Distal Femoral Oblique Fracture in a Young Male Soldier: Case Report of an Unusual Presentation.

Here, we report a case of a distal femoral fracture in a 23-year-old male army cadet who presented to the Accident and Emergency department following a twisting injury while participating in a routine military marching exercise. A pathological fracture was considered but this suspicion was put to rest following thorough investigations, leaving only a diagnosis of a nontraumatic spontaneous femoral fracture.To our knowledge, there have been no reported cases of distal femoral fractures associated with nontraumatic military exercises, with the majority of injuries instead related to stress fractures. A vigilant literature search yielded no cases of similar injury nature, which is the primary reason we believe that those interested in orthopaedics or military doctors would find themselves drawn to this case.The patient presented with severe pain in his left thigh and on examination there was a deformity of his left thigh.In terms of investigations, a bone profile, plain film radiographs, C-reactive protein, erythrocyte sedimentation rate, and tumor markers were all preformed and proved unremarkable. The definitive treatment was by open reduction and internal fixation.Femoral fractures often require significant amounts of force, particularly in young, healthy individuals. Generally, these injuries in this demographic follow high-energy traumas, with the lion's share occurring following a road traffic accident or other high-speed impact. More often than not, the treatment is surgical. Given the extraordinary manner of this such, one must be attentive and exhaustive in their investigation of such presentations.

Introductory evaluation of an oral, killed whole cell enterotoxigenic Escherichia coli plus cholera toxin B subunit vaccine in Egyptian infants.

BACKGROUND: We conducted the first trial to assess the safety and immunogenicity of an oral, killed enterotoxigenic Escherichia coli plus cholera toxin B-subunit vaccine in children <2 years old. METHODS: Three doses of vaccine or killed E. coli K-12 control were given at 2-week intervals to 64 Egyptian infants, 6 to 18 months old, in a randomized, double blind manner. Adverse events were monitored for 3 days after each dose. Blood was collected before immunization and 7 to 10 days after each dose to assess vaccine-specific serologic responses. RESULTS: There was no statistically significant intergroup difference in the percentage of subjects reporting the primary safety endpoint (diarrhea or vomiting) after the first (31%, vaccine; 30%, control) or third (14%, vaccine; 18%, control) dose, whereas there was a trend toward greater reporting in the vaccine group after Dose 2 (36%, vaccine; 18%, control; P = 0.052). The percentage of children showing IgA seroconversion after any dose was higher in the vaccine than the control group for recombinant cholera toxin B-subunit (97% vs. 46%), colonization factor antigen I (61% vs. 18%) and coli surface antigen 4 (39% vs. 4%) (P < 0.001 for each comparison). IgG seroconversion rates in the vaccine and control groups were 97 and 21% to recombinant cholera toxin B-subunit (P < 0.001), 64 and 29% for colonization factor antigen I (P < 0.01), 53 and 21% for coli surface antigen 2 (P < 0.05) and 58 and 4% for coli surface antigen 4 (P < 0.001), respectively. The third vaccine dose was followed by augmented IgG antitoxin titers. CONCLUSION: The oral enterotoxigenic E. coli vaccine was safe and immunogenic in this setting in Egyptian infants.