Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life?

OBJECTIVE

Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females.

DESIGN

We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives.

RESULTS

The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures.

CONCLUSIONS

We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.

Evaluation of the patient with seizures: an evidence based approach

Statistics tell us that as many as 1 in 20 members of the population will suffer a seizure at some point in their lifetime, a figure which becomes even more likely if one lives to the age of 80. Thus, a careful evidence based approach to the patient with seizure is immensely useful to the emergency physician. The authors evaluate current studies on the subject, discuss seizures as they relate to specific patient groups, and, ultimately, make recommendations on this important subject.

Nephrotoxicity of pravadoline maleate (WIN 48098-6) in dogs: evidence of maleic acid-induced acute tubular necrosis

Single oral administration of pravadoline maleate (WIN 48098-6), the maleic acid salt of WIN 48098, induced acute tubular necrosis (ATN) in male and female beagle dogs at dosages > or = 40 mg/kg (WIN 48098 base (31 mg/kg) and maleic acid (9 mg/kg)). Subsequent oral studies were conducted with equimolar dosages of maleic acid and WIN 48098-7, the ethanesulfonate salt of WIN 48098, to determine the nephrotoxic moiety of WIN 48098-6. ATN was observed for dogs given only maleic acid at single oral dosages > or = 9 mg/kg. This result provided evidence that maleic acid was responsible for the nephrotoxicity observed in dogs given single oral dosages of WIN 48098-6. The induction of maleic acid-related nephrotoxicity in dogs may confound the interpretation of toxicologic studies of maleic acid salts of basic pharmaceutics, if the dosage of test article results in the delivery of dosages of maleic acid > or = 9 mg/kg. Furthermore, the results of these studies underscore the importance of establishing maximum no-observed-effect dosages and target organ toxicity profiles for acids and bases that are commonly used in the development of salts of pharmaceutics.

Oral agents in the management of urticaria: patient perception of effectiveness and level of satisfaction with treatment

OBJECTIVE

Orally administered diphenhydramine, famotidine, and cromolyn sodium were compared for their abilities to alleviate symptoms of acute urticaria.

DESIGN AND SETTING

This was a prospective, randomized, blind study, implemented in the emergency departments (EDs) of two teaching hospitals, each with an annual average of 40,000 ED patient visits. Patient perception of the effectiveness of treatment was assessed using a visual analog scale.

PATIENTS

33 adult patients presenting to the EDs were entered into the study over a one-year period. Of these, 8 were lost to follow-up and 5 were noncompliant with medications and not included in data analysis. Twenty adult patients, aged 19-78 years, completed the five-day study: 7 received diphenhydramine, 6 received famotidine, and 7 received cromolyn sodium.

RESULTS

Patients receiving diphenhydramine reported the greatest satisfaction with treatment: 86 percent (6/7) indicated they would use the medication again. Fifty percent (3/6) in the famotidine group and 43 percent (3/7) in the cromolyn sodium group rated the treatment as worth using again. Patients receiving famotidine reported the greatest occurrence of adverse effects (50 percent, 3/6); the lowest incidence of such effects was seen in the cromolyn sodium group (14 percent, 1/7). Patients receiving diphenhydramine reported adverse effects at a rate of 43 percent (3/7).

CONCLUSIONS

Our results suggest that patients receiving diphenhydramine are more satisfied with their treatment than are patients receiving famotidine or cromolyn sodium.

A quantitative method for assessing the extent of experimental gastric erosions and ulcers

Evaluation of acute gastric erosions and ulcers induced by chemicals such as ethanol or aspirin is difficult because these lesions are predominantly multiple and irregularly shaped. A commercially available, relatively inexpensive microprocessor-linked planimeter (Micro-Plan II) with a stereomicroscope was used to measure the area of gastric mucosa damaged following intragastric administration of various doses of ethanol or aspirin. An enlarged image of rat glandular stomach was projected from the stereomicroscope onto a planimeter on which the perimeter of the entire glandular stomach and each lesion was traced with an electronic cursor. An attached printer recorded the area of stomach assessed, the number of lesions, the surface area of each lesion and the total area of mucosal damage. The technique was compared with semiquantitative methods used previously to assess experimentally induced gastric mucosal damage. The quantitative morphometric method was sufficiently sensitive to demonstrate a dose-response effect of ethanol and aspirin. The stereomicroscope--planimeter combination provides a sensitive method to quantitate either a few small, or numerous large, regularly or irregularly shaped hemorrhagic and nonhemorrhagic gastric mucosal lesions.

An 18-month evaluation of the Akron General Medical Center assault/rape protocol

A prospective study of the Akron General Medical Center rape protocol reviewed the examination and follow-up of 60 alleged sexual assault victims. Six of eight examining physicians thought the protocol was too thorough; five of eight believed it took too long. The average time required for an examination was 53 minutes. Three of six nurses experienced technical difficulties with the protocol. Saliva specimens were inadequate in seven cases, and two vaginal swabs contained insufficient material. Thirteen cases reached Summit County Grand Jury, where no medical/legal difficulties with the protocol were encountered during testimony.

Experimental antiulcer drugs.4. 1,3-Disubstituted 2,4,5,6-tetrahydro-4,6,6 -trimethyl-2-phenylcyclopenta[c]pyrrole-4-carboxamides

The synthesis of 1,3-disubstituted 2,4,5,6-tetrahydro-4,6,6-trimethyl-2-phenylcyclopenta[c]pyrrole-4-carboxamides is reported. The derivatives included R1 = R3 = H, R1 = CH2OH with R3 = H (16) or CH3, R1 = CH3 with R3 = CH2OH (17), and R1 = R3 = CH2OH. The monohydroxymethyl derivatives were as active as the parent cyclopentapyrrole, where R1 = R3 = CH3 (1), when administered orally in the pyloric ligated rat. The compounds lacking one or both CH3 groups at C-1 or C-3 were much less active. Compounds 16 and 17 inhibited histamine-induced gastric acid secretion in the dog.

Experimental antiulcer drugs. 2. 2-Substituted 2,4,5,6-tetrahydro-1,3,4,6,6-pentamethylcyclopenta[c]pyrrole-4-carboxamides

Condensation of a 1-substituted 2,5-dimethylpyrrole 6 with 2 mol of 2-amino-2-methylpropionitrile in hot acetic acid yielded a 2-substituted 2,4,5,6-tetrahydro-1,3,4,5,6,6-pentamethylcyclopenta[c]pyrrole-4-carbonitrile (4). Hydrolysis of the nitriles to the amides gave a group of compounds which were active as antisecretory agents in the pyloric-ligated rat. Outstanding in this respect was the 2-phenyl derivative 5b, the most active compound in the series. It did not possess anticholinergic properties. In contrast to the indoles and pyrroles reported earlier, 5b demonstrated marked activity in blocking gastric acid secretion in the histamine-stimulated dog.

Experimental antiulcer drugs. 1. Indole-1-alkanamides and pyrrole-1-alkanamides

The synthesis and gastric antisecretory activity of a series of indole-1-alkanamides and pyrrole-1-alkanamides are presented. A marked elevation of the pH of the gastric secretions of the rat was observed after oral administration of 100 mg/kg of 2,3-dimethylindole-1-acetamide (2), -1-propionamide (8), and -1-butyramide (13). Replacement of either methyl group by a hydrogen atom or an ethyl radical resulted in greatly diminished activity. In the acetamide and propionamide series the 3-hydroxymethyl-2-methyl (14 and 15) derivatives exhibited activity but only when administered by the subcutaneous route. 2,3-Dimethylindole (18) was active and 2,3,4,5-tetramethylpyrrole-1-acetamide was moderately active. A number of the activ compounds were tested in the mouse mydriasis test for anticholinergic activity and found to be inactive. They were also found to be inactive in blocking histamine-induced acid secretion in the dog.