Background:Differentiating into transudate or exudate is the first step in the evaluation of effusions. Light's criteria is the standard but a significant number of transudates may not be differentiated based on these criteria. Acute phase proteins (APP) are present in plasma, which increase or decrease by about 25% during an acute inflammatory response. Ceruloplasmin (CP) is a positive APP. Hence, this study was done to know the diagnostic value of pleural fluid (pf) CP and pf to serum ceruloplasmin ratio (CPr) to differentiate the pleural effusion (PE) into exudate and transudate as compared to Light's criteria.Materials and Methods:Setting: Medical wards of St John's Medical College Hospital, Bangalore.Design:Cross-sectional descriptive study. Patients with PE were divided into exudate and transudate by definitive diagnosis. pfCP, CPr and Light's criteria were compared with definitive diagnosis for the differentiation of pf into exudate and transudate.Results:The mean value of the pfCP and CPr was found to be significantly different between exudates and transudates. Sensitivity and specificity of pfCP at ≥ 13.34 mg/dl is 89.7% and 83.3%, CPr at ≥ 0.37 is 91.4% and 83.3%, Light's criteria 94.82% and 83.3%, respectively. Light's criteria, pfCP and CPr have similar PPV (98%) with Light's criteria having higher NPV (62.5%) than pfCP (45%) and CPr (50%), respectively. CPr has higher NPV than pfCP.Conclusions:pfCP and CPr can differentiate pf into exudate and transudate with comparable PPV to Light's criteria.
24 hours traditional urine collection method is cumbersome and tedious process with less patient compliance. Our study proposes a novel fractional urine collection method for protein estimation that would entail collection of small volumes of urine each time patient voids Over 24h Period. Our aim was to compare urine protein in proposed method versus traditional 24hour sampling method. Cross-sectional, prospective study was a collaborative work between Departments of Nephrology and Biochemistry in our tertiary care hospital. Volunteers (48) and Chronic Kidney disease subjects (52) were recruited. Out of which, 76 subjects were selected. Novel method was compared with conventional method in each of these groups, before and after centrifugation and with and without preservative. Intraclass correlation coefficient (ICC) and Bland Altman analysis was used to evaluate for agreement between the two methods. All the values were combined without categorization into subgroups. Fractional urine collection method (before centrifugation) without preservative (F1) and with preservative (F2) was compared to conventional method, ICC was 0.93 (C.I, 0.9 to 0.95) and 0.96 (C.I, 0.94 to 0.97) respectively. After centrifugation, fractional urine collection method for F1and F2 versus conventional method, ICC was 0.95 (C.I, 0.92 to 0.97) and 0.91 (C.I, 0.86 to 0.94) respectively. The novel collection method is comparable and reliable as traditional 24-hour method. The use of thymol as preservative leads to negative interference and centrifugation is mandatory before urine analysis. With proper sampling, urine protein by novel method has a good agreement with the conventional technique.
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