By dr kartik sood
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This document discusses using alkaline phosphatase (ALP) levels to distinguish between tuberculous and non-tuberculous pleural effusions. It presents a study that measured ALP concentrations in the pleural fluid and serum of patients with confirmed tuberculous or non-tuberculous effusions. The results showed that patients with tuberculous effusions had significantly higher pleural fluid ALP levels and pleural fluid to serum ALP ratios than those with non-tuberculous effusions. The study confirms that ALP can help differentiate the two types of effusions, with cut-off values of ≥71 IU/L for pleural fluid ALP and ≥0.51 for
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![INTRODUCTION Tuberculosis is one of the important causes of exudative pleural effusion in our country. Other causes- Neoplasticdiseases ,[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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This document discusses several advanced modes of mechanical ventilation. It begins by describing triggered modes like volume support (VS) and proportional assist ventilation (PAV) which provide pressure support that varies based on patient effort. It then covers hybrid modes like volume-assured pressure support and pressure regulated volume control (PRVC) which use dual controls. Newer dual-controlled modes are presented that regulate pressure and volume both within and between breaths. Modes like adaptive support ventilation (ASV) automatically adapt settings to patient changes. Pros, cons and indications are provided for some of the more complex modes.
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This document discusses oxygen therapy in acutely ill patients. It begins by outlining the learning objectives, which include understanding oxygen delivery and the differences between hypoxia and hypoxemia. It then discusses assuring patient safety and optimizing oxygen delivery to tissues. Different devices for oxygen delivery are described, including nasal cannulae, masks, and Venturi masks. Limitations of pulse oximetry are also reviewed. The key points are that oxygen therapy must be carefully prescribed with both the type of mask and the appropriate flow rate specified; hypoxemia can be harmful but hyperoxemia should also be avoided; and pulse oximetry has limitations, especially at low saturation levels.
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2. Directly observed therapy (DOT) is the best way to ensure patients complete appropriate TB treatment. Studies show DOT is associated with lower rates of drug resistance and relapse compared to standard self-administered therapy.
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Usg applications in anaesthesia dr gs
Ultrasound Basics, Troubleshooting And Outline Of Uses In Anaesthesia is a presentation that covers:
1) The history, physics, and interactions of ultrasound waves including how ultrasound machines work and form images.
2) Current and potential applications of ultrasound in anesthesiology such as regional anesthesia, vascular access, airway assessment, and focused cardiac ultrasound.
3) An overview of ultrasound uses including lung, gastric, and cardiac ultrasound as well as emerging technologies.
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This summary reviews a journal club discussion on two phase 3 clinical trials evaluating the efficacy and safety of nintedanib in patients with idiopathic pulmonary fibrosis (IPF). The trials found that nintedanib significantly reduced the rate of decline in forced vital capacity (FVC) over 52 weeks compared to placebo. There was no consistent effect on time to first acute exacerbation or change in symptoms. Common side effects included diarrhea. While the study design was valid, questions remain regarding the clinical significance of the outcomes and relevance of factors like smoking status.
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This document provides an overview of weaning from mechanical ventilation. It discusses preliminary concerns like ventilatory support strategies, physical rehabilitation, and sedation practices. Readiness criteria for weaning and the spontaneous breathing trial are also covered. Some highlights include problems like rapid breathing, cardiac dysfunction, and respiratory muscle weakness. Extubation concerns such as airway protection, laryngeal edema, and post-extubation stridor are also summarized. The document emphasizes being vigilant in recognizing readiness for weaning trials and their success or failure.
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This document discusses the use of capnography, or the monitoring of end-tidal carbon dioxide levels (EtCO2). It begins by stating that capnography is the most reliable method to confirm proper endotracheal tube placement. It then covers the physiology of respiration and how factors like increased/decreased cardiac output, bronchospasm, or hypo/hyperventilation can affect EtCO2 levels. Normal EtCO2 ranges from 35-45 mmHg. The document outlines the four main applications of capnography: assessing asthma severity, monitoring head injuries, during cardiac arrest, and tube confirmation. It provides examples of normal and abnormal waveforms and discusses how capnography can be used to guide treatment and evaluate
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1) ARDS is characterized by hypoxemia, bilateral lung infiltrates, and respiratory failure not fully explained by cardiac failure. The Berlin definition classifies ARDS as mild, moderate, or severe based on oxygenation levels.
2) Management of ARDS focuses on treating underlying causes, preventing complications, and using ventilator strategies like low tidal volume ventilation to prevent ventilator-induced lung injury.
3) Other ventilator strategies discussed include prone positioning, neuromuscular blockade, recruitment maneuvers, and extracorporeal membrane oxygenation for severe cases, though evidence on benefits is mixed.
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This document discusses PiCCO (Pulse Contour Cardiac Output) monitoring. PiCCO enables assessment of a patient's hemodynamic status by measuring various volumetric and cardiac parameters. It requires a central venous pressure catheter and arterial line. PiCCO works by transpulmonary thermodilution, using cold saline injections to calculate volumes, and pulse contour analysis of the arterial waveform to provide continuous cardiac output monitoring. The document defines various parameters measured by PiCCO like preload, contractility, lung function, and afterload, and provides normal ranges. It also outlines indications, contraindications and the decision tree for hemodynamic monitoring using PiCCO.
Hypersensitivity pneumonitis
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by repeated inhalation and sensitization to various antigens. It affects the lung interstitium and has variable clinical presentations. Common causative agents include avian and microbial antigens. The immunopathogenesis involves both humoral and cellular immune responses. HP is classified as acute, subacute, or chronic based on clinical manifestations. Diagnosis relies on a history of antigen exposure, precipitating antibodies, clinical features, imaging, and pathology. Chest radiography and HRCT are important diagnostic tools, with HRCT showing findings like nodules, ground glass opacity, and fibrosis that vary depending on the disease stage.
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This document discusses fluid responsiveness in critically ill patients. It begins by defining fluid responsiveness as an increase in cardiac index after fluid infusion. It then describes three scenarios involving fluid resuscitation: patients with acute blood or fluid loss requiring immediate resuscitation, patients with suspected septic shock where early goal-directed therapy with fluids is important, and ICU patients who have already received fluids and their fluid responsiveness needs to be assessed. The document discusses various methods of assessing preload and preload dependence, including filling pressures, volumes, respiratory variations in inferior vena cava diameter, inspiratory drops in right atrial pressure, and predicting responsiveness through respiratory variations in parameters related to cardiac index. It emphasizes that preload alone
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Pericardial effusion and cardiac tamponade are conditions caused by an abnormal accumulation of fluid in the pericardial space. Cardiac tamponade occurs when excess fluid buildup leads to reduced ventricular filling and hemodynamic compromise. Symptoms include breathlessness, chest pain, and hypotension. Diagnosis is made through ECG, echocardiogram, and x-ray. Treatment depends on severity but may include medications, drainage of fluid via pericardiocentesis, or surgery. Cardiac tamponade requires urgent pericardiocentesis to drain fluid and prevent further hemodynamic compromise.
Advanced ventilatory modes
This document discusses several advanced modes of mechanical ventilation. It begins by describing triggered modes like volume support (VS) and proportional assist ventilation (PAV) which provide pressure support that varies based on patient effort. It then covers hybrid modes like volume-assured pressure support and pressure regulated volume control (PRVC) which use dual controls. Newer dual-controlled modes are presented that regulate pressure and volume both within and between breaths. Modes like adaptive support ventilation (ASV) automatically adapt settings to patient changes. Pros, cons and indications are provided for some of the more complex modes.
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The document discusses basic principles of mechanical ventilation including factors that can lead to ventilatory failure, airway resistance, lung compliance, hypoventilation, V/Q mismatch, intrapulmonary shunting, and diffusion defects. It also covers different types of ventilator waveforms including pressure, volume, flow and pressure/volume loops which can be used to assess a patient's respiratory status and response to therapy.
Brachial block
Upper limb nerve blocks provide anesthesia for surgeries on the arm and hand. The brachial plexus supplies sensation and movement to the upper limb and can be blocked at different levels, including supraclavicular, interscalene, axillary, and infraclavicular. Nerve stimulators can help locate nerves more accurately than paresthesia alone. Potential complications depend on the specific block but may include pneumothorax, phrenic nerve block, and accidental spinal or epidural injection.
Physics of mechanical ventilation
The document discusses the physics of ventilation and mechanical ventilation. It covers topics such as compliance, resistance, flow, pressure, modes of ventilation including pressure support ventilation and airway pressure release ventilation. Key variables that ventilators can manipulate or that determine the breath cycle are discussed. The importance of proper inspiratory cycle termination to avoid lung overinflation is highlighted.
Oxygen therapy in acutely ill patients
This document discusses oxygen therapy in acutely ill patients. It begins by outlining the learning objectives, which include understanding oxygen delivery and the differences between hypoxia and hypoxemia. It then discusses assuring patient safety and optimizing oxygen delivery to tissues. Different devices for oxygen delivery are described, including nasal cannulae, masks, and Venturi masks. Limitations of pulse oximetry are also reviewed. The key points are that oxygen therapy must be carefully prescribed with both the type of mask and the appropriate flow rate specified; hypoxemia can be harmful but hyperoxemia should also be avoided; and pulse oximetry has limitations, especially at low saturation levels.
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Pulmonary hypertension is high blood pressure in the lungs caused by either increased pulmonary blood flow or increased pulmonary vascular resistance. It can lead to right ventricular hypertrophy and failure over time. Symptoms include dyspnea, chest pain, and syncope. Diagnosis is made through echocardiogram, right heart catheterization, and ruling out secondary causes. Treatment focuses on reducing pulmonary vascular resistance through vasodilators, diuretics, oxygen, and in severe cases, lung transplantation.
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2. Directly observed therapy (DOT) is the best way to ensure patients complete appropriate TB treatment. Studies show DOT is associated with lower rates of drug resistance and relapse compared to standard self-administered therapy.
3. Treatment of drug-resistant TB requires using at least four effective drugs, including a parenteral agent. Management requires careful review of previous medications and regimens to determine effective treatment.
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This document provides an overview of thoracentesis, including:
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Thoracocentesis
Thoracentesis is a procedure where a needle is inserted into the pleural space to remove pleural fluid for analysis or relief of symptoms. It can be done for diagnostic purposes to analyze the fluid or therapeutically to drain a large volume of fluid. Indications include evaluating an undiagnosed pleural effusion or atypical features in heart failure patients. Contraindications include bleeding risks or small effusions. The procedure involves localizing the site, administering anesthesia, inserting a needle while aspirating to drain fluid, and analyzing the fluid removed. Potential complications include pain, bleeding, pneumothorax, and infection, with pneumothorax being the most common clinically significant complication.
Thoracoscopy
Medical thoracoscopy is an invasive procedure used to visualize the pleural space and lungs through small incisions in the chest wall. It allows physicians to biopsy pleural surfaces and diagnose conditions causing pleural effusions. The procedure was originally developed in 1910 and was widely used until the 1950s to divide pleural adhesions in tuberculosis patients. Modern thoracoscopy uses video imaging and improved instruments to perform biopsies and pleurodesis under local anesthesia. It provides fast diagnoses but carries risks of pain, infection and failed procedures if not performed carefully in suitable patients.
Tb treatment new
This document provides treatment guidelines for tuberculosis. It outlines the aims of TB treatment as curing the patient, preventing death from active or relapsed TB, decreasing transmission, and preventing drug resistance. It describes the initial and continuation phases of treatment for new and previously treated cases. It also defines different types of TB cases and provides recommended drug regimens and dosages depending on the category of TB patient. Isoniazid, rifampicin, pyrazinamide, and ethambutol are first-line oral drugs, while streptomycin and thioacetazone are also mentioned. BCG vaccination guidelines are also briefly covered.
Thoracentesis
Thoracentesis is a procedure to remove fluid from the pleural space by inserting a needle between the ribs and into the pleural cavity. It is done both diagnostically to evaluate pleural effusions and therapeutically to drain large fluid collections. The document outlines the indications, contraindications, necessary equipment and supplies, step-by-step procedure, monitoring after the procedure, potential risks and complications, and documentation required.
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Cont...
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
TUBERCULOSIS PLEURAL
ES UNA DE LAS FORMAS EXTRAPULMONARES MAS FRECUENTES, CONSIDERAR LA PROBABILIDAD EN PACIENTES CON DERRAME PLEURAL UNILATERAL EN LUGARES DONDE EXISTA ALTA PREVALENCIA DE LA MISMA
Ultrasound Guided Pleural Procedures
Ultrasound is useful for both diagnosing and guiding procedures involving the pleura. It can detect pleural effusions and pneumothoraces more sensitively than chest x-rays. Ultrasound improves the accuracy of pleural procedures by identifying the best puncture site and reducing complications. Evidence shows ultrasound-guided thoracenteses reduce the risk of pneumothorax compared to procedures without ultrasound. The document discusses using ultrasound to characterize pleural effusions, detect pneumothoraces, identify pleural thickening, and guide biopsies and drainage of pleural tumors or collections.
Tuberculosis pleural
La tuberculosis pleural es una acumulación de líquido en el espacio pleural causada por una infección por Mycobacterium tuberculosis. Los síntomas incluyen dolor torácico, tos no productiva y fiebre. El diagnóstico se basa en la demostración de bacilos de tuberculosis en el líquido pleural, biopsia pleural que muestre granulomas o niveles elevados de ADA. El tratamiento consiste en quimioterapia antituberculosa durante seis meses para prevenir la reactivación.
Derrame pleural
Este documento describe la fisiopatología, etiología, manifestaciones clínicas, diagnóstico y tratamiento del derrame pleural. Explica que el derrame pleural es la acumulación de líquido en el espacio pleural y puede ser causado por varios factores como aumento de presión hidrostática, disminución de presión oncótica, o aumento de permeabilidad microvascular. Los síntomas más comunes son disnea, tos y dolor torácico. El diagnóstico se basa en análisis de líquido pleural
Thoracentesis
Thoracentesis is a procedure to drain excess fluid from the pleural space between the lungs and chest wall. It involves inserting a needle through the chest wall under local anesthesia to remove fluid for analysis or to relieve symptoms like shortness of breath. Precautions are taken before and during the procedure to monitor vital signs and breathing. After the procedure, the patient is observed for complications and a chest x-ray may be taken to evaluate the drainage.
WHO and RNTCP guidelines - Tuberculosis management
- Tuberculosis treatment regimens outlined by WHO and Indian guidelines involve directly observed therapy with a combination of drugs given either daily or 3 times per week. The standard regimen for new TB patients is 2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampicin. Previously treated patients receive a longer regimen.
- Multidrug-resistant TB is treated with a minimum of 6 drugs over 24 months, with intensive phase lasting at least 6 months. Adverse drug reactions are managed through dose adjustment, temporary drug withdrawal, or substitution of offending agents.
Derrame pleural
Este documento describe el derrame pleural, incluyendo su definición, fisiopatología, causas, signos clínicos y de laboratorio, y hallazgos radiológicos. El derrame pleural se produce cuando se alteran las fuerzas que controlan el flujo de líquido en el espacio pleural. Puede ser transudativo o exudativo, dependiendo de si el líquido es un ultrafiltrado del plasma o contiene proteínas, respectivamente. Las causas más comunes incluyen insuficiencia cardíaca y neumonía. El diagnó
Derrame pleural
Este documento presenta información sobre derrame pleural, incluyendo su definición, fisiología, tipos, signos y síntomas, y pruebas de diagnóstico. Explica que un derrame pleural ocurre cuando se altera el flujo de líquido dentro del espacio pleural, y puede ser transudativo o exudativo dependiendo de las causas subyacentes. También describe los hallazgos en la inspección, palpación, percusión y auscultación del tórax, así como las pruebas de imagen y análisis de líquido
The Top Skills That Can Get You Hired in 2017
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Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Cont...
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Nephrotic syndrome
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Multiple Myeloma (Case presentation)
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Pathophysiology of edema and its applied aspects
Laboratory investigation of a patient presenting with edema should include tests to identify potential underlying causes. A complete blood count, renal function tests, liver function tests, serum protein and albumin levels, lipid profile, and thyroid function tests can help detect issues like kidney disease, liver disease, malnutrition, or hypothyroidism. Additional tests like chest x-ray, electrocardiogram, brain natriuretic peptide, D-dimer, ultrasound of the abdomen and pelvis, Doppler study, lymphoscintigraphy, and echocardiogram can help diagnose causes such as congestive heart failure, deep vein thrombosis, or lymphatic abnormalities. Together, these lab tests aim to determine the cause and guide treatment of the
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The document discusses proteinuria and hematuria in children. It covers the definition, causes, evaluation, and treatment of both conditions. Proteinuria can be caused by glomerular, tubular, or overflow mechanisms and is evaluated through urine dipsticks, 24-hour urine collection, and urine protein to creatinine ratio. Hematuria can be gross or microscopic and is seen in conditions like UTI, nephrolithiasis, glomerulonephritis, IgA nephropathy, and Alport syndrome. Evaluation of hematuria involves urinalysis, urine culture, imaging, and considering familial causes. Specific renal diseases like post-streptococcal glomerulonephritis
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Approach to Sepsis & Septic Shock in Emergency Medicine.
Sepsis and septic shock result from a dysregulated host response to infection. Sepsis criteria include suspected or proven infection and an increase in the SOFA score of 2 or more, while septic shock requires sepsis with vasopressor need to maintain blood pressure and elevated lactate. Treatment involves early recognition, source control with antibiotics, initial fluid boluses of 1-2L for hypotension or elevated lactate, vasopressors if needed, and lactate clearance-guided resuscitation.
Fibrosis[1]
Cirrhosis results from fibrosis and nodular regeneration of the liver. It leads to increased resistance to blood flow within the liver and portal hypertension. Common complications include variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Treatment focuses on managing the complications through medications, dietary changes, paracentesis, and sometimes transplantation. Prognosis depends on disease severity and presence of complications.
Pleural effusion icd niv
This document provides information on pleural effusion, including anatomy of the pleural space, physiology of pleural fluid movement, classification of pleural effusions, etiology, clinical features, investigations, and management. Key points include:
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- Pleural effusions are classified as transudative or exudative based on fluid characteristics and cause increased hydrostatic pressure or inflammation/permeability.
- Common causes include congestive heart failure, pneumonia, malignancy, and liver/renal failure.
- Investigations include chest x-ray
Pleural Effusion for Undergraduates
This document provides an overview of pleural effusion, including:
- Pleural effusion is abnormal fluid accumulation in the pleural space between the lungs and chest wall. Fluid builds up due to changes in pressure or permeability.
- Effusions are classified as transudative or exudative based on their mechanism and composition. Causes include infections, cancers, heart failure, and other conditions.
- Symptoms depend on the underlying cause but may include chest pain, difficulty breathing, and cough. Diagnosis involves physical exam, imaging like x-rays, and analyzing pleural fluid obtained via thoracentesis.
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Renal manifestations of systemic disease(s).
Systemic diseases that commonly present with renal manifestations: diabetic and hypertensive nephropathy, lupus nephritis, congestive heart failure (Cardiorenal Syndromes), liver disease, and paraproteinemia , infections (HCV, HIV, COVID-19,..), other rheumatological disorders (Rhod A., Gout, SCL), HSP, Vasculitis, hereditary kidney diseases, Familial Mediterranean Fever (FMF), and Malignancy.
Anesthesia Management in CRF Patients
1) Chronic renal failure results from the progressive deterioration of renal function due to diseases like diabetes and hypertension. It is defined as kidney damage or a glomerular filtration rate less than 60 mL/min/1.73 m2 for more than 3 months.
2) Anesthetic management of chronic renal failure patients requires special considerations due to electrolyte imbalances, unpredictable fluid status, cardiac disease, and slower drug clearance. Induction and maintenance agents must be chosen and dosed carefully to avoid large decreases in blood pressure.
3) Postoperative monitoring is important due to risks of muscle weakness from incomplete drug reversal, cardiac issues from hyperkalemia, and respiratory depression from opioid accumulation in these patients.
Chronic kidney failure
Chronic kidney disease (CKD) is defined as kidney damage or decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. The Cockcroft-Gault and MDRD Study equations can be used to estimate GFR and stage CKD. CKD is common and prevalence increases with age, affecting 11-13% of the global population. Common causes include diabetes, hypertension, glomerular diseases, and vascular diseases. Later stages may present with metabolic complications, fluid disturbances, and anemia. Diagnosis involves lab tests, imaging, and renal biopsy when needed. Progressive loss of nephrons leads to remaining nephrons compens
Malignant Pleural Effusion.pptx
This document discusses pleural effusions, including their classification as transudates or exudates based on protein concentration. It describes common causes of pleural effusions such as heart failure, infection, cancer, and connective tissue diseases. Malignant pleural effusions are discussed in more detail, noting they are usually due to lung cancer or mesothelioma and cause fluid buildup by increasing production and decreasing absorption. Symptoms include dyspnea, chest pain, and cough. Management options include observation for asymptomatic patients, therapeutic aspiration for short life expectancies, or tube drainage and pleurodesis using talc for longer life expectancies. Complications of chest tubes like infection, metastasis, or blockage
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Thrombotic microangiopathy (TMA) is a pathology that results in thrombosis in capillaries and arterioles, due to an endothelial injury.
Coverted PPT
Pulmonary-renal syndrome is a potentially life-threatening disorder characterized by diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis. It requires early diagnosis and treatment to prevent serious complications like respiratory distress and renal failure. The most common causes are ANCA-associated vasculitis (60% of cases) and Goodpasture's syndrome (20% of cases). Diagnosis involves tests for ANCA, anti-GBM antibodies, complement levels, and renal biopsy. Treatment depends on the underlying condition but typically involves steroids, cyclophosphamide, and plasmapheresis.
Thrombosis Case Study
A 27-year-old woman presented with fatigue, shortness of breath, easy bruising, and a syncopal episode. Laboratory workup revealed hemolytic anemia. A bone marrow biopsy showed hypocellular marrow consistent with aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH). She was treated with immunosuppression but later developed multiple thromboses. Testing confirmed PNH diagnosis. She received eculizumab therapy which stabilized her hemoglobin levels and reduced transfusion requirements. PNH causes hemolytic anemia due to lack of protective proteins on blood cells, predisposing to complement-mediated destruction and thrombosis.
PNH (2).pptx
This document discusses the clinical presentation, management, and treatment of paroxysmal nocturnal hemoglobinuria (PNH). Key points include:
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By dr kartik sood
- 1. ALKALINE PHOSPHATASE: DISTINGUISHING BETWEEN TUBERCULOUS AND NON TUBERCULOUS PLEURAL EFFUSION BY DR KARTIK SOOD JUNIOR RESIDENT DEPARTMENT OF PULMONARY MEDICINE ELMCH ORIGINAL ARTICLE-LUNG INDIA VOL-26,ISSUE 3,SEPT 2009 JAYASHREE SUHAS ASHISH JADHAV
- 8. Sarcoidosis
- 9. Uremia
- 10. Meigs' syndrome
- 13. Nitrofurantoin
- 14. Dantrolene
- 15. Methysergide
- 16. Bromocriptine
- 17. Procarbazine
- 18. Amiodarone
- 19. Trapped lung
- 22. Hemothorax
- 25. Chylothorax
- 27. Pleural fluid protein/serum protein >0.5
- 28. Pleural fluid LDH/serum LDH >0.6
- 29. Pleural fluid LDH more than two-thirds normal upper limit for serum
- 31. Pleural fluid cholesterol level > 60mg/dl
- 33. These include: Pleural fluid(PF) adenosine deaminase, PF lysozyme, PF gamma interferon, PF alpha 1 antitrypsin,PF protease inhibitors,PF CA 125, PF tumor necrosis factor, PF interleukin-1,PF polymerase chain reaction,and reported to be elevated in tuberculous pleural effusionAlkaline phosphatase (ALP) is one of the biochemical markers found in pleural effusion. Previous studies have used ALP to differentiate between exudates and transudates.
- 35. VALUES PF ALP level greater than 71 was observed in 27 out of 30 cases of tuberculous pleural effusion and six out of 30 cases of nontuberculous pleural effusion . PF/S ALP ratio greater than 0.51 was observed in 27 out of 30 cases of tuberculous pleural effusion and 4 out of 30 of non tuberculous pleural effusion
- 36. DISCUSSION Result confirms that alkphsactivity is useful in differentiating tuberculous and non tuberculous effusion a cut-off value of ≥71 IU/L for pleural alkaline phosphatase activity; and a cut-off value of ≥0.51 for pleural fluid/serum alkaline phosphatase ratio.