Comparison of serum procalcitonin and c-reactive protein in diagnosis of bacterial meningitis

The diagnostic accuracy of Procalcitonin [PCT] as compared with C - reactive protein [CRP] for early diagnosis of bacterial meningitis in children was evaluated. Descriptive diagnostic study. This study was conducted in Pathology department of Army Medical College Rawalpindi from September 2007 to September 2008. Descriptive diagnostic accuracy study was conducted in Pathology Department of the Army Medical College, Rawalpindi. Total 77 subjects consisted of 31 patients of bacterial meningitis and 46 healthy children were included as controls from the Military hospital, Rawalpindi. The patients comprised of 18 [58%] male and 13 [42%] female with mean age 6 years. Patient's investigations including cerebrospinal fluid [CSF] examination and culture were carried out at admission. PCT and CRP were analyzed on Vidas analyzer and Immulite 1000 respectively. PCT levels were significantly high median [range] of 4.5 ng/ml [0.10-19.00] ng/ml than controls 0.45 ng/ml [0.10-3.00]. Serum CRP levels were moderately elevated with median [range] 11 mg /L [0.30 - 23.00] as compared with 0.30 mg/L [0.30-9.5] controls. The Area under receiver characteristic curve of PCT 0.86 [95% CI: 0.76-0.93] was significantly higher than CRP 0.72 [95% CI: 0.61-0.82]. The optimum diagnostic cutoff point for PCT and CRP were 2 ng/ ml and 6 mg/L respectively by ROC analysis. PCT had maximum sensitivity 74% and specificity 84% at cutoff > 2 ng/ ml while CRP revealed sensitivity 58% and specificity 83% at cutoff > 6mg/ L. This study has demonstrated PCT as a more reliable diagnostic marker than CRP for early diagnosis of bacterial meningitis and can be used in combination with clinical evaluation for proper management of the seriously ill children

Characteristics of patients with Guillain Barre syndrome at a terrtiary care centre in Pakistan, 1995-2003

To study the clinical presentation, hospital course and outcome of patients admitted with Guillain Barre Syndrome [GBS] to a tertiary care hospital in Karachi, Pakistan. The charts of patients conforming to International Classification of Diseases [ICD] code 9.0, for GBS, from September 1995 to January 2003 were reviewed. Clinical data was recorded on a standardized questionnaire, which included patients' age, sex, antecedent events, neurological signs and symptoms and ventilation requirement. The hospital course was analyzed, including nosocomial infections, therapy given and the functional status of patients, using the Rankin scale [0-6]. Standard SPSS 11.5 software [Windows] was used for data analysis. Thirty-four cases of GBS were admitted to the hospital during the study period, with an age range of 3 to 70 years. The mean age for disease onset was 35.2 years for female patients, compared to 30 years for males; the male/female ratio was 1.6:1.Gastrointestinal infections [12/22, 54.6%] were the most common antecedent event, followed by upper respiratory tract infections [9/22, 40.9%] and skin lesions [1/22, 4.5%]. Most patients developed GBS within one month of the preceding infection. Cranial nerve abnormalities [30/34, 88.2%], autonomic dysfunction [21/34, 61.8%] and respiratory failure requiring intubation [19/34, 55.9%] were also common. The median Rankin score of patients at admission, and at 30 and 60 days thereafter was 5, 4 and 3.5 respectively. The in-patient mortality was 1 of 34 [2.4%]. We found that GBS occurred at all ages and was slightly more common in males. Majority of patients had an antecedent history of infection and had severe disease on presentation. The patients were treated with either plasmapheresis or intravenous immunoglobulins and there was no significant difference in outcome in the two groups. Despite severe persistent disability, in-hospital mortality was low