Body mass index and asthma severity in a population of Nigerian asthmatics.

BACKGROUND: Asthma and obesity have considerable impact on public health. There is increase prevalence of both conditions worldwide. This study was undertaken to determine the prevalence of obesity among asthma patients as well as determine the effect of body mass index (BMI) on asthma severity and pulmonary functions. METHODS: The study was conducted at the asthma clinic of the medical outpatient of Lagos State University Teaching Hospital, Ikeja. Ethical clearance was obtained from the hospital's research and ethics committee. Non probability sampling method was used with consecutive asthma patients diagnosed by the respiratory physicians according to NHLBI guideline recruited into the study. The weight, height and pulmonary function tests were carried out using standard methods. Acarefully designed interviewer administered questionnaire were used to collect information on the socio demographic characteristics of the patient, asthma symptoms, control use of rescue medications and emergency visits. RESULTS: One hundred and fifty eight (158) asthma patients participated in the study. There were 63 (39.9%) males and 95 (60.1%) females. The prevalence of obesity was 53.8%. The mean age of respondents was 46.48 +/- 17.16 years. Age, educational level and employment status were related to the body mass index while gender and duration of asthma were not. There was no difference in the severity of asthma and utilization of emergency services across the BMI categories. The obese asthmatics generally recorded lower lung function volumes compared with the non-obese asthmatic groups. CONCLUSION: Prevalence of obesity is high among the asthmatics studied. There is no difference in asthma severity across the BMI categories. Pulmonary functions are lower in obese asthmatics.

Five-year Audit of Spirometry at the Lasuth; Ikeja; South-West Nigeria

Spirometry is a non-invasive tool of importance in respiratory medicine. There is an enormous burden ofpulmonary disease worldwide, including in Nigeria.This retrospective study was done to determine the utilisation of spirometry services in the Lagos StateUniversity Teaching Hospital (LASUTH). It determined the sources of referral, indications, and pattern of pulmonary abnormalities.This is a retrospective study. An audit was done on the data collected at the Pulmonary Function Laboratory of the LASUTH between September 2006 and October 2011. Spirometry was done using the Gold Standard Vitalograph spirometer. The demographic characteristics of the patients who had spirometry as well as FEV1, (forced expiratory volume in 1 second)FVC (forced vital capacity), and their predicted values were noted.A total of 849 patients had spirometry done over the 5-year period. Slightly more than half were male patients. The mean age of the patient was 50±19 years. There was a steady increase in the number of spirometry tests performed from 2006 reaching a peak in 2009. Thereafter, a sharp decline was seen in 2010 with a steady rise in the first 10 months of 2011.The most common indication for spirometry was in the evaluation and assessment of asthma in 487 patients (57%). Most of the referrals for spirometry were from the medical department of the hospital representing 532 (63%) patients; 202 (24%) of the request were from the general out-patient department by family physicians, while 115 (13%) came from the surgical department. The outcome of the ventilatory abnormalities showed that 372 (44%) had normal ventilatory indices, 206 (24%) had obstructive patterns,169 (20%) had mixed type, while restrictive patterns were seen in 102 (12%).We concluded that although spirometry is frequently used in our clinical practice, this can be improved upon

Understanding medication and use of drug delivery device by asthmatic in Lagos.

BACKGROUND: There are several internationally accepted guidelines for the management of asthma. OBJECTIVE: To examine the utilization of these guidelines in the management of asthmatics as well as the use of inhaler devices among the asthmatics presenting for specialist assessment and treatment in Lagos, Nigeria. METHODS: One hundred and six consecutive patients with physician-diagnosed asthma referred on account of poor control for specialist review participated in the study between April 2006 and March 2007. The setting was the Chest Clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos. The patients aged between 13 and 64 years were interviewed about asthma control using previous hospitalization, frequency of night-time symptoms, and frequency of attendance at The Emergency Unit. Their knowledge of medications was assessed. Inhaler techniques were directly observed. RESULTS: Fifty two (49.1%) had previous hospitalization for asthma. Fifty (47.2%) had weekly nighttime symptoms. Forty-eight (45.3%) had exacerbations requiring treatment at the emergency room in the week preceeding the interview. The metered dose inhaler was the commonest drug delivery device, in use by 72 (67.9%) of the patients. Thirty-two (30.2%) used diskus. Only 10 (10.6%) used nebulisers at any point. The inhaler technique was rated as good by thirty-four (47.2%) out of the seventy-two respondents and poor by thirty-eight (52.8%). Only thirty-four satisfactorily performed all steps. One hundred respondents (943%) skipped their medications. Majority of the asthmatics did not receive any health education about their condition. Possession of peak flow meter and use were low among the patients with only 22 (20.8%) having one. CONCLUSION: Asthma control is poor among the patients in Lagos, Nigeria. Poor knowledge of disease, medication use and inhaler techniques contribute significantly to this problem.

Prevalence of symptoms of asthma, rhinitis and eczema in 13- to 14-year-old children in Africa: the International Study of Asthma and Allergies in Childhood Phase III.

Phase I of the International Study of Asthma and Allergies in Childhood has provided valuable information regarding international prevalence patterns and potential risk factors in the development of asthma, allergic rhinoconjunctivitis and eczema. However, in Phase I, only six African countries were involved (Algeria, Tunisia, Morocco, Kenya, South Africa and Ethiopia). Phase III, conducted 5-6 years later, enrolled 22 centres in 16 countries including the majority of the centres involved in Phase I and new centres in Morocco, Tunisia, Democratic Republic of Congo, Togo, Sudan, Cameroon, Gabon, Reunion Island and South Africa. There were considerable variations between the various centres of Africa in the prevalence of the main symptoms of the three conditions: wheeze (4.0-21.5%), allergic rhinoconjunctivitis (7.2-27.3%) and eczema (4.7-23.0%). There was a large variation both between countries and between centres in the same country. Several centres, including Cape Town (20.3%), Polokwane (18.0%), Reunion Island (21.5%), Brazzaville (19.9%), Nairobi (18.0%), Urban Ivory Coast (19.3%) and Conakry (18.6%) showed relatively high asthma symptom prevalences, similar to those in western Europe. There were also a number of centres showing high symptom prevalences for allergic rhinoconjunctivitis (Cape Town, Reunion Island, Brazzaville, Eldoret, Urban Ivory Coast, Conakry, Casablanca, Wilays of Algiers, Sousse and Eldoret) and eczema (Brazzaville, Eldoret, Addis Ababa, Urban Ivory Coast, Conakry, Marrakech and Casablanca).

Pulmonary function studies in Kuwaiti children with sickle cell disease and elevated Hb F.

Conflicting ventilatory defects have been reported in children with sickle cell disease (SCD). In Kuwait, the disease is relatively mild with a low incidence of acute chest syndrome and other complications, presumably due to the Arab-Indian haplotype chromosomal background and elevated Hb F levels. There have been no previous studies of pulmonary function in patients with this haplotype. Pulmonary function test (PFT) was carried out on 28 steady state children with SCD (21 homozygous sickle cell (SS), seven S beta(o) thal) and two group of controls: 17 age- and sex-matched healthy children and 10 children with HbH disease. The charts of the SCD patients were reviewed for frequency of acute chest syndrome and vaso-occlusive crisis. The mean values of forced vital capacity (FVC) (83.2 +/- 11.9 vs. 91.2 +/- 11.7) and vital capacity (VC) (81.5 +/- 11.8 vs. 90.5 +/- 10.9) were significantly lower in the SS patients compared with healthy controls (p < 0.05). Similarly, these values were significantly lower than in those of the HbH group (p < 0.001 for VC and p < 0.01 for FVC). The mean forced expiratory volume in 1 s (FEV1) was lower in SS patients (86.4 +/- 11.5) compared with healthy controls (94.2 +/- 14.2), but the difference was not significant (p = 0.07). Also, the FEV1 was significantly lower in SS patients than in the HbH group (p < 0.001). There was no significant difference in the PFT parameters between SS patients with acute chest syndrome and those without. Although patients with frequent vaso-occlusive crisis had lower PFT parameters, the differences were not significant in comparison to those with infrequent crisis. This study revealed an early restrictive and obstructive pulmonary function pattern in steady state children with SCD. The finding also indicates that the changes of PFT parameters in SS patients could not be attributed to anaemia per se as patients with HbH who also have chronic anaemia did not show similar changes. This observation underscores the early occurrence of pulmonary involvement, even in patients with an otherwise relatively mild SCD.

Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait.

OBJECTIVE: To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. RESULTS: Seventy-four of 104 (71%) hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 +/- 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients (78%) had a baseline FEV1 <50% before hospitalization and 45 (64%) had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen (19%) died on admission. Risk factors identified included severity of disease (p < 0.05); presence of comorbid disease (p < 0.01); acidemia (p < 0.0001); hypercapnia (p < 0.0001); previous hospitalization (p < 0.01), and assisted ventilation (p < 0.001). CONCLUSION: This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Changes in blood levels of eosinophil cationic protein and tryptase after exercise challenge in adolescents with exercise-induced asthma.

BACKGROUND: Exercise-induced asthma (EIA) is increasingly encountered among school children in Kuwait. Available evidence has shown that inflammatory mediators may be involved in the pathogenesis of EIA. Studies on release of inflammatory mediators have been carried out in adult patients with asthma in Kuwait, but no study on EIA involving children has taken place in this region. OBJECTIVE: To investigate changes in the concentration of some of the mediators involved in EIA in adolescent school children, using exercise challenge. DESIGN: Prospective, case control study. SETTING: Respiratory and Cardiology units Mubarak Hospital, Kuwait, between January and June 2001. SUBJECTS: Nine EIA and 14 non-EIA and 10 normal control subjects, designated as groups one, two and three aged between 13 and 17 years, who were non-smokers, were enrolled for the study. MAIN OUTCOME MEASURES: Blood eosinophils (EOS), eosinophil cationic protein (ECP) and tryptase were estimated pre-exercise, 5 and 30 minutes after exercise. Spirometry was measured at the same period. RESULTS: In group one, ECP and tryptase levels fell after exercise, but significant difference in the levels were obtained only in tryptase between pre-exercise and 30 minutes after exercise (4.1 microg/L Vs 3.8 microg/L) P <0.05, while the difference for ECP was not significant (P=0.09). In group two, both tryptase (6.0 microg/L Vs 5.7 microg/L) P < 0.05, and ECP (21.8 microg/L Vs 12.1 microg/L) P<0.01, fell after exercise. However, in group three, no appreciable difference was observed between pre and post exercise. Correlation between tryptase and EOS (r=0.770; P<0.05) and between tryptase and ECP (r=0.850; p<0.05) was observed pre-exercise and after exercise in groups one and two. CONCLUSION: A fall in the level of the mediators was observed after exercise challenge, but the relevance of this finding in the pathogenesis of EIA remains unclear. Further studies are required to verify this finding.

Clinical patterns of diffuse parenchymal lung disease in Kuwait: a prospective study.

OBJECTIVE: To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease (DPLD). SUBJECTS AND METHODS: Over a 4-year period, 75 patients (41 males, 34 females), aged 13-76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography (HRCT), pulmonary function test and lung biopsy. RESULTS: Of the 75 patients 60 (80%) were over 40 years of age. The duration of symptoms in 34 patients (45%) was less than 6 months and longer than 1 year in 28 (37.7%) patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity (FVC), total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers (p < 0.05). The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases. CONCLUSION: DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear.

Prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 6- to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood.

OBJECTIVE: To determine the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and eczema in Nigerian children aged 6-7 years. SUBJECTS AND METHODS: A cross-sectional study of selected children in primary schools in Ibadan, Nigeria was conducted using phase I of the International Study of Asthma and Allergies in Childhood (ISAAC) format. Standardized questionnaires were distributed to parents and guardians of 2,325 children aged 6-7 years in 31 primary schools randomly selected among 272 in Ibadan. RESULTS: Data was collected from 1,704 children (797 boys and 907 girls; M:F ratio 1:1.14), giving a participation rate of 73.3%. Both recent rhinoconjunctivitis and wheeze were reported by 5.1%, and itchy flexural rash in the past 12 months was reported by 8.5%. The cumulative prevalences of reported symptoms of wheezing, rhinitis and eczema were 7.2, 11.3 and 10.1%, respectively. These symptoms were basically the same among the boys and girls (rhinitis 11.4 vs. 11.2%; eczema 10.7 vs. 9.5%), except for wheezing, which was higher in boys (9.0%) than girls (5.6%), p = 0.015. Current symptoms of rhinitis and atopic eczema were associated with current wheeze and severe wheezing, whereas current symptoms of allergic rhinoconjunctivitis were only associated with severe wheezing attacks. One or more current symptoms occurred in 13.2% of the children, and all three symptoms were reported by 0.5%. CONCLUSION: The study demonstrates a high prevalence of atopic conditions among children 6-7 years old in Ibadan, Nigeria, with more than three fifths of the children who had current wheezing also showing symptoms of other atopic diseases. Children with allergic rhinoconjunctivitis were more likely to have severe wheezing attacks if they had developed atopic eczema before 2 years of age.

Clinicopathological and therapeutic patterns of idiopathic pulmonary fibrosis in Kuwait: a prospective study.

Though common, the exact incidence and clinical pattern of idiopathic pulmonary fibrosis (IPF) in Gulf countries are not known. The results of a four-year prospective study undertaken in two tertiary hospitals in Kuwait are presented. The mean age at diagnosis of the 52 patients studied was 55.40 +/- 11.87 years. Thirty-two (61.5%) patients were male and 22 (42.3%) were smokers. The mean duration of symptoms at diagnosis was 2.1 +/- 0.92 years. Digital clubbing was found in 34 (65%) patients. The mean FVC, TLC and TLCO were 57%, 64.4% and 55% of predicted normal, respectively. The FVC value showed a significant difference between smokers and non-smokers (p < 0.05). HRCT findings were abnormal in all patients. Typical histological and high-resolution computed tomography findings of usual interstitial pneumonia, desquamative interstitial pneumonia and non-specific interstitial pneumonia were observed. This study revealed that IPF is prevalent in Kuwait, with patterns showing some similarities to those established elsewhere. The response to treatment was not encouraging, especially in the usual interstitial pneumonia subtype.

Prevalence of active pulmonary tuberculosis in human immunodeficiency virus seropositive adult patients in University College Hospital, Ibadan, Nigeria.

Infection with Human Immunodeficiency Virus (HIV) has reached a pandemic proportion. There is a resurgence of tuberculosis (TB) Worldwide, this return of an old enemy has been attributed to a number of factors among which HIV infection has emerged as the strongest known risk factor determining the outcome of infection with Mycobaterium tuberculosis (M. tuberculosis). Pulmonary tuberculosis (PTB) accounts for more than 80% of TB cases and is the main problem on account of its frequency and infectivity. There have been studies determining prevalence of HIV in TB cases but that of prevalence of PTB in HIV infected patients have been limited. This study was undertaken to establish the prevalence of active PTB in HIV seropositive adult patients in University College Hospital (UCH), Ibadan. Fifty-eight confirmed HIV-seropositive adults patients were studied. All subjects were interviewed and examined. Subjects with positive respiratory symptoms and signs had their sputum examined and cultured for M. tuberculosis and had chest radiograph done. In this study, the prevalence of active PTB in HIV-seropositive subjects was 32.8% The TB prevalence shows a bimodal distribution at the extremes of age, while the age group 30-39 years had the lowest prevalence of 23.3%.

Pattern of active pulmonary tuberculosis in human immunodeficiency virus seropositive adult patients in University College Hospital, Ibadan, Nigeria.

Fifty-eight confirmed HIV-seropositive adult patients were studied. All subjects were interviewed and examined. Subjects with positive respiratory symptoms and signs had their sputum examined and cultured for Mycobacterium tuberculosis (M. tuberculosis). Their chest radiograph, full blood count (FBC) and erythrocyte sedimentation rate (ESR) were also estimated. Subjects with Pulmonary tuberculosis were treated using directly observed therapy short course (DOTS) regimen. Sixty-three percent of subjects were positive for Mycobacterium tuberculosis on direct smear and/or culture. Sputum acid fast bacilli (AFB) positive subjects who completed the intensive phase of antituberculous drugs were sputum converted at 2 months. The chest x-ray finding at diagnosis showed 2 subjects (11%) with normal chest x-ray; localised lesion in 7 (37%) subjects; diffuse lesion in 7 (37%); pulmonary cavities in 3 (16%); miliary pattern in 2 (11%); pleural effusion in 2 (11%); hilar adenopathy in 2 (11%). Repeat chest-x-ray at 3 months showed complete clearance of pulmonary infiltrates in 29% whilst 71% had appreciable improvement in radiologic features. The study showed that although chest x-ray may be "normal" in sputum AFB positive HIV infected individuals, radiologic picture tends to be more diffuse and extensive. This study was therefore undertaken to determine the pattern of PTB in HIV seropositive adult patients in U.C.H., Ibadan.

An open study to evaluate the safety and efficacy of zafirlukast ("Accolate") in patients with mild to moderate asthma in Ibadan, Nigeria.

An open study to evaluate the safety and efficacy of Zafirlukast (oral leukotriene-receptor antagonist) in patients with mild to moderate asthma was conducted at the out-patient department of the University College Hospital (UCH), Ibadan. A total of 30 patients aged 16-70 years were screened into the trial but 20 patients that fulfilled the inclusion and exclusion criteria were enrolled in a 7-week open study to receive 20mg b.i.d. of "Accolate". Efficacy of treatment was assessed by changes in symptoms, beta-agonist use and pulmonary function tests (PEFR and FEV1). Safety was assessed by adverse experiences, laboratory test results, results of physical examination and chest-x-ray (when necessary). Zafirlukast (Accolate) significantly decreased daytime asthma symptoms scores (28.8%), night-time awakenings (80.76%), morning with asthma (36.4%) and beta-agonist use (31.3%) and significantly increased the mean PEFR values (11.3%); FEV, (17.4%) at end point from their baseline values. Changes in symptoms, beta-agonist use, and pulmonary function occurred within the first week of zafirlukast treatment and continued throughout the trial. Zafirlukast was well tolerated. Headache was reported in two patients. No significant changes were observed in laboratory test results, findings on physical examination. I concluded that zafirlukast produces early and sustained effects in the treatment of mild-to-moderate asthma.

Technetium 99mTc-DTPA clearance in the evaluation of pulmonary involvement in patients with diabetes mellitus.

Systemic thickening of capillary endothelial basement membrane underlies the chronic complications of human diabetic microangiopathy. Since 99mTc-DTPA aerosol scintigraphy is a sensitive, non-invasive test of membrane permeability, we decided to study the effect of diabetes on the permeability of lung epithelium in diabetic patients using this test. Fifty (NIDDM) patients, aged 40-70 years, with or without complications, and who were non-smokers, were subjected to evaluation using 99mTc-DTPA aerosol. At the same time, pulmonary function tests, including carbon monoxide diffusion capacity, were done. Normal non-smoking subjects with no history of cardio-respiratory disease, who underwent 99mTc-DTPA and pulmonary function tests, served as controls. The risk factors which included age, sex, degree of control and presence of complications were noted. Twenty-nine (58%) of the patients had abnormal 99mTc-DTPA clearance. Thirty-four percent of the patients with complications and 24% of those without complications had abnormal clearance. Complications recorded included retinopathy, neuropathy and nephropathy. Fifty-five percent of patients with abnormal 99mTc-DTPA had suffered from diabetes for longer than 10 years. Sixty-two percent of patients with poor glycaemic control had abnormal 99mTc-DTPA. Diffusion capacity was not significantly affected in patients with complicated diabetes. Our preliminary results suggest that 99mTc-DTPA is a potentially sensitive test in assessing the degree of lung affection in diabetic patients. No significant correlation exists between diffusion capacity and 99mTc-DTPA. The risk factors did not affect the 99mTc-DTPA clearance, probably due to the small sample size.

Clinical features and outcome of management of severe acute asthma (status asthmaticus) in the intensive care unit of a tertiary medical center.

AIM OF THE STUDY: The recognition and management of severe acute asthma have attracted considerable attention since the seventies because of the morbidity and mortality that may accompany the condition. Recognition and appropriate management of severe acute asthma is essential. Admission to intensive care, intubation and ventilation risks versus benefit have been argued. We highlight these controversies by documenting our experience and comparing it to others in the literature METHODOLOGY: We prospectively document our experience over a two-year period in the management of severe asthma in the intensive Care Unit (ICU). Patients were established asthmatics, who came in severe exacerbation. Attention was paid to the duration of onset of acute attack, time to presentation, spirometric and blood gas data, the type of treatment given, factors responsible for complications and mortality were identified. The findings in this study were compared with those in similar studies in the literature. RESULTS: A total of 30 patients were studied. Twenty-one patients were ventilated and 9 were not. 82% had a history of asthma longer than 5 years. The duration of symptoms before admission to ICU was very short (one day or less in 57%). Hypercapnia was significantly higher in intubated patients. The duration of stay in ICU and hospital was longer for intubated patients (P<0.02). Complications were higher in intubated patients. CONCLUSION: ICU care provides an excellent setting for management of acute severe asthma. The reported high morbidity and mortality in ICU can be improved. Without ICU care the mortality and morbidity increases,so physicians should not hesitate to admit asthmatics early to ICU.

The association of skin test reactivity, total serum IgE levels, and peripheral blood eosinophilia with asthma in Kuwait.

There is evidence that elevated serum immunoglobulin E (IgE) and eosinophilia correlate well with allergic skin test reactivity. These parameters have been used as alternative methods to characterize atopic subjects. Skin test reactivity is the only measure used routinely in clinical practice in Kuwait to reflect atopy in asthma patients. This study examines the usefulness of the two other parameters of atopy in patients with asthma, and to determine the most common allergens involved in Kuwait. Between 1998 and 1999, 101 asthma patients and 33 healthy controls were recruited for this study. Skin sensitivity test, serum total and specific IgE, total blood eosinophil count (B-EOS), and eosinophil cationic protein (ECP) tests were performed in patients and controls. Nine allergens known to be prevalent in this environment were selected for the skin test and specific IgE test. Spirometry was also measured. These parameters were repeated after 4 weeks of therapy in the patients only. Skin test reaction was positive in 81% of the patients, while total IgE above 200 kU/L was obtained in 63% of cases. B-EOS above 300 x 10(3)/L was found in 75% of cases. House dust mite reactivity (positivity) was the most frequently encountered skin allergy, occurring in 28% of the patients. IgE correlated positively with B-EOS and ECP. B-EOS similarly correlated positively with ECP. There was a negative correlation between ECP and forced expiratory volume in 1 sec (FEV1) (% predicted) as expected. At least one positive parameter of atopy was found in 95% of the patients. In 48% of the patients, all three parameters of atopy were found to be positive. Skin test reactivity and elevated IgE were found together in 62% of the cases. This study reveals a significant degree of allergy among patients with asthma in this environment. Skin testing was found to be the most effective measure of atopy in this environment, and correlates well with the other more sensitive newer tests.

Modified short-course chemotherapy of pulmonary tuberculosis in Ibadan, Nigeria--a preliminary report.

Over a 3 year period 3rd of April 1995 and 6th of April 1998 a controlled clinical trial of the modified short-course chemotherapy (SSC) in newly diagnosed cases of pulmonary tuberculosis in Nigeria was carried out. Between The SCC used was the one adopted from World Health Organisation/International Union Against Tuberculosis and Lung Diseases for developing countries by the Nigerian National Tuberculosis and Leprosy Control Programme (NTLCP). The regimen used consisted of streptomycin (S), isoniazid (H), Rifampicin (R) and pyrazinamide (Z) in the initial or intensive phase of 2 months. Ethambutol (E) was sometimes substituted for streptomycin. The continuation phase was 6 months of thiacetazone, (T) and isoniazid (H), i.e., 2SHRZ/6TH or 2EHRZ/6TH. Sputum conversion was 90% at the second month of treatment and there was no bacteriological relapse after 18 months of follow-up. Side effects were few and consisted mainly of acne vulgaris which occurred in twenty (20.6%) of 97 patients during the continuation phase. It is concluded that the 8-month chemotherapy regimen adopted by NTLCP is efficacious in treatment of smearpositive pulmonary tuberculosis (PTB).

The effect of corticosteroid therapy on blood eosinophils and eosinophilic cationic protein in patients with acute and chronic asthma.

There is evidence that eosinophils are involved in inflammation in asthma, a correlation having been observed between blood eosinophil (B-EOS) count and pulmonary function. It has been suggested that eosinophils, and its product, eosinophil cationic protein (ECP), can serve as markers of disease activity. This paper examines this hypothesis. B-EOS count, serum ECP level, and peak expiratory flow (PEF) were estimated in two groups of asthmatics and controls at three visits in 4 weeks. The mean B-EOS count in acute and stable asthmatic groups was higher than in controls at presentation; the difference was statistically significant (p<0.02). Similarly, mean ECP was higher in the two groups than in controls, but with no statistically significant difference. The B-EOS count and serum ECP level within the groups fell between week 0 and week 4 because of treatment. There was positive correlation between ECP and PEF and also between B-EOS and ECP and PEF. The findings reveal that blood eosinophils reflect some degree of activity in asthmatic patients in the acute and chronic state.

Serum eosinophil cationic protein as a predictor of disease activity in acute and chronic asthma.

BACKGROUND: Eosinophils may contribute to airway hyper responsiveness in asthma through the effects of eosinophil derived granular proteins in the bronchial epithelium. Increased concentration of eosinophil cationic protein (ECP) has been reported in patients with acute and chronic asthma. OBJECTIVE: To examine if ECP can serve as a marker of disease activity in acute and chronic asthma patients. DESIGN: Prospective case control study. PATIENTS: Sixteen non smoking asthmatics in exacerbation (group 1); twenty two in relatively stable state (group 2); and sixteen normal control subjects (group 3) were recruited into the study. SETTING: Casuality and outpatients departments, Mubarak hospital, Kuwait between August 1997 and July 1998. MAIN OUTCOME MEASURES: The mean serum ECP, blood eosinophil count and peak expiratory flow rate (PEFR). RESULTS: There was a statistically significant difference between the groups in blood eosinophil count (p < 0.01) and in PEFR (p < 0.0001). At week four, the mean ECP and blood eosinophil count fell as a result of therapy in group 1. The difference in PEFR values between week 0 and 4 in group 1 reached statistical significance (p < 0.05). In group 2 patients, the mean serum ECP, blood eosinophil count and PFER values between week 0 and 4 did not show any significant difference. A correlation was observed between ECP and PEFR in group 1 (p < 0.05) and between ECP and eosinophil count in group 2 (p < 0.01). CONCLUSION: Serum ECP has the potential to serve as a marker for predicting and monitoring the clinical course of asthma. Further studies are required to verify these baseline findings in our environment.

The predictive value of provisional clinical diagnosis in the evaluation of respiratory disorders.

BACKGROUND: Many non-pulmonary physicians in hospital and family care practice base the diagnosis of pulmonary disorders on clinical impressions made from the history and physical examination. Experience has shown that relying on these parameters alone is not adequate, since this may result in missing a significant number of diseases, or in the unnecessary treatment of others. This study set out to compare the sensitivity, specificity and positive predictive value of the clinical assessment (provisional clinical diagnosis or PCD) with the combined clinical assessment and other investigations, including pulmonary function test (PFT). PATIENTS AND METHODS: One thousand and fifteen (1015) patients referred for PFT to the pulmonary function laboratory of a teaching hospital were involved in the study. The referring physicians were asked to fill a specially prepared form giving details of the patientsâ history and clinical assessment. The PFT was performed using an Erich-Jager Master Lab. RESULTS: Analysis of the final diagnosis revealed that only 51% of patients with a pre-evaluation diagnosis of asthma were actually confirmed to have asthma after further tests. Similar findings of 59% and 52% of patients with chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis were observed, respectively. The positive predictive value of PCD for asthma and lung fibrosis was 64.1% and 61.9%, respectively, while that for COPD was 74.2%. CONCLUSION: This study showed conclusively that the predictive value of provisional clinical diagnosis in the evaluation of pulmonary disorders is usually inadequate, and needs to be augmented with additional simple investigations such as PFT, in order to establish a more accurate diagnosis.