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BACKGROUND Community-Acquired Pneumonia (CAP) is defined as “an acute infection of the pulmonary parenchyma. The most important complication of CAP is Acute Respiratory Failure (ARF) and some of them may require Invasive Mechanical Ventilation (IMV) to manage hypoxia and hypoventilation along with appropriate antibiotic therapy. A number of studies, however, indicate that IMV is associated with high rates of serious complications and mortality in patients with ARF. For this reason Non-Invasive Ventilation (NIV) has been used for ARF of diverse aetiologies.The most important rationale for using NIV in early stages of respiratory failure is to decrease the workload on respiratory muscles and improve ventilation by applying positive airway pressure. This may help to overcome an episode of severe ARF without the need for MV. In this study we evaluated the efficacy of NIV in patients with ARF and compare the outcome of using NIV in CAP with ARF patients with and without comorbidities. METHODS This prospective observational study was done on 150 CAP patients in acute respiratory failure who received NIV. It was conducted in the Department of Respiratory Medicine in Gandhi Hospital, Secunderabad, for a period of one year and six months. A comparative analysis of the outcome of using NIV in CAP with ARF patients with and without co-morbidities was carried out. RESULTS In the current study 150 CAP patients with ARF who needed NIV, were treated initially with NIV, antibiotic therapy and other supportive measures as per the American Thoracic Society (ATS) guidelines 32. 95 (63.3 %) of 150 patients were continuously treated with NIV. Apart from these, 55 (36.7 %) patients required MV. In patients with continued NIV, 93 (98 %) recovered, remaining 2 died with sudden cardiac arrest. In patients who were gone for MV, 12 (22 %) survived. CONCLUSIONS Early intervention by NIV in CAP patients suffering from acute respiratory failure secondary to community acquired pneumonia was found to be successful in avoiding mechanical ventilation and its attendant morbidity and mortality31. Early intervention with NIV, identifying risk factors for NIV failure, addressing associated co-morbid conditions will go in a long way in effectively managing these patients by significantly minimizing the ICU and hospital stay. Patients with co-morbidities have more chances of NIV failures. Patients with co morbidities on NIV stayed significantly more number of days in the hospital than patients without co-morbidities. The current study suggests that co morbid patients require more monitoring as compared to patients without co morbidities on NIV. KEY WORDS Community-Acquired Pneumonia (CAP), Non-Invasive Ventilation (NIV), Mechanical Ventilation (MV), Acute Respiratory Failure (ARF), Arterial Blood Gas Analysis (ABG), Intensive Care Unit (ICU), Intubation

BACKGROUNDTuberculosis is an infectious disease caused by Mycobacterium tuberculosis which spreads by inhalation of infected droplet nuclei. Prevalence of TB is three times higher among ever-smokers as compared to that of never smokers. Mortality from TB is three to four times higher among ever-smokers as compared to never smokers. Smoking contributes to 50% of male deaths from TB in India in the 25-69 years age group. We performed a prospective study over one and half year period with objective of comparing the sputum conversion, clinical and radiological presentation, in smokers and non-smokers in newly diagnosed sputum positive pulmonary tuberculosis patients started on anti-tuberculosis treatment. METHODSThis prospective observational study was done on the adult newly diagnosed sputum positive (micro biologically confirmed) pulmonary tuberculosis patients started on anti-tuberculosis therapy in the Department of Pulmonary Medicine, Gandhi Hospital, Secunderabad. This study was performed over a period of 18 months. A comparative analysis of sputum conversion, clinical and radiological presentation between smokers and non-smokers in newly diagnosed sputum positive pulmonary tuberculosis patients who were on anti-tuberculosis treatment was carried out. RESULTSIn the present study, 100 patients were seen during the study period, and divided into 2 groups comprising of 50 smokers and 50 non-smokers who were diagnosed as newly sputum positive pulmonary tuberculosis. Overall mean age in the present study was 40.34 years and in smokers groups mean age is 49.44 years and among non-smokers it is 31.21 years. Among non-smokers, females contribute 46% and male accounted for 54%. CONCLUSIONSSmoking is associated with delayed sputum conversion, more complications like hemoptysis, more advanced and extensive lesions radiologically. Hence, smokers pose an epidemiological threat by remaining infective as they remain a source of infection for longer period of time. Hence smoking should be enquired into and discouraged in all patients. This study can be made extensive by increasing the size of the sample, by examining the sputum smear for AFB at 15 days intervals, and by following up the patients to look for relapse in patients who have quit smoking and in patients who have continued to do so.

BACKGROUND The pleura is involved in pulmonary or systemic tuberculosis by various mechanisms like delayed hypersensitivity. Tuberculous empyema usually results from failure of a primary tubercular effusion to resolve and further progresses to chronic suppurative form. In tuberculous empyema, the pleural fluid is purulent, and is loaded with tuberculous organisms on direct acid-fast bacillus (AFB) smear examination and / or culture of pus. We need to assess the role of cartridge based nucleic acid amplification test (CBNAAT) in the diagnosis of tuberculous empyema. METHODS This study was a prospective observational study of all adult patients of empyema above 15 years of age, admitted in the Department of Pulmonology, over a period of 1 year, 6 months after obtaining clearance from ethical committee and proper consent from the study subjects. RESULTS A total of sixty-three (63) empyema cases were recruited and analysed further. On evaluation, we diagnosed 26 cases with tubercular aetiology (41.27 %) and remaining thirty-seven (58.73 %) cases with non-tubercular aetiology. CONCLUSIONS Pleural fluid (pus) cartridge based nucleic acid amplification test (CBNAAT) is very sensitive and provides a rapid confirmed diagnosis within 2 hrs. including drug susceptibility. In this study, sensitivity of CBNAAT in suspected tuberculous empyema patients was 88.5 % and specificity was 100 %. Pleural fluid CBNAAT is more sensitive in both pleural fluid AFB smear positive (100 %) and pleural fluid AFB smear negative (72.7 %) cases. So, pleural fluid and sputum direct AFB smear and CBNAAT should be sent in all suspected tuberculous empyema cases for early diagnosis of tuberculosis and early detection of rifampicin resistance. KEY WORDS Mycobacterium Tuberculosis, Tubercular Empyema, Pleural Fluid, CBNAAT, AFB, Anti-Tubercular Drugs

BACKGROUNDTuberculosis is a deadly disease, which can be cured only by anti-tuberculosis therapy. Anti-tuberculosis therapy will be effective only when the drugs are given in ideal combinations and doses, which can achieve adequate Minimal Inhibitory Concentrations (MIC) in the tissues. Slow response to Tuberculosis (TB) therapy in spite of good adherence may lead to prolonged infectiousness or acquired drug resistance, which further burdens public health systems by extending treatment duration. Hence, there is a need for measuring therapeutic drug concentrations in patients on anti-tuberculosis therapy, at least in special comorbid conditions like diabetes mellitus and HIV. High Performance Liquid Chromatography (HPLC) is a sensitive and specific method of measuring rifampicin levels.