Microscopy of gram stained uncentrifuged drop of urine for presumptive diagnosis of urinary tract infections

To evaluate the diagnostic efficiency of microscopic examination of Gram stained uncentrifuged drop of urine for presumptive diagnosis of urinary tract infections [UTI]. 250 samples collected from March 2005 to August 2005 comprising of both in patient and out patient samples were analyzed. Urine sample was homogenized and a nickel-chrome loop, calibrated to 10 micro l was used to take a drop of urine and was applied on glass slide [25mm x 75mm]. The drop was allowed to dry in air at room temperature [25°C approx.] without spreading. The slides after drying were stained with Gram method of staining. The microscopic examination was carried out with a 100x oil immersion objective, 30 fields were examined. Observation of one or more microorganism per high power oil immersion lens was taken as a positive reading. Culture of urine was taken as reference method and performed by using filter paper strips applying 2micro l of urine on cystine-lactose-electrolyte-deficient agar. Culture results obtaining a mixed growth of >/= 2 organisms were excluded out of the study. Only those cultures were taken as positive and made part of the study which yielded more than 10[5] or 10[4] to 10[5] CFU of pure single type /ml of urine. Sensitivity, specificity, positive and negative predictive values were calculated by using appropriate formulas. A total of 250 samples were processed for the study. Out of which 39 [15.6%] samples yielded mixed growth of > 2 organisms. All these samples were excluded out of the study [remaining 211 samples]. Microscopic examination of 97[45.9%] samples showed no organism and no growth was obtained on subsequent culture of these samples [true negative]. 61 [28.9%] samples were found to have >/= 1 organism in Gram stained smear of uncentrifuged single drop of urine and their culture yielded growth of > 10[5] or 10[4] to 10[5] CFU of pure single type /ml of urine [true positive]. No organism was detected on microscopic examination of 9 [4.2%] samples however pure growth of single organism was obtained on their culture [false negative]. >/= 1 organisms were seen on the microscopic examination of 44 [20.8%] samples which failed to grow on culture media [false positive]. Sensitivity [87.1%], specificity [61 .39%], positive predictive value [58.09%], negative predictive value [91.5%] was calculated by using respective formulas. This method provides a good negative predictive value and helps to rule out the presence of UTI efficiently when bacteria are not seen on microscopic examination. A very simple method without the use of laboratory centrifuge and culture media makes it an ideal practice in peripheral laboratories devoid of adequate resources and facilities to deal with one of the most commonly received specimens

Frequency and clinical Importance of Anti - TG auto antibodies [ATG]

To note the frequency of anti thyroglobulin autoantibodies [ATG] and its clinical importance in 25 follow-up cases of differentiated thyroid cancer [DTC]. Design: A case control study. Place and Duration of Study: The total duration of study was one year [September 2000 to August 2001]. Majority of the patients included were the routine follow-up cases at IRNUM, Peshawar. However, few of the cases were also included from NORI, Islamabad and AFIP, Rawalpindi. Subjects and All the patients who had undergone sub-total or total thyroidectomy followed by I-131 ablation therapy were selected for this study. Thyroglobulin [Tg] and ATG were measured using immunometric assay technique with reference range of non-detectable to 40 IU/L. Patients with serum Tg level ' 10 ng/mL were included in group-1 [n=15] and all the remaining [n=10] in group-2. Overall, 11 patients showed ATG titer above the pre-defined threshold level. In group -1 patients, 8 had positive anti-Tg antibodies in their sera while in group-2, it was positive in only 3 cases. Risk of relapsing metastatic/recurrent disease in association with ATG was calculated which showed that patients with positive ATG have almost seven - fold increased risk of having recurrent/metastatic disease than those who do not. Samples for s-Tg measurements must also be evaluated for ATG status because more than one-third of these patients have positive ATG titer in their sera. Although in the presence of positive ATG, the risk of concurrent metastatic/recurrent thyroid disease is increased but still more studies are required to support its significance

Stress fracture in soldiers

The present day fast and competitive life affects the sports and military training alike. The sense of competition and the desire to achieve the required standard during training makes it necessary to tolerate physical stress after getting fatigued. The muscle can not take the load after getting fatigued and load tolerated above muscle threshold will result in stress fracture. In this study a group of 141 male gentleman cadets/recruits with lower extremity pain and functional disorders were evaluated. The radionuclide bone seintigraphy and X ray studies were carried out to determine the incidence, and prognosis of stress fractures. It is concluded that the incidence of Stress fracture is higher among gentleman cadets, the commonest single bone involved is right tibia followed by left. Tibia and fibula. Drill exercise resulted the highest incident and the cemented and metalled ground were the main contributing factors to the stress fractures. Lack of exercise before coming to training centre is an additional important contributing factor. The plain radiograph are of little use in establishing the diagnosis in the early stage of injury while the investigation of choice is the radionuclide bone scan