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Background: The age, gender, and height, percentiles requirements for the ‘gold-standard’ diagnosis of hypertension and prehypertension in adolescents make it time-consuming for clinicians and difficult-to-use by non-professionals. Simplified diagnostic tools are therefore needed. The use of blood pressure-to-height ratio (BPHR), systolic (SBPHR) and diastolic (DBPHR), has been reported in Han adolescents, and it requires validation in other racial groups. The diagnostic accuracy of SBPHR and DBPHR in Bhavnagar, Gujarat, India was therefore studied. Methods: From a population of 1000 school going Caucasian adolescents aged 12-18 years from two schools; Blood pressures were measured using standard procedures. Hypertension and prehypertension (HTPHT) were defined according to the 2004 Working Group normative tables. ROC curve analyses were used to assess the diagnostic accuracy of BPHR in defining HTPHT in this population. Sex-specific threshold values for SBPHR and DBPHR were determined and thereafter used to define HTPHT. The sensitivity/specificity of this method was determined. Results: The accuracy of SBPHR and DBPHR in diagnosing HTPHT, in both sexes, was >92%. The optimal threshold ratio for prehypertension was 0.725/0.465 in boys and 0.745/0.465 in girls; while for hypertension, they were 0.765/0.495 in boys and 0.795/0.515 in girls. The sensitivity and specificity of this method was >88%. Conclusions: The use of blood pressure-to-height ratio BPHR is valid, simple, and accurate in this population. Keywords: Adolescents; Blood pressure-to-height ratio; Diagnosis; Prehypertension; Hypertension; Bhavnagar; School

Background: Several studies have shown potential value of serum Procalcitonin level (SPCT) for diagnosing and differentiating bacterial meningitis (BME) from other, but the results were inconsistent.Methods: Children from birth to 12 years, with clinical suspicion of meningitis were enrolled. Clinical and laboratory information was collected and cases were classified according to pre decided case definition (based on clinical and laboratory) as bacterial or non-bacterial meningitis (NBME).Results: Out of 4393 admission (2016-17) 60 patients were selected for final study (on basis of case definition) which were equally distributed in both group (BME and NBME) in terms of age and sex (p 0.97). 29/41 (70%) patients of pyogenic meningitis had high level of SPCT which was significant, whereas only 2/19 (10.5%) patients of NBME had high level of SPCT. Although SPCT seems to be the good marker in differentiating between BME and NBME, SPCT level specificity (89%) in the diagnosis of BME was not higher than CSF protein level (94%) and CSF glucose level (94%).Conclusions: Measurement of plasma SPCT levels are of value in differentiating BME & NBME in children. However, SPCT should not be used as single sole diagnostic marker of BME if CSF protein and glucose are available. CSF WBC Count alone should not to be used in diagnosis of BME as specificity is low. This study needs to be validated with a larger sample size and microbiological confirmation of bacterial disease.

Background: Thalassemia is a genetic disorder caused by an imbalance between α or β globin chain production resulting in an ineffective synthesis of hemoglobin chains. Treatment involves regular blood transfusions that cause iron build-up and tissue damage in organs causing, cardiomyopathy, diabetes, hyperthyroidism, interstitial lung fibrosis, cirrhosis, etc.Aims: To assess the efficacy of iron chelators: daily oral deferasirox vs combination of daily oral deferasirox + intermittent injectable deferoxamine in reducing serum ferritin level in thalassemia major patient. The main outcome was a decrease in serum ferritin after 1 year. Methods: They are randomly allocated into two groups. Both groups will take periodically blood transfusions but one group will receive oral deferasirox (group A) daily alone and group B will receive Deferasirox along with injectable deferoxamine by intravenous route only during periodic blood transfusions. In the B group along with it post-transfusion injectable deferoxamine will be given over four hours diluted in normal saline. Every 2 monthly serum ferritin level was done for 12 months.Results: Group A (n=30) with s ferritin mean± SD at base 7581.6±2389.7 and at 1 year 5288.5 ±2226.0, a decrease of 25.8%; and in Group B (n=30) with Mean± SD at base 9096.2± 3063.6 and 4698.4 ±2689.9 at 1 year, a decrease of 43.2% which is significant (p=<0.001). Conclusion: A combination of daily oral deferasirox +intermittent injectable deferoxamine is a significantly better iron chelator, to decrease serum ferritin than oral deferasirox tablets in the subjects studied. No adverse events were noted.