Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures

Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions.

[An assessment of fluoride release from a compomer and four resin-modified glass-ionomers]

OBJECTIVE

To compare the fluoride release into water from a compomer (Dyract) and four resin-modified glass-ionomer cements (Fuji II LC, Photac-Fil, VariGlass, Vitremer).

METHODS

Five specimens of each material were prepared according to manufacturers' instructions and placed into 3.0 mm diameter x 2.7 mm thick disposable Teflon molds. The specimens were placed in well-sealed polypropylene vials with 2 ml of de-ionized water and stored in an incubator at 37 degrees C. The solutions were replaced weekly and the levels of fluoride (ppm) were analysed at day 1, 7, 30 and subsequently every 28 days for 253 days. The results were analysed using one-way ANOVA followed by the Student-Newman-Keuls range test.

RESULTS

All materials except the compomer (Dyract) showed high initial release values of fluoride which decreased exponentially, then showed a slow decline during the ensuing time. Initial fluoride release values were significantly different between Dyract, VariGlass, and the three other resin-modified glass-ionomers. The compomer released significantly less fluoride than did the other resin-modified glass-ionomers.

CONCLUSION

With high caries risk patients, it may be most beneficial to use a high fluoride release resin-modified glass-ionomer cement as the restorative material of choice.