Tropical Doctor current issue

Amputation surgery in children: an analysis of frequency and cause of early wound problems

Banza, L N, Mkandawire, N C, Harrison, W J — 2009-06-17

Amputation surgery in children is a relatively uncommon procedure. The objective of our study was to determine the incidence of complications in this type of surgery as well as any related factors. The results of our retrospective study of children aged between one and 18 years, over a five-year period were collected and analysed. The most frequent indications for amputation were congenital limb deformities (60%). Trauma, tumours, infection and other rare conditions were less common.

Results also revealed that in our hospital the wound infection rate was 38 %, the wound breakdown rate was 11 % and the general wound sepsis rate was around 1%. More complications were observed following through-knee amputation. We had noticed fewer complications (25%) when the surgery was performed by a consultant than when it was performed by a junior trainee (66%).

Clinical neuropathy in HIV/AIDS: an eight-year review of hospitalized patients in Sokoto, northwestern Nigeria

Isezuo, S A, Sani, A Z, Ezunu, E, Maiyaki, S, Njoku, C H, Obembe, A — 2009-06-17

HIV/AIDS is a multi-systemic disease that targets mainly the immune and nervous systems. Although about 4.4% of Nigerians are infected with HIV, data on the spectrum of HIV-related nervous disease in this population is rare. This study describes the neurological manifestations of HIV/AIDS in northern Nigeria. We undertook retrospective and descriptive analyses of the demographic, clinical, neurologic and laboratory data of all hospitalized HIV/AIDS adults in a referral hospital in northwestern Nigeria. The study period covered 2000 to 2007. We studied 322 HIV/AIDS patients (218 men, 104 women) aged 33.4 ± 11.4 years (range: 18–65 years) who constituted 3.5% of the total medical admissions. HIV transmission was exclusively by heterosexual intercourse involving multiple partners. The majority (70.2%) was married and 78.9% were in stage III/IV HIV/AIDS disease. Fifty-two (16.2%) had CD4+ T-cell count determination, the mean value being 220 ± 147.2 cells/m³, and 58 (18.0%) were on highly active antiretroviral therapy. Fifty-one (15.8%) had neurological complications dominated by central nervous diseases including encephalitis (17.6%), dementia (16.2%) and stroke (14.9%). Peripheral nerve involvements were relatively infrequent. Compared with HIV/AIDS patients without neurological complications, a significantly higher proportion of those with HIV-associated neuropathy had a stage IV disease (30% versus 9.4%, ² = 19.5, P < 0.001). Neurological complications, particularly central nervous diseases, are an important cause of morbidity in the HIV/AIDS population.

Neonatal tetanus in the babies of Nigerian mothers immunised against Tetanus

Fetuga, B. M., Ogunlesi, T. A., Adekanmbi, F., Olanrewaju, D. — 2009-06-17

The objective of this study was to describe the clinical characteristics of babies with neonatal tetanus (NNT) whose mothers were immunised against tetanus and determine the outcome of their hospitalisation. The hospital records of babies affected by NNT whose mothers received at least two doses of anti-tetanus vaccine during pregnancy were identified and compared with similarly affected babies whose mothers were not immunised against tetanus during pregnancy in a Nigerian hospital. Out of 175 cases of NNT, the mothers of 24 (13.7%) babies were immunised against tetanus during pregnancy while the mothers of 151 (86.3%) were not. The proportions of babies of immunised mothers and unimmunised mothers who presented within the first three days of life, within a day of the onset of symptoms and with spasms were similar. Nevertheless, the survival rate was higher (62.5% vs. 26.5%; P = 0.0004) among babies of immunised mothers. Despite similarities in clinical presentation of babies of mothers with and without anti-tetanus vaccination, the survival rate was higher for the former.

Limitations in the role of ulcer edge biopsy in establishing the aetiology of nontraumatic small bowel perforation

Sharma, S., Kotru, M., Batra, M., Gupta, A., Rai, P., Sharma, R. — 2009-06-17

Spontaneous small intestinal perforations are common in India. Surgeons operating on patients with an obscure peritonitis should be aware of the diverse aetiologies of small intestinal perforations in order to be able to provide the appropriate management. We reviewed the pathology records of 165 patients operated on for nontraumatic perforations of the small intestines in our hospital between 2005 and 2007. Perforation edge biopsy was diagnostic in 53 cases, with typhoid being the most common aetiology, followed by TB. The majority of cases, however, revealed only a non-specific inflammatory granulation tissue. However, the sensitivity of biopsy diagnosis could be increased by taking additional biopsy material from the mesenteric lymph nodes, tubercles or omental nodules. We conclude that perforation edge biopsy is useful in a third of cases, but the diagnostic rate could be improved by taking additional biopsy material.

Impact of day care cataract surgery on inpatient services in a tertiary care ophthalmic setup

Prakash, G., Sharma, N., Jhanji, V., Agarwal, T., Titiyal, J. S — 2009-06-17

We retrospectively reviewed the admission patterns for one year before and one year after the introduction of day care cataract surgery at our cornea services and noted that the number of cataract surgeries per month improved from year 2003 to 2005 (P < 0.001), with a higher number of admissions for non-emergency corneal pathology seen in 2005 (P < 0.001). There was a 69.1% more chance of admission for a corneal pathology patient after the introduction of day care services cataract surgery. Day care cataract surgery decongests non-cataract pathology related inpatient services and is therefore a viable alternative in the developing world.

Delivery room logbook - fact or fiction?

Duffy, S., Crangle, M. — 2009-06-17

The delivery room logbook entries of Gimbie Adventist Hospital for a period of one month were monitored and compared with the actual number of births recorded on a separate worksheet for that period. The implications of the missing data were reviewed. This data was compared to a previous audit of the same design. Eighty per cent of births were recorded during this one month period which reflected an improvement from 72% reported in a previous study. Underreporting resulted in discrepencies when calculating the number of births and signal functions such as caesarean section rates, blood transfusion, administration of parenteral anticonvulsants and removal of retained products. In turn, these discrepencies impact the calculation of process indicators of safe motherhood projects. The reliability of the delivery room logbook as the sole source of information to create health policy and to monitor and evaluate health programs is questionable.

Stroke at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Onwuchewa, A., BellGam, H., Asekomeh, G. — 2009-06-17

The case records of 202 consecutive adult Nigerian in-patients with stroke at the University of Port Harcourt Teaching Hospital (UPTH) were retrospectively reviewed. The mean age at presentation was 62.62 ± 14.2 years. The male to female ratio was 1:1.2. The commonest risk factors were hypertension, diabetes mellitus, hypercholesterolaemia, older age and a previous history of stroke. Clinically, 67.3% had cerebral infarction (CI), while 27.7% had intracerebral haemorrhage (ICH). The peak age of events for both sub-types was the 7th decade. The case fatality was 55.4% for ICH and 23.5% for CI. Thus, stroke is associated with high mortality at the UPTH. Improved emergency care of stroke patients is needed while the setting up of dedicated stroke centres is advocated. A community-based study is necessary to provide more insight into the problem and also highlight the basis for appropriate intervention and policy.

Prevalence of transfusion transmitted infections in blood donors: an Indian experience

Chandra, T., Kumar, A., Gupta, A. — 2009-06-17

A retrospective study was done on blood units collected from replacement and voluntary donors from 2001 to 2007. Seropositivity of transfusion transmitted disease in replacement donors was 1.96% in hepatitis B surface antigen, 0.85% in hepatitis C virus, 0.23% in HIV and 0.01% in syphilis. Voluntary donors had an almost negligible infectivity rate.

The frequency of hepatitis D virus in patients with hepatitis B in Iran: an increasing rate?

Somi, M. H, Farhang, S., Miri, S. M., Pouri, A. A, Mjidi, G., Alavian, S. M. — 2009-06-17

This study sought to determine the seroprevalence of the hepatitis D virus (HDV), the risk factors and its association with the severity of liver disease. Continuous patients at Tabriz and Tehran Hepatitis Clinics were enrolled during 2007–2008 in a cross-sectional study. Demographic data and possible risk factors for infection were recorded for all hepatitis B surface antigen positive patients. The blood samples of 847 patients infected with the hepatitis B virus were evaluated. The seroprevalence of HDV was 9.3%. This rate was significantly higher after reaching 40 years of age. The rate was 12.7% in patients with chronic hepatitis B and 4.7% in patients with in-active hepatitis B; the difference was statistically significant. A history of dental interventions and several trips abroad were good predictors of HDV infection in logistic regression. No significant difference in liver function tests was found. The seroprevalence of HDV was higher than in some other studies from Iran but a decrease was noted in younger age.

The incidence of selected congenital malformations during a two-year period in Tehran, Iran

2009-06-17

In this descriptive cross-sectional study carried out from March 2005 to March 2007, 410 congenital malformations were recorded among 61,112 live births in six general hospitals in different districts of Tehran. The overall incidence was 0.6% (0.69% in males and 0.62% in females) and the most affected system was the digestive system (40%), followed by the musculoskeletal system (20.5%), central nervous system (19.5%), genitourinary system (12.2%) and cardiovascular system (3%). It is essential that government organizations educate the population through scheduled preconceptional primary care visits on interventions like diet supplementation and avoidance of teratogenic agents, in order to decrease the rate of congenital malformations.

Risk factors for fatality in patients with Crimean-Congo haemorrhagic fever

Fisgin, N. T., Tanyel, E., Doganci, L., Tulek, N. — 2009-06-17

Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal viral disease. In this study, the aim was to investigate the prognostic factors affecting the patient's survival and risk factors to fatality. At Ondokuz Mayis University Faculty of Medicine, a tertiary referral centre near the CCHF epidemic region, patients with typical clinical findings and indicative microbiological results for IgM and/or reverse transcriptase-polymerase chain reaction of CCHF virus were enrolled in the study, from 2004 to 2007. Patients were divided into two subgroups according to their survival outcomes; group I (n = 44) survived patients and group II (n = 6) consisted of fatal cases.

The median platelet count was significantly lower in the fatal group (11000/mm³) when compared to the survived group (49500/mm³). Aspartate transferase and alanine transferase (ALT) levels were significantly higher in group II, when compared to group I. Also, the median range of serum lactic dehydrogenase (LDH) and creatinine phosphokinase (CPK) levels were much more elevated, and prothrombin time (PT) and activated partial thromboplastin time (aPTT) were prolonged in fatal cases. There was also a significant difference in median age of these two groups. Advanced age, late admission, low platelet count, increased AST, ALT, CPK and LDH levels, and prolonged PT and aPTT could be an early indicator of poor prognosis in patients with CCHF.

Serological immunity to diphtheria and tetanus in healthy adults in Delhi, India

Saxena, S., Jais, M., Dutta, R., Dutta, A K — 2009-06-17

Widespread childhood immunization with DPT (diphtheria, pertussis and tetanus) has largely eradicated diphtheria and tetanus from many countries. The reduction in the circulation of toxigenic strains has resulted in less natural boosting of adult immunity. As a result, the adult population in countries with high childhood immunization coverage have become susceptible to the disease. The duration of immunity after primary immunization to diphtheria and tetanus is limited and a reduction in immunity is common in adults. With this perspective, the present study was carried out on a random serum sample of 255 healthy individuals aged 20-50 years. The serum samples were tested for immunoglobulin G levels against diphtheria and tetanus by enzyme immuno assays. Fifty-three per cent of adults were unprotected; 22 % were seen to have only a basic protection against diphtheria; 25% were protected against both diseases; and 47% were susceptible to tetanus. The susceptibility was seen to increase with age. To avoid epidemics in the future, immunity must be improved. It is important to treat even the most trivial wound with care and tetanus toxoid immunization. Also, it is necessary to monitor the community for immunity to diphtheria using standard techniques in order to undertake epidemiological surveillances of, and prevention from, these dreadful diseases.

Pulmonary nocardiosis from a tertiary care hospital in Southern India

Chawla, K., Mukhopadhyay, C., Payyanur, P., Bairy, I. — 2009-06-17

The present study highlights eight cases of pulmonary nocardiosis diagnosed during the time period of January 2006–March 2008. Nocardia otitidiscaviarum, N. asteroides and N. brasiliensis were isolated from these cases. Whereas six patients were treated successfully, one showed partial response and one case expired before the institution of treatment. Early and correct microbiological diagnosis can help to decrease the disease-related morbidity and mortality.

Tuberculosis in systemic lupus erythematosus in Chinese patients

Wang, J., Pan, H.-F., Su, H., Li, X.-P., Xu, J.-H., Ye, D.-Q. — 2009-06-17

This study investigates the prevalence and clinical and laboratory features of patients with systemic lupus erythematosus (SLE) associated with TB in Chinese patients, as well as its similarities to and differences from patients without TB. Our results show that SLE patients with TB (SLE-TB) might be a subgroup of patients with distinct clinical and laboratory features. Therefore, specific treatment should be given in order to provide a better outcome for SLE-TB patients.

Incidence and outcome of peripartum cardiomyopathy from a tertiary hospital in South India

Pandit, V., Shetty, S., Kumar, A., Sagir, A. — 2009-06-17

There is very little literature regarding peripartum cardiomyopathy (PCM) from Asian countries. A study of PCM was conducted at Kasturba Medical College Hospital, Manipal, with special reference to incidence and outcome. The incidence of PCM was 1 case per 1374 live births. Major risk factors for the development of PCM were multiparity and advanced maternal age. Echocardiography is useful in early diagnosis and for follow-up assessment of left ventricular function. Most of the patients noticed good symptomatic improvement at time of discharge and during the follow-up with standard therapy. Clinical improvement was well correlated with improvement of LV function by echocardiography. Significant thrombotic complications were noticed. None of the patients died during the study and follow-up period.

The use of hospital medical records for child injury surveillance in northern Malawi

2009-06-17

Our study evaluates the usefulness and the limitations of using the medical records of a central referral hospital to develop a child injury surveillance system in northern Malawi. The most prevalent types of injury were falls (29.6%), road traffic injuries (22.0%), burns (21.4%) and poisoning (15.1%). Older children (aged 5–14 years), in the cool-dry season (May to August) and the hot-dry season (September to October), were significant predictors for total injury admissions. Our study indicated that hospital medical records are a valuable component of a child injury surveillance system and can illustrate the trends and patterns of moderate to severe injuries as well as suggest potential prevention strategies for local settings. Combined with a specially designed trauma registry form, it is possible for developing countries at local level to combat the emerging public health issues.

Rare primary extrahepatic intra-abdominal hydatid cysts

De, U. — 2009-06-17

Hydatid disease is an endemic parasitic disease prevalent in sheep-rearing countries. Although liver and lung are the commonly involved organs, hydatid disease can occur in any organ or tissue. In this case series, we share our experience of some rare primary extrahepatic intra-abdominal hydatid cysts.

Idiopathic CD4+ T-lymphocytopenia with cryptococcal meningitis: first case report from Cambodia

Augusto, E., Raguenaud, M.-E., Kim, C., Mony, M., Isaakidis, P. — 2009-06-17

We report on a patient with cryptococcal meningitis with CD4+ T-lymphocytopenia and no evidence of HIV infection.

Amoebic liver abscesses complicated by inferior vena cava and right atrium thrombus

Khan, S., Ameen Rauf, M. — 2009-06-17

Amoebiasis is a common protozoal infection that is endemic in South Asia. Hepatic involvement that manifests as abscess formation occurs in approximately 10% of all patients. Identified expeditiously, this can be treated with metronidazole. We present a case of multiple, large amoebic liver abscesses, that were complicated by thrombus formation in the inferior vena cava extending to the right atrium, requiring surgical removal.

Severe adverse reactions to meglumine antimoniate in the treatment of visceral leishmaniasis: a report of 13 cases in the southwestern region of Brazil

2009-06-17

Antimony-based medications continue to be the chosen drug for visceral leishmaniasis treatment in most countries. Pentavalent antimony compounds are highly effective but frequently have adverse reactions. Although toxic effects are almost always reversible, some of them can be severe. Clinical and laboratory data of 13 patients who developed severe adverse reactions to meglumine antimoniate in a teaching hospital in southwestern Brazil in 2004–2005 were analysed. Most patients were adults (10/13), mainly at the age of 50 or older (4/13). The main severe adverse reactions were renal failure (eight episodes), pancreatitis (six episodes) and hepatic failure/hepatitis (five episodes). Six patients died in the period; all presented acute renal failure and four presented hepatic failure. Meglumine antimoniate can cause severe reactions, which can lead to death if not promptly identified. Further studies are warrented on the effect of less toxic drugs.

Unusual presentation of tuberculosis

Singh, S., Pandey, D., Ahmad, Z., Bhargava, R., Hameed, I., Mehfooz, N. — 2009-06-17

Mediastinal mass is not an unusual entity. It occurs mostly due to lymphoma, thymoma, germ cell tumours, granulomatous diseases, and so on. Tuberculosis is an uncommon cause of mediastinal mass. It is rarely suspected when it is presented in such an unusual way. We report here a case of a 35-year-old male who presented with mediastinal mass, which was later confirmed as a case of tuberculosis on histopathological examination. He was successfully treated with anti-tubercular drugs.

Pulmonary nocardiosis presenting with cardiac tamponade and bilateral pleural effusion in a HIV patient

Chandrashekar, U K, Acharya, V., Gnanadev, N C, Varghese, G. K, Chawla, K. — 2009-06-17

Nocardiosis induces a high mortality rate in those infected with HIV. It is now being increasingly described in patients with AIDS. Nocardia infection usually involves the lungs. In immunocompromised individuals it tends to disseminate. It mimics pulmonary TB both clinically and radiologically and many a time is wrongly treated with anti-tubercular drugs. Involvement of the pericardium is uncommon, having only been reported infrequently in the past. We describe a patient who presented with a cardiac tamponade and was confirmed as having pulmonary parenchymal and pleural disease.

Acute glomerulonephritis in hepatitis A virus infection: a rare presentation

Aggarwal, A., Kumar, D., Kumar, R. — 2009-06-17

An eight-year-old boy presenting with features of acute glomerulonephritis (AGN), developed jaundice. He was positive for hepatitis A immunoglobulin M. AGN is a rare complication of hepatitis A. Here, we describe a temporal association of hepatitis A infection complicated by AGN.

Death due to chikungunya

2009-06-17

After its first appearance in Kolkata (Calcutta) during 1963–1965, chikungunya occurred in epidemic form in India in 17 states and union territories. There were 13,90,322 cases suspected to be suffering from chikungunya in 2006, 59,535 in 2007 and 11,222 in 2008; in 2006, 2007 and 2008 there were 15,961, 7,837 and 262 samples, respectively, sent to the National Institute of Virology, Pune, and the National Institute of Communicable Disease, Delhi, for serological diagnosis. Of these, 2001, 1826 and 44, respectively, were confirmed as chikungunya. There were no deaths (data from the National Vector Borne Disease Control Programme, Government of India).

Cutaneous dirofilariasis presenting as an eyelid swelling

Shenoi, S. D, Kumar, P., Johnston, S. P, Khadilkar, U. N — 2009-06-17

Dirofilariasis is a common filarial infection occurring in domestic and wild animals as a result of arthropod bites. However, it can be transmitted to humans after mosquito bites. Here, we report a case of a 54-year-old lady who developed an unilateral eyelid swelling secondary to Dirofilaria repens.

Scurvy-a forgotten disease with an unusual presentation

Kumar, V., Choudhury, P. — 2009-06-17

We report an unusual case of scurvy where a six-year-old female presented with clinical and radiological features suggestive of juvenile idiopathic arthritis. However, follow-up radiological examination, carried out in view of refractory arthritis, was diagnostic for scurvy and the patient later responded well only with vitamin C therapy.