Tropical Doctor最新文献

Pregnancy-related acute kidney injury (PR-AKI) is an uncommon but serious complication that poses significant maternal and foetal risks. This retrospective study analysed 83 cases of PR-AKI to evaluate causes, clinical features, and outcomes. Overall, 71% recovered, 23% developed chronic kidney disease (CKD), and 6% died. Thrombotic microangiopathy carried the highest CKD risk (85%), while sepsis caused most deaths (27%). Patients who could be managed conservatively recovered fully, whereas those more severe illness requiring dialysis inevitably had less favourable outcomes. Early recognition of high-risk conditions and timely intervention can therefore improve renal recovery and maternal survival.

We report two such cases. Case 1: A 30-year-old male presented with right forearm swelling and pain; examination revealed a non-mobile, fluctuant intramuscular swelling. Case 2: A 30-year-old female had a 3-month history of midline chest pain with a mobile, fluctuant swelling over the xiphisternum. In both cases, aspirated pus showed numerous pus cells with few Gram-negative bacilli. Culture revealed non-lactose fermenting, smooth convex colonies identified as Salmonella Typhi by biochemical tests, Vitek 2 (bioMérieux), and serology. The isolates were susceptible to ceftriaxone, ciprofloxacin, azithromycin, cotrimoxazole, and ampicillin, but resistant to chloramphenicol. Both patients were immunocompetent, with no history of trauma, diabetes, or haemoglobinopathy, and responded well to antibiotic therapy. These cases highlight the need for clinical awareness of atypical presentations of S. Typhi osteomyelitis and the importance of timely diagnosis in endemic regions.

Pregabalin, a gamma-aminobutyric acid analogue, is extensively used for neurological and psychiatric disorders, such as neuropathic pain, anxiety, and epilepsy. Although its clinical efficacy is not in doubt, increasing evidence indicates a high risk of psychological side effects and abuse, and concerns regarding safety and dependency. Our systematic review found severe psychiatric symptoms such as psychosis, hallucinations, anxiety, and depression with pregabalin. These effects were intensified by factors such as high doses, sudden withdrawal, and preexisting psychiatric illness. Sexual disinhibition and dependency cases were reported, especially in substance-dependent patients. Effective management involved tapering doses gradually, adjunct psychiatric treatment, and close monitoring.

Milk curd syndrome is an infrequent, iatrogenic cause of bowel obstruction in neonates and early infants, which arises mainly due to inspissation of formula feeds or dried cow's milk, but is very uncommon after feeding with unmodified animal milk, such as goat's milk. A systematic review aims to gain a deeper understanding of its demographics, causes, clinical profile, diagnosis, and management. If treated promptly, outcomes are favourable.

Morbidity and mortality (M&M) meetings in many low- and middle-income countries (LMICs) remain irregular, rushed, poorly attended and largely symbolic, limiting their potential to drive genuine quality and safety improvement. This paper outlines how M&M meetings can be transformed from ritualistic exercises into structured, psychologically safe platforms for shared learning and system-level change. Effective M&M meetings require regular scheduling, standardised case selection, clear objectives, multidisciplinary participation and a focus on system factors rather than individual blame. Incorporating structured analytical tools, such as root cause analysis, helps identify contributory factors and actionable solutions. Equally essential are formal mechanisms for documenting recommendations, assigning responsibilities and tracking implementation. By embedding principles of transparency, accountability and 'a just culture', LMIC health systems will convert M&M meetings into one of the most cost-effective strategies for reducing preventable harm and strengthening patient safety.

A patient bitten by Deinagkistrodon acutus developed prolonged venom-induced consumption coagulopathy without local necrosis and recovered with supportive care alone in a setting where species-specific antivenom is unavailable.