High resolution computed tomography in asthma

High-resolution computed tomography [HRCT] can detect the structural abnormalities in asthma. This study attempts to correlate these abnormalities with clinical and pulmonary function test [PFT] data. Consecutive stable asthma patients attending Mubarak Al Kabeer Hospital, Kuwait, were subjected to HRCT during a six month period from July 2004 to December 2004, after initial evaluation and PFT. Of the 28 cases, sixteen [57.1%] had moderate, 6 [21.4%] had mild and 6 [21.4%] had severe persistent asthma. Thirteen [46.4%] patients had asthma for 1 to 5 years and 12 [42.9%] were having asthma for >10 years. Bronchial wall thickening [57.1%], bronchiectasis [28.6%], mucoid impaction [17.9%], mosaic attenuation [10.7%], air trapping [78.6%] and plate like atelectasis [21.4%] were noted. Bronchial wall thickening [p=0.044] and bronchiectasis [p=0.063] were most prevalent in males. Ten [35.7%] patients exhibited mild, 9 [32.1%] had moderate and 3 [10.7%] had severe air trapping. The difference in Hounsfield units between expiratory and inspiratory slices [air trapping] when correlated with percent-predicted FEV1 in right upper [r=0.25; p=0.30], left upper [r=0.20; p=0.41], right mid [r=0.15; p=0.53], left mid [r=-0.04; p=0.60], right lower [r=0.04; p=0.86] and left lower zones [r=-0.13; p=0.58] showed no relation. The same when correlated as above with the percent predicted FEF 25-75 did not show any significant association. The presence of air trapping was compared with sex [p=0.640], nationality [p=1.000], disease duration [p=1.000] and severity of symptoms [p=0.581]. Abnormal HRCT findings are common in asthma; however, air trapping when present was not related to the duration or severity of the illness or to the FEV1

Changing trends in the managment of acute myocardial infarction: a five-year study

Over the past two decades, there has been considerable progress in the treatment of acute myocardial infarction [AMI] that led to substantially lower mortality and morbidity. Therefore, we carried out this study to evaluate the changes in our practice as related to AMI treatment over a five year period. This is a retrospective analysis that included all patients with a diagnosis of AMI, admitted to the coronary care unit between the first of January 1998 and the end of December 2002. The total number of patients with AMI was 2,280. Comparing the first year to the last year of the study, the use of medications at discharge increased significantly for beta-blockers [76 vs 88, p < 0.0001]; for angiotensin converting enzyme inhibitors [ACEI] [40 vs 45%, p = 0.02] and for lipid lowering drugs [25 vs 66%, p < 0.0001]. Similarly, the use of thrombolytic dru g s increased significantly [60 vs 66%, p < 0.001]. The time to administration of thrombolytic treatment shortened significantly [104 vs 70 minutes, p < 0.001]. The use of inhospital cardiac catheterization increased as well [7 vs 14%; p = 0.006]. Our study showed significant changes in the practice of AMI treatment over the five year study period. The use of therapies with proven benefit such as beta- blockers, ACEI, lipid lowering drugs, thrombolysis and in-hospital cardiac catheterization has increased. Although the time to thrombolytic treatment did shorten, it needs to be shortened further to obtain the maximum benefit from such therapy

Vibrio cholerae necrotizing fasciitis

We report a rare cause of necrotizing fasciitis in our geographical area. The patient was already compromised with chronic liver disease and diabetes mellitus

Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis. A case report

To report a case of glucocorticoid substitution in panhypopituitarism that can lead to uncontrolled rise in serum sodium and myelinolysis. Clinical Presentation and Intervention: A 42-year-old man presented with disturbed conscious level and hyponatremia. Initial data suggested glucocorticoid deficiency. Later, hormonal levels indicated panhypopituitarism. MRI of the brain led to the diagnosis of a pituitary macroadenoma. Glucocorticoid substitution was initiated immediately after admission, and possible myelinolysis subsequently became a complication. We report this case to illustrate the fact that glucocorticoid substitution can lead to rapid rise in serum sodium and myelinolysis in panhypopituitarism. This case illustrated the need to use minimum doses of glucocortcoids with close monitoring of serum sodium, in order to avoid this complication