Gender-related Differences In Outcomes Research Articles

Impact of gender-related differences in outcomes in acute myocardial infarction: non-obstructive coronary arteries versus obstructive coronary arteries

Abstract Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents 6-10% of acute myocardial infarction (AMI) and is more prevalent in females. The impact of gender on the outcomes of MINOCA patients has been poorly understood. Purpose To evaluate the impact of gender on the prognosis of MINOCA. Methods We enrolled 2455 patients with AMI undergoing coronary angiography from January 2016 to June 2021. Patients were divided according to type of AMI and gender: male (n=1593) and female (n=607) in AMI with obstructive coronary arteries (MIOCA); male (n=87) and female (n=168) in MINOCA. Each cohort was further stratified based on age (<=/> 70 years). The primary endpoint was a composite of all-cause death, recurrent AMI, and hospitalization for heart failure (MACE) at 5-year follow-up. Secondary outcomes included: all-cause and cardiovascular death, recurrent AMI, HF re-hospitalization and stroke. Results MINOCA patients were more likely to be females compared to MIOCA ones (p<0.001). The incidence of MACEs was significantly higher in females compared to males, both in MINOCA (p=0.018) and MIOCA cohorts (p=0.002). Age was an independent predictor of MACEs in both cohorts. No difference in outcomes was found comparing females to males >70 years, in both MINOCA and MIOCA. MINOCA females <70 years old had a higher incidence of MACEs (p=0.003), mainly driven by a higher prevalence of re-hospitalization for HF (p=0.045) and recurrence of AMI (p=0.006). Only in this sub-group of MINOCA patients, female gender was an independent predictor of MACEs (HR=3.09; 95%CI: 1.02-9.59; p=0.040). MINOCA females <70 years old had worse outcomes than MIOCA peers. Conclusion MINOCA females <70 years old had a significantly higher incidence of MACEs, compared to males and MIOCA peers, likely due to the different pathophysiology of the ischemic event.Survival curves in MINOCA and MIOCASurvival curves stratified for age

Body surface area and gender-related differences in outcomes of patients with peripheral artery disease

Body surface area and gender-related differences in outcomes of patients with peripheral artery disease

Are Women at High Risk of Complications from Sickle Cell Disease: Insights from National Database Analysis

Introduction: Published data reporting gender-related differences in outcomes from sickle cell disease (SCD) is scarce, consisting of small single-center studies. Therefore, using a large sample size from a nationally representative database, we looked into the effect of gender on outcomes from SCD. Methods: We investigated the National Inpatient Sample 2019 using International Classification of Diseases-10 (ICD-10) codes to include adult SCD patients. Morbidity, disease complication, and resource utilization were compared, stratified by patients' gender. Analyses were performed using STATA (version 14.2), considering 2-sided P< 0.05 as statistically significant. Proportions were compared using Fisher exact test and continuous variables using the Student's t-test. Confounding variables were adjusted using multivariate logistic and linear regression analyses. Results: A total of 97,244 patients were included (mean age 34.61 years, 57.26% females). Female patients had 24% lower odds of acute chest syndrome on presentation (Adjusted odds ratio (aOR) 0.76, 95% confidence interval (CI): 0.64 - 0.91, P<0.01). The rates of splenic sequestration crisis, posterior reversible encephalopathy syndrome, myocardial infarction, and gallbladder stones were comparable between the two groups. Males had higher odds of developing acute kidney injury during hospitalization (aOR 0.80, 95% CI: 0.70 - 0.92, P<0.01), but the rates of in-hospital mortality and other morbidity markers were not different between the two groups. Packed Red Blood Cell (pRBC) transfusion, total hospital costs, and length of stay were not statistically different between males and females. Discussion: Using a large sample size, we found that females are not at high risk of SCD complications or adverse hospitalization outcomes. Male patients have a higher risk of presenting with acute chest syndrome and developing acute kidney injury. This could be due to the estrogen protective effect or other factors. Despite menstrual losses, females did not have significantly higher pRBC transfusions or lower secondary hemochromatosis. Our study showed that gender does not represent an indicator of morbidity and mortality in SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Cardiac tumors-sex-related characteristics and outcomes after surgical resection.

Cardiac tumors represent a rare and heterogeneous pathological entity, with a cumulative incidence of up to 0.02%. Gender was previously reported to influence outcomes after tumor surgery. This study aimed to investigatefor gender-related differences in outcomes after cardiac surgery. Between 2009 and 2021, 95 male and 88 female patients underwent surgery for tumor extirpation in our center. Preoperative baseline characteristics, intraoperative data, and long-term survival were analyzed. The diagnosis was confirmed postoperatively by (immune-)histopathological analysis. There were no significant differences in baseline characteristics and survival. Myxoma was the most common tumor type overall and was more diagnosed in women (n = 36 vs. n = 62, p ≤ 0.001). Sarcoma was the most common malignant tumor type (n = 5). Tumor location at the atrial septum was more likely in women (n = 26 vs. n = 16, p = 0.041), whereas ventricular localization was more common in male patients (n = 20 vs. n = 7, p = 0.001). Minimally invasive tumor extirpation was significantly more often performed in women, and in-hospital stay was shorter in female patients. The localization and dignity of cardiac tumors differ between genders, not affecting survival. Surgical tumor extirpation remains the gold standard of treatment for cardiac tumors in both genders as it is highly effective and associated with good long-term survivorship.

Gender-related differences in outcomes after endoscopic sinus surgery.

International Forum of Allergy & RhinologyVolume 11, Issue 5 p. 949-952 RESEARCH NOTE Gender-related differences in outcomes after endoscopic sinus surgery Michela Borrelli BS, orcid.org/0000-0003-1311-9329 Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CASearch for more papers by this authorMartin L. Hopp MD, PhD, Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CASearch for more papers by this authorAlexis Desales BA, Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CASearch for more papers by this authorJonathan Y. Ting MD, Department of Otolaryngology, Indiana University Health, Indianapolis, INSearch for more papers by this authorElisa A. Illing MD, Department of Otolaryngology, Indiana University Health, Indianapolis, INSearch for more papers by this authorThomas S. Higgins MD, MPH, orcid.org/0000-0002-2020-6386 Department of Otolaryngology, University of Louisville School of Medicine, Louisville, KYSearch for more papers by this authorArthur W. Wu MD, Corresponding Author arthurwu@gmail.com orcid.org/0000-0001-8993-6355 Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA Correspondence to: Arthur W. Wu, MD, Cedars-Sinai Sinus Center, 8631 West Third Street, Suite 915E, Los Angeles, CA 90048, e-mail: arthurwu@gmail.comSearch for more papers by this author Michela Borrelli BS, orcid.org/0000-0003-1311-9329 Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CASearch for more papers by this authorMartin L. Hopp MD, PhD, Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CASearch for more papers by this authorAlexis Desales BA, Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CASearch for more papers by this authorJonathan Y. Ting MD, Department of Otolaryngology, Indiana University Health, Indianapolis, INSearch for more papers by this authorElisa A. Illing MD, Department of Otolaryngology, Indiana University Health, Indianapolis, INSearch for more papers by this authorThomas S. Higgins MD, MPH, orcid.org/0000-0002-2020-6386 Department of Otolaryngology, University of Louisville School of Medicine, Louisville, KYSearch for more papers by this authorArthur W. Wu MD, Corresponding Author arthurwu@gmail.com orcid.org/0000-0001-8993-6355 Cedars-Sinai Sinus Center, Los Angeles, CA Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA Correspondence to: Arthur W. Wu, MD, Cedars-Sinai Sinus Center, 8631 West Third Street, Suite 915E, Los Angeles, CA 90048, e-mail: arthurwu@gmail.comSearch for more papers by this author First published: 04 December 2020 https://doi.org/10.1002/alr.22749 Potential conflicts of interest: A.W.W.: Sanofi/Regeneron, consultant, speaker; Optinose, speaker; Gossamer, investigator. The remaining authors have no disclosures. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Volume11, Issue5May 2021Pages 949-952 RelatedInformation

Gender-related outcomes of chimney EVAR within the PERICLES registry

Gender-related differences in outcomes in complex endovascular aortic repair have not been profoundly investigated. Use of low profile abdominal devices as in chimney endovascular repair may be beneficial for female patients with pararenal pathologies. With the chimney technique, there is no need for large introduction sheaths. This could be an advantage in case of smaller in diameter iliac access especially in combination with stenosis or elongation. Aim of the present study was to compare the perioperative and mid-term outcomes between males and females patients treated with the chimney/snorkel technique for pararenal aortic pathologies. The PERICLES registry collected the world wide experience with the chimney technique. According to the gender, patients were classified in two cohorts. Primary endpoints were freedom from occlusion of the chimney grafts and reintervention. Secondary endpoints included access site complications and need for surgical or interventional revision, Endoleak Type I rate, 30-day overall complications and mortality. Univariate comparison P-values were generated using either the likelihood ratio χ2 test, the Fisher exact test, the Wilcoxon rank sum test, or the log rank test. Kaplan-Meier curves estimated the outcomes in the long run. A total of 412 patients underwent Ch-EVAR, 71 (17%) females and 341 (83%) males with a mean age for both groups being 74 years were included in the present study. After 36 months of mean follow-up, no statistically significant difference was observed between the two cohorts regarding re-interventions ( P= .44). Freedom from occlusion rates at 36 months did not differed between the two groups (females 84% vs. 80% for males ( P= .033). For patients receiving more than one chimney stent, the odds of having a complication did not differ between males and females (M:F OR = 2.0, 95% CI: 0.6-6.4, P = 0.228); 30-day mortality was 0% in the female group, instead five male patients died within one month. ( P = 0.59). The incidence of acute renal failure was low in both groups without statistical difference: 2 (3.1%) vs. 13 (4.6%) 58 ( P = 1.00). Neither patient received an endoconduit to insert the abdominal device. No statistically significant difference regarding the freedom from reintervention and chimney graft patency was observed between the two genders. The results highlight the beneficial use of the chimney technique in female patients who can have potentially higher risk of access complications.

Altered adrenal and gonadal steroids biosynthesis in patients with burn injury

IntroductionBurn injury inevitably leads to changes in the endogenous production of cytokines, as well as adrenal and gonadal steroids. Previous studies have reported gender-related differences in outcome following burn injury, which suggests that gonadal steroids may play a role. The aim of this study was to assess alterations in concentration of endogenous steroids in patients with burn injury. MethodsFor this single-center, prospective descriptive study, high-sensitivity liquid chromatography tandem mass spectrometry (LC-MS/MS)-based steroid quantification was used to determine longitudinal profiles of the concentrations of endogenous steroids in plasma from sixteen adult male patients with burn injury (14.5–72% of total body surface area). Steroids were extracted from plasma samples and analyzed using multiple reaction monitoring acquisition, with electrospray ionization on a triple quadruple mass spectrometer. Total protein concentration was measured in the samples using spectrophotometry. ResultsSteroid and total protein concentration distributions were compared to reference intervals characteristic of healthy adult men. Concentrations of the following steroids in plasma of burn injured patients were found to correlate positively to the area of the burn injury: cortisol (r=0.84), corticosterone (r=0.73), 11-deoxycortisol (r=0.72), androstenedione (r=0.72), 17OH-progesterone (r=0.68), 17OH-pregnenolone (r=0.64) and pregnenolone (r=0.77). Concentrations of testosterone decreased during the acute phase and were up to ten-times lower than reference values for healthy adult men, while concentrations of estrone were elevated. By day 21 after injury, testosterone concentrations were increased in younger, but not older, patients. The highest concentrations of estrone were observed on day 3 after the injury and then declined by day 21 to concentrations comparable to those observed on the day of the injury. ConclusionBurn injury alters endogenous steroid biosynthesis, with decreased testosterone concentrations and elevated estrone concentrations, during the first 21days after the injury. Concentrations of glucocorticoids, progestagens and androgen precursors correlated positively with the area of burn injury. The finding of increased estrone following burn injury needs to be confirmed in a larger hypothesis-driven study.

Gender-related differences in outcome of patient education for osteoarthritis–a register study

Gender-related differences in outcome of patient education for osteoarthritis–a register study

Commentary on “Male Sex Associated With Increased Long-term Cardiovascular Mortality After Peripheral Vascular Surgery for Atherosclerosis Despite Optimal Medical Treatment”

Budtz-Lilly et al. suggest that males have higher mortality rates following surgical revascularization for lower limb ischaemia (LLI) compared with females. These findings are, therefore, in conflict with findings in other arterial pathologies (abdominal aortic aneurysm/carotid disease/ischaemic heart disease) where female gender is associated with poorer outcomes. Previous studies of LLI, however, suggest that despite an increased risk of complications following surgery in women, there is no difference in mortality between genders. Why then, might there be gender-related differences in outcomes in varying arterial diseases? In the study by Budtz-Lilly et al., there are methodological issues, in keeping with registry data, that might confound the results, including the definition of smoking, long-term compliance with medications, and lack of data regarding endovascular and conservative management of patients. Although cause of death is not available, the high long-term mortality rates remain concerning, possibly because of lack of awareness of the associated risks of PAD. This needs urgent attention by the vascular community. Cardiovascular (CV) disease, as a whole, is the main cause of death in both males and females, with the prevalence being higher in women. What is apparent is that although traditional CV risk factors are important and may account for some of the findings in this study, there are a number of gender-specific factors that need to be considered. These include both sex (biology) and gender (behavioral/environmental) factors. There is increasing awareness of prenatal/ early childhood factors, pregnancy-related issues (gestational hypertension and diabetes), endocrine issues

Gender-Related Differences in Outcomes on Acupuncture and Moxibustion Treatment Among Depression Patients.

This study sought to (1) assess the effectiveness of acupuncture and moxibustion with a method of soothing the liver and regulating the mind on the quality of life among patients with depression and (2) study the sex differences of acupuncture and moxibustion in the treatment of depression on the basis of patient-reported outcomes. In a single-blind, randomized, controlled trial conducted in Guangdong Province, China, in January and December 2010, 163 patients who met the criteria for depression were enrolled. Eligible patients were allocated to three treatment groups (soothing liver and regulating mind group, acupoint shallow puncturing group, and non-acupoint shallow puncturing group). In all three groups, the treatment was given twice a week for 12 weeks. The Hamilton Depression Rating Scale (HAMD) and Symptom Checklist 90 (SCL90) were used to quantitatively assess patients before and 1 and 3 months after treatment. Non-statistically significant differences in the acupuncture and moxibustion therapeutic effects of soothing liver and regulating mind treatment were found between men and women (p>0.05). An item-by-item analysis of the SCL90 and HAMD scores showed sex differences between the efficacy of the soothing liver and regulating mind group and the group receiving acupoint shallow puncturing. Women obtained lower scores in somatization, interpersonal relationship, anxiety, terror, and extremeness items and HAMD scores in the soothing liver and regulating mind group than in the acupoint shallow puncturing group (p<0.05), while men showed no significant differences between the soothing liver and regulating mind group and the acupoint shallow puncturing group (p>0.05). The therapeutic effect of soothing liver and regulating mind is similar for both sexes, but women were more sensitive to the efficacy of the soothing liver and regulating mind treatment compared with other methods. These findings could indicate an important issue to consider for the different acupuncture and moxibustion treatments for depression in men and women.

Evolution of gender-related differences in outcomes from two decades of endovascular aneurysm repair

Women have been under-represented in trials that set guidelines for the management of aortic aneurysms. Several studies reported inferior outcomes in women compared with men after endovascular aneurysm repair (EVAR). We investigated the relationship between gender and outcomes after EVAR. A total of 1380 consecutive patients underwent elective EVAR from 1992 to 2012. Baseline, intraoperative, and postoperative variables by gender were analyzed from a prospective database. The cohort comprised 214 women (15.5%) and 1166 men (84.5%). Women were older than men at repair (77.8 vs 74.5 years, P < .001) and had less cardiac disease (P = .005). They had shorter (19.8 ± 12.9 vs 26.3 ± 14.7 mm; P < .001) more angulated aortic necks (38.8° ± 16.1° vs 31.2° ± 14.7°; P < .001) and fewer iliac aneurysms (P = .002). Women had more arterial reconstructions (iliac conduits, P = .006; thrombolysis and thrombectomy, P = .013; patch angioplasty, P < .001; endarterectomy, P < .001), more perioperative complications (16.9% vs 9.1%; P = .001), and more in-hospital days (4.1 vs 3.4 days; P = .029). Perioperative mortality was equivalent (women: 2% vs men: 2.3%; P = .73). Mean follow-up was 30.9 months. Women and men experienced equivalent aneurysm-related deaths and overall survival. Survival curve analysis showed endoleaks were more likely to develop in women than men (P = .005); however, there was no difference in rates of arterial reinterventions required for each gender during the follow-up period. Female gender is associated with more periprocedural complications, adjunctive arterial procedures, and increased endoleaks but does not affect long-term reinterventions or survival. Further studies are warranted to elucidate the effect of gender on outcomes. These data should be considered when selecting EVAR for men and women.

Gender-related differences in outcomes and attrition on antiretroviral treatment among an HIV-infected patient cohort in Zimbabwe: 2007–2010

SUMMARYObjectivesTo determine (1) gender-related differences in antiretroviral therapy (ART) outcomes, and (2) gender-specific characteristics associated with attrition.MethodsThis was a retrospective patient record review of 3919 HIV-infected patients aged ≥15 years who initiated ART between 2007 and 2009 in 40 randomly selected ART facilities countrywide.ResultsCompared to females, males had more documented active tuberculosis (12% vs. 9%; p < 0.02) and a lower median CD4 cell count (117 cells/μl vs. 143 cells/μl; p < 0.001) at ART initiation. Males had a higher risk of attrition (adjusted hazard ratio (AHR) 1.28, 95% confidence interval (CI) 1.10–1.49) and mortality (AHR 1.56, 95% CI 1.10–2.20). Factors associated with attrition for both sexes were lower baseline weight (<45 kg and 45–60 kg vs. >60 kg), initiating ART at an urban health facility, and care at central/provincial or district/mission hospitals vs. primary healthcare facilities.ConclusionsOur findings show that males presented late for ART initiation compared to females. Similar to other studies, males had higher patient attrition and mortality compared to females and this may be attributed in part to late presentation for HIV treatment and care. These observations highlight the need to encourage early HIV testing and enrolment into HIV treatment and care, and eventually patient retention on ART, particularly amongst men.

Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: insights from the DESERT cooperation

Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: insights from the DESERT cooperation

Gender-related differences in outcome after BMS or DES implantation in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: Insights from the DESERT cooperation

BackgroundSeveral studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug-eluting stents (DES). Therefore, the aim of this study was to investigate sex-related differences in clinical outcome in patients with STEMI treated with primary angioplasty with Bare-Metal Stent (BMS) or DES. MethodsOur population is represented by 6298 STEMI patients undergoing primary angioplasty and stent implantation included in the DESERT database. Follow-up data were collected from 3 to 6 years after primary angioplasty. ResultsFemale gender was observed in 1466 (23.2%) out of 6298 STEMI patients. Women were older (65.3 ± 12.4 vs 59.3 ± 11.4 years, p < 0.001), with higher prevalence of diabetes (18.6% vs 14.5%, p < 0.001), hypertension (52.4% vs 41.4%, p < 0.001), slightly longer ischemia time (272 ± 247 vs 258 ± 220 min, p = 0.06). No difference was observed in terms of angiographic and procedural characteristics. Follow-up data were available at a mean of 1201 ± 441 days. At long-term follow-up female gender was associated with a significantly higher rate of death (11.7% vs 8.5%, HR [95% CI] = 1.45 [1.18–1.78], p < 0.001), while no difference was observed in terms of reinfarction (HR [95% CI] = 1.14 [0.89–1.45], p = 0.3), ST (HR [95% CI] = 1.12 [0.85–1.48], p = 0.4), with similar temporal distribution (acute, subacute, late and very late) between male and female patients, and no difference in TVR (HR [95% CI] = 1.11 [0.95–1.3], p = 0.2, p = 0.2). These results were confirmed in both patients receiving BMS or DES. The impact of female gender on mortality disappeared after correction for baseline confounding factors (HR [95% CI] = 0.88 [0.71–1.09], p = 0.25). ConclusionsThis study shows that in patients with STEMI treated by primary angioplasty, female gender is associated with higher mortality rate in comparison with men, and this is mainly due to their higher clinical and angiographic risk profiles. In fact, female sex did not emerge as an independent predictor of mortality.

Outcomes in Women Undergoing Electrophysiological Procedures.

The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.

Outcome of Invasive Electrophysiological Procedures and Gender: Are Males and Females the Same?

The aim of this review is to summarize the available evidence on gender-related differences in outcome of invasive electrophysiological procedures. Gender exerts significant influences on the epidemiology, pathophysiology, and clinical presentation of many cardiac rhythm disorders. Women with supraventricular arrhythmias have a higher incidence of atrioventricular nodal reentrant tachycardia, a lower prevalence of atrioventricular accessory pathways, and increased arrhythmia inducibility during luteal phases of the menstrual cycle. Catheter ablation of supraventricular arrhythmias appears equally effective in the 2 genders, although women present to catheter ablation later, with more symptoms, and after having failed more antiarrhythmic drugs. The outcome of catheter ablation of atrial fibrillation in women has been reported worse than in men, which may be explained by a later referral. Accordingly, women present to catheter ablation with a higher incidence of long-standing persistent atrial fibrillation. Of note, the outcome of catheter ablation of atrial flutter does not seem to differ between genders. To date, with regard to ventricular arrhythmias, no gender-related differences in outcome of catheter ablation procedures have been reported. However, pathophysiology and risk factors underlying ventricular arrhythmias appear different in the two genders. Severe left ventricular dysfunction does not perform equally as a predictor for sudden cardiac death in women as compared to men, and the survival benefit of prophylactic implantable cardioverter-defibrillator (ICD) implantation in women is inconclusive. On the other hand, the clinical outcome after cardiac resynchronization therapy seems to be more favorable in women, who experience a greater degree of reverse left ventricular remodeling.

Asthma in 10- to 13-Year-Olds: Challenges at a Time of Transition

In 10- to 13-year-old children with asthma, we know less than is desirable about the nature of the disease management tasks they face as youngsters approaching adolescence. This article reviews aspects of asthma management in youngsters at a time of significant transition. They experience puberty and growth spurts. Their cognitive abilities enable more abstract thinking. They seek individuation from their parents and socialization with peers. These factors influence asthma outcomes, including symptom control, health care use, and school attendance and performance. Furthermore, significant sex- and gender-related differences in outcome exist. Those with asthma who are 10 to 13 years of age contend not only with the particular management demands their chronic condition imposes on them but also the challenges associated with maturation. Most asthma management interventions do not account for the challenges faced at this transitional phase, and developmentally appropriate programs are needed.

Gender-related differences in outcome after ST-segment elevation myocardial infarction treated by primary angioplasty and glycoprotein IIb–IIIa inhibitors: insights from the EGYPT cooperation

Several studies have found that among patients with ST-elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. The aim of this study was to investigate sex-related differences in clinical and angiographic findings in patients with STEMI treated with primary angioplasty and Gp IIb-IIIa inhibitors. Our population is represented by 1662 patients undergoing primary angioplasty included in the EGYPT database. Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Follow-up data were collected between 30 days and 1 year after primary angioplasty. Among 1662 patients, 379 were women (22.8%). Female sex was associated with more advanced age, higher prevalence of diabetes, hypertension, more advanced Killip class, longer ischemia time, less often smokers, with higher prevalence of preprocedural recenalization. No difference was observed in terms of postprocedural TIMI flow, myocardial perfusion and distal embolization. Similar findings were observed in terms of enzymatic infarct size and preprocedural ejection fraction. Female gender was associated with higher mortality (6.4% vs. 3.6%, HR = 1.83 [1.12-3.0], P = 0.015). However, the difference disappeared after correction for baseline confounding factors (HR = 1.01 [0.56-1.83], P = 0.98). This study shows that in patients with STEMI treated by primary angioplasty, female gender is associated with higher mortality rate in comparison with men, and this is mainly due to their higher clinical and angiographic risk profiles. In fact, female sex did not emerge as an independent predictor of mortality.

Gender impact on the outcomes of critically ill patients with nosocomial infections*

: To investigate gender impact on the outcomes of severe nosocomial infections (pneumonia, bacteremia, catheter-related bloodstream infections, poststernotomy mediastinitis, urinary infections) occurring in a large cohort of patients hospitalized in a medical-surgical intensive care unit. Highly controversial data exist regarding gender-related differences in outcomes of severe nosocomial infections, reflecting potential confounders related to case-mixes or heterogeneity of populations evaluated. : Retrospective study of patients admitted to our intensive care unit. Multivariable logistic regression-analysis was used to control for confounders in the evaluation of gender impact on intensive care unit death post nosocomial infections. : An 18-bed tertiary referral medical-surgical intensive care unit in a teaching hospital. : Mixed population of patients who developed nosocomial infections in the intensive care unit. : Among the 5081 patients admitted to our intensive care unit from 1995 to 2004, 1341 (34% women) developed nosocomial infections. Pneumonia and mediastinitis were more frequent in men (51% vs. 44%, p = .01 and 29% vs. 22%, p = .01, respectively) whereas urinary infections predominated for women (46% vs. 24%, p < .001). Durations of mechanical ventilation and intensive care unit stays and treatment intensity did not differ between genders. However, intensive care unit mortality was higher for women (37% vs. 32%, p = .06) and this excess mortality was statistically significant (odds ratio = 1.50, 95% Confidence Interval = 1.11-2.03), after controlling for other independent risk factors of intensive care unit death. Compared with those observed for men of the same subgroup, crude ICU death rates were significantly higher for women who developed pneumonia, who were <50 yrs old or had undergone heart surgery before intensive care unit admission. However, multivariable analyses retained feminine gender as significantly associated with mortality only for the last subgroup. : Female intensive care unit patients developing nosocomial infections seem to be at increased risk of intensive care unit mortality, after carefully controlling for other prognostic factors. Further studies are needed to elucidate the pathophysiology underlying this gender-related difference, to devise tailored gender-specific therapies that might improve outcomes.

Gender‐specific activity of chemotherapy correlates with outcomes in chemosensitive cancers of young adulthood

Good evidence indicates that adolescents and young adults (AYAs) with cancer do badly compared with children with similar cancers. The reasons are poorly understood. Australian registry data on 14,824 cancers of adolescence and young adulthood seen between 1982 and 2002 were reviewed. A detailed substudy of clinical characteristics was analyzed from 179 AYAs with Hodgkin lymphoma (HL), Ewing sarcoma (ES) or osteosarcomas (OS) treated at a single institution. Despite significant improvements in survival for both groups over the period in question, for acute lymphoblastic leukaemia, rhabdomyosarcoma, ES, OS and HL, survival for AYAs was worse than for children. For ES, OS and HL, the survival gap occurred almost entirely in males (Hazard ratios compared with female AYAs of 1.8 [p < 0.01], 1.4 [p = 0.03] and 1.5 [p < 0.01] respectively). Survival outcomes from ES, OS and HL for female AYAs were not significantly different from children of either sex. For brain tumors and thyroid cancers, which are primarily treated surgically, there were no gender-related differences in outcomes. Although no differences in tumor stage or compliance were identified, male AYAs experienced less toxicity and lower response rates to chemotherapy (p = 0.008). Young males account almost entirely for excess mortality from chemosensitive cancers of adolescence and young adulthood compared to children, which may be due to relative underdosing with current chemotherapy dosing algorithms.