-
PloS One 2021We compared diagnostic accuracy of pleural fluid adenosine deaminase (ADA) and interferon-gamma (IFN-γ) in diagnosing tuberculous pleural effusion (TPE) through... (Comparative Study)
Comparative Study
OBJECTIVE
We compared diagnostic accuracy of pleural fluid adenosine deaminase (ADA) and interferon-gamma (IFN-γ) in diagnosing tuberculous pleural effusion (TPE) through systematic review and comparative meta-analysis.
METHODS
We queried PubMed and Embase databases to identify studies providing paired data for sensitivity and specificity of both pleural fluid ADA and IFN-γ for diagnosing TPE. We used hierarchical summary receiver operating characteristic (HSROC) plots and HSROC meta-regression to model individual and comparative diagnostic performance of the two tests.
RESULTS
We retrieved 376 citations and included 45 datasets from 44 publications (4974 patients) in our review. Summary estimates for sensitivity and specificity for ADA were 0.88 (95% CI 0.85-0.91) and 0.91 (95% CI 0.89-0.92), while for IFN-γ they were 0.91 (95% CI 0.89-0.94) and 0.96 (95% CI 0.94-0.97), respectively. HSROC plots showed consistently greater diagnostic accuracy for IFN-γ over ADA across the entire range of observations. HSROC meta-regression using test-type as covariate yielded a relative diagnostic odds ratio of 2.22 (95% CI 1.68-2.94) in favour of IFN-γ, along with better summary sensitivity and specificity figures. No prespecified subgroup variable significantly influenced the summary diagnostic accuracy estimates.
CONCLUSION
Pleural fluid IFN-γ estimation has better diagnostic accuracy than ADA estimation for diagnosis of TPE.
Topics: Adenosine Deaminase; Biomarkers; Humans; Interferon-gamma; Sensitivity and Specificity; Tuberculosis, Pleural
PubMed: 34166463
DOI: 10.1371/journal.pone.0253525 -
PloS One 2015Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF). These natriuretic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous studies have reported that natriuretic peptides in the blood and pleural fluid (PF) are effective diagnostic markers for heart failure (HF). These natriuretic peptides include N-terminal pro-brain natriuretic peptide (NT-proBNP), brain natriuretic peptide (BNP), and midregion pro-atrial natriuretic peptide (MR-proANP). This systematic review and meta-analysis evaluates the diagnostic accuracy of blood and PF natriuretic peptides for HF in patients with pleural effusion.
METHODS
PubMed and EMBASE databases were searched to identify articles published in English that investigated the diagnostic accuracy of BNP, NT-proBNP, and MR-proANP for HF. The last search was performed on 9 October 2014. The quality of the eligible studies was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. The diagnostic performance characteristics (sensitivity, specificity, and other measures of accuracy) were pooled and examined using a bivariate model.
RESULTS
In total, 14 studies were included in the meta-analysis, including 12 studies reporting the diagnostic accuracy of PF NT-proBNP and 4 studies evaluating blood NT-proBNP. The summary estimates of PF NT-proBNP for HF had a diagnostic sensitivity of 0.94 (95% confidence interval [CI]: 0.90-0.96), specificity of 0.91 (95% CI: 0.86-0.95), positive likelihood ratio of 10.9 (95% CI: 6.4-18.6), negative likelihood ratio of 0.07 (95% CI: 0.04-0.12), and diagnostic odds ratio of 157 (95% CI: 57-430). The overall sensitivity of blood NT-proBNP for diagnosis of HF was 0.92 (95% CI: 0.86-0.95), with a specificity of 0.88 (95% CI: 0.77-0.94), positive likelihood ratio of 7.8 (95% CI: 3.7-16.3), negative likelihood ratio of 0.10 (95% CI: 0.06-0.16), and diagnostic odds ratio of 81 (95% CI: 27-241). The diagnostic accuracy of PF MR-proANP and blood and PF BNP was not analyzed due to the small number of related studies.
CONCLUSIONS
BNP, NT-proBNP, and MR-proANP, either in blood or PF, are effective tools for diagnosis of HF. Additional studies are needed to rigorously evaluate the diagnostic accuracy of PF and blood MR-proANP and BNP for the diagnosis of HF.
Topics: Atrial Natriuretic Factor; Biomarkers; Exudates and Transudates; Heart Failure; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Pleural Effusion; Sensitivity and Specificity
PubMed: 26244664
DOI: 10.1371/journal.pone.0134376 -
International Immunopharmacology Oct 2022Neopterin (NEO) is a marker of immune stimulation. Increased NEO levels have been associated with autoimmune diseases, infections, and malignancies. Studies of NEO... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neopterin (NEO) is a marker of immune stimulation. Increased NEO levels have been associated with autoimmune diseases, infections, and malignancies. Studies of NEO alterations in tuberculosis (TB) with or without HIV co-infection show inconsistent results. Moreover, challenges exist regarding TB diagnosis in people with HIV.
METHODS
We did a systematic review and meta-analysis of studies comparing urinary, pleural, and blood NEO levels between patients with TB or HIV-TB co-infection as the case group and subjects without TB and HIV or subjects with HIV without TB as the control group, respectively.
RESULTS
Blood NEO levels in patients with active TB were higher than healthy controls, with a large effect size of 1.99. Patients with TB had higher blood NEO levels before anti-tuberculosis therapy (ATT) than after ATT for months or when treatment ended with moderate effect sizes (1.13-1.46). meta-analysis of studies of patients with HIV-TB co-infection yielded similar results, with higher blood NEO levels in patients than controls that remained significant in subgroups of studies on pulmonary TB (PTB) patients and serum NEO and higher blood NEO levels in patients before than after ATT.
CONCLUSION
Meta-analyses reveal alteration in NEO levels in different specimens, e.g., blood, urine, and pleural fluid, in patients with TB with or HIV-TB co-infection compared to the control groups. Future studies need to investigate the utility of NEO as a diagnostic/prognostic biomarker for TB. Also, cellular and molecular mechanisms linking NEO and TB remain to be addressed.
Topics: Coinfection; HIV Infections; Humans; Neopterin; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 35973370
DOI: 10.1016/j.intimp.2022.109147 -
PloS One 2019Pleural fluid adenosine deaminase (ADA) is a useful diagnostic test for tuberculous pleural effusion (TPE), but its exact threshold and accuracy in clinical... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Pleural fluid adenosine deaminase (ADA) is a useful diagnostic test for tuberculous pleural effusion (TPE), but its exact threshold and accuracy in clinical decision-making is unclear. We aimed to assess diagnostic performance of ADA in TPE and to clarify its optimal diagnostic threshold.
METHODS
We searched PubMed, Embase, and Cochrane Library databases for articles indexed up to October 2018. We included English language studies that provided both sensitivity and specificity of ADA in TPE diagnosis. Summary estimates for sensitivity and specificity were obtained through bivariate random effects model, both overall and at prespecified threshold ranges of <36, 40±4, 45-65 and >65 IU/L.
RESULTS
We retrieved 2162 citations, and included 174 publications with 27009 patients. All studies showed high risk of bias. Summary sensitivity, specificity and diagnostic odds ratio estimates were 0.92 (95% CI 0.90-0.93), 0.90 (95% CI 0.88-0.91) and 97.42 (95% CI 74.90-126.72) respectively. 65 studies with ADA threshold of 40±4 IU/L showed summary sensitivity and specificity of 0.93 (95% CI 0.90-0.95) and 0.90 (95% CI 0.87-0.91) respectively. Four studies with ADA threshold >65 IU/L showed summary sensitivity and specificity of 0.86 (95% CI 0.61-0.96) and 0.94 (95% CI 0.80-0.99) respectively.
CONCLUSION
ADA levels in pleural fluid show good diagnostic accuracy in diagnosis of TPE; however, all included studies showed high risk of bias. It was not possible to derive any firm inference on relative clinical utility of different diagnostic thresholds.
Topics: Adenosine Deaminase; Animals; Female; Humans; Male; Pleural Effusion; Tuberculosis, Pleural
PubMed: 30913213
DOI: 10.1371/journal.pone.0213728 -
Urolithiasis Oct 2022We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy... (Meta-Analysis)
Meta-Analysis Review
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
Topics: Humans; Kidney Calculi; Length of Stay; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Fistula
PubMed: 35674819
DOI: 10.1007/s00240-022-01337-y -
SAGE Open Medicine 2023Visceral leishmaniasis remains a deadly parasitic disease with diagnostic complexities. Currently, point-of-care chest imaging is gaining momentum in the diagnosis of... (Review)
Review
OBJECTIVES
Visceral leishmaniasis remains a deadly parasitic disease with diagnostic complexities. Currently, point-of-care chest imaging is gaining momentum in the diagnosis of infectious diseases. Respiratory symptoms are common in visceral leishmaniasis. Here we aimed to systematically synthesize the evidence on the utility of chest imaging on the diagnosis and management of patients with visceral leishmaniasis.
METHODS
We searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar databases for studies reporting chest imaging findings in patients with visceral leishmaniasis, published in English from database inception to November 2022. We used the Joanna Briggs Institute checklists to evaluate the risk of bias. The protocol of this systematic review was registered with the Open Science Framework: https://doi.org/10.17605/OSF.IO/XP24W.
RESULTS
Of 1792 studies initially retrieved, 17 studies with 59 participants were included. Of the 59 patients, 51% (30) had respiratory symptoms and 20% (12) were human immunodeficiency virus co-infected. Chest X-ray, high-resolution computed tomography, and chest ultrasound findings were available for 95% (56), 93% (55), and 2% (1) of the patients, respectively. The most common findings were pleural effusion (20%; 12), reticular opacities (14%; 8), ground-glass opacities (12%; 7), and mediastinal lymphadenopathies (10%; 6). High-resolution computed tomography was more sensitive than chest X-ray and detected lesions that were lost on chest X-ray, 62% (37) versus 29% (17). In almost all cases, regression of the lesions was observed with treatment. Microscopy of pleural or lung biopsy detected amastigotes. Polymerase chain reaction yield was better in pleural and bronchoalveolar lavage fluids. A parasitological diagnosis from pleural and pericardial fluid was possible in AIDS patients. Overall, the risk of bias was low.
CONCLUSIONS
Visceral leishmaniasis patients frequently had abnormal findings on high-resolution computed tomography. Chest ultrasound is a useful alternative in resource-limited settings to aid in diagnosis and subsequent treatment follow-up, especially when routine tests yield negative results despite clinical suspicion.
PubMed: 37284569
DOI: 10.1177/20503121231177812 -
Annals of Translational Medicine Oct 2019Several studies have investigated the diagnostic accuracy of serum lactate dehydrogenase (LDH) to pleural fluid adenosine deaminase ratio (cancer ratio, CR) for...
BACKGROUND
Several studies have investigated the diagnostic accuracy of serum lactate dehydrogenase (LDH) to pleural fluid adenosine deaminase ratio (cancer ratio, CR) for malignant pleural effusion (MPE), but the results were various. Therefore, we performed this systematic review and meta-analysis to ascertain the diagnostic accuracy of CR for MPE.
METHODS
The PubMed and EMBASE databases were searched up to 7 June, 2019 to identify publications concerning diagnostic accuracy of CR for MPE. The sensitivities and specificities of CR in included studies were pooled with a bivariate model. A summary receiver operating characteristic (sROC) curve was used to estimate the global diagnostic accuracy of CR. Quality of the included studies was assessed with the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2).
RESULTS
Finally, five studies with 596 MPE patients and 863 benign pleural effusion (BPE) patients were included in this systematic review and meta-analysis. The pooled sensitivity and specificity of CR were 0.97 (95% CI: 0.92-0.99) and 0.89 (0.69-0.97), respectively. The area under sROC curve was 0.98 (95% CI: 0.97-0.99). The major design weaknesses of the included studies were patients selection and partial verification bias.
CONCLUSIONS
CR has high diagnostic accuracy for MPE. Considering the design weaknesses of available studies, further studies with rigorous design are needed to further validate the findings of this meta-analysis.
PubMed: 31807535
DOI: 10.21037/atm.2019.09.85 -
Indian Journal of Anaesthesia Oct 2021Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and...
BACKGROUND AND AIMS
Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient.
METHODS
An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I statistics. Funnel plots were used for the assessment of publication bias.
RESULTS
Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5-5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03-0.84) and 0.1 (0-0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies.
CONCLUSION
POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.
PubMed: 34898698
DOI: 10.4103/ija.ija_820_21 -
PloS One 2022Changes in endothelial function are implicated in the spread of tuberculosis (TB). Studies suggest a role for the vascular endothelial growth factor (VEGF) in TB-related... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Changes in endothelial function are implicated in the spread of tuberculosis (TB). Studies suggest a role for the vascular endothelial growth factor (VEGF) in TB-related endothelial function changes. However, the findings of studies investigating the VGEF profile in TB are not consistent, and no formal systematic review and meta-analysis exists summarizing these studies.
METHODS
We did a meta-analysis of studies assessing VEGF levels in patients with TB. A systematic search on June 25, 2021, was conducted for eligible studies that made VEGF measurements in an unstimulated sample, e.g., a blood fraction (plasma or serum), cerebrospinal fluid (CSF), pleural effusion (PE), or bronchoalveolar lavage fluid, and ascites or pericardial fluid for patients with TB and controls without TB. Also, studies that made simultaneous measurements of VEGF in blood and PE or CSF in the same patients with TB were included. Longitudinal studies that provided these data at baseline or compared pre-post anti-tuberculosis treatment (ATT) levels of VEGF were included. The primary outcome was the standardized mean difference (SMD) of VEGF levels between the comparison groups.
RESULTS
52 studies were included in the meta-analysis. There were 1787 patients with TB and 3352 control subjects of eight categories: 107 patients with transudative pleural effusion, 228 patients with congestive heart failure (CHF)/chronic renal failure (CRF), 261 patients with empyema and parapneumonic effusion (PPE), 241 patients with cirrhosis, 694 healthy controls (with latent TB infection or uninfected individuals), 20 patients with inactive tuberculous meningitis (TBM), 123 patients with non-TBM, and 1678 patients with malignancy. The main findings are as follows: (1) serum levels of VEGF are higher in patients with active TB compared with healthy controls without other respiratory diseases, including those with latent TB infection or uninfected individuals; (2) both serum and pleural levels of VEGF are increased in patients with TPE compared with patients with transudative, CHF/CRF, or cirrhotic pleural effusion; (3) ascitic/pericardial fluid, serum, and pleural levels of VEGF are decreased in patients with TB compared with patients with malignancy; (4) pleural levels of VEGF are lower in patients with TPE compared with those with empyema and PPE, whereas serum levels of VEGF are not different between these patients; (5) both CSF and serum levels of VEGF are increased in patients with active TBM compared with controls, including patients with inactive TBM or non-TBM subjects; (6) post-ATT levels of VEGF are increased compared with pre-ATT levels of VEGF; and (7) the mean age and male percentage of the TB group explained large and total amount of heterogeneity for the meta-analysis of blood and pleural VEGF levels compared with healthy controls and patients with PPE, respectively, whereas these moderators did not show any significant interaction with the effect size for other analyses.
DISCUSSION
The important limitation of the study is that we could not address the high heterogeneity among studies. There might be unmeasured factors behind this heterogeneity that need to be explored in future research. Meta-analysis findings align with the hypothesis that TB may be associated with abnormal vascular function, and both local and systemic levels of VEGF can be used to trace this abnormality.
Topics: Exudates and Transudates; Humans; Latent Tuberculosis; Male; Pleural Effusion; Tuberculosis, Meningeal; Tuberculosis, Pleural; Vascular Endothelial Growth Factor A
PubMed: 35613134
DOI: 10.1371/journal.pone.0268543 -
Reviews on Recent Clinical Trials 2019Malignant pleural effusion, which is a common clinical problem in patients with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the...
BACKGROUND
Malignant pleural effusion, which is a common clinical problem in patients with cancer, may be due to both primary thoracic tumours or to a metastatic spread in the chest and constitutes the first sign of disease in approximately 10% of patients. Almost all cancers can potentially produce a pleural effusion. The presence of malignant tumour cells in the pleural fluid is generally indicative of advanced disease and is associated with high morbidity and mortality with reduced therapeutic options. Dyspnoea during mild physical activity or at rest is generally the typical sign of restrictive respiratory failure.
METHODS
This is a systematic review of all the main articles in the English language on the topic of malignant pleural effusion and reported by the Pubmed database from 1959 to 2018. I reviewed the literature and guidelines with the aims to focus on what is known and on future pathways to follow the diagnosis and treatment of malignant pleural effusions.
RESULTS
The main goal of palliation of a malignant pleural effusion is a quick improvement in dyspnoea, while thoracentesis under ultrasound guidance is the treatment of choice for patients with a limited life expectancy or who are not candidates for more invasive procedures such as drainage using an indwelling small pleural catheter, chemical pleurodesis with sclerosing agents, pleurectomy or pleuro-peritoneal shunt.
CONCLUSION
Despite progress in therapeutic options, the prognosis remains severe, and the average survival is 4-9 months from the diagnosis of malignant pleural effusion. Moreover, mortality is higher for patients with malignant pleural effusion compared with those with metastatic cancer but no malignant pleural effusion. Therefore, the prognosis of these patients primarily depends on the underlying disease and the extension of a primary tumour. This review focuses on the most relevant updates in the management of malignant pleural effusion.
Topics: Disease Progression; Drainage; Female; Humans; Male; Needs Assessment; Neoplasms; Palliative Care; Pleural Effusion, Malignant; Pleurodesis; Prognosis; Risk Assessment; Severity of Illness Index; Survival Analysis; Thoracentesis; Treatment Outcome; Ultrasonography, Doppler
PubMed: 30514193
DOI: 10.2174/1574887114666181204105208