Comparative Efficacy of Anti-asthma Therapy in Non-asthmatic Cough: A Cross-Sectional Study in Dubai, United Arab Emirates.

Background Cough is one of the most common presenting complaints for physicians across the world, with the potential to result in a significant influence on one's daily life. It is typically categorized into acute cough (<3 weeks), subacute cough (three to eight weeks), and chronic cough (>8 weeks). The lack of specific treatment guidelines and evidence-based recommendations for resolving cough creates reasonable controversy in the medical field. This retrospective study aims to identify the clinical features of cough and evaluate the comparative efficacy between different anti-asthmatic treatment modalities in the urban city of Dubai, United Arab Emirates. Methods A retrospective cross-sectional study was performed on patients presenting to pulmonology or respiratory outpatient clinics with complaints of cough in the absence of any known history of chronic respiratory illness (e.g., asthma). Analysis was conducted via chi-squared and analysis of variance (ANOVA) testing. Results A total of 308 patients were eligible for inclusion, with 273 patients presenting for follow-up. Overall, patients with acute, subacute, and chronic coughs had similar clinical presentations, with no statistically significant differences noted. However, patients with pets were more likely to develop an acute cough (p = 0.04). Moreover, the follow-up outcomes of acute, subacute, and chronic cough were similar, with no significant statistical difference noted. Furthermore, patients receiving dual therapy using budesonide and montelukast, and patients receiving triple therapy using budesonide, montelukast, and tiotropium/ipratropium were most likely to gain complete relief of their symptoms, although triple therapy treatment was also associated with the highest rate of null improvement (p = 0.012). Additionally, chronic cough patients were more likely to be subject to higher C-reactive protein (CRP) levels in comparison to other cohorts (p = 0.26). Conclusion The comparative superiority of dual therapy using budesonide and montelukast, and triple therapy using budesonide, montelukast, and tiotropium/ipratropium were highlighted in this study. In the sparseness of specific treatment guidelines and evidence-based recommendations for cough, the use of anti-asthmatic therapy for cough patients has shown favorable results. Moreover, the lack of clinical differences between acute, subacute, and chronic cough may result in difficulties with the treatment of cough patients. To arrive at a valid conclusion, further comprehensive studies with larger and more diversified sample populations are encouraged.

Development of Asthma-Like Symptoms After COVID-19: A Cross-Sectional Study in Dubai, United Arab Emirates.

Background Coronaviruses are viral agents that commonly infect animals, but have the ability to cause respiratory illness in humans, exemplified by the ongoing novel coronavirus outbreak (COVID-19). Due to the sparse literature on the effects of COVID-19 on the respiratory system, and the possible development of persistent asthma-like symptoms after infection, this cross-sectional analysis was performed in order to compare the clinical and investigative parameters between post-COVID patients and asthmatic patients. Methods A retrospective cross-sectional study was conducted on patients with prior history of COVID-19 infection that presented to the pulmonology or respiratory outpatient clinics with asthma-like symptoms and were subsequently compared to known asthmatic patients with absent history of prior COVID-19 infection, in order to evaluate the degree of similarity between both cohorts. In this study, asthma-like symptoms were defined as: (i) cough, (ii) wheezing, (iii) chest tightness, and (iv) shortness of breath. Moreover, comparisons of investigative parameters were also performed, including (i) fractional exhaled nitric oxide (FeNO), (ii) serum immunoglobulin E (IgE), (iii) absolute eosinophil counts, and (iv) qualitative spirometry results. All statistical analyses were conducted via chi-squared testing for categorical variables, and independent t-test for continuous variables. Results In this study, there were a total of 76 patients included that conformed to the eligibility criteria, including 39 patients with post-COVID symptoms with absent history of asthma or other respiratory illnesses, and 37 patients with known asthma with absent history of prior COVID-19 infection or other respiratory illnesses. Overall, this study revealed the similarities between both cohorts with respect to the incidence of cough, chest tightness, and shortness of breath. Moreover, there were similarities between the serum IgE and spirometry results. However, there were differences within the complaint of wheeze, FeNO values, and eosinophil counts between both cohorts. The placement of post-COVID patients on bronchodilator therapy involving inhaled corticosteroids and long-acting beta-agonists revealed improvement in all follow-up patients. Conclusion In conclusion, there was considerable similarity in the complaint of asthma-like symptoms after COVID-19 infection, associated with an improvement after the use of bronchodilator therapy, indicating the potential role of anti-asthma therapy (e.g., bronchodilator therapy) in managing post-COVID asthma-like symptoms. In order to validate our conclusion, further comprehensive studies with robust methodologies and larger sample populations are encouraged.

Trauma, resiliency and recovery in children: lessons from the field.

War atrocities, natural disasters, community violence, physical abuse and catastrophic illnesses are many faces of trauma and are endemic and the children are the most vulnerable victims. Since 1994, this author has visited war zones and disaster areas 80 times in 18 different countries and has collected data on children's reactions across cultures. Most children around the world show similar responses to the exposure to traumatic experience. Sleep disturbance, nightmares, flashbacks and re-enactment of traumatic events are common. Most children recover from these symptoms in couple of weeks depending on the resiliency and vulnerability factors that they may or may not possess. This author also studied resiliency in children across cultures. In this presentation, the author will present the current understanding of PTSD including the role of amygdala, medial prefrontal cortex and hippocampus in symptom formation. Drawing from the lessons learned during his work with children around the world, the author will discuss the role of resiliency in recovery from trauma.

Review of hygiene adaptations among UK doctors in controlling the spread of SARS-CoV-2 infection.

BACKGROUND: A significant number of healthcare workers around the world have contracted COVID-19 from their workplace, thus there is a need to investigate common hygiene practices. AIM: We aimed to describe the common hygiene adaptations of doctors in the hospital and at home. METHODS: A survey of 110 doctors in UK was carried out to determine their hygiene adaptations and practices. Data were collected on demographics and personal protective equipment compliance. RESULTS: The key findings were frequent hand washing (51%), change of clothing entering and leaving hospital (88% and 92%, respectively), taking a shower upon returning home (85%) and washing work attire at temperatures of 60-80°C (50%). A higher proportion of junior doctors washed their scrubs (p=0.004) and stethoscopes (p=0.014) compared with consultants and seniors. Female doctors cleaned their mobile phones (p=0.022) and work belongings (p=0.01) more frequently. CONCLUSION: This study signified that junior doctors were more meticulous in hygiene adaptations and female doctors were more fastidious in personal hygiene. The observations of this study may be beneficial in preventing transmission of infection to families of healthcare professionals and are important to implement in the case of a second wave of COVID-19.

Favourable Prognosis when Lung-Cancer Patients with Superior Vena Cava Obstruction (SVCO) are Referred Promptly to EBUS-TBNA Prior to Medical or Surgical Management.

BACKGROUND: Primary care patients with superior vena cava obstruction (SVCO) syndrome are usually referred to emergency departments for urgent medical management (high-dose corticosteroids to reduce inflammation), pre-biopsy radiotherapy and/or stent placements to restore patency to the vessel. Biopsy, diagnosis and staging of the mediastinal mass is often postponed until resolution of SVCO symptoms. However, lung cancers metastasise rapidly and delays can influence the eventual outcome of patients. An additional merit in treating SVCO symptoms post-biopsy is that high-dose corticosteroids and pre-biopsy radiotherapy will degrade the quality of biopsy specimens, complicating diagnosis and subsequent management. AIMS: To determine if direct referrals of SVCO patients from primary care to the respiratory department for Endobronchial ultrasound (EBUS)-transbronchial needle-aspiration (TBNA) resulted in better outcomes. METHODS: Direct referrals to the respiratory department from primary care physicians were sought. A total of 8 patients with symptoms of SVCO were rapidly diagnosed via EBUS-TBNA and ROSE, radiotherapy and specific chemotherapy was initiated following communication with oncology colleagues. High-dose corticosteroids were administered post-EBUS. RESULTS: Rapid resolution of symptoms for SVCO were noted, without need for surgical intervention. In particular, one patient with small-cell lung cancer (the most aggressive type of lung cancer) remains well and cancer-free 14 months from diagnosis. DISCUSSION: EBUS-TBNA is a safe modality for biopsy in SVCO as there is no risk of further compression of the vessel. We need a paradigm shift in referral and a guideline of SVCO patients in primary care, an urgent biopsy is important in mediastinal cancers which have high metastatic potentials.

Children's trauma and adjustment reactions to violent and nonviolent war experiences.

OBJECTIVE: According to most studies, more than half of children exposed to war meet criteria for posttraumatic stress disorder (PTSD). Although we know that children are adversely affected by atrocities of war, we do not know which specific war events are associated with children's stress reactions. For example, it is unclear whether differences exist in response to violent versus nonviolent war-trauma experiences. This study examined the relationship of violent and nonviolent war experiences to children's trauma reactions and adjustment in a group of children from Bosnia. METHOD: During the 1994 siege in Sarajevo, 791 children aged 6 to 16 years participated in a study of trauma experience and response, in which assessment questionnaires (Impact of Event Scale, PTSD Reaction Index, Children's Depression Inventory, Child Behavior Checklist, and War Experience Questionnaire) were completed by children and their teachers. RESULTS: In this sample 41% had clinically significant PTSD symptoms. Children were adversely affected by exposure to both violent and nonviolent war-traumas. An additive effect of trauma exposure on trauma reactions was also found. However, many war experiences were not associated with children's adjustment and trauma reactions. CONCLUSIONS: Additive effects of violence and deprivations during war may overwhelm the coping skills of children and leave them vulnerable to externalizing and internalizing adjustment difficulties and symptoms of PTSD.