Tropical doctor
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Every major mass disaster challenges the health care services, especially in the third world. These challenges include the expected situations mainly pertaining to the overload of patients and the stretching of hospital facilities. We report our experiences about several unforseen challenges faced by our hospital in the 2005 earthquake that struck the Kashmir region.
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This prospective observational study describes the rates of nosocomial infections (NI), the sites of infection, the pathogens involved, their antibiogram and the risk factors at a tertiary care hospital in northern India. In 62 of the 182 enrolled patients 95 episodes of NI were recorded (incidence rate 28.6/1000 person days): pneumonia (77%); urinary tract infection (24%) and blood stream infection (24%). All isolates of Acinetobacter, Pseudomonas and Klebsiella and 83.3% of Escherichia coli were resistant to the third generation cephalosporins. An increased duration of the time spent in intensive care units and days of intervention were associated with incident NI.
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Nepal is a mountainous country of 27 million people where the widespread lack of access to operative services is a major cause of morbidity and mortality. One critical reason for this is the lack of trained, appropriately distributed anaesthesia providers. We discuss the evolution of the 'anaesthesia assistant' in Nepal, review the international literature concerning the development of non-doctor anaesthetists, and invite links with others working in this field.
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We studied 52 cases of neurocysticercosis from January 1991 to December 2006 in order to increase our understanding of the diagnosis and treatment of the disease. The majority of patients were between 18 and 45 years old (78.8%). Men were more subject to the disease than women. ⋯ The effectiveness rate was 57.7% (30), the improvement rate was 28.8% (15), and the inefficacy rate was 14.0% (6). Neurocysticercosis was easy to misdiagnose. Praziquantel and albendazole are effective drugs for neurocysticercosis.
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In a case series of 152 children aged from 2 to 132 months will pleural emphema from a paediatric tertiary hospital in Luanda, Angola between September 2004 and March 2005, the authors found a high prevalence of anaemia and malnutrition. The most prevalent bacteria in pleural fluid were: D pneumoniae, Haemophyllus and S aureus. The median for hospital stay was 25 days. The lethality was 7.8% and was not statistically associated with malnutrition, although this variable was associated, in multivariate analysis, with prolonged hospitalization time.