Background and hypothesis: Noninvasive risk stratification for coronary artery disease (CAD) is less accurate in women than in men. Based on recent reports that gender‐specific exercise ...electrocardiogram (ECG) parameters predict CAD, we evaluated the independent predictive value of the resting ECG for angiographic CAD in women with chest pain.
Methods: Women (n = 850, mean age 58 years) with chest pain in the NHLBI Women's Ischemia Syndrome Evaluation (WISE) underwent 12‐lead ECG testing and quantitative coronary angiography.
Results: Significant angiographic CAD (≥ 50% stenosis in ≥1 coronary) was present in 39% of women. Q waves in ≥2 contiguous ECG leads were present in 107 women (13%), including 49 of 657 (7%) without history of infarction. Among 585 women without prior infarction or revascularization, 48% of those with Q waves in contiguous leads versus 26% of others, had significant CAD (p = 0.003; odds ratio OR = 2.5, 95% confidence interval CI = 1.3‐4.8). Women with Q waves in ≥2 inferior ECG leads were particularly likely to have CAD (63 vs. 26% of others, p < 0.001; OR = 4.6, 95% CI = 2.0‐10.8). Other ECG findings predictive of CAD were any ST‐T abnormality (OR = 1.9, 95% CI = 1.3‐2.8) and T‐wave inversion (OR = 2.4, 95% CI = 1.3‐4.2). In risk‐adjusted analysis, inferior Q waves and T‐wave inversion independently predicted significant CAD. When considered together with radionuclide perfusion test results, T‐wave inversion on resting ECG added significant independent predictive value (OR = 2.8, 95% CI = 1.1‐7.2, p = 0.03).
Conclusions: Selected resting ECG parameters independently predict angiographic CAD in women with chest pain, including women who have also undergone radionuclide stress testing. Prospective studies should consider resting ECG parameters in diagnostic algorithms for CAD in women.
Reply: To PMID 22954239 Marzilli, Mario; Merz, C Noel Bairey; Boden, William E ...
Journal of the American College of Cardiology,
2013-Jan-22, 20130122, Volume:
61, Issue:
3
Journal Article
Background. Enteral fluconazole, a triazole antifungal agent with an excellent oral bioavailability, has not been widely studied in critically ill surgical patients. Methods. During a randomized ...placebo-controlled trial of enteral fluconazole (N = 130) versus placebo (N = 130) for the prevention of fungal infections in critically ill surgical patients, trough fluconazole levels were measured after the loading dose and 3 times weekly during intensive care unit stay. Minimum inhibitory concentrations (MICs) for fluconazole were measured on all infecting Candida isolates. Results. Four hundred sixty-seven serum samples were assayed for fluconazole levels in 121 patients. The most common infecting fungal species was Candida albicans, isolated in 14 of 31 infections (45%). Other infecting species were C glabrata, C tropicalis, and C parapsilosis. Mean fluconazole levels were above the highest MIC for C albicans and C parapsilosis in all but 5 patients (4%). Mean fluconazole levels were below the median MIC for C glabrata in 93 of 121 patients (77%). No significant relationship was seen between fluconazole levels and risk for fungal infection. Conclusions. Serum fluconazole levels are above the MIC of most yeast species found in these patients. These levels may not be above the MIC of C glabrata, the second most common Candida isolate causing infection in this study. (Surgery 2002;131:534-40.)
A recalcitrant corneal ulcer resulted in an extensive corneal opacity requiring penetrating keratoplasty. Histopathologic studies and subsequent cultures established the diagnosis of Acanthamoeba ...keratitis. A second transplant was performed due to a culture-proven recurrence of the keratitis in both the recipient and the graft, with progressive thinning. This has remained clear for six months on systemic ketoconazole and topical miconazole drops. This case demonstrates the difficulty in initial diagnosis of Acanthamoeba keratitis and the apparent successful medical control of the infection despite transplantation into an infected recipient bed.
Background
The U.S. Department of Defense (DoD) is challenged with monitoring and protecting the health and wellbeing of its service members. The growing number of women on active duty and the ...diverse hazardous exposures associated with military service make reproductive health issues a special concern of DoD. To address this concern, the DoD Birth Defects Registry was established at the DoD Center for Deployment Health Research located at the Naval Health Research Center, San Diego, California.
Methods
The registry captures comprehensive data on healthcare utilization to calculate the prevalence of birth defects in the children of military beneficiaries. Population‐based electronic surveillance is supplemented by active case validation efforts.
Results
Since its establishment in 1998, the registry has captured data on more than 90,000 births that occur in military families each year. Detailed analyses, to include linking registry data with military occupational exposure data (e.g., anthrax vaccination), are underway.
Conclusions
The DoD Birth Defects Registry provides important reproductive health information on the geographically dispersed military population. This program is expected to complement civilian public health programs and be especially valuable to military members and their families. Teratology 64:S26–S29, 2001. Published 2001 Wiley‐Liss, Inc.
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