Epidemiological Profile of Stroke in Central Kerala

Background: There is a rising trend in the incidence of stroke among Keralites, but proper data regarding the same are scarce.To date, no study has been published delineating the epidemiological profile of stroke in Central Kerala harboring a populationof more than 5 million.Objectives: The objectives of the study were to characterize the clinical profile, risk factors, type, and etiology of stroke inCentral Kerala.Methodology: A prospective cohort study was conducted in the Department of General Medicine in Amala Institute of MedicalSciences, Thrissur, Kerala, from January 2014 to January 2015 that evaluated 464 patients admitted with a diagnosis of stroke.Based on clinical examination and brain computed tomography/magnetic resonance image findings, patients were classifiedinto ischemic and hemorrhagic stroke subtypes and enrolled.Results: Of the total 464 patients, 44.6% were female and 55.4% were male. A maximum amount of cases were observed inthe age group between 61 and 70 years. Among them, 63.6% of patients were hypertensive, 45.5% were diabetic, 12.7% hada cardiac disease, and 0.6% of patients had peripheral vascular disease. The incidence of hemorrhagic stroke was 27.8% andischemic stroke was 72.2%. Most of the ischemic strokes were due to large artery atherosclerosis.Conclusion: Our study has shown that systemic hypertension followed by diabetes mellitus was the prime risk factor contributingto stroke among Central Keralites. Tobacco use is widely prevalent among males in Central Kerala which could account forthe increasing incidence of stroke among males. There is an urgent need to improve the lifestyle of people, especially in theage group between 61 and 70 years who were the most susceptible to stroke by implementing proper monitoring and controlof modifiable risk factors.

Adenomatoid odontogenic tumor of the mandible with unusual radiographic features: A case report

Adenomatoid odontogenic tumor (AOT) usually presents as a unilocular, pericoronal radiolucency in the maxillary anterior region in adolescent females. Very few conditions occur in such a narrow age range and at such a restrictive site. Rarely, these tumors present with varied clinical features. A case of AOT of the mandible is reported with unusual features such as large size, multilocular appearance, and aggressive behavior. The role of radiology in diagnosis of atypical AOT is extremely important. The unique radiological manifestations of the lesion helped in the diagnosis, and it was managed conservatively with no evidence of recurrence.

Rising incidence of beta-lactam resistance among pneumococci in Kuwait: Failure of cefotaxime therapy in pneumococcal meningitis

Pneumococcal resistance to antimicrobial agents has become a global problem. This study was done to evaluate the resistance of Streptococcus pneumoniae [pneumococci] to penicillin G in Kuwait, and to assess the efficacy of other -lactam agents [cefotaxime or ceftriaxone] in the management of invasive pneumococcal infections. Surveillance studies were done in a general teaching hospital in Kuwait for penicillin G resistance [intermediate or high level resistance] of pneumococci isolated from clinical specimens by agar diffusion method using oxacillin [1 micro g] disc. In cases of pneumococcal meningitis, minimum inhibitory concentrations [MICs] of penicillin and cefotaxime were determined by agar dilution method, to differentiate intermediate resistance and high level resistance. An increase in the incidence of penicillin G-resistant pneumococci from 20.6% [94 out of 457 isolates] for the period 1985-1988 to 28.5% [40 out of 140 isolates] during 1992-1994 and 38.3% [43 out of 112 isolates] during 1995/96 was observed. During the period 1992-1994, 40-45% [7 out of 16 isolates] blood culture isolates of pneumococci were intermediate or highly resistant to penicillin. Therapy with cefotaxime or ceftriaxone produced a positive outcome in 6 of the 7 patients. However, failure of cefotaxime therapy to achieve a cure was noted in 1 patient who had systemic lupus erythematosus and intermediate resistant [penicillin MIC 0.5 mg/l; cefotaxime MIC 1 mg/l] pneumococcal septicaemia complicated with meningitis. A cure was however achieved with the addition of chloramphenicol to the regimen. Resistance of pneumococci to penicillin G and other -lactam agents is increasing in Kuwait. Penicillin-resistant pneumococcal bacteraemia in an immunosuppressed setting, if managed with cefotaxime or ceftriaxone, should be given high doses [cefotaxime 12 g/day or ceftriaxone 4 g/day] from the beginning. Cases of pneumococcal meningitis with cefotaxime-intermediate resistant strains [MIC 0.5-1 mg/l] on monotherapy consisting of cefotaxime or ceftriaxone should be viewed with caution. Chloramphenicol or vancomycin with rifampicin should be added to the regimen if therapeutic failure is suspected

Glomerulonephritis following haemophilus influenzae pneumonia

Post-infectious glomerulonephritis is a common immune-complex mediated disease. In this report we describe a 23 year old Egyptian female who developed such a disease following lobar pneumonia due to Hemophilus influenzae. The clinical course and management of this patient was similar to that of other post-infectious glomerulonephritis. Nephritis was managed conservatively and resolved following treatment of the underlying pneumonia with a combination of third-generation cephalosporin and erythromycin. This association has not been reported previously