Platelet dysfunction and coagulation assessment in patients of tuberculous meningitis.

INTRODUCTION: Tuberculous meningitis (TBM) is the most severe form of tuberculosis. As reported in various studies, stroke is common among patients with TBM, with a prevalence of 17-54%. The present study assessed platelet dysfunction and coagulation abnormality in patients with TBM. METHODS: This was a prospective observational study that included 123 consecutive patients with TBM. In addition to clinical and radiological parameters, the complete platelet function and coagulation function were studied. The patients were followed up to 6 months. RESULTS: A significant correlation between platelet abnormality and stroke in patients with TBM was reported in this study. Results of the univariate analysis revealed that haematological parameters such as mean platelet volume (MPV) (p < 0.001), platelet distribution width (PDW)(p < 0.001), platelet-large cell ratio (P-LCR) (p < 0.001), and platelet aggregometry (PAg) (p < 0.001) were significantly associated with infarct. However, other haematological parameters such as bleeding time (p = 0.712), clotting time (p = 0.362), activated partial thromboplastin time (p = 0.094), INR (p = 0.420), protein C (p = 0.988), and protein S (p = 0.579) were not significantly associated with infarct. During follow-up at 3 and 6 months, parameters such as MPV (p < 0.001), PDW (p < 0.001), and P-LCR (p < 0.001) were significantly associated with infarct. CONCLUSION: The present study concluded that platelet abnormalities in patients with TBM contribute to infarct and are associated with poor clinical outcomes. This study suggested the role of antiplatelet agents in preventing stroke in patients with TBM.

Permanent pacemaker-related upper extremity deep vein thrombosis: a series of 20 cases.

BACKGROUND: Upper extremity deep vein thrombosis (DVT) has become a common occurrence nowadays due to emergence of multiple newer risk factors, such as implantation of permanent pacemaker (PPM) and implantable cardioverter-defibrillators. We are reporting 20 cases of upper extremity DVT related to PPM implantation. METHODS AND RESULT: All the patients presented within 6 months, with unilateral upper extremity swelling (90%), pain (45%), erythema (15%), and other less frequent features. Venography established the diagnosis in all the cases. Considering the distribution of possible risk factors of venous thrombosis among our patients, diabetes was the most frequent (present in 45%) followed by smoking (35%), hypertension (30%), obesity with body mass index ≥30 (30%), history of acute myocardial infarction (25%), chronic obstructive pulmonary disease (20%), and history of congestive cardiac failure (15%). Antiplatelets were not found protective against the development of this situation. There was no statistically significant difference in respect to venous access, number of leads, use of previous temporary pacing lead, or poor left ventricular systolic function (ejection fraction ≤40%) among the six patients who presented with complete occlusion of subclavian vein compared to the rest of the 14 patients who had partial occlusion. There were complete resolutions of symptom in 85% of patients after 6 months of anticoagulation therapy in the form of initial intravenous unfractinated heparin followed by oral warfarin. CONCLUSION: Anticoagulation with warfarin for 6 months with initial intravenous unfractionated heparin was a safe and effective mode of therapy in most of the patients with PPM related upper extremity DVT.

The New Zealand nuclear veteran and families study, exploring the options to assess heritable health outcomes.

AIMS: To describe health conditions in New Zealand nuclear veterans and their offspring, and examine the utility of tests to assess their heritability. METHOD: An online survey, open to all veterans and offspring, with questions on health conditions, the GHQ12 to measure psychological distress, the Euroquol-5D visual analogue scale (EQ5D VAS) to measure health state, and free text items on veteran support. RESULTS: Eighty-three responses (56%) were from veterans, 65 (44%) from offspring. Anxiety and depression were prevalent in both groups, with cancers (n=31, 37%) and joint conditions common in veterans (n=26, 31%). Few offspring reported cancer, rather problems with fertility (n=18, 40%). The free text themes fell into four domains, official commitment, health, emotional and information support; however, little support had been sought. CONCLUSION: Cancers have utility in assessing heritability, but a low prevalence and lack of diagnostic data rules this out. Psychological conditions may be heritable, but the techniques to assess this are still developing. Chromosomal damage in veterans and offspring can be detected, but with present knowledge cannot explain health outcomes. Future work should assemble a veteran and family register with linkage to routine data-sets. Veterans and offspring should be encouraged to seek support.