Resumen: Consenso internacional para la nomenclatura y clasificación de la válvula aórtica bicúspide congénita y su aortopatía, con fines clínicos, quirúrgicos, intervencionistas y de investigación / Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes

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Abstract This consensus of nomenclature and classification for congenital bicuspid aortic valve and its aortopathy is evidence-based and intended for universal use by physicians (both pediatricians and adults), echocardiographers, advanced cardiovascular imaging specialists, interventional cardiologists, cardiovascular surgeons, pathologists, geneticists, and researchers spanning these areas of clinical and basic research. In addition, as long as new key and reference research is available, this international consensus may be subject to change based on evidence-based data1.

Revisiting the Chingleput BCG vaccination trial for the impact of BCG revaccination on the incidence of tuberculosis disease

Background & objectives: Vaccines play a crucial role in the prevention of tuberculosis (TB). Revaccination with Bacille Calmette–Guerin (BCG) for the prevention of TB is an important strategy that is currently gaining interest. The objective of this study was to reanalyze the community-based Chingleput BCG vaccination trial for protective efficacy of BCG revaccination against incident TB disease. Methods: A retrospective analysis of the Chingleput BCG vaccination trial (conducted in 1968) data was carried out. Data on participants with evidence of prior BCG vaccination at trial intake and randomized to BCG vaccine [low dose (0.01 mg), high dose (0.1 mg)] and placebo arms were analyzed. The incidence of TB disease, which was based on sputum culture and/or chest X-ray was compared between the BCG and placebo arms over a 15 yr follow up period. Results: Of the 269,727 individuals randomized in the trial; 263,158 had no evidence of TB at baseline, of which 4436 (1.68%) had evidence of BCG vaccination at trial intake (2890 in the BCG vaccine and 1546 in the placebo arms, respectively). There were 77 (190 per 100,000) and 64 (296 per 100,000) incident TB cases in the BCG and placebo arm, respectively, at 15 yr post-vaccination. The incidence of TB disease was significantly lower in the BCG arm [Hazard ratio of BCG arm (95% confidence interval): 0.64 (0.46-0.89)]. Interpretation & conclusions: Retrospective data analysis of this community-based trial revealed that BCG revaccination in a community offered modest protection against the development of TB disease at the end of 15 years which, however, requires further evaluation.

A Tinnitus Inventory Focusing on Body Function, Activities, and Participation Using the International Classification of Functioning, Disability and Health

Background and Objectives@#This study describes the development of an International Classification for Functioning, Disability and Health (ICF)-based inventory for tinnitus (ICF-TINI) that measures the impact of tinnitus on the function, activities, and participation of an individual. @*Subjects and Methods@#This cross-sectional study utilized the ICF-TINI, which included 15 items from the two ICF components of body function and activities. We included 137 respondents with chronic tinnitus. Confirmatory factor analysis validated the two-structure framework (body function, activities and participation). The model fit was assessed by comparing fit values of chi-square (df), root mean square error of approximation, comparative fit index, incremental fit index, and Tucker-Lewis index, with the suggested fit criteria values. Cronbach’s alpha was used to assess internal consistency reliability. @*Results@#The fit indices confirmed the presence of two structures in ICF-TINI, while the factor loading values suggested each item’s goodness of fit. The ICF-internal TINI exhibited high consistency reliability (0.93). @*Conclusions@#The ICFTINI is a reliable and valid tool for assessing the impact of tinnitus on an individual’s body function, activities, and participation.

Does BCG Or MMR Or Routine Vaccination Coverage Protect Against COVID Infection And Mortality In India?

Background: The routine vaccinations and acquired immunity by other viral infections were believed to be acting as a protective factor against severe COVID-19 outbreaks in some countries. Objective: This study is overviewing the relationship of routine BCG, MMR vaccinations and reported MMR disease outbreak with reported COVID-19 infection across the Indian states. Methods: The data on vaccination coverage and respiratory disease infection was obtained from Univer-sal immunization program and Integrated disease surveillance project reports. Spearman rank correla-tion has been used to assess the relationship of routine vaccination and COVID-19 infection. Results: The result did not find any relationship of routine vaccination with BCG and MMR or exposure to MMR infection on COVID-19 infections in India. Conclusion: The exposure to BCG or MMR vaccination did not have a non-specific protection against COVID-19 infection. The results imply that a larger proportion of the Indian population is still vulnerable to COVID-19 infection.

Novel management of internal root resorption with vertical root fracture using mineral trioxide aggregate - A case report

Introduction: This case report presents the diagnosis and management of extensive internal root resorption (IRR) in a 17?year?old male patient, with a 9?year?old history of trauma. Method: The affected tooth 21 was associated with vertical root fracture (VRF) and incomplete apex closure with a substantial loss of tooth structure, including dentin and cementum. Encouraged by a healthy periodontal condition, the choice was made to use mineral trioxide aggregate (MTA) to reconstruct and reinforce the resorptive defect and the fractured segment. A composite veneer was placed to enhance the aesthetics. Result: A follow?up of the patient after 2 years revealed healing with a resolution of the lesion. Conclusion: This case report highlights the use of MTA as a lone?standing filling material for the treatment of IRR with VRF in a non?vital immature tooth

ASSOCIATION BETWEEN CRP, D–DIMER, SERUM FERRITIN, INITIAL CT–CHEST SEVERITY SCORE AND THE OUTCOME OF COVID–19 IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction: The surge of Covid -19 pandemic and the earlier depletion of resources have led to the need of allocation of patients based on levels of risk. The COVID 19 related mortality has been on increase in people with old age, male gender, infiammatory markers elevation and in people with history of co morbidities. With this background, thus study aimed to observe association between CRP, D-Dimer, Serum Ferritin, The Initial CT Chest Severity Score and the outcome of Covid 19 in patients with Type 2 Diabetes mellitus. A hospital based retrospective study was done among COVID 19 patie Materials and methods: nts from the period of September to December 2020. Patients with Type 2 diabetes mellitus admitted with RT-PCR positive (or) CT Thorax – CORADS 4 and above with age more than 18 years and having CRP, D-Dimer, Serum Ferritin results within 24 hours after admission were included in the study. The data was collected using a semi structured questionnaire. A total of 531 individuals were participa Results: ted in the study. The mean respiratory rate and oxygen saturation between the survived and deceased groups was statistically significant (p value 0.024 and 0.044 respectively). All the patients had normal blood urea and serum creatinine values. The mean CORADS score of the participants is 4.78 ± 0.60. There is statistically Conclusion: significant difference in the mean respiratory rate and mean SPO2 between deceased and recovered patients. With advancements in medical sciences, it may not be a rigid process to predict severity with laboratory investigations

Interstitial granulomatous dermatitis: a rare case report of dermatological manifestation of rheumatoid arthritis

Interstitial granulomatous dermatitis (IGD), a rare dermatological disorder was first described by Ackerman et al, in the year 1993. It is characterized by a heterogeneous clinical spectrum and a specific histopathological pattern. It has been described in association with a number of auto-immune disorders, drugs, fungal infections, and malignancies. It may manifest as papules, patches, plaques, nodules, annular lesions, or less frequently, as described classically, as indurated linear subcutaneous cords. This case is being reported as interstitial granulomatous dermatitis is rare dermatological manifestation of rheumatoid arthritis and presentation as large ulcerated skin lesions is further extremely rare. In this case report we describe a 67-year-old gentleman with Seropositive Rheumatoid arthritis. He presented to our hospital with complaints of multiple well defined skin lesions with pus discharge over lower limbs, trunk and upper limbs. Biopsies from left upper limb and abdomen showed focal necrobiosis with surrounding granulomatous inflammation with rare perivascular granulomas. He was subsequently diagnosed to have interstitial granulomatous dermatitis based on histopathological examination. Interstitial granulomatous dermatitis has been described to be associated with a number of autoimmune conditions and drugs. It is very important for clinicians to have knowledge about this rare skin condition as it may be heralding presentation of a serious underlying condition like lymphoproliferative disorders or solid organ malignancies. There is no specific treatment and causative disease has to be diagnosed and targeted.

Prevalence of Acute Pancreatitis in Dogs

The study was aimed to study the prevalence of acute pancreatitis in dogs. Forty dogs with history of acute onset of vomiting, abdominal pain and anorexia were screened for acute pancreatitis by radiography, abdominal ultrasound and confirmed by SNAP cPL (Canine pancreatic lipase) kit test. Fourteen (0.375 per cent of gastrointestinal cases) dogs found to be positive for acute pancreatitis by abdominal ultrasound, out of which SNAP cPL was positive in nine dogs (64 per cent). Among this 64.3 per cent was secondary acute pancreatitis and 35.7 per cent being primary acute pancreatitis. Highest prevalence was observed in male, Non-descriptive dogs, irrespective of age group. The common history and clinical findings recorded were anorexia, lethargy, vomiting, diarrhea, abdominal pain, dehydration, tachycardia, tachypnea, praying posture and pyrexia.

Treatment of Idiopathic Immune Mediated Hemolytic Anaemia in Dogs

Immune-mediated hemolytic anemia (IMHA) is the most common autoimmune disease in dogs. This study was conducted to evaluate prednisolone and azathioprine therapeutic protocols for the management of idiopathic IMHA in dogs. The anaemic dogs brought with clinical signs such as pale or icteric mucous membranes were screened for IMHA by saline agglutination and spherocyte count and confirmed by flow cytometry. The positive cases were further subjected to haematology, biochemistry, coagulation profile, MAT and polymerase chain reaction (PCR) for the diagnosis of underlying secondary causes like Babesia spp, Ehrlichia canis and Leptospira spp (secondary IMHA). Thirty two cases were positive for IMHA, out of which thirteen cases were primary (Idiopathic) IMHA (17.3 %) and remaining nineteen cases were secondary IMHA (82.7 %) due to underlying causes such as Babesia gibsoni (13), Ehrlichia canis (3) and Leptospira spp. (3) respectively. Immunosuppressive therapy with prednisolone and prednisolone in combination with azathioprine and specific therapy of etiological agent with supportive therapy was used. Significant increase in Hb, PCV, RBC and thrombocyte count, significant decrease in leucocyte, neutrophil, monocyte and total protein and significant increase in ALT activity was recorded after therapy. Prednisolone was found to be effective in the management of canine IMHA than prednisolone combined with azathioprine

Role of risk factors, clinical features and treatment modality in early detection and management of Buerger’s disease: a study from tertiary care centre Pondicherry

Background: Thromboangiitis obliterans is a disease of unknown aetiology seen under 45 years of age with no form of treatment has been successful in offering the victims of this disease a cure nor even a long-term remission. Objective of the study was to study the role of different risk factors, clinical features and treatment modality in early detection and management of Buerger’s disease.Methods: This is an experimental study carried out in 50 cases of Buerger’s disease after obtaining a well-informed written consent in department of General Surgery in Aarupadai Veedu Medical College and Hospital. Period of study was from October 2015 to October 2017. Data was analysed with SPSS 23.0 version.Results: Majority were from 31-40 years age group i.e. 30 (60%). Left lower limb was involved in 52% subjects. 80% smoked more than 20 cigarettes per day. Signs of ischemia was present in all 50 patients. Gangrene of the limb was seen in 14 patients (28%). Out of 3 patients with recurrent pain, 2 (66.7%) were relieved. Ulcer healing occurred in 5 out of 6 patients i.e. 83.3% and intermittent claudication was relieved in 2 out of 7 patients i.e. 28.6%.Conclusions: Males are commonly involved in our study. Majority of patients were in age group 31-40 years. Smoking is an important and definite risk factor in relation with the development of Buerger’s disease. Lower limb is commonly involved. Majority of patients in our series were treated by conservative management.

A randomised controlled trial on effect of splinting a joint on the lifespan of intravenous cannula in pediatric patients

Background: Children admitted to hospital and ICUs for various reasons like sepsis, respiratory distress, dehydration, shock etc. require an intravenous line for medications and IV fluids. Properly securing an intravenous line is very important. It is equally important to maintain the patency of the intravenous line for longer periods of time. But there is no adequate data regarding factors affecting the duration of patency of an IV line. This study was done to compare effect of limb splinting versus non-splinting with the functional duration of peripheral IV cannula.Methods: This study was done over 3 months between October - December 2018 in pediatric patients (age 6 months to 5 years) admitted to Kempegowda Hospital. Patients were randomised into splint group and non-splint group. In the splint group a firm splint was applied to the joint that was cannulated. No such intervention was done in the non-splint group. Time from IV line placement to removal was measured.Results: Total 438 patients were taken into study. After exclusion 200 patients were given a splint and 200 were not splinted. The median survival time was more in splint group when compared to non-splint group.Conclusions: This study shows that splinting helps to maintain patency of IV line for a more longer duration than non splinting of the joint.

Prevalence of Ankyloglossia among Children Reporting with Speech Pathology to District Early Intervention Centre (DEIC)- An Observational Study.

A sound is produced as a result of various movements and positions of the mobile and immobile elements of the articulation system. Tongue being one of the important mobile elements if restricted may lead to difficulty in articulation of one or more sounds. However, the relationship between speech and ankyloglossia is less investigated. So, we conducted a study to evaluate the prevalence of ankyloglossia among children with speech pathology reporting to District Early Intervention Centre (DEIC).METHODSAn observational study was conducted in the Department of Dental Surgery in association with DEIC of a tertiary care hospital for a period of one year. Children reporting for evaluation of speech pathology between 3 and 11 years of age were examined. Children with a history of traumatic injury or any surgical / chemo radiation treatment to oral cavity were excluded from the study.RESULTSAmong the total of 8911 patients who visited DEIC, 380 patients were referred for evaluation of speech difficulty. Among them a total of 304 patients were diagnosed with ankyloglossia. The overall prevalence of ankyloglossia was 3.4 percent and that among patients with speech problem was 80 percent. The prevalence was distributed as 63.5 percent in males and 36.5 percent in females. Type 2 ankyloglossia was highly prevalent (72 percent) than the others.CONCLUSIONSA substantial proportion of children with speech problem had ankyloglossia (80 percent). So, all the children with speech difficulty should be screened for ankyloglossia and correction undertaken. Awareness should be created among the common people about ankyloglossia, and the treatment options available.

Comparison of Radiography, Ultrasonography and SNAP cPL in the Diagnosis of Acute Pancreatitis in Dogs

The study was aimed to compare various diagnostic modalities in the diagnosis of acute pancreatitis in dogs. Forty dogs with history of acute onset of vomiting, abdominal pain and anorexia were screened for acute pancreatitis by radiography, abdominal ultrasound and confirmed by SNAP cPL (Canine pancreatic lipase) kit test. Fourteen (0.375 per cent of gastrointestinal cases) dogs found to be positive for acute pancreatitis by abdominal ultrasound were selected and further subjected to radiography to rule out the underlying causes of acute pancreatitis and confirmed by SNAP cPL test. Out of fourteen dogs, four dogs (29 per cent) having specific radiographic changes gas filled intestinal loops with loss of serosal details, SNAP cPL was positive in nine dogs (64 per cent). Abdominal ultrasonography revealed hypoechoic pancreas, hyperechoic surrounding fat saponification, enlarged or irregular pancreas and dilatation of biliary or pancreatic duct as the major changes in acute pancreatitis dogs. Ultrasound was found to be superior to radiography in the diagnosis of acute pancreatitis and SNAP cPL was found to be effective in confirming only in acute stages of pancreatitis

Clinical study of cutaneous infections in children

Background: Dermatological ailments contribute to one third of outpatient visits in paediatric clinics. Among these, cutaneous infections are found to be the commonest as per various studies. This study was conducted to find out the commonest cutaneous infections in children. Aim was to find out the prevalence of various cutaneous infections in children.Methods: In this study 200 children aged between 1- and 12-years attending outpatient clinic with signs and symptoms suggestive of cutaneous infection were included in the study. History, physical examination and appropriate tests were done to arrive at the diagnosis.Results: Here, 133 children were male and 67 were female. Viral infections were found to be the commonest cutaneous infections and were found in 85 children followed by bacterial infections in 52, fungal infections in 42 and infestations in 21. The presence of high humidity and hot climate in our coastal city along with the prevalent clothing pattern, overcrowding and socio economic factors play a significant role in the type of cutaneous paediatric infection found in that geographical area.Conclusions: Proper hygiene, education and clothing along with avoidance of overcrowding and early medical attention will help to prevent peadiatric cutaneous infections.

Identification of Plasmodium Species by Multiplex PCR in a Single Tube Reaction

Epidemiological studies based on molecular methods for identification of Plasmodium vivax and Plasmodium falciparum is gaining importance, because the conventional methods like microscopy, cannot detect low-level parasitaemia and mixed infections. Even though different types of laboratory investigations for diagnosing malaria-like rapid antigen detection and QBC were developed, still there are some negative interpretations among convalescent cases identified in endemic areas. These issues can be overcome by using molecular techniques like multiplex PCR, nested PCR, real-time PCR and reverse transcriptase PCR. Among these methods real-time PCR has been shown to be more sensitive in studying the epidemiology of malaria. We wanted to standardize Multiplex PCR for the identification of Plasmodium species in a single reaction mix.METHODSA total of 52 blood samples were collected from suspected cases of clinical malaria which were tested for microscopy by using Leishman's stain and confirmed by conventional and multiplex PCR. Standardization of multiplex PCR for the identification of Plasmodium species in a single reaction mix was done for the diagnosis of malaria.RESULTSOut of 52 blood samples collected, about 38 (73.08 %) samples were confirmed with a multiplex PCR technique and only 34 (65.38 %) by microscopy. The four samples negative by microscopy were found to be Plasmodium falciparum. A significant correlation was found with the positive samples by conventional and standardized multiplex PCR.CONCLUSIONSMultiplex PCR is more useful for accurate diagnosis and epidemiological study for the detection of various species of the genus Plasmodium in a single-step reaction.

Short- and long-term predictors of spontaneous bacterial peritonitis in Singapore

INTRODUCTION@#Spontaneous bacterial peritonitis (SBP) is the commonest complication of liver cirrhosis. Timely and appropriate treatment of SBP is crucial, particularly with the rising worldwide prevalence of multidrug-resistant organisms (MDROs). We aimed to investigate the clinical outcomes of SBP in Singapore.@*METHODS@#All cirrhotic patients with SBP diagnosed between January 2014 and December 2017 were included. Nosocomial SBP (N-SBP) was defined as SBP diagnosed more than 48 hours after hospitalisation. Clinical outcomes were analysed as categorical outcomes using univariate and multivariate analysis.@*RESULTS@#There were 33 patients with 39 episodes of SBP. Their mean age was 64.5 years and 69.7% were male. The commonest aetiology of cirrhosis was hepatitis B (27.3%). The Median Model for End-stage Liver Disease (MELD) score was 17; 33.3% had acute-on-chronic liver failure and 60.6% had septic shock at presentation. N-SBP occurred in 25.6% of SBP cases. N-SBP was more commonly associated with MDROs, previous antibiotic use in the past three months (p = 0.014) and longer length of stay (p = 0.011). The 30-day and 90-day mortality among SBP patients was 30.8% and 51.3%, respectively. MELD score > 20 was a predictor for 30-day mortality. N-SBP and MELD score > 20 were predictors for 90-day mortality.@*CONCLUSION@#N-SBP was significantly associated with recent antibiotic use, longer hospitalisation, more resistant organisms and poorer survival among patients with SBP. N-SBP and MELD score predict higher mortality in SBP. Judicious use of antibiotics may reduce N-SBP and improve survival among cirrhotic patients.

Post-operative analgesia of 2% lignocaine with or without magnesium sulfate for inferior alveolar nerve block in symptomatic mandibular molars - a randomized double blind controlled clinical trial

Background@#Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO4), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO4 in patients with symptomatic irreversible pulpitis and apical periodontitis. @*Methods@#Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO4 (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker–Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. @*Results@#Administration of 150 mg MgSO4 hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. @*Conclusion@#Combining 75 mg or 150 mg of MgSO4 with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO4 is adequate for endodontic procedures.

Medical Management of Rumen Collapse in Cows

Rumen collapse or rumen void is a syndrome usually observed in cattle affected with other primary diseases. It is a sequelae to other primary diseases due to total anorexia for several days. Recently purchased and calved animals brought into Large Animal Outpatient Medicine Unit, Madras Veterinary College Teaching Hospital, with the history of prolonged anorexia, mastitis and metritis were screened for rumen collapse. A total of 20 cases were included for the study. Animals were subjected to clinical, physical, rectal, haematological and biochemical examination. Anamnesis included were anorexia in all cases, high rise of temperature 15(75%) and high coloured urine 14(70%). An rumen collapsed in case of recently purchased animals were 12(60%). Clinical signs were anemia 18(90%), enlarged lymph node 17(85%), decreased rumen motility 17(85%), decreased or suspended rumination 16(80%). Rectal examination revealed a small sized rumen (rumen collapsed). Rumen fluid examination revealedvery few live protozoa or complete absence of protozoal motility and increased in MBRT (Methylene blue reduction test) time. The haematological examination revealed reduced level of Hb, PCV and RBC level. Biochemical examination revealed reduced level of total protein and other parameters were remain in the normal range. The suggestive of the primary diseases involved were hypocalcaemia, theileriosis, anaplasmosis, mastitis, septic metritis, indigestion and babesiosis. The animals were firstly treated for primary diseases followed by rumen cud transplantation and oral administration of rumenotorics bolus.

Successful Medical Management of Pregnancy Toxemia in Goats

Pregnancy toxaemia is a metabolic disorder that occurs in does and ewes during the late stage of pregnancy. Pregnant does that have low energy levels and having multiple numbers of fetuses are more susceptible to toxaemia. The present study was carried out in twenty five goats in advanced stage of pregnancy with the history of anorexia, torticolis, grinding of teeth, salivation and rigors. On clinical examination of animals, they were dull, depressed with tachycardia, tachypenia, opisthotonus and pale conjunctival mucous membrane. The biochemical parameters revealed hypoglycemia and hypocalcemia. Urine samples were collected and urine analysis revealed positive for ketone bodies. The goats were successfully treated with 25% dextrose i/v as a bolus, multiple electrolytes solution containing 5% dextrose i/v, glycerin orally and Vitamin B-complex injection intramuscularly and all the twenty five animals survived. Out of 25 animals medical termination of pregnancy was done in 21 cases and four animals delivered a live kid.

Cytology and Biochemical Analysis of Pleural Effusion in Dogs

Pleural effusion is the accumulation of fluid in the pleural space due to disruption of the hydrostatic and starling forces which maintain the pressure of pleural cavity. A total of 42 dogs presented to Madras Veterinary College Teaching Hospital Small Animal Medicine Outpatient Unit with a history of cough and dyspnea were selected. Pleural effusion was diagnosed and classified into cardiac, hepatic and tumour and others group based on physical examination, radiography, electrocardiography, ultrasonography, echocardiography, cytological and biochemical evaluation of pleural fluid. The incidence of pleural effusion was 13.5% of the respiratory cases. Cytology of pleural fluid revealed the presence of lymphocytes, neutrophils, macrophages, RBCs, fibrin and mesothelial cells. Cytology of tumour group revealed mesothelioma (3), adenocarcinoma (1) and lymphoma (1). Cytology of other group revealed the presence of numerous RBCs and a few mesothelial cells in hemothorax and mature and degenerated neutrophils along with the presence of numerous clumps of bacteria and macrophages in pyothorax. Estimation of LDH of pleural effusion and ratio of pleural fluid to serum LDH was effective to classify pleural fluid into transudate, exudate and modified transudate