Polymyositis presenting with respiratory failure.

Polymyositis is a systemic autoimmune disorder characterised by inflammatory myopathy of the skeletal muscles predominantly affecting the proximal muscles and associated with extra-muscular manifestations like dysphagia and skin involvement. In this case report, we describe the occurrence of diaphragmatic weakness and respiratory failure due to polymyositis with relatively well preserved power in limb muscles.

Prevalence of asthma in urban and rural children in Tamil Nadu.

BACKGROUND: There are very few community-based studies on the prevalence of asthma in Indian children. We aimed to estimate the prevalence of asthma in children under 12 years of age and to study possible differences in the prevalence of childhood asthma in urban and rural areas of Tamil Nadu. METHODS: A total of 584 children from Chennai and 271 children from 25 villages around Chennai formed the urban and rural groups, respectively. From November 1999 to February 2000, data were collected using a simplified version of the ISAAC questionnaire, which was administered by trained students. Symptoms suggestive of asthma or hyperreactive airways disease in children under 12 years of age were recorded from the selected urban and rural populations by questioning the parents. The results were analysed separately for children 0-5 and 6-12 years of age. RESULTS: Of the 855 children studied, the overall prevalence of breathing difficulty (including asthma) was 18% and the prevalence of 'diagnosed' asthma was 5%. Twenty-two per cent of urban and 9% of rural children 6-12 years of age reported breathing difficulty 'at any time in the past' (p < 0.01). A significantly higher proportion of 6-12-year-old urban children also reported nocturnal drycough (28.4% v. 18.7%, p < 0.05). Urban children reported recent wheeze more often than rural children (92% v. 77%, p = 0.01). CONCLUSIONS: Symptoms suggestive of asthma were present in 18% of children under 12 years of age. Though the prevalence of diagnosed childhood asthma was about 5% in both urban and rural areas, the prevalence of 'breathing difficulty' and nocturnal cough was significantly higher among urban children in the age group of 6-12 years. Children living in urban areas also reported 'recent wheeze' more often than rural children. Our data suggest that the actual prevalence of asthma and other 'wheezy' illnesses may be higher than that previously documented. Further studies are needed to confirm the difference in prevalence between urban and rural children and also to identify possible causes that could account for the higher urban prevalence of asthma in Tamil Nadu.