Rose Angina Questionnaire: Validation with cardiologists' diagnoses to detect coronary heart disease in Bangladesh

Aim/objectivesThe study aimed to validate the Rose Angina Questionnaire (RAQ) to detect coronary heart disease (CHD) by comparing with cardiologists' diagnoses in Bangladesh.MethodsPatients aged 40–75 years attending to two cardiac hospitals were diagnosed as either CHD positive or CHD negative by cardiologists. The RAQ was used to reclassify them into CHD positive [RAQ] and CHD negative [RAQ].FindingsThere were 302 CHD positive [cardiologists] and 302 CHD negative [cardiologists] individuals. The RAQ reclassified 194 individuals as CHD positive [RAQ] and 409 individuals as CHD negative [RAQ]. Therefore, the RAQ had 53% sensitivity and 89% specificity. There was no difference in sensitivity and specificity during subgroup analyzes by age and gender; the sensitivity was higher among people from lower socio-economic status.ConclusionThe RAQ, having moderate sensitivity but high specificity to detect CHD, can be used to screen individuals at risk of CHD in large-scale epidemiological surveys.     

Rose K contact lens fitting for keratoconus

Purpose We evaluated the clinical outcome and fitting characteristics with Rose K contact lenses in patients with irregular astigmatism due to keratoconus. Methods About 19 patients with keratoconus were fitted with Rose K lens in the Cornea Department at the Fatih Sultan Mehmet Training and Research Hospital between May 2005 and April 2006. Patients were between 19 and 32 years of age. All the patients underwent a complete ophthalmic examination and best-corrected visual acuity measurements were taken with glasses at the baseline visit. During biomicroscopic evaluation, position, and centralization of the contact lens and fluorescein staining were noted. Visual acuity, contact lens comfort, and daily contact lens wearing time after fitting were evaluated. Results A total of 96% of the patients tolerated the fitting. The mean daily wearing time was 10.7 h. There was a significant increase in visual acuity with Rose K lens compared with best-corrected spectacle visual acuity. Conclusion Rose K lenses are a viable alternative in the visual rehabilitation of patients with keratoconus. This study has been presented in the XXIV Congress of the ESCRS, September 9–14, 2006 London as a poster.     

From the Cover: Multifunctional supramolecular polymer networks as next-generation consolidants for archaeological wood conservation

The preservation of our cultural heritage is of great importance to future generations. Despite this, significant problems have arisen with the conservation of waterlogged wooden artifacts. Three major issues facing conservators are structural instability on drying, biological degradation, and chemical degradation on account of Fe³⁺-catalyzed production of sulfuric and oxalic acid in the waterlogged timbers. Currently, no conservation treatment exists that effectively addresses all three issues simultaneously. A new conservation treatment is reported here based on a supramolecular polymer network constructed from natural polymers with dynamic cross-linking formed by a combination of both host-guest complexation and a strong siderophore pendant from a polymer backbone. Consequently, the proposed consolidant has the ability to chelate and trap iron while enhancing structural stability. The incorporation of antibacterial moieties through a dynamic covalent linkage into the network provides the material with improved biological resistance. Exploiting an environmentally compatible natural material with completely reversible chemistries is a safer, greener alternative to current strategies and may extend the lifetime of many culturally relevant waterlogged artifacts around the world.The 16th century Mary Rose was a marvel of her time, a world-class warship with state-of-the-art weaponry. She sank in battle in 1545 and lay submerged for more than 400 y until she was raised in 1982 (1, 2). Centuries underwater have caused many complications in her preservation, as the cellulosic components of the wood cells have been severely damaged from waterlogging and biological action by marine organisms (3, 4). The production of acid within the timbers (5, 6) from localized Fe³⁺ deposits is a third contributor to the loss of cellulose, but has yet to be adequately addressed by conservation technologies (7, 8).For the last 20 y, the ship’s timbers have been sprayed continuously with increasing concentrations of aqueous poly(ethylene glycol) (PEG; maximum 50 vol.%) containing a broad spectrum biocide. This treatment aims to support the cell walls, preventing collapse, whereas the biocide hinders biological growth. Although PEG is easily applied, nontoxic, and inexpensive, a number of significant disadvantages exist for the conservation process. The need for lengthy treatment makes PEG application costly (9); additionally, PEG acts as a solid-state ion transporter (10), enabling the movement of acidic salts and iron through the timbers, creating more widespread chemical degradation issues. Finally, the action of bacteria, Fe³⁺, natural acids, temperature, and humidity on PEG can cause its degradation to acidic byproducts over time (9). It is clear from the examination of PEG consolidants that another conservation strategy is necessary (11).Recently, alternative consolidants have appeared in the literature with the focus moving toward oligoamides and natural polymers such as chitosan, guar, and 2-hydroxyethyl cellulose (11–14). These consolidants represent renewable and environmentally friendly alternatives to PEG with no acidic degradation products, enhanced timber compatibility, and a significantly reduced cost as they are often sourced as waste products from industrial processes. Despite such benefits, these materials alone do not offer a method of reducing or trapping Fe³⁺.Through a straightforward chemical functionalization of chitosan and guar and addition of a macrocyclic host molecule, cucurbit[8]uril (CB[8]), a new supramolecular polymer network was developed for the conservation of waterlogged wooden artifacts that simultaneously addresses the three major issues facing conservators (Fig. 1). Chitosan was selected because of its native antibacterial properties, ability to form a gel network, and readily accessible amine groups for functionalization (15). Guar shares the gelling ability of chitosan and is amenable to dynamic functionalization through the diol unit. Neither polymer forms acidic byproducts on degradation (11).Open in a separate windowFig. 1.Supramolecular consolidants. Schematic representation of the formation of the functional supramolecular polymer network and its suggested differing behaviors within timbers that have a low or high iron concentration, showing the dynamic behavior of the material.The ability to link polymers through dynamic and reversible interactions has received much attention recently (16–19). The functional consolidants developed here exploit the unique host-guest chemistry of CB[8] to link polymer chains and form dynamic networks in equilibrium (18, 20). Because of its ability to bind two guests in its cavity simultaneously, CB[8] has gained much interest as a supramolecular physical cross-link (21–23). This supramolecular “handcuff” is particularly effective in joining together polymer chains to form 3D networks (22, 24). Aqueous solutions of chitosan and guar, two naturally sourced polymers, have been shown to provide enhanced structural support and stability at reduced concentrations (11). Functionalizing these polymers created a material tailored toward hindering biological activity and chelating catalytically active Fe³⁺.Electron-poor (first guest) and electron-rich (second guest) moieties pendant from the polymer chains facilitated physical cross-linking through the CB[8] ternary complexation to create the dynamic network. The functionalization of chitosan with both naphthol (Nap; CB[8] complexation) and catechol (Cat; siderophore) second guests was carried out using amidation/esterification chemistry. Appending a methyl viologen (MV, first guest) proved more problematic because of the chitosan’s reducing environment. The use of a boronic acid (BA) functionalized viologen derivative (MV-BA) enabled attachment to guar through a boronic acid–diol dynamic covalent interaction. Coupled with the natural antibacterial properties of chitosan, MV-BA significantly enhanced the biocidal activity of the entire network.On addition of CB[8] to the functionalized polymers, both chitosan polymers could be cross-linked with the MV-BA guar. The reversibility of the ternary complex formation and, therefore of the assembly of the polymer network, is of particular interest to this application. Formation and disassembly of the ternary complex can be mediated by heat and modulating the water content. As is described later, the CB[8] linkage provides the structural component for the consolidant. Thus, by manipulating the ternary complex with, most likely, water content in this application due to the heat sensitivity of the archaeological timbers, the viscosity of the structural element can be controlled. This ability to control viscosity suggests that the material could be made to flow out of the conserved timbers at some later point after consolidant if required, a feature that is currently under investigation.The catechol functionalized polymer binds more strongly to Fe³⁺ than the CB[8] ternary complex; therefore, in the presence of Fe³⁺, these metal–ligand interactions create an additional set of cross-links, further strengthening the system. Because of this difference in affinity, the naphthol functionalized chitosan is essential to preserve the network formed by CB[8] cross-links. By using a combination of all three functional polymers, biological degradation (MV-BA, chitosan), iron saturation (catechol), and structural stability (guar, chitosan, CB[8] cross-links) were all addressed in a single treatment (Fig. 1). Natural polymers provide the additional benefit of removing the plasticizing effect of consolidants on the timbers (11, 25). Although none of the constituent materials of the polymer are themselves extraordinary or novel, the interaction of the various units and their assembly to form a multifunctional chemotactic consolidant material is completely innovative, to both this field and supramolecular chemistry in general, and results in a consolidant material that addresses the three most pressing issues facing conservators of waterlogged archaeological timbers.     

Association of Helicobacter pylori infection with cardiovascular disease--is it just a myth?

Objective

To test the hypothesis that Helicobacter pylori infection is associated with a higher rate of documented cardiovascular disease (CVD) in subjects undergoing elective upper gastrointestinal endoscopy.

Methods

202 consecutive patients (median age 60 years, 101 men) were studied. H. pylori infection was established by a rapid urease test in a gastric tissue sample (CLO test) and by histological examination of gastric mucosa from the stomach antrum and body. CVD was documented by completion of the Rose questionnaire. The association of H. pylori infection with CVD was determined by multivariate logistic regression modelling after adjusting for potential confounding factors.

Results

A total of 104 (51.5%) subjects were found H. pylori positive. Forty patients had a confirmed history of CVD. Multiple logistic regression analysis verified the strong associations of CVD with established risk factors of atherosclerotic disease but not with H. pylori infection.

Conclusion

Our findings suggest that there is no association of H. pylori infection with CVD. Eradication of H. pylori to prevent CVD is not warranted.     

Validity of subjective assessment as screening tool for dry eye disease and its association with clinical tests

AIM: To determine the role of subjective assessment using McMonnies dry eye questionnaire in diagnosing dry eye disease and its association with clinical tests. METHODS: There were 500 patients screened for dry eye using McMonnies dry eye questionnaire between May to October 2013 at the outpatient Department of Ophthalmology of a medical college hospital. All 500 patients were subjected to clinical tests. Dry eye was defined as having one or more symptoms often or all the time. Positive signs were if one or both eyes revealed tear film breakup time (TBUT) of ≤10s, a Schirmer test score of ≤10 mm, a Rose Bengal staining score of ≥1, a Lissamine green staining score of ≥1 or existence of meibomian gland disease (≥grade 1). Statistical analysis was performed to describe the distribution of symptoms and signs, to assess the correlations between McMonnies score (MS) and variable clinical signs of dry eye, and to explore the association between dry eye symptoms and variable clinical signs. Analysis was performed using software package Epi info. A Probability (P) value using Chi-square test of <0.005 was taken as significant. RESULTS: Dry eye prevalence with symptoms (questionnaire), Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining was 25.6%, 15.20%, 20.80%, 23.60%, and 22.60% respectively. Among those with severe symptoms (MS>20), 75.86% had a low TBUT (<10s), 58.62% had a low Schirmer’s I test (≤10 mm), 86.20% had Rose Bengal staining score of ≥1, 79.31% had Lissamine green staining score of ≥1. We found statistically significant associations between positive Schirmer test and arthritis (P<0.002), dryness elsewhere (P<0.001), contact lens use (P<0.002), systemic medication (P<0.0001), sleeping with eyes partly open (P<0.002), history of dry eyes treatment (P<0.0001), environmental factors (P<0.001), swimming (P<0.001). CONCLUSION: Subjective assessment plays an important role in diagnosing dry eye disease. There is strong correlation between MS and Schirmer test, TBUT, Rose Bengal staining and Lissamine green staining in normal as well as marginal and pathological dry eye.     

Restoration of sensibility to anesthetic scarred digits with free vascularized nerve grafts from the dorsum of the foot

Five cases of segmental vascularized nerve grafts that bridge scarred beds for digital sensory nerve reconstruction where previous nonvascularized nerve grafts have failed are reported. Average follow-up in this study was 27 4/5 months. Three patients were men and two were women. Average age was 35 1/2 years. The thumb was the recipient digit in one patient; the index finger in two patients; and the long finger in two patients (primary opposing digit). Three digits had suffered amputation and two had crush lacerations. Average graft length was 6.6 mm. Pin prick, touch, and vibratory sensation were restored in all patients (slightly impaired in one). Average moving two-point discrimination was 7.2 mm; average static two-point discrimination was 9.5 mm. Von Frey monofilament cutaneous pressure averaged 4.03 gm. Donor morbidity was negligible except for a neuroma in one patient and slight superficial skin loss in another.     

Discriminability of nicotine in tobacco smoke: Implications for titration

Cigarette smokers were presented with puffs from either high (2.5 mg), medium (1.5 mg) or low (.5 mg) nicotine cigarettes in order to determine their ability to discriminate nicotine delivery in tobacco smoke. Puffs were presented in random order during each of two conditions and tar content was controlled by using research cigarettes and a smoke mixing device that varied only nicotine. The first condition allowed olfactory stimuli to be used in discrimination, while the second condition blocked olfaction by occluding subjects' nostrils. In both conditions, subjects discriminated between the nicotine content of different puffs, with higher nicotine puffs rated as significantly stronger (by roughly 50%). Subjective desirability ratings did not vary with nicotine delivery. The implications of the magnitude of change in subjects' ratings for theories of nicotine titration are discussed.     

Changes in the diagnostic parameters during keratoconjunctivitis sicca therapy

In 35 patients with mild, moderate and severe keratoconjunctivitis sicca, an association was found between treatment effect, break-up time value and Rose bengal score. Neither of these tests, used separately, was successful as a clinically valuable predictor of treatment effect as the scatter, in score points, was too large. Analysed together, however, as in a partial regression analysis, an adequate prediction is possible, which is clinically of some value.     

Hemostatic effectiveness of fibrin glue derived from single-donor fresh frozen plasma

Fibrin glue derived from pooled human blood is an effective sealant for high-porosity vascular grafts and a valuable topical hemostatic agent in heparinized patients. Use of this agent in the United States is prohibited because of potential transmission of hepatitis B, acquired immunodeficiency syndrome, and other serologically transmitted illnesses. We have developed a cryoprecipitation technique that allows preparation of fibrin glue from single-donor fresh frozen plasma. Use of this agent presumably entails no greater risk of disease transmission than intravenous administration of single-unit fresh frozen plasma. This report describes our early clinical experience with this material. Fibrin glue was used as a sealant for porous woven Dacron tubular prostheses and cardiovascular patches in 19 patients. The fibrin glue sealant has also been employed to control bleeding from needle holes and small anastomotic tears in 22 patients. No patient in this series had a bleeding complication from a suture line or graft treated with fibrin glue. This experience indicates that like fibrin glue from pooled blood, fibrin glue from single-donor plasma is effective as a graft sealant and topical hemostatic agent. Preparation of fibrin glue from single-donor plasma is simple and economical, and may provide cardiothoracic surgeons in the United States with a widely available, valuable hemostatic adjunct.     

The prevention of leg injuries in motorcycle accidents

Leg injuries due to motorcycle accidents are becoming increasingly common, and a relatively high proportion of these injuries are severe, requiring intensive and prolonged treatment with an often disappointing final result. A total of 309 injured motorcyclists consented to take part in a study investigating the possibility that crash bars fitted to motorcycles might protect the motorcyclist's legs from injury. In the group as a whole, it seemed possible that crash bars would afford some protection, but the figures were not statistically significant. In the group of 150 motorcyclists injured by side impact, 8 of the 25 with crash bars escaped injuries of the legs compared with only 17 out of 125 who did not have crash bars. These results suggest that crash bars provide a measure of protection to motorcyclist's legs, especially when the impact is from the side.