Higher Prevalence Of Female Patients Research Articles

Prevalence of Autoimmune and Autoinflammatory Diseases in Chronic Urticaria: Pathogenetic, Diagnostic and Therapeutic Implications.

Chronic spontaneous urticaria (CSU) is defined as the almost daily occurrence of widespread wheals, angioedema, or both, for more than 6 weeks. It affects 1-2% of the general population, with a higher prevalence in female patients, and is more frequent patients over 20 years of age. More than half of all cases of chronic idiopathic urticaria are thought to occur due to an autoimmune mechanism, specifically the production of autoantibodies against the high-affinity immunoglobulin E (IgE) receptor (FcεRI). The quality of life in these patients is often greatly compromised, also due to the onset of comorbidities represented by other autoimmune diseases, such as thyroid disease, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, celiac disease, and type 1 diabetes, among others. This review aimed to analyze the close correlation between CSU and some autoimmune and autoinflammatory diseases, in order to encourage a multidisciplinary and multimorbid approach to the patient affected by CSU, which allows not only control of the natural course of the disease, but also any associated comorbidities.

Prevalence of Pulmonary Hypertension in an Unselected Community-Based Population: A Retrospective Echocardiographic Study-RES-PH Study.

Introduction. The actual prevalence of pulmonary hypertension (PH) in Italy is unknown. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmonary artery systolic pressure (PASP) from the regurgitant tricuspid flow velocity evaluation, according to the simplified Bernoulli equation. Objectives. We aimed to evaluate the frequency of suspected PH among unselected patients. Methods. We conducted a retrospective cross-sectional database search of 7005 patients, who underwent echocardiography, to estimate the prevalence of PH, between January 2013 and December 2014. Medical and echocardiographic data were collected from a stratified etiological group of PH, using criteria of the European Society of Cardiology classifications. Results. The mean age of the study population was 57.1 ± 20.5 years, of which 55.3% were male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs. 48.7%; p = 0.873). The prevalence of high probability of PH was 4.3%, with slightly but not significant higher prevalence in female patients (43.2 vs. 56.8%; p = 0.671). PH is predominant in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction and related with age. PASP was significantly linked with left atrial increase and left ventricular ejection fraction. In addition, an increased PASP was related to an enlargement of the right heart chamber. Conclusions. PH has a frequency of 4.3% in our unselected population, but the prevalence may be more relevant in specific subgroups. A larger epidemiological registry could be an adequate strategy to increase quality control and identify weak points in the evaluation and treatment of these patients.

Hospitalization for Primary Care-Sensitive Conditions in Adults and Its Impact on Hospital Care in São Paulo City, Brazil.

Identifying conditions among all cause hospitalizations that could be prevented at the primary care level would allow the development of strategies to reduce the range of diseases treated in hospital and promote a more efficient utilization of resources. We sought to evaluate hospitalizations for clinical conditions that are sensitive to primary care in adults. Cross-sectional study with data captured in hospital electronic health records using the diagnosis related groups classification system. Primary care-sensitive conditions were associated with longer duration of hospitalization, older age, higher prevalence of female patients, higher complexity at admission and during hospitalization, and a higher risk of mortality as compared with other conditions not sensitive to primary care. A significant proportion of hospitalizations are due to causes sensitive to primary care. Hospitalizations due to primary care-sensitive conditions are associated with longer hospital stay, greater complexity and severity, and a higher risk of mortality.

Gender differences in prevalence of LRRK2-associated Parkinson disease: A meta-analysis of observational studies

BackgroundThe gender effect in the prevalence of leucine-rich repeat kinase 2 (LRRK2) associated Parkinson disease (PD) remains controversial. Herein, we conducted a meta-analysis to investigate the gender effect among these patients. MethodsPubMed and EMBASE databases were searched to identify the potential related studies published before December 2017. Case-control studies with separated data of sex and mutation status were included in further analyses. We pooled relative risk (RR) using fixed-effect model. The publication bias and sensitivity analyses were also performed. ResultsSixty-four studies with 32452 patients diagnosed with PD were included. Higher prevalence of female patients with LRRK2-associated PD was observed with a pooled RR of 1.22 (95% CI 1.14–1.30, P＜0.001). Further subgroup analyses showed that higher prevalence of female patients was only obtained in G2019S mutation patients (RR = 1.32, 95% CI 1.23–1.43, P＜0.001), but not in G2385R variant patients (RR = 1.03, 95% CI 0.91–1.17, P = 0.651). No significant heterogeneity and publication bias were observed in additional analyses. ConclusionsHigher female prevalence of LRRK2 mutation suggests roles of gender-related risk factors in PD patients, especially who carried G2019S mutation. Contrary to idiopathic PD, no sex difference was observed in prevalence of patients carried G2385R variant.

Cushing's disease due to somatic USP8 mutations: a systematic review and meta-analysis.

Cushing's disease (CD) is a severe illness generally caused by microcorticotropinomas (MICs) and in approximately 7-20% of patients by macrocorticotropinomas (MACs). USP8-mutations have been identified as a major genetic cause of CD (~ 50%). Few studies have reported the distribution between MICs-MACs related to USP8-mutations and their genotype-phenotype correlations. Therefore, we aimed to evaluate USP8-mutations in a cohort of MICs-MACs from a unique center and to perform a systematic review and meta-analysis. DNA-tumor-tissues from 47 corticotropinomas (16 MICs and 31 MACs) were sequenced. Clinical-biochemical data, radiological imaging data and remission/recurrence rates were evaluated. In addition, we performed a meta-analysis of nine published series (n = 630). We identified four different USP8-mutations previously described, in 11 out of 47 (23.4%) corticotropinomas; 8 out of 11 were MACs. The urinary cortisol levels of our patients with corticotrophin USP8-mutated-alleles were lower than those of patients with wild-type (WT) alleles (p ≤ 0.017). The frequency of USP8-mutated-alleles among the series was approximately 30% with a higher prevalence in female-patients (p < 0.1 × 10-4). Among the 5 series, the remission rates were higher in patients with USP8-mutated-alleles than in those with the USP8-WT-alleles (p < 0.1 × 10-4). Our data, as well as the retrospective review of CD series associated with USP8-mutated alleles, show heterogeneous findings among the series. Several drawbacks included the lack of a systematic protocol to evaluate these patients before surgery and follow-up. Further prospective studies using a systematic protocol will provide more consistent information about the influence of the corticotropinomas with USP8-mutated alleles on the phenotype, responses to treatment and outcome of patients with CD.

A retrospective study of clinical features of cough variant asthma in Chinese adults

BackgroundClinical features of cough variant asthma (CVA) in Chinese adults are largely uncertain.MethodsA total of 303 patients newly diagnosed as uncontrolled asthma (symptom control and future risk of adverse outcomes), including 175 CVA and 128 classic asthma (CA), were enrolled in this retrospective survey. Clinical features including basic characteristics, pulmonary function, airway hyperresponsiveness (AHR) and cell counts of induced sputum, were compared retrospectively. All patients were classified into four inflammatory subtypes based on the counts of induced sputum eosinophils and neutrophils as eosinophilic (E), neutrophilic (N), mixed granulocytic (M), and paucigranulocytic (P) subtypes. Inflammatory subtype distribution was also compared.ResultsCompared with CA patients, CVA patients were younger (P = 0.009), had a higher prevalence of female patients (P = 0.001), higher parameter values of baseline pulmonary function (P ≤ 0.01 for all), shorter duration of disease (P = 0.002), lower AHR (P = 0.001) and lower sputum eosinophil% (P = 0.009). There was a difference in the AHR distribution as the percentage of moderate and severe AHR in CVA was significantly lower than in CA (41.72% VS 64.70%, P = 0.001). The inflammatory subtype distribution was different as the proportion of E and M subtypes in CVA was lower than in CA (56.0% vs 67.19%, P = 0.049). The proportion of subtype P was the lowest and subtype M was the highest in both CVA and CA patients. There was a similar negative correlation of sputum eosinophil% with AHR in CVA and CA (r = − 0.337, P < 0.0001 and r = − 0.27, P = 0.026, respectively), and a positive correlation between sputum eosinophil% and improvement rate of FEV1 after inhalation of bronchodilator (ΔFEV1%) (r = 0.33, P = 0.01).ConclusionsCVA patients showed a better pulmonary function and lower airway inflammation in contrast to CA patients, which may participate in the pathogenesis of chronic cough in CVA.

Sex differences in the prevalence of genetic mutations in FTD and ALS: A meta-analysis.

To conduct a meta-analysis that investigates sex differences in the prevalence of mutations in the 3 most common genes that cause amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD)-chromosome 9 open reading frame 72 (C9orf72), progranulin (GRN), or microtubule-associated protein tau (MAPT)-in patients clinically diagnosed with these conditions. MEDLINE, EMBASE, and PsycINFO databases were searched (inception to June 30, 2016). Studies of patients with FTD or ALS that reported the number of men and women with and without mutations of interest were selected. Female to male pooled risk ratios (RR) and 95% confidence intervals (CI) for each mutation were calculated using random-effects models. Thirty-two articles reporting 12,784 patients with ALS (including 1,244 C9orf72 mutation carriers) revealed a higher prevalence of female patients with C9orf72-related ALS (RR 1.16, 95% CI 1.04-1.29). Twenty-three articles reporting 5,320 patients with FTD (including 488 C9orf72 mutation carriers) revealed no sex differences in C9orf72-related FTD (RR 0.95, 95% CI 0.81-1.12). Thirty-six articles reporting 3,857 patients with FTD (including 369 GRN mutation carriers) revealed a higher prevalence of female patients with GRN-related FTD (RR 1.33, 95% CI 1.09-1.62). Finally, 21 articles reporting 2,377 patients with FTD (including 215 MAPT mutation carriers) revealed no sex difference in MAPT-related FTD (RR 1.21, 95% CI 0.95-1.55). Higher female prevalence of C9orf72 hexanucleotide repeat expansions in ALS and GRN mutations in FTD suggest that sex-related risk factors might moderate C9orf72 and GRN-mediated phenotypic expression.

PP.04.35] PREVALENCE AND OPREDICTORS OF PULMONARY HYPERTENSION IN A GENERAL COMMUNITY-BASED POPULATION

Objective: The exact prevalence of PH in Italy is not known. Echocardiography is useful in the screening of patients with suspected PH by estimation of the pulmonary artery systolic pressure (PASP) by regurgitant tricuspid flow velocity evaluation, according to the simplified Bernoulli equation. Design and method: We conducted a retrospective study to estimate the prevalence of PH in 7005 patients who underwent echocardiography. Clinical data and echocardiographic results were used to determine etiological group of PH. PH causality was coded using criteria and subcategories of the ESC classifications. Results: The mean age of the study population was 57.1 ± 20.5 years with 55.3% male. The prevalence of intermediate probability of PH was 8.6%, with nearly equal distribution between men and women (51.3 vs 48.7%; P = NS) whereas the prevalence of high probability of PH was 4.3%, with slightly but not significant higher prevalence in female patients (43.2 vs 56.8; p = ns); PH is more prevalent in patients with chronic obstructive pulmonary disease (COPD) or left ventricle (LV) systolic dysfunction. PH prevalence increased with age. Also, sPAP was significantly associated with left atrial enlargement, left ventricular ejection fraction and, in addition, an increased sPAP was related to an enlargement of the right atrium and right ventricle. Conclusions: PH as measured by echocardiography has low prevalence in our general population, but the estimates may be higher in specific subgroups. Analysis of the registry data could be an instrument for quality control and might help identify weak points in assessment and treatment of these patients.

Assessment of direct causes and costs of medical admissions in Bingham University Teaching Hospital – Jos, Nigeria

Background: As health-care costs continue to rise and the population ages, an individual Nigerian continues to experience financial hardship in settling medical bills, especially when health insurance schemes are still far from reality for most Nigerians, making health-care financing burdensome in Nigeria like many developing countries. This has made out-of-pocket expenditure the most common form of health-care financing. Aims: This study assessed the average costs, duration, and causes of inpatient admission so as to know the direct costs associated with medical care for proper health-care planning. Settings and Design: This was a pilot study of a prospective cohort design whereby all patients were admitted to medical wards during the study period. Materials and Methods: Cost analysis was performed from the societal perspective, but included only direct medical care cost for this analysis. Patients input charts and pharmacy dispensing charts of all patients admitted to medical wards between May and July 2015 were reviewed. All costs were in local currency (Naira) using the average exchange rates proposed by Central Bank of Nigeria for June 2015. Statistical sAnalysis Used: Statistical analysis was carried out using SPSS version 20. Results: A total of 293 out of 320 patients met inclusion criteria and were assessed. Female patients admitted during the study period had an overall higher mean cost of care ₦84, 303.94 ± 6860.56 (95% confidence interval [CI]: 68,991.65–96,103.27) compared to male patients ₦68, 601.59 ± 57,178.37 (95% CI: 59,081.51–78,121.67) (P < 0.102). Civil servants had higher mean overall costs of care ₦90, 961.70 ± 105,175.62 (95% CI: 65,883.46–116,039.94) (P < 0.203). Conclusions: The higher prevalence of female patients with higher mean cost of inpatient care in this study suggests that Jos females may be more health conscious than their male counterparts. Overall mean cost of inpatient care stay was not proportional to the length of stay, suggesting early discharge from hospital did not necessarily eliminate the cost of patient management.

OP0263 First Results from “Be-Giant”: Baseline Characteristics of an Early Spondyloarthritis Cohort

BackgroundThe underlying idea for the development of the ASAS classification criteria for Spondyloarthritis (SpA) was to allow earlier recognition and diagnosis of patients with axial and/or peripheral SpA, given the...

Prevalence of removable partial dentures users treated at the Aracatuba Dental School – UNESP

The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School. The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007. 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior-posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps. The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy's classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior-posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.

Phlyctenular Keratitis Associated With Meibomitis in Young Patients

To describe the unique clinical features of phlyctenular keratitis, including the association with meibomitis, in young patients. Observational case series. The study population consisted of 23 Japanese patients aged under 35 years with phlyctenular keratitis. We examined their clinical history, signs and symptoms, human leukocyte antigen (HLA), bacterial cultures of meibum, and the efficacy of antibiotics. The minimal diagnostic criteria included corneal nodules consisting of cellular infiltrates and superficial neovascularization. Of the 23 patients, 20 (87%) were women, and 13 (56.5%) had a history of chalazia. In all cases, the lesions and the severity of corneal nodules and neovascularization corresponded well with the location and the severity of meibomitis. The frequency of HLA-A26 and HLA-B35 was significantly increased in our patients (P = .003 and .016, respectively). Propionibacterium acnes in bacterial cultures of pure meibum in 12 of the 20 patients (60%) was statistically more highly positive than those in four of the 17 age-matched normal control subjects (23.5%; P = .028). The characteristics of phlyctenular keratitis in our cases include significantly higher prevalence in female patients, severity variation of ocular surface manifestation corresponding to meibomitis, specific HLA association, and possible P. acnes involvement.

Hair Pain (Trichodynia): Frequency and Relationship to Hair Loss and Patient Gender

Background: Patients complaining of hair loss frequently claim that their hair has become painful. Objective and Methods: The aim of the study was to evaluate the frequency of this phenomenon and its relationship to hair loss. Patients seeking advice for hair loss either spontaneously reported or were questioned about painful sensations of the scalp. Hair loss activity was quantified by a hair pull, daily count and wash test. Telogen percentage was obtained by a hair pluck. The scalp surface was examined by dermatoscopy. Results: Of 403 examined patients, 20% of women and 9% of men reported hair pain, irrespective of the cause and activity of hair loss. A minority presented scalp telangiectasia. This strongly correlated with hair pain. Conclusions: Hair pain (trichodynia) affects a significant proportion of patients complaining of hair loss and may increase the anxiety. The symptom neither allows discrimination of the cause nor correlates with the activity of hair loss. A higher prevalence of female patients might be connected to gender-related differences in pain perception in relation to anxiety. The role of vasoactive neuropeptides in the interaction between the central nervous system and skin reactivity is discussed. In the absence of any correlation with quantitative parameters of hair loss or specific morphologic changes of the scalp, management remains empiric and tailored to the individual.