Endobronchial ultrasound guided transbronchial needle aspiration [EBUS-TBNA] for diagnosis of mediastinal and hilar masses

Objective: To determine the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration [EBUS-TBNA]

Study Design: A cross-sectional validation study

Place and Duration of Study: Department of Histopathology, Army Medical College, in collaboration with Department of Pulmonology, Military Hospital Rawalpindi, from March 2014 to March 2015

Methodology: Cases of EBUS-TBNA comprised of both TBNAs and cell block/biopsy of the same patients. Diagnosis was made on the TBNA slides and cell block/biopsy material. Taking biopsy/cell block as the gold standard, the data was analysed to calculate the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of EBUSTBNA

Results: The sensitivity of EBUS-TBNA was found to be 96.5%; whereas, specificity and positive predictive values were 100%. The negative predictive value was calculated at 50%. Diagnostic accuracy of the procedure was found to be 96.67%

Conclusion: EBUS-TBNA is a sensitive and a specific test and is accurate in diagnosing mediastinal and hilar pathologies

clinical account of hospitalized 2009 pandemic influenza A [H1N1] cases

To determine the clinical characteristics in adults with confirmed pandemic influenza A [H1N1] infection 2009. A case series. The study was carried out at the Department of Pulmonology and Critical Care, Military Hospital, Rawalpindi, from 1st December 2009 to 30th May 2010. Thirty six adults with confirmed 2009 pandemic H1N1 infection by reverse transcriptase polymerase chain reaction [RT-PCR] were included in the study. All patients were followed in-hospital and clinical features, laboratory and radiological investigations and management data was collected on a pre-designed patient data collection form. Mean age was 34.24 +/- 13.92 years with 61.1% females. Seventeen [47.2%] had at least one risk factor for complications with 2009 H1N1 infection; namely obesity in 19.4%, pregnancy in 8.3%, COPD in 5.6%, cardiac failure in 5.6%, chronic liver disease in 5.6%, Diabetes mellitus in 5.6%, immunosuppression in 2.3%, smoking in 25%. Fever [97.2%], cough [97.2%], rhinnorhea [80.6%], and shortness of breath [58.3%] were the commonest symptoms. Radiographic abnormalities were interstial/reticular infiltrates [30.6%], patchy consolidations [11.1%] and reticular shadows with areas of consolidation [25%]. PaO2/FiO2 ratio was less than 200 in 27.8% cases. Thirty six percent cases had creatinine kinase [CK] levels greater than 400 U/L and lactate dehydrogenase [LDH] levels higher than 1000 U/L. Twenty seven percent cases were managed in ICU and 16.7% cases died during hospital stay. The 2009 pandemic H1N1 virus infection had a wide clinical spectrum with a potential to cause high morbidity and mortality. Early empirical antiviral therapy for hospitalized suspected influenza A [H1N1] is vital to prevent the rapid disease progression

Health professionals in armed forces and their continuing professional development [CPD]

Biomedical knowledge is rapidly changing with nearly a million new citations in MEDLINE alone every year. There is currently no structured or systematic Continuing Professional Development [CPD] program for health professionals in the Armed Forces of Pakistan. The overall aim is to develop a system of continually updating our knowledge, skills and attitudes that will promote heightened professionalism, both in peace time and war. All health professionals need to be offered opportunities and facilities for their professional growth. Such systems are already in place all over the world. To achieve these objectives careful regulatory mechanism and implementation strategies have to be instituted. Target populations in the order of priority and dedicated providers have to be identified, trained and motivated. With proper monitoring and facilitation a culture of self improvement can easily be created and propagated. Armed forces can easily take the lead in Pakistan. The ultimate beneficiaries will be the armed forces personnel and their families