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Objective:To determine diagnostic accuracy of Cerebro Spinal Fluid (CSF) Adenosine De-Aminase (ADA) in detecting Tuberculous Meningitis (TBM) keeping CSF Polymerase Chain Reaction (PCR) for Mycobacterium Deoxy Ribonucleic Acid (DNA) as gold standard.Methods:This cross sectional validation study was conducted at Department of General Medicine of PNS Shifa Naval Hospital Karachi, Pakistan from Oct 2015 to Mar 2017 for a total duration of one and a half year. One hundred and thirty six patients were included. The diagnosis of TBM was based clinically on symptoms like fever, headache, altered mental state and signs of meningeal irritation with CSF findings of increased proteins, low glucose and lymphocytic pleocytosis. Lumbar puncture was done and approximately 4ml of CSF sample was withdrawn for analysis. Diagnosis of TBM was confirmed by doing CSF PCR test for mycobacterium tuberculosis DNA.Results:Total 136 patients were enrolled in this study. Mean age in our study was 47.09±12.80 years, whereas frequency and percentages of male and female patients was 102 (75%) and 34 (25%) respectively. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CSF ADA level in detecting TBM was 71.32%, 84.21%, 95.45%, 98.97% and 53.85% respectively.Conclusion:The study concludes that diagnostic accuracy of CSF ADA in detecting TBM is high which is proposed as an investigation to differentiate it from other causes of meningitis in places where PCR test is not available.

Objective: To determine the frequency and antibiotic susceptibility pattern of CA-MRSA in patients with uncomplicated skin and soft tissue infections reporting to the dermatology outpatient of a tertiary health care hospital. Study Design: A descriptive study. Place and Duration of Study: Dermatology outpatient of a tertiary care hospital in Punjab province of Pakistan, from September 2020 to August 2021. Methodology: Patients of all age groups and both genders reporting during the study period with community-associated uncomplicated bacterial skin and soft tissue infections were enrolled in the study. Samples were collected from skin lesions and cultured on blood agar and MacConkey agar plates. Antimicrobial susceptibility testing using the modified Kirby Baur disc diffusion technique was performed. Results: A total of 157 patients were included in the study. Impetigo was most common infection (n=80, 51%), followed by Furunculosis (n=47, 29.9%). The frequency of MRSA isolates was 54.1% (n=85). MRSA was significantly more frequently isolated from patients with furunculous, carbuncle and cutaneous abscesses as compared to impetigo. All MRSA isolates were sensitive to linezolid, teicoplanin, and vancomycin. 97.6%, 84.7%, and 72.9% of MRSA isolates were sensitive to rifampicin, minocycline, and fusidic acid respectively. 89.4% of MRSA were sensitive to amikacin and clindamycin. 63.5% were sensitive to doxycycline and 58.8% were sensitive to co-trimoxazole. Only 20% of MRSA were sensitive to ciprofloxacin. Conclusion:The antibiotics active against CA-MRSA including rifampicin, minocycline, amikacin, and clindamycin may be used empirically in patients with furunculosis, cutaneous abscess, and carbuncles. Linezolid, teicoplanin, and vancomycin should be reserved for severe infections.

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Objective: To determine and compare Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) in predicting severity of disease in patients with COVID-19. Study design: Descriptive comparative study. Place and Duration of study:  Department of Medicine, CMH Thal from April to July, 2020 Patients & Methods: 61 patients of COVID-19 confirmed through polymerase chain reaction were recruited and divided into severe and non severe disease. Complete blood counts were done. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio were calculated and analyzed. Results: 14 patients (23%) of severe disease had mean age of 49.93±19.42 and 47 patients (77%) with non-severe disease had mean age of 33.32±9.16. The mean Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte ratio in patients who had severe disease was 7.20±4.20 and 204.25±148.42 (p=0.001 and p=0.026) respectively. The diagnostic performance of both Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio produced statistically significant area under the curve (AUC), (p <0.001). The adjusted and unadjusted area under curve for Neutrophil to Lymphocyte Ratio was 0.92 (95% CI: 0.85–1.00) and 0.923 (95% CI: 0.839-1.000) and for Platelet to Lymphocyte Ratio it was 0.883 (95% CI: 0.781–0.985) and 0.825(95% CI:  0.707-0.943) respectively.  Conclusion: Elevated Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are independent biomarkers which predict severity of disease in COVID-19 patients with Neutrophil to Lymphocyte Ratio being better predictor in terms of diagnostic accuracy.  Keywords: Corona virus disease 2019 (COVID‐19), Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio