ABSTRACT
Background: The 2014 Asia Pacific - Asthma Insight and Management (AP-AIM) study showed that none of the Indian asthmatics had controlled asthma when evaluated objectively. Our study aims to detect through objective measurements, uncontrolled asthma in OPD patients, the adequacy of their inhaler technique, and their awareness regarding the importance of inhaler technique. Method: The asthma Control Test (ACT) score was used to screen for uncontrolled asthma. A validated objective questionnaire and scoring were used to objectively assess the correctness and awareness of the inhalation technique. Result: The study was carried out over 2 month period and 80 patients meeting the inclusion criteria were enrolled. Out of 80 patients; 47 (58.75%) had well-controlled asthma and 33 (41.25%) had uncontrolled asthma. 64 (80%) patients had good, and 16 (20%) had poor inhalation techniques. Among the 64 patients with good inhalation technique 43 (67.18%) had well-controlled asthma and 21 (32.82%) had uncontrolled asthma. Among the 16 patients with poor inhalation technique 4 (25%) had well-controlled asthma and 12 (75%) had uncontrolled asthma. There was a statistically significant association between asthma control and inhaler technique (P value 0.002). In the study population 56 (70%) patients were aware of the inhalation technique and 24 (30%) were unaware of the inhalation technique. Out of the 56 patients who were aware of the inhalation technique 53 (94.64%) had good inhaler technique and 3 (5.36%) had poor inhalation technique. Among the 24 patients who were unaware of the inhaler technique 11 (45.83%) had good inhaler technique and 13 (54.17%) had poor inhaler technique. There was a statistically significant association between awareness of inhaler technique and good inhaler technique (P value 0.001). Conclusion: There is a statistically significant association between asthma control and inhaler technique and between inhaler technique and inhaler awareness. Improving the awareness regarding inhaler technique among bronchial asthma patients is the way forward to improve asthma control in our country.
ABSTRACT
Autoimmune hemolytic anemia (AIHA) is a very rare cause of anemia in a case of malaria and drug-induced AIHA is even rarer. A 50-year old patient with a history of fever for 8 days was diagnosed with a case of complicated malaria with mixed infection having initial parasite index of 45%. He showed good response on initial therapy with artesunate (parasite count reduced to <1%) but his haemoglobin (Hb) continued to drop from 12 g% to 4.9 g% over a course of 11 days. Direct coombs test was positive with reduced haptoglobin and increased lactate dehydrogenase suggesting AIHA. The patient was put on steroids and transfused with saline washed O-negative blood. He gradually recovered over 8 weeks with Hb level rising up to 12 g%. This is a rare case of AIHA following treatment of severe malaria with parenteral artesunate suggesting of the drug immune-related mechanism.
ABSTRACT
Leptospirosis is an important re-emerging infectious disease. Leptospirosis has been estimated to affect tens of millions of humans annually with a case fatality rate ranging from 5% to 25%; however, it is underreported due to the lack of clinical suspicion and barriers to diagnostic capacity. A 33-year-old healthy male presented with a history of fever of 2-day duration. His examination revealed icterus. His workup did not show any significant findings except for a mild transaminitis and a rise in serum creatinine by 0.5 mg/dl. Later, the patient developed bradycardia. An ELISA test for Leptospira antibodies was positive. The patient recovered after a course of intravenous antibiotics. Leptospirosis should be considered early in the diagnosis of any patient who presents with acute, nonspecific febrile illness with multiorgan involvement. Our case had an atypical presentation with involvement of the cardiovascular system in the form of junctional rhythm.
