Introduction: Platelets play a vital role in systemic inflammation and thrombus formation in ST Elevation Myocardial Infarction (STEMI). Understanding its role has diagnostic and prognostic implications in developing therapeutic strategies. Aim: To estimate the prognostic accuracy of platelet indicesMean Platelet Volume (MPV), Platelet Distribution Width (PDW) and MPV/Platelet Count (PC) Ratio (MPV/PC ratio) on reperfusion outcome in STEMI patients. Materials and Methods: This prospective cohort study enrolled 262 subjects, who presented with acute chest pain within a window period of 12 hours, and an Electrocardiogram (ECG) suggestive of STEMI. Blood samples collected on admission were measured for MPV and PDW. The major endpoints studied were angiographic thrombus burden and in-hospital Major Adverse Cardiovascular Events (MACE). Data was summarised by Mean and SD for continuous variables, frequency and percentage for categorical variables. Results: This study demonstrated that Acute Coronary Syndrome- STEMI (ACS-STEMI) patients with larger PDW had Larger Thrombus Burden (LTB). PDW of more than 13 fL was the best cut off for predicting LTB with a sensitivity of 67.01% and a specificity of 53.23%. There was no significant difference between the means of MPV in LTB and small thrombus burden. The total in-hospital MACE at the end of one week was 20.99% (n=55/262 patients). The maximum MACE was contributed by acute heart failure (12.6%), followed by cardiac death (6.1%) and stent thrombosis (1.5%). There was a significant association between increased PDW and in-hospital MACE, mortality and acute heart failure (p-value=0.024, p-value=0.03, p-value=0.02, respectively). The best cut-off PDW value for prediction of the composite MACE endpoint was 14.7 fL with sensitivity of 75.6% and specificity of 51.4% and the area under the Receiver Operating Characteristic (ROC) curve was 0.63 (95% CI, 0.57 to 0.69). Conclusion: The study emphasises the use of platelet indices, especially PDW, as a predictor of poorer reperfusion outcomes in primary Percutaneous Coronary Intervention (PCI) as evidenced by higher MACE rates in patients with higher PDW. Hence, PDW can help in predicting the thrombus burden even before doing the angiogram and such high-risk patients could benefit from early initiation of stronger antiplatelets, Gp IIb/IIIa (Glycoprotein) antagonist drugs and thrombus aspiration techniques.
The salient clinical and pathological features are reported of Aspergillus cerebral aneurysms in four young women who had undergone intra-abdominal surgery under spinal anaesthesia and developed clinical features of meningitis 7-16 days postoperatively. The circle of Willis showed ruptured aneurysm in the basilar artery and its branches. The role of iatrogenic factors in the pathogenesis of Aspergillus cerebral aneurysms is highlighted.
A 20-year-old man presented with left-sided headache and seizures of three years duration. Conglomerate ring-enhancing lesions were seen in the first magnetic resonance imaging study. He was initially treated with anticonvulsants for two years. Because the symptoms and the lesions were persisting, antitubercular treatment was added. He was asymptomatic after antitubercular treatment despite persisting lesion. Lesion showed exuberant ring enhancement with increased perfusion. Because the lesion was persisting even after 24 months of antitubercular treatment, excision was considered. Lesionectomy was done and histopathology reported meningoencephalitis secondary to neurocysticercosis. The case report highlights the difficulty in differentiating cysticercosis from tuberculoma in patients from countries where both the conditions are endemic.
In the study Mycobacterium tuberculosis was isolated in the cerebrospinal fluid (CSF) specimens of patients with tuberculous meningitis (TBM) by the conventional bacteriological technique. The isolation rate of M. tuberculosis was found to be 11.5% in lumbar, 75% in ventricular and 87.5% in cisternal CSFs. Low isolation rate of M. tuberculosis in lumbar CSF is due the low density of tubercle bacilli in lumbar CSF than in cisternal CSF. However M. tuberculosis antigen 5 is present in significant concentration in CSFs. The antigen concentration in CSF was estimated by an inhibition enzyme-linked immunosorbent assay (ELISA). Since CSF specimens can not be collected from ventricular or cisternal routes for the routine bacteriological investigations in patients with TBM, estimation of M. tuberculosis antigen 5 concentration in lumbar CSF by an inhibition ELISA may be considered as an adjunct in the laboratory diagnosis of TBM. This is particularly relevant in those patients in whom bacteriological methods fail to demonstrate M. tuberculosis in CSF specimens.
IgG antibody to M. tuberculosis antigen-5 and tuberculin purified protein derivative (PPD) was measured by enzyme linked immunosorbent assay (ELISA) in cerebrospinal fluid (CSF) specimens of 55 patients with tuberculous meningitis (TBM) and 55 patients with non-tuberculous neurological diseases (control group). The geometric mean antibody titre in CSF specimens of TBM patients was 82.4 with antigen-5 and 96.5 with PPD. In the control group, the geometric mean antibody titres for these antigens in CSF specimens were 4.6 and 10.8 respectively. The antibody titres did not show any correlation with tuberculin reactor status, duration of chemotherapy and IgG levels in CSF specimens in patients with TBM. At dilution end point 1:80, specificity of the assay was 100 per cent with antigen-5 and sensitivity of the assay was 70.9 per cent. False positivity observed in the control group with PPD antigen could be eliminated in 1:80 dilution in the assay with antigen-5. Antigen-5 is more specific than PPD antigen for the diagnosis of tuberculous meningitis.
In this study, clinical and histopathological features of primary lymphomas of the brain have been described in eight patients. The primary nature of lymphoma in these patients was confirmed by extensive clinical as well as radiological investigations and supported by a detailed histopathological examination. Computerised tomography (CT) scan showed multiple intra-cerebral lesion in two patients and in six patients the lesion was solitary. Although primary lymphoma of the brain carries poor prognosis, it is essential that these tumours should be accurately diagnosed as well as should be distinguished from secondary tumours.
Radiation induced gliomas are uncommon. Occurrence of glioma following radiotherapy for craniopharyngiomas is extremely uncommon and only eight case reports have been so far published. We present our experience with one similar case of temporal gliomas occurring twelve years following radiotherapy for a sub totally excised craniopharyngioma. Although the exact mechanism of gliomas formation is unclear, their occurrence following conventional radiotherapy is a distinct possibility and signifies a poor prognosis.
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