Tropical Doctor最新文献

Pancreatitis-panniculitis-polyarthritis (PPP) syndrome is a rare extra-pancreatic manifestation of pancreatic disease. Its pathogenesis is probably related to the direct release of pancreatic lipase into the bloodstream, causing systemic fat necrosis. Initial treatment involves symptomatic relief, while addressing the underlying pancreatic enzyme leakage through endoscopic or surgical interventions. We report the case of a 10-year old girl who presented with abdominal symptoms, ascites, pleural effusion, panniculitis, and arthritis, and was ultimately diagnosed with chronic pancreatitis with associated PPP syndrome. She was successfully treated with percutaneous drainage, antibiotics, and endoscopic pancreatic duct stenting. This case highlights the importance of recognising systemic signs of pancreatic disease in children, which, if left untreated, can lead to significant morbidity and mortality.

Hepatomegaly results from diverse inflammatory, infiltrative, and congestive disorders. Massive hepatomegaly may arise from amyloidosis and can rarely be a sole presenting manifestation of this systemic disorder.

Preterm infants on gavage feeding encounter difficulties during their transition to direct oral feeds, which prolongs their hospital stay. The objectives of our study was to compare the transition time from gavage feeding to full katori spoon feeding in oromotor intervention (OMI) and control groups with feeding efficiency and milk volume transfer. An open labelled randomised control trial (RCT) was conducted. The new-born was followed up till reaching full katori spoon feeding. The mean transition time was shorter in the intervention group. Mean weight gain and mean length of stay in intervention group was improved compared to control. We concluded that OMI leads to shortened transition time to reach full katori spoon feeds and better feeding performance in the form of volume transfer and feeding efficiency.

Familial auto-inflammatory Behçet-like syndrome-1 is a rarely reported entity. The clinical manifestations of this condition mimic Behçet's disease in the form of recurrent oral ulcers and gastro-intestinal manifestations. The complete clinical spectrum is yet to be ascertained, as this is a genetic syndrome involving multiple mutations. Here, we report the case of a child with severe malnutrition and failure to thrive in infancy, who turned out to have the said genetic syndrome.

Chikungunya virus (CHIKV) typically causes febrile illness and arthralgia. However, severe complications such as encephalitis, rhabdomyolysis, and multiorgan dysfunction are increasingly recognised, particularly during epidemics in endemic regions. We report a case of a 61-year old male presenting with progressive flaccid paraparesis and respiratory failure following febrile illness. Magnetic resonance imaging (MRI) revealed white matter hyperintense foci with restricted diffusion in the periventricular, deep white matter, cerebellum, and middle cerebellar peduncles, consistent with encephalitis. Laboratory findings indicated rhabdomyolysis and acute kidney injury. Serological confirmation of CHIKV highlighted the diagnosis of CHIKV encephalitis complicated by rhabdomyolysis. Despite intensive care, the patient succumbed to refractory shock and hyperkalaemia. This case underscores the importance of early recognition of atypical manifestations of CHIKV, particularly MRI findings, to facilitate timely diagnosis and multidisciplinary management in severe cases.

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.

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.