Commercial self-retaining perineal retractors provide excellent exposure during anorectal and vaginal surgery but remain prohibitively expensive for many resource-limited hospitals. We designed an indigenous self-retaining perineal retractor using readily available materials, incorporating a re-usable stainless-steel ring, modified barbless fishing hooks, disposable Foley catheter traction strings and a novel self-locking slot mechanism. The device was prospectively evaluated in three patients undergoing colorectal and gynecological procedures. It provided stable self-retaining circumferential exposure, facilitated precise dissection and suturing and was not associated with device-related complications. Costing approximately US$10, this reusable system offers an affordable, versatile alternative for perineal surgery in low-resource settings.
Academic equity has become a dominant theme in global health and research discourse, yet meaningful structural change often lags behind increasingly sophisticated rhetoric. Through satire, this commentary examines the gap between declarations of commitment and everyday academic practice, illustrating how institutions can enthusiastically champion equity while preserving existing hierarchies of power, authorship, funding, and decision-making. By exaggerating familiar behaviours into "Ten Commandments of Academic Equity Theatre," the article invites readers to reflect on performative inclusiveness and asks whether academia is prepared to move beyond measuring, discussing, and celebrating equity to genuinely sharing it.
The 2025 neonatal resuscitation guidelines, developed jointly by the American Heart Association and the American Academy of Pediatrics, provide evidence-based recommendations for the most crucial actions during delivery and throughout the neonatal period. Ventilation remains the cornerstone of resuscitation, starting with ventilation rates of 30-60/ min, ≥ 30% oxygen for very preterm infants (<32 weeks), guided by pulse oximetry and electrocardiography monitoring to avoid hyperoxia. Deferred cord clamping (≥60 sec), strict thermal regulation and skin-to-skin contact are strongly encouraged. Laryngeal mask airways can be used as an alternate device in failed bag-mask ventilation in term infants. The 2025 guidelines shift neonatal resuscitation from an algorithmic event to a continuum of care, emphasizing system readiness, team integration, precise physiological targets and structured recovery - while maintaining core resuscitation principles established in 2015.
Traditionally, tropical medicine has been concerned with infectious diseases in terms of diagnosis, treatment, prevention, and control. But there is a growing dual burden of communicable and non-communicable diseases in many low- and middle-income countries due to commercial determinants of health (CDoH). The marketing and availability of tobacco, alcohol, sugared drinks, and ultra-processed foods impact on health behaviour and lead to obesity, diabetes, heart disease, cancer, and poor infection outcomes. Hence, tropical medicine needs to move beyond the clinical realm to include consideration of the commercial context of disease. This requires healthcare practitioners, universities, scientific societies, and medical publications to promote informed regulation of commercial determinants, healthy food environments, taxation policy, health literacy, and protection from harmful commercial activity. It is vital that CDoH be incorporated into research, teaching and health promotion activities as an integral part of the preventive mandate of tropical medicine.
One-fifth of rabies cases may present with features of acute-onset flaccid paralysis, which mimic Guillain-Barré syndrome (GBS). Diagnosing paralytic rabies is challenging as the hallmark features such as aerophobia or hydrophobia tend to be absent in almost half of cases.
Testicular torsion causes a compartment syndrome physiology in which detorsion alone may fail to restore perfusion because intratesticular pressure remains elevated after untwisting. This report describes a simple intraoperative adjunct practised by the author in a district hospital setting in Zambia: multiple needle punctures of the tunica albuginea immediately after detorsion, without formal fasciotomy or tunica vaginalis flap. The technique decompresses the intratesticular compartment, releases congested venous blood and allows clinical grading of testicular viability by the colour and speed of bleeding from the puncture sites. It requires no equipment beyond a standard needle, adds less than two minutes to the procedure and avoids the complexity of formal fasciotomy. The colour grading system derived from needle puncture response is described, and the physiological basis of the technique is outlined. Prospective documentation is encouraged.
Alcohol use contributes substantially to global morbidity and mortality, necessitating reliable biomarkers for detection and monitoring. Existing biomarkers, including indirect markers and direct markers, have important limitations related to specificity, sensitivity and temporal detection windows. As a biomarker, creatine kinase (CK) demonstrates strong biological plausibility, as alcohol exerts direct and indirect myotoxic effects through oxidative stress, impaired protein synthesis and metabolic disruption, leading to muscle injury and enzyme leakage. However, its diagnostic specificity is also limited, as CK elevation can result from multiple non-alcohol-related conditions, including trauma, seizures and metabolic disturbances. Despite these limitations, CK shows clinical utility in identifying complications such as rhabdomyolysis, severe withdrawal states and risk of acute kidney injury. It correlates with withdrawal severity and may aid in risk stratification. Overall, CK is best positioned as a supplementary biomarker reflecting alcohol-related complications rather than a primary indicator of alcohol consumption.
Acute febrile illnesses in pregnant women living in sanitation-compromised regions of the Global South present overlapping symptoms of dengue, typhoid, and malaria, frequently causing severe maternal anemia, thrombocytopenia, and pregnancy loss. Peripheral frontline clinics often default to toxic, multi-class antimicrobial over-prescriptions owing to the absence of rapid differential tools. A streamlined syndromic triage framework is vital to rationalize care and improve outcomes.
Behçet's disease (BD) is a multi-system inflammatory disorder characterised by recurrent oral, genital or ocular inflammation, and may present with variable-vessel vasculitis.1 It has a distinctive geographic distribution, with the highest prevalence along the historic Silk Road, particularly in Turkey and Iran.2- 4 In contrast, BD is considered rare in India, with limited epidemiological data and predominantly hospital-based series.5, 6 Although recurrent oral ulcers are nearly universal, systemic manifestations, including ocular, vascular, neurological and gastrointestinal involvement, vary across regions.2, 3 Fever is not a classic presenting symptom in mucocutaneous disease, but may occur in vascular or neuro-Behçet's, where it reflects heightened systemic inflammatory activity.7 Consequently, BD may masquerade as a prolonged febrile illness, particularly before characteristic features emerge. Atypical presentations may delay diagnosis, particularly in low-prevalence regions.
Respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm neonates. Aerosolized (nebulized) surfactant offers a non-invasive safe alternative. However, its safety, feasibility, and clinical effectiveness in low-resource settings remain under-investigated. Fifteen inborn preterm neonates ≥ 28 weeks of gestation with RDS requiring FiO2 >30% on NIPPV were administered Neosurf surfactant via aerogen vibrating mesh nebulizer. Each enrolled neonate was matched to three historical controls (n = 45) who received surfactant via INSURE. The primary outcome was the need for repeat surfactant dosing within 72 hours. Repeat surfactant dosing was required in 13.3% (2/15) of the nebulized group vs. 11.1% (5/45) of controls (p = 0.08). Nebulized surfactant delivery using a vibrating mesh nebulizer is safe, well tolerated, and feasible in preterm neonates ≥28 weeks gestation with RDS on non-invasive ventilation. Larger randomized controlled trials are warranted to confirm efficacy and optimize delivery strategies.
