CSF-ADA as diagnostic tool for tuberculous meningitis patients.

Introduction : TB is widely prevalent in India and a common form of TB is Tuberculous Meningitis (TBM), with great mortality, mainly in childhood. Available methods of TBM diagnosis are time-consuming and expensive. ADA is being recognized as marker of T-cell-mediated immunity. There is a need for cost-effective and relatively rapid method at tertiary-healthcare-settings. The study was carried out to assess the role of CSF-ADA for TBM diagnosis. Materials and Methods : In this cross-sectional study at SSG Hospital, Baroda between June-October 2011, 50 patients and 20 controls were selected. ADA in CSF and other biochemical markers were assessed after due informed consent. Microxpress ADA-MTB reagent was used for CSF-ADA estimation. Results : Out of 50, 22 children were male and 28 were female. 17 TBM (34%), 19 PM (38%) and 14 AM (28%) cases were detected. 72% of cases had CSF-ADA levels less than 10 IIU/L (mean 4.37±1.32), CSF-ADA levels were less than 10 in all controls (mean 2.8±0.8). Comparative CSF-ADA estimation in TBM, PM and AM showed higher values for TBM (p<0.001). Sensitivity and specificity of CSF-ADS for TBM diagnosis were 78% and 98% respectively at cut-off value of 11 IU/L. Discussion : Difference in the CSF - ADA levels of meningitis due to tuberculous and non-tuberculous etiology is statistically highly significant. CSF-ADA level at 11 IU/L differentiate tuberculous from non-tuberculous meningitis with reasonable sensitivity and great specificity. A country with extremely high TB prevalence requires a robust healthcare delivery and accurate therapy to prevent subsequent emergence of MDR and XDR-TB forms. High specificity of CSF-ADA test can prove immensely useful. ADA estimation in CSF is simple, inexpensive, rapid and fairly specific method for making a diagnosis of tuberculous etiology in TBM.

Absence of Association Between Serum Homocysteine Levels and Coronary Artery Disease.

Background: High prevalence of premature coronary artery disease is reported in Asian Indians. Traditional risk factors do not explain this excess. Elevated levels of homocysteine are reported to be associated with coronary artery disease amongst Europeans. Present study was carried out with objective to find any possible association between serum homocysteine levels and coronary artery disease Gujarati population of urban Vadodara. Methods: 21 Cases (individuals with coronary artery disease) and 20 controls were studied. Results: The mean homocysteine value amongst the cases was 12.9±2.3 ìmol/L and 12.8±2.4 ìmol/L in controls. There was no significant difference in the homocysteine levels between the groups studied. The prevalence of hyperhomocysteinemia, defined as a level of 17.1 μmol/L (the 95th percentile for serum homocysteine in the control group) was not significantly different among the groups. Conclusions: Elevated serum homocysteine levels are not associated with coronary artery disease in male subjects of Vadodara. However, the results must be interpreted with caution because of limited sample size.