Gram-negative bacillary meningitis in an immunocompetent adult.

Escherichia coli is a rare cause of community-acquired meningitis comprising about 1% of adult cases. However, it is a common pathogen in neonatal meningitis and in nosocomial setting (especially after penetrating craniocerebral injury or subsequent to neurosurgical procedures). We report a middle-aged woman, who was admitted with features of acute meningitis and subsequent investigations revealed E. coli growth in cerebrospinal fluid culture. The case is distinctive as no additional predisposing risk factors associated with gram-negative bacillary meningitis (traumatic brain injury, neurosurgical procedures, malignancy, immunosuppressive therapy, HIV infection, chronic alcoholism and diabetes) were present. She was treated with intravenous antibiotics as per sensitivity reports and discharged in clinically stable condition, without any residual neurological deficit.

A Clinical Comparison along with Prediction of the Outcome and Prognosis of Anterior and Posterior Circulation Stroke Patients Admitted in Tertiary Care Hospital.

INTRODUCTION: Stroke is the third common cause of death in India after ischemic heart disease and chronic obstructive pulmonary disease. Clinical features and outcomes vary in different types of strokes. OBJECTIVES: To compare the National Institutes of Health Stroke Scale (NIHSS) score of anterior and posterior circulation stroke patients (confirmed by neuroimaging) on the day of admission, admitted in Department of General Medicine, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata and to predict the prognosis and outcome of the two types of strokes based on the modified Rankin Scale (mRS) on day 5 of admission. METHODOLOGY: After approval from Institutional Ethics Committee and taking written informed consent from participants an observational cross-sectional study was conducted in the Department of General Medicine of a tertiary care hospital over 1.5 years. Clinical features, outcome, and prognosis between anterior and posterior circulation stroke group are compared and results are analyzed. RESULTS: In anterior circulation, the mean of age (mean ± SD) of patients was 59.2875 ± 6.7790 years; 25 (31.3%) patients were female and 55 (68.8%) patients were male; three (3.8%) patients were Christian, 39 (48.8%) patients were Hindu, and 38 (47.5%) patients were Muslim; the mean of BMI (mean ± SD) of patients was 24.7038 ± 2.3695 kg/m2 ; 71 (88.8%) patients were from rural area and nine (11.3%) patients were from urban area; 73 (91.3%) patients had hypertension, 51 (63.8%) patients had diabetes mellitus, 24 (30.0%) patients had hypothyroidism, and 56 (70.0%) patients had ischemic heart disease; the mean of NIHSS score on day 0 (mean ± SD) of patients was 13.9875 ± 4.0362, the mean of mRS score on day 5 (mean ± SD) of patients was 2.1125 ±.9936. In posterior circulation, the mean of age (mean ± SD) of patients was 59.2167 ± 6.7826 years; 20 (33.2%) patients were female and 40 (66.7%) patients were male; two (3.3) patients were Christian, 29 (48.3%) patients were Hindu, and 29 (48.3%) patients were Muslim; the mean of BMI (mean ± SD) of patients was 24.7017 ± 2.3265 kg/m2 ; 51 (85.0%) patients were from rural area and nine (15.0%) patients were from urban area; 54 (90.0%) patients had hypertension, 37 (61.7%) patients had diabetes mellitus, 18 (30.0%) patients had hypothyroidism, and 42 (70.0%) patients had ischemic heart disease; the mean of NIHSS score on day 0 (mean ± SD) of patients was 23.8833 ± 4.5737, the mean of mRS score on day 5 (mean ± SD) of patients was 4.6333 ± .8227. CONCLUSION: Symptoms of PCI stroke patients are more severe than that of ACI stroke patients. The outcome and prognosis of PCI stroke patients are worse compared to the ACI stroke patients.

Hypercalcaemia in primary hyperparathyroidism: a rare cause of recurrent acute pancreatitis.

Hyperparathyroidism leading to hypercalcaemia is a rare cause of acute pancreatitis with debatable association. The diagnosis of hyperparathyroidism is frequently overlooked or delayed as symptoms are non-specific and serum calcium is not routinely measured in acute pancreatitis. Early diagnosis and treatment of hyperparathyroidism may reduce the chances of complications. We report a 35-year-old woman, who was admitted with recurrent episodes of acute pancreatitis. She was previously diagnosed with gall-stone induced acute pancreatitis, had undergone laparoscopic cholecystectomy, but the recurrence of acute pancreatitis suggested an alternative aetiology and provoked extensive investigations. Serum calcium was found to be elevated. No additional risk factor for pancreatitis was found. Further workup revealed primary hyperparathyroidism, which was due to a functioning parathyroid adenoma. She has undergone parathyroidectomy followed by an uneventful recovery. She subsequently conceived and is now in her first trimester, without any recurrence of acute pancreatitis since her surgery.