ABSTRACT
Introduction: Asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic airway inflammation. Lack of knowledge about the correct inhalation techniques leads to poor control of both diseases. This study aimed to study the effectiveness of inhalation technique training in patients with COPD and asthma. Materials and methods: A total of 132 patients fulfilling the inclusion criteria were trained with the correct technique of inhalation on day 0 and at the end of 1 and 6 months. Evaluation of technique training was done on these three occasions posttraining. The mean score of devices was obtained, and the mean inhalation technique score of various devices was compared. Results: Out of 132 patients, 65.1% (86/132) patients were using a dry powdered inhaler (DPIs), 26.5% (35/132) patients used metered dose inhalers (MDIs), and 8.4% (11/132) patients used MDI with spacer. The mean scores of patients using MDI at baseline were 5.68 ± 0.83, and after 1 month, 6.68 ± 0.58 (p < 0.000). The inhalation technique mean score of MDI improved after 6 months, 7.02 ± 0.56 as compared to baseline (p < 0.008) mean score of the patients using DPIs improved after 1 month, 5.53 ± 0.58 as compared to baseline 4.37 ± 5.53 (p < 0.000). There was no statistical improvement in the device mean score of DPIs after 6 months, 5.62 ± 0.55 when compared with 1 month, 5.53 ± 0.58 (p < 0.117). Patients who used pressurized metered-dose inhalers (pMDI) with spacers improved their inhalation score after 1 month by 6.90 ± 0.94 as compared to the baseline score of 6.90 ± 0.94 (p < 0.001). The mean score decreased marginally after 6 months, 7.818 ± 0.60, as compared to the score at the end of 1 month of 8.27 ± 0.64 (p < 0.053). Discussion: Patients showed improvement in the technique of inhalation after educational training, reinstructions, and a standard checklist.
ABSTRACT
Introduction: Leptospirosis is a widespread zoonosis causedby the spirochete leptospira. Epidemic leptospirosis is beingreported from Kerala during the monsoon. Its incidence hasincreased over the past two decades. Severe leptospirosisresults in sepsis with multi organ dysfunction syndrome andmortality rate varies from 5-40%. In this study we attemptedto identify the risk factors associated with mortality ofleptospirosis.Material and methods: This was a retrospective case-controlstudy among patients diagnosed with severe leptospirosisand admitted in a tertiary care hospital in Thrissur District ofKerala during the monsoon of 2014. Data was collected fromcase records of 48 patients out of which 21 were cases (nonsurvivors) and 27 were controls (survivors) and Statisticalanalysis was done using X2 test with Epi info software.Results: Mean age of study population was 42 yrs. There were38 male (79%) out of which 14 were cases and 10 females(21%) out of which 7 were cases. Mortality rate was 44%. 77%of them presented with myalgia. Among cases 62% had icterus,81% had oliguria, 66% underwent mechanical ventilationand 62% undergone blood and blood product transfusion.Dyspnoea (p=0.08), Chest crepitations (p=0.005), decreasedurine output(p=0.012), acute kidney injury(p=0.005), hepaticdysfunction(p=0.06), shock (p=0.019), haemoglobin less than10g% (p=0.03) and platelet count less than 20000(p=0.025)were found to have significant association with mortality.Conclusion: The severe disease is more common in middleaged males but mortality is more in female. Platelet countless than 20000 and shock were found to be the independentpredictors of mortality.
ABSTRACT
Isoniazid (INH) is an integral component of treatment of tuberculosis. An acute overdose is potentially fatal and is characterised by the clinical triad of repetitive seizures unresponsive to the usual anticonvulsants, metabolic acidosis with a high anion gap and coma. A case of isoniazid induced seizures after therapeutic dose of 600 mg. as a part of CAT I thrice weekly intermittent anti-tuberculosis regimen for pulmonary tuberculosis is reported. The frequency of the usage of Isoniazid as antituberculosis therapy requires that physicians be aware of such toxicity.