Lineage switch of acute myeloid leukemia to T-Cell acute lymphoblastic leukemia – A unique case report

“Lineage switch” is term described when leukemic cells on relapse exhibit a new phenotype, where losses of one lineage defining markers with simultaneous gain of another lineage defining markers occur. Relapse of acute leukemia is although a very common event, lineage switch occurs and reported very rarely in such cases. The pathogenesis involved in this phenomenon remains unclear; however plasticity of hematopoietic progenitor affected by intrinsic and extrinsic environmental cues can be a possible explanation. In most of the cases at the time of relapse conversion of B-acute lymphoblastic leukemia (ALL) to acute myeloid leukemia (AML) occurs. Here, we presented an unusual case of 10 year old boy with AML switched to T-ALL upon relapse, which is very rare and not well documented till date in literature. The diagnosis was further supported by morphologic, cytochemistry and flowcytometric immunophenotyping (FCM-IPT). Prognosis and survival of such cases remains poor even by the use of standard chemotherapy.

Door to Balloon Time in St-Segment Elevation Myocardial Infarction (STEMI): A Prospective Study

Background: The most acute manifestation of coronary artery disease is ST-segment elevation myocardial infarction (STEMI) and is associated with mortality and morbidity. In the majority of cases, complete thrombotic occlusion develops from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI. Early diagnosis and immediate reperfusion reduce the risk of post-STEMI complications and heart failure and thereby are the most effective ways to limit myocardial ischemia and infarct size. If primary percutaneous coronary intervention (PCI) cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus and PCI has become the preferred reperfusion strategy in patients with STEMI. Methods: From the emergency section of the hospital in the month of October 2021, 7 adult patients were identified with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary. We used the framework of regression discontinuity to test for discontinuity at 90 minutes among the included cases. The Door - Balloon as 90 minutes minus the time between hospital arrival and catheterization laboratory arrival -defined as a novel variable. To assess the relationship between remaining Door - Balloon time and access site we have estimated multivariable logistic regression models. Results: The results of primary PTCA in the month of October 2021 were performed in less than 90 minutes without any mortality in 7 patients. Conclusions: Our Data on mortality and morbidity benefits of primary angioplasty shows a 100% decrease in mortality of patients undergoing primary PTCA within 90 minutes as compared to international data which shows a 40% decrease.

Correlation of Leptin and Vaspin Serum Concentration in Newly Diagnosed Type 2 Diabetes Mellitus

Objectives : The aim of the study was to explore the correlation of circulating leptin and vaspin levels with lipid profile, fasting blood sugar, HbA1c and anthropometric variable as inflammatory markers between diabetic patients and non - diabetic subjects. Material and Methods: This study was conducted with 120 newly diagnosed type 2 diabetes mellitus (T2DM) patients with age - matched 120 non - diabetic sub jects as controls. Results: We found that there is significant increase in the parameters like serum Leptin, Vaspin, FBS, PPBS, HbA1c and lipid profile (TC, TG & VLDL). No significant differences were found between BMI, LDL & HDL parameters of T2DM patient s compared to non - diabetic subjects. The results have been shown a significant positive correlation between Vaspin and Leptin in T2DM patients, (r = .755) and ( P ?0.01 ) as compared to controls. The body mass index was positively correlated with Vaspin in T2DM patients, (r = .50) and ( P <0.01 ) and with leptin in T2DM patients, (r = .265) and ( P <0.01) . A positive correlation had also observed between vaspin and LDL in T2DM patients, (r = .189) and ( p <0.05 ). We also found that significant increased leve l of leptin and vaspin in females compared to males in our study group. Conclusions: Serum leptin and vaspin level is positively associated with BMI and LDL and negatively correlated with fasting blood sugar, post - prandial glucose, HbA1c, VLDL and age.

Therapeutic experience of ticagrelor in Indian patients with acute coronary syndrome: A non-interventional, prospective, and observational study

Objective This observational study was designed to understand the usage pattern of ticagrelor in real-life clinical practice among a large number of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or medical management (MM). The study also recorded clinical events, i.e., bleeding, dyspnea, and cardiovascular (CV) events, reported by the investigator during the follow-up period. Methods The ACS patients aged ≥18 years hospitalized for ACS and were prescribed ticagrelor upon discharge or ≤1 month and patients who underwent PCI, CABG, or MM for ACS were enrolled. The subjects were followed up for a period of up to 12 months. The data were collected on a case report form. Result The study recruited 2997 subjects from 49 sites in India. Approximately half of the ACS subjects had ST segment elevation myocardial infarction (48.9%), and PCI was used as management in 92.4% subjects. The mean (±SD) duration of use of ticagrelor was 314 (±110.2) days over a period of 12 months. Of 136 subjects (4.5%) who experienced any clinical events, CV deaths were reported in 20 (0.7%), myocardial infraction in 19 (0.6) subjects and ischemic stroke in 23 (0.8%) subjects, and severe dyspnea was reported in 68 (2.2%) subjects. Out of 33 bleeding cases, 25 (0.8%) subjects had thrombolysis in myocardial infarction (TIMI) minimal, seven (0.2%) had TIMI minor, and one TIMI major. Platelet inhibition and patient outcomes (PLATO) major was reported in two subjects and CABG bleed in one subject. The incidence of PLATO defined major and minimal bleeding were lower in subjects undergoing fibrinolysis than overall population. Conclusion Ticagrelor has been used across ACS types and in different management strategies in real world settings in India. The incidence of clinical events was lower as compared with data in literature.

Antibiotic-resistant Enterobacteriaceae in healthy gut flora: A report from north Indian semiurban community

Background & objectives: Rampant use of ?-lactam antibiotics in both community and hospitals has transformed the human healthy intestinal gut flora into a reservoir of antibiotic-resistant organisms. This study was conducted to find the faecal presence of antibiotic-resistant Enterobacteriaceae in faecal samples in the community in north India. Methods: In this prospective study, 207 stool samples were collected from apparently healthy individuals residing in a semiurban community in Chandigarh, India, from August to October, 2015. Isolates belonging to family Enterobacteriaceae were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and antibiotic susceptibility was determined using Clinical Laboratory Standard Institute disc diffusion method. Detection of extended spectrum ?-lactamases (TEM, SHV, OXA-1, CTXM 1, CTXM 2, CTXM 9 and CTXM 8/25), carbapenemases (IMP, VIM and KPC) and New Delhi metallo-?-lactamase was done by multiplex PCR. Results: Of the population studied, 55.5 per cent were females and 60 per cent were illiterate or had only primary education; 43.4 per cent individuals were aged <20 yr. Overall, 70.5 per cent of stool samples had antibiotic-resistant isolates. Maximum resistance was seen for cephalosporins (60.4%) followed by fluoroquinolones (41.5%). The multidrug-resistant (MDR) isolates were 2.4 per cent. The most commonly detected genes were TEM, SHV, OXA-1, CTXM-1, CTXM-2, CTXM-9 and CTXM-8/25 ?-lactamases. Escherichia coli was the most common resistant isolate, and TEM was the most common gene detected. Interpretation & conclusions: Overall, 70.5 per cent members of Enterobacteriaceae had antibiotic resistance in the community and 2.4 per cent were MDR. Higher resistance rates were observed for most commonly used drugs such as cephalosporins and fluoroquinolones. High rate of antibiotic-resistant Enterobacteriaceae in gut of healthy individuals points towards the need for active screening and prevention of dissemination.

Molecular characterization of extended-spectrum ?-lactamases among clinical isolates of Escherichia coli & Klebsiella pneumoniae: A multi-centric study from tertiary care hospitals in India

Background & objectives: The increasing prevalence of extended-spectrum ?-lactamases (ESBLs) has abated therapeutic options worldwide. This study was undertaken to investigate the molecular profile and resistance patterns of ESBLs among clinical isolates of Escherichia coli and Klebsiella pneumoniae at four tertiary care centres in India. Methods: Clinical isolates of E. coli and K. pneumoniae were collected from the All India Institute of Medical Sciences (AIIMS), New Delhi; the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry; Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh and Christian Medical College (CMC), Vellore, over one and a half year period. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method. ESBLs were confirmed phenotypically, and multiplex PCR was performed to identify genes for ?-lactamases (blaTEM, blaSHV, blaOXA-1, blaCTXM-1, blaCTXM-2, blaCTXM-9 and blaCTXM-15). Results: Among 341 E. coli isolates collected during the study period, 171 (50%) harboured blaTEM, 145 (43%) blaOXA-1,70 (21%) blaCTXM-1, 19 (6%) blaSHV and four (1%) harboured blaCTXM-2. Phenotypically, combined disc test detected ESBL production in 98/298 (33%) E. coli. Among 304 K. pneumoniae isolates, 115 (38%), 89 (29%), 83 (27%), 64 (21%) and two (0.6%) harboured blaTEM, blaOXA-1, blaCTXM-1, blaSHV and blaCTXM-2, respectively. Combined disc test (CDT) detected ESBL production in 42 per cent K. pneumoniae. Most of the blaCTXM-1positive isolates were also blaCTXM-15 positive. The carbapenem susceptibility ranged from 56 to 88 per cent for E. coli and from 20 to 61 per cent for K. pneumoniae. Antibiotic sensitivity patterns showed that colistin (CST) was the most sensitive drug for both E. coli (271/274, 99%) and K. pneumoniae (229/234, 98%). Interpretation & conclusions: The prevalence of ESBL among four study centres varied, and blaTEM, blaOXA-1 and blaCTXM-15 were the most common genotypes in E. coli and K. pneumoniae isolates in India. The growing carbapenem resistance and emerging colistin resistance warrant the judicious use of these antimicrobials.

Relation between Obesity and Osteoporosis in Women

Osteoporosis is a multifactorial skeletal disease, whose mechanisms are not fully understood. It is more common in older people, especially in Post menopausal women. Body Mass Index (BMI) is often used to predict Bone Mineral Density (BMD). Obese women have always been considered protected against Osteoporosis and Osteoporotic fractures. Objectives: Several studies have challenged the widespread belief that obesity is protective against fracture. The aim of this study was to assess the effects of BMI on BMD in premenopausal and postmenopausal women

Pattern of bloodstream infections in patients with hematological malignancies in a tertiary care centre.

BACKGROUND: The purpose of our study was to evaluate the clinical characteristics, to understand the pattern of bloodstream infections (BSIs), and to determine the risk factors contributing to high‑risk febrile neutropenia in patients with hematological malignancy. MATERIALS AND METHODS: A comprehensive review of retrospective data was done from 2004 till 2012 from a single center. RESULTS: There were total 171 consecutive febrile episodes with 103 acute lymphoblastic leukemia (ALL) patients and 63 acute myeloid leukemia (AML) patients. The highest number of febrile neutropenia episodes occurred during ALL and AML induction followed by consolidation treatment with high‑dose cytarabine. In our study population, the most common organisms isolated were Gram‑positive (20%) followed by Gram‑negative (6.4%) organisms. The incidence of fungal sepsis was only 3%. In our study, it was seen that the recovery from febrile neutropenia depends upon the disease, ALL recovered rapidly compared to AML (P < 0.001) and also the on the phase of treatment, i.e consolidation recovered earlier than induction (P < 0.001). There was no death recorded in this study population during febrile neutropenia. CONCLUSIONS: The incidence of febrile neutropenia depends upon the type of haematological malignancy and the aggressiveness of therapy required treating the disease especially during induction. The improvement in antimicrobial coverage and its prompt use leads to the selective growth of Gram‑positive organisms.

Role of Ilizarov ring fixator in infected non union tibia.

Background: The main surgical principle in the management of diaphyseal bone infection is thorough debridement of all nonviable tissue. None of the previously mentioned techniques afford surgeon the ability to correct deformities, eliminate antibiotic therapy, regenerate new bone without grafts and allow weight bearing during treatment. Objectives: The present study was conducted to evaluate the clinical follow-up results with Ilizarov technique using three parameters: union, infection and function and to know the complications if any faced by the patients. Material and Methods: This was a prospective study planned to evaluate the results of Ilizarov ring fixator on follow-up of 18 cases of either sex with infected non-union tibia. Average age of presentation was 34.5 years. Follow-up roentgenographs were used to assess alignment, bone contact and later callus formation. Healing status of the fracture was monitored using biplane roentgenographs, unchanged fracture alignment with loosening of the frame, absence of pain during ambulation with the frame destabilized. The data thus collected were analysed by using percentage and valid conclusions were drawn. Result: Pain and swelling were the most common complication after application of ilizarov ring fixator. In this study of 18 cases, 11 (61.11%) patients had excellent, 2 (11.11%) good, 5 (27.77%) fair and none had poor results as per criterion laid down by Catteneo et al. Conclusion: Ilizarov technique was found to be useful to progressively lengthen the extremity, achieve union without bone grafting and to correct deformities in infected non-union with or without bone gap.

Laboratory observations on the larvicidal efficacy of three plant species against mosquito vectors of malaria, Dengue/Dengue Hemorrhagic Fever (DF/DHF) and lymphatic filariasis in the semi-arid desert.

Comparative larvicidal efficacy of aqueous and organic solvent extracts from seeds, leaves and flowers of three desert plants viz. Calotropis procera (Aiton), Tephrosia purpurea (L.) Pers. and Prosopis juliflora (Sw.) DC. was evaluated against Anopheles stephensi (Liston), Aedes aegypti (Linnaeus) and Culex quinquefasciatus (Say). For this purpose larvae of all the three mosquito species were reared in the laboratory and studies carried out on late 3rd or early 4th instars using standard WHO technique. Based on concentration mortality data 24 and 48 hr LC50 and LC90 values along with their 95% fiducial limits, regression equation, chi-square (c2)/ heterogeneity of the response were determined by log probit regression analysis. Experiments were carried out with different solvent extracts of seeds of C. procera which revealed that methanol (24 hr LC50: 127.2, 194.8, 361.0) and acetone (229.9, 368.1, 193.0 mg l-1) extracts were more effective with the three mosquito species, respectively. Petroleum ether extract was effective only on An. stephensi while aqueous extracts were not effective at all with any of the mosquito species (mortality <10-30%). Tests carried out with methanol extracts of fresh leaves (24 hr LC50: 89.2, 171.2, 369.7) and flowers (24 hr LC50: 94.7,617.3, 1384.0 mg l-1) of Calotropis showed that preparations from fresh parts were 2-3 times more effective as compared to the stored plant parts. Efficacy was less than 10-30% with both An. aegypti and Cx. quinquefasciatus while An. stephensi was still susceptible to extracts from both leaves and flowers even after two years of storage. The 24 hr LC50 values as observed for methanol extracts of seeds of T. purpurea and leaves of P. juliflora were 74.9, 63.2 and 47.0 and 96.2, 128.1 and 118.8 mg l-1 for the above three mosquito species, respectively. Experiments carried out up to 500 mg l-1 with leaves (T. purpurea) and seeds (P. juliflora) extracts show only up to 10-30% mortality indicating that active larvicidal principle may be present only in the seeds of Tephrosia and leaves of Prosopis. In general, anophelines were found more susceptible than the culicines to the plant derived derivatives. More studies are being carried out on some other desert plants found in this arid region. The study would be of great importance while formulating vector control strategy based on alternative plant based insecticides in this semi-arid region.

Comparative larvicidal potential of different plant parts of Withania somnifera against vector mosquitoes in the semi-arid region of Rajasthan.

Larvicidal potential of the extracts from different parts viz. green and red fruits, seeds, fruit without seeds, leaves and roots of Withania somnifera in different solvents was evaluated against larvae of Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus, the important disease vectors prevalent in the semi-arid region. Experiments were carried out on late 3rd or early 4th instar larvae of these mosquitoes using standard WHO technique. 24 and 48 hr LC 50 values along with their 95% confidence limits, regression equation, chi-square (c2)/ heterogeneity of the response have been determined by log probit regression analysis. The 24 hr LC50 values as observed for whole green fruits in water, methanol and petroleum ether were 350.9, 372.4, 576.9; 115.0, 197.1, 554.6; 154.9, 312.0, 1085.0 while corresponding values for red fruits were 473.5, 406.4, 445.2; 94.7, 94.5, 1013.0; 241.8, 535.0, 893.3 mg l-1 for An. stephensi, Ae. aegypti and Cx. quinquefasciatus respectively showing that methanol extracts were more effective against anophelines as compared to culicines when whole fruits were taken. The 24 hr LC50 values as observed for seeds in acetone, methanol and petroleum ether were 188.1, 777.5, 822.5; 245.5, 769.0, 1169.0; 140.3, 822.9, 778.4 and for fruit without seeds were 80.2, 97.6, 146.6; 88.4, 404.4, 1030.0; 30.0, 44.5, 54.2 mg l-1 for the above mosquito species respectively showing that extract of fruit without seeds were most effective in petroleum ether followed by acetone and methanol extracts. However, experiments conducted with methanol extracts of leaves and roots of this plant species did not show any appreciable larvicidal activity and a 20-40% mortality was observed up to 500 mg l-1 of the extracts. Overall larvae of anophelines were found more susceptible as compared to culicines to all the extracts tested. Petroleum ether extract of fruit without seeds was found most effective against all the mosquito species showing that active ingredient might be present in this part of the plant species. The study would be of great importance while planning vector control strategy based on alternative plant derived insecticides.

Evaluation of larvicidal efficacy of Solanum xanthocarpum storage against vector mosquitoes in north - western Rajasthan.

Efficacy of the methanol extracts from fruits without seeds, whole yellow ripe fruits and seeds of the plant Solanum xanthocarpum was evaluated against larvae of Anopheles culicifacies, Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus, the important vector mosquitoes prevalent in the arid region. Experiments were carried out on late 3rd or early 4th instar larvae of these mosquitoes using standard WHO technique. 24 and 48 hr LC50 and LC90 values along with their fiducial limits, regression equation, chi-square (x2)/ heterogeneity of the response have been determined by log probit regression analysis. The 24 hr LC50 values as observed for fruit without seeds, whole fruits and seeds after six months were 79.6, 91.7 and 131.7; 131.4, 186.9 and 195.6; 273.4, 290.9 and 377.6 and 384.9, 450.6 and 520.0 mgl-1 for An. culicifacies, An. stephensi, Ae. aegypti and Cx. quinquefasciatus respectively. However, the 24 hr LC50 values for fresh yellow ripe fruits and seeds determined previously were 51.6 and 66.9; 52.2 and 73.7; 118.3 and 123.8 and 157.1 and 154.9 mgl-1 for the above four vector species respectively showing that the efficacy was decreased two to three times more after six months of storage. The 24 hr LC50 values were also determined after one year of storage for fruit without seeds, whole fruits and seeds. The values were 103.3, 120.1 and 195.7; 146.3, 224.3 and 251.2; 316.9, 336.5 and 426.2 and 393.0, 500.3 and 656.7 mgl-1 as compared to the 24 hr LC50 values of 47.4,51.6 and 66.9; 52.3,52.2 and 73.7; 108.0,118.3 and 123.8 and 141.1, 157.1 and 154.9 mgl-1 of all the three fresh preparations for the above four vector species respectively showing that the efficacy was further decreased after one year of storage. Further the extracts should be used when they have been prepared from the fresh plant parts instead of the old stored parts. Larvae of anophelines were found more susceptible as compared to culicine. HPLC and IR studies showed that active component might be present in the fruits and seeds of this plant species. The study would be of great importance while planning vector control strategy based on alternative plant derived insecticides.

Larvicidal activity of the extracts from different parts of the plant Solanum xanthocarpum against important mosquito vectors in the arid region.

Larvicidal efficacy of the aqueous and methanol extracts from green unripe and yellow ripe fruits, seeds, leaves and roots of the plant Solanum xanthocarpum was evaluated against Anopheles culicifacies, Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus, the important mosquito vectors prevalent in the arid region. Studies were carried out on late 3rd or early 4th instar larvae of these species using standard WHO technique. Based on concentration mortality data LC50 and LC90 values along with their fiducial limits, regression equation, chisquare (l2)/ heterogeneity of the response have been determined by log probit regression analysis. The 24 hr LC50 values as observed for aqueous extracts for green unripe and yellow ripe fruits were 112.7, 498.2 and 846.3 mgl-1 and 104.7, 267.7 and 832.2 mg l-1 for Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus respectively. However, the 24 hr LC50 values for methanol extracts of yellow ripe fruits and seeds were 51.6, 52.2, 118.3 and 157.1 mg l-1 and 66.9, 73.7, 123.8 and 154.9 mg l-1 for the above four vector species respectively. The results showed that larvae of anophelines were much more susceptible as compared to culicines to both the aqueous and methanol extracts from fruits and seeds of the plant tested. The methanol extracts were found 2-5 times more effective as compared to the aqueous extracts. The chi-square values calculated during the analysis did not show any heterogeneity of the response. Experiments conducted with aqueous and methanol extracts from leaves and roots of this plant species didn’t show any larvicidal activity against any of the mosquito species tested. The study would be of great importance while formulating vector control strategy based on alternative plant based insecticides.

Relative susceptibility of some common mosquito vector larvae to synthetic insecticidal compounds in north-western Rajasthan.

Relative susceptibility of three important mosquito vector larvae viz., Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus, prevalent in the arid region was determined against four organophosphates (malathion, fenitrothion, fenthion, temephos) and three synthetic pyrethroid (alphamethrin, deltamethrin and fanvalerate) compounds. Studies were carried out on late 3rd or early 4th instar larvae of these species using standard WHO technique. Based on concentration mortality data LC50 and LC90 values along with their fiducial limits, regression equation, chi-square (chi2)/heterogeneity of the response have been determined by log probit regression analysis. LC50 values as observed for the above seven insecticides were 0.8097, 0.0398. 0.0432, 0.0035, 0.0025, 0.0092, 0.1006; 1.2370, 0.0531, 0.0655, 0.0076, 0.00004, 0.00004, 0.0046 and 1.4980, 0.0719, 0.0817, 0.0056, 0.00021, 0.00073, 0.0112 mg/l for the above three mosquito species respectively Among the four organophosphates tested temephos was the most effective followed by fenitrothion, fenthion and malathion. In general, Anopheles was found more susceptible as compared to the other two culicines to the above four compounds. The results also showed that larvae of Ae. aegypti were most susceptible followed by Cx. quinquefasciatus and An. stephensi to all the three pyrethroids tested. Among the three compounds tested alphamethrin was found to be the most toxic followed by deltamethrin while fanvalerate was the least toxic. The study would be of great importance while planning use of these insecticides for the control of different vector species in this area.

Women with septic abortion: who, how and why? A prospective study from tertiary care hospital in India.

A prospective descriptive interview based hospital study was carried on 47 women admitted with septic abortion to evaluate their psychosocial, demographic and clinical profile These women were predominantly parous (75%), hindus (60%), between 20-30 years of age (60%) and mostly married (91.4%) house wives (63.8%). More than 90% already had one or more male child. The contraceptive use was dismally low (23.4%). Their knowledge about legalisation, place and persons authorized to conduct abortions was very less, however large majority (87%) underwent abortions within 3 months of pregnancy. Large family, poverty and spacing were the main reasons cited for abortions. Abdominal pain, fever, genital bleeding, diarhoea and abdominal distension were presenting clinical features in order of frequency. Advanced sepsis and associated medical and surgical complications were present in more than half the patients and 6% succumbed to these problems. The current experience was an eye opener for most of them and changed their future attitude. Hence education, economic prosperity, easy access to reproductive health facilities and institutional management of sepsis is the key to make abortions safe.

Study on serum and urinary cortisol levels of asthmatic patients after treatment with high dose inhaled beclomethasone dipropionate or budesonide.

BACKGROUND: The potential for long-term adverse effects from inhaled corticosteroids relates to their systemic absorption. With increasing use of high dose inhaled corticosteroids, there is need to establish whether similar doses of beclomethasone dipropionate (BDP) and budesonide (BUD) produce clinically important differences in untoward side effects specially hypothalamo-pituitary-adrenal (HPA) axis suppression. METHODS: Fifteen asthmatic patients were started on BDP or BUD (2000 microg/day) through spacer for six weeks. Serum cortisol (9 AM and 4 PM), 24-hour urinary steroid and pulmonary function testing parameters were performed. RESULTS: The serum cortisol levels were not found to be suppressed with either BDP or BUD. Similarly no significant changes were found in 24 hours urinary excretion of steroids with either of the drugs. Significant improvement was found in values of forced expiratory volume in the first second (FEV1) with BDP. With BUD the changes in forced vital capacity (FVC) and FEV1 were found to be significant. CONCLUSION: BDP or BUD in high doses of 2000 microg/day given upto six weeks through spacer are equally effective for treatment of bronchial asthma and do not cause any significant change in serum and urinary cortisol levels, and adrenal function/HPA axis.