Pulled/nursemaid’s elbow

Nursemaid’s elbow is a radial head subluxation caused by axial traction on the extended arm while the forearm is pronated, allowing for slippage of the radial head. A 2-year-old boy presented with pain, swelling and reduced range of movement of the right elbow for 4 days. The mother noted that the child was moving the right upper limb less often and there was tenderness over the right elbow. X-ray of the right elbow showed subluxation of the elbow joint with no obvious fracture. A trial of conservative management was decided upon and the patient was placed on a right elbow backslab with the right forearm in a supine position. On follow-up, there was no swelling, tenderness or neurological deficit noted. A repeate x-ray revealed normal findings.

Chronic heel pain: It could be tuberculosis

: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions—if undetected early—may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities.

Potassium hydroxide mount versus culture in onychomycosis

In this work, 140 patients [84 males and 56 females] provisionally diagnosed as onychomycosis were examined mycologically using potassium hydroxide [KOH] mount and two culture media [one with cyclohexamide and the other without it]. Clinically, fingernails were affected more than the toenails. Mycologically, KOH mount was positive in 112 cases. Eighty-one cases were positive for hyphae and /or arthrospores and 31 were positive for yeast. On the Sabouraud's media with cyclohexamide, 62 cases were positive for dermatophytes, while on the culture without cyclohexamide, 29 cases were positive for non- dermatophyte species. The total positive cultures were 91 cases and the isolated organisms were T. rubrum, 59 cases; C. albicans, 27 cases; E. floccosum, three cases and Scopulariopsis brevicaulis, two cues. Cyclohexamide-containing media allowed only the dermatophytes to grow including E. floccosum. However, the growth of E. floccosum was slower in rate and lesser in size than its growth on culture without cyclohexamide