Serum procalcitonin in pediatric bacterial meningitis versus pediatric non bacterial meningitis: open label prospective study

Background: Several studies have shown potential value of serum Procalcitonin level (SPCT) for diagnosing and differentiating bacterial meningitis (BME) from other, but the results were inconsistent.Methods: Children from birth to 12 years, with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected and cases were classified according to pre decided case definition (based on clinical and laboratory) as bacterial or non-bacterial meningitis (NBME).Results: Out of 4393 admission (2016-17) 60 patients were selected for final study (on basis of case definition) which were equally distributed in both group (BME and NBME) in terms of age and sex (p 0.97). 29/41 (70%) patients of pyogenic meningitis had high level of SPCT which was significant, whereas only 2/19 (10.5%) patients of NBME had high level of SPCT. Although SPCT seems to be the good marker in differentiating between BME and NBME, SPCT level specificity (89%) in the diagnosis of BME was not higher than CSF protein level (94%) and CSF glucose level (94%).Conclusions: Measurement of plasma SPCT levels are of value in differentiating BME & NBME in children. However, SPCT should not be used as single sole diagnostic marker of BME if CSF protein and glucose are available. CSF WBC Count alone should not to be used in diagnosis of BME as specificity is low. This study needs to be validated with a larger sample size and microbiological confirmation of bacterial disease.

A rare case of subconjunctival dirofilariasis by Dirofilaria repens in rural Gujarat.

Dirofi lariasis is a worldwide zoonotic fi lariasis with over 782 cases reported so far from diff erent parts of the world. Human dirofi lariasis, caused by Dirofi laria repens, have been reported to occur widely throughout Asia, Europe, and Africa. It has not been widely recognized in India, however; several cases have been reported in last few years. There is probably a focus of human infection with D. repens in Kerala. Herein, we present a review of human infections by D. repens, along with a case report of subconjunctival dirofi lariasis from rural part of Gujarat.

The meniscal cyst : Arthroscopic decompression and modified outside-in suture repair of the anterior horn of lateral meniscus.

This article describes a modified suture technique designed for the vertical repair of the ante-rior horn of the meniscus after arthroscopic decompression of a large meniscal cyst. This procedure comprises of three steps: first, the meniscus was pierced vertically using a suture hook and a No. II PDS suture. Second, both ends of the No. II PDS on the femoral and tibial surfaces of the meniscus were pulled to the out-side of the joint capsule using a spinal needle pre-loaded with suture material. Finally, a skin incision was made adjacent to the suture materials, and both ends were tied. We recommend this technique not only for the vertical repair of the anterior horn of the meniscus after decompression of large meniscal cyst, but also to repair a longitudinal tear of the meniscus.