ABSTRACT
Background: Tuberculosis [TB] is a major cause of pleural effusion, which in TB usually has lymphocytic and exudative characteristics. The final diagnosis of TB pleurisy was based on combining clinical judgment with radiological findings, and microbiologic tests, In cases of suspected pleural tuberculosis, a rapid and accurate laboratory diagnosis through ADA activity and PCR detection is of prime importance, since traditional techniques of detecting acid- fast bacilli have limitations
Aim of the work: To examine the diagnostic efficiency of Ziehl-Neelsen [Z.N] staining, tuberculin test, ADA activity, and PCR in patients with pleural effusions and related the results to clinical signs and symptoms in a population with a high prevalence of TB
Patients: The study included 92 patients with pleural effusion of different etiologies taken from Chest Department, Minia University Hospital and Minia Chest Hospital between July and 2007 and March 2008. The diagnosis of pleural [p] TB was confirmed in any patient presenting with positive findings of Mycobacterium tuberculosis, either on the sputum or pleural fluid and also, in the absence of negative laboratory results, those patients with clinical improvement after empirical treatment
Methods: A single specimen of pleural fluid [50 to 100 ml] was submitted for appearance, and protein content, Ziehl-Neelsen staining, pleural ADA activity determination and PCR. Also 10 ml blood for estimation of hemoglobin, ESR and serum ADA activity. The sputum was examined for acid fast bacilli by Z.N. staining
Results: Out of 92 cases studied there were 40 cases [43%] of highly suspicious of tuberculous pleural effusion .Examination of pleural effusion by Z and N stain in all cases was negative. On the other hand, +ve PCR was found only in 16 cases [40%] of TB pleural effusion and 3 cases of empyema. All 40 cases of tubercular pleural effusion showed greatly significant elevated ADA levels in pleural fluid, with a mean value of 57.4+/-7.7 U/L in comparison with other nonTB pleural effusion ADA levels including 25 cases of Para pneumonic effusions with a mean value of 27.5 +/- 9 U/L., 7 cases of empyema with a mean value of 24.8 +/- 3 U/L, and, of 18.5 +/- 6.5 U/L was the mean value of pleural fluid ADA among cases of liver cell failure. A significant +ve. correlation was observed between sputum examination by ZN and tuberculin test, and PCR in TB pleural effusion group [p <0.05]
Conclusion: Tuberculin test ,adenosine deaminase [ADA] activity and the detection of mycobacterial DNA by polymerase chain reaction [PCR] in clinical samples are very useful diagnostic approaches to achieve a more rapid and precise diagnosis in cases of pleural TB
ABSTRACT
In addition to causing serious liver disease [cirrhosis and liver cancer], HCV infection can also contribute to the development of some diseases outside the liver among these, diabetes mellitus. [DM]. the frequency of type 2 diabetes mellitus tends to be higher in patients infected with hepatitis C virus [HCV] than those without HCV infection [Mehta et al., 2000]. The study was carried on 70 individual, 60 were HCV positive patients and 10 apparently healthy persons. We found that 31.6% of the patients were diabetic, 45% of the patients have impaired glucose tolerance, and 23.4% patients with normal blood glucose. There was a highly significant increase in both C-peptide and blood insulin levels in diabetic patients when compared to patients with impaired glucose tolerance and patients with normal blood glucose, p-value 0.0001