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BACKGROUND One of the most common forms of central nervous tuberculosis is tubercular meningitis and has high morbidity and mortality. The natural course of TBM is subacute in nature; hence, the symptoms may persist for weeks before diagnosis. The diagnosis of tuberculosis is based on clinical presentation and cerebrospinal fluid analysis. GeneXpert is a reliable and rapid diagnostic modality for diagnosing pulmonary tuberculosis. Various studies have shown various sensitivity patterns of GeneXpert in TBM. This study aims to find the utility of GeneXpert in TBM. METHODS All adult patients who presented with signs and symptoms of meningitis were included in the study. Detailed history was recorded and physical examination done. All patients were subjected to routine blood investigations, chest X ray, brain imaging along with lumbar puncture for cerebrospinal fluid (CSF) analysis. Apart from routine CSF analysis for cell type, cell count, and biochemical analysis, 3-5 ml of CSF was sent for GeneXpert to intermediate reference laboratory at Government Hospital for Chest Diseases, Pondicherry. On the basis of clinical history, examination, and investigations, composite gold standard for the diagnosis of TBM was defined. The composite gold standard included definite case of TBM, highly probable case of TBM, probable case of TBM and definitely not TBM. Sensitivity and specificity were calculated for GeneXpert for the composite gold standard. RESULTS 100 patients were included in the study. 64 were males and 36 were females. TBM was detected in 22 cases. Mean age for TBM was 42 ± 19.2 years. Among 22 cases of TBM, only one case was categorized as definite TBM, and the rest 21 were either highly probable TBM (7) or probable TBM cases (14). Common clinical signs and symptoms on presentation were headache (87%), fever (78%), neck rigidity (69%), seizure (52%) and altered sensorium (74%). GeneXpert and CSF culture was positive in only one case with sensitivity of 14% and specificity of 100%. Adenosine deaminase (ADA) was high in 13 cases with sensitivity of 60% and specificity of 100%. CONCLUSIONS The utility of GeneXpert in diagnosing tubercular meningitis is very insignificant. Negative GeneXpert in CSF analysis does not rule out TBM as sensitivity is 14% but positive GeneXpert has 100% specificity. In the absence of reliable diagnostic test, clinician should look for specific signs and symptoms of meningitis along with routine CSF analysis and CSF ADA level.

BACKGROUND Metabolic syndrome is an important risk factor for cardiovascular disease and type 2 diabetes mellitus. According to International Diabetes Federation, the risk factor associated with metabolic syndrome are central obesity, hypertension, increased fasting glucose, triglyceride level and decreased HDL. Recent studies also found that hyperuricaemia is also associated with insulin resistance and increased cardiovascular disease related morbidity. A cross-sectional study was conducted at Pondicherry Institute of Medical Sciences with an objective to find the prevalence of hyperuricaemia among patients with metabolic syndrome and also to find the association of risk factor of metabolic syndrome with serum uric acid level. MATERIALS AND METHODS 103 patients (49 males and 54 females) who fulfilled the inclusion criteria were included in the study. Detailed medical history and physical examination including height, weight, BMI, waist circumference and blood pressure were recorded. Five millilitre of fasting blood sample was taken for lipid profile, serum uric acid and fasting blood glucose. Chi-square test was done to find out the association between metabolic syndrome and risk factors of hyperuricaemia with ‘p’ value of 0.05). Exercise had negative influence on uric acid level in both gender, 41% less in males and 14% less in females. Diet also had positive influence on uric acid levels in both male and female. CONCLUSION The prevalence of hyperuricaemia among males is higher than females. The risk factors of metabolic syndrome like obesity, hypertension and increased cholesterol level are associated with hyperuricaemia.

BACKGROUND Hyponatraemia is one of the commonest electrolyte abnormalities among admitted patients. It is also the commonest electrolyte abnormality associated with morbidity and mortality. Hence, we aimed to study the clinical and aetiological profile of patients admitted with severe hyponatraemia in Pondicherry Institute of Medical Sciences, Pondicherry. MATERIALS AND METHODS A prospective observational study conducted at tertiary care hospital in South India during last 18 months. All patients above age of 18 presenting with serum sodium less than or equal to 125 mEq/L were included in the study. Detailed medical and surgical history was recorded. Routine investigation like complete haemogram, renal function test, serum electrolytes, thyroid function test, serum cortisol and urine spot sodium and osmolality were done. Descriptive variables were expressed in mean and standard deviations. They were compared using Mann-Whitney U test and x 2 test. RESULTS 89 patients presented with serum sodium of less than 135 mEq/L out of which 50 patients had serum sodium level of less than 125 mEq/L. The patients with serum sodium level of less than 125 mEq/L were included in the study. 56% were males and 44% were females. More than 50% of the patients were above the age of 60. Mean sodium level at admission was 115 mEq/L. 64% of the patients were euvolaemic at admission while 24% were hypervolaemic. Syndrome of Inappropriate Antidiuretic Hormone (SIADH) was the commonest cause for hyponatraemia (18%) and thiazide diuretics use was the second most common cause (12%). One death due to hyponatraemia was recorded during our study. There was no association of severity of hyponatraemia and symptoms (p >0.05). CONCLUSION Hyponatraemia is common among elderly. SIADH is the commonest cause for hyponatraemia among the admitted patients. Chronic hyponatraemia may have a weak association with serum sodium and symptoms.

BACKGROUND Hashimoto’s thyroiditis is the most common cause of hypothyroidism in Iodine sufficient areas. Diagnosis depends on histopathological or cytological features. The accuracy of autoantibodies among hypothyroid patients for diagnosis of Hashimoto’s thyroiditis was explored in this study. MATERIALS AND METHODS A cross sectional study was conducted on persons with laboratory confirmed hypothyroidism at a tertiary care hospital. All subjects underwent determination of anti-thyroid peroxidase antibodies (anti-TPO) and Fine Needle Aspiration Cytology (FNAC) of the thyroid. The sensitivity and specificity of anti-TPO antibodies was determined using FNAC as gold standard. RESULTS Fatigue was the most common symptom among the hypothyroid patients. The diagnostic sensitivity and specificity of anti-TPO antibodies was 88.37% and 50% respectively for Hashimoto’s thyroiditis. Using this sensitivity and specificity, the calculated positive likelihood ratio (LR) is 1.80 and negative likelihood ratio is 0.23. CONCLUSION Anti-TPO appears to be a relatively sensitive test for diagnosis of Hashimoto’s thyroiditis among patients with hypothyroidism; however, its specificity is low. The low negative likelihood ratio transforms it into an effective test to rule out Hashimoto’s thyroiditis in populations with low pre-test probability of Hashimoto’s thyroiditis.