共找到 20 条结果
Consult Online is a telemedicine system used to provide advice to Dutch tropical doctors. Set up in 2008 by the Dutch Association of Tropical Doctors in Training, it aims to support tropical doctors who would otherwise not have access to specialist consult. By logging onto the website www.tropenopleiding.nl, they can consult over 50 experts from 17 different specialties, most of whom are Dutch specialists who have previously worked as tropical doctors. Four years after its start, Consult Online was evaluated: it had received 146 consultations from 15 different countries. Over half of these (54%) had been answered the same day; 79% within two days. The average number of reactions to a consultation was 3. In this way, Consult Online makes it possible to provide expert advice to doctors of patients in developing countries.
Consult Online is a Dutch telemedicine system for physicians who work in international healthcare and tropical medicine (formerly known as 'tropical doctors'). It provides specialist advice for complicated cases where local specialist services are lacking. Eighty-nine experts from 25 different specialties are available for advice via www.troie.nl/consult-online. Most of these experts have worked in low resource settings for years before becoming specialists in other disciplines. Since its inception in 2008, Consult Online has received 639 consultations from 41 different countries. On average, a consultation resulted in 2.3 reactions. Consult Online is not the only telemedicine service for low resource settings, but it offers Dutch physicians the unique opportunity to liaise with specialists from their home country, who understand their background, training and limitations. A decade later, it continues to be available to anyone in need of tailor-made specialist advice for patients in low resource settings.
Together with economic causes, the declining belief in the relevance of clinical skills, the omission of the hospital from the health system, and the erroneous generalisation of a complaint centred approach enhanced the decline in clinical medicine in several developing countries over the last decades. Despite a growing interest and important efforts in continuous education, basic training remains generally knowledge-directed. Clinical training should start from a realistic job description, and aim at acquiring skills instead of knowledge. Basics of clinical epidemiology can help refine clinical logic both at the health centre and the hospital level. the district hospital should be awarded a key role in pre-graduate and continuous clinical training. Awaiting a revival of the economy in most tropical countries, and especially in tropical Africa, an effective way for improving clinical practice is to invest in training, at all levels, with an emphasis on continuous medical training.
Paederus dermatitis occurs due to contact with the vesicant rather than the bite. It can present as erythematous papules, plaques, vesicles, bulla and crusting. Its diagnosis dermatitis can be quite challenging, especially in cases where the patient does not recall any history of contact with the beetle, which is often the case. Biopsy, being an invasive diagnostic technique, is typically avoided. There is a paucity of studies describing the dermoscopic characteristics of dermatitis. This case series elucidates the dermoscopic features associated with it.
Chronic knee and back (knee/back) problems are common, painful, and disabling. Routine health-related quality of life (HRQOL) measurement may enhance doctor-patient communication and person-centred care by identifying unmet biopsychosocial needs, guiding personalized care, and encouraging engagement. We examined whether routine measurement and reporting of HRQOL using the electronic EuroQol 5-Dimension 5-Level (e-EQ-5D-5L) could improve HRQOL in participants allocated to the intervention (IG) or control (CG) groups. Participants were Chinese adult patients with a doctor-diagnosed knee/back problem with a scheduled follow-up visit within 12 months. The IG completed the e-EQ-5D-5L before each consultation at baseline and each scheduled follow-up visit, with reports available to their doctors during consultations. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes were Patient Enablement Instrument-version 2 (PEI-2), Pain Rating Scale (PRS), and Short-form 6-Dimension (SF-6D) health utility scores and management options. The effects of the intervention on the outcomes were assessed by generalised estimating equations (GEE) with linear function. 1200 participants were randomised to the IG (n = 595) and CG (n = 605). At 12 months, both groups reported higher (worse) WOMAC scores, with a greater increase in the IG than the CG (β = 2.43, p = 0.018). The IG reported higher (better) PEI-2 than the CG (β = 0.99, p = 0.010). There was no difference in PRS and SF-6D scores between groups. The IG received more oral medications, while the CG had more referrals to orthopaedic specialists. Routine measurement of HRQOL by the e-EQ-5D-5L did not improve HRQOL or pain, but was associated with better self-care enablement in primary care patients with chronic knee/back problems. HRQOL data may prompt primary care doctors to offer more conservative treatments before specialist referral, potentially easing the burden on secondary care.
Targeted water treatment and hygiene (WASH) programs for those residing near diarrhoea patients can be a cost-effective approach during outbreaks to reduce diarrhoea spread by targeting those at highest risk. We designed the WASHmobile mobile health (mHealth) program for high risk populations for diarrhoea. In our previous randomised controlled trials in the Democratic Republic of the Congo (DRC) (PICHA7) and Bangladesh (CHoBI7), WASHmobile delivery to diarrhoea patient households through a healthcare facility visit and mobile messages from a doctor significantly reduced diarrhoea, cholera, and improved child growth. Building on this, we adapted WASHmobile for large scale implementation through a mHealth and e-voucher program for diarrhoea outbreak areas. A pilot program evaluation of this approach was conducted in DRC health areas with ongoing diarrhoea outbreaks among 2022 participants. Voice and SMS messages from a doctor were sent to those within 500 m of diarrhoea patients stating there was a diarrhoea outbreak nearby and emphasising the importance of treating and safely storing household drinking water and handwashing with soap for the next 7-day high-risk period. The SMS messages contained an e-voucher to redeem for free chlorine tablets at a pharmacy or shop. Unannounced spot checks assessed WASH behaviours 7 days after program initiation. Fifty-seven percent of WASHmobile households redeemed e-vouchers. Compared to control, WASHmobile households redeeming e-vouchers had higher stored drinking water with free chlorine concentrations > 0.2 mg/L (Odds Ratio: 6.93, [95% Confidence Interval: 1.76, 27.24]) (64% [WASHmobile] vs. 20% [control]), higher stored drinking water completely covered (4.55 [2.68, 7.70]) (73% vs. 38%), and higher presence of a cleansing agent within 10 steps of latrine and cooking areas (latrine: 3.64 [1.47, 9.02] [70% vs. 39%] and cooking: 2.50 [1.31, 4.77] [70% vs. 49%]). The WASHmobile PICHA7 mHealth and e-voucher program significantly increased water treatment, safe water storage and hygiene behaviours in diarrhoea outbreak areas in DRC.
Exchange transfusion remains the definitive treatment for severe neonatal hyperbilirubinaemia; yet its aetiology and outcomes in rural tropical settings are poorly characterised. This five-year retrospective analysis of 58 neonates at a North Indian rural tertiary centre reveals that Rh incompatibility accounted for 76% of cases - a striking divergence from high income-country patterns where ABO incompatibility predominates - indicating critical gaps in antenatal Rh immuno-prophylaxis. The procedure achieved a mean bilirubin reduction of 50% (424 ± 106 to 212 ± 70&mu/L, p < 0.001) with no procedure-related mortality, though clinically significant adverse events occurred in 19% of neonates. Notably, 10.2% presented with acute bilirubin encephalopathy at the time of intervention, representing potentially preventable neurological injury. These findings make a compelling case for urgent, systematic improvements in antenatal screening, Rh immuno-prophylaxis access, and early jaundice recognition in tropical resource-limited settings.
As modern naval operations increasingly occur in littoral and tropical marine environments, the threat of marine zoonoses-infectious diseases transmitted from marine organisms to humans-has emerged as a potent asymmetric challenge. Unlike conventional military threats, these pathogens bypass hardware defenses and instead target personnel, compromising mission readiness, creating operational delays, and threatening force health protection. This review explores the biological and operational dimensions of marine zoonoses, including bacterial, parasitic, viral, and toxin-related risks such as Vibrio spp., Anisakis spp., norovirus, ciguatera, and scombroid poisoning. It analyzes transmission chains, risk pathways, and epidemiological patterns relevant to naval deployments. The review also introduces a strategic biosecurity framework for naval forces composed of three pillars: prevention, detection, and response. This framework integrates health education, medical intelligence, environmental surveillance, and outbreak control protocols to safeguard personnel in maritime settings. A strong cross-sector collaboration, integrating military-civilian efforts in surveillance, diagnostics, and response is essential. Embedding marine biosecurity into military doctrine through training, diagnostic capacity building, and outbreak simulations enhances frontline preparedness. Marine medicine thus plays a vital role in defending both personnel and operations through proactive, coordinated, and strategic biosecurity actions.
Scabies is a neglected tropical disease affecting 12% of the population globally, with a rise in incidence in many countries. It presents with intense itching, more intense nocturnally. Untreated complications such as secondary bacterial infections and systemic illnesses may ensue. However, its impact on mental health is relatively understudied. Most studies have focused on the assessment of the quality of life, with limited research on psychiatric illnesses. Clinicians in dermatology settings should be aware of the possibility of comorbid psychiatric illnesses in scabies patients and consider brief screening and timely referrals for psychiatric care. Psychiatric patients may be vulnerable to scabies infestation, and mental health professionals should assess for scabies in psychiatric patients presenting with pruritus.
Dengue is endemic in tropical regions and bleeding, ranging from minor to life-threatening, is a dreaded complication. With the increasing incidence of atherosclerotic cardiovascular disease in low- to middle-income countries where Dengue is prevalent, whether to stop or continue antiplatelet agents in patients with thrombocytopenia is a clinical conundrum.
Guillain-Barré syndrome (GBS) is a leading cause of acute flaccid paralysis and has been associated with several arboviral infections. It is an acute immune-mediated polyradiculo-neuropathy characterised by rapidly progressive limb weakness, areflexia, and variable cranial nerve involvement. Antecedent infections are reported in the majority of patients, most commonly gastro-intestinal or respiratory. In recent years, arboviruses such as Dengue, Chikungunya, and Zika have emerged as important infectious triggers of GBS, particularly in tropical regions. Zika virus infection is often asymptomatic or presents with non-specific febrile illness, making it likely to be under-diagnosed in endemic settings.
Pit viper envenoming commonly causes venom-induced consumption coagulopathy with hypofibrinogenaemia. However, isolated thrombocytopenia without fibrinogen depletion is less recognised and may alter transfusion strategy. We report a confirmed Ovophis tonkinensis bite from northern Vietnam presenting with severe isolated thrombocytopenia and local necrosis. The case highlights the importance of serial platelet monitoring, awareness of fibrinogen availability and appropriate timing of antivenom and platelet support in resource-limited tropical settings.
暂无摘要（点击查看详情）
Portugal faces challenges in implementing the One Health approach for zoonotic disease. To foster integrated solutions, a "One Health Living Lab" initiative engaged diverse stakeholders, focusing on junior professionals (ie, veterinary students, public health residents, and environmental health technicians). For 2 months, multidisciplinary teams addressed Avian influenza H5N1 in cats, Mycobacterium caprae, Streptococcus suis, Crimean-Congo hemorrhagic fever (CCHF) through research, stakeholder engagement and solution codesign. Key outcomes included establishing a feline HPAI sentinel network, confirming S suis occupational risks, developing a timely CCHF preparedness exercise and identifying potential M caprae underdiagnosis. The living lab successfully fostered collaboration and generated practical, bottom-up initiatives. While highlighting persistent systemic barriers like data sharing, the model demonstrates a promising approach for engaging future professionals and strengthening Portugal's health security against zoonotic threats, ensuring sustained support and integration.
Osmotic demyelination syndrome (ODS) is a rare complication in hospitalised patients, most commonly associated with rapid correction of hyponatraemia. While being uncommon, it is a dangerous problem that could result in death or severe disability. It has been mostly associated with rapid correction of hyponatraemia. However, few reports have shown it in complicated diabetes mellitus, either during rapid correction of hyperglycaemia or at any time during the course of the disease. ODS is a non-inflammatory demyelination of neurons caused by oligodendrocyte apoptosis and macrophage infiltration which degrades myelin. ODS is divided into two categories: central pontine myelinolysis and extrapontine myelinolysis based on the site of demyelination. It is important to raise awareness of ODS among clinicians, particularly when correcting hyperglycaemia.
The 2025 pediatric advanced life support guidelines, developed by the American Heart Association and the American Academy of Pediatrics, are a resource for healthcare professionals caring for infants and children under 18 years of age in peri-arrest and other emergency care situations. The new guidelines address evolving pediatric cardiac arrest patterns, characterized predominantly by respiratory failure or shock, with persistent disparities in out-of-hospital survival and neurological outcomes. Major revisions include setting a blood pressure target above the 10th centile post-cardiac arrest, administering epinephrine after two attempts of defibrillation in a shockable rhythm, and administering early epinephrine in non-shockable cardiac arrest, as well as preventing hyperthermia. It also emphasizes evidence-based strategies such as early high-quality cardiopulmonary resuscitation (CPR), targeted post-arrest care, continuous electroencephalogram for neurological monitoring, and IV sotalol as an option for refractory supraventricular tachycardia. Long-term survivor support and family presence during resuscitation are integrated as vital aspects of care. While core recommendations-such as CPR technique, ventilation strategies, and shock management-are reaffirmed, the update provides a robust framework for multicentric harmonization. The adoption of these updated protocols in promises enhanced resuscitation outcomes, consistent neurological recovery, and the development of context-specific best practices in pediatric emergency care.
In 2024, the global progress towards the 2025 End TB milestones of reducing TB incidence and mortality by 50% and 75% respectively, stood at only 12% and 29% respectively. Although the end TB strategy emphasizes both biomedical and social interventions, country-level efforts have focused more heavily on medical approaches while paying comparatively less attention to the underlying social and structural determinants that fuel TB transmission and risk. Zambia, despite achieving remarkable progress in implementing biomedical interventions as evidenced by the high TB treatment coverage, a high treatment success rate and a comparatively high uptake of TB preventive treatment among eligible populations, continues to be a high TB, high TB/HIV, and high MDR/RR TB burden country. Without tackling the root causes of TB, high-burden countries will remain trapped in a cycle of short-term gains and long-term stagnation. Implementation of the multisectoral accountability framework (MAF) offers a practical pathway forward.
A young man with multiple stab wounds underwent emergency trauma laparotomy for penetrating abdominal injury. Initial exploration revealed only an omental tear. The postoperative course, however, was complicated by early intestinal obstruction. Re-exploration revealed a Richter's hernia through a missed traumatic abdominal wall defect. This case highlights a rare but important cause of postoperative obstruction following trauma laparotomy.
暂无摘要（点击查看详情）
Histoplasmosis, caused by Histoplasma capsulatum, is a dimorphic fungus typically endemic to parts of the Americas, Africa, and Asia. Inhalational exposure leads primarily to pulmonary infection, and extrapulmonary or isolated hepatic presentations are rare, particularly in immuno-competent individuals. We present an unusual case of hepatic histoplasmosis with no evident lung involvement, highlighting a diagnostic challenge and a rewarding pathologic discovery.