Tropical doctor
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Cardiopathies are common in tropical regions and echocardiography could be of substantial value. However, it is difficult to practice. We suggest simple techniques with conventional instruments that are available in many rural hospitals, and describe the most common echocardiographic procedures and findings that can be undertaken with short training by non-cardiologist physicians.
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Neonatal tetanus (NNT) remains among the leading causes of morbidity and mortality in Nigeria and a huge challenge in achieving the fourth goal of the Millennium Development Goals. We reviewed the morbidity and mortality pattern among neonates with NNT admitted to the District General Hospital in north-east Nigeria from 2006 to 2009. Half of the patients were from rural areas and were delivered at home by untrained traditional birth attendants with no prior antenatal health care. ⋯ Spasticity, lack of sucking, trismus, fever, omphalitis, risus sardonicus and opisthotonus were the most common presenting signs and symptoms. Overall, mortality was 56%. Health education of mothers and traditional birth attendants, the promotion of hospital delivery and antenatal tetanus immunization of all pregnant women, particularly in rural areas, are recommended if NNT is to be prevented.
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Acute appendicitis is among the commonest surgical diseases faced by an emergency clinician. A prompt diagnosis is mandatory to reduce morbidity and mortality, which may be difficult for junior doctors who first see the patient in the emergency department. This study was conducted to assess the efficacy of Alvarado score as a tool to improve the accuracy of diagnosis of appendicitis. ⋯ Alvarado scoring was used for the post-test study. We found that the Alvarado scoring system is an effective diagnostic method, which decreases overdiagnosis of appendicitis in the emergency department, and at the same time reduces the risk of missing acute appendicitis cases. It is inexpensive and easy to implement by junior doctors with good results.
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Case Reports
Epileptiform seizures revealing neurocysticercosis: report of two clinical cases in Libreville, Gabon.
Neurocysticercosis (NCC) is the most common helminth infection of the central nervous system. It is caused by the larval form of the tapeworm Taenia solium and is increasingly recognized as a major cause of neurologic disease worldwide. Epilepsy is the usual mode of revelation. ⋯ Medical treatment with albendazole, anti-epileptic drugs and corticosteroids led to full recovery. NCC should be considered in tropical countries as a leading cause of epilepsy. Moreover, NCC should be included in the differential diagnosis of neurologic infections in HIV patients in endemic populations.
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Caecal volvulus is an uncommon cause of acute intestinal obstruction caused by axial twisting of the caecum along with the terminal ileum and ascending colon. Early diagnosis is essential in order to reduce the high mortality rate, though the condition is rarely diagnosed correctly at the time of presentation. We report a series of four cases describing their presentation, management and subsequent outcome.