Dietary Composition, Angiographic Coronary Disease, and Cardiovascular Outcomes in the WISE Study (Women's Ischemia Syndrome Evaluation)

BACKGROUND

Studies relating diet to angiographic coronary artery disease (CAD) and subsequent major adverse cardiac events (MACE) in women are limited. Information on diet was collected in the Women's Ischemia Syndrome Evaluation (WISE), a prospective cohort study of symptomatic women referred for coronary angiography to evaluate suspected ischemic heart disease.

METHODS

A consecutive subgroup (n = 201 of 936) of enrolled women completed the modified Block food frequency questionnaire (FFQ). Data on outcomes were collected and adjudicated after 8-year follow-up. A set of logistic regression models were fitted for non-obstructive versus obstructive coronary stenosis (<50% versus ≥50%). Cox proportional hazard regression models were fitted for outcomes, with each dietary composition variable adjusted for the degree of coronary stenosis.

RESULTS

At baseline, the subgroup cohort was 58 ± 12 years old with a body mass index (BMI) of 30 ± 7 kg/m2. An increased proportion of calories consumed from protein was associated with higher levels of baseline obstructive coronary stenosis. Those individuals who ate a higher amount of protein, carotene, and servings of vegetables and meat, however, were each associated with lower subsequent adverse outcomes, respectively.

CONCLUSIONS

Among women undergoing coronary angiography for suspected CAD, a higher percentage of protein intake was associated with higher baseline stenosis severity; however, the amount of protein intake, vegetable, meat, and carotene intake, was conversely associated with subsequent lower adverse cardiovascular outcome risk.

Soft tissue displacement for detection of left ventricle apical dyskinesis with transthoracic echocardiography

We tested the hypothesis that the use of outward displacement of the soft tissue between the apex and the chest wall as seen in TTE, is a sign of apical displacement and would allow for more accurate diagnosis of apical dyskinesis. This is a retrospective study of 123 patients who underwent TTE and cardiac magnetic resonance imaging (MRI) within a time frame of 6 months between 2008 and 2019. 110 subjects were deemed to have good quality studies and included in the final analysis. An observer blinded to the study objectives evaluated the echocardiograms and recorded the presence or absence of apical dyskinesis. Two independent observers evaluated the echocardiograms based on the presence or absence of outward displacement of the overlying tissue at the LV apex. Cardiac MRI was used to validate the presence of apical dyskinesis. The proportion of studies which were identified as having apical dyskinesis with conventional criteria defined as outward movement of the left ventricular apex during systole were compared to those deemed to have dyskinesis based on tissue displacement. By cardiac MRI, 90 patients had apical dyskinesis. Using conventional criteria on TTE interpretation, 21 were diagnosed with apical dyskinesis (23.3%). However, when soft tissue displacement was used as the diagnostic marker of dyskinesis, 78 patients (86.7%) were diagnosed with dyskinesis, p < 0.01. Detection of displacement of soft tissue overlying the LV apex facilitates better recognition of LV apical dyskinesis.

Hemoptysis After Heart Transplantation Caused by Pulmonary Amyloidosis

Pulmonary involvement is a common sequela of systemic amyloidosis, occurring in up to 50% of cases. The patterns of involvement include focal nodular, diffuse interstitial, and tracheobronchial. This can lead to a variety of symptoms, including cough and shortness of breath. Although hemoptysis is not uncommon, massive hemoptysis is rare. (Level of Difficulty: Advanced.).

Recurrent Myocarditis Treated with Intravenous Immune Globulin and Steroids

Patient: Male, 18-year-old

Final Diagnosis: Myocarditis

Symptoms: Chest pain • palpitation • shortness of breath

Medication: —

Clinical Procedure: Angiogram • cardiac MRI • transthoracic echocardiogram

Specialty: Cardiology

Cocaine exposure impairs multilineage hematopoiesis of human hematopoietic progenitor cells mediated by the sigma-1 receptor [corrected]

Prenatal exposure to cocaine is a significant source of fetal and neonatal developmental defects. While cocaine associated neurological and cardiac pathologies are well-documented, it is apparent that cocaine use has far more diverse physiological effects. It is known that in some cell types, the sigma-1 receptor mediates many of cocaine's cellular effects. Here we present a novel and concise investigation into the mechanism that underlies cocaine associated hematopoietic pathology. Indeed, this is the first examination of the effects of cocaine on hematopoiesis. We show that cocaine impairs multilineage hematopoiesis from human progenitors from multiple donors and tissue types. We go on to present the first demonstration of the expression of the sigma-1 receptor in human CD34 + human hematopoietic stem/progenitor cells. Furthermore, we demonstrate that these cocaine-induced hematopoietic defects can be reversed through sigma-1 receptor blockade.

Mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal

PURPOSE

To report a case of Mycobacterium chelonae keratitis after laser in situ keratomileusis successfully treated with medical therapy and flap removal.

METHODS

Case report. A 36-year-old white woman in good health developed a paracentral keratitis in her right eye 1 month after bilateral laser in situ keratomileusis. Initial treatment included topical steroids and then intensive Ocuflox (ofloxacin ophthalmic solution; Allergan, Inc, Irvine, California) without success. Cultures were negative. The keratitis worsened, and she was referred to our institution. Interface infiltration was noted, and the flap was lifted to obtain adequate laboratory studies. Cultures were positive for M chelonae.

RESULTS

The keratitis was treated with intensive topical amikacin sulfate 1%, topical clarithromycin 1%, and Ciloxan (ciprofloxacin HCL; Alcon Laboratories, Inc, Fort Worth, Texas) with minimal improvement in her clinical condition. She developed a toxic reaction to amikacin 1%. In order to improve antibiotic penetration, the hazy, ulcerated corneal flap was removed. The keratitis then resolved with intensive topical clarithromycin 1% and Ocuflox over 5 weeks. The patient now has visual acuity without correction of 20/50, despite superficial corneal haze.

CONCLUSION

M chelonae is a rare and insidious cause of infection after laser in situ keratomileusis. Diagnosis can be difficult and is often delayed. Aggressive medical management, with flap removal, if needed, may lead to resolution of infection.

Refractive surgery for active patients: weighing the pros and cons

Athletes who need corrective lenses may ask about refractive surgery. Radial keratotomy, photorefractive keratectomy, and laser in situ keratomileusis surgically alter the shape of the cornea. All three methods generally result in vision sufficient to pass a driver's test without corrective lenses. A thorough patient evaluation and education about risks must be undertaken before an active patient undergoes any type of refractive surgery.

Early prediction of posterior crossbite in the complete unilateral cleft lip and palate

Dental study casts on 35 patients with unilateral cleft lip and palate (UCLP) were evaluated at the late primary and early mixed dentition stages for the presence of significant (more than one tooth) posterior crossbites. Using this crossbite criterion patients were divided into "acceptable" and "unacceptable" groups. Eleven arch dimensions on the presurgical dental casts were measured to see if any, either singly or in combination, could be used to predict the later occurrence of significant crossbite. No single measurement of infant arch dimensions significantly differed between children with and without crossbite. Data from 26 patients were used for discriminant function analysis. This produced an equation correctly predicting the presence or absence of posterior crossbites in 88% of cases in the primary and 91% in the mixed dentitions.

Effects of psychological preparation on children hospitalized for dental operations

We studied the effect of preoperative preparation on stress reduction in children hospitalized for dental surgery under general anesthesia. Participants were 45 children, 3 and 4 years of age, with no previous hospital-surgery experience and no history of medical or psychological conditions requiring special care. Subjects were randomly assigned to one of three experimental groups: control, receiving no preoperative preparation; unrelated play therapy, receiving a preoperative play session unrelated to hospital or surgical procedures; and related play therapy, receiving a preoperative play session focusing on hospital and surgical procedures. Subjects' behavior was assessed using behavior observation scales for cooperation and upset at seven stress points: admission, nurse's examination, pediatric medical examination, blood test, preoperative injection, transfer to surgery, and induction. The related play therapy group was more cooperative and less upset than either the unrelated play therapy group or the control group across stress points. No significant heart rate differences were found among the three groups. The results suggest that play therapy related to hospital and surgical procedures can alleviate stress and anxiety in 3- and 4-year-old children.