Prevalence of obesity in asthmatic adults.
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Adult↗
Biomedical subjects
H Moudgil
Publications and source records attributed to H Moudgil.
Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK.
BACKGROUND: Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation. This study reports clinical outcomes and quality of life from a community based project investigating white European (W/E) and Indian subcontinent (ISC) ethnic groups with asthma living in deprived inner city areas of Birmingham, UK. METHODS: Six hundred and eighty nine asthmatic subjects (345 W/E, 344 ISC) of mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory volume in one second (FEV(1)) of 80% predicted were interviewed in English, Punjabi, Hindi, or Urdu. Subjects randomised to the active limb of a prospective, open, randomised, controlled, parallel group, 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up (active intervention). Control groups were seen only at the beginning and end of the study. Urgent or emergency interactions with primary and secondary health care (clinical outcomes) and both cross sectional and longitudinal data from an Asthma Quality of Life Questionnaire (AQLQ) were analysed. RESULTS: Clinical outcomes were available for 593 subjects. Fewer of the active intervention group consulted their GP (41.8% versus 57.8%, odds ratio (OR) 0.52 (95% CI 0.37 to 0.74)) or were prescribed antibiotics (34.9% versus 51.2%, OR 0.51 (95% CI 0.36 to 0.72)), but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits. Active intervention reduced the number of hospital admissions (10 versus 30), GP consultations (341 versus 476), prescriptions of rescue oral steroids (92 versus 177), and antibiotics (220 versus 340), but again significant improvements by ethnicity only occurred in the active W/E group. AQLQ scores were negatively skewed to the higher values; regression analysis showed that lower values were associated with ISC ethnicity. Longitudinal changes (for 522 subjects) in the mean AQLQ scores were small but statistically significant for both ethnic groups, with scores improving in the active and worsening in the control groups. CONCLUSIONS: Active intervention only improved clinical outcomes in the W/E group. AQLQ scores, although lower in the ISC group, were improved by active intervention in both ethnic groups.
Adolescent↗
Pyoderma gangrenosum.
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Antibodies, Antineutrophil Cytoplasmic↗
Differences in asthma management between white European and Indian subcontinent ethnic groups living in socioeconomically deprived areas in the Birmingham (UK) conurbation.
BACKGROUND: Hospital admission rates for asthma have been higher for Asian (Indian subcontinent, ISC) ethnic minority groups in the UK than for white Europeans (W/E). As this may in part be due to differences in the uptake or delivery of preventative health care strategies, the extent to which targeted education and treatment programmes reach these groups needs to be determined. METHODS: Six hundred and eighty nine asthmatic subjects (345 W/E, 344 ISC) of mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory volume in one second (FEV1) 80% predicted from districts of high ethnicity and socioeconomic deprivation within inner city Birmingham were reviewed in the appropriate dialect (English, Punjabi, Hindi, Urdu) in a community based study. RESULTS: Data adjusted for age and analysed separately for men (M) and women (F) showed no significant differences in the numbers reporting previous asthma education, assessment of delivery techniques, or being taught about medications, but there were significant differences for advice on trigger factors (M: 52% vs 42%; F: 56% vs 42%), recognition of symptoms (M: 51% vs 43%; F: 53% vs 33%), and ownership of peak flow meters (M: 35% vs 22%; F: 36% vs 24%) for W/E and ISC groups, respectively. Anti-inflammatory asthma medications were highly prescribed, but self reported drug compliance (M: 73% vs 62%), understanding medications (F: 59% vs 39%), and self management (F: 23% vs 12%) varied significantly. Asthma follow up in the community was low for both groups with more of the ISC subjects also being followed up by hospital. CONCLUSIONS: The management of both ethnic groups has centred on drug prescription, delivery techniques and compliance, but has been deficient, particularly in the ISC group, in developing understanding of the disease and self management.
Adult↗
Concentrations of OPC-17116, a new fluoroquinolone antibacterial, in serum and lung compartments.
The efficacy of an antibiotic is usually predicted from serum concentration and MICs for likely pathogens, but in the lung, tissue concentrations may be more relevant. This study compares concentrations of a new fluoroquinolone, OPC-17116, in serum, epithelial lining fluid (ELF), alveolar macrophages and bronchial mucosa, in 24 adults. OPC-17116 400 mg was given daily for 4 days, and diagnostic bronchoscopy was performed up to 13 h after the final dose. Mucosal biopsies were taken from macroscopically normal sites, alveolar macrophages were harvested by lavage, and ELF volume was derived from urea concentrations in bronchial lavage fluid and blood. A microbiological assay, using Escherichia coli, was used to assay OPC-17116 concentration in serum, bronchial mucosa, ELF and alveolar macrophages. The mean concentration of OPC-17116 in serum was 1.2 mg/L. Serum concentrations were significantly exceeded in bronchial mucosa (mean ratio 3.13) in ELF (mean ratio 12.21) and in macrophages (mean ratio 194.52). Penetrations of these compartments considerably exceeded those reported for other fluoroquinolones, and concentrations in all tissues were substantially higher than previously reported MIC90 levels for a variety of bacteria, including Streptococcus pneumoniae. A clinical role for OPC-17116 is suggested in a wide range of respiratory infections, including those due to intracellular bacteria.
Adult↗
Reactivation disease: the commonest form of tuberculous pleural effusion in Edinburgh, 1980-1991.
From 1980-1991 82 (7.2%) of 1134 tuberculosis notifications in Edinburgh were for pleural effusion. Study of the available records of 62 cases satisfying defined diagnostic criteria identified 14 cases (6 M, 8 F) with a mean age of 27.6 years (range 11-51 years) of primary tuberculous effusion and 25 cases (21 M, 4 F) with a mean age of 51 years (range 19-79 years) with pleural effusion due to reactivation disease. Twenty-three patients (19 M, 4 F) with a mean age of 48.9 years (range 25-85 years) defied classification. Symptoms, associated and diagnostic test findings were similar in all three groups of patients. Parenchymal radiographic shadowing was seen in 1/14 primary, 16/25 reactivation and 3/25 unclassified pleural effusions. Twenty-three of 30 patients treated with corticosteroids showed no residual radiographic abnormality compared to 17/30 not so treated (P < 0.06). Reactivation disease is currently a commoner cause of tuberculous pleural effusion than primary disease in Edinburgh. We suggest that the unclassified cases, so similar in age and sex to the defined reactivation disease cases, also represent largely extrapulmonary reactivation disease occurring in middle age.
Adrenal Cortex Hormones↗
Time to extend 'the timetable of tuberculosis'?
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Adult↗
Extra-pulmonary tuberculosis in Lothian 1980-1989: ethnic status and delay from onset of symptoms to diagnosis.
We have retrospectively determined the incidence and delay in diagnosing extrapulmonary tuberculosis (ETB) by ethnic group in Lothian, Scotland, from 1980-1989. One hundred and sixteen (13.3%) of 874 TB notifications were for ETB. Eighty-seven records were available for analysis: 59 with a mean age of 57.9 years (range 10-90) were Caucasian (C) and 28 with a mean age of 30.3 years (range 10-86) were non-Caucasian (NC). There were 42 cases of lymphatic TB; 23 (7M,16F) with a mean age of 62 years (range 10-82) were C and 19 (14M,5F) with a mean age of 29 years (range 10-60) were NC. Lymphatic TB was a significantly commoner ETB site in NC (67.9%) cf C (39%) (P < 0.01). Of 24 cases of genito-urinary TB, 23 (14M,9F) with a mean age of 54 years (range 24-82) were C compared to one NC male aged 29 years. Genito-urinary TB was a significantly commoner ETB site in C (39%) cf NC (3.6%) (P < 0.001). Bone and joint TB was found in 11 (5M,6F) C with a mean age of 55 years (range 28-86) compared to five (3M,2F) NC with a mean age of 36 years (4-47). Five cases of abdominal TB (2C,3NC) were also identified. Delay from onset of symptoms to diagnosis for lymphatic TB was significantly longer for NC (mean 26 weeks, range 0-156) than for C (mean 9 weeks, range 2-28) (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗