The comparison of pleural fluid TNF-alpha and IL-10 levels with ADA in tuberculous pleural effusion.

OBJECTIVES: Our aim was to evaluate the diagnostic value of pleural fluid TNF-alpha and IL-10 levels in tuberculous pleural effusion (TPE) and compare with that of ADA. MATERIAL AND METHODS: 70 patients were enrolled in the study. Fourteen patients had TPE, 19 patients malignant pleural effusion (MPE), 18 patients complicated parapneumonic effusion (PPE) and 19 patients had transudative pleural effusion. RESULTS: The pleural fluid TNF-alpha levels were significantly higher in TPE than MPE and transudates. There was no significant difference in pleural fluid IL-10 levels between groups. Among exudative effusions, TNF-alpha was significantly higher in tuberculous group, while there was no difference in IL-10 levels between tuberculous and nontuberculous group. The pleural fluid ADA levels were significantly higher in TPE than other groups. ROC analysis was performed and the optimal cut-off points of TNF-alpha and ADA were 13.3 pg/mL and 41.5 U/L, respectively. The sensitivity of TNF-alpha was 71% and specificity was 66% in the diagnosis of TPE. In contrast, the sensitivity and specificity of ADA was 78% and 86% respectively. CONCLUSION: TNF- alpha is a useful marker in the diagnosis of TPE and IL-10 has no diagnostic value. However, the sensitivity and specificity of TNF-alpha is lower than that of ADA.

Therapy of acute hepatitis C with interferon-alpha2b plus ribavirin in a health care worker.

Hepatitis C virus can be transmitted to health care workers through needlestick accidents. In this report, the result of short-term therapy with interferon-alpha2b plus ribavirin combination of acute hepatitis C in a health care worker who infected through laboratory accident was presented. The patient received combination of interferon-alpha2b (5 MU three times a week) plus ribavirin (1000 mg daily) for three months. Aminotransferase levels were normalised and clearance of HCV RNA was obtained in the first month of the therapy. After 19 months of follow-up, he had undetectable levels of HCV RNA so sustained response (clearance of HCV RNA and normalisation of aminotransferases at least six months after cessation of therapy) was achieved. According to this result, short-term therapy of acute hepatitis C with interferon-alpha2b plus ribavirin may be an alternate to others.

HLA-DRB1 genes and disease severity in rheumatoid arthritis in Turkey.

OBJECTIVE: Association with human leukocyte antigen (HLA)-DRB alleles, implicated in the aetiopathogenesis of rheumatoid arthritis (RA), is found to be different in various ethnic groups. This study aimed to investigate DRB1 alleles in RA patients in Turkey, and to examine the effect of these alleles on disease severity. METHODS: We performed PCR-based DRBI genotyping of 104 RA patients recruited from clinical settings and 110 healthy controls. HLA DRB1 alleles frequencies in RA patients and healthy controls were determined. Phenotype frequencies of patients and controls were compared. Disease severity was assessed by radiological erosion, presence of extra-articular involvement, and functional index. RESULTS: Significant differences were in the frequencies of DRB1*04 (46.2% versus 20.9%, p < 0.001), DRB1*0401 (10.6% versus 0%, p < 0.001), DRB1*0405 (8.7% versus 0%, p = 0.001), DRB1* 0404 (15.4% versus 3.6%, p < 0.01), DRB1*01 (21.2% versus 10.9%, p < 0.05) and DRB1*0101 (16.3% versus 5.5%, p = 0.01) between RA patients and controls. HLA-DRB1 alleles did not show any association with seropositivity, extra-articular involvement, radiological erosion, or functional index. CONCLUSION: Our results suggest that the HLA-DRB1 alleles, particularly HLA-DRB1*04 and subtypes, were associated with RA.