Objective Evaluation and management of small bowel disorders have always been challenging due to the limitations of the existing technology. Motorized power spiral enteroscopy (PSE) is an innovative new technique that offers easier, faster, and more complete small bowel evaluation with the ability to perform therapeutics. We aimed to evaluate the safety and efficacy of PSE in various indications. Methods Retrospective analysis of prospectively collected data of consecutive patients, who underwent PSE at a tertiary care center. Primary outcome measures were technical success rate, pan‐enteroscopy rate, diagnostic and therapeutic yield, and the secondary outcomes measures were the depth of maximal insertion, median insertion time, and adverse events. Results Fifty‐four patients (mean age of 49.38 ± 16.26 years) underwent PSE for small bowel evaluation. Technical success rate was 95.55% (antegrade route) and 93.10% (retrograde route).  Pan‐enteroscopy rate is 46.29% and antegrade enteroscopy to the cecum was achieved in eight patients.  Overall diagnostic and therapeutic yields were 85.18% and 30.76%, respectively. The most common findings were ulcero‐stricturing lesions (51.92%) followed by vascular lesions (9.61%). The most common histopathologic diagnosis was Crohn's disease in 29.62%. Median depth of maximal insertion was 400 cm (range 150–550 cm; antegrade route) and 180 cm (range 50–350 cm; retrograde route). The median insertion time to depth of maximal insertion was 70 min (range 30–110 min; antegrade route) and 45 min (range 20–70 min; retrograde route).  PSE‐associated major adverse events occurred in one patient and minor adverse events were seen in 48.14%. Conclusion PSE is a safe and effective modality for the evaluation of small bowel disorders with a high diagnostic yield.

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Pyrexia of unknown origin (PUO) is a common clinical problem. PUO has been defined by Petersdorf and Beeson as duration of illness of more than 3 weeks before diagnosis and repeatedly documented increased body temperature of more 38.3°C [1]. This has now been modified to include patients who are diagnosed after two outpatient visits or 3 days in hospital. Additional categories have now been added which including HIV-associated PUO includes HIV-positive patients with fever as above for 4 weeks as outpatients or 3 days as inpatients, with an uncertain diagnosis after 3 days of investigation, where at least 2 days have been allowed for cultures to incubate [2] Many times a four stage clinical protocol is used to investigate PUO which includes infections, collagen vascular diseases, malignancies and miscellaneous [3]. The etiology of PUO varies with age, sex and geographical location. Bone marrow examination is often performed when other investigation have been non-contributory [4]. Present study was designed to evaluate the clinical utility of performing bone marrow culture in patients with undiagnosed PUO.Retrospective data of patients in whom bone marrow examination was performed for PUO was analysed. Study period was over 3 years from 1st January 2013 to 31st December 2015. Diagnostic work-up included a history, physical examination, complete blood count, liver and kidney function tests, antinuclear antibody, viral markers, urinalysis, blood and urine cultures, chest radiography, and diagnostic contrast-enhanced chest, abdominal, and pelvic CT scans. Blood, urine, cerebrospinal fluid (when indicated), sputum, tracheal secretions, bronchoalveolar lavage and stool analysis were performed for diagnosis as and when indicated. If these were inconclusive then bone marrow aspirate and biopsy were performed by trained physicians/haematologist under sterile aseptic conditions and immediately inoculated into BacT/ALERT FA plus bottle for adults (5-10 ml)-manufactured by Biomerieux and BacT/ALERT PF for paediatrics (3-5 ml)-manufactured by Biomerieux. All Cultures were performed in an automated blood culture system BacT/ALERT 3D (Biomerieux).Blood culture was sent in 28 patients and was positive in 1 (3.5 %). The organism isolated in blood culture was E. faecalis. Urine culture was sent in 31 patients and was positive in 8 (25 %). The organisms isolated were E. faecium, followed by E. coli and others which included Pseudomonas aeruginosa, Chryseobacterium indologenes and Providencia kettgiri.Bone marrow examination and biopsy was performed in 39 cases of PUO. A bone marrow culture was sent in 23 (59 %) cases. Out of 39 patients of PUO in the study group 20 (51 %) were males and 19 (49 %) were females. Median age was 49 years (3-92 years). Bone marrow examination helped in reaching a diagnosis of 7 (17 %) cases with granuloma in 5 cases, metastasis in 1 case and chronic lymphoproliferative disorder in 1 case.Bone Marrow Culture was sterile in all 23 (100 %) cases sent and was non contributory.Bone marrow aspiration and biop...

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