Antibiotic Susceptibility, Carrier State and Predictors of Outcome of Staphylococcus aureus Infections in Hospitalized Children

Objectives: To evaluate the antibiotic resistance pattern, clinical profile and predictors for adverse outcomes in children hospitalized due to staphylococcal infection; and the frequency of nasal and axillary carrier states in these children. Methods: This descriptive study enrolled 100 symptomatic children (aged 1 month - 12 years) in whom S. aureus was isolated from cultures of blood, pus or cerebrospinal fluid. All samples were processed as per the Clinical and Laboratory Standards Institute (CLSI) standards. Antimicrobial susceptibility was tested using disc diffusion method; minimum inhibitory concentration (MIC) for vancomycin was measured using E strips. Predictors for poor recovery were determined by univariate and multivariable logistic regression analysis. Results: Skin and soft tissue infections were the most common (47%) followed by respiratory infections (37%). Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 62%, out of which 63% (39/62) were multi-drug resistant. Carrier state was present in 49% (93% MRSA); 80% were axillary carriers. High MIC (>1 µg/mL) for vancomycin was seen in 65% of patients, and was the only factor associated with poor recovery [aOR (95%CI) 5.3 (1.6,18.5); P=0.008] on multivariable logistic regression analysis. Conclusion: MRSA is the predominant strain in severe staphylococcal infections requiring hospitalization, and majority of them are multidrug resistant. High MIC to vancomycin among S. aureus is an emerging concern.

Risk Factors Predicting Early In-Hospital Mortality among Underfive Children and Need for Decentralization of Pediatric Emergency Care Services

Background: Lack of pediatric triage and emergency care system in peripheral healthcare centers leads to unnecessary referral of low- and medium?risk patients. This study was conducted to study the risk factors predicting mortality within 48 h of admission in neonates and under?five children referred to the pediatric emergency of a tertiary care hospital in India. Methods: This prospective study was conducted on children (0–5 years) referred to the pediatric emergency who were enrolled and followed up. The outcome was defined as “survival” or “death” at 48 hours. Logistic regression analysis was conducted to assess the predictors of early in?hospital mortality. Results: A total of 246 consecutive pediatric (62 neonates, 52 young infants, and 132 children aged 1–5 years) referral cases were enrolled; mortality within 48 hours was 20%. Lack of pediatric intensive care (odds ratio [OR] 4.07, 95% confidence interval [CI] 2.0, 8.32, P = 0.02), lack of neonatal intensive care (OR 2.10, 95% CI 1.01,4.28, P ? 0.001), distance from referral center >20 km (OR 4.61, 95% CI 2.01, 10.58, P = 0.0003), >1 h taken during transport (OR 7.75, 95% CI 2.93, 20.46, P < 0.001), lack of ambulance facility (OR 0.04, 95% CI 0.009, 0.143, P < 0.0001), very sick condition on arrival (OR 210.1, 95% CI 12.1, 3643.41, P = 0.0002), and unstable temperature?oxygenation?perfusion?sugar on arrival were the independent risk factors predicting in early in-hospital mortality. Conclusion: Developing a pediatric triage and monitoring system, tele-pediatric intensive care unit, regionalizing referral-back-referral services with robust interhospital communication, and strengthening pediatric emergency services are the need of the hour to reduce early in-hospital mortality

Association of inflammatory markers with the disease & mutation status in pancreatic cancer

Background & objectives: Inflammation has been studied to be an important contributory factor to carcinogenesis through pro-inflammatory markers such as interleukin (IL)-6 and C-reactive protein (CRP). Furthermore, K-ras mutation is an important genetic alteration in the pathogenesis of pancreatic cancer. This study aimed to compare these inflammatory markers in pancreatic ductal adenocarcinoma (PDAC) with the diseased and healthy controls (HCs) and to check for any association between IL-6 and CRP serum levels with the disease status, survival and K-ras mutation status of PDAC patients. Methods: The study included 135 PDAC, 25 chronic pancreatitis (CP) patients and 25 HCs. The serum levels of IL-6 and CRP were detected by enzyme-linked immunosorbent assay and K-ras mutations were detected by polymerase chain reaction-restriction fragment length polymorphism technique. Results: The serum levels of both these markers were elevated in PDAC cases than that in HCs. High IL-6 levels and higher CRP levels were found to be associated with locally advanced disease, lymphatic invasion, metastasis and advanced stage of the PDAC. In patients with unresectable PDAC, higher IL-6 levels were found to be associated with the presence of K-ras mutations. Interpretation & conclusions: Higher IL-6 and CRP levels in patients with advanced PDAC suggest an important role of these inflammatory markers in tumour progression. Furthermore, the association of mutations in the K-ras gene with serum IL-6 indicates cross-talks that may contribute to the progression of the PDAC.

Synergy in penicillin, cephalosporin, amphenicols, and aminoglycoside against MDR S. aureus isolated from Camel milk

Abstract This study investigated the synergy testing of penicillin, cephalosporin, amphenicols, and aminoglycoside in the camel milk (n=768 samples), subsequently used for isolation of MDR S. aureus targeting mecA gene. Antibiotic susceptibility of S. aureus showed >90% isolates were sensitive to ciprofloxacin and trimethoprim and resistant against oxacillin, ampicillin, and cefoxitin. Further, 50-85% of the S. aureus were sensitive to gentamicin, oxytetracycline, and chloramphenicol and resistant against cefotaxime, vancomycin, and cefixime. Minimum inhibitory concentration (MIC) of cefotaxime, (C) and ampicillin (A) in combination with gentamicin (G) was reduced by 99.34% and 70.46%, respectively, while with chloramphenicol (Ch), reduction was 57.49% and 60%, respectively. In addition, the Fractional Inhibitory Concentration Index (FICI) of G+A, Ch+C and Ch+G combinations showed synergy against 80%, 60%, and 30% of MDR S. aureus, respectively. Similarly, C+A and Ch+G displayed indifferent interaction against 70 % and 30% of isolates, respectively, while the later showed additive interaction against 10% of MDR S. aureus. Altogether, our results described effective combination of gentamicin and chloramphenicol with ampicillin and cefotaxime to combat MDR S. aureus

Mental health of mothers after natural childbirth and cesarean section: a comparative study in kohat, khyber pakhtunkhwa, pakistan / Saúde mental de mães após parto normal e cesariana: um estudo comparativo em kohat, khyber pakhtunkhwa, paquistão / Salud mental de madres después del parto normal y cesárea: un estudio comparativo en kohat, khyber pakhtunkhwa, pakistán

ABSTRACT Objective: to compare the quality of life of women after natural childbirth and cesarean section from a mental health perspective. Method: this is a causal-comparative study that included 104 women, 52 of whom underwent natural childbirth: and 52 cesarean sections. It was conducted in the gynecology ward of Liaqat Memorial Hospital in Kohat Khyber Pakhtunkhwa, Pakistan using the Quality-of-Life Questionnaire. Pakistani Nurses made direct translation of it in to Urdu language, interview by interview (read in English and told in Urdu). The results related to Emotional Health Problems, Energy, Emotions and Social Activities were analyzed. Results: women after cesarean section reported more problems regarding emotional health variables than women after natural childbirth. The mean quality of life score among the natural childbirth group was 89.94 and 66.02 among the cesarean section group (p<0.001). Conclusion: women who undergo natural childbirth have better quality of life than women who undergo cesarean section (average versus poor quality of life). Mental health is also affected, especially for those who undergo cesarean section. Thus, natural childbirth demonstrates benefits in the puerperium in terms of emotional indicators.

RESUMO Objetivo: comparar a qualidade de vida de mulheres após parto normal e cesariana na perspectiva da saúde mental. Método: estudo causal-comparativo que incluiu 104 mulheres, das quais 52 tiveram parto normal e 52 cesarianas. O estudo foi realizado na enfermaria de ginecologia do Liaqat Memorial Hospital em Kohat Khyber Pakhtunkhwa, Paquistão, usando o Questionário de Qualidade de Vida. As enfermeiras paquistanesas fizeram a tradução direta para o idioma Urdu, entrevista por entrevista (lida em inglês e falada em urdu). Foram analisados os resultados relacionados aos Problemas de Saúde Emocional, Energia, Emoções e Atividades Sociais. Resultados: as mulheres após cesariana relataram mais problemas em relação às variáveis de saúde emocional do que as mulheres após o parto normal. O escore médio de qualidade de vida no grupo de mulheres após parto normal foi de 89,94 e 66,02 no grupo de mulheres após cesariana (p<0,001). Conclusão: as mulheres que realizaram parto normal apresentaram melhor qualidade de vida do que as mulheres após cesariana (média versus má qualidade de vida). A saúde mental também é afetada, principalmente para aquelas que são submetidas a cesariana. Assim, o parto normal demonstra benefícios no puerpério em termos de indicadores emocionais.

RESUMEN Objetivo: comparar la calidad de vida de las mujeres después del parto natural y cesárea desde la perspectiva de la salud mental. Método: estudio causal-comparativo que incluyó 104 mujeres, de las cuales 52 tuvieron parto natural y 52 cesáreas. El estudio se realizó en la enfermería de ginecología del Liaqat Memorial Hospital en Kohat Khyber Pakhtunkhwa, Pakistán, utilizando el Cuestionario de Calidad de Vida. Las enfermeras paquistaníes hicieron la traducción directa al idioma Urdu, entrevista por entrevista (leída en inglés y hablada en urdu). Los resultados relacionados con los Problemas de Salud Emocional, Energía, Emociones y Actividades Sociales fueron analizados. Resultados: Las mujeres después de la cesárea reportaron más problemas en relación a las variables de salud emocional que las mujeres después del parto natural. El puntaje medio de calidad de vida en el grupo de parto natural fue de 89,94 y 66,02 en el grupo de cesárea (p<0,001). Conclusión: las mujeres que tuvo parto natural tienen mejor calidad de vida que las mujeres después de la cesárea (media versus mala calidad de vida). La salud mental también se ve afectada, especialmente para aquellos que se someten a cesárea. Por lo tanto, el parto natural muestra beneficios en el período posparto en términos de indicadores emocionales.

In Vitro Evaluation of Dalbergia sissoo and Acacia modesta gum as Pharmaceutical Binders for Drug Delivery System

Abstract The present study aimed to compare the crude, modified and hydrolyzed gums of Dalbergia sissoo and Acacia modesta as a biodegradable binder for drug delivery system using acetaminophen as a model drug. The physiochemical properties such as pH, fluorescence analysis and swelling index were determined. The gums were hydrolyzed and modified. Acetaminophen tablets were prepared using wet granulation technique and the gum solutions were used as a binder. Hydroxypropyl methylcellulose was used as a synthetic binder. Different properties of granules and tablets were evaluated. Results showed that both gums were acidic in nature, while D. sissoo and A. modesta showed light brown and creamy color in fluorescence analysis. The swelling ratio was the highest in water followed by 0.1N HCl and least in phosphate buffer. The prepared tablets showed faster and slower dissolution profiles in the same dissolution system. The crude gums have the highest dissolution rate, and this rate was decreased in the case of modified and hydrolyzed gums samples. The crude gums showing slower release can be useful in sustained-release tablets, while the modified gums having faster release rate are helpful in conventional tablet formulation. Taken together, the selected gums could be a good model for evaluation as a binder or hydrophilic polymer in tablet formulation.

Indian Academy of Pediatrics Guidelines on the Fast and Junk Foods, Sugar Sweetened Beverages, Fruit Juices, and Energy Drinks

Justification: In view of easy availability and increasing trend of consumption of fast foods and sugar sweetened beverages (fruit juicesand drinks, carbonated drinks, energy drinks) in Indian children, and their association with increasing obesity and related non-communicable diseases, there is a need to develop guidelines related to consumption of foods and drinks that have the potential toincrease this problem in children and adolescents. Objectives: To review the evidence and formulate consensus statements related toterminology, magnitude of problem and possible ill effects of junk foods, fast foods, sugar-sweetened beverages and carbonated drinks;and to formulate recommendations for limiting consumption of these foods and beverages in Indian children and adolescents. Process:A National Consultative group constituted by the Nutrition Chapter of the Indian Academy of Pediatrics (IAP), consisting of variousstakeholders in private and public sector, reviewed the literature and existing guidelines and policy regulations. Detailed review ofliterature was circulated to the members, and the Group met on 11th March 2019 at New Delhi for a day-long deliberation on framing theguidelines. The consensus statements and recommendations formulated by the Group were circulated to the participants and aconsensus document was finalized. Conclusions: The Group suggests a new acronym ‘JUNCS’ foods, to cover a wide variety ofconcepts related to unhealthy foods (Junk foods, Ultra-processed foods, Nutritionally inappropriate foods, Caffeinated/colored/carbonated foods/beverages, and Sugar-sweetened beverages). The Group concludes that consumption of these foods and beveragesis associated with higher free sugar and energy intake; and is associated with higher body mass index (and possibly with adversecardiometabolic consequences) in children and adolescents. Intake of caffeinated drinks may be associated with cardiac and sleepdisturbances. The Group recommends avoiding consumption of the JUNCS by all children and adolescents as far as possible and limittheir consumption to not more than one serving per week. The Group recommends intake of regional and seasonal whole fruits over fruitjuices in children and adolescents, and advises no fruit juices/drinks to infants and young children (age <2 y), whereas for children aged 2-5 y and >5-18 y, their intake should be limited to 125 mL/day and 250 mL/day, respectively. The Group recommends that caffeinatedenergy drinks should not be consumed by children and adolescents. The Group supports recommendations of ban on sale of JUNCSfoods in school canteens and in near vicinity, and suggests efforts to ensure availability and affordability of healthy snacks and foods. TheGroup supports traffic light coding of food available in school canteens and recommends legal ban of screen/print/digital advertisementsof all the JUNCS foods for channels/magazines/websites/social media catering to children and adolescents. The Group further suggestscommunication, marketing and policy/taxation strategies to promote consumption of healthy foods, and limit availability and consumptionof the JUNCS foods

Synchronous occurrence of lobular breast carcinoma and granulosa cell tumor of ovary mimicking metastatic lobular breast carcinoma

Breast cancer is one of the main sources of ovarian metastasis. Diffuse sheet of lobular carcinoma cells can strongly mimic granulosa cell tumor (GCT) which itself is a rare ovarian neoplasm constituting <5% of all the ovarian neoplasms. A 55-year-old female presented with a painful lump in the right breast associated with nipple discharge for 4 months, which on radiological and cytological findings was suspicious of an epithelial malignancy. During routine work-up, a solid-cystic lesion in the left ovarian adnexa was identified. The patient underwent right modified radical mastectomy along with left salpingo-oophorectomy. Histopathological and immunohistochemical features confirmed the diagnosis of a synchronous lobular carcinoma breast with GCT ovary. Simultaneous occurrence of Lobular carcinoma breast (LCB) and GCT ovary is extremely rare. Morphologically, these can look similar, raising a suspicion of LCB metastasis to ovary. This is important to differentiate the two for a proper patient management and prognosis

Comparative Evaluation of Physical and Physicochemical Properties and Antioxidant Potential of Various Cooking Oils

The study was based on the comparative evaluation of physical and physicochemical properties and antioxidant potential of different cooking oils as awareness for the consumers. The cooking oils extracted from sunflower, corn, canola, soybean, and rapeseed and available for consumers as different commercial brands were purchased from the local market and analysed for their physical, physicochemical and antioxidant properties. All of the selected oils were found to be statistically similar on the basis of their physical properties including odour, specific gravity (P=.65) and refractive index (P=0.84). All of the selected oils contained vitamin A except one brand of each of the sunflower, corn and canola oils. The selected oils and their blend showed statistically different physicochemical properties and antioxidant potential (P=.000). The corn oil and rapeseed oil were found to be the best quality oil due to comparatively lower acid, peroxide and saponification values and higher antioxidant potential in terms of free radical scavenging capacity. The study results would provide valuable information to the consumers and the researchers regarding the selection of the best quality cooking oils available in the market.

Computed tomography- guided percutaneous core needle biopsy for diagnosis of intathoracic mass lesions: experience at a tertiary care centre of North India

Background: CT guided core needle biopsy is a less invasive method for initial diagnostic workup in the assessment of intrathoracic masses. This study was conducted to evaluate the diagnostic yield of the procedure as well as to demonstrate the spectrum of various disease in our population.Methods: Present study was conducted in a tertiary care hospital for a study period of two years. Patients with intrathoracic mass were included and CT guided biopsies were performed following a protocol. The CT guided biopsies received were examined for histological diagnosis. Immunohistochemistry was carried out where ever routine histopathology was not sufficient for diagnosis. Relevant immunohistochemical panels were applied for lung, mediastinal and pleural tumours according to the histological differential diagnosis. Detailed demographic and clinical profiles along with radiological findings were noted.Results: Total of 138 cases were taken for CT guided FNAC procedure and 123 (89.1%) cases yielded diagnostic biopsy. Lung was the most commonly involved organ followed by mediastinum. Bronchogenic carcinoma was the most common lesion reported in lung and Non-Hodgkin Lymphoma was the most common mediastinal lesion. Lung collapse was most common radiological feature.Conclusions: CT guided percutaneous biopsy is a valuable diagnostic technique providing for early accurate diagnosis and being minimally invasive procedure. Care should be taken while tissue processing and section cutting of intrathoracic biopsies as the biopsies are small and tissue loss should be prevented so that sufficient material is available for immunohistochemistry.

Clinicopathological and immunohistochemical analysis of Sarcomatoid carcinoma of head and neck mucosal region: a retrospective analysis

Background: Sarcomatoid carcinoma is a biphasic tumour comprising both of malignant epithelial and mesenchymal elements derived monoclonally from same stem cells. These are unusual variants of squamous cell carcinoma and constitute less than 1% of the head and neck mucosal tumors. Only few studies have been published and needs more understanding to establish treatment guidelines. The aim of this study was to review the cases of carcinosarcoma arising from mucosal sites of head and neck and study their clinical, histological and Immunohistochemical features.Methods: Retrospective data and slides of histologically proven sarcomatoid carcinoma over a period of thirty -four months between January 2016 - October 2018 were retrieved and evaluated for various clinical and histopathological parameters.Results: Total of 22 cases were included in the study and the mean age of presentation was 58years with male: female ration 2:1. Most of the patients (81.8%) presented with a mass lesion of less than 6 months duration. The most common site was oral cavity (68.1%) followed by larynx (22.7%). Clinical stage was known in eleven cases. One case presented with pulmonary metastasis. Histopathologically, epithelial differentiation was identified in nine cases (41%) on morphology and in thirteen cases could be highlighted by cytokeratin positivity. The Mesenchymal component was arranged in sheets (63.7%) and fascicles (31.8%). Marked anaplasia and brisk mitosis wereseen in 54.5% and 19.3% respectively.  On immunohistochemistry all 22 cases were positive for Vimentin, twenty cases were positive for cytokeratin/EMA and aberrant mesenchymal markers were expressed in 10% of cases.  Follow up was available in eighteen cases out of which fourteen cases died within one year of diagnosis.Conclusions: Diagnosis of sarcomatoid carcinoma is challenging especially on small biopsy because of overlapping features with other spindle cell tumors. Understanding the clinicopathological features facilitates their diagnosis and effective clinical management.

Silent Intracerebral Hemorrhage in Patients Randomized to Stenting or Endarterectomy for Symptomatic Carotid Stenosis / 대한뇌졸중학회지

No abstract available.

A POLG2 Homozygous Mutation in an Autosomal Recessive Epilepsy Family Without Ophthalmoplegia

No abstract available.

Blowing Your Own Trumpet: How to Increase the Online Visibility of Your Publication?

After seeing one’s manuscript in the print form in a journal, the author feels a sense of elation which is indescribable. However, if one reallywant peers and other researchers to take note of the work, some more effort is needed. With the massive increase in the number ofbiomedical journals in print – supplemented by another large chunk online – quite a few published papers remain unread by majority of thereaders. The availability of social sites, persistent identifiers, and manuscript-sharing sites has simplified the job of increasing the impactof an article. We herein share some of these tricks-of-the-trade

A Novel Nonsense Mutation in Leucine-Rich, Glioma-Inactivated-1 Gene as the Underlying Cause of Familial Temporal Lobe Epilepsy

No abstract available.

Structural and functional annotation of citrate synthase from Aspergillus niger ANJ-120

Citrate synthase [CS] is involved in citric acid biosynthesis which is a well-established metabolic pathway. The condensation of acetyl-CoA with oxaloacetate is catalyzed by CS. Citric acid [CA] has a number of applications in pharmaceutical industry. CA in combination with bicarbonates is used as an effervescent in the preparations of tablets and powders. It has also been used as an anticoagulant and acidulant to form mild astringent. In current study, detailed structural and functional analyses of CS protein were carried out using various bioinformatics tools. Structural modeling was also done by building 3D model of CS from Aspergillus niger ANJ-120 using Modeller 9.16 software. The 3D Model was then evaluated using different online approaches. Furthermore, superimposition of query and template structures, Root Mean Squared Deviation and visualization of generated model were done through UCSF Chimera 1.5.3. Even though various roles of CS protein were already known and verified experimentally, here we presented a structural analysis of CS protein. The structural investigation of CS protein will be helpful for protein engineering strategies and understanding the interactions among proteins. Due to large number of applications, the production of citric acid by A. niger and its bioinformatics studies will offer substantial improvement in commercial scale intensification of this useful product

Measuring central percentiles of blood pressure levels among adults in Pakistan: a case study of Rawalpindi

The prevalence pattern of hypertension [HTN] in developing countries is different from that in the developed countries. In Pakistan, the percentage of hypertensive patients has been growing since last two decades. Various factors might have contributed to this rising trend like, age, body mass index [BMI], lack of physical activity, family history of HTN and smoking etc. In this study, we examine prevalence of HTN in Rawalpindi district of Pakistan using the Eighth Joint National Committee [JNC 8] criteria, with the aim to measure central percentiles of blood pressure [BP] depending on different stated factors. For this purpose, quantile regression is used. A cross-sectional study including 2000 volunteer adults was designed. The data were obtained about systolic BP [SBP], diastolic BP [DBP], gender, age, weight height, family history of HTN, physical activity, presence of any kidney disease and diabetic status etc. Quantile regression was used to estimate the central percentiles of SBP and DBP. The present study concludes that the central percentiles of BP reflect alarming situation as half of the adults fall into either pre-hypertensive or hypertensive category and thus, some special awareness program about HTN should frequently be organized

Assessment of functional health literacy among adolescents of model schools of Islamabad

Objectives: To assess the functional health literacy among adolescents of Model schools of Islamabad. To determine association between health literacy and health seeking behaviour of adolescents. Study Design: Cross sectional descriptive study

Material and Methods: Multi stage systematic sampling was done and a sample size of 350 using WHO sample size calculator. After taking informed consent from the students data were collected using the newest vital sign [NVS] for assessment of functional health literacy. Data were analyzed using SPSS version 22. Place and duration of study: The study was conducted in Model schools of Islamabad, from Jan to Dec 2016

Results: The mean age of the respondents was 15 [SD +/- 0.6] years. There were 181 [52%] females and 169 [48%] males in the study. Out of 350 respondents 73 [20.9%] had very limited health literacy, while 187 [53.4%] had limited while 90 [25.7%] had adequate health literacy. In health seeking 30 students [8.6%] scored 1-2 on the health seeking behaviour score of 1-6 and therefore were categorized as having poor health seeking behaviour. While 164 students [46.9%] scored 3-4 and were categorized as having satisfactory health seeking. One hundred and fifty six students [44.6%] scored 4-5 and had good health seeking behavior

Conclusion: The health literacy among the adolescents was limited and had no association with health seeking behaviour

Frequency and risk factors of frequent exacerbations of asthma in patients in a tertiary care hospital: a hospital-based comparative study

Objective: To determine the frequency of recurrent exacerbations in asthma patients and compare the risk factors for frequent and non-frequent exacerbations. Study Design: Cross-sectional study. Place and Duration of Study: KRL Hospital Islamabad from Jun to Dec 2016

Patients and Methods: Non-probability technique was used to sample two hundred and eighty one patients. Asthma exacerbations were defined by GINA guidelines. Frequent exacerbations were defined as two or more in the previous year. Data regarding demographics and risk factors were collected. Inhaler technique was checked. BMI and blood eosinophil levels were measured. SPSS 22 was used for data analysis

Results: Out of total 281 patients, frequent asthma exacerbations were observed in 143 [50.9%] patients. Female gender [p=0.00] and lower education [p=0.02] led to frequent exacerbations. Patients education about disease or treatment [p=0.03], URTI [p=0.00], allergen exposure [p=0.00], drug history [p=0.04], treatment step-II [p=0.00], medication non-compliance [p=0.00], incorrect inhaler technique [p=0.01], anxiety [p=0.01], previous ICU admission [p=0.02] and blood eosinophilia [p=0.00] were significantly associated with frequent exacerbations. Of these, independent predictors were patient education [p=0.02], URTI [p=0.00], allergen exposure [p=0.00], drug history [p=0.00], treatment step-II [p=0.03], medication non-compliance [p=0.02], anxiety [p=0.01] and eosinophilia [p=0.00]

Conclusion: Majority of our patients underwent frequent exacerbations. Risk factors found to be associated with frequent exacerbations were female gender, lower education, patient unawareness, URTI, allergen and drug exposure, treatment step-II, medication non-compliance, anxiety and blood eosinophilia