Open Access Case Study

Squamous Cell Carcinoma of Gallbladder – An Uncommon Presentation

Vikas Gupta, Paramjeet Kaur, Anil Khurana, Ashok K. Chauhan, Padam Parmar

International Journal of TROPICAL DISEASE & Health, Page 1-4
DOI: 10.9734/IJTDH/2016/19834

A 51-year-old male patient presented with pain in the upper right quadrant of abdomen since two months, associated with weight loss and fever. Contrast enhanced computed tomography abdomen revealed gallbladder with wall thickening which was asymmetric and heterogeneous at junction of body. An initial diagnosis of cholecystitis with element of cholangitis and abnormal wall thickening with multiple tiny calculi was considered. Open radical cholecystectomy was done. Microscopic and immunohistochemical findings established the diagnosis of moderately differentiated squamous cell carcinoma of the gallbladder. Adjuvant chemotherapy regimen consisting of paclitaxel 175 mg/m2 and carboplatin AUC 6 was given three weekly for six cycles in the present case. Six months after treatment completion, patient is on regular follow up and disease free on clinical and radiological examination.

Open Access Original Research Article

Profile of Snakebite Accidents in the State of Rio de Janeiro, Brazil, from 2001 to 2012: An Epidemiological Study

Isabel Cristina Melo Mendes, Maria José Conceição

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2016/24535

Aims: The present study aimed to epidemiologically characterize snakebite accidents in Rio de Janeiro, from 2001 to 2012.

Study Design: This was an ecological study, using secondary data.

Place and Duration of Study: The data used referred to cases notified in the state of Rio de Janeiro in the official database SINAN between the years of 2001 to 2012.

Methodology: Data registered in SINAN were obtained through the online platform DATASUS, consisting of the number of notified cases, snake genera involved, accident classification, victim age group, time elapsed between accident and medical care, and case evolution.

Results: The analysis was impaired by the great amount of data not informed in notifications. From the registered data, it can be seen that the total number of notified cases has been increasing, which may be due to greater contact with snakes among individuals over the course of the years and/or better notification. In all the years, the genus most frequently involved was Bothrops, as occurs at national level. The individuals affected were most frequently aged between 20 and 59 years. Most cases were classified as mild and evolved to cure without sequelae.

Conclusions: It is concluded that snakebites in Rio de Janeiro have been gaining importance as a public health issue, especially due to the increasing numbers of cases and their potential severity, and because they mainly affect individuals of productive age. Investments in prevention programs and in training healthcare professionals are recommended in order to recognize and treat these accidents. The need for better data entry on the compulsory notification form is highlighted, with the aim of improving data quality and enabling reliable analysis on the country’s health problems.

Open Access Original Research Article

Tuberculosis in the Head and Neck Region: Experience in the Eastern Tertiary Care Centre of Nepal

Apar Pokharel, Shyam T. Chettri, Deepak Paudel

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2016/24088

Introduction: Tuberculosis (TB) primarily affects lungs, however extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in head and neck region.

Objective: To study the otorhinolaryngological manifestations of tuberculosis in eastern tertiary care centre of Nepal and its relationship with primary tuberculosis of lung and human immunodeficiency virus infection.

Methods: This is a retrospective study conducted in the Department of Otolaryngology and Head and Neck Surgery in B. P. Koirala Institute of Health Sciences, Nepal. Our study group comprised of 85 patients diagnosed with extrapulmonary manifestations of tuberculosis in the head and neck region from 2012-2014 over the period of 2 years. Records of patients diagnosed and treated for tuberculosis in the head and neck region at our institute for two year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Pulmonary tuberculosis was screened in all patients by doing chest radiography and sputum AFB (Acid Fast Bacillus). HIV (Human Immunodeficiency Virus) screening was also done in all patients.

Results: 85 cases showed extrapulmonary otorhinolaryngological manifestations of tuberculosis. Majority of the cases were male and in the third decade of life. Commonest manifestation was cervical lymphadenopathy. Fine needle aspiration cytology (FNAC), histopathological diagnosis and Acid Fast Bacilli (AFB) staining were used to confirm the diagnosis. All patients were treated with category I anti TB treatment (ATT) in the DOTS (Direct Observed Treatment Shortcourse) clinic which achieved cure in all cases.

Conclusion: Extrapulmonary manifestations of tuberculosis in the head and neck region is a frequent, clinical entity encountered especially in developing countries like Nepal. It should always be kept as one of the differential diagnosis in the pathology of head and neck region. High degree of suspicion is necessary to reach diagnosis. Category I ATT is effective for treatment.

Open Access Original Research Article

Evaluation of a Tuberculosis Surveillance System in the Harare City Health Department in Zimbabwe

Ronnie Matambo, Cuthbert Duri, Vurayai Ruhanya, Stanley Mungofa, Elizabeth Chadambuka, Nyasha Chin’ombe

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2016/24056

Aims: To evaluate a tuberculosis surveillance system (TBSS) in Harare.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Harare City Health Department, Zimbabwe, between January 2013 to September 2013.

Methodology: Standard CDC surveillance evaluation guidelines were employed to assess the performance of TBSS in the Harare City. Health care officers involved in TB surveillance were recruited. Data were collected using a questionnaire and analysed.

Results: Respondents were knowledgeable about the TBSS, with 93% being aware of the TB screening test and 18% knowledgeable of all the five standard questions used in TB screening, while 53% knew about 4 of them. Only 22% could state all the seven clinical case definitions of TB. However 60% were not aware of the objectives of the TBSS. About 64% indicated that they had analysed TB data and 69 % indicated that the TBSS was useful. On simplicity, the majority (95%) of the respondents indicated that it was easy to use the case definitions used in TB classification of patients. The TBSS was acceptable to 100% of the respondents. On flexibility, 76% of the respondents showed that the TB notification form could accommodate additional diseases and 75% indicated that other health conditions be included.

Conclusion: The study concluded that the TBSS within the Harare City Health department was simple, flexible, stable, representative and acceptable to the health care workers and data completeness was commendable. The surveillance system addressed the TB control priorities and effectively monitored the disease in the City.

Open Access Original Research Article

Investigation of an Outbreak of Acute Methanol Poisoning in a Southwest State of Nigeria

Dayo Adeyanju, Akinola Ayoola Fatiregun, Olubowale Ekundare-Famiyesin, Pascal Mkanda, Rui Miguel Vaz, Elvis Isere, Elizabeth Adedire, Adefisoye Adewole, Oluwapelumi Fadahunsi, Michael Oguntoye, Kayode Ojo, Akinyode Akinfemi, Maureen Anyanwu, Patrick Nguku

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2016/24464

Aims: An outbreak of sudden deaths with clinical features suggestive of acute methanol poisoning was reported. An epidemiological investigation was conducted to verify the diagnosis and identify risk factors.

Methodology: A joint team of officials of the Ondo State Ministry of Health, the World Health Organization, and the Nigerian Field Epidemiology and Laboratory Training Programme residents investigated the outbreak which was limited to two Local Government Areas of Ondo State, in Southwest Nigeria. An incident management coordination approach, modelled after the emergency operation centre for the elimination of polio virus and ebola virus disease in Nigeria was used. Field survey involving active case searches of health facilities, households and neighbourhoods using an operational case definition was carried out. Blood and urine specimen, including remnant of home-made alcoholic beverages were collected for analysis of viral antigens, heavy metals and methanol. A case-control study was also carried to identify potential risk factors.

Results: A total of 37 cases were found with 27 deaths inclusive (case fatality rate; 73%), most (76%) of whom were in the age group ≤ 49 years. The odd of being a case was 17 fold higher among those who consumed a locally brewed gin. Laboratory reports from samples from remnants of gin consumed as well as human samples; urine and blood, were consistent with acute methanol poisoning.

Conclusion: There is a need for enforcement of regulatory measures to address the consumption of illicitly produced alcoholic beverages to forestall future outbreaks.