Pleural Effusion In Patients Research Articles

The Level of Expression and Diagnostic Value of Biomarkers in Tuberculous Pleurisy

Objective: Observe and analyze the clinical significance of the differences in the expression levels of sCD163, haptoglobin and cytokines. Methods: 120 patients with tuberculous pleural effusion diagnosed in our hospital from January 2019 to December 2021 were randomly selected as the experimental group. On the other hand, 40 patients with non-tuberculous pleural effusion admitted in the same period were selected as the control group. The expression levels of sCD163, haptoglobin and cytokines were observed and analyzed. Results: The expression levels of sCD163 (?g/mL), haptoglobin (g/L), IL-6 (pg/mL) and IL-12 (pg/mL) of the control group were 31.26 ± 14.12, 32.14 ± 18.79, 401.23 ± 24.36 and 1.32 ± 0.14, respectively. As for the experimental group, the expression levels of sCD163 (?g/mL), haptoglobin (g/L), IL-6 (pg/mL) and IL-12 (pg/mL) were 74.12 ± 14.78, 113.25 ± 19.45, 612.12 ± 36.98 and 4.12 ± 0.56 respectively, and p < 0.05 which shows that the data was statistically significant. Conclusion: The level of inflammatory cytokines in the pleural fluid of tuberculous pleural effusion patients are higher, which can be used for the diagnosis of auxiliary tuberculous pleurisy. Tuberculous pleural effusion patients has a significantly increased expression levels of sCD163 and haptoglobin in the pleural fluid. The combination of sCD163 and haptoglobin in the diagnosis of tuberculous pleural effusion has higher clinical diagnostic value, and sCD163 and haptoglobin are not interfered by inflammatory factors in the diagnosis of tuberculous pleural effusion

953P EGFR mutation testing from pleural effusions of advanced lung adenocarcinoma patients in Serbia

In Serbia, EGFR mutation testing is performed from liquid biopsy of lung cancer patients only by qPCR. The aim of this study was to evaluate the efficacy of this approach in pleural effusions of patients at diagnosis and after progression on EGFR-TKIs. Mutation testing was performed from blood and pleural effusions of advanced lung adenocarcinoma patients (stage IIIB or IV, ECOG performance status 0, 1, 2) using the Cobas® EGFR Mutation Test. In the period from 2016-2021, 124 patients were tested at baseline (53 % males, 47 % females, age range 37-83 years, median 61), and 104 after progression on first-line EGFR-TKIs (41 % males, 59 % females, age range 34-81 years, median 60). At diagnosis, 9 mutated samples were detected (7.3 %) with a turnaround time of 2 working days, and a 99.2 % testing success rate. At progression, an accordance rate of only 67 % with the initial driver mutation was observed from blood. The T790M mutation was detected in 34 patients (49 % of the mutated samples, 33% of total) which rendered them eligible for third-generation EGFR-TKIs. In the same period, only 6 samples (4.8 %) of pleural effusions were sent to our Laboratory along with blood, all from patients at progression. The testing was performed with a turnaround time of 2 working days, a 100 % testing success rate, and an accordance rate of 100 % with the initial driver mutation. In 3 samples (50 %), the T790M mutation was detected while the corresponding blood sample showed only the presence of the driver mutation. EGFR mutation testing from pleural effusion has proven valuable as an alternative liquid biopsy sample to blood, for detecting the T790M acquired resistance mutation in patients who progressed on first-line EGFR-TKIs in Serbia.

Diagnostic presentations of different pleural effusion patients to a tertiary care centre

BACKGROUND-Pleural effusion is defined as collection of fluid between the two pleural covering. OBJECTIVE-To evaluate the different etiologies of pleural effusion according to laboratory report. METHODOLOGY-Data was collected in a nonprobability convenience technique with descriptive cross- sectional study in indoor patient of pulmonary medicine department of Balangir Bhima Bhoi medical college from 2017 nov to 2020 nov,202 patients included in this technique.Diagnosis was confirmed by chest -x-Ray, and USG Chest in some cases, .Pleural fluid is aspirated from all and analysed with necessary investigation carried out ,like pleural fluid cytology, Biochemical and culture .computed tomography ,echocardiography and connective tissue profile for evaluating the underlying cause of pleural effusion. RESULT- Out of 202 patients 145 (73%) were male and 57(26)% were female Mean age was 44.8years with 19,832 SD .Among patients of pleural effusion most common cause was tuberculosis (65.3%). followed by Para pneumonic effusion/empyema (11.4%), malignancy both metastatic and primary accounted for (15%), heart failure also showed its presence in 5% of cases. Connective tissue disorder was found to be the cause in only one case (0.5%). In one case (0.5%) pleural effusion remained undiagnosed.

Incidence and management of pleural effusions in patients with Wilms tumor: A Pediatric Surgical Oncology Research Collaborative study.

Wilms tumor (WT) is the most common renal malignancy in children. Children with favorable histology WT achieve survival rates of over 90%. Twelve percent of patients present with metastatic disease, most commonly to the lungs. The presence of a pleural effusion at the time of diagnosis of WT may be noted on staging imaging; however, minimal data exist regarding the significance and prognostic importance of this finding. The objectives of our study are to identify the incidence of pleural effusions in patients with WT, and to determine the potential impact on oncologic outcomes. A multi-institutional retrospective review was performed from January 2009 to December 2019, including children with WT and a pleural effusion on diagnostic imaging treated at Pediatric Surgical Oncology Research Collaborative (PSORC) participating institutions. Of 1259 children with a new WT diagnosis, 94 (7.5%) had a pleural effusion. Patients with a pleural effusion were older than those without (median 4.3 vs 3.5 years; P=.004), and advanced stages were more common (local stage III 85.9% vs 51.9%; P < .0001). Only 14 patients underwent a thoracentesis for fluid evaluation; 3 had cytopathologic evidence of malignant cells. Event-free and overall survival of all children with WT and pleural effusions was 86.2% and 91.5%, respectively. The rate and significance of malignant cells present in pleural fluid is unknown due to low incidence of cytopathologic analysis in our cohort; therefore, the presence of an effusion does not appear to necessitate a change in therapy. Excellent survival can be expected with current stage-specific treatment regimens.

Monocytes subtypes from pleural effusion reveal biomarker candidates for the diagnosis of tuberculosis and malignancy.

BackgroundPleural effusion is a common clinical condition caused by several respiratory diseases, including tuberculosis and malignancy. However, rapid and accurate diagnoses of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) remain challenging. Although monocytes have been confirmed as an important immune cell in tuberculosis and malignancy, little is known about the role of monocytes subpopulations in the diagnosis of pleural effusion.MethodsPleural effusion samples and peripheral blood samples were collected from 40 TPE patients, 40 MPE patients, and 24 transudate pleural effusion patients, respectively. Chemokines (CCL2, CCL7, and CX3CL1) and cytokines (IL‐1β, IL‐17, IL‐27, and IFN‐γ) were measured by ELISA. The monocytes phenotypes were analyzed by flow cytometry. The chemokines receptors (CCR2 and CX3CR1) and cytokines above in different monocytes subsets were analyzed by real‐time PCR. Receiver operating characteristic curve analysis was performed for displaying differentiating power of intermediate and nonclassical subsets between tuberculous and malignant pleural effusions.ResultsCCL7 and CX3CL1 levels in TPE were significantly elevated in TPE compared with MPE and transudate pleural effusion. Cytokines, such as IL‐1β, IL‐17, IL‐27, and IFN‐γ, in TPE were much higher than in other pleural effusions. Moreover, CD14+CD16++ nonclassical subset frequency in TPE was remarkably higher than that in MPE, while CD14++CD16+ intermediate subset proportion in MPE was found elevated. Furthermore, CX3CL1‐CX3CR1 axis‐mediated infiltration of nonclassical monocytes in TPE was related to CX3CL1 and IFN‐γ expression in TPE. Higher expression of cytokines (IL‐1β, IL‐17, IL‐27, and IFN‐γ) were found in nonclassical monocytes compared with other subsets. Additionally, the proportions of intermediate and nonclassical monocytes in pleural effusion have the power in discriminating tuberculosis from malignant pleural effusion.ConclusionsCD14 and CD16 markers on monocytes could be potentially used as novel diagnostic markers for diagnosing TPE and MPE.

Clinical Presentation of Pleural Effusion Among Patients after CABG and its Prevalence

Objective: Pleural effusion often occurs after CABG. Usually, this effusion is slight and asymptomatic. There is also high symptomatic effusion, but in a small percentage of patients. Pleural effusion after CABG may be associated with significant morbidity and prolonged hospital stay. Early diagnosis and treatment can reduce morbidity of patients and extent of hospital stay. Aim: The aim of the study is to determine the risk factors and the severity of pleural effusion in patients after CABG. Place and Duration: In the Cardiology department of Qazi Hussain Ahmed Medical Complex, Nowshera for six-months duration from July 2020 to December 2020. Material and methods: The study was held among 120 patients after meeting the inclusion criteria and selected for the study. Patients were included in study population before referral for CABG from QHAMC to multicenters of Khyber Pakhtunkhwa. Their records were closely followed during admissions for CABG and post CABG and also assessed on various follow up visits. The study procedure was described to the patient and informed consent was obtained. Demographics, name, age, gender, surgery details, comorbidities such as COPD, EF and smoking were recorded on the attached form. The patients stayed in the intensive cardiac surgery unit for at least 7 days. The presence and severity of pleural effusion was assessed on the CXR. A chest x-ray was done on daily basis and evaluated by a chest specialist in the morning round. The amount of effusion in CXR was classified as follows: low effusion covering less than half of the chest, high effusion covering more than half of the chest. Possible risk factors for the development of pleural effusion in post-CABG patients have been reported. Results: The majority 99(82.5%) of the 120 subjects who had pleural effusion done with CABG were male. The patients mean age was 55.28 ± 10.47 years. Most patients 93(77.5%) had left pleurotomy. LIMA harvesting was reported in 98(81.7%) of patients. Most patients 100(83.3%) had left sided pleural effusions and 5(4.2%) had right sided and bilateral pleural effusions in 15(12.5%) of cases. A total of 102 patients (85%) had low (less than half of the chest) pleural effusion and large symptomatic pleural effusion in 18(18%) (more than half of the chest). 104 patients (86.7%) required pleural aspiration. Most of the patients 110(91.7%) had decreased serum albumin. Of the patients requiring effusion aspiration, 46 (38.3%) had dyspnea, 18 (15.0%) cough, 34 (28.3%) ABGs abnormalities, and 8 (7.7%) had atelectasis. Preoperative EF was normal in 80 (66.7%) patients, but poor EF was present in 50 (33.3%) patients on the 7th postoperative day. Conclusion: A slight left-sided effusion developed in the majority of patients after CABG. There was also large size of pleural effusion, but occurs in small extent. The effusion mainly causes some respiratory symptoms that require pleural aspiration. LIMA harvesting, pleurotomy and hypoalbuminemia were the main risk factors for pleural effusion in patients after CABG. Keywords: CABG = coronary artery bypass grafting, LIMA = Left internal mammary artery, CXR = chest X-ray, ICU = intensive care unit, COPD = chronic obstructive pulmonary disease and EF = ejection fraction.

A Cross-sectional Prospective Study of Pleural Effusion Among Cases of Chronic Kidney Disease

Pleural effusions of diverse aetiologies are encountered in patients with chronic kidney disease (CKD). The objectives of the present study were to examine the frequency of occurrence, causes, clinical features and management strategies of pleural effusion in patients with CKD including renal transplant recipients. A prospective cross-sectional observational analysis of pleural effusion in adult patients with CKD (stages 3 to 5) attending the Departments of Nephrology and Respiratory Medicine of a tertiary care institution in Eastern India was performed over a period of one year (February 2010 to January 2011). Pleural effusion was found in 29 out of 430 patients with CKD (6.7%) and in two out of 34 post-renal transplant recipients (5.9%) evaluated during the study period. The mean age was 37.35 +/- 1.8 (mean +/- SEM [standard error of mean]) with a male to female ratio of 2:1. Exudates and transudates were found in equal frequencies. Heart failure was the single most common cause (41.9%, 13 of 31). Tuberculosis (TB) (n = 8, 25.8%) and uraemic effusions (n = 6, 19.4%) were responsible for the majority of exudates. Unilateral effusion with a normal heart size had a positive predictive value of 83.3% for non-heart failure aetiology. Symptomatic pleural effusion was present in a small proportion of 6.7%; (n = 29) patients with CKD including post-renal transplant recipients. Heart failure, TB and uraemic effusions accounted for most of the cases. Differentiating TB from uraemic effusion requires a combined clinico-pathological approach and this differentiation is absolutely necessary for proper management.

Inconsistencies in Modeling the Efficacy of the Oncolytic Virus HSV1716 Reveal Potential Predictive Biomarkers for Tolerability.

Treatment with HSV1716 via intralesional administration has proven successful for melanoma patients with the hope that oncolytic virotherapy would become another weapon in the systemic anticancer therapy (SACT) arsenal. In addition to challenges surrounding the systemic delivery of oncolytic viruses (OVs), problems associated with its in vivo modeling have resulted in low predictive power, contributing to the observed disappointing clinical efficacy. As OV’s efficacy is elicited through interaction with the immune system, syngeneic orthotopic mouse models offer the opportunity to study these with high reproducibility and at a lower cost; however, inbred animals display specific immune characteristics which may confound results. The systemic delivery of HSV1716 was, therefore, assessed in multiple murine models of breast cancer. Tolerability to the virus was strain-dependent with C57/Bl6, the most tolerant and Balb/c experiencing lethal side effects, when delivered intravenously. Maximum tolerated doses were not enough to demonstrate efficacy against tumor growth rates or survival of Balb/c and FVB mouse models; therefore; the most susceptible strain (Balb/c mice) was treated with immunomodulators prior to virus administration in an attempt to reduce side effects. These studies demonstrate the number of variables to consider when modeling the efficacy of OVs and the complexities involved in their interpretation for translational purposes. By reporting these observations, we have potentially revealed a role for T-cell helper polarization in viral tolerability. Importantly, these findings were translated to human studies, whereby a Th1 cytokine profile was expressed in pleural effusions of patients that responded to HSV1716 treatment for malignant pleural mesothelioma with minimal side effects, warranting further investigation as a biomarker for predictive response.

Detection and Significance of Cell-Free DNA Mutation in Pleural Effusion in Patients with Advanced NSCLC.

Objective To detect EGFR/KRAS genes in pleural effusion cell-free DNA in patients with advanced non-small-cell lung cancer (NSCLC) and to explore the clinical significance of EGFR/KRAS mutation status in pleural effusion. Methods A retrospective collection was performed on the specimens of pleural effusion and matched tissues from 50 patients with advanced NSCLC admitted to the hospital between January 2019 and January 2021. DNA mutation status of EGFR/KRAS in different specimens was detected and compared by pyrosequencing. The clinicopathological data and follow-up data of survival were collected. The relationship between DNA mutation and clinicopathological characteristics and prognosis was analyzed. Results In the 50 pleural effusion specimens, there were 22 cases (44.00%) with EGFR mutations (19/21 exon mutations), including 12 cases with EGFR19 deletion mutation and 10 cases with EGFR21 exon L858R mutation. There were 6 cases (12.00%) with KRAS mutations (single-base substitution mutations), including 4 cases with 12-codon mutation and 2 cases with 13-codon mutation. In the 50 tissue specimens, there were 24 cases (48.00%) with EGFR mutations and 4 cases (8.00%) with KRAS mutations. There was no significant difference between pleural effusion specimens and tissue specimens, with good consistency (kappa = 0.920–0.779, P > 0.05). EGFR mutation in pleural effusion was related to smoking history, types of pathological tissues, and lymph node metastasis (P < 0.05). The incidence of EGFR mutation was higher in nonsmokers, patients with lung adenocarcinoma, and patients with lymph node metastasis. The carcinoembryonic antigen (CEA) in patients with EGFR mutation was higher than that with wild-type EGFR, while the level of cytokeratin 19 fragment (Cy21-1) was lower than that with wild-type EGFR (P < 0.05). The 1-year overall survival rate in the EGFR mutation group was significantly higher than that in the EGFR wild group (68.18% vs. 42.86%) (HR = 0.419, 95% CI = 0.178–0.989, and P < 0.001). Conclusion For the detection of EGFR gene mutation, the results of the pleural effusion specimens and the tumor pathological tissue specimens were well consistent and the detection of pleural effusion could be used as an alternative method when tissue specimens cannot be obtained. EGFR gene mutations are present in majority in patients with advanced NSCLC. The incidence of EGFR mutation is higher in nonsmokers, patients with lung adenocarcinoma, those with lymph node metastasis, those with high-expression CEA, and those with low-expression Cy21-1. The prognosis is better in patients with EGFR mutation.

Pleural Effusions in Patients With Congestive Heart Failure: Frequency, Pathogenesis, Diagnosis, and Implications.

Patients with cardiac disease frequently develop pleural effusions; the incidence is approximately 500,000 cases per year in the United States. These effusions often represent important clinical events for patients, indicating that either there has been an acute change in the patient's clinical status or the patient's chronic management program needs review. These effusions usually develop in both the right and left hemithorax but can be unilateral. The pathogenesis involves increased fluid transfer from parietal pleural capillaries into the pleural space and possibly decreased pleural fluid uptake into parietal pleural lymphatic structures. The increased fluid transfer develops due to increased capillary pressure secondary to elevated venous outflow pressure and secondary to decreased lymphatic flow into central vessels secondary to heart failure. Most pleural effusions associated with heart failure are transudates, but 20% to 25% have increased protein and lactate dehydrogenase levels suggesting an exudative process. Additional testing can clarify the situation and requires calculation of the serum albumin to pleural fluid albumin gradient or measurement of N-terminal pro-brain natriuretic peptide in the pleural fluid. An albumin gradient of greater than 1.2 g/dL suggests that the fluid is a transudate. The presence of a pleural effusion in a hospitalized patient at discharge is associated with an increased likelihood of rehospitalization and mortality within the next year. Patients with large symptomatic pleural effusions may require therapeutic thoracentesis. Recurrence of symptomatic effusions presents a management dilemma that might require repeated thoracenteses, indwelling intrapleural catheter placement, or other management steps used in advanced chronic heart failure.

Prognostic significance of pleural effusion exhausted CD8+ T cell subsets in non-small cell lung cancer and mesothelioma.

e21111 Background: Following repeated tumor antigen stimulation, T cells lose functional capacity and become exhausted. T cell exhaustion is a progressive change in phenotype. Early in the pathway, stem-like exhausted T cells (Texstem) retain proliferative and cytotoxic potential. However, they differentiate into terminally exhausted T cells (Texterm) that become epigenetically fixed in a suppressed state and lose much of their effector function. Malignant pleural effusion is a peri-tumoral microenvironment that could offer insight into anti-tumor immune responses. In this study we characterized exhausted CD8+ T cells, examined the prognostic significance of Texstem and Texterm levels in the pleural effusions of patients with non-small cell lung cancer (NSCLC) and validated our findings in a mesothelioma cohort. Methods: Pre-treatment malignant pleural effusions from 43 NSCLC (41 non-squamous and 2 squamous) and 50 mesothelioma patients were analyzed by flow cytometry. The percentages of Texstem (PD1midCD39- or PD1midCD39-CD28+) and Texterm (PD1hi CD39+) CD8+ T cells were correlated with overall survival (OS). Survival analysis was performed using Kaplan-Meier and multivariate Cox regression analysis adjusting for age, sex, histological and molecular subtypes, performance status, smoking history, comorbidities and the number of lines of systemic therapy. Results: The relative percentages of exhausted T cells within the CD8+ T cell compartment of pleural effusions from NSCLC and mesothelioma were similar (Table). In NSCLC patients, multivariate analysis demonstrated that the percentage of Texstem was an independent predictor of OS. The median OS for patients with high (above median) Texstem was significantly longer than those with low Texstem (9.9 vs 3.4 months, HR 0.398, p = 0.020). In addition, the ratio of Texstem to Texterm also showed a positive association with OS. Similarly, in mesothelioma patients, a greater percentage of Texstem was associated with longer OS in multivariate analysis (p = 0.049). The median OS for patients with high vs low Texstem was 33.5 vs 11.1 months (HR 0.302, 95% CI 0.129 – 0.705, p = 0.006). In addition, there was also a positive association between Texstem to Texterm ratio and OS. Conversely, Texterm CD8+ T cells did not impact OS in either cancer type. Conclusions: NSCLC and mesothelioma patients with greater abundance of pleural effusion stem-like exhausted CD8+ T cells exhibit better survival outcomes irrespective of patient and disease characteristics, supporting its role as a prognostic biomarker.[Table: see text]

Role of Point of care ultrasound of lungs at pulmonology department of Gajju Khan Medical College, Swabi.

Objective: To evaluate the usefulness of Point of care Lung Ultrasound at Pulmonology Department Gajju Khan Medical College Swabi. Study Design: Cross Sectional study. Setting: Department of Pulmonology, Gajju Khan Medical College, Swabi. Period: March 2019 to December 2019. Material &amp; Methods: All the patients presented to OPD meeting inclusion and exclusion criteria were included, patients were selected by consecutive non-probability sampling technique. Results: Total of 139 patients were included in our study mean age was 50.40 years, range 21-93 years and standard deviation was ±18.257. Eighty one patients had Pleural Effusion, thirteen had pneumonia and 45 patients had diffuse alveolar-interstitial syndrome. Diagnostic thoracocentesis were performed on first attempt in all patients of pleural effusions without any complication. Conclusion: Our study concluded that Point of care lung Ultrasound is a useful strategy both for diagnosis and intervention of pulmonary patients at a resource limited areas.

Cardiopulmonary ultrasound correlates of pleural effusions in patients with congestive heart failure

BackgroundPleural effusions are common in patients with congestive heart failure. However, there is a need to assess systematically the correlation between effusion volume, extravascular lung water and echocardiographic parameters. We used combined cardiopulmonary ultrasound to evaluate the relationship between effusion volume, extravascular lung water, and echocardiographic parameters in patients with congestive heart failure.MethodsPatients who were hospitalized for congestive heart failure underwent combined cardiopulmonary ultrasound. A semiquantitative score of pleural effusions was derived by pulmonary ultrasound and extravascular lung water was estimated by ultrasound lung comets. The measurements were compared with echocardiographic and clinical results.ResultsAmong 168 patients (median age 66 years, 69.6% men), 102 (60.7%) had pleural effusions, 84.3% bilateral, 10.8% right-sided, and 4.9% left-sided. High pleural effusion scores were associated with high ultrasound lung comet scores (P < 0.0001). Compared with patients without pleural effusions, patients with pleural effusions were significantly older and had higher systolic pulmonary artery pressure (SPAP), NT-proBNP, New York Heart Association scale, larger left atrium, larger right ventricle, more severe mitral regurgitation, and worse left and right heart function. Adjusted for age, multiple logistic regression analysis showed that SPAP (OR 5.688, P = 0.006) and E/A (OR 3.941, P = 0.043) were the significant variables and risk factors associated with pleural effusions in heart failure.ConclusionFor patients with left heart failure, the degree of pleural effusions was associated with pulmonary congestion. Elevated SPAP and E/A were the main risk factors for the formation of pleural effusions in patients with congestive heart failure.

Prognostic impact of pleural effusion in patients with malignancy: A systematic review and meta-analysis.

The exact role of pleural effusion in the prognosis of cancer patients remains unclear. We aimed to systematically review the prognostic value of pleural effusion in patients with cancer. We performed a systematic review and meta‐analysis with a systematic literature search. All cohort studies with available overall survival (OS) and progression‐free survival (PFS) results for patients with cancer with or without pleural effusion were included. The Mantel–Haenszel method was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were examined. Subgroup analysis and sensitivity analysis were performed. A total of 47 studies with 146,117 patients were included in the analysis. For OS, pleural effusion was a prognostic factor associated with a poor prognosis for patients with cancer (HR, 1.58, 95% CI, 1.43–1.75; I 2 94.8%). In the subgroup analysis, pleural effusion was a prognostic factor associated with poor survival for patients with lung cancer (HR, 1.44, 95% CI, 1.35–1.54; I 2 60.8%), hematological cancer (HR, 2.79, 95% CI, 1.63–4.77; I 2 29.4%) and other types of cancer (HR, 2.08, 95% CI, 1.43–3.01; I 2 55.1%). For PFS, pleural effusion was a prognostic factor associated with a poor prognosis for patients with cancer (HR, 1.61, 95% CI, 1.28–2.03; I 2 42.9%). We also observed that massive pleural effusion was a prognostic factor associated with a poorer prognosis compared to minimal pleural effusion. Pleural effusion had prognostic value in both OS and PFS of patients with cancer, except for patients with malignant pleural mesothelioma, regardless of whether the malignant effusion was confirmed histologically or cytologically. However, future evidence of other pleural effusion characteristics is still needed.

Etiology, pathological characteristics, and clinical management of black pleural effusion: A systematic review.

Background:Pleural effusion is characterized by excessive fluid collection in the pleural cavity. Black pleural effusion (BPE) is a rare entity with only limited scientific data. We aimed to review the current literature on black pleural effusion to characterize demographics, etiology, clinical presentation, pathological findings, available treatment strategies, and prognosis of this rare condition.Methods:We performed a systematic review of case reports and series and synthesized data on demographics, manifestations, management, and outcomes of patients with BPE. We searched Cochrane Library, PubMed, SCOPUS, and Google Scholar for any date until January 10, 2021. All studies (n = 31) that reported black pleural effusion in patients were added to the review. Prospective Register of Systematic Reviews registration number: CRD42020213839. Summary and descriptive analysis was performed on Jamovi version 1.2.Results:The mean age of 32 patients with BPE was 53 years, with male predominance (69%). The commonest risk factor was smoking (n = 9) followed by alcohol intake (n = 8). Dyspnea was the commonest symptom (n = 24, 75%). Pleural fluid was mostly exudative (n = 21). The commonest associated diagnosis was malignancy (n = 14), with 50% secondary to metastatic melanoma. The commonest intervention was therapeutic thoracocentesis (n = 25, 78%), and the effusion recurred in half of the cases where recurrence was reported (n = 13). In our review, we found the mortality rate to be at 20.8% (n = 20.8%). 58.3% of the patients were successfully treated and discharged home (n = 14).Conclusion:Although rare, BPE appears to be a relevant symptom as it seems to be frequently associated with modifiable risk factors and underlying malignancy. Our systematic review substantiates a vital research gap as observational research is imperative to characterize BPE further and form a basis for designing tailored diagnostic, preventive, and therapeutic strategies for BPE.

Malignant pleural effusion in patients with ovarian cancer

Introduction. Ovarian cancer is the most lethal gynecological cancer. The most common manifestation of thoracic metastasis is pleural effusion. Pleural effusion with positive cytology is regarded as stage IVa of the International Federation of Gynecology and Obstetrics classification, and the overall five-year survival in these patients is less than 20%. We analyzed the data of patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina, in order to establish the incidence of malignant pleural effusions, laterality of pleural effusions, and clinical manifestations. Material and Methods. The study included 731 patients with ovarian cancer who were treated at the Oncology Institue of Vojvodina from January 2012 to May 2020. The obtained data were compared with data found in the literature in the same period. Results. The incidence of malignant pleural effusion in our study was 5.75%; right-sided pleural effusion was found in 57.15% of patients, 33.33% of patients had effusion on the left side, and 9.52% had bilateral effusions. Thus, unilateral effusion was found in 90.48% of cases, and bilateral in only 9.52%. The most common symptom was dyspnea, reported in 33 patients (78.6%). Conclusion. The incidence of malignant pleural effusion in our study was most similar to data found by Zamboni et al. published in 2015; the right side was the dominant side of pleural effusions. The most common symptoms were dyspnea, shortnes of breath and chest pain.

Development and Validation of a Clinical Prediction Model to Assess the Probability of Tuberculous Pleural Effusion in Patients with Unexplained Pleural Effusion: Diagnostic Study

Development and Validation of a Clinical Prediction Model to Assess the Probability of Tuberculous Pleural Effusion in Patients with Unexplained Pleural Effusion: Diagnostic Study

Histomorphological Spectrum of Pleural Biopsy Specimen of Exudative Pleural Effusion in a Tertiary Care Hospital in Bangladesh

Background: The commonest manifestation of pleural pathology is pleural effusion. Most of the time, in spite of routine biochemical and cytological examination of pleural fluid we can’t evaluate the etiology of pleural effusion. Aim: Aim of present study was to make an etiological diagnosis of exudative pleural effusion by pleural biopsy and histopathological examination. Study design and setting: Fifty consecutive patients of pleural effusion were selected from the outpatient and indoor department of a tertiary medical college hospital in Sylhet. It was a prospective and observational study. It was conducted over a period of one and a halfyears. Material and method: In all the cases, cytological examination of pleural fluid (for malignant cell) and pleural biopsy by Abram’s needle were done. Subsequently, histopathological diagnoses were made to determine the etiology of effusion. Results: Out of 50 subjects, males outnumbered females, Age is ranged between 19 and 85 years. According to the histopathological examination of the submitted pleural biopsy specimen, granulomatous inflammation is the most common etiology (40%) followed by chronic inflammation of non-specific origin (38%) and malignancy (22%). Conclusion: This study represents the result of the experience acquired over one and half years in the histopathological interpretation of pleural biopsies and its correlation with cytology of the pleural fluid. Pleural biopsy is a useful, minimally invasive procedure with no or little complication and has more sensitivity and specificity than pleural fluid cytology smears.

Pleural pathology in HIV-infected patients: features of morphological diagnostics

Background. The progression of HIV infection is accompanied by the development of opportunistic diseases, including pleural effusions of various origins. Morphological examination of pleura tissue in cases of pleural effusion serves as the basis for establishing the etiology of the pathological process and, therefore, the final clinical diagnosis. Objective – analysis of results of morphological diagnostics of pleura lesions in HIV-infected patients in comparison with other laboratory tests and clinical diagnosis. Methods. 103 cases of pleurisy of various origins were studied. Pleural biopsies were obtained by various types of minimally invasive diagnostic interventions with subsequent morphological examination. Results were compared with the available data of microbiological and molecular genetic studies of pleural biopsies. Results. At the time of hospitalization the preliminary clinical diagnosis was pleurisy of unknown etiology in 96,1 % of cases. A combined disease was diagnosed – hepatitis C in a third of all observations according to the results of laboratory tests. Due to routine staining with hematoxylin and eosin, tuberculosis lesions of the pleura were diagnosed in 59,2 %, the second most frequent was the diagnosis of nonspecific pleurisy, 20,4 %. According to the duration of the process, acute pleural tuberculosis was established in 19,7 % of cases, the subacute form of tuberculosis pleurisy – in 54,1 % of cases, and chronic pleural tuberculosis was established in 22,9 % of cases. In 17,5 % of cases, in order to clarify the etiology of pleurisy, additional histochemical staining for infectious agents was performed. The results of microbiological and molecular genetic studies were established in 76,7 % of cases. The greatest number of M. tuberculosis detection was obtained during the culture study of the biopsy material and exudates. When comparing the final clinical diagnosis and the level of CD4 cells in peripheral blood, it was found that in most cases (74,5 %) pleural effusions developed at low counts of CD4 cells, less than 350/l. Conclusion. Tuberculosis predominates in the etiological structure of pleural effusions in patients with HIV infection. Pleural tuberculosis can be the main secondary disease or be combined with pulmonary tuberculosis. In second place in terms of frequency of occurrence, nonspecific pleurisy was diagnosed as a complication of the main secondary disease. Pleural effusions develop when CD4 cell counts are low. Morphological diagnostics of pleural lesions is the main research method in the diagnostic algorithm of cases of pleural effusions of unknown etiology against the background of HIV infection.

Do drains help reduce the risk of complications after thoracoplasties in posterior spinal fusions for adolescent idiopathic scoliosis?

In adolescent idiopathic scoliosis (AIS), the rib prominence is a major cosmetic concern which can be improved using thoracoplasties. We sought to determine if the use of deep drains helps minimize the development of pleural effusions after thoracoplasties. Retrospective study of 45 patients with AIS undergoing posterior spinal fusion (PSF) and thoracoplasties. Thirty six out of 45 patients(80.0%) required placement of a deep surgical drain, and 16 out of 45 (35.6%) developed pleural effusions after PSF with concomitant thoracoplasty. Of the 16 patients who developed pleural effusion, 12 of 36 (33.3%) required a placement of a deep drain (p > 0.05). Of the total 45 patients in this cohort, 3 patients (6.7%)required chest tubes, and 4 patients (8.9%) developed surgical site infections (SSIs). We found that deep drains were associated with a lower incidence of SSI (2.8% vs 33.3%; p = 0.021). Patients who had a pleural effusion had longer ICU stays (p = 0.037) and longer requirements of nasal oxygen (p = 0.025). The presence of a pleural effusion in patients with AIS undergoing PSF with thoracoplasty was associated with longer oxygen requirements and length of hospital ICU admission. Thirty six percent of patients with thoracoplasties developed pleural effusions, but deep subfascial drains did not significantly decrease the incidence of pleural effusions.