A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2)

Abstract Introduction The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. Patients and methods This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. Results Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. Conclusion The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

The value of peripheral blood and pleural effusion T-SPOT.TB combined with pleural effusion adenosine deaminase in diagnosis of tuberculous pleurisy / 中国热带医学

@#Abstract: Objective To explore the relationship between peripheral blood and pleural effusion tuberculosis (TB) infection effector T cells, and to further evaluate the value of combined pleural effusion adenosine deaminase (ADA) for rapid diagnosis of tuberculous pleurisy. Methods The test data of 80 cases of tuberculous pleurisy and 70 cases of nontuberculous pleurisy treated in the Sixth People's Hospital of Nantong City from January 2017 to December 2020 were analyzed. The TBinfected effector T cells were also detected simultaneously in the peripheral blood and the pleural effusion by the T-SPOT technique, and the pleural effusion ADA was detected by the rate method. The subject operating characteristic curve (ROC) was applied to take the optimal pleural effusion ADA threshold to compare the sensitivity and specificity of different critical values. Person phase analysis was applied to analyze the correlation between peripheral blood and pleural effusion T-SPOT.TB. Data of peripheral blood, pleural effusion T-SPOT.TB and ADA were integrated. Results When pleural effusion ADA>45 U/L, the sensitivity and specificity for the diagnosis of tuberculous pleurisy were 50.0% and 94.3%, respectively; when ADA > 25.15 U/ L, the sensitivity and specificity were 80.0% and 72.9%. When ADA > 45 U / L, pleural/ blood T-SPOT.TB spot ratio (spot forming cells, SFCs) > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 100% (highest); when 25.15 U/L< pleural effusion ADA ≤ 45 U/L, pleural/blood T-SPOT.TB spot ratio > 2 times, the specificity for the diagnosis of tuberculous pleurisy was 92.3% (second). When pleural effusion ADA ≤ 25.15 U/L, and the pleural effusion/blood T-SPOT.TB spot number ratio > 2 times, with 83.3% specificity (the lowest of the three groups). Conclusions The level of pleural effusion ADA is one of the most used methods for diagnosing tuberculous pleurisy. Further combination of pleural effusion and blood T-SPOT.TB, if the ratio of pleural effusion / blood T-SPOT. TB spots is greater than 2 times, it can further improve the diagnosis rate of tuberculous pleurisy.

Pleural tuberculosis: experiences from two centers in Brazil

Abstract Objective: This study aimed to describe the clinical and laboratory findings of patients diagnosed with pleural tuberculosis at two hospitals in southern Brazil. Methods: Patients aged < 18 years were evaluated retrospectively. The patients' medical and epidemiological history, tuberculin skin test results, radiological and pathological findings, and pleural fluid analysis results were retrieved. Results: Ninety-two patients with pleural tuberculosis were identified. The mean age was 10.9 years old. Twenty-one percent were children aged six years or less. The most common symptoms were fever (88%), cough (72%), and chest pain (70%). Unilateral pleural effusion was observed in 96% of the cases. Lymphocyte predominance was found in 90% of the pleural fluid samples. The adenosine deaminase activity of the pleural fluid was greater than 40 U/L in 85% of patients. A diagnosis of community-acquired pneumonia with antibiotic prescriptions was observed in 76% of the study population. Conclusions: Tuberculosis etiology must be considered in unilateral pleural effusion in a child with contact with a case of tuberculosis. Pleural fluid biomarkers contribute to the diagnosis of pleural tuberculosis in children and adolescents.

Correlation of Serum Adenosine Deaminase (ADA) with Glycated Heamoglobin (HbAcl) in Type 2 Diabetics Mellitus Patients: A Single Center Study in Bangladesh

Background: Worldwide, diabetes mellitus is a major health problem leading to remarkable mortality and morbidity day by day. Adenosine deaminase (ADA) catalyzes the irreversible deamination of adenosine to inosine is a polymorphic enzyme which is considered to be related to type 2 diabetes mellitus (T2DM). So, it may be useful in formulating proper guideline for evaluating the glycemic status in T2DM. The aim of the study was to assess the correlation of serum adenosine deaminase (ADA) with glycated heamoglobin (HbA1c) in type 2 diabetics mellitus patients.Material & Methods:It was a cross sectional study and conducted in the Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh from July 2014 to June 2015. A total number of 150 participants of both sexes were included in this study as the study population. The samples were divided into major two groups. The control group (Group A) consisted of 50 age matched healthy subjects for comparison and the study group (Group B) consisted of 100 type 2 diabetic patients with the age ranging from 40-55 years. Again, depending on HbA1c level, the study group was divided into two subgroups. Group B1 consisted of 50 participants with HbA1c<6.5% and Group B2 consisted of 50 participants with HbA1c>6.5%. The study parameters were including serum ADA, FPG, HbA1c. For statistical analyses one-way ANOVA test, unpaired Student’s test and Pearson’s correlation coefficient (r) test were performed as applicable using SPSS version 20.0.Results:type-2 DM as compared to healthy controls. Again, serum ADA (P<0.001) levels were significantly higher in type2DM with HbA1c ?6.5% than that of type2 DM with HbA1c <6.5%. There is a positive correlation of serum ADA with FPG, HbA1c in type 2 diabetic patients.Conclusion:After analyzing the results of the study, it is concluded that estimation of serum ADA level might be used as a new marker for prediction of glycemic in type2 diabetes mellitus.

Diagnostic Significance Of Adenosine Deaminase And Lymphocytes In Suspected Tuberculous Pleural Effusion

CONTEXT: Tuberculosis is a major public health problem in India. Tuberculous pleural effusion is a paucibacillary manifestation of the Tuberculosis, so isolation of Mycobacterium tuberculosis is difficult, biomarkers being an alternative for diagnosis. Pleural fluid Adenosine deaminase (ADA) level is being used in diagnosis of Tubercular pleural effusion. The combination of ADA and pleural fluid lymphocyte count is being recognized as a better method for increasing the specificity of ADA test. The present study was conducted to analyze the diagnostic usefulness ofAIM: ADA alone (? 40U/L) compared with the combination of ADA and pleural fluid lymphocyte count ( ? 50% ). SETTINGS AND DESIGN: METHODS AND MATERIAL:Retrospective study. Study was conducted for a period of one year from May 2017 to April 2018. A total of 110 pleural fluid samples data was analysed. SPSS 20STATISTICAL ANALYSIS USED: statistical software. ADA level in Tuberculous pleural effusion ranged from 40U/L to 112U/L with mean value ofRESULTS: 69.4U/L. Sensitivity, Specificity, Positive predictive valve (PPV) and Negative predictive values (NPV) for ADA alone were 93.2%, 76.4%, 82% and 90.6% respectively. For ADA and lymphocyte count the Specificity and PPV increased (98% and 98.1% respectively) with hardly any decrease in sensitivity or NPV (89.8% and 89.5% respectively). CONCLUSION: Combined use of ADA and pleural fluid lymphocyte count increases the specificity and PPV when compared to the specificity of ADA test alone in diagnosing Tubercular pleural effusion

Effect of diallyl disulfide on liver nucleotide metabolism in experimentally induced hepatoma in mice.

Background: The antitumorigenic effects of active ingredient of garlic, diallyl disulfide (DADS), has been extensively studied & found to retard the growth of neoplastic cells than any other allyl sulfur compounds of garlic. Earlier we have reported antitomorogenic properties of DADS, showing tumor regression by interfering with the liver glucose utilization, protein synthesis as well as lipid synthesis in tumor cells. Aim: To assess the effect of diallyl disulfide on liver nucleotide metabolism in experimentally induced hepatoma in mice. Materials & Methods: Swiss albino male mice were divided into four groups - normal, control, preventive and curative groups. Hepatoma was induced by intraperitoneal injection of Ehrlich ascites carcinoma (EAC) cells. DADS (100 mg/kg body weight/mouse/day) was orally fed to protective and curative group mice for a stipulated time period. Mice of all the groups were sacrificed, and liver tissue adenosine deaminase (ADA) activity and uric acid (UA) levels were measured. Results: The present study shows a significant decrease in ADA activity and UA levels in protective (p >0.001) and curative groups (p >0.01) as compared to control group. Conclusion: DADS has inhibitory effects on nucleotide metabolism by inhibiting the activities of ADA and xanthine oxidase enzymes, and by reducing the production of deoxy ribonucleotides, probably by involving in thiol-disulfide exchange reactions.

A Cross-sectional study on oxidative stress markers in type 2 Diabetes Mellitus and their correlation with blood sugar levels

Background: Among major metabolic disorders of glucose metabolism, diabetes mellitus is the most common one, in which Insulin deficiency and insulin resistance are the common observations. It is a renowned fact that long-standing hyperglycaemia is associated with oxidative stress, caused by an increase in the reactive oxygen species. Adenosine deaminase(ADA) is a purine metabolic enzyme that degrades adenosine. Gamma-glutamyl transferase (GGT) maintains antioxidant levels by maintaining reduced glutathione in the cells. Ceruloplasmin is a known acute phase reactant. Aim: 1. To Study and compare the levels of Serum FBS, PPBS, ADA, GGT and Ceruloplasmin in T2DM patients and nondiabetic subjects. 2. To study the correlation between these parameters and blood sugar levels in cases. Materials and methods: A descriptive cross-sectional study was done at Subbaiah medical college in Shimoga, taking 50 T2DM patients and 50 controls. Serum levels of fasting blood sugar(FBS), Postprandial blood sugar (PPBS), Adenosine deaminase, Gamma-glutamyl transferase and Ceruloplasmin were estimated. Data were analysed in SPSS software 17 using independent student t test. p < 0.01 was considered significant. Results: Increased levels of ADA, GGT and ceruloplasmin in cases were found, and they were statistically significant. Pearson correlation of these inflammatory markers with FBS and PPBS showed a positive significant correlation.

STUDY OF ADENOSINE DEAMINASE LEVEL IN BRONCHOALVEOLAR LAVAGE FLUID AND ITSCORRELATION WITH GENXPERT IN SPUTUM NEGATIVE SUSPECTED PULMONARYTUBERCULOSIS AND SUSPECTED LUNG MALIGNANCY.

Abstract:Introduction:Tuberculosis (TB) has been one of the health problems in the world.Diagnosis of pulmonary tuberculosis based on finding of AFB in thesputum has several limitations and mycobacterial culture is timeconsuming. So we decided to evaluate biomarker like AdenosineDeaminase (ADA) activity in Bronchoalvolar Lavage(BAL) fluid .Objectives: To study level of BAL ADA in sputum negative suspectedcases of pulmonary tuberculosis and correlate it with BAL GenXpert(Cartridge Based Nucleic Acid Amplification) result.Method: We have enrolled suspected sputum negative pulmonary TBand suspected lung malignancy patients (as control). Total 33 patients -17 suspected sputum negative pulmonary TB, 16 suspected lungmalignancy were enrolled in study and subjected to bronchoscopy andBAL fluid was submitted for ADA level and GenXpert for TB.Result: Increased BAL ADA level was found in suspected sputumnegative pulmonary TB as compare to suspected malignancy. IncreasedBAL level was well correlared with GenXpert positivity in suspected TBgroup.Conclusion: BAL fluid ADA can be useful tool for early diagnosis ofsuspected sputum negative pulmonary TB.

CNS Tuberculosis

Tuberculosis can involve almost any organ of the body. In the Central Nervous System (CNS) it can cause meningitis, tuberculoma, abscess,spondylitis, arachnoiditis, myeloradiculitis or other manifestations. Around 10% of all patients with tuberculosis have CNS involvement. Tuberculosis is rampant in the developing world and has reemerged as a major public health menace with the HIV pandemic. Compared with HIV-negative individuals, HIVpositive individuals with TB are 5 times more likely to have CNS involvement. Laboratory confirmation of CNS TB is difficult and hence empirical treatment has to be initiated as early as possible based on clinical and radiological features. In this article,we review the CNS manifestations of tuberculosis and their diagnosis and treatment

Determinación del valor de adenosina deaminasa en tuberculosis pleural / Determination of the adenosine deaminase value in pleural tuberculosis

Resumen La determinación de adenosina deaminasa (ADA) es de utilidad en países donde la prevalencia de tuberculosis (TB) es alta/moderada. El objetivo del trabajo fue analizar el punto de corte de ADA en pacientes con tuberculosis en nuestra institución. Se incluyeron todos los pacientes con derrame pleural, desde mayo del 2016 a marzo 2019. Se excluyeron aquellos con serología positiva para HIV y los trasudados. Todos fueron agrupados en los siguientes diagnósticos: TB, neoplasia, paraneumónico u otro de causa no aclarada. Se efectuó determinación de ADA y cultivo para micobacterias a todas las muestras de líquido pleural. Se realizó una curva ROC para establecer el mejor punto de corte de ADA para el diagnóstico de TB. Se recolectó información de 309 pacientes, se incluyeron 220, 87 tuvieron diagnóstico de TB. El mejor punto de corte obtenido para el ADA fue de 52 U/l, con una sensibilidad de 79% y una especificidad de 90%. El área bajo la curva (AUC) resultó de 0.90. En los menores de 40 años, el mejor punto de corte fue de 41 U/l, por debajo del obtenido para el total de la población en estudio. En nuestra población, el punto de corte para el valor de ADA en exudado pleural para el diagnóstico de tuberculosis de 52 U/l, presentó la mayor especificidad y sensibilidad.

Abstract The determination of adenosine deaminase (ADA) is useful in countries where the prevalence of tuberculosis (TB) is high/ moderate. The objective of this study was to analyze the cut-off point for ADA in patients with TB at our institu tion. All patients with pleural effusion were included, from May 2016 to March 2019, except those with positive serology for HIV and transudates. They were grouped into the following diagnoses: TB, neoplasm, parapneumonic or other with an unclear cause. ADA determination and culture for mycobacteria were performed on all samples of pleural fluid. A ROC curve was performed to establish the best ADA cut-off point for the diagnosis of TB. Information was collected from 309 patients; 220 were included and 87 had a diagnosis of TB. The best cut-off point obtained for ADA was 52 U/l, with a sensitivity of 79% and a specificity of 90%. The area under the curve (AUC) was 0.90. In patients under 40 years old the best cut-off point was 41 U/l, below that obtained for the total study population. In our population the cut-off point for the ADA value in pleural exudate for the diagnosis of tuberculosis of 52 U/l presents the highest specificity and sensitivity.

Critical Cerebrospinal Fluid Adenosine Deaminase Activity In Tubercular Meningitis

Background:Tuberculosis of the central nervous system accounts for ~5% of extrapulmonary cases in the United States. It is seen most often in young children but also develops in adults, especially those infected with HIV. If unrecognized, tuberculous meningitis is uniformly fatal. This disease responds to chemotherapy.Cerebrospinal fluid (CSF) evaluation is the single most important aspect of laboratory diagnosis of meningitis. Basic studies of CSF that should be performed in meningitis include measurement of pressure, cell count and differential count, estimation of glucose and protein levels, Gram's stain and culture.Objectives:To evaluate the diagnostic significance of CSF adenosine deaminase (ADA) activity in tuberculous meningitis.Material & Methods:70 Tubercular Meningitis patients who were admitted in Department of Medicine, Victoria hospital were included. The study was approved by the Ethical Committee of Bangalore Medical College and Research Institute, Bangalore. Patients were selected after fulfilling the following inclusion and exclusion criteria.Results:The mean age of the 70 patients studied was 39.82+16.48 years. The youngest patient was 18 years old and oldestpatient was 70 years.The mean value of ADA activity in tubercular meningitis was 18.07±8.03IU/L. Cut-off value of ADA in our study was 10 IU/. The result was statistically significant with a p value<0.001. Conclusion: The test for ADA in CSF is simple and can be carried out in a central laboratory with a rapid diagnosis, thus reducing unwarranted or harmful therapy for patients.Elevated CSF-ADA level helpsin differentiating tubercular from non-tubercular meningitis.

Biochemical characterization of adenosine deaminase (CD26 EC 3. 5. 4. 4) activity in human lymphocyte-rich peripheral blood mononuclear cells

The conversion of adenosine to inosine is catalyzed by adenosine deaminase (ADA) (EC 3.5.4.4), which has two isoforms in humans (ADA1 and ADA2) and belongs to the zinc-dependent hydrolase family. ADA modulates lymphocyte function and differentiation, and regulates inflammatory and immune responses. This study investigated ADA activity in lymphocyte-rich peripheral blood mononuclear cells (PBMCs) in the absence of disease. The viability of lymphocyte-rich PBMCs isolated from humans and kept in 0.9% saline solution at 4-8°C was analyzed over 20 h. The incubation time and biochemical properties of the enzyme, such as its Michaelis-Menten constant (Km) and maximum velocity (Vmax), were characterized through the liberation of ammonia from the adenosine substrate. Additionally, the presence of ADA protein on the lymphocyte surface was determined by flow cytometry using an anti-CD26 monoclonal human antibody, and the PBMCs showed long-term viability after 20 h. The ADA enzymatic activity was linear from 15 to 120 min of incubation, from 2.5 to 12.5 µg of protein, and pH 6.0 to 7.4. The Km and Vmax values were 0.103±0.051 mM and 0.025±0.001 nmol NH3·mg-1·s-1, respectively. Zinc and erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA) inhibited enzymatic activity, and substrate preference was given to adenosine over 2′-deoxyadenosine and guanosine. The present study provides the biochemical characterization of ADA in human lymphocyte-rich PBMCs, and indicates the appropriate conditions for enzyme activity quantification.

Role of cancer ratio and other new parameters in the differential diagnosis of malignant pleural effusion

OBJECTIVES: We compared the diagnostic potential of cancer ratio (CR, serum lactate dehydrogenase [LDH]/pleural fluid adenosine deaminase [pfADA]), cancer ratio plus (CR plus, cancer ratio/pleural lymphocyte percentage), and age/pfADA ratio with pfADA in malignant pleural effusion. METHODS: Data from 100 patients with malignant pleural effusion (MPE) and 119 patients with tuberculous pleural effusion (TPE) were retrospectively collected. PfADA, age/pfADA ratio, CR, and CR plus were compared between patients with MPE and those with TPE in two age groups (≤50 and >50 years). The best cut-off value was determined, and the diagnostic performance was evaluated according to the receiver operating characteristic curve. RESULTS: PfADA was statistically significantly lower while age/pfADA ratio, CR, and CR plus were significantly higher in the MPE group than in the TPE group in both age groups (p<0.05). For patients aged ≤50 years, the differential diagnostic value of pfADA for MPE was better than those of age/pfADA ratio, CR, and CR plus. At a cut-off value of 13.0 U/L, the sensitivity, specificity, and accuracy were 88.9%, 100.0%, and 98.9%, respectively. For patients aged >50 years, the diagnostic performance of CR plus was superior to those of pfADA, age/pfADA ratio, and CR. At a cut-off value of 22.6, the sensitivity, specificity, and accuracy of CR plus for the diagnosis of MPE were 86.8%, 84.6%, and 86.2%, respectively. CONCLUSIONS: The best parameter for diagnosing MPE was different for patients aged ≤50 years and >50 years. For patients aged >50 years, CR plus was a good parameter for the differential diagnosis of MPE. For patients aged ≤50 years, pfADA was better.

Performance of the quantification of adenosine deaminase and determination of the lactate dehydrogenase/adenosine deaminase ratio for the diagnosis of pleural tuberculosis in children and adolescents / Desempenho da quantificação de adenosina desaminase e determinação da relação lactato desidrogenase/adenosina desaminase para o diagnóstico de tuberculose pleural em crianças e adolescentes

ABSTRACT Objective: To evaluate the accuracy of determining the adenosine deaminase (ADA) level, the 2'-deoxyadenosine/ADA ratio, and the LDH/ADA ratio in pleural fluid for the diagnosis of pleural tuberculosis (PT) in children and adolescents. Methods: This was a retrospective cross-sectional study conducted at a tertiary hospital in a high-tuberculosis-incidence area, between 2001 and 2018. All patients with ADA in pleural fluid and a confirmed diagnosis of PT (cPT) or parapneumonic effusion (PPE) were included. Results: The cPT and PPE groups comprised 25 and 68 individuals, respectively. At a cutoff of 40 U/L, ADA measurement showed the following: sensitivity, 88%; specificity, 31%; positive predictive value (PPV), 32%; negative predictive value (NPV), 88%; and overall accuracy, 46%. The best cutoffs were an ADA level of 125 U/L, a 2'-deoxyadenosine/ADA ratio of 0.5, and an LDH/ADA ratio of 8.3, with AUC of 0.67, 0.75, and 0.82, respectively. The sensitivity, specificity, PPV, NPV, and overall accuracy of the 125 U/L ADA cutoff were 84%, 65%, 47%, 92%, and 70%, respectively, compared with 79%, 79%, 59%, 91%, and 79%, respectively, for the 8.3 LDH/ADA ratio cutoff. Changing the LDH/ADA ratio cutoff to 3.0 increased the specificity to 98%. Conclusions: The ADA level and the 2'-deoxyadenosine/ADA ratio are not good biomarkers for the diagnosis of PT in pediatric patients. Determination of the LDH/ADA ratio provides the best overall accuracy for the diagnosis of PT in such patients.

RESUMO Objetivo: Avaliar a acurácia da determinação do nível de adenosina desaminase (ADA), da relação 2'-desoxiadenosina/ADA e da relação LDH/ADA no líquido pleural para o diagnóstico de tuberculose pleural (TP) em crianças e adolescentes. Métodos: Estudo transversal retrospectivo realizado em um hospital terciário em uma área de alta incidência de tuberculose entre 2001 e 2018. Todos os pacientes com determinação de ADA no líquido pleural e com diagnóstico confirmado de TP (TPc) ou de derrame parapneumônico (DPP) foram incluídos. Resultados: Os grupos TPc e DPP foram compostos por 25 e 68 indivíduos, respectivamente. Num ponto de corte de 40 U/L, a medida de ADA mostrou o seguinte: sensibilidade, 88%; especificidade, 31%; valor preditivo positivo (VPP), 32%; valor preditivo negativo (VPN), 88%; e acurácia geral, 46%. Os melhores pontos de corte foram ADA de 125 U/L, relação 2'-desoxiadenosina/ADA de 0,5 e relação LDH/ADA de 8,3, com ASC de 0,67, 0,75 e 0,82, respectivamente. A sensibilidade, especificidade, VPP, VPN e acurácia geral do ponto de corte de 125 U/L para ADA foram de 84%, 65%, 47%, 92% e 70%, respectivamente, em comparação com 79%, 79%, 59%, 91% e 79%, respectivamente, para o ponto de corte de 8,3 para a relação LDH/ADA. Ao alterar o ponto de corte da relação LDH/ADA para 3,0 a especificidade aumentou para 98%. Conclusões: O nível de ADA e a relação 2'-desoxiadenosina/ADA não são bons biomarcadores para o diagnóstico de PT em pacientes pediátricos. A determinação da relação LDH/ADA fornece a melhor acurácia geral para o diagnóstico de PT nesses pacientes.

Role of polymerase chain reaction of ascitic fluid and its correlation with adenosine deaminase levels in the diagnosis of abdominal tuberculosis

Background: It is still difficult to diagnose tuberculosis as a source of abdominal pain. Due to the lack of non-invasive diagnostic testing, the diagnosis remains a problem. Determining the role of polymerase chain reaction (PCR) in ascitic fluid in the diagnosis of abdominal tuberculosis, we can conclude whether it is sensitive/specific or not and further its use in the diagnosis of abdominal tuberculosis. Objective: The objective of the study was to determine the role of PCR in ascitic fluid in the diagnosis of abdominal tuberculosis and also to correlate the ADA levels of ascitic fluid with the PCR report. Materials and Methods: This prospective comparative study includes 41 clinically suspected abdominal tuberculosis patients (age range 15–65 years) over a period of 2 years. A detailed history, clinical evaluation, and relevant investigations, including radiology, were done in all patients. Bacteriological or histological approaches had to support the diagnosis of abdominal tuberculosis, and PCR was also tested for Mycobacterium tuberculosis in ascitic fluid. Results: The mean age of patients was 31.71±12.32 years with male:female ratio was 1.4:1. PCR was positive in 24 (58.8%) cases. A receiver operating characteristic curve showed that a cutoff value of 35.3 IU/L (AUC 0.998, P < 0.001) for the ADA level produced the best results as a diagnostic test for abdominal tuberculosis, yielding the following parameter values: Sensitivity 100%, specificity 94.1%, positive predictive value 96%, negative predictive value 100%, and diagnostic accuracy 97.56%. ADA values were significantly elevated during abdominal tuberculosis, indicating that ADA can still be a valuable diagnostic tool. Conclusion: Our findings indicate that ascitic fluid PCR is a safe tool for diagnosing it and should be tried at least before surgical intervention.

Spectrum of cerebrospinal fluid analysis and nervous system diseases in hospitalised patients: a hospital based prospective study from a hilly state of Himachal Pradesh in North India

Background: The cerebrospinal fluid (CSF) analysis is an invaluable diagnostic aid in various nervous system diseases. Many times, alterations in normal CSF parameters with variable and overlapping results are challenging in differential diagnosis and treatment of the diseases. The aim of the study is to know the spectrum of CSF analysis and nervous system diseases with different prevalence in our setup.Methods: Total 150 hospitalised patients with various nervous system diseases and indications were subjected to lumbar puncture and the CSF analysis was done, in a period of one year study.Results: A total of 150 patients with mean age of 50.41±19.54 years had male to female ratio of 1.63:1. CSF analysis revealed most of tuberculous meningitis (TBM) in 30(20%) patients with higher adenosine deaminase (ADA) levels of 10.7±20.24 IU/L and lymphocytic leukocytosis (81.93%). Bacterial meningitis in 8(5.3%) patients revealed highest increase in CSF mean protein levels of 349.63±226.39 mg/dL and in mean cell count of 1039.50±930.23 cells/mm3. There was significant increase in protein levels and decrease in glucose levels of CSF, both in TBM and bacterial meningitis compared to viral, fungal meningitis and other central nervous system (CNS) diseases(p<0.001).Conclusions: Spectrum of CSF analysis and CNS diseases revealed consistent findings of alteration of normal CSF variables and therefore, was found as an invaluable, rapid and cost-effective differentiating diagnostic tool.

Application value of detection of 157-114 protein level combined with ADA and CEA levels in pleural effusion in differential diagnosis of pleural effusion / 吉林大学学报(医学版)

Objective: To detect the levels of B7-H4 protein, adenosine deaminase (ADA) and carcinoembryonic antigen (CEA) in the malignant pleural effusion associated with lung cancer (LC-MPE) and tuberculous pleural effusion (TPK), and to evaluate the values of single and combined detection of B7-H4 protein, ADA and CEA in differential diagnosis of LC-MPE and TPK. Methods: A total of 202 samples of pleural effusion (PE) from 120 LC-MPE patients (LC-MPE group) and 82 TPE patients (TPE group) were collected. The levels of ADA and CEA and B7-H4 protein in PE were detected by the enzymatic, electrochemiluminescence and ELISA methods, respectively; and the receiver operating characteristic curve (ROC curve) was used to determine the diagnostic efficiencies of the above indexes alone or in combination, such as the sensitivity, the specificity, the Yoden index (YI)» and the area under ROC curve ( AUC). Results: The level of ADA in PE of the patients in TPE group was higher than that in LC-MPE group (P<0. 05); the levels of CEA and B7-H4 protein in PE of the patients in LC-MPE group were higher than those in TPE group ( P'-CO. 05). The ROC curve analysis results showed that the sensitivities of single detection of ADA, CEA and B7-H4 protein were 93.30%, 83.33% and 79.90%, respectively; the specificities were 86. 59%, 96.34% and 72. 50%, respectively; the AUC were 0. 927, 0. 925 and 0. 836, respectively. The combined detection of the three indexes had the highest diagnostic value; the sensitivity was 93. 90% , the specificity was 97. 50% , the YI was 0. 971, and the AUC was 0. 998. Conclusion: The combined detection of levels of ADA, CEA and B7-H4 protein in PE is superior to the single evaluation of each index, which can greatly improve the differential diagnosis efficiencies of LC-MPE and TPE.

Utility of pleural fluid adenosine deaminase in diagnosing tubercular pleural effusion: a prospective observational study in a tertiary care hospital

Background: The diagnosis of Tubercular (TB) pleural effusion continues to be a challenge in clinical practice, as traditional diagnostic methods are useful but do not provide enough sensitivity and specificity.Methods: This was a prospective observational study carried out at Tertiary care Hospital with study population of 76 patients. Etiological diagnosis was based on clinical history with radiological imaging, biochemical and cytological examination of pleural fluid. Pleural fluid ADA was used as a biomarker for the diagnosis of tubercular pleural effusion.Results: The study included 76 patients with 69.7% (n=53) males and 30.3%(n=23) females. The mean age of patients was 48.97 17.03 years. Of 76 cases of pleural effusion, 62 were exudates and 14 transudates. Tuberculosis was the most common cause among exudates which accounted for 51.3% (n=39) of cases. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV), Accuracy of pleural fluid ADA in diagnosing tubercular pleural effusion was 92.3%, 97.3%, 97%, 92% and 94.7% respectively.Conclusions: Pleural fluid ADA can be one of the most reliable biomarkers for the diagnosis of TB pleural effusion considering its high sensitivity and specificity.

Role of Adenosine Deaminase in Pleural Effusions and its Cytological Correlation

Diagnosis of pleural diseases creates difficulty due to overlapping features of various benign and malignant conditions. However pleural fluid cytology of closed pleural biopsy specimen is most commonly used procedure to diagnose various pleural diseases in developing country like India. Present study was conducted to establish diagnostic utility of ADA in Pleural Fluids and its correlation with cytological findings. Methods: The present study includes 100 samples of pleural fluid samples taken from patients coming to the Department of Chest and TB, Government Medical College and Hospital, Amritsar with the complaint of pleural effusion. Results: For ADA levels in pleural fluid Sensitivity is 92%, Specificity is 81.33%, Positive predictive value is 62.16% and Negative predictive value is 96.83%. For lymphocyte count in pleural fluid Sensitivity is 100%, Specificity is 16.67%, Positive predictive value is 31.25 % and Negative predictive value is 100%. In Combination of ADA and lymphocyte count to diagnose tubercular pleural effusion Sensitivity is 100%, Specificity is 77.27%, Positive predictive value is 82.14 % and Negative predictive value is 100%. Conclusion: Measurement of ADA level in pleural fluid in combination with the differential count of pleural fluid will give best results to categorize and to rule in the diagnosis of tubercular pleural effusion.

The clinical utility of Adenosine Deaminase (ADA) levels for the differentiation of tubercular and non-tubercular pleural effusion

Background: Extra pulmonary TB accounts for 15% of all TB cases. Its incidence is much higher about 50% in HIV positive patients. Tuberculous pleurisy is present in around 4% of all TB cases2. Tuberculosis is always the leading etiology of pleural effusions in the developing countries3. Aims and Objectives: We have lot of investigations to diagnose pulmonary tuberculosis like sputum AFB, CBNAAT, LPA. These tests have some limitations in pleural fluid. So we are in need of a better test for diagnosis of tuberculous pleural effusion especially in high burden countries like India. Methods: In this study we have evaluated the usefulness of ADA level in pleural fluid for diagnosis of tuberculous pleural effusion. This study conducted from May 2017 to June 2018. Conclusion: This is a case control study done in a tertiary care center in Varanasi included 100 cases (Tuberculous pleural effusion) and 100 controls (Non Tuberculous pleural effusion).