Possible Influence of Ethnicity on CT Perfusion Parameter Thresholds in Acute Ischemic Stroke.

Introduction Tissue at risk, as estimated by CT perfusion utilizing Tmax+6, correlates with final infarct volume (FIV) in acute ischemic stroke (AIS) without reperfusion. Tmax thresholds are derived from Western ethnic populations but not from ethnic Asian populations. We aimed to investigate the influence of ethnicity on Tmax thresholds. Methods From a clinical-imaging registry of Australian and Indonesian stroke patients, we selected a participant subgroup with the following inclusion criteria: AIS under 24 hours and absence of reperfusion therapy. Clinical data included demographics, time metrics, stroke severity, premorbid, and 3-month Modified Rankin Score. Baseline CTP and MRI <72 hours were performed. Volumes of Tmax utilizing different thresholds and final infarct volumes (FIV) were calculated. Spearman correlation was used to evaluate relationship involving ordinal variables and calculate the optimal Tmax threshold against FIV in both populations. Results Two hundred patients were included in the study sample 100 in Jakarta and 100 in Geelong. The median National Institutes Health Stroke Scale (IQR) were 6(3-11) and 3(1-5), respectively. The median Tmax+6(IQR) was 0 (0-46.5) in Jakarta group and 0(0-7.5) in Geelong group. The median FIV(IQR) was 0 (0-30.5) and 0 (0-5.5). Tmax +8s in Jakarta population against FIV showed Spearman's coefficient =0.72, representing the optimal Tmax threshold. Tmax+6s showed Spearman's coefficient =0.51 against FIV in the Geelong population. Conclusions Tmax thresholds approximating FIV were possibly different in the Asian when compared with the non-Asian populations. Future studies are required to extend and confirm the validity of our findings.

A large primary lung abscess due to Klebsiella oxytoca: How critical the combination between early antibiotic therapy and bronchoscopy?

Lung abscess is a microbial infection that can cause necrosis of the lung tissue and formation of cavities. Antibiotics and bronchoscopy are needed in the management of large lung abscess to prevent further complications. However, some of the cases have poor clinical improvement. The aim of this case report was to describe a patient with large lung abscess who had well responded to antibiotic therapy combined with bronchoscopy drainage. We reported a 55-year-old man with a lung abscess presented with initial symptom of acute productive cough for two weeks. Chest computed tomography (CT) scan with contrast of patient indicated a massive abscess on the right lung segment with a size of 10.9 × 10.41 × 8 cm. Laboratory examination showed leukocytosis. Bronchoscopy was performed as a diagnostic and therapeutic procedure. Antibiotic resistance test was conducted from bronchoalveolar lavage sample to determine the most suitable antibiotics for the patient. The culture yielded a positive for Klebsiella oxytoca that was resistant to ampicillin and cefazolin. The bacterium was sensitive to piperacillin-tazobactam, aztreonam, ceftazidime, ceftriaxone, ertapenem, cefepime, nitrofurantoin, meropenem, amikacin, gentamicin, ciprofloxacin, tigecycline, trimethoprim- sulfamethoxazole, and levofloxacin. Levofloxacin 750 mg injection was given for 14 days followed with oral levofloxacin 500 mg once a day for four weeks and bronchoscopy to stop the microbial infection process in the lung tissues. Lung abscess reduced significantly and the patient was followed until recovered. In conclusion, early combination therapy of adequate antibiotics and bronchoscopy is effective in treating a massive lung abscess caused by Klebsiella oxytoca.