Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in patients on mechanical ventilation (MV). There is paucity of data in our country regarding incidence, crude mortality rate, clinical profile, microbiological organism profile, mortality in early and late onset VAP and mortality as well as appropriate antibiotic therapy in these patients. Methods: The study involved patients above 15 years of age with clinical suspicion of VAP, receiving MV for more than 48 hours in intensive care unit of our hospital. Patients were without evidence of pneumonia on admission. Study patients were followed until they were successfully treated and discharged from the hospital or death. Results: Out of 50 patients, 31 (62%) patients were in 4th to 6th decades of life. Incidence of VAP was 21% and crude mortality rate was 42%. Due to neurological conditions, 22 (44%) patients required MV. VAP developed in 38 (76%) patients within 15 days of initiation of MV. Mortality in late onset VAP was found to be twice as compared to mortality in early onset VAP. Mortality in inappropriately treated patients was significantly higher than that of appropriately treated patients. Conclusions: The incidence of VAP increases with increase in duration of hospital stay. There is significant morbidity and mortality in mechanically ventilated patients of VAP; if not treated appropriately early.

Background: Non-specific interstitial pneumonia (NSIP) has now been accepted to be a distinct clinical entity. However, very limited data is available in western Indian population regarding its clinical presentation, treatment options and survival of patients diagnosed with idiopathic NSIP. Methods: A retrospective, observational analysis of clincial, radiological, treatment and survival of patients data collected from hospital records who were diagnosed with idiopathic NSIP over the six years was carried out. Results: Out of a total of 146 patients of interstitial lung disease (ILD), 46 (31.5%) patients diagnosed with idiopathic non-specific interstitial pneumonia were included in the study. There were 12 male patients. Mean age of female was 60.6 years and 60.5 years for male patients. Clubbing was seen in 12 (26%) patients. Fifteen (32.6%) patients were on anti-tuberculosis medications prior to the diagnosis of idiopathic NSIP. The mean forced vital capacity (FVC) in the present study was 56%. High resolution computed tomography (HRCT) of the chest revealed reticulation with basal predominance in 35 (76%) patients and ground-glass opacities in 9 (19%). Median survival from initial visit was 29.6 months; while that from symptom onset was 46.2 months (p=0.03). Stabilisation of disease was seen in 26 (56.5%). Twenty patients died during the study period. Conclusions: Idiopathic NSIP is a disease of the elderly with female predominance with a five-year mortality of 25%. Late presentation worsened the prognosis.

Background and objective. Bronchial asthma is a heterogeneous disease, usually characterised by chronic airway inflammation, reversible airway narrowing, airway hyperresponsiveness (AHR) and airway remodelling. The study was designed to evaluate the anti-inflammatory and immunomodulatory potentials of Albizia lebbeck in experimental model of bronchial asthma in rats. Methods: Wistar rats were immunised with ovalbumin (OVA) on day 0 and were challenged with 1% OVA aerosol for 20 minutes daily, from 15th to 22nd day to induce inflammatory model of bronchial asthma. Standardised aqueous extract of Albizia lebbeck (bark) was administered orally for 22 days at doses of 100, 200 and 400 mg/kg, in separate groups. Rats were anesthetised and blood and bronchoalveolar lavage (BAL) fluid were collected and analysed for markers of inflammation (inflammatory cell counts, tumour necrosis factor-alpha [TNF-á], interleukin-6 [IL-6]) and immunomodulation [Ova sIgE], IL-4 and interferon-gamma [IFN-ã]). Results: Pre-treatment with Albizia lebbeck significantly attenuated the levels of eosinophils, neutrophils, OVA sIgE, TNF-á, IL-6, IL-4 whereas, elevated the levels of IFN-ã in both blood and BAL fluid, thus validating the antiinflammatory and immunomodulatory effect of the extract. Conclusion: Taken together, the results showed that standardised extract of Albizia lebbeck has anti-inflammatory and immunomodulatory activity as evident from the modulation of cellular and molecular markers of inflammation and immunity in the model of airway inflammation.

Schwannoma or neurilemmoma is a benign tumour arising from the nerve-sheath, with spinal nerve roots being the most common primary location. Though neurogenic tumours are common in the mediastinum, primary neurogenic tumours arising from lung parenchyma are very rare. Here we report a case of a primary lung schwannoma and its management.

Hereditary haemorrhagic telangiectasia (HHT), synonymously known as Osler-Weber-Rendu syndrome, is a rare autosomal inherited disorder characterised by abnormal blood vessel formation in the skin, mucous membranes, and organs including the lungs, liver and central nervous system. Straight back syndrome is characterised by the loss of normal upper thoracic spinal curvature, i.e. thoracic kyphosis, resulting in reduced antero-posterior diameter of thorax, often associated with cardiac murmurs on auscultaion and cardiomegaly on chest radiograph. The association of these abnormalities occurring simultaneously has been rarely reported. We present a case of HHT and mitral valve prolapse (MVP) associated with straight back syndrome. The patient also had respiratory failure.