The diagnosis of enteric fever poses several problems due to the non-specific and wide array of clinical features. A five-year retrospective study enrolling 136 culture-proven cases of enteric fever was undertaken in order to estimate the clinical and laboratory characteristics, fever clearance time and outcome. The common symptoms and signs were: fever, vomiting, cough, anorexia, diarrhoea, abdominal pain, hepatomegaly, splenomegaly and coated tongue. Enteric fever should be considered in the differential diagnosis of febrile patients with abdominal symptoms.
Procedural skill learning is usually unobserved during post graduate training. This study is an attempt to evaluate feasibility and acceptability of direct observation of procedural skills in a medical school in Northern India for postgraduates in Pediatrics. Eighty procedures performed by 15 trainees were observed by 9 faculty members. Seven of nine assessors considered direct observation to be feasible and non-intrusive in their routine clinical and teaching schedule while 5 out of 9 felt that it was time consuming. All fifteen trainees felt that direct observation enhanced their procedural skills and wished it to be extended to all procedures.
There is a sound scientific basis for adopting the IMCI approach since: (1) Co-existence of morbidities is a rule rather than exception for sick under-five children. (2) The algorithm provides good sensitivity and specificity for assessing severe illness and (3) IMCI algorithm is superior to vertical disease specific programs. It is, however, important to carefully adapt the generic IMCI algorithm to reflect the local morbidity profile.
We report a case of a 6-year-old female child with Takayasu's aorto-arteritis (TA) with severe coarctation of the aorta which resulted in an aortic dissection post-ballooning. This happened despite ensuring that markers for disease activity were negative, with appropriate corticosteroid therapy started before the procedure, and using a low-profile, low-pressure, and slightly undersized balloon for dilating the stenotic segment. It required immediate endovascular stenting to tide over the crisis. Following the procedure, she became normotensive with well-palpable lower limb pulses.
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