Clinical characteristics and sensitisation to common aeroallergens in patients with asthma and rhinitis

Allergic disorders such as asthma and rhinitis are common and their prevalence is rising Differences in climatic and living conditions may modify the disease prevalence. The causes of allergic asthma and rhinitis vary considerably in different parts of the world depending on the type of the allergens present in the environment. We studied the clinical characteristics and causative allergens in patients with asthma and rhinitis. All patients seen in a respiratory allergy clinic with symptoms suggestive of rhinitis and asthma over a twelve months period were invited to participate in a prospective study. A detailed history was obtained, seeking information on the type and duration of symptoms and current treatment. Skin prick test [SPT] to a standard battery of common aeroallergens were performed. The analysis in confined to 109 adults and children who fulfilled the criteria. Common presenting symptoms for rhinitis were rhinorrhoea and sneezing and for asthma; dyspnea, cough and wheezing. Antihistamines were most commonly used [35%] in rhinitis and bronchodilator [54%] in asthma. Overall, skin test were positive to one or more common allergens in 91 [84%]. The rate of sensitization was 88% in asthma and 82% in rhinitis. Dust-mites by far the commonest allergen with 60-70 sensitised. Between 30-40% were positive to pollens, fungi and cat dander. The pattern of sensitization was similar in patients with asthma and rhinitis. Conclusion: Interesting differences were observed in the presenting complaints, treatment prescribed and pattern of sensitization to common allergens form conducted in the western world. This may reflect difference in environmental factors and way of living

study of otomycosis in Karachi

In a multicenter study of 544 consecutive ear-swab referrals cultured during a 9-month period ending June 1999. Staph. aureus [38.6%] and Pseudomonas spp. [28.5%] accounted for 67% of isolates among 10 bacterial species, Aspergillus niger [7.1%] and Candida albicans [3.8%] were two fungal agents also recognized. Subjects clinically suspected of otomycosis presented mainly with chronicity, itching and fullness of ear, sometimes with hearing impairment, otorrhoea and occasionally pain, gender and age were other unidirectional variables did not influence the study. Sterile alginate-tipped swabs of wet discharge of desquamated material from the external auditory canal were examined directly by light microscopy of a smear in 20% KOH, and by paired culture on Sabouraud-Dextrose and Chocolate agar plates incubated at 30°C and 37°C for 1-3 days. Aspergilli were visible in some cases with mycelium in black-gray clumps in the external ear canal, in contrast to Candida, which presented with a whitish discharge

Suppurative otitis in Karachi: an audit of 510 cases

Suppurative disease of the middle ear is a constant challenge for otologists to treat. "Watchful waiting" may be acceptable for a few cases, but possibly all patients with chronic otitis media should receive antimicrobial therapy to minimize mastoid pathologies. Selection of a potentially effective drug, however, in the absence of discharge culture analysis, depends on the regional prevalent microflora. In a multicentre study of 596 consecutive ear-swab referrals processed during a 10-month period ending July 1997. Staph. aureus [40.4%] and Pesudomonas [29.6%] accounted for 70% of isolates among 10 bacterial species. Aspergillus [6.2%] and Candida [3.1%] were additional irritants. However, approximately 14.4% of swabs were culture-negative, suggesting possible other or non-infective aetiology. The finding that pseudomonas was increasingly implicated in recent months warrants tailored drug prescription; moreover, 37.9% of our Staph isolates were beta-lactamase producers and methicillin-resistant, necessitating the choice of "enzyme-stable" antibiotics for first-line use. The high number of gram-negative aerobes isolated from our cases of otitis media casts serious doubt on the role of the nasopharynx as the major contributor to this infective process; an alternate presumption that the faecal-aural route is often involved, seems more practical in our environment

URTI in Karachi: an appraisal of current isolated and antibiotic therapy

Recent reports in the literature indicate increasing involvement of Pneumnococci, HAEMOPHILUS INFLUENZAE and Klebsiella in community acquired throat infections. This was also our observation in a scrutiny of 576 throat swabs cultured during a 10 month period ending October, 1995. STREP. PYOGENES was isolated in only 6.6% of our cases, and remains 100% sensitive to the pencillins and cephalosporins. However, the possibility that its incidence is higher in deep tonsillar tissue is currently being investigated. Though Amoxycillin, Augmentin and Erythromycin have remained popular drugs for empirical treatment, increasingly, however, oral quinolones are being prescribed, which do not effectively cover pneumococci and are too broad in spectrum for common infected throats. H.INFLUENZAE, which is reported to colonize 25-75% of healthy human mucosa, can cause irritation ranging from uncomplicated pharyngitis to acute laryngoepiglottitis, and should be reported. It is currently resistant to several drugs including penicillin V, Doxycycline, Cotrimoxazole and Erythromycin [upto 97%] due to plasmid-mediated beta-lactamases and altered penicillin-binding proteins. While Klebsiella [15-20%] isolates are in different to several cephalosporins, it was sensitive to Augmentin, as were a majority of our pneumococcal and hemophilus cases. An audit is therefore presented encouraging the prescription of Augmentin, Amoxil and first generation Cephalosporins in uncomplicated URTI, with a macrolide such as Erythromycin, if LRTI symptoms are observed