Evaluation of Asthma Control in Children Using Childhood- Asthma Control Test (C-ACT) and Asthma Therapy Assessment Questionnaire (ATAQ).

OBJECTIVE: To evaluate the efficacy of Childhood-asthma control test (C-ACT) and the Asthma therapy assessment questionnaire by (ATAQ) checking its consistency with Global Initiative for Asthma (GINA) criteria. METHODS: Asthma control of 97 children was assessed using C-ACT, ATAQ and GINA criteria separately, and their results were compared. RESULTS: C-ACT had better performance for evaluating control as per GINA criteria with sensitivity of 48.3%, specificity of 68.9%, and area under the receiver operative curve (ROC) of 0.647. The above parameters for ATAQ were: 93.1%, 17.2% and 0.552, respectively. A cut-off score of 20 for C-ACT is more suitable as it has maximum ROC area (0.667), and higher kappa score (0.315); P= 0.001. CONCLUSION: C-ACT can be validity used to monitor asthma control. However, the cut-off score 20 is more accurate for the Indian population. The performance of ATAQ in evaluating asthma control is not satisfactory.

Spastic quadriparesis caused by anomalous vertebral artery compression of spinal cord at the cervico-medullary junction.

Vascular compression of medulla or spinal cord at the cervico-medullary junction has been commonly described in the literature and is often attributed to dolichoectasia of the vertebrobasilar arteries. We describe a case of anomalous course of the cervical segments of the bilateral vertebral arteries which were seen entering the spinal canal directly after exiting the transverse foramen of axis and causing significant cord compression at the cervico-medullary region leading to spastic quadriparesis.

Reversible cerebral vasoconstriction syndrome in a patient with systemic lupus erythematosus.

A 42-year-old woman, a diagnosed case of systemic lupus erythematosus (SLE), developed severe headache followed by left hemiparesis and cortical blindness. Magnetic resonance imaging (MRI) of brain demonstrated right parieto-occipital infarct and the patient was initiated on high-dose steroids and antiplatelet agents with which the patient had clinical and radiological deterioration. Magnetic Resonance angiography showed severe narrowing of bilateral anterior, middle, and posterior cerebral arteries (PCA) suggestive of reversible cerebral vasoconstriction syndrome (RCVS). Patient was treated with IV nimodipine and she recovered over a period of 2 weeks. Repeat MR-angiography done on day-30 was normal. The diagnosis of RCVS in patients with SLE is of practical importance, because treatment and prognosis for SLE-associated cerebral vasculitis differ strongly from the treatment of RCVS. Empirical high-dose glucocorticoid therapy should be avoided in patients with typical features of RCVS.

Massive gastrointestinal bleeding in a patient with AIDS.

Cytomegalovirus enteritis can lead to gastrointestinal bleeding in patients with the acquired immune deficiency syndrome. The commonest site of involvement is the colon, followed by the stomach and terminal ileum. Most of these lesions can be diagnosed by colonoscopy or gastroscopy. We present our experience of a patient with cytomegalovirus infection involving only the proximal jejunum causing massive lower gastrointestinal bleeding. Conventional endoscopy and imaging had failed to locate the source of bleeding. Enteroscopy performed at the time of laparotomy showed an ulcerated lesion in the jejunum. Resection followed by histological examination of the resected area confirmed the diagnosis of cytomegalovirus infection. In addition to highly active antiretroviral therapy, ganciclovir was given for 14 days in a dose of 5 mg/kg twice a day and tapered over a period of 3 months. There has been no further episode of gastrointestinal bleeding over a follow up of 9 months.

Haemorrhage during cranial CT : spontaneous or contrast related?

Two cases of haemorrhage during cranial computed tomography (CT) occurring during the enhancement phase of CT examination immediately after the administration of intravenous contrast medium are reported. In both cases, the preceding unenhanced scansshowed evidence of haemorrhage. The risk of aneurysmal rupture as a result of retching and vomiting induced by intravenous contrast is stressed. Judicious use of contrast enhanced CT is suggested in patients with suspected aneurysmal subarachnoid haemorrhage.