Chest pain score: a novel and practical approach to angina pectoris. A diagnostic accuracy study

ABSTRACT BACKGROUND: The chest pain classifications that are currently in use are based on studies that are several decades old. Various studies have indicated that these classifications are not sufficient for determining the origin of chest pain without additional diagnostic tests or tools. We describe a new chest pain scoring system that examines the relationship between chest pain and ischemic heart disease (IHD). DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level university hospital and two public hospitals. METHODS: Chest pain scores were assigned to 484 patients. These patients then underwent a treadmill stress test, followed by myocardial perfusion scintigraphy if necessary. Coronary angiography was then carried out on the patients whose tests had been interpreted as positive for ischemia. Afterwards, the relationship between myocardial ischemia and the test score results was investigated. RESULTS: The median chest pain score was 2 (range: 0-7) among the patients without IHD and 6 (1-8) among those with IHD. The median score of patients with IHD was significantly higher than that of patients without IHD (P = 0.001). Receiver operating characteristic analysis showed that the score had sensitivity of 97% and specificity of 87.5% for detecting IHD. CONCLUSION: We developed a pre-test chest pain score that uses a digital scoring system to assess whether or not the pain was caused by IHD. This scoring system can be applied easily and swiftly by healthcare professionals and can prevent the confusion that is caused by other classification and scoring systems.

Prevalence of the Helicobacter pylori in the tonsils and adenoids / Prevalência do Helicobacter pylori em amígdalas e adenoides

INTRODUCTION: There is an ongoing debate about the existence and effects of Helicobacter pylori (Hp) in adenotonsillar tissue. OBJECTIVE: A clinical study was conducted to assess the existence of Hp in the adenoid and/or adenotonsillar tissues, which were surgically excised due to chronic adenotonsillitis. METHODS: Phosphoglucosamine mutase gene for the detection of Hp and cytotoxin-associated gene as virulence gene were examined in 84 adenotonsillar tissues obtained from 64 patients and patients' serum by using polymerase chain reaction. RESULTS: Hp IgG was detected in 57 (89%) patients' serum. A total of seven tissue samples from 64 patients (10.9%) were found positive for Hp DNA, of which five were adenoids and two were tonsil tissues. All polymerase chain reaction positive samples were also positive for the cytotoxin-associated gene, which is a virulence determinant for the organism. CONCLUSION: This study suggests that children are exposed to Hp at an early age of their life in this province. Hp may have a role in the pathogenesis of chronic adenotonsillitis, especially in endemic areas. .

INTRODUÇÃO: Há um debate atual sobre os efeitos da Helicobacter pylori (HpHp) no tecido adenotonsilar. OBJETIVO: Conduzimos um estudo clinico para avaliar a existência de Hp nos tecidos adenoideano e/ou adenotonsilar, os quais foram removidos cirurgicamente em decorrência de adenotonsilite crônica. MÉTODO: No total, 84 amostras de tecido obtidos de 64 pacientes foram analisadas para o gen fosfoglucosamina mutase para a detecção de Hp. Os casos positivos foram a seguir examinados para o gen associado à citotoxina, relacionado à virulência, usando-se o método de Reação de Polimerase em Cadeia (PCR). RESULTADOS: A IgG de Hp foi detectado em 57 (89%) soros de pacientes. Sete amostras de tecido de sessenta e quatro pacientes (10.9%) resultou positivo para o DNA de Hp, das quais cinco eram adenóides e duas eram tecido tonsilar. No PCR todas as amostras foram também positivas para o gen associado à citotoxina, o qual é um determinante de virulência. CONCLUSÃO: Esse estudo sugere que as crianças são expostas ao Hp nos primeiros anos de vida nessa província e que o Hp pode ter um papel na patogênese da adenotonsilite crônica, principalmente em áreas endêmicas. .