P12 Role of Interferon gamma release assay (QuantiFERON-TB Gold In Tube) in blood in the diagnostic work up of active tuberculosis in a high TB prevalence region

Tuberculosis (TB)-associated uveitis is a common cause of infectious uveitis in the developing world. Diagnosis of TB uveitis remains a challenge. The role of interferon gamma release assays (IGRAs) is uncertain. Herein we summarise the available literature on the utility of IGRAs in the diagnosis and management of TB uveitis. We searched PubMed database from 1 August 2010 to 31 July 2020 using the following keywords alone and in combination: ‘interferon-gamma release assay’, ‘QuantiFERON’, ‘T-SPOT.TB’, ‘TB uveitis’, ‘serpiginous like choroiditis’, ‘tuberculoma’, ‘TB vasculitis’, ‘TB panuveitis’ and ‘ocular tuberculosis’. Data from 58 relevant studies were collated. The review is focused on currently marketed versions of IGRA tests: QuantiFERON-TB Gold In-Tube assay, QuantiFERON-TB Gold Plus assay (QFT-Plus) and T-SPOT.TB. We found limited evidence regarding the diagnostic utility of IGRA in patients with uveitis. No study was identified evaluating the newer QFT test—the QFT-Plus—in patients with uveitis. Similarly, there is lack of data directly comparing QFT-Plus with T-SPOT.TB specifically for the diagnosis of TB uveitis.

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General practitioner use of D-dimer in suspected venous thromboembolism: historical cohort study in one geographical region in the Netherlands

BMJ Open ◽

10.1136/bmjopen-2018-026846 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026846 ◽

Cited By ~ 1

Author(s):

Angel M R Schols ◽

Eline Meijs ◽

Geert-Jan Dinant ◽

Henri E J H Stoffers ◽

Mariëlle M E Krekels ◽

...

Keyword(s):

Cohort Study ◽

General Practitioner ◽

Clinical Assessment ◽

Geographical Region ◽

Historical Cohort ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

D Dimer

ObjectivesTo investigate how many general practitioner (GP)-referred venous thromboembolic events (VTEs) are diagnosed during 1 year in one geographical region and to investigate the (urgent) referral pathway of VTE diagnoses, including the role of laboratory D-dimer testing.DesignHistorical cohort study.SettingGP patients of 47 general practices in a demarcated geographical region of 161 503 inhabitants in the Netherlands.ParticipantsWe analysed all 895 primary care patients in whom either the GP determined a D-dimer value or who had a diagnostic work-up for suspected VTE in a non-academic hospital during 2015.Primary and secondary outcome measuresThe primary outcomes of this study were the total number of VTEs per year and the diagnostic pathways—including the role of GP determined D-dimer testing—of patients urgently referred to secondary care for suspected VTE. Additionally, we explored the use of an age-adjusted D-dimer cut-off.ResultsThe annual VTE incidence was 0.9 per 1000 inhabitants. GPs annually ordered 5.1 D-dimer tests per 1000 inhabitants. Of 470 urgently GP-referred patients, 31.3% had a VTE. Of those urgently referred based on clinical assessment only (without D-dimer testing), 73.8% (96/130) had a VTE; based on clinical assessment and laboratory D-dimer testing yielded 15.0% (51/340) VTE. Applying age-adjusted D-dimer cut-offs to all patients aged 50 years or older resulted in a reduction of positive D-dimer results from 97.9% to 79.4%, without missing any VTE.ConclusionsAlthough D-dimer testing contributes to the diagnostic work-up of VTE, GPs have a high detection rate for VTE in patients who they urgently refer to secondary care based on clinical assessment only.

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Role of colonoscopy in the diagnostic work-up of bowel endometriosis

World Journal of Gastroenterology ◽

10.3748/wjg.v21.i16.4997 ◽

2015 ◽

Vol 21 (16) ◽

pp. 4997 ◽

Cited By ~ 10

Author(s):

Marco Milone

Keyword(s):

Bowel Endometriosis ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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Acute liver failure

Challenging Concepts in Paediatric Critical Care ◽

10.1093/med/9780198794592.003.0008 ◽

2020 ◽

pp. 89-104

Author(s):

Andrew Jones ◽

Akash Deep

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Organ Support ◽

Fulminant Liver Failure ◽

Management Of Complications ◽

Diagnostic Work ◽

Work Up ◽

Paediatric Critical Care ◽

Diagnostic Work Up

The work-up and management of patients with acute liver failure in paediatric critical care are often challenging. This chapter takes the readers through definitions, grading of severity, and diagnostic work-up of acute liver failure in children. General principles underlying the management of acute liver failure, including immediate resuscitation and retrieval; organ support, including renal replacement therapy; and the management of complications, including bleeding, are discussed. In particular, this chapter focuses on neuromonitoring and neuroprotection strategies in children with hepatic encephalopathy as a complication. The role of liver transplantation in fulminant liver failure and a brief overview of complications are also discussed.

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