Sex Differences in Proximal Thoracic Aortic Disease Pathology: A Call to Action

Abstract Introduction/Objective Sex disparity is reported across all forms of cardiovascular diseases. Only few studies have focused on sex differences in thoracic aortic disease pathology. We aim to identify and understand sex differences in this patient group to bridge the knowledge gap and improve clinicopathologic outcomes. Methods/Case Report This is a retrospective analysis of 83 proximal thoracic aortic aneurysm and dissection (TAAD) cases treated at a single quaternary care center in 2019. Chart review was done for demographics. Consensus criteria (Stone JR et al. Cardiovasc Pathol 2015; 24:267-78; Halushka MK et al. Cardiovasc Pathol 2016; 25:247-57) and a scoring system (Waters KM et al. Cardiovasc Pathol 2017; 30:6-11) were used for pathology reporting. Clinical correlation was also made. Pearson’s chi-square test was used for statistical analysis. Results (if a Case Study enter NA) 83 patients (61 male and 22 female) were retrieved. Overall thoracic aortopathy was higher among males, accounting for 73.4% of individuals with TAAD. In a subgroup analysis, there was no sex difference in dissection, aortic root involvement, and bicuspid aortic valve (p>0.05). Genetic aortopathy was more prevalent in females than males (27.2% vs 9.8%, p=0.04) alongside early age at first aortic event (median age: 31y vs 52y). Histopathologically, females had frequent translamellar mucoid extracellular matrix accumulation (45.4% vs 22.9%, p=0.04), extensive (54.5% vs 27.8%, p=0.02) and severe (59% vs 34.4%, p=0.04) elastic fiber fragmentation, higher band like (9% vs 6.5%, p>0.05) plus extensive (13.6% vs 4.9%, p>0.05) smooth muscle nuclei loss, and extensive (13.6% vs 1.6%, p=0.01) plus dense (4.5% vs 1.6%, p>0.05) laminar medial collapse than males. Conclusion In our patient population, females have a lower prevalence of thoracic aortic disease treated with open repair. However, those who develop TAAD harbor a greater burden of wall pathology and probable worse outcomes. We recommend sex-based analysis of all research on thoracic aortic diseases.

Download Full-text

Sex differences in thoracic aortic disease: A review of the literature and a call to action

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.09.194 ◽

2020 ◽

Vol 160 (3) ◽

pp. 656-660

Author(s):

Jennifer Chung ◽

Thais Coutinho ◽

Michael W.A. Chu ◽

Maral Ouzounian

Keyword(s):

Sex Differences ◽

Aortic Disease ◽

Review Of The Literature ◽

Thoracic Aortic Disease ◽

Call To Action

Download Full-text

Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i2.20315 ◽

2018 ◽

Vol 16 (2) ◽

pp. 222-227 ◽

Cited By ~ 2

Author(s):

Smriti Shrestha

Keyword(s):

Lipid Profile ◽

Clinical Symptoms ◽

Care Center ◽

Tertiary Care ◽

Thyroid Stimulating Hormone ◽

Bivariate Analysis ◽

Female Adult ◽

Chi Square ◽

Chi Square Test ◽

Relationship Of

Background: Acne beyond 25 years of age is frequently associated with hormonal derangement in women. Hormonal association provides the impetus for hormonal therapy as well as underpins the need for blood investigations in this population. Hence, we aim to estimate the presence of hormonal derangement and lipid alteration in female adult acne.Methods: A prospective, observational study was conducted in Dhulikhel Hospital from July 2015 to February 2016. Females older than 25 years with acne were taken in the study after informed consent. Total 100 patients were enrolled aftersample sizeestimation. Hormonal paneland lipid profile were measured. Hormones tested were androgens, C-peptide and thyroid stimulating hormone. Data analysis was done with SPSS-23. Bivariate analysis was done by chi-square test for categorical data.Results: In this study, majority of patients were younger than 30 years (70.5%) and perioral area most commonly involved. Hormonal alteration was seen in 37.2% patients, among which 17.9% had hyperandrogenism, 15.4% had abnormal thyroid level and 10.3% had high C-peptides respectively. Lipid profile was altered in 15.4% patients. Hormonal alteration had significant association with irregular menstruation (P<0.05) but not acne severity.Conclusions: We observed hormonal alteration frequently in females with adult acne, which comprised of various hormonal parameters including hyperandrogenism. Hormonal alteration reflects deranged metabolic milieu and we suggestthat wide hormonal panel should be done in female adult acne. Relationship of hormones with menstrual irregularity but not with acne severity, suggest that clinical symptoms should lead hormonal investigations in all grades of acne.

Download Full-text

Validation of a Breastfeeding History Questionnaire for the Risk of In-Hospital Formula Supplementation Among Multiparous Women

Journal of Human Lactation ◽

10.1177/0890334419868157 ◽

2019 ◽

Vol 35 (4) ◽

pp. 665-671

Author(s):

Whitney R. Bender ◽

Nathanael C. Koelper ◽

Mary D. Sammel ◽

Celeste Durnwald

Keyword(s):

Hospital Stay ◽

Care Center ◽

Tertiary Care ◽

Categorical Variables ◽

Chi Square ◽

Multiparous Women ◽

Chi Square Test ◽

Student’S T ◽

Relationship Of ◽

The Relationship

Background: A woman’s prior breastfeeding history may influence future decisions regarding infant feeding. Few quantitative tools utilizing this information have been demonstrated to predict breastfeeding success. Research aim: To evaluate the efficacy of a prenatal breastfeeding history (BAP) questionnaire administered in prenatal care to predict in-hospital formula supplementation among multiparous women. Methods: This is a prospective observational study of multiparous women with singleton pregnancies who presented to a Baby-Friendly urban tertiary care center for 1st prenatal visit at < 20 weeks’ gestation. The BAP tool generates a numerical score, with higher score (≥ 2) indicating prior successful breastfeeding experiences. The primary outcome was occurrence of non-medically indicated formula supplementation during the postpartum hospital stay. Student’s t test and Pearson’s chi-square test were used to compare continuous and categorical variables. A multivariable logistic regression was performed to assess the relationship of BAP score to formula supplementation. Of 587 women screened, 433 (73.8%) mother–infant dyads were analyzed. Results: Rates of formula supplementation in women with BAP scores ≤ 1 were 67% (156/234) compared with 37% (73/199) in women with higher scores ( p < 0.0001). After controlling for race/ethnicity, insurance, and obesity, women with BAP scores of ≤ 1 were 2.6 times more likely to supplement formula than women with higher scores (a OR 2.62, 95% CI [1.70, 4.04], p < .0001). Conclusion: In this prospective validation study, women with negative prior breastfeeding experiences, as evidenced by a lower BAP score, were more likely to supplement formula during the postpartum hospital stay.

Download Full-text

Types and Patterns of Colonic Polyps Encountered at a Tertiary Care Center in a Developing Country in South Asia

Analytical Cellular Pathology ◽

10.1155/2014/248142 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Dakshitha Praneeth Wickramasinghe ◽

Sanjeev F. Samaranayaka ◽

Chamila Lakmal ◽

Sashi Mathotaarachchi ◽

Chula Kanishka Lal ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Colonic Polyps ◽

Colorectal Polyps ◽

Tubular Adenoma ◽

Tubulovillous Adenoma ◽

Chi Square ◽

Chi Square Test ◽

Pathology Reports ◽

Spearman’S Correlation

Purpose. To identify the prevalence, types, and patterns of colonic polyps in a cohort of patients presenting to a tertiary care referral center in Sri Lanka.Methods. Endoscopy and pathology reports of a single unit from 2006 to 2013 were analyzed retrospectively. Spearman’s correlation coefficient and chi-square test were used to identify correlations.Results. There were a total of 158 patients (M : F, 10 : 57) who had polyps encountered on colonoscopy (n=1408) and flexible sigmoidoscopy (n=2402) with an incidence of 4.1%. Mean age was 56.5 years (SD 16.4) and the incidence of polyps increased with age. The majority (81.6%) had one polyp. A total of 188 polyps were assessed and most were seen in the rectum (33.5%) followed by sigmoid colon (22.9%). The commonest histological type was tubulovillous adenoma (33.5%) followed by tubular adenoma (24.5%). Most polyps were benign (91.5%). There was no statistically significant correlation with age or gender with malignancy, site, or histology.Discussion and Conclusion. The incidence of colorectal polyps was lower than the values reported in the west. More polyps were identified in males. There was no statistically significant association between age, gender, or multiplicity and malignant change in the polyps.

Download Full-text

Effect of Aortic Stent Implantation in the Treatment of Thoracic Aortic Disease

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i3.2240 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Cheng Chen

Keyword(s):

Stent Implantation ◽

Operation Time ◽

Aortic Disease ◽

Observation Time ◽

Inflammatory Factors ◽

Clinical Effects ◽

Aortic Diseases ◽

Thoracic Aortic Disease ◽

Number Of Patients ◽

Significant Difference

Objective: To explore the effect of aortic stent implantation on patients in the treatment of thoracic aortic diseases. Methods: Selected patients from Yunnan Fuwai Cardiovascular (YFC) Hospital as a sample group to carry out the study, the main participants were thoracic aortic aneurysm patients admitted from June 2020 to June 2021. The number of patients involved were 80. The patients are divided into two groups and different treatment methods were adopted. A comparative analysis of the effects of aortic stent placement on patients was conducted. Results: Before treatment, there was no significant difference in the levels of various inflammatory factors between the two groups of patients, P>0.05. After treatment, the data indicators of the two groups were significantly different, as there were significant differences in the surgical indicators among the two groups of patients, P<0.05. As a result, the experimental group had shorter operation time, less intraoperative blood loss, shorter ICU observation time, lower levels of inflammatory factors, and better results. Conclusion: In the treatment of patients with thoracic aortic disease, the application of aortic stent implantation has significant clinical effects and are more conducive to the recovery of patients. It can be promoted and used in clinical trials.

Download Full-text

Predictors of Death in Severe COVID-19 Patients at Millennium COVID-19 Care Center in Ethiopia: A Case-Control Study

10.1101/2020.10.07.20205575 ◽

2020 ◽

Cited By ~ 2

Author(s):

Endalkachew H. Maru ◽

Tigist W. Leulseged ◽

Ishmael S. Hassen ◽

Wuletaw C. Zewde ◽

Nigat W. Chamesew ◽

...

Keyword(s):

Case Control Study ◽

Care Center ◽

Binary Logistic Regression ◽

Case Control ◽

P Value ◽

Chi Square ◽

P Values ◽

Significant Difference ◽

Chi Square Test ◽

Control Study

ABSTRACTBackgroundAs the number of new cases and death due to COVID-19 is increasing, understanding the characteristics of severe COVID-19 patients and identifying characteristics that lead to death is a key to make an informed decision. In Ethiopia, as of September 27, 2020, a total of 72,700 cases and 1165 deaths were reported.ObjectiveThe study aimed to assess the determinants of death in Severe COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA case-control study of 147 Severe COVID-19 patients (49 deaths and 98 discharged alive cases) was conducted from August to September 2020. A comparison of underlying characteristics between cases (death) and controls (alive) was assessed using a chi-square test and an independent t-test with a p-value of <0.05 considered as having a statistically significant difference. Multivariable binary logistic regression was used to assess a statistically significant association between the predictor variables and outcome of Severe COVID-19 (Alive Vs Death) where Adjusted Odds ratio (AOR), 95% CIs for AOR, and P-values were used for testing significance and interpretation of results.ResultsHaving diabetes mellitus (AOR= 3.257, 95% CI= 1.348, 7.867, p-value=0.00), fever (AOR=0.328, 95% CI: 0.123, 0.878, p-value= 0.027) and Shortness of breath (AOR= 4.034, 95% CI= 1.481, 10.988, p-value=0.006) were found to be significant predictors of death in Severe COVID-19 patients.ConclusionsThe outcome of death in Severe COVID-19 patients is found to be associated with exposures to being diabetic and having SOB at admission. On the other hand, having a fever at admission was associated with a favorable outcome of being discharged alive.

Download Full-text

A Study on Otorhinolaryngological Presentations in Covid 19 Patients in a Tertiary Health Care Center

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-021-02564-2 ◽

2021 ◽

Author(s):

S. G. Smitha ◽

Nikitha Pillai ◽

Bindya Nayak ◽

Jedhin Raveendran

Keyword(s):

Blood Group ◽

Rna Virus ◽

Statistical Significance ◽

Care Center ◽

Chi Square ◽

Health Care Center ◽

Corona Virus ◽

Chi Square Test ◽

The Relationship ◽

Written Informed Consent

AbstractCorona virus also known as 2019 novel corona virus, a single stranded positive sense RNA virus is the causative agent of COVID 19 disease. It mainly spreads via the respiratory route by means of aerosols. The objectives of our study were. To know the prevalence of ENT presentations in COVID 19 patients and to know the relationship between the symptoms and category of the disease as well as to know the relation between the blood group and recovery from the disease. The first 500 patients who were tested positive for COVID 19 and getting treated in our hospital were included in the study after taking written informed consent from the patients who were willing to participate in the study. A detailed history was taken from all the patients and more stress was given on the ENT symptoms with respect to its onset, duration and time taken for the relief of symptoms. The ENT symptoms were compared with the category of the disease as well as the blood group of the patients. Statistical analysis was done using Chi square test and Statistical Package for Social Sciences [SPSS] for Windows Version 22.0 Released 2013. Armonk, NY: IBM Corp., was used to perform statistical analyses. In our study 310 (62.0%) were males and 190 (38.0%) patients were females (38%), of age group ranging from 2 years to 87 years. In our study 367 (73.3%) patients were symptomatic and the rest 133 (26.6%) were asymptomatic. There were 335 (67.0%) patients in category A, 140 (28.0%) in category B and 25 (5.0%) in category C. The most common ENT presentation was headache and its prevelance was more in category C and it was of statistical significance. On comparing the blood group and the ENT symptoms occurrence of sore throat was of statistical significance and its prevelance was more among the O blood group patients. In terms of recovery from the disease the patients with blood group O had good recovery rate. Covid 19 pandemic is still an on going problem and newer strains of the virus are arising as well hence. In our study we found out that isolated ENT symptoms such as aguesia and anosmia were the only presentation of the disease. Thus they can be considered as early marker of the disease and it will be helpful in early detection and isolation of the patient as well as prevention of further spread of the disease.

Download Full-text

Genetic diseases of the aorta: chromosomal and inherited diseases

ESC CardioMed ◽

10.1093/med/9780198784906.003.0622 ◽

2018 ◽

pp. 2608-2611

Author(s):

Dorien Schepers ◽

Bart Loeys

Keyword(s):

Aortic Aneurysm ◽

Aortic Coarctation ◽

Thoracic Aortic Aneurysm ◽

Genetic Diseases ◽

Aortic Disease ◽

Arterial Stenosis ◽

Genetic Syndromes ◽

Aortic Diseases ◽

Cardiovascular Morbidity And Mortality ◽

Aortic Aneurysm And Dissection

Genetic diseases of the aorta account for significant cardiovascular morbidity and mortality worldwide. The most common inherited aortic diseases are thoracic aortic aneurysm and dissection, aortic coarctation, and arterial stenosis. These clinical entities can occur either as part of a syndrome or as isolated diseases. Over recent years, an increasing number of disease-causing genes affecting the aorta have been identified, leading to the demarcation of several genetic syndromes related to aortic disease.

Download Full-text

Determinants of Developing Symptomatic Disease in Ethiopian COVID-19 Patients

10.1101/2020.10.09.20209734 ◽

2020 ◽

Cited By ~ 2

Author(s):

Tigist W. Leulseged ◽

Degu G. Alemahu ◽

Ishmael S. Hassen ◽

Endalkachew H. Maru ◽

Wuletaw C. Zewde ◽

...

Keyword(s):

Logistic Regression ◽

Management Practice ◽

Care Center ◽

Severe Disease ◽

Binary Logistic Regression ◽

P Value ◽

Chi Square ◽

Symptomatic Disease ◽

Significant Difference ◽

Chi Square Test

ABSTRACTBackgroundStudies show that having some symptoms seems to be associated with more severe disease and poor prognosis. Therefore, knowing who is more susceptible to symptomatic COVID-19 disease is important to provide targeted preventive and management practice. The aim of the study was to assess the determinants of having symptomatic disease among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA case-control study was conducted from August to September 2020 among a randomly selected 765 COVID-19 patients (372 Asymptomatic and 393 Symptomatic patients). Chi-square test and independent t-test were used to detect the presence of a statistically significant difference in the characteristics of the cases (symptomatic) and controls (asymptomatic), where p-value of <0.05 considered as having a statistically significant difference. Multivariable binary logistic regression was used to assess a statistically significant association between the independent variables and developing symptomatic COVID-19 where Adjusted Odds ratio (AOR), 95% CIs for AOR, and P-values were used for testing significance and interpretation of results.ResultsThe result of the multivariable binary logistic regression shows that age group (AOR= 1.818, 95% CI= 1.210, 2.731, p-value=0.004 for 30-39 years; AOR= 1.611, 95% CI= 1.016, 2.554, p-value=0.043 for 40-49 years and AOR= 4.076, 95% CI= 2.582, 6.435, p-value=0.0001 for years and above), sex (AOR= 1.672, 95% CI= 1.216, 2.299, p-value=0.002) and history of diabetes mellitus (AOR= 2.406, 95% CI= 1.384, 4.181, p-value=0.002) were found to be significant factors that determine the development of symptomatic disease in COVID-19 patients.ConclusionsDeveloping a symptomatic COVID-19 disease was found to be determined by exposures of old age, male sex, and being diabetic. Therefore, patients with the above factors should be given enough attention in the prevention and management process, including inpatient management, to pick symptoms earlier and to manage accordingly so that these patients can have a favorable treatment outcome.

Download Full-text

Arrhythmia and cardiomyopathy in Heritable Thoracic Aortic Disease: an international retrospective cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.1989 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Demolder ◽

L Muino-Mosquera ◽

A Pini ◽

A Evangelista ◽

A Lopez-Sainz ◽

...

Keyword(s):

Medical Records ◽

Myocardial Dysfunction ◽

Aortic Disease ◽

Genetic Profile ◽

Aortic Diseases ◽

Contributing Factors ◽

Thoracic Aortic Disease ◽

Reduced Ejection Fraction ◽

Funding Sources ◽

Fbn1 Gene

Abstract Background Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS) and related heritable thoracic aortic diseases (HTAD) are well-known for their aortic complications. Myocardial dysfunction and arrhythmia are less known in this setting but have been increasingly reported as additional causes of morbidity and mortality. Related to the rarity of the disorders, data on the prevalence of these features and clinical characteristics of the patients are difficult to obtain, calling for a multicentre initiative. Purpose To study the prevalence of myocardial dysfunction and arrhythmia in patients with HTAD and describe their clinical and genetic profile. Methods Nine centres from seven countries participated in this multicentre retrospective study. Medical records of patients 12 years or older carrying a (likely) pathogenic variant in the FBN1 gene, LDS genes (TGFBR1, TGFBR2, TGFB2, TGFB3 and SMAD3) or ACTA2 gene were screened. Patients presenting myocardial dysfunction and/or arrhythmia were identified, and clinical and genetic data were collected. Myocardial dysfunction included (a)symptomatic reduced ejection fraction (EF <50% – HFrEF) or symptomatic preserved EF (HFpEF), as documented in the patient charts. Arrhythmias included atrial fibrillation or flutter (AF/AFL), ventricular tachycardia (VT), ventricular fibrillation (VF) and (aborted) sudden cardiac death (SCD) (presumed arrhythmogenic). Results In total, 3219 patients with HTAD were screened: 2761 with a variant in FBN1, 385 with a variant in one of the LDS genes (TGFBR1, TGFBR2, TGFB2, TGFB3 and SMAD3) and 73 carrying a variant in ACTA2. Myocardial dysfunction and arrhythmia were not reported in patients carrying an ACTA2 variant. Myocardial dysfunction was observed in patients with a variant in FBN1 and the LDS genes, without significant differences in prevalence (2.3% vs. 1.8%, p=0.563). Patients with a variant in the LDS genes presenting myocardial dysfunction were younger than patients carrying a variant in FBN1 (25±11 years vs. 39±17 years, p=0.034). The prevalence of VT/VF/SCD was similar in patients with a variant in one of the LDS genes compared to those with a variant in FBN1 (1.6% vs. 0.8%, p=0.132) and there was no difference in age at time of event (26±13 years vs. 33±14 years, p=0.289). Among patients with a variant in the LDS genes, the prevalence of VT/VF/SCD was highest in patients carrying a variant in the TGFBR2 gene and was significantly higher compared to patients with a variant in FBN1 (3.4% vs. 0.8%, p=0.017). In contrast, AF/AFL was significantly more often reported in patients with a variant in FBN1 compared to those with a variant in one of the LDS genes (1.7% vs. 0.3%, p=0.033). Conclusions Myocardial dysfunction and arrhythmia are rare features in patients with HTAD. They occur predominantly in patients with a variant in FBN1 and LDS genes, but were not reported in patients carrying a variant in the ACTA2 gene. Further analysis to identify other contributing factors is necessary. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

Download Full-text