Mini-cex: an assessment tool for observed evaluation of medical postgraduate residents during their training program: an overview and recommendations for its implementation in cpsp residency program

The mini-CEX is a workplace-based assessment to assess professional performance of medical trainees. Proper reporting of the gap between desired and observed performance forms the basis and the incentive for the trainees to improve their skills. It plays a key role by combining learning with assessment There is an urgent need for including this form of assessment in our clinical training programs especially postgraduate residents training

Early onset neonatal sepsis in preterm premature rupture of membranes

To determine the frequency of early onset neonatal sepsis in newborn with various duration of preterm premature rupture of membranes [PPROM]. Cross sectional study. Neonatal Intensive Care Unit Combined Military Hospital, Lahore from November 2009 to November 2010. Neonates of singleton pregnancies complicanted by pretern premature rupture of the membranes [PPROM] with delivery between 30 and 36 weeks gestation were included in the study. The overall frequency of neonatal sepsis was calculated on clinical and serological basis. Comparison of the frequency of sepsis among groups with varying duration of rupture of membranes was done. Out of 164 babies, 84 [51.2%] were female and 80 [48.8%] were male. Mean maternal age was 23 year [range: 18-36 years] .Mean gestational age was 33 weeks [range: 30-36 weeks]. Sepsis was suspected in 41 [25%] babies on clinical grounds. C-reactive protein was raised in 36 [22%] neonates. There was statistically insignificant difference between clinical versus serological diagnosis [p=0.515]. Frequency of neonatal sepsis was significantly higher in mothers with longer duration of rupture of membrane [p< 0.001]. Frequency of neonatal sepsis was observed to be 22%. PPROM is an important risk factor for early onset neonatal sepsis

role of public relations at the childhood associations in cultural awareness of Egyptian child

Problem: It is crystallized in the role of public relations in childhood associations in cultural awareness of Egyptian child

Objective: The study drives at identifying the most important activities and publications of public relations in childhood institutions practice, leading to child's enlightenment, identifying as well the quality of information children prefer, It also exposes topics and issues discussed in public relations activities and their association with children cultural edification, and the extent children follow up these activities

Significance: The study sheds light on the role of public relations in children cultural awareness of children in childhood associations, This study adds to the scientific reality represented in public relations in childhood institutions a new dimension in dealing with components and tasks of public relations by developing cultural awareness of Egyptian child, The study is concerned with the age stage [9-12] year olds, The study significance is crystallized in the significant role the public relations play in childhood institutions by increasing children cultural awareness, The study spotlights the role of the communicator in public relations in developing children cultural awareness

Method: the study counts on the media survey method

Sample: It consists of 200 [Male/Female] children members in childhood associations

Instruments: Scale of Cultural Awareness

Results: The study tackles with several important topics crystallized in cultural enlightenment of children, organizing relations with requirements, meeting problems and negatives in society, making children aware of rights and duties of citizenship, and identifying the political institution and approaches of nomination and election

Suggestions: The study suggests developing activities of public relations in order to develop cultural awareness through variation in cultural activities, handling topics associated with children, seeking assistance of professional, holding training courses, and cooperation with other institutions

Head and neck infections; secondary to dental causes; diagnosis and treatment

To analyse the risk factors responsible for different head and neck infections secondary to dental causes. DESIGN: Retrospective study. Department of ENT and Head and Neck Surgery, Allied Hospital, Punjab Medical College, Faisalabad. October 2011 to September 2014. The study consisted of 50 patients who presented with history of head and neck infections secondary to dental causes in the department of ENT and Head and Neck Surgery at Allied Hospital Faisalabad. Patients of head and neck infections of either sex ranging from 12 to 57 years of age and having history of dental infections / extractions were included in the study. Patients having head and neck infections secondary to some other cause other than dental etiology were excluded from the study. SPSS software, version 10 was used to analyse the data. Chi square test was applied to analyse the data. In our study 62% patients with head and neck infections were males while 38% patients were females. Age ranged from 12 years to 57 years with mean age 33.68 years. 96% of our patients presented with deep neck abscesses while only 02% of the patients had osteomyelitis of maxilla and further 02% of the patients presented with necrotizing fasciitis of the submandibular region. 58% of the patients had dental infections whereas 42% patients were having dental extraction as the root cause responsible for these head and neck infections. Moreover, all the patients had poor oro-dental hygiene. It was also observed that 76% of the patients, having history of dental extraction, were treated by unqualified dental practitioners without adequate aseptic conditions. Twelve patients out of fifty [24%] were found to have diabetes mellitus and one patient each was suffering from malignancy and chronic renal failure. 10 [20%] of our patients were smokers. Some of the patients [16%] were having anemia. Two patients out of fifty [04%] were suffering from pulmonary tuberculosis. All these patients were managed with adequate parentral antibiotics and surgical interventions. We had to perform an emergency tracheostomy in one patient. All the patients had good response to the management without any complication. Dental infections and dental extractions are still an important cause for potentially life threatening head and neck infections in developing countries like Pakistan. Unhygienic dental practices and lack of proper dental care facilities along with immunocompromizing conditions such as diabetes mellitus are most common risk factors for these avoidable head and neck infections. Therefore it is necessary that unhygienic dental practices as well as practices by unqualified dental practitioners should be strictly banned

Cytological Evaluation And Significance Of Cell Cannibalism In Effusions And Urine Cytology

Cell cannibalism is believed to be an indicator of high-grade aggressive cancers with increased metastatic potential. It denotes both anaplastic grade and invasiveness and is valuable in assessing tumor behavior. The present study was a 2-year retrospective and 1-year prospective study conducted in the Department of Pathology, Government Medical College, Jammu. PAP and MGG stained smears of effusions and urinary cytology were evaluated for cannibalism. Cannibalism was assessed by parameters like cellularity of cannibalism, diameter of cannibalistic cells, chromatin pattern and background of the smears. Of 350 cases evaluated, 260 (74.2%) were benign and 90 (25.8%) were malignant. Cannibalism was absent in all benign cases. Cannibalism was present in 14 ascitic fluids, 7 pleural fluids, 1 pericardial fluid and 3 cases of urine cytology. Comparison of distribution of cannibalism in effusions and urine did not yield statistically significant result (X2 = 0.8678 and p >0.05). Comparison of other parameters between effusions and urine samples also did not yield significant results. We conclude that cytological parameters of cellular cannibalism are better observed in malignant effusions than in urine cytology but did not reach statistical significance. Cannibalism can be assessed morphologically in malignant body fluids and is an indicator of increased tumour growth.

To Evaluate The Usefulness of Cytological Grading of Breast Cancer as a Predictor of Lymph Nodal Metastasis.

In a 5-year retrospective and 1-year prospective study a total of 110 fine-needle aspiration cytology (FNAC) cases of breast cancer were studied. These were graded according to Robinson's and Mouriquand's grading methods and relationship between grading and lymph node metastasis; cell dissociation parameter of Robinson's grading and lymph node metastasis evaluated. Of the 110 cases graded by Robinson's method, Grade I tumours had lymph node involvement in 3.57% of cases. Grade II and Grade III tumours had lymph node involvement in 6.52% and 47.22% of cases respectively where as when graded by Mouriquand's method, Grade I tumours had lymph node involvement in 3.57% of cases. Grade II and Grade III tumours had lymph node involvement in 7.14% and 42.5% of cases respectively. Although both grading systems showed significant relationship with lymph node involvement but Robinson's grading was a much better predictor of lymph node metastasis. Our study showed that greater cell dissociation was associated with higher incidence of regional lymph node metastasis. A highly significant relationship was observed between cell dissociation and lymph node involvement (p=0.00000). We conclude that cytological grading of breast cancers is a strong predictor of lymph nodal metastasis and greater cell dissociation is associated with higher incidence of regional lymph node metastasis.

Comparison of real time polymerase chain reaction with microscopy and antigen detection assay for the diagnosis of malaria

To determine the sensitivity of a real time polymerase chain reaction [PCR] for malaria diagnosis and to compare its accuracy with microscopy and an antigen based rapid diagnostic test [OptiMal]. Cross-sectional analytical study. Military Hospital, Armed Forces Institute of Transfusion and Armed Forces Institute of Pathology, Rawalpindi, from July to December 2011. Venous blood samples of 300 clinically suspected patients of malaria were tested for malaria parasite by microscopy and OptiMal; and malaria parasite index was calculated for the positive samples. Plasmodium genus specific real time PCR was performed on all specimens, targeting small subunit rRNA gene. Diagnostic accuracy of three tests was compared and cost analysis was done. Out of 300 patients, malaria parasite was detected in 110, 106 and 123 patients by microscopy, OptiMAL and PCR respectively. Real time PCR was 100% sensitive while microscopy and OptiMal had sensitivity of 89.4% and 86.2% respectively. All methods were 100% specific. The cost per test was calculated to be 0.2, 2.75 and 3.30 US$ by microscopy, OptiMal and PCR respectively, excluding the once capital cost on PCR equipment. Genus specific real time PCR for the diagnosis of malaria was successfully established as a highly sensitive and affordable technology that should be incorporated in the diagnostic algorithm in this country.

Analysis of adverse events reported following single dose monovalent H1N1 [swine flu] vaccine

To identify the adverse events reported following monovalent single dose intramuscular Swine Flu Vaccine within a period of 6 weeks after vaccination. This descriptive study was conducted from November 2010 to January 2011 in Lady Reading Hospital Peshawar, a 1400 bedded, tertiary care hospital, where single dose monovalent swine flu vaccine was available free of cost. Recipients were all healthy hospital employees, above 18 years of age. A printed proforma was designed, in which adverse events were recorded [either by telephone or personal appearance] after 24 hours, 1 week and then after 6 weeks. Informed consent was taken before vaccine administration. The study was approved by the ethical review committee of the institution. Seven hundred and ninety two individuals were included in the study with mean age of 27.67 [SD=10.7]. Males were 52.3% while the rest were female. Two hundred and fifty [31.6%] were students, 214 [27%] were paramedical staff, 153 [19.3%] were doctors, 139 [17.6%] were nursing staff, while 19 [2.4%] were senior teaching staff. After 24 hours of vaccination, redness at injection site was found in 36 [4.5%], soreness in 29 [3.7%], and itching in 23 [2.9%], headache in 66 [8.3%], nausea in 35 [4.4%], fever in 21 [2.7%], dizziness in 6 [0.8%], and muscle aches in 1 [0.1%]. After 7 days, only 3 [0.4%] individuals had soreness and tenderness at injection site, 2 [0.3%] had fatigue, 4 [0.5%] had fever and 2 [0.3%] had dizziness. After 6 weeks, no local or systemic adverse events were noted. Swine flu vaccine causes minor local or systemic side-effects in the form of pain, headache, fever, and fatigue in the first 24 hours of administration, and is free of short term and serious adverse events

Cultural barriers and assessment of dementia: a case report

Background: There are a number of reasons for the discrepancy that exists when people are assessed using standardcognitive assessment tools for cognitive impairment and their actual presentation.Case description: The authors describe the case of Mrs P who is a 72 years old lady of Polish descent but has lived inthe United Kingdom (UK) for most part of her life. Mrs. P was removed from her job where she used to work as acashier as she would miscalculate the money. She scored 3/30 on Mini Mental State Examination (MMSE), which wasremarkably low probably due to language and cultural issues. According to the family she did not face any challengesand problems due to her language, as she was able to speak good English though she would revert to Polish languagein between.Discussion: British Minority Ethnic groups respond poorly on MMSE due to language issues. There is a need forculturally appropriate assessment tools to assess people with dementia who belong to different ethnic background.There is a need for training professionals in understanding the language and cultural issues of BME groups.Conclusion: Cultural sensitivities of dementia patients need to be understood and respected.

Feasibility of short tandem repeats [STR] analysis for carrier detection and prenatal diagnosis in families with duchenne muscular dystrophy [DMD]

To determine the feasibility of Short tandem Repeats [STR] based linkage analysis for carrier detection and prenatal diagnosis [PND] in families having children affected with Duchemnne Muscular Dystrophy. Case series. Department of Chemical Pathology and Endocrinology in collaboration with Department of Molecular Biology, Armed Forces institute of Pathology [AFIP], Rawalpindi. From February 2007 to January 2008. six unrelated families with at least one affected child in each family who had characteristic features of DMD [index case]. PCR for Duchenne Muscular Dystrophy was carried out with STR based linkage analysis at introns 44, 46, 49 and 50 of DMD gene. Thermal cycling in TC-480 [Perkin Elmer] included 25 cycles each comprising 30 sec denaturation at 94 [degree sign] C, annealing at 62 [degree sign] C for 30 sec, extension at 65 [degree sign] C for 2 min. The final extension was done for 3 min. The amplified products were run on 8% nondenaturing polyacrylamide gel electrophoresis [PAGE] carried out at 200V for three hours on electrophoresis apparatus [Bio-Rad UK]. The gels were stained in silver nitrate. By comparing STR pattern of X-chromosome allele of index case with X-chromosome alleles of the mother, the diseased or affected X-chromosome was ascertained. Carrier detection and prenatal diagnosis was feasible with STR marker at intron 44 in DMD families. It was informative in 5 out of 6 DMD families. Carrier detection and PND by STR based linkage analysis is technically feasible in Pakistani families with DMD

Determination of glycosylated hemoglobin reference range in adult population attending a military care set up in Rawalpindi

To determine the glycosylated hemoglobin reference range in healthy adult population attending a military care setup in Rawalpindi in accordance with National Glycohemoglobin Standardization Program [NGSP] and International Federation of Clinical Chemistry [IFCC]. Descriptive cross-sectional study. Armed Forces Institute of Pathology Rawalpindi from May- Oct 2010. A total of 254 healthy adults [18-80 years] comprising 169 males and 85 females, were included by non probability consecutive sampling from Rawalpindi. History and clinical examination were carried out. Blood HbA1c was analyzed high performance liquid chromatography on biorad D-10. Data were analyzed by SPSS-17. Total 254 subjects consisting of 169 males and 85 females were recruited from Rawalpindi Pakistan. The reference range of total population was found 4.6-6.56% and 2.69-4.81 mmol/ mol in accordance with NGSP and IFCC, respectively. When compared in gender, HbA1c levels were not significantly changed. However, the healthy elderly population had higher HbA1c levels. Reference range for HbA1c based on NGSP in individuals <40 years was found 4.52-6.4% while for individuals aged > 40 years, it was 4.8-6.68%. The reference ranges for healthy individuals and the recommended values for optimal therapy in diabetic patients have to be revised and adjusted. Population based reference ranges should be established to provide better patient care services

Evaluation of stable coronary artery disease by multiple cardiac biomarkers

Effective management of stable coronary artery disease [SCAD] relies on early detection of coronary atherosclerosis. The objective was to evaluate diagnostic accuracy and risk stratification of SCAD patients by high sensitivity C reactive protein [hs CRP], Myeloperoxidase [MPO] and Pregnancy Associated Plasma Protein-A [PAPP-A]. validation study was conducted at Pathology Department of the Army Medical College, in collaboration with Armed Forces Institute of Cardiology [AFIC/NIHD] Rawalpindi. Total 122 subjects consisting of 61 patients of SCAD and 61 angio-negative controls were included. The levels of biomarkers were measured before angiography by using kits provided by Siemens [UK] for hs CRP and Abbott for MPO on Immulite 1000 and Architect Analyzer respectively, whereas serum PAPP-A was measured by an ELISA based method using kit provided by IBL Germany. The mean age of the patients was 56.57 +/- 8.35 years and consisted of 53 [86.9%] males and 8 [13%] females. Area under curve [AUC] and 95% CI of hs CRP 0.817 [0.736-.881] was significantly higher than that of MPO 0.685 [0.594-0.766] [p=0.018] and PAPP-A 0.565 [0.472-0.655] [p<0.001] for the diagnosis of SCAD. Patients in the highest quartile of PAPP-A were at the highest risk for adverse events as PAPP-A had the highest Hazard Ratio [HR] of 3.4 [p=0.004], as compared to hs CRP 1.124 [p=0.191] and MPO 0.998 [p=0.176]. hs CRP has superior diagnostic ability for detection of SCAD than MPO whereas PAPP-A is a more reliable marker for risk stratification among the cardiac biomarkers

Etiology and the role of proctosigmoidoscopy in patients with acute bloody diarrheas

To find out the etiology of acute bloody diarrheas in patients admitted to a tertiary care hospital. This descriptive study was conducted in the department of medicine, Lady Reading hospital from 2005 to 2008. A total of 50 patients were studied, comprising of 35 males and 15 females. Mean age of the sample was 32.66 +/- 15.4 years]. Patients who presented with acute bloody diarrhea of between 3-30 days duration were studied. Patients who had history of recurrent bloody diarrhea were also included. Patients below 12 years, severely dehydrated and seriously ill were excluded. All patients underwent fibreoptic proctosigmoidoscopy and rectal biopsy. Amebic colitis was confirmed on stool examination for Trophozoites of Entameoba histolytica, typical proctosigmoidoscopic findings and response to anti-amebic drugs. Thirty-two patients [64%] were having new onset bloody diarrhea, while 18 patients [36%] were giving history of recurrent bloody diarrhea. All patients had evidence of Procto-colitis on fibreoptic sigmoidoscopy. The most common conditions were ulcerative colitis in 25 [50%], bacterial dysentery in 15 [30%] and Amebic proctocolitis in 7 [14%]. Findings on proctosigmoidoscopy were mucosal hyperemia [50%], bleeding points [38%], ulcers [44%], pus [20%], pseudo polyps [4%] and mass [4%]. Fibreoptic Proctosigmoidoscopy is a simple and easier procedure to diagnose different causes of acute bloody diarrhea and should be considered in all cases except in seriously ill and dehydrated patients. The common causes of acute bloody diarrhea in our community are bacterial proctocolitis, amebiasis and ulcerative colitis

Significance of platelet indices in the diagnosis of immune thrombocytopenic purpura and aplastic anaemia

To compare the platelet indices in thrombocytopenia due to immune thrombocytopenic purpura and aplastic anaemia. This is observational study that was carried out from May 2006 to May 2007 at The Department of Haematology, Armed Forces Institute of Pathology [AFIP] and Armed Forces Bone Marrow Transplant Centre [AFBMTC], Rawalpindi. Seventy six [76] patients of thrombocytopenia were studied, of which 35 were patients of Immune thrombocytopenic purpura [ITP] and 41 patients of Aplastic anaemia [AA]. Platelet indices were measured on peripheral blood using automated haematology analyzer. Based on the bone marrow diagnosis, 35 patients of immune thrombocytopenic purpura and 41 patients of aplastic anaemia were studied. All indices were significantly higher in immune thrombocytopenic purpura than apiasiic anaemia. The mean MPV [Mean Platelet Volume] was 10.5fl in immune thrombocytopenic purpura and 8.6fl in aplastic anaemia [p <0.001], mean PDW [Platelet deviation width] was 15.6fl in immune thrombocytopenic purpura and 10.7fl in aplastic anaemia [p <0.001] and mean P-LCR [Platelet large cell ratio] was 31.2% in immune thrombocytopenic purpura and 17.7% in aplastic anaemia [p <0.001]. Our results suggest that these indices can provide reliable information to clinicians about the underlying etiology of thrombocytopenia and may help to avoid bone marrow examination, which is an invasive procedure, in some patients

Impact of CYP2C9 genetic polymorphism on warfarin dose requirements in Pakistani population

Variations of cytochrome-P450 enzyme system [CYP2CP] are associated with impaired metabolism of warfarin. The objective of our study was to estimate the frequency of genetic and allelic variants of CYP2C9 in Punjabi population of Pakistan and their effects on warfarin dose requirement. One hundred and twenty unrelated Pakistani subjects belong to Punjab province, were randomly included from the registry of National Institute of Heart Disease Rawalpindi, Pakistan. The patients had stable international normalized ratio [INR] of 2 to 3 for last 3 months with warfarin therapy after heart valves replacement. The detection of CYP2C9 variant was done on polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] assay. Total 120 patients [73 males; 47 females] of mean age of 37 years participated in the study. Nine patients had mutant allele CYP2C9*3 [7.5%], one CYP2C9*2 [0.8%] and 110 patients exhibited wild type CYP2C9*1 [91.7%]. The frequency of CYP2C9 genotype was *1/*1 [0.858] ; *1/*3 [0.117] ; 2/*20 [0.08] and *3/*3 [0.017] in our study population. A high dose of warfarin [42.2 +/- 9.56] mg/week is required for patients with *1/*1 genotype as compared to patients with *2/*2 [17.5 +/- 1.9] and *1/*3 [16.6 +/- 2.3] allele [p<0.001]. Individuals with CYP2C9*3/3* need lowest [8.75 +/- 1.76 mg/week] daily warfarin dose. In conclusion, the genetic variations in the CYP2C9 occur in 14% of Punjabi ethnic group in Pakistan. Presence of CYP2C9*2 or *3 variants is an independent predictor of low warfarin dose requirement in our patients. CYP2C9 variants assay may be used in high risk groups for appropriate dose adjustment to avoid complications on long term basis

Use of autologus cartilage grafts in augmentation rhinoplasty

Objectives: To study merits and demerits of autologous cartilage grafts used in augmentation rhinoplasty

Design: Comparative

Setting: Study carried out in the department of ENT Allied Hospital Faisalabad. Period: From June 2005 to June 2010

Material and Methods: The majority of patients were admitted through ENT out patient department. The data was collected on the basis of history, physical examination, investigations, photography, management and follow up

Results: Total 50 patients 35 males [70%] and 15 females [30%]. The majority of patients were from 3rd decade of life [53%]. The duration of deformity in majority of patients was with in 2 years [73%]. Majority of patients were belonging to the lower class [60%]. In many of the patients indication for augmentation rhinoplasty was cosmetic [100%]. In all patients autologus cartilage graft was used [100%]. The etiological factor for saddle deformity in majority of cases was trauma [67%]. Overall success rate was 94%

Conclusion: The autologus cartilage grafts because of their lower rate of infection, rejection, resoropton, extrusion, donor site morbidity, easy reshaping and due to their natural look should be regarded as the graft of choice in augmentation rhinoplasty

Regulation of neuropeptide Y, vasoactive intestinal peptide and galanin by insulin in rats

To study the regulation of neuropeptide Y, vasoactive intestinal peptide and galanin by insulin in rats. Experimental study. The study was conducted at the department of Metabolic Medicine Hammersmith hospital, Royal Postgraduate Medical School, London for on year [1996-1997]. Tissue levels of neuro peptide Y [NPY] and vaso intestinal peptide [VIP] decreased of the intestine and pancreas in insulin infused rats. NPY was also decreased significantly in hypothalamus. No significant effect on NPY in brain stem and on VIP in hypothalamus was observed. Galanin decreased significantly in intestine and hypothalamus. Galanin mRNA decreased to 57.7 +/- 8.8 percent of controls [p < 0.05] in intestine and 58.7 +/- 17.7 percent of controls in hypothalamus. Therefore insulin decreased the tissue levels of galanin by inhibiting its mRNA. It is concluded that NPY, VIP and galanin are negatively regulated by insulin. Actions of insulin on endocrine pancreas and central control of glucose homeostasis and food intake by insulin may be partly modulated through changes in these peptides. VIP acts synergistically with glucagon in the development of hyperosmolar coma in NIDDM patients. NPY and galanin increase ketone bodies formation and hyperphagia in diabetics and contribute in the development of diabetic ketoacidosis and obesity

Reference value for high-sensitivity c-reactive protein in the northern pakistani population

High-sensitivity C-reactive protein [hS-CRP] is an acute phase protein that is often used for the risk estimation of cardiovascular diseases. Objective was to find out the reference range of hS-CRP in the healthy adult northern Pakistani population and compare the distribution in relation with age, gender, body mass index [BMI], ethnicity and smoking. Cross-sectional study. Army Medical College Rawalpindi from Nov 2007 - Mar 2009 In this cross-sectional study a total of 297 healthy adults [>18 years] comprising 207 males, 90 females, Punjabis [n=178] and Pathans [n=119] were randomly included from Rawalpindi, Lahore, Peshawar and Sawabi Districts. History and clinical examination were carried out. Serum hS-CRP was analysed in Clinical Pathology Laboratory, Army Medical College Rawalpindi by two site sequential chemiluminiscent immunometric assay kit on immulite 1000 [USA]. Data were analysed by SPSS-16. The reference values for hS-CRP are presented as median [2.5 th - 97.5 th percentile]. In the healthy adult population of Northern Pakistan it was 1.84 mg/L [0.37-4.81] mg/l; in Punjabis 1.75 [0.30-4.65] mg/l and in Pathans 1.93 [0.50-5.30] mg/l. Females had higher hS-CRP levels 2.05 [0.53-5.66] mg/l as compared to the males 1.76 [0.31-5.06] mg/l. Smokers had relatively higher hS-CRP 1.98 mg/l [0.47-5.56] mg/l than non-smokers 1.68 mg/l [0.30-4.60]. Our data also revealed that hS-CRP had significant positive correlation with advancing age [r=0.20;p<0.05] and increasing BMI [r=0.29;p<0.01]. The reference range for hS-CRP in the population of Northern Pakistan is 0.37-4.81 mg/l. Pathans have higher hS-CRP levels than Punjabis. Demographic factors including age and BMI were positively correlated to the distribution of hS-CRP

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