Severe pulmonary involvement in leptospirosis. Alternate antibiotics and systemic steroids

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem [1 g every 8 hours], moxifloxacin [400 mg once daily], and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions

Is clinical judgment of asthma control adequate? A prospective survey in a tertiary hospital pulmonary clinic

Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma [GINA] scoring. Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases [67.5%]. In the other 32.5% [n = 51], the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists [72%] as compared to non-pulmonologists [47%; P = 0.009]. Physicians classified 76 patients [48.4%] as well-controlled by clinical judgment compared to 48 [30.6%] using GINA criteria [P <0.001]. Conversely, they classified 34 patients [21.7%] as uncontrolled as compared to 57 [36.3%] by GINA criteria [P <0.001]. In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate [PEFR] [46.7%] and limitation of activity [21.4%] were the most frequent parameters for downgrading the level of control. Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control

Management and control of asthma in patients attending a specialist centre in Oman

The management of asthma by specialists is likely to become more evidence-based. This study analysed the characteristics of patients reporting to a specialist clinic including demographics, dispensed medications and the level of asthma control. All consecutive stable asthmatics seen in the adult pulmonary clinics of Sultan Qaboos University Hospital, Oman, between December 2005 and November 2006 were prospectively evaluated using a structured assessment protocol. Of the 207 patients, [mean age 40.64 +/- 14.8], 72% were females. The majority, 83.1%, had moderate persistent asthma. A positive history of allergic rhinitis, eczema and a family history of asthma were obtained in 58.0%, 11.1%, and 50.7% of patients respectively. Total serum immunoglobulin E [IgE] was elevated in 66.7%. Skin testing was positive for more than 2 antigens in 52.3%, with the house dust antigen being reactive in 49%. Inhaled steroids, long-acting beta agonists [LABA], antihistamines and leukotriene receptor antagonists were prescribed in 94.2%, 85%, 54.5% and 11.6% of cases respectively. The majority [40.1%] was receiving medium dose inhaled steroids. Although asthma was controlled in 162 [78.3%], during the previous month 66 [31.9%] patients had visited the emergency department and 31 [15.0%] patients were hospitalised at least once during the previous year. Only 63 [30.4%] patients were using their inhalers correctly. Good compliance with inhaled steroids was observed in only 53 [25.6%] patients. Allergic comorbidities and a strong family history of asthma were common. Although the level of asthma control in the previous month was high, it was much lower in the long term. The concepts of short term, long term and total control of asthma need to be explored

Absence of left pulmonary artery: case report

Agenesis and hypoplasia of left-sided pulmonary artery anomalies have been infrequently reported. The majority of cases are diagnosed in childhood, but occasionally some asymptomatic cases are first recognised in adulthood when detected by an abnormal chest radiograph. We report a twenty-one year old female patient with left pulmonary artery agenesis who was asymptomatic till adulthood, but presented with mild respiratory symptoms and an abnormal chest X-ray. A contrast enhanced computerised tomography [CECT] scan helped to establish the diagnosis. Early diagnosis of this condition is essential to avert potentially lethal complications