Tropical doctor
-
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.
-
The viral haemorrhagic fevers are a group of diseases that share many clinical features. Ebola, Marburg and Lassa are diseases that cause a relatively small number of deaths globally, but pose special risks to medical staff due to the ease of transmission, and can have a profound impact to the communities they affect. This article gives a brief overview of diseases caused by the Ebola, Marburg and Lassa viruses. It gives some practical advice to the clinician on the diagnosis and management of these diseases.
-
This review discusses the problem of abortion in adolescents across the world and highlights the gaps in knowledge. It also examines the need for adolescent-friendly services.
-
Streptococcus pneumoniae is the most important bacterial cause of pneumonia and meningitis among adults world wide. It is a particularly common cause of these infections and also bacteraemia among HIV infected adults with rates of disease increasing to more than 100 times the normal as HIV infection progresses to AIDS. ⋯ Factors underlying susceptibility to pneumococcal infection in HIV infected adults are then reviewed, along with the effectiveness of current vaccines. Finally, novel approaches that will be needed to combat PD in HIV afflicted parts of the world are suggested.
-
Most African children with severe malaria who die do so on the day of admission as a result of the complications of falciparum malaria. We highlight the value of a rapid structured triage assessment to look for emergency signs that will prioritize initial management and implementation of basic life support. This can be delivered with few resources and by non-specialist medical personnel. ⋯ Hypovolaemia has emerged as a common feature of children presenting with severe malaria complicated by acidosis. Early recognition and prompt treatment may lead to improvements in outcome. We discuss the new evidence supporting the role of hypovolaemia in severe malaria and potential treatment options whilst awaiting the results of clinical trials.