Severe pulmonary involvement in leptospirosis. Alternate antibiotics and systemic steroids

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem [1 g every 8 hours], moxifloxacin [400 mg once daily], and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions

Management and control of asthma in patients attending a specialist centre in Oman

The management of asthma by specialists is likely to become more evidence-based. This study analysed the characteristics of patients reporting to a specialist clinic including demographics, dispensed medications and the level of asthma control. All consecutive stable asthmatics seen in the adult pulmonary clinics of Sultan Qaboos University Hospital, Oman, between December 2005 and November 2006 were prospectively evaluated using a structured assessment protocol. Of the 207 patients, [mean age 40.64 +/- 14.8], 72% were females. The majority, 83.1%, had moderate persistent asthma. A positive history of allergic rhinitis, eczema and a family history of asthma were obtained in 58.0%, 11.1%, and 50.7% of patients respectively. Total serum immunoglobulin E [IgE] was elevated in 66.7%. Skin testing was positive for more than 2 antigens in 52.3%, with the house dust antigen being reactive in 49%. Inhaled steroids, long-acting beta agonists [LABA], antihistamines and leukotriene receptor antagonists were prescribed in 94.2%, 85%, 54.5% and 11.6% of cases respectively. The majority [40.1%] was receiving medium dose inhaled steroids. Although asthma was controlled in 162 [78.3%], during the previous month 66 [31.9%] patients had visited the emergency department and 31 [15.0%] patients were hospitalised at least once during the previous year. Only 63 [30.4%] patients were using their inhalers correctly. Good compliance with inhaled steroids was observed in only 53 [25.6%] patients. Allergic comorbidities and a strong family history of asthma were common. Although the level of asthma control in the previous month was high, it was much lower in the long term. The concepts of short term, long term and total control of asthma need to be explored

case of disseminated tuberculosis with adrenal insufficiency

We present the case of a 37 year-old female who had disseminated tuberculosis [TB] with bilateral adrenal involvement resulting in primary adrenal failure [Addison's disease] with refractory hyponatraemia and possible extrapontine 'myelinolysis'. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB

Familial mineralocorticoid induced hypertension in the Sultanate of Oman

In Oman, many hypertensive patients with a family history of the disease respond to treatment with spironolactone, a mineralocorticoid receptor [MC-R] blocking agent thus suggesting a high prevalence of mineralocorticoid [MC] induced disease. The aim of this study was to document the prevalence of MC induced disease in patients with a positive family history of hypertension [HTN]. Serum calcium, potassium, creatinine, aldosterone and renin levels were measured under standard conditions in all patients together with an abdominal ultrasound scan and an adrenal computed tomography [CT] scan in four patients. In this small study, we show that 18 of the 27 patients [66%] had undetectable [suppressed] renin levels with usually normal aldosterone values [14 patients] and respond to treatment with spironoactone. We suggest that MC induced hypertension is likely to be common in the Middle East. In evolutionary terms, this makes sense as the ability to conserve salt in hot climates might be expected to confer a definite survival advantage