Tropical Doctor最新文献

Meigs syndrome is characterised by the triad of ovarian fibroma associated with ascites and pleural effusion, the latter of which resolves after removal of the fibroma. This uncommon but important clinical entity mimics malignancy in postmenopausal females. We present two such cases.

Gartner's duct cyst is a congenital, benign, usually small-sized and asymptomatic cyst arising from the remnants of the Wolffian duct. Larger cysts can cause dyspareunia, pelvic swelling and urinary symptoms.

Cleft lip and/or palate (CLP) is among the most common congenital anomalies worldwide. While primary surgical repair is essential, comprehensive CLP care also depends on equally important secondary services such as speech therapy, audiologic support, orthodontic care, and revision surgeries. In many low- and middle-income countries (LMICs), these services remain limited or inaccessible, resulting in suboptimal long-term functional, aesthetic, and psychosocial outcomes. Our narrative review searched across PubMed and Embase databases to identify the availability, delivery models, and outcomes of secondary CLP services in LMICs. We found 17 relevant studies and mapped existing evidence, identified key gaps, and explored barriers related to workforce shortages, training, infrastructure, and financial constraints. Our findings highlight the urgent need to strengthen multidisciplinary CLP care pathways beyond primary surgery. Investments in sustainable local capacity, tele-health enabled service models, task-sharing, and community-based interventions are crucial to achieving equitable, high-quality CLP outcomes in resource-limited settings.

Metabolic bone disease (MBD) is a significant concern in very preterm neonates, with clinical signs often delayed compared to biochemical and radiological markers. MBD was defined as serum phosphate <1.81 μmol/L and alkaline phosphatase >600 IU/L or alkaline phosphatase >1000 IU/L. Key risk factors included lower gestational age, lower birth weight, prolonged total parenteral nutrition, delayed attainment of full enteral feeding (>7 days), cholestasis, bronchopulmonary dysplasia, and anaemia requiring transfusion. Logistic regression identified delayed attainment of full enteral feeding (>7 days) as a significant predictor for developing MBD.

Wilson's disease, a rare genetic disorder caused by ATP7B gene mutations, disrupts copper metabolism, often presenting with psychiatric symptoms in 20-30% of cases before diagnosis. Diagnostic challenges arise owing to non-specific symptoms, leading to potential misdiagnosis. Dhat syndrome, a culture-bound syndrome prevalent in the Indian subcontinent, involves distress over perceived semen loss and, thus, the loss of vitality. We report a case of a young male with dhat syndrome, asymmetrical hand movements, behavioural changes, and gaming disorder who, after long being treated for functional neurological disorder, was later diagnosed with Wilson's disease after a comprehensive evaluation.

Vestibular fistula is the most common anorectal malformation in females. Traditionally managed with a staged posterior sagittal anorectoplasty (PSARP) following colostomy, concerns remain regarding colostomy-related morbidity. Intra-operative, early, and late postoperative complications, and functional outcomes (voluntary bowel movements, soiling, and constipation) were compared between secondary PSARP (after colostomy) and primary PSARP (without) using appropriate statistical tests. Functional outcomes were comparable, with >90% achieving voluntary bowel movements. Thus, we conclude that primary PSARP is a safe and effective treatment, avoiding colostomy-related morbidity. Colostomy should be reserved for selected cases.

Accurate heart rate assessment is vital during neonatal resuscitation. While pulse oximetry is widely used, it may delay heart rate detection in the delivery room. Electrocardiography however may offer a faster, more reliable alternative.