Variations in the Management of Cervical Thoracic Duct Cyst

We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-year-old woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.

The economic burden of malaria on households and the health system in a high transmission district of Mozambique

Background Malaria remains a leading cause of morbidity and mortality in Mozambique. Increased investments in malaria control have reduced the burden, but few studies have estimated the costs of malaria in the country. This paper estimates the economic costs associated with malaria care to households and to the health system in the high burden district of Mopeia in central Mozambique. Methods Malaria care-seeking and morbidity costs were routinely collected among 1373 households with at least one child enrolled in an active case detection (ACD) cohort in Mopeia, and through cross-sectional surveys with 824 families in 2017 and 805 families in 2018. Household costs included direct medical expenses, transportation and opportunity costs of the time lost due to illness. Structured questionnaires were used to estimate the health system costs associated with malaria care in all 13 district health facilities. Cost estimations followed an ingredient-based approach with a top-down allocation approach for health system expenses. Results Among participants in cross-sectional studies, households sought care for nine severe malaria cases requiring hospital admission and for 679 uncomplicated malaria cases. Median household costs associated with uncomplicated malaria among individuals of all ages were US$ 3.46 (IQR US$ 0.07–22.41) and US$ 81.08 (IQR US$ 39.34–88.38) per severe case. Median household costs were lower among children under five (ACD cohort): US$ 1.63 (IQR US$ 0.00–7.79) per uncomplicated case and US$ 64.90 (IQR US$ 49.76–80.96) per severe case. Opportunity costs were the main source of household costs. Median health system costs associated with malaria among patients of all ages were US$ 4.34 (IQR US$ 4.32–4.35) per uncomplicated case and US$ 26.56 (IQR US$ 18.03–44.09) per severe case. Considering household and health system costs, the overall cost of malaria care to society was US$ 7.80 per uncomplicated case and US$ 107.64 per severe case, representing an economic malaria burden of US$ 332,286.24 (IQR US$ 186,355.84–1,091,212.90) per year only in Mopeia. Conclusions Despite the provision of free malaria services, households in Mopeia incur significant direct and indirect costs associated with the disease. Furthermore, the high malaria cost on the Mozambican health system underscores the need to strengthen malaria prevention to reduce the high burden and improve productivity in the region.

A case of albendazole and niclosamide resistant Taenia saginata infection

Taenia saginata infection is an important food-borne parasitic zoonosis which is endemic in countries where majority of people eat raw or inadequately cooked beef. The infection is rare in India except in Jammu Kashmir and Northeast states, India. Majority of taeniasis patients are asymptomatic, few may present with a variety of abdominal symptoms and rarely hepatobiliary complications. Diagnosis is made commonly by finding proglottids and or eggs in the faeces. Here we report a chronic and uncomplicated case of saginata taeniasis resistant to niclosamide and albendazole but responded to a single dosage of praziquantel 15 mg per Kg body weight.

Endovascular Treatment of Congenital External Carotid-Jugular Fistula: Case Report and Review of the Literature

Congenital vascular malformation (CVM) between the external carotid artery and the internal jugular vein is a rare disease, it originates as a consequence of arrested development during various stages of embryogenesis. The natural history of CMVs is progressive growth, it can remain clinically silent until it progresses causing local swelling accompanied by symptoms and signs of arteriovenous shunting, mass effect, ischemic insult with ulceration of skin or bleeding. In literature only few cases of CMVs have been reported, therefore there is still no consensus about the correct surgical approach to this pathology. We report an uncomplicated case of CVMs in a 15-year-old female successfully treated with coils embolization. To our knowledge, this is the eighth reported case in the literature review.

Spontaneous Sternal Fracture — A Misnomer

Spontaneous sternal fractures, although rare, may present to the Accident and Emergency Department as a severe central chest pain of sudden onset. These may be confused with myocardial infarction1 or pulmonary embolism2. Treatment in the uncomplicated case may be symptomatic with analgesics, but this fracture may require sternal wiring if paradoxical sternal movement embarrasses respiration. Spontaneous fracture of the sternum appears in the majority of cases to be due either to secondary metastatic infiltration, myelomatosis or extreme osteoporosis3. We report a case which emphasizes the importance of investigating these patients.

Meconium Ileus: A New Roentgen Sign

Neuhauser described a "bubble" appearance in roentgenograms of the abdomen, apparently due to air mixed with thick meconium, as a diagnostic sign of meconium ileus. It was present in 40% of cases but has subsequently been found not to be specific, as it occurs in cases of imperforate anus. In the present report the author states that, in six uncomplicated cases of meconium ileus, fluid levels were not observed in the dilated loops of small bowel in films taken in the upright position. The lack of fluid levels in the roentgenogram is attributed to a paucity of mucosal secretions in the uncomplicated case of meconium ileus. This is contrary to the usual findings in intestinal obstruction in the newborn. This diagnostic sign is not seen in the presence of complications such as volvulus, gangrene, and peritonitis. In the complicated cases fluid levels appear probably because of the release of proteolytic enzymes by infection and vascular occlusion, the meconium being rendered more fluid by these released enzymes. This appears to be an additional valuable sign to be observed in the diagnosis of meconium ileus by roentgenograms.

Some Practical Considerations in the Control of Louse-Borne Typhus Fever in Great Britain in the Light of Experience in Russia, Poland, Rumania and China

This paper deals with some aspects of the control of louse-borne typhus fever. The epidemic form is associated with famine and overcrowding. In producing an epidemic in a hitherto endemic area malnutrition is of greater importance than over-crowding; another factor which brings this about is widespread movement of civil or military population thus bringing non-immunes into a district where typhus is endemic. Endemic typhus usually occurs in the early months of the year, whilst the epidemic form may appear at any time. Conditions under which epidemic typhus occurs favour the outbreak of other diseases so that an uncomplicated case is rarely seen. Louse-borne typhus fever lasts from twelve to sixteen days. The incubation period is usually twelve to fourteen days, though it may be from five to twenty-one days. The onset is sudden, but is often preceded by malaise and a rise of temperature. Two common initial symptoms are acute frontal or occipital headache and bronchitis. The first sign may be mental confusion or delirium. Acute delirium is usually present after the first week.

A Fatal Case of Silicosis

1. A typical uncomplicated case of silicosis with fatal outcome in a porcelain turner is described.2. Microscopic examination of lung tissue and of ashes therefrom showed numerous mineral needles resembling those found in kaolin from his factory.3. The findings in this case are taken to support in part the theory advanced by W. R. Jones, that silicosis can be produced by fibrous minerals.We are indebted to Mr Bögvad, M.S., for valuable aid in the mineralogical diagnosis.