9 research outputs found
Performance of lactate in discriminating bacterial meningitis from enteroviral meningitis
The cytological and biochemical examination of cerebrospinal fluid (CSF) has been used for the presumed diagnosis of bacterial meningitis until the final microbiological results are achieved. We assessed the ability of CSF lactate in comparison with other CSF parameters to discriminate bacterial and enteroviral community acquired meningitis. We included 1,187 CSF samples of acute community-acquired meningitis, being 662 cases of bacterial and 525 of enteroviral meningitis. Lactate concentration (mg/dL), leukocyte count/mm3 , protein (mg/dL), and glucose (mg/dL) were compared between bacterial and viral meningitis. Receiver operator characteristic (ROC) curves were used to assess diagnostic performance. CSF leukocytes, CSF protein and CSF lactate were significantly higher in bacterial meningitis cases (P<0.0001). CSF glucose was significantly lower in bacterial meningitis cases (P<0.0001). CSF lactate showed the best predictive ability with an area under the curve of 0.944 (95% CI 0.929 – 0.959). Considering a cut off of CSF lactate of 30 mg/dL, the sensitivity and specificity for bacterial meningitis were 84.1% and 99%, respectively. In the cytological and biochemical CSF analysis, CSF lactate was the most accurate marker for bacterial meningitis
A esclerose múltipla em uma abordagem metabolômica untargeted por espectrometria de massas
Multiple sclerosis (MS) is a chronic autoimmune chronic inflammatory neurological disease of the central nervous system (CNS) that attacks the myelin sheath causing its destruction to varying degrees. The cause of MS is unknown and the most accepted theory involves combining genetic susceptibility with a non-genetic trigger in addition to a conducive immune system and contributing factors in the CNS. There is still no biological marker capable of detecting MS or predicting the prognosis of the disease or its clinical evolution. There are several possible biomarkers, but they still remain clinically relevant and none have the sensitivity and reliability to diagnose MS and monitor the course of the disease. The objective of clinical research in the area of demyelinating diseases and mainly MS is to find biomarkers that make it possible to evidence subclinical disease, disease activity or allow evaluation of treatment. This study analyzed by mass spectrometry cerebrospinal fluid (CSF) metabolic aspects in patients with suspected and confirmed diagnosis of Multiple Sclerosis with the objective and to discover a biomarker able to differentiate non-diseased persons from people diagnosed with multiple sclerosis in addition to being able to differentiate different classifications of multiple sclerosis. The untarget analysis performed demonstrated that there are viable means of differentiating patients with multiple sclerosis from normal individuals in addition to differentiating patients from different MS types. Through the analysis by PCA, PLS-DA, VIP and Heat map, it was possible to evidence a possible candidate for biomarker. This biomarker candidate is already cited in the literature. However, there are still few studies that show the mechanism and the relationship of decreased phosphatidylcholine levels in CSF samples. It is believed that the levels of this potential biomarker is directly related to the increased age of affected patients.A esclerose múltipla (EM) é uma doença neurológica inflamatória crônica autoimune do sistema nervoso central (SNC) que agride a bainha de mielina causando sua destruição em graus variados. A causa da EM é desconhecida e a teoria mais aceita envolve a combinação da suscetibilidade genética com um gatilho não genético associado a um sistema imune propÃcio e fatores contribuintes no SNC. Ainda não existe marcador biológico capaz de detectar a EM ou prever o prognóstico da doença nem sua evolução clÃnica. Existem vários possÃveis biomarcadores, mas ainda permanecem sem relevância clÃnica e nenhum possui sensibilidade e confiabilidade para diagnosticar EM e monitorar o curso da doença. O objetivo da pesquisa clÃnica na área de doenças desmielinizantes e principalmente EM é encontrar biomarcadores que possibilitem evidenciar doença subclÃnica, a atividade da doença ou permitam avaliação do tratamento. Este estudo analisou por cromatografia lÃquida acoplada à espectrometria de massas (LC-MS) aspectos metabolômicos de lÃquido cefalorraquidiano (LÃquor - LCR) em pacientes com suspeita e diagnóstico confirmado de EM com o objetivo de descobrir um biomarcador capaz de diferenciar pessoas não doentes de pessoas com o diagnóstico de esclerose múltipla e caracterizar as diferentes classificações de EM. Neste trabalho, a análise LC-MS com abordagem untarget demonstrou que existem meios viáveis de diferenciar pacientes com EM de indivÃduos normais e diferenciar pacientes de diferentes tipos de EM. Através de análises estatÃsticas como PCA, PLS-DA, da VIP e do Heat map consegui-se evidenciar um possÃvel candidato a biomarcador, a fosfatidilcolina. Entretanto, ainda há poucos estudos que mostram o mecanismo e a relação da diminuição dos nÃveis de fosfatidilcolina em amostras de lÃquor. Acredita-se que os nÃveis deste potencial biomarcador está diretamente relacionado com o aumento da idade de pacientes afetados.Dados abertos - Sucupira - Teses e dissertações (2019
Lumbar puncture in patients using anticoagulants and antiplatelet agents
ABSTRACT The use of anticoagulants and antiplatelet agents has largely increased. Diagnostic lumbar puncture in patients taking these drugs represents a challenge considering the opposing risks of bleeding and thrombotic complications. To date there are no controlled trials, specific guidelines, nor clear recommendations in this area. In the present review we make some recommendations about lumbar puncture in patients using these drugs. Our recommendations take into consideration the pharmacology of these drugs, the thrombotic risk according to the underlying disease, and the urgency in cerebrospinal fluid analysis. Evaluating such information and a rigorous monitoring of neurological symptoms after lumbar puncture are crucial to minimize the risk of hemorrhage associated neurological deficits. An individualized patient decision-making and an effective communication between the assistant physician and the responsible for conducting the lumbar puncture are essential to minimize potential risks
Performance of lactate in discriminating bacterial meningitis from enteroviral meningitis
ABSTRACT The cytological and biochemical examination of cerebrospinal fluid (CSF) has been used for the presumed diagnosis of bacterial meningitis until the final microbiological results are achieved. We assessed the ability of CSF lactate in comparison with other CSF parameters to discriminate bacterial and enteroviral community acquired meningitis. We included 1,187 CSF samples of acute community-acquired meningitis, being 662 cases of bacterial and 525 of enteroviral meningitis. Lactate concentration (mg/dL), leukocyte count/mm3, protein (mg/dL), and glucose (mg/dL) were compared between bacterial and viral meningitis. Receiver operator characteristic (ROC) curves were used to assess diagnostic performance. CSF leukocytes, CSF protein and CSF lactate were significantly higher in bacterial meningitis cases (P<0.0001). CSF glucose was significantly lower in bacterial meningitis cases (P<0.0001). CSF lactate showed the best predictive ability with an area under the curve of 0.944 (95% CI 0.929 – 0.959). Considering a cut off of CSF lactate of 30 mg/dL, the sensitivity and specificity for bacterial meningitis were 84.1% and 99%, respectively. In the cytological and biochemical CSF analysis, CSF lactate was the most accurate marker for bacterial meningitis
Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients
ABSTRACT Objectives Inflammatory molecules and neurotrophic factors are implicated in pain modulation; however, their role in primary headaches is not yet clear. The aim of this study was to compare the levels of serum biomarkers in migraine and tension-type headache. Methods This was a cross-sectional study. We measured serum levels of adiponectin, chemokines, and neurotrophic factors in patients with migraine and tension-type headache. Depression and anxiety symptoms, headache impact and frequency, and allodynia were recorded. Results We included sixty-eight patients with migraine and forty-eight with tension-type headache. Cutaneous allodynia (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), and ADP (p = 0.017) were significantly higher in migraine than in tension-type headache. The differences occurred independently of anxiety and depressive symptoms, frequency and impact of headache, and the presence of pain. Conclusions This study showed higher CCL3/MIP-1α, CCL5/RANTES, and ADP levels in migraine in comparison with tension-type headache. Our findings suggest distinctive roles of these molecules in the pathophysiology of these primary headaches