Nucleic acid amplification tests in the diagnosis of tuberculous pleuritis: a systematic review and meta-analysis

BACKGROUND: Conventional tests for tuberculous pleuritis have several limitations. A variety of new, rapid tests such as nucleic acid amplification tests – including polymerase chain reaction – have been evaluated in recent times. We conducted a systematic review to determine the accuracy of nucleic acid amplification (NAA) tests in the diagnosis of tuberculous pleuritis. METHODS: A systematic review and meta-analysis of 38 English and Spanish articles (with 40 studies), identified via searches of six electronic databases, hand searching of selected journals, and contact with authors, experts, and test manufacturers. Sensitivity, specificity, and other measures of accuracy were pooled using random effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. Heterogeneity in study results was formally explored using subgroup analyses. RESULTS: Of the 40 studies included, 26 used in-house ("home-brew") tests, and 14 used commercial tests. Commercial tests had a low overall sensitivity (0.62; 95% confidence interval [CI] 0.43, 0.77), and high specificity (0.98; 95% CI 0.96, 0.98). The positive and negative likelihood ratios for commercial tests were 25.4 (95% CI 16.2, 40.0) and 0.40 (95% CI 0.24, 0.67), respectively. All commercial tests had consistently high specificity estimates; the sensitivity estimates, however, were heterogeneous across studies. With the in-house tests, both sensitivity and specificity estimates were significantly heterogeneous. Clinically meaningful summary estimates could not be determined for in-house tests. CONCLUSIONS: Our results suggest that commercial NAA tests may have a potential role in confirming (ruling in) tuberculous pleuritis. However, these tests have low and variable sensitivity and, therefore, may not be useful in excluding (ruling out) the disease. NAA test results, therefore, cannot replace conventional tests; they need to be interpreted in parallel with clinical findings and results of conventional tests. The accuracy of in-house nucleic acid amplification tests is poorly defined because of heterogeneity in study results. The clinical applicability of in-house NAA tests remains unclear

Thermal Decomposition of 2‑Pentanol: A Shock Tube Study and RRKM Calculations

A single pulse shock tube was used to study the thermal decomposition of 2-pentanol in the temperatures between 1110 and 1325 K. Three major decomposition products are methane, ethylene, and propylene. The minor products detected in lower concentration are ethane, acetylene, acetaldehyde, 1-pentene, and 2-pentene. The rate coefficient for the overall decomposition of 2-pentanol was found to be <i>k</i>_total^exp(1110–1325 K) = (4.01 ± 0.51) × 10⁹ exp­(−(36.2 ± 4.7)/<i>RT</i>) s^–1, where the activation energies are given in kcal mol^–1. To simulate reactant and product distribution over the experimentally studied temperatures between 1110 and 1325 K, a reaction scheme was constructed with 34 species and 39 reactions. In addition to this, the temperature and pressure dependent rate coefficients were computed for various unimolecular dissociation pathways using RRKM theory. The high pressure limit rate coefficient for overall decomposition of 2-pentanol was obtained to be <i>k</i>_total^theory(500–2500 K) = (9.67 ± 1.11) × 10¹⁴ exp­(−(67.7 ± 2.9)/<i>RT</i>) s^–1. The calculated high pressure rate coefficients and experimentally measured rate constants are in good agreement with each other. The reaction is primarily governed by the unimolecular elimination of water