Consensus & Evidence-based INOSA Guidelines 2014 (First edition).

Obstructive sleep apnoea (OSA) and obstructive sleep apnoea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences amongst the general public as well as the majority of primary care physcians across India is poor. This necessiated the development of the INdian initiative on Obstructive Sleep Apnoea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health & Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep related symptoms or comorbidities or >15 such episodes without any sleep related symptoms or comorbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents and high risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography (PSG) is the “gold standard” for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioural measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.

Rayon lung in a non-flocking industry worker.

We report a case of a 65-year-old male working in a rayon (synthetic fibre) manufacturing industry who developed interstitial lung disease. The diagnosis was established by thoracoscopic lung biopsy.

Pulmonary arteriovenous malformation treated with embolotherapy.

Pulmonary arteriovenous malformations (PAVM) represent pulmonary vascular anomalies and in majority of cases are congenital in origin. We report a case that presented with predominant complaints of dyspnoea on exertion and cyanosis. Clinical examination revealed a bruit in the left lower interscapular and infrascapular areas which led us to suspect PAVM. The diagnosis was established on the basis of computed tomography (CT) thorax with three-dimensional virtual reconstruction technology (3D VRT) images and pulmonary angiography. Patient was successfully treated by embolotherapy using steel coils, which resulted in 90% exclusion of the aneurysm from the rest of the systemic circulation.