The effect of lemon slices, as well as ascorbic and citric acid impregnated paper discs, on the growth of ten non-typhoidal Salmonella, six Citrobacter freundii and four Proteus mirabilis species on Desoxycholate Hydrogen Sulfide Lactose (DHL) agar were examined in comparison to controls without fruit slices or paper discs applied. After 24 h incubation, thick black rings were observed around fruit slices and impregnated discs growing on non-typhoidal Salmonella serovars and not around the other species. We named this the “MY Phenomenon”. We propose that the phenomenon can be used as a rapid, simple and inexpensive screening test that distinguishes non-typhoidal Salmonella species from other enterobacteriaceae in stool samples.

Tuberculosis (TB) is an infectious disease commonly found in both developing and developed countries. Tuberculosis meningitis (TBM) is a serious central nervous system infection with a high mortality rate despite anti-TB drug treatment and is associated with HIV/AIDS. The diagnosis of TBM is difficult since the clinical aspects of the disease are similar to other central nervous system infections, examination for AFB in cerebrospinal fluid (CSF) stained with Ziehl-Neelsen is not sensitive and culture of Mycobacterium tuberculosis from CSF takes too long to influence initial therapy. Delayed diagnosis and treatment of TBM results in high mortality and disability. We report a Lao patient who had pulmonary TB in combination with TBM (confirmed by positive AFB in a sputum examination and a positive culture of Mycobacterium tuberculosis in the CSF) whose diagnosis and treatment were delayed resulting in serious nervous system sequelae and disability which may not be easily reversible. We discuss TBM diagnosis and use of simple clinical and laboratory features and suggest a low threshold for empirical treatment with anti-TB drug in case of suspected TBM.

Serological diagnoses for infectious diseases such as those based on disease¬specific IgM antibody detection often confuse clinicians and therefore make treatment decisions difficult. This is due to the relatively long persistence of IgM in the blood circulation following exposure to the organism or nonspecific polyclonal activation of memory cells. We report a Lao patient diagnosed as having scrub typhus on admission based on detection of IgM to Orientia tsutsugamushi and initially treated with Doxycycline. The patient became afebrile but had severe pulmonary involvement. The blood culture was subsequently positive for Leptospira spp. which is the cause of leptospirosis. The admission blood sample of the patient was negative for Orientia tsutsugamushi, Rickettsia typhi, and Rickettsia spp. DNA targets, by PCR, suggesting that the patient did not have scrub typhus, murine typhus or Spotted Fever. After one week of IV ceftriaxone treatment, the patient improved and was discharged well. The positive IgM to scrub typhus detected on admission was probably due to previous exposure to O. tsutusgamushi, and scrub typhus was not the cause of her presenting illness. Fortunately, Doxycycline, given to the patient for scrub typhus treatment, is also effective for leptospirosis preventing death. However, the patient required intravenous ceftriaxone (which would not have been effective for scrub typhus) when she developed severe disease. This patient’s illness is a reminder that clinicians should be cautious about serological diagnosis. At present, laboratory diagnosis of leptospirosis remains a big challenge for the clinicians because the existing gold standard test such as Microscopic Agglutination Test (MAT) and culture are labour intensive, expensive and seldom available. Until the development of the simple, rapid, and more reliable tests, the empirical treatment of patients with suspected leptospirosis with doxycycline, penicillins or ceftriaxone are strategies to reduce severe complications and death although it should be born in mind that penicillins and ceftriaxone will not be effective against rickettsial organisms.

Objectives: The mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our studygives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana. Patients and Methods: This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries. Results: A total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the lead-ing cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and indus-trial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) oc-curred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation. Conclusion Closed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, es-pecially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.

Poor quality medicines have been described as a global pandemic that threatens the lives of millions of people. The problem is much more severe in poor-resource countries where pharmaceutical legislation and regulation are limited. Poor quality medicines are divided into three categories: substandard, degraded and falsified and the countermeasures vary according to each category. The use of poor quality medicine leads from minimal to severe complications (including death) for the individuals but also harms the community. Furthermore, they lead to a loss of confidence of the patients in essential medicines, in manufacturers and in health system and they increase the work burden for health workers, customs and police. To detect them, different techniques have been developed, each with advantages and limits. This article describes these aspects of poor quality medicines and also presents the factors that contribute to the existence and spread of poor quality medicines. A section of the article is devoted to the issue of poor quality medicine in Laos.

Diagnosis of infective endocarditis is challenging as the clinical diversity of the disease sometimes misleads clinicians in the recognition, correct diagnosis and rapid treatment, which are important to reduce the morbidity and mortality associated with this disease. We report the case of a 14-year-old girl who presented with left axillary pain and fever. She was eventually diagnosed with infective endocarditis caused by Abiotropia defectiva, complicated by a large saccular aneurysm of the left axillary artery.