Background and aim: Majority of cirrhotic patients develop varices, the rate of variceal bleeding is 10-30% yearly with death rate from bleeding is 17-57%. esophagogastroduodenoscopy (EGD) is an invasive and unpleasant technique carrying rare but serious complications. We aimed to investigate the serum ascites albumin gradient (SAAG) and portal vein congestion index (PCI) as non-invasive methods for prediction of esophageal varices (EV) in patients with liver cirrhosis. Patients and Methods: 125 cirrhotic patients with ascites and no past history of EGD were included. Patients were grouped into; Group I: 38 cirrhotic patients without EV. Group II: 87 cirrhotic patients with EV. Patients were subjected to full clinical evaluation, calculation of SAAG, abdominal ultrasound with a duplex study and measurement of PCI, and Esophagogastroduodenoscopy for detection and grading of esophageal varices . Results: Cirrhotic patients with EV had higher SAAG values (1.85 ± 0.24 gm/dl) than cirrhotic patients without EV (1.27 ± 0.15 gm/dl). Additionally, cirrhotic patients with EV showed a higher PCI than those without (0.16 ± 0.02 and 0.12 ± 0.01 respectively). For prediction of EV in cirrhotic patients, SAAG had AUC 0.986 (p<0.001) with cutoff >1.4 with sensitivity 97.70% and specificity 89.47% and portal congestion index, AUC was 0.974 (p<0.001) with cutoff >0.135 had sensitivity 90.80% and specificity 94.74%. Conclusion: SAAG could be used as a non-invasive predictor for the presence of EV in cirrhotic patients along with SAAG cutoff >1.4 requiring clinical attention. Combination of SAAG and PCI had a high ability to predict esophageal varices in cirrhotic patients with AUC 1.000.

Background and study aim : Several serologic tests for typhoid fever have been introduced which detect IgM or IgG antibodies to various purified antigens of S. Typhi as TUBEX test. This study aims to evaluate the performance of TUBEX test as a rapid diagnostic test of typhoid fever. Patients and Methods: The present study involved 44 patients admitted to Shebin El Kom Fever Hospital fulfilling the criteria of typhoid fever by WHO as (suffering from continuous fever at least 2 days, greater than 38.5°C in addition to headache, constipation or diarrhea) without identified cause of fever as pneumonia. Compared with 20 subjects; 10 with non specific fevers and 10 without fever using TUBEX test in correlation to the usual Widal test and blood culture as a gold standard. Results: We revealed sensitivity, specificity, positive predictive value and negative predictive value respectively for Widal; 75%, 60%, 80.5%, 52.2% and for culture; 65.9%, 100%, 100%, 57.1%. In correlation with TUBEX test the results are at cutoff point 5 showing sensitivity, specificity, positive predictive value and negative predictive value respectively; 84.1%, 95%, 97.4% and 73.1%. Conclusion: TUBEX results are superior to Widal test results in specificity and slightly in sensitivity as compared to the blood culture as a reference test.

Background and Study aim: Serum procalcitonin (PCT) is specific for the diagnosis of bacterial infection. The aim of this study is to evaluate the role of serum PCT in diagnosis of septic meningitis in adults and its efficacy in differential diagnosis. Patients and Methods: The study included 30 adults of septic meningitis and 30 adults with aseptic meningitis admitted in Menouf Fever Hospital and Tropical Medicine Department with fever, headache, vomiting and seizure. The diagnosis of septic meningitis was based on clinical features; physical examination, blood and cerebrospinal fluid (CSF) cytochemical findings, Gram stain and bacterial culture. Thirty cases of aseptic meningitis admitted during same period were also included in the study, and 20 subjects of matched age and sex, free from any CNS diseases undergoing spinal anaesthesia for non CNS surgical causes as control. Serum PCT was measured by Gloryscience ELISA Kit. Results: Serum PCT level was significantly higher in patients with septic meningitis than those with aseptic meningitis (P<0.001). In culture and Gram stain positive 23 and 20 cases respectively, serum PCT was significantly elevated (23.123 ± 9.894 pg) than aseptic meningitis (8.652± 1.777pg) (P<0.001). At optimum cut off value of ≥10.36 pg/mL, based on area under receiver operating characteristic (ROC) curve, PCT showed sensitivity, specificity of 100 % and 86.6% respectively for the differentiation of septic from aseptic meningitis. Conclusions: Serum PCT may be used as diagnostic marker for septic meningitis and its differentiation from aseptic meningitis.

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