Bone mineral density in asthmatic patients on inhaled corticosteroids in a developing country

Prolonged use of oral corticosteroids is a risk factor for osteoporosis. However, the effect of inhaled corticosteroids [ICS] on bone mineral density [BMD] of asthmatic patients remains controversial. We aimed to determine the prevalence of osteopenia and osteoporosis in our patients with asthma receiving ICSs for more than one year compared with patients who did not have asthma and to determine the risk factors for osteopenia and osteoporosis among the asthmatic patients. This was a cross-sectional study conducted from August 2007 to July 2009. Asthmatic patients aged 18 years and older who had been on ICS for at least one year and a control group of subjects not on ICS were included. BMD was measured using DEXA [dual energy X-ray absorptiometry] scan. The WHO classification of T-scores for osteopenia and osteoporosis were used. A total of 143 subjects were recruited [69 asthmatics and 74 control subjects]. T-scores of the spine, femur, and hip of the asthmatics vs the control subjects were mean, -0.72 vs -0.57 [P=0.98]; median, -0.60 vs -0.80 [P=0.474]; and mean, 0.19 vs 0.06 [P=0.275]; respectively. T-scores of the spine, femur, and hip showed significant negative correlation with age and significant positive correlation with body mass index [BMI]. The risk factors for osteoporosis and osteopenia among asthmatic patients were older age and lower BMI, but not the cumulative dose of ICS. Asthmatic patients on ICS have no added risk of osteoporosis or osteopenia as compared with non-asthmatic subjects

Massive hemothorax following administration of intrapleural streptokinase

The administration of intrapleural streptokinase [IPSK] is widely practiced in the management of loculated empyema thoracis. To our knowledge, there have been only 4 cases of hemorrhagic complications attributed to the administration of IPSK reported in the literature. In this article, we report a case of a 17-year-old girl who received IPSK and developed shock, anemia, coagulopathy and massive hemothorax. Our discussion focuses on the hemorrhagic complication of chest tube insertion and the role of IPSK in blood clot lysis and inhibition of local hemostasis