Tropical Doctor最新文献

Chronic mesh infections after inguinal hernia repair present significant clinical challenges due to biofilm-mediated resistance, involvement of multidrug-resistant and atypical pathogens, and gaps in preventive strategies. Our case series of four patients highlights critical research gaps, including the overlooked role of atypical pathogens such as Mycobacterium tuberculosis, diagnostic challenges in detecting slow-growing or resistant organisms and perioperative sterilisation lapses, especially inconsistent Glutaraldehyde use during late-day operations. Many patients suffered with persistent sinuses and recurrent hernias months after surgery. Microbiological analyses identified Pseudomonas aeruginosa, Klebsiella pneumoniae, Mycobacterium tuberculosis and mixed flora. Complete mesh removal and culture-directed antimicrobial therapy resolved all cases within 8-12 months. Our study underscores the need for robust sterilisation protocols, advanced diagnostic measures and biofilm-resistant biomaterials.

Dengue infection is emerging as one of the most common tropical diseases globally. It manifests in varying severity from asymptomatic to the most severe forms of the disease, characterized by coagulopathy, increased vascular fragility, and permeability (dengue haemorrhagic fever) that may progress to hypovolaemic shock (dengue shock syndrome). For atypical manifestations, a new terminology known as expanded dengue syndrome (EDS) was introduced. Haemophagocytic lymphohistiocytosis (HLH), is considered a spectrum of EDS, which is a rare, potentially fatal hyperinflammatory condition. A case of a pregnant woman with dengue fever diagnosed as secondary HLH is reported here. It was successfully managed with intravenous dexamethasone and supportive care. A high index of suspicion is paramount in diagnosing HLH when a patient deteriorates even after giving appropriate care for dengue infection. Early recognition and prompt treatment with immuno-suppressive therapy can bring a successful response.

Amoebic liver abscess (ALA), a common tropical infection, is caused by Entamoeba histolytica (EH). For decades, the first-line treatment for ALA has been metronidazole which has several drawbacks. The thioredoxin reductase enzyme in EH is essential for its anti-oxidative defence and survival during tissue invasion. Recently, the benzimidazole nucleus of proton pump inhibitors has been found to inhibit it quite effectively. An in vitro study found pantoprazole to be over 100 times more potent than metronidazole. We therefore conducted a randomised open-label pilot study, comparing adjunct pantoprazole with standard medical therapy in patients with uncomplicated ALA. We found this resulted in a shorter hospital stay and faster resolution of fever, abdominal pain, and leucocytosis, compared to standard therapy.

Placenta accreta spectrum (PAS) represents a complex obstetric condition characterised by the abnormal invasion of anchoring villi and trophoblast into the myometrium. This case report explores two instances where the diagnosis of PAS was overlooked during antenatal care leading to significant complications during conservative management. Both patients presented with heavy menstrual bleeding and raised beta human chorionic gonadotrophin (β-hCG), mimicking gestational trophoblastic disease. The report delves into the clinical presentations, diagnostic challenges, and outcomes of two cases, shedding light on the importance of effective communication and follow-up in the management of PAS.

Vaccine hesitancy, anti-Vax campaigners and misinformation hound the administration of vaccines. Our study, conducted at Malwa region of the Punjab, India, was systematically carried out to look for adverse neurological effects after COVID-19 vaccination, given to 1000 people (>18 years and <60 years) who had received either single or multiple doses. No major neurological complications were found; the only side-effect was a transitory headache in 15% of the participants.

Death due to electrical injuries are a major health concern and has a high rate of morbidity and mortality. Electrocution death is defined as that occurring due to passage of electric current inside the body and is obviously a form of unnatural death.¹ The cause includes ventricular fibrillation, paralysis of respiratory muscles and the central respiratory centre.⁴ The amount of current that passes through the body² and the point of contact are the main factors that determine the extent of injury.³ The morphological changes observed in electrocution deaths are still not clear and this often leads to a 'negative' autopsy, especially when there is lack of circumstantial evidence. We discuss two cases of electrocution death and various histopathological changes observed in visceral organs including heart and skin. A brief literature review is added.

Faeco-vaginal fistulae are not uncommon. We suggest a simple management algorithm to provide tailored approach for every patient.