Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

PURPOSE: Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). METHODS: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. RESULTS: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. CONCLUSIONS: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.

Evaluation of role of chest physical therapy in thoracic surgery

Study was conducted to evaluate the efficacy of post operative chest physiotherapy in cases of thoracic surgery. Eighty patients who underwent various surgical procedures were divided into two groups: one where adequate physiotherapy was carried out and the other where adequate physiotherapy could not be carried out. It was found that rate of postoperative complications was double in the group where chest physiotherapy could not be carried out due to any reasons

Effect of an oral health education curriculum package on knowledge, attitudes and behavior of Kuwait adolescents

The effect of a school-based, teacher-mediated oral health education curriculum package on oral health knowledge, attitude and behavior of 11-14 years old Kuwaiti adolescents were assessed by means of a questionnaire. The curriculum package consisted of five simple lessons relating to the various aspects of dental health education. The study included 7664 students. Each student received a curriculum package and an oral hygiene kit including a toothbrush, toothpaste, disclosing tablet and cup for rinsing. Upon completion of the study significant improvements in dental health knowledge and attitude were observed among both sexes with girls showing more significant improvement than boys. However, none of the improvements in the reported oral hygiene behavior were significant at the 5% level. Several reasons for not achieving the desired behavioral changes were elicited. Recommendations to improve the effectiveness of school-based dental health education programs were given

oral hygiene program for a group of institutionalized mentally handicapped children in Kuwait

An oral hygiene program was carried out at the Rehabilitation Center for the Handicapped in Kuwait. A total of 68 mentally handicapped children with an age range 5-14 years were included in the study. A specially designed examination chart was used to assess the gingival condition and oral hygiene status of the children. Following the initial examination, scaling was performed for all children with calculus deposits by means of three dental hygienists. Oral health education sessions were held for the nursing staff responsible for the hygiene of the handicapped patients to teach them the different ways of caring for the oral health of the handicapped patients. Following the sessions, professional tooth brushing was instituted for all children once daily. After one month from the initiation of tooth brushing, the children were reassessed to determine the short term effects of the program on their oral health. The means for reduction in gingival, oral debris and oral calculus index scores following the program were all significant at the 5% level indicating that effective complete plaque removal even once a day can improve gingival health and oral hygiene status among mentally handicapped. Recommendations were given in order to attain an acceptable level of oral health in such vulnerable priority groups