Diagnostic Accuracy of Contrast-Enhanced FLAIR MRI in the Diagnosis of Meningitis, Keeping CSF Analysis as the Gold Standard

Aymen Shahab — 2026-09-30

Meningitis is a potentially life-threatening inflammation of the meninges that requires prompt diagnosis to reduce neurological complications and mortality. Cerebrospinal fluid (CSF) analysis remains the reference standard, but contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (CE-FLAIR MRI) may improve detection of meningeal enhancement and complement CSF assessment. Objective: To determine the diagnostic accuracy of CE-FLAIR MRI for meningitis using CSF analysis as the reference standard. Methods: This cross-sectional diagnostic accuracy study included 103 patients with suspected meningitis at MTI/Hayatabad Medical Complex, Peshawar, from May to November 2022. All participants underwent CE-FLAIR MRI and CSF analysis. Diagnostic performance was assessed using a 2 × 2 contingency table, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated with 95% confidence intervals. Results: Among 103 patients, 61 were CSF-positive, and 42 were CSF-negative. CE-FLAIR MRI identified 55 true-positive, 34 true-negative, 8 false-positive, and 6 false-negative cases. Sensitivity was 90.2% (95% CI: 80.2–95.4), specificity 81.0% (66.7–90.0), PPV 87.3% (76.9–93.4), NPV 85.0% (70.9–92.9), and overall accuracy 86.4% (78.5–91.7). CE-FLAIR MRI showed a strong association with CSF-confirmed meningitis (Cramer’s V = 0.717, p<0.001). Conclusions: CE-FLAIR MRI showed good diagnostic performance and may serve as a useful non-invasive adjunct to CSF analysis in suspected meningitis; however, it should not replace CSF assessment where lumbar puncture is feasible.

Role of Academia and Research Institutions in Advancing Indigenous Vaccine Development

Saira Afzal — 2026-09-30

Research and academic institutions play a vital role in advancing the development of indigenous vaccines. The self-driven research and production of vaccines that suit national or regional public health needs reduces reliance on imports and enhances self-reliance, which is particularly important for developing countries [1].

These institutions contribute at many stages of the development of vaccines. Their work includes pathogen isolation and characterization, antigen discovery, and the development of platform technologies, including inactivated, recombinant, and subunit approaches. Their involvement may extend to early-stage clinical trials and immunological data that support vaccine research. Collaboration with industry provides another way by which vaccine research can progress from laboratory development to large-scale manufacturing [2].

Training of candidates for vaccine research encompasses skills development with a focus on affordable biopharmaceuticals and vaccines. Universities and research institutions can contribute in terms of discovery, clinical trial infrastructure, and specialized scientific expertise. Collaboration between academia, industry, and government can further support the movement of research towards product development [1].

Comparable roles for public research institutions can be seen in other countries. In Brazil, institutions such as Fiocruz (Bio-Manguinhos), together with partnerships involving universities, have supported technology transfer, local production of COVID-19 vaccines, and efforts to develop indigenous vaccine platforms, including mRNA approaches. These activities have also been linked to wider efforts to reduce dependence on external vaccine supply. In other low- and middle-income countries, research institutions contribute to vaccine research, scientific training, and collaborations intended to address pathogen strains and logistical needs relevant to their own settings [3].

For Pakistan, strengthening domestic vaccine production is particularly relevant because of the country’s heavy dependence on imported vaccines. Approximately 90–95% of the vaccines used in the national immunization program are reported to be imported. Such dependence may increase exposure to global supply disruptions, higher procurement costs, and potential vaccine shortages during pandemics or other emergencies [4].

Overall, academic and research institutions are particularly important during the early stages of vaccine development, when evidence must be generated for subsequent regulatory and policy decisions, including those made through bodies such as India’s NTAGI. Academic and research institutions also contribute to training the next generation of vaccinologists and to maintaining the scientific capacity needed to respond to emerging infectious threats. Academic research alone, however, is not sufficient. Its contribution to indigenous vaccine development depends on continued funding, supportive policy, and effective links with industry. Together, these factors can strengthen domestic vaccine capacity, improve access to vaccines, and support preparedness for future public health emergencies.

Pakistan BioMedical Journal

Diagnostic Accuracy of Contrast-Enhanced FLAIR MRI in the Diagnosis of Meningitis, Keeping CSF Analysis as the Gold Standard

Role of Academia and Research Institutions in Advancing Indigenous Vaccine Development