further contamination for other people. We describe three cases of external ophthalmomyiasis due to infestation with the first instar larvae of O. ovis An awareness of larval conjunctivitis in endemic areas may avoid misdiagnosis and allow immediate management to prevent complications.
- Meningitis following spinal anaesthesia in an obstetric patient. [JOURNAL ARTICLE]
- Trop Doct 2014 Mar 28.
Meningitis following lumbar puncture and spinal anaesthesia is a rare but serious complication. A 19-year-old woman was administered spinal anaesthesia at another centre prior to a Caesarean section. The following day she experienced headaches. On the fourth day, she started vomiting and having convulsions, and became agitated. Meningitis was diagnosed based on a clinical examination and analysis of a lumbar puncture sample. After 21 days of treatment, she was discharged.Meningitis should be considered in the differential diagnosis of a patient presenting with headaches following spinal anaesthesia. The causes of meningitis following spinal anaesthesia are debated, and it is difficult to distinguish between aseptic and bacterial meningitis. It should be compulsory to wear a face mask while performing a dural puncture.
- Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea. [JOURNAL ARTICLE]
- Trop Doct 2014 Mar 25.
We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea.
- Human rabies in Iran. [JOURNAL ARTICLE]
- Trop Doct 2014 Mar 24.
BackgroundLike most Asian and African countries, Iran is highly endemic for rabies, which is a preventable disease with the timely utilisation of post-exposure prophylaxis (PEP). With the availability of affordable vaccination in Iran, there are still several rabies deaths which are assumed misdiagnosed or received ineffective PEP.MethodsWe reviewed the files of 16 human rabies deaths, consisting of two groups: 1, ineffective treatment; and 2, erroneous PEP.ResultsMost of the studied cases were male and were from rural areas. Stray dogs were found to be the common biting animal (68.75%). Of the patients, 10/16 (62.5%) who had injuries on their head and/or face demonstrated shorter incubation periods. The incubation period was longer in a 4-year-old boy who sustained injuries in his abdomen and back. All the patients in group 1 received four doses of vaccine and administration of human rabies immune globulin (HRIG), and death occurred with the mean of 49 days after the bite. This mean was 27 days in three patients in group 2, who received vaccine without administration of HRIG.ConclusionIn a total of 1,188,579 cases of PEP given in Iran during: 2002-2011, it is not known whether all PEPs were correctly administered by World Health Organization standards. Extending rabies awareness programmes and timely PEP education in the community in accordance with the implementation of rabies control measures might lead to a decrease in these unfortunate scenarios and heavy financial burden of vaccination required due to the prevalence of rabies.
- Editorial. [Journal Article]
- Trop Doct 2014 Apr; 44(2):61.