Role of interleukin-6 in diagnosis of pleural effusion

AbstractObjectivesTo determine the level of interleukin-6 (IL-6) in both serum and pleural fluid in order to evaluate the diagnostic utility of IL-6 in differentiation between different types of pleural effusion.BackgroundPleural effusion is a relatively common clinical condition. It is often diagnostic dilemma for the physician. Interleukin-6 (IL-6) has multiple functions on various cells and tissues. It is often used as a marker for systemic activation of pro-inflammatory cytokines.MethodsThis study was conducted on 40 patients of pleural effusion, they were selected from Al-Mahalla Chest Hospital in the period between October 2012 and May 2013. All patients were subjected to detailed clinical history, thorough clinical examination, plain chest-X-ray (postero-anterior and lateral views), blood sample for: Complete blood picture (CBC), erythrocyte sedimentation rate (ESR), liver functions, renal functions and serum and pleural fluid (LDH, protein and IL-6) by ELISA.ResultsSerum and effusion IL-6 could differentiate between exudate transudate as it increased in exudate than transudate. In the present study there was higher concentration of IL-6 in the serum and pleural effusion of parapneumonic effusion than malignant and tuberculous exudative pleural effusion and higher concentration in malignant than tuberculous effusion.ConclusionEffusion IL-6 could be used to differentiate between exudate and transudate and serum IL-6 could be used as an alternative non invasive method for differentiation between exudates and transudate as there was a significant positive correlation between serum IL-6 and effusion IL-6

Dissipation and Residues of Imidacloprid and Its Efficacy against Whitefly, Bemisia tabaci, in Tomato Plants under Field Conditions

The whitefly, Bemisia tabaci, is the main pest for many field and horticultural crops, causing main and significant problems. The efficiency of imidacloprid insecticide as seed treatment and foliar spray at three rates against the whitefly, B. tabaci, was evaluated in tomato plants under field conditions; in addition, insecticide residues were determined in tomato leaves and fruits. The obtained results revealed that the seedlings produced from treated seeds with imidacloprid were the most effective treatment in decreasing whitefly stages. Reduction percentages of whitefly stages in seedlings produced from treated seeds and sprayed with ½, ¾ and 1 field rates of imidacloprid were more than that produced from untreated seeds. Tomato fruit yield in seedlings produced from treated seeds and sprayed with one recommended rate of imidacloprid was more than that of untreated seeds. The residues of imidacloprid in leaves and fruits in seedlings produced from treated seeds and sprayed with field rate were more than that of untreated seeds; additionally, the residues were higher in leaves than in fruits. The residual level in fruits was less than the maximum residual level (MRL = 1 mg kg−1) of the Codex Alimentarius Commission. The half-life (t ½) was 6.99 and 6.48 days for leaves and fruits of seedlings produced from treated seeds and 5.59 and 4.59 days for untreated seeds. Residues in tomato fruits were less than the MRL, therefore, imidacloprid is considered an unconventional insecticide appropriate for B. tabaci control that could be safe for the environment

Study of the characteristics and outcomes of patients on mechanical ventilation in the intensive care unit of EL-Mahalla Chest Hospital

Background: Improving the outcome of mechanically ventilated patients remains a mission we all strive to achieve. Aim: To provide baseline information for epidemiological trends, prognostic factors, and outcomes of patients on MV that will help planning of proper MV management programs. Patients and methods: All adult patients received MV at EL-Mahalla Chest Hospital ICU between July 2013 and June 2014 were prospectively recruited. Different demographic, clinical and laboratory variables were recorded at the time of admission, during the ICU stay and at time of discharge. Results: Out of the 412 patients admitted to the ICU, 130 patients received MV, either invasive MV (40%), noninvasive MV (50.7%) and 9.2% of the patients showed noninvasive failure and needed invasive ventilation. The commonest indication of MV was acute on top of chronic respiratory failure (77.7%). Chronic obstructive pulmonary disease was the most prevalent diagnosis (48.5%). Invasive MV was associated with low Glasgow coma scale, high APACHE II score, low admission PH, Po2 and high Pco2 higher morbidity and mortality rates compared to noninvasive MV. For an optimal discrimination of patients with highest risk of ICU mortality, a cutoff point of APACHE II score >30 showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 57.1, 88.1, 48, 91.4 and 0.73 respectively. At a cutoff point of GCC >30, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 71.4, 76.1, 36.6, 93.3 and 0.689 respectively. Conclusion: Survival among mechanically ventilated patients depended on the baseline characteristics at the start of MV, as well as on the development of complications and the management protocols in the ICU

Role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion

Background: The accurate diagnosis of pleural effusion remains a challenging problem even after thoracentesis and closed pleural biopsy. Medical thoracoscopy has been established to have a greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy, pleural brush and lavage could be used through medical thoracoscopy to obtain pleural specimens. Objective: The aim of this study is to evaluate the role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion. Patients and methods: This prospective study was carried out on 25 patients having undiagnosed exudative pleural effusion. All patients submitted to medical thoracoscopy, where forceps biopsy, pleural brush and pleural lavage specimens were taken for all patients and sent for histopathological and cytological examination. Results: Combined thoracoscopic pleural specimens were diagnostic in 24 patients (96%), and all of them were malignant. Forceps biopsy was positive in 23 patients (92%), while pleural brush and pleural lavage were positive in 18 patients (72%) and 15 patients (60%) respectively. Pleural brush was the only diagnostic modality in one patient. Minimal complications were recorded. Conclusion: Combined thoracoscopic pleural specimens (forceps biopsy, brush and lavage) increase the diagnostic yield of medical thoracoscopy for patients with undiagnosed exudative pleural effusion than separate them. Thoracoscopic pleural brushing is a safe diagnostic technique as it can brush certain dangerous areas of the pleura. Pleural lavage is more diagnostic than the initial thoracentesis

GSTM1, GSTT1 and EPHX1 gene polymorphisms and susceptibility to COPD in a sample of Egyptian population

Background: Gene polymorphisms and COPD susceptibility have been paid special attention and were explored in a large number of studies. The results varied between studies and populations. We aimed to analyze the relation between susceptibility to COPD and polymorphisms of Glutathione S-transferases (GST); GSTM1, GSTT1 and Microsomal epoxide hydrolase-1 (EPHX1) genes in a sample of Egyptian population. Methods: Genetic polymorphisms of GSTM1, GSTT1 and EPHX1 genes in 146 COPD patients and 130 controls were investigated using multiplex PCR for GSTM1 and GSTT1 genes and PCR-RFLP for EPHX1 genes. Results: The frequency of GSTM1-null genotype was higher in patients than in controls (72.6% versus 43.8%, P < 0.001). Carriers with both null GSTT1 and GSTM1 genes were at a higher risk of COPD (OR 3.45, 95% CI = 1.07–11.14). The frequency of EPHX1 exon 3 His allele was higher in patients than controls (19.2% versus 12.7%, P = 0.04). Carriers with exon 3 His allele were at a higher risk of COPD (OR 1.63, 95% CI = 1.02–2.6, P = 0.04). Carriers with both GSTM1-null and EPHX1 113Tyr/Tyr or EPHX1 113Tyr/His genotypes were at a higher risk of COPD (OR 3.33, 95% CI = 1.32–8.35 and OR 14.24, 95% CI = 3.02–67.17 respectively). Carriers with both GSTM1-null and EPHX1 139His/His genotypes were at a higher risk of COPD (OR 5.58, 95% CI = 2.14–14.52). Conclusions: EPHX1 exon 3 His allele in addition to the coexistence of other genetic variants, were significant risk factors in susceptibility to COPD in the Egyptian population

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims: The Acute Cardiac Care Association (ACCA)-European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results: Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients' outcomes. Patients will be followed for 1 year after admission. Conclusion: The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population