During breathing activity, chest wall moves out & in, lungs expand & relax. For the smooth movement of the lungs inside the chest cavity, they are lined by pleura.

Pleura includes two thin linings, the layer lining lungs is called visceral pleura and the one lining chest wall is called parietal pleura. The cavity formed between these two layers is called Pleural cavity. It contains a small amount of lubricant called Pleural fluid which helps smooth sliding of two pleural surfaces. Any condition which results in inflammation of the pleural surfaces or accumulation of excessive fluid in the pleural cavity gives rise to symptoms attributable to pleural involvement or disease.

Pleural effusion is nothing but the collection of excess fluid in the pleural cavity. Excess fluid in the pleural space is not normal and can occur due to a variety of reasons. Depending on the chemical composition it is broadly divided into two categories, transudate and exudate. 


What Causes Pleural Effusion?

1. Transudate pleural effusions 

Transudate pleural effusion is formed when fluid leaks from blood vessels into the pleural space. Chemically, transudates contain less protein and LDH than exudates. It is generally seen in the following conditions.

Congestive heart failure

Liver failure or cirrhosis

Kidney failure or nephrotic syndrome

Peritoneal dialysis

2. Exudate pleural effusions 

Exudate pleural effusion is caused by inflammation of the pleura itself and are often due to diseases involving the lung. Following are some common illnesses giving rise to exudate pleural effusion.

Tuberculosis
Pneumonia
Lung or breast cancer
Lymphoma
Pulmonary embolism
Post chest wall trauma or surgery
Asbestosis and mesothelioma
Secondary to intra-abdominal pathology 
Pancreatic pseudocyst, etc
Symptoms of Pleural Effusion -

Chest Pain: Chest pain is mainly due to irritation of the pleural lining. The pain is sharp, localized and worsens with a deep breath, yawning, coughing which is usually described as pleuritic. If the effusion causes inflammation of the diaphragm the pain may be referred to the shoulder or the upper abdomen. As the pleural effusion increases in size, the pain may increase or disappear altogether due to the separation of inflamed pleural surfaces.

Shortness of breath: As the effusion grows larger with more fluid, the harder it is for the lung to expand and the more difficult it is for the patient to breathe resulting in shortness of breath.

Other Symptoms: Other symptoms are generally attributable to the underlying disease process.

Diagnosis of Pleural Effusion -

Patient s Detailed History and Clinical Examination are the mainstays of diagnosing pleural effusion and it s the underlying cause. Following investigative modalities are generally opted for working out the final diagnosis before instituting appropriate therapy.

Chest X-ray: X-ray will help indicate the presence of fluid. 
Chest Ultrasound(USG): will help in confirming the presence of the fluid and it s localization which in turn can guide the physician about its quantity and its capability.
CT Scan: CT scan of the chest may at times be required to ascertain the underlying cause or to know about any other co-morbid conditions.
Thoracentesis: Thoracentesis is a procedure used to sample the fluid from the pleural effusion. Using a long thin needle, fluid can be removed and sent for testing to confirm the diagnosis.
This can be just for diagnostic purposes or can even be used as a therapeutic procedure.
Chemical analysis of the fluid will help determine the type of pleural effusion.
Treatment of Pleural Effusion -

Treatment of underlying Disease: The treatment of a pleural effusion usually requires that the underlying illness or disease is treated and controlled to prevent the accumulation of the pleural fluid. Like anti-TB therapy for Tubercular etiology or treatment of Cancer in malignant pleural effusion, etc.

Thoracentesis: As discussed earlier Thoracentesis can be used as a therapeutic procedure to remove excess fluid and help lung expand and function properly.

Tube thoracostomy: Thoracostomy or chest tube insertion may be done to drain and treat fluids which cannot be removed by needle aspirations, e.g. empyemas (pus collections).

Pleurodesis: Some pleural effusions reoccur multiple times; sclerosing agents that induce scarring such as talc or tetracycline was used to prevent a recurrence.

Decortication: If sclerosing agents fail, surgery may be required, called Decortication.

Pleural Effusion - What Is It?

There are two primary factors that are more likely to cause a stroke in a person i.e age and a family history. While both are inevitable, this necessarily doesn t have to be the fate of a person. Brain stroke is entirely preventable as with the case of other diseases. By working on the potential health risk factors, a stroke can be prevented. Here is a list of few such steps which, when followed can pay rich dividends to a person facing the risk of a brain stroke:

Blood Pressure: Blood pressure is the single most important factor that can increase the chance of a brain stroke. If a perfect blood pressure reading seems too difficult to achieve, a more realistic blood pressure target of 140/190 should be aimed for. Some of the common steps in order to achieve an acceptable blood pressure figure include reducing salt in the diet, exercising on a daily basis, regular intake of fresh fruits & vegetables and fast processed food containing processed fats. Finally, quitting drinking and smoking goes a long way in ensuring that a person is safe from strokes.

Losing Weight: Obesity increases the risk of diabetes and blood pressure subsequently increasing the risk of a stroke. Being overweight, therefore greatly increases the odds of a stroke. A BMI of 25 should be maintained by engaging in activities such as walking, running and playing on a daily basis.

Regular Exercise: Exercise is a clear mandate for people facing an increased risk of brain strokes. A moderate intensity exercise schedule for a minimum of 5 days per week is necessary. Some simple steps in order to achieve this include taking the stairs while climbing, joining a fitness club, 30 minutes of daily walk in a day etc.

Moderate Drink: Surprising as it may sound, moderate drinking on a daily basis can dramatically reduce the risk of a brain stroke. Red wine should be the choice of preference in this case. It should be ensured that the level of drinking does not surpass more than a glass. Regular drinking in excessive quantity can increase the chance of brain stroke.

Check For Atrial Fibrillation: This is a disease that is related to the heart due to an irregular heartbeat. There is a possibility of the clots travelling to the brain causing a brain stroke. Certain possible symptoms of this disease such as palpitation of heart and shortness of breath should be checked with a doctor to negate the chance of brain stroke. Certain blood thinners like warfarin and aspirin can shield against atrial fibrillation. A doctor has to be consulted before starting any medication related to the heart.

Top Ways To Prevent A Brain Stroke

How Do You Recognise a Stroke?

Strokes occur when blood to the brain gets interrupted or reduced. When this occurs, brain cells begin to die as they don't get enough nutrients and oxygen. Such life-threatening episodes can strike you anytime.

There are certain signs that can help you to clearly recognise an occurrence of stroke:

Face drooping on one side
Weakness or numbness on one side of the body, usually a leg or an arm
You're unable to think or say anything clearly
You experience slurred speech
Difficulty in moving your tongue
You get a sudden and severe headache

What Tests can be Done to Identify the Stroke?

There are certain tests that you can do to identify these warning signs.

To identify facial weakness, the smile test is used wherein you're simply asked to show your teeth to check for any changes in this facial expression - a lopsided smile.

To check for weakness in the body, the arm test is performed in which you raise both your arms to the same height. In case you're unable to do so, you may be experiencing arm weakness, a sign of stroke.

For slurring of speech, you may be asked to repeat sentences such as 'Don't cry over spilt milk' or 'The pen is mightier than the sword'.

Stroke can also be identified through the walk test wherein with the help of another person, you walk across the room to check for changes in your step.

If not treated in time, strokes can cause permanent brain damage. More importantly, unlike heart attacks, anxiety may not always be the cause of your stroke symptoms. That's why, being aware of these symptoms and recognising them on time can help you to quickly seek medical assistance.

How To Recognise a STROKE, Before it's Too Late!

Cholesterol is a vital component, which helps the body to make healthy cells. This wax like component is found in the lipid of the blood. An increased cholesterol count elevates the risk of heart diseases in a person. It thickens the vessels of the arteries resulting in less oxygen flow in the heart. This, in turn, increases the chances of a stroke. High cholesterol can happen from lifestyle habits and inheritance. It is completely treatable and preventable.

What causes high cholesterol?
The blood carries the cholesterol which is attached to the proteins. The combination of cholesterol and protein is known as the lipoprotein. Primarily there are two different kinds of cholesterol that the lipoprotein carries:

    Low-density lipoprotein: LDL is the bad guy that carries all kinds of cholesterol present in the body. It eventually rests on the walls of the arteries, making it narrow and hard.
    High-density lipoprotein: This is the good guy which scans the excess cholesterol and take them back to the liver.

Ideally, the body should have low LDL and high HDL. But often the reverse happens, resulting in high cholesterol and cardiac diseases. Factors such as unhealthy diet, inactivity for most of the day and obesity is responsible for the same. Even the genetic set up can play a hand in a high count of LDL in the body. There is nothing that can be done in this case except to seek medical help.

6 factors that put you at risk:

    Poor diet: Cholesterol levels are dramatically increased when baked products and saturated fats are consumed in an excess amount. Other high cholesterol food products include dairy products, processed fats and red meat. Refraining from this food items will drastically reduce the chances of getting high cholesterol in the body.
    Obesity: Obesity results from too much of fat storage in the body. It not only fatigues a person faster, but puts a person at high risk of getting cholesterol. The body mass index should be always lesser than 30 to abstain the risk of cholesterol.
    Waist circumference: A waist circumference of more than 40 inches in men and 35 inches in women can increase the risk of cholesterol.
    Diabetes: This is one of the major causes of high cholesterol. It not only damages the artery lining, but results in higher LDL and lower HDL.
    Less workout: Leading a life which is devoid of exercise and jogging can increase the chances of getting high cholesterol. Exercise boost HDL count in the body and mitigates the risk of low HDL.
    Smoking: The blood vessel walls get damaged with smoking. The blood vessels start accumulating fatty acids thereby increasing the chances of getting high cholesterol.

What Causes High Cholesterol? 6 Factors That Put You at Risk

A sensation of pain in the chest is almost automatically associated with having a heart attack. While it is true that it is one of the best indicators of a heart attack, there are quite a few other things which can cause one s chest to pain and not all need to necessarily be as time critical as a heart attack. So, what are the various things one should be aware of when it comes to pain in the chest? In order to understand chest pain better, it is first very important to understand the various types of chest pain better! So, there is a sharp pain, its opposite which happens to be a dull pain, burning, aching, stabbing pain, as well as a crushing sensation.

Let s start with the elephant in the room, which is medically known as myocardial infarction or referred to as the infamous heart attack. This occurs when the muscle cells, which are located in the heart die on account of not enough blood flowing through the heart. In simple terms, the best way to get to know that one is having a heart attack is when the person feels a seriously crushing pain in the centre or the left side of the chest. What could be said to be unique about this type of pain is that resting does not make it better.

Another condition of the heart which is often mistaken by the layman for a heart attack happens to be myocarditis. Inflammation of the heart muscle leads to fatigue and a fast beating of the heart. The person would also experience some difficulty breathing.
Heart disease can come in multiple forms and one of those is known as CAD or Coronary Artery Disease. When there is a blockage in the blood vessels of the heart, the pain [which is known as angina] is caused by this blockage. The probably solitary source of good news is that permanent damage to the heart is not caused by CAD!
That being said, a heart attack is a greater possibility. The pain in the chest could spread to the jaw or the back, or even the arm. The sensation is that of the body part being squeezed. The first thing to be done when angina occurs is to rest in order to lower the pain.
While these conditions have focused on the heart, pneumonia affecting the lungs can cause deep chest ache. It causes a cough and chills. There is also likely to be pus from the respiratory tract which is coughed up!
Asthma is yet another respiratory issue which could cause chest pain!

Chest Pain - Reasons Behind It!

Dialysis is a very important and life-saving procedure. It is performed to replace kidney function in case of renal failure. Wastes and extra fluids in the blood are filtered out during this process. To be able to perform Dialysis, the connection between the patient s bloodstream and the equipment for performing Dialysis (dialyzer) outside the body is established. This connection is created through Dialysis Access Surgery. It is a type of Vascular Surgery which forms the vascular opening for access during Dialysis. Thus, Dialysis Access Surgery is the lifeline for the survival of the patient.

Types of Vascular Access for Dialysis- 
There are three types of Vascular Access for Dialysis: Arteriovenous (AV) Fistula, Arteriovenous (AV) Graft, and Venous Catheter.

  Arteriovenous (AV) fistula is a surgical connection of an artery to a vein. An AV fistula is usually placed in the upper arm or in the forearm. It causes extra blood to flow into vein making it grow large. A larger vein hence provides easy access to blood vessels. An AV fistula is preferred over other methods as it lasts longer than other methods of access and provides a good flow of blood. Moreover, it is less prone to infection and blood clots than other methods. Before an AV Surgery, a Vessel Mapping Test is sometimes performed for assessing the blood vessels most suitable for Dialysis. An AV fistula is performed under local anaesthesia and requires two to three months for maturation before hemodialysis. If it fails to mature, the procedure is repeated.

  Arteriovenous (AV) graft is performed when AV fistula fails to mature. It is hence the second most preferred choice for long-lasting access to vascular tissues for Dialysis. An AV graft is a looped plastic tube which establishes a connection between an artery and a vein. Like AV fistula, AV graft is also performed under local anaesthesia. It is slightly more difficult to maintain than an AV fistula.

  A venous catheter is used for short- term hemodialysis. It is a tube which is inserted into chest, neck, leg, or near groin for vascular access. After exiting the body, the tube splits into two halves. In the case where a renal disease has made quick progression leaving little or no time for the AV fistula or AV graft to mature, a venous catheter is used to establish the required vascular connection. This procedure is also performed under local anaesthesia. It is a tool for emergencies but is not suited for long- term use. It can cause narrow vein due to an infection,
scarring, or blood clot. If long- term venous catheter is used, it is tunnelled under the skin which has fewer problems associated with it and is more comfortable. 

How to Care for a Vascular Access?
  Get checked for infections and other problems before each hemodialysis session;
  Use the operated site for access only for the intended use;
  Always keep the access clean;
  Prevent cutting or bumping the access;
  Check for thrill/ vibration in the access and inform the doctor if any;
  Do not put pressure on the access site;
  Do not put blood pressure cuff around the access arm;
  Do not wear jewellery or tight-fitting garments over the site;
  Do not lift a weight.

Take Away-
Vascular Surgery for Dialysis is performed to provide vascular access for the procedure. AV fistula is the most preferred type followed by an AV graft. A venous catheter is recommended to be used only in case of an emergency when there is not much time left for the other two options to mature.

Vascular Surgery - Can It Help For Dialysis?

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