Background: The acute phase treatment to prevent coronary artery stenosis have not been established in Kawasaki disease (KD). Objective: To ascertain the outcomes of coronary artery lesions (CAL) in patients who received an initial intravenous immunoglobulin (IVIG) therapy (2 g/kg) with delayed use of aspirin (DUA) for KD. Materials and Methods: The outcomes in 201 patients who underwent initial IVIG therapy at 2 g/kg/dose with DUA for KD were investigated retrospectively. The patients who received flurbiprofen instead of aspirin were also included. These subjects were divided into those who were associated with CAL (CAL group, n = 4) and those without CAL (non-CAL group, n = 197). Statistical analyses were performed using Stat Flex Version 6 for Windows (Artech Co., Ltd., Osaka, Japan). Chi-square, Fisher’s exact, and Mann–Whitney U tests were used as appropriate, with sample size considerations. Results: The prevalence of resistant patients and those who required rescue therapies in the CAL group were significantly higher than those in non-CAL group (75.0% vs. 21.3%, P = 0.036 and 75.0% vs. 11.1%, P = 0.006, respectively). The values of neutrophil to lymphocyte ratio (NLR) after initial IVIG therapy in CAL group were significantly higher than those in non-CAL group (median: 5.91, range: 1.01-12.65 vs. 0.87, 0.01-11.29, P = 0.013). The one patient in CAL group who required plasma exchange had the highest value of the NLR. No patient had the large CAL>6.0 mm with high-risk for stenosis, and only one patient had persistent CAL of moderate-sized solitary right coronary artery at 60th day of illness. Conclusion: An initial IVIG therapy (2 g/kg) with DUA may be useful for prevention of coronary artery stenosis caused in KD.

Objectives: Community-acquired and nosocomial respiratory tract infections are public health problems of major concern and a leading cause of mortality. In the current prospective observational study, we intend to study the utility of procalcitonin (PCT) estimation in the diagnosis and prognosis of Community-acquired Pneumonia (CAP) and Ventilator-associated Pneumonia (VAP). Materials and Methods: The study was conducted over a period of two years. 40 patients with diagnosis of CAP and 40 patients of VAP were included in the study. Serum Procalcitonin levels were estimated using BRAHMS PCT Kryptor Immunofluorescent Assay (Biomerieux, France). Other routine investigations including sputum culture and endotracheal secretions cultures were done. Chi-square analysis was done to assess its prognostic and diagnostic significance. Results: PCT was positive (> 0.05ng/ml) in 68% patients with CAP and 80% patients with VAP. Higher absolute values of PCT were seen in patients with VAP compared to CAP. In VAP PCT was positive in more patients with bronchopneumonia than lobar pneumonia. Streptococcus pneumoniae was the most common bacterial etiology of CAP, and was associated with a positive PCT in 75% cases. Acinetobacter was the most common bacterial etiology of VAP, and was associated with a positive PCT in 80% cases. Mortality was more in PCT positive patients in both CAP and VAP. Maximum mortality in VAP was with PCT >10 ng/ml. Conclusion: PCT is a useful adjuvant in the diagnosis of both CAP and VAP. Positive PCT levels indicate a bacterial etiology for pneumonia. A high PCT level is a poor prognostic indicator and is associated with a higher mortality.

COPD- OSA overlap syndrome has been defined in the recent past as a syndrome of these two co-existing illnesses. Whether the overlap is synergistic is unknown, however it has been proven to have increased risk of complications like pulmonary artery hypertension. Mechanisms for each worsening the other have been postulated, putting a potential scare for the prognosis. An attempt to understand and recognize this syndrome will be the basis of defining treatment options for the same. The difficulties in defining and treating this syndrome have also been highlighted in this review.

Background: Gastroesophageal reflux disease (GERD) is the most common among gastric disorders and treated by antacids especially proton pump inhibitors (PPIs). Though symptoms are reported to be controlled by PPIs, however the complications like barrettes esophagus, Cancers at GE junction are not studied and reported extensively. In view of symptomatic relief, the long, non-supervised, over the counter medication use has increased. Safety of such long-term has been attempted with the review of available evidence and presentation of a case. Aim: To update available literature on the long-term use of PPIs and possible mechanisms behind adverse events. Materials and Methods: A case of Barrette’s esophagus was presented, with long-term use of PPIs. Detailed history taking of the case was done and another evidence synthesis was done on the effects of the long and short-term use of PPIs. The literature search using Medline, Scopus, Scholar on adverse effects of the use of PPIs was done which were language and date unrestricted. Results: Studies report many adverse effects on short-term (up to 5 years of use, namely: clostridium associated diarrhea, bacterial peritonitis, cholecystitis, pyogenic liver, liver cirrhosis, pneumonia, esophageal inflammations, nocturnal breakthrough acid reflux, interstitial nephritis, drug interaction and nutritional deficiencies mainly of Vitamin B 12 and iron) and long-term use, namely: Concomitant dyspepsia, Barrettes esophagus, osteoporosis, dementia, hypomagnesia, cancers at GE junction. Conclusion: The health care providers and community should be made cautious, larger cohort observational studies are also recommended for more evidence.