Background: Dengue infection occurs among more than 50 million annually. In India, the case fatality rate is up to 3-5%. Early diagnosis is crucial to the clinical care. However the currently recommended diagnostic tests by WHO is costly, time consuming, labor and technologically demanding which may not be available in the resource limited set up where the large burden of dengue related illness occur.This study evaluated the role of immunochromatographic method based rapid diagnostic test kits (RDT) and costeffectiveness for the diagnosis of acute dengue infection.Methods & Materials: 281 adult patients presenting to Christian Medical College, Vellore, India with community acquired acute febrile illness between September 2012 to February 2013 were recruited for the study. The patients with other proven etiology were used as negative control. 132 cases of dengue and 149 cases of non-dengue infection were enrolled. The RDTs tested from 4 manufacturers were Panbio, SD, J.Mitra and Reckon. SPSS version 16.0.1 was used for statistical analysis.Results: Performance of the RDTs based on IgM: The sensitivity, specificity, PPV and NPV of Panbio, SD, Reckon and J.Mitra. The inter-rater kappa agreement between Panbio with SD duo of 0.54 was found to be moderate. Performance of the RDTs based on NS1 detection:The sensitivity, specificity, PPV and NPV of the SD, Reckon, and J.Mitra. The inter-rater kappa agreement between SD with Reckon of 0.79 was found to be best and substantial.Combination of RDTs: the best sensitivity of 99.2% was achieved by testing Panbio and SD in parallel. The best specificity of 99.9% and 100% respectively was obtained when Reckon with Panbio or SD was performed in series.None of the RDTs could not adequately differentiate between acute primary and secondary dengue. Conclusion:In the region of high dengue endemicity, Panbio RDT alone is highly sensitive, cost effective (∼13.6 USD), easier to perform and shorter turnover time makes it a test of choice in resource limited set up during an outbreak season.
Rectal duplication cysts are rare congenital anomalies of the gastrointestinal tract. They can present with pain, gastrointestinal bleeding, infection or compressive symptoms on the rectum and urinary bladder. A 79-year-old man presented with a 8×5 cm swelling in the sacral region above the natal cleft with a positive cough impulse. During surgical exploration, there were two cysts with the posterior one presenting as the hernia. The cyst was excised and histopathological examination confirmed a diagnosis of rectal duplication cyst. Rectal duplications can lie anterior or more commonly posterior to the rectum. Differential diagnoses include dermoid cyst, diverticular cyst, sacrococcygeal teratoma or meningocele and endoscopic ultrasound is imaging of choice for diagnosis. Surgical excision is the treatment of choice. This is a rare presentation of a rectal duplication cyst as a perineal hernia with only a handful of cases in literature.
Gastrointestinal stromal tumors (GISTs) are a rare variety of tumors of mesenchymal origin found in the gastrointestinal (GI) tract forming about 1% of all GI tumors. These originate from the interstitial cells of Cajal. Small bowel GISTs have been shown to present as obscure GI bleeding, obstruction and perforation in literature. We report a 57 years old female patient presenting with pain abdomen, fever and vomiting and palpable right iliac fossa (RIF) mass diagnosed as an appendicular mass and managed conservatively. She was planned interval appendicectomy and was discovered to have a jejunal GIST at laparotomy treated with resection and anastomosis. There are case reports of small bowel GISTs presenting as sources of obscure or overt GI bleeding and luminal or extra luminal mass causing small bowel obstruction. Surgery is mainstay of treatment with imatinib for adjuvant or neoadjuvant therapy. This case highlights an unusual presentation of a jejunal GIST with a sealed off perforation mimicking an appendicular mass in the RIF treated by surgical resection followed by adjuvant Imatinib therapy. GIST being an uncommon tumor with varied presentations can lead to misdiagnosis and delays in treatment. This differential should be kept in mind while evaluating small bowel pathologies to aid a timely diagnosis.
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