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Inflammation of the pleura. It is usually caused by infections. Chest pain while breathing or coughing is the presenting symptom.

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Tuberculous pleurisy results from inflammation of the membrane that covers the lungs (the pleura) caused by exposure to Mycobacterium tuberculosis bacteria infecting the lungs. This results in a build up of fluid around the lung (pleural effusion) that causes pain and fever, impairs breathing, and may lead to impairment of lung function in the long term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 14, 2017

This systematic review and meta-analysis was performed to determine accuracy and usefulness of adenosine deaminase (ADA) in diagnosis of tuberculosis pleurisy. Medline, Google scholar and Web of Science databases were searched to identify related studies until 2014. Two reviewers independently assessed quality of studies included according to standard Quality Assessment of Diagnosis Accuracy Studies (QUADAS) criteria. The sensitivity, specificity, diagnostic odds ratio and other parameters of ADA in diagnosis of tuberculosis pleurisy were analyzed with Meta-DiSC1.4 software, and pooled using the random effects model. Twelve studies including 865 tuberculosis pleurisy patients and 1379 non-tuberculosis pleurisy subjects were identified from 110 studies for this meta-analysis. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnosis odds ratio (DOR) of ADA in the diagnosis of tuberculosis pleurisy were 45.25 (95% CI 27.63-74.08), 0.86 (95% CI 0.84-0.88), 0.88 (95% CI 0.86-0.90), 6.32 (95% CI 4.83-8.26) and 0.15 (95% 0.11-0.22), respectively. The area under the summary receiver operating characteristic curve (SROC) was 0.9340. Our results demonstrate that the sensitivity and specificity of ADA are high in the diagnosis of tuberculosis pleurisy especially when ADA≥50 (U/L). Thus, ADA is a relatively sensitive and specific marker for tuberculosis pleurisy diagnosis. However, it is cautious to apply these results due to the heterogeneity in study design of these studies. Further studies are required to confirm the optimal cut-off value of ADA.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

BACKGROUND AND OBJECTIVE: The diagnosis of tuberculous pleurisy by analysis of pleural fluid using standard diagnostic tools is difficult. Recently, T-cell interferon-γ release assays (IGRA) have been introduced for the diagnosis of tuberculous pleurisy. The aim of the present meta-analysis was to establish the overall diagnostic accuracy of IGRA on both pleural fluid and peripheral blood, for diagnosing tuberculous pleurisy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

This review assessed the accuracy of interferon-gamma in pleural effusions for the diagnosis of tuberculous pleurisy. The authors concluded that it is a sensitive and specific test. The review suffered from limitations relating to the literature search, quality assessment and synthesis, and very few individual study details were presented. These findings should therefore be interpreted with extreme caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

The review produced summary measures of test accuracy, using heterogeneous data sets, from studies with a range of diagnostic thresholds. The authors concluded that adenosine deaminase assays are likely to be useful in tuberculosis pleurisy diagnosis. The wide range of sensitivity and specificity values reported by included studies, and weaknesses in the meta-analytical methods, limit the reliability of these conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

BACKGROUND: Conventional tests for tuberculous pleuritis have several limitations. A variety of new, rapid tests such as nucleic acid amplification tests--including polymerase chain reaction--have been evaluated in recent times. We conducted a systematic review to determine the accuracy of nucleic acid amplification (NAA) tests in the diagnosis of tuberculous pleuritis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

This guideline makes recommendations on the prevention, diagnosis and management of latent and active tuberculosis (TB), including both drug susceptible and drug resistant forms of the disease. It covers the organisation of relevant TB services. It relates to activities undertaken in any setting in which NHS or public health services for TB are received, provided or commissioned in the public, private and voluntary sectors.

NICE Guideline - Internal Clinical Guidelines Team (UK).

Version: January 2016

The study found that adult patients with ulcerative colitis receiving infliximab, adalimumab or golimumab were more likely to achieve clinical response and remission than those receiving placebo.

Health Technology Assessment - NIHR Journals Library.

Version: May 2016

The microbial causes of pneumonia vary according to its origin and the immune constitution of the patient. Pneumonia is classified into community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and pneumonia in the immunocompromised. The guideline development process is guided by its scope - published after stakeholder consultation. This guideline does not cover all aspects of pneumonia, but focuses on areas of uncertainty or variable practice and those considered of greatest clinical importance. Best practice guidance on the diagnosis and management of CAP and HAP is offered, based on systematic analysis of clinical and economic evidence with the aim of reducing mortality and morbidity from pneumonia and maximising resources.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2014

Severe asthma is a chronic condition in which patients experience airway inflammation and airway muscle contraction leading to symptoms of breathlessness, wheezing, coughing, and chest tightness. It is one of the most common chronic conditions with an estimated 235 million people affected worldwide, an increasing global prevalence, and a lifetime of impacts on healthcare systems. Exacerbations of this condition can be serious, negatively impact patient quality of life, require hospitalization and emergency department (ED) services. The standard approach to care employs regular maintenance medications, usually inhaled corticosteroids (ICS) and a long-acting β2-agonist (LABA), while other medications may also be used including omalizumab and oral corticosteroids. Bronchial thermoplasty (BT) is an endoscopic therapy, the first nonpharmacologic intervention approved by Health Canada for the treatment of severe asthma. BT employs radiofrequency energy pulses to selectively reduce the thicker airway smooth muscle found in asthmatic patients. This selective ablation is thought to reduce airway hyper-responsiveness, airway obstruction, and asthma symptoms. Further research is required to help more clearly determine the mechanisms of action of bronchial thermoplasty. Limitations of the technique include the inability to treat distal symptomatic airways due to their small diameter, and contraindications for patients with implanted medical devices.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: August 27, 2015

Single CEA tests for triage in follow-up of colorectal cancer generate many false positives and are less clinically useful than CEA trends.

Health Technology Assessment - NIHR Journals Library.

Version: April 2017

The study found that people with different health conditions and in different seldom-heard groups valued the same eight core aspects of health care, even though their experiences of that care varied considerably. Several barriers were identified to using unpublished tailor-made analyses in National Institute of Health and Care Excellence clinical guidelines and quality standards; such analyses may have more potential when the qualitative literature is sparse, unclear or contradictory.

Health Services and Delivery Research - NIHR Journals Library.

Version: November 2014

Cancer is an important condition, both in terms of the number of people affected and the impacts on those people and the people close to them. Around one third of a million new cancers are diagnosed annually in the UK, across over 200 different cancer types. Each of these cancer types has different presenting features, though there may be overlap. More than one third of the population will develop a cancer in their lifetime. Although there have been large advances in treatment and survival, with a half of cancer sufferers now living at least ten years after diagnosis, it remains the case that more than a quarter of all people alive now will die of cancer.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: June 2015

This study found that people with active rheumatoid arthritis eligible to start biologic treatment in England achieve similar clinical benefits at a lower cost from starting combinations of conventional disease modifying anti-rheumatic drugs.

Health Technology Assessment - NIHR Journals Library.

Version: October 2014

Rheumatoid arthritis (RA) is an inflammatory condition that typically causes a symmetrical chronic arthritis. Timely use of disease-modifying antirheumatic drugs (DMARDs) is an essential aspect of disease management, but many patients may not respond even when conventional agents are used optimally.

Health Technology Assessment - NIHR Journals Library.

Version: March 2011

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008

To update a previous report on the comparative benefits and harms of oral non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, over-the-counter supplements (chondroitin and glucosamine), and topical agents (NSAIDs and rubefacients, including capsaicin) for osteoarthritis.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2011

BACKGROUND: Many studies have investigated the usefulness of adenosine deaminase activity (ADA) in pleural fluid for the early diagnosis of tuberculous pleurisy. To summarize the diagnostic characteristics of ADA we undertook a meta-analysis using a summary receiver operating characteristic (SROC) curve method.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Systematic Reviews in PubMed

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