RESUMO
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
RESUMO
Coronary artery bypass grafting [CABG] surgery has been successfully introduced at Assiut university hospital. The purpose of this study was to encourage recommend other starting centers to do this by pass. In the initial feasibility trial 60 patients were selected to receive CABG, between January 2009 and December 2010, 55 of them underwent CABG with cardiopulmonary bypass and 5 patients were submitted to beating heart CABG. All patients were symptomatic for angina before surgery and had single or multivessel coronary artery disease. Overall the calculated preoperative risk for both groups was indicated by EUROSCORE. The patients were evaluated during operation, immediately postoperative during hospital stay by hemodynamic monitoring, serial ECGs, cardiac enzymes and echocardiography. Among 130 distal anastomoses, 55 were fashioned with single internal thoracic artery to bypass Left anterior descending artery [LAD] and 5 with radial artery to bypass left coronary branches. Saphenous vein was used in the remaining 70 anastomoses. A complete myocardial revascularization was achieved; an average of 2 grafts/patient was performed. There were two postoperative strokes [3%] and one case of renal impairment [1.7%]. Mean ICU and in patient-hospital length of stay were 3.4 +/- 2.2 and 11.9 +/- 5.8 days, respectively. Off pump coronary artery bypass grafting is an alternative method to conventional bypass grafting. As it is indicated in single vessel coronary disease, renal impairment and calcified aorta. In the overall, CABG surgery significantly had low incidence of complications resulting in a shorter ICU stay, hospital stay and lower mortality. Coronary artery bypass graft surgery in Assiut university hospital is well established technique with accepted results. The doctors at the hospital are dedicated to introduce new procedures for better treatment and quick recovery