Médecine tropicale : revue du Corps de santé colonial
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The PubMed search engine is an essential tool to stay abreast of the latest medical literature on specific topics. While the basic search techniques are common knowledge, the ability to use medical subject headings properly is an essential in obtaining valuable references. The purpose of this article is to explain what medical subject headings are and how they can be used to improve the results of reference searches in PubMed.
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Epidemiological information on marine envenomation is generally less extensive in Europe than in tropical regions where these injuries are more severe and the need for medical advice is more frequent. For these reasons use of regional Poison Control Centers in the area where the injury occurs must be encouraged. The purpose of this review is to describe envenomation by bony fish (lion fish, stone fish, and catfish), cartilaginous fish (stingrays and poisonous sharks), or other venomous aquatic vertebrates (moray-eels and marine snakes). Understanding of these envenomation syndromes is important not only in tropical areas but also in Europe where importation of dangerous species has increased in recent years.
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Envenomation by Elapidae snakes is less frequent than by Viperidae snakes but represents a true medical emergency due to rapid progression of cobra syndrome. Elapidae venom contains neurotoxins that paralyze striated muscles especially in the thoracic cavity. ⋯ When cobra envenomation is suspected, antivenom administration by the direct venous route must be undertaken as quickly as possible to stop the envenomation process. Artificial ventilation is necessary in case of dyspnea.
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Case Reports
[Late-occurring cutaneous vasculitis after successful treatment of diffuse lepromatous leprosy: Lucio's phenomenon].
O Lucio's phenomenon is an uncommon type 2 reactional state occurring exclusively in patients with diffuse lepromatous leprosy (Lucio-Latapi leprosy). Previous case reports have been most frequent in Central America and rare in Asia and Africa. Lucio's phenomenon is characterized by necrotic ulcerations of the skin preferentially on the lower extremities usually in association with ongoing Lucio lepromatosis. ⋯ The remarkable features of our case are that Lucio's phenomenon occurred a long time after successful treatment of lepromatous leprosy and that the patient responded promptly to treatment. The pathogenesis of Lucio's phenomenon is often compared with that of erythema nodosum leprosum. Discussion focuses on pathophysiologic features and natural course of Lucio's phenomenon.
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The threat for opportunistic diseases in HIV-infected adults in sub-Saharan Africa is characterized by a higher frequency of tuberculosis and invasive bacterial diseases than in Europe and by the presence of malaria. Since these three infections may occur early after the onset of immuno-deficiency, HIV-infected patients with less than 200 CD4/mm3 are more likely to develop an infectious episode with severe morbidity in sub-Saharan Africa than in Europe. For this reason the WHO now recommends starting cotrimoxazole prophylaxis at 350 and even 500 CD4/mml in sub-Saharan Africa. The question of whether antiretroviral treatment should also be initiated "earlier" in sub-Saharan Africa than in Europe has also been raised.