RESUMO
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.
RESUMO
Occupational exposure to silica has been seldom implicated to cause systemic sclerosis. Erasmus syndrome is a rare condition where there is development of systemic sclerosis following silicosis. Early diagnosis is essential for appropriate treatment and symptom control. We describe a 42-year-old stone cutter with silicosis who was subsequently diagnosed to have diffuse pattern of systemic sclerosis. A multidisciplinary team including pulmonologists, specialist palliative care physicians, rheumatologists and radiologists were involved in diagnosis and management. Timely diagnosis and a multidisciplinary team management with pharmacological and non-pharmacological measures was essential in holistic care provision. This is the first report of specialist palliative care team facilitating diagnosis of this rare syndrome and promoting integration in the overall care and management.