Pleural Fluid Levels Research Articles

Diagnostic value of IFN-gamma in tuberculous pleural effusion

BackgroundSimple, rapid, and accurate diagnosis of tuberculous pleural effusion (TPE) remains challenging. This study aimed to determine the accuracy of IFN-γ in diagnosing TPE. MethodsWe quantified the expression of interferon-gamma (IFN-γ) in blood (B), adenosine deaminase (ADA), and IFN-γ in pleural effusions (PE) from 25 TPE patients and 31 non-TPE patients using a combination of immunological assays and flow cytometric analysis. The diagnostic performance of these three biomarkers was evaluated using receiver operating characteristic (ROC) curves. ResultsWe found that IFN-γ levels in blood and pleural fluid were higher in the TPE group than in the non-TPE group. The mean concentration of IFN-γ in pleural fluid of the TPE group was 3140.90 (1817.94, 6611.05) pg/mL, while that of the non-TPE group was 4.91 (0.69, 8.6) pg/mL), and the difference was statistically significant (z = 6.39, P < 0.001). The mean blood IFN-γ was 40.19 (16.45, 59.08) pg/mL in the TPE group and 2.76 (1.96, 6.02) pg/mL in the non-TPE group, which was statistically different (z = 5.12, P < 0.001). The area under the ROC curve (AUC) for pleural fluid IFN-γ, blood IFN-γ, and ADA were 0.999 (95 % CI: 0.994–1.00), 0.901 (95 % CI: 0.798–1.00) and 0.996 (95 % CI: 0.987–1.00), respectively. ConclusionThis study confirms that IFN-γ has high diagnostic validity in patients with TPE and can potentially be an excellent biomarker.

Clinical and biological effects of different energetic surgical devices currently used for mini-invasive anatomical lung resections for the treatment of NSCLC: a prospective interventional study.

This study aims to compare three commonly used energy devices for dissection during Video-Assisted Thoracoscopic Surgery (VATS) lobectomy: monopolar hook, advanced bipolar, and ultrasonic device, in terms of duration of the surgical procedure and clinical intra- and post-operative outcomes. In this prospective single-center study, 75 patients undergoing VATS lobectomy for non-small cell lung cancer between January 2022 and May 2023 were enrolled and divided into 3 groups based on the device used during the surgical procedure (Group 1: Ultrasonic Device, Group 2: Advanced Bipolar, Group 3: Monopolar Hook). The duration of the surgical procedure, daily pleural fluid production, post-operative pain, length of hospital stay, and occurrence of post-operative complications were compared for each group. In a subgroup of 20 patients (10 from Group 1 and 10 from Group 3), concentrations of inflammatory cytokines in pleural fluid at 3h and 48h post-surgery were analyzed. Pleural fluid production on the first and second post-operative days was significantly lower in patients treated with the Ultrasonic device compared to the other two groups (p < 0.001). The duration of the surgical procedure was significantly shorter when using the Ultrasonic device (p < 0.001). There were no significant differences in length of hospital stay (p = 0.975), pain on the first and second post-operative days (p = 0.147 and p = 0.755, respectively), and blood hemoglobin levels on the first post-operative day (p = 0.709) and at discharge (p = 0.795). No differences were observed in terms of post-operative complications, although the incidence of post-operative cardiac arrhythmias was borderline significant (p = 0.096), with no cases of arrhythmias recorded in Group 1. IL-10 levels in pleural fluid of patients in Group 3 peaked at 3h post-surgery, with a significant reduction at 48h (p = 0.459). The use of the ultrasonic device during VATS lobectomy may reduce pleural fluid production and shorten the duration of the surgical procedure compared to using a monopolar hook or advanced bipolar device. The choice of energy device may influence the local inflammatory response, although further studies are needed to confirm these results.

Ventilator-induced Lung Injury Promotes Inflammation within the Pleural Cavity.

Mechanical ventilation contributes to the morbidity and mortality of patients in intensive care, likely through the exacerbation and dissemination of inflammation. Despite the proximity of the pleural cavity to the lungs and exposure to physical forces, little attention has been paid to its potential as an inflammatory source during ventilation. Here, we investigate the pleural cavity as a novel site of inflammation during ventilator-induced lung injury. Mice were subjected to low or high tidal volume ventilation strategies for up to 3 hours. Ventilation with a high tidal volume significantly increased cytokine and total protein levels in BAL and pleural lavage fluid. In contrast, acid aspiration, explored as an alternative model of injury, only promoted intraalveolar inflammation, with no effect on the pleural space. Resident pleural macrophages demonstrated enhanced activation after injurious ventilation, including upregulated ICAM-1 and IL-1β expression, and the release of extracellular vesicles. In vivo ventilation and invitro stretch of pleural mesothelial cells promoted ATP secretion, whereas purinergic receptor inhibition substantially attenuated extracellular vesicles and cytokine levels in the pleural space. Finally, labeled protein rapidly translocated from the pleural cavity into the circulation during high tidal volume ventilation, to a significantly greater extent than that of protein translocation from the alveolar space. Overall, we conclude that injurious ventilation induces pleural cavity inflammation mediated through purinergic pathway signaling and likely enhances the dissemination of mediators into the vasculature. This previously unidentified consequence of mechanical ventilation potentially implicates the pleural space as a focus of research and novel avenue for intervention in critical care.

The role of lactate dehydrogenase of the pleural liquid in the cytopathological diagnosis

Elevated serum or pleural fluid lactate dehydrogenase (LDH)enzyme levels can be associated with various conditions, including neoplasia, reticuloendothelial tumors, and leukemia. These conditions can lead to cell damage or death, causing LDH to be released into the bloodstream and pleural fluid. An increase in LDH levels may prompt further investigation into the underlying cause, which could include malignancies or other diseases. Elevated LDH levels in pleural fluid are often associated with certain conditions, and our study seeks to establish a quantitative assessment of LDH in conjunction with cytopathological examination for diagnostic purposes. We show here that the presence of abnormal or malignant cells in pleural fluid, as indicated by positive cytopathological results, can be concerning and often necessitates further evaluation. Elevated LDH levels provide biochemical evidence that supports the cytopathological findings, strengthening the case for a potential underlying disease or condition.

GLUCOSE LEVELS OF PLEURAL EFFUSION FLUID AND HER2 STATUS IN PLEURAL-METASTATIC BREAST CANCER

Highlights Patients with breast cancer who have distant metastases are frequently impacted by pleural effusion. HER2 status was found to be substantially correlated with glucose levels in pleural effusion fluid. Abstract Background: Patients diagnosed with breast cancer who have also been affected by distant metastases often suffer from pleural effusion. The prognosis of malignant pleural effusions worsens when glucose levels in the pleural fluid are low. Elevated levels of anaerobic glycolysis due to HER2 overexpression cause breast cancer cells to take in more glucose. Objective: This study aimed to identify any correlation between glucose levels in pleural fluid and HER2 status in breast cancer patients. Material and Method: In this research, 35 female patients with thoracocentesis pleural metastatic breast cancer participated in an analytical observational study using a cross-sectional design. Patients who had undergone thoracocentesis had their HER2 status determined based on the information included in their medical records in the Integrated Oncology Clinic (Poli Onkologi Satu Atap (POSA)) Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. After obtaining data on glucose levels in pleural fluid and HER2 status, statistical analysis was carried out to determine the relationship between the two parameters. Results: The statistical test results with a 95% significance level obtained p=0.004 (p&lt;0.05), so it could be statistically said that there was a significant relationship between the glucose level of pleural fluid effusion with HER2 status. The obtained OR values were 10.93 and CI=95% (1.87-63.97), so that it could be interpreted that the low-glucose levels of pleural effusion fluid increase the proportion of patients with positive HER2 compared to not low-glucose levels of pleural effusion fluid. The correlation between the glucose level of pleural effusion fluid and HER2 status was moderately positive (Chi-Square Contingency Coefficient = 0.44). Conclusion: Glucose levels in pleural effusion fluid were significantly correlated with HER2 status.

Diagnostic and prognostic utility of serum adenosine deaminase in tuberculosis: Worth a revisit or are we flogging a dead horse?

Background Measurement of adenosine deaminase (ADA) activity in body fluids is one of the biochemical methods for the diagnosis of tuberculosis (TB). While the role of ADA levels in pleural fluid and cerebrospinal fluid for diagnosis of TB has been established, the role of serum ADA is yet to be established. Aims To study the role of serum ADA levels in diagnosis and prognosis of TB. Settings and Design This prospective observational study was carried out at a hospital in central India. All TB patients managed at the center in 2021 were included in the study. Materials and Methods Two hundred and thirty-three TB patients who met the inclusion criteria were recruited for the study. The subjects were divided into various study groups on the basis of TB subtypes. The study subjects were treated with first-line DOTS antitubercular therapy (ATT). The subjects underwent analysis of serum ADA levels at 0, 2, and 5 months of ATT initiation. Various factors affecting serum ADA levels were studied. Results There was no statistically significant difference in mean serum ADA levels among all study groups (I–IV) at month 0 (treatment initiation). The mean serum ADA levels of TB patients in all study groups (17.8 ± 5.1) were significantly higher than in the control group (10.1 ± 1.2). Mean serum ADA levels showed a sustained fall from month 0 to month 5 of treatment in all study groups. Low vitamin D levels (below 20 ng/mL), Mantoux negativity, and sputum smear status were not found to affect serum ADA levels. Conclusion Serum ADA levels can be used to evaluate response to ATT and for disease prognostication.

Toll-like Receptor 2 Mediates VEGF Overexpression and Mesothelial Hyperpermeability in Tuberculous Pleural Effusion.

Toll-like receptor (TLR) is essential for the immune response to Mycobacterium tuberculosis (MTB) infection. However, the mechanism whereby TLR mediates the MTB-induced pleural mesothelial hyperpermeability in tuberculous pleural effusion (TBPE) remains unclear. Pleural effusion size and pleural fluid levels of vascular endothelial growth factor (VEGF) and soluble TLR2 (sTLR2) in patients with TBPE (n = 36) or transudative pleural effusion (TPE, n = 16) were measured. The effects of MTB H37Ra (MTBRa) on pleural mesothelial permeability and the expression of VEGF and zonula occludens (ZO)-1 in human pleural mesothelial cells (PMCs) were assessed. Levels of VEGF and sTLR2 were significantly elevated in TBPE compared to TPE. Moreover, effusion VEGF levels correlated positively, while sTLR2 values correlated negatively, with pleural effusion size in TBPE. In human PMCs, MTBRa substantially activated JNK/AP-1 signaling and upregulated VEGF expression, whereas knockdown of TLR2 remarkably inhibited MTBRa-induced JNK phosphorylation and VEGF overexpression. Additionally, both MTBRa and VEGF markedly reduced ZO-1 expression and induced pleural mesothelial permeability, while TLR2 silencing or pretreatment with anti-VEGF antibody significantly attenuated the MTBRa-triggered effects. Collectively, TLR2 mediates VEGF overproduction and downregulates ZO-1 expression in human PMCs, leading to mesothelial hyperpermeability in TBPE. Targeting TLR2/VEGF pathway may confer a potential treatment strategy for TBPE.

Characterization of pediatric patients with necrotizing pneumonia treated at a quaternary care center in Bogotá, Colombia, 2010-2017

Introduction: The incidence of Necrotizing Pneumonia (NP) as a complication of pneumonia has increased. Between 0.6 and 2% of parapneumonic effusions result in empyema, while up to 20% are complicated by necrosis. Methodology: A observational, ambispective study was conducted. The retrospective phase included patients treated between 2010 and 2015; the prospective between 2015 and 2017. The clinical records of patients with pneumonia were reviewed. Patients with pneumatoceles in radiography (Rx) or chest tomography (CT), or bronchopleural fistulas diagnosed were included. Results: 69 patients were collected. Information on immunization was obtained in 67% of patients. Laboratory test results showed leukocytosis &gt; 15,000/mL (65%), thrombocytosis &gt; 450,000/mL (45%), and LDH in pleural fluid &gt; 2500 IU/L (61% of 18 patients). Imaging findings were consolidation (75% vs. 100%) and pneumatocele (33% vs 90%). Microbiological isolates were collected from 27 patients. Streptococcus pneumoniae (56%) and Staphylococcus aureus (30%) were the most common agents. Twelve (80%) pneumococci were identified: five serotype 3, two serotypes 14 and 19A, one serotypes 6A, 8, and 1. Conclusions: NP is a complication that should be suspected in children under 5 years of age with torpid evolution, leukocytosis, thrombocytosis, increased LDH levels in pleural fluid, and pneumatoceles in imaging scans.

Diagnostic Value of Pleural Fluid Adenosine Deaminase In Patients With Pleural Tuberculosis

Background and Objectives Extra-pulmonary tuberculosis occurs in about 10-20% of patients with tuberculosis. It most commonly manifests as tuberculous lymphadenitis or pleural effusion. Pleural fluid Adenosine deaminase (ADA) activity considered as a useful biomarker for detecting pleural tuberculosis. The purpose of this study was to evaluate the diagnostic accuracy of pleural fluid adenosine deaminase level in patients with pleural tuberculosis. Methods In this study, 113 patients with exudative pleural effusion with unknown underlying diagnosis, were enrolled. Physical examination, chest CT, ADA level of pleural fluid, direct thoracoscopic examination, and biopsy of pleura were obtained for all individuals. ADA level and thoracoscipoc appearance of the lesions was then compaierd among the patients with regard to the pleural biopsy report as the diagnostic goldstandard. Results The diagnosis of tuberculous pleurisy was established in 40 individuals based on the pathology reports. The mean ADA level of the TB and the non-TB group was 39.90±22.93 IU/L and 30.74±38.27 IU/L, respectively (P-value=0.167). Sensitivity, specificity, positive predictive value, and negative predictive value of ADA test were 35%, 86.30%, 58.33%, and 70.79%, respectively. Conclusion Based insuffiecient sensitivity and specificity of ADA, in patients with unexplained exudative pleural effusion especially in those with a high suspicion of tuberculous pleurisy, despite the low level of ADA, direct thoracoscopic pleural evaluation with obtaining multiple biopsies of pleura is highly recommended.

Diagnostic utility of LDH measurement for determining the etiology of modified transudate pleural effusion in cats.

Fluid analysis is an initial approach for determining the underlying causes of body cavity effusions. Modified transudate is commonly diagnosed in pleural effusion in cats, however, it provides limited diagnostic information. Aims of this study were to investigate common etiologies causing different pleural fluid types and to evaluate the usefulness of lactate dehydrogenase (LDH) for differentiating the etiology in modified transudates in cats. Pleural effusion samples from 122 cats were analyzed and classified into three types: transudate, modified transudate, and exudate. Causes of pleural effusion were classified into four conditions: cardiac disease, neoplasia, feline infectious peritonitis (FIP), and pyothorax. The relationship of underlying etiology and fluid types was described. The LDH levels in pleural fluid and plasma were compared between the causes in the samples classified as modified transudate. The fluid analysis of pleural effusion showed that modified transudate was the most common fluid type (44.2%). Neoplasia was predominantly diagnosed (38.5%) as the etiology of pleural effusion. There was no significant correlation between pleural fluid and plasma LDH level in any type of pleural fluid, suggesting that pleural fluid LDH does not appear to be affected by plasma LDH. The occurrence of modified transudate was not associated to its etiologies, however, the LDH level in modified transudates showed significant differences between etiologic groups. The LDH level in modified transudate was excellent in separating cardiac from non-cardiac diseases with a cut-off value of <535 U/L and separating FIP from non-FIP diseases with a cut-off value of >641 U/L. Based on the current findings, pleural fluid LDH can be a useful adjunctive marker for differentiating some causes of modified transudate pleural effusion and should be added in the routine diagnostic work-up of feline patients with pleural effusions.

Activated partial thromboplastin time as a potential biomarker for the diagnosis of tuberculous pleural effusion

BackgroundThe aim of this study was to explore the difference in activated partial thromboplastin time (APTT) levels in patients with tuberculous and non-tuberculous pleural effusion (TPE and non-TPE) and its possible mechanism to provide a new direction for the diagnosis of pleural effusion (PE). MethodsA total of 61 patients diagnosed with tuberculous pleurisy with pleural effusion at Shunde Hospital of Southern Medical University from July 2013 to September 2020 were selected as the observation group (tuberculosis group). Another 89 patients (45 with malignant pleural effusion (MPE) and 44 with parapneumonic pleural effusion (PPE) composed the control group. The adenosine deaminase (ADA) level in pleural fluid and plasma APTT level were measured in the two groups. ResultsThe levels of APTT and ADA in the TPE group were significantly higher than the control group, and were 40.03 (37.00, 42.60) (s) and 55.00 (47.00, 69.25) (U/L) for TPE, 29.50 (25.45, 34.20) (s) and 11.90 (9.15, 19.05) (U/L) for malignant pleural effusion (MPE) and 31.35 (27.43, 35.76) (s) and 15.15 (7.40, 35.00) (U/L) for parapneumonic pleural effusion (PPE), respectively. ConclusionsThe level of plasma APTT has certain significance in differentiating tuberculous pleural effusion from nontuberculous pleural effusion.

CONSIDERING PLEURAL FLUID GLUCOSE LEVELS COULD PREVENT UNNECESSARY PROCEDURES

CONSIDERING PLEURAL FLUID GLUCOSE LEVELS COULD PREVENT UNNECESSARY PROCEDURES

Elevated neopterin in tuberculosis and co-infection with HIV and the effect of treatment: A systematic review, meta-analysis, and meta-regression

BackgroundNeopterin (NEO) is a marker of immune stimulation. Increased NEO levels have been associated with autoimmune diseases, infections, and malignancies. Studies of NEO alterations in tuberculosis (TB) with or without HIV co-infection show inconsistent results. Moreover, challenges exist regarding TB diagnosis in people with HIV. MethodsWe did a systematic review and meta-analysis of studies comparing urinary, pleural, and blood NEO levels between patients with TB or HIV-TB co-infection as the case group and subjects without TB and HIV or subjects with HIV without TB as the control group, respectively. ResultsBlood NEO levels in patients with active TB were higher than healthy controls, with a large effect size of 1.99. Patients with TB had higher blood NEO levels before anti-tuberculosis therapy (ATT) than after ATT for months or when treatment ended with moderate effect sizes (1.13–1.46). meta-analysis of studies of patients with HIV-TB co-infection yielded similar results, with higher blood NEO levels in patients than controls that remained significant in subgroups of studies on pulmonary TB (PTB) patients and serum NEO and higher blood NEO levels in patients before than after ATT. ConclusionMeta-analyses reveal alteration in NEO levels in different specimens, e.g., blood, urine, and pleural fluid, in patients with TB with or HIV-TB co-infection compared to the control groups. Future studies need to investigate the utility of NEO as a diagnostic/prognostic biomarker for TB. Also, cellular and molecular mechanisms linking NEO and TB remain to be addressed.

The value of interleukin-27 for differentiating tuberculous pleural effusion from Mycoplasma pneumoniae pneumonic effusion in children.

ObjectivesThe early diagnosis of tuberculous pleural effusion (TPE) is challenging due to the difficulty of isolating Mycobacterium tuberculosis, and pleural biomarkers are an optional choice. Recent studies showed that interleukin-27 (IL-27) appears to be a new accurate biomarker for TPE in adults and no related studies were reported in children. In this study, we aimed to evaluate the potential value of IL-27 in pediatric tuberculous pleurisy by detecting its levels in pleural fluid and serum.MethodsA total of 48 children with TPE and 64 children with severe Mycoplasma pneumoniae (MP) pneumonic effusion (SMPPE) were enrolled in this study. IL-27 concentrations were measured in serum and pleural fluid. The diagnostic yield of IL-27 was evaluated using receiver operating characteristic (ROC) curves.ResultsThe level of p-IL-27 in TPE showed statistically no significant difference when compared with SMPPE (p > 0.05). However, pleural fluid IL-27 (p-IL-27) / serum IL-27 (s-IL-27) ratio in TPE were significantly much higher than those in SMPPE (p < 0.05). By the analysis of the ROC curves, the diagnostic sensitivity and specificity of the p-IL-27/s-IL-27 ratio were 100% and 48.44%, respectively (cutoff value of 1.0280). The area under the ROC curve for p-IL-27/s-IL-27 was 0.7295.ConclusionPleural fluid IL-27 alone was not accurate in distinguishing pediatric TPE from SMPPE, which was different from the diagnostic value of IL-27 in adult studies due to the different disease spectra between children and adults. Our results implied that the p-IL-27/s-IL-27 ratio had a potential value in distinguishing TPE from SMPPE. However, the specificity of IL-27 was relatively lower and it is necessary to find a more specific marker in tuberculous pleurisy of children.

Assessment of the value of mesothelin in differentiating between different pleural malignancies by different interventional modalities

Abstract Context Malignant mesothelioma is an insidious neoplasm, with malignant pleural mesothelioma as the most common type, which is characterized by poor prognosis in most patients owing to late presentation. The use of noninvasive markers for early diagnosis of malignant pleural mesothelioma is of great importance in decreasing the incidence of associated morbidity and mortality. Aims To evaluate the value of soluble mesothelin level in serum and pleural fluid as a diagnostic marker in patients with pleural malignancies and in differentiation of different causes of pleural effusion. Patients and methods We included 48 patients who were classified into three groups: group A (mesothelioma), group B (metastatic malignancy), and group C (transudative effusion). History taking, clinical examination, and laboratory assessment were performed in all groups, in addition to measuring mesothelin level in serum and pleural fluid. Histopathological examination of pleural biopsies was performed in groups A and B. Results Mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in group A as compared with the cases in groups B and C (P&lt;0.001). Moreover, mesothelin levels in serum and pleural fluid demonstrated a statistically significant increase in the samples taken from the cases in group B as compared with the cases in group C (P&lt;0.001). Conclusion Soluble mesothelin-related peptides (SMRP) could be used as a valuable marker in diagnosis of different causes of pleural effusion. The diagnostic accuracy of pleural fluid SMRP was higher as compared with the serum SMRP.

Combined uric acid and cholesterol pleural fluid levels as biochemical markers for differentiation between transudative and exudative pleural effusions

Combined uric acid and cholesterol pleural fluid levels as biochemical markers for differentiation between transudative and exudative pleural effusions

Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

Diagnosis of parapneumonic pleural effusion with serum and pleural fluid Activin A

ObjectiveThe aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE). MethodsThe authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis. ResultsLevels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. ConclusionActivin A in pleural fluid correlated with disease severity could act to diagnose PPE.

The pleural fluid lactate dehydrogenase /adenosine deaminase and pleural fluid adenosine deaminase /serum C-Reactive Protein ratios for differentiating between Tuberculosis and other causes in a sample of Iraqi patients

Objectives: This study aim is to evaluate the importance of pleural fluid LDH/ADA ratio and pleural fluid ADA/serum CRP ratio in differentiating tuberculous pleural effusion from other causes in a sample of Iraqi patients. Methods: A prospective study of 100 patients&nbsp; with pleural effusion whom age ranges from 18-70&nbsp; years&nbsp; where admitted at medical department at Al-Imamein Kadhimein medical city in Bagdad&nbsp; and in Marjan and Al-Sadik hospitals at Babylon province. Out of 61(61%) are males and 39 (39%) are females. The study period was 9 months started from&nbsp; 1st of February to End of October 2019. &nbsp; Results: in this study the result of comparison of mean level of pleural fluid&nbsp; LDH/ADA ratio&nbsp; and pleural fluid&nbsp; ADA/Serum CRP ratio&nbsp; between tuberculous and para pneumonic pleural effusions were significant =0.025 and 0.002 respectively. Also the comparison of pleural fluid&nbsp; LDH /ADA ratio and pleural fluid&nbsp; ADA/Serum CRP ratio between tuberculous and malignant pleural effusions were significant =0.005 in both. Conclusion: Pleural fluid LDH /ADA ratio is of great value in differentiation tuberculous pleural effusion from malignant pleural effusion with predominant lymphocytes, pleural fluid ADA/serum CRP ratio is of great value in differentiation tuberculous pleural effusion from para pneumonic pleural effusion with elevated pleural fluid ADA and elevated serum CRP.

ANA positivity and complement level in pleural fluid are potential diagnostic markers in discriminating lupus pleuritis from pleural effusion of other aetiologies

ObjectiveLupus pleuritis is the most common pulmonary manifestation of systemic lupus erythematosus (SLE). We aimed to compare various biomarkers in discriminating between pleural effusions due to lupus pleuritis and other...