Serum Procalcitonin in Septic Meningitis

Objective

To evaluate the role of serum procalcitonin (PCT) in diagnosis of septic meningitis in children and its efficacy in differential diagnosis.

Methods

The study included 40 children of septic meningitis admitted in pediatric ward with fever, headache, vomiting and seizure, up to 14 y of age. The diagnosis of septic meningitis was based on clinical features; physical examination, blood and cerebrospinal fluid (CSF) cytochemical findings, gram’s stain and bacterial culture. Fifteen cases of aseptic meningitis admitted during same period were also included in the study, and 15 children with normal CSF were taken as control. Serum PCT was measured by ELISA Kit.

Results

Serum PCT level was significantly higher in children with septic meningitis than those with aseptic meningitis or in controls (p?<?0.001). In culture and gram’s stain positive 7 cases, serum procalcitonin was significantly elevated (24,768.21?±?6,567.45 pg/mL) than aseptic meningitis(14,451.24?±?4,266.15 pg/mL) (p?<?0.001). Further its level was found significantly elevated in partially treated septic meningitis as compared to aseptic meningitis cases (p?<?0.001). At optimum cut off value of ≥ 5,000 pg/mL, based on area under ROC curve, PCT showed sensitivity, specificity, positive predictive value and negative predictive value of 98.5 %, 93.5 %, 98.6 % and 93.3 % respectively. Serum PCT with cut off level of 15,000 pg/ml showed sensitivity, specificity, PPV and NPV of 92 %, 67 %, 91.4 % and 71.4 % respectively for the differentiation of septic from aseptic meningitis.

Conclusions

Serum PCT may be used as diagnostic marker for septic meningitis and its differentiation from aseptic meningitis.     

Current indications for hip resurfacing arthroplasty in 2016

Hip resurfacing arthroplasty (HRA) is an alternative to conventional, stemmed total hip arthroplasty (THA). The best reported results are young, active patients with good bone stock and a diagnosis of osteoarthritis. Since the 1990s, metal-on-metal (MoM) HRA has achieved excellent outcomes when used in the appropriate patient population. Concerns regarding the metal-on-metal bearing surface including adverse local tissue reaction (ALTR) to metal debris have recently lead to a decline in the use of this construct. The current paper aims to provide an updated review on HRA, including a critical review of the most recent literature on HRA.     

Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules

The purpose of the present study was to determine the role of repeat fine-needle aspiration biopsy (FNAB) in the evaluation of thyroid nodules initially classified as "nondiagnostic" due to limited cellularity or as "indeterminate for neoplasm." We reviewed a cohort of 431 patients (352 females, 79 males; average age 50 yr); 237 patients were classified as "nondiagnostic" due to limited cellularity and 194 as "indeterminate for neoplasm" over a 3-yr period (1999-2002). Repeat FNAB under ultrasound guidance was performed in 226 patients (226/431, 52%); surgical pathology results were available in 101 patients. Repeat FNAB diagnoses were: benign 70 (31%), follicular/Hürthle cell neoplasm 62 (27%), suspicious for papillary carcinoma 25 (12%), malignant 17 (7%), and nondiagnostic 52 (23%) cases. Surgical follow-up was available in 101 (45%) patients; malignancy was identified in 50 (49%) patients. The malignancy rate was 51% and 48% in cases in which initial FNAB was nondiagnostic and indeterminate for neoplasm, respectively. There were no false-positives and all malignant cases undergoing surgery were found to be malignant. This study demonstrates that repeat FNAB is warranted in patients with thyroid nodules diagnosed on initial FNAB as nondiagnostic and indeterminate for neoplasm since it can yield a definitive diagnosis in the majority of cases with an overall malignancy rate of 49%.     

Sebaceous gland adenoma of the tarsal conjunctiva in a patient with Muir-Torre syndrome

PURPOSE: To highlight the recognition and diagnosis of Muir-Torre syndrome (MTS) in patients with sebaceous tumors of the eyelid/conjunctiva and to determine the role of immunohistochemical markers as a screening test in patients with Muir-Torre syndrome. DESIGN: Single interventional case report. METHODS: The clinical and family history was reviewed from the records of a 41-year-old man who had a sebaceous gland adenoma of the tarsal conjunctiva of the left upper eyelid. The lesion was completely excised and submitted for histopathologic examination. Immunohistochemical stains using an antibody to MSH2 were performed on the paraffin-embedded sections of the tumor. RESULTS: Histopathologic examination of the tumor showed a lobular pattern with basaloid cells at the periphery of the lobules with central areas of sebaceous differentiation. Immunohistochemical stains showed a lack of MSH2 expression in the tumor, which is highly consistent with MTS. CONCLUSIONS: Muir-Torre syndrome should be considered in patients initially seen with sebaceous tumors of the eyelid. Immunohistochemistry for MSH2 is a practical initial approach to screen for MTS in patients with sebaceous tumors.     

Plasma acetylcholinesterase as a biomarker of triazophos neurotoxicity in young and adult rats

The organophosphate pesticides exhibit their action by inhibiting acetylcholinesterase (AChE) enzyme in central and peripheral nervous system. They are known to affect the young animals to a greater extent, as their developing brain is more susceptible to their toxic effects. Besides inactivating acetylcholine at synaptic terminals AChE also plays an important role in neuronal growth and differentiation. A reduction in AChE activity in plasma has no known physiological function in causing brain or tissue damage, but if a good correlation between brain and plasma AChE inhibition exists, then circulating plasma AChE can be used as a reliable marker for detection of cholinesterase inhibitors. Therefore, the present investigation was designed to differentiate age and gender related neurotoxicity of an organophosphate pesticide-triazophos and to explore whether plasma AChE can serve as a biomarker of its neurotoxicity in young, i.e. post natal days 20 (PND 20) and adult rats i.e. post natal days 90 (PND 90) after single intraperitoneal administration in different doses.