STUDY OF PLEURAL FLUID TO SERUM CHOLINESTERASE RATIO TO DIFFERENTIATE BETWEEN TRANSUDATE AND EXUDATE AND ITS CORRELATION WITH LIGHT'S CRITERIA

Background: Pleural effusion is a common clinical condition faced in everyday practice. The first step in the management of pleural effusion is its differentiation into transudates and exudates. Light’s criteria is the most widely used parameter to differentiate pleural effusions but studies have shown that Light’s criteria misclassifies a significant amount of cases. Methods: Study included 125 patients who had pleural effusion who met the inclusion and exclusion criteria. Duration of the study was 12 months. Results: Accordingly the mean value of this ratio was 0.10 + 0.05 in the transudates group and 0.39 + 0.14 in the exudates group. This difference was found to be statistically significant (p-value < 0.001). This ratio misclassified 5 cases. Among them 2 (3.2%) were transudates that were misdiagnosed as exudates and 3 (4.8%) were exudates that were misdiagnosed as transudates.In this study Light’s criteria misclassified 13 cases in total with a sensitivity of 91.9% and a specificity of 87.3%. Conclusions: Light’s criteria has a good sensitivity and specificity but P/S ChE was the most efficient parameter in differentiating between transudates and exudates in this study.

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Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v11i02.22957 ◽

2018 ◽

Vol 11 (02) ◽

pp. 19-25

Author(s):

Keshab Sharma ◽

PS Lamichhane ◽

BK Sharma

Keyword(s):

Computed Tomography ◽

Pleural Effusion ◽

Ct Scan ◽

Pleural Fluid ◽

Pleural Effusions ◽

Hounsfield Units ◽

Fluid Analysis ◽

Ct Attenuation ◽

The Mean ◽

Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

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Pleural fluid cytology, biochemistry and adenosine deminase level study in differentiating tubercular and non tubercular causes of pleural effusion

KYAMC Journal ◽

10.3329/kyamcj.v9i1.36620 ◽

2018 ◽

Vol 9 (1) ◽

pp. 28-31

Author(s):

Kazi Shihab Uddin ◽

Md Mahbub Rashid Sarker ◽

Md Abdur Razzaque ◽

Md Zulfikar Ali

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

High Sensitivity ◽

Malignant Cell ◽

Mean Value ◽

Cell Distribution ◽

Pleural Effusions ◽

The World ◽

Biochemical Examination ◽

Fluid Cytology

Background: Adenosine deaminase (ADA) level in pleural fluid study has gained popularity for quick diagnosis and treatment of tuberculous pleural effusion in tuberculosis burden countries. Studies have confirmed high sensitivity and specificity across the world. Pleural fluid cytology, biochemistry and malignant cell examinations are already in use and widely available.Objectives: Diagnostic approach to quickly differentiate between tubercular and non tubercular pleural effusions by analyzing cytology, biochemistry and ADA level.Materials & Methods: This study was carried out on 85 patients who were admitted or visited outpatient department with pleural effusion. The pleural fluid study was including measurement of ADA level was done.Results: 41 cases were diagnosed as tubercular pleural effusion. Among the low ADA group, 9 cases were diagnosed as malignant pleural effusion with positive malignant cell and 13 cases were transudative effusion.7 cases were diagnosed as parapneumonic effusion with exudative fluid, neutrophilic cell distribution and mixed ADA activity.Conclusion: ADA was found positive with a mean value of 88.3 U/L in tubercular pleural effusions. Non tubercular pleural effusion showed low ADA level. However the cytological and biochemical examination of pleural fluid was also found to be important in differentiating tubercular from non tubercular causes.KYAMC Journal Vol. 9, No.-1, April 2018, Page 28-31

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Assessment of the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions

Bionatura ◽

10.21931/rb/2021.06.03.10 ◽

2021 ◽

Vol 3 (3) ◽

pp. 1944-1947

Author(s):

Hanie Raji ◽

Seyed Hamid Borsi ◽

Mehrdad Dargahi MalAmir ◽

Ahmad Reza Asadollah Salmanpour

Keyword(s):

Pleural Effusion ◽

Tumor Marker ◽

Pleural Fluid ◽

Tumor Markers ◽

Low Cost ◽

High Specificity ◽

Diagnostic Value ◽

Pleural Effusions ◽

Cross Sectional ◽

The Mean

Pleural effusion is divided into exudative and transudative effusion, and the distinction between exudate and transudate requires multiple investigations of biochemical parameters and their comparison in pleural fluid and serum. This study aimed to assess the diagnostic value of CEA, CA125, and CRP and their cut-off point for discrimination of exudative pleural effusions. This epidemiological and cross-sectional study was performed on 50 patients aged between 18 to 90 years with the diagnosis of exudative pleural effusion referred to Imam Khomeini Hospital in Ahvaz in 2018 and 2019. Demographic and clinical information of patients were collected. The pleural effusion was diagnosed based on physical examination and chest radiography. Pleural effusion was confirmed by thoracentesis. A pleural fluid sample was taken from all patients, and the levels of CEA, CA125, and CRP markers were measured in the pleural fluid. Differentiation of transudate and exudate pleural effusions was performed using Light criteria. The mean CEA and CA125 level of pleural fluid were significantly higher, and the mean CRP level of pleural fluid was significantly lower in patients with malignant diagnoses (P <0.05). Cut-off value with highest sensitivity and specificity in differentiating types of exudative pleural effusions was obtained for CEA tumor marker (greater than 49.8), CA125 tumor marker (greater than 814.02), and CRP marker (less than 7.56). Also, in differentiating types of exudative pleural effusions, CEA tumor marker had sensitivity (89.03%) and specificity (78.42%); CA125 tumor marker had sensitivity (53.18%) and specificity (62.44%), and CRP marker had sensitivity (82.16%), and specificity (89.05%) were. Although the tumor markers had high specificity in the present study, the low sensitivity of some of these tumor markers reduced their diagnostic value. On the other hand, given the numerous advantages of tumor markers, such as low cost and non-invasive, combining them with another can increase the diagnostic value and accuracy.

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Clinical and laboratory differences and role of gene xpert in tuberculous pleural effusion

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v10i1.37082 ◽

2021 ◽

Vol 10 (1) ◽

pp. 4-7

Author(s):

Manoj Kumar Shah ◽

Sushil Baral ◽

Tulsi Bhattarai

Keyword(s):

Pleural Effusion ◽

Pleural Fluid ◽

Mean Value ◽

P Value ◽

Common Symptom ◽

Cross Sectional ◽

Fluid Analysis ◽

Laboratory Investigations ◽

The Difference

Background: The diagnosis of pleural effusion and its cause are essential for pleural fluid analysis. We have evaluated clinical and laboratory differences among the tubercular pleural effusion. Methods: The cross-sectional, observational hospital based study was conducted in Bir hospital, Nepal. All patients were evaluated by clinically and laboratory investigations. Patients enrolled for study have pleural effusion and pleural fluid analysis indicative of an exudative pleural effusion using lights criteria. The criteria of enrollment of the patients were pleural fluid for Adenosine deaminizes value more than 40 IU/L, positive for gene xpert test and pleural effusion of any cases with sputum positive pulmonary tuberculosis. Patients were divided into two groups lymphocytic and neutrophilic predominant pleural effusion. Results: Among 100 patients with diagnosis of exudative tubercular pleural effusion, the most common symptom was pleuritic chest pain in 85%, followed by fever in 84% and cough in 82%. Among the tubercular pleural effusion, 21% had neutrophils predominant and 79% had Lymphocytes predominant. The patients with neutrophil predominant Tubercular pleural effusion had higher fever rates (90.5vs.82.5%) than those with lymphocyte-predominant Tubercular pleural effusion. The mean value of Neutrophil predominant pleural fluid for lactate dehydrogenase (LDH) level was 1657.5 IU/L and protein was 5.3gm/dl and in lymphocyte predominant pleural fluid for LDH value was 610.2 IU/L and protein was 4.6 gm/dl; the difference was statistically significant with P value of <0.001. Only 15% of patients had sputum positive for Acid fast bacilli. Among the sputum positive patients, 47% had positive for pleural fluid for gene xpert test with all patients had rifampicin sensitive. The sensitivity of pleural fluid for gene xpert test was 46.6%, and specificity was 90%. Conclusion: In pleural effusion, the positivity of gene xpert for pleural fluid was higher among the sputum positive patients. The prevalence of Neutrophil-predominant pleural effusion was common in tubercular pleural effusion.

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Efficacy of procalcitonin and pentraxin-3 as early biomarkers for differential diagnosis of pleural effusions

Pleura and Peritoneum ◽

10.1515/pp-2021-0111 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Anita Sharma ◽

Apurva Agrawal ◽

Girish Sindhwani ◽

Ashish Sharma ◽

Sojit Tomo ◽

...

Keyword(s):

Differential Diagnosis ◽

Pleural Effusion ◽

Pleural Fluid ◽

Biochemical Markers ◽

Predictive Accuracy ◽

P Value ◽

Pentraxin 3 ◽

Pleural Effusions ◽

Operating Characteristics ◽

Diagnostic Significance

Abstract Objectives Pleural effusion, defined as an abnormal accumulation of fluid in pleural space, can be of two types: transudative and exudative. The primary aim of the study was to assess the predictive accuracy of procalcitonin (PCT) and pentraxin-3 (PTX-3) in comparison to other biochemical markers such as C-reactive protein (CRP), and adenosine deaminase (ADA) in the differential diagnosis of pleural effusions. Methods A cross-sectional analytical study was conducted on patients with pleural effusion. Multiple comparisons and receiver-operating characteristics (ROC) analyses were made to evaluate the diagnostic significance of biochemical markers. Results Sixty-six patients with exudative pleural effusion classified as malignant, tuberculous, and parapneumonic effusions (malignant pleural effusion [MPE], tuberculous [TPE], and parapneumonic [PPE]) were included. Significant differences in pleural fluid levels in both PCT (p-value: 0.001) and PTX-3(p-value: 0.001), as well as serum levels of PCT (p-value: 0.001), were observed between the three groups. ROC analysis showed both PTX-3 and PCT having favorable discrimination ability with high sensitivity (≥90%) and specificity to predict PPE from TPE and MPE. Conclusions Evaluation of serum and pleural fluid PCT and levels of PTX-3 in the pleural fluid may be used as an early biomarker to differentiate the etiology of pleural effusion.

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Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

Journal of Fatima Jinnah Medical University ◽

10.37018/jfjmu.558 ◽

2020 ◽

Vol 13 (4) ◽

pp. 184-190

Author(s):

Muhammad Irfan ◽

Abdul Rasheed Qureshi ◽

Zeeshan Ashraf ◽

Muhammad Amjad Ramzan ◽

Tehmina Naeem ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Accuracy ◽

Pleural Fluid ◽

Gold Standard ◽

Pleural Effusions ◽

Diagnostic Efficacy ◽

Chest Sonography ◽

X Ray ◽

Non Invasive ◽

Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard. Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

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Correlation of AGR2 expression with the incidence of metastasis in luminal breast cancer

Breast Disease ◽

10.3233/bd-219015 ◽

2021 ◽

pp. 1-5

Author(s):

David Samuel Kereh ◽

John Pieter ◽

William Hamdani ◽

Haryasena Haryasena ◽

Daniel Sampepajung ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Mean Value ◽

Rank Test ◽

Luminal Breast Cancer ◽

P Value ◽

Strong Positive Correlation ◽

Breast Cancer Patients ◽

The Mean ◽

Spearman Test

BACKGROUND: AGR2 expression is associated with luminal breast cancer. Overexpression of AGR2 is a predictor of poor prognosis. Several studies have found correlations between AGR2 in disseminated tumor cells (DTCs) in breast cancer patients. OBJECTIVE: This study aims to determine the correlation between anterior Gradient2 (AGR2) expression with the incidence of distant metastases in luminal breast cancer. METHODS: This study was an observational study using a cross-sectional method and was conducted at Wahidin Sudirohusodo Hospital and the network. ELISA methods examine AGR2 expression from blood serum of breast cancer patients. To compare the AGR2 expression in metastatic patients and the non-metastatic patient was tested with Mann Whitney test. The correlation of AGR2 expression and metastasis was tested with the Rank Spearman test. RESULTS: The mean value of AGR2 antibody expression on ELISA in this study was 2.90 ± 1.82 ng/dl, and its cut-off point was 2.1 ng/dl. Based on this cut-off point value, 14 subjects (66.7%) had overexpression of AGR2 serum ELISA, and 7 subjects (33.3%) had not. The mean value AGR2 was significantly higher in metastatic than not metastatic, 3.77 versus 1.76 (p < 0.01). The Spearman rank test obtained a p-value for the 2 tail test of 0.003 (p < 0.05), which showed a significant correlation of both, while the correlation coefficient of 0.612 showed a strong positive correlation of AGR2 overexpression and metastasis. CONCLUSIONS: AGR2 expression is correlated with metastasis in Luminal breast cancer.

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Assessment of the Tissue Response to Modification of the Surface of Dental Implants with Carboxyethylphosphonic Acid and Basic Fibroblastic Growth Factor Immobilization (Fgf-2): An Experimental Study on Minipigs

Biology ◽

10.3390/biology10050358 ◽

2021 ◽

Vol 10 (5) ◽

pp. 358

Author(s):

Javier Aragoneses ◽

Ana Suárez ◽

Nansi López-Valverde ◽

Francisco Martínez-Martínez ◽

Juan Manuel Aragoneses

Keyword(s):

Surface Treatment ◽

Test Group ◽

Mean Value ◽

Control Group ◽

P Value ◽

Implant Surface ◽

Bone Contact ◽

Bone Implant ◽

Significant Difference ◽

The Mean

The aim of this study was to evaluate the effect of implant surface treatment with carboxyethylphosphonic acid and fibroblast growth factor 2 on the bone–implant interface during the osseointegration period in vivo using an animal model. The present research was carried out in six minipigs, in whose left tibia implants were inserted as follows: eight implants with a standard surface treatment, for the control group, and eight implants with a surface treatment of carboxyethylphosphonic acid and immobilization of FGF-2, for the test group. At 4 weeks after the insertion of the implants, the animals were sacrificed for the histomorphometric analysis of the samples. The means of the results for the implant–bone contact variable (BIC) were 46.39 ± 17.49% for the test group and 34.00 ± 9.92% for the control group; the difference was not statistically significant. For the corrected implant–bone contact variable (BICc), the mean value of the test group was 60.48 ± 18.11%, and that for the control group, 43.08 ± 10.77%; the difference was statistically significant (p-value = 0.035). The new bone formation (BV/TV) showed average results of 27.28 ± 3.88% for the test group and 26.63 ± 7.90% for the control group, meaning that the differences were not statistically significant (p-value = 0.839). Regarding the bone density at the interthread level (BAI/TA), the mean value of the test group was 32.27 ± 6.70%, and that of the control group was 32.91 ± 7.76%, with a p-value of 0.863, while for the peri-implant density (BAP/TA), the mean value of the test group was 44.96 ± 7.55%, and that for the control group was 44.80 ± 8.68%, without a significant difference between the groups. The current research only found a significant difference for the bone–implant contact at the cortical level; therefore, it could be considered that FGF-2 acts on the mineralization of bone tissue. The application of carboxyethylphosphonic acid on the surface of implants can be considered a promising alternative as a biomimetic coating for the immobilization of FGF-2. Despite no differences in the new bone formation around the implants or in the interthread or peri-implant bone density being detected, the biofunctionalization of the implant surface with FGF-2 accelerates the mineralization of the bone–implant interface at the cortical level, thereby reducing the osseointegration period.

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Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

10.53350/pjmhs2115113288 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3288-3292

Author(s):

Wahid Bakhsh ◽

Asad Ullah Jan ◽

Muhammad Shafiq ◽

Naveed Iqbal ◽

Muzafar Hussain Buriro ◽

...

Keyword(s):

Pain Score ◽

Triamcinolone Acetonide ◽

Corticosteroid Injection ◽

Mean Value ◽

Injection Pain ◽

P Value ◽

Duration Of Symptoms ◽

De Quervain’S Tenosynovitis ◽

Minimum Age ◽

The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

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The Differential Diagnostic Values of Cytokine Levels in Pleural Effusions

Mediators of Inflammation ◽

10.1155/mi.2005.2 ◽

2005 ◽

Vol 2005 (1) ◽

pp. 2-8 ◽

Cited By ~ 15

Author(s):

Saadet Akarsu ◽

A. Nese Citak Kurt ◽

Yasar Dogan ◽

Erdal Yilmaz ◽

Ahmet Godekmerdan ◽

...

Keyword(s):

Differential Diagnosis ◽

Pleural Effusion ◽

Pleural Fluid ◽

Parapneumonic Effusion ◽

Pleural Effusions ◽

Tuberculous Pleural Effusion ◽

Cytokine Levels ◽

Diagnostic Values

The aim is to examine whether the changes in pleural fluid interleukin (IL)-1β, IL-2, IL-6, and IL-8 levels were significant in differential diagnosis of childhood pleural effusions. IL-1β, IL-2, IL-6, and IL-8 levels in pleural fluids of all 36 patients were measured. The levels of IL-1β, IL-2, IL-6, and IL-8 in pleural fluids were statistically significantly higher in the transudate group compared with those of the exudate group. The levels of IL-1β, IL-6, and IL-8 were also found to be statistically significantly higher in the empyema group compared with both the parapneumonic and the tuberculous pleural effusion groups. The levels of IL-2 and IL-6 were detected to be statistically significantly higher in the tuberculous pleural effusion group in comparison with those of the parapneumonic effusion group. The results showed that pleural fluids IL-1β, IL-2, IL-6, and IL-8 could be used in pleural fluids exudate and transudate distinction.

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