Frequent coexistence and strong etiological linkage between asthma and allergic rhinitis (AR) result in higher burden with comorbid condition than individual disease. To understand attitude, perceptions, and current management practices among general practitioners (GPs) and pediatricians towards coexistent asthma-AR. A cross sectional survey was conducted in India, China, Malaysia, Vietnam, etc. Results presented here are focused on India. Physicians working in public and private sector of 10 Metropolitan cities were approached in person for this survey. A representative national sample of physicians was recruited at hospitals and clinics using a probability-based sampling methodology for a total of 200 physician in India. 98 GPs and 102 pediatricians in India were surveyed. Clinical features and family history of atopy was used by 96% and 82% physicians, respectively to form a diagnosis of asthma. 54% of physicians enquired about common triggers, 48% conducted spirometry. 25% of physicians used patient outcome questionnaires to assess control. AR was diagnosed by nasal (91% of physicians) or ocular symptoms (72% of physicians) and 32% performed skin prick test or serum Immunoglobulin E (IgE). In uncontrolled coexisting asthma-AR, 78% of physicians modified treatment, 21% of physicians referred to a specialist. 88% of physicians were concerned that treating both conditions required added medications, 59% of physicians felt managing both simultaneously was difficult, and 55% of physicians believed it was enough to manage more severe condition. Study highlights low implementation of guidelines despite awareness and need for continued medical education to encourage appropriate diagnosis and management of co-existent asthma-AR. Though the physicians are aware of the guidelines, there was poor utilization in clinical practice. This indicates a need for increase in awareness of guideline recommendations on co existent asthma-AR and improving management of patients. This also eludes to the development of an easy to use diagnostic tool for asthma- AR co-existence.

Urinothorax is a rare cause of pleural effusion characterized by the collection of urine in the pleural space. The index of suspicion should be higher when a pleural effusion is associated with cases of urinary tract obstruction or obstructive uropathy (renal calculi) and trauma. The characteristic feature in the diagnosis of urinothorax lies in the biochemistry, where the ratio of pleural fluid to serum creatinine is higher than 1. The present case is a unique instance of urinothorax with left urinoma and hydronephrosis where the ratio of pleural fluid to serum creatinine is below one.

Care of a severe brain injury is one of the most daunting tasks in critical care and the importance of golden hour and quick treatment cannot be overemphasized while dealing with such patients. On many occasions the severity of injury or the unfortunate incident of not getting timely help may see many a patient evolve to the condition of brain death. It is important to understand that brain death for all practical reasons is death and there is futility of medical science in the treatment of this condition which is a prerequisite for organ donation and transplantation. Certification of brain death and thus facilitation of organ donation results in many patients getting a new lease of life. This article provides a concise but complete review of the diagnosis of brain death and the management of a brain death organ donor.