Utility and benefits of sulfonylureas beyond glycemic control

Department of medicine, Educare institute of dental science Malappuram, Kerala and SafeCare clinics, Tirur, Keralasulfonylureas (SUs) are one of the oldest, time tested and most commonly used oral antidiabetic agent in Type 2 diabetes. Modern SUs like glimepiride and gliclazide XR were preferred over conventional SUs due to its better efficacy and minimal side effects. The use of Modern SUs in the treatment armamentarium of T2DM has evolved, over past few decades. Modern SUs possesses beneficial pancreatic glucose lowering effect and more interestingly extra-pancreatic pleiotropic benefits. This review article discusses on the utility and benefits of SUs beyond glycemic control and explaining on their pleiotropic effects.

Hughes-stovin syndrome and massive hemoptysis: a management challenge

Hughes-Stovin syndrome is a very rare clinical entity characterized by pulmonary artery aneurysms and deep vein thrombosis [DVT]. Here we report the case of a 53-year-old man, admitted to Sultan Qaboos University Hospital, Muscat, Oman, with bilateral pulmonary artery aneurysms and lower-limb DVT who developed massive hemoptysis. He was managed successfully with high-dose steroids in combination with cyclophosphamide

Severe pulmonary involvement in leptospirosis. Alternate antibiotics and systemic steroids

Pulmonary complications in leptospirosis, though common, are often unrecognized in a non-endemic area. We report here a patient with leptospirosis and severe pulmonary involvement who was treated with meropenem [1 g every 8 hours], moxifloxacin [400 mg once daily], and high doses of corticosteroids. Systemic steroids were continued for 3 months because of persistent pulmonary lesions

Is clinical judgment of asthma control adequate? A prospective survey in a tertiary hospital pulmonary clinic

Asthma control is often difficult to measure. The aim of this study was to compare physicians' personal clinical assessments of asthma control with the Global Initiative for Asthma [GINA] scoring. Physicians in the adult pulmonary clinics of a tertiary hospital in Oman first documented their subjective judgment of asthma control on 157 consecutive patients. Immediately after that and in the same proforma, they selected the individual components from the GINA asthma control table as applicable to each patient. The same classification of asthma control was achieved by physicians' clinical judgment and GINA classification in 106 cases [67.5%]. In the other 32.5% [n = 51], the degree of control by clinical judgment was one level higher than the GINA classification. The agreement was higher for the pulmonologists [72%] as compared to non-pulmonologists [47%; P = 0.009]. Physicians classified 76 patients [48.4%] as well-controlled by clinical judgment compared to 48 [30.6%] using GINA criteria [P <0.001]. Conversely, they classified 34 patients [21.7%] as uncontrolled as compared to 57 [36.3%] by GINA criteria [P <0.001]. In the 28 patients who were clinically judged as well-controlled but, by GINA criteria, were only partially controlled, low peak expiratory flow rate [PEFR] [46.7%] and limitation of activity [21.4%] were the most frequent parameters for downgrading the level of control. Using clinical judgment, physicians overestimated the level of asthma control and underestimated the uncontrolled disease. Since management decisions are based on the perceived level of control, this could potentially lead to under-treatment and therefore sub-optimal asthma control

Acute drug overdose: clinical profile, etiologic spectrum and determinants of duration of intensive medical treatment

Acute drug overdosing is an important cause of organ dysfunction and metabolic derangements and the patients often require intensive care. This study aims to determine the clinical pattern of severe drug overdose as well as the factors influencing the duration of intensive care. The clinical characteristics and course of consecutive adult patients admitted with a diagnosis of acute drug poisoning in the ICU of a tertiary hospital in Oman from January 2007 to December 2008 were reviewed retrospectively from the electronic case records. Acute drug poisoning [n=29] constituted 3.9% of admissions to the ICU. Mean age was 29.38 +/- 7.9 years. They were brought in by their relatives [72%] or the state services [24%]. Accidental poisoning was noted in 21 patients [72%] and suicidal overdosing in 6 [21%]. The commonest drug was an opioid [65.5%]. Glasgow Coma Scale score of

High resolution computed tomography in asthma

High-resolution computed tomography [HRCT] can detect the structural abnormalities in asthma. This study attempts to correlate these abnormalities with clinical and pulmonary function test [PFT] data. Consecutive stable asthma patients attending Mubarak Al Kabeer Hospital, Kuwait, were subjected to HRCT during a six month period from July 2004 to December 2004, after initial evaluation and PFT. Of the 28 cases, sixteen [57.1%] had moderate, 6 [21.4%] had mild and 6 [21.4%] had severe persistent asthma. Thirteen [46.4%] patients had asthma for 1 to 5 years and 12 [42.9%] were having asthma for >10 years. Bronchial wall thickening [57.1%], bronchiectasis [28.6%], mucoid impaction [17.9%], mosaic attenuation [10.7%], air trapping [78.6%] and plate like atelectasis [21.4%] were noted. Bronchial wall thickening [p=0.044] and bronchiectasis [p=0.063] were most prevalent in males. Ten [35.7%] patients exhibited mild, 9 [32.1%] had moderate and 3 [10.7%] had severe air trapping. The difference in Hounsfield units between expiratory and inspiratory slices [air trapping] when correlated with percent-predicted FEV1 in right upper [r=0.25; p=0.30], left upper [r=0.20; p=0.41], right mid [r=0.15; p=0.53], left mid [r=-0.04; p=0.60], right lower [r=0.04; p=0.86] and left lower zones [r=-0.13; p=0.58] showed no relation. The same when correlated as above with the percent predicted FEF 25-75 did not show any significant association. The presence of air trapping was compared with sex [p=0.640], nationality [p=1.000], disease duration [p=1.000] and severity of symptoms [p=0.581]. Abnormal HRCT findings are common in asthma; however, air trapping when present was not related to the duration or severity of the illness or to the FEV1

Management and control of asthma in patients attending a specialist centre in Oman

The management of asthma by specialists is likely to become more evidence-based. This study analysed the characteristics of patients reporting to a specialist clinic including demographics, dispensed medications and the level of asthma control. All consecutive stable asthmatics seen in the adult pulmonary clinics of Sultan Qaboos University Hospital, Oman, between December 2005 and November 2006 were prospectively evaluated using a structured assessment protocol. Of the 207 patients, [mean age 40.64 +/- 14.8], 72% were females. The majority, 83.1%, had moderate persistent asthma. A positive history of allergic rhinitis, eczema and a family history of asthma were obtained in 58.0%, 11.1%, and 50.7% of patients respectively. Total serum immunoglobulin E [IgE] was elevated in 66.7%. Skin testing was positive for more than 2 antigens in 52.3%, with the house dust antigen being reactive in 49%. Inhaled steroids, long-acting beta agonists [LABA], antihistamines and leukotriene receptor antagonists were prescribed in 94.2%, 85%, 54.5% and 11.6% of cases respectively. The majority [40.1%] was receiving medium dose inhaled steroids. Although asthma was controlled in 162 [78.3%], during the previous month 66 [31.9%] patients had visited the emergency department and 31 [15.0%] patients were hospitalised at least once during the previous year. Only 63 [30.4%] patients were using their inhalers correctly. Good compliance with inhaled steroids was observed in only 53 [25.6%] patients. Allergic comorbidities and a strong family history of asthma were common. Although the level of asthma control in the previous month was high, it was much lower in the long term. The concepts of short term, long term and total control of asthma need to be explored

Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait

The aim of this study is to determine the microbial etiology and severity of community-acquired pneumonia [CAP] in Kuwait. The severity of consecutive adult CAP cases admitted to 3 hospitals over a 1-year period was classified according to the Pneumonia Outcome Research Team [PORT] severity index. The microbial etiology was determined using st and ard methods for bacteria and serological tests for atypical and viral pathogens. The study population was 124 of the 135 admissions; 63 female, 61 male; mean age 41.3 +/- 18 years. The severity class distribution was: class 131%, class II 37%, class III 17%, class IV 13%, and class V 2%. Etiological agents were identified from 44 patients [35%], with one pathogen in 31 [25%], two in 9 [7%], and three or more in 4 [3%]. The most common pathogens identified were: Mycoplasma pneumoniae in 14 patients [11%], Legionella pneumophila in 10 [8%], Chlamydia pneumoniae in 8 [6%], influenza B virus in 8 [6%], influenza A virus in 5 [4%], Haemophilus influenzae in 4 [3%], Streptococcus pneumoniae in 3 [2%], Staphylococcusaureus in 3 [2%], gram-negative enterobacteria in 5 [4%], Moraxella catarrhalis in 2 [2%], and viruses in 4 [3%]. The yields from laboratory tests were 48% for paired serology, 20% from adequate sputum sample, and 3% from blood culture. Our study shows that a large percentage of mild CAP cases are admitted to hospitals in Kuwait, Atypical pathogens have a significant role in the etiology of CAP. There is overtreatment of CAP with a combination treatment consisting mainly of third-generation chephalosporins and macrolides

Clinical patterns of diffuse parenchymal lung disease in Kuwait: aprospective study

To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease [DPLD]. Subjects and 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. 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. 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

Flexible fiberoptic bronchoscopy. Diagnostic yield

Fiberoptic bronchoscopy is a minimally invasive procedure with a high diagnostic yield. The aim of this study was to document the usefulness of the procedure in the diagnosis of various respiratory disorders in a Middle East country. Data on all bronchoscopies carried out in Chest Diseases Hospital, Kuwait from January 1996 to December 1998 were retrospectively collected. Out of 968 cases, only 620 [64%] patients had a full follow up. Suspected pulmonary tuberculosis [TB] [51.6%], unresolving pneumonia [16.1%], hemoptysis with a normal chest radiograph [8.4%], lung mass [7.7%] and hilar lymphadenopathy [3.2%] were the most common indications. Eleven% of patients who underwent bronchoscopy had a normal chest radiograph, the reason being hemoptysis in 75.4%, inhalation injury in 21.8% and suspected upper airway obstruction in 2.9%. In smear negative suspected TB cases, 22.5% proved to have active disease. Acid fast bacillus was identified in bronchoalveolar lavage, either by smear or culture, in 44 [73.3%] patients with suspected pulmonary TB and in 6 [54.5%] patients with miliary shadows. An underlying cause was identified in 28 [28%] patients with unresolving pneumonia. Ninety-four% of cases with clinical impression of bronchogenic carcinoma could be diagnosed. Transbronchial biopsy was diagnostic in 79% patients with diffuse parenchymal lung disease. No complications other than transient hypoxemia and controllable bleeding were noticed. Generally, the indications for flexible fiberoptic bronchoscopy remained similar to elsewhere. Unlike western series, the majority of the cases were for the diagnosis of pulmonary infections especially TB