Objective: To determine diagnostic accuracy of NMP 22 and urine cytology in the detection of transitional cell carcinoma (TCC) urinary bladder taking cystoscopy as a gold standard in patients having provisional diagnosis of bladder cancer (BC). Methods: This cross sectional validational study enrolled 380 patients fulfilling selection criteria and was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan form July 2018 to July 2019. The urine sample collected underwent NMP22 and cytological analysis followed by rigid cystoscopy. Reports of all three tests divided patients into positive or negative for malignancy as per defined criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NMP 22, urine cytology and their combination was determined. Receiver operating characteristic (ROC) curve analysis performed and area under the curve (AUC) compared among these tests. Results: The average age of patients was 53.08 ± 12.41 years having male to female ratio 3.75:1(300 males and 80 females). NMP 22 had better sensitivity and comparable specificity to cytology (81.9 & 81.2% vs 54 & 93.9%). Combination of NMP 22 / cytology outperformed both in terms of sensitivity (91.63 vs 81.83 vs 53.96), NPV (87.59 vs 77.46 vs 61.02) and diagnostic accuracy (85.26 vs 81.58 vs 71.32) but at the cost of specificity (76.97 vs 81.21 vs 93.94) and PPV (83.83 vs 85.02 vs 92.06). ROC curve revealed statistically significant higher AUC (0.843 vs .815 vs .73) for combination as compared to NMP 22 and Cytology (p<0.001). Conclusion: NMP22 is a quick, point of care test having higher sensitivity, NPV and accuracy but similar specificity and PPV to urine cytology for detection of TCC urinary bladder. Combination outperformed both in terms of sensitivity while having modest specificity. doi: https://doi.org/10.12669/pjms.36.4.1638 How to cite this:Sajid MT, Zafar MR, Ahmad H, Saif Ullah, Mirza ZI, Shahzad K. Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1638 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction: Urinary tract infections (UTIs) are one of the most frequent infections encountered by doctors. It can be a significant source of morbidity for some patients. Microbes are growing resistant to commonly prescribed antimicrobials and UTIs are becoming more difficult to treat day by day. The study aimed to investigate the common uropathogens encountered in our geographical region and to study their antibacterial susceptibility patterns.Material and Methods: It was a retrospective descriptive study carried out in the Armed Forces Institute of Urology, in collaboration with the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, during the year 2019. Positive reports for urine culture and sensitivity performed during the last two years were studied to document various isolates and their antimicrobial sensitivity.Results: A total of 3191 positive urine cultures in the last two years (2017-2019) were studied. Escherichia coli (66%), followed by Klebsiella Pneumonia (12%) were the most frequently encountered organisms. Overall resistance to Ciprofloxacin was 66%, Cotrimoxazole was 62%, Gentamycin was 40%, Fosfomycin (9.5%) followed by Meropenem (28%) and Nitrofurantoin (35%) were the most sensitive antibiotics.Conclusion: Gram-negative bacilli are the predominant organisms responsible for urinary tract infections. These uropathogens show significant resistance to routinely used antibiotics. Fosfomycin and Nitrofurantoin are suitable oral anti-bacterials for patients with UTI, whereas Meropenem is suitable if an injectable therapy is required. Our study may act as a guide for the choice of empiric antibiotics based on local resistant patterns.
Objective: To compare the efficacy of voided urine cytology with findings of cystoscopy and histopathology of biopsy specimens in the diagnosis of bladder cancer. Study Design: Comparative cross-sectional study Place and Duration of Study: Armed forces Institute of Urology (AFIU), Rawalpindi Pakistan from Jan 2019 to Jan 2020. Methodology: All patients presenting to the urology clinic with complaints of haematuria, visible and non-visible, and any radiologic evidence of bladder growth were included in the study after informed consent. Urine cytology was performed for all patients, followed by cystoscopy under anaesthesia, transurethral resection was conducted, and biopsy was taken where needed. Results: 170 patients were included in the study134 (78.8%) were males, while 36 (21.2%) were females. The mean age was 54 ± 9.47 years (range 36 to 73 years). The overall sensitivity of voided urine cytology was 46.7%, while specificity was 79.2%. The positive predictive value was 85.1%, and the negative predictive value was 36.9%. Conclusion: Bladder cancer is a disease which demands an early diagnosis, prompt treatment, and long-term follow-up. Cystoscopy remains the gold standard for this purpose; urine cytology can be used as a supplement as it is non-invasive, more specific and cost-effective.
This is the first research done to explore the morphologic changes in two stage tendon grafting as compared to one stage tendon grafting. AIMS: To compare morphology of grafted tendons with and with out first stage silicon rubber rod implantation. STUDY DESIGN: Comparative experimental study. PERIOD: 1994-2007. MATERIAL AND METHODS: 30 patients were included in this study. They was divided into 3 groups. Group 1 underwent 2 stage tendon grafting group 3 was used as control morphological study of tendons. RESULTS: Group 1 (1-stage) tendon grafting showed degeneration and fibrous reaction as morphological changes. Group 2. (2 Stage) appeared as normal tendons morphologically. CONCLUSION: This study concludes that instead of direct tendon grafting, two stage tendon grafting is recommended.
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