Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion

Noninvasive diagnosis of pleural tuberculosis [TB] remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis [MTB]-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information. Evaluation of pleural fluid interferon [INF]-gamma levels vs Quantiferon -TB Gold In tube assay [QFT- IT] in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB. Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-gamma assays. Ex vivo pleural fluid INF-gamma levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy. The final clinical diagnosis was TB in 20 [53%], malignancy in 10 [26%], and effusion due to other causes in eight patients [21%]. Ex vivo pleural fluid INF-gamma levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid [70 and 78% sensitivity, with 60 and 83% specificity, respectively]. QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay. The ex vivo pleural fluid INF-gamma level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-gamma in the diagnosis of pleural TB

Evaluation of recently validated non- invasive formula using basic lung functions as new screening tool for pulmonary hypertension in idiopathic pulmonary fibrosis patients

A prediction formula for mean pulmonary artery pressure [MPAP] using standard lung function measurement has been recently validated to screen for pulmonary hypertension [PH] in idiopathic pulmonary fibrosis [IPF] patients. To test the usefulness of this formula as a new non invasive screening tool for PH in IPF patients. Also, to study its correlation with patients' clinical data, pulmonary function tests, arterial blood gases [ABGs] and other commonly used screening methods for PH including electrocardiogram [EGG], chest X ray [CXR], trans-thoracic echocardiography [TTE] and computerized tomography pulmonary angiography [CTPA]. Cross-sectional study of 37 IPF patients from tertiary hospital. The accuracy of MPAP estimation was assessed by examining the correlation between the predicted MPAP using the formula and PH diagnosed by other screening tools and patients' clinical signs of PH. There was no statistically significant difference in the prediction of PH using cut off point of 21 or 25 mm Hg [P= 0.24]. The formula-predicted MPAP greater than 25mm Hg strongly correlated in the expected direction with O[2] saturation [r = -0.95, P < 0.000], partial arterial O[2] tension [r = -0.71, P < 0.000], right ventricular systolic pressure measured by TTE [r = 0.6, P < 0.000] and hilar width on CXR [r = 0.31, P = 0.03]. Chest symptoms, EGG and CTPA signs of PH poorly correlated with the same formula [P > 0.05]. The prediction formula for MPAP using standard lung function measurements is a simple non invasive tool that can be used as TTE to screen for PH in IPF patients and select those who need right heart catheterization

Respiratory symptoms and pulmonary functions in patients with chronic hepatitis C infection

Extra-hepatic manifestations of hepatitis C virus [HCV] infection are common. The interaction between chronic hepatitis C virus [HCV] infection and chest diseases is of considerable interest. Chronic hepatitis C viral infection has been incriminated as an aetiological agent that increases the risk for development of COPD and idiopathic pulmonary fibrosis. This prospective study was designed to determine chest symptoms and the effects of chronic hepatitis C virus [HCV] infection non lung functions in two groups of patients. Design: Prospective observational study. Setting: Assiut University Hospital. Patients: Fifty-two patients with chronic hepatitis C vieral infection [group 1, 35 HCV-positive patients with liver cirrhosis; group 2, 17 HCV-positive patients without liver cirrhosis]. The most common reported chest symptom among either group was dysnea [52.29%] for group 1, and [29.41%] for group 2. Arterial blood gases [ABGs] results were pH of 7.39 +/- 0.4 for group 1 and 7.38 +/- 0.3 for group 2, partial arterial tension of carbon dioxide [PaCO[2]] of 37.9 +/- 7.19 mm Hg for group 1 and 43.07 +/- 5.39 for group 2, partial arterial tension of oxygen [PaO[2]] of 87.0 +/- 9.58 mm Hg for group 1 and 89.12 +/- 8.5 for group 2, arterial O[2] Sat of 96.1 +/- 2.2 for group 1 and 96.85 +/- 1.39 for group 2, and alveolar-arterial gradient of 22 +/- 11 mm Hg for group 1 and 13 +/- 1.2 for group 2. Despite higher impairment of ABGs levels among group 1, this was statistically not significant for all parameters [P > 0.05]. Eight patients [15.4%], 5 in group 1 and 3 in group 2 had pulmonary function tests parameters that were within normal range, 9.6% had obstructive airway disease, 51.9% had restrictive lung impairment, 15.4% had combined obstructive and restrictive dysfunction and 7.7% had small airway obstruction. Restrictive lung impairment was significantly the commonest type of pulmonary dysfunction [P <0.05]. Various pulmonary function test abnormalities did not lead to significant differences in arterial blood gases. Our findings suggest that pulmonary changes were frequent in patients with chronic hepatitis C virus infection. The commonest form of pulmonary dysfunction is restrictive pattern. Despite the lack of much pulmonary symptoms; however, dyspnoea was the most commonly reported one

Serum immunoglobulins profile, eosinophil count in nasal secretions and blood in nasal allergy with or without bronchial asthma: relationship to bronchial hyperresponsiveness

In this study, the serum levels of IgE, IgA, IgM and IgG in two comparable groups [25 each] of patients with allergic rhinitis with or without asthma, in addition to 20 healthy matching control volunteers were compared. They were also studied for eosinophils count in nasal secretions and blood. These data has been further correlated with lung function and methacholine provocation test of the studied population. The study suggested that there is a high level of blood eosinophils in patients with nasal allergy with or without bronchial asthma. Also, patients with allergic rhinitis with or without asthma pose high serum level of immunoglobulins IgE, IgA, IgM and IgG as well as high level of eosinophils either in blood or in nasal secretions. Lastly, patients with allergic rhinitis even without clinical asthma have air flow limitation and lowPD 20 that positively correlate with blood eosinophil count in patients with concomitant rhinitis and asthma. Hence, the present study objectively demonstrates that nasal allergy and bronchial asthma frequently coexist and they appear to share key elements of pathogenesis with strong physiological and immunological inter-relationship