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Table 1: Demographic and clinical history in sputum positive and sputum negative PTB patients Parameters SPPT SNPT P value (n=34) (n=20) Age (y) mean[+ or -]SD 39.53[+ or -]6.23 39.80[+ or -]7.03 0.884 Cough (*) number of 27 (79.4) 10 (50) 0.035 patients (%) Fever number of patients (%) 24 (70) 10 (50) 0.154 Anorexia number of 24 (70.5) 10 (50) 0.154 patients (%) History of weight loss 20 (58.8) 9 (45) 0.401 number of patients (%) Hemoptysis number of 4 (11.7) 0 (0) 0.284 patients (%) (*) Significant at P<0.05.
Given the lack of resources to use sophisticated laboratory tests for this problem in our country, we tried to develop a CPR to diagnose SNPT. The objective of the study was therefore to develop it in the format of a score based on simple clinical variables for the diagnosis of SNPT in an area of high endemicity.
As we excluded the patients with smear-positive tuberculosis, finally we had 2 groups: culture positive SNPT and culture-negative patients.
Out if these, 27 (10.31%) were diagnosed with SNPT. Baseline characteristics of the population as well as radiological findings are shown in Tables 1 and 2.
The main aim of our study was to prospectively develop a clinical prediction rule that could be useful for improving the diagnostic approach to the patient with clinical suspicion of SNPT.
Two aspects we would like to comment are the presence of an age of more than 45 years and the presence of productive cough as factors associated with a lower probability of having SNPT. Advanced age is normally associated with a higher susceptibility to tuberculous disease.
In the ideal situation, the criteria for diagnosis of SNPT should include other clinical and laboratory parameters (for example clinical evolution of patients and/or demonstration of AFB or caseating granuloma in histopatological specimens).
The developed score did not include other clinical tools that have been employed for the diagnosis of SNPT such as fibrobroncoscopy [9-13], the use of induced sputum [14-20], concentration techniques [21-24], auramine-rhodamine enhanced AFB detection [25,26], or Adenosine deaminase activity in sputum or bronchoalveolar lavage [27-30] or fine needle aspiration [31,32].
This can reduce the number of unnecessary procedures done (for example, in patients with a negative score and therefore a very low probability of SNPT) and can be used to avoid the delay in treatment for those patients with high scores while pending other tests.
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