A case of severe Plasmodium knowlesi in a splenectomized patient

Plasmodium knowlesi, a zoonotic malaria, is now considered the fifth species of Plasmodium causing malaria in humans. With its 24-hour erythrocytic stage of development, it has raised concern regarding its high potential in replicating and leading to severe illness. Spleen is an important site for removal of parasitized red blood cells and generating immunity. We reported a case of knowlesi malaria in a non-immune, splenectomized patient. We observed the delay in parasite clearance, high parasitic counts, and severe illness at presentation. A thorough search through literature revealed several case reports on falciparum and vivax malaria in splenectomized patients. However, literature available for knowlesi malaria in splenectomized patient is limited. Further studies need to be carried out to clarify the role of spleen in host defense against human malaria especially P. knowlesi

Coexistence of neurofibromatosis type-1 and primary pulmonary sarcoma: a case report and review of the literature

Neurofibromatosis type-1 (NF1) is a genetic disorder characterized by café-au-lait spots, neurofibroma and other associated features. The risk of malignancy is approximately 2.5 to 4-fold higher as compared to general population. However, primary pulmonary sarcoma is rarely reported in patients with NF1. Here, we describe a case of NF1 complicated with primary pulmonary sarcoma

Recurrent pulmonary embolism: is filarial lymphedema a risk factor for deep vein thrombosis?

Lymphatic filariasis is caused by nematodes that inhabit the lymphatic system and subcutaneous tissues. 90% of the infections are caused by Wuchereria bancrofti while most of the remainder by Brugia malayi and Brugia timori. The presence of filarial lymphedema or elephantiasis leads to disfigurement and disability. However, its relationship with deep vein thrombosis and pulmonary embolism was not well-documented. Here, we described a case of recurrent pulmonary embolism associated with left leg elephantiasis

Pulmonary actinomycosis masquerading as lung cancer: a case report

Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Bilateral optic neuritis with maculopathy: A rare manifestation of dengue fever

Dengue fever is a common mosquito-borne disease, which is endemic in tropical and subtropical countries. Bilateral optic neuropathy is a relatively unusual dengue-related ocular complication. Here, we present a case of bilateral optic neuritis with maculopathy complicating dengue infection

Evaluation of Active, Beautiful, Clean Waters Design Features in Tropical Urban Cities : A Case Study in Singapore

In Singapore, active, beautiful, clean waters design features (ABCWDFs), such as rain gardens and vegetated swales, are used as a sustainable approach for stormwater management. Field monitoring studies characterising the performance of these design features in the tropical region are currently limited, hampering the widespread implementation of these systems. This study characterised the performance of individual ABCWDFs in the tropical climate context by monitoring a rain garden (FB7) and a vegetated swale (VS1) that were implemented in a 4-ha urban residential precinct for a period of 15 months. Results showed that total suspended solids (TSS), total phosphorus (TP) and total nitrogen (TN) concentrations were low in the new residential precinct runoff, leading to poor removal efficiency despite the effluent concentrations of individual ABCWDFs that were within the local stormwater treatment objectives. Average TSS, TP and TN EMCs of four sub-catchment outlets were lower (23.2 mg/L, 0.11 mg/L and 1.00 mg/L, respectively) when compared to the runoff quality of the major catchments in Singapore, potentially demonstrating that the ABCWDFs are effective in improving the catchment runoff quality. Findings from this study can help to better understand the performance of ABCWDFs receiving low influent concentrations and implications for further investigations to improve stormwater runoff management in the tropics.</p