A detailed description of the causes and diagnosis of pleural effusion. The presentation includes a discussion of the causes and exudative and transudative pleural effusions. Light's criteria and its modification are described along with definition and clinical implication of pleural fluid acidosis, glucose, adenosine deaminase, hemorrhagic pleural effusion and protein and LDH as well.

A decade ago we thought that Chikungunya was a tropical disease restricted to the rain forests. However, after the 2007 epidemic in Italy and later in the Reunion islands, this dreaded condition has now spread to the Carribean and the Americas. Its an arthropod borne alpha virus which causes fever, polyarthralgia and arthritis. There could be serious complications in the adult such as meningoencephalitis or GBS as well as in neonates. This presentation discusses in detail the clinical features, diagnosis and management of Chikungunya fever. A detailed discussion of its complications is also included. Check out our other videos

Systemic lupus erythematous is an autoimmune condition characterised by damage to organ systems due to autoantibodies and immune complex deposition. Genes, epigenetic changes and environment play a role in its pathogenesis. SLE is a truly multi system disease causing widespread clinical manifestations in almost all organ systems. Autoantibodies in SLE are numerous and mainly include ANA, dsDNA, Sm and others.

Hypoglycemia is a common and serious medical emergency which may occur in both daibetic and non-diabetic patients. The signs and symptoms of hypoglycaemia may be present in many individuals, but may also be masked in several individuals due to a condition called hypoglycaemia induced autonomic failure. This presentation aims to deal with the causes, clinical features, diagnosis and management of various causes of hypoglycaemia. The causes of hypoglycaemia may be divided into hypoglycaemia in ill or medicated individuals and hypoglycaemia in previously asymptomatic individuals. A variety of causes are discussed under both headings. Management of hypoglycaemia is also discussed in detail. There is also a brief discussion about management of insulinoma.

Chronic myeloid leukaemia is a common malignancy worldwide. We have come a long way from the limited treatment options and survival in this condition. Today, CML is a treatable malignancy with more than 80% patients surviving beyond 10 years after diagnosis, in absence of complications. This presentation deals with the definition, diagnostic criteria of chronic phase, accelerated and blastic phase (MD Anderson cancer centre, International bone marrow transplant registry and the WHO for the latter two) and management (first and second generation tyrosine kinase inhibitors) of this condition. Finally, a stepwise approach to chronic myeloid leukaemia is also presented including the definitive modality of treatment, allogeneic stem cell transplantation.

Diabetic ketoacidosis is an acute complication of uncontrolled hyperglycaemia characterised by high anion gap metabolic acidosis, dehydration and other metabolic abnormalities. Upto half of patients with Type 1 diabetes mellitus may have DKA. The incidence in T2DM is also rising. Precipitants include acute illness such as myocardial infarction, trauma and infection. Paitents of diabetic ketoacidosis may present with vomiting, pain abdomen and lethargy. Mental obtundation may also be present. Management of diabetic ketoacidosis revolves around administration of IV normal saline, insulin, replacement of potassium with frequent monitoring of sugars and electrolytes.

Acute kidney injury is common entity in medical practice. The present definition is based on a serum creatinine rise of more 0.3 mg/dl in 48 hours or less, a 50% increase from the baseline over a period of 07 days or a urine output of less than 0.5 ml/kg/hour for more than 06 hours. The main causes of acute kidney injury may be classified into pre renal, intrinsic or post renal causes. Rapid diagnosis and prompt treatment is essential to prevent mortality or morbidity. This presentation discusses in detail the causes of all three mechanisms, pre-renal, post renal and intrinsic.

Aplastic anemia is a hematopoietic disorder caused due to T lymphocyte mediated destruction of stem cells resulting in pancytopenia with a cellular bone marrow and normal cell cytogenetics. The causes of aplastic anaemia may be inherited or acquired. The causes and the diagnostic approach, along with spectrum of severity of this disorder is discussed in this presentation. A detailed discussion of the management options, along with pharmacological therapy and supportive therapy in these cases is also discussed. The treatment options include, in addition to a stem cell transplant, anti-thymocyte globulin, cyclosporine, methyprednisolone and eltrombopag (for patients who have failed treatment on combined modality therapy with ATG and cyclosporine)

Ascites, the collection of fluid within the peritoneal space is caused due to a variety of causes including cirrhosis, cardiac causes, sinusoidal obstruction syndrome, tubercular peritonitis and pancreatitis, amongst others. Most commonly, the cause of ascots may be cirrhosis , which in turn, is most frequently causes by alcohol use, hepatitis C and non-alcoholic steatohepatitis. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Both low SAAG and high SAAG ascites have been dealt with in some depth, with a brief overview of the management of these conditions

Hyponatremia is defined as a serum sodium of less than 135 Meq per litre and occurs in upto 22 % of hospitalised patients. The causes of hyponatremia may be understood based on the pre-existing volume status of the patient which may either be hypovolemic, euvolemic or hypervolemic hyponatremia. This presentation discusses in detail, the causes of these underlying conditions. Also mentioned are the clinical features and management options and therapeutic sodium targets in patients with hyponatremia. Drugs such as demeclocycline and vaptans (Tolvaptan, Conivaptan) are also mentioned as management options which may be used on a case to case basis. Finally, the all important targets of sodium correction over 24 hours are also mentioned, along with a practical formula for calculation of sodium deficit which is explained with an example.

Small cell lung cancer, which occurs almost exclusively in smokers, is a malignancy characterised by rapid doubling time, high growth fraction and widespread metastasis at presentation. In this presentation, we will briefly discuss the classification of pulmonary Neuro-endocrine tumours by the World Health Organisation followed by a detailed discussion of the clinical features, lab evaluation and management of SCLC, both limited and extended stage. The frontline therapy in small cell lung cancer is etoposide and cisplatin along with thoracic radiotherapy and prophylactic cranial irradiation in patients who have a good response to therapy. Hyperfractionation of radiotherapy may provide some benefit but is also associated with increase incidence of complications. Newer agents for SCLC include Vandetanib and immunotherapy molecules, such as Iplimumab and nivolumab.

Acute respiratory distress syndrome is characterised by rapid onset dyspnea, bilateral infiltrates on chest x-ray and respiratory failure. This may be due to conditions which directly affect the lung such as pneumonia, aspiration and near drowning. It may also be due to indirect lung injury, as in conditions like sepsis, pancreatitis, trauma and poisoning. The diagnostic criteria of ARDS, often described as the Berlin criteria is discussed in this presentation along with various management aspects of ARDS including ventilation strategies and use of antibiotics and diuretics. Finally prognostic features and alternative strategies are also discussed.

Renal replacement therapies are a set of interventions and techniques aimed at replacement of the filtering function of the kidneys. These include both dialysis and renal transplant. In this presentation we will talk about the indication and modalities of dialysis. This includes hemodialysis, peritoneal dialysis and continuous renal replacement therapies. The circuit diagram of each modalities along with its procedure and complications are also discussed.