Hughes-stovin syndrome and massive hemoptysis: a management challenge

Hughes-Stovin syndrome is a very rare clinical entity characterized by pulmonary artery aneurysms and deep vein thrombosis [DVT]. Here we report the case of a 53-year-old man, admitted to Sultan Qaboos University Hospital, Muscat, Oman, with bilateral pulmonary artery aneurysms and lower-limb DVT who developed massive hemoptysis. He was managed successfully with high-dose steroids in combination with cyclophosphamide

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

Is clinical judgment of asthma control adequate? A prospective survey in a tertiary hospital pulmonary clinic

Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma [GINA] scoring. Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases [67.5%]. In the other 32.5% [n = 51], the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists [72%] as compared to non-pulmonologists [47%; P = 0.009]. Physicians classified 76 patients [48.4%] as well-controlled by clinical judgment compared to 48 [30.6%] using GINA criteria [P <0.001]. Conversely, they classified 34 patients [21.7%] as uncontrolled as compared to 57 [36.3%] by GINA criteria [P <0.001]. In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate [PEFR] [46.7%] and limitation of activity [21.4%] were the most frequent parameters for downgrading the level of control. Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control