Rate Of Female Patients Research Articles

IL28BとHCV Core aa70置換との関連

IL28 locus polymorphisms have been reported to affect PEG-IFN plus ribavirin combination therapy for patients with genotype 1b hepatitis C virus (HCV) infection. We examined a relationship between IL28B SNPs (rs8099917 and rs12979860) and amino acid substitutions in core region of HCV in patients with genotype 1b chronic hepatitis C. In each SNP, frequency of core aa 70 mutation was higher rate in female patients carrying minor allele than in male or female patients carrying no minor allele. Measurement of IL28B and Core aa70 before treatment is useful in PEG-IFN plus ribavirin therapy.

Carotid endarterectomy in female patients

To evaluate early and late results of carotid endarterectomy (CEA) in female patients in a large single center experience. Over a 12-year period ending in December 2007, 4009 consecutive primary and secondary CEAs in 3324 patients were performed at our institution. All patients were prospectively enrolled in a dedicated database containing pre-, intra-, and postoperative parameters. Patients were female in 1200 cases (1020 patients; Group 1) and male in the remaining 2809 (2304 patients, Group 2). Early results in terms of intraoperative neurological events and 30-day stroke and death rates were analyzed and compared. Follow-up results were analyzed with Kaplan Meier curves and compared with log-rank test. Patients of Group 1 were more likely to have hyperlipemia, diabetes, and hypertension; patients of Group 2 were more likely to be smokers and to have concomitant coronary artery disease (CAD) and peripheral arterial disease (PAD). There were no differences in terms of clinical status or degree of stenosis. Patients of Group 2 had a significantly higher percentage of contralateral carotid artery occlusion than patients in Group 1 (6.9% and 3.9%, respectively; P < .001). Thirty-day stroke and death rates were similar in the two groups (1.2% for both groups). Univariate analysis demonstrated the presence of CAD, PAD, diabetes, and contralateral carotid artery occlusion to significantly affect 30-day stroke and death rate in female patients. At multivariate analysis, only diabetes (odds ratio [OR] 3.6, 95% confidence interval [CI] 0.1-0.9; P = .05) and contralateral occlusion (OR 7.4, 95% CI 0.03-0.6; P = .006) were independently associated with an increased perioperative risk of stroke and death. Median duration of follow-up was 27 months (range, 1-144 months). There were no overall differences between the two groups in terms of survival, freedom from ipsilateral stroke, freedom from any neurological symptom, and incidence of severe (>70%) restenosis. In contrast to male patients, univariate and multivariate analysis demonstrated that female patients with diabetes or contralateral occlusion had an increased risk of developing ipsilateral neurological events during follow-up. Female sex per se does not represent an adjunctive risk factor during CEA, with early and long term results comparable to those obtained in male patients. However, in our study we found subgroups of female patients at higher surgical risk, requiring careful intra- and postoperative management.

Tension-Free Vaginal Tape in the Management of Recurrent Urodynamic Stress Incontinence after Previous Failed Midurethral Tape

BackgroundData about the use of tension-free vaginal tape (TVT) in the management of recurrent urodynamic stress incontinence (RUSI) after previous failed midurethral sling procedure (MUSP) are limited. ObjectiveAssessment of the efficacy and the indications of the TVT procedure in the management of patients with RUSI after failed previous MUSP. Design, setting, and participantsThirty-one patients with RUSI after previous failed MUSP were prospectively enrolled at a single tertiary academic center. MeasurementsPreoperatively and postoperatively, patients were assessed with physical examination, urinalysis, urine culture, bladder diary for 2–3 d, Q-tip test, uroflow, filling and voiding cystometry, urethral profilometry, and 1-h pad test. Mean follow-up was at 18.6mo (range: 12–28mo). Results and limitationsOverall, the objective cure rate based on the pad test findings was 74%, the improvement rate was 6.5%, and the failure rate was 19.5%. The objective cure rate based on cough stress test during filling cystometry was 77.4%, and the subjective cure rate based on patients’ answers was 71%. The study could have some limitations. The relatively small number of patients enrolled could affect the findings of study to some degree. Additionally, because urethral pressure profiles show a significant degree of directional dependence when side-hole microtip transducers are used, as in the present study, the orientation of the transducer could affect the values measured. ConclusionsThe TVT procedure as a second operation could provide an overall cure rate of 74% with a low complication rate in female patients with RUSI after previous failed midurethral tape procedures.

Detection of large deletion mutations in the COL4A5 gene of female Alport syndrome patients

Alport syndrome is the most common form of hereditary nephritis, and the majority of cases are caused by mutations in the COL4A5 gene. However, direct sequencing by polymerase chain reaction (PCR), from genomic DNA, or reverse transcriptase-polymerase chain reaction (RT-PCR), from mRNA, or polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) has reportedly resulted in detection rates of 31% to 84%, but of only 20% to 71% when restricted to female patients. This report concerns two female patients with X-linked Alport syndrome. Although mutational analysis of the COL4A5 gene was conducted with direct sequencing using genomic DNA and mRNA extracted from leukocytes, the results were negative for detection of mutations. Semi-quantitative PCR using genomic DNA was therefore conducted to detect large heterozygous deletions. The results were that the first patient showed complete loss of the COL4A5 gene and the second patient showed deletion from exons 37 to 51. Our patients possessed large heterozygous deletions in the COL4A5 gene that could not be detected with the standard direct sequencing method and were identified with semi-quantitative PCR. Previously reported mutation detection rates for female patients have been lower than overall rates. Our findings indicate that this difference may, in part, be due to failure to detect this type of mutation with conventional analytical methods.

Emerging Problems of Heart Failure Practice in Japanese Women Lessons From the CHART Study

The prognosis of patients with chronic heart failure (CHF) is poor in both men and women. However, the characteristics of, and effective treatment strategy for, female CHF patients still remain unclear. This study was designed to evaluate the prognosis and characteristics of female patients in a CHF cohort termed the Chronic Heart Failure Analysis and Registry in the Tohoku District. Of 1,278 patients registered in the cohort, the study population comprised 1,166 symptomatic CHF patients with sufficient data. As compared with male patients, female patients were more likely to be older, have preserved systolic function and non-ischemic etiology of CHF, and underuse standard CHF medications. Although a previous study showed that sex-difference was not a significant prognostic factor in CHF patients, the unadjusted survival analysis revealed an increased event rate in female patients in the present study. Multivariate analysis revealed that older age, diabetes, ventricular tachycardia and anemia were significant prognostic risks in both men and women with CHF. Female sex had a significant link with elderly CHF patients. Given the explosive increase in elderly patients in Westernized countries, further studies are needed to elucidate the evidence for treatment of female CHF patients.

The role of artificial urinary sphincters in modern incontinence management

The first artificial urinary sphincter (AUS) was described in 1947. The AUS used now was first implanted in 1972. The initial device had valves that controlled flow direction and pressure. Later models included several modifications. The current three-part AUS incorporates high-quality aerospace components. After 20 years of use, this device has been implanted in more than 20,000 patients. The overall continence rate in female patients after insertion of an AUS is satisfactory. It should be considered first-line treatment in this group, although the risk of revision surgery is high. Pelvic irradiation is a contraindication to the AUS in female patients. The use of AUS in children has been extensively described mainly in those with neurogenic bladder dysfunction. This treatment has changed the quality of life of patients with this disease. Before AUS insertion, it is important to ensure that these patients have an adequate capacity and a stable bladder.

Phase angle is a predictor of basal metabolic rate in female patients with anorexia nervosa

The aim of the study was to evaluate the relationship between basal metabolic rate (BMR) and bioelectrical impedance analysis (BIA) in undernourished female patients with anorexia nervosa. Participants were 86 female patients with anorexia nervosa (age 20.8 ± 4.7 years; weight 39.3 ± 5.2 kg; body mass index 15.4 ± 1.6 kg m−2). BMR was measured by indirect calorimetry and single-frequency BIA was determined at 50 kHz on the whole body. The BIA variables considered were resistance, reactance, phase angle and the bioimpedance index (height2/resistance). Fat-free mass was calculated from subcutaneous skin fold thickness. In the study group BMR was 3782 ± 661 kJ d−1 while bioimpedance index varied between 27.6 and 49.9 cm2 Ω−1 and phase angle between 2.54° and 6.49°. BMR was significantly correlated with weight, height, body mass index and fat-free mass, and, among BIA variables, with reactance and phase angle. Multiple regression analysis indicated that phase angle was a predictor of BMR not only when solely BIA variables were considered, but also in combination with either weight and age or fat-free mass. In conclusion, phase angle emerged as a strong predictor of BMR in female patients with anorexia nervosa. Nevertheless, further studies are necessary to confirm this finding in other forms of protein energy malnutrition and justify the inclusion of BIA variables in the equations used to predict BMR in the clinical setting.

Extrapulmonary and pulmonary tuberculosis in antananarivo (madagascar): high clustering rate in female patients.

Antananarivo, the capital city of Madagascar, has an endemic focus of tuberculosis (TB). We specifically studied patients with extrapulmonary TB (EPTB) and grouped patients according to infected body site. The strains were characterized by IS6110 fingerprinting and compared with those isolated from patients with pulmonary TB (PTB) during the same period in order to determine the possible association between the genotype and the clinical expression of TB. A total of 316 TB patients were included in this study: 151 individuals with EPTB, 10 with both PTB and EPTB, and 155 with PTB alone. Pleural TB was the major EPTB localization (77%) and was found more often in older patients, while PTB or EPTB in which the localization was other than pleural (other EPTB) was found in younger patients. The male-to-female ratio was slightly higher in pleural TB patients (3.06:1) than in patients with other EPTB (1.35:1). There was no significant difference in the BCG status among patients with PTB, pleural TB, and other EPTB. Analysis of IS6110 patterns showed that 167 patients (52.8%) were assigned to 37 clusters of 2 to 34 patients. Analysis of the IS6110 clusters and the IS6110 families did not show any association with a particular clinical expression of the disease. Patients with PTB or other EPTB were more likely to have strains with one IS6110 copy than patients with pleural TB. The clustering rate was found to be significantly higher in female patients (62%) than in male patients (48%) (P = 0.029), suggesting that Malagasy women were more likely to progress to disease after infection than men.

Outcome Of The Artificial Urinary Sphincter In Female Patients

We reviewed the outcome in female patients at our unit in whom an artificial urinary sphincter was inserted. We reviewed notes on 68 patients and mailed a questionnaire to those without recent followup. Median time since insertion was 12 years. Overall 25 patients (37%) had the original artificial urinary sphincter in situ and were dry at a median followup of 7 years. The artificial urinary sphincter was replaced for loss of function in 12 patients, of whom 11 were dry with the replaced device. The device was removed for erosion or infection in 31 patients, of whom 19 underwent successful replacement or were continent after removal. Overall 55 of 68 patients (81%) were continent. Those with neuropathic bladder dysfunction achieved a continence rate of greater than 90%, although half required sphincter removal initially. When the indication for insertion was stress incontinence, 70% of the patients had the original or a replaced artificial urinary sphincter in situ and 82% were continent. All patients with previous pelvic irradiation had the sphincter removed and urinary diversion was done. The overall continence rate in female patients after insertion of an artificial urinary sphincter is satisfactory. A satisfactory outcome was achieved in terms of stress incontinence and we would recommend an artificial urinary sphincter after an adequate anti-stress incontinence operation fails. Continence in patients with neuropathic bladder dysfunction is excellent and the artificial urinary sphincter should be considered first line treatment in this group, although the risk of revision surgery is high. Pelvic irradiation is a contraindication to the artificial urinary sphincter in female patients.

Influence of premorbid factors on survival following subarachnoid hemorrhage.

The goal of this study was to explore the relationships between premorbid patient characteristics, especially cigarette smoking, and the risk of death following subarachnoid hemorrhage (SAH). A population-based study design was used with multiple overlapping methods of case identification. A strict definition of SAH was used. Relationships between patients' age and sex as well as their cigarette smoking and hypertension statuses were explored by calculating relative risks (RRs). Confounding effects were examined using logistic regression analysis. The author identified 800 cases in which the patient had experienced his or her first SAH. Seventy-seven percent of cases were verified by review of computerized tomography scans, 22% by autopsy, and 1% by lumbar puncture. A prior history of hypertension had no effect on the risk of mortality. There was a higher case mortality rate in female patients than in male patients, but this did not reach statistical significance. The RR of death at 30 days post-SAH for patients older than 60 years compared with those who were younger was 2.95 (95% confidence interval [CI] 2.18-3.97). The RR of death at all time intervals was lower for smokers than for nonsmokers (smokers/nonsmokers RR 0.47 [95% CI 0.32-0.69] at 7 days). The protective effect of smoking diminished on Day 3 post-SAH and increased again on Day 7. Advanced age is an important determinant of survival following SAH. Smoking appears to have a protective effect. The author presents evidence indicating that increased vasospasm in smokers may reduce the severity of the initial hemorrhage.

Frequency and causes of premature termination (drop-out) during in-patient opiate detoxification

A typical problem concerning in-patient detoxification is the high drop-out rate. This phenomenon represents a significant problem for both the patient and the therapeutic team, as it is a factor which reduces motivation. While several studies confirm a positive shift of early drop-out behavior with the aid of methadone-supported detoxification, the overall drop-out rate still saw no improvement. Unexpectedly the latter rate was found to be around 50 %. The aim of the present study was to determine the sociodemographic, dispositional and addiction-related factors, as well as subjective ratings of the present state, which have predictive value, i. e. which could discriminate drop-outs from those patients who bring their detoxification to a regular end. 176 patients from two different clinical detoxification wards of the Hannover Clinic of Psychiatry and Psychotherapy participated in the study. The overall drop-out rate was 49.4 %, the rate of female patients failing to conclude detoxification was significantly higher than that of males (68.4 % vs. 44.2 %). On average drop-out patients were 2.2 years younger and their former (i. e. uninterrupted) periods without drug consumption were shorter, while criminal circumstances (e. g. therapy as probation vs. voluntary participation) did not play a major role in influencing staying power. As expected, patients terminating their treatment against medical advice evaluated the therapeutic program more critically than the others. Interestingly drop outs rated their own mental and somatic condition very pessimistic. We concluded from these results two essentials being necessary to improve staying power of drug patients during clinical detoxification: systematic induction of (1) a positive self concept and (2) an optimistic view of chances to reach social adjustment and health.

The prediction of basal metabolic rate in female patients with anorexia nervosa.

To evaluate in female patients with anorexia nervosa the accuracy of a specific predictive formula for basal metabolic rate (BMR) already proposed in the literature and to derive a new disease-specific equation with the same purpose. Cross-sectional study. One-hundred and twenty adolescent girls (<18 y) and young-adult women (18-30 y) with anorexia nervosa. BMR was determined by indirect calorimetry or predicted according to the Schebendach formula, which was specifically derived for anorexia nervosa. On average the Schebendach formula performed well in the adolescent group but not in the young-adult group. The range including 95% of the predicted-measured differences was in both cases wider than 2000 kJ/day. In the young-adult patients the accuracy of the prediction was also related to age and body mass index. Weight and age (but not height or body mass index) emerged as predictors of BMR in the sample as a whole, and only weight when the two age groups were considered separately, thus leading to three different equations. The intercepts of these regression lines were very close and not significantly different from zero while their standard error of estimate was 500-550 kJ/day. The Schebendach formula is not very accurate in estimating the BMR of female anorectic patients. Moreover, in this group the relationship between BMR and weight was altered. The predictive formulas proposed by the present study have a reasonable prediction power.

Pseudarthrosis After Postoperative Wound Infection in the Lumbar Spine

This retrospective investigation attempts to define the incidence of fusion success after postoperative infection after a posterior lumbar fusion, as well as which risk factors may adversely affect arthrodesis after successful debridement. At an average follow-up of 37 months, 18 of 29 patients (62.1%) had a successful arthrodesis. Eighty-seven percent of patients whose fusion excluded the sacrum had a solid arthrodesis, compared with only 36% of those fusions including the sacrum. The fusion rate in female patients was 33.3%, compared with 82.4% in male patients. The rate of fusion with allograft bone was 17.2 versus 83.3% with autograft bone. Female sex, the use of allograft bone, and extension of the fusion mass to the sacrum significantly increase the incidence of nonunion after a postoperative deep spinal wound infection.

Topical treatment of venereal warts: a comparative open study of podophyllotoxin cream versus solution

Podophyllotoxin solution (0.5%) is licensed for use in the treatment of condylomata acuminata (genital warts) in men in a number of European countries. In some countries, approval also extends to treatment of genital warts in women. This controlled randomized prospective study evaluated the efficacy and safety of a cream formulation of podophyllotoxin at 2 concentrations (0.15% and 0.3%), using 0.5% podophyllotoxin solution as a reference treatment. Two separate studies were initiated, to assess the 3 treatment groups in (a) male patients, and (b) female patients. Statistical evaluation was based on a "response rate' calculated at each clinic visit. The mean "response rates' in the male patient study at 4 weeks were 75.1%, 79.0% and 85.6% in the 0.15% cream, 0.3% cream and 0.5% solution groups, respectively. The corresponding "response rates' for the female patient study were 86.2%, 92.6%, and 93.1%, respectively. The relapse rates for both male and female patients were 6.0% in the 0.15% cream group, 8.6% in the 0.3% cream group and 8.6% in the 0.5% solution group. The results show that there were no statistically significant differences between the 3 treatments with regard to both efficacy and safety. This was true for both the male and female patient groups.

Indications of parathyroidectomy for bone disease associated with secondary hyperparathyroidism

The indications and suitable operative time of parathyroidectomy for secondary hyperparathyroidism were discussed. From October 1978 to September 1994 parathyroidectomy was performed for 71 patients who had bone and/or joint pain due to secondary hyperparathyroidism. There were 37 men and 34 women (mean age 48.4 years). The duration of dialysis treatment before parathyroidectomy was 0.8 to 19 years, with a mean of 10.9 years. Postoperative subjective improvement was noted in 69% of the patients. No significant difference was observed between the improved and non-improved groups regarding age and the duration of dialysis treatment. But the improvement rate in female patients was significantly lower than that in male patients. Patients with high carboxyl-terminal PTH level and generalized fibrous osteitis were good suitable objects for parathyroidectomy. But, those with high serum aluminum level were unsuitable objects for it. Furthermore, 99mTc-Pyrophosphate bone scintigraphy and bone mineral determination using dual photon absorptiometry (DPA) or dual energy X-ray absorptiometry (DEXA) were proved to be valuable for patient selection for parathyroidectomy.

HIV Infection in American Indians and Alaska Natives

A network of surveys of HIV seroprevalence in American Indians and Alaska Natives (AI/AN) was begun in 1989. From July 1, 1989 through June 30, 1991, 37,681 serologic specimens were collected from prenatal and sexually transmitted disease patients in 58 facilities operated or funded by the Indian Health Service. Specimens from AI/AN women receiving initial prenatal care showed an overall HIV prevalence of 0.3/1,000, while specimens obtained during the third trimester of pregnancy showed an overall prevalence of 1.0/1,000. The rate for rural third trimester prenatal patients (0.9/1,000) was similar to that for urban patients (1.1/1,000). HIV rates among third trimester AI/AN patients in three western states were 4 to 8 times higher than rates observed in childbearing women of all races in those states. The overall HIV seroprevalence in AI/AN seeking care for sexually transmitted diseases was 4.5/1,000 for males (urban 10.8/1,000; rural 2.0/1,000) and 0.7/1,000 for females (urban 0.9/1,000; rural 0.6/1,000). Approximately 1,210 to 4,250 (midpoint of range = 2,730) AI/AN in the U.S. are projected from survey findings to be currently infected with HIV. The presence of HIV in multiple specimens from rural areas and the similarity of HIV infection rates for female patients from rural and urban locations provides evidence of diffusion of the HIV epidemic to rural AI/AN, and emphasizes the need for effective HIV prevention for this population.

Epidemiology of hepatitis E in China

A total of 9 hepatitis E epidemics have been documented in China since 1982. Five of them were waterborne and four foodborne, and they occurred in 6 of 30 provinces or autonomous regions in the country. The disease most frequently affects young adults, with fewer cases in children and the elderly. A relative male excess of cases has been observed. However, the fatality rate in female patients with hepatitis E is significantly higher than in males. The disease has a distinctive autumn seasonality in endemic areas. A peak of fecal excretion of hepatitis E virus is found at the late incubation period and early acute phase. The incubation period of the disease ranges from 15 to 75 days, with a mean of 36 days. A randomized double-blind and controlled study showed that human immune serum globulin had no prophylactic effects on hepatitis E.

MALIGNANT MELANOMA: AN ANDROGEN-DEPENDENT TUMOUR?

Of 688 melanoma patients registered during 1956-78, 267 developed merastatic spread of the disease. Sex differences in the course of the disease in this subset were studied. Intervals between subsequent stages of melanoma activity were longer, but not significantly so, in female than male patients. Survival times from initial distant metastasis were significantly longer in women than in men. Tumour doubling time of pulmonary secondaries revealed a clear tendency to a slower growth rate in female patients. Our analysis suggests that malignant melanoma might be an androgen-dependent tumour. Therapy with anti-androgens or orchidectomy deserves consideration in male patients with metastatic melanoma.