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Background: Pleural effusion is a common diagnostic dilemma for the pulmonologist. A histological diagnosis would many a time steer the way to an accurate diagnosis of the aetiologies of pleural effusions. This study has compared two methods for obtaining histological specimens in cases of undiagnosed pleural effusions. Aim: To compare the efficacy of closed pleural biopsy with Abrahm’s needle and medical thoracoscopic biopsy in the diagnosis of undiagnosed exudative pleural effusions at a tertiary care setting. Study Design: Randomized controlled study. Study Period: November 2008–October 2010. Methodology: All patients who were admitted with pleural effusions underwent a clinical workup for pleural effusions. Light’s criterion was used to differentiate between exudative and transudative pleural effusions. Those patients with exudative pleural effusions, who did not have a specific diagnosis, were included in the study. Fifty eight patients were included in the study and they were randomized into 2 Groups of 29 patients each. One group was subjected to medical thoracoscopic pleural biopsy and the other to closed pleural biopsy with Abrahm’s needle. Demographic, clinical and biochemical characteristics, diagnostic yields and the complications among the two groups were compared. Result: Medical thoracoscopy has a diagnostic yield of 86.2% with complication rate of 10.3% compared to 62.1% and 17.2% respectively in closed pleural biopsy group. Conclusion: Medical thoracoscopic pleural biopsy had a better diagnostic yield with a lower complication rate as compared to closed pleural biopsy with Abrahm’s needle.

Current waist circumference (WC) and waist-to-hip ratio (WHR) cutoffs have been identified from studies of predominantly European-derived populations. However, these cutoffs may not be appropriate for other ethnic groups. This paper reviews the literature regarding ethnic differences in body composition and the appropriateness of ethnic-specific WC and WHR cutoffs in various ethnic groups. Studies investigating ethnic-specific cutoffs were identified among Aboriginal, Asian, African (Sub-Saharan), African-American, Hispanic, Middle Eastern, Pacific Islander and South American populations. Abstracts that recommended WC and/or WHR cutoffs (or rejected the use of cutoffs) were included with their supporting literature. The evidence for ethnic-specific WC and/or WHR cutoffs was then rated as either convincing, probable, possible or insufficient. The majority of studies recommending ethnic-specific cutoffs was for Asian populations. Few studies recommended cutoffs in Aboriginal, African (Sub-Saharan), Pacific Islanders and South American populations. All studies were cross-sectional, and the overwhelming majority of studies used receiver operating characteristic curves. The studies used a number of methods for assessing WC and WHR, and a variety of outcome measures, making cross-study comparison difficult. There is possible evidence that Asians should have a lower WC cutoff than Europeans. The evidence is insufficient for specific cutoffs for African-American, Hispanic and Middle Eastern populations but some studies indicate current cutoffs for Europeans may be appropriate, whereas there is insufficient evidence for the other ethnic groups. Future studies are needed to address the methodological limitations of the current literature. European Journal of Clinical Nutrition (2010) 64, 42-61; doi:10.1038/ejcn.2009.70; published online 12 August 2009 Keywords: ethnicity; obesity; waist circumference; waist-to-hip ratio, Introduction Abdominal obesity is generally assessed by either the waist circumference (WC) or waist-to-hip ratio (WHR) measures. Prospective and case-control studies indicate that even with a 'normal' body mass index [...]

Thirty-eight people with a moderate to severe degree of aerophobia self-referred themselves to a course designed to help them travel by air. The course involved three long sessions based on giving information, graded exposure without avoidance, and group support with natural coping models. Measures of self-reported anxiety levels were taken at regular intervals. The results showed that being given information or undergoing a simulated flight had little effect on perceived anxiety. Prolonged exposure to flying had a marked effect on reducing anxiety and anticipated apprehension about future flying. At one-year and three-year follow-up, 40% and 60% of participants had flown commercially, although there was some minor restoration of anticipated anxiety associated with flying; 84% showed less anxiety about flying. Psychological intervention, in collaboration with airlines, may have marked benefits in reducing fear of flying. [ABSTRACT FROM AUTHOR]