Interferon gamma release assays [IGRA] in the diagnosis of active pulmonary tuberculosis

Tuberculosis is one of the deadliest diseases over the world. Diagnosis of pulmonary- TB depends on combination various parameters. IGRA measure T cell release of IFN-gamma in response to M.TB antigen. WHO policy statement on IGRA use in low and middle countries is not established yet. The present study aimed to compare between tuberculin skin test [TST] and interferon gamma release assay [IGRA] in the diagnosis of active tuberculosis infection and study the effect of 3 months of first line of anti-TB therapy on the positivity of the IGRA test. 40 Egyptian patients were included in the study, and assigned as two groups; Group I comprised 20 patients with negative sputum for AFB by Ziehl-Neelsen stains with positive sputum culture for M.TB and Group II [IIa and lIb] that included 20 patients with positive sputum and Ziehl-Neelsen for AFB before and after 3 months of first line of anti-TB therapy. All patients were subjected to full history taking, clinical examination, X- ray chest, lab investigations, ESR measurements, microbiological tests and EL1SA measurement of Quantiferon-TB Gold. Lower significant values were found in group IIb than group IIa as regarding clinical parameters and 1[st] and 2[nd] hours ESR. IGRA test and TST showed sensitivity [91.18%, 76.4%], specificity [83.33%, 66.67%], positive predictive value [96.88%, 92.86%], negative predictive value [62.5%, 33.3%] and accuracy of [90%, 75%] respectively. IGRA results had no statistical significant differences between the studied groups with poor agreement with TST [[k]= 0.025].1GRAS test had high sensitivity' and specificity in diagnosis of active TB. More studies are needed to evaluate the effect of anti-TB therapy on IGRA level

value of use of amino-terminal brain naturitic peptide as marker in cases of pleural effusion of different etiologies

Background: The criteria of Light et al. have been used to make the differentiation between transudate and exudate effusion for the past 25 years. The main problem with those criteria is that although they identify nearly all exudates correctly, they misidentify about 20-25% of transudates as exudates. The plasma NT-proBNP level is a sensitive marker of cardiac dysfunction and has proved to be a useful tool for the identification and management of systolic and diastolic cardiac dysfunction

Objective: The aim of this work was to study the value of pleural NT-pro brain natriuretic peptide in the diagnosis of pleural effusion of different causes in comparison to the conventional diagnostic procedures in cases of pleural effusion

Subjects and methods: The present study was conducted on 32 patients who suffered from pleural effusion, they were classified according to Light's criteria into two groups namely transudate, exudate, and the third group of 10 normal healthy subjects as control group

Results: The levels of both serum and pleural fluid pro-BNP in group I patients with transudate effusion were significantly higher than group II patients with exudate effusion [P > 0.001, 0.003] respectively

Conclusion: The results support the feasibility of using the pleural fluid amino terminal proBNP measurement in thoracentesis that would enhance discrimination among the different causes of pleural effusion especially for heart failure patients. Serum and pleural fluid levels of NT-pro BNP were closely correlated and measurement of NT-pro BNP in serum showed equally good diagnostic properties

Diagnostic and therapeutic implications of hypomagnesemia in respiratory intensive care unit

The present study aimed at determining: the frequency of serum Mg2 + abnormalities in respiratory ICU patients and its possible association with other electrolyte abnormalities or ECG changes; the possible effect of commonly used drugs in ICU on serum Mg2+ level and the impact of I.V. administration of MgSO4 in hypomagnesaemic patients on the course of severe asthma or COPD [chronic obstructive pulmonary diseases]. This study included 75 Patients divided into five groups: group I stable state of a] COPD [7 patients] and b] bronchial asthma [8 patients], group II acute exacerbation a] COPD [6 patients] and b] bronchial asthma [9 patients], group III [respiratory failure under mechanical ventilation], group IV [difficult weaning] and group V [status asthmaticus]. The following parameters were assessed: serum electrolytes [Mg[2] +, Na+, K+ and Ca[2] +],ECG, respiratory functions when possible [FEVI, FVC and PEFR] and arterial blood gases [PaO2 and PaCO2]. 77.33% of studied patients were normomagnesaemic, 16% were hypomagnesaemic and 6.6% were hypermagnesaemic. The incidences of hyponatraemia, hypokalaemia and hypocalcaemia in hypomagnesaemic patients were 25%, 33.33% and 25% respectively. ECG changes seemed to be more frequent in hypomagnesemia than in normomagnesaemic patient however, these differences were statistically insignificant. beta2 -agonists, diuretics, corticosteroids and parenteral glucose were accompanied with significantly lower serum Mg[2] + level as compared to an adjusted mean of normal range. Magnesium replacement therapy significantly improved serum Mg[2] + deficiency, ECG abnormalities and arterial blood gases in 4 out of 12 hypomagnesaemic patients as compared to their baseline. On the other hand, a single infusion of 2 gm MgSO4 over 20 minutes significantly improved clinical signs and symptoms as well as PaO2 and PaCO2 in 4 patients with severe acute asthma but not in COPD as compared to their baseline measurements. [1] A 16% incidence of hypomagnesemia was found, along with other electrolyte abnormalities in the respiratory ICU patients. [2] Because of its potential negative pathophysiologic effects on cardiac and respiratory functions, serum Mg2] + determination is recommended in such patients especially in those taking beta2 -agonists, diuretics, corticosteroids and parenteral glucose. [3] Mg[2] + replacement therapy significantly improved the clinical outcome in some hypomagnesaemic patients. [4] A single I.V. infusion of MgSO4 improved clinical outcome and arterial blood gases in some severe asthmatic patients but not in COPD

Study of ventilatory, cardiovascular and metabolic effects of inhaled salbutamol, terbutaline, fenoterol and isoprenaline in stable asthmatic subjects

Forty, non smoking stable asthmatic subjects, 27 male and 13 female, were choosen to study the ventilatory, cardiovascular and metabolic effects of B2 agonists; salbutamol, terbutaline, fenoterol and isoprenaline. The drugs were administered by metered dose inhalers 400 ug [dose that asthmatic patients may use during the attack]. Measurements of heart rate, blood pressure, Q-T interval, serum Na, K, glucose and pulmonary function test [PFT[s]] were made before and 15 minutes after the inhalation. There was a significant increase in PFT[s], FVC, FEV1, FEV1/FVC, MEFR and MMFR following inhalation of bronchodilators. No difference in the bronchodilating effect of salbutamol, trebutaline, fenoterol or isoprenaline was observed. A significant increase in heart rate was found after terbutaline, fenoterol and isoprenaline inhalation with an insignificant change after inhalation of salbutamol. There was significant rise in systolic blood pressure, significant prolongation in Q.T. interval following bronchodilators inhalation with significant fall in diastolic blood pressure. Serum Na and K demonstrated significant increase and decrease respectively after bronchodilators inhalation, while blood glucose showed significant increase. From the present study, we conclude that a great attention should be paid for cardiovascular and metabolic effects of B2 agonists when taken by metered dose inhalers in recommended therapeutic dose and should be used with caution in patients prone to cardiovascular disorders, hypokalaemia and/or diabetes mellitus

Effect of passive smoking on pulmonary functions in children

The effect of passive smoking on static lung volume, flow rates and arterial blood gases [ABG] have been studied in 50 healthy children whose age ranged between 5-10 years and the results were compared with those of 20 controls. Subjective reaction to cigarette smoke inhalation included: 405 suffered from eye irritation and lacrimation, 22% from sneezing and cough and 30% of headache and dizziness. In passive smoker children, FVC, FFV1, MVV and FER 25-75 were 80.4%, 79.45, 79.8 and 80.7% of their predicted values respectively compared to 97.1, 96.3, 97.29 and 95.9% for the controls. The differences were statistically significant [P<0.001]. Meanwhile the mean values of T.V. FEV1/FVC% and FER 200-1200 for passive smoker were 436.8, 84.5% and 129.2 L/min respectively compared to 435.5 ml. 91.7% and 145.8 L/min for controls. The differences were statistically insignificant. Classification of children into male and female revealed that there were statistically significant difference in pulmonary function tests between male, female passive smoker and the corresponding male, female controls. Meanwhile. Passive smoker female showed lower values for FER 25-75 and FER 200- 1200 than those of male passive smoker. The differences were statistically significant. ABG analysis were within the normal range and demonstrated no significant difference between the two groups. So this cross sectional study offers evidence that passive smoking constitutes a real threat to respiratory systems of our children

Neoplasms and cysts of the mediastinum, clinical presentation, methods of diagnosis and management

This study included fifty five patients, thirty one males and twenty four females, who were admitted for mediastinal masses in Alexandria main University Hospital during the period from 1980 to 1988. Symptoms and signs were present in 60.5% of patients, such as cough in 18.2% Dyspnoea in 10%, Chest pain in 10%, superior vena canal obstruction in 7.3%, Dysphagia in 5%, and other. 42 of the presenting patients required thoracotomy for diagnosis and treatment, 9 patients were diagnosed by mediastinoscopy and mediastinotomy, the remaining cases were diagnosed by lasser procedures such as cervical lymph node biopsy in two patients, fiberoptic bronchoscopy was done in two and the remaining patient diagnosed by CT guided needle biopsy. The primary mediastinal masses included mediastinal lymphadenopathy [41.8%], mediastinal cysts [14.55%], thymic tumors [10.9%], retrosternal goitre [7.27%], carcinoma of the mediastinum [5.45%], germ cell tumors [5.45%], mesenchymal tumors [3.64%], and neurogenic tumors [7.27%]. The anterosuperior mediastinum was the most commonly involved site of mediastinal masses [65.5%], followed by the posterior mediastinum [21.8] and the middle mediastinum [10.9%]. 45.5% of the cases were treated by excision, 45.5% were treated by excision followed by radio therapy and chemotherapy and 9.1% were treated medically by antituberculous drugs and steroids