A Pleural Effusion with an Unusual Cause

Abstract

Background and Aims: Peritoneal dialysis (PD) is a rare cause of pleural effusion. It appears as a complication of PD in approximately 2% patients. Hydrothorax in this situation is called "sweet hydrothorax" as hypertonic glucose solution fills the pleura. Methods: 62-year-old woman with end stage renal disease presented with dyspnea on exertion and chest pain for about 4 weeks after initiation of PD six months back. A chest x-ray was done showed massive unilateral right-sided pleural effusion. She underwent small bore chest drainage for massive pleural effusion.Pleural fluid was crystal clear with high glucose concentration of 735 mg/dl.The pleural fluid protein was 0.2g/dl .Cytological and microbiological examination of the pleural fluid showed no abnormalities .Pleural fluid analysis was consistent with transudate and pleural fluid glucose concentration was higher than patient serum glucose concentration suggestive of sweet hydrothorax.She was switched over to haemodialysis for 4 weeks. After 4 weeks she was started back on peritoneal dialysis with reduced fluid volume and reduced dwell time and increased frequency of fluid change without recurrence for six months under followup. Results: Hydrothorax may develop several weeks or months after starting of PD. Diagnostic pleural tapping and pleural-fluid analysis are often diagnostic, revealing a crystal clear pleural fluid with a low protein and a high glucose concentration. In the patient presented here, glucose concentration in the pleural fluid was much higher than that in the serum drawn concomitantly. Conclusions: It is advisable to keep sweet hydrothorax as a differential diagnosis while evaluating hydrothorax in patients on peritoneal dialysis.

Rejuvenating the Market for Earth-Based Building Construction Materials in a Developing Economy

“…This component accounts for 8.71% of the TVE and has an extracted factor eigenvalue of 2.265.Less harmful, with zero toxic gas emissions = 0.740; improving human health and safety = 0.734; environmentally friendly = 0.697; the earth is abundant in most regions = 0.682; providing a protective covering to earthen walls = 0.630; earth construction promoting local culture, heritage, and material = 0.541; and creating employment opportunities = 0.516.Following a cursory look at the features of these items, it was subsequently named "Emissions and environmental benefits. "This finding is in support of the previous findings [6,44,54,56]. The use of green building materials like laterite in foundations, walls, and roofs is because of their inherent characteristics of producing zero toxic gases.…”

“…Based on the latent characteristics of these items, the component was named "cost and pollution-related benefits." The finding here is in support of the previous report on green building materials such as earth or laterite [28,41,43,45,56,57]. Earthen materials offer a lot of opportunities when it comes to the delivery of cheap and affordable building projects anywhere in the world.…”

“…This study took a post-positivism philosophical stance, employing a structured questionnaire to collect participant opinions [54,55]. The Questionnaire is appropriate for studies that require a large audience and cover a wide range of topics, where economy and data collection time are critical [56]. This study covered experienced construction experts in the six states of the southsouth geopolitical zone of Nigeria.…”

“…These materials are cheap and abundantly available in our locality in their natural forms. Earth-based materials are commonly and readily available, which makes them cheap for the building of houses, thus offering a reduced cost of construction [28,56]. Earth materials are economical because their maintenance and operation costs are low.…”

“…These materials are recyclable, and being re-usable makes it possible for them to be put into continuous use without constituting a problem for society. They provide a conducive interior living environment, and with their pollution-free properties, they improve the quality of life of the occupants [56].…”