Role of Montelukast in Improving Quality of Life in Patients with Persistent Asthma.

Introduction Maintenance therapy of asthma has a crucial role in keeping the disease dormant and preventing frequent acute exacerbations. Asthma control may be achieved by inhaled corticosteroids (ICS) and/or long-acting beta-agonists (LABA). Leukotriene receptor antagonist - montelukast - may be added as an add-on to ICS/LABA or may also be given in monotherapy. The aim of this study was to evaluate the role of montelukast monotherapy as asthma control and its impact on the quality of life of these patients. Methods In this prospective, open-label, interventional study, montelukast 10 mg once daily was given to patients with mild to moderate persistent asthma for four weeks. Quality of life (QOL) was assessed on the Asthma Quality of Life Questionnaire - Standard (AQLQ-S) questionnaire. Asthma control was assessed on the Asthma Control Test (ACT). Data was entered and analyzed using SPSS version 23.0. Results On AQLQ-S, overall QOL improved with one month of montelukast therapy significantly. On sub-scales, except for emotional function, all other three sub-scales including symptoms, activity limitation, and environmental function improved significantly. Asthma control score also significantly improved with one month of montelukast therapy. Conclusion Montelukast has an effective role in asthma control and improvement of QOL in patients with mild to moderate persistent asthma.

Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country.

Introduction Any infection occurring at the site of a surgical incision superficially or deep within the fascia, within 30 days of a surgical procedure is termed as a surgical site infection (SSI). Due to limited resources, non-adherence to infection control guidelines and substandard sterilization practices, the incidence is higher in developing countries. The aim of this study is to estimate the incidence of surgical site infections in general surgeries at a tertiary care hospital in Pakistan and identify the predisposing risk factors. Methods This was a retrospective analysis that included all surgical records from June 1, 2018, to December 31, 2018. After exclusion, 882 records were included. The incidence of SSI and predisposing risk factors were noted. Data were entered and analyzed using SPSS v. 22.0 (IBM Corp, Armonk, NY, US). Results The incidence of SSI was 8.84% (n=78). SSIs were more common in older participants (11.4% vs. 6.4%; p=0.009), in patients with more than 24 hour of preoperative hospital stay (11.2% vs. 64%; p=0.013), in procedures of longer duration (1.53 ± 0.35 vs 2.57 ± 0.17; p<0.0001), and in emergency surgeries (19.2% vs. 7.5%; p=0.0001). The combined incidence of SSIs in American Society of Anesthesiologists (ASA) index III and above was 37 (47.4%) and that in I and II was 41 (52.6%) (p<0.00001). Conclusion This study has revealed a very high incidence of surgical site infections. These infections are more common in elderly patients, patients undergoing emergency surgeries, those with longer preoperative hospital stay and longer surgical duration, and patients with a high ASA index.

Frequency of Cognitive Impairment in Patients with Parkinson's Disease.

Introduction More than its motor symptoms, cognitive impairment is being increasingly identified as a cause of worse functional outcome, morbidity and mortality, and caregiver dependence in Parkinson's disease (PD). The aim of this study was to identify the frequency of cognitive decline and evaluate the factors associated with it. Methods In this cross-sectional study, 124 PD patients fulfilling the United Kingdom Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria were included. Motor and non-motor symptoms were recorded. Disease duration, age at the time of onset, and severity of disease on Hoehn and Yahr Scale (HY scale) were recorded. Data was entered and analyzed using SPSSs v. 22.0. Results The ratio of men to women was 7.2:1. The mean age of the participants was 64 ± 10 years (range: 38-82 years). Rigidity (n = 121; 97.5%), bradykinesia (n = 119; 95.9%), and tremor (n = 11; 90.3%) were the three most common symptoms. Cognitive impairment was present in 45 (36.3%) patients. Cognitive decline was more frequent in patients of age less than 50 years at the time of disease onset (p < 0.00001) and in those with disease duration more than 10 years (p = 0.00001). Patients with longer disease duration had more severe disease (stage III or above on HY scale; p = 0.008). Conclusion Motor symptoms such as rigidity, bradykinesia, and tremor remain the most frequent clinical presentation among Pakistani Parkinson's patients. One-third of these patients have cognitive dysfunction. Early age at the time of disease onset and longer duration of disease were associated with cognitive impairment.

Severity of Caregiver Stress in Relation to Severity of Disease in Persons with Parkinson's.

Introduction Parkinson's disease (PD) is a progressive neurological disorder. It presents with motor symptoms and gradually progresses to cognitive impairment. It has debilitating impact not only on the psychological health of the patient but also of the caregivers. The aim of this study is to evaluate the stress level among caregivers of PD and assess its correlation with the disease factors including duration, severity, and presence of on-off phenomenon. Methods One hundred and fifty-six patients of Parkinson's disease and their caregivers were enrolled. Severity of Parkinson's disease was assessed using Hoehn and Yahr Scale. Caregiver stress was evaluated using Caregiver Burden Inventory. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA). Results There were 112 (71.8%) women and 44 (28.2%) men in the caregiver group. Their mean age was 47.75 ± 11.98 years. There were 98 (62.8%) stressed caregivers and 58 (37.2%) non-stressed caregivers. In patients with stage 4 and 5 PD, 67-80% caregivers were stressed as compared to only 28% caregivers of stage 1 PD (p-value = 0.0008). Duration of Parkinson's disease more than 10 years and presence of on-off phenomenon was also significantly associated with higher stress in the caregivers (p-value < 0.00001; p-value = 0.002, respectively). Among the stressed caregivers, 85 (86.7%) were women and only 13 (13.3%) were men (p-value < 0.0001). Conclusion Psychological health of caregivers of persons with Parkinson's is bleak. As the disease progresses, they further succumb to debilitating stress and depression. Qualitative and quantitative studies must be conducted in Pakistan to understand the psychosocial status of Parkinson's disease caregivers and plan strategies to improve their quality of life.