Pleural Fluid Protein Research Articles

Diagnostic scoring systems for tuberculous pleural effusion in patients with lymphocyte-predominant exudative pleural profile: A development study

BackgroundDiagnosing tuberculous pleural effusion (TPE) in patients presenting with Lymphocyte-Predominant Exudative pleural effusion (LPE) is challenging, due to the poor clinical utility of TB culture. Adenosine deaminase (ADA) has been recommended for diagnosis, but its high cost and limited availability hinder its clinical utility. We aim to develop diagnostic prediction tools for Thai patients with LPE in scenarios where pleural fluid ADA is available but yields negative results and in situations where pleural fluid ADA is not available. MethodsTwo diagnostic prediction tools were developed using retrospective data from patients with LPE at Surin Hospital. Model 1 is for ADA-negative results, and Model 2 is for situations where pleural fluid ADA testing is unavailable. The models were derived using multivariable logistic regression and presented as two clinical scoring systems: round-up and count scoring. The score cut-point that achieves a positive predictive value (PPV) comparable to the post-test probability of a pleural fluid ADA at a cut-point of 40 U/L was used as a threshold for initiating anti-TB treatment. ResultsA total of 359 patients were eligible for analysis, with 166 diagnosed with TPE and 193 diagnosed with non-TPE. Age <40 years, fever, pleural fluid protein ≥5 g/dL, male gender, pleural fluid color, and pleural fluid ADA ≥20 U/L were identified as final predictors. Both models demonstrated excellent discriminative ability (AuROC: 0.85 to 0.89). The round-up scoring demonstrated PPV above 90% at cut-off points of 4 and 4.5, while the count scoring achieved cut-off points of 3 and 4 for Model 1 (Lex-2P2A) and Model 2 (Lex-2P-MAC), respectively. ConclusionThese diagnostic tools offer valuable assistance in differentiating between TPE and non-TPE in LPE patients with negative pleural fluid ADA (Lex-2P2A) and in settings where pleural fluid ADA testing is not available (Lex-2P-MAC). Implementing these diagnostic scores may have the potential to improve TPE diagnosis and facilitate prompt initiation of treatment.

Clinical characteristics of chylothorax: results from the International Collaborative Effusion database.

Chylothorax is an uncommon medical condition for which limited data are available regarding the contemporary aetiology, management and outcomes. The goal of this study was to better define these poorly characterised features. The medical records of adult patients diagnosed with chylothorax at 12 centres across Europe, America and South Africa from 2009-2021 were retrospectively reviewed. Descriptive and inferential statistics were performed. 77 patients (median age 69 years, male to female ratio 1.5) were included. Subacute dyspnoea was the most typical presenting symptom (66%). The commonest cause of chylothorax was malignancy (68.8%), with lymphoma accounting for 62% of these cases. Other aetiologies were trauma (13%), inflammatory/miscellaneous conditions (11.7%) and idiopathic cases (6.5%). At the initial thoracentesis, the pleural fluid appeared milky in 73%, was exudative in 89% and exhibited triglyceride concentrations >100 mg·dL-1 in 88%. Lymphangiography/lymphoscintigraphy were rarely ordered (3%), and demonstration of chylomicrons in pleural fluid was never ascertained. 67% of patients required interventional pleural procedures. Dietary measures were infrequently followed (36%). No patient underwent thoracic duct ligation or embolisation. Morbidity included infections (18%), and thrombosis in malignant aetiologies (16%). The 1-year mortality was 47%. Pleural fluid protein >3.5 mg·dL-1 (sub-distribution hazard ratio (SHR) 4.346) or lactate dehydrogenase <500 U·L-1 (SHR 10.21) increased the likelihood of effusion resolution. Pleural fluid protein ≤3.5 mg·dL-1 (HR 4.047), bilateral effusions (HR 2.749) and a history of respiratory disease (HR 2.428) negatively influenced survival. Chylothoraces have a poor prognosis and most require pleural interventions. Despite the standard recommendations, lymphatic imaging is seldom used, nor are dietary restrictions followed.

Comparison of the Efficacy of Light's Criteria With Serum-Effusion Albumin Gradient and Pleural Effusion Glucose.

Introduction While Light's criteria exhibit high sensitivity (98%) in detecting exudative pleural effusions, the capacity to rule out transudates is relatively limited. A previous study showed thatapproximately one-fifth of patients with congestive cardiac failure on diuretics also met the criteria for exudate. This study compares the diagnostic value of Light's criteria, the serum-effusion albumin gradient (SEAG) method, and pleural effusion glucose levels for accurately categorizing pleural effusion as transudate or exudate. Methodology We conducted this cross-sectional observational study in a tertiary care hospital in Ahmedabad, India. Two hundred patients with pleural effusion undergoing thoracentesis were included. Laboratory parameters measured in pleural fluid analysis included pleural fluid protein, pleural fluid lactate dehydrogenase (LDH), pleural fluid albumin, and pleural fluid glucose. Serum protein, serum LDH, and serum albumin were also collected. Mean values and standard deviations (SDs) were calculated for analysis. Results A significant difference was observed in the mean value of exudative and transudative effusions for each parameter (pleural fluid protein/serum fluid protein ratio, pleural fluid LDH/serum fluid LDH ratio, pleural fluid LDH, SEAG, and pleural fluid glucose) (P < 0.001). Light's criteria demonstrated the highest efficacy in diagnosing exudates (accuracy = 97.50%), while SEAG demonstrated the highest efficacy in diagnosing transudates (accuracy = 97.50%). Conclusion SEAG is an effective alternative diagnostic tool for identifying transudates misclassified by Light's criteria. Its use can contribute to prompt diagnosis and timely treatment of patients with pleural effusion, improving patient outcomes.

Diagnostic Value of Pleural Fluid Cholesterol versus Pleural Fluid Protein / Serum Protein Ratio to Differentiate Exudative from Transudative Pleural Effusion

Diagnostic Value of Pleural Fluid Cholesterol versus Pleural Fluid Protein / Serum Protein Ratio to Differentiate Exudative from Transudative Pleural Effusion

Relationship of lactate dehydrogenase, pH, glucose and protein pleural fluids with one year life of patients with non-small cell lung carcinoma with malignant pleural effusion in Prof. Dr IGNG Ngoerah Denpasar

Malignant pleural effusion (MPE) is one of the most common metastases in Non-Small Cell Lung Carcinoma (NSCLC). Some part of the pleural fluid analysis affects the patient's survival. A retrospective cohort study using medical record data of 76 patients was done in Prof. Dr. IGNG Ngoerah General Hospital. The one-year survival was 36.6%, with a median survival of 240 days or 8 months (95% CI 110.94–369.05). The cut-off point for pleural fluid protein was 5 g/dL (sensitivity 33.3%, specificity 32.1%), glucose 47.5 mg/dL (sensitivity 81.3%, specificity 32.1%), lactate dehydrogenase (LDH) 978.5 IU/L (sensitivity 41.7%, specificity 46.4%) and pH 7.3 (sensitivity 62.5%, specificity 35.7%). Bivariate analysis showed that only protein was associated with survival. Protein &lt; 5 g/dL had a median survival of 116 days (95% CI 67.96 – 164.05, p = 0.001). Multivariate analysis showed pleural fluid protein &lt; 5gr dL, best supportive care therapy, and non-adenocarcinoma histology were independent risk factors for death {HR 2,345,95% CI: 1,055-5,214; p= 0.037; HR 5,332. 95% CI: 2.109 – 13.478; p = 0.000; HR 2,635, 95% CI 1,096 – 6,335; p = 0.30).

Indwelling tunneled pleural catheters in patients with hepatic hydrothorax: A single-center analysis for outcomes and complications

Rationale Patients with refractory hepatic hydrothorax (HH) are challenging to manage due to associated risks involved with repeated procedures required for drainage of the effusion. There is paucity of data describing the role of indwelling pleural catheters (IPC) in HH. We describe our experience with IPCs for management of refractory HH in collaboration with our homecare nursing services. Objective We are describing our Canadian experience using IPCs for HH, focusing on outcomes, safety, and complications to improve the management of this condition. Methods This is a retrospective study of a prospectively maintained database of all patients with HH who underwent IPC insertion between May 2006 and February 2019 at our tertiary center. Patients’ characteristics, procedural variables, outcomes and estimated survival analysis post IPC insertion were analyzed. Measurements and main results A total of 40 patients underwent 43 IPC insertions. Seven catheters (17.5%) resulted in pleural infection, without any associated deaths. Mean pleural fluid protein level was lower among patients who developed pleural infection compared to those who did not (11.5 g/L vs 16 g/L; p = 0.0015). Median survival was 12.7 months (95% CI, 6.4-43.4). Twenty-one catheters were removed within 149 days (+/- 50.2). Twelve patients died with the IPC in-situ within 69.5 days (+/- 48.7). Conclusion In refractory HH, IPCs can be safely used. Associated complications can be mitigated with frequent clinical monitoring and intermittent drainage of the effusion by dedicated homecare nursing services. Further studies establishing the role for prophylactic antibiotics in high-risk population may be of value.

Diagnostic value of pleural cholesterol in differentiating exudative and transudative pleural effusion

BackgroundPleural effusions are most commonly classified as transudative or exudative based on Light's criteria which has shown misclassification in 10%–20% of cases. Studies have demonstrated lesser misclassification with pleural fluid cholesterol criteria. Thus, this study aimed to find the diagnostic properties of pleural fluid cholesterol in differentiating the type of effusion. Materials and methodsThis cross-sectional study involving 72 patients was undertaken in a tertiary center in Nepal for a duration of 2 years. On the basis of Light's, Heffner's, etiological, and pleural fluid cholesterol criteria, pleural effusion was classified as exudative or transudative. The findings were then evaluated to determine the diagnostic value of each approach in identifying the effusion type and comparing them on the basis of sensitivity, specificity, positive predictive value and negative predictive value. ResultPleural fluid cholesterol detected effusion as exudative with sensitivity of 91.94% and specificity of 80.00% against Light's criteria; with a sensitivity of 98.28% and specificity of 85.71% against the etiological diagnosis. Additionally, against the etiological diagnosis, sensitivity of both Light's and Heffner's criteria was 100%; however, specificity was 71.43% and 64.29% respectively, which is far less than that of pleural fluid cholesterol (85.71%). Furthermore, pleural fluid cholesterol was also found to have better results than protein ratio, LDH ratio and pleural fluid protein ratio in determining the type of effusion. ConclusionWhen considering the avoidance of confusing outcomes in equivocal instances and cost effectiveness in developing nations, pleural fluid cholesterol can be one of the most useful alternative diagnostic methods for differentiating between exudative or transudative effusions.

Echographic septation: A potentially useful indicator discriminating tuberculous from malignant pleural effusion.

Tuberculous (TBE) and malignant (MPE) pleural effusions present with similar lymphocytic exudates. As TBE is an inflammatory and hypersensitivity process, we hypothesized that echographic septation may be more prevalent in TBE than in MPE, potentially serving as a good clinical predictor for TBE. A total of 183 TBE and 266 MPE patients were recruited retrospectively. Multivariate logistic regression was performed to determine significant predictors for TBE. TBE diagnosis was confirmed histologically (caseating granuloma) in 84.7% of the cases, while MPE was biopsy-proven in 63.9% of the cases. Echographic septation was more evident in TBE than in MPE (46.5% vs. 8.2%, p<0.001). Multivariate logistic regression analysis showed that male sex, serum leucocyte count ≤9×109/L or pleural fluid protein ≥50g/L, and echographic septation (aOR: 9.28, p<0.001) were independent predictors for TBE. These parameters collectively provided a diagnostic accuracy of 79.61% (95% CI 74.13-84.38). Echographic septation may potentially facilitate discrimination between TBE and MPE as part of a clinical prediction model. Prospective validation of this prediction model in an external cohort is anticipated.

Descriptive study of clinical profile of malignant pleural effusions in a tertiary care centre

Introduction: Pleural effusion (PE) refers to the excessive or abnormal accumulation of fluid in the pleural space. PE is commonly encountered medical problem and caused by a variety of underlying pathological conditions.1 They are classified broadly in to exudative and transudative effusion based on Light's criteria.2 Common causes of transudative effusions are congestive cardiac failure, cirrhosis, nephrotic syndrome, superior venacava obstruction, peritoneal dialysis, glomerulonephritis, myxoedema, pulmonary emboli and sarcoidosis whereas exudative PE is caused by neoplastic diseases, infections, pulmonary embolism, gastrointestinal diseases, collagen vascular diseases, drug induced, iatrogenic, hemothorax and chylothorax. Materials and Methods: A total of 178 consecutive cases ≥ 18 years having pleural effusion with proven underlying malignancy were included in the study. Detailed clinical history, general and systemic examination was done in all patients. A chest radiograph was done and the size of effusion was estimated in all cases. If the size of effusion was more than 2/3rd, it was considered large/ massive effusion. After preliminary examination and investigations, an informed consent was taken from all the patients regarding diagnostic thoracentesis. Further, every study participant was subjected to following investigations: pleural fluid cytology, pleural fluid LDH, pleural fluid proteins, S. proteins and S. LDH.

A Case of Pleural Effusion Secondary to Covid-19

Normal radiological discoveries of Covid 19 disease incorporate reciprocal ground glass opacities in lower flaps with a fringe circulation. Pleural radiation is viewed as an uncommon indication of Covid 19 contamination. Pleural effusion can be divided into transudative &amp; exudative pleural effusions. Transudative pleural effusion occurs due to cirrhosis, heart failure, post open heart surgery &amp; pulmonary embolism whereas an exudative pleural effusion are triggered by pulmonary bacterial pneumonia or tuberculosis, cancer, inflammatory disorders such as pancreatitis, lupus, rheumatoid arthritis, post-cardiac injury syndrome, chylothorax (due to lymphatic obstruction), hemothorax (blood in the pleural space), and benign asbestos pleural effusion. This two types of pleural effusion can be identified by measurement of the pleural fluid protein and lactic dehydrogenase (LDH). When the patient's serum total protein is normal but the pleural fluid protein is less than 25g/L, the fluid is classified as a transudate. The fluid is an exudate if the protein content of the pleural fluid is greater than 35g/L. We'll look at the case of a 55-years-old male farmer with complains of breathlessness, cough, fever and left sided chest pain since 3 weeks. He had a history of Covid 19 Positive status 1 month back for which he took medications based on Covid 19 guidelines and HRCT score was 12/25. High amounts of Creactive protein &amp; ferritin were discovered in laboratory tests. Chest X-ray &amp; CT scan identified a massive left sided pleural effusion.

Comparison of Diagnostic Yield and Complications in Ultrasound-Guided Closed Pleural Biopsy Versus Thoracoscopic Pleural Biopsy in Undiagnosed Exudative Pleural Effusion.

IntroductionMalignancy, tuberculosis, and non-tubercular pleural infections account for most exudative pleural effusion. Pleural fluid cytology, biochemical tests and even pleural fluid cell block studies may fail to yield a diagnosis in certain cases. Medical thoracoscopy is the gold standard for the diagnosis of unexplained pleural effusions. However, access to medical thoracoscopy may be limited, particularly in developing countries. Also, certain patients may not be fit to undergo the procedure because of medical conditions. An ultrasound-guided pleural biopsy is an option in such conditions. The present study is intended to compare the diagnostic yield and complications of both methods of pleural biopsy in undiagnosed exudative pleural effusion under a randomized controlled trial.MethodAfter fulfilling all the inclusion criteria, participants were randomized to either ultrasound-guided closed pleural biopsy or thoracoscopic-guided pleural biopsy groups. The primary outcome was to compare the diagnostic yield of ultrasound-guided Tru-Cut® (Newtech Medical Devices, Faridabad, India) closed pleural biopsy versus thoracoscopic pleural biopsy, and the secondary outcomes were to compare the complications rate, duration of the procedure, and hospital stay in the patients undergoing ultrasound-guided pleural biopsy versus thoracoscopic pleural biopsy, and predictors of a positive biopsy result in both groups.ResultA total of 118 patients with pleural effusion were screened; 39 of them who were eligible, randomized into the ultrasound group (20 patients) and the thoracoscopic group (19 patients). The median age of participants was 53.5 (50-58) years and 55 (45-64) years in the ultrasound and thoracoscopic groups, respectively. Pleural fluid cell count, protein, adenosine deaminase (ADA), and lactate dehydrogenase (LDH) were similar in both groups, although pleural fluid glucose was low in the ultrasound group. Diagnostic yield was 90% (18/20) and 94.7% (18/19) in the ultrasound and thoracoscopic groups, respectively, which was statistically non-significant (p=0.963). The median duration of hospital stay was 9.5 (5.3-27) days and 15 (12-22) days in ultrasound and thoracoscopic groups respectively. The thoracoscopic group had a more prolonged stay compared to the ultrasound group, but it was statistically non-significant (p=0.09). The duration of the procedure was significantly longer in the thoracoscopic group 90 (85-105) minutes, in comparison to ultrasound 47.5 (41.3-55) minutes (p=0.001). No major complications were seen in both groups. Subcutaneous emphysema was the most common complication in the thoracoscopic group (10%), followed by hemorrhage (5.3%), and respiratory failure (5.3%). Hypotension was the only complication in the ultrasound group (5%). The rate of complications was significantly higher in the thoracoscopic group (p<0.01).ConclusionUltrasound-guided closed pleural biopsy is as good as thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. It was associated with a shorter procedure duration, a shorter hospital stay, and fewer complications as compared to thoracoscopic biopsy. Both the procedures were safe in experienced hands and a hospital setup, but the thoracoscopic pleural biopsy was associated with complications.

Diagnostic value of pleural C-reactive protein levels in assessing severity of pediatric parapneumonic effusions

The immediate determination of complicated parapneumonic effusion is featured by instant remedial advantages. Consequently, we attempted to evaluate whether C-reactive protein (CRP) in pleural fluid can ameliorate the identification of cases with parapneumonic effusions that eventually require intervention. Patients and methods. A case-control study enrolled 43 patients with parapneumonic effusions from the inpatient ward and emergency room of Ain Shams Pediatric University Hospital, Egypt. Twenty of those patients had complicated effusions (complicated parapneumonic pleural effusion, CPPE), and 23 had uncomplicated parapneumonic pleural effusions (UCPPE). The differentiation characteristics of pleural fluid biochemical parameters as well as pleural CRP were estimated. Pleural fluid parameters were applied to classify cases of CPPE or UCPPE. ROC analysis established CRP setting to distinguish between both groups. Results. Pleural CRP was significantly higher in CPPE and empyema (48.97 mg/L) than in UCPPE (7.75 mg/L). The optimal cut-off point between CPPE and UCPPE in relation to pleural CRP was found to be 12.26 mg/L with a sensitivity of 95.00%, specificity of 95.65%, and AUC of 94.8%. Conclusion. Pleural fluid CRP can indeed be a beneficial spare test in pleural effusions and contribute to the differential diagnosis of CPPE and UCPPE. Key words: parapneumonic effusion, empyema, pleural CRP, pediatrics

ANASARCA AND MALIGNANT PLEURAL EFFUSION

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Anasarca is commonly caused by proteinuria, gastroenteral protein loss, low-synthesis states, or low intake. Etiologies of anasarca include nephrotic syndrome, cirrhosis, protein-losing enteropathy, and malnutrition [1]. Our case describes diffuse edema secondary to protein loss from recurrent malignant pleural effusion, an etiology not previously reported in the literature. CASE PRESENTATION: A 59-year-old male with stage IV non-small cell lung cancer presented with complaint of increased bilateral lower extremity edema. In the preceding month he had experienced recurrent right-sided pleural effusions requiring multiple thoracenteses and placement of a right indwelling pleural catheter. He reported draining up to 800 cc daily, with volumes of 500 cc every other day at the time of admission. The patient's lower extremity edema evolved over a span of one month and had significantly increased just prior to admission, precluding his ability to don footwear. The patient's exam was significant for diffuse edema most prominent at the feet and ankles and diminished breath sounds with dullness to percussion at the right lung base. Workup showed non-nephrotic range proteinuria, no evidence of cirrhosis, and normal ejection fraction on transthoracic echocardiogram. His total serum protein was 5.3 g/dL and serum albumin was 2.6 g/dL. He continued to drain pleural fluid from his pleural catheter at an average of 150-250cc/day. Pleural fluid protein was as high as 2.2 g/dL. Average daily pleural drainage was 200 cc, resulting in a daily protein loss of approximately 4g/day. This degree of protein loss was surmised to be the likely cause of the patient's anasarca. Over the course of his admission, the patient underwent multiple dialysis sessions resulting in a total net weight loss of 15kg. He demonstrated improvement in edema about his abdomen and legs but his ankles and feet continued to have pitting edema to a depth of 4-5 mm. DISCUSSION: This is an unusual case of protein loss via recurrent pleural effusion leading to anasarca. Diffuse edema resulting from recurrent/persistent malignant has not been previously described and thus, there is no clear guidance regarding potential complications nor management options. Other more common causes of anasarca may give some insight regarding potential problems and possible therapies. In low-protein states, diuresis has been a standard of care. Data from the treatment of nephrotic syndrome has demonstrated the loss of clotting factors resulting in coagulopathy. Additionally, patients are at increased cardiac risk due to increased lipid levels from upregulated liver synthesis [2]. Furthermore, loss of antibodies and other proteins theoretically increases the risk for infection [3]. CONCLUSIONS: The prevalence of malignant effusions leading to anasarca is unclear. This case highlights a cause of anasarca that should be considered in similar patient populations. REFERENCE #1: Blankfield RP, Finkelhor RS, Alexander JJ, Flocke SA, Maiocco J, Goodwin M, Zyzanski SJ. Etiology and diagnosis of bilateral leg edema in primary care. Am J Med. 1998;105(3):192. REFERENCE #2: Crew RJ, Radhakrishnan J, Appel G. Complications of the nephrotic syndrome and their treatment. Clin Nephrol. 2004;62(4):245. REFERENCE #3: Umar SB, DiBaise JK. Protein-losing enteropathy: case illustrations and clinical review. Am J Gastroenterol. 2010;105(1):43. Epub 2009 Sep 29. DISCLOSURES: No relevant relationships by Jaime Stull, source=Web Response

Diagnostic value of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in differentiating parapneumonic effusion from tuberculous pleurisy

Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P&lt;0.001). The median values of pleural fluid LDH/ADA ratio between TBP and PPE groups were 16.10 (12.53) and 32.90 (34.45), respectively, which was found to be significantly lower in TBP group (P&lt;0.001). Pleural fluid LDH/ADA ratio’s sensitivity, specificity, positive predictive value, and negative predictive value were 90, 59.85, 70.4, and 84.9%, respectively, in the diagnosis of TBP for values less than 28 (P&lt;0.001). Conclusion The ratio of pleural fluid LDH/ADA determined from routine biochemical analysis predicts TBP at value of 28. Measurement of this parameter may help clinicians distinguish between TBP and PPE.

Combined analysis of C-reactive protein in pleural fluid and serum is effective in the differential diagnosis of exudative pleural effusions.

BackgroundExudative pleural effusion (EPE) is one of the common pleural manifestations of various diseases. Differential diagnosis of EPE is imperative clinically as it identifies different causes of EPE, thereby, enabling effective treatments. Thoracoscopy is a useful tool for differential diagnosis of EPE; however, some patients refuse thoracoscopic examination due to its invasive nature. In addition, the specificity and sensitivity of existing routine tests of EPE are unsatisfactory. Therefore, there is a great need to establish an effective method for the differential diagnosis of EPE.MethodsThis study was a single-institution retrospective analysis of diagnostic efficiency of C-reactive protein (CRP) and procalcitonin (PCT) between March 2018 and September 2018. A total of 87 patients diagnosed with EPE were enrolled. All participants underwent diagnostic thoracentesis. The EPE was examined using biochemical, routine, microbiological, and cytological methods. Pathological cytology detection was necessary for those suspected of malignant PE. Benign PE originates in patients with pneumonia, empyema, and tuberculosis. The levels of CRP and PCT in EPE and serum were measured before treatment. Correlation analysis and receiver-operating characteristic (ROC) curve analysis were conducted to determine the underlying relationship between levels of CRP and PCT, and for differential diagnosis.ResultsThe ROC analysis showed that the sensitivity and specificity for the analysis of pleural fluid CRP (p-CRP) were higher (cut-off: 17.55 pg/mL; sensitivity: 75.00%, specificity: 83.90%) than that of serum CRP (s-CRP, cut-off: 23.90 pg/mL; sensitivity: 71.00%, specificity: 80.4%) in the differential diagnosis for EPE. However, the analysis of pleural fluid PCT (p-PCT) and serum PCT (s-PCT) did not demonstrate correlations with EPE. Combined analysis of p-CRP (cut-off: 17.55 mg/dL) with s-CRP (cut-off: 23.9 pg/mL) showed the highest diagnostic accuracy (88.4%) in diagnosing infectious EPE.ConclusionsThe data support the close relationship between combined analysis of p-CRP with s-CRP and effective and accurate differential diagnosis of EPE, due to its higher sensitivity and specificity. However, as a highly sensitive marker for diagnosing bacterial infections, neither s-PCT nor p-PCT, showed correlations with the differential diagnosis of EPE.

48-Year-Old Woman With Dyspnea and Chest Pain

48-Year-Old Woman With Dyspnea and Chest Pain

Study to identify incidence and risk factors associated Residual pleural opacity in tubercular pleural effusion

IntroductionResidual pleural opacity (RPO) is a common radiographic sequela in patients with tubercular pleural effusion at the end of the treatment. This study was designed to find out the risk factors associated with residual pleural opacity (RPO). Materials & methodsThis was a prospective longitudinal study performed to analyse data of 56 patients (46 males & 10 females) who were diagnosed as tubercular pleural effusion and treated for the same between 1st Jan 2019 to 30th March 2020. Chest X-ray posteroanterior & Lateral view was done (performed) at 0 and 6 months of treatment to quantify the amount of pleural effusion and measured the residual pleural opacity at the end of the treatment. RPO included both non resolving pleural effusion as well as residual pleural thickening (RPT). All statistical analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Multivariate logistic regression was performed to explore the association of risk factors and Residual pleural opacity. The statistical significance level was set at 0.05 (two-tailed). ResultsThe incidence of Residual pleural opacity (RPO) at the end of 6 months of antituberculosis treatment was 53.57% (30/56)). The study patients were divided into RPO and non- RPO group. Male gender had significantly higher incidence of RPO (93.3% vs 69.2% P = 0.01)). Patients with RPO group had significantly more cough and weight loss as compared to non RPO group (96.6% vs 65.3% P = 0.002 and 60% vs 23% P = 0.005). The proportion of patients who underwent therapeutic aspiration and gained weight of more than 5kg during treatment (19.5% vs 7.6% P = 0.02 & 46.6% vs 7.6% P = 0.001) was significantly higher in RPO group. A significantly lower protein, glucose and higher LDH level in pleural fluid was observed in the RPO group compared to non-RPO group (P = 0.006, P = 0.01, P = 0.001)). No significant difference was found in the pleural fluid ADA, lymphocyte, neutrophil levels between the two groups (p > 0.05). Logistic regression analysis showed that the male gender, low pleural fluid glucose, presence of cough and weight loss were associated with significantly increased risk of residual pleural opacity and thickening (p < 0.05). ConclusionTubercular pleural effusion is associated with residual pleural opacity in more than half of the patients. Male gender and low glucose levels in pleural fluid was associated with increased risk of residual pleural opacity.

A study on adenosine deaminase activity in pleural effusion of tuberculous and non tuberculous origin

Introduction: Accumulation of fluid in the pleural space that exceeds the physiological amount is defined as pleural effusion. Pleural effusion can be either transudative or exudative. The exudative pleural effusion is predominantly observed in tuberculosis. Adenosine deaminase (ADA) level remains high in disorders where cellular immunity is stimulated. Tuberculosis is one such disease. Materials and Methods: The cases were classified as two groups. 30 patients of tubercular pleural effusion were enrolled in Group I and 30 patients of non-tubercular pleural effusion were Group II. In non-tubercular pleural effusion, 6 cases were malignant effusions, 12 cases were parapneumonic effusions and 12 cases were transudative effusions, which include 4 cases of congestive cardiac failure, 4 cases of nephrotic syndrome and 4cases of hepatic cirrhosis. The following biochemical parameters in pleural fluid were estimated. They are Glucose, Protein and Adenosine deaminase. Results: In this study mean pleural fluid glucose level was significantly higher in transudative when compared to exudative pleural effusions. In exudative pleural effusions, mean pleural fluid protein level was increased significantly as compared to transudative pleural effusions. The activity of ADA in tubercular effusion was significantly higher when compared to non tubercular pleural effusions of different etiology such as malignant parapneumonic and transudative. Conclusion: The assessment of ADA act as better marker for identifying tuberculosis than the traditional markers. Keywords: Pleural effusion, Exudative, Transudative, Tuberculosis, Adenosine deaminase.

“ROLE OF TB PCR IN CLINICALLY DIAGNOSED AND TREATED CASES OF TUBERCULAR PLEURAL EFFUSION”.

Background: Tuberculosis is still a major health problem worldwide. It is estimated that about one-third of the world's population is infected with mycobacterium tuberculosis. While pulmonary tuberculosis is most common presentation; pleural effusion is one of the common complications of primary tuberculosis or in conjunction with pulmonary infiltrate typical of post primary tuberculosis. Diagnosis of pleural tuberculosis (TB) remains a challenge due to its nonspecific clinical presentation and paucibacillary nature.TB PCR is a self-automated method from Roche for the detection of mycobacterium tuberculosis. This test allows for detection and identification of MTB from direct specimens within 24 – 48 hours of the receipt in the laboratory. We determined the role of TB PCR in diagnosis of tubercular etiology in pleural effusion in our study. Materials and methods: Prospective and analytical studyin a tertiary care centre of the study area was conducted after Ethics Committee permission. The study period was from June 2018 to December 2019.Data of 36tubercular pleural effusion patients was retrieved. Role of TB PCR in the diagnosis of tubercular etiology was assessed. Results: Pleural fluid samples collectedwere sent for various investigations like Routine microscopy, cytology, Pleural fluid pH, protein, LDH and TB PCR. Serum protein and serum LDH were also done.The diagnosis of Tubercular Pleural Effusion was made by clinical examination, radiological presentation, results of pleural fluid investigations and response to Anti Tubercular treatment collectively. Out of the 36 patients diagnosed to have tubercular pleural effusion, 8(22%) patient’s pleural fluid TB PCR report was positive. Conclusion:TB PCR is not a useful test in the diagnosis of tubercular etiology in pleural effusion.

Diagnosis dan tatalaksana terbaru penyakit pleura

Pleural effusion is a common problem. Pleural effusion developed as a sequel to the underlying disease process, including pressure/volume imbalance, infection, and malignancy. In addition to pleural effusion, persistent air leak after surgery and bronchopleural fistula remain a challenge by a physician. An understanding of the pleural disease, including its diagnosis and management, has made an extraordinary step. The introduction of molecular detection of organism-specific infections, risk stratification, and improvement in the non-surgical treatment of patients with pleural infection are all within reach and maybe the standard of care shortly. This article discusses the role of existing techniques, and some of the more recent ones, which are now available for establishing the diagnosis of pleural disease. The initial approach to diagnosis usually begins by distinguishing between transudates and exudates, based on the concentration of protein and lactate dehydrogenase (LDH) in pleural fluid. The exact role of amylase and LDH can provide additional information towards the differential diagnosis of various exudative pleural effusions. With newer cytochemical staining techniques in pleural fluid, diagnostic results of malignant pleural effusion can increase by up to 80%. Ultrasound (US) and thoracic computed tomographic (CT) scans have further improved the diagnosis of undiagnosed pleural effusion. The reappearance of thoracoscopy as the latest diagnostic and therapeutic tool (e.g., Pleurodesis) for undiagnosed or recurrent pleural effusions. Management of malignant pleural effusion continues to develop with the introduction of tunneled pleural catheters and chemical pleurodesis procedures. Advances in the diagnostic and therapeutic evaluation of pleural disease and what appears to be an increasing multidisciplinary interest in a doctor managing patients with pleural disease.