Clinton's blood clot an uncommon complication

The kind of blood clot in the skull that doctors say Hillary Rodham Clinton has is relatively uncommon but can occur after an injury like the fall and concussion the secretary of state was diagnosed with earlier this month.

Doctors said Monday that an MRI scan revealed a clot in a vein in the space between the brain and the skull behind Clinton's right ear.

The clot did not lead to a stroke or neurological damage and is being treated with blood thinners, and she will be released once the proper dose is worked out, her doctors said in a statement.

Clinton has been at New York-Presbyterian Hospital since Sunday, when the clot was diagnosed during what the doctors called a routine follow-up exam. At the time, her spokesman would not say where the clot was located, leading to speculation it was another leg clot like the one she suffered behind her right knee in 1998.

Clinton had been diagnosed with a concussion Dec. 13 after a fall in her home that was blamed on a stomach virus that left her weak and dehydrated.

The type of clot she developed, a sinus venous thrombosis, "certainly isn't the most common thing to happen after a concussion" and is one of the few types of blood clots in the skull or head that are treated with blood thinners, said neurologist Dr. Larry Goldstein. He is director of Duke University's stroke center and has no role in Clinton's care or personal knowledge of it.

The area where Clinton's clot developed is "a drainage channel, the equivalent of a big vein inside the skull — it's how the blood gets back to the heart," Goldstein explained.

It should have no long-term consequences if her doctors are saying she has suffered no neurological damage from it, he said.

Dr. Joseph Broderick, chairman of neurology at the University of Cincinnati College of Medicine, also called Clinton's problem "relatively uncommon" after a concussion.

He and Goldstein said the problem often is overdiagnosed. They said scans often show these large "draining pipes" on either side of the head are different sizes, which can mean blood has pooled or can be merely an anatomical difference.

"I'm sure she's got the best doctors in the world looking at her," and if they are saying she has no neurological damage, "I would think it would be a pretty optimistic long-term outcome," Broderick said.

A review article in the New England Journal of Medicine in 2005 describes the condition, which more often occurs in newborns or young people but can occur after a head injury. With modern treatment, more than 80 percent have a good neurologic outcome, the report says.

In the statement, Clinton's doctors said she "is making excellent progress and we are confident she will make a full recovery. She is in good spirits, engaging with her doctors, her family, and her staff."

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Online:

Medical journal: http://dura.stanford.edu/Articles/Stam_NEJM05.pdf

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Hillary Clinton Hospitalized With Blood Clot

(MICHAL CIZEK/AFP/Getty Images)

By DANA HUGHES and DEAN SCHABNER

Secretary Hillary Clinton was hospitalized today after a doctors doing a follow-up exam discovered a blood clot had formed, stemming from the concussion she sustained several weeks ago.

She is being treated with anti-coagulants and is at NewYork-Presbyterian Hospital so that they can monitor the medication over the next 48 hours, Deputy Assistant Secretary Philippe Reines said.

Her doctors will continue to assess her condition, including other issues associated with her concussion. They will determine if any further action is required, Reines said.

Clinton, 65, originally fell ill from a stomach virus following a whirlwind trip to Europe at the beginning of the month, which caused such severe dehydration that she fainted and fell at home, suffering a concussion. No ambulance was called and she was not hospitalized, according to a state department official.

The stomach virus had caused Clinton to cancel a planned trip to North Africa and the United Arab Emirates, and also her scheduled testimony before Congress at hearings on the attack on the U.S. consulate in Benghazi, Libya.

According to a U.S. official, the secretary had two teams of doctors, including specialists, examine her after the fall.  They also ran tests to rule out more serious ailments beyond the virus and the concussion. During the course of the week after her concussion, Clinton was on an IV drip and being monitored by a nurse, while also recovering from the pain caused by the fall.

Medical experts consulted by ABC News said that it was impossible to know for sure the true nature or severity of Clinton’s condition, given the sparse information provided by the State Department. However, most noted that the information available could indicate that Clinton had a deep venous thrombosis,which is a clot in the large veins in the legs.

“A concussion (traumatic brain injury) in itself increases risk of this clot. Likely the concussion has increased her bed rest,” said Dr. Brian D. Greenwald, Medical Director JFK Jonson Rehabilitation Center for Head Injuries. “Immobility is also a risk for DVT. Long flights are also a risk factor for DVT but the recent concussion is the most likely cause.

“Anticoagulants are the treatment,” he said. “If DVT goes untreated it can lead to pulmonary embolism (PE). PE is a clot traveling from veins in legs to lungs which is life threatening. Many people die each year from this.

“Now that she is being treated with blood thinners her risks of PE are decreased,” he said. “Blood thinners carry risk of bleeding but are common and can be safely used.”

Dr. Allen Sills, associate professor of Neurological Surgery at Vanderbilt University Medical Center, said it was most likely that the clot was not located in Clinton’s brain, since she is being treated with anticoagulants.

“This is certainly not a common occurrence after a concussion, and is most likely related to either inactivity or some other injury suffered in the fall,” he said.

Dr. Neil Martin, the head of Neurovascular Surgery at the University of California, Los Angeles, Medical Center, said blood thinners are often given for blood clots in the legs, and it is “very unusual” for anticoagulants to be given for blood clots in the head.

But he cautioned about speculating too much about Clinton’s condition before more information is available.

“If we don’t know where it is, there is the possibility of several different indications,” he said. “I don’t know if there is any connection between what she’s got now and the concussion. All I can tell you is, at this point, it’s almost impossible to speculate unless we know what’s going on there.”

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Chavez suffers new post-surgery complications

CARACAS (Reuters) - Venezuelan President Hugo Chavez is suffering more complications linked to a respiratory infection that hit him after his fourth cancer operation in Cuba, his vice president said in a somber broadcast on Sunday.

Vice President Nicolas Maduro flew to Cuba to visit Chavez in the hospital as supporters' fears grew for the ailing 58-year-old socialist leader, who has not been seen in public nor heard from in three weeks.

Chavez had already suffered unexpected bleeding caused by the six-hour operation on December 11 for an undisclosed form of cancer in his pelvic area. Officials said doctors then had to fight a respiratory infection.

"Just a few minutes ago we were with President Chavez. He greeted us and he himself talked about these complications," Maduro said in the broadcast, adding that the third set of complications arose because of the respiratory infection.

"Thanks to his physical and spiritual strength, Comandante Chavez is confronting this difficult situation."

Maduro, flanked by his wife Attorney-General Cilia Flores, Chavez's daughter Rosa Virginia and her husband, Science Minister Jorge Arreaza, said he would remain in Havana while Chavez's condition evolved.

He said Chavez's condition remained "delicate" - a term he has used since the day after the surgery, when he warned Venezuelans to prepare for difficult times and urged them to keep the president in their prayers.

"We trust that the avalanche of love and solidarity with Comandante Chavez, together with his immense will to live and the care of the best medical specialists, will help our president win this new battle," Maduro said.

A senior government official in Caracas said the New Year's Eve party in the capital's central Plaza Bolivar had been canceled. "Everyone pray for strength for our comandante to overcome this difficult moment," the official, Jacqueline Faria, added on Twitter after making the announcement.

OIL-FINANCED SOCIALISM

Chavez's resignation for health reasons, or his death, would upend politics in the OPEC nation where his personalized brand of oil-financed socialism has made him a hero to the poor but a pariah to critics who call him a dictator.

His condition is being closely watched around Latin America, especially in other nations run by leftist governments, from Cuba to Bolivia, which depend on subsidized fuel shipments and other aid from Venezuela for their fragile economies.

Chavez has not provided details of the cancer that was first diagnosed in June 2011, leading to speculation among Venezuela's 29 million people and criticism from opposition leaders.

Chavez's allies have openly discussed the possibility that he may not be able to return to Venezuela to be inaugurated for his third six-year term as president on the constitutionally mandated date of January 10.

Senior "Chavista" officials have said the people's wishes were made clear when the president was re-elected in October, and that the constitution makes no provision for what happens if a president-elect cannot take office on January 10.

Opposition leaders say any postponement would be just the latest sign that Chavez is not in a fit state to govern and that new elections should be called to choose his replacement. If Chavez had to step down, new elections would be called within 30 days.

Opposition figures believe they have a better shot against Maduro, who was named earlier this month by Chavez as his heir apparent, than against the charismatic president who for 14 years has been nearly invincible at the ballot box.

Any constitutional dispute over succession could lead to a messy transition toward a post-Chavez era in the country that boasts the biggest oil reserves in the world.

Maduro has become the face of the government in Chavez's absence, imitating the president's bombastic style and sharp criticism of the United States and its "imperialist" policies.

In Sunday's broadcast, Maduro said Chavez sent New Year greetings to all Venezuelans, "especially the children, whom he carries in his heart always."

(Additional reporting by Deisy Buitrago and Mario Naranjo; Editng by Kieran Murray and Christopher Wilson)

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Electricity tariffs to be lowered

SINGAPORE: Electricity tariffs will be reduced by an average 3.7 per cent from January to March 2013.

SP Services attributed the reduction to lower costs of electricity generation, largely due to lower fuel prices compared to the previous quarter.

Non-fuel costs of power generation have also been adjusted.

The average monthly electricity bill for families living in four-room HDB flats will go down by S$3.83.

Tariffs were also reduced by 2.9 per cent in the fourth quarter of this year and 2.5 per cent in the third quarter.

- CNA/al

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Castrate all rapists, says Zubin Mehta

BEIJING: World famous composer of Indian origin, Zubin Mehta, called for castration of all accused in the Delhi gang-rape case and others found committing the rape in India. He expressed excitement about the protests against the gang-rape of Nirbhaya and expects positive changes to come out of it.

"I am fuming, but I see a very healthy sign of public objection, public demonstration. I hope it will not die down. I hope it will not be short-lived," Mehta told Toi in an exclusive interview.

He said the Indian government should realize what the people really want from it. "It is not only about justice, but the future of India. Police has to take it seriously".

Mehta said the issue is being discussed the world over like the case of Malala, the Pakistani girl, and brought shame to Indians. He also questioned the government's decision to shift the rape victim for medical treatment to Singapore. "Where they trying to remove her from the locality, for her own safety?" he asked.

The least that should be done is to castrate all the four accused in the Delhi gang rape case, he said. "I heard that a girl who reported rape was advised to marry one of the criminals. How can a human being do such a thing?" he asked.

"An important issue that needs to be addressed is how to look after the poor ladies who have been attacked," he said.

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Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

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Associated Press reporter Tom Odula contributed to this report.

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Woman Charged With Murder in NYC Subway Push

A woman who allegedly told New York City police she pushed a man onto the subway tracks because she hated Hindus and Muslims has been charged with murder as a hate crime.

Erica Menendez, 31, allegedly told police that she "pushed a Muslim off the train tracks because I hate Hindus and Muslims ever since 2001 when they put down the twin towers I've been beating them up."

Menendez was taken into custody this morning after a two-day search, and when detectives were interviewing her she allegedly made the statements implicating herself in Thursday night's subway-platform death.

"The defendant is accused of committing what is every subway commuter's worst nightmare -- being suddenly and senselessly pushed into the path of an oncoming train," Queen District Attorney Richard A. Brown said. "The victim was allegedly shoved from behind and had no chance to defend himself. Beyond that, the hateful remarks allegedly made by the defendant and which precipitated the defendant's actions can never be tolerated by a civilized society."

Menendez was due to be arraigned this evening. She could face 25 years to life in prison if convicted of the second degree murder charge.

On Thursday night, a woman shoved a man from a subway platform at Queens Boulevard, and the man was crushed beneath an oncoming train. Police had searched the area for her after the incident.

New York City Subway Pusher Charged With Murder Watch Video

The victim was Sunando Sen, identified by several media outlets as a graphic designer and Indian immigrant who opened a print shop, Amsterdam Copy, on Manhattan's Upper West Side. Sen was struck by the No. 7 train after the unidentified woman allegedly pushed him from the northbound platform at 40th Street and Queens Boulevard at 8:04 p.m. on Thursday.

Witnesses told police they had seen the woman mubling to herself, pacing along the platform. She gave Sen little time to react, witnesses said.

"Witnesses said she was walking back and forth on the platform, talking to herself, before taking a seat alone on a wooden bench near the north end of the platform. When the train pulled into the station, the suspect rose from the bench and pushed the man, who was standing with his back to her, onto the tracks into the path of the train," NYPD Deputy Commissioner Paul J. Browne said earlier today. "The victim appeared not to notice her, according to witnesses."

READ: What to Do If You Fall on the Subway Tracks

Police released brief surveillance video of the woman fleeing the subway station, and described the suspect as a woman in her 20s, "heavy set, approximately 5'5" with brown or blond hair."

It was New York's second death of this kind in less than a month. On Dec. 3, 58-year-old Ki-Suck Han of Queens was shoved onto the tracks at New York's Times Square subway station. Two days later, police took 30-year-old Naeem Davis into custody.

On Friday, New York City Mayor Michael Bloomberg was asked whether the attack might be related to the increase of mentally ill people on the streets following closures of institutions over the past four decades.

"The courts or the law have changed and said, no, you can't do that unless they're a danger to society. Our laws protect you," Bloomberg said on his weekly radio show.

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Italy upbeat at end of 2012 after year of market tension

ROME: Italy is ending 2012 on an upbeat note, with renewed financial market confidence and optimism among analysts that the worst of the financial crisis is over, despite expectations of political uncertainty in the run-up to a general election in February.

The Treasury's borrowing rates were slightly higher at short, medium and long-term debt auctions last week, but were well below levels seen at the end of 2011, when Prime Minister Mario Monti took over from Silvio Berlusconi as Italy teetered on the brink amid the eurozone debt crisis.

In late November 2011, the country was paying a 7.56 per cent rate for its benchmark ten-year bonds, sparking widespread concerns it might have to ask for a bailout.

On Friday, that rate stood at 4.48 per cent.

As 2012 draws to a close, "even if public debt has breached the two trillion euros mark, Italy's ability to finance itself is no longer in doubt," said Enrico Marro in Italy's Il Sole 24 Ore financial daily.

"For 2013, optimism reigns," he concluded.

The turnaround is principally the result of two factors: the European Central Bank's promise to buy sovereign debt issued by eurozone member states without limit if necessary if they meet certain strict conditions, and Monti's decisive reforms which have restored Italy's credibility internationally.

Experts have forecast a couple of months of volatility on the markets in the lead up to the February 24 and 25 elections, but the worst appears to be over.

Italian bank Intesa Sanpaolo said "the fever should drop off in 2013 compared with 2012."

The bond spread -- a key measure of the difference between Italian and German 10-year bond yields -- has also dropped sharply over the year, dipping below 300 basis points in early December from double that figure at its peak.

While European leaders congratulated Monti on restoring calm to the markets, Berlusconi's announcement at the start of December that he is running again for prime minister sparked panic and the spread began to inch up again.

The media magnate has dismissed the spread measure as "a trick and an invention" used to bring down his government.

Investors will be watching closely in the coming weeks to see if Berlusconi's large-scale media campaign for re-election wins him potential votes from Italians tired of Monti's austerity packages and record unemployment levels.

Renewed confidence in financial markets contrasts sharply with official forecasts for economic growth over the coming year, as Italy struggles to pull itself out of a recession.

Despite Monti's "Grow Italy" plan, the economy is not expected to return to growth before the end of 2012 or the beginning of 2014.

"Business and household sentiment does not appear to have benefited from the easing market tension," Intensa Sanpaolo said.

The government has forecast a 0.2 per cent contraction of the country's gross domestic product in 2013 -- an outlook considered overly optimistic by Italy's business association Confindustria, which expects GDP to shrink by 1.1 per cent next year.

One figure is on the rise however: the number of people on Twitter following Monti, who is drumming up support for a reform-led electoral campaign.

Monti, who resigned last week after Berlusconi's People of Freedom party pulled support from the government, has said he is keen to lead the country again after the elections -- a message welcomed by the markets, European leaders and Italy's Catholic Church alike.

- AFP/ck

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July blasts in Valley a terror strike: Cops

SRINAGAR: The Jammu & Kashmir police have claimed that two Lashkar-e-Taiba terrorists killed in an encounter on Friday in Pulwama were responsible for a blast on a bus that had killed four tourists in Anantnag in July. The claim contradicts their statement that ruled out a terror angle to the blast then and had said that an LPG cylinder inside the bus had exploded and killed the four women from Mumbai.

ADG S M Sahai said the two terrorists had thrown a grenade at the bus."... it seemed to be a gas cylinder blast at that time. However, after forensic examinations, it was termed as a grenade attack," he said.

The surviving tourists had then said "something" was tossed into the bus, which was followed by the explosion. Doctors at Srinagar's Sher-e-Kashmir Institute of Medical Sciences had said that none of the victims had burn injuries, which a cylinder explosion can cause. "It could be splinter injuries of a grenade," a doctor had said.

Separately, separatist leader Mirwaiz Umar Farooq blamed security forces for firing on people after the Pulwama encounter. The separatists have called a bandh on Monday to protest the firing.

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Kenya hospital imprisons new mothers with no money

NAIROBI, Kenya (AP) — The director of the Pumwani Maternity Hospital, located in a hardscrabble neighborhood of downtown Nairobi, freely acknowledges what he's accused of: detaining mothers who can't pay their bills. Lazarus Omondi says it's the only way he can keep his medical center running.

Two mothers who live in a mud-wall and tin-roof slum a short walk from the maternity hospital, which is affiliated with the Nairobi City Council, told The Associated Press that Pumwani wouldn't let them leave after delivering their babies. The bills the mothers couldn't afford were $60 and $160. Guards would beat mothers with sticks who tried to leave without paying, one of the women said.

Now, a New York-based group has filed a lawsuit on the women's behalf in hopes of forcing Pumwani to stop the practice, a practice Omondi is candid about.

"We hold you and squeeze you until we get what we can get. We must be self-sufficient," Omondi said in an interview in his hospital office. "The hospital must get money to pay electricity, to pay water. We must pay our doctors and our workers."

"They stay there until they pay. They must pay," he said of the 350 mothers who give birth each week on average. "If you don't pay the hospital will collapse."

The Center for Reproductive Rights, which filed the suit this month in the High Court of Kenya, says detaining women for not paying is illegal. Pumwani is associated with the Nairobi City Council, one reason it might be able to get away with such practices, and the patients are among Nairobi's poorest with hardly anyone to stand up for them.

Maimouna Awuor was an impoverished mother of four when she was to give birth to her fifth in October 2010. Like many who live in Nairobi's slums, Awuor performs odd jobs in the hopes of earning enough money to feed her kids that day. Awuor, who is named in the lawsuit, says she had saved $12 and hoped to go to a lower-cost clinic but was turned away and sent to Pumwani. After giving birth, she couldn't pay the $60 bill, and was held with what she believes was about 60 other women and their infants.

"We were sleeping three to a bed, sometimes four," she said. "They abuse you, they call you names," she said of the hospital staff.

She said saw some women tried to flee but they were beaten by the guards and turned back. While her husband worked at a faraway refugee camp, Awuor's 9-year-old daughter took care of her siblings. A friend helped feed them, she said, while the children stayed in the family's 50-square-foot shack, where rent is $18 a month. She says she was released after 20 days after Nairobi's mayor paid her bill. Politicians in Kenya in general are expected to give out money and get a budget to do so.

A second mother named in the lawsuit, Margaret Anyoso, says she was locked up in Pumwani for six days in 2010 because she could not pay her $160 bill. Her pregnancy was complicated by a punctured bladder and heavy bleeding.

"I did not see my child until the sixth day after the surgery. The hospital staff were keeping her away from me and it was only when I caused a scene that they brought her to me," said Anyoso, a vegetable seller and a single mother with five children who makes $5 on a good day.

Anyoso said she didn't have clothes for her child so she wrapped her in a blood-stained blouse. She was released after relatives paid the bill.

One woman says she was detained for nine months and was released only after going on a hunger strike. The Center for Reproductive Rights says other hospitals also detain non-paying patients.

Judy Okal, the acting Africa director for the Center for Reproductive Rights, said her group filed the lawsuit so all Kenyan women, regardless of socio-economic status, are able to receive health care without fear of imprisonment. The hospital, the attorney general, the City Council of Nairobi and two government ministries are named in the suit.

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Associated Press reporter Tom Odula contributed to this report.

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