Guidance on the diagnosis and management of asthma among adults in resource limited settings.

BACKGROUND: Optimal management of asthma in resource limited settings is hindered by lack of resources, making it difficult for health providers to adhere to international guidelines. The purpose of this review is to identify steps for asthma diagnosis and management in resource limited settings. METHODS: Review of international asthma guidelines and other published studies on diagnosis and management of asthma. RESULTS: We establish that clinical diagnosis of asthma can be made if recurrent respiratory symptoms especially current wheeze or wheeze in the last 12 months are present. Presence of a trigger, other allergic diseases, personal or family history of asthma; clinical improvement and increase in the peak flow and forced expiratory volume in one second of ≥12% after salbutamol administration increases the likelihood of asthma. At diagnosis severity grading, patient education, removal or reduction of trigger should be done. Follow up 2-6 weeks and assessment of control during therapy is essential. Therapy should be adjusted up or down depending on control levels. Patients should be instructed to increase the frequency of their bronchodilators and/or steroids therapy when they start to experience worsening symptoms. CONCLUSION: Good quality asthma care can be achieved in resource limited settings by use of clinical data and simple tests.

Prevalence of positive tuberculin skin test and associated factors among Makerere medical students, Kampala, Uganda.

BACKGROUND: Tuberculosis infection among medical students is thought to be higher than that among comparable groups. OBJECTIVES: To determine the prevalence of positive Tuberculin Skin Test (TST) and associated factors among medical students at Makerere University. METHODS: A-cross-sectional study among randomly selected medical students. Using intra-dermal technique, TST was performed by administering 0.1ml of purified protein derivative. Readings performed after 72 hours and positive TST based on an induration of ≥10mm. RESULTS: Of 302 students selected to participate, 292 received TST and 288 were analyzed. Of 288 students, 173(60%) were pre-clinical (years 1-3) and 115(40%) clinical (years 4&5). Overall 130 students [45.1%(C.I.39.3-51.1)] had positive TST, not different from one derived from mixture analysis [46.3%(95% Bayesian credibility interval 36.5%-55.8%)]. Positive TST prevalence among pre-clinical was 39.9%(67/173) compared to 53.0%(61/115) among clinical students, OR=1.70,C.I.(1.06-2.74) and increases in a linear pattern with increasing years of study (p=0.002,OR=5.04). CONCLUSION: The prevalence of TB infection among medical students was twice higher than that of adults living in the suburbs and higher among those in clinical relative to pre-clinical years suggesting that exposure and infection might be related to clinical work. We recommend urgent institution of infection control measures.

Risk factors for asthma exacerbation in patients presenting to an emergency unit of a national referral hospital in Kampala, Uganda.

BACKGROUND: Asthma exacerbations are caused by a variety of risk factors. Reducing exposure to these risk factors improves the control of asthma and reduces medication needs. Knowledge of the particular risk factors is essential in formulating controlling and treatment protocols. This study set out to determine the risk factors for asthma exacerbations in patients presenting to the emergency unit of Mulago Hospital. METHODS: An unmatched case-control study involving 43 cases and 43 controls was conducted from November 2011 through February 2012. Asthma patients with exacerbations presenting to Mulago hospital's emergency unit were chosen as cases. The controls were asthma patients recruited from the hospital's outpatient department who had not had an exacerbation in the past 7 days. The study variables were age, sex, level of education, adherence to treatment, exercise, upper respiratory tract infections, household pets, smoking, strong emotions, exposure to in house wood or charcoal burning, weather, use of corticosteroids, beta-blockers and non-steroidal anti-inflammatory drugs. Univariate and multivariate statistical analysis was done using SPSS version 16 to identify independent risk factors for exacerbations. RESULTS: Lack of corticosteroid use (OR = 22.109; 95% Confidence interval 6.952 to 70.315; p < 0.001) and presence of upper respiratory tract infections (OR 4.516; CI 1.258-16.213; p = 0.018) were significantly associated with exacerbations. CONCLUSION: Lack of corticosteroid use and upper respiratory tract infections are associated with exacerbations in asthma patients presenting to the Emergency unit of Mulago Hospital.

Destructive rib lesions in an HIV sero-negative male: an unusual presentation of tuberculosis in a high tuberculosis prevalence setting.

Tuberculosis (TB) of the rib is a very rare form of skeletal TB and its diagnosis may be difficult because of a low index of suspicion by clinicians. The presentation often mimics malignant disease clinically and radiologically and diagnosis may only be confirmed by tissue biopsy. We present a 32-year-old HIV-negative man who presented with a three-month history of progressively worsening pleuritic chest pain, weight loss, fatigue, anorexia and low-grade fever with night sweats. A chest computerized tomography (CT) scan showed destructive lesions in the right fourth and seventh ribs with no pulmonary lesions. A diagnosis of TB of the rib was made after surgical resection and histopathology of the affected tissue. There was significant improvement when anti-TB therapy was initiated. This case report emphasizes the importance of a high index of suspicion of TB in patients presenting with destructive bone lesions in regions with high prevalence of TB.