Hilum is a tricky part in chest X-ray (CXR) for understanding. Anatomically, pulmonary arteries and veins, major bronchi, and lymph nodes with pulmonary arteries contributed most of the radiographic density of the hila with superior pulmonary veins making a smaller contribution. Though both hila should be indistinguishable in size and density, we do not get equal hila in majority of CXRs. Rotational malpositioning must be kept in mind, while interpreting CXRs of unequal hilum. For interpreting hilum, we should search for four factors shape, radiopacity, proportionate size, absolute size, hilar angle, contour of pulmonary artery. There are numerous causes of hilar enlargement. It is the clinical presentation which will help in tapering the differential diagnosis. Asymmetric hilum is a challenging subject for pulmonologists. Interpretation of unequal hilum depends on findings of detail history, meticulous clinical examination, and appropriate investigation.

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Background: Light's criteria is the gold standard to differentiate transudative pleural effusion (PE) from exudative PE, but it requires four biochemical estimations which, in developing countries such as India, may not be feasible in every patient due to economic constraints. Aims: To evaluate the comparative usefulness of pleural fluid biochemical parameters with relative usefulness of pleural cholesterol to the traditional Light' criteria. Setting and Design: Prospective institutional based study. Materials and Methods: A total of 56 cases of PE were studied consecutively, of which 34 cases were of tuberculous effusion and 22 cases of nontubercular effusion. The data obtained from the patients were collected, analyzed, and observations noted down. Statistical Analysis: Sensitivity, specificity, positive predictive value and negative predictive value of different biochemical parameters single or in combination were analyzed by SPSS 16 software. Results: According to their etiology, 7 of the effusions were transudates and 49 were exudates. Using a cutoff point of 45 mg for pleural cholesterol and values for protein and lactate dehydrogenase (LDH) of Light et al., the best diagnostic power corresponded to the combination of pleural cholesterol and LDH; cholesterol level over 45 mg/dL and/or LDH over 200 IU/L differentiate exudates from transudates with a sensitivity of 99% and a specificity of 98%. Conclusions: The measurement of pleural cholesterol and LDH permits the separation of pleural exudates from transudates with accuracy similar to the original report of Light et al., with the advantage of requiring only two laboratory determinations and no simultaneous blood sample, especially in a country like India where financial and technical constraints are immense.

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The aim of this article is to review the surgical management of lung carcinoma. Lung cancer is the most common cancer in the world, and a leading cause of death in men and women. By any conventional measure, the enormity of this global problem is immense. In some countries incidence and mortality rates have peaked and are beginning to decline. In many developing nations, the burden of disease is rising and will continue to rise because of aggressive tobacco industry marketing which is leading to a growing prevalence of cigarette smoking. This is also one of the major causes of cancer deaths in our Kashmir valley. The method of literature search was from articles published in PubMed and Google Scholar.

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Background: As to the profile of adverse drug reactions (ADRs) due to directly observed treatment, short course (DOTS), there is no report available in patients receiving antituberculosis (anti-TB) chemotherapy in Manipur, India. One of the main reasons for non-adherence to anti-TB therapy (ATT) is ADRs, even under DOTS. Aims: This study aimed to determine the incidence of ADRs due to DOTS therapy with a TB population of Manipur, India. Setting and Design: A prospective institution-based cohort study, and performed during July 2009-December 2010. Materials and Methods: The study included 102 diagnosed TB patients on anti-TB treatment under DOTS. Every patient was followed-up for the duration he/she received the treatment. Statistical Analysis: Frequency of different ADRs was assessed and p value was determined. Results: Incidence of TB was more among males than female (76.47% against 23.53%). Seventy-one patients (69.01%) showed one or more ADR. Incidence of ADRs based on affected organ was: Gastrointestinal (GI) disorders in 38 patients (53.52%), generalized weakness in 12 patients (16.9%), liver dysfunction in 11 patients (15.49%), allergic skin reactions in six patients (8.45%), neurological system disorders in two patients (2.82%), and fever in two patients (2.82%). However, 30.99% did not experience any ADRs. Conclusion: Incidence of ADRs due to DOTS therapy was 69.01%. Majority of cases suffered from GI symptoms. This highlighted the importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely.

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Background: The association between low body mass index (BMI) and poor prognosis of patients with chronic obstructive pulmonary disease (COPD) is a common clinical observation and it varies with different stages of COPD. Aims: To find out any correlation between BMI and severity of obstruction (Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging) of COPD patients. Settings and Design: We conducted a cross-sectional, observational study among 101 male patients of COPD, attending the chest medicine department in our medical college during the period from March 2011 to February 2012. Materials and Methods: We classify the severity of obstruction in COPD patients according to GOLD staging through spirometry. BMI of all the patients was measured. Correlation between BMI and severity of obstruction (post bronchodilator forced expiratory volume in 1 ^st second (FEV ₁ ) % predicted) in COPD patients was determined. Statistical Analysis: Analysis was carried out using Statistical Package for Social Sciences (SPSS) 20.0 software for windows. Pearson correlation, one way analysis of variance (ANOVA) analysis and post hoc Turkey test were used to determine the relationship between BMI and post bronchodilator FEV ₁ %predicted. Results: Mean age of the study subject was 58.18 ± 9.29 years. Commonest age group was 50-59 years (40%). Mean BMI of stage 1 COPD subjects was 26.21, stage 2 was 22.91, stage 3 was 20.78, and stage 4 was 15.71. One-way ANOVA showed that BMI of the patients were decreasing with increasing severity of the disease (GOLD) and it was statistically significant (P < 0.05). The post hoc Turkey test also indicated that there were significant differences present in different GOLD stages of COPD in respect to BMI. Conclusion: There was positive correlation between severity of airway obstruction and BMI in COPD patients.

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Background: The tuberculosis (TB) literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perception to determine why people seek treatment and may stop taking treatment. Aims: To investigate knowledge about TB, perceptions of (access to) TB treatment, and adherence to treatment among a Pakistani population. Setting and Design: Descriptive cross-sectional study. Materials and Methods: A total of 175 participants were selected nonrandomly, 100 were TB patient and 75 were non-TB patient in proportion to the total number of participants in each ward of hospital. Statistical Analysis: Analysis of attitudes and perceptions toward TB, adherence to TB treatment, health seeking behavior, and TB treatment types done by frequency counts and percentages. Regression analysis and logistic regression analysis were performed to test whether differences in age, gender, and education level led to different knowledge scores and different attitudes and preferences toward TB, adherence to TB treatment, health seeking behavior, and TB treatment types. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) 16.0. Result: TB knowledge can be considered fairly well among this community. Respondents' perceptions suggest that stigma may influence TB patients' decision in health seeking behavior and adherence to TB treatment. A full 95% of those interviewed believe people with TB tend to hide their TB status out of fear of what others may say. Conclusion: Most of the subjects were unaware of TB that seems to be due to their illiteracy and those who knew had got the knowledge from media, but the majority of the patients who were on directly observed treatment, short-course (DOTS) were found to be satisfied.

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Adult presentation of congenital Bochdalek's hernia is rare. Here we report the case of a 18-year-old boy who presented to us with dyspnea, low grade fever, and cough for whom the diagnosis of congenital Bochdalek's hernia was confirmed by computed tomography (CT) scan of thorax after barium ingestion. Problems of this adult presentation because of difficulty in diagnosis, operative management, and rudimentary lung were properly and successfully dealt with in our case. We concluded that before undergoing operation in adult Bochdalek's hernia, thorough check-up is necessary as rudimentary lung may not expand resulting in ventilatory insufficiency during postoperative phase.

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