1.Diagnostic Accuracy of Lactate Dehydrogenase/Adenosine Deaminase Ratio in Differentiating Tuberculous and Parapneumonic Effusions: A Systematic Review
Larry Ellee NYANTI ; Muhammad Aklil Abd RAHIM ; Nai-Chien HUAN
Tuberculosis and Respiratory Diseases 2024;87(1):91-99
Background:
Tuberculous pleural effusion (TPE) and parapneumonic effusion (PPE) are often difficult to differentiate owing to the overlapping clinical features. Observational studies demonstrate that the ratio of lactate dehydrogenase to adenosine deaminase (LDH/ADA) is lower in TPE compared to PPE, but integrated analysis is warranted.
Methods:
We conducted a systematic review to evaluate the diagnostic accuracy of the LDH/ADA ratio in differentiating TPE and PPE. We explored the PubMed and Scopus databases for studies evaluating the LDH/ADA ratio in differentiating TPE and PPE.
Results:
From a yield of 110 studies, five were included for systematic review. The cutoff value for the LDH/ADA ratio in TPE ranged from <14.2 to <25. The studies demonstrated high heterogeneity, precluding meta-analysis. Quality Assessment of Diagnostic Accuracy Studies Tool 2 assessment revealed a high risk of bias in terms of patient selection and index test.
Conclusion
LDH/ADA ratio is a potentially useful parameter to differentiate between TPE and PPE. Based on the limited data, we recommend an LDH/ADA ratio cutoff value of <15 in differentiating TPE and PPE. However, more rigorous studies are needed to further validate this recommendation.
2.The great masquerade: Empyema thoracis as an unusual presentation of primary lung malignancy
Larry Nyanti ; Kho Sze Shyang ; Tie Siew Teck
The Medical Journal of Malaysia 2019;74(1):79-81
Primary lung malignancy presenting as empyema is rare,
with a reported incidence of 0.3%. We report a case of a 60-
year-old man presenting with unilateral pleural effusion;
diagnostic thoracocentesis confirmed Salmonella
empyema. Post-drainage, chest radiograph showed
persisting right hemithorax opacity; subsequent computed
tomography revealed a right lung mass with right upper lobe
bronchus obliteration. Percutaneous biopsy confirmed
advanced stage lung adenocarcinoma. We discuss the
mechanism of post-obstructive pneumonia in lung cancerassociated
empyema and the utility of bedside ultrasound in
diagnosis of lung masses. Clinicians are alerted to the
possibility of lung malignancy in elderly patients presenting
with empyema.
3.Determinants of Willingness to Undergo Lung Cancer Screening among High- Risk Current and Ex-smokers in Sabah, Malaysia: A Cross-Sectional Pilot Study
Larry Ellee NYANTI ; Chia Zhen CHUA ; Han Chuan LOO ; Cheng Zhi KHOR ; Emilia Sheau Yuin TOH ; Rasvinder Singh GILL ; Eng Tat CHAN ; Ker Yin TAN ; Taufiq ROSLI ; Muhammad Aklil Abd RAHIM ; Arfian IBRAHIM ; Nai Chien HUAN ; Hema Yamini Devi RAMARMUTY ; Kunji Kannan Sivaraman KANNAN
Tuberculosis and Respiratory Diseases 2023;86(4):284-293
Background:
Attitudes towards smoking, lung cancer screening, and perceived risk of lung cancer have not been widely studied in Malaysia. The primary objective of this study was to describe the factors affecting the willingness of high-risk current smokers and ex-smokers to undergo low-dose computed tomography (LDCT) screening for lung cancer.
Methods:
A prospective, cross-sectional questionnaire study was conducted in current smokers or ex-smokers aged between 55 and 80 years at three hospitals in Kota Kinabalu, Sabah, Malaysia. The questionnaire recorded the following parameters: perceived lung cancer risk; Prostate Lung Colon Ovarian Cancer 2012 risk prediction model excluding race and ethnicity predictor (PLCOm2012norace); demographic characteristics; psychosocial characteristics; and attitudes towards lung cancer and lung cancer screening.
Results:
A vast majority of the 95 respondents (94.7%) indicated their willingness to undergo screening. Stigma of lung cancer, low levels of knowledge about lung cancer symptoms, concerns about financial constraints, and a preference for traditional medication were still prevalent among the respondents, and they may represent potential barriers to lung cancer screening uptake. A desire to have an early diagnosis (odds ratio [OR], 11.33; 95% confidence interval [CI], 1.53 to 84.05; p=0.02), perceived time constraints (OR, 3.94; 95% CI, 1.32 to 11.73; p=0.01), and proximity of LDCT screening facilities (OR, 14.33; 95% CI, 1.84 to 111.4; p=0.01) had significantly higher odds of willingness to undergo screening.
Conclusion
Although high-risk current smokers and ex-smokers are likely to undergo screening for lung cancer, several psychosocial barriers persist. The results of this study may guide the policymakers and clinicians regarding the need to improve lung cancer awareness in our population.