Adenosine Deaminase Levels Research Articles

Effects of adenosine and dipyridamole on serum levels of IL-6, TNF - , and some antioxidants in rabbits

Nearly 30 years of research findings stated that adenosine adjust ischemia. Although, adenosine use for treatment has not been accepted clinically in wide manner, also there have no many clinical trials. Aims: study the effects of adenosine and dipyridamole on total Antioxidant Capacity (TAC), Adenosine Deaminase (ADA), GSH (Glutathione), TNF - a (tumor necrosis factor Alpha) and IL-6 (Interleukin 6) in rabbits. Material and methods: Thirty five male rabbits were included in the study. The animals were divided into 3 groups: Group one(5 animals): injected (i.p) with 2 ml of distilled water/day (control group). Group two (15 animals): were treated by intraperitoneal injection of adenosine, they were divided into 3 sub groups (5 animals) according to adenosine dose:1 mg/kg, 2mg/kg and 4 mg/kg.Group 3 (15 animals): were treated by dipyridamole orally, they were divided into 3 sub groups (5 animals) according to dipyridamole dose:4 mg/kg, 8 mg/kg and 12 mg/kg. Total Antioxidant Capacity Assay kit, Adenosine Deaminase (ADA) colorimetric Assay kit, Rabbit IL-6 (Interleukin 6) ELIISA kit, Rabbit TNF - a (tumor necrosis factor Alpha), GSH (Glutathione) ELISA kits were used. Results: ANOVA Test and Duncan’s Multiple Range Test were applied between study groups. In comparison among adenosine, dipyridamole and control groups, highly significant differences were found among them in TAC,ADA and GSH levels while no significant differences were found in TNF -a and IL-6 levels among all groups. Conclusion: both adenosine, dipyridamole cause reduction in total Antioxidant Capacity together with increase in glutathione levels and Adenosine Deaminase.

Clinical Value of Pleural Effusion and Serum MMP-3 and CYFRA21-1 Combined with ADA in Differential Diagnosis of Pleural Exudative Effusion.

Objective The aim of the study is to investigate the clinical value of matrix metalloproteinases-3 (MMP-3) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) combined with adenosine deaminase (ADA) in pleural effusion and serum in benign and malignant pleural exudative effusion (PEE). Methods A total of 119 adult patients with PEE admitted in our hospital from May 2018 to October 2021 were selected. According to the patient's condition, the patients were divided into the benign group (n = 75) and the malignant group (n = 44). The levels of MMP-3, CYFRA21-1, and ADA in pleural effusion and serum were detected. The receiver operating characteristic (ROC) curve was used to analyze the individual and combined predictive value of MMP-3, CYFRA21-1, and ADA levels. Results In the malignant group, the pleural effusion and serum MMP-3 and CYFRA21-1 levels were higher than those in the benign group and the ADA levels were lower than those in the benign group (P < 0.05). In the malignant group, the positive detection rate of pleural effusion and serum MMP-3 and CYFRA21-1 was higher than that in the benign group and the positive detection rate of pleural effusion and serum ADA were lower than that in the benign group (P < 0.05). The AUC of pleural effusion MMP-3, serum MMP-3 and the combination of them in the diagnosis of PEE were 0.764, 0.722 and 0.810, respectively. The AUC of pleural effusion CYFRA21-1 and serum CYFRA21-1 and combination of them in the diagnosis of PEE were 0.776, 0.748 and 0.822, respectively. The AUC of pleural effusion ADA, serum ADA and their combination in differential diagnosis of PEE were 0.762, 0.737 and 0.836, respectively. The AUC of pleural effusion and serum of MMP-3 and CYFRA21-1 combined with ADA for differential diagnosis of PEE was 0.923. Conclusions The diagnostic efficacy of MMP-3 combined with CYFRA21-1 and ADA in pleural effusion and serum for benign and malignant PEE are better than single index, which has certain clinical values for the selection of early intervention scheme for PEE patients.

Adenosine Deaminase Detection in Serum of Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis patients at Dr. Ramelan Hospital Surabaya

Diagnosis of active tuberculosis (TB) is the first step to determine the next treatment management of patient care. The success of the treatment will not be achieved without the determined accurate diagnosis rapidly. The definitive diagnosis of tuberculosis includes the presence of Mycobacterium tuberculosis through smear staining or histopathological examination or culture method or molecular methods, however some of the methods have limitations for TB diagnosis, especially on extrapulmonary tuberculosis (EPTB). In EPTB, culture method is time consuming till 6-8 weeks, where as it requires a rapid diagnosis, while tissue biopsy to obtain histopathological images is an invasive procedure. Likewise, the constrains on determining diagnosis of pulmonary TB (PTB) especially child TB and EPTB. In certain condition, the detected ADA level exceeds the detection limit as well as in TB disease with an active process. To study the meaning detection of Serum Adenosis Deaminase in serum of patients as an indicator in diagnosing of active disease process in Pulmonary and Extra Pulmonary Tuberculosis. This study was an observational study with a cross sectional study method, carried out in 8 months, by taking serum of blood samples from patients diagnosed with PTB and EPTB. The sample examination, then measuring the ADA serum levels using the ELISA method in Dr Ramelan Hospital Surabaya Indonesia, and cofirmed MTBC in blood samples using standard PCR of gyrB gene region in the Tuberculosis Laboratory, Tropical Disease Institute, Airlangga University, Surabaya, Indonesia. In totally 176 serum samples form PTB and EPTB patients, at January 2020 until December 2020, there were no significant results between serum Adenosine Deaminase (ADA) levels in diagnosing Pulmonary Tuberculosis and Extra Pulmonary Tuberculosis at Dr. Ramelan Hospital Surabaya. So, in this study, ADA serum levels could have the potential role in the diagnosis of pulmonary tuberculosis and EPTB, otherwise this study revealed that ADA serum activity is not a useful test for differentiating tuberculosis from other respiratory diseases, and could be an additional test especially for disease active progressive or recovery.

DIAGNOSTIC SIGNIFICANCE OF ADENOSINE DEAMINASE AND LYMPHOCYTES IN SUSPECTED TUBERCULOUS PLEURAL EFFUSION

CONTEXT: Tuberculosis is a major public health problem in India. Tuberculous pleural effusion is a paucibacillary manifestation of the Tuberculosis, so isolation of Mycobacterium tuberculosis is difficult, biomarkers being an alternative for diagnosis. Pleural fluid Adenosine deaminase (ADA) level is being used in diagnosis of Tubercular pleural effusion. The combination of ADA and pleural fluid lymphocyte count is being recognized as a better method for increasing the specificity of ADA test. The present study was conducted to analyze the diagnostic usefulness ofAIM: ADA alone (≥ 40U/L) compared with the combination of ADA and pleural fluid lymphocyte count ( ≥ 50% ). SETTINGS AND DESIGN: METHODS AND MATERIAL:Retrospective study. Study was conducted for a period of one year from May 2017 to April 2018. A total of 110 pleural fluid samples data was analysed. SPSS 20STATISTICAL ANALYSIS USED: statistical software. ADA level in Tuberculous pleural effusion ranged from 40U/L to 112U/L with mean value ofRESULTS: 69.4U/L. Sensitivity, Specificity, Positive predictive valve (PPV) and Negative predictive values (NPV) for ADA alone were 93.2%, 76.4%, 82% and 90.6% respectively. For ADA and lymphocyte count the Specificity and PPV increased (98% and 98.1% respectively) with hardly any decrease in sensitivity or NPV (89.8% and 89.5% respectively). CONCLUSION: Combined use of ADA and pleural fluid lymphocyte count increases the specificity and PPV when compared to the specificity of ADA test alone in diagnosing Tubercular pleural effusion.

The immuneoreaction and antioxidant status of Chinese mitten crab (Eriocheir sinensis) involve protein metabolism and the response of mTOR signaling pathway to dietary methionine levels

To study the effects of dietary methionine on growth performance, immunity, antioxidant capacity, protein metabolism, inflammatory response and apoptosis factors in Chinese mitten crabs (Eriocheir sinensis). Five diets with different methionine levels (0.63%, 0.85%, 1.06%, 1.25% and 1.47%) were fed to E. sinensis for 8 weeks. Results showed that in the 1.25% Met group, both growth performance and feed utilization were significantly increased. The crude protein content of crab muscle in the 1.06% and 1.25% Met groups was significantly higher than that in the control group. The immune and antioxidant enzyme activities, as well as gene expression levels of anti-lipopolysaccharide factor 1 (ALF1), Crustin-1, prophenoloxidase (proPO), cap ‘n’ collar isoform C (CncC) in 1.25% Met group were significantly higher than other groups. The activities of adenosine deaminase (ADA) and glutamate transaminase (GPT) in serum decreased first and then increased with the increase of methionine content, while the changes of ADA and GPT in hepatopancreas increased first and then decreased. 1.25% Met group exhibited significantly increased levels of GOT, GPT, and ADA compared to the control group. 1.25% Met diet group significantly up-regulated protein synthesis and anti-apoptotic factors, and significantly down-regulated inflammatory and pro-apoptotic factors in hepatopancreas. At 1.25% in the diet, methionine was found to boost E. sinensis growth, muscle protein deposition and immunity, as well as its antioxidant capacity. Combined with the above results, based on the expression of factors involved in the mammalian target of rapamycin (mTOR) signaling pathway and the mitogen-activated protein kinase (MAPK) signaling pathway, it is proved that methionine can not only promote protein metabolism, improve feed utilization, but also alleviate the inflammatory response and apoptosis caused by oxidative stress in the body.

10-Year Retrospective Review of the Etiologies for Meningitis With Elevated Adenosine Deaminase in Cerebrospinal Fluid: Etiologies Other Than TB.

PurposeAn elevated adenosine deaminase (ADA) level in the cerebrospinal fluid (CSF) is considered a reliable marker of tuberculous meningitis (TBM). However, CSF-ADA levels can also be elevated in other diseases. We aimed to find the most common diagnosis of patients with elevated CSF-ADA levels for the last 10 years.MethodsWe retrospectively investigated the diagnoses of all patients with elevated CSF-ADA (ADA ≥ 10 IU/L) levels between 2010 and 2019 at the Samsung Medical Center. Definite TBM was defined based on microbiological evidence. Clinical TBM was defined based on the brain imaging and response to the standard TB treatment. We compared the laboratory characteristics of the three most common diagnoses.ResultsCSF-ADA levels were elevated in 137 (5.6%) of 2,600 patients. The most common diagnoses included hematologic malignancy (HM; n = 36, 26.2%), TBM (n = 26, 19.0%), and viral meningitis (VM; n = 25, 18.2%). CSF-ADA levels did not differ significantly between TBM [median (interquartile range (IQR)), 20.2 IU/L (13.8–29.3)] and HM [16.5 (12.8–24.0)]. However, CSF-ADA levels were lower in VM [14.0 (11.0–16.1)] than in TBM (p = 0.027). Lymphocyte-dominant pleocytosis was more common in VM [77.0% (70.8–81.5)] than in TBM [16.0 (3.0–51.0), p = 0.015] or HM [36.0 (10.0–72.0); p = 0.032]. Interestingly, the CSF characteristics of clinical TBM were similar to those of VM but not definite TBM.ConclusionThe most common diagnoses with elevated CSF-ADA levels were HM, followed by TBM and VM. Clinicians should carefully consider the differential diagnoses in patients with elevated CSF-ADA levels, especially those in the early stage of meningitis without microbiological evidence for TBM.

Stroke in Tuberculous Meningitis and Its correlation with Magnetic Resonance Angiography Manifestations.

Objective The primary objective of the study was to assess the location of cerebral infarction and look for corresponding magnetic resonance angiography (MRA) changes in patients with tuberculous meningitis (TBM). We also evaluated the predictors of ischemic stroke in TBM and the impact of these infarctions on patient's outcome. Methods This was a single-center prospective study between September 2018 and September 2020. Demographic and laboratory parameters were noted. Cranial magnetic resonance imaging and MRA were performed at the time of admission to the hospital. Results Among 120 patients with TBM, 46 had stroke. Nineteen (15.8%) patients died, of which 12 (10%) suffered from stroke. The most common site of infarction was the basal ganglia (54.3%). The commonest site of MRA abnormalities was the middle cerebral artery (39.1%). British Medical Research Council (BMRC) stage 3, cerebrospinal fluid (CSF) sugar, CSF adenosine deaminase (ADA) level, basal exudates, hydrocephalus, and hyponatremia were found to be predictors of stroke in TBM, while BMRC stage 3, CSF cell count, CSF ADA level, and anemia were found to be significantly associated with mortality in TBM patients with stroke. Conclusion The basal ganglia were the most common site of ischemic stroke in TBM, and middle cerebral artery was the most often involved intracranial blood vessel. BMRC stage 3 was significantly associated with both stroke and mortality in TBM patients with stroke.

Characterization of multiple soluble immune checkpoints in individuals with different Mycobacterium tuberculosis infection status and dynamic changes during anti-tuberculosis treatment

BackgroundImmune checkpoints are crucial for the maintenance of subtle balance between self-tolerance and effector immune responses, but the role of soluble immune checkpoints (sICs) in Mycobacterium tuberculosis (M. tb) infection remains unknown. We assessed the levels of multiple sICs in individuals with distinct M. tb infection status, and their dynamic changes during anti-tuberculosis treatment.MethodsWe enrolled 24 patients with pulmonary tuberculosis, among which 10 patients were diagnosed with tuberculous pleurisy (TBP), 10 individuals with latent tuberculosis infection (LTBI), and 10 healthy volunteers from Wuxi Fifth People’s Hospital and Huashan Hospital between February 2019 and May 2021. Plasma concentrations of thirteen sICs were measured at enrollment and during anti-tuberculosis treatment using luminex-based multiplex assay. sICs levels in tuberculous pleural effusion (TPE) and their relations to laboratory test markers of TPE were also assessed in TBP patients.ResultsThe circulating levels of sPD-1, sPD-L1, sCTLA-4, sBTLA, sGITR, sIDO, sCD28, sCD27 and s4-1BB were upregulated in tuberculosis patients than in healthy controls. A lower sPD-L1 level was found in LTBI individuals than in tuberculosis patients. In TBP patients, the levels of sPD-1, sPD-L2, sCD28, sCD80, sCD27, sTIM-3, sLAG-3, sBTLA, s4-1BB and sIDO increased significantly in TPE than in plasma. In TPE, sBTLA and sLAG-3 correlated positively with the adenosine deaminase level. sIDO and sCD80 correlated positively with the lactate dehydrogenase level and the percentage of lymphocytes in TPE, respectively. Meanwhile, sCD27 correlated negatively with the specific gravity and protein level in TPE. In tuberculosis patients, the circulating levels of sBTLA and sPD-L1 gradually declined during anti-tuberculosis treatment.ConclusionsWe characterized the changing balance of sICs in M. tb infection. And our results revealed the relations of sICs to laboratory test markers and treatment responses in tuberculosis patients, indicating that certain sICs may serve as potential biomarkers for disease surveillance and prognosis of tuberculosis.

Medical Thoracoscopy for Undiagnosed Pleural Effusions: Experience from a Tertiary Care Hospital in North India

Medical thoracoscopy, also called pleuroscopy, has received renewed interest in the recent past for diagnostic as well as therapeutic uses. In this study, we describe our experience with thoracoscopy for undiagnosed pleural effusions. In a retrospective analysis of thoracoscopic procedures we performed between January 2007 and December 2008, yield of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions, defined as pleural effusions with adenosine deaminase (ADA) levels less than 70 IU/L and negative pleural fluid cytology for malignancy on three occasions was evaluated. Complications of thoracoscopy were also analysed. Overall diagnostic yield of thoracoscopic pleural biopsy was 74.3% in patients with undiagnosed pleural effusions. Pleural malignancy was diagnosed in 48.6% of patients. There was only one case of mesothelioma and the rest were due to pleural metastasis. Lung cancer and breast cancer were the most common sites of primary malignancy. Tuberculosis was diagnosed with pleural biopsy in 22.8% of patients. We had low complication rate after thoracoscopy. Only two cases of empyema were observed. Medical thoracoscopy is a safe procedure and has good diagnostic yield in patients with undiagnosed pleural effusions.

AFB culture and adenosine deaminase levels in subjects with tubercular pleural effusion

Background: Tuberculosis is the communicable infectious disease usually caused by Mycobacterium Tuberculosis Bacteria (MTB). Tuberculosis generally affects lungs, but can also affect other parts of the body. ADA has been found to be useful parameter to conclude the tubercular etiology. Tuberculous Pleural effusion is diagnosed by demonstration of tubercular bacilli in pleural fluid or granuloma in pleural biopsy specimen. Objectives of this study: The objectives of this study were to estimate ADA levels and to study AFB culture in subjects with and without tubercular pleural effusion. Materials and Methods: Biochemical analysis for Protein and Glucose were performed on Automated Biochemistry Analyser and ADA was estimated by ADA-MTB kit method. Cytological examination and ADA Microbiological demonstration of AFB by ZN stain and AFB culture was done by conventional LJ method. Statistical Analysis: Data were expressed as mean ± SD. The Student t test was used for the comparison. Statistical analysis was done using Microsoft Excel spreadsheet, and statistical package for the social sciences (SPSS) version 20.0 software.

The challenges of ascites management: An Indian perspective.

Content available: Author Interview and Audio Recording.

Effect of Commercial Grade Malathion on Immunological Responses in Mice infected with Staphylococcus aureus

The pervasive use of organophosphorus compounds as pesticides in recent years has posed a major threat to the population especially to the occupational workers. Once developed as a chemical warfare in the early 1940’s and having been used in World War II as nerve toxic agent, it has gained entry to almost every household worldwide. Malathion, the OP insecticide was first registered for use in 1956 in the United States. The deleterious effects of Malathion are less studied and have been intriguing to the researchers. The current study focused on the immunosuppressing effect of Commercial Grade Malathion (CGM) on normal and infection induced mice assayed by three immunological markers the Adenosine Deaminase (ADA) levels, Hemagglutination titer (HA) and Carbon Clearance index (CCI). A comparative study was made on normal and subcutaneous Staphylococcus aureus (SA) infected mice exposed to 5% LD50 of CGM. The results obtained showed adverse effect on immunological response in mice that were exposed to CGM alone and in mice exposed to CGM plus subcutaneous S. aureus infection. The effect of CGM was observed by an increase in ADA, decrease in antibody-producing capacity in HA assay and decrease in carbon clearance capacity being greater in the CGM plus subcutaneous SA infection group. This indicates that immunosuppression by pesticide chemicals may be greater in different pathological conditions like an infection in which the immune status is compromised.

Adenosine, adenosine- deaminase and implantable recorder outcome in syncopal patients.

Adenosine test was proposed as atool for identification of syncopal patients who benefit from pacemaker implantation. Aim of the study was to assess the relationship between adenosine levels, the outcome of adenosine test and results of implantable loop recorder (ILR) monitoring in patients with syncope. In 29 patients (mean age 59±11 years, 15 men, 14 women) with unexplained syncope ILR was implanted. In addition, adenosine test (intravenous injection of 20mg adenosine bolus) and assays of plasmatic adenosine and adenosine-deaminase were performed. Adenosine test was positive in 15 patients and negative in 14 patients. Patients with positive adenosine test had lower adenosine levels compared to patients with negative test (8.86±2.07ng/ml vs. 15.18±2.14ng/ml, p=.04). No difference was observed in adenosine deaminase levels (16.35±2.20 IU/l vs. 13.20±2.48 IU/l, p=.40). There was a negative correlation between adenosine level and AVB duration during adenosine test (p=.04; R2 =0.22). Patients with positive adenosine test had more frequent asystole during ILR monitoring than patients with negative test (9pts vs. 1pt, p=.005). Adenosine levels were lower in patients with asystolic syncope on ILR compared to vasodepressor syncope 8.20±2.86ng/ml versus 13.27±7.26ng/ml, p=.05). Patients with positive adenosine test have decreased production of endogenous adenosine compared to patients with negative adenosine test. Positivity of adenosine test and low adenosine level in the peripheral blood were associated with more frequent asystolic episodes during ILR monitoring.

Assessment of adenosine deaminase levels and lypmhocyte counts in tubercular ascitis

Ascitis is the pathological accumulation of free fluid within the peritoneal cavity. Ascitis is manifestation of number of diseases. Traditional classification of ascitis into “Exudative” and “Transudative” which involves estimation of ascitic fluid total protein, which is ≥ 2.5 g/dl in exudates and &lt;2.5 g/dl in transudate. To estimate and compare the ascitic fluid ADA levels between the tubercular ascitis and non-tubercular ascitis and to correlate the levels of ascitic fluid ADA with total protein, albumin, sugar, SAAG and lymphocytes in subjects with tubercular ascites. In our study, we included a total of 140 subjects, out of which 21 (15%) subjects had tubercular ascitis. Out of 140 subjects 105 of them had cirrhosis of liver and 35 of them had ascitis due to other causes. Biochemical analysis for Protein, albumin, LDH and Glucose were performed on Automated Biochemistry Analyser and ADA was estimated by ADA-MTB kit method. The mean levels of total protein and albumin in Group T were 5.4±0.98 and 3.4±0.96 and in Group NT were 2.2±1.1 and 3.2±1.1 respectively. There were statistically significant elevated levels of total protein and decreased albumin in Group T as compared to Group NT.

Investigating the appropriate adenosine deaminase cutoff value for the diagnosis of tuberculous pleural effusion in a country with decreasing TB burden

As the burden of tuberculosis (TB) in South Korea decreases while that of malignancy increases with an aging society, the composition of etiology for pleural effusion is changing. The aim of this study was to investigate the diagnostic value of adenosine deaminase (ADA) for diagnosis of tuberculous pleural effusion (TPE) in this circumstance. Medical records of patients who underwent medical thoracoscopy from May 2015 to September 2020 in Incheon St. Mary Hospital, Korea were retrospectively reviewed. TPE was diagnosed if one of the following criteria was met: (1) granuloma in pleura, (2) positive TB polymerase chain reaction or culture in pleural fluid or tissue with non-specific pathologic findings in pleura, or (3) bacteriologically confirmed pulmonary TB with non-specific pathologic findings in pleura. A total of 292 patients, including 156 with malignant pleural effusion (MPE), 52 with TPE, and 84 with other benign effusion, were analyzed. Among 206 patients with lymphocyte dominant pleural effusion, the area under receiver characteristic curve of ADA for diagnosis of TPE was 0.971. The sensitivity and specificity of a current cutoff value of 40 IU/L were 1.00 and 0.61, respectively, whereas those of a raised cutoff value of 70 IU/L were 0.93 and 0.93, respectively. Among 54 patients with ADA levels of 40–70 IU/L, 30 (55.6%) patients were diagnosed as MPE, 21 (38.9%) as other benign effusion, and only 3 (5.6%) as TPE. Caution is needed in clinical diagnosis of TPE with current ADA cutoff value in countries with decreasing TB incidence, due to many false positive cases.

Evaluation of Inflammatory markers in different stages of Chronic Renal Disease

Background: Chronic kidney disease (CKD) refers to a long-term loss of kidney function. The progression of CKD leads to the damage of other organs including cardiovascular disease which increased the risk of mortality. Early detection of kidney failure can slow down the end-stage renal disease. Aims and Objectives: To estimate the inflammatory marker Adenosine deaminase (ADA) activity in different stages of CKD. To correlate the level of ADA activity with Serum Creatinine with different stages of CKD on the basis of estimated glomerular filtration rate (eGFR). Materials and Methods: The participants having age more than 18 and &lt;60 years having CKD have been enrolled as a study group. CKD was confirmed by calculating eGFR using Cockcroft-Gault equation, plasma creatinine estimation done in all the patients. This study was approved by the Ethical Committee of TMMC and RC. Results: It is observed that the incidence of CKD reaches its maximum strength during middle age. 28% of the young patients, i.e., 45 years of age or younger at the time of CKD, had increased level of ADA. Serum levels of ADA, Creatinine were higher among participants with lower level of eGFR. Inflammation was higher among those with lower eGFR. All biochemical parameter (ADA, CRP, ESR) shows the negative correlation with eGFR. eGFR shows a negative highly significant correlation withESR with a correlation coefficient of r=−4.702 (P&lt;0.001). Conclusion: With the progression of Kidney disease (CKD stages 1–5) it comes to significantly increase of inflammatory markers as decrease in the eGFR with statistical significance. Inflammatory Biomarkers were inversely associated with the measure of kidney function. It is clear that a single indicator of renal function is not sufficient in evaluating the kidney disease stage.

Serum adenosine deaminase activity: A novel test for early diagnosis of pulmonary tuberculosis - What about efficacy?

Background: Pulmonary tuberculosis is a tremendous public health problem, increasing significantly, especially in developing countries. Getting a TB-free globe appears to be not more than a dream. Mycobacterial culturing is the gold standard for precise diagnosis but requires six-week time, in the meantime, patients remain a source of inadvertent disease dissemination in the community. The unavailability of sputum also poses a challenge several times. As adenosine deaminase level measurement is easy, rapid and independent of a sputum sample, this study was conducted to determine the diagnostic efficacy of adenosine deaminase activity for pulmonary tuberculosis.Patients and methods: This prospective study was conducted at Pulmonology-OPD, Gulab Devi Chest Hospital, Lahore, from 01-01-2019 to 30-06-2019. A total of 300 sputum smear-positive patients with clinical and radiological evidence consistent with diagnosis of pulmonary tuberculosis and 30 normal participants without any clinical, radiological or haematological evidence of tuberculosis were included. While, smear-negative patients and those having any evidence of hepatic disease, hematopoietic malignancy, infectious mononucleosis, typhoid or pregnancy were excluded. The serum ADA level of each participant was determined. All patients were subjected to AFB culture. Diagnostic accuracy was determined by considering sputum culture as a gold standard.Results: At cut-off value of &gt;15 IU/L, a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 98.30%, 100.00%, 100.00%, 85.71%, 98.46% respectively were defined. Conclusion: Serum ADA level, having excellent sensitivity and specificity, can diagnose pulmonary tuberculosis even if sputum sample is not available.

Tuberculous polyserositis in endemic areas with an emphasis on empiric therapy

Abstract Rationale: Polyserositis describes contemporaneous inflammation of multiple serous membranes accompanied by effusions in serous cavities. It has been associated with different aetiologies, including autoimmune diseases, endocrine diseases, neoplasia, drug-associated cases, and infectious diseases, such as tuberculosis. Patient concerns: We report the case of a 34-year-old woman who presented with abdominal swelling for 8 months, fatigability, and shortness of breath for 2 months. She denied a history of lower-limb swelling, orthopnea, paroxysmal nocturnal dyspnoea, or right upper quadrant pain. She had no history of cigarette smoking, prior treatment for tuberculosis, malignancy, or contact with someone known to have tuberculosis (TB). On examination, she had a weak pulse, muffled heart sounds, and ascites. Diagnosis: Polyserositis was suspected following visualization of fluid in the peritoneal, pleural, and pericardial cavities on imaging. Interventions: The patient underwent pericardiocentesis and ascitic taps. The patient also received spironolactone, prednisolone, and paracetamol. Despite repeated ascitic tapping and use of diuretics, fluid continued to accumulate until the initiation of empiric anti-TB drugs (rifampicin, isoniazid, pyrazinamide, and ethambutol), as noted from the elevated levels of adenosine deaminase (pleural fluid-46.30U/L) and living in an endemic area for tuberculosis (Kenya). Outcomes: Three weeks after the initiation of anti-TB drugs, the ascites and pericardial and pleural effusions resolved. Two months after discharge, the patient showed marked improvement, with no residual fluid noted in the serous cavities on imaging. Lessons learnt: We report a case of extrapulmonary TB presenting with polyserositis (pericardial, pleural, and ascitic fluid) with elevated adenosine deaminase levels when the traditional Ziehl Neelsen staining yielded negative results. Good clinical judgment and more novel diagnostic tools are necessary to avoid unnecessary delays in initiating definitive management.

Adenosine deaminase activity in serum and pleural fluid of patients with tuberculosis and those without tuberculosis

Background Adenosine deaminase (ADA) has been considered as a marker for cell-mediated immunity. The purpose of this study is to evaluate the usefulness of ADA as a biomarker in diagnosis of pleural effusion in tuberculosis (TB). Patients and methods Forty patients from Abbasia Chest Hospital who were suspected to have exudative pleural effusion and prepared for pleural biopsy were enrolled in the study. ADA in pleural fluid and serum was measured for all of them, and then data were reported and analyzed. Results Of the 40 patients included in the study, most of the 20 patients with TB pleurisy were diagnosed mainly by thoracoscope (16/20), whereas the rest four cases were diagnosed by sonar-guided biopsy. The other 20 patients, diagnosed as non-TB pleural effusion (6/20), mesothelioma (8/20), pneumonia, and adenocarcinoma (6/20). There were significant statistical difference between both groups regarding age, total leukocyte count, erythrocyte sedimentation rate, and tuberculin skin test, whereas no significant association regarding sex, clinical presentation, and radiological finding within any groups. ADA in effusion, serum, and index had a significant statistical difference between the two groups, with cutoff point value in effusion and serum of ∼31.4 and 29.5 U/l, respectively, and 1.1 for the index, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ∼100, 90, 90, 100, and 95%, respectively, for ADA in effusion and serum, whereas for the index of ∼80, 65, 69, 76, and 73%, respectively. Conclusion Serum and pleural fluid ADA level significantly increases in patients with TB pleural effusion than non-TB pleural effusion with higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in prediction.

THE STUDY OF PLEURAL FLUID LACTATE DEHYDROGENASE /ADENOSINE DEAMINASE RATIO TO DIFFERENTIATE BETWEEN TUBERCULOUS AND PARA PNEUMONIC PLEURAL EFFUSION

Background: Pleural Effusion is a commonly observed clinical manifestation which is associated with more than 50 recognized diseases and disorders. Pleural uid lactate dehydrogenase (LDH) and adenosine deaminase (ADA) levels are often used to distinguish between tuberculous pleural effusion (TPE) and para pneumonic pleural effusion (PPE). This is challenging as the LDH level varies from normal to severely increased in PPE and a signicantly elevated ADA is frequently measured in both conditions. In this study, we evaluated use of the pleural uid LDH/ADA. Material and Methods:This was a prospective observational case study. this study included 51 cases more than 18 years of age; presenting with unilateral pleural effusion meeting criteria of exudative pleural effusion to the OPD &amp; IPD of Department of Medicine and Department Pulmonary Medicine S.R.N. Hospital Prayagraj, U.P. Following allotment, Pleural uid aspiration was done, and patients were divided into 2 groups: tubercular and parapneumonic pathology. Pleural uid sent for analysis (cytology, microbiology, and biochemistry). Pleural uid LDH and ADA levels and LDH/ADA ratios were compared between two groups and results were obtained. Results: out of 51 study subjects , 27 were diagnosed to have Tubercular pleural effusion and 24 were found to have parapneumonic pleural effusion .The median pleural uid LDH,ADA and LDH/ADA ratio in TPE group were found to be 293.8 U/L ,59.8 U/L &amp; 6.1 where as in PPE group it was found to be 503.3 U/L , 12.6 U/L and 40.Using LDH/ADA ratio as indicator of TPE an area under the ROC curve of 0.998 was obtained at cutoff value of 16.465.The sensitivity ,specicity , positive predictive value and negative predictive value was found to be 96.4%,100%,100% and 95.8%. Conclusion: The pleural uid LDH/ADA ratio at cut-off level of 16.465 is highly effective in differentiating between TPE and PPE and can be used as a useful diagnostic aid for the clinicians and thus improving patient care.