Introduction and objectiveST elevation myocardial infarction (STEMI) is caused by formation of a thrombus at a ruptured atheromatous plaque. Larger platelets are enzymatically and metabolically more active and play a crucial role in thrombus formation. Our objective was to study the association between platelet volume indices (mean platelet volume (MPV) and platelet distribution width (PDW)) and STEMI.MethodsA hospital-based case control study to compare the platelet indices of 52 STEMI patients before commencing antiplatelet therapy and age and gender matched 52 controls who had no history of ischemic heart disease or antiplatelet therapy. Blood samples were collected to EDTA bottles and analyzed using Mindray BC 6800 automated analyzer.ResultsSTEMI patients had significantly increased mean MPV and PDW compared to the control group ((8.22 ± 0.99 fL vs 7.74 ± 0.69 fL, p = 0.005) and (15.81 ± 0.41 fL vs 15.62 ± 0.33 fL, p = 0.007) respectively). Significant positive correlation existed between MPV and PDW (R = 0.556, p = 0.000) and weak negative correlation in platelet count with MPV (R = −0.323, p = 0.019) and PDW (R = −0.309, p = 0.026) of STEMI patients. Receiver Operating Characteristic (ROC) curves showed that MPV and PDW with cutoff values of 7.55 fL, 15.55 fL and with Area under the curve (AUC) of 0.640, 0.620 respectively. The sensitivities and specificities were found to be 73.1%, 69.2% and 61.5%, 55.8% for MPV and PDW respectively.ConclusionIncreased MPV and PDW were found to have a significant association with STEMI and this test has the potential to be used as a preliminary test to identify high-risk patient for myocardial infarction.

We describe a case of a 36-year-old woman who presented with bilateral symmetrical polyarthritis of the hands, malar rash, and discoid rash over three months. She was initially diagnosed and treated as systemic lupus erythematosus but later proven to have lepromatous leprosy. The patient showed a remarkable improvement after the administration of steroids. Due to typical features of a connective tissue disorder, a positive serological marker, photosensitivity, typical age of onset and initial response to treatment led to the confusion and delay in diagnosis of lepromatous leprosy. Further, this case emphasizes the importance of obtaining a detailed contact history and taking a skin biopsy even in a typical connective tissue lesion. Our case illustrates an unusual presentation of lepromatous leprosy mimicking systemic lupus erythematosus.

Coronavirus disease 2019 (COVID-19), besides its well-known deleterious effects on the respiratory system, is also reported to affect the central nervous system (CNS), presenting with neurological manifestations, that are commoner among older patients with associated co-morbidities and in the critically ill with COVID pneumonia. Infective, cerebrovascular, and hypoxic-toxic-metabolic etiology have been implicated. Reported outcomes have been poor with persistent neurological deficits among the majority who have survived. We report a young lady who presented with neurological manifestations alongside moderately severe COVID-19 pneumonia. Diagnosed early and managed as severe encephalopathy after excluding infective and cerebrovascular aetiology. Responded well to conservative measures and made a complete recovery. Early recognition of neurological manifestations of COVID-19 disease followed by the institution of appropriate therapies improved the outcomes.

Background: Witnessed cardiac arrest is a common occurrence in an A&E department. The reported incidence of witnessed cardiac arrest is variable around the world. Overall unadjusted survival to hospital discharge rate was 18.4%. Objective: To assess the aetiology, factors associated in outcomes of witnessed cardiac arrests, and the rate of occurrence of cardiac arrest at the A&E of Provincial General Hospital Kurunegala (PGHK). Methods: This descriptive study was conducted between January1, 2016, to December 31, 2016 (one year) at the A&E department of PGHK. Survivors were followed up on for a one-year period. Results: There were 123 witnessed cardiac arrests (mean age 64 (+/-15.9) years, 64% male), out of which 25 patients were successfully resuscitated {return of spontaneous circulation (ROSC)} and transferred to intensive care units for further care. However, only 6 (4.9%) patients were discharged from the hospital. The three-month and one-year survival numbers were 6 (4.9%) (males: 4, females: 2) and 4 (3.3%) (males: 3, female: 1) respectively. The age of the female survivor after one year was 43 years and the ages of the three male survivors were 46, 54, and 55 years respectively. The most common aetiology for cardiac arrest was myocardial infarction (43.1%) while the most common initial rhythm was non-shockable (82%). The initial rhythm was shockable in all 6 survivors. Conclusion: The overall ratio of survival to discharge was much lower in comparison to international figures. The poor survival rate in our study may be due a very high rate of cardiac arrests with initial non-shockable rhythms.

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