Background: Continuous positive airway pressure (CPAP) is an effective therapy for obstructive sleep apnoea (OSA). Despite proven benefits of CPAP in OSA, adherence has been sub-optimal. The present study was designed to evaluate the compliance of CPAP therapy and factors affecting it in patients with moderate to severe OSA. Methods: Patients diagnosed to have moderate/severe OSA (apnoea-hypopnoea index [AHI] > 15) during the period April to December 2015 were evaluated using a pre-defined questionnaire on the number of hours of usage, number of nights per week usage and challenges faced in using CPAP; Epworth Sleepiness Score was recorded. CPAP usage was documented from the downloaded data from their CPAP machines. Results: Forty patients (mean age 50.6±11.4 years; 29 men) were studied. Their average body mass index (BMI) was 33.2 Kg/m2. Of these, 31 had severe OSA (mean AHI 47.8 per hour). The objective usage of CPAP among patients with OSA was less by 89 minutes when compared with perceived duration (p=0.001). Twenty patients had used the device for less than four hours per night. Patients reported social factors, dryness of mouth, not reapplying machine after nocturia, power shut down and reduced motivation as reasons for non-adherence to use CPAP. Conclusions: Despite the recognised benefits of CPAP, the acceptance and adherence with therapy remains a considerable barrier. Objective assessment of CPAP compliance should be a part of routine follow-up in patients with OSA.

Background: Lower respiratory tract infection (LRTI) is an acute illness (presenting for 21 days or less), usually with cough as the main symptom, and with at least one other lower respiratory tract symptom, such as fever, sputum production, breathlessness, wheeze, chest discomfort or pain. Out of the LRTIs, pneumonia is the most common. This study was conducted to determine the clinical profile of pneumonia in a medical and respiratory intensive care unit (ICU) of a tertiary care hospital, to identify different micro-organisms in respiratory samples of the patients and pattern of antibiotic susceptibility and to develop antibiogram charts for starting empirical therapy in the ICU. Methods: Patients admitted to the Medical and Respiratory ICUs of Geetanjali Medical College and Hospital, Udaipur (Rajasthan), India during January 2016 to October 2017 were included in this study. CURB-65 (Confusion, urea, respiratory rate, blood pressure plus age ≥65 years) score was retrospectively evaluated in the admitted patients. Results: Out of 84 patients, most (81%) were males, smokers (73%) and above 65 years of age. Most common co-morbidity was chronic obstructive pulmonary disease (COPD) (n=47, 56%) and most common symptom was cough (84%). Chest radiograph revealed multi-lobar involvement as the most common finding. Commonest organism isolated in our study was Pseudomonas (n=24, 29%). Pseudomonas aeruginosa (n=13, 41%) was the commonest organism found in previously hospitalised patients, whereas Streptococcus pneumoniae (n=12, 23%) was the commonest organism found in previously non-hospitalised patients. Most of the Gram-negative isolates were sensitive to colistin (97%). Vancomycin showed highest activity (100%) against Grampositive isolates. Conclusions: The most common pathogen in patients with pneumonia admitted to ICU in our area was Streptococcus pneumonia in routine patients and Pseudomonas aeruginosa in previously hospitalised patients. For the effective management of pneumonia, detailed bacteriological diagnosis and susceptibility testing, and local anti-biogram are required in view of the global problem of antibiotic resistance.

Background: Chest radiograph is presently considered the investigation of choice for diagnosing pneumonia in children. Lung ultrasonogaphy has evolved as a useful alternative technique as it avoids exposure to ionising radiation, is easy to perform at the child's bedside and takes little time to conduct. Methods: Lung ultrasonography was done in 100 children with clinical suspicion of pneumonia by a radiologist. Chest radiograph was interpreted by another radiologist who had no knowledge of the lung ultrasonography findings. Findings were recorded as positive or negative for pneumonia, on both the imaging modalities. The time taken for lung ultrasonography was also recorded. Considering chest radiograph as the reference standard, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of lung ultrasonography were calculated. Results: The mean time taken to conduct lung ultrasound in children was 6.4 minutes. The sensitivity, specificity, PPV and NPV of lung ultrasonography in detecting pneumonic consolidation was 91%, 73%, 64.5% and 83.3%, respectively. Conclusions: Performing lung ultrasonography has a short learning curve. Lung ultrasonography appears to be a good alternative to chest radiograph as the investigation of choice for the diagnosis of pneumonia in children.

Multidrug- and rifampicin-resistant tuberculosis (MDR-TB/RR-TB) has been an area of growing concern to human health worldwide and posing a threat to the control of tuberculosis (TB). Proper treatment of every diagnosed case of MDR-TB/RR-TB is of paramount importance. For the treatment of MDR-TB/RR-TB, standardised, empirical and individualised approaches have been laid down. There can be two types of treatment regimen — conventional and shorter regimen. A conventional regimen of at least five effective anti-TB drugs (ATDs) during the intensive phase is recommended, including pyrazinamide and four core second-line ATDs. Intensive phase including injectables should be given for atleast eight months. The total duration of the treatment is atleast 20 months which can be prolonged upto 24 months depending upon the response of the patient. Shorter regimen for the treatment for subset of MDR-TB/RR-TB patients who have not been previously treated with secondline drugs and in whom resistance to flouroquinolones and second-line injectable agents has been excluded can given for 9-11 months. The intensive phase of 4 to 6 months consists of kanamycin, high dose moxifloxacin, ethionamide, clofazimine, pyrazinamide, high-dose isoniazid and ethambutol, followed by the continuation phase of five months that consist of high dose moxifloxacin clofazimine, pyrazinamide and ethambutol. Extra-pulmonary MDR-TB/RR-TB including TB meningitis is treated with a longer regimen with same duration as pulmonary MDR-TB/RR-TB. All patients initiated on treatment and their family members should be intensively counselled prior to the treatment initiation and during all the follow-up visits. Surgery may be considered with recommended MDR-TB/RR-TB regimen only with good surgical facilities, trained and experienced surgeons and with careful selection of the patients. The treatment outcomes varied from 50% to 80% in different studies.

Obliteration of pleural space by the adhesion of both the layers of pleura with chemical agents instilled intra-pleurally is termed as pleurodesis. Povidone-iodine is one of the newer agents used for pleurodesis in adults. We report a case of a successful povidone-iodine pleurodesis in a child who presented with recurrent pneumothorax.

A 30-year-old female presented with respiratory failure and left lung collapse. Possibility of tumour related endobronchial obstruction was considered. Bronchoscopy revealed thick mucus in the left main bronchus, acid-fast bacilli were present on examination of bronchial washings and Gene-Xpert test was positive for Mycobacterium tuberculosis. In view of significant mucoid impaction, possibility of allergic bronchopulmonary aspergillosis was considered. Serum Aspergillus specific immunoglobulin E levels, Aspergillus precipitins and total serum immunoglobulin E levels were elevated. A diagnosis of allergic bronchopulmonary aspergillosis co-existent with pulmonary tuberculosis was made. Patient was treated with anti-tuberculosis therapy along with oral corticosteroids.

Non-Hodgkin's lymphoma can present with various clinical manifestations, such as fever, weight loss, lymphadenopathy, hepatosplenomegaly or some opportunistic infection. However, it has seldom been reported to be present with Pneumocystis jirovecii pneumonia in respiratory failure as initial presentation. We report a case of non-Hodgkin's lymphoma who presented with Pneumocystis jirovecii pneumonia.

Boerhaave syndrome consists of spontaneous longitudinal transmural rupture of the oesophagus, usually in its distal part. It generally develops during or after persistent vomiting as a consequence of a sudden increase in intraluminal pressure in the oesophagus. It is extremely rare in clinical practice. It is manifested by Mackler's triad: vomiting, chest pain and subcutaneous emphysema which is actually uncommon.