Suboptimal compliance to aerosol therapy in pediatric asthma: A prospective cohort study from Eastern India.

BACKGROUND: Suboptimal compliance to aerosol medication is common in pediatric asthma. Accordingly, the objective of this study is to assess noncompliance to aerosol therapy in childhood asthma and determine contributory factors. MATERIALS AND METHODS: A prospective cohort study was conducted among pediatric patients attending asthma clinic. Patients (n = 215) having "mild" and "moderate" asthma severity rating were included. The total study duration was 12 months (June 2016-June 2017), with an active recruitment phase of 6 months. The minimum period for follow-up was 90 days. Caregivers were instructed to maintain an "asthma diary" for daily dosages of inhalers. At follow-up, the diary entries were corroborated with the amount of inhaler medication unused. Subsequently, medication compliance ratio (CR) was calculated according to the following formula: CR = number of medication doses taken/number of medication doses prescribed. CR% >80 was considered as "good compliance". RESULTS: A total of 169 patients (78.6%) returned for follow-up. The mean compliance to asthma medication was suboptimal (75.3%). The children were primarily prescribed inhaled corticosteroids and short-acting beta-agonist (SABA)-based regimens on index visit. Leukotriene receptor antagonist was added in select cases (67.9%). Nearly 45.6% of the patients had "good compliance." CR correlated with the sociodemographic profile and disease severity. Higher socioeconomic status and proper inhaler technique reflected better symptom control. Fear of side effects, behavioral difficulties, and economic restrictions were the identified causes of medication default. CONCLUSION: In the Eastern part of India, compliance to aerosol therapy in pediatric asthma is suboptimal. Sociodemographics, disease severity, and inhaler technique are important determinants.

Congenital Cystic Adenomatoid Malformation, Type II: A Rare Cause of Haemoptysis.

Congenital cystic adenomatoid malformation (CCAM) occurs secondary to the cystic adenomatous over-growth of terminal bronchioles, which results in the secondary inhibition of alveolar growth. In most of the cases, respiratory distress is the presenting feature during the neonatal period. In about 90% of patients, recurrent respiratory infections necessitating chest imaging reveal CCAM before the age of two years. We describe here the occurrence of congenital cystic adenomatoid malformation of right lung in a 12-year-old girl presenting with haemoptysis and hypovolaemic shock. She underwent right middle lobectomy; and histopathological examination confirmed the diagnosis. She has been doing well on follow-up.

Childhood multiple sclerosis mimicking acute disseminated encephalomyelitis.

Multiple sclerosis is a demyelinating disease affecting people in early to middle adulthood and is uncommon in childhood. Here we report a patient of multiple sclerosis who presented much before 10 years of age with features suggestive of acute disseminated encephalomyelitis and altered sensorium which is quite different from the features of multiple sclerosis in adults. Diagnosis in this patient was made on the basis of predominant white matter involvement with clinically remitting and relapsing course of the disease on follow up over 3 1/2 years, substantiated by finding multiple areas of demyelinating plaques in magnetic resonance imaging, while visual evoked potential and cerebrospinal fluid study supported demyelination. Hence, children with initial diagnosis of acute disseminated encephalomyelitis need long term follow up as they may develop multiple sclerosis.

Efficacy of oral rehydration therapy in dehydrating diarrhoea of children.

Establishment of diarrhoea treatment and training units (DTTUs) in all major health facilities for promotion of appropriate oral rehydration therapy (ORT) is an important strategy for control of diarrhoeal diseases (CDD) in children in this country. Univariate analysis of mortality experiences of a random sample of 225 diarrhoea cases among children treated at DTTU in the department of paediatric medicine, RG Kar Medical College, Kolkata revealed that case fatality rate (CFR) of diarrhoea was much higher among children treated with parenteral fluid therapy with or without drugs (20.6% and 20.9% respectively), compared to those treated with oral rehydration solution (ORS) only (0.75%). Certain child care practices, like immunisation, breastfeeding and use of ORS at home also favourably influenced survival of children suffering from diarrhoea. The CFR of diarrhoea cases did not depend on type of diarrhoea or nutritional status of the child. Thus, promotion of correct practice of ORT merits attention through all possible means.