Objective: To assess the efficacy of pleural fluid cholesterol in differentiating transudates and exudates as compared with Light's criteria. Methods:Patients with pleural effusion during a 6-month period were enrolled in the study and underwent thoracentesis. Pleural fluid was analyzed for the levels of protein, lactate dehydrogenase (LDH), and cholesterol. Etiological diagnosis, which was established after considering clinical and biochemical factors, was the gold standard for comparison. Cut-off values for pleural fluid cholesterol were taken as 60 mg/dL and 45 mg/dL. Results:A total of 53 patients were included for final analysis. Of them, 19 were with transudates and 34 with exudates in their pleural fluids. The sensitivity, specificity, positive predictive value, and negative predictive value of the pleural fluid cholesterol (cut-off >45 mg/dL) were 97.06%, 94.74%, 97.06%, and 94.74%, respectively, for identifying exudates. These values were differentiating better than those obtained by Light's criteria for pleural fluid cholesterol (cut-off >60 mg/dL) (p<0.0001). Combining pleural fluid protein with pleural fluid cholesterol (>45 mg/dL) gave a higher specificity (100%) and positive predictive value (100%) but a lower sensitivity (82.93%) and negative predictive value (63.16%). Conclusion:Pleural fluid cholesterol is better than Light's criteria for the differentiation of transudates and exudates and is less cumbersome as it does not require a simultaneous blood sampling. Cut-off value of pleural fluid cholesterol for differentiating transudates and exudates should be 45 mg/dL. Further studies are warranted to assess the efficacy of the combination of pleural fluid protein and cholesterol as criteria for classifying effusions.

Persistent tracheo-cutaneous fistula, or persistent tracheal stoma, is a potential late complication of a tracheostomy. It commonly occurs in children due to a failure of spontaneous closure after decannulation. In adults, however, this is relatively less common. Described is a case of a 38-year-old man who, despite undergoing early and successful decannulation, presented with a persistent tracheal stoma due to pulmonary tuberculosis.

In this note, a fuzzy inventory model with multiple items is considered. Economic order quantities (EOQs) are developed for these items. The costs involved in inventory are always assumed to be exact, otherwise called as crisp or hard, but in practice these costs are not exact or precise but vary over a range. In such cases an application of fuzzy set theory plays a vital role in obtaining the EOQ. An application of this model to manpower planning is studied with an example; sensitivity analysis is also made.

A 56-year-old male presented with complaints of cough with expectoration for 3 months duration and fever for 15 days. He had no associated complaints of breathlessness, wheeze, loss of weight and appetite. For the above complaints, he had received two courses of antibiotics before this presentation elsewhere. He is a smoker for 30 years. There is no significant past medical history. There was no evidence of similar illness in the family. On presentation, patient had investigations done outside like chest x-ray that revealed a right upper and mid-zone cavity and CT thorax that revealed a cavity with fluid level with no evidence of lymphadenopathy or bone erosion. On examination, he was tachypnoeic with respiratory rate of 32/min, pulse rate was 90/min and saturation was 95% on room air. He had no clubbing or lymphadenopathy. Respiratory examination revealed expiratory rhonchi and diminished breath sounds in right mammary, infra-axillary and infrascapular areas.