Leukotriene (LT) modifiers are anti-inflammatory drugs that are useful as an add-on therapy with first-line asthma-controller medications. This group includes LT synthesis inhibitors (eg, Zileuton) and receptor antagonists (eg, Montelukast), whose direct comparative clinical data are not available. This study was conducted to assess the comparative efficacy and safety of orally administered Zileuton extended-release (ER) with Montelukast sodium in patients suffering from chronic persistent asthma. Patients of 18-65 years of age with mild to moderate chronic stable asthma were randomized to treatment with Zileuton ER 2400 mg/d or Montelukast 10 mg/d for 12 weeks. Peak expiratory flow rate (PEFR) and asthma symptoms (cough, wheeze, chest tightness, and shortness of breath each on a 4-point scale) were assessed on monthly scheduled out-patient visits. Safety assessments by clinical and laboratory parameters were carried out during the course of the study. Among 210 patients eligible for efficacy assessment, PEFR improved by 64.8 ± 52.8 (95% confidence interval: 54.8-74.7) L/min with Zileuton ER (n = 109) and 40.6 ± 47.5 (31.3-49.9) L/min with Montelukast (n = 101; P < 0.001), whereas percent improvements were 27.0% (22.6%-31.5%) versus 18.4% (14.1%-22.7%), respectively (P = 0.006). Zileuton ER lead to ≥12% PEFR improvements in 74 of 109 [67.9% (59.1%-76.7%)] patients, whereas the same was noted in 52 of 101 [51.5% (41.7%-61.2%)] patients receiving Montelukast (P = 0.015). The reduction in the mean overall symptom intensity score was also significantly better with Zileuton ER [-5.0 ± 2.1 (4.6-5.4) versus -4.2 ± 2.3 (3.8-4.7)] (P = 0.018); however, the same was not observed for the decline in the individual symptom scores. A lesser but not significantly different adverse event rate was reported in the Zileuton ER group than the Montelukast group with the commonest events being headache and gastrointestinal effects in both the groups. Thus, Zileuton ER seems to be more efficacious than Montelukast and well tolerated for the treatment of mild to moderate chronic persistent asthma in adult patient population. Further studies can elucidate the comparative treatment benefits of these LT modifiers in asthma management.

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Poland’s Syndrome is a rare congenital condition. It is classically characterized by absence of unilateral chest wall muscles and sometimes ipsilateral symbrachydactyly (abnormally short and webbed fingers). The condition typically presents with unilateral absence of the sternal or a breast portion of the pectoralis major muscle which may or may not be associated with the absence of nearby musculoskeletal structures. Authors report a 13-year-old male patient with typical features of Poland syndrome associated with synbrachydactyly and dextrocardia. This association is very rare, till 2010, only 19 cases have been described in scientific literature (Poland syndrome with dextrocardia), in this case synbrachydactyly also associated on ipsilateral side. To the best of our knowledge, this is the first documented case of the left sided Poland syndrome with dextrocardia and symbrachydactyly reported from the South East Asia Region (SEAR).

Pulmonary artery pseudoaneurysms is a rare pulmonary entity. Pseudoaneurysm do not have a covering of all three layers of the arterial wall and are effectively contained arterial leaks considered to be at high risk of rupture. The common clinical manifestations of pulmonary artery pseudoaneurysms include cough and haemoptysis. Pulmonary artery pseudoaneurysms can also present as life-threatening haemorrhage or incidental lesions that enlarge for days, months or years. Vascular complications in the chest, involving the pulmonary as well as bronchial vasculature are known to occur due to tubercular infection. 1 We present a case of a female who was diagnosed as a case of pulmonary artery pseudoaneurysm with tuberculosis as an aetiology. case reportA 28-year-old female presented with cough, haemoptysis, fever and dyspnoea since two months. She had no history of loss of appetite, loss of weight, and chest pain. Initial clinical assessment revealed normal vital signs without any obvious respiratory distress with an oxygen saturation of 98% by pulse oximetry on room air. Laboratory investigations revealed: haemoglobin 11.6g/gL, total leucocyte count 4060/ mm 3 , platelet count 2.73 lakhs/mm 3 and erythrocyte sedimentation rate of 50mm. Renal function tests, urine analysis, serum electrolytes and liver function tests were within normal limits. Human immunodeficiency virus (HIV) was non-reactive. Sputum for Ziehl-Neelsen staining and cartridge-based nucleic acid amplification test (CBNAAT) was negative. No fungus grown on culture. Two-dimensional (2D) transthoracic

A 50-year-old male, a tobacco smoker, who was known to have ulcerative colitis presented with dry cough, chest pain, dysponea and frequent passage of blood and mucous mixed stools. Physical examination revealed clubbing, subcutaneous emphysema of upper chest and auscultatory findings of crunching sound over pre-cordial area and basal crepitations. Spirometry was suggestive of restrictive pattern. High resolution computed tomography (HRCT) of thorax revealed pneumomediastinum, subcutaneous emphysema, bilateral diffuse centrilobular nodules and ground-glass haziness with mosaic pattern along with posterior basal fibrotic changes. The present case documents the uncommon pulmonary involvement of spontaneous pneumomediastinum and subcutaneous emphysema diffuse parenchymal lung disease, in a patient with ulcerative colitis.