ARCUS SENILIS IN MIDDLE-AGED MEN

An Evaluation of the Arcus Corneae For Age Estimation

Although the arcus corneae (AC) has long been used as an age indicator for forensic purposes, its diagnostic value has not been evaluated. To evaluate the AC as a predictor of chronological age, the author has studied the correlation of AC with respect to age of the deceased. A cross-sectional study was conducted of 342 Thai corpses at the Maharat Nakhon Ratchasima Hospital, Thailand. AC was graded into three levels: no AC, incomplete ring, and complete ring. One-way analysis of variance, chi-square test, binomial logistic regression, sensitivity, specificity, predictive values, and likelihood ratios were used for analysis. The Cohen's kappa was used to determine the intraobserver and interobserver reliability. The prevalence of AC and the probability of complete AC were significant higher in corpses aged 60 years and above than in those under 60 years. Consequently, this study confirmed that the prevalence of AC was significantly correlated with the age of Thai individuals. If the complete AC is used as an indicator of age of 60 years and above, complete AC has high sensitivity (92.56%) but low specificity (72.85%), low positive predictive value (65.12%), but high negative predictive value (94.71%). For diagnostic value, the presence of AC can be used for age screening but not for absolute confirmation. The absence of AC indicates young age, incomplete AC indicates middle age, and complete AC indicates old age. The high intraobserver and interobserver reliability provides assurance of the value of AC as a means to estimate personal age.

Significance of Arcus Senilis in Caucasians

A study of arcus senilis in Caucasian men and women is reported. The prevalence of arcus senilis increases with age in both sexes and occurs more frequently in men. In women arcus senilis is uncommon before the menopause. The occurrence of arcus senilis in Caucasians is not a significant finding, except in men under the age of 40 years, when it is associated with an increased risk of coronary artery disease.

Visible aging signs as risk markers for ischemic heart disease: Epidemiology, pathogenesis and clinical implications

Association of common aging signs (i.e., male pattern baldness, hair graying, and facial wrinkles) as well as other age-related appearance factors (i.e., arcus corneae, xanthelasmata, and earlobe crease) with increased risk of ischemic heart disease was initially described in anecdotal reports from clinicians observing trends in the physical appearance of patients with ischemic heart disease. Following these early observations numerous epidemiological studies have reported these associations. Since the prevalences of both visible aging signs and ischemic heart disease have a strong correlation with increasing age, it has been extensively debated whether the observed associations could be entirely explained by a common association with age. Furthermore, the etiologies of the visible aging signs are rarely fully understood, and pathophysiological explanations for these associations remain controversial, and are mostly speculative. As a consequence of inconsistent findings and lack of mechanistic explanations for the observed associations with ischemic heart disease, consensus on the clinical importance of these visible aging signs has been lacking. The aim of this review is for each of the visible aging signs to (i) review the etiology, (ii) to discuss the current epidemiological evidence for an association with risk of ischemic heart disease, and (iii) to present possible pathophysiological explanations for these associations. Finally this review discusses the potential clinical implications of these findings.

Neonatal malaria in the gambia

BACKGROUND

Neonatal malaria was thought to be uncommon, even in malaria endemic areas. Neonates with febrile illness and / or related symptoms are often presumed to have neonatal septicaemia and examination of blood films for malaria parasites is rarely included in the initial work-up of these babies.

OBJECTIVE

To determine the existence, or otherwise, and the clinical features of malaria in neonates with clinical features suggestive of septicaemia.

PATIENTS AND METHODS

In a prospective study, all consecutive babies admitted in the neonatal unit of the Royal Victoria Hospital over an eighth month period with an initial diagnosis of neonatal septicaemia were screened for malaria in addition to an extensive sepsis work-up. Malaria parasitaemia was diagnosed on Giemsa stained blood smears.

RESULTS

One hundred and five babies admitted in the neonatal unit of the Royal Victoria Hospital, The Gambia with an initial diagnosis of neonatal septicaemia were studied. Fourteen (13.3%) of these babies had positive blood smears for malaria parasites and bacterial cultures of their blood, cerebrospinal fluid and urine yielded no pathogen. Plasmodium falciparum was the only species identified in all the babies. A male preponderance was obtained with a male: female ratio of 2.5:1. Malaria occurred more commonly in babies aged more than one week, thus suggesting that acquired rather than congenital malaria was the more common form of neonatal malaria in the area. All the babies with malaria were admitted within the rainy season period. The principal clinical features observed in these babies were fever, refusal to feed, maternal fever in the last trimester, excessive crying, difficulty in breathing, vomiting, hepatomegaly, abdominal distension and irritability. A similar picture was observed among babies with proven neonatal septicaemia. In addition, depressed primitive reflexes was found to be more common in babies with septicaemia (p=0.01).

CONCLUSIONS

These data show that neonatal malaria is not uncommon in The Gambia and that the clinical features are akin to those of neonatal septicaemia.

Possible risk factors for congenital malaria at a tertiary care hospital in Sagamu, Ogun State, South-West Nigeria

Congenital malaria, defined as the presence of malaria parasites in the erythrocytes of newborns aged <7 days, was considered rare in endemic areas until recent studies started reporting high prevalence rates. Various theories have been postulated to explain this phenomenon, but they are not proven conclusively from research. Against this background, a prospective study was designed with the following objectives. To determine the prevalence of congenital malaria parasitaemia and identify possible risk factors amongst newborns delivered in O.O.U.T.H Sagamu, Ogun State. Over a 6-month period, 192 live newborns and their mothers were consecutively recruited into the study. Within 3 days of life, neonatal peripheral blood samples were collected for malaria screening by blood film microscopy and detection of plasmodium lactate dehydrogenase (pLDH) with the OptiMAL Rapid Malaria Test kit. Maternal peripheral blood samples were taken simultaneously, to check for malaria infestation by blood film microscopy, and questionnaires were administered on the mothers to identify possible factors associated with the development of neonatal parasitaemia. Neonatal clinical and laboratory data were recorded in a pro forma designed for the study. Data analysis was done with Epi-info version 6 software and level of significance set at <5%. Twenty-one of 192 newborns delivered in O.O.U.T.H within the study period were diagnosed as having congenital malaria by blood film microscopy, giving a prevalence rate of 10.9%. The main identified innate neonatal risk factor for congenital malaria parasitaemia was prematurity. First-order pregnancy, history of fever within 3 months of delivery and peripheral parasitaemia at delivery (p < 0.001) were the variables that were significantly higher in the mothers of the parasitemic newborns. We conclude that congenital malaria parasitaemia in tropical endemic areas is not rare. Pre-term neonates, infants of primigravidae, women with history of fever within 3 months of delivery and women with post-partum peripheral parasitaemia may benefit from routine screening for malaria.

The cornea and disorders of lipid metabolism

Disorders of lipid metabolism, either hyperlipidemia or hypolipidemia, are associated with the formation of corneal opacities. Corneal arcus, the most commonly encountered peripheral corneal opacity, is frequently associated with abnormal serum lipid levels, but may occur without any predisposing factors. Reports also have linked corneal arcus with alcoholism, diabetes mellitus and atherosclerotic heart disease. Unilateral arcus is a rare entity that is associated with carotid artery disease or ocular hypotony. Diffuse corneal opacities associated with hypolipidemic disorders such as LCAT deficiency, fish eye disease and Tangier disease, may be the initial manifestation of these disorders and puts the ophthalmologist in a position to make an early diagnosis. Corneal arcus, along with a central corneal opacity, is seen in Schnyder's crystalline stromal distrophy. The association of the disorder with a dyslipidemia remains controversial. A review of lipid metabolism, corneal arcus and several disorders of lipid metabolism that affect the cornea are presented.

Association between corneal arcus and some of the risk factors for coronary artery disease

The relationships between coronary artery disease risk factors and corneal arcus were examined in 150 adults aged 55 years and above of both sexes and from different ethnic origins. The width of the corneal arcus was measured accurately by a digitiser, and the risk factors for coronary artery disease were examined according to the standard procedure used by the Lipid Research Clinics. The results show that the corneal arcus is more frequent in males; the frequency and size of corneal arcus are positively associated with age; there is a positive correlation between the size of corneal arcus and the levels of cholesterol and low-density lipoprotein in males; and that there is negative correlation between corneal arcus and diastolic blood pressure in both sexes. No associations were found between corneal arcus and other coronary artery disease risk factors such as triglyceride, high-density lipoprotein, very low-density lipoprotein, weight, Quetelet's ratio, glucose, and smoking.

Studies in asymptomatic primary hyperlipidaemia II. Clinical findings

A clinical and laboratory examination of abnormalities not attributable to atherosclerosis has been performed on 188 male and 126 female adult subjects with hyperlipidaemia. The sample was recruited from 20000 subjects screened at a health control centre who had an initial serum cholesterol and/or triglyceride (TG) concentration above 350 mg/100 ml and 3.50 mmol/l. All were subjectively healthy and had no history of atherosclerotic disease. Known cases of secondary hyperlipidaemia were excluded. Lipoprotein (LP) analysis with preparative ultracentrifugation and electrophoresis was made on all subjects including control group with "nonelevated" serum lipids. Typing of hyperlipoproteinaemia (HLP) was performed according to the modified system of Fredrickson et al. Compared to controls, subjects who had elevated very low density ?LP (VLDL) (types II B, III, IV and V) were more obsese, while subjectI B and women with type IV HLP than in the control groups. Arcus corneae was seen in 29% of control groups. Arcus corneae was seen in 29% of controls and in higher frequencies in types II A and II B. A positive correlation existed between the frequency of arcus corneae and the mean low density LP cholesterol in the different types. Multiple tendon xanthomata (n equals 11) were found exclusively in type II A HLP, palmar xanthomata (n equals 3) only in the presence of floating beta-LP and eruptive xanthomata in one male with type V HLP. The mean ESR was increased in all types of HLP. The mean S-GPT and uric acid concentrations were higher in type IV HLP in both sexes than in the control groups. In men with type IV HLP S-GPT was positively correlated to tvldl tg. the uric acid level was correlated to both the VLDL TG concentration and body weight independently. Of the male subjects with HLP 1/3-1/2 had a diabetic or borderline i.v. glucose tolerance.

Arcus senilis: its relation to certain attributes and risk factors in patients with coronary heart disease

The frequency and degree of arcus in relation to a number of attributes or risk factors were tested in 534 male patients of all ages with coronary heart disease. Frequency and degree of arcus were positively associated with age and with lifetime alcohol intake. Arcus was negatively associated with obesity. All other correlations proved negative. The link between precocious arcus senilis and coronary heart disease is discussed. This investigation failed to show any relation between the acknowledged high-grade coronary heart disease risk factors and arcus senilis. It is suggested that the relation between arcus and alcohol intake merits further investigation.