Diagnostic Value of Adenosine Deaminase Level for the Differential Diagnosis of Tuberculosis and Malignancy in Exudative Lymphocytic Pleurisy

WOS: 000382877000004Objective: To evaluate the diagnostic performance of adenosine deaminase (ADA) levels in patients with exudative lymphocytic pleurisy for the differential diagnosis of tuberculous pleurisy (TBP) and malignant pleural effusion (MPE). Methods: Data on patients with exudative lymphocytic pleurisy were retrospectively analyzed. The study population comprised 54 patients. Thirty-seven were diagnosed with TBP and 17 were diagnosed with MPE. Results: Significant differences were determined in terms of age and ADA, total protein, albumin, and LDH levels between the TBP and MPE groups. The optimal cut-off value of ADA levels was 35.1 U/L for diagnosing TBP. Sensitivity and specificity were 92% and 100%, respectively. Logistic regression analysis was performed to assess independent variables associated with TBP. Independent predictive factors in the model were ADA (OR: 1.21, 95% CI: 1.06-1.39, p=0.006)], and (OR: 0.92, 95% CI: 0.84-1.00, p=0.052)]. The AUC value by the regression equation was 0.979 (p= 50), two different cut-off values (> 13.51 and > 35.1) for each age range were found in all, but one, TBP patients. Conclusion: ADA levels are useful for the diagnosis of TBP in cases where pleural biopsy cannot be performed or that are inconclusive in making a diagnosis of TBP. In this group, reducing the conventional cut-off value and/or performing an age-based approach seems to improve the diagnostic performance of ADA levels

Increase in Size of Lymph Nodes or Occurrence of New Lymphadenopathy During Antituberculosis Chemotherapy: Paradoxical Response

WOS: 000339539100021PubMed: 23621740The aim of this letter was to present four more cases of tuberculosis (TB) in whom paradoxical response developed. These presented cases had not been mentioned in the manuscript namely "Paradoxical radiologic progression despite appropriate antituberculous therapy" published in Mikrobiyol Bul 2012; 46(2): 299-303. Paradoxical response was identified in these patients by exclusion of clinical deterioration during antituberculosis therapy such as secondary infections, inadequate anti-tuberculosis therapy as a result of drug resistance, poor compliance, and adverse reactions due to therapy. The first case had received treatment due to right paratracheal tuberculous lymphadenitis and lung TB, and who exhibited a progression in lymphadenopathy (LAP) in the 5th month of treatment. Upon the completion of treatment to one year, the lesions regressed however, right inguinal LAP developed after 20 months of initiation of therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis and the adenopathy regressed without treatment. The second case was a patient with right paratracheal tuberculous lymphadenitis, whose lesions regressed at 3rd months of treatment. However, progression was detected in the lesions at 6th month of treatment and the treatment was prolonged to one year. The third case is the one to whom anti-TB treatment was initiated upon the diagnosis of right cervical tuberculous lymphadenitis. A new LAP developed at the left cervical site and the biopsy taken from the lesion revealed nothing diagnostic. The treatment was prolonged to one year and then ceased in this patient. The fourth case is the one to whom anti-TB treatment was initiated upon the diagnosis of lung TB and who developed right paratracheal LAP at the 4th month of treatment. The anti-TB treatment was prolonged to six months in this patient. These cases were presented to draw attention to paradoxical response which is originally known to occur primarily in HIV positive patients. However, it should be kept in mind that in TB endemic areas such as our country, paradoxical response can develop in HIV negative or non-immunocompromised TB patients

Conventional markers in determination of activity of sarcoidosis

Aim and background: Currently, there are no objective criteria to determine sarcoidosis activity. The present study aimed to discover a sensitive serum marker that would determine the activity of sarcoidosis and can be used during disease follow-up

Evaluating the Behaviours of Citizens and Physicians During Healthcare System Changes in Turkey

This study may provide insights into the positive and negative perceptions of physicians and citizens in Turkey regarding the Transformation in Health Project.We aimed to evaluate the views of physicians and citizens regarding the changing healthcare system using different questionnaires.We interviewed 1190 actively working physicians and 1997 citizens using face-to-face questionnaires to determine how the changing healthcare system has affected the behaviours of physicians and citizens. When asked whether the behaviours of patients and relatives had improved, 495 physicians (41.6%) answered yes and 580 (48.7%) answered no. When citizens were asked whether the behaviours of physicians had improved, 1399 (70.1%) answered yes and 362 (18.1%) answered no. According to the results of this study, there have been some changes in our healthcare system associated with the Transformation in Health Project. [Med-Science 2016; 5(2.000): 505-18

Disseminated hydatid disease treated with albendazole: 15-year experience

Medical therapy is recommended in various situations such as multiple cysts, high risk surgery , presence of small cyst and perioperative phase in the treatment of hydatid cyst. Present study was designed to determine the features of disseminated hydatid cyst cases, outcome of albendazole treatment , diagnosis and management of complications and patients outcome. Methods: 21 patients who had the diagnosis of hydatid cyst based on clinical, radiological, and pathological findings with multiple hydatid cyst in a single organ and/or more than one organ were retrospectively analyzed. The mean age was 34±17.9 (range, 7-71) and F/M was 17/4. Hydatid disease was detected as multiple cysts in the lung in four patients, as multiple cysts in the lung and pleura in one case, and as multiple organ involvement in 16 cases. The most common presentation was the involvement of both lung and liver. The most common symptom was cough. Four asymptomatic patients were detected during family screening. In six patients, Albendazole was started before the operation and the remainders were started after the operation. Cure was achieved in eight patients at the end of medical and/or surgical treatment. Convenient medical treatment with albendazole treatment in appropriately selected patients is an effective treatment option with minimal side effects in hydatid cyst disease. [Med-Science 2018; 7(4.000): 935-9

Diagnostic Value of Strain Echocardiography, Galectin-3, and Tenascin-C Levels for the Identification of Patients with Pulmonary and Cardiac Sarcoidosis

Cardiac involvement in sarcoidosis has been associated with poor prognosis. We evaluated myocardial contractility quantitatively in a cohort of pulmonary sarcoidosis (PS) patients with and without cardiac involvement. We also studied markers of fibrosis (tenascin-C [Tn-C] and galectin-3 [Gl-3]) as diagnostic tools for PS and cardiac sarcoidosis (CS)

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV mortality prediction score (IMPRES)

KUCUK, Ahmet Oguzhan/0000-0002-6993-0519; Kirakli, Cenk/0000-0001-6013-7330; KUCUK, Mehtap PEHLIVANLAR/0000-0003-2247-4074; Aksoy, Iskender/0000-0002-4426-3342WOS: 000504051300010PubMed: 31655511Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: 8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total 1M PRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data