Pulmonary manifestations in malaria.

Malaria, a major killer of mankind, apart from classical ague presentation, may present with respiratory manifestations. This may be misdiagnosed and important time may be lost in instituting antimalarials leading to higher morbidity and mortality. Present work was undertaken to study the clinical presentations of malaria with special reference to respiratory system and to evaluate the effect of antimalarials to such atypical presentation. One hundred slide positive cases of malaria were taken and detailed for respiratory involvement. Response to antimalarials was seen in these cases and associated complications (if any) were looked for. Mean age of the cases was 29.3 years with a male predominance. Positivity of peripheral smear read as: P vivax(53%), P falciparum (36%) and mixed infection (11%). Twenty-six patients had presented with respiratory manifestations-bronchitis (15), pneumonia (4), asthmatic bronchitis (1), adult respiratory distress syndrome (ARDS) (4) and pulmonary tuberculosis (2). Of these 26 cases, presenting symptoms noticed were cough (77%), dyspnoea (32%), expectoration (29%) and chest pain (15%). Twenty-five (96%) of these 26 patients were positive for P falciparum. Response to antimalarials was not significantly different in these 26 patients as compared to the rest (74 cases). All patients developing ARDS expired. The present study concludes that malarial atypical respiratory presentations are far higher in incidence than reported in literature. Peripheral smear examination in all patients of high grade fever with chills and rigors and having respiratory manifestations may unmask malarial infection and warrant early antimalarial treatment resulting in decreased morbidity and mortality.

Double-blind crossover study of carbuterol and salbutamol in bronchial asthma.

A double-blind crossover comparative study between carbuterol 3 mg thrice daily, carbuterol 2 mg thrice daily and salbutamol 4 mg thrice daily by the oral route was conducted in thirty patients suffering from bronchial asthma, selected at random, with more than 20% reduction in airway obstruction following isoprenaline inhalation. Each patient received all three drugs consecutively, each for 6 days, with a wash-out period in-between. The present study established a relative superiority of carbuterol 3 mg thrice daily over carbuterol 2 mg and salbutamol 4 mg thrice daily as evidenced by a higher percentage of subjective improvement (78.8%), preference shown by more cases (17/27), and need of additional drugs in a minimum number of cases (6/27), and significant improvement in FEV1 and MMEFR (p less than 0.05). Salbutamol is known to produce tachycardia and a rise in blood pressure. There were no adverse side-effects on the cardiovascular system but unlike salbutamol, carbuterol produced a fall in pulse rate and blood pressure which should make carbuterol more acceptable to patients, especially on prolonged usage. There was an absence of significant side-effects on the haemopoietic system and kidneys; other side-effects observed with all three types of treatment were of a minor nature and did not necessitate withdrawal of the drug. Thus, carbuterol is an effective and safe selective beta 2-adrenergic stimulant, is relatively free from side-effects, and has a sustained bronchodilator effect, an advantage in therapeutic application, and is, as a result, a new effective drug in the management of bronchial asthma.