Impact of Rest Myocardial Perfusion Imaging on Clinical Management of Non-High Risk Chest Pain in the VA Caribbean Healthcare System Emergency Department: 2006-2008.

OBJECTIVE: To evaluate the appropriate clinical use of an acute rest myocardial perfusion imaging (R-MPI) in the initial emergency department (ED) evaluation of a patient presenting with chest pain (CP). METHODS: This is a retrospective study of patients evaluated with CP at the ED with an acute R-MPI. The data collected included medical history, clinical presentation, electrocardiogram, laboratory data, MPI results, confirmatory studies, disposition diagnosis and cost analysis. RESULTS: Three-hundred-sixty-six (366) patients were evaluated. The population studied had a mean Thrombolysis in Myocardial Infarction (TIMI) score of 2 and predominance of patients in the Virginia Commonwealth University (VCU) CP Category-Scale between level 3 and 4 (34% and 49% respectively). The risk of acute coronary syndrome (ACS) was significantly higher in patients with abnormal compared to normal studies (50% versus 0.4%; P < .0005; RR, 129.5; 95% CI, 18 to 924). There were a total of 14 and 19 major adverse cardiovascular events (MACE) events during the follow-up of 30-days and 1-year respectively. There were no cardiovascular fatalities. The risk of MACE at 30-days was significantly higher in patients with abnormal compared to normal studies (12% versus 0.4%; P < .001; RR, 32; 95% CI, 4.2 to 240), as well as with 1-year of follow-up (14% versus 1.6%; P < .001; RR, 9.1; 95% CI, 3.1 to 27). CONCLUSION: Using acute R-MPI in the evaluation of non-high risk patients presenting with CP is a safe, reliable and cost-effective strategy to be used in the ED to predict ACS and future MACE.

Brisk deep-tendon reflexes as a distinctive phenotype in an Argentinean spinocerebellar ataxia type 2 pedigree.

Slow saccades, postural/intention tremor, peripheral neuropathy, and decreased deep-tendon reflexes are valuable neurological signs for clinical suspicion of spinocerebellar ataxia type 2 (SCA2). We report the presence of abnormally brisk deep-tendon reflexes in nonsymptomatic carriers and mildly and severely affected subjects of a large Argentinean SCA2 pedigree. The identification of this distinctive SCA2 phenotype in an entire pedigree reinforces the current concept that clinical algorithms are of limited value as indicators for genetic testing in SCA. Combined with published pedigrees of SCA2 manifesting as levodopa-responsive parkinsonism, this finding suggests that modifier genes could influence the clinical phenotype of SCA2.

[The impact of domestic violence on children's health]. / Impacto de la violencia doméstica en la salud infantil.

BACKGROUND: There is close association between maltreatment during pregnancy and child abuse after birth. AIM: To compare anthropometric growth and use of health services of children whose mothers suffered maltreatment with children coming from families without domestic violence. SUBJECTS AND METHODS: A longitudinal study of two cohorts. An index groups formed by 76 children whose mothers experienced maltreatment and control group of 46 children coming from families without domestic violence. Data was obtained from patient files in private health centers. RESULTS: Respiratory diseases were the most prevalent cause of consultation and hospital admission. Children in the index group had a 2.8 times higher risk of bronchopneumonia in the post natal period and a poor attendance to health care controls. In four children, cerebral contusion was registered as the cause of hospital admission. CONCLUSIONS: Domestic violence is associated with a higher risk of respiratory diseases and hospital admissions in children. New strategies are necessary to detect and prevent child abuse and neglect.