Tropical Doctor最新文献

Cystic lesions of the pancreas are being increasingly diagnosed incidentally in recent decades due to easy availability of abdominal imaging. They may be neoplastic or benign. Tuberculosis, the great masquerader, may rarely involve the pancreas mimicking pancreatic malignancy, cyst, or abscess. Identification of this rare entity is crucial to avoid potentially risky surgery as anti-tubercular pharmacotherapy is highly effective. We report a case of a 40-year old cirrhotic man who presented with a cystic hypodense lesion in the pancreatic tail and was subsequently diagnosed with pancreatic tuberculosis. Apart from the rarity of diagnosis, our case also highlights the utility of endoscopic ultrasound for minimally invasive assessment of pancreatic lesions.

Study Design: Retrospective case study. Objective: To study the feasibility and ease of freestyle SGAP perforator flaps for sacral ulcers. Setting: This study was conducted in tertiary care hospital in India.Sacral ulcers are commonly encountered in long-term bedridden patients. Various options to cover these ulcers include the gluteus muscle flaps (v-y, rotation and advancement), fascio-cutaneous flaps, superior and inferior gluteal artery perforator flaps. The superior gluteal artery perforator (SGAP) flap is a reliable option for sacral sore management. Using this flap, only one out of ten patients had partial flap necrosis. None had wound dehiscence nor seroma formation. No recurrence was seen at three months follow-up. This flap can safely be used as a 'free style' flap.

Bladder Pain Syndrome (BPS) is a puzzling and complicated disorder. 12 such patients, with a mean age 48.3 years, were treated with weekly intravesical instillation of admixture of alkalinized lidocaine, bupivacaine, heparin and steroids for six weeks. Evaluating the benefits of this therapy, patients experienced 82.2% & 90.9% relief at 3_rd & 6_th week of instillation. After completion of six cycles of therapy, patients experienced 68.7% & 65.3% relief at 3_rd & 6_th month follow up, concluding the early and long term relief of BPS.

A 72-year woman with a history of multiple cerebrovascular accidents presented with severe epigastric pain. An oesophageal perforation by the tip of a Ryles tube, which had migrated into the mediastinum, was diagnosed by radiography. An attempt at pushing the nasogastric tube into the stomach resulted in increasing the rupture to about 6 cm in size. Replacement by a triple-lumen nasojejunal feeding tube and subsequent feeding with c.1,400 calories per day enabled the perforation to close without further intervention.

In this report we describe the implementation of a new electricity supply system at Mulanje Mission Hospital, Malawi, which integrates the use of grid electricity, solar-generated electricity and battery back-up. To realize the system, suppliers from several countries had to be used and external expertise and funding were vital. The completed system provides reliable and good quality electricity to all departments in the hospital, prioritizing essential equipment when needed. Implementation of the system has reduced cost of electricity bills by 60%, ended black-outs and extended longevity of electrical equipment. We describe our approach, the materials used and results with challenges and recommendations to governments, donors interested in hospital infrastructure and other health facilities operating in similar circumstances. Others in similar settings can benefit from the experiences documented.