Browsing by Author "R, Dhakal"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
Publication Enteric fever: Diagnostic value of clinical features(Kathmandu University, 2006) A, Neopane; M, Poudel; B, Pradhan; R, Dhakal; DB, KarkiObjectives: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. Design: Prospective observational study Setting: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal Materials and methods: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. Results: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. Conclusion: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever. Key words: enteric fever, clinical features, diagnostic criteriaPublication Management of Typhoid fever in the Department of Medicine at Kathmandu Medical College(Kathmandu University, 2003) M, Dhakal; A, Neopane; N, Subedi; R, Dhakal; DB, KarkiAim 1. To assess the ongoing management strategy of typhoid fever in department of medicine at Kathmandu Medical College, Sinamangal, Kathmandu. 1. To suggest changes, if required for the benefit of patients and doctors Method Prospective study of clinically suspected enteric fever from 2060/01/29 to 2060/04/25. Assessment and analysis of the rationality of the diagnostic parameters that are being used in the ward for clinically suspected enteric fever in unit one of department of medicine. Treatment outcome of the patients with the commonly used antibiotics. Analysis of the sensitivity pattern of the salmonellae isolated among the study group. Result 1. Only 11 cases (37%) were actually culture proven among the 30 cases suspected to be enteric fever on clinical basis. 2. 19 cases (63 %) of the clinically suspected enteric fever were diagnosed only on the basis of single widal test (titre more than 1:320), blood culture being negative. 3. Bone marrow was subjected to culture for salmonella only in 4 Cases (13%) despite blood culture being sterile. 4. The laboratory could provide sensitivity pattern of salmonellae only in 5 cases out of 11 culture positive cases (45%). 5. Eighteen cases (60%) had to be given 3rd generation cephalosporin after not responding to 5 days course of fluoroquinolones (ciprofloxacin or ofloxacin). On the other hand all the cases in the study group subjected to 3rd generation cephalosporin (injection ceftriaxone or cefixime orally) responded well to the treatment. Conclusion 1. We shouldn’t be relying too heavily on a single titre of widal test for the diagnosis of enteric fever and should be sending blood for culture for salmonella and even bone marrow culture, if necessary. This can be concluded on the basis of lots of literature against single widal test in the diagnosis of enteric fever. 2. Widal test should be positive with clearly significant rising titre (with paired sample) or modified widal test has to be performed if one wants to give gravity to the test for the diagnosis of enteric fever. 3. Laboratory personnel’s need to be more serious in their works so as to try to see sensitivity pattern in all positive cultures, if rational use of antibiotics is really desired in view of increasing antibiotic resistance. 4. Fluoroquinolones, once thought to be super powerful antibiotic & still taken as the drug of choice almost everywhere, has been found to be resistant in most of the cases in this study. Though the sample size is too small and there are lots of limitations in this study to come to a firm conclusion, it has borne one serious question in the minds of our unit doctors: Correspondence Dr. Mahesh Dhakal Dept. of Medicine, Kathmandu Medical College, Teaching Hospital Kathmandu University Medical Journal (2003) Vol. 1, No. 3, 197-204 198 whether we are over-using fluoroquinolones for trivial infections and leading to the emergence of resistant strains of salmonellae?