The gender gap in stroke: a meta-analysis

Several studies have indicated that gender differences might exist in stroke.

OBJECTIVES AND METHODS

Our goal was to perform a comprehensive meta-analysis in order to evaluate and quantify stroke gender disparities through a systematic search of relevant articles published up to October 2009 and addressing gender related differences in ischemic stroke risk factors, stroke subtype and severity, diagnostic tests, and acute phase and secondary prevention treatments.

RESULTS

Forty-five articles were included in the analysis, representing a total of 673,935 patients. Women were globally older than men (+5.2 years) and suffered more hypertension (P = 0.017) and atrial fibrillation (P < 0.001), although they were less likely to drink alcohol (P < 0.001), smoke cigarettes (P < 0.001), present hyperlipidemia (P = 0.033) or diabetes (P = 0.003) than men. Baseline stroke severity was not different between genders. Women suffered more cardioembolic strokes, while men had more atherothrombotic strokes. Moreover, women were less likely to receive stroke-related treatments, such as antiplatelets (P < 0.001), statins (P < 0.001), and tPA (P < 0.001) than men. Although meta-regression did not identify age or stroke etiology as sources of heterogeneity, caution should be taken as that analysis was possible only for gender differences in secondary prevention with antiplatelets because of limited data for other end points.

CONCLUSIONS

Gender differences have been identified on the risk factors profile and diagnostic and therapeutic management of patients with ischemic stroke. Active measures should thus be taken to avoid bias in clinical practice.

Timing of oseltamivir administration and outcomes in hospitalized adults with pandemic 2009 influenza A(H1N1) virus infection

BACKGROUND

Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with A(H1N1).

METHODS

Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed A(H1N1) was performed at 13 Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, hospital length of stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes.

RESULTS

Five hundred thirty-eight hospitalized patients with A(H1N1) were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR], 2-5 days). With regard to outcomes, the median duration of fever was 2 days (IQR, 1-3 days), the median LOS was 5 days (IQR, 3-8 days), 49 patients (9.1%) underwent mechanical ventilation, and 11 patients (2%) died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (χ(2) test for trend P = .001, P ≤ .001, P = .008, and P = .001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+ 1-day increase) was associated with a prolonged duration of fever (OR, 1.10; 95% CI, 1.02-1.19), prolonged LOS (OR, 1.07; 95% CI, 1.00-1.15), and higher mortality (OR, 1.20; 95% CI, 1.06-1.35).

CONCLUSIONS

Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with A(H1N1), even in those who are admitted beyond 48 h after onset of symptoms.

P01-44-The e-mail as a potential therapeutic tool in patients with alcohol dependence: The patient's perspective

Introduction

The use of Internet-based communication tools has spread to multiple areas of life. E-mail is a fast and easy tool that can be used by the health care system to facilitate doctor-patient communication.

Objectives

To assess the use and value of the e-mail for communication between physician and patient, from patients’ perspective.

Aims

To evaluate the use of e-mail as a potential therapeutic tool in patients with alcohol dependence.

Methods

The sample included patients who reported to have an e-mail account at their first visit in Alcohol Unit (n = 44 of 238 patients seen during one year). 23 patients were given the contact e-mail of the Alcohol Unit, and were instructed to contact their physician, if needed, by e-mail. The rest of the sample (n = 21) could contact their physician only by phone. Six months later, the whole sample received an electronic survey measuring their satisfaction of the communication with the physician.

Results

57% patients who received the contact e-mail of the Alcohol Unit answered the survey (n = 13). Of those, 54% used e-mail to contact their physician. 71% found e-mail easy-to-use; 86% reported being satisfied with e-mail communication.

Conclusions

E-mail contact with physician was considered useful by most patients, although they report using also other contact methods, such as phone call.

Predictive baseline criteria of primary therapeutic failure in chronic hepatitis C genotype 1

BACKGROUND AND AIMS

more than half of patients with genotype 1 chronic hepatitis C (CHC) do not achieve a sustained viral response (SVR) to current antiviral therapy due to primary non-response, relapse or intolerance. Factors related to each of these unfavorable outcomes are different and the last two may be partially prevented. Our aim was to identify basal criteria to predict the risk of primary failure.

PATIENTS AND METHODS

we included 251 consecutive patients (152 males) from a single centre, infected with HCV genotype 1 and not previously treated. SVR was achieved in 141 patients and primary failure in 110.

RESULTS

high vs. low viral load (> 400,000 IU/mL, OR = 6.17; 95% CI: 2.50-15.23), high serum GGT (> 60 IU/mL, OR = 4.25; 95% CI: 2.49-7.24), low serum cholesterol ( < 178 mg/dL, OR = 2.93; 95% CI: 1.75-4.92) and older age (> 47 yrs., OR = 1.79; 95% CI: 1.08-2.96) were associated to the risk of primary failure in the lineal logistic regression analysis. From the 58 patients carrying all the first three negative criteria, 46 (79.3%) were primary non-responders.

CONCLUSIONS

the negative basal profile identified in this study is based on easily available data and provides information about the risk of primary therapeutic failure, and may help to decide whether antiviral therapy should be offered to a single patient.

Oscillations in serum ferritin associated with antiviral therapy in chronic hepatitis C

BACKGROUND

Hyperferritinemia is often found in patients with chronic hepatitis C (CHC) and is predictive of poorer response to antiviral therapy.

OBJECTIVE

To investigate changes in ferritinemia during and after antiviral therapy.

PATIENTS AND METHODS

serum ferritin levels were measured in 262 CHC patients (163 males, mean age 48.5 years +/- 10.1) before and during antiviral therapy, and six months post-treatment in all 154 patients with undetectable serum HCV-RNA after therapy completion.

RESULTS

Baseline serum ferritin was higher in patients with primary therapeutic failure than in those reaching sustained viral response (330 +/- 291 ng/mL vs. 211 +/- 192 ng/mL, p = 0.002). Serum ferritin transiently increased during therapy from baseline (257 +/- 242 ng/mL vs. 875 +/- 630 ng/mL, p < 0.001). Six months after finishing therapy, serum ferritin decreased under baseline values both in sustained responders (117 +/- 102 ng/mL vs. 211+/- 192 ng/mL, p < 0.001) and, to a lesser extent, in relapsers (217 +/- 174 ng/mL vs. 257 +/- 221 ng/mL, p = 0.047).

CONCLUSIONS

Baseline serum ferritin may predict response to antiviral treatment in chronic hepatitis C. Combined antiviral therapy induces a marked increase in serum ferritin that falls below baseline values after sustained viral response, suggesting that the cause of hyperferritinemia in many patients is HCV infection itself rather than iron overload.

Effect of chondroitin sulphate in a rabbit model of atherosclerosis aggravated by chronic arthritis

BACKGROUND AND PURPOSE

Among the agents employed to manage osteoarthritis, chondroitin sulphate (CS) is a natural glycosaminoglycan with an anti-inflammatory effect on joint cells. CS might also influence the inflammatory component of atherosclerosis. Our aim was to examine the effect of CS administration on vascular injury and on markers of systemic inflammation in a rabbit model of atherosclerosis aggravated by systemic inflammation provoked by chronic antigen-induced arthritis.

EXPERIMENTAL APPROACH

Atherosclerosis was induced in rabbits by maintaining them on a hyperlipidaemic diet after producing an endothelial lesion in the femoral arteries. Simultaneously, chronic arthritis was induced in these animals by repeated intraarticular injections of ovalbumin in previously immunized rabbits. A group of these rabbits were treated prophylactically with CS (100 mg kg(-1)day(-1)) and when the animals were killed, serum and peripheral blood mononuclear cells (PBMC) were isolated. Furthermore, femoral arteries and thoracic aorta were used for gene expression studies and histological examination.

KEY RESULTS

CS administration reduced the concentration of the proinflammatory molecules C-reactive protein and IL-6 in serum. Likewise, CS inhibited the expression of CCL2/monocyte chemoattractant protein (MCP)-1 and cyclooxygenase (COX)-2 in PBMC, and reduced the nuclear translocation of nuclear factor-kappaB. In the femoral lesion, CS also diminished the expression of CCL2 and COX-2, as well as the ratio of the intima/media thickness. Moreover, CS decreased the percentage of rabbits with atherosclerosis and chronic arthritis that developed vascular lesions in the aorta.

CONCLUSIONS AND IMPLICATIONS

These findings suggest that CS treatment may to some extent impede the progression of atherosclerosis.

TCF7L2 polymorphisms are associated with type 2 diabetes in Khatri Sikhs from North India: genetic variation affects lipid levels

Recently, the transcription factor-7-like 2 (TCF7L2) gene has been identified as the most important type 2 diabetes mellitus (T2DM) susceptibility gene. Common intronic polymorphisms in this gene have been found to be strongly associated with T2DM susceptibility showing marked reproducibility in multiple populations. The purpose of this study was to confirm the reported association of six TCF7L2 variants in a Khatri Sikh diabetic sample from North India. We genotyped six-associated SNPs in a case-control sample consisting of 556 T2DM cases and 537 controls. We also examined the impact of these variants on body mass index (BMI), waist to hip ratio (WHR), fasting insulin, and glucose and lipid levels. We report replication of association of four of the six SNPs with T2DM in this Khatri Sikh sample [rs7903146, (p = 0.010); rs11196205, (p = 0.011); rs10885409, (p = 0.002) and rs4918789, (p = 0.029)], under a dominant model conferring odds ratios (ORs) of 1.39, 1.44, 1.57 and 1.36, respectively. Haplotype analysis provided further evidence of association by showing a significant difference between cases and controls as revealed by the global omnibus test (chi(2)= 19.36; p = 0.0036). Multiple linear regression analysis also revealed the risk allele carriers of three of four significant SNPs (rs7903146, rs11196205, rs10885409) to be significantly associated with increased fasting total cholesterol (p value = 0.019, 0.025, 0.006) and LDL cholesterol levels (p value = 0.021, 0.018, 0.005), respectively. Our findings confirm that the TCF7L2 gene is a major risk factor for development of T2DM in Khatri Sikhs. It also provides new information about the significant impact of TCF7L2 gene variants on plasma cholesterol levels that appear to be independent of BMI.

Effects of visual flicker on subjective time in a temporal bisection task

This experiment investigated the effects of visual flicker on subjective time in humans using a temporal bisection task. A 200-800 ms duration range and 400-1600 ms duration range were presented. Each duration range was presented separately in three different conditions: (1) filled stimuli were presented in both the training and the testing phases, (2) flickering stimuli were presented in the training phase and filled stimuli were presented in the testing phase, and (3) filled stimuli were presented in the training phase and flickering stimuli were presented in the testing phase. Psychophysical functions displacements and bisection point values suggested that flicker increased the speed of the clock; however the direction of the displacement and bisection point changes depended on the phase of the task in which the flicker was presented. This result agrees with the specific storage in either working or reference memory components of Scalar Expectancy Theory of the increased number of pulses from the clock. Weber fractions and difference limens suggested that flicker did not affect subjects' temporal sensitivity.

Neurofibroma with psammoma bodies

Neurofibromas are benign tumours of the nerve sheath. Histologically they vary depending on their contents of cells, myxoid stroma and collagen. A 41-year old male with radicular pain had a tumour involving the posterior chest wall. Microscopically it resulted to be a neurofibroma with abundant psammoma bodies. Although these bodies are very frequent in some neoplasias, to our knowledge they have not been described in neurofibromas to date.

[Valve replacement for aortic regurgitation associated with rheumatoid arthritis: a series of 5 cases]

Between 30 and 50% of patients with rheumatoid arthritis (RA) have cardiac involvement but only 2 to 10% have clinical manifestations. The authors report the results of a retrospective study of 5 cases of aortic regurgitation (AR) requiring valve replacement. There were 4 women and 1 man with an average age of 48.4 years. The average duration of the RA was 19.6 years. All patients had cardiac failure. Aortic valve replacement was performed in all cases, with bioprostheses in 4 out of 5 patients. The histopathological examination of the valves showed a rheumatoid nodule in 3 cases and non-specific lesions in one case. In the fifth patient, rheumatoid serology was positive in the pericardial effusion. The average interval between the onset of symptoms and cardiac surgery was 3.6 months (range 1 to 6 months) There were 3 deaths at 3 days, 20 months and 10 years, two patients survive after 12 and 14 years. The characteristic rapid progression of this form of AR, which may be life-threatening, should be emphasised.