Pleural Effusion: Transudate vs. Exudate

Pleural membrane is the layer of membrane the covers lung from the pleural space.
Pleural space is the space between the lung and the chest wall; it’s a space where the lung can expand to when the person inhales.
Effusion is the escape of fluid from the normal vessels by rupture or abnormal transition.
When there is a pathology involving the lung such as from pneumonia (lung infection) or cancer, fluid from the vessels surrounding the lung tend to exit out in the interstitial space and in the pleural space, hence effusion. Effusion can be classified in to two types: the lighter effusion is called transudate and the heavier effusion is called exudate.
Pleural Effusion
Transudate effusion is due to an imbalance between hydrostatic and oncotic pressures that increases fluid movement across the capillaries into the visceral pleura and the pleural space. Transudates fluid does not require further intervention except for treatment for the underlying cause.
Exudative effusions are due to capillary membrane permeability caused by pleural and lung inflammation. A specific criteria called the Light criteria, defines exudate:
  • Pleural fluid protein/serum protein ratio >0.5
  • Pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6
  • Pleural fluid LDH >2/3 of the upper limit of normal for serum LDH
Exudate effusion will also have a criteria of pleural fluid glucose <60 mg/dL due to the high metabolic rate of leukocytes (and/or bacteria) within the fluid.  

Updated 6/14/2014
The lungs are not the only areas of effusion; other areas can have effusion as well such as the peritoneum (the abdominal area).
Causes of Transudate Effusion

– Congestive Heart failure
– Cirrhosis (portal hypertension and hypoalbuminemia)
– Peritoneal dialysis

Causes of Exudate Effusion
– Pneumonia
– Malignancy (usually lung cancer in men and breast cancer in women); when there is a large unilateral pleural effusions then it’s mostly due to malignancy

Image source: Clevelend Clinic

Greetings from Saint Vincent and the Grenadines

Camille is starting SJSM in St. Vincent island for the summer semester; she already there and she sent some pictures of the island and SJSM’s building.
I’ve safely arrived at Saint Vincent and am astounded at its beauty. The hills are great, a few of the Grenadines are visible, and the people are friendly. The party never stops here!
The first few days has been a mix of excitement and anxiety, but I am almost fully settled in and ready to start the MD program at Saint James. I can’t wait to meet the other students and hopefully find a roommate..
Thank you for all of your support during this transition, and we’ll keep in touch.
P.S. I’ve attached some photos for you to enjoy!
Camille Renee, BSc.
Saint James School of Medicine

Pictures from St. Vincent and the Grenadines Island

Pictures of the Saint James School of Medicine Building in Construction

Pros and Cons of Attending Saint James School of Medicine

I’m sure this post will get a lot of attention because this post will lay out key information to any potential future students who want to attend Saint James School of Medicine.
  • Cheap Tuition
    Even though the tuition for SJSM has been increasing, it’s still cheaper than any other medical school in the Caribbean.
  • Flexibility
    There are times when random things happen and we cannot stay on track like the traditional crazy medical schools schedule, SJSM will give you a lot of flexibility in terms of studying and curving on the finals. SJSM will also give you flexibility in timing for studying for the USMLE tests.
  • Various Elective Spots
    MUA (Medica University of the Americas) students have a very hard time with their school because MUA will not set up any electives for them and they refuse to pay third party companies to set up electives. However, SJSM sets up all the electives for their students and if you want to set up your own electives then you submit the proper papers to them and you are good to go. SJSM has spots in West Virginia, Arizona, and obviously Chicago.
  • Friendly Office Staff
    I don’t about other students but most of the people I’ve talked to when I called the SJSM office are friendly and they seem to cooperate with me; may be because I pay on time LOL. Just follow the rules and don’t rely on them for all the answers because most of the staff members have not gone to the islands.
  • Senior SJSM Students Are Helpful
    The students are willing to help you out. SJSM Students are all over Hyde Park, Chicago, and they will sit down and guide you on what you need to do. If you go on FaceBook you can find their contact information there.
  • Three Campuses to Choose From
    You can choose to go to either go to Anguilla, Bonaire, or St. Vincent islands. Each island is different from each other and each island has their own pros and cons. You have to ask senior students how the island is like. I went to Bonaire and I wrote many articles  on this blog regarding my experiences there.
  • School is Almost 15 years Old
    After the 15 year mark a Caribbean school’s accreditation goes up based on what I read, but correct me if I’m wrong. After 2015, SJSM will be to apply to more states for approval for it’s students to conduct residencies; but that’s only for the Bonaire/St. Vincent campus students.
  • It’s a Caribbean School
    At the end of the day SJSM is a school overseas. Therefore, we (American/Canadian citizens) are second in line after American Medical graduates.
  • Limited Core Rotation Spots
    Unfortunately, SJSM has limited core rotation spots. Most of the students do their core rotations at Jackson Park Hospital and other green-book hospitals.
  • Extra Weeks of Clinical Rotations
    We are supposed to do 72 weeks of both core and elective rotations and be ECFMG certified. But SJSM requires 80 weeks which which 2 more months of rotations. The time to do these extra 8 weeks of rotations sometimes hinders students from applying for residency for that year.
  • Limited Knowledge from the Office Staff
    Some of the office staff have never been on the islands so they are not the best people to ask about where to go once you are on the islands. Also, they cannot tell you which states we are eligible to apply for residencies other than Illinois because they haven’t done their research. It’s the SJSM students who do most of the work to find out and their spread their information through the word of mouth in rotations.
  • Limited States to Get Residency Spots
    Because we don’t know which states we are eligible for, students apply to limited number of states for residencies. I’ve seen students of SJSM getting residencies every year but majority of them get it in Chicago because they don’t know where else to go.
  • No Federal Loans
    Because SJSM is a foreign medical school and it’s not one of the “big three” schools (Ross, AUC, SGU), the students of SJSM are not eligible for Federal loans. Delta loans are available to SJSM students but it’s limited amount and it’s not guaranteed because it depends on your credit history. Most students either get other private loans, max out their credit card, or try to get money from family and friends.
  • AICM is Only in Chicago
    Unfortunately AICM is mandatory for all students. And those who are not Chicago residents have to move to Chicago in order to complete the course.
  • No Guidance
    If you ask any SJSM student, they will tell you that there was no official guidance from the SJSM staff. Such guidance of how to study for the USMLE tests. Most of the guidance come from senior SJSM students. As a matter of fact, I created this blog as a foundation of guidance to help SJSM students and I’m glad to find out that it has helped a good number of people.
It doesn’t matter which Caribbean school you go to, you will always have some obstacles to go through. So I strongly recommend that you work hard in undergrad and apply to US med schools first, and if it doesn’t work then choose the “big three” Caribbean med schools so you don’t have to worry about financing as your tuition and personal expense would be covered if you are a US citizen/US green card holder. But if you feel comfortable with the pros and cons of SJSM then go for SJSM; it’s what you make out of it.