Introduction: A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae (K. pnuemoniae) had emerged. It has shown ability to cause serious infection in healthy ambulatory hosts as well as infect unusual sites. Though there have been numerous studies on severe infection by K. pneumoniae, little data has been documented on such infections involving Klebsiella oxytoca. (K. oxytoca). It is capable of causing metastatic spread of the infection even in healthy young individuals. This report was written to describe the clinical spectrum of a case of metastatic Klebsiella infection. Case presentation: We illustrate a case of a 73-year-old diabetic and hypertensive female presenting with headache and eye discharge. She was initially managed as the case of conjunctivitis as out-patient. After three weeks of topical ophthalmic antibiotics, she developed decrease in sensorium leading to her eventual admission. Workup pointed towards a disseminated infection to the eye, brain, and urinary tract. The patient was placed on broad-spectrum antibiotics and a vitreous tap was done. However, the patient’s sensorium decreased further, and was eventually intubated and started on inotropes. The indolent course of the disease, which unfortunately led to the demise of the patient, directed the attending physicians to suspect a more virulent infection. Discussion: Infection by hypervirulent variant of Klebsiella has been classically known to be nosocomial and opportunistic in nature. But cases have also been reported from the community setting. A common denominator in this population is that they are usually immunocompromised as in the case of our patient being elderly and diabetic. Unfortunately, there are no molecular or biochemical markers being used in the clinical setting to identify this strain. Hence, the attending physicians had to rely on the presentation of metastatic disease to diagnose our patient. Conclusion Early diagnosis, appropriate antibiotic treatment and drainage are keys in the management of these cases.
Infections

The incidence of CNS infection is common in developing countries such as ours, a common complication of which is elevated intraaanial pressure. The deleterious effects of increased ICP in may manifest as severe headache, visual impairment and mortality. Several modalities have been suggested for the management of ICP either medical or surgical. However, for developing countries surgical procedures is not always feasible in most clinical centers due to lack of facilities or experts and as such medical management of ICP becomes the primary mode of treatment. Acetazolamide is an inexpensive, widely available drug that in theory can lower elevated ICP. There are also some anecdotal evidence on its efficacy. This paper aims to assess the efficacy of using acetazolamide in the management of increased ICP. Intensive search of the online medical journals were done using the following keywords: "Acetazolamide", "intracranial pressure", "hydrocephalus", "acetazolamide and increased intraaanial pressure", "cryptococcal meningitis". Five citations were obtained and based on the set inclusion and exclusion criteria, two trials were deemed appropriate for this review. Critical appraisal was done which validated the trials. Overall, the two studies analyzed showed conflicting data regarding the use of acetazolamide in the management of inereased intracranial pressure. The data available from this meta-analysis shows little or no effect in giving acetazolamide for the treatment of increased ICP. This meta-analysis, however is based only on 2 RCTs with a total of 40 patients. There is still a need to conduct studies with bigger sample sizes to provide more conclusive evidence on the utility or non-utility ofacetazolamied in ICP.

Human ; Male ; Female ; Acetazolamide ; Intracranial Pressure ; Musculoskeletal And Neural Physiological Phenomena ; Nervous System Physiological Phenomena ; Cerebrospinal Fluid Pressure ; Hydrocephalus ; Nervous System Diseases ; Central Nervous System Diseases ; Brain Diseases ; Meningitis, Cryptococcal ; Bacterial Infections And Mycoses ; Mycoses ; Central Nervous System Fungal Infection ; Meningitis, Fungal ; Therapeutics ; Therapy ; Treatment Outcome

BACKGROUND

Delayed cerebral vasospasm remains a major cause of delayed neurologic deficits and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). Statins may ameliorate clinically significant cerebral vasospasm by increasing endothelial NO synthase and hasten basal endothelial NO release.

OBJECTIVES

This study was conducted to determine whether acute statin therapy plus standard care compared to standard care alone can prevent incidence of cerebral vasospasm and improve functional outcome.

METHODS

The author searched Medline, Cochrane, Ovid, Stroke Group Trial Register and Herdin databases for eligible randomized controlled trials on the use of statins plus standard care versus standard care alone in patients with aneurysmal SAH. The studies were analyzed using Review Manager 4.2 software. An estimate of treatment effect was measured using relative risk with 95% confidence
interval.

RESULTS

Two studies involving 119 patients were included. Delayed ischemic neurologic deficits were observed in 12 of 59 patients in treatment group (20.33%) but 24 of 60 patients in control group (40%). Overall effect favors treatment (P value of .02).

Human ; Hydroxymethylglutaryl-coa Reductase Inhibitors ; Subarachnoid Hemorrhage ; Meta-analysis ; Aneurysm

BACKGROUND AND SIGNIFICANCE

Previous prospective studies done abroad recommend rhe use of magnesium sulfare in rhe control of spasms and amonomic dysfuncrion in teranus. The use of magnesium sulfate in reran us is attractive as it is cheap and easily ritrable.

OBJECTIVES

This study aims to determine whether the use of magnesium sttlfate among the tetanus parients admitred from January 2005 to August 2007 in a tertiary hospital is correlated to the need for mechanical venrilarion, rhe development of dysauronomia, the duration of hospital sray and the outcome (death or recovery).

METHODS

This is a retrospective chart review of all the tetanus cases seen at the emergency department of a tertiary hospital from January 2005 to August 2007. All patients admitted for tetanus were included. Descriprive sratisrics were done on age, sex, disease severiry, presence of tracheostomy, use of magnesium sulfate, need for ventilato1y support, development of dysautonomia and durarion of hospiral stay and ourcome (whether recovered or expired). Correlation berween the use of magnesium sulfate and these variables were reseed using Pearson's coefficient of correlarion, using SPSS 1 5.0.

RESULTS

Twenty-seven cases of reran us were seen from January 2005 to August 2007. Majoriry of the patients were males, on stage 2 and had wounds on the lower exrremiry prior to the development of symptoms. Most underwent prophylactic tracheostomy, were placed on IV MgSO4 and needed mechanical ventilation. Half developed dysautonomia; 77% recovered. The mean hospital stay was 18 days. There was poor correlation between MgSO4 therapy, the need for mechanical ventilation, and the development of dysautonomia.and outcome. There is a weak positive correlation between MgSO4 use and the length of hospital stay (Pearson 0.489). The stage at admission is weakly negatively correlated with the duration ofhospical sray.

CONCLUSION

MgSO4 therapy is poorly associated with the need for mechanical ventilation, development of dysautonomia, and outcome. It is weakly positively associated with the duration of hospital stay.

RECOMMENDATIONS

A randomized trial comparing MgSO4 + benzodiazepine and benzodiazepine alone in the management of tetanus is recommended to ensure chat the temporal relationship between MgSO4 and treatment outcomes are more adequately studied.

Human ; Magnesium Sulfate ; Primary Dysautonomias ; Therapeutics ; Tetanus

BACKGROUND AND PURPOSE

All major antiepileptic drugs (AEDs) have been reported to be associated with cognitive side effects and one of the most common questions being asked by patients in the OPD department is whether or not the drugs they are taking affects their memory and cognition. To better address these questions, we performed a meta-analysis on the cognitive effects of different AED's.

OBJECTIVES

This study was conducted to determine which of the anti-epileptic drugs commonly being used in our setting have the most significant cognitive effects, particularly in the areas of memory, cognitive/ motorspeed, and subjective mood measures.

METHODOLOGY

Through PubMed, Ovid and additional searches by hand, were searched to identify RCTs that have studied the effects of AED's on cognition. We searched for studies where the subjects underwent neuropsychological testing, particularly those evaluating memory, cognitive/motorspeed, and subjective mood measures. Common variables in these studies were then compiled and analyzed as continuous data using the Review Manager 4.2 software. We compared the baseline results (control), with the results of the treatment group.

Human ; Fungi ; Cognition ; Therapeutics ; Pharmaceutical Preparations