Diagnostic yield of semi rigid thoracoscopy in unexplained exudative pleural effusion- Experience from tertiary care hospital of east India.

INTRODUCTION: In most of the pleural effusion, fluid analysis generally gives the etiological diagnosis but in almost 20% it remains unclear. This study was designed to determine the diagnostic yield of a pleural biopsy using semi rigid thoracoscope and its complication rates. MATERIALS AND METHODS: This was a retrospective observational study conducted in the Department of Pulmonary Medicine, AIIMS Patna. All the patients diagnosed as unexplained pleural effusion between Jan 2018 and December 2019 were included in the study. RESULTS: Total 76 out of 97 patients with unexplained exudative pleural effusion underwent medical thoracoscopy in the given period of 2 years. The mean age of the patients was 57.63 years. There were 46 males and 30 females. 38 patients (50%) had right-sided pleural effusion. More than half (52.6%) of study patients were on Anti-tubercular treatment in which only 11.84% had tuberculosis. In both unilateral and bilateral pleural effusion, the proportions of small, moderate, and large size of pleural effusions were 10.52, 42.10, and 47.36%, respectively. Thoracoscopy yielded a definitive diagnosis in 66 out of 76 patients (86.84%), and in 10 patients (13.15%), biopsy was inconclusive. Of 76 patients, malignancy was confirmed in 58 (76.31%), and tuberculosis in 8 (11.84%) patients CONCLUSION: This study concludes that, medical thoracoscopy with semi-rigid thoracoscope is an invaluable tool in the diagnosis of patients with unexplained exudative pleural effusion. It is a very simple and safe method with high diagnostic yield and associated with few complications. Malignancy was found to be the most common cause of unexplained exudative pleural effusion.

Porous Hydrophobic-Hydrophilic Composite Hollow Fiber and Flat Membranes Prepared by Plasma Polymerization for Direct Contact Membrane Distillation.

High water vapor flux at low brine temperatures without surface fouling is needed in membrane distillation-based desalination. Brine crossflow over surface-modified hydrophobic hollow fiber membranes (HFMs) yielded fouling-free operation with supersaturated solutions of scaling salts and their precipitates. Surface modification involved an ultrathin porous polyfluorosiloxane or polysiloxane coating deposited on the outside of porous polypropylene (PP) HFMs by plasma polymerization. The outside of hydrophilic MicroPES HFMs of polyethersulfone was also coated by an ultrathin coating of porous plasma-polymerized polyfluorosiloxane or polysiloxane rendering the surface hydrophobic. Direct contact membrane distillation-based desalination performances of these HFMs were determined and compared with porous PP-based HFMs. Salt concentrations of 1, 10, and 20 wt% were used. Leak rates were determined at low pressures. Surface and cross-sections of two kinds of coated HFMs were investigated by scanning electron microscopy. The HFMs based on water-wetted MicroPES substrate offered a very thin gas gap in the hydrophobic surface coating yielding a high flux of 26.4-27.6 kg/m2-h with 1 wt% feed brine at 70 °C. The fluxes of HFMs on porous PP substrates having a long vapor diffusion path were significantly lower. Coated HFM performances have been compared with flat hydrophilic membranes of polyvinylidene fluoride having a similar plasma-polymerized hydrophobic polyfluorosiloxane coating.

Preoperative Quadriceps Muscle Strength and Functional Ability Predict Performance-Based Outcomes 6 Months After Total Knee Arthroplasty: A Systematic Review.

Background: One-third of individuals report limitations in activities of daily living even 6 months after total knee arthroplasty (TKA). Moderate-quality evidence exists for several sociodemographic and clinical predictors of patient-reported outcome measures of perceived functionality. Objectively measured performance-based measures (PBMs) provide a less subjective approach to informing patient treatment after TKA; however, information about predictors of functionally relevant PBMs is scarce. Purpose: This systematic review synthesized the available research on preoperative predictors of PBMs after primary TKA for osteoarthritis. Data Sources: In June 2016 and January 2017, MEDLINE, EMBASE, and PsycINFO databases were searched. Study Selection: Cohort studies exploring preoperative predictors of stair climbing, walking speed, and gait speed measured ≥6 months after primary TKA were included. Screening of abstracts and selection of full texts were undertaken by 2 independent reviewers. Data Extraction: Information on study design, patient characteristics, analysis, and results was extracted using pilot-tested forms. Two independent reviewers assessed risk of bias using modified Quality in Prognostic Studies criteria. Data Synthesis: Of the eligible 12 studies involving 6 prospective cohorts, 10 studies reported information on baseline predictors. Meta-analysis of predictors was not possible because of missing information on effect size or standard errors. Narrative synthesis of evidence of predictors was therefore performed. Limitations: The quality of evidence was low because of the risk of bias and heterogeneity of included studies as well as nonreporting of measures of effect. Conclusions: Low-quality evidence exists for an association of preoperative functional ability and quadriceps muscle strength with functionality at 6 months after TKA. Improved reporting of predictor analyses is needed to enable evidence generation for clinical management.

Functional compared to anatomical imaging in the initial evaluation of patients with suspected coronary artery disease: An international, multi-center, randomized controlled trial (IAEA-SPECT/CTA study).

OBJECTIVE: To test the hypothesis that, in the initial evaluation of patients with suspected coronary artery disease (CAD), stress myocardial perfusion imaging (MPI) would result in less downstream testing than coronary computed tomographic angiography (CCTA). METHODS: In this international, randomized trial, mildly symptomatic patients with an intermediate likelihood of having CAD, and asymptomatic patients at intermediate risk of cardiac events, underwent either initial stress-rest MPI or CCTA. The primary outcome was downstream noninvasive or invasive testing at 6 months. Secondary outcomes included cumulative effective radiation dose (ERD) and costs at 12 months. RESULTS: We recruited 303 patients (151 MPI and 152 CTA) from 6 centers in 6 countries. The initial MPI was abnormal in 29% (41/143) and CCTA in 56% (79/141) of patients. Fewer patients undergoing initial stress-rest MPI had further downstream testing at 6 months (adjusted OR 0.51, 95% CI 0.28-0.91, P = 0.023). There was a small increase in the median cumulative ERD with MPI (9.6 vs. 8.8 mSv, P = 0.04), but no difference in costs between the two strategies at 12 months. CONCLUSION: In the management of patients with suspected CAD, a strategy of initial stress MPI is substantially less likely to require further downstream testing than initial testing with CCTA. TRIAL REGISTRATION: clinicaltrials.gov identification number NCT01368770.

Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study.

OBJECTIVES: Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. SETTING: Urban poor community in the Southeast district of Delhi, India. PARTICIPANTS: We randomly sampled 1849 children aged 1-3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria-pertussis-tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers' recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. RESULTS: Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. CONCLUSIONS: Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban communities. TRIAL REGISTRATION NUMBER: CTRI/2011/091/000095.

Reproductive healthcare utilization in urban poor settlements of Delhi: Baseline survey of ANCHUL (Ante Natal and Child Health care in Urban Slums) project.

BACKGROUND: Disparity in utilization of reproductive healthcare services between the urban poor and the urban non-poor households in the developing nations is well known. However, disparity may also exist within urban poor households. Our objective was to document the extent of disparity in reproductive healthcare utilization among the urban poor and to identify the socio-demographic determinants of underutilization with a view to characterizing this vulnerable subpopulation. METHODS: A survey of 16,221 households was conducted in 39 clusters from two large urban poor settlements in Delhi. From 13,451 consenting households, socio-demographic data and information on births, maternal and child deaths within the previous year was collected. Details of antenatal care (ANC) was collected from 597 pregnant women. Information on ANC and postnatal care was also obtained from 596 recently delivered (within six months) mothers. All data were captured electronically using a customized and validated smart phone application. Households were categorized into quintiles of socio-economic position (SEP) based on dwelling characteristics and possession of durable assets using principal component analysis. Potential socio-demographic determinants of reproductive healthcare utilization were examined using random effects logistic regression. RESULTS: The prevalence of facility based birthing was 77% (n = 596 mothers). Of the 596 recently delivered mothers only 70% had an ANC registration card, 46.3% had ANC in their first trimester, 46% had visited a facility within 4 weeks post-delivery and 27% were using modern contraceptive methods. Low socio-economic position was the most important predictor of underutilization with a clear gradient across SEP quintiles. Compared to the poorest, the least poor women were more likely to be registered for ANC (OR 1.96, 95%CI 0.95-4.15) and more likely to have made ≥ 4 ANC visits (OR 5.86, 95%CI 2.82-12.19). They were more likely to have given birth in a facility (OR 4.87, 95%CI 2.12-11.16), to have visited a hospital within one month of childbirth (OR 3.18, 95%CI 1.62-6.26). In general, government funded health insurance and conditional cash transfers schemes were underutilized in this community. CONCLUSION: The poorest segment of the urban poor population utilizes reproductive healthcare facilities the least. Strategies to improve access and utilization of healthcare services among the poorest of the poor may be necessary to achieve universal health coverage.