RESUMO

OBJECTIVE: The aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE). METHODS: The authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Levels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. CONCLUSION: Activin A in pleural fluid correlated with disease severity could act to diagnose PPE.

Assuntos

RESUMO

Abstract Objective The aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE). Methods The authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis. Results Levels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. Conclusion Activin A in pleural fluid correlated with disease severity could act to diagnose PPE.

RESUMO

Objetivo: El presente trabajo tuvo como propósito describir las características físicas, citológicas y bioquímicas, así como clasificar los líquidos pleurales de pacientes con COVID-19 como exudados o trasudados. Material y Métodos: Se realizó un estudio observacional, transversal descriptivo. Se recopiló datos del examen citoquímico de muestras de líquido pleural procesadas entre los meses de abril a setiembre del 2020, en el laboratorio del Centro de Emergencias de Lima Metropolitana (CELIM). Resultados: Durante el periodo de estudio un total de 81 muestras de líquido pleural de pacientes con COVID-19 fueron evaluadas, de estos, 26 cumplieron con nuestros criterios de elegibilidad. Catorce líquidos (54%), tuvieron un color rojo y 18 (69%) tuvieron un aspecto turbio. Los líquidos pleurales exudativos fueron la mayoría (n = 17), las proteínas totales presentaron una media de 3.3 gr/dl (DE: 1.5), LDH una mediana de 544 U/L (RIC: 262-2016), el recuento leucocitario tuvo una mediana de 610 leucocitos/ul (RIC: 180-968) y el recuento diferencial de polimorfonucleares una mediana 29% (RIC: 15-60). En cuanto a las características clínicas, del total de exudados el 41% correspondían a neoplasias y el 23% a neumonías. Mientras que, del total de trasudados (n=9), 45% provenían de pacientes con neoplasias. Conclusiones: En nuestro estudio observamos que la mayoría de las muestras de líquido pleural de pacientes con COVID-19 fueron clasificadas como exudados. Estas presentaron un bajo porcentaje diferencial leucocitario de polimorfonucleares. Los valores de los parámetros bioquímicos tales como proteínas totales y LDH se relacionaron adecuadamente con la clasificación de exudados.

Objetive:The purpose of this work was to describe the physical, cytological and biochemical characteristics, as well as to classify the pleural fluids of patients with COVID-19 as exudates or transudates. Materials and Methods: An observational, descriptive cross-sectional study was carried out. Data was collected from the cytochemical examination of pleural fluid samples processed between the months of April to September 2020, in the laboratory of the Emergency Center of Metropolitan Lima (CELIM). Results: During the study period, a total of 81 samples of pleural fluid from patients with COVID-19 were evaluated, of these, 26 met our eligibility criteria. Fourteen liquids (54%) had a red color and 18 (69%) had a cloudy appearance. Exudative pleural fluids were the majority (n = 17), total proteins presented a mean of 3.3 g / dl (SD: 1.5), LDH a median of 544 U / L(IQR: 262-2016), the leukocyte count had a median of 610 leukocytes / ul (IQR: 180-968) and the differential polymorphonuclear count a median 29% (IQR: 15-60). Regarding the clinical characteristics, of the total exudates, 41% corresponded to neoplasms and 23% to pneumonia. While, of the total transudates (n = 9), 45% came from patients with neoplasms. Conclusions: In our study we observed that most of the pleural fluid samples from patients with COVID-19 were classified as exudates. These presented a low differential leukocyte percentage of polymorphonuclear cells. The values of the biochemical parameters such as total proteins and LDH were adequately related to the classification of exudates.

RESUMO

INTRODUCTION: The initial evaluation of patients with thoracic trauma remains a diagnostic challenge for surgery and emergency physicians. Chest sonography plays a key role in the approach for this group of patients, through extended and focused evaluation with trauma sonography (E-FAST). OBJECTIVES: To establish the diagnostic performance of the extension of the thoracic spine sign using chest sonography in trauma to diagnose hemothorax and compare it with the gold standard test chest computed tomography (CT). METHODS: This prospective observational study was conducted over 1 year. Patients who attended the emergency room with closed or penetrating thoracic or thoraco-abdominal trauma, an indication for a chest CT as part of a diagnostic evaluation according to institutional protocols, and who previously underwent a chest sonogram to determine the extent of the thoracic spine sign to diagnose hemothorax. Sonographic results were compared to a radiologist's interpretation of the chest CT. The radiologists were blinded to the initial sonogram interpretation. RESULTS: Seventy-six patients were enrolled with an average age of 32 years. They mainly had closed trauma, which accounted for 77.6% of samples, and 222 chest images were taken. The sensitivity and specificity for this study were 78.7% and 92.6%, respectively, with a positive predictive value and negative predictive value of 65% and 97.8%, respectively. CONCLUSIONS: Extension of the thoracic spine sign allows rapid identification of the presence, and more precisely, the absence of pleural effusion. This, therefore, allows an appropriate diagnosis and approach in the emergency room in patients with chest trauma.

Assuntos

RESUMO

OBJECTIVE: To evaluate culture-independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture-negative pleural fluid (PF) in children. METHOD: Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture-independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real-time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of ß-lactam agents, in PF samples. RESULTS: We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods. From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty-four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving ß-lactam antibiotics administered empirically. Of the 24 lytA real-time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of ß-lactam susceptibility. CONCLUSION: The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of ß-lactam susceptibility should be explored further.

Assuntos

RESUMO

Background: Tuberculosis (TB) is the world's leading cause of death from infectious disease. The World Health Organization (WHO) recognized 6.3 million new TB cases in 2017, 16% corresponding to extrapulmonary forms; pleural tuberculosis (PT) is the most common extrapulmonary form in adults. PT diagnosis is often challenging because the scarcity of bacilli in pleural fluid (PF), sometimes requiring invasive procedures to obtain pleural tissue for histological, microbiological or molecular examination. In regions of medium and high disease prevalence, adenosine deaminase (ADA), interferon gamma (IFN-γ) and interleukin 27 (IL-27) dosages are useful to establish presumptive diagnosis in patients with compatible clinical/radiological picture who present with lymphocytic pleural effusion. PT treatment is similar to the pulmonary TB treatment regimen recommended by WHO. Area covered: In this update, we present a PT review, including epidemiology, pathogenesis, clinical features, diagnosis, and therapy. Expert opinion: There is no PF test alone accurate for PT diagnosis, despite the evolution in clinical laboratory. ADA, IFN-γ and IL-27 are valuable laboratory biomarkers; however, IFN-γ and IL-27 are quite expensive. Molecular tests present low sensitivity in PF, being useful for diagnostic confirmation. Multidrug therapy remains the PT treatment choice. Advancing research in immunotherapy may bring benefits to PT patients.

Assuntos

RESUMO

OBJECTIVES: Tuberculosis is one of the most prevalent infections in humans. Although culture is the reference for diagnosis, its sensitivity is compromised, especially in paucibacillary samples. Because polymerase chain reaction (PCR) amplifies mycobacterial DNA, it is more sensitive than culture for the diagnosis of Mycobacterium tuberculosis (Mtb). However, its performance can be affected by intrinsic sample inhibitors and by the extraction/detection techniques used. METHODS: We evaluated the influence of preanalytical conditions on Mtb detection in samples of sputum (SPU), bronchoalveolar lavage (BAL), and pleural fluid (PF) using combinations of extraction/detection methods. Respiratory samples were prepared to contain different concentrations of red blood cells and nucleated cells to which increasing amounts of Mtb colonies were inoculated and submitted to PCR. RESULTS: Up to 102 CFU/ml of Mtb were detected in the SPU in all methods, except for the Roche extraction/detection method, regardless of the preanalytical sample condition. In BAL samples, medium and high concentrations of cells and high concentrations of red blood cells contributed to a lower Mtb detection, regardless of the extraction method used. In PF, red blood cells were the variable that most interfered with Mtb detection, with better recovery (102 CFU/ml) observed with the Qiagen/Nanogen combination. CONCLUSION: The choice of Mtb extraction and detection method is of fundamental importance for PCR analytical sensitivity, especially when paucibacillary samples and/or samples containing potential PCR inhibitors are analyzed.

Assuntos

RESUMO

La determinación de los niveles de la adenosina deaminasa en el líquido pleural es sensible y específica para la tuberculosis pleural. La adenosina deaminasa en el líquido pleural disminuye con el tiempo a temperatura ambiente. El objetivo de este estudio es demostrar si existe diferencia en los valores de la adenosina deaminasa en líquidos pleurales en cuatro medios diferentes de transporte (hielo, citrato de sodio, heparina y ninguna sustancia, química añadida). Se determinaron los niveles de la enzima en ochenta y ocho (88) muestras de líquido pleural procedentes de 22 pacientes con derrames pleurales no diagnosticados. Se demostró la concordancia diagnóstica entre los diferentes medios de transporte. No se demostró diferencia significativa entre los niveles de la adenosina deaminasa en cada una de los diferentes medios de transporte hasta dos (2) horas posterior a su recolección. Se recomienda enviar las muestras de líquido pleural con el conservativo adecuado o con ácido etilen diamino tetracético de rutina en nuestro país

The determination of the levels of adenosine deaminase in pleural fluid is sensitive and specific for pleural tuberculosis. Adenosine deaminase in pleural fluid decreases over time at room temperature. The objective of this study is to demostrate if there is difference on the average values of adenosine deaminasa in pleural fluids in four different means of transport (ice, sodium citrate, heparin and no added chemical substance). The levels of the enzyme in eighty-eight (88) pleural fluid samples from 22 patients with diagnosed pleural effusions were determined. We demonstrated diagnostic concodance between the differents modes of transport. No significant difference is between the levels of adenosine deaminase in each of the different means of transport up to two (2) hours after collection. It is recommended to send by routine in our country samples of pleural fluid with the right conservative or Acid etilen diamino tetracetic

Assuntos

RESUMO

El objetivo del trabajo es analizar las características morfo-citoquímicas de los líquidos pleurales, de pacientes con derrame pleurales, para proporcionar métodos útiles de diagnóstico etiológico. Se extrajeron entre 10 y 50 ml. de líquido pleural de 104 pacientes. Los líquidos pleurales se clasificaron en exudados y trasudados. Se practicó estudio morfo-citoquímico, citología, coloración de Ziehl-Neelsen y cultivo para bacilo de Koch, hongos y biopsia. La distribución de los derrames pleurales fue: tuberculosos (n=36-35,0%); neoplásicos (n=28-27,0%); indeterminados (n=18-17,3%) infecciones respiratorias (11,0%); insuficiencia renal (7,0%) y otros. El 84,0% de los derrames pleurales fue de tipo exudado. El 50,0% de los líquidos pleurales hemorrágicos fueron neoplásicos. En los derrames pleurales de tipo exudado hubo una predominancia de linfocitos/polimorfonucleares. La coloración de Ziehl-Neelsen resultó siempre negativa. Los cultivos fueron positivos para bacilo de koch (10,0%). En el 17,9% se diagnosticaron derrames pleurales neoplasicos. Concluimos, que las características morfo-citoquímicas del líquido pleural son importantes para hacer un diagnóstico etiológico del derrame pleural aun cuando se disponga de métodos más actualizados

The objective of the study is to analyze the characteristics of pleural fluid patients with pleural effusions to provide useful methods of etiological diagnosis. It was extracted between 10 and 50 ml pleural fluid 104 patients. The pleural fluids were classified in transudates and exudates. Was precticed morph-cytochemical, cytology, staib of Ziehl-Neelsen and cultivation for Koch's bacilli and fungi and biopsy. The distribution of the pleural effusions was: tuberculosis (n=36-35.0%); neoplastic (n=28-27.0%), indeterminate (n=18-7.3%) respiratory infections (n=18-17.3%); kidney failure (7,0%) and others. The 84.0% of the pleural fluids was exudates type. The 50.0% of bleeding pleural fluids were neoplastic. There was a predominance of lymphocytes/polymorphonuclears in the pleural effusions of exudates type; the stain of Ziehl-Neelsen was always negative. The cultures were positive for Koch's bacilli (10.0%). Neoplastic effusions were diagnosed at 17.0%. We conclude that the morph-cytochemical features of the pleural fluid are important making a diagnosis etiological effusion even when most up-to-date methods are available

Assuntos

RESUMO

El diagnóstico de la neoplasia pleural se basa en la demostración de células neoplásicas en fluido pleural (FP) o en biopsias de pleura. Sin embargo, aún en casos de malignidad hay un elevado porcentaje de informes falsos negativos (30-60%). Los FP neoplásicos presentan valores detectables de marcadores tumorales (MT) producidos por las células neoplásicas de la pleura. El objetivo de este trabajo ha sido evaluar la utilidad diagnóstica de algunos marcadores tumorales, de uso corriente en el laboratorio, en los fluidos de punción pleural. En 20 de ellos se analizaron: Antígeno cárcinoembrionario (CEA), fragmentos de la citoqueratina 19 (CYFRA 21-1) y Antígeno CA 125. Se efectuó el estudio fisicoquímico, recuento celular y examen citológico (Papanicolaou). En algunos casos se realizó diagnóstico anátomo-patológico. Los MT se dosaron por inmunoensayo de electroquimioluminiscencia. La comparación se efectuó por Kruskal-Wallis. Las muestras fueron clasificadas en 4 grupos y se determinó en cada uno mediana y rango para CEA (ng/mL), CYFRA (ng/mL) y CA 125 (UI/mL), respectivamente: 1) Citología positiva con diagnóstico previo de cáncer de pulmón (n: 5) 112 (2,3-1.610), 134,4 (45,8-600), 1.048 (498-2999); 2) Citología positiva con diagnóstico previo de cáncer de otro origen (n: 4) 15,28 (1,1-93,80), 108,1 (7,42-497,2), 1.827 (1.103-14.130); 3) Citología negativa con diagnóstico incierto (n: 4) 1,89 (0,91-2,96), 17,1 (1,5-29,6), 578,2 (27,8-12); 4) Citología no concluyente con diagnóstico incierto (n: 7) 31,8 (1,28-370,2), 96,3 (23,8-860), 585 (94,4-4.584). Se observó diferencia significativa entre los grupos. La combinación de citología y MT aumentó el diagnóstico de neoplasia pleural en 25%. Los resultados preliminares permiten concluir que un panel de marcadores tumorales en FP, sumado a los estudios tradicionales, representa una ayuda diagnóstica.

The diagnosis of pleural cancer is supported by the demonstration of neoplastic cells in pleural fluid or in pleural biopsies. However, even in malignancy there are a great number of false negatives results (30-60%). Tumor fluids. To establish the value of different tumor markers, frequently used in clinical laboratories, in the diagnosis of pleural fluids. 20 pleural fluids were processed for physical and chemical study, cellular counting, morphological examination (Papanicolaou stain) and electrochemiluminescense immunoassay for carcinoembryonic antigen (CEA), CYFRA 21-1 and CA 125. The results were analysed by Kruskal-Wallis. In some cases, biopsies were performed. The samples were classified in four groups, and the median and rank were calculated in each case (CEA, CYFRA and CA 125). 1) Positive cytology with previous diagnosis of lung cancer (n: 5) 112 (2.3-1610), 134.4 (45.8-600), 1048 (498-2999) 2) Positive cytology with previous diagnosis of not-lung cancer(n: 4) 15.28 (1.1-93.80), 108.1 (7.42- 497.2),1827 (1103-14130), 3) Negative cytology with uncertain diagnosis (n: 4)1.89 (0.91- 2.96), 17.1 (1.5-29.6), 578.2 (27.8-12, 4) Inconclusive cytology with uncertain diagnosis (n: 7) 31.8 (1.28-370.2), 96.3 (23.8-860), 585 (94.4 -4584). There were stastistic differences among the four groups. Joining the cytology to the assays for tumor markers raised sensitivity by 25%. The assay for tumor markers can be a complementary tool in the diagnosis of effusions.

Assuntos