Diagnostic accuracy of Typhidot in patients of Typhoid Fever

Objective: To assess the diagnostic accuracy of Typhidot test in patients with acute febrile illness taking blood culture as gold standard

Study Design: Cross-sectional validation study

Place and Duration of Study: The study was conducted at Combined Military Hospital Kohat, from Mar 2016 to Oct 2016

Material and Methods: In this study 211 patients with acute febrile illness were included. All patients had Typhidot IgM test done along with blood cultures, blood counts, chemistries and relevant diagnostic tests. Patients were divided into two groups based on blood culture results and both groups were compared in terms of positivity for Typhidot. Sensitivity, specificity, positive predictive value and negative predictive value were calculated using SPSS v 20. Chi square was applied to assess the association between Typhidot and blood culture results

Results: Out of total 211patients, 49 patients had typhoid fever [culture positive] and 162 had non-typhoidal illnesses [culture negative]. Typhidot IgM was positive in 47 [95.9percent] cases of typhoid fever and in 155 [73.5percent] cases of non-typhoidal fevers. The sensitivity of Typhidot for diagnosis of typhoid fever was 95.9percent and specificity was 26.5percent

Conclusion: Our study reveals that Typhidot IgM has high sensitivity for typhoid fever but specificity and diagnostic accuracy are very low. Nevertheless, a high negative predictive value means it can help rule out the disease in suspected cases

High altitude illness: experience of one year

Objectives of this study was to analyze symptoms of altitude illness commonly necessitating evacuation of patients from high altitude to the base hospitals in Siachin area by simple clinical screening. This was a prospective observational. Place and duration of study was Northern areas of Pakistan. This study was carried out at altitudes of 3633 meters [GOMA] and 2833 meters [Siksa] from Oct 2003 till Oct 2004. One hundred and thirty eight patients of altitude illness were studied, who were evacuated from altitude above 4000 meters. Out of 138 cases, 103 [74.6%] patients suffered from acute mountain sickness [AMS], while 21[15.2%] patients developed high altitude pulmonary edema [HAPE] and 14 [10.1%] patients developed high altitude cerebral edema [HACE], of which 3 patients were having concomitant HAPE. The most common symptom combination was headache and vomiting which was the presenting feature in 53[38.4%] patients, followed by headache, loss of appetite and insomnia, in 41[29.7] patients. Headache was the most common single symptom present in about 120[86.96%] patients that required evacuation. The next common symptom was vomiting that was found in 51[36.96%] patients while shortness of breath was present in 33[23.91%] patients. We conclude that headache is the most common presenting symptom in all the patients of AMS. Therefore, headache at high altitude should be taken seriously, if does not respond to common medication, then patient should be evacuated to a lower altitude. The incidence of AMS, HAPE, and HACE may be reduced by improving the physical fitness of mountaineers and observing the protocol of acclimatization