Atopy in Omani patients with asthma

To determine the range of serum IgE in healthy subjects and in asthmatic patients in Oman and to assess the degree of atopy in the asthmatic patients. Serum IgE and in vivo [the skin prick test] and in vitro [the ImmunoCAP test] allergen- specific IgE levels were measured in 44 patients with asthma. Control groups were 19 healthy subjects and 27 asymptomatic allergic subjects. The normal range for serum IgE in the Omani population was established at >/= 101 IU/ml. The geometric mean [and 95% confidence interval] for asthmatic patients was 468 IU/ml [323-676]. Positive results for allergen-specific IgE, defined as responses to >/= 1 allergen mix in the ImmunoCAP and to >/= 3 allergens in the skin prick test, occurred in 26/35 [74%] and in 34/44[77%] asthmatic patients respectively. Six out of 38 patients with serum IgE >/= 101 IU/ml and 2/6 with levels < 101 IU/ml gave negative and positive results respectively in the skin prick test. Overall, the degree of reactivity in the skin prick test correlated with the level of total serum IgE [r = 0.54, p < 0.001]. A similar correlation could not be established with ImmunoCAP reactivity, but sIgE levels >/= 101 IU/ml were supported by a high frequency of positive ImmunoCAP responses for the majority of allergen mixes. Total serum IgE levels should be routinely monitored in asthmatic subjects as this may give an indication of atopy where skin prick testing is not indicated. Since in a minority of patients serum IgE levels and skin prick results do not predict in the same direction, all laboratory data should be interpreted in context of clinical history

Prevalence of asthma symptoms in Omani schoolchildren

To determine the prevalence of asthma in Omani schoolchildren using the International Study of Asthma and Allergies in Children [ISAAC] protocols. The ISAAC-written questionnaire was completed by a total of 7,067 Omani schoolchildren [3,893 children aged 6-7 years of which 56% were boys and 3,174 aged 13-14 years of which 51% were boys] from the 10 health regions in the country. The estimated mean national 12-month prevalence of any wheeze, night waking with wheeze, speech limiting wheeze and exercise wheeze were respectively 7.8%,3.5%, 3.2% and 6.9% for the 6-7 year age group and 8.9%, 2.9%, 4.0% and 19.2% for the 13-14 year age group. Both age groups reported high prevalence of night cough [19.6% and 20.9% in the younger and the older children respectively]. The prevalence of self-reported asthma diagnosis was higher in the older age group [20.7% vs. 10.5%, p < 0.001]. In the younger age group, the diagnosis of asthma was more common in boys [12.5% vs. 8.0%, p > 0.001], but there was no significant difference between the two sexes in the older age group [22.0% of boys vs. 20.5% of girls]. There was nearly three-fold difference in the prevalence of self-reported diagnosis of asthma between the regions with the highest and the lowest prevalence of asthma for both young and older children [from 5.3% and 9.5% in Musandam to 14.2% and 30.6% in South Sharqiya, respectively]. The results of this first epidemiological survey pf asthma in Oman indicate that asthma is common in Omani children and adolescents. Night cough is the most frequent symptom. There is also significant regional variation in prevalence of asthma symptoms and diagnosis within the country and this requires further investigation

Metered dose inhaler technique among healthcare providers practising in Oman

To evaluate the correctness of metered-dose inhaler [MDI] technique in a sample of healthcare providers practicing in Oman, considering that poor inhaler technique is a common problem both in asthma patients and healthcare providers, which contributes to poor asthma control. A total of 150 healthcare providers [107 physicians, 33 nurses and 10 pharmacists] who were participants in symposia on asthma management conducted in five regions of Oman, volunteered for the study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counseling, a trained observer assessed their MDI technique using a checklist of nine steps. Of the 150 participants, 148 [99%] were involved in teaching inhaler techniques to patients, and 103 of 107 physicians [96%] had prescribed inhaled medications. However only 22 participants [15%] performed all steps correctly. Physicians performed significantly better than non-physicians [20% vs. 2%, p < 0.05] among the physicians, internists performed better [26%] than general practitioners [5%] and accident and emergency doctors [9%]. The majority of healthcare providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly indicating the need for regular formal training programmes on inhaler techniques

Churg- Strauss syndrome without bronchial asthma complicated with lower gastrointestinal bleeding

We describe a 25-year old male with Churg Strauss syndrome [CSS] without bronchial asthma His lung biopsy findings showed pulmonary eosinophilia and no evidence of vasculitis. The course of his disease was complicated by severe lower gastrointestinal bleeding. The control of his disease needed the addition of cyclophosphamide to the steroid therapy

Nocardial pulmonary infection in a non-compromised patient

This report describes nocardial pulmonary infection in a lady with bronchiectasis who was otherwise not immunocompromised. She was successlly treated with co-trimoxazole [160 mg trimethoprim + 800 mg sulphamexazole orally 12 hourly]. The first indication of the presence of nocardial infection was the detection of branching gram positive bacilli in the sputum