Journal of Translational Medical Research

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Background and Aim: Diagnosis of tuberculous meningitis is difficult because of its non-specific clinical presentations which may be confused with other disorders of central nervous system. The initiation of anti-TB medication can often be delayed because of lack of available laboratory tests. This study was aimed at evaluating the adenosine deaminase (ADA) concentration in differentiating tuberculous meningitis from non-tuberculous meningitis to determine the cut-off point of ADA in the cerebrospinal fluid (CSF) of tuberculous meningitis patients. Materials and Methods: In this descriptive-analytical study, 42 meningitic patients (21 patients with tuberculous meningitis and 21 with non-tuberculous meningitis) admitted to Boali, Khatam al anbia and Ali ebne Abitaleb hospitals in Zahedan between 2006 and 2007 were selected. From each patient 5 ml of CSF was taken and sent to laboratory to analyze ADA concentration, cells, blood sugar, protein, smear and culturing of Mycobacterium tuberculosis. ADA concentration of CSF in TB meningitic patients was compared with that of non-TB meningitis patients. By using receiver operator characteristics curve (ROC), the optimal Cut-off point for tuberculous meningitis was determined. Results: Out of 21 patients with TB meningitis, 17 (81%) were males and 4 (19%) females and out of 21 patients with non-TB meningitis 14 (66%) were males and 7 (34%) were females. There was a statistically significant difference (P<0.0001) between mean of ADA levels in CSF among the TB and non-TB meningitic patients. The cut off value for the diagnosing of TB meningitis was 10.5 U/L with a sensitivity of 80.95% and specificity of 85.71%. Conclusion: This study demonstrated that ADA concentration in the CSF of TB meningitis patients, using a cut off value 10.5 U/L, can be useful in diagnosing of TB meningitis in Sistan and Balochestan province.

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  Background and Aim: Frozen section is a common intraoperative practice with the aim of determining the lesion as benign or malignant. The aim of this study was the comparison between diagnostic results of cytology and frozen section with intraoperative histopathology in Zahedan Ali Ebne Abitaleb hospital between 2007 and 2008.

  Materials and Methods: In this prospective and analytical study the diagnostic value of intraoperative cytology and frozen section was applied to 100 consecutive biopsies. Sensitivity, specificity, positive and negative predictive values were used as statistical tools for comparison, using routine histopathological examination as the gold standard. We used kappa and chi-square tests for statistical analysis using SPSS 14 software. P<0.05 was taken as the significant level.

  Results: Sensitivity, specificity, positive and negative predictive values in intraoperative cytology were 70.5%, 93.75%, 92.3% and 75% respectively and for frozen section these were 58.8%, 100% , 100% and 69.6% respectively. There was a significant statistical agreement between these two methods (P=0.001).

  Conclusion: The obtained data confirms the value of intraoperative cytology in the diagnosis of all mass lesions. This method can also be used as an alternative technique to frozen section in cases where there are no technical requisites or where the specimen is tiny and unfreezable.