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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Fiscal Cliff Deal Vote Likely in Senate

The so-called "fiscal cliff" came tonight -- but now there is a specific deal on the table to try to soften it after the fact, according to congressional sources.

Senate Majority Leader Harry Reid, D-Nev., said the deal -- brokered by Vice President Joe Biden and Senate Minority Leader Mitch McConnell -- would get a vote in the Senate sometime after midnight. The House would not vote before Tuesday afternoon at the earliest, sources said.

"I feel really very, very good about this vote," Biden told reporters leaving the meeting with Senate Democrats, "but having been in the Senate for as long as I have there's two things you shouldn't do: You shouldn't predict how the Senate is going to vote before they vote....[and] you surely shouldn't predict about how the House is going to vote."

The proposal would extend Bush-era tax cuts permanently for people making less than $400,000 per year and households making less than $450,000, the sources said.

The steep "sequester" budget cuts scheduled to go into effect with the New Year would be postponed two months, said sources. They said half the money would come from cuts elsewhere, and the other half from new revenue.

The deal also would affect taxes on investment income and estates, and extend unemployment benefits for a year, the congressional sources added.

"The end is in sight," said a Democratic aide with Senate Majority Leader Harry Reid's office. "If everyone cooperates, it's possible things can move pretty quickly."

After the Biden meeting, Sen. Charles Schumer, D-N.Y., said there was "strong" support for the plan among Senate Democrats.

"There is a feeling that it's not that this proposal is regarded as great or as loved in any way, but it's a lot better than going off the cliff," he said.

Sen. Dianne Feinstein, D-Calif., called the compromise the "best" that could be done.

Even with progress in the Senate tonight, the "cliff" deadline will pass without action by the House, where Republican leaders said they would "consider" the deal starting tomorrow.

'Fiscal Cliff': Lawmakers Scramble for Last-Minute Deal Watch Video

"Decisions about whether the House will seek to accept or promptly amend the measure will not be made until House members -- and the American people -- have been able to review the legislation," said House Speaker John Boehner, Majority Leader Eric Cantor, Majority Whip Kevin McCarthy, and Republican Conference Chair Cathy McMorris Rodgers in a statement.

The failure of a deal to pass Congress by Jan. 1 technically triggers an income tax hike on all Americans and automatic spending cuts, though lawmakers could still prevent a tax hike by making retroactive any legislation that passes in the weeks ahead, experts said.

The deal at hand will not entirely solve the problem of the "fiscal cliff," however. In fact, it could set up a new showdown over the same spending cuts in just two months that would be amplified by a brewing fight over how to raise the debt ceiling beyond $16.4 trillion. That new fiscal battle has the potential to eclipse the "fiscal cliff" in short order.

Earlier, during a midday news conference, Obama said he was optimistic about compromise in the short-term.

"It appears that an agreement to prevent this New Year's tax hike is within sight, but it's not done," he said. "There are still issues left to resolve, but we're hopeful that Congress can get it done."

In addition to extending current tax rates for households making $450,000 or less, the latest plan would raise the estate tax from 35 to 40 percent for estates larger than $5 million; and prevent the alternative minimum tax from hammering millions of middle-class workers, according to sources familiar with the talks.

Capital gains taxes would rise to 20 percent from 15, according to a senior White House official.

The deal would also extend for one year unemployment insurance benefits set to expire Tuesday, and avert a steep cut to Medicare payments for doctors, congressional sources said.

"I can report that we've reached an agreement on the all the tax issues," said Senate Minority Leader Mitch McConnell in an afternoon speech on the Senate floor.

At the time, McConnell said that federal spending cuts remained a sticking point. That hurdle later appeared to be cleared by postponing the debate two more months, though it is unclear whether House Republicans will go along.

"In order to get the sequester moved, you're going to have to have real, concrete spending cuts," said Rep. Mike Rogers, R-Mich. Without that, he said, "I don't know how it passes the House."

Some Republicans also said Obama unduly complicated progress toward an agreement by seeming to take a victory lap on taxes at his campaign-style event at the White House.

"Keep in mind that just last month Republicans in Congress said they would never agree to raise tax rates on the wealthiest Americans," Obama said, raising the ire of several Republicans. "Obviously, the agreement that's currently discussed would raise those rates, and raise them permanently."

Those words drew a sharp retort from Republican Sen. John McCain.

Rather than staging a "cheerleading rally," McCain said, the president should have been negotiating the finishing touches of the deal.

"He comes out and calls people together and has a group standing behind him, laughs and jokes and ridicules Republicans. Why?" said McCain.

Several Democrats also voiced disappointment with the president and the emerging deal.

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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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S'pore stocks close lower

SINGAPORE: Share prices in Singapore closed lower in line with other regional markets in a shortened pre-holiday session.

Markets were weighed down by the US fiscal deadlock, as hopes faded that a deal will be reached just a day before the deadline.

The Straits Times Index fell 24.72 points, or 0.77 per cent, to end at 3,167.08.

On the broader market, losers outnumbered gainers by 216 to 175.

Volume totalled 1.54 billion shares valued at S$957.6 million.

Among the declining issues, Great Eastern dropped 18 cents to $15.66, DBS lost 14 cents S$14.84, and SIA also moved down 14 cents to finish at S$10.75.

Ramba Energy rose 21.5 cents to 60 cents, Venture added 6 cents to S$8.06, while City Developments gained 4 cents to S$12.87.

- CNA/al

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Patrick Suckling appointed as Australia's next envoy to India

MELBOURNE: Career diplomat Patrick Suckling has been appointed as Australia's next high commissioner to India.

Suckling will take up the post in New Delhi next month, according to media reports here.

The appointment was announced by foreign minister Bob Carr who said the role was important because India is Australia's fourth largest export market, with trade between the two countries reaching 18-billion dollars a year.

Suckling is a career diplomat who has previously been posted to New Delhi and Washington.

He has a post-graduate diploma in Hindi from the University of Sydney. Suckling will replace Peter Varghese, who is returning to Australia to head the department of foreign affairs and trade.

"Suckling is an accomplished career diplomat with expertise in policy development, public diplomacy and consular service," Carr said in a statement on Sunday.

"His previous postings to New Delhi and Washington and postgraduate qualifications in Hindi will serve him well as high commissioner."

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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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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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Suspected norovirus outbreak kills four in Japan hospital

TOKYO: A suspected norovirus outbreak has killed four people and infected almost 100 others at a hospital in the Japanese city of Yokohama south of Tokyo, officials said.

Four patients aged between 80 and 97 died of breathing problems and pneumonia between Wednesday and Friday after suffering vomiting and diarrhoea, officials at the city's Denentoshi Hospital said late Saturday.

A total of 72 patients including the four and 27 hospital staffers have been infected since Tuesday, they said.

The norovirus, which strikes in winter and causes vomiting and diarrhoea, killed six elderly patients at a hospital in Miyazaki in the south and two others at a hospital in the western city of Osaka earlier this month.

It is highly contagious and typically transmitted from person to person.

The virus has been detected in stool samples from 11 of the infected people in Yokohama, the hospital's director Seiji Shibuya told a news conference.

"Many patients are still suffering from the symptoms and we can't see an end to the situation," Shibuya said. "We apologise for our inability to prevent it."

- 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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