Systemic tuberculosis presenting with acute transient myopia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Transient myopia has been reported to occur in a number of conditions, either ocular in origin or associated with an underlying systemic cause. We present a rare case of this abnormality occurring in the setting of systemic tuberculosis.</p> <p>Case presentation</p> <p>A 29-year-old Indian woman presented with sudden onset blurred distance vision and fever. Examination revealed visual acuity of counting fingers in both eyes improving to 6/9 with pinhole with N5 reading acuity. Anterior segment examination revealed narrow angles on gonioscopy. Posterior segments were normal. Systemic examination revealed a fluctuant mass in her left loin, aspiration of which yielded pus which was culture-positive for <it>Mycobacterium tuberculosis</it>. The Mantoux test elicited a strongly positive reaction. Chest X-ray and magnetic resonance imaging of the brain were unremarkable. Computed tomography scan and magnetic resonance imaging of the spine and abdomen revealed a large psoas abscess communicating with the loin mass. Two vertebrae were involved but not the spinal cord or canal.</p> <p>Conclusion</p> <p>Transient myopia is a rare presenting feature of systemic tuberculosis. A postulated mechanism in this patient is that development of a uveal effusion related to systemic tuberculosis caused anterior rotation of the iris-lens diaphragm, thereby inducing narrowing of the angle and acute myopia.</p

The contribution of female community health volunteers (FCHVs) to maternity care in Nepal: a qualitative study.

BACKGROUND: In resource-poor settings, the provision of basic maternity care within health centres is often a challenge. Despite the difficulties, Nepal reduced its maternal mortality ratio by 80% from 850 to an estimated 170 per 100,000 live births between 1991 and 2011 to achieve Millennium Development Goal Five. One group that has been credited for this is community health workers, known as Female Community Health Volunteers (FCHVs), who form an integral part of the government healthcare system. This qualitative study explores the role of FCHVs in maternal healthcare provision in two regions: the Hill and Terai. METHODS: Between May 2014 and September 2014, 20 FCHVs, 11 health workers and 26 service users were purposefully selected and interviewed using semi-structured topic guides. In addition, four focus group discussions were held with 19 FCHVs. Data were analysed using thematic analysis. RESULTS: All study participants acknowledged the contribution of FCHVs in maternity care. All FCHVs reported that they shared key health messages through regularly held mothers' group meetings and referred women for health checks. The main difference between the two study regions was the support available to FCHVs from the local health centres. With regular training and access to medical supplies, FCHVs in the hill villages reported activities such as assisting with childbirth, distributing medicines and administering pregnancy tests. They also reported use of innovative approaches to educate mothers. Such activities were not reported in Terai. In both regions, a lack of monetary incentives was reported as a major challenge for already overburdened volunteers followed by a lack of education for FCHVs. CONCLUSIONS: Our findings suggest that the role of FCHVs varies according to the context in which they work. FCHVs, supported by government health centres with emphasis on the use of local approaches, have the potential to deliver basic maternity care and promote health-seeking behaviour so that serious delays in receiving healthcare can be minimised. However, FCHVs need to be reimbursed and provided with educational training to ensure that they can work effectively. The study underlines the relevance of community health workers in resource-poor settings

Migration as adaptation to freshwater and inland hydroclimatic changes? A meta-review of existing evidence

Due to its potential geo-political and environmental implications, climate migration is an increasing concern to the international community. However, while there is considerable attention devoted to migration in response to sea-level rise, there is a limited understanding of human mobility due to freshwater and inland hydroclimatic changes. Hence, the aim of this paper is to examine the existing evidence on migration as an adaptation strategy due to freshwater and inland hydroclimatic changes. A meta-review of papers published between 2014 and 2019 yielded 67 publications, the majority of which focus on a handful of countries in the Global South. Droughts, floods, extreme heat, and changes in seasonal precipitation patterns were singled out as the most common hazards triggering migration. Importantly, most of the papers discuss mobility as part of a portfolio of responses. Motivations to migrate at the household level range from survival to searching for better economic opportunities. The outcomes of migration are mixed — spanning from higher incomes to difficulties in finding employment after moving and struggles with a higher cost of living. While remittances can be beneficial, migration does not always have a positive outcome for those who are left behind. Furthermore, this meta-review shows that migration, even when desired, is not an option for some of the most vulnerable households. These multifaceted results suggest that, while climate mobility is certainly happening due to freshwater and inland hydroclimatic changes, studies reviewing it are limited and substantial gaps remain in terms of geographical coverage, implementation assessments, and outcomes evaluation. We argue that these gaps need to be filled to inform climate and migration policies that increasingly need to be intertwined rather than shaped in isolation from each other