Cerebrospinal fluid lactate: a differential biomarker for bacterial and viral meningitis in children / Lactato no líquido cefalorraquidiano: um marcador diferencial para meningite bacteriana e meningite viral em crianças

Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.

Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.

Correlation of sonographic and Doppler findings with histopathological findings in premenopausal and postmenopausal bleeding

This study was carried on 50 patients complaining of abnormal uterine bleeding, 40 of them were suffering from premenopausal bleeding and the other 10 cases were complaining of postmenopausal bleeding. Transvaginal ultrasound [TVS] to measure the endometrial thickness and Pulsed - colour Doppler [PCD] of the uterine artery was clone for all cases. Endometrial sampling using vabra aspiration was then done for all the cases and the specimens were subjected to histopathological examination. The sonographic and colour Doppler findings were correlated with the histopathologic findings. From this study it was found that the uterine artery resistance index [0.93 +/- 0. 17] and pulsatility index decrease [1.87 +/- 0.22] as the pathological process increases. Also the endometrial thickness increases with the increase in the degree of the pathological condition [9.51 +/- 3.21] mm in premenopausal bleeding compared to 10.83 +/- 6.79mm in postmenopausal bleeding. It was concluded [rum this study that TVS and PCD are very reliable complementary procedures for screening and diagnosis of the etiology of abnormal uterine bleeding because TVS reports about endometrial morphology while PCD is concerned about endometrial vascularity which reflects the nature of the pathology rather than its gross anatomical features

effect of passive smoking on intrauterine fetal growth

This study aimed to evaluate the effect of variable degrees of environmental exposure to tobacco smoke during pregnancy in 152 nonsmoking pregnant women. Based on a questionnaire fulfilled by the parents, newborns were classified into five groups depending on degree of exposure. Birth weight of babies born to mothers significantly exposed to tobacco smoke was 230 grams less than those babies born to non- exposed mothers. Also, there was a difference of 176 grams in birth weight between babies born to mothers significantly exposed to tobacco smoke and babies born to mothers occasionally exposed to tobacco smoke. It was concluded that passive smoking has a negative influence on intrauterine fetal growth and duration of exposure is more important than intensity of exposure