This study evaluated the use of reagent strips to diagnose infectious pleural effusions in 82 ICU patients with pleural effusions. Reagent strips were used to test pleural fluid for protein and leukocyte levels and pH. The strips accurately classified effusions as transudative or exudative based on protein levels (sensitivity 93.1%, specificity 50%). The leukocyte esterase test on the strips effectively detected infectious exudative effusions (sensitivity 42.8%, specificity 91.3%). Pleural pH was predicted by the strips but did not help differentiate infectious from non-infectious effusions. The strips were as accurate as conventional tests for categorizing effusions and identifying percentages that were infectious or non-inf
This study investigated whether monitoring levels of immature neutrophils (myelocytes, metamyelocytes, and band cells) could help differentiate patients with sepsis from those with non-infectious systemic inflammatory response syndrome (SIRS). Blood samples from 136 critically ill patients and 20 healthy controls were analyzed. Patients were retrospectively classified as having definite sepsis, possible sepsis, or non-infectious SIRS. Higher levels of band cells were seen in patients with definite sepsis compared to other groups, with a sensitivity of 84% and specificity of 71% for detecting sepsis. Patients who died within a week had higher levels of myelocytes and metamyelocytes than those who died later, indicating immature neutrophils may have
The T2 magnetic resonance (T2MR) assay demonstrated high sensitivity and specificity for rapid diagnosis of candidemia directly from whole blood. In a multicenter clinical trial of 1801 patients, T2MR had an overall sensitivity of 91.1% and specificity of 99.4% for detecting five Candida species, with results available in an average of 4.4 hours. Subgroup analysis showed sensitivities ranging from 88.1-94.2% for individual species and specificities of 98.9-99.9%. The assay has the potential to improve outcomes for candidemia by enabling earlier targeted antifungal treatment.
This study aimed to develop a pre-operative risk scoring system to predict post-operative sepsis in HIV-infected surgical patients. The researchers analyzed data from 762 HIV-infected surgical patients in China. They developed a scoring system using five predictive variables: CD4 count, incision scale, surgical grade, opportunistic infections, and organ function. When validated on a separate dataset of 182 patients, the scoring system predicted post-operative sepsis with 95% sensitivity and 93.6% specificity. The researchers concluded the risk scoring system had high predictive accuracy and could help surgeons evaluate sepsis risk before operating on HIV-infected patients.
Prospective, randomized comparison of 2 methods of cold snare polypectomy for...ENDONOTICIAS
This study compared two methods of cold snare polypectomy for removing small colorectal polyps: 1) using a dedicated cold snare designed specifically for cold polypectomy, and 2) using a traditional polypectomy snare for cold polypectomy. The study found that using the dedicated cold snare resulted in a significantly higher rate of complete polyp removal compared to the traditional snare, especially for polyps between 8-10mm. Rates of immediate bleeding were similar between the two groups. Histological examination found similar rates of arteries and injured arteries in the submucosa between groups.
This study evaluated the predictive value of red cell distribution width (RDW) on the development of anastomotic leak or readmission within 30 days following colectomy. The study reviewed 118 patients who underwent colectomy and found that an elevated RDW (greater than or equal to 14.0) had a sensitivity of 89.8% for predicting readmission or leak. A normal RDW below 14.0 had a negative predictive value of 87.7% for predicting an uncomplicated postoperative course without readmission or leak. The RDW test was found to be a readily available and effective criterion for predicting readmissions and leaks following colectomy.
Antibiotic prophylaxis in sever Acute PanceriatitisSaeed Al-Shomimi
This document summarizes a systematic review and meta-analysis of randomized controlled trials examining whether antibiotic prophylaxis is protective in severe acute pancreatitis. The review included 502 patients from studies comparing antibiotic prophylaxis to placebo. The meta-analysis found no significant difference in mortality between the antibiotic and placebo groups, with a relative risk of 0.76. Sensitivity analyses also found no benefit of antibiotics on outcomes like infected necrosis, surgical interventions, or mortality in higher quality studies. The only benefit seen was a reduction in non-pancreatic infections with antibiotics.
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
This study evaluated the diagnostic accuracy of elevated leukocyte count in predicting acute appendicitis. The study analyzed 233 patients who underwent appendectomy. It found that 67.38% of patients with confirmed acute appendicitis had elevated leukocyte counts. Elevated leukocyte count had a sensitivity of 91.81% but a specificity of only 43.55% for diagnosing acute appendicitis. While an elevated count strongly suggested appendicitis, a normal count did not rule it out. The study concluded that leukocyte count is a sensitive marker for acute appendicitis but has low specificity, so clinical assessment is also needed.
This study investigated whether monitoring levels of immature neutrophils (myelocytes, metamyelocytes, and band cells) could help differentiate patients with sepsis from those with non-infectious systemic inflammatory response syndrome (SIRS). Blood samples from 136 critically ill patients and 20 healthy controls were analyzed. Patients were retrospectively classified as having definite sepsis, possible sepsis, or non-infectious SIRS. Higher levels of band cells were seen in patients with definite sepsis compared to other groups, with a sensitivity of 84% and specificity of 71% for detecting sepsis. Patients who died within a week had higher levels of myelocytes and metamyelocytes than those who died later, indicating immature neutrophils may have
The T2 magnetic resonance (T2MR) assay demonstrated high sensitivity and specificity for rapid diagnosis of candidemia directly from whole blood. In a multicenter clinical trial of 1801 patients, T2MR had an overall sensitivity of 91.1% and specificity of 99.4% for detecting five Candida species, with results available in an average of 4.4 hours. Subgroup analysis showed sensitivities ranging from 88.1-94.2% for individual species and specificities of 98.9-99.9%. The assay has the potential to improve outcomes for candidemia by enabling earlier targeted antifungal treatment.
This study aimed to develop a pre-operative risk scoring system to predict post-operative sepsis in HIV-infected surgical patients. The researchers analyzed data from 762 HIV-infected surgical patients in China. They developed a scoring system using five predictive variables: CD4 count, incision scale, surgical grade, opportunistic infections, and organ function. When validated on a separate dataset of 182 patients, the scoring system predicted post-operative sepsis with 95% sensitivity and 93.6% specificity. The researchers concluded the risk scoring system had high predictive accuracy and could help surgeons evaluate sepsis risk before operating on HIV-infected patients.
Prospective, randomized comparison of 2 methods of cold snare polypectomy for...ENDONOTICIAS
This study compared two methods of cold snare polypectomy for removing small colorectal polyps: 1) using a dedicated cold snare designed specifically for cold polypectomy, and 2) using a traditional polypectomy snare for cold polypectomy. The study found that using the dedicated cold snare resulted in a significantly higher rate of complete polyp removal compared to the traditional snare, especially for polyps between 8-10mm. Rates of immediate bleeding were similar between the two groups. Histological examination found similar rates of arteries and injured arteries in the submucosa between groups.
This study evaluated the predictive value of red cell distribution width (RDW) on the development of anastomotic leak or readmission within 30 days following colectomy. The study reviewed 118 patients who underwent colectomy and found that an elevated RDW (greater than or equal to 14.0) had a sensitivity of 89.8% for predicting readmission or leak. A normal RDW below 14.0 had a negative predictive value of 87.7% for predicting an uncomplicated postoperative course without readmission or leak. The RDW test was found to be a readily available and effective criterion for predicting readmissions and leaks following colectomy.
Antibiotic prophylaxis in sever Acute PanceriatitisSaeed Al-Shomimi
This document summarizes a systematic review and meta-analysis of randomized controlled trials examining whether antibiotic prophylaxis is protective in severe acute pancreatitis. The review included 502 patients from studies comparing antibiotic prophylaxis to placebo. The meta-analysis found no significant difference in mortality between the antibiotic and placebo groups, with a relative risk of 0.76. Sensitivity analyses also found no benefit of antibiotics on outcomes like infected necrosis, surgical interventions, or mortality in higher quality studies. The only benefit seen was a reduction in non-pancreatic infections with antibiotics.
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
This study evaluated the diagnostic accuracy of elevated leukocyte count in predicting acute appendicitis. The study analyzed 233 patients who underwent appendectomy. It found that 67.38% of patients with confirmed acute appendicitis had elevated leukocyte counts. Elevated leukocyte count had a sensitivity of 91.81% but a specificity of only 43.55% for diagnosing acute appendicitis. While an elevated count strongly suggested appendicitis, a normal count did not rule it out. The study concluded that leukocyte count is a sensitive marker for acute appendicitis but has low specificity, so clinical assessment is also needed.
Anyone who has had blood drawn is familiar with common diagnostic tests. Recent advances have enabled smaller, cheaper diagnostic technologies that can detect biomarkers in bodily fluids. This has created new market opportunities. However, pre-analytical variability in sample collection and handling can undermine the reliability of diagnostic technologies. Factors like sample degradation, inconsistent preparation methods, and differences in collection environments can introduce variability. Technology developers must standardize and rigorously control pre-analytical workflows to mitigate these sources of noise and ensure diagnostic tests work reproducibly across target populations. Dried blood spot cards are one example that aims to simplify sample collection but still introduces variability that challenges downstream analysis.
Guidance isth _management_of_coagulopathy_in_covid-19 Dr. Freddy Flores Malpa...Freddy Flores Malpartida
1) This document provides interim guidance from the International Society on Thrombosis and Haemostasis (ISTH) on recognizing and managing coagulopathy in COVID-19.
2) It recommends measuring D-dimers, prothrombin time, and platelet count in all COVID-19 patients to help stratify risk, with increased D-dimers indicating a higher risk of severe illness.
3) For hospitalized COVID-19 patients, the guidance suggests regular monitoring of D-dimers, prothrombin time, platelet count, and fibrinogen to identify worsening coagulopathy, which correlates with poorer outcomes. More aggressive care may be warranted for patients with worsening markers.
This study compared central venous catheters (CVCs) and peripherally inserted central venous catheters (PICCs) in 149 patients who required central venous access. The patients were either randomized to receive a CVC or PICC, or were evaluated based on the total number who received each type of catheter. The study found no significant differences between CVCs and PICCs in terms of complications, function, or risk of treatment interruptions. While CVC patients received antibiotics more frequently, both catheter types were used for similar durations and had comparable complication rates. The study concluded that among patients with serious gastrointestinal disorders, CVCs and PICCs did not differ in safety or function for providing central venous access.
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
Medical laboratories play an important role in disease diagnosis, treatment, and prevention. They are divided into two main sections - anatomical pathology and clinical pathology. Clinical pathology contains several units that study microbiology, chemistry, hematology, and other areas. Microbiology units include bacteriology, virology, parasitology, and mycology which identify microbes in specimens. Clinical chemistry analyzes blood components and other substances. Hematology studies blood cells and coagulation.
An observational descriptive study of pattern of pathological changes in live...AI Publications
Background- Autopsy finding in liver with pathological changes are studied. Aim and Objectives- To correlate histopathological findings in the liver with gross examination in routine medicolegal practice of autopsy. To find out the type of liver diseases in relation to age and sex of the studied autopsy cases from the local population. To assess and compare histopathology of liver among accidental deaths, sudden natural deaths and deaths due to poisonings. To compare results of this study with other studies. Suggestion of authenticity of diagnosis from the histopathology findings of liver. Material and Methods- This observational cross section study will be carried out in the department of forensic medicine and toxicology on 100 cases in JLN Medical college and attached hospitals with cooperation from the department of pathology after obtaining due permission from the institutional ethical committee. Conclusion- hepatic lesion can present in various forms at autopsy. Non-neoplastic Lesions should be given equal importance as neoplastic. An enlarged liver does not always indicate malignancy. There are many clinical conditions in which liver are affected as secondary phenomenon. Gross and histo-morphological examination of the tissue can diagnose the liver lesions with great accuracy and is beneficial for patient’s further survival, in setups where facilities to perform liver biopsies are available. Liver should be investigated as a part of routine autopsy procedure in all post-mortem cases.
This study evaluated the outcomes of hepatic resection (HR) versus percutaneous tube drainage (PD) for patients with pyogenic liver abscesses and an APACHE II score ≥15. The study found that patients who underwent HR had significantly lower mortality, failure, and double treatment rates compared to those who only underwent PD. HR patients also had significantly shorter hospital stays, shorter duration of antibiotic use, and fewer procedure-related complications. The study concludes that aggressive HR may produce better clinical outcomes than PD alone for patients with severe liver abscesses as indicated by high APACHE II scores.
This meta-analysis compared the effectiveness of surgical procedures for portal hypertension, including selective or nonselective shunts, devascularization, and combined shunt and devascularization. It found that shunt procedures were more effective at reducing rebleeding compared to devascularization alone, but also carried a higher risk of encephalopathy. Combined shunt and devascularization was more effective at reducing portal vein pressure and rebleeding than devascularization alone. There were no significant differences in outcomes between selective and nonselective shunts. The analysis was based on data from randomized controlled trials involving over 1000 patients with portal hypertension.
This study examined disseminated intravascular coagulation (DIC) scores on day 1 and day 3 in sepsis patients and their association with mortality. The incidence of overt DIC was 27.9% on day 1 and 30.1% on day 3. While day 1 and 3 DIC scores were not associated with mortality, the change in DIC score between days was significantly associated with mortality. Patients with pneumonia had lower DIC on day 1 but higher mortality than other sepsis patients. Day 3 DIC scores predicted mortality more accurately than day 1 scores, especially for non-pneumonia sepsis patients.
This document describes a study that evaluated using a single injection of diluted sodium bicarbonate while monitoring exhaled carbon dioxide levels to confirm correct placement of intravenous catheters before chemotherapy. The study involved injecting either sodium bicarbonate or saline through catheters in 67 oncology patients and monitoring exhaled CO2 levels. A rise in exhaled CO2 levels confirmed correct placement, identifying all 56 catheters deemed positively placed and 10 of 11 deemed questionable. This simple test could help prevent chemotherapy extravasation injuries by verifying catheter placement before treatment.
This document summarizes a randomized controlled trial that compared the effectiveness of talc pleurodesis administered through an indwelling pleural catheter versus placebo among patients with malignant pleural effusions. The trial recruited 154 patients across 18 UK centers who underwent catheter insertion and were randomly assigned to receive either talc or placebo through the catheter. The primary outcome was successful pleurodesis at day 35, defined as less than 50ml of fluid drained on 3 consecutive occasions and less than 25% chest radiograph opacification. At day 35, successful pleurodesis was achieved in 43% of the talc group versus 23% of the placebo group, demonstrating talc administered through a catheter was more effective at inducing pleuro
Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identifi ed signifi cant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion.
Glisodin, a vegetal sod with gliadin, as preventative agent vs atherosclerosi...Esther K
SUMMARY: Prevention of cardiovascular disease should target high-risk subjects based on genetic/familial factors, blood chemistry, blood pressure, body mass index (BMI), and a history of/or current cigarette smoking. We selected active adults (n=76) aged 30-60 and investigated these risk factors, in order to recommend preventive measures.
Another interesting variable is the preclinical status or atheroma of the arterial (carotid) wall or lumen. We also investigated the presence of oxidative stress in, and the anti-oxidant status of these subjects.
We studied the anti-oxidative efficacy of superoxide dismutase (SOD) and variations of malondialdehyde (MDA).
Supplementation with GliSODin®, a vegetal SOD associated with gliadin, was effective in controlling the thickness of the carotid artery intima and media layers as measured by ultrasonography-B.
We could demonstrate the preventive efficacy of GliSODin at a preclinical stage in subjects with risk factors of cardiovascular disease.
Evaluation of Oxidative status of gout patients in a Cameroonian urban hospit...J-réné Nkeck
This study evaluated the oxidative status of patients experiencing acute gout attacks compared to healthy controls in Cameroon. The study found higher levels of malondialdehyde, a marker of oxidative stress, in patients with gout attacks. However, levels of antioxidant enzymes like superoxide dismutase, glutathione peroxidase and catalase were similar between patients and controls. Thus, patients with gout attacks have evidence of elevated oxidative stress based on higher malondialdehyde levels, but their overall antioxidant defenses appear to be similar to healthy individuals.
This article summarizes a study examining predictors of septic arthritis in adults. The study evaluated 458 knee aspirates from patients with suspected septic arthritis. Twenty-two patients (4.8%) were confirmed to have septic arthritis based on positive synovial fluid cultures. Key findings included:
- Erythrocyte sedimentation rate and serum white blood cell counts were not significantly different between septic arthritis and non-septic groups. Many septic arthritis patients had normal serum WBC counts and were afebrile.
- Mean synovial fluid WBC count was higher in the septic arthritis group (70,581 cells/μL) compared to the non-septic group (
The document summarizes the literature on the value of synovial fluid (SF) assays in diagnosing joint disease. It finds:
1) Traditional SF tests like microbiology, cell counts, and crystal identification lack quality control evidence and show worrying variations between laboratories in reliability.
2) Claims for newer assays like cytology and biochemical markers are mainly anecdotal, and interpretation difficulties limit their clinical use.
3) Overall, SF analysis remains valuable for diagnosing acute arthritis or suspected septic/crystal arthropathy, and in intercritical gout, but quality control and rationalization of tests is needed. Further research is also recommended.
Clinical guidelines were developed through a consensus process involving 25 experts to provide evidence-based recommendations for managing nonvariceal upper gastrointestinal bleeding. The guidelines emphasize initial patient resuscitation and clinical risk stratification to determine the need for early endoscopy. For low-risk patients, endoscopy can allow safe early discharge. For high-risk patients, endoscopic hemostasis is recommended. The guidelines also make recommendations regarding H. pylori testing and eradication, as well as the use of proton pump inhibitors after endoscopic therapy. Future research is still needed to evaluate newer endoscopic therapies and optimal medical management.
This study evaluated the performance of the GeneXpert MTB/RIF assay on pulmonary and extrapulmonary samples. For pulmonary samples (n=12,257), the assay showed 87.1% sensitivity and 99.9% specificity. For extrapulmonary samples (n=2,818), sensitivity ranged from 53.7% for total cavitary fluids to 100% for CSF. Sensitivity was over 80% for urine, pus, gastric aspirates and biopsies but only 53.7% for total cavitary fluids. The study found the GeneXpert MTB/RIF assay to be an accurate test for pulmonary and most extrapulmonary TB diagnosis, except for cavitary fluids which
The document discusses a study evaluating the use of The Paris System (TPS) for reporting urinary cytology specimens. The study reevaluated 46 urinary cytology specimens according to TPS criteria and found fair agreement between TPS categorizations and biopsy results. However, the study identified limitations in TPS criteria for evaluating specimen adequacy and diagnostic categories of atypical urothelial cells and low-grade urothelial neoplasia. The study concludes that revising these TPS criteria could help establish its more widespread use and improve communication between pathologists and clinicians.
Two observational studies were included in a meta-analysis examining the association between fluoroquinolone use and risk of aortic dissection or aneurysm. The studies found current fluoroquinolone use was associated with a significantly increased risk of aortic dissection (OR 2.79) and aneurysm (OR 2.25). The number needed to harm for aortic aneurysms in elderly patients was estimated to be 618. The evidence was rated as moderate quality based on the strengths and limitations of the observational studies.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
Anyone who has had blood drawn is familiar with common diagnostic tests. Recent advances have enabled smaller, cheaper diagnostic technologies that can detect biomarkers in bodily fluids. This has created new market opportunities. However, pre-analytical variability in sample collection and handling can undermine the reliability of diagnostic technologies. Factors like sample degradation, inconsistent preparation methods, and differences in collection environments can introduce variability. Technology developers must standardize and rigorously control pre-analytical workflows to mitigate these sources of noise and ensure diagnostic tests work reproducibly across target populations. Dried blood spot cards are one example that aims to simplify sample collection but still introduces variability that challenges downstream analysis.
Guidance isth _management_of_coagulopathy_in_covid-19 Dr. Freddy Flores Malpa...Freddy Flores Malpartida
1) This document provides interim guidance from the International Society on Thrombosis and Haemostasis (ISTH) on recognizing and managing coagulopathy in COVID-19.
2) It recommends measuring D-dimers, prothrombin time, and platelet count in all COVID-19 patients to help stratify risk, with increased D-dimers indicating a higher risk of severe illness.
3) For hospitalized COVID-19 patients, the guidance suggests regular monitoring of D-dimers, prothrombin time, platelet count, and fibrinogen to identify worsening coagulopathy, which correlates with poorer outcomes. More aggressive care may be warranted for patients with worsening markers.
This study compared central venous catheters (CVCs) and peripherally inserted central venous catheters (PICCs) in 149 patients who required central venous access. The patients were either randomized to receive a CVC or PICC, or were evaluated based on the total number who received each type of catheter. The study found no significant differences between CVCs and PICCs in terms of complications, function, or risk of treatment interruptions. While CVC patients received antibiotics more frequently, both catheter types were used for similar durations and had comparable complication rates. The study concluded that among patients with serious gastrointestinal disorders, CVCs and PICCs did not differ in safety or function for providing central venous access.
This study analyzed data from 2,668 patients in Denmark who underwent surgery for perforated peptic ulcer between 2003-2009 to evaluate the association between hourly surgical delay and 30-day survival. The results showed that for every hour of delay between admission and surgery, there was an average 2.4% decreased probability of survival. Overall, 26.5% of patients died within 30 days of surgery. Limiting surgical delay seems critically important for patients with perforated peptic ulcers.
Medical laboratories play an important role in disease diagnosis, treatment, and prevention. They are divided into two main sections - anatomical pathology and clinical pathology. Clinical pathology contains several units that study microbiology, chemistry, hematology, and other areas. Microbiology units include bacteriology, virology, parasitology, and mycology which identify microbes in specimens. Clinical chemistry analyzes blood components and other substances. Hematology studies blood cells and coagulation.
An observational descriptive study of pattern of pathological changes in live...AI Publications
Background- Autopsy finding in liver with pathological changes are studied. Aim and Objectives- To correlate histopathological findings in the liver with gross examination in routine medicolegal practice of autopsy. To find out the type of liver diseases in relation to age and sex of the studied autopsy cases from the local population. To assess and compare histopathology of liver among accidental deaths, sudden natural deaths and deaths due to poisonings. To compare results of this study with other studies. Suggestion of authenticity of diagnosis from the histopathology findings of liver. Material and Methods- This observational cross section study will be carried out in the department of forensic medicine and toxicology on 100 cases in JLN Medical college and attached hospitals with cooperation from the department of pathology after obtaining due permission from the institutional ethical committee. Conclusion- hepatic lesion can present in various forms at autopsy. Non-neoplastic Lesions should be given equal importance as neoplastic. An enlarged liver does not always indicate malignancy. There are many clinical conditions in which liver are affected as secondary phenomenon. Gross and histo-morphological examination of the tissue can diagnose the liver lesions with great accuracy and is beneficial for patient’s further survival, in setups where facilities to perform liver biopsies are available. Liver should be investigated as a part of routine autopsy procedure in all post-mortem cases.
This study evaluated the outcomes of hepatic resection (HR) versus percutaneous tube drainage (PD) for patients with pyogenic liver abscesses and an APACHE II score ≥15. The study found that patients who underwent HR had significantly lower mortality, failure, and double treatment rates compared to those who only underwent PD. HR patients also had significantly shorter hospital stays, shorter duration of antibiotic use, and fewer procedure-related complications. The study concludes that aggressive HR may produce better clinical outcomes than PD alone for patients with severe liver abscesses as indicated by high APACHE II scores.
This meta-analysis compared the effectiveness of surgical procedures for portal hypertension, including selective or nonselective shunts, devascularization, and combined shunt and devascularization. It found that shunt procedures were more effective at reducing rebleeding compared to devascularization alone, but also carried a higher risk of encephalopathy. Combined shunt and devascularization was more effective at reducing portal vein pressure and rebleeding than devascularization alone. There were no significant differences in outcomes between selective and nonselective shunts. The analysis was based on data from randomized controlled trials involving over 1000 patients with portal hypertension.
This study examined disseminated intravascular coagulation (DIC) scores on day 1 and day 3 in sepsis patients and their association with mortality. The incidence of overt DIC was 27.9% on day 1 and 30.1% on day 3. While day 1 and 3 DIC scores were not associated with mortality, the change in DIC score between days was significantly associated with mortality. Patients with pneumonia had lower DIC on day 1 but higher mortality than other sepsis patients. Day 3 DIC scores predicted mortality more accurately than day 1 scores, especially for non-pneumonia sepsis patients.
This document describes a study that evaluated using a single injection of diluted sodium bicarbonate while monitoring exhaled carbon dioxide levels to confirm correct placement of intravenous catheters before chemotherapy. The study involved injecting either sodium bicarbonate or saline through catheters in 67 oncology patients and monitoring exhaled CO2 levels. A rise in exhaled CO2 levels confirmed correct placement, identifying all 56 catheters deemed positively placed and 10 of 11 deemed questionable. This simple test could help prevent chemotherapy extravasation injuries by verifying catheter placement before treatment.
This document summarizes a randomized controlled trial that compared the effectiveness of talc pleurodesis administered through an indwelling pleural catheter versus placebo among patients with malignant pleural effusions. The trial recruited 154 patients across 18 UK centers who underwent catheter insertion and were randomly assigned to receive either talc or placebo through the catheter. The primary outcome was successful pleurodesis at day 35, defined as less than 50ml of fluid drained on 3 consecutive occasions and less than 25% chest radiograph opacification. At day 35, successful pleurodesis was achieved in 43% of the talc group versus 23% of the placebo group, demonstrating talc administered through a catheter was more effective at inducing pleuro
Purpose: To assess the effectiveness of a fast track referral system from Vascular Laboratory to Interventional Radiology on
threatened vein bypass grafts in the lower limbs.
Methods: A Fast Track System (FTS) was set up in February 2011 to minimise the delay from duplex scan to intervention for bypass grafts with identifi ed signifi cant stenoses. 111 scans were performed pre - FTS over one year and compared with 190 scans which were performed post-FTS introduction over two years.
Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion.
Glisodin, a vegetal sod with gliadin, as preventative agent vs atherosclerosi...Esther K
SUMMARY: Prevention of cardiovascular disease should target high-risk subjects based on genetic/familial factors, blood chemistry, blood pressure, body mass index (BMI), and a history of/or current cigarette smoking. We selected active adults (n=76) aged 30-60 and investigated these risk factors, in order to recommend preventive measures.
Another interesting variable is the preclinical status or atheroma of the arterial (carotid) wall or lumen. We also investigated the presence of oxidative stress in, and the anti-oxidant status of these subjects.
We studied the anti-oxidative efficacy of superoxide dismutase (SOD) and variations of malondialdehyde (MDA).
Supplementation with GliSODin®, a vegetal SOD associated with gliadin, was effective in controlling the thickness of the carotid artery intima and media layers as measured by ultrasonography-B.
We could demonstrate the preventive efficacy of GliSODin at a preclinical stage in subjects with risk factors of cardiovascular disease.
Evaluation of Oxidative status of gout patients in a Cameroonian urban hospit...J-réné Nkeck
This study evaluated the oxidative status of patients experiencing acute gout attacks compared to healthy controls in Cameroon. The study found higher levels of malondialdehyde, a marker of oxidative stress, in patients with gout attacks. However, levels of antioxidant enzymes like superoxide dismutase, glutathione peroxidase and catalase were similar between patients and controls. Thus, patients with gout attacks have evidence of elevated oxidative stress based on higher malondialdehyde levels, but their overall antioxidant defenses appear to be similar to healthy individuals.
This article summarizes a study examining predictors of septic arthritis in adults. The study evaluated 458 knee aspirates from patients with suspected septic arthritis. Twenty-two patients (4.8%) were confirmed to have septic arthritis based on positive synovial fluid cultures. Key findings included:
- Erythrocyte sedimentation rate and serum white blood cell counts were not significantly different between septic arthritis and non-septic groups. Many septic arthritis patients had normal serum WBC counts and were afebrile.
- Mean synovial fluid WBC count was higher in the septic arthritis group (70,581 cells/μL) compared to the non-septic group (
The document summarizes the literature on the value of synovial fluid (SF) assays in diagnosing joint disease. It finds:
1) Traditional SF tests like microbiology, cell counts, and crystal identification lack quality control evidence and show worrying variations between laboratories in reliability.
2) Claims for newer assays like cytology and biochemical markers are mainly anecdotal, and interpretation difficulties limit their clinical use.
3) Overall, SF analysis remains valuable for diagnosing acute arthritis or suspected septic/crystal arthropathy, and in intercritical gout, but quality control and rationalization of tests is needed. Further research is also recommended.
Clinical guidelines were developed through a consensus process involving 25 experts to provide evidence-based recommendations for managing nonvariceal upper gastrointestinal bleeding. The guidelines emphasize initial patient resuscitation and clinical risk stratification to determine the need for early endoscopy. For low-risk patients, endoscopy can allow safe early discharge. For high-risk patients, endoscopic hemostasis is recommended. The guidelines also make recommendations regarding H. pylori testing and eradication, as well as the use of proton pump inhibitors after endoscopic therapy. Future research is still needed to evaluate newer endoscopic therapies and optimal medical management.
This study evaluated the performance of the GeneXpert MTB/RIF assay on pulmonary and extrapulmonary samples. For pulmonary samples (n=12,257), the assay showed 87.1% sensitivity and 99.9% specificity. For extrapulmonary samples (n=2,818), sensitivity ranged from 53.7% for total cavitary fluids to 100% for CSF. Sensitivity was over 80% for urine, pus, gastric aspirates and biopsies but only 53.7% for total cavitary fluids. The study found the GeneXpert MTB/RIF assay to be an accurate test for pulmonary and most extrapulmonary TB diagnosis, except for cavitary fluids which
The document discusses a study evaluating the use of The Paris System (TPS) for reporting urinary cytology specimens. The study reevaluated 46 urinary cytology specimens according to TPS criteria and found fair agreement between TPS categorizations and biopsy results. However, the study identified limitations in TPS criteria for evaluating specimen adequacy and diagnostic categories of atypical urothelial cells and low-grade urothelial neoplasia. The study concludes that revising these TPS criteria could help establish its more widespread use and improve communication between pathologists and clinicians.
Two observational studies were included in a meta-analysis examining the association between fluoroquinolone use and risk of aortic dissection or aneurysm. The studies found current fluoroquinolone use was associated with a significantly increased risk of aortic dissection (OR 2.79) and aneurysm (OR 2.25). The number needed to harm for aortic aneurysms in elderly patients was estimated to be 618. The evidence was rated as moderate quality based on the strengths and limitations of the observational studies.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research paper publishing, where to publish research paper, journal publishing, how to publish research paper, Call for research paper, international journal, publishing a paper, call for paper 2012, journal of pharmacy, how to get a research paper published, publishing a paper, publishing of journal, research and review articles, Pharmacy journal, International Journal of Pharmacy, hard copy of journal, hard copy of certificates, online Submission, where to publish research paper, journal publishing, international journal, publishing a paper
The document describes the development and validation of a new prognostic model called the Lille model to identify patients with severe alcoholic hepatitis who are unlikely to survive when treated with corticosteroids. The model was developed based on data from 320 patients and validated in 118 additional patients. It combines six reproducible variables measured at baseline and at day 7 of treatment - age, renal insufficiency, albumin, prothrombin time, bilirubin, and the change in bilirubin at day 7. The Lille model had an area under the receiver operating characteristic curve of 0.89 for predicting 6-month mortality, outperforming other existing models. It identified a cutoff of 0.45 that distinguished patients with low
Evaluation of immunosuppressive ahai.pdfleroleroero1
This study evaluated the outcomes of 42 dogs treated for immune-mediated hemolytic anemia (IMHA) using different immunosuppressive regimens. The dogs were treated with prednisolone alone or in combination with cyclosporine or azathioprine. Treatment regimen had a significant effect on survival during hospitalization, but the small number of subjects prevented determining the cause. Higher serum bilirubin and urea concentrations were associated with poorer prognosis. This was the first report to find a significant difference in outcomes between immunosuppressive drugs commonly used to treat IMHA in dogs.
This study aimed to develop an unbiased RNA profiling approach for the early detection of colorectal cancer (CRC) and advanced adenomas (AA) using blood samples. The researchers combined a literature review with microarray analysis of circulating RNA purified from plasma to identify RNA biomarker panels. They tested the panels on two cohorts, detecting CRC with 75% sensitivity and 93% specificity using an 8-gene panel, and detecting AA with 60% sensitivity and 87% specificity using a 2-gene panel. The study demonstrates the feasibility of unbiased molecular diagnosis of CRC and AA from blood and introduces circulating RNA profiling as a potential non-invasive screening approach.
The kSORT assay to detect renal transplant patients at risk for acute rejecti...Kevin Jaglinski
Development of noninvasive molecular assays to improve disease diagnosis and patient monitoring is a critical need. In renal transplantation, acute rejection (AR) increases the risk for chronic graft injury and failure. Noninvasive diagnostic assays to improve current late and nonspecific diagnosis of rejection are needed. We sought to develop a test using a simple blood gene expression assay to detect patients at high risk for AR.
This study aims to discover potential white blood cell surface biomarkers that could predict which patients presenting to the emergency department with suspected sepsis will develop severe sepsis. The study will prospectively collect data from three patient populations - 300 patients with suspected sepsis in the emergency department, 100 critically ill patients with established sepsis in the ICU, and 100 non-septic control patients in the emergency department. White blood cell surface markers will be analyzed using flow cytometry. Candidate biomarkers will be selected by comparing markers between cohorts, and their predictive value for clinical outcomes will be explored within the suspected sepsis emergency department cohort. The goal is to identify biomarkers that could help predict deterioration early to guide triage, treatment and monitoring.
The kSORT Assay to Detect Renal Transplant Patients at High RiskKevin Jaglinski
This document describes a study that developed a blood gene expression assay called kSORT to detect renal transplant patients at high risk for acute rejection. Researchers analyzed gene expression data from over 500 blood samples across eight transplant centers. They selected a set of 17 genes that could detect acute rejection with high accuracy based on a training set of samples. This gene set was then validated on two independent sets of samples and could predict acute rejection up to 3 months before standard detection methods. A reference-based algorithm using the 17 genes was developed to provide a numerical risk score classifying patients as high or low risk for acute rejection. Overall, the kSORT assay provides a noninvasive tool for detecting acute rejection risk in renal transplant patients.
This study evaluated the ability of 7 international sites to characterize a panel of 50 diverse HIV-1 isolates representing different subtypes, circulating recombinant forms, and unique recombinant forms. Sites used various PCR and sequencing methods to determine subtypes and detect drug resistance mutations in partial or full pol gene sequences. When compared to reference sequences, most sites correctly determined subtypes for 83-97.9% of group M viruses using partial pol sequences. All major drug resistance mutations were also detected. However, next generation sequencing at one site missed some viruses and contained host DNA fragments. Standardizing PCR protocols could improve characterization of diverse HIV strains globally.
Hospital outbreak of middle east respiratory syndromeDee Evardone
This study describes a hospital outbreak of 23 cases of MERS-CoV (Middle East Respiratory Syndrome Coronavirus) infection in Saudi Arabia between April and May 2013. The outbreak originated from multiple community introductions and spread within the hospital, primarily affecting patients undergoing dialysis and those in the intensive care unit (ICU). The median incubation period was estimated to be 5.2 days, and the median serial interval was 7.6 days. Phylogenetic analysis showed the viruses formed a monophyletic clade, indicating a common source. Most cases involved older males with underlying conditions like diabetes, renal disease, cardiac or lung disease.
Study of some Pulmonary Function Tests in Children with Sickle Cell Anemia: C...iosrphr_editor
This study examined pulmonary function tests in 40 children with sickle cell anemia and correlated the results with iron overload levels. The study found significantly lower lung function test results in patients compared to controls, including lower forced vital capacity, forced expiratory volume, and peak expiratory flow rate. There was also a significant negative correlation between serum ferritin levels and two lung function measurements, indicating greater iron overload is associated with poorer lung function. The majority (75%) of patients showed a restrictive lung pattern on spirometry testing, while 25% showed a mixed obstructive and restrictive pattern. This suggests sickle cell anemia commonly causes abnormal and reduced lung function, predominantly through a restrictive lung mechanism.
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
This systematic review analyzed 22 studies involving over 825,000 people in Mexico to determine the prevalence of hepatitis C virus (HCV) infection. The studies tested asymptomatic low-risk populations, mainly blood donors, for anti-HCV antibodies between 1993-2005. The weighted mean prevalence of anti-HCV was 0.37%, and most studies reported a prevalence below 1%. Blood transfusion was the main risk factor reported. Genotype 1 was the most prevalent among those with confirmed HCV infection, with subtype 1b being the most common. The review concludes that HCV prevalence in Mexico may be lower than previous estimates of 1%, and calls for a nationwide study to better determine the epidemiology of HCV in the country.
This document summarizes the process used to develop a new definition and clinical criteria for identifying septic shock in adults. A task force conducted a systematic review of existing studies, a Delphi consensus process, and analysis of large clinical databases. Based on these analyses, the task force agreed on a new definition of septic shock and identified hypotension requiring vasopressors and an elevated serum lactate level as criteria for identifying adult patients with septic shock. These criteria were validated in separate clinical databases and shown to identify a patient group with significantly higher mortality compared to other commonly reported definitions of septic shock.
This document summarizes results from a study of 148 patients initiating quadruple antiretroviral therapy during primary HIV-1 infection. By week 48 of treatment, 36% of patients had stopped treatment or were lost to follow-up. Among the 115 patients still in follow-up, viral loads decreased by a median of 5.4 log copies/mL and CD4 counts increased by a median of 147 cells/mm3. 84.2% of patients had viral loads ≤50 copies/mL and lower baseline CD8+/CD38++ T cell counts and cell-associated DNA levels predicted achieving viral loads ≤3 copies/mL. 83 patients experienced serious adverse events. The study demonstrates significant antiviral activity and immune reconstit
Antiretroviral bioanalysis methods of tissues and body biofluidsRutva Patel
This document summarizes a review of 205 publications measuring concentrations of antiretrovirals (ARVs) in non-traditional specimen types like tissues and biofluids. The review found methods for measuring 31 different ARVs in tissues like brain, liver and hair, and biofluids like cerebrospinal fluid, breast milk and seminal fluid. Many methods analyzed more than one specimen type or ARV. While HPLC was most common, MS detection increased over time. Some methods provided full validation data but few provided stability data, which is important for interpreting results given biological and storage differences across specimens. The review aims to identify details on specimen handling and analysis to help standardize methods and facilitate future HIV research on treatment,
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Integrating Ayurveda into Parkinson’s Management: A Holistic Approach
Diagnosis of infection pleural effussion by reagen strips
1. 914
Rapid Diagnosis of Infectious Pleural Effusions by Use of Reagent Strips
Elie Azoulay,1
Muriel Fartoukh,3
Richard Galliot,4
Fre´de´ric Baud,4
Ge´rald Simonneau,3
Jean-Roger
Le Gall,1
Benoıˆt Schlemmer,1
and Sylvie Chevret2
1
Medical Intensive Care Unit and 2
Biostatistics Department, Saint
Louis Teaching Hospital, Paris 7 University, 3
Medical and Respiratory
Intensive Care Unit, Antoine Beclere Teaching Hospital, and 4
Medical
Intensive Care Unit, Lariboisiere Teaching Hospital, Paris, France
Reagent strips have not yet been tested for use in the diagnosis of infectious pleural effusions.
A reagent strip was used to evaluate 82 patients with pleural effusions: 20 patients had tran-
sudative effusions, 35 had infectious exudative effusions (empyema in 14 and parapneumonic
effusion in 21), and 27 had noninfectious exudative effusions. Pleural fluid protein, as eval-
uated by the reagent strip, proved accurate for the detection of exudative effusions (sensitivity,
93.1%; specificity, 50%; positive predictive value, 84.3%; negative predictive value, 71.5%; odds
ratio [OR], 6.77; and 95% confidence interval [CI], 1.87–24). The reagent strip leukocyte es-
terase test effectively detected infectious exudative effusions (sensitivity, 42.8%; specificity,
91.3%; positive predictive value, 88.2%; negative predictive value, 51.2%; OR, 4.46; and 95%
CI, 1.2–16.4). Pleural pH was significantly predicted by the reagent strip but was of no as-
sistance in categorization of exudative effusions as infectious or noninfectious. Compared
with physical, laboratory, and microbiological data, the reagent strip was as accurate for
estimation of percentages of infectious and noninfectious exudative effusions. Thus, reagent
strips may be a rapid, easy-to-use, and inexpensive technique for discriminating transudative
from exudative pleural effusions and for categorizing exudative pleural effusions as infectious
or noninfectious.
A pleural effusion must be characterized as transudative or
exudative and, if exudative, as infectious or noninfectious.
These distinctions are important for choosing the appropriate
management, such as therapy for heart failure, drainage of an
infectious exudative effusion, or microbiological documenta-
tion and adequate antibiotics for empyema. Exploratory thora-
centesis is classically indicated because, in combination with
blood tests, examination of pleural fluid frequently provides the
etiologic diagnosis [1].
Use of reagent strips has been proposed for the rapid di-
agnosis of meningitis, ascites, and urinary tract infections [2–5]
and has also been validated for determination of the pH of
pleural effusions [6, 7]. However, reagent strips have not been
tested for their accuracy in the determination of the levels of
protein and leukocyte esterase in pleural fluid, 2 parameters
that are of paramount importance for distinguishing transu-
dates from exudates and for determining whether an exudate
is due to an infection [8].
We conducted a prospective 3-center study to evaluate the
performance of reagent strips in the diagnosis of pleural infec-
Received 25 October 1999; revised 16 February 2000; electronically pub-
lished 20 October 2000.
The appropriate institutional review board approved the study, and all
patients gave their informed consent.
Reprints or correspondence: Dr. Elie Azoulay, Medical ICU, Saint Louis
Teaching Hospital, 1, avenue Claude Vellefaux, 75010 Paris, France (elie
.azoulay@sls.ap-hop-paris.fr).
Clinical Infectious Diseases 2000;31:914–9
᭧ 2000 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2000/3104-0010$03.00
tion in medical intensive care unit (ICU) patients with pleural
effusions. We evaluated the value of the strips for separating
transudative from exudative effusions and then for categorizing
exudative infections as infectious or noninfectious.
Patients and Methods
Patients. From 1 December 1997 to 1 December 1998, 3 teach-
ing-hospital medical ICUs prospectively included all patients who
had a pleural effusion at or after admission to the ICU and who
were deemed by the ICU physicians to require exploratory
thoracentesis.
Pleural effusion was diagnosed clinically on the basis of absent
breath sounds at auscultation, flatness to percussion, and reduced
tactile fremitus. A chest radiograph was obtained to confirm the
diagnosis. The decision to perform exploratory thoracentesis was
based on the criteria normally used at each of the study centers.
Pleural fluid was obtained by insertion of an 8-mm needle and was
sent to the appropriate laboratories for biochemical tests (for pH
and levels of lactate dehydrogenase, protein, and glucose), micro-
biological studies (identification of pathogens in smears and cul-
tures), and cytological studies (leukocyte and lymphocyte counts).
The pleural fluid was then tested, by use of a reagent strip designed
for the testing of urine (Multistix 8SG; Bayer, Leverkusen, Ger-
many), by an investigator who was unaware of the results of the
test described above.
Data collection. The following information was collected for
each patient. Epidemiological and clinical data included sex, age,
comorbidities (chronic heart failure, chronic obstructivepulmonary
disease, immunodepression, cirrhosis, and neutropenia), the reason
for admission to the medical ICU (acute respiratory or renal failure,
shock, or coma), the severity score at admission (simplified acute
Downloaded from https://academic.oup.com/cid/article-abstract/31/4/914/376234
by guest
on 18 March 2018
2. CID 2000;31 (October) Rapid Diagnosis of Pleural Infection 915
Table 1. Pathogens isolated from patients with microbiologically
documented pneumonia and from patients with empyema.
Documented infection
No. of
patients
Pneumonia
Branhamella catarrhalis 2
Enterobacter cloacae 1
Haemophilus influenzae 4
Proteus mirabilis 2
Pseudomonas aeruginosa 7
Staphylococcus aureus 3
Streptococcus pneumoniae 3
Streptococcus species 3
Total 25
Empyema
Escherichia coli 2
Klebsiella pneumoniae 2
Mycobacterium tuberculosis 2
Peptostreptococcus species 2
Staphylococcus aureus 3
Streptococcus species 3
Total 14
physiological score II [SAPSII] [9]), and presence or absence of
clinically or microbiologically documented infection at the time of
thoracentesis. Characteristics of the pleural effusion included bio-
chemical and cytological test findings (fluid/serum [F/S] ratios for
protein and lactate dehydrogenase, glucose level, leukocyte count,
and percentage of neutrophils); findings from Gram-stained smears
and cultures for bacteria, mycobacteria, and fungi; and results from
the reagent strip (protein and leukocyte esterase measurements and
pH). The cause of the effusion was determined on the basis of
clinical findings and results of laboratory tests of the pleural fluid
and serum. Reagent strip results were read by use of a colorimeter
(Clinitek 50; Bayer [10]) and were expressed on a 6-grade scale
(grades 0–5), for the protein and leukocyte esterase levels, and as
the value for the pH (range, 6–8.50, with intervals of 0.50). All 3
reagent strip results were assigned and collected by an investigator
who was unaware of the results of the other tests.
Criteria for the etiologic diagnosis of pleural effusion. Three
categories of pleural effusion were defined [8]. Transudative effu-
sion was defined as an F/S protein ratio !0.5; infectious exudative
effusion was defined as an F/S protein ratio у0.5 and either a
positive bacteriologic culture (empyema) or clinical or microbio-
logical evidence of pneumonia (parapneumonic effusion); and non-
infectious exudative effusion was defined as an F/S protein ratio
10.5 with negative bacteriologic cultures and no evidence of pneu-
monia.
Statistical analysis. The categories of patients defined above
were considered. Transudative effusions were compared with ex-
udative effusions, and infectious exudative effusions were com-
pared with noninfectious exudative effusions. These comparisons
were made by use of the x2
test or Fisher exact test, for categorical
variables, and by use of the Wilcoxon test or the Kruskal-Wallis
test, for continuous variables. Regression splines were used to ob-
tain a nonparametric estimate of the cutoff of continuous covar-
iates influencing the risk of each effusion category. A multivariate
logistic regression model was then constructed to determine the
OR of each reagent strip result for predicting whether any effusion
was exudative and whether an exudative effusion was infectious.
The percentage of each diagnosis established on the basis of con-
ventional tests was used as the reference and is hereafter referred
to as the “observed” percentage, as opposed to the “predicted”
percentage, which was established on the basis of reagent strip
findings. Continuous variables were dichotomized according to the
spline regression results. Values for Hosmer-Lemeshow goodness
of fit were computed, as were calibration curves (observed vs. pre-
dicted rates of each event). The SAS software package (SAS, Cary,
NC) was used for all statistical evaluations.
Results
Patient characteristics. From 1 December 1997 to 1 De-
cember 1998, 82 patients admitted to the 3 medical ICUs par-
ticipating in the study underwent thoracentesis for evaluation
of a pleural effusion.
The patients were 42 men and 40 women with a median age
of 59.5 years (25th–75th percentile, 42.5–69.5 years) and a me-
dian SAPSII score of 46 (25th–75th percentile, 27.7–46.5).
Seven patients (8.5%) were HIV infected, 18 (22%) had im-
munodepression resulting from other causes, and 8 (10%) were
receiving steroid therapy (daily administration of 11 mg of
prednisone or equivalent per kg for the past 30 days). Fourteen
patients (17%) had diabetes, 29 (35%) were alcoholics, 19 (23%)
had chronic obstructive pulmonary disease, and 13 (16%) had
documented chronic heart failure. The reasons for admission
to the ICU (patients could have more than 1 reason) and the
number and percentage of patients with each reason were as
follows: acute respiratory failure (67 patients [82%]), decom-
pensation of chronic respiratory failure (10 [12%]), shock (32
[39%]), cardiogenic pulmonary edema (19 [23%]), acute renal
failure (14 [17%]), coma (11 [13.5%]), and pulmonary embolism
(7 [8.5%]). Forty-five patients (55%) required mechanical ven-
tilation (of these, 33 [40%] had a positive end-expiratory pres-
sure of 15 cm H2O), 35 (42.5%) required vasopressor agents,
and 6 (7.5%) required dialysis.
On average, admission to the ICU occurred 1 day after ad-
mission to the hospital (25th–75th percentile, 0–7 days), and
exploratory thoracentesis was done within 2 days (25th–75th
percentile, 0–7 days) after admission to the ICU. The median
duration of stay in the ICU was 11 days (25th–75th percentile,
6–19 days), and the mortality rate in the ICU was 35% (29
deaths).
On the day of thoracentesis, 47 patients (57%) were taking
antibiotics and 28 (34%) were taking diuretics. Clinical evidence
of infection was present in 55 patients (67%), including 45 with
pneumonia, 3 with digestive infection, 2 with bacteremia, 2 with
skin and soft tissue infections, 1 with meningitis, 1 with urinary
tract infection, and 1 with catheter-related infection. Microbi-
ological documentation of an infection was obtained for 32 of
these patients (39%), including 25 of those with pneumonia
(table 1). Before thoracentesis, 5 pleural effusions were con-
firmed by chest sonogram and 3 were confirmed by CT scans;
for all other effusions, thoracentesis was done on the basis of
Downloaded from https://academic.oup.com/cid/article-abstract/31/4/914/376234
by guest
on 18 March 2018
3. 916 Azoulay et al. CID 2000;31 (October)
Table 2. Results of conventional laboratory tests and of reagent strip testing of pleural fluid.
Test results
Type of pleural effusion
a
P
b
Transudative
( )n p 20
Infectious exudative
( )n p 35
Noninfectious exudative
( )n p 27
Conventional testing, median (25th–75th percentile)
pH 7.76 (7.54–8.15) 7.50 (7.39–7.94) 7.81 (7.54–8.00) .03
Fluid/serum protein ratio 0.29 (0.25–0.38) 0.58 (0.47–0.74) 0.57 (0.42–0.64) !.0001
Fluid/serum LDH ratio 0.46 (0.33–1.01) 2.41 (1.06–6.6) 0.73 (0.45–1.59) !.0001
Leukocyte count 131 (42–267) 1020 (100–2050) 250 (92–467) .005
Percentage of neutrophils 25 (11–40) 80 (63–85) 9 (1.7–20) !.0001
Reagent strip testing
c
, no. (%)
Protein grade 13 10 (50) 33 (94.3) 21 (77.7) .0006
Leukocytes grade 12 0 (0) 15 (42.8) 2 (7.4) .003
NOTE. LDH, lactate dehydrogenase.
a
According to the criteria of Light et al. [8].
b
By use of the Kruskal-Wallis test, for conventional findings, and by use of the x2
test, for reagent strip findings with the null
hypothesis that distribution of each variable was identical in the 3 groups.
c
Results not available for 4 patients with hemothorax.
clinical examination. The only adverse event related to thora-
centesis was pneumothorax, which occurred in 6 patients (7%).
Characteristics of the pleural effusion. Among the 82 ef-
fusions, 20 (24.4%) were transudates, 35 (42.7%) were infectious
exudative effusions associated with pneumonia (21 effusions)
or empyema (14 effusions) (table 1), and 27 (32.9%) were non-
infectious exudative effusions (of which 10 were malignancies,
4 were pulmonary embolisms, 4 were postoperative effusions
following upper abdominal surgery, 4 were hemothoraxes, 3
were effusions of unknown origin, and 2 were pancreatitis).
Gram-staining was positive for 6 (42.8%) of the 14 empyemas.
Table 2 reports the main findings from conventional pleural
fluid tests in the 3 patient categories as well as the results of
reagent strip testing (which was not performed for the 4 patients
with hemothorax). With the reagent strip, grade 3 was the pro-
tein level cutoff that distinguished transudative from exudative
effusions, and grade 2 was the leukocyte esterase cutoff that
distinguished infectious exudative from noninfectiousexudative
effusions (figure 1). Figure 2 displays the weak correlations
between pleural fluid pH, protein level, and leukocyte count,
either by use of the reagent strip or by use of a conventional
laboratory technique. Pleural fluid glucose levels were signifi-
cantly decreased only in the 14 patients with empyema (median,
1.7 mM/L [25th–75th percentile, 1.2–4.4 mM/L] vs. 7.9 mM/L
[25th–75th percentile, 5.5–10.1 mM/L] in patients with para-
pneumonic effusions [ ]; median, 6.4 mM/L [25th–75thP p .02
percentile, 5.1–9.2 mM/L] in patients with other effusions
[ ]). Moreover, all patients with a positive Gram stainP p .009
had a leukocyte esterase test result of grade у2. Otherwise, as
shown in table 2, pH was significantly lower in infectious ex-
udative effusions than in transudative or noninfectious exu-
dative effusions. Moreover, in patients with empyema, pH was
significantly lower than in other patients, both according to
laboratory findings (median pH, 7.46 [25th–75th percentile,
7.27–7.50] vs. 7.77 [25th–75th percentile, 7.50–8.00]; )P p .004
and according to results of reagent strips. There were 3 patients
with a pH of 7.00 and 8 patients with a pH of 7.50 among the
14 patients with empyema ( ).P p .03
Multivariate analysis. As shown in table 3, among the re-
agent strip findings, only the protein grade discriminated sig-
nificantly between exudates and transudates (sensitivity, 93.1%;
specificity, 50%; positive predictive value, 84.3%; negative pre-
dictive value, 71.5%; OR, 6.77; and 95% CI, 1.87–24). Similarly,
among the 58 patients with exudates, only a positive reagent
strip test for leukocyte esterase was significantly predictive of
infection (sensitivity, 42.8%; specificity, 91.3%; positive predic-
tive value, 88.2%; negative predictive value, 51.2%; OR, 4.46;
and 95% CI, 1.2–16.4).
Figure 3 compares the percentages of exudative effusions and
infectious effusions determined by use of conventional tests
(observed percentage) and by use of reagent strip testing (pre-
dicted percentage). Regardless of the type of effusion consid-
ered, it appears that rates of exudative or infectious effusion
observed by use of conventional laboratory tests are close to
those predicted by the results of reagent strip testing (P p
and , respectively, according to the MacNemar test)..32 P p .27
Discussion
Our 3-center prospective study compared the results of pleu-
ral fluid testing done by means of conventional methods with
those obtained by use of reagent strip testing among 82 ICU
patients with transudative, infectious exudative, or noninfec-
tious exudative pleural effusions. This classification of pleural
effusions is a valuable aid in the selection of the most appro-
priate management (e.g., treatment for heart failure or change
in antibiotic therapy and pleural drainage). Results of reagent
strip testing were not available for the 4 patients with hemo-
thorax. Data from the remaining 78 patients showed that pleu-
ral fluid protein level, as evaluated by use of the reagent strip,
was effective in discriminating between exudative and transu-
dative effusions (OR, 6.77). Moreover, in the 62 patients with
exudates, the reagent strip leukocyte esterase result, which was
available for 58 patients, accurately identified the cases of in-
fection (OR, 4.46). Among the patients with exudative effu-
sions, the percentages of infectious and noninfectious effusions
Downloaded from https://academic.oup.com/cid/article-abstract/31/4/914/376234
by guest
on 18 March 2018
4. CID 2000;31 (October) Rapid Diagnosis of Pleural Infection 917
Figure 1. Nonparametric spline estimate (thick line; [thin lines de-
note 95% CI]) of regression function f that models influence on prob-
ability of detection of exudative effusions (top) or of discrimination of
infectious from noninfectious effusions (bottom) by use of grades for
protein or leukocyte esterase measurements obtained by reagent strip
testing.
Figure 2. Comparison of pleural fluid findings from conventional
laboratory tests (fluid/serum protein ratio, neutrophil percentage, and
pH) and from reagent strip testing (protein and leukocyte esterase level
and pH). Horizontal lines in each box plot represent (bottom to top)
10th, 25th, 50th (median), 75th, and 90th percentiles. Such plots allow
for comparison of distribution of each variable (y axes) among groups
defined by results of reagent strip testing (x axes). Distributions of
conventional laboratory tests were compared with categorical results
of reagent strip testing, by use of nonparametric Wilcoxon (A and
B) or Kruskal-Wallis (C) tests. *P ! .05.
predicted on the basis of the results of reagent strip testing were
very close to those determined on the basis of conventional
laboratory tests.
To our knowledge, reagent strips have not yet been tested
for their ability to identify a pleural effusion as an exudate or
as a manifestation of infection. Reagent strips have, however,
been validated for the determination of pleural fluid pH [6, 7].
In our study, pleural pH was not an independent predictor for
infection, but it was significantly lower for infectious effusions
than for noninfectious effusions, particularly in the case of em-
pyema. As suggested by other studies, low pH values, detected
by use of either reagent strip tests or laboratory tests, could be
used as an aid when chest tube drainage is discussed [11, 12].
Urine test strips accurately estimated the pleural protein
grade: 54 (84.3%) of the 64 patients with a reagent strip pleural
protein grade 13 had an exudate, and 54 (93.1%) of the 58
patients with exudates had a reagent strip pleural protein grade
13. Nevertheless, 10 of the patients with transudates also had
a protein grade 13. Of these 10 patients, 1 had congestive heart
failure with a bilateral pleural effusion and an F/S ratio for
protein of 0.75 because of pleural amyloidosis. In 4 patients
with hemostasis abnormalities, the pleural fluid was blood-
stained and consequently produced a reagent strip proteingrade
13.
Reagent strip testing for leukocyte esterase has been found
useful in the diagnosis of infections of many body fluids but
has not yet been tested for pleural effusions [2–4]. Of the 17
patients in our study who had a reagent strip leukocyte esterase
grade у2, 15 (88.2%) had an infectious exudative effusion. Fif-
teen (42.8%) of the 35 patients with an infectious exudative
effusion had a reagent strip leukocyte esterase grade у2, ac-
counting for the same sensitivity rate as the Gram stain. The
Downloaded from https://academic.oup.com/cid/article-abstract/31/4/914/376234
by guest
on 18 March 2018
5. 918 Azoulay et al. CID 2000;31 (October)
Figure 3. Percentages of cases of exudative effusion (top) and infectious effusion (bottom) determined by results of reagent strip tests (predicted
percentage [denoted by the unshaded bars) and results of conventional laboratory tests (observed percentage [denoted by the shaded bars). L,
reagent strip leukocyte esterase grade (cutoff, grade 2); P, reagent strip protein grade (cutoff, grade 3).
grade was у2 for only 2 patients (8.7%) with noninfectious
exudative effusions and for none of the patients with transu-
dative effusions. Nevertheless, 20 patients with infectious ex-
udative effusions had a leukocyte esterase grade !2, a finding
perhaps ascribable in part to the fact that 2 patients had pleural
tuberculosis with a predominance of lymphocytes in their ef-
fusion and that most of the remaining patients were already
taking antibiotic therapy at the time of the thoracentesis.
The percentages of exudative effusions (infectious or non-
infectious) and of infectious exudative effusions predicted on
the basis of protein and leukocyte esterase findings from reagent
strip tests were very close to those determined on the basis of
conventional tests. This finding suggests that, in patients with
exudates, reagent strip leukocyte esterase testing may be val-
uable for providing rapid diagnostic orientation and for iden-
tifying pleural fluid specimens that require particular attention
from laboratory technicians because of an increased likelihood
of disease. Moreover, all patients with a positive result of Gram
staining of pleural fluid had results of grade у2 with the leu-
kocyte esterase test, and the sensitivities of these 2 tests are
equal [13]. Therefore, results of reagent strips could help ICU
physicians to maintain a high index of suspicion regarding in-
fectious pleural effusion and to alert the laboratories to shorten
the turnaround time for conventional laboratory tests to allow
for an adequate antibiotic treatment on the basis of the Gram
stain. Furthermore, reagent strips may provide sound infor-
mation on which to base immediate treatment decisions (e.g.,
whether to use antibiotics) in places where technical and/or
economic constraints reduce the availability of laboratory test-
ing, or before the results of conventional tests are available.
The epidemiology of pleural effusions in patients in medical
ICUs remains poorly known. Of the 82 patients included in
our 3-center prospective study, only 20 (24.4%) had transu-
dative effusions. In contrast, in a study that did not use a need
for thoracentesis as an inclusion criterion, Mattison et al. [14]
found that fluid overload was by far the most common cause
of pleural effusion. In our patients, infection was the leading
cause, and the bacteriologic profile was that usually observed
in community- or hospital-acquired infections in patients in
ICUs. Moreover, although many pleural fluid components have
been suggested as useful for the differentiation of exudates from
transudates, the tools widely used to determine the cause of a
pleural effusion remain the protein level, the F/S protein ratio,
and the leukocyte count [15, 16]. Our results suggest that re-
agent strips accurately predict the results of these conventional
tests and may deserve to be recommended as an ancillary tool
in the diagnostic assessment of potentially infectious pleural
effusions.
Valuable insights into the significance of pleural effusions in
patients in medical ICUs (i.e., as a symptom or syndrome) could
be obtained by performing exploratory thoracentesis, a pro-
cedure that has been proved safe [17], followed by examination
Downloaded from https://academic.oup.com/cid/article-abstract/31/4/914/376234
by guest
on 18 March 2018
6. CID 2000;31 (October) Rapid Diagnosis of Pleural Infection 919
Table 3. Multivariate analysis of exudative effusions and infection
by use of 2 models.
Model and reagent strip result
No. of
patients OR (95% CI) P
Prediction of presence of exudate in 78 pa-
tients with available reagent strip results
Protein grade 13 64 6.77 (1.87–24) .003
Leukocyte grade 12 17 6.48 (0.69–60) .10
Glucose grade !2 39 0.72 (0.17–2.9) .64
pH !7.50 10 0.98 (0.3–3.2) .98
Prediction of presence of pleural infection in
58 patients with exudative effusions
Protein grade 13 54 0.38 (0.06–2.4) .32
Leukocyte grade 12 17 4.46 (1.2–16.4) .02
Glucose grade !2 30 0.93 (0.21–4) .92
pH !7.50 9 0.79 (0.25–2.4) .67
NOTE. , by the Hosmer-Lemeshow test.2
P 1 .05 x
of the fluid at the bedside by use of reagent strips. Further
studies in a large number of patients are needed to determine
the value of this rapid, easy-to-use, and inexpensive tool for
identification of pleural fluids that do not require more expen-
sive tests, notably the impact of its use on patient outcome.
References
1. Light RW. Diagnostic principles in pleural disease. Eur Respir J 1997;10:
476–81.
2. Moosa AA, Quortum HA, Ibrahim MD. Rapid diagnosis of bacterial men-
ingitis with reagent strips. Lancet 1995;345:1290–1.
3. DeLozier JS, Auerbach PS. The leukocyte esterase test for detection of cere-
brospinal fluid leukocytosis and bacterial meningitis. Ann Emerg Med
1989;18:1191–8.
4. Smalley DL, Doyle VR, Duckworth JK. Correlation of leukocyte esterase
detection and the presence of leukocytes in body fluids. Am J Med Technol
1982;48:135–7.
5. Levy M, Tournot F, Muller C, Carbon C, Yeni P. Evaluation of screening
tests for urinary infection in hospital patients. Lancet 1989;2:384–5.
6. Cheng DS, Rodriguez RM, Rogers J, Wagster M, Starnes DL, Light RW.
Comparison of pleural fluid pH values obtained using blood gas machine,
pH meter, and pH indicator strip. Chest 1998;114:1368–72.
7. Byrd RP Jr, Roy TM. Pleural fluid pH determination. Chest1998;113:1426–7.
8. Light RW, MacGregor I, Luchsinger PC, et al. Pleural effusion: the diagnostic
separation of transudates and exudates. Ann Intern Med 1972;77:507–13.
9. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score
(SAPS II) based on a European–North American multicenter study.
JAMA 1993;270:2957–63.
10. Pugia MJ, Lott JA, Luke KE, Shihabi ZK, Wians FH Jr, Phillips L. Com-
parison of instrument-read dipsticks for albumin and creatinine in urine
with visual results and quantitative methods. J Clin Lab Anal 1998;12:
280–4.
11. Heffner JE, Brown LK, Barbieri C, DeLeo JM. Pleural fluid chemical analysis
in parapneumonic effusions: a meta-analysis. Am J Respir Crit Care Med
1995;151:1700–8.
12. Light RW. Parapneumonic effusions and empyema. Clin Chest Med 1985;6:
55–62.
13. Ferrer A, Osset J, Alegre J, et al. Prospective clinical and microbiological
study of pleural effusions. Eur J Clin Microbiol Infect Dis 1999;18:237–41.
14. Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA. Pleural
effusions in the medical ICU: prevalence, causes, and clinical implications.
Chest 1997;111:1018–23.
15. Kinasewitz GT. Transudative effusions. Eur Respir J 1997;10:714–8.
16. Heffner JE, Brown LK, Barbieri CA. Diagnostic value of tests that discrim-
inate between exudative and transudative effusions. Chest 1997;111:
970–80.
17. Colt HG, Brewer N, Barbur E. Evaluation of patient-related and procedure-
related factors contributing to pneumothorax following thoracentesis.
Chest 1999;116:134–8.
Downloaded from https://academic.oup.com/cid/article-abstract/31/4/914/376234
by guest
on 18 March 2018