Primary hyperparathyroidism (PHPT) is common among adults. However, its incidence is rare among children associated invariably with delay in diagnosis. In children, it is caused by hyperplasia, adenoma or related hereditary disorders. Herein, a 17-year male with PHPT presented with rare skeletal manifestations of genu valgum and bilateral epiphyseal displacement of femur. Investigations done three years ago reported hypocalcemia and vitamin-D deficiency. He was diagnosed with rickets and received plenty of calcium and vitamin D supplements. Due to lack of clinical improvement following the supplementation, re-evaluation revealed hypercalcemia, elevated vitamin D levels and elevated parathyroid hormone (PTH). A 99mTc-sestamibi scan reported increased uptake in the left inferior lobe of the thyroid gland. Surgical removal of the parathyroid gland was done and histopathology revealed parathyroid adenoma. Rickets in the setting of PHPT can masquerade as PHPT. In a patient with rickets, hypercalcemia at presentation or following the calcium and vitamin supplementations, should warn the physicians to rule out PHPT.
Objective: To determine and compare the performance of TUBEX® TF, widal test & blood culture in the diagnosis of enteric fever.
Methods: After approving with the ethical committee, we retrospectively identified patients presented with fever at Northwest General Hospital and Research Centre. Typhidot, Widal test and blood culture was performed as part of their evaluation from January 2018 to December 2018. SPSS 16 was used for data analysis.
Results: Of the 241 patients, blood culture was positive for salmonella in 68(28.21%) and negative in 173(71.79%). In the culture positive group, TUBEX® TF was positive in 29(42.64%) and negative in 39(57.36%). Of these culture positive patients, Widal was positive in 25(36.76%) and negative in 43(63.24%). In patients with negative culture, TUBEX® TF was positive in 58(37.66%) and negative in 96(62.34%), Widal was positive in 77(44.5%) and negative in 96(55.5%). The positive predictive value of TUBEX® TF was 33.33% and the negative predictive value was 71.77%. The sensitivity of TUBEX® TF was 42.65% while specificity was 62.34%. The positive predictive value of Widal was 24.51% and the negative predictive value was 69.06%. The sensitivity of Widal was 36.76% while specificity was 55.49%.
Conclusion: Sensitivity, specificity, positive predictive value and negative predictive value of TUBEX® TF and Widal test is very low as compared to blood culture.
Keywords: Enteric Fever, TUBEX® TF, Widal, Continuous...
Reversible posterior encephalopathy syndrome is a clinic radiologic entity characterized by headaches, altered mental status, seizures, and visual loss and is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain. We herein, present a rare complication of mixed connective tissue disease. A 12-year old boy presented with generalized tonic clonic fits, aphasia, fever and generalized body swelling since 2 weeks. His labs showed hypercholestremia, hypoalbuminemia and massive proteinuria. Renal biopsy revealed secondary membranous glomerulopathyand and he developed posterior reversible encephalopathy syndrome. His anti RNP and anti-smooth muscle came back positive. Evaluation by magnetic resonance scan of the brain showed that the child had hyper intense signal in the parieto-occipital regions. All signs of PRES started resolving after seven days of supportive treatment evidenced by subsequent radiological evaluation. PRES and secondary membranous glomerulopathyshould be kept in mind in any connective tissue disease that is on prolonged immunosuppressive therapy.
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