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Collection of more than normal quantity fluid in a serous cavity is called effusion. Itis classified as per location i.e. pericardial, pleural and peritoneal. Fluid collection inabdominal cavity is called ascites. Effusions are of two types - (1) Transudate (2)Exudate. Transudate develops as a result of physiological disturbances of circulationusually a rise in venous pressure or decrease in oncotic pressure, while exudateforms as a result of increased capillary permeability which is usually due toinflammation. Transudates usually have low specific gravity due to low proteincontent whereas exudates have high specific gravity due to high protein content.Transudates are usually associated with cardiac-, hepatic- or renal-disease. Whileexudates are caused by inflammatory conditions like tuberculosis and malignanciesof pelvic and abdominal organs. Recently fibronectin and cholesterol levels ofperitoneal fluid have been found to differentiate between ascites of differentaetiologies. The estimation of fibronectin levels in fluid is sensitive but complicated.So, in this study we have taken the value of cholesterol for the aetiologic diagnosisof ascites as a simple procedure.METHODSThe present descriptive study of 100 cases of ascites was conducted over a period of12 months i.e. January. 2019 to January 2020. Various fluids were collected fromOPD and IPD of Medical and Surgery units.RESULTSIn the present study, 84% of the cases were transudates while exudates accountedfor 16% of cases. Cirrhosis (65%) was the commonest cause among transudates.Other causes included congestive cardiac failure (09%), nephrotic syndrome (06%),& anaemias (04%). Exudative ascites was caused by tuberculosis in 10% cases &malignancy in 06% cases. Cholesterol level of >70 mg/dL was found in 82% ofmalignant ascites. So, it was concluded that ascitic fluid cholesterol levels weresignificantly greater in malignant cases in comparison to ascites caused by non -malignant aetiologies. Inference - Cholesterol concentration in ascitic fluid helps todifferentiate ascites in malignancy, from non - malignant ascites.CONCLUSIONSCholesterol estimation in ascitic fluid is a better parameter to differentiatemalignant ascites from non - malignant ascites.
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Background: The traditional method of classification of ascites by AFTP offers little insight into the pathophysiology of ascites formation and it has many drawbacks. In order to overcome it, the classification of ascites based on SAAG has emerged. Even SAAG has some draw backs like non correlation with ascites due to non-alcoholic cirrhosis and difficulty in identifying the ascites due to mixed etiology. This study is conducted to compare the diagnostic accuracies of SAAG and AFTP in identifying the pathophysiology of ascites.Methods: A total of fifty patients who were admitted with ascites were included in the study. Ascitic fluid total protein and SAAG were calculated. They were classified on the basis of SAAG into High SAAG and Low SAAG and on the basis of AFTP into Transudate and Exudate. After the etiology of ascites evaluated by various diagnostic procedures, the sensitivity, specificity and diagnostic accuracy of SAAG and AFTP in identifying the pathophysiology of ascites calculated sepereately. The diagnostic accuracies of SAAG and AFTP were compared statistically.Results: The sensitivity of SAAG was found to be 86.84% and that of AFTP 60%. The specificity of SAAG was found to be 83.33% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG was found to be 86% and that of AFTP was found to be 60%. The diagnostic accuracy of SAAG and AFTP for individual etiologies of ascites were found and compared. SAAG was found to be superior to AFTP with a P value of <0.01 which was statistically significant.Conclusions: The sensitivity and specificity of SAAG was superior to AFTP in identifying the etiology of ascites.
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Es importante saber diferenciar los derrames pleurales como resultado de un exudado o de un trasudado para poder diagnosticar las diferentes causas de esta enfermedad. Se describieron las características y la formación del líquido pleural, las causas según el tipo de derrame, así como los procedimientos necesarios para tomar muestras útiles para un mejor análisis en el laboratorio clínico. Se planteó una estrategia actualizada para diferenciar los líquidos trasudados y exudados mediante métodos bioquímicos propuestos por Light y el progresivo enriquecimiento de esta estrategia por otros investigadores. Se plantea la utilidad del recuento de las células. Se analizaron algunas limitaciones que existen para diferenciar los tipos de derrames y la de algunos marcadores bioquímicos para diferenciar un exudado de un trasudado, así como los procedimientos que pueden aplicarse en el laboratorio clínico. Encontramos que el criterio de Light es el más eficiente para diferenciar los exudados de los trasudados en los derrames pleurales de causa desconocida.
It is important to know how to differentiate pleural effusions resulting from whether an exudate or transudate in order to diagnose the different causes of this disease. We describe the characteristics and formation of pleural fluid, the causes for each type of effusion, as well as the necessary procedures to take useful samples that allow better analysis in the clinical laboratory. An updated strategy was designed to differentiate transudate and exudate fluids through the biochemical methods proposed by Light and by other researchers who have developed and enriched their methods. We also mentioned the usefulness of cell count. We analyzed some limitations to differentiate the types of effusions and those some biochemical markers present to distinguish an exudate from a transudate, as well as the procedures that can be applied in the clinical laboratory. We concluded that Light's criterion is the most efficient to differentiate exudates from transudates in pleural effusions of unknown cause.
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Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.
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A correta classificação do líquido pleural em transudato ou exsudato é importante para início do diagnóstico da síndrome do derrame pleural. Um exame ou um conjunto deles precisa ter bom rendimento para cumprir este objetivo. Os autores neste trabalho propuseram novo critério de classificação entre exsudatos e transudatos pleurais com dosagens de proteínas totais (PtnT) e desidrogenase lática (DLH) exclusivamente no líquido pleural. Para as dosagens de PtnT-L, o novo ponto de corte determinado para diagnosticar exsudato pleural foi superior a 3,4g/dL e transudato menor ou igual a 3,4g/dL com uma AUC na curva ROC igual a 0,886 (p=0,0001). Em relação à DLH-L, o novo ponto de corte determinado para diagnosticar exsudato pleural foi superior a 328,0U/L e transudato menor ou igual a 328,0U/L com uma AUC igual a 0, 922 (p = 0,0001). O novo critério de classificação proposto obteve significância estatística e clínica para ser utilizado na prática diária considerando seu rendimento diagnóstico quando validado com o critério clássico de Light. AU
The correct classification of pleural fluid between transudate or exudate is important for early diagnosis of pleural effusion. An exam or a set of them need to have good income to meet this objective. The authors in this paper proposed new classification criteria between exudates and transudate pleural with total protein (Ptn-T) dosages and lactate dehydrogenase (LDH) exclusively on pleural fluid. For PtnT-L, a cutoff point for pleural exudate was higher than 3.4 g/ dL and transudate less or equal to 3.4 g/dL with an AUC on ROC curve equal to 0.886 (p = 0.0001). Regarding to LDH-L, a cutoff point for pleural exudate was higher to 328.0 U/L and less than or equal to 328.0 U/L for pleural transudate with an AUC of 0. 922 (p = 0.0001). The proposed new classification criteria had statistical significance and clinical validation for use in daily practice considering its performance when validated with the classic criteria of Light. AU
Subject(s)
Humans , Pleural Effusion/diagnosis , Exudates and TransudatesABSTRACT
Background: Cytological study of pleural fluid is a simple, cost effective non invasive technique to detect specific pathologies in the pleural cavity. Though it has relatively low specificity and sensitivity owing to its very nature, it can be of immense help in detecting malignancies and nonneoplastic aetiologies such as infection. Aim: To evaluate pleural fluids with clinical correlation. Materials and methods: The present work was a descriptive cross sectional analytical retrospective type of study undertaken at the department of Pathology of a tertiary care rural hospital over a period of one year from January 2015 to December 2015. Pleural fluids were processed according to standard protocol and studied. They were analysed for cell count, cell features and presence of organisms (if any). Malignancies were also noted. Results: Out of a total of 338 fluid samples received in the one year, a total of 130 cases (38.46%) of pleural fluids were received. Majority of cases were females 72 (55.38%). Mean age of presentation was 51.60 years. A total of 13 cases (10.0%) were malignancies. 89 cases (68.46%) were pleural exudates and 41 (31.53%) were transudates. Conclusion: Pleural fluid comprised of one of the major specimen to be received for evaluation. Owing to its dynamic nature, the pleural cavity has a potential to be a haven to various pathologies. In our study, exudative effusions were commonly encountered, in which, tuberculosis was the prime cause. Malignancies also played an important role giving rise to effusions.
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A total of 1,132 pleural fluid culture results obtained from October 2012 to July 2014 were analyzed to elucidate the microbiological characteristics according to transudative and exudative pleural fluid. The pleural fluid cultures were performed using aerobic and anaerobic blood culture bottles. The blood and pleural fluid for total protein, lactate dehydrogenase, and glucose measurement were submitted to laboratory at the same time with pleural fluid cultures. The rates for culture positivity, anaerobes isolation, and polymicrobials between transudative and exudative pleural fluid were 5.2% vs. 10.4%, 14.8% vs. 7.8%, and 14.8% vs. 10.9%.
Subject(s)
Exudates and Transudates , Glucose , L-Lactate DehydrogenaseABSTRACT
Objective To evaluate the clinical value of fast detection of high sensitivity C-reaction protein(hs-CRP)in distinguis-hing between transudate and exudate.Methods 100 cases of patients were enrolled in the investigation.The levels of TP,LDH, GLU in serum and pleural effusion respectively,as well as the level of hs-CRP in the pleural effusion.Results According to Light standard,82 cases of patients were diagnosed as transudate(transudate group)and 18 cases of patients were diagnosed as exudates (exudates group).The sensitivities of Rivalta test,TP(pleural effusion)/TP(serum)and LDH(pleural effusion)/LDH(serum) were 83.14%,80.49% and 79.27%,respectively.Hs-CRP showed 84.15% sensitivity and 27.78% specificity at a cutoff value of 5 mg/L.TP(pleural effusion)/TP(serum)and LDH(pleural effusion)/LDH(serum)had the highest specificities,and both were 100.00%.The levels of LDH(pleural effusion)/LDH(serum)and hs-CRP in transudate group were significantly higher than those in exu-dates group(P<0.05).Combined detection of hs-CRP,TP(pleural effusion)/TP(serum)and LDH(pleural effusion)/LDH(serum)had the highest specificity (100.00%).Conclusion The fast detection of hs-CRP in pleural effusion is sensitive,combining with other tests can prove its specificity.The fast assay of hs-CRP has special clinic value in the distinguish between exudate and transudate.
ABSTRACT
Pleural effusions are common and of highly diverse etiologies. These effusions can form based on disease of the pleural membranes themselves or of thoracic or abdominal organs. In initial approach, these effusions can be separated as exudates or transudates with Light's criteria. Exudative pleural effusions meet at least one of the following criteria, whereas transudative effusions meet none: pleural fluid protein-to-serum protein ratio of more than 0.5, pleural fluid lactate dehydrogenase (LDH)-to-serum LDH ratio of more than 0.6, and pleural fluid LDH more than two thirds of the upper normal limit for serum. If a patient appears to have clinically a transudative effusion, additional tests can be assessed to verify its transudative etiology. Congestive heart failure and cirrhosis are responsible for almost all transudative pleural effusions. However, it has been determined that the patient has an exudative pleural effusion, one should attempt to determine which of the diseases, remembering that pneumonia, malignancy, and tuberculosis account for the great majority of all exudative pleural effusions. In all patients with undiagnosed exudative pleural effusions, the appearance of the fluid should be noted, and the pleural fluid protein and LDH levels, glucose level, differential cell count, and microbiologic and cytologic studies should be obtained. In selected patients, other tests on the pleural fluid, such as pH, amylase level, antinuclear antibody level, rheumatoid factor level, adenosine deaminase, lipid analysis, and so forth, may be of value.
Subject(s)
Humans , Adenosine Deaminase , Amylases , Antibodies, Antinuclear , Cell Count , Exudates and Transudates , Fibrosis , Glucose , Heart Failure , Hydrogen-Ion Concentration , L-Lactate Dehydrogenase , Membranes , Pleural Effusion , Pneumonia , Rheumatoid Factor , TuberculosisABSTRACT
OBJECTIVE: The aim of this study was to identify the participation of the coagulation system in the differential diagnosis of pleural effusions. INTRODUCTION: Imbalance between immunologic and metabolic factors triggers a sequence of events resulting in pleural reactions and accumulation of fluid. The coagulation system, which is fundamental for the maintenance of homeostasis, contributes to the inflammatory process responsible for pleural effusions, and participates in cellular proliferation and migration as well as in the synthesis of inflammatory mediators. METHODS: We evaluated the laboratory profile of coagulation and fibrinolysis in 54 pleural fluids (15 transudates and 39 exudates). RESULTS: The coagulation system acts according to the pathophysiologic mechanisms involved in the development of pleural effusions. In inflammatory effusions (exudates), there is activation of coagulation with increased levels of fragment 1+2 and thrombin-antithrombin complex in addition to reduction of fibrinogen levels due to fibrinolysis and fibrin tissue incorporation. As a consequence, there is activation of the fibrinolytic system with increased levels of fibrin degradation products, including the D-dimer. These changes are not sufficient for differentiation of different subgroups of exudates. In transudates, these events were observed to a lesser degree. CONCLUSION: The coagulation system plays an important role in the development of pleural diseases. Coagulation tests show differences between transudates and exudates but not among exudate subgroups. Understanding the physiopathological mechanisms of pleural disorders may help to define new diagnostic and therapeutic approaches.