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

Hand osteoarthritis: correlation between functional evaluation, imaging and disease activity

This study aimed at investigating the relationship between functional evaluation, imaging and disease activity in hand Osteoarthritis. Twenty-five patients fulfilling the ACR criteria for classification of hand osteoarthritis were enrolled in this study. Full demographic data was obtained and all patients underwent thorough rheumatologic examination which included tender joint count as well as node count. The patients completed the AUSCAN questionnaire. Grip and pinch strength was measured bilaterally. Postero-anterior hand radiographs were taken and power doppler ultrasonography was performed on both hands. They all had ESR and ultrasensitive CRP measured. Seventeen patients [68%] had tender joints, 22 patients [88%] had nodes. Kellgren-Lawrence grading of the x-rays ranged from 2- 4. Grip and pinch strength were not correlated with OA severity or disease activity. Seventeen patients [68%] had positive power doppler findings indicative of synovitis. There was no correlation between doppler findings and hand function. Twenty-three patients [92%] had elevated ESR and twenty-four patients [96%] had elevated ultrasensitive CRP. There was a positive correlation between CRP and OA severity. However, CRP did not correlate with hand function. Tender joint count was positively correlated with pain, stiffness and functional disability [AUSCAN]. Tender joints also correlated with ESR. There was no correlation between tender joint count and power doppler findings. Tender joint count correlates well with lab findings and AUSCAN scoring. However, hand function measured both objectively and subjectively does not correlate with acute phase reactants or power doppler ultrasonography and radiographic findings in hand OA. It seems that hand function does not reflect disease activity or severity