Pleural Exudate Research Articles

Hesperidin attenuates inflammation and oxidative damage in pleural exudates and liver of rat model of pleurisy

ABSTRACTObjectives: This study investigated the potential anti-inflammatory effect of hesperidin against carrageenan induced pleurisy in rat model.Methods: Twenty-four adult female Wistar rats (350 - 450g) were grouped as follows: Group I: rats were administered saline solution only (Normal control group); Group II: rats were administered saline solution (NaCl 0.9%) orally and injected with carrageenan (Inflammation control group); Group III: rats were administered hesperidin only (Hesperidin group); Group IV: rats were administered hesperidin orally and intrapleurally injected with 2% carrageenan (Inflammation treated with hesperidin group). The exudate volume, total leukocyte count, reactive oxygen species (ROS), myeloperoxidase (MPO),δ–aminolevulinate dehydratase (δ-ALA-D), catalase (CAT), superoxide dismutase (SOD), activities as well as non-protein thiol group (NPSH) and thiobarbituric acid reactive substances (TBARS) levels were determined.Results: Pretreatment with hesperidin at a dose of 80 mg/kg orally per day for 21 days, minimized the increase in pleural exudate volume and leucocyte count and modulated the activities of MPO, SOD and CAT, as well as the levels of ROS, NPSH and TBARS in carrageenan-induced rats.Conclusion: Our results suggest that hesperidin can elicit its anti-inflammatory action by blocking exudate and leukocyte influx into pleural cavity, inhibiting MPO activity and preventing oxidative damage.

Further analysis of acute antinociceptive and anti-inflammatory actions of 4-phenylselenyl-7-chloroquinoline in mice.

A new quinoline containing selenium, 4-phenylselenyl-7-chloroquinoline (4-PSQ), was described and synthetized by our research group. Recently, we demonstrated the potential antinociceptive and anti-inflammatory of 4-PSQ. For this reason, the first objective of this study was to expand our previous findings by investigating the contribution of glutamatergic, serotonergic, and nitrergic systems to the acute antinociceptive action of this compound. Pretreatment with 4-PSQ (0.01-25 mg/kg, p.o.) reduced the nociception induced by glutamate. MK-801 (an uncompetitive antagonist of the N-Methyl-d-aspartate (NMDA) receptor) blocked the antinociceptive effect exerted by 4-PSQ (25 mg/kg, p.o.) in the acetic acid-induced abdominal writhing test. The pretreatment with WAY100635 (a selective antagonist of 5-HT1A receptor), ketanserin (a selective antagonist of 5-HT2A/2C receptor), and pindolol (a nonselective antagonist of 5-HT1A/1B receptors) partially blocked the antinociceptive effect caused by 4-PSQ (25 mg/kg, per oral, p.o.) in the acetic acid-induced abdominal writhing test. Nitric oxide precursor, l-arginine hydrochloride, partially reversed antinociception caused by 4-PSQ or ω-nitro-l-arginine (l-NOARG). Treatments did not modify the locomotor and exploratory activities of mice. Additionally, the acute anti-inflammatory effect of 4-PSQ in a model of pleurisy induced by carrageenan in mice was investigated. 4-PSQ reduced the cellular migration, pleural exudate accumulation, and myeloperoxidase activity induced by carrageenan exposure. 4-PSQ protected against the increase in reactive species levels and reduction of nonprotein thiol levels induced by carrageenan. Data presented here showed that the modulation of serotonergic, nitrergic, and glutamatergic systems contributed to the antinociceptive effect of 4-PSQ and it reinforced the therapeutic potential of this quinolinic compound for acute inflammation.

Utility of CEA and CA 15-3 Measurements in Non-Purulent Pleural Exudates in the Diagnosis of Malignancy: A Single-Center Experience

ObjectiveTo establish the diagnostic accuracy of pleural fluid (PF) CEA and CA 15-3 in identifying malignancy, and to determine the additional value of these markers in patients with malignant pleural effusions (MPEs) with false negative results from cytological fluid examination. MethodsPF concentrations of CEA and/or CA 15-3 were determined in 1575 patients with non-purulent exudates, 549 of whom had confirmed MPEs, 284 probable MPEs, and 742 benign effusions. Tumor marker cut-off points were set to ensure 100% specificity for malignant effusion. ResultsThe 41%, 40% and 60% of MPE patients had high PF levels of CEA (>45ng/mL), CA 15-3 (>77UI/l) or both, respectively. These percentages were 30%, 19% and 41% in MPEs with positive pleural biopsy and negative PF cytology; and 24%, 13% and 35% in clinical MPEs without histocytological confirmation. Tumor markers were of no value in lymphomas and mesotheliomas. The area-under-the-curve for CEA was 0.819 (95% CI: 0.793–0.845) and for CA 15-3, it was 0.822 (95% CI: 0.796–0.847). The use of tumor markers compared to cytology alone, increased the diagnosis of malignancy by 14%. ConclusionsMeasurements of PF CEA and CA 15-3 may complement pleural cytology in the identification of MPEs.

Diagnóstico y manejo de los trasudados pleurales

Various clinical trials have been published on the optimal clinical management of patients with pleural exudates, particularly those caused by malignant tumors, while little information is available on the diagnosis and treatment of pleural transudates.The etiology of pleural transudates is wide and heterogeneous, and they can be caused by rare diseases, sometimes constituting a diagnostic challenge. Analysis of the pleural fluid can be a useful procedure for establishing diagnosis. Treatment should target not only the underlying disease, but also management of the pleural effusion itself.In cases refractory to medical treatment, invasive procedures will be necessary, for example therapeutic thoracentesis, pleurodesis with talc, or insertion of an indwelling pleural catheter. Little evidence is currently available and no firm recommendations have been made to establish when to perform an invasive procedure, or to determine the safest, most efficient approach in each case.This article aims to describe the spectrum of diseases that cause pleural transudate, to review the diagnostic contribution of pleural fluid analysis, and to highlight the lack of evidence on the efficacy of invasive procedures in the management and control of pleural effusion in these patients.

Pharmacological evaluation and molecular docking of new di-tert-butylphenol compound, LQFM-091, a new dual 5-LOX/COX inhibitor

Dual 5-LOX/COX inhibitors are potential new dual drugs to treat inflammatory conditions. This research aimed to design, synthesis and to evaluate the anti-inflammatory and antinociceptive effects of the new compound, which is derived from nimesulide and darbufelone lead compounds. The new dual inhibitor 5-LOX/COX has the possible advantage of gastrointestinal safety. A voltammetric experiment was conducted to observe the drug's antioxidative effect. A formalin test, a hot plate test and carrageenan-induced mechanical hyperalgesia were employed to evaluate the analgesic nature of LQFM-091. To evaluate anti-inflammatory activity, we measured edema, leukocyte count, myeloperoxidase activity and cytokines levels in carrageenan-induced inflammation tests. We elucidated the underlying mechanisms by assessing the interaction the with COXs and LOX enzymes by colorimetric screening assay and molecular docking. The lethal dose (LD50) was estimated using 3T3 Neutral Red Uptake assay. Our results indicate that the LQFM-091 prototype is a powerful antioxidant, as well as able to inhibit COX-1, COX-2 and LOX activities. LQFM091 was classified in GHS category 4 (300<LD50<2000mg/Kg). This prototype showed analgesic activity in the formalin test and decreased carrageenan-induced mechanical hyperalgesia. Furthermore, LQFM-091 reduced the paw edema induced by carrageenan and reduced the leukocyte count, myeloperoxidase activity, TNF-α and IL-1β levels in the pleural exudate. Another interesting finding was the absence of gastrointestinal lesions. These data indicate that LQFM-091 produced antinociceptive and anti-inflammatory effects while maintaining gastrointestinal safety. Furthermore, this compound presented a safe toxicological profile. Blocked COXs and LOX enzymes are important targets for manipulating the mechanism of this compound.

The case against performing pleural biopsies for the aetiological diagnosis of exudates

In most cases, the etiological diagnosis of pleural exudates does not require a pleural biopsy. However, when it is considered necessary, the biopsy should seldom be conducted using invasive methods such as thoracoscopy. Two paradigmatic examples are pleural tuberculosis and malignant effusions. In many centers, pleural fluid adenosine deaminase measurement has replaced closed pleural biopsies in the diagnosis of tuberculosis. Similarly, pathological and molecular studies on pleural fluid cell blocks or alternatively, image-guided pleural biopsies have drastically reduced the need for thoracoscopy.

¿Se debe realizar una biopsia pleural para el diagnóstico etiológico de los exudados? No

In most cases, the etiological diagnosis of pleural exudates does not require a pleural biopsy. However, when it is considered necessary, the biopsy should seldom be conducted using invasive methods such as thoracoscopy. Two paradigmatic examples are pleural tuberculosis and malignant effusions. In many centres, pleural fluid adenosine deaminase measurement has replaced closed pleural biopsies in the diagnosis of tuberculosis. Similarly, pathological and molecular studies on pleural fluid cell blocks or alternatively, image-guided pleural biopsies have drastically reduced the need for thoracoscopy.

AAT – A Novel Cartilage‐Protective Mediator

IntroductionThe resolution of inflammation is a process that ensures repair and restoration of tissue physiology. Using integrated approach with proteomic analyses and bio‐assays with human chondrocytes and experimental arthritis, we identified α1‐Antitrypsin(AAT), the chief neutrophil elastase(NE) inhibitor, as a novel chondroprotective protein produced in resolving exudates.MethodsResolving rat pleural exudates (24h post‐carrageenan injection) were run for mass spectrometry using ion‐trap mass analyzer (MS/MS LTQ Orbitrap XL). Human C28/I2 chondrocytes were grown in high‐density micromass(MM)1 incubated with AAT with/without catabolic stimuli interleukin(IL)‐1β (20ng/ml) or osteoarthritic synovial fluids (OASF; 1:100) for 48h. Glycosaminoglycans (GAG) deposition was assessed using Alcian Blue(AB) staining. Gene expression was quantified by qPCR. Data are expressed as 2−ΔΔCt equation–relative amount of target genes, normalized to GAPDH and vehicle, with expression set to 1.0 (N=3). Inflammatory arthritis was induced though K/BxN serum transfer model2. Knee joint structure and cartilage integrity were determined 48h after intra‐articular(i.a.) or intra‐peritoneal(i.p.) injection of AAT (n=8) by the GAG‐sensitive toluidine blue staining of knee sections. Knee inflammation (diameter; n=14), changes in leukocyte kinetics (number of rolling and adherent leukocytes; intravital microscopy; n=8), blood perfusion (Laser Speckle Contrast Analysis; n=8), and pain (von Frey algesiometry; n=8) were evoked by i.a. injection of NE (5μg)3 with/without AAT(100ng) and quantified 4h post‐injection. One‐way ANOVA, or student's T‐test were applied for stats.ResultsProteomics identified AAT in pro‐resolving (24h post‐carrageenan) exudates. Exogenous AAT abrogated the effect of IL‐1β on MMP13 (p&lt;0.05). Incubation of chondrocyte MM with OASF augmented IL6 and MMP13 mRNA, with concomitant down‐regulation of COL2A1 and ACAN gene products: tested at 3–10 μg/ml, AAT significantly attenuated these effects (p&lt;0.01). GAG deposition confirmed the chondroprotection afforded by AAT: ~80% reduction by OASF and reversal to control levels with AAT (p&lt;0.01).In the model of arthritis, knee joint cartilage was eroded by ~65% (GAG content; p&lt;0.05). Intra‐articular injection of AAT(100ng) recovered cartilage integrity by 52% compared to vehicle‐injected contralateral joints (p&lt;0.05). Systemic AAT (10μg i.p.) reduced cartilage destruction by ~30%, compared to vehicle‐injected animals (p&lt;0.05).NE induced acute inflammation and pain in knee joints of mice: it caused a marked increase in knee diameter, synovial microcirculation, vascular response with increased leukocyte kinetics and a decrease in hindpaw withdrawal threshold (p&lt;0.01). Co‐administration of NE and AAT(100ng) significantly counteracted NE‐induced knee inflammation (p&lt;0.01) and potently reverted the NE‐induced pain (p&lt;0.01).ConclusionUsing resolving exudates as a bio‐source, we identified the neutrophil elastase inhibitor AAT as a novel tissue‐protective protein with a broad spectrum of activities, thus paving the way for new strategies to prevent joint pain and repair/restore compromised cartilage functions.

The experience of using thoracoscopic surgery for treatment of patients with acute nonspecific parapneumonic pleural empyema

Objective. To evaluate the effectiveness of thoracoscopic operations and to study the clinical and epidemiological characteristic of patients with pleural empyema (PE). Materials and Methods. A retrospective analysis of 51 patients with PE treatment results has been done. All participants were examined by standard clinical and laboratory tests, X-rays and CT scans of the chest, ultrasound of pleural cavities. All patients (n = 51, 100%) were subject to thoracoscopic interventions. Results. The average age of patients was 44.4 ± 14.7 years. Men prevailed among them - 36 (71%). The first stage of PE was diagnosed in 18 (35%) patients, and the second - in 33 (65%). Almost all patients (50 patients – 98%) had been treated in other hospitals before hospitalization to a specialized department. Diagnostics of PE and patients admission to the thoracic surgery department took place on the 2 - 3 week of disease in 70% of cases. The main types of surgery on the first stage of PE were: 1) thoracoscopy with targeted drainage of pleural cavity and pleural biopsy (n = 4, 22%), 2) video-assisted thoracoscopic surgery (VATS) with destruction of fibrinous adhesions (n = 14; 78%). It has been done at the second stage of PE: 1) VATS pneumolysis (n = 22; 67%) and 2) VATS decortication of lung (n = 11; 33%). The positive results of pleural exudates bacteriological analysis have been obtained from 9 patients (18%). The median of pleural exudation duration at the first stage of PE was 5 days (4, 6), at the second stage - 6 (5, 9) days (p = 0.058). Good results were obtained in 33 patients (65%), satisfactory - in 15 (29%), unsatisfactory - in 3 (6%). The median of hospital stay duration was 18 (16; 21). There have not been lethal outcomes. Conclusions. Diagnosis of pleural empyema is a complex task and requires a broad introduction of modern techniques (CT and ultrasound). Standard microbiological testing is not effective in the diagnosis of PE pathogens, due to imperfection of anaerobic bacteria methods of detection and previous antibiotic therapy. The use of VATS in patients with PE on the first and the second stage is effective and reasonable, leads to good and satisfactory results in 95 % and 94 % of cases respectively.

138: THE EVALUATION OF CONCENTRATION OF CALPROTECTIN, IN PLEURAL FLUID WITH CAUSES OF EXUDATIVE PLEURAL EFFUSION IN THE PATIENTS REFERRED TO SHAHID SAYYAD SHIRAZI HOSPITAL OF GORGAN IN 2014

Background and aims:Nowadays, routine invasive techniques to diagnose the causes of exudative pleural effusion are going to be replaced by new noninvasive methods such as biomarkers which with the same...

Anti-inflammatory and toxicological evaluation of essential oil from Piper glabratum leaves

Ethnopharmacological relevanceAlthough some of the species of the genus Piper exhibit interesting biological properties, studies on Piper glabratum Kunth are very limited. Aim of the studyThis study investigated the anti-inflammatory activity and the toxicological profile of the essential oil from P. glabratum leaves (OEPG) in mice. Materials and MethodsThe acute toxicity of OEPG was evaluated by oral administration to female mice as single doses of 500, 1000, 2000 or 5000mg/kg/body weight. In the subacute toxicity test, the females received 500 or 1000mg/kg/body weight of OEPG for 28 days. The anti-inflammatory potential of OEPG was evaluated using four models including pleurisy, edema, mechanical hyperalgesia and cold allodynia models in mouse paws. ResultsNo clinical signs of toxicity were observed in animals after acute treatment, which suggested that the LD50 is greater than 5000mg/kg. The subacute exposure to OEPG produced no significant changes in the hematological or biochemical parameters. Similarly, the histology of the organs and the estrus cycle displayed no marked alterations. OEPG exhibited anti-inflammatory activity as indicated by inhibition of the leukocyte migration (100, 300, 700mg/kg) and the protein extravasation into the pleural exudates (700mg/kg). After intraplantar injection of carrageenan, it was observed that the 700mg/kg dose of OEPG reduced edema formation and decreased the sensitivity to mechanical stimulation and cold. ConclusionsThese results demonstrate the anti-inflammatory potential of the essential oil of P. glabratum leaves in the absence of toxicity in female mice.

A case report of a patient with community3acquired pneumonia caused by Legionellа pneumophila

A clinical case of community-acquired pneumonia (CAP) caused by Legionellа pneumophila is described in the article. A 37-year-old male, a worker of a nuclear power station, was admitted with dry cough, dyspnea on light exertion, and fever. The disease onset was acute; the patient had been unsuccessfully treated with b-lactam antibiotics for 5 days before the admission. Two weeks before the disease onset, he had been to a neighbor region by business and stayed in a hotel. Non-severe bilateral CAP caused by Legionella was diagnosed using standard methods including Legionella rapid urine antigen test. Pneumonia was complicated by pleural exudate and moderate respiratory failure (class III according to PORT scale). Clinical particularities included diarrhea in the first day of the disease, elevated hepatic enzyme levels in blood, elevated blood urea, and hepatomegaly. Adequate specific therapy with levofloxacin and supplemental oxygen resulted in slow resolving of physical signs of pneumonia and pleuritis during 14 days with complete resolution of clinical symptoms and laboratory abnormalities and long-term maintenance of pulmonary infiltration.

Characteristics of Pleural Effusion and Role of Computed Tomography (CT) Attenuation values (Hounsfield units) in Differentiating Pleural Fluid transudate, exudate and empyema.

Characteristics of Pleural Effusion and Role of Computed Tomography (CT) Attenuation values (Hounsfield units) in Differentiating Pleural Fluid transudate, exudate and empyema.

A novel technique for chest drain removal using a two layer method with triclosan-coated sutures.

In thoracic surgery, a thoracic drain is always inserted after the surgical procedure. Repair of the wound after removal of the thoracic tube is performed postoperatively, but no universally standard methods currently exists for this tube removal. Here we report a technique using triclosan-coated sutures that is used in thoracic surgery in our hospital. There are several advantages of this technique. First, there is no need for stitches removal on follow-up. Second, it prevents the leakage of pleural exudate because of the tight two-layer sutures. In addition, it was observed to be superior in terms of both wound healing and cosmetic aspects, due to the layer-to-layer sutures. The use of triclosan-coated sutures helps prevent infection and empyema is quite unlikely to occur as the result of the tight ligating of the muscular layer using these sutures. We applied this method in 168 patients over a period of 24 months. There were no complications on removal of the chest tube such as infection, fluid leakage or opening of the surgical wound.

Endoscopic ultrasound-guided evaluation of the pleura and cases of pleural effusion.

The most efficient and cost-effective approach for the diagnosis of pleural exudates remains uncertain and is a subject of controversy. Essential factors to be considered include the respective diagnostic yields of thoracocentesis, closed pleural biopsy, and thoracoscopy. The role of endoscopic ultrasound (EUS) of the esophagus as a modality for the evaluation of pleural exudates has not yet been evaluated. The applied anatomy of the pleura has been discussed. The techniques involved in the EUS imaging of different aspects of the pleura in normal cases and in cases with pleural effusion are elaborated. The practical application of this knowledge can be useful in EUS-guided sampling of the pleural wall, pleural nodules, and in cases of pleural effusion.

Modulation of reactive oxygen species production, apoptosis and cell cycle in pleural exudate cells of carrageenan-induced acute inflammation in rats by rutin.

The present study seeks to investigate the effect of rutin, a flavonoid compound in rat models of acute inflammation induced by carrageenan (CAR). Twenty-four female Wistar rats weighing 222-247 g received saline or 2% λ-carrageenan in the pleural cavity and treatment with rutin (80 mg kg-1) or saline by oral gavage for 21 days prior to the intrapleural induction of CAR. After 4 h of induction, the rats were euthanized, the plasma was prepared from the blood for the analysis of haematological parameters and the pleural exudate was obtained for the analysis of the total cell count, cell viability, reactive oxygen species (ROS) production, apoptosis and cell cycle. The result revealed that rutin exhibited anti-inflammatory effects by modulating the ROS level, apoptosis and cell cycle. This study indicates that rutin may exert a protective effect against ROS-mediated oxidative damage associated with an anti-inflammatory activity in rat models of acute inflammation.

Role of MCP-1 in pleural effusion development in a carrageenan-induced murine model of pleurisy.

Exudative pleural effusions affect over 1500 patients per million population each year. The pathobiology of pleural exudate formation remains unclear. Our recent study revealed monocyte chemotactic protein-1 (MCP-1) as a key driver of fibrinolytic-induced exudate effusion while another study found a role for MCP-1 in malignant effusion formation. In the present study, we further evaluated the role of MCP-1 in the development of pleural effusion in a mouse model of acute pleural inflammation. λ-Carrageenan (CAR) was injected into the pleural cavity of CD1 mice and pleural effusion volume measured up to 16 h post-injection. Pleural effusion and serum protein and MCP-1 concentrations were measured and differential cell counts performed in fluids. Mice were also treated with either intraperitoneal (i) anti-MCP-1 antibody or isotype control or (ii) an MCP-1 receptor (CCR2) antagonist or vehicle control 12 h prior to and at the time of CAR injection. Intrapleural CAR induced significant pleural fluid accumulation (300.0 ± 49.9 μL) in mice after 4 h. Pleural fluid MCP-1 concentrations were significantly higher than corresponding serum MCP-1 (144 603 ± 23 204 pg/mL vs 3703 ± 801 pg/mL, P < 0.0001). A significant decrease in pleural fluid formation was seen both with anti-MCP-1 antibody (median (interquartile range, IQR): 36 (0-168) μL vs controls 290 (70-436) μL; P = 0.02) or CCR2 antagonist (153 (30-222) μL vs controls 240 (151-331) μL, P = 0.0049). Blockade of MCP-1 activity significantly reduced inflammatory pleural effusion formation in a CAR model. Together with recent successes in MCP-1 blockade in other effusion formation models, our data strongly support clinical evaluation of MCP-1 antagonists as a novel approach to pleural fluid management.

Profile of Metalloproteinases and Their Association with Inflammatory Markers in Pleural Effusions.

Matrix metalloproteinases (MMPs) are responsible for the breakdown of the extracellular matrix and play an important role in the inflammatory processes of pleural exudates. The imbalance between MMPs and their inhibitors (TIMPs) is present in various pathological processes. To evaluate the profile of MMPs and TIMPs in pleural effusions of different etiologies correlated with inflammatory markers. The patients with pleural effusion due to tuberculosis (TB), cancer (CA) or transudate were prospectively evaluated. Pleural fluid was submitted to cytological, biochemical, cytokines, MMP, and TIMP analysis. Statistical analysis was performed using ANOVA and Spearman's correlation, and p<0.05 was considered significant. One hundred and fourteen patients were enrolled, 80 exudates (41 TB and 39 CA) and 34 transudates. The levels of MMP-8 and MMP-9 were higher in exudates compared to transudates. The level of MMP-8 was significantly higher in TB than in CA. TIMP-1 levels were higher in exudates. IL-6, VEGF, and TGF-β1 showed differences between exudates and transudates. However, IL-6 level was higher in TB than in CA. We found a significant correlation between MMPs and TIMPs with inflammation markers. MMP-1 was correlated with LDH levels. MMP-8 was correlated with LDH, total cell count, neutrophils, and ADA as well as MMP-1 levels. MMP-9 was correlated with IL-6, TGF-β1, and VEGF. TIMP-1 was correlated with MMP-9 and IL-6. MMPs and TIMPs are expressed in pleural fluid of different etiologies and correlate with inflammatory mediators. MMPs may be useful in determining the cause of fluid, but more studies are needed to determine the spectrum of diseases associated with the various isoforms of MMPS and TIMPs.

Community-acquired pneumonia in children. The modern features

Acute respiratory infections are one of the most frequent diseases among children and teenagers around the World. Pneumonia which caused by infectious agents is dangerous disease of the lower respiratory tract that can lead to the death. The continuing high level of morbidity and mortality causes the issue. The article describes the WHO criteria for the diagnosis of community-acquired pneumonia (CAP) and CAP severity indicators, also radiographic signs of CAP and modern epidemiological data. The etiological structure of CAP has age-specific peculiarities. Streptococcus pneumoniae (S. pneumoniae) is leading causative agent of CAP, it causes invasive and non-invasive forms of pneumonia. The role of atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae) and viruses was mentioned. The etiology of CAP may vary depending on geographic area, vaccination coverage, using antibiotics. The modern methods for identification of S. pneumoniae were itemized in the article. The own identification from blood lytA gene and cpsA gene S. pneumoniae by polymerase chain reaction (PCR) frequency data was presented. Among examined patients who were hospitalized in clinic SPbGPMU in 2011-2015 years attending preschool children less than 5 years of age prevailed (which accounted for 48%). The invasive form is revealed at 34% of the patients with CAP. In this group of patients course of the disease was severity, there was complications such as pneumothorax, pulmonary edema, and pleural exudation.

The effect of therapeutic pleural drainage on the short- and long-term sequelae of tuberculous pleural effusions

&lt;p&gt;&lt;strong&gt;Background. &lt;/strong&gt;Tuberculosis (TB) remains a common cause of pleural exudates in many parts of the globe. Pleural fibrosis with restriction is a well-known complication of tuberculous pleuritis. Current evidence suggests that pleural drainage offers little benefit over and above anti-TB treatment in improving pulmonary function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods. &lt;/strong&gt;We enrolled 20 patients with proven tuberculous pleural effusions (mean age 32.7 years, 10 males, 12 HIV-positive), and performed therapeutic pleural drainage in 10 randomly selected cases. Pulmonary function testing (PFT), chest radiography and transthoracic ultrasound were performed on all patients before treatment and at 7 - 10 days, 3 months and 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results. &lt;/strong&gt;Complete therapeutic drainage was achieved in only 4 of the 10 patients randomised to undergo drainage. No significant immediate benefit was achieved in the 10 patients assigned to intervention. However, compared with the non-intervention group, the intervention group showed significant changes in several functional parameters at 6 months, including changes in forced vital capacity from baseline (1.40 L v. 0.65 L; &lt;em&gt;p&lt;/em&gt;&amp;lt;0.001), forced expiratory volume in 1 second (1.37 L v. 0.60 L; &lt;em&gt;p&lt;/em&gt;=0.002), total lung capacity (1.76 L v. 0.88 L; &lt;em&gt;p&lt;/em&gt;=0.034) and diffusion capacity for carbon monoxide (7.42 v. 2.19 mL/min/mmHg, &lt;em&gt;p&lt;/em&gt;=0.013). No difference was observed in the change in 6-minute walking distance (113.4 m v. 126 m; &lt;em&gt;p&lt;/em&gt;=0.798) compared with the control group at 6 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions. &lt;/strong&gt;Therapeutic drainage may offer additional medium- and long-term functional benefits to patients with pleural TB, in addition to anti-TB drug therapy alone, as evident in the improvement in PFT results.&lt;/p&gt;