Introduction: The diagnosis of meningitis due to Mycobacterium tuberculosis (TBM) in general can be extremely difficult in the absence of culture confirmation. A non-definitive test such as adenosine deaminase (ADA) could potentially assist in this regard, although its current value for the diagnosis of TBM remains unclear. The literature on the usefulness of ADA measurement in CSF to assist in the diagnosis of TBM shows inconsistencies especially from an analytical point of view regarding the actual ADA assay methodology. Methods: Clinical and laboratory data relating to cerebrospinal fluid (CSF) ADA requests during 2009 and 2010 at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) were extracted from patient files and the National Health Laboratory Service (NHLS) laboratory information system. An optimal cut-off for CSF ADA for the diagnosis of TBM was calculated using Receiver Operating Characteristic (ROC) curve analysis. In addition, the performance of CSF ADA in different infective and non-infective categories was assessed. Specifically the performance of CSF ADA was compared between the ‘Confirmed TBM’ category and the categories for ‘Confirmed bacterial meningitis’, ‘Confirmed ventriculitis’, ‘Confirmed cryptococcal meningitis’, and ‘Confirmed viral meningitis / encephalitis’. An attempt was made to develop a prediction rule using the data collected, including the CSF ADA result, to improve the clinical diagnosis of TBM in the absence of culture confirmation. Results: Total CSF ADA requests considered for these 2 years amounted to 3548. Of these 1490 accounted for patients who had both a CSF ADA and a culture for mycobacteria requested. The optimal CSF ADA cut-off to assist in the diagnosis of TBM was calculated at 2.0 U/l (AUC of 0.86; 95% CI of 0.82 – 0.89; p – value of < 0.0001). The sensitivity at this cut-off was 85.9% and the specificity was 77.7%. A considerable overlap was noted in the 95% distribution of CSF ADA values as well as the outliers for each of the categories considered. No statistically significant difference was noted between the ‘Confirmed TBM’ and the ‘Confirmed bacterial meningitis’ categories as well as between the ‘Confirmed TBM’ and the ‘Confirmed ventriculitis’ categories. Stepwise logistic regression analysis failed to produce a combination of factors with appropriate performance characteristics to be used as a prediction rule. Discussion and Conclusion: The CSF ADA cut-off determined in this study is unusually low. This cut-off as well as those reported in other studies, in addition to the actual CSF ADA result, are of dubious value in the diagnosis of TBM and may potentially mislead clinicians. Fundamental issues of specimen integrity, ADA assay standardisation and the overlap in the performance of the assay in different diagnostic categories (especially between ‘Confirmed TBM’ and ‘Confirmed bacterial meningitis’) affect interpretation of the CSF ADA result. An inadequate number of correlations between variables chosen possibly prevented generation of an acceptable prediction rule that included CSF ADA.

Thesis (M.D.)--Boston University

No description available.

Diss. (sammanfattning) Umeå : Univ., 2005. / Härtill 4 uppsatser.

Thesis (M.Sc. (Pharmacology)) -- Mahidol University, 1971.

Thesis (doctoral)--Freie Universität Berlin, 1978.

Thesis (M.A.)--Boston University

A cerebrospinal fluid (CSF) shunt system is used for treatment of hydrocephalus and abnormal intracranial pressure (ICP) conditions. Mostly a shunt system is placed under skin for creating a low resistance pathway between intracranial space and appropriate discharge sites within body by doing so excess CSF volume can exit the intracranial space. Displaced intracranial CSF volume normally results in lowered ICP. Thereby, a CSF shunt can manage ICP. In a healthy person, normal ICP is primarily maintained by CSF production and reabsorption rate as a natural tendency of body. If intracranial CSF volume starts increasing due to under reabsorption, this mostly results in raised ICP. Abnormal ICP can be treated by discharging excess CSF volume via use of a shunt system. Once a shunt system is placed subcutaneously, a patient is expected to live a normal life. However, shunt failure as well as flow regulatory problems are major issues with current passive shunt systems which leaves patients with serious consequences of under-/over CSF drainage condition. In this research, a shunt system is developed which is resistant to most shunt-related causes of under-/over CSF drainage. This has been made possible via use of an on-board medical monitoring (diagnostic) and active flow control mechanism. The developed shunt system, in this research, has full external ventricular drainage (EVD) capability. Further miniaturization will make it possible for an implantable shunt. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

No description available.

No description available.