Study on influencing factors of positive peritoneal cytology and its relationship with prognosis in patients with endometrial cancer / 肿瘤研究与临床

Objective:To investigate the risk factors of positive peritoneal cytology (PPC) in patients with endometrial cancer and the impact of PPC on patients' prognosis.Methods:The clinicopathological data of 202 patients who underwent initial surgical treatment and were diagnosed with endometrial cancer by postoperative pathology at Qilu Hospital of Shandong University from January 2015 to December 2019 were retrospectively analyzed, and the peritoneal fluid of patients were sent intraoperatively for cytological liquid-based smear examination. Logistic regression was used to perform univariate and multivariate analyses of PPC in the whole group of patients and the early-stage patients; Univariate analysis of the progression-free survival in the whole group of patients and the early-stage patients was performed by Kaplan-Meier method and compared by log-rank method, and multivariate analysis of the progression-free survival in the whole group of patients and the early-stage patients was performed by Cox proportional hazards model.Results:Of 202 patients, 183 (90.6%) had negative peritoneal cytology (NPC) and 19 (9.4%) had PPC; 180 patients (89.1%) were stage Ⅰ-Ⅱ and 22 (10.9%) were stage Ⅲ-Ⅳ; 180 patients (89.1%) had early-stage endometrial cancer. Deep myometrial infiltration ( OR = 3.57, 95% CI 1.02-12.45, P = 0.046) and lymph node metastasis ( OR = 7.16, 95% CI 1.70-30.23, P = 0.007) were independent risk factors for PPC in patients with endometrial cancer; deep myometrial infiltration was an independent risk factor for PPC in patients with early-stage endometrial cancer ( OR = 6.22, 95% CI 1.22-31.73, P = 0.028). The 3-year PFS rates for the whole group of patients with PPC and NPC were 72.9% and 92.7%, and the difference was statistically significant ( P = 0.001); the 3-year PFS rates for early-stage patients with PPC and NPC were 82.5% and 96.2%, and the difference was statistically significant ( P = 0.002). PPC was an independent risk factor for PFS in the whole group of patients with endometrial cancer ( HR = 4.80, 95% CI 1.14-20.17, P=0.032); PPC was also an independent risk factor for PFS in patients with early-stage endometrial cancer ( HR = 8.85, 95% CI 1.96-39.93, P = 0.005). Conclusions:Deep myometrial infiltration is an independent risk factor for PPC, and PPC is an independent risk factor for PFS in patients with endometrial cancer. Routine cytological examination of peritoneal fluid is recommended in patients with endometrial cancer.

Diagnóstico, manejo y tratamiento de pacientes con peritonitis secundaria en una unidad de cirugía general / Diagnosis, management and treatment of patients with secondary peritonitis in a general surgery unit

La peritonitis es una inflamación aguda o crónica del peritoneo que generalmente tiene un origen infeccioso. Existen varios tipos, siendo la de tipo secundario la más frecuente. El término peritonitis secundaria se define como la inflamación localizada o generalizada de la membrana peritoneal causada por infección polimicrobiana posterior a la ruptura traumática o espontánea de una víscera o secundaria a la dehiscencia de anastomosis intestinales. Esta entidad se caracteriza por la presencia de pus en la cavidad peritoneal o de líquido; que, en el estudio microscópico directo, contiene leucocitos y bacterias. El tratamiento de esta patología constituye una urgencia y puede ser de tipo clínico y/o quirúrgico. El objetivo del manejo operatorio se basa en identificar y eliminar la causa de la infección, recoger muestras microbiológicas, realizar una limpieza peritoneal y prevenir la recidiva. El tratamiento clínico se ocupa de las consecuencias de la infección mediante la reanimación perioperatoria y el tratamiento antibiótico1. A pesar de los avances en diagnóstico, procedimientos quirúrgicos, terapia antimicrobiana y cuidados intensivos, la mortalidad asociada con la peritonitis secundaria grave es aún muy alta. El pronóstico y el manejo oportuno representan la clave para mejorar la sobrevida y reducir la mortalidad asociada a infecciones intraabdominales extensas2. Es importante establecer lineamientos en cuanto al diagnóstico, manejo antibiótico y pautas de tratamiento quirúrgico para disminuir la morbilidad y mortalidad asociada a esta enfermedad. Palabras clave: Peritonitis; Peritoneo; Cavidad Abdominal/cirugía; Cavidad Peritoneal; Líquido Ascítico/patología; Procedimientos Quirúrgicos Operativos.

Peritonitis is an acute or chronic inflammation of the peritoneum that generally has an infectious origin. There are several types, with secondary peritonitis being the most frequent. The term secondary peritonitis is defined as localized or generalized inflammation of the peritoneal membrane caused by polymicrobial infection following traumatic or spontaneous rupture of a viscus or secondary to dehiscence of intestinal anastomoses. This entity is characterized by the presence of pus in the peritoneal cavity or fluid which, on direct microscopic examination, contains leukocytes and bacteria. The treatment of this pathology constitutes an emergency and can be clinical and/or surgical. The aim of operative management is based on identifying and eliminating the cause of the infection, collecting microbiological samples, performing peritoneal cleansing and preventing recurrence. Clinical management deals with the consequences of the infection by perioperative resuscitation and antibiotic treatment1 . Despite advances in diagnosis, surgical procedures, antimicrobial therapy and intensive care, mortality associated with severe secondary peritonitis is still very high. Prognosis and timely management represent the key to improving survival and reducing mortality associated with extensive intra-abdominal infections2. It is important to establish guidelines for diagnosis, antibiotic management and surgical treatment guidelines to reduce the morbidity and mortality associated with this disease.

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratorial

Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method (AU)

Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado (AU)

Does ascitic fluid filtration improve the microbiological diagnosis of spontaneous bacterial peritonitis? An experimental laboratory study / A filtração do líquido ascítico melhora o diagnóstico microbiológico da peritonite bacteriana espontânea? Um estudo experimental laboratoria

ABSTRAC: Background: Spontaneous Bacterial Peritonitis (SBP) is a serious and frequent complication among cirrhotic patients with ascites and can be diagnosed by cytological analysis of the ascitic fluid. The microbiological culture of ascitic fluid, however, is positive in less than 40% of SBP cases, which often results in inappropriate antimicrobial therapy. Empirical therapy may be suboptimal, increasing patient's risk of aggravation, or overestimated, unnecessarily boosting bacterial resistance. Objective: This experimental laboratory study aimed to standardize and verify the technical feasibility of ascitic fluid vacuum filtration, as a way to optimize the etiological diagnosis of SBP, compared to the automated method. Method: The method evaluated and standardized in this study was ascitic fluid vacuum filtration. Its principle is the concentration of bacteria on a filter membrane. Results: This study included 36 cirrhotic patients treated at a public university hospital between 11.13.2017 and 06.30.2019. Among them, 47.2% (17/36) presented cytology test results compatible with SBP. For these patients, culture sensitivity using the automated method was 35.3% (6/17), against 11.8% (2/17) with the vacuum filtration method. Conclusion: In conclusion, vacuum filtration does not improve the microbiological diagnosis of SBP in this population compared to the automated method. (AU)

RESUMO:Contexto: A Peritonite Bacteriana Espontânea (PBE) é uma complicação grave e frequente entre pacientes cirróticos com ascite, diagnosticada por meio da análise citológica do líquido ascítico. A cultura microbiológica do líquido ascítico, por sua vez, é positiva em menos de 40% dos casos de PBE, o que resulta frequentemente na instituição de terapia antimicrobiana inapropriada. A terapia empírica pode ser subótima, aumentando o risco de agravamento do paciente, ou superestimada, impulsionando desnecessariamente a resistência bacteriana. Objetivo: Estudo experimental laboratorial, propôs padronizar e verificar a viabilidade técnica da filtração a vácuo do líquido ascítico, como forma de otimizar o diagnóstico etiológico na PBE, comparativamente ao sistema automatizado de culturas de sangue. Método: O método avaliado e padronizado neste estudo foi a da filtragem a vácuo do líquido ascítico. Esse tem como princípio a concentração da bactéria em uma membrana filtrante. Resultados: Nesse estudo, foram incluídos 36 pacientes cirróticos atendidos em um hospital público universitário, entre 13.11.2017 e 30.06.2019. Entre eles, 47,2% (17/36) apresentaram citologia compatível com PBE. Nesses, a sensibilidade da cultura pelo método semi-automatizado foi de 35,3% (6/17) e da cultura pelo método da filtragem a vácuo foi de 11,8% (2/17). Conclusão: Em conclusão, a filtragem a vácuo não melhora o diagnóstico microbiológico da PBE em relação ao método automatizado. (AU)

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.

Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis / Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis

Resumen Se comunica el caso clínico de un varón, con antecedentes de una cirrosis hepática alcohólica y gota, usuario crónico de antiinflamatorios, incluyendo corticoesteroides. Consultó por una melena secundaria a una úlcera bulbar. Durante su internación presentó fiebre, tratándose con ceftriaxona por un probable foco urinario. Por persistir febril, se realizó una paracentesis diagnóstica. En la muestra de líquido ascítico se observaron larvas de Strongyloides stercoralis. Recibió tratamiento antiparasitario con ivermectina, con buena respuesta clínica. Aunque la infección por S. stercoralis es relativamente frecuente en pacientes con cirrosis hepática alcohólica, la ascitis infectada por Strongyloides corresponde a una forma de presentación infrecuente. Este caso muestra la importancia de la paracentesis diagnóstica en todo paciente con ascitis secundaria a una cirrosis. Es importante considerar la presentación atípica de la infestación por Strongyloides en el contexto del paciente inmunocomprometido, ya que sin tratamiento puede tener una alta mortalidad.

Abstract Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

Recuperación de bacterias aerobias y anaerobias de pacientes con apendicitis aguda mediante botellas de hemocultivo / Recovery of aerobic and anaerobic bacteria from patients with acute appendicitis using blood culture bottles

Introducción. La apendicitis aguda es la primera causa de abdomen agudo; sin embargo, poco se conoce sobre las bacterias asociadas y su perfil de sensibilidad. Objetivo. Identificar y determinar el patrón de resistencia de las bacterias aerobias y anaerobias aisladas en cultivo de líquido periapendicular tomado de los pacientes con apendicitis aguda, y establecer la proporción de bacterias según la fase clínica. Materiales y métodos. Se llevó a cabo un estudio descriptivo y prospectivo en el Hospital Universitario de San José de Bogotá (Colombia), en pacientes mayores de 16 años sometidos a apendicectomía abierta. Se tomaron muestras de líquido periapendicular, las cuales se sembraron directamente en botellas de hemocultivos para aerobios y anaerobios. Resultados. Se incluyeron 154 pacientes. Del total de cultivos, el 87 % (n=134) fueron positivos: 77 % (n=118) para aerobios y 51 % (n=79) para anaerobios. La proporción de cultivos positivos fue inferior en los casos de apendicitis no complicada, en comparación con aquellos de apendicitis complicada (80 % (66/83) Vs. 95 % (67/71); p=0,003). Los microorganismos aislados con mayor frecuencia fueron: Escherichia coli (53 %) (n=84), Bacteroides sp. (25 %) (n=25), Propionibacterium acnes (21 %) (n=21), Staphylococci coagulasa negativo (17 %) (n=27), Enterococcus sp. (10 %) (n=15) y Fusobacterium sp. (11 %) (n=11). La sensibilidad de E. coli a la amplicilina sulbactam fue de 30 %. La sensibilidad de Bacteroides spp. a la clindamicina y la ampicilina sulbactam fue de 91 %. El 100 % de los anaerobios fueron sensibles a piperacilina tazobactam, ertapenem, meropenem y metronidazol. Conclusiones. Los cultivos intraoperatorios son pertinentes en la apendicitis para determinar el patrón epidemiológico local, y establecer los antibióticos profilácticos y terapéuticos para esta enfermedad. Su siembra directa en botellas de hemocultivo permite una gran recuperación de microorganismos.

Introduction: Acute appendicitis is the first cause of acute abdomen, however, there is a little information about the associated bacteria and its sensibility profile. Objetive: To identify and to determine the resistance pattern of aerobic and anaerobic bacteria isolated in periapendicular fluid cultures taken in patients with acute appendicitis and to establish the proportions of isolates according to the clinical phase. Materials and methods: A descriptive and prospective study was undertaken at the Hospital Universitario de San José (Bogotá, Colombia) of patients older than sixteen years of age, undergoing an open appendectomy. A sample of periappendiceal fluid was taken, which was deposited directly into aerobic and anaerobic blood culture bottles. Results: One hundred and fifty-four patients were included. The overall positivity of cultures was 87% (n=1344); 77% (n=118) for aerobes and 51% (n=79) for anaerobes. The proportion of positive cultures was lower in the uncomplicated appendicitis cases as compared to the complicated ones (80% (66/83) vs. 95%(67/71), p = 0.003). The microorganisms isolated most frequently were: Escherichia coli (53%) (n=84); Bacteroides spp. (25%) (n=25); Propionibacterium acnes (21%) (n=21); coagulase negative Staphylococci (17%) (n=27); Enterococcus spp. (11%) (n=15), and Fusobacterium spp. (11%) (n=11). The sensitivity of E.coli to ampicillin/sulbactam was 30%. The sensitivity of Bacteroides spp. to clindamycin and ampicillin/sulbactam was 91%. All anaerobe isolates were sensitive to piperacillin/tazobactam, ertapenem, meropenem and metronidazole. Conclusions: Intraoperative cultures in acute appendicits are relevant in order to determine the local epidemiological pattern and to establish prophylactic and therapeutic antibiotics for this pathology; direct inoculation in blood culture bottles allows a high recovery of microorganisms.

A comparative study of serum ascitic fluid albumin gradient with ascitic fluid total protein in evaluating the etiology of ascites

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.

Study on Ascitic Fluid Culture and Antimicrobial Sensitivity Profile in Cirrhotic Patients admitted in a Medical College Hospital

Background: Spontaneous bacterial peritonitis is a fatal complication of liver cirrhosis. Ascitic fluid culture is positive in half of the cases. Materials and methods: The present cross-sectional study was conducted upon the patients admitted in Medicine ward of VIMS, Pawapuri. Bacterial examination of ascitic fluid, culture and antibiotic sensitivity was done. Results: 47.2% of SBP cases were culture positive. E. coli (46.2%), Klebsiella (26.9%), Acinetobacter (7.7%) and Pseudomonas aeruginosa (3.8%) were the common organisms isolated. Conclusion: As half of SBP cases have positive culture, ascitic fluid culture and antibiotic sensitivity testing is essential in such cases.

Infección severa por Strongyloides stercoralis en líquido ascítico / Severe infection by Strongyloides stercoralis in ascitic liquid

La estrongiloidiosis es una infección cuyos agentes responsables son Strongyloides stercoralis y S. fuelleborni. Estos nematodos son de localización intestinal, el factor de riesgo principal es el andar descalzo en lugares contaminados con las larvas filariformes. El estudio presenta a un paciente varón de 23 años de edad, residente de San Juan de Lurigancho, presentó 14 meses de enfermedad con signos de meteorismo, náuseas, vómitos y permaneció afebril, se indica también que 28 días antes presentó dolor del epigastrio irradiado a la espalda de duración constante. Al examen físico se encontró un abdomen distendido, blando timpánico doloroso a la palpación, el informe de ecografía abdominal evidenció dilatación de las asas intestinales, meteorismo, con presencia abundante de líquido libre en la cavidad abdominal (ascitis) y en los exámenes parasitológicos del líquido se observó larvas rabditoides L1, L2 y filariformes L3 de Strongyloides stercoralis; por lo que recibió tratamiento con Ivermectina, obteniéndose la recuperación del paciente.

The strongyloidiasis is an infection whose responsible agents are Strongyloides stercoralis and S. fuelleborni. These nematodes have an intestinal location; the main risk factor is to be barefoot in places contaminated with filariform larvae. The study presents a male 23-year-old resident of San Juan de Lurigancho, with 14 months of illness with signs of bloating, nausea, vomiting and wasafebrile,also indicates that 28 days before he had epigastric pain irradiated to the back. On physical examination a distended abdomen was found, soft painful tympanic tenderness, the abdominal ultrasonography showed dilated bowel loops, bloat, with abundant presence of free fluid in the abdominal cavity (ascites) and parasitological examinations observed, rabditoides larvae L1 and L2 and filariform L3 of Strongyloides stercoralis. He received Ivermectin, obtaining the patient's recovery.

Cytological And Analytical Study Of Pleural, Ascitic & Pericardial Effusions : One Year Study At Tertiary Care Hospital In Western Maharashtra.

Background :Cytological analyses of body effusions plays an important role in the diagnosis of various lesions. Material & Methods : A retrospective study for one year duration from Jan 2016 to Dec 2016 was undertaken in the Department of Pathology. It includes all samples of pleural, ascitic & pericardial fluid received in cytology section. Results : Cytological analysis was done on all 284 cases of effusion fluids. Pleural fluid was the most common type of fluid received followed by ascitic & pericardial fluids. Maximum number of cases were transudates in nature. 257 cases were non neoplastic & 27 were neoplastic. Adenocarcinoma was the most common morphological pattern. Conclusion : Cytological study of body fluids is an inexpensive & simple procedure, useful in studying the etiology, course of disease and also to monitor the response to the therapy

Study the usefulness of ascitic fluid cholesterol level in diagnosis of malignant related ascites

Background: Dengue fever is currently the most important arthropod borne viral disease. Since occurrence of dengue infections has been an epidemic in many parts of India and complications like DHF and DSS are increasing, while at the same time the diagnosis is challenging, particularly the laboratory diagnosis is confusing, this study was conducted to evaluate the different laboratory test methods and to compare their respective efficacy, timing, advantages and disadvantages.Methods: This study was done in the Department of Microbiology in collaboration with the Department of Medicine and Pediatrics in two tertiary care medical colleges and hospitals in eastern India. Blood samples from 319 patients with clinical features suggestive of Dengue fever were included in this study. Laboratory investigations were done which included immunological assays that were performed using commercially available kits - SD dengue duo NS1Ag + Ab combo rapid test, NS1 Ag capture ELISA, IgM capture ELISA, IgG capture ELISA test for dengue and other routine tests -full blood cell count, coagulation tests, routine biochemical and lipid profile were also done. Ethical considerations were taken care of and statistical evaluations were done.Results: An increased detection of IgM antibody (46.15%) was seen in the early febrile period (1-5 days) as compared to the mid-febrile period (6-10 days), and late febrile period (6-10 days) when it is 6.89%. IgG antibody is much less in early febrile period (4.16%). Compared to mid-febrile period (24.13%), and late febrile period (62.5%). IgM antibodies were detected in 44.5% of the samples, IgG antibodies were detected in 43.5% of the samples, Rapid test was positive in 36.9% and NS1AG ELISA was detected in 43.5% of the samples in the study.Conclusions: It can be inferred from our study that for detection of dengue in the early febrile period (1-5 days), estimation of dengue-specific serum IgM is the most sensitive antibody detection method.

Apendicitis perforada, ¿lavar o no lavar la cavidad peritoneal? / Perforated appendicitis, peritoneal lavage versus non-lavage?

Introducción. El tratamiento adecuado de la cavidad peritoneal en la peritonitis secundaria constituye una preocupación permanente de los cirujanos y es primordial en el manejo integral del paciente. Objetivo. Evaluar los resultados de lavar la cavidad abdominal frente al secado peritoneal en los casos de peritonitis secundaria, por apendicitis aguda perforada. Material y métodos. Estudio observacional retrospectivo en el Servicio de Cirugía General del Hospital de Especialidades Carlos Andrade Marín, período enero 2016 a diciembre 2017. Se incluyeron 301 historias clínicas de pacientes con diagnóstico de apendicitis aguda perforada. El objetivo principal del estudio fue evaluar las complicaciones presentadas con cada uno de los procedimientos quirúrgicos empleados. Resultados. Los registros de 301 pacientes, 212 (70,4%) sometidos a lavado peritoneal y 89 (29,6%) a secado del peritoneo. La frecuencia de complicaciones entre los grupos estudiados fue similar, no hubo diferencias significativas. La única variable significativa fue el tiempo operatorio (OR 1,01, p<0,005). Conclusiones. No se encontraron diferencias significativas con el tipo de manejo de cavidad en pacientes con peritonitis secundaria a apendicitis aguda perforada (lavado versus secado de cavidad) en cuanto a complicaciones posoperatorias. El lavado peritoneal requirió un tiempo quirúrgico mayor al secado de la cavidad.

Introduction. The adequate treatment of the peritoneal cavity in peritonitis is a primary concern in the comprehensive management of the patient. Objective. To compare the results of thoroughly washing the peritoneal cavity vs simply just drying the peritoneal cavity in cases of secondary peritonitis due to acute perforated appendicitis. Materials and methods. A retrospective observational study was carried out in the General Surgery Department at Carlos Andrade Marín Specialties Hospital, from January 2016 until December 2017. The study main end-point was assessing the postoperative complication between peritoneal lavage versus cavity drying. Results. The records of 301 patients, 212 (70.4%) who underwent peritoneal lavage and 89 (29.6%) with just drying the peritoneum. The frequency of complications between both groups did not reach statistical significance. The only significant variable was the operative time (OR 1.01, p<0.005). Conclusions. No statistically significant differences were found with the type of cavity management in patients with peritonitis secondary to perforated appendicitis (lavage versus cavity drying). Peritoneal lavage required more time than cavity drying.

Evaluation of pleural and ascitic fluid analysis on the Sysmex XE-5000 hematology analyzer / Avaliação da análise dos líquidos pleural e ascítico no analisador hematológico Sysmex XE-5000

ABSTRACT Introduction: Body fluid (BF) analysis is critical to the diagnosis and monitoring of several pathological conditions. The limitations of manual cell counts have led to greater interest in the development of automated BF analysis. Objective: To evaluate the analytical performance of the Sysmex XE-5000 hematology analyzer in the analysis of pleural and ascitic fluids in the laboratory routine of a large university hospital. Methods: A total of 56 samples (35 ascitic and 21 pleural fluids) were analyzed by manual optical microscopy (OM) and XE-5000. Analytical performance includes linearity, carryover, functional sensitivity and comparison of patient samples. Results: Performance studies showed linearity up to 25,825 WBC-BF/µl (r2 = 0.999), WBC-BF showed carryover of 0.18%, and the lower limit of quantitation was set at 22 WBC-BF/µl. Good correlations between the methods were observed just for total cell (TC-BF) and white blood cell (WBC-BF) counts in pleural and ascitic fluids. The high-fluorescence cell count (HF-BF) showed poor correlation but high positive predictive value (PPV) for both fluids (94.74% for pleural and 96.97% for ascitic fluid). Conclusion: XE-5000 provides accurate and precise count for TC-BF, WBC-BF and polymorphonuclear cells (PMN-BF) in pleural and ascitic fluids in medical decision levels, but the morphological differentiation should continue to be held by OM. Histogram and scattergram displayed on XE-5000 must always be analyzed to assess if there is any interference or flag. The HF-BF parameter is a potential tool for screening.

RESUMO Introdução: A análise de líquidos corporais é fundamental para o diagnóstico e o acompanhamento de várias condições patológicas. Devido às limitações da contagem manual de células, tem ocorrido maior interesse no desenvolvimento da análise automatizada de líquidos corporais. Objetivo: Verificar o desempenho analítico do analisador hematológico Sysmex XE-5000 na análise de fluidos pleurais e ascíticos na rotina laboratorial de um hospital universitário de grande porte. Métodos: Um total de 56 amostras (35 de líquidos ascíticos e 21 de líquidos pleurais) foi analisado por microscopia ótica manual (MOM) e pelo XE-5000. O estudo de verificação incluiu linearidade, carryover, limite de quantificação e comparação de amostras de pacientes. Resultados: O estudo de verificação mostrou linearidade de até 25.825 WBC-BF/ml (r2 = 0,999); WBC-BF, carryover de 0,18%; e o menor limite de quantificação foi fixado em 22 WBC-BF/ml. Boas correlações entre o método manual e o automatizado foram observadas apenas para as contagens de total de células nucleadas (TC-BF) e glóbulos brancos (WBC-BF) em líquidos pleurais e ascíticos. A contagem de células de alta fluorescência (HF-BF) mostrou correlação fraca, porém valor preditivo positivo (VPP) elevado para ambos os líquidos corporais (94,74% pleural; 96,97% ascítico). Conclusão: O XE-5000 fornece contagem confiável para TC-BF, WBC-BF e células polimorfonucleares (PMN-BF) em fluidos pleurais e ascíticos em níveis de decisão médica, contudo a diferenciação morfológica deve continuar a ser realizada por MOM. O histograma e o diagrama de dispersão exibidos no XE-5000 devem ser sempre avaliados quanto à existência de qualquer interferência ou alerta suspeito. A contagem de HF-BF constitui uma potencial ferramenta para triagem.

Study of Ascitic Fluid by Liquid Based Cytology and Its Comparision with Conventional Cytosmears and Cell Block Preprations.

Background: Ascites refers to increased volume of fluid collecting within peritoneal cavity which becomes clinically detectable when atleast 500 ml has accumulated. Cytological examination of ascitic fluid gives information about inflammatory and noninflammatory lesions including malignancies, which is done by conventional cytosmears, SurePath liquid based cytological smears and cell block preparations. Aims: The aim of our study was to study the different causes of ascites and their comparison on liquid based cytology with conventional cytology and cell blocks. Methods: Ascitic fluid was obtained from 75 patients of either sex. Microscopic examined was carried out by SurePath liquid based cytology, conventional fixed sediment smears, and cell blocks. Results: Observations were categorised into inflammatory, malignant and inconclusive. Out of 75 cases examined by conventional smears, cytological diagnosis of inflammatory or benign was rendered in 45(60%), 7(9.3%) were diagnosed as malignant and 5(6.7%) were given suspicious of malignancy and 18(24%) were inconclusive. By liquid based cytology 53(70.7%) were rendered inflammatory or benign, 12 (16%) as malignant, 2(2.7%) as suspicious of malignancy and 8(10.7%) were rendered inconclusive. By cell block methodology 52(69.3%) were rendered inflammatory or benign, 11(14.7%) as malignant and 12(16%) as inconclusive. Statistical analysis: Revealed that liquid based cytology was most sensitive (85.71%) and accurate (97.33%) method for analysis of ascitic fluid and conventional smears were least sensitive (50%) and accurate (90.67%). Conclusion: Liquid based cytology showed more sensitivity and accuracy than conventional cytosmears and cell block methods in diagnosing malignant lesions.

EVALUATION OF LEUKOCYTE ESTERASE REAGENT STRIPS TEST IN THE DIAGNOSIS OF SPONTANEOUS BACTERIAL PERITONITIS IN CHILDREN WITH CIRRHOSIS / Avaliação de tiras reagentes de teste de esterase de leucócitos no diagnóstico de peritonite bacteriana espontânea em crianças com cirrose

BackgroundSpontaneous bacterial peritonitis is defined as an ascetic fluid infection without an evident intra-abdominal surgically treatable source. Spontaneous bacterial peritonitis is one of the severe complications in patients with cirrhosis and ascites. Without early antibiotic treatment, this complication is associated with high mortality rate; therefore, early diagnosis and treatment of spontaneous bacterial peritonitis is necessary for survival. Leukocyte esterase reagent can rapidly diagnose the spontaneous bacterial peritonitis.ObjectiveThis study aimed to find out the diagnostic accuracy of leukocyte esterase dipstick test for the diagnosis of spontaneous bacterial peritonitis.MethodsA single centered hospital-based cross-sectional study was conducted during July 2013 to August 2014 on children with cirrhotic liver disease and ascites who were admitted in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated to Shiraz University of Medical Sciences (Iran). All patients underwent abdominal paracentesis, and the ascitic fluid was processed for cell count, leukocyte esterase reagent strip test (Combiscreen SL10) and culture. Spontaneous bacterial peritonitis was defined as having a polymorphonuclear count (PMN ≥250/m3) in ascitic fluid. Sensitivity, specificity, positive predictive value and negative predictive value of leukocyte esterase test were calculated according to the formula.ResultsTotally, 150 ascitic fluid sample of cirrhotic male patients (53.2%) and their mean age (4.33±1.88 years) were analyzed. Biliary atresia (n=44, 29.4%) and idiopathic neonatal hepatitis (n=29, 19.3%) were the most frequent etiology of cirrhosis. Also, abdominal pain (68.6%) and distension (64%) were the most common presenting complaint. Of all cases, 41patients (27.35%) were diagnosed to have spontaneous bacterial peritonitis (PMN ≥250/mm3). Sensitivity and specificity of leukocyte esterase reagent test according to PMNs ≥250mm3 were 87.80% and 91.74%, also on ascitic fluid culture results were 88.23% and 77.44%. Positive predictive value and negative predictive value of this test in PMNs ≥250mm3 were 80% and 95.23% and in cases with positive culture 33.33% and 98.09% were obtained, respectively. Efficiency of leukocyte esterase reagent test in diagnosing spontaneous bacterial peritonitis, according to PMNs ≥250mm3 and culture results were 90.66% and 78.66%.ConclusionThe leukocyte esterase strip test may be used as rapid test for diagnosis of spontaneous bacterial peritonitis due to its high diagnostic validity.

ContextoA peritonite bacteriana espontânea é definida como uma infecção do fluido ascítico sem evidente origem intra-abdominal cirurgicamente tratável. A peritonite bacteriana espontânea é uma das complicações graves em pacientes com cirrose e ascite. Sem tratamento antibiótico precoce, esta complicação é associada com alta taxa de mortalidade. Portanto, o diagnóstico precoce e tratamento de peritonite bacteriana espontânea são necessários para a sobrevivência. O reagente de esterase de leucócitos pode rapidamente diagnosticar a peritonite bacteriana espontânea.ObjetivoEste estudo teve como objetivo descobrir a acurácia diagnóstica do teste com tiras de esterase de leucócitos para o diagnóstico de peritonite bacteriana espontânea.MétodosUm estudo transversal hospitalar unicêntrico foi realizado entre julho de 2013 e agosto de 2014 em crianças com cirrose hepática e ascite que foram admitidas no Departamento de Gastroenterologia Pediátrica no Hospital de Nemazee afiliado à Universidade de Ciencias Médicas de Shiraz (Irã). Todos os pacientes foram submetidos a paracentese abdominal, e o líquido ascítico foi processado para contagem de células, teste de tira de reagente de esterase de leucócitos (Combiscreen SL10) e cultura. Peritonite bacteriana espontânea foi definida como tendo uma contagem de polimorfonucleares (PMN ≥250/m3) no líquido ascítico. Sensibilidade, especificidade, valor preditivo positivo negativo do teste de esterase de leucócitos foram calculados de acordo com a fórmula.ResultadosForam analisados um total de 150 amostras de líquido ascítico de pacientes cirróticos; (53,2%) eram do sexo masculino e sua média de idade (4,33±1,88 anos). A atresia biliar (n=44, 29,4%) e hepatite neonatal idiopática (n=29, 19,3%) foram as etiologias mais frequentes de cirrose. Além disso, dor abdominal (68,6%) e distensão (64%) foram as queixas mais comuns de apresentação. De todos os casos, 41 (27,35%) foram diagnosticados com peritonite bacteriana espontânea (PMN ≥250/mm3). A sensibilidade e especificidade do teste de reagente de esterase de leucócitos segundo PMN ≥250mm3 foi de 87,80% e 91,74% e, para os resultados de cultura de líquido ascítico, de 88,23% e 77,44%. Valor preditivo positivo e valor preditivo negativo do teste em PMN ≥250mm3 foi de 80% e 95,23% e em casos com cultura positiva 33,33% e 98,09%, respectivamente. A eficiência do teste de reagente esterase de leucócitos no diagnóstico de peritonite bacteriana espontânea, de acordo com resultados de ≥250mm3 e cultura PMN, foi de 90,66% e 78,66%.ConclusãoO teste de tiras de esterase de leucócitos pode ser usado como um teste rápido para diagnóstico de peritonite bacteriana espontânea, devido a sua alta validade diagnóstica.

The combination of flow cytometry and automated cell image analyzer in determining the nature of ascites and pleural effusion nature / 中华检验医学杂志

Objective To explore the clinical value of flow cytometry( FCM) and DNA automated cell image analyzer ( AICM) in determine the character of ascites and pleural effusion.Methods This was a cross-sectional study.203 ascites and pleural effusionsamples were random selected from PLA hospital inpatients between August 2013 to June 2014 .The DNA content of sediment cells were detectedthrough the FCM and AICM respectively benign and malignant disease were differentiated according the counts and proportion of aneuploid cells.The sensitivity, specificitywere calculated byROC curves.Results The sensitivity, specificity and accuracy of flow cytometry cell in detectingtumor cells were 78.6%,80.0% and 79.2%%, while the sensitivity, specificity and accuracy of image analyzer were 83.5%,78.6% and 81. 3%respectively.When FCM and AICMwere combined ,the sensitivity, specificity and accuracyincreased to 92.2%, 86.3% and 89.6%.Conclusions Compared toconventional cytology test, the sensitivity and specificity were significantly high when the two methods were combined .Therefore, the combination method can be used to assist in clinical identification of the nature of ascites and pleural effusion and to help the diagnosis of disease.

Clinical and laboratorial features of spontaneous bacterial peritonitis in southern Brazil / Características clínicas e laboratoriais da peritonite bacteriana espontânea no sul do Brasil

CONTEXT AND OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a severe complication that occurs in 8-27% of hospitalized patients with liver cirrhosis and ascites, with high mortality rates. This study aimed to identify the clinical characteristics associated with SBP. DESIGN AND SETTING: Cross-sectional study, conducted in a public university. METHODS: The study consecutively included individuals with liver cirrhosis and ascites between September 2009 and March 2012. Forty-five patients were included: mean age 53.2 ± 12.3 years, 82.2% male, 73.8% Caucasian, mean Model of End-stage Liver Disease (MELD) score of 19.5 ± 7.2, and 33.3% with SBP. The subjects were divided into two groups: SBP and controls. RESULTS: Comparison between individuals with SBP and controls showed that those with SBP had lower mean prothrombin activity time (36.1 ± 16.0% versus 47.1 ± 17.2%; P = 0.044) and lower median serum-ascites albumin gradient (SAAG) (1.2 versus 1.7, P = 0.045). There was a tendency towards higher mean MELD in the SBP group, not significant (22.2 ± 7.6 versus 17.9 ± 6.7; P = 0.067). There was a strong positive correlation between the neutrophil count in ascitic fluid and serum leukocyte count (r = 0.501; P = 0.001) and a negative correlation between the neutrophil count in ascitic fluid with prothrombin activity time (r = -0.385; P = 0.011). CONCLUSION: A few characteristics are associated with the presence of SBP, especially liver dysfunction, SAAG and peripheral leukocytosis. .

CONTEXTO E OBJETIVO: Peritonite bacteriana espontânea (PBE) é uma complicação grave que ocorre em 8-27% dos pacientes hospitalizados com cirrose hepática e ascite, e apresenta altas taxas de mortalidade. O objetivo deste estudo é identificar as características clínicas associadas à PBE. TIPO DE ESTUDO E LOCAL: Estudo transversal, conduzido em uma universidade pública. MÉTODOS: O estudo incluiu, consecutivamente, indivíduos com cirrose hepática e ascite entre setembro 2009 e março 2012. Foram incluídos 45 indivíduos com média de idade de 53,2 ± 12,3 anos, sendo 82,2% homens, 73,8% brancos, com MELD (Modelo para Doença Hepática Terminal) de 19,5 ± 7,2, e 33,3% com PBE. Os indivíduos foram divididos em dois grupos: PBE e controles. RESULTADOS: Quando se compararam os indivíduos com PBE aos controles, observou-se menor média de tempo de atividade da protrombina (TAP; 36,1 ± 16,0% versus 47,1 ± 17,2%; P = 0,044) e menor mediana de gradiente albumina soro-ascite (GASA; 1,2 versus 1,7; P = 0,045). Houve tendência do grupo com PBE de apresentar maior média de MELD, sem significância estatística (22,2 ± 7,6 versus 17,9 ± 6,7; P = 0,067). Foi observada forte correlação positiva entre neutrófilos do líquido ascítico e contagem sérica de leucócitos (r = 0,501; P = 0,001) e correlação negativa de neutrófilos do líquido ascítico com TAP (r = -0,385; P = 0,011). CONCLUSÃO: Poucas características estão associadas à presença de PBE, em especial a disfunção hepática, o GASA e a leucocitose periférica. .

Eficacia de la gradiente de albúmina sangre-ascitis y los análisis de proteínas en líquido ascítico en el diagnóstico de ascitis hipertensiva portal: accuracy of the serum-ascites albumin gradient and protein analises in ascitic fluid / Diagnostic of ascites due to portal hypertension

Objetivo: Evaluar la exactitud diagnóstica de la gradiente albúmina sangre/ascitis (GASA), proteínas totales en líquido ascítico (PTLA), albúmina en líquido ascítico (CAA) e índice de proteínas ascitis/suero (IPAS) para el diagnóstico de ascitis por hipertensión portal. Materiales y métodos: Se realizó un estudio, observacional, retrospectivo, de validez de pruebas diagnósticas. La población estudiada fueron pacientes mayores de 15 años con diagnóstico de ascitis a los cuales se les tomó una muestra para estudio del líquido ascítico mediante la técnica estándar de paracentesis, analizando proteínas totales y albúmina, además de estudio de proteínas totales y albúmina en sangre en el Hospital de Salud Pública Nacional Daniel Alcides Carrión del Callao, Perú (HNDCA), durante el periodo de enero a diciembre del 2012. Se obtuvo la exactitud diagnóstica, sensibilidad, especificidad, VPP y VPN de la gradiente albumina sangre/ascitis (GASA), proteínas totales en líquido ascítico (PTLA), albúmina en líquido ascítico (CAA) e índice de proteínas ascitis/suero (IPAS) para el diagnóstico de ascitis por hipertensión portal o no HTP. Para determinar ascitis por HTP según las pruebas diagnósticas se tomo en cuentas: GASA≥1,1, PTLA<2,5, CAA<1,1 o IPAS<0,5. Resultados: se obtuvieron 126 pacientes con diagnóstico de ascitis a los cuales se excluyó 10 pacientes por tener datos incompletos. De los 116 pacientes finales la edad promedio fue de 53,03 ± 15,73 años, pacientes de sexo masculino fueron 65 (56%) y femenino 51 (44%). Se encontró 61 (52%) líquidos ascíticos debido a HTP por cirrosis hepática, y 55 (48%) de ascitis por NO HTP. La sensibilidad y especificidad para el GASA fue de 93% y 47% respectivamente, para PTLA fue de 80% y 89% respectivamente, para CAA fue de 85% y 87% respectivamente y para el IPAS fue de 83% y 80% respectivamente. El área bajo la curva ROC para el GASA fue de 0,70, de las PTLA fue de 0,84, del IPAS fue de 0,81 y de la CAA fue de 0,86; encontrándose diferencia estadísticamente significativa entre el GASA comparado con los otros tres parámetros (p<0,01). Conclusión: La exactitud diagnóstica de la CAA, PTLA y IPAS es superior a la del GASA para discriminar entre ascitis por HTP o NO HTP, por lo que podrían ser usados en la práctica clínica de forma aislada, o en conjunto para lograr una aproximación diagnóstica más acertada.

Objective: To evaluate the diagnostic accuracy of the Serum-Ascites Albumin Gradient (GASA), Protein Concentration in the Ascitic Fluid (PTLA), Albumin Concentration in the ascitic fluid (CAA) and the Protein Ascites/Serum Ratio (IPAS) for the diagnosis of ascites due to portal hypertension. Materials and methods: it was an observational and retrospective study of validation of diagnostic tests. The study population was patients from a National Public Health Hospital Daniel Alcides Carrion of Callao, Peru, during the period January to December of 2012, patients over 15 years old with a diagnosis of ascites which samples were taken for study by paracentesis with an standard technique, it was analyzed total protein and albumin, as well as study of total protein and albumin in blood. We obtained the diagnostic accuracy, sensitivity, specificity, PPV and NPV of the Serum-Ascites Albumin Gradient (GASA), Protein Concentration in the Ascitic Fluid (PTLA), Albumin Concentration in the ascitic fluid (CAA) and the Protein Ascites/Serum Ratio (IPAS) for the diagnosis of ascites due to portal hypertension. To determine ascites by HTP as diagnostic tests we took into account: GASA ≥ 1.1, PTLA <2.5, CAA <1.1 or IPAS< 0.5. Results: There were 126 patients diagnosed with ascites, 10 patients was excluded for having incomplete data. Of the 116 patients, the average age was 53.03 +/- 15.73 years old, male 65 (56%) and female 51 (44%). 61 (52%) had ascites due to portal hypertension from liver cirrhosis, and 55 (48%) of ascites due to NO HTP. The sensitivity and specificity for GASA was 93% and 47% respectively, for PTLA was 80% and 89% respectively, for CAA was 85% and 87% respectively and for the IPAS was 83% and 80% respectively. The area under the ROC curve for GASA was 0.70, ATPL was 0.84, IPAS was 0.81 and CAA was 0.86, we found statistically significant differences between GASA compared to the other three parameters (p<0.01 ). Conclusion: The diagnostic accuracy of CAA, ATPL and IPAS is higher than the GASA to discriminate between ascites due to HTP or NO HTP, so that they could be used in clinical practice alone or together to achieve a diagnostic approach more successful.