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Diabetic dyslipidaemia in Kuwait.

About 15% of the adult Kuwaiti population has type 2 diabetes and over 50% are hyperlipidaemic by current diagnostic criteria. Not surprisingly, coronary heart disease (CHD) is the leading cause of death in Kuwait. Reports from coronary care units in Kuwait suggest that 40-80% of the CHD patients were diabetic and 50-80% hyperlipidaemic. The pattern worldwide is similar. International guidelines have therefore consistently recognised diabetes as a major risk factor for CHD. In our Lipid Clinic population in Kuwait, about 30% are diabetic. The commonest lipid abnormalities seen in Kuwaiti diabetic patients, as elsewhere, are hypertriglyceridaemia with low HDL levels and variable LDL levels. About 75% of the subjects had either mixed hyperlipidaemia or predominant hypertriglyceridaemia. There are possibly some compositional changes in LDL in the diabetic subjects in that there were important differences in the statistical relationships between LDL and HDL and their respective apolipoproteins - apo B and apo A-1 in diabetic as compared to non-diabetic subjects. Other important observations made in diabetic subjects in Kuwait are: (i) similar serum Lp (a) levels and pattern of apo(a) polymorphism with non-diabetic subjects, with no demonstrable relationship between serum levels of Lp(a) and insulin/insulin sensitivity, although with CHD, Lp(a) levels were increased; (ii) diabetic hyperlipidaemic subjects had elevated PAI-1 levels with significant correlations between blood PAI-1 and insulin levels suggesting underlying insulin resistance (syndrome X). Various landmark trials of cholesterol-lowering therapies in the prevention of CHD have consistently demonstrated near-normalization of the increased CHD risk in diabetes. Our experience in Kuwait suggests that diabetic patients and others with mixed hyperlipidaemia benefit from tight glycaemic control, appropriate advice on diet and exercise with regular reinforcement by continuing contact with professional dietitians and regular availability of drugs where prescribed. Often, it is the regular compliance with medication that is important, rather than the specific medication used particularly where HMG CoA reductase inhibitors (statin drugs) are not always available. A useful guideline for management of dyslipidaemia in diabetes is suggested.

Clinical Trials as Topic↗

The seasonal variation in allergic rhinitis and its correlation with outdoor allergens in Kuwait.

BACKGROUND: Allergic rhinitis (AR) is the most common allergic problem in Kuwait. Most of the patients who have either AR or asthma are referred to the Al-Rashed Allergy Center. OBJECTIVE: To determine if there is a seasonal variation in AR in Kuwait and to correlate it with the daily pollen count. METHODS: Information about the new patients referred to the center over a 5-year study period (1996-2000) was extracted from the center's records. The daily pollen count in Kuwait city was obtained from the Air Biology Laboratory. RESULTS: There was a significant seasonal variation with a bimodal increase in the number of patients with AR referred to the center. The main peak in the number of patients occurred in September-October, and there was a smaller peak in April-May. The mean number +/- SD of new patients per month over the 5-year period varied from 87 +/- 32 for December to 367 +/- 104 for September. Similarly, the average daily pollen count varied from 3.7 +/- 1.0 pollens per mm3 in January to 124 +/- 92 in October. There was high correlation between the number of new AR patients and the average total pollen count (Pearson correlation, r=0.77, p<0.001), as well as with Chenopodiaceae and Amaranthaceae (weed) pollens (r=0.75, p<0.001), while there was no correlation between the number of new patients and either tree or grass pollens. CONCLUSION: Seasonal AR occurs during two periods in Kuwait, i.e. September-October and April-May, with September-October being the main season. The rise in AR during late summer in Kuwait is mainly associated with the pollination of Chenopodiaceae species.

Allergens↗

Preliminary study of effect of the Iraqi invasion on addictive behaviour in Kuwait.

During the Iraqi invasion, Kuwait was flooded with alcoholic substances and drugs which, if used, could induce harmful radical changes in the personality and behaviour of Kuwait citizens (not Islam prohibits alcohol). After liberation aggressive behaviour prevailed among some Kuwait citizen groups, including addicts, as the government of Kuwait had not yet reestablished discipline and control over the citizens. Forensic cases of addicts referred to Kuwait Psychiatric Hospital before and after the invasion were examined. Marked differences were observed concerning age, education, occupation, marital status, addictive behaviour, crime committed, and place of referral and discharge.

Adolescent↗

Epidemiology of tuberculosis in Kuwait from 1965 to 1999.

BACKGROUND: After several decades of continuous decline, the incidence of tuberculosis (TB) has increased over the last 10 years in several regions of the world. No reports have been published describing the epidemiology of TB in Kuwait. OBJECTIVES: To examine the trend of TB in Kuwait from 1965 to 1999 and analyse the factors associated with this trend. METHODS: Annual reports of the Kuwait central TB unit were examined. Tuberculosis registers recommended by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD), which were available for the years 1998 and 1999, were also examined. RESULTS: The notification rate of TB for the whole population has declined from 259 per 100000 in 1965 to 24/100000 in 1999. There has been a steeper decline among Kuwaiti nationals, from 355/100 000 in 1965 to 14/100000 in 1999. The average annual rate of decline in all cases of TB among Kuwaiti nationals was 11.9% from 1965 to 1976, and 11.0% from 1976 to 1989, but there was a slight rise of 4.3% per year from 1989 to 1999. The average annual rate of decline in all cases of TB among non-nationals was 6.3% from 1965 to 1976, and 8.3% from 1976 to 1989, but there was a rise of 2.3% per year from 1989 to 1999. CONCLUSION: Tuberculosis in Kuwait declined steadily from 1965 to 1989. Since 1989 there has been a slight rise in TB incidence in Kuwait among both Kuwaiti nationals and non-nationals.

Adolescent↗

[Stress management of overseas Japanese in Kuwait].

Forty percent of the Japanese businessmen in overseas positions are working in developing countries. However, few reports on the mental health care for them have been published. The Japan Overseas Medical Fund and The Kuwait Japanese Association has promoted the Kuwait Japanese Clinic. I had an opportunity to work at this clinic and to study the environmental health of Japanese businessmen in Kuwait. I found that in Kuwait, Japanese businessmen had to adapt to climatic, religious, cultural, and historical differences. Therefore, I investigated the incidence of stress related diseases which are caused by these environmental differences. Stress diseases occurred in 15.7 percent of total cases frequently, and some of them were very severe. After my stay in Kuwait, I believe that the setting up of medical information networks between various countries to alleviate medical anxiety and a system whereby instructions in the differences of medical systems in various countries would be very beneficial.

Environmental Health↗

Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States.

BACKGROUND: Antimicrobial resistance is an under-appreciated threat to public health in nations around the globe. With globalization booming, it is important to understand international patterns of resistance. If countries already experience similar patterns of resistance, it may be too late to worry about international spread. If large countries or groups of countries that are likely to leap ahead in their integration with the rest of the world--China being the standout case--have high and distinctive patterns of resistance, then a coordinated response could substantially help to control the spread of resistance. The literature to date provides only limited evidence on these issues. METHODS: We study the recent patterns of antibiotic resistance in three geographically separated, and culturally and economically distinct countries--China, Kuwait and the United States--to gauge the range and depth of this global health threat, and its potential for growth as globalization expands. Our primary measures are the prevalence of resistance of specific bacteria to specific antibiotics. We also propose and illustrate methods for aggregating specific "bug-drug" data. We use these aggregate measures to summarize the resistance pattern for each country and to study the extent of correlation between countries' patterns of drug resistance. RESULTS: We find that China has the highest level of antibiotic resistance, followed by Kuwait and the U.S. In a study of resistance patterns of several most common bacteria in China in 1999 and 2001, the mean prevalence of resistance among hospital-acquired infections was as high as 41% (with a range from 23% to 77%) and that among community- acquired infections was 26% (with a range from 15% to 39%). China also has the most rapid growth rate of resistance (22% average growth in a study spanning 1994 to 2000). Kuwait is second (17% average growth in a period from 1999 to 2003), and the U.S. the lowest (6% from 1999 to 2002). Patterns of resistance across the three countries are not highly correlated; the most correlated were China and Kuwait, followed by Kuwait and the U.S., and the least correlated pair was China and the U.S. CONCLUSION: Antimicrobial resistance is a serious and growing problem in all three countries. To date, there is not strong international convergence in the countries' resistance patterns. This finding may change with the greater international travel that will accompany globalization. Future research on the determinants of drug resistance patterns, and their international convergence or divergence, should be a priority.

Journal Article↗

Seasonality of disease in Kuwait.

To compare the seasonal variation in total mortality and deaths from cardiovascular, respiratory, and malignant disease, data were collected from North-East Scotland (Grampian region) and Kuwait. Seasonal differences were similar, in both timing and degree, for total mortality and deaths from circulatory disease, but were greater in Kuwait for respiratory disease. Peak mortality was during winter in both areas: in Grampian, when the climate is most uncomfortable, and in Kuwait, when the climate is at its most comfortable. Socioeconomic changes in Kuwait have been accompanied by a rapid fall in the degree of seasonality (deseasonality) for both total and infant mortality. These findings suggest that mortality peaks in winter, not because of a seasonally low temperature, but because of a seasonal fall in mean temperature irrespective of the annual mean temperature.

Adult↗

Environmental management of construction and demolition waste in Kuwait.

There is an increasing pressure on the construction industry to reduce costs and improve the quality of our environment. The fact is that both of these goals can be achieved at the same time. Although construction and demolition (C&D) constitutes a major source of waste in terms of volume and weight, its management and recycling efforts have not yet seen the light in Kuwait. This study focuses on recycling efforts leading to the minimization of the total C&D waste that is currently landfilled in Kuwait. This paper presents the current status of C&D waste disposal system in Kuwait and identifies the potential problems to the environment, people and economy. Then, it investigates alternative solutions to manage and control this major type of waste in an economically efficient and environmentally safe manner. Next, the paper describes the feasibility of establishing a C&D waste recycling facility in Kuwait. It concludes by highlighting the major benefits and bottleneck problems with such a recycling facility.

Conservation of Natural Resources↗

The prevalence and antibiotic susceptibility pattern of gram-negative bacterial isolates in two ICUs in Saudi Arabia and Kuwait.

In surveys of the prevalence and antibiotic susceptibility pattern of consecutive Gram-negative bacterial isolates in two intensive care units (ICUs) in Saudi Arabia (Jeddah) and Kuwait, 106 and 101 isolates, respectively, were analyzed. The most common bacterial isolates in Jeddah versus Kuwait ICUs were Pseudomonas aeruginosa (26%, 26%), Escherichia coli (23%, 3%), Klebsiella pneumoniae (20%, 17%), inducible Enterobacteraecae group (17%, 14%), and Acinetobacter spp. (9%, 33%). Overall, about 99% of all isolates were susceptible to ciprofloxacin in both centers, whereas 87 and 96% were susceptible to imipenem, 69 and 64% to ceftazidime, 59 and 52% to cefotaxime, and 25 and 67% to piperacillin, respectively, in Jeddah and Kuwait. Prior antibiotic usage was more common among patients in Jeddah than in Kuwait. Dominant features of the study in Jeddah were the E. coli and Klebsiella spp. demonstrating multiresistance to monobactams, cephems, and all three aminoglycosides, and evidence of two classes of resistance to beta-lactam antibiotics which were not seen among the Kuwaiti isolates. The Kuwaiti Pseudomonas spp. were more sensitive to imipenem than the Jeddah Pseudomonas spp. (100% versus 68%). The higher number of resistant bacteria seen in Jeddah than Kuwaiti may be a reflection of the higher antibiotic consumption, in particular higher usage of broad spectrum cephalosporins in Jeddah ICU.

Adolescent↗

Prevalence of asthma, allergic rhinitis, and eczema in 13- to 14-year-old children in Kuwait: an ISAAC study. International Study of Asthma and Allergies in Childhood.

OBJECTIVES: To determine the prevalence of asthma and allergic diseases in 13 to 14 years old children in Kuwait. DESIGN: Supervised self-administered written and video questionnaires of the international study of asthma and allergies in childhood (ISAAC). SUBJECTS: Students at third and fourth years from 40 intermediate level schools chosen randomly from across Kuwait. RESULTS: 3,110 students were surveyed. The prevalence rates (95% CI) in the written questionnaire for wheeze ever, current wheeze (within the last 12 months), and physician diagnosis of asthma are 25.9% (24.5 to 27.4), 16.1% (15.8 to 17.4), and 16.8% (15.5 to 18.1) respectively. The prevalence rates (95% CI) for symptoms of allergic rhinitis (AR) ever, current symptoms of allergic rhinitis (AR), and diagnosis of AR are 43.9% (42.2 to 45.6), 30.7% (29.1 to 32.4) and 17.1% (14.8 to 18.4) respectively. The prevalence rates (95% CI) for itchy rash ever, current itchy rash, and diagnosis of eczema are 17.5% (16.2 to 18.8), 12.6% (11.4 to 13.8), and 11.3% (10.2 to 12.4) respectively. The prevalence of wheeze ever, wheeze during the last year, and physician diagnosis of asthma are higher in males compared with females, P < .01. In multiple logistic regression: male gender (OR 1.6, 95% CI, 1.3 to 2.0) and diagnosis of AR (OR 1.7, 95% CI, 1.4 to 2.2) were associated with the physician diagnosis of asthma even after controlling for symptoms of asthma. CONCLUSION: This is the first study on the prevalence of allergic diseases in Kuwait and it shows that children in Kuwait have a moderate prevalence of asthma, AR, and eczema compared with other countries where the ISAAC study is done. The prevalence of asthma is higher in boys compared with girls.

Adolescent↗

Aspergillus and other moulds in the air of Kuwait.

A one-year survey was carried out to study the aerial prevalence of Aspergillus species and other moulds in the outdoor and indoor environments of Kuwait. Petri plates containing rose-Bengal medium were exposed for 20 minutes twice a month using a six-stage Andersen air sampler at the pre-determined sites. The exposed plates were incubated at 28 degrees C +/- 1 degree C up to 5 days and colonies were enumerated and identified by colonial and microscopic morphology. The data revealed that Aspergillus species were the predominant component (27.7%) of the outdoor aerospora of Kuwait and A. fumigatus alone accounted for 21.3% of the total aspergilli. In contrast, Cladosporium species formed the major component of the indoor aerospora (22.8%), followed by Aspergillus species (20.9%), Penicillium species (14.6%), and Bipolaris species (10.6%). A comparison of the fungi recorded in the outdoor and in the indoor air revealed that Aspergillus, Alternaria and Fusarium were significantly higher in the outdoor environment, whereas Cladosporium, Penicillium, and Bipolaris were significantly higher in the indoor environment. The relative prevalence of Aspergillus species and other moulds in the outdoor and indoor air of Kuwait was as follows: A. fumigatus 5.9 and 9.8%, A. flavus 4.9 and 3.9%, other aspergilli 16.8 and 7.0%, Alternaria species 19.8 and 7.9%, Cladosporium species 13.7 and 22.8%, Penicillium species 7.6 and 14.6%, and other moulds 31.2 and 34.1%, respectively. During the study, 25 different genera were identified, indicating a wide diversity in the spectrum of local fungal aerospora. The study provides useful information on the prevalence of allergenic fungi in the outdoor and indoor environments of Kuwait.

Air Microbiology↗

Registered blindness and low vision in Kuwait.

AIM: To estimate the incidence rates and major causes of registered blindness and low vision in Kuwait. METHODS: Data on age, gender and cause of blindness and low vision were collected from the Visual Disability Committee while evaluating Kuwaiti citizens applying for a blindness allowance from January 2000 to December 2004. Criteria for legal blindness in Kuwait are visual acuity 6/60 or less in the better eye with best possible correction or a visual field less than 20 degrees around the central fixation point. Incidence rates per 100,000 person years of observation were calculated for both genders in four age subgroups and four severity categories. The causes of registered blindness were classified according to the International Classification of Diseases, 10th edition. RESULTS: 412 persons were registered as blind, 272 males (66.01%) and 140 females (33.98%), mean age 28.7 +/-25.2 years, 39.32% below 20 years of age, 31.79% 21-40 years, 18.68% 41-60 years, and 9.95% 61 years and over . Male gender was prevalent for all age subgroups. The overall incidence rate was 9.97 per 100,000 person years of observation, 13.33 for the male and 6.69 for the female patients. The incidence rates rose from 7.35 for those 20 years and younger to 14.80 for the age subgroup 41-60 and 23.16 for those 61 years and above. The rates of severe visual impairment classified in categories 4 and 5 were higher than the rates for categories 2 and 3. Retinitis pigmentosa was the leading cause of blindness, followed by congenital anomalies and optic atrophy. In the subgroup below 20 the rate of optic atrophy was highest, followed by congenital malformations, retinitis pigmentosa and retinopathy of prematurity. In the next age subgroup (21-40 years), the rate of retinitis pigmentosa was three times as high as in the younger subgroup, followed by optic atrophy, congenital malformations and albinism. In the subgroup 41-60 the incidence rate for phthisis bulbi was twice as high as the rates for retinitis pigmentosa and optic atrophy. For those 61 years and older, the incidence rate of phthisis bulbi was almost five times as high as that for optic atrophy. The incidence rates for the male patients were higher for the major causes of disability in all age subgroups. CONCLUSIONS: The overall incidence rate of registered blindness for Kuwait is less than in many other national registries. The marked prevalence of the male gender in all age subgroups is specific for Kuwait. The rates of the leading causes of registered blindness reflect the prevalence of the younger subgroups in our registry. Additional data on co-morbidity and dedicated efforts to reveal unrecognized and unregistered blindness, particularly among females, will overcome the limitations of the registry, and will serve to outline the tendencies in avoidable vision loss and monitor the efficacy of the prevention programs in the future.

Adolescent↗

Awareness of and attitude toward hormonal emergency contraception among married women in Kuwait.

OBJECTIVE: To describe the awareness of and attitudes toward hormonal emergency contraception among women in Kuwait. METHODS: A cross-sectional survey was conducted among married women at obstetrics/gynecology outpatient clinics at the government Maternity Hospital in Kuwait. A pretested Arabic self-administered questionnaire was distributed to the women in March 2005. The questionnaire provided a short explanation as to what was meant by hormonal emergency contraception and then elicited whether the respondent was aware of it, what concerns she had, and whether she thought it should be made available in Kuwait. RESULTS: One hundred three questionnaires were completed. Respondents were mostly Kuwaiti (78%) and non-Bedouin (78%) with postsecondary school education (74%) and a mean (SD) age of 33.1 (7.8) years and a mean (SD) number of children of 2.8 (1.9) About half of the women were not currently using contraceptive methods; 40% of contraceptive users were taking oral contraceptive pills. Bedouin women were more likely than non-Bedouins to use breastfeeding as a contraceptive measure (p = 0.012). Ten women (9.7%, 95% CI 4.8-17.1) reported having heard of hormonal emergency contraception, mostly from informal sources, 1 had used it, and 7 knew of other women who had used it. Only 8 (7.8%) respondents were willing to use or inform a friend about hormonal emergency contraception, but 89.3% thought it should be available in the health system. CONCLUSIONS: Awareness of hormonal emergency contraception is low among women in Kuwait. Despite concerns and apparent negative attitudes, women believe it should be made available in the health system.

Adolescent↗

Ciprofloxacin resistance and its molecular mechanism in Campylobacter spp. isolated in Kuwait.

Campylobacter spp. are an important cause of diarrhea in Kuwait. Because susceptibility data for ciprofloxacin and erythromycin, the two recommended drugs for treatment, are not available for this part of the world, 64 Campylobacter spp. isolates obtained from human diarrheal stools in Kuwait during 2000--2003 were studied for susceptibility to these antimicrobials by E-test. The utility of a simple mismatch amplification mutation assay (MAMA) PCR to detect base substitution in the gyrA gene mediating resistance to ciprofloxacin was also explored. Approximately, 53% (34/64) of the isolates were resistant to ciprofloxacin (MIC, 4-64 microg/ml) and 5% (3/64) to erythromycin (MIC>256 microg/ml). MAMA PCR showed a Thr-86-to-Ile mutation in gyrA gene of 23/26 ciprofloxacin-resistant C. jejuni, and in all resistant C. coli. Sequencing of PCR product showed that two resistant strains of C. coli studied had Thr-86-to-Ile (ACT--> ATT) gyrA mutation and three resistant strains of C. jejuni studied had Thr-86-to-Ile (ACA--> ATA) gyrA mutation. In addition, all the three C. jejuni strains had silent mutations. Thus, ciprofloxacin is of limited use for treatment in Kuwait and MAMA PCR is a useful assay to study gyrA mutation. Because Kuwait has a large expatriate population of workers, it can be a focus of spread of antimicrobial resistance.

Campylobacter↗

Health effects of the 1991 Kuwait oil fires: a survey of US army troops.

The burning of oil wells in Kuwait in 1991 discharged a high volume of potentially toxic pollutants into the air. To determine whether there were health-related complaints associated with having lived and worked there, questionnaires were administered to 1599 soldiers after their return from a 3-month mission in Kuwait. Symptoms occurring before, during, and after the mission were queried. Compared with baseline, symptoms reported more frequently for the Kuwait period were eye and upper respiratory tract irritation, shortness of breath, cough, rashes, and fatigue. Symptoms were associated with reported proximity to oil fires, and their incidence generally decreased after the soldiers left Kuwait. Oil-fire smoke is one of several possible factors that may have contributed to the reporting of symptoms.

Adult↗

Mode of presentation and first line of management of non-recurrent urolithiasis in Kuwait.

AIMS: To determine the incidence, mode of presentation, first line of management and composition of non-recurrent urolithiasis in Kuwait. METHODS: Consecutive patients admitted between January 1999 and December 2002 with non-recurrent urolithiasis were prospectively analyzed. RESULTS: The average annual incidence of hospital admission for non-recurrent urolithiasis in Kuwait was 43.44 per 100,000 population, representing men and women (ratio, 9:1) with a median age of 41.91 years. Of the hospital admissions for non-recurrent urolithiasis, 57.2% of cases were acute. Overall, the most predominant symptom was flank pain, while the least common symptom was acute urinary retention. Ureteroscopic stone manipulation was the most common initial treatment modality in the present series, as it was utilized in 43.3% and 37.09% for patients admitted on elective and emergency basis, respectively. Of the calculi available for chemical analysis, 91% contained calcium, 73% contained calcium oxalate, 17% contained mixed calcium and 1% contained calcium phosphate. The composition of the rest of the stones were urate in 7%, struvite in 1% and cystine in 1%. CONCLUSIONS: Urolithiasis is a common disease in the Kuwait region that mainly presents with flank pain. Ureteroscopic calculus removal is the most common modality of treatment. The majority of the calculi seen in Kuwait contained calcium.

Acute Disease↗

Dental education in Kuwait.

For a long time there has been a need to establish a dental school in Kuwait, due to the fact that the majority of dentists working in Kuwait are expatriates from various countries. An Amiri decree in 1996 made it possible, and the first dental students were admitted to the Kuwait University Faculty of Dentistry in 1998. The mission of the Faculty of Dentistry is 'to promote oral health in Kuwait through education, research and cooperation with other professional health care institutions as well as the community at large'. A 6.5-year dental curriculum was completed after 2 years of committee work and was accepted by the University Council in 2001. This curriculum incorporates current trends in medical and dental education, such as the evidence-based and community-based approaches, problem-solving methodology for outcome-based learning, and competency achieved through comprehensive patient care.

Curriculum↗

Risk factors, subtypes and outcome of ischaemic stroke in Kuwait--a hospital-based study.

OBJECTIVE: To report on stroke subtypes, associated risk factors and outcome in Kuwait. METHODS: The records of 62 patients (30 male, 32 female) admitted with diagnosis of stroke to Kuwait Oil Company Hospital, Kuwait, a tertiary care hospital, during a 5-year period (1995-1999), were retrospectively reviewed. RESULTS: Small artery infarction was the most common subtype and occurred in 37 subjects (59.7%); less common were atherosclerotic large artery strokes (19 patients, 30.6%) and strokes of cardio-embolic origin (6 patients, 9.7%). Identifiable risk factors or associated morbidities were hypertension (72.5%), diabetes mellitus (69.4%), ischaemic heart disease (14.5%), history of migraine (8.1%), lone atrial fibrillation (5.0%), and valvular heart disease (1.6%). The most important determinants of a deleterious 30-day outcome, as indicated by severe disability or death, were female gender, lack of use of anti-platelet drugs, presence of a large artery infarction stroke subtype, and cardio-embolic stroke. CONCLUSION: Prevalence of hypertension and diabetes is high among patients with stroke in Kuwait, with rates higher than those found in any previous reports from the Gulf region. Two unusual observations were that women had a rather high frequency of stroke, and infarction of the small artery was more common than that of the large artery. Outcome, as indicated by severe disability or death, was worse among women, elderly patients, and those with large artery atherosclerotic and cardio-embolic strokes. There is some evidence that such a deleterious outcome might be ameliorated with use of anti-platelet drugs.

Adolescent↗