Role of fibulin-3 in the diagnosis of malignant mesothelioma

Early detection of malignant pleural mesothelioma [MPM] is critical to survival, the use of pleural or blood fibuin-3 might allow this early detection. Studying the validity of measuring serum and pleural fibulin-3 in the diagnosis of MPM. Fibulin-3 levels were measured in serum and pleural fluid by enzyme-linked immunosorbant assay [ELISA] in 45 patients with exudative pleural effusion. Patients with non-conclusive cytology or microbiological examination had undergone medical thoracosope for histopathological examination. Twenty five was diagnosed as MPM, 11 cases as pleural metastasis of carcinoma [Mets] and nine cases with benign pleural effusions. Patients with MPM had significantly higher pleural effusion and serum fibulin-3 levels than those with metastatic effusion of carcinoma or benign pleural effusion [p-value < 0.001]. Using a cut-off point of pleural fluid fibulin-3 [150 ng/ml] with AUC of 0.878 [sensitivity 72.3%, specificity 80] and at a cut-off point of serum fibulin-3 [66.5 ng/ml], with AUC of 0.776 [sensitivity 88%, specificity 81.8%], discrimination between MPM and Mets occurred. Also, using a cut-off point of pleural fluid fibulin-3 [127.5 ng/ml] with AUC of 0.909 [sensitivity 88%, specificity 77.8%], and at a cut-off point of serum fibulin-3 [18 ng/ml], with AUC of 0.931 [sensitivity 100%, specificity 77.8%], discrimination between MPM and benign pleural effusion could occur. Fibulin-3 in the serum and pleural fluid is a good biomarker in the diagnosis of MPM and in differentiation between MPM from malignant pleural metastasis other than mesothelioma and also from benign pleural effusions

Assessment of carotid artery wall in patients with OSA syndrome and the effect of CPAP on its thickness

In patients with Obstructive sleep apnea [OSA], the risks of fatal and nonfatal cardiovascular diseases and coronary artery disease are increased and measuring carotid intima-media thickness [CIMT] can assess these complications. Studying the effect of OSA syndrome in the carotid artery wall thickness as an indicator to cardiovascular complications, and the effect of CPAP on these changes. Polysomnography [PSG] was done for 45 patients; 29 patients of them proved to have OSA, and 10 obese subjects with normal PSG were included as a control group. All of them had ultrasonographic assessment of CIMT. 17 patients with OSA used CPAP overnight for 6 months and the CIMT was remeasured. 29 were diagnosed with OSA [12 severe, 9 moderate and 8 mild OSA]. There was a highly significant difference [p < 0.01] in CIMT between patient and control groups, and also between severe and mild OSA patients with non-significant difference [p > 0.05] between severe and moderate OSA. Regarding the different risk factors predispose to atherosclerosis, only factors related to OSA syndrome were correlated with CIMT. There was a highly significant reduction [p < 0.01] in CIMT after six months of CPAP usage. CIMT as a marker of atherosclerosis is significantly increased in patients with OSA and the use of CPAP in those patients is very important not only for improving sleep efficiency but also for reducing cardiovascular complications associated with OSAS

Utility of quantitative analysis of urine lipoarabinomannan in the diagnosis of tuberculosis

Urinary lipoarabinomannan [LAM] detection is a promising approach for the rapid diagnosis of active tuberculosis [TB]. To assess the diagnostic accuracy of urine LAM among TB patients either pulmonary or extra pulmonary. This study was carried out on 85 cases [46 male and 39 female] with active tubercular infection divided into three groups; pulmonary [n = 40], extra pulmonary [n = 30] and disseminated tuberculosis [n = 15]. Twenty-five normal individuals were included as the control group. LAM level was measured in urine by enzyme-linked immunosorbant assay [ELISA]. TB Patients with disseminated disease had a higher urine LAM level [1.75 +/- 1.65 ng/ ml] than that for patients with pulmonary [0.58 +/- 0.53 ng/ml] or extra pulmonary TB [0.17 +/- 0.1 Ing/ml] [P < 0.001]. Patients with smear positive specimens had a higher urine LAM level [0.63 +/- 0.54 ng/ml] than that of smear negative [0.040 +/- 0.06 ng/ml] [P < 0.001]. Quantitative urine LAM test results positively correlate with the degree of bacillary burden. Advanced age, immunosuppressant state and advanced radiological lesion were significant factors that were associated with higher quantitative urine LAM [P < 0.05]. Urine LAM test is a simple, rapid, and reliable diagnostic modality for active pulmonary or extra pulmonary tuberculosis. Quantitative LAM detection results increasedprogressively with bacillary burden and immunosuppression. Patients with disseminated TB are target populations for urine LAM detection

Clinical probability of pulmonary embolism: comparison of different scoring systems

Pulmonary embolism is one of the greatest diagnostic challenges in emergency medicine and clinical probability assessment is a fundamental step in its diagnosis. To evaluate the role of estimating clinical probability of pulmonary embolism and to compare between different pre-test probability scoring systems as regards their sensitivity and specificity. We used seven scoring systems [original Geneva score, revised Geneva score, simplified Geneva score, Wells score, simplified Wells score, simplified Charlotte rule, Pisa model] to assess the clinical probability of PE in 41 patients with suspected pulmonary embolism for whom the final diagnosis was based on multislice CT pulmonary angiography [CTPA]. Twenty-four patients [58.5%] had pulmonary embolism. The scores with the strongest correlation with the result of CTPA were the Pisa model [P 6

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. The diagnosis of TB is difficult in patients who cannot produce sputum spontaneously. This study aimed to compare between sputum induction using nebulized hypertonic saline, and fiberoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. Thirty suspected pulmonary tuberculosis cases were subjected to: 1-Tuberculin skin test. 2-Sample collection: a. Three successive spontaneous morning sputum samples, b. Sputum induction for 3 successive mornings c. Fiberoptic bronchoscopy with bronchial washing, brushing and Post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on Lowenstein-Jensen [L.J] medium. According to L J cultures there were 25[83.3%] positive bronchial wash samples VS 22[73.3%] induced sputum samples. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant .The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. To compare between sputum induction using nebulized hypertonic saline, and fibreoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. 30 patients were subjected to: 1-Tuberculin skin test. 2-Microbiological examination of: a. Three successive spontaneous morning samples, b. Sputum induction for 3 successive mornings c. Fibreoptic bronchoscopy with Bronchial washing, brushing and post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on L.J medium. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant. The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB. There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures