ABSTRACT
PURPOSE: Tuberculous meningitis (TBM) is one of the most serious and difficult to diagnose manifestations of TB. An ADA value >9.5 IU/L has great sensitivity and specificity. However, all available studies have been conducted in areas of high endemicity, so we sought to determine the accuracy of ADA in a low endemicity area. METHODS: This retrospective study included 190 patients (105 men) who had ADA tested in CSF for some reason. Patients were classified as probable/certain TBM or non-TBM based on clinical and Thwaite's criteria. Optimal ADA cutoff was established by ROC curves and a predictive algorithm based on ADA and other CSF biochemical parameters was generated. RESULTS: Eleven patients were classified as probable/certain TBM. In a low endemicity area, the best ADA cutoff was 11.5 IU/L with 91 % sensitivity and 77.7 % specificity. We also developed a predictive algorithm based on the combination of ADA (>11.5 IU/L), glucose (<65 mg/dL) and leukocytes (≥13.5 cell/mm(3)) with increased accuracy (Se: 91 % Sp: 88 %). CONCLUSIONS: Optimal ADA cutoff value in areas of low TB endemicity is higher than previously reported. Our algorithm is more accurate than ADA activity alone with better sensitivity and specificity than previously reported algorithms.
Subject(s)
Adenosine Deaminase/cerebrospinal fluid , Cerebrospinal Fluid/chemistry , Tuberculosis, Meningeal/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Female , Humans , Male , Middle Aged , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Young AdultABSTRACT
Objetivos: Distintos ensayos clínicos han demostrado que el tratamiento antitrombótico puede ser eficaz en la prevención del ictus en pacientes con fibrilación auricular (FA) no reumática. El objetivo del presente estudio fue conocer si se cumplen las recomendaciones de los grandes ensayos clínicos en la práctica clínica y, valorar los factores que pueden influir en la decisión del distinto tratamiento antitrombótico empleado. Métodos: Analizamos la historia clínica de 225 pacientes diagnosticados de FA no reumática en Cáceres durante los meses de Febrero y Marzo de 1998. Se excluyeron 20 pacientes por contraindicación para mantener tratamiento antitrombótico o, sin evidencia de FA crónica, por lo que finalmente 205 enfermos formaron parte del estudio. Se compararon los pacientes que seguían tratamiento antitrombótico (anticoagulante o antiagregante) y sin tratamiento, con distintas características demográficas y factores de riesgo embolígeno. Resultados: De los 205 enfermos que formaron parte del estudio, 149 (72,6%) tenían un riesgo embolígeno elevado. Sesenta y dos pacientes (30,2%) del total seguían tratamiento con anticoagulantes, 94 (45,8%) antiagregantes, 5 (2,4%) doble tratamiento y 49 (24%) no realizaban ningún tipo de tratamiento. No hubo diferencias entre el grupo de pacientes con tratamiento anticoagulante, antiagregante o sin tratamiento respecto a la edad, sexo, presencia de cardiopatía isquémica, hipertensión arterial e insuficiencia cardiaca en los últimos 3 meses, mientras que, el antecedente de accidente cerebrovascular y otras variables ecocardiográficas (valvulopatía, calcificación valvular, disfunción ventricular) fueron mas frecuentes en los pacientes anticoagulados y antiagregados, que en aquellos sin tratamiento. Conclusiones: Un alto porcentaje de pacientes con FA no reumática sigue algún tipo de tratamiento preventivo antitrombótico, aunque posiblemente todavía un gran número de enfermos con FA podría beneficiarse del tratamiento anticoagulante. En nuestro medio, la valoración terapéutica de los enfermos con FA crónica debería tener en cuenta, además de hallazgos ecocardiográficos, otras características clínicas, como hipertensión arterial, cardiopatía isquémica e insuficiencia cardiaca (AU)
Subject(s)
Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Atrial Fibrillation , Clinical Protocols , Clinical Trials as Topic , Thrombolytic Therapy , Atrial Fibrillation/drug therapy , Thrombolytic Therapy/standards , Guideline AdherenceABSTRACT
OBJECTIVES: Several clinical trials have demonstrated that antithrombotic treatment may be effective in prevention of stroke in nonrheumatic atrial fibrillation (AF). The aim of this study was to assess if we follow clinical trial recommendations in community practice. METHODS: We analyzed 225 medical records of patients diagnosed of nonrheumatic AF in Cáceres, during February and March 1998. Patients who were contraindicated to follow antiagreggation or anti-coagulation treatment were excluded. We compared patients with and without antithrombotic treatment with different demographic characteristics and embolic risk factors. RESULTS: 205 patients were included in the study, 149 (72.6%) had high embolic risk. 62 (30.2%) followed anticoagulation, 94 (45.8%) antiaggregation treatment, 5 (2.4%) both treatment and 49 (24%) were not receiving therapy. We didn't findings differences between age, sex, presence of ischemic heart disease, hypertension and congestive heart failure in last three months compared with the patients in respect to the group of patients with anticoagulation and antiaggregation therapy or without it. We determinate as well that previous stroke and echocardiographical finds (valve disease, valve calcification, ventricular dysfunction) were more frequent in the anticoagulation and antiaggregate patients than in those without therapy. CONCLUSION: A high range of nonrheumatic AF patients take any kind of antithrombotic preventive therapy, though a great number of patients with high embolic risk could still get benefits from anticoagulation therapy. We should considerate in the therapy assessment some other clinical characteristics as hypertension, isquemic heart disease and heart failure apart from echocardiographical findings.
