Community acquired pneumonia (CAP) is a common condition and attributes to a significant amount of mortality and morbidity. In the United States of America, it is estimated that 5-6 million people suffer from CAP, 1.1 million people require to be admitted to hospitals and 60,000 deaths occur per year. 1,2 Recent studies have documented major cardiac complications in patients with CAP, particularly in patients requiring hospitalisation. 3 Multiple epidemiological studies [4][5][6][7] demonstrate that respiratory tract infections are associated with an increased risk for the development of an acute cardiac event (ACE). Thus, CAP and cardiac diseases are mutually aggravating conditions. There is a surge of interest in the association between major cardiac conditions and CAP, and therefore, the present study was done. Material and MethodsThis was an observational study where we did a retrospective analysis of patients admitted with CAP between January 2011 and January 2012 at our tertiary care referral centre, in Bengaluru, Karnataka, India.We studied patients with the association of CAP and ACE on admission or any patient with CAP on admission, developing ACE after 48 to 72 hours of hospital stay. The patients who were admitted in the hospital with ACE but developed a CAP after 48 to 72

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Introduction:The inflammation and fibrosis in diffuse parenchymal lung diseases (DPLDs) in varied proportions give rise to different patterns in radiology and histopathology. The radiological pattern on CT of the thorax most often allows us to make a diagnosis with varying levels of confidence, to optimize management. With a multidisciplinary team bringing the strengths of their individual domains of knowledge, clinical, radiological, histopathological, and in many cases rheumatological, the level of confidence in making this diagnosis increases, often to the stage where the diagnosis is most often right, is concordant with the diagnosis achieved at histopathology and therefore obviates the need for lung biopsy which carries its own costs and risks of complications. Our study emphasizes the role of the multidisciplinary team (MDT) in the management of DPLDs at a tertiary care referral center. Materials and Methods: Every case of DPLD presenting to our pulmonology department was discussed in an MDT meeting before subjecting them to any diagnostic intervention or therapy. A clinico-radiological diagnosis was made according to the 2002 ATS/ERS guidelines initially. Later an official ATS/ERS/JRS/ALAT statement on idiopathic pulmonary fibrosis and a 2013 ATS/ERS consensus for the classification and diagnosis of idiopathic interstitial pneumonia was used. The concordance in our study was defined as the percentage of histopathological diagnoses that were identical to the clinico-radiological MDT diagnosis prior to the biopsy. Results: A total of 434 patients with DPLDs were evaluated. The MDT suggested biopsy for only 38.7% (168/434) patients since the pattern was very clear in 266 (61.3%) cases. As not all patients consented to undergo the biopsy procedure when recommended, histopathology was obtained in 102 patients. The histological diagnosis was concordant with the initial MDT diagnosis in 80.3% (82/102) of samples. On an individual basis, connective tissue disease-interstitial lung disease and sarcoidosis showed the best concordance (87%). In idiopathic non-specific interstitial pneumonitis (NSIP) cases, the histopathological diagnosis concurred in only 53.3% (8/15), 761 | MURALI MOHAN et AL How to cite this article: Murali Mohan BV, Tousheed SZ, Manjunath PH, et al. Multidisciplinary team obviates biopsy in most patients with diffuse parenchymal lung diseases-A retrospective study from India.

Chronic thrombo-embolic pulmonary hypertension (CTEPH) is a life-threatening condition, wherein organised thrombi obstruct the pulmonary vascular bed causing a progressive increase in pulmonary artery systolic pressure (greater than 25mmHg) persisting for at least six months after the inciting event of acute pulmonary thrombo-embolism (PTE). [1][2][3] There is limited information on the incidence and prevalence of CTEPH. The incidence of CTEPH is around 0.1% to 0.5% in patients surviving an acute PTE. 4,5 The cumulative incidence following an acute PTE varies from 0.8% after four years 6 or 3.8% after two years. 7 Although the understanding of the natural history of acute PTE and its evolution to CTEPH, and pathophysiology of CTEPH have greatly improved, the true frequency of CTEPH is likely under-estimated. There is a paucity of data about the incidence and prevalence of CTEPH from the Indian sub-continent. We investigated the clinical profile of acute PTE and the incidence of CTEPH over a one-and-a-half-year follow-up in a tertiary care cardiology hospital in Southern India. MATERIAL AND METHODSThis observational study was carried out from January 2009 to June 2012. There was a total of 200 patients who were suspected to have acute PTE. The suspicion was based on the clinical scenario and the Wells pretest probability scoring system. The clinical signs and symptoms raising the clinical suspicion were acute onset dyspnoea, orthopnoea, chest pain, haemoptysis and a loud second heart sound.The diagnosis of acute PTE was confirmed in 104 patients by computed tomography pulmonary angiography (CTPA). After confirming the diagnosis, the patients were advised anticoagulation therapy with regular follow up and with monitoring of prothrombin time/international normalised ratio (PT/INR).The patients were followed up every three months for one-and-a-half years. The 2D-eahocardiography was done on admission and then every three months. The CTPA was repeated at three months, six months and at one year of follow-up.The diagnostic criteria used for CTEPH included symptoms of pulmonary hypertension, mean pulmonary artery systolic pressure (greater than

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