Typhidot IgM as a reliable and rapid diagnostic test for typhoid fever among children in a tertiary care hospital

Background: Typhoid fever still continues to be a major public health problem in Nepal. A clinical spectrum of typhoid varies widely. It causes significant complication as well as mortality. A simple, reliable, affordable and rapid diagnostic test has been a long felt need of the clinicians to prescribe specific medication, adopt prevention of the emergence of antibiotics resistance and overall reduce the disease burden in the community.Methods: The prospective descriptive study was performed in 125 children between 2 years to 15 years of age admitted to the Pediatrics Department from September 2017 to September 2018. Blood culture, Typhidot rapid IgM were performed. MEDCALC software was used to calculate 95% confidence interval for sensitivity, specificity, predictive value positive, predictive value negative and accuracy. Kappa test was used to determine the agreement between Typhidot IgM and blood culture methods.Results: The study consisted of 125 children with acute febrile illness for more than 3 days with clinical symptomatology, consistent with typhoid fever. The reliability of Typhidot IgM in relation with blood culture and the study lighten that sensitivity 92.3% (95% CI: 63.9, 99.8), specificity 49.1% (95% CI: 39.5, 58.7), PPV 17.4% (95% CI: 14.2, 21.1), NPV 98.2% (95% CI: 89.2, 99.7) and accuracy 53.6% (95% CI: 44.5, 62.6). The two methods i.e. Typhoid IgM and blood culture shows significant agreement with p value 0.004.Conclusions: The present study demonstrates that Typhidot IgM has all the attributes of an ideal screening test.

Short term outcome of open reduction and internal fixation with plating in displaced intra articular calcaneal fractures

Background: Calcaneum fractures constitute the majority of the tarsal bone fractures worldwide. There is no gold standard consensus as of now for the management of the displaced intra articular calcaneal fractures. Open reduction and internal fixation with plating is one of the management options available.Methods: Authors studied the results of open reduction and internal fixation with plating in 22 calcaneal fractures in a study with a minimum follow up of 6 months. Outcome was studied using Maryland foot score.Results: Authors observed excellent results in 5 patients (22.72%), good results in 12 patients (54.54%), fair results in 4 patients (18.18%) and poor result in 1 patient (04.54%). Authors encountered wound infection in 1 patient (4.54%), heel varus in 1 patient (4.54%), heel broadening in 1 patient (4.54%), reduced range of motion at ankle in 2 patients (9.9%) and persistent heel pain in 1 patient (4.54%).Conclusions: Open Reduction and Internal Fixation (ORIF) with calcaneum plating, through an extensive lateral approach, for displaced intra articular fractures of the calcaneum is an effective treatment modality with very good results in experienced hands.

Diagnostic Value of Median Sensory-Ulnar Motor Latency Difference in Mild Carpal Tunnel Syndrome and it’s Comparison with Difference in Sensory and Motor Latencies of Median and Ulnar Nerves

Introduction: Diagnosis of carpal tunnel syndrome (CTS)is based on clinical symptoms, examination findings, andelectrodiagnostic studies. Recent studies have shown theefficacy of median sensory-ulnar motor latency differencewas devised as another way to improve diagnostic accuracyfor mild carpal tunnel syndrome. Current research aimed tostudy diagnostic value of Median sensory ulnar motor latencydifference (MSUMLD) in mild carpal tunnel syndromeand compare it with median-ulnar (MU) sensory and motorlatency differences.Material and methods: 100 hands of CTS were studied andafter a detailed history and physical examination, routine testsand nerve conduction study was done .In mild CTS cases notdetected by routine NCS, MSUMLD was calculated and itssensitivity was compared with MU sensory and motor latencydifference.Results: It was found that Median Ulnar sensory latencydifference had the highest sensitivity.Conclusion: MSUMLD can be added as a new diagnosticparameter in detecting mild CTS with no additional testingalthough it’s sensitivity is less than Median-Ulnar sensorylatency difference

Femoral Neck Fatigue Fracture as the First Manifestation of Celiac Disease: A Case Report.

Young individuals with fatigue fractures are often a result of the repetitive athletic activity. Military recruits, distance runners, and dancers are commonly affected and are at an increased risk of developing stress fractures in the hip. We report a case of fatigue fracture of the femoral neck in a 20-year-old software professional as the first presentation of celiac disease. The skeletal manifestation of celiac disease is rare (0.6%). The case was managed with in situ fixation with cannulated screws and gluten free diet. The patient was pain free with no evidence of osteonecrosis, nonunion, or any other complication at 1-year follow-up.

Operative Management of Metacarpal and Phalangeal Fractures.

Fractures of metacarpals and phalanges are probably the most common fractures in the skeletal system and are often neglected as minor injuries. Most of the fractures are treated conservatively but some form of fixation is often indicated in unstable fractures, intra-articular fractures, open fractures and multiple fractures. Various implants ranging from K-wires to mini-plates are used. A retrospective analysis of 50 cases of metacarpal and phalangeal fractures treated by different methods over a period of one year was undertaken. The study showed that right hand was more commonly involved. Most common mechanism of injury was fall and second ray was most commonly involved. Most common fracture pattern was transverse and K-wires were frequently used as mode of fixation followed by mini-plates. The patients were followed up at regular intervals and union was achieved in 98% of fractures. From our study we would emphasize that operative management of metacarpal and phalangeal fractures has definitely an advantage over the closed methods of treatment especially in displaced, unstable, comminuted, intraarticular, open and multiple fractures. Operative management of hand fractures should be undertaken only if a definite indication exists. Indiscriminate use of it should be avoided. The operative management of metacarpal and phalangeal fractures results in accurate reduction of the fracture and joints should be mobilised early following fixation to prevent stiffness of the fingers and regain the desired range of motion at the joint.