Sensitivity and Specificity of Bedside Qualitative Troponin I Test Kit as Compared with the Standardized Quantitative Lab Test for Troponin I.

Background and objective Myocardial infarction (MI) is the leading cause of mortality and morbidity worldwide. Early diagnosis of MI remains the mainstay of prompt treatment. Thus, the shorter the door-to-needle time, the more efficient is the emergency department (ED) to cope with a heart attack emergency. To improve the diagnosis of MI, this study aimed to determine the sensitivity and specificity of (qualitative) troponin I kit against the quantitative lab test for troponin I. Materials and methods Patients of both genders admitted at the Karachi Institute of Heart Diseases with acute coronary syndrome (ACS)/non-ST-elevation myocardial infarction (NSTEMI) were administered a standardized questionnaire. Quantitative analysis of troponin I was carried out by the hospital laboratory. The sample was simultaneously used for qualitative analysis of troponin I using the troponin I test kit. Results We recruited 200 patients comprising 134 (67%) males and 66 (33%) females. In total, 130 (65%) were hypertensive, 64 (32%) had dyslipidemia, 56 (28%) presented with a family history of MI, 60 (30%) had diabetes mellitus, 56 (28%) were smokers, and 24 (12%) presented with a previous history of MI. The kit showed 98% sensitivity and 100% specificity as compared to the quantitative test with a cutoff of 0.30 ng/dl, i.e., the quantitative test showed 128 positive and 72 negative cases, whereas the qualitative test showed 125 positive and 75 negative cases. The differences in test results were on values of 0.39, 0.40, and 0.42 ng/dl, as the qualitative test showed negative results. Conclusion This study showed that the qualitative kit is highly sensitive and specific at higher values of troponin I, i.e., ≥ 0.5 ng/dl. The qualitative test could be very beneficial in cost and time savings for the non-conclusive patients, like NSTEMI and ACS in the ED, and patients coming to the outreach chest pain centres where laboratory services are not adequate and whose Trop I values are not very close to the minimum cutoff values.

Ten Year Review of Pulmonary Nocardiosis: A Series of 55 Cases.

Introduction Nocardiosis is a rare opportunistic bacterial infection usually seen in immunosuppressed patients. It is caused by gram-positive, aerobic actinomycetes of the Nocardia genus. The most common site of infection is lungs; but it may affect other organs or even disseminate into blood. Methods In this a 10-year retrospective review, all diagnosed cases of Pulmonary Nocardiosis in a tertiary care hospital were included. The clinical and radiological characteristics, course of complications and lifesaving interventions, and disease outcome were evaluated. Results Among the 55 identified cases, most common risk factor was chronic steroid therapy (n=38; 69.1%). Among respiratory diseases, chronic obstructive pulmonary disease (n=13; 23.6%) and tuberculosis (n=12; 21.8%) were the most common. On chest radiograph, pleural effusion (n=23; 41.8%) and consolidation (n=22; 40.0%) were the common findings. Complications were observed in 32 (58.2%) patients with septicemia and respiratory failure being the most common (n=15; 46.8% in each). Dissemination occurred in 10 (31.2%) patients. The mortality rate of Nocardia is 34.5% (n=19). Conclusion The disease burden of Nocardia is underestimated by clinicians and researchers. Pulmonary Nocardia should always be a differential diagnosis of signs of lower respiratory tract infection and must be excluded in patients not responding to treatment of chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis. Early recognition and individualized management plan can ensure successful recovery.

Richter's Hernia Presenting As Faecal Fistula In Female; A Rare Entity.

Strangulated hernia in quite common in surgical practice and always present with its typical symptoms. In this hardly found unique case, a 76-year's old female with no co morbid presented to us with abdominal pain, vomiting and diarrhoea initially and later developed left groin abscess after 4 days of swelling. It was assumed to be inguinal lymphadenitis leading to abscess formation but after complete evaluation on digital examination, diagnosis of Strangulated Femoral hernia of Richter type was made. This distinguishing presentation among the list of all hernias has to be discussed for the differential diagnosis.

AUTOIMMUNE HYPOTHYROIDISM IN PATIENT WITH NEUROFIBROMATOSIS-1.

A 53 year old woman, diagnosed with Neurofibromatosis I with multiple neurfibromas over trunk, upper limb & lower limb, she had café au lait spots on her abdomen skin. She was admitted to the tertiary care setup with the complains of cold intolerance, numbness in the limbs, high blood pressure & constipation, patient also had complain of weight gain, lab revealed high TSH, low Free thyroid hormones & positive anti thyroglobulin antibodies. Case was diagnosed with autoimmune hypothyroidism. This is the first case reported with such association of these two diseases.

Multiple Enteroenteric Fistulas- Crohn's Disease- A Case Report.

Crohn's disease is a type of chronic inflammatory bowel disease (IBD) of unknown etiology that may affect any part of the gastrointestinal tract from mouth to anus and shows extra-intestinal involvement. It characteristically shows skip lesions. This case report reported in 2014 describes a middle age Pakistani male known to have documented evidence of significant crohn's disease since past 18 years. He was diagnosed with multiple fistulas that are a rare entity of patients with crohn's disease, which is itself a rare disease in Asian countries.