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Background: Multiple myeloma (MM), a hematological malignancy marked by clonal plasma cells in the bone marrow, occasionally presents with myelomatous effusion—a rare condition with a median survival of <4 months. Central nervous system involvement (CNS-MM), characterized by plasma cell infiltration in the CNS, leptomeninges, or cerebrospinal fluid (CSF), is similarly rare and associated with dismal outcomes. Aims: To analyze the plasma cell involvement in body fluids and CSF in plasma cell neoplasms, correlating these findings with treatment strategies and patient outcomes. Materials and Methods: This retrospective study was conducted in the Oncopathology Department of a tertiary state cancer institute over 10 years (2013–July 2024). It included cases of plasma cell neoplasms with confirmed involvement of body cavity fluids or CSF. Data reviewed included epidemiological profiles, biochemical and hematological findings, immunohistochemistry results, treatment regimens, and follow-up information. Results: A total of 16 cases demonstrated neoplastic plasma cell involvement: 12 cases in pleural fluid and 4 cases in CSF. Of these, nine cases were diagnosed with MM, five cases with plasmacytoma, and two cases with plasma cell leukemia. Treatment included chemotherapy (10 patients), palliative radiotherapy (4 patients), combined palliative radiotherapy and chemotherapy (1 patient), and curative radiotherapy with chemotherapy (1 patient). Despite these interventions, the mean survival was only 2 months. Conclusion: Myelomatous involvement of effusion fluids and CSF is associated with a grim prognosis. These findings underscore the urgent need for multidisciplinary research and the development of innovative therapeutic strategies to improve outcomes for these patients. [ABSTRACT FROM AUTHOR]

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions. [ABSTRACT FROM AUTHOR]

Background: The usual sign of a wide variety of diseases is the formation of fluid in the pleural region. Pleural effusion (PE) is a prevalent condition in regular medical practice and has a wide range of underlying medical conditions as causes. The prognosis and treatment of PE can be greatly affected by the cause; hence, accurate differential diagnostic classification is essential. Materials and Methods: This prospective and observational clinical study was conducted between August 2013 and February 2015. A total of 100 patients were enrolled in the study. The clinical history and physical examination were done. For radiological evaluation X-ray of the chest was taken, and if necessary, ultrasonography and computed tomography were done. Thoracocentesis was performed after obtaining informed consent, and all necessary investigations were done. Results: Out of 511 patients, 100 patients were included in the study who were 60 or above 60 years of age. The most common comorbid condition was hypertension, which was found to be (32.81%) in males and (30.56%) in females. In exudative PE, tuberculosis (TB) was mostly found in males (53.13%) and malignancy in females (25%), while in transudative PE, the cardiac cause was mostly found in females (30.56%) as compared to males (15.63%). Conclusion: In India incidence of tubercular PE is more common than malignant. Accurate diagnosis and treatment can prevent disease progression and complications. [ABSTRACT FROM AUTHOR]

Background: Cytological study of pleural fluid helps establishing the underlying cause of pleural effusion. It is considered the most important tool in diagnosing malignancy in effusions. However, accurate identification of cellular morphology can be a problem in conventional cytology. Cell block preparation from pleural effusion aids in this diagnosis due to the preservation of tissue architecture, and multiple sections can be obtained for further studies. Aims and Objectives: The objectives of this study were to compare the diagnostic results of conventional cytology and cell block studies of suspected malignant pleural effusions and find out the diagnostic agreement or concordance between the two methods. Materials and Methods: A recordbased study was conducted at the Department of Pathology on conventional cytology and cell block study reports of 150 suspected malignant pleural effusion cases over 35 months. The diagnoses were expressed in five categories -- non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. Χ2 test was used to identify the percentage of malignancy reported. Agreement of both methods was assessed through Kappa statistics. Results: About 4.67% of cases were reported as malignant by conventional cytology, whereas cell block study diagnosed malignancy in 19.33% of cases. Relative diagnostic agreement between the two methods was 0.73 and concordance by Cohen's Kappa was 0.34, which signifies fair concordance. Conclusion: Cell block study, though having a fair concordance, is much superior to conventional cytology smears in detecting malignant cells and diagnosing a pleural effusion as malignant. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis is a worldwide public health problem associated with high morbidity and mortality. Tuberculosis can manifest in active and latent forms. Improving the diagnosis, treatment, and screening of tuberculosis is crucial for effective tuberculosis control. Chest X-ray and Computed Tomography chest play a vital role in diagnosing and screening for tuberculosis. Aim: To analyse the spectrum of radiological findings in pulmonary tuberculosis. Materials and Methods: The present retrospective descriptive study was conducted at a teritary care hospital in the Department of Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India. The data of 160 patients diagnosed with pulmonary tuberculosis between January 2019 and December 2020 were accessed and analysed. The recorded variables included forms of pulmonary tuberculosis, age/gender distribution, co-morbidities, Acid-fast Bacillus (AFB) smear status, and radiological findings and distribution. Descriptive statistics are presented in frequency and percentage. Results: Among the 160 cases of pulmonary tuberculosis, 30 (18.75%) cases were active primary tuberculosis, 105 (65.63%) cases were active post-primary tuberculosis, and 25 (15.62%) cases were inactive tuberculosis. Among the 30 cases of active primary tuberculosis, 14 (46.67%) cases had consolidation with air bronchogram, and 6 (20%) cases had consolidation without air bronchogram. Among the 105 cases of active post-primary tuberculosis, 65 (61.9%) cases had consolidation, 50 (47.62%) cases had cavities, and 56 (81.9%) cases had centrilobular nodules with a tree-in-bud appearance. Among the 25 cases of inactive tuberculosis, 18 (72%) cases had fibrosis with bronchiectasis, while 4 (16%) cases had fibrosis without bronchiectasis, and 3 (12%) cases had calcified granulomas. Conclusion: The study conclusively demonstrates the diverse radiological manifestations of pulmonary tuberculosis in different patient demographics. It highlights a higher incidence of active post-primary tuberculosis, especially in patients above 45 years, with varying radiological findings such as consolidation, cavitation, and fibrosis. [ABSTRACT FROM AUTHOR]

Background: The most typical pleural pathology manifestation is still pleural effusion. Despite routine biochemical and cytological examination of the pleural fluid, it can sometimes be challenging to distinguish between tubercular and malignant pleural effusion. Aims- This study aims to assess the value of pleural biopsy in identifying the cause of pleural effusion and correlating it with cytological and biochemical pleural fluid parameters. Methods: thirty consecutive patients of pleural effusion were selected from the out patient and indoor department of a tertiary hospital of central India. Biochemical, cytological and microbiological evaluation of pleural fluid was done in all cases. Those with exudative pleural effusions underwent pleural biopsy. Subsequently, the etiology of effusion was determined. Results: Malignancy was the most common etiology, followed by tuberculosis. Pleural biopsy was done in 30 patients. Malignancy was diagnosed in 13, tuberculosis in 10 and 7 cases were remain undiagnosed, on histopathological examination. Mean value of pleural fluid ADA in malignancy patients is 11.5, whereas in tuberculosis patients its 28.6. Conclusions: In our study, malignancy is more common than tuberculosis. pleural fluid cytology and pleural biopsy can give definite diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: A pleural effusion is accumulation of excessive fluid in the pleural space due to an imbalance between the production and absorption of pleural fluid by pleurae (visceral as well as parietal). Pleural effusion is a common clinical manifestation and about 3000 per Million people in the world suffers from pleural disease. Aims: To assess usefulness of ratio of serum LDH to Pleural Fluid ADA in differentiating Malignant Pleural Effusion and Tubercular Pleural Effusion. Materials and Methods: The study was a Descriptive Observational Crosssectional study was conducted in Department of Respiratory Medicine, Kamala Nehru Chest Hospital, Dr S N Medical College Jodhpur (Rajasthan), and a tertiary care centre for Respiratory Disease in Rajasthan, India after getting clearance from the Ethical committee. Result: found that most patients with tubercular pleural effusion (n=20) had Pleural Fluid ADA levels >35 and majority of the patients had Biopsy proven Malignant pleural effusion [22 (44.0%)] and it was statistically significant (p< .00001), (z=4.1036). Conclusion: We found that, most number of patients had Tubercular Pleural Effusion. It was statistically significant and majority of the patients had Biopsy proven malignant pleural effusion and it was statistically significant. [ABSTRACT FROM AUTHOR]

Background: Medical thoracoscopy (MT) has gained widespread acceptance in the diagnosis of undiagnosed exudative pleural effusions. In developing countries, including India medical thoracoscopy is not widely available., Aims: 1. To analyze the yield of closed pleural biopsy (CPB) in comparison with MT in the diagnosis of undiagnosed exudative pleural effusions. 2. Comparison of complications between CPB and MT., Methodology: This was a prospective randomized controlled study conducted in a tertiary care centre, from January 2020 to September 2021. The patients with undiagnosed exudative pleural effusions were included in the study. The enrolled patients were randomized into two groups, group A and group B. Total of 38 patients were taken, 19 patients in each group. Group A was subjected to MT. Group B was subjected to CPB with cope's needle. Ultrasound was used to mark the site of pleural effusion., Results: Diagnostic yield was 78.9% in both MT and CPB group. CPB was significantly less painful procedure compared to MT. The duration of hospital stay was also significantly less in CPB as compared to MT (P < 0.001). CPB was associated with 5.3% mortality and there was no mortality in MT group., Conclusions: Our study recommends that, in the era of medical thoracoscopy, closed pleural biopsy still holds a significant role in the diagnosis of undiagnosed exudative pleural effusions especially where prevalence of tuberculosis is high. It is also a cost effective approach in developing countries like India., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases. Objectives: Diagnostic yield of medical thoracoscopy was evaluated in cases of undiagnosed pleural effusion. Materials and methods: Rigid medical thoracoscopy was performed in 40 patients having undiagnosed pleural effusion at the Chest Disease Hospital, Srinagar, J&K India. Results: Medical thoracoscopy gave a definitive diagnosis in 38 out of 40 patients with diagnostic yield 95%. Malignancy was diagnosed in 28 patients (70%), one patient was diagnosed as empyema (2.5%), tuberculosis was found in 9 patients (22.5%), and it was non diagnostic in 2 patients (5%). The post-thoracoscopic complications in the studied group have occurred only in 4 patients (10%). Conclusion: Medical thoracoscopy is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is a simple and safe method with high diagnostic yield and with low complication. [ABSTRACT FROM AUTHOR]

Background: Empyema thoracis is an accumulation of pus in the pleural space. It is estimated that 0.6% of childhood pneumonias progress to empyema, affecting 3.3/1,00,000 children. Various treatment options available include antibiotics alone or with chest tube drainage, intrapleural fibrinolytics, video-assisted thoracoscopic surgery, and open decortications. Aims and Objectives: (1) The objective of the study was to study clinico-epidemiological and lab profile of pediatric patients with pleural effusion of infective etiology and (2) to study outcome and short term follow-up. Materials and Methods: Prospective observational study conducted from June 2020 to May 2021 at the pediatric department of a tertiary care hospital, central India. Inclusion criteria: Children between 6 months and 14 years diagnosed with pleural effusion clinically and radiologically. Exclusion criteria: Effusion of traumatic or malignant origin. Detailed history, examination, and relevant investigations were recorded. Data were compiled and analyzed. Patients were treated with intercostal drainage, antibiotics and were referred for surgical intervention wherever necessary. Results: Thirty-five patients were included in this study. The mean age of the patients was 4.4 years. Fever (100%), cough (88.5%) and breathlessness (65.7%) were the most common symptoms found at admission. Staphylococcus aureus was the most common organism isolated from pleural fluid. In the present study, 77% (27) patients were treated with ICD and antibiotics, 11.5% patients required surgical intervention, and 11.5% patients responded to antibiotics alone. The mortality rate in our study was 5.7% and the rest of the patients were successfully discharged and followed up. Conclusion: Antibiotics and tube thoracostomy are effective methods of treating pyogenic empyema thoracis in children in resource poor settings. [ABSTRACT FROM AUTHOR]

Background: Differentiating between tuberculosis and malignancy as the cause of an exudative lymphocyte predominant pleural effusion is difficult due to similarities in the cellular and biochemical characteristics of the pleural fluid in both conditions. Microbiological tests in tubercular pleural effusions have a poor diagnostic yield, and the long turnaround time for results prevents an early diagnosis. The diagnosis of malignant pleural effusion (MPE) is hampered by a variable yield of pleural fluid cytology and closed pleural biopsy and the fact that thoracoscopy may not be readily available or feasible in each patient. A key gap in the existing knowledge is the performance of the serum lactate dehydrogenase to pleural adenosine deaminase ratio (ie, "cancer ratio"; CR) in differentiating between tuberculous and MPE in a high tuberculosis prevalence country like India, although its use has been well established in Western literature. The CR may find a practical application in the community health care settings in low-income countries without ready access to biopsy., Objective: This study aimed to evaluate the CR as a test to differentiate tubercular and malignant etiology in patients with an exudative lymphocyte predominant pleural effusion. Secondary objectives to be assessed include a comparison of CR to pleural fluid carcinoembryonic antigen in MPE and the association of histologic type of lung carcinoma to the CR positivity., Methods: This hospital-based, prospective, observational study will include patients admitted with pleural effusion whose pleural fluid reports indicate a lymphocyte-predominant exudate. The ability of the CR to discriminate between tuberculous and MPE will be evaluated as a primary objective of this study. The performance of CR and pleural fluid carcinoembryonic antigen in the diagnosis of MPE will be compared using the receiver operating characteristics and area under the curve for both tests as a secondary objective. The association between a positive CR and histologic type of lung cancer will be analyzed as well., Results: Data collection began in June 2022. As of March 24, 2024, we have recruited 22 patients. Outcomes of the study are expected at the end of 2024., Conclusions: The results of this study will provide an objective basis for the use of CR in differentiating between tuberculosis and malignancy as the cause of an exudative lymphocyte predominant pleural effusion., International Registered Report Identifier (irrid): DERR1-10.2196/56592., (©Sai Pooja Chalamalasetty, Preetam Acharya, Thomas Antony, Anand Ramakrishna, Himani Kotian. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 23.12.2024.)

Background: Pleural effusion indicates an imbalance between pleural fluid formation and removal. Classified into exudative and transudative, with common symptoms of dry cough, dyspnea and pleuritic chest pain. Confirmed etiology has to be established for effective treatment., Objective: Correlate clinical and biochemical profile of various etiologies of pleural effusion., Materials & Methods: Retrospective observational study of 2 years in the department of respiratory medicine, GMC Bhopal on 280 cases of pleural effusion., Results: Most common etiology was tubercular 202 (72.4%) followed by malignant in 36 (12.8%). With respect to tubercular, malignant pleural effusion has relative risk (RR) of 0.138 (p value < 0.05) in the age group of 51-60 years, which is statistically significant. Patients of tuberculosis complained of fever 158 (78.2%) whereas with malignancy complained of chest pain 16 (44.4%) followed by hemoptysis 12 (33.3%). For hemoptysis, with respect to tubercular, malignant effusion has RR of 5.68 (p value < 0.05) which is significant. History of smoking was significant in malignant effusion with RR of 2.57 (p value < 0.05) as compared to tubercular. Pleural fluid ADA was >70 in 83.7% in tubercular effusion, glucose was <60 mg/dl in 79% tubercular, malignant and bacteriological cause, LDH was >1000 in 88.4% in bacteriological and 72.3% in malignant effusion., Conclusion: Lack of tools for confirming diagnosis leads to diagnostic dilemma and delay in treatment initiation, leading to deterioration and untoward fatality in some cases. Our goal is early diagnosis by correlating clinical symptoms with biochemical profile and help initiate rapid treatment., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Medical thoracoscopy (MT) is a useful diagnostic and therapeutic procedure for a variety of pleural conditions. There is a lack of literature on prevalent practices of MT in India. Aims and Objectives: The objective of the study was to study the prevalent practices of MT in India. Materials and Methods: A structured online survey on various aspects of thoracoscopy was designed on the "Google Forms" web software. Results: One hundred and eight responses were received, of which 100 respondents performed MT. The majority were pulmonologists, and most had started performing thoracoscopy within the last 5 years. Rigid thoracoscope was the most commonly used instrument. The common indications of procedure included undiagnosed pleural effusion, talc pleurodesis, and adhesiolysis. Local anesthesia with conscious sedation was the preferred anesthetic modality. Midazolam, along with fentanyl, was the most widely used sedation combination. 2% lignocaine was the most commonly used concentration for local infiltrative anesthesia. Nearly two-thirds of the respondents reported having encountered any complication of thoracoscopy. Significant reported complications included empyema, incision/port-site infection, re-expansion pulmonary edema, and procedure-related mortality. Conclusion: MT is a rapidly evolving interventional pulmonology procedure in India. There is, however, a significant variation in practice and variable adherence to available international guidelines on thoracoscopy. Formal training programs within India and national guidelines for pleuroscopy considering the local resources are required to improve the safety and yield of this useful modality. [ABSTRACT FROM AUTHOR]

Dengue is a febrile illness, disease of tropical areas, commonly encountered in India. Most of the infections are asymptomatic. The course of dengue infection varies from individual to individual and even in the same individual from time to time. The patient of dengue fever can present with a wide range of clinical manifestations from mild fever to life threatening Dengue Shock Syndrome (DSS) and severe Dengue Hemorrhagic Fever (DHF). Pleuro- Pulmonary complications involve parenchymal infiltration, pleural effusion (small, moderate, massive), pneumonitis, non-cardiogenic pulmonary oedema, hemorrhage-hemoptysis, acute respiratory failure. We report a case of 55 year old male who developed bilateral pleural effusion & pedal oedema and presented to us in acute respiratory failure, semiconscious and shock which was consistent with the diagnosis of Dengue Shock Syndrome. [ABSTRACT FROM AUTHOR]

Serum CA 125 is widely used as a tumor marker for epithelial ovarian cancer. Our laboratory receives few requests for evaluation of this marker in men. In males an elevation of this marker may occur due to malignant and benign lesions of organs derived from the coelomic epithelium. However, in the absence of evidence of a neoplasm (via clinical examination and other diagnostic modalities), it is useful to consider a diagnosis of tuberculosis, particularly in regions where the disease is endemic. Herein, we describe one such case that we investigated at our medical center in Kolkata, India. [ABSTRACT FROM AUTHOR]

We present the case of a 26-year-old Indian male who developed pleural effusion while undergoing treatment for tuberculous lymphadenitis. We describe the work-up for his condition and how he was managed. The possibility of development of a paradoxical reaction in the form of pleural effusion after initiation of anti-tuberculous therapy has to be kept in mind while treating such patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis and is superior to closed pleural biopsy. Medical thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the 2 thoracoscopes. METHODS: Subjects with undiagnosed exudative pleural effusions were randomly assigned to undergo pleural biopsy with either the rigid or the semirigid thoracoscope. The primary outcome was the diagnostic yield of the procedure, while the secondary outcomes were requirement of sedative/analgesic agents, scar size, biopsy sample size, and the operator's view of the procedure. RESULTS: Of the 145 screened subjects with exudative pleural effusions, 90 were randomized to undergo thoracoscopy with the 2 thoracoscopes (n = 45 each). The diagnostic yield of rigid thoracoscopy was superior to semirigid thoracoscopy (97.8% vs 73.3%, P = .002) on an intention-to-treat analysis but was similar (100% vs 94.3%, P = .18) in those with successful biopsy. The requirement of sedative/analgesic agents was higher in the rigid thoracoscopy arm. The scar size was slightly larger (mean ± SD, 23.1 ± 4 vs 18.7 ± 3.2 mm, P _ .0001), whereas the biopsy sample size was distinctly larger in the rigid arm (mean ± SD, 13.9 ± 4.4 vs 4.4 ± 1.4 mm, P = .001). The operator-rated visual analog scale score for the ease of taking a biopsy sample was significantly higher with the rigid instrument (mean _ SD, visual analog scale 86 ± 12 vs 79 ± 12 mm, P = .01), while the quality of image was superior in the semirigid arm (mean ± SD, visual analog scale 88 ± 7 vs 92 ± 5 mm, P = .002). The number of complications were similar in the 2 groups. CONCLUSIONS: Rigid thoracoscopy was found to be superior to semirigid thoracoscopy overall, but the diagnostic yield was similar if pleural biopsy could be successfully performed. Due to the small sample size, a larger study is required to define the usefulness and choice between the 2 procedures.. [ABSTRACT FROM AUTHOR]

Objective: To study the cases of H1N1 influenza admitted in our hospital.Method: Hospital records of all the admitted patients diagnosed as H1N1 positive by throat swab rt-PCR (real time polymerase chain reaction) were retrospectively studied.Results: Between November 2009 and February 2010 total 62 children were hospitalized with 2009 H1N1 influenza virus infection. Of the admitted children, 19 (30.6%) were admitted in ICU and 4 (6.4%) expired. Consolidation was observed in 25 (40%) cases while 4 (6%) patients had pleural effusion and 1 patient each developed pneumothorax and pulmonary edema.Conclusions: Pandemic 2009 H1N1 influenza caused serious respiratory complications in children not usually seen with seasonal influenza. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic utility of adenosine deaminase (ADA) in exudative pleural effusions of different etiologies. Setting and Design: It was an observational study conducted at a tertiary care teaching institute. Materials and Methods: Of a total of 171 pleural fluid samples, 122 were found to be exudates and were included in the study. Pleural fluid ADA was done for all included patients. Pleural fluid ADA .40 U/l was taken as diagnostic cut off for TB effusion. Statistical Analysis: Sensitivity, specificity positive and negative predictive value of pleural fluid ADA for diagnosing TB was calculated by using clinical calculator . 1, Richard Lowry 2001-2013. Results: There were 171 patients with pleural effusion, out of which 122 (71.8%) were found to be exudative and were studied further. There were 49 (40.1%), 36 (29.5%) and 33 (27%) cases of TB, malignancy and para pneumonic effusion respectively, whereas 4 (3.3%) cases remained undiagnosed. Median ADA values for TB, malignancy and para pneumonic effusion were 55.8 U/l (range 9.7.756 U/l), 18 U/l (6.5.81 U/l) and 25 U/l (3.4.172 U/l) respectively. Pleural fluid ADA >40U/l yielded 85.7% sensitivity, 80.8% specificity, 75% positive predictive value and 89.5% negative predictive value. Conclusion: Pleural fluid ADA remains useful in diagnosing tuberculosis pleural effusion. The median ADA for TB effusion in present cohort was 51.8 IU/ml. Pleural fluid ADA of 40 U/L yielded 89.5% negative predictive value and 75% positive predictive value. Pleural fluid ADA is cost effective and good screening test for diagnosis of TB. [ABSTRACT FROM AUTHOR]

Background: Diagnostic thoracentesis is the initial diagnostic investigation in the workup of an undiagnosed Pleural effusion. However, a significant percentage of pleural effusions remain undiagnosed after this step and after closed pleural biopsy. Medical thoracoscopy (MT) has a high diagnostic yield in these patients. MT is now widely practised in India. This survey endeavours to study the practice of this technique by respiratory physicians in India., Methods: An electronic survey called 'Indian Thoracoscopy survey' was prepared and conducted under the aegis of Indian Chest Society. In all there were 63 Questions in English prepared and disseminated as a "Google Form" to conduct this survey. The subjects were recruited from the e-mail lists of the three major professional surgeries that serve the interests of the respiratory physicians. The participation in the survey was voluntary and no incentive of any sort was offered to the participants. The survey link was kept open for a 3-month period., Results: There were total 659 respondents, whose mean age was 41.5 years and majority of them were males (n = 564, 85.6%). The largest group of respondents practiced in corporate/private hospitals (n = 315, 47.8%). Only 311 (47.2%) respondents performed MT. Of these, 190 (61.1%) used flex-rigid/semi rigid thoracoscopes. Undiagnosed pleural effusions (N = 194; 62.4%) and recurrent pleural effusions (N = 117; 37.6%) were the most common indications for performing MT. Majority of the thoracoscopists (222, 71.4%) used conscious sedation and a combination of Midazolam and Fentanyl was the most preferred combination (n = 238; 76.5%). Most follow the manufacturer's recommendation for thoracoscope cleaning and disinfection and had safety check lists in place., Conclusion: Our survey captures the practice of MT in India. MT seems to be increasing in popularity with significant numbers of respiratory physicians performing the procedure. Respondents felt that MT was a valuable investigation that was underused and more of them wanted to learn. It is safe to perform MT under conscious sedation and local anaesthesia and a boon to patients who required surgical procedures for evaluation of difficult to diagnose pleural diseases. The setup cost is significant and would not justify installation in all centres. The lack of opportunities for training is something that needs to be looked in to., Competing Interests: Declaration of competing interest The authors have none to declare., (Copyright © 2021 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Summary: Salmonella enterica serovar Enteritidis (S. Enteritidis), a non-typhoid Salmonella, is an important emerging pathogen that usually causes gastroenteritis. Here, we report polyserositis with right-sided pleural effusion and loculated collection of fluid in the peritoneum caused by S. Enteritidis in a 60-year-old man from southern India. The patient was immunocompetent and did not have preceding gastroenteritis or any local structural abnormality. Malnutrition and old age might have been the predisposing factors. The patient received intravenous ceftriaxone for 2 weeks followed by oral ciprofloxacin. Pleurocentesis and abdominal paracentesis were also done. The patient was cured as evidenced by clinical improvement and radiological disappearance of the fluid collection. [Copyright &y& Elsevier]

About 36% to 57% of bacterial pneumonias develop parapneumonic effusion. When the chest tube is correctly positioned as evidenced by postero-anterior and lateral chest radiographs and there is a significant amount of pleural fluid, the major reasons for failed drainage are multiple pleural space loculations or tube obstruction by thick and viscous fluid. The various modalities of treatment available for loculated pleural effusion are: saline flushes, placing one or more catheters in loculi under image guidance, video assisted thoracoscopic surgery (VATS), standard thoracotomy with drainage of empyema and decortication. The first two modalities are not so effective in improving drainage. The last two surgical modalities are more invasive, not easily available and, if available, are not affordable by majority of patients in the developing countries like India. The fibrinolytic agents, if used early in loculated pleural effusions, break loculations and early pleural peel thereby facilitating pleural space drainage., (© Journal of the Association of Physicians of India 2011.)

Background: Pleural effusions (PE) complicate cirrhosis in ~5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large-scale studies on interventions for refractory PE are limited., Methods: Consecutive hospitalized cirrhotics having PE were retrospectively analysed. None had liver transplantation (LT) within 6-month follow-up. We determined safety, efficacy and mortality predictors for PE managed with standard medical treatment (SMT), thoracentesis, catheter drainage and TIPS., Results: Of 1149 cirrhotics with PE (mean Child-Pugh 10.6 ± 1.8 and MELD 21.2 ± 7.4), 82.6% had hepatic hydrothorax (HH) and 12.3% were suspected tubercular PE (TBPE). Despite comparable HVPG and MELD scores, patients with HH developed more AKI, encephalopathy and septic shock (all P < .01) on follow-up. Among HH, 73.5% were symptomatic, 53.2% isolated right-sided PE and 21.3% had SBE. Presence of SBP [Odd's ratio, OR: 4.5] and catheter drainage [OR: 2.1] were independent predictors for SBE. In 70.3% of admissions, HH responded to SMT alone, 12.9% required thoracentesis and 11.5% underwent catheter drainage. Fifty-one patients were selected for TIPS [lower mean CTP 9.9 ± 1.6 and MELD score 18.7 ± 5.4]. Despite reduction in pressure gradient from 23.1 ± 3.8 mm Hg to 7.2 ± 2.5 mm Hg, 25 patients had partial response, 10 had complete HH resolution. Major post-TIPS complications were portosystemic encephalopathy (eight patients, six resolved) and ischaemic hepatitis (four patients, two resolved). Overall, 35.9% patients with HH had 6-month mortality and independent predictors were MELD > 25, SBP and septic shock., Conclusion: Refractory PE in cirrhosis requiring interventions including TIPS has poor outcome. The role of haemodynamics in predicting post-TIPS response and complications is limited. Early referral for LT is imperative., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

An epidemic of dengue haemorrhagic fever/dengue shock syndrome occurred in Chennai, South India in 1989 during and following the rainy season. Sixty-nine infants and children admitted to the Institute of Child Health and Hospital for Children with a brief febrile illness associated with skin and mucous membrane bleeds and/or shock were studied. Forty-nine had antibodies to dengue viruses. The specific serotype of the virus responsible could not be identified owing to cross-reacting antibodies. Primary infection occurred in 11 cases, secondary infection in 17 cases, antibodily titres were indicative of 'probable' dengue infection in 16 and were uninterpretable in five. In 11 cases, serology could not be done. The pattern of disease in these 60 cases was similar, with a high mortality. Haemoconcentration was not a feature in the majority and the Hess test was negative in all those tested. Nine cases with a similar but milder illness tested negative for dengue.