Background:Closed pleural biopsy was previously considered a procedure of choice in cases of undiagnosed pleural effusion with good efficacy. Currently, the closed pleural biopsy has been replaced by thoracoscopic biopsy but not easily available in resource-limited setups.Objective:The objective of this study was to analyze the diagnostic yield and safety of closed needle pleural biopsy in exudative pleural effusion and assessment of patients' characteristics with the yield of pleural biopsy.Design:This was a cross-sectional study.Settings:This study was conducted at Institute of Respiratory Diseases, SMS Medical College, Jaipur, a tertiary care center of West India.Patients and Methods:A total of 250 cases of pleural effusion were evaluated with complete pleural fluid biochemical, microbiological, and cytological examination. Out of these 250 patients, 59 were excluded from the study as the diagnosis could be established on initial pleural fluid examination. The remaining (191) patients were considered for closed pleural biopsy with Abrams pleural biopsy needle.Main Outcome Measures:The main outcome measure was diagnostic yield in the form of confirming diagnosis.Results:Out of the 191 patients with exudative lymphocytic pleural effusion, 123 (64.40%) were diagnosed on the first pleural biopsy. Among the remaining 68 patients, 22 patients had repeat pleural biopsy with a diagnostic yield of 59.9%. The overall pleural biopsy could establish the diagnosis in 136 (71.20%) patients with pleural effusion. The most common diagnosis on pleural biopsy was malignancy followed by tuberculosis.Conclusions:Closed pleural biopsy provides diagnostic yield nearly comparative to thoracoscopy in properly selected patients of pleural effusions. In view of good yield, low cost, easy availability, and very low complication rate, it should be used routinely in all cases of undiagnosed exudative lymphocytic pleural effusion.Limitations:There was no comparison with a similar group undergoing thoracoscopic pleural biopsy.

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Background: Hormones also take part in respiratory control via peripheral chemo receptors or by their local effects on the lungs and the airways. In chronic obstructive pulmonary disease patients, respiratory muscles are required to work efficiently than normal individuals to establish a sufficient respiration. Changes in serum hormone levels of COPD patients adversely affect functioning of respiratory muscles. Objective of the study was to assess endocrinal profile in COPD patient with comparable control groups.Methods: A Hospital based Case control study conducted at Department of Pulmonary Medicine, Late B.R.K.M Government Medical College, Jagdalpur, Chhattisgarh, India during July 2016 to January 2017. Study included 75 diagnosed cases of COPD in which moderate, severe, very severe COPD was 25 in each of this group (per GOLD ‘s guideline) and compared to age matched 25 healthy control.Results: In this study serum growth hormone and serum testosterone showed significant difference between COPD cases and control group and fair significant difference in serum FSH between COPD cases and control groups. There was no significant correlation between serum growth hormone, serum testosterone and serum FSH with COPD grading. There was no statistically difference observed in serum LH (p=0.425) level between COPD cases and control groups. Present study showed there was statistically difference in FT3, FT4 and TSH level between COPD cases and control groups. There was significant negative correlation between FT4 levels between COPD grading. But no correlation seen between COPD grading and control with respect to serum FT3 and TSH level.Conclusions: Endocrinal assessment in present study showed significant decrease in serum growth hormone and serum testosterone in COPD patients, which are anabolic hormones. Early detection and correction of such an anabolic hormonal abnormality may prevent skeletal and diaphragmatic muscle weakness, and improve respiratory drive of COPD patients.

Poland’s Syndrome is a rare congenital condition. It is classically characterized by absence of unilateral chest wall muscles and sometimes ipsilateral symbrachydactyly (abnormally short and webbed fingers). The condition typically presents with unilateral absence of the sternal or a breast portion of the pectoralis major muscle which may or may not be associated with the absence of nearby musculoskeletal structures. Authors report a 13-year-old male patient with typical features of Poland syndrome associated with synbrachydactyly and dextrocardia. This association is very rare, till 2010, only 19 cases have been described in scientific literature (Poland syndrome with dextrocardia), in this case synbrachydactyly also associated on ipsilateral side. To the best of our knowledge, this is the first documented case of the left sided Poland syndrome with dextrocardia and symbrachydactyly reported from the South East Asia Region (SEAR).

Reason behind such response in only selective patients is not clearly understood. We evaluated the pattern and predictors for paradoxical response(s) (PR) in patients with peripheral lymph node tuberculosis (TB). Materials and Methods: Study included patients aged > 6 years with peripheral lymphadenopathy of tubercular etiology attending a tertiary care hospital from Jan 2010 to Dec 2010. PR in our study was defined as worsening of pre-existing disease or development of new lesions in a patient who has been on anti-TB therapy for at least 2 weeks. Results