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Background and Objectives: Primary-progressive multiple sclerosis (PPMS) is characterized by gradual neurological deterioration without relapses. This study aimed to investigate the clinical impact of gender and age at disease onset on disease progression and disability accumulation in patients with this disease phenotype. Methods: Secondary data from the RelevarEM registry, a longitudinal database in Argentina, were analyzed. The cohort comprised patients with PPMS who met inclusion criteria. Statistical analysis with multilevel Bayesian robust regression modeling was conducted to assess the associations between gender, age at onset, and Expanded Disability Status Scale (EDSS) score trajectories. Results: We identified 125 patients with a confirmed diagnosis of PPMS encompassing a total of 464 observations. We found no significant differences in EDSS scores after 10 years of disease progression between genders (−0.08; credible interval (CI): −0.60, 0.42). A 20-year difference in age at onset did not show significant differences in EDSS score after 10 years of disease progression (0.281; CI: −0.251, 0.814). Finally, we also did not find any clinically relevant difference between gender EDSS score with a difference of 20 years in age at onset (−0.021; CI: −0.371, 0.319). Conclusion: Biological plausibility of gender and age effects does not correlate with clinical impact measured by EDSS score. [ABSTRACT FROM AUTHOR]

Problem alcohol drinking continues to be a substantial cost and burden. In addition, alcohol consumption in women has increased in recent decades, and women can have greater alcohol problems and comorbidities. Thus, there is a significant need for novel therapeutics to enhance sex‐specific, individualized treatment. Heart rate (HR) and HR variability (HRV) are of broad interest because they may be both biomarkers for and drivers of pathological states. HRV reflects the dynamic balance between sympathetic (SNS, 'fight or flight') and parasympathetic (PNS, 'rest and digest') systems. Evidence from human studies suggest PNS predominance in women and SNS in men during autonomic regulation, indicating the possibility of sex differences in risk factors and physiological drivers of problem drinking. To better understand the association between HRV sex differences and alcohol drinking, we examined whether alcohol consumption levels correlated with time domain HRV measures (SDNN and rMSSD) at baseline, at alcohol drinking onset, and across 10 min of drinking, in adult female and male Wistar rats. In particular, we compared both HRV and HR measures under alcohol‐only and compulsion‐like conditions (alcohol + 10 mg/L quinine), because compulsion can often be a significant barrier to treatment of alcohol misuse. Importantly, previous work supports the possibility that different HRV measures could be interpreted to reflect PNS versus SNS influences. Here, we show that females with higher putative PNS indicators at baseline and at drinking onset had greater alcohol consumption. In contrast, male intake levels related to increased potential SNS measures at drinking onset. Once alcohol was consumed, HR predicted intake level in females, perhaps a pharmacological effect of alcohol. However, HRV changes were greater during compulsion‐like intake versus alcohol‐only, suggesting HRV changes (reduced SNS in females, reduced PNS and increased HR in males) specifically related to aversion‐resistant intake. We find novel and likely clinically relevant autonomic differences associated with biological sex and alcohol drinking, suggesting that different autonomic mechanisms may promote differing aspects of female and male alcohol consumption. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is a significant contributor to morbidity and death in infants who are born premature. Male sex is an independent risk factor for the development of BPD. However, whether male sex is associated with adverse outcomes that occur after formal diagnosis of severe BPD prior to hospital discharge remains unclear. Is male sex associated with a higher risk of adverse outcomes in infants with established severe BPD? A retrospective, multicenter cohort study of infants enrolled in the BPD Collaborative Registry from January 1, 2015, to June 29, 2022, was performed. Demographics, clinical characteristics, and outcomes were stratified by sex (ie, male vs female). Regression modeling was used to estimate the association of sex with the primary composite outcome of death or tracheostomy at hospital discharge. We identified 1,156 infants with severe BPD, defined at 36 weeks postmenstrual age by the National Institutes of Health 2001 consensus definition. The cohort was predominantly male (59% male infants, 41% female infants). However, rates of mechanical ventilation at 36 weeks postmenstrual age (ie, type 2 severe BPD) did not differ by sex. Overall mortality rates within the cohort were low (male infants, 5.3%; female infants, 3.6%). The OR of death or tracheostomy for male-to-female infants was 1.0 (95% CI, 0.7-1.5). Our results lead us to speculate that, although sex is an important variable that contributes to the development and pathogenesis of severe BPD, it does not appear to be associated with adverse outcomes in this cohort of infants with established disease. The surprising results raise important questions surrounding the temporal role of biological sex in the development of severe BPD and its progression during the neonatal ICU stay. As we explore the phenotypes and endotypes of BPD, it is imperative to consider how sex modulates the disease from birth through hospital discharge. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries (TBIs) are a significant cause of morbidity and mortality in the United States. but have a disproportionate impact on patients based on gender. This systematic review and meta-analysis aim to compare gender differences in clinical outcomes between male and female adult trauma patients with moderate and severe TBI. Studies assessing gender differences in outcomes following TBIs on PubMed, Google Scholar, EMBASE, and ProQuest were searched. Meta-analysis was performed for outcomes including in-hospital mortality, hospital length of stay, intensive care unit length of stay, and Glasgow outcome scale (GOS) at 6 mo. Eight studies were included for analysis with 26,408 female and 63,393 male patients. Meta-analysis demonstrated that males had a significantly lower risk of mortality than females (RR: 0.88; 95% CI 0.78, 0.99; P = 0.0001). Females had a shorter hospital length of stay (mean difference −1.4 d; 95% CI - 1.6 d, −1.2 d). No significant differences were identified in intensive care unit length of stay (mean difference −3.0 d; 95% CI -7.0 d, 1.1 d; P = 0.94) or GOS at 6 mo (mean difference 0.2 d; 95% CI -0.9 d, 1.4 d; P = 1). Compared to male patients, female patients with moderate and severe TBI had a significantly higher in-hospital mortality risk. There were no significant differences in long-term outcomes between genders based on GOS at 6 mo. These findings warrant further investigation into the etiology of these gender disparities and their impact on additional clinical outcome measures. [ABSTRACT FROM AUTHOR]

Background: The issue of sex differences in stroke has gained concern in the past few years. However, multicenter studies are still required in this field. This study explores sex variation in a large number of patients and compares stroke characteristics among women in different age groups and across different countries. Methods: This multicenter retrospective cross-sectional study aimed to compare sexes regarding risk factors, stroke severity, quality of services, and stroke outcome. Moreover, conventional risk factors in women according to age groups and among different countries were studied. Results: Eighteen thousand six hundred fifty-nine patients from 9 countries spanning 4 continents were studied. The number of women was significantly lower than men, with older age, more prevalence of AF, hypertension, and dyslipidemia. Ischemic stroke was more severe in women, with worse outcomes among women (p: < 0.0001), although the time to treatment was shorter. Bridging that was more frequent in women (p:0.002). Analyzing only women: ischemic stroke was more frequent among the older, while hemorrhage and TIA prevailed in the younger and stroke of undetermined etiology. Comparison between countries showed differences in age, risk factors, type of stroke, and management. Conclusion: We observed sex differences in risk factors, stroke severity, and outcome in our population. However, access to revascularization was in favor of women. [ABSTRACT FROM AUTHOR]

Neurological diseases and neurotrauma manifest significant sex differences in prevalence, progression, outcome, and therapeutic responses. Genetic predisposition, sex hormones, inflammation, and environmental exposures are among many physiological and pathological factors that impact the sex disparity in neurological diseases. MicroRNAs (miRNAs) are a powerful class of gene expression regulator that are extensively involved in mediating biological pathways. Emerging evidence demonstrates that miRNAs play a crucial role in the sex dimorphism observed in various human diseases, including neurological diseases. Understanding the sex differences in miRNA expression and response is believed to have important implications for assessing the risk of neurological disease, defining therapeutic intervention strategies, and advancing both basic research and clinical investigations. However, there is limited research exploring the extent to which miRNAs contribute to the sex disparities observed in various neurological diseases. Here, we review the current state of knowledge related to the sexual dimorphism in miRNAs in neurological diseases and neurotrauma research. We also discuss how sex chromosomes may contribute to the miRNA sexual dimorphism phenomenon. We attempt to emphasize the significance of sexual dimorphism in miRNA biology in human diseases and to advocate a gender/sex-balanced science. [ABSTRACT FROM AUTHOR]

Late-onset Adamantiades-Behçet's disease (ABD) is a rare inflammatory condition that primarily affects males and has similar clinical features to early-onset ABD. This study compared the prevalence and characteristics of late-onset ABD with early-onset ABD through a systematic review and meta-analysis. The findings showed that late-onset ABD is less common and associated with milder symptoms, such as recurrent oral and genital ulcers, ocular lesions, and a positive pathergy test. Late-onset ABD also has lower rates of vessel involvement. Overall, late-onset ABD may occur predominantly in males and have a milder course compared to early-onset ABD. [Extracted from the article]

Background: The knowledge of sex and gender differences in disease are crucial for nursing students. Methods: This quasi-experimental study assesses nursing students' motivation, awareness, and knowledge related to women's health before and after a pathology course for first-year nursing students, using a pre–posttest design (pretest: n = 312, posttest: n = 156). Results: More than 90% of students were motivated to learn about sex and gender differences in pathology. Awareness increased significantly for the following topics: cardiovascular disease (CVD), osteoporosis, and breast cancer (BC). The knowledge level was low for CVD and high for BC, where the knowledge level increased significantly for BC. Having another first language predicted CVD (B −2.123, 95% CI −3.21 to −1.03) and osteoporosis (B −0.684, 95% CI −0.98 to −0.39) knowledge negatively, while age group (≥21 years) predicted menstruation (B 0.179, 95% CI 0.03 to 0.33) and BC (B 0.591, 95% CI 0.19 to 1.00) knowledge positively, in the total sample (pre- and postdata, n = 468). Conclusion: There is a lack of pathology knowledge among nursing students, especially related to CVD and symptoms of heart attacks in women. To ensure equality in health for women, these perspectives should be systematically integrated into the nursing students' curriculum in the future. [ABSTRACT FROM AUTHOR]

This article discusses the importance of addressing mental health disparities and promoting well-being. It explores various aspects of mental health disparities, including race, gender, sexual identity, age, disability, socioeconomic status, and geographic location. The goal is to inspire and inform researchers in this field and provide guidance on reducing disparities and promoting equity in mental health. The article also highlights specific studies that examine different vulnerable populations and their increased risk of mental health disorders. The findings emphasize the need for targeted interventions and tailored support for specific populations, as well as comprehensive approaches that address socioeconomic factors and access to care. [Extracted from the article]

In Huntington disease (HD) the prodromal phase has been increasingly investigated and is currently in focus for early interventional treatments. Also, the influence of sex on disease progression and severity in patients is under discussion, as a sex-specific impact has been reported in transgenic rodent models for HD. To this end, we have been studying these aspects in Sprague Dawley rats transgenic for HD. Here, we took up on the congenic F344tgHD rat model, expressing a fragmented Htt construct with 51 CAG repeats on an inbred F344 rat background and characterized potential sexual dimorphism and genedosage effects in rats during the pre-symptomatic phase (1-8 months of age). Our study comprises a longitudinal phenotyping of motor function, emotion and sensorimotor gating, as well as screening of metabolic parameters with classical and automated assays in combination with investigation of molecular HD hallmarks (striatal cell number and volume estimation, appearance of HTT aggregates). Differences between sexes became apparent during middle age, particularly in the motor and sensorimotor domains. Female individuals were generally more active, demonstrated different gait characteristics than males and less anxiolytic-like behavior. Alterations in both the time course and affected behavioral domains varied between male and female F344tgHD rats. First subtle behavioral anomalies were detected in transgenic F344tgHD rats prior to striatal MSN cell loss, revealing a prodromal-like phase in this model. Our findings demonstrate that the congenic F344tgHD rat model shows high face-validity, closely resembling the human disease's temporal progression, while having a relatively low number of CAG repeats, a slowly progressing pathology with a prodromal-like phase and a comparatively subtle phenotype. By differentiating the sexes regarding HD-related changes and characterizing the prodromal-like phase in this model, these findings provide a foundation for future treatment studies. [ABSTRACT FROM AUTHOR]

Background: Non-motor symptoms of Parkinson's disease (PD) are highly prevalent and heterogenic. Previous studies aimed to gain more insight on this heterogeneity by investigating age and gender differences in non-motor symptom severity, but findings were inconsistent. Furthermore, besides examining the single effects of age and gender, the interaction between them in relation to non-motor functioning has -as far as we know-not been investigated before. Objectives: To investigate the association of age and gender identity -as well as the interaction between age and gender identity-with non-motor symptoms and their impact on quality of life. Methods: We combined three large and independent studies. This approach resulted in a total number of unique participants of 1,509. We used linear regression models to assess the association of age and gender identity, and their interaction, with non-motor symptoms and their impact on quality of life. Results: Older people with PD generally had worse cognitive functioning, worse autonomic functioning and worse quality of life. Women with PD generally experienced more anxiety, worse autonomic functioning and worse quality of life compared to men with PD, whereas men with PD generally had worse cognitive functioning. In interaction analyses by age and gender identity, depressive symptoms and anxiety were disproportionally worse with increasing age in women compared to men. Conclusion: Our findings indicate that both age and gender -as well as their interaction-are differentially associated with non-motor symptoms of PD. Both research and clinical practice should pay more attention to demographic subgroups differences and possible different treatment approaches with respect to age and gender. We showed how combining datasets is of added value in this kind of analyses and encourage others to use similar approaches. [ABSTRACT FROM AUTHOR]

Background: Increased prevalence of cardiovascular autonomic failure might play a key role on Parkinson's disease (PD) progression of glucocerebrosidase gene (GBA)-mutated patients, determining a malignant phenotype of disease in these patients. Objective: To objectively characterize, for the first time, the cardiovascular autonomic profile of GBA -mutated patients compared to idiopathic PD patients by means of cardiovascular reflex tests (CRTs). Methods: This is a case-control (1 : 2) study on PD patients belonging to well-characterized prospective cohorts. For each PD patient carrying GBA variants, two idiopathic PD patients, matched for sex and disease duration at CRTs, were selected. Patients recruited in these cohorts underwent a complete clinical and instrumental evaluation including specific autonomic questionnaires, CRTs and extensive genetic analysis. Results: A total of 23 GBA -PD patients (19 males, disease duration 7.7 years) were included and matched with 46 non-mutated PD controls. GBA -mutated patients were younger than controls (59.9±8.1 vs. 64.3±7.2 years, p = 0.0257) and showed a more severe phenotype. Despite GBA -mutated patients reported more frequently symptoms suggestive of orthostatic hypotension (OH) than non-mutated patients (39.1% vs 6.5%, p = 0.001), the degree of cardiovascular autonomic dysfunction, when instrumentally assessed, did not differ between the two groups, showing the same prevalence of neurogenic OH, delayed OH and cardiovascular reflex impairment (pathological Valsalva maneuver). Conclusion: GBA -PD patients did not show different instrumental cardiovascular autonomic pattern than non-mutated PD. Our findings suggested that symptoms suggestive of OH should be promptly investigated by clinicians to confirm their nature and improve patient care and management. [ABSTRACT FROM AUTHOR]

The Young-HUNT Study, part of the Trøndelag Health Study in Norway, focuses on adolescents aged 13-19 years. The study collects data through surveys and allows for longitudinal follow-ups and within-family studies. The most recent survey, Young-HUNT4, included 8066 participants and introduced new measures such as body composition analysis and DNA samples. The study aims to investigate trends in adolescent health, explore the impact of societal changes, and study the long-term effects of early life health and behaviors. The data collected will contribute to research on mental health, physical activity, and genetic factors. The surveys cover a wide range of topics related to population characteristics, self-reported questionnaires, lifestyle factors, mental health, physical and somatic health, various health influencing factors, sexual orientation, school, adverse life events, and health care use. The surveys aim to gather comprehensive data on the health and well-being of young individuals. Key findings from the study include an increase in obesity and overweight among adolescents, high levels of physical activity that meet national recommendations, and a rise in mental health problems, particularly among girls. The study also found associations between screen time, mental distress, and poorer quality of life. The Young-HUNT Study has strengths such as high participation rates, the ability to link data to registries, and the availability of genetic material. However, a weakness is the low participation rate among adolescents not in school. Researchers can apply for access to the data through a Norwegian research institution [Extracted from the article]

Allergic Rhinitis (AR) is rising in incidence in both developed and developing countries. Genetics and epigenetics have a potential role to play. The pattern and severity of AR have implications with regard to choice of treatment, which itself could be related to patient specific genetic and epigenetic factors. Hence, the present study was undertaken to correlate the patient characteristics with AR pattern and severity, in order to understand the pathophysiology of AR. The study also aimed to find out the allergen sensitivity pattern among patients attending a tertiary care centre of rural central India, where climatic variations make it a high prevalence zone. Prospective Observational study on 90 patients with clinically diagnosed Allergic Rhinitis confirmed by Skin Prick Tests. Patient characteristics like demographic data, data relevant to allergen exposure, occupation, family history of atopy and gender; and Disease characteristics like severity (mild, mod-severe), pattern (continuous/ intermittent), type of disease (seasonal/perennial) were noted, analysed and correlation studied. Majority of the patients with AR were in the age group of 15–40 years. Medical students (52%) suffered from moderate to severe type of Allergic Rhinitis, with Persistent disease in approximately 80%. Similarly, 70.59% of farmers had moderate to severe type of the disease, with persistent disease in 70%. In the present study, in clinically diagnosed allergic rhinitis patients, Mite was the commonest allergen found on Skin Prick Test overall and in Medical students, whereas Pollen sensitivity was more common among farmers. 56.66% of the patients had negative family history of atopy. Severity and type of AR depend on allergen exposure. In farmers and medical professionals, persistent and moderate to severe type of disease was more common, as they were persistently exposed to different type of allergens, mites in case of medical professionals and pollens in farmers. Hence, the Disease characteristics, as defined by ARIA guidelines, should not be taken in isolation and management should consider the Patient characteristics for deciding and devising protocols. In the present study, more than 50% patients were without family history of atopy. Hence, the role of various environmental factors, leading to epigenetic changes could be a major contributor in the increase in incidence of allergic rhinitis in recent times. Occurrence of perennial moderate to severe form of disease, in majority of farmers, defies the phenomenon of "Hygiene Hypothesis", focusing on the role of epigenetic changes and various outdoor allergens in the development of allergic rhinitis in them. [ABSTRACT FROM AUTHOR]

This article explores the topic of secondary Parkinsonism caused by brain metastasis. It emphasizes the importance of correctly identifying and diagnosing secondary Parkinsonism in patients with brain metastasis, as the symptoms can resemble those of primary Parkinson's disease. The article stresses the need for comprehensive management strategies to address the underlying cause of secondary Parkinsonism and improve patient outcomes. Additionally, the study examines the use of telemedicine for neurological care in Colombia and assesses patient satisfaction with telemedicine consultations. The majority of patients, particularly those with movement disorders or Parkinson's disease, reported high levels of satisfaction with telemedicine appointments, finding them comparable to in-person visits. Patients found the process of connecting with healthcare professionals through telemedicine easy and expressed a preference for future telemedicine appointments. The study suggests that telemedicine can be a valuable and convenient option for neurological care, particularly for patients in remote or underserved areas. [Extracted from the article]

Background: Functional parkinsonism is an important differential diagnosis of Parkinson's disease (PD). Based on anecdotal experience, we hypothesized that arm swing while walking and running could differentiate these two conditions, but this assumption has not been previously explored systematically. Objectives: To examine differences in arm swing while walking and running between patients with PD and functional parkinsonism. Methods: We analyzed blinded video assessments of arm swing and other gait parameters in patients with asymmetrical PD (n = 81) and functional parkinsonism (n = 8) while walking and running. The groups were matched for age, sex and disease duration. Results: In contrast to those with PD, patients with functional parkinsonism (i) were more likely to have a marked asymmetry in arm swing while walking (5/8 vs. 25/81; P = 0.06), (ii) were less likely to improve arm swing while running with full effort (3/8 vs. 72/81; P < 0.001) and (iii) demonstrated normal passive arm swing even when asymmetry of arm swing was marked during running/walking (6/6 vs. 9/33; P = 0.002). Conclusions: Assessment of arm swing while walking and running and passive arm swing could be important differentiating clinical features between functional parkinsonism and PD. [ABSTRACT FROM AUTHOR]

This article discusses the use of endoscopic transpapillary drainage through the pancreatic stump as a treatment for postoperative pancreatic fistula (POPF) after distal pancreatectomy. POPF is a common complication following this surgery, and interventions such as percutaneous drainage and endoscopic ultrasound-guided transluminal drainage are often used. However, these methods may not always be suitable. The authors present a case study of a 59-year-old man who underwent endoscopic transpapillary drainage through the pancreatic duct stump, which successfully relieved the POPF. This method provides an alternative option for patients with certain characteristics or when other interventions are not appropriate. [Extracted from the article]

This document is an editorial published in Frontiers in Neurology, discussing the early diagnosis and mechanism analysis of non-motor symptoms of Parkinson's syndrome. The editorial highlights the importance of non-motor symptoms in Parkinson's syndrome and their impact on patients' quality of life. It also emphasizes the need for improved recognition and treatment of these symptoms. The document includes a summary of eight articles that explore various aspects of non-motor symptoms, such as neuropsychiatric symptoms, autonomic dysfunctions, and cognitive impairments. The research presented in these articles aims to enhance our understanding of non-motor symptoms, identify diagnostic biomarkers, and develop innovative treatment strategies to improve the lives of patients with Parkinson's syndrome. [Extracted from the article]

This article discusses the potential implementation of polygenic risk scores (PRSs) into clinical practice for cardiovascular disease risk prediction. PRSs combine multiple genetic variants to assess an individual's genetic risk for a particular disease. The study examined the integration of a PRS into guideline-recommended prediction of cardiovascular disease risk using data from the UK Biobank. The results showed that the addition of PRSs to clinical risk factors led to significant risk reclassification, particularly for individuals originally classified as intermediate risk. This suggests that PRSs could be useful in identifying individuals who would benefit from intensified preventive treatment. However, challenges remain in terms of interpreting and communicating PRS results to clinicians and patients. Further research is needed to investigate the impact of low genetic risk and to include other ethnic groups in the study. Overall, this study contributes to the ongoing discussion on the clinical utility of PRSs and brings us closer to their implementation in daily clinical practice. [Extracted from the article]

A recent study published in Cardiovascular Research explores the use of a technique called translating ribosome affinity purification (TRAP) to analyze gene expression in vascular smooth muscle cells (VSMCs) in atherosclerosis. The study found that TRAP-seq profiles of mice with atherosclerosis revealed disease-induced VSMC-specific transcripts associated with extracellular matrix organization and remodeling. The study also identified a novel gene, ITIH4, which may play a role in the pathogenesis of atherosclerosis. This research provides valuable insights into VSMC phenotyping and the potential for clinical targeting in cardiovascular disease. [Extracted from the article]

This article summarizes the findings of a multinational study on the impact of ichthyosis, a rare skin condition, on patients' quality of life and stigmatization. The study collected data from 384 patients in France, Italy, Spain, and the UK through an online questionnaire. The results showed that ichthyosis had a significant influence on personal and professional life, leading to difficulties in work or school, cancellation of social events, and impact on relationships. Individuals with visible areas affected by ichthyosis experienced higher levels of stigmatization. The study emphasizes the need for comprehensive evaluation and support for patients with ichthyosis to address the physical, psychological, and social impairments associated with the disease. [Extracted from the article]

Background: Alterations in the intestinal microbiota may play a role in the pathogenesis of functional bowel disorders (FBDs). Probiotics are widely used to improve intestinal dysbacteriosis in FBDs. In the context of FBDs, washed microbiota transplantation (WMT) appear to be a promising therapeutic option. We aimed to compare probiotics with WMT by using a propensity-score matching analysis (PSMA). Methods: We conducted a retrospective investigation of 103 patients with FBDs, including irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FDr), functional abdominal bloating (FAB). Patients were divided into the WMT group or probiotics group (taking probiotics capsules). Data on the following parameters were matched for PSMA: age; sex; disease course; body mass index; anxiety; insomnia; tobacco smoking; alcohol consumption; and levels of D-lactate, diamine oxidase, and lipopolysaccharide. Intestinal barrier function (IBF) and symptoms were evaluated both before and after treatment initiation. Prognostic factors were assessed by Cox proportional hazards regression analysis. Results: PSMA identified in 34 matched pairs (11 IBS, 12 FC, 7 FDr, and 4 FAB in the probiotics group and 14 IBS, 13 FC, 5 FDr, and 2 FAB in the WMT group. Improvement of FBD symptoms was greater with WMT than probiotics (P = 0.002). The WMT group had significantly fewer patients with intestinal barrier damage than the probiotics group (38.2% vs. 67.6%, P = 0.041). This improvement of FBD with WMT was further reflected as a reduction in D-lactate levels (P = 0.031). Increased D-lactate levels which were identified as a prognostic factor for FBDs (HR = 0.248, 95%CI 0.093–0.666, P = 0.006) in multivariate Cox regression analysis. Conclusion: WMT could improve symptoms and IBF in patients with FBDs. Increased D-lactate levels in patients with FBDs may predict a favorable response to WMT treatment. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a severe and complex mental disorder that traditionally has been found to be more frequent in the female gender in clinical samples. More recently, epidemiological studies have provided conflicting data about the prevalence of borderline disorder in the two genders in community samples. In order to explain this heterogeneity, some authors hypothesized the presence of a bias in the diagnostic criteria thresholds (more prevalent in one gender than another), in the population sampling (community versus clinical), in the instruments of evaluation (clinician versus self-report measures), and in the diagnostic construct of BPD. Beyond the question of the different prevalence of the disorder between genders, the debate remains open as to how personality and clinical characteristics, and attitude toward treatments express themselves in the two genders. This narrative review is aimed to provide an updated overview of the differences among genders in BPD in terms of diagnosis, temperamental and clinical characteristics, comorbidities, findings of neuroimaging, and treatment attitudes. Studies that specifically investigated the gender differences in BPD patients are rather limited. Most of the investigations did not consider gender as a variable or were characterized by a significant imbalance between the two genders (more commonly in favor the female gender). The main results indicated that men were more likely to endorse the criteria "intense and inappropriate anger" and "impulsivity," whereas women endorsed the criteria "chronic feelings of emptiness," "affective instability," and "suicidality/self-harm behaviors." These findings reflect differences in temperament and symptoms of the two genders. Other relevant differences concern pattern of comorbidity, specific neurobiological mechanisms and attitude to treatments. Main limitations were that only one database was searched, time of publications was limited, non-English manuscripts were excluded, and the quality of each paper was not commented. [ABSTRACT FROM AUTHOR]

Available data suggest that there may be gender differences in the effect of STN-DBS in the treatment of Parkinson's disease (PD). The aim of this study was to review data on gender discrepancies and gender differences in clinical outcomes in PD patients treated with deep brain stimulation of the subthalamic nucleus (STN-DBS). Included were original studies that specifically examined gender discrepancies or gender differences in PD patients with STN-DBS. Men receive more DBS than women, for various indications. The decision-making process for DBS in women compared to men is more influenced by personal preferences and external factors. Motor symptoms improve in both genders, but bradykinesia improves more in men. The postoperative reduction of the levodopa equivalent daily dose seems to be more pronounced in men. Men show more cognitive deterioration and less improvement than women after STN-DBS. Women show more depressive symptoms before surgery, but they improve similarly to men. Men show more improvement in impulsivity and less decrease in impulsive behaviour symptoms than women. Anxiety and personality traits remain unchanged in both genders. Voice quality improves more in men and deteriorates less often than in women. Men gain fat-free mass and fat mass, but women only gain fat mass. Regarding sexual function the evidence is inconsistent. More urinary symptoms improve in women than in men. Pain and restless leg syndrome seems to improve more in men. Regarding quality of life, the evidence seems to be inconsistent, and activities of daily living seems to improve in both genders. Better prospective controlled studies, focusing directly on gender differences in PD patients treated with STN-DBS, are needed to better explain gender differences in STN-DBS for PD. [ABSTRACT FROM AUTHOR]

Background: Around 10% of people infected by SARS-COV-2 report symptoms that persist longer than 3 months. Little has been reported about sex differences in symptoms and clustering over time of non-hospitalised patients in primary care settings. Methods: This is a descriptive study of a cohort of mainly non-hospitalized patients with a persistence of symptoms longer than 3 months from the clinical onset in co-creation with the Long Covid Catalan affected group using an online survey. Recruitment was from March 2020 to June 2021. Exclusion criteria were being admitted to an ICU, < 18 years of age and not living in Catalonia. We focused on 117 symptoms gathered in 18 groups and performed cluster analysis over the first 21 days of infection, at 22–60 days, and ≥ 3 months. Results: We analysed responses of 905 participants (80.3% women). Median time between symptom onset and the questionnaire response date was 8.7 months. General symptoms (as fatigue) were the most prevalent with no differences by sex, age, or wave although its frequency decreased over time (from 91.8 to 78.3%). Dermatological (52.1% in women, 28.5% in men), olfactory (34.9% women, 20.9% men) and neurocognitive symptoms (70.1% women, 55.8% men) showed the greatest differences by sex. Cluster analysis showed five clusters with a predominance of Taste & smell (24.9%) and Multisystemic clusters (26.5%) at baseline and _Multisystemic (34.59%) and Heterogeneous (24.0%) at ≥3 months. The Multisystemic cluster was more prevalent in men. The Menstrual cluster was the most stable over time, while most transitions occurred from the Heterogeneous cluster to the Multisystemic cluster and from Taste & smell to Heterogeneous. Conclusions: General symptoms were the most prevalent in both sexes at three-time cut-off points. Major sex differences were observed in dermatological, olfactory and neurocognitive symptoms. The increase of the Heterogeneous cluster might suggest an adaptation to symptoms or a non-specific evolution of the condition which can hinder its detection at medical appointments. A carefully symptom collection and patients' participation in research may generate useful knowledge about Long Covid presentation in primary care settings. [ABSTRACT FROM AUTHOR]

Background: The objective of the study is to analyse the regions, age and sex differences in the incidence of knee osteoarthritis (KOA). Methods: Data were extracted from the global burden of diseases (GBD) 2019 study, including incidence, years lived with disability (YLD), disability-adjusted life-years (DALYs) and risk factors. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends in age standardized rate (ASR) of KOA. Paired t-test, paired Wilcoxon signed-rank test and spearman correlation were performed to analyze the association of sex disparity in KOA and socio-demographic index (SDI). Results: There were significant regional differences in the incidence of knee osteoarthritis. In 2019, South Korea had the highest incidence of knee osteoarthritis (474.85,95%UI:413.34–539.64) and Thailand had the highest increase in incidence of knee osteoarthritis (EAPC = 0.56, 95%CI = 0.54–0.58). Notably, higher incidence, YLD and DALYs of knee osteoarthritis were associated with areas with a high socio-demographic index (r = 0.336, p < 0.001; r = 0.324, p < 0.001; r = 0.324, p < 0.001). In terms of age differences, the greatest increase in the incidence of knee osteoarthritis was between the 35–39 and 40–44 age groups. (EAPC = 0.52, 95%CI = 0.40–0.63; 0.47, 95%CI = 0.36–0.58). In addition, there were significant sex differences in the disease burden of knee osteoarthritis (P < 0.001). Conclusions: The incidence of knee osteoarthritis is significantly different with regions, age and sex. [ABSTRACT FROM AUTHOR]

Intranasal mucosal vaccines can more effectively induce mucosal immune responses against SARS-CoV-2. Here, we show in hamsters that an intranasal subunit mucosal vaccine boost with the beta variant S1 can prevent weight loss, in addition to reducing viral load, which cannot be studied in macaques that don't develop COVID-like disease. Protective efficacy against both viral load and weight loss correlated with serum antibody titers. A sex bias was detected in that immune responses and protection against viral load were greater in females than males. We also found that priming with S1 from the Wuhan strain elicited lower humoral immune responses against beta variant and led to less protection against beta viral challenge, suggesting the importance of matched antigens. The greater efficacy of mucosal vaccines in the upper respiratory tract and the need to consider sex differences in vaccine protection are important in the development of future improved COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Background: Recent decades have seen an exponential rise in global obesity prevalence, with rates nearly doubling in a span of 40 years. A comprehensive knowledge base regarding the systemic effects of obesity is required to create new preventative and therapeutic agents effective at combating the current obesity epidemic. Previous studies of diet-induced obesity utilizing mouse models have demonstrated a difference in bodyweight gain by sex. In such studies, female mice gained significantly less weight than male mice when given the same high fat (HF) diet, indicating a resistance to diet-induced obesity. Research has also shown sex differences in gut microbiome composition between males and females, indicated to be in part a result of sex hormones. Understanding metabolic differences between sexes could assist in the development of new measures for obesity prevention and treatment. This study aimed to characterize sex differences in weight gain, plasma lipid profiles, fecal microbiota composition, and fecal short chain fatty acid levels. We hypothesized a role for the gut microbiome in these sex differences that would be normalized following microbiome depletion. Methods: A mouse model was used to study these effects. Mice were divided into treatment groups by sex, diet, and presence/absence of an antibiotic cocktail to deplete genera in the gut microbiome. We hypothesized that sex differences would be present both in bodyweight gain and systemic measures of obesity, including hormone and circulating free fatty acid levels. Results: We determined statistically significant differences for sex and/or treatment for the outcome measures. We confirm previous findings in which male mice gained significantly more weight than female mice fed the same high fat diet. However, sex differences persisted following antibiotic administration for microbiome depletion. Conclusions: We conclude that sex differences in the gut microbiome may contribute to sex differences in obesity, but they do not explain all of the differences. Highlights: Analyzed the fecal microbiome at the genus level for male and female C57Bl/6 mice on a low fat diet, high fat diet, with and without antibiotic treatment. Measured ten short chain fatty acids in fecal samples for male and female C57Bl/6 mice on a low fat diet, high fat diet, with and without antibiotic treatment. Measured circulating free fatty acids for male and female C57Bl/6 mice on a low fat diet, high fat diet, with and without antibiotic treatment. Male mice gained the most weight on a high fat diet, following antibiotic treatment, compared to all other groups. Significant depletion of the microbiome via antibiotic treatment does not decrease body weight and does not normalize sex differences in obesity. [ABSTRACT FROM AUTHOR]

The aim was to investigate prevalence of dry eye syndrome (DES) in a population-based sample in Germany. The association between coexisting eye diseases and DES was also of interest. We recontacted participants of the Heinz Nixdorf Recall study between 2018 and 2021 by postal questionnaire that included the Women's Health Study questionnaire on DES. We estimated prevalence of DES and examined DES-associated factors among 2095 participants aged 62–91 years. We performed interaction analyses between sex and coexisting eye diseases in relation to the DES prevalence and performed bias analyses to examine the robustness of the results. The DES prevalence was 31.5% (34–36% after correction for potential non-response bias, 24.1% after correction for outcome misclassification) and it was almost 2.1-times higher in women than in men (women 42.3%, men 20.4%). Among DES subjects, 70.3% had received treatment in the previous 12 months. There was synergism between female sex and coexisting eye diseases (cataract, glaucoma, macular degeneration) in terms of DES prevalence. The extrapolated numbers of patients aged 62–91 years with DES in Germany are 1.1–1.3 million men and 6.1–6.8 million women. The observed synergism may be explained by differences in ocular physiology, subjective perception and response behavior. Women with eye diseases (cataract, glaucoma, macula degeneration) appear to have a markedly higher susceptibility to suffer from DES than men, so that a diagnostic workup of DES symptoms is particularly justified in women with these eye diseases. [ABSTRACT FROM AUTHOR]

As its prevalence increases and its association with cardiovascular disease and mortality is established, there is a need to improve prevention and management strategies for hypertension. Therefore, we aimed to compare differences in cardiovascular health status between men and women with hypertension defined by systolic blood pressure ≥140 mmHg and diastolic blood pressure ≥90 mmHg, and/or treatment with antihypertensive drugs. The association between cardiovascular health status and health-related quality of life was also evaluated. Additionally, a secondary analysis was performed on the cross-sectional data from 7306 adults with hypertension, ≥40 years of age between 2013 and 2018. Of this sample, 51.2% of patients were women from the Korean National Health and Nutrition Examination Survey. The seven Cardiovascular Health Metrics were used to quantify cardiovascular health status and the 5-dimensional European Quality of Life Questionnaire (EQ-5D) was used to evaluate health-related quality of life. A higher proportion of men than that of women was observed in the poor cardiovascular health score group [total score 0–7], with a higher proportion of women in the intermediate group [total score 8–10] and ideal group [total 11–14] (p<0.0001). The proportion of women in the EQ-5D index was higher than that of men in the poor and intermediate groups (p<0.0001), with no difference in the proportion of men and women in the ideal group (p = 0.1452). Furthermore, specific cardiovascular risk factors were different between men and women: women had lower physical activity level and higher prevalence of high cholesterol (≥200 mg/dl), and men had higher body mass indices and worse diet management. These findings indicate that prevention and management strategies for hypertension and cardiovascular health might need to differ for men and women to improve outcomes. [ABSTRACT FROM AUTHOR]

This document contains summaries of various medical case studies and research studies related to rheumatology and autoimmune diseases. The studies cover topics such as the association between health-related quality of life and mortality in patients with antineutrophil cytoplasmic antibody-associated vasculitis, cases of inflammatory arthritis in children with joint destruction and dislocation, and a case report of a patient with systemic lupus erythematosus who also developed multiple sclerosis. Other summaries discuss avascular necrosis of the femoral head in a patient with lupus and the correlation between the Western Ontario and McMaster Universities Osteoarthritis Index score and radiographic severity of knee osteoarthritis. The studies provide valuable insights into the diagnosis, treatment, and management of rheumatic and autoimmune diseases. [Extracted from the article]

Background: Obesity rates in the U.S. continue to increase, with nearly 50% of the population being either obese or morbidly obese. Obesity, along with female sex, are leading risk factors for sporadic Alzheimer's Disease (AD) necessitating the need to better understand how these variables impact cellular function independent of age or genetic mutations. Animal and clinical studies both indicate that autophagy-lysosomal pathway (ALP) dysfunction is among the earliest known cellular systems to become perturbed in AD, preceding cognitive decline, yet little is known about how obesity and sex affects these cellular functions in the hippocampus, a brain region uniquely susceptible to the negative effects of obesity. We hypothesized that obesity would negatively affect key markers of ALP in the hippocampus, effects would vary based on sex, and that caloric restriction would counteract obesity effects. Methods: Female and male mice were placed on an obesogenic diet for 10 months, at which point half were switched to caloric restriction for three months, followed by cognitive testing in the Morris watermaze. Hippocampus was analyzed by western blot and qPCR. Results: Cognitive function in female mice responded differently to caloric restriction based on whether they were on a normal or obesogenic diet; male cognition was only mildly affected by caloric restriction and not obesity. Significant male-specific changes occurred in cellular markers of autophagy, including obesity increasing pAkt, Slc38a9, and Atg12, while caloric restriction reduced pRPS6 and increased Atg7. In contrast females experienced changes due to diet/caloric restriction predominately in lysosomal markers including increased TFE3, FLCN, FNIP2, and pAMPK. Conclusions: Results support that hippocampal ALP is a target of obesity and that sex shapes molecular responses, while providing insight into how dietary manipulations affect learning and memory based on sex. [ABSTRACT FROM AUTHOR]

This article examines the differences in aortic elasticity and histological patterns between male and female patients with aortopathy. The study included 96 patients who underwent thoracic aortic surgery, and measurements were taken using transthoracic echocardiography. The results showed that there were no significant differences in arterial distensibility, arterial strain, or most histological parameters between male and female patients. Therefore, the study suggests that changes in aortic elasticity and aortic wall patterns do not explain the higher risk of aortic dissection in female patients. [Extracted from the article]

Background: Developing effective strategies for reducing dementia risk requires a detailed understanding of the risk and protective factors associated with the progression of mild cognitive impairment (MCI) to dementia. Objective: We aimed to systematically review the evidence for sex differences in these factors. Methods: Five online databases (PubMed/CINAHL/EMBASE/PsycINFO/Cochrane) were searched from inception until 17 October 2022 for cohort studies that focused on sex differences in risk and protective factors in the progression of MCI to dementia. Results: A total of 2,972 studies were identified, of which 12 studies from five countries were included in the systematic review. There was substantial variability in study designs, study populations and outcome measures. Sex differences were present in the associations of sociodemographic, health, psychological factors, genetic and other biomarkers with the progression of MCI to dementia. APOE ɛ4 status and depression appeared to increase the risk of progression for females, whereas history of stroke, MRI markers and cerebrospinal fluid biomarkers appeared to increase the risk of progression for males. APOE ɛ2 status and marital status (unmarried) were observed to reduce risk of progression in males and females, respectively. Conclusions: The ability of studies to accurately detail risk factors for dementia are likely limited when solely controlling for the effects of sex. Although the heterogeneity and underpowered nature of the studies made it difficult to synthesize the findings for each risk factor, this study highlights the apparent need for further research examining risk factors for dementia in males and females with MCI separately. [ABSTRACT FROM AUTHOR]

Frontal Fibrosing Alopecia (FFA) is a distinctive form of cicatricial alopecia characterized by gradual hairline recession, predominantly affecting postmenopausal individuals, thus implying a potential hormonal origin. This narrative review, spanning 2000 to 2023, delves into PubMed literature, focusing on the menopausal and hormonal status of women with FFA. The objective is to unravel the intricate nature of FFA and its plausible associations with hormonal dysregulations in women. While menopause remains a pivotal demographic characteristic linked to FFA, existing data suggest that its hormonal imbalances may not fully account for the development of FFA. Conversely, substantial evidence indicates a strong association between a reduction in fertile years, particularly through surgical interventions leading to an abrupt hormonal imbalance, and FFA in women. Additionally, exposure to hormone replacement therapy or oral contraceptives has shown varying degrees of association with FFA. Gynecologists should maintain a heightened awareness regarding the ramifications of their interventions and their pivotal role in overseeing women's fertility, recognizing the potential influence on the progression of FFA. The recurrent theme of hormonal disruption strongly implies a causal connection between alterations in sex hormones and FFA in women. Nevertheless, this relationship's extent and underlying mechanisms remain subjects of ongoing debate. [ABSTRACT FROM AUTHOR]

This article aims to explore the relationship between chronic diseases and the participation of men and women in the Brazilian labor market, based on the National Health Survey (PNS) of 2019. The findings point to distinct identity and economic profiles of workers, with disadvantaged earnings for sick women compared to men and non-sick women. Chronic diseases diminish the probabilities of labor force participation, becoming more intense with comorbidities, though the effect is less prominent for women. Men’s labor decisions are predominantly hindered by mental illness and stroke, while women’s decisions are affected by stroke and arthritis. Asthmatic men and women with chronic kidney conditions and musculoskeletal disorder have less difficulty in economic integration. These findings can guide strategies that take into consideration diverse social groups, comorbidities, and disease typologies that impact labor markets in (un)favorable ways. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the predictive value of the serum IgA/C3 ratio and glomerular C3 deposits in kidney biopsy in adult IgA nephropathy. Methods: The study included 718 adult IgAN patients diagnosed based on kidney biopsy. Patients without corticosteroids or immunosuppressive drugs >1 month were regularly followed up for at least 1 year or until the study endpoint. The optimum serum IgA/C3 ratio was calculated by the AUROC-based cutoff ratio. Proteinuria, creatinine, eGFR, serum IgA, and serum C3 were evaluated at baseline. Kidney biopsy was categorized using the Oxford classification, with a calculation of the MEST-C score. The degree of glomerular C3 staining was semiquantitatively determined (grade 0, no or trace; grade 1, mild; grade 2, moderate; grade 3, marked) by immunofluorescence microscopy. The patients were divided into four groups by the serum IgA/C3 ratio and glomerular C3 staining. Results: The baseline data suggested that when the serum IgA/C3 ratio was at the same level, patients with a high glomerular C3 staining score (≥2) always had mesangial proliferation, segmental glomerulosclerosis, and tubular atrophy/interstitial fibrosis (group 1 vs. group 2; group 3 vs. group 4). When glomerular C3 staining was at the same level, proteinuria was significantly higher in patients with serum IgA/C3<2.806 (group 1 vs. group 3; group 2 vs. group 4), which was contrary to previous studies that have suggested that the serum level of IgA/C3 was associated with disease severity. Hence, this study set out to investigate the combined effects of the serum IgA/C3 ratio and glomerular C3 staining on the renal outcome in adult IgA nephropathy. Renal survival analysis indicated that serum IgA/C3 ≥2.806 and glomerular C3 staining ≥2 (group 1) may be correlated with a poorer prognosis, especially in different clinicopathological characteristics of IgAN patients based on the subgroup analysis. Multivariate Cox analysis demonstrated that hypertension, serum creatinine, CKD stage, T1/2 and C3 staining were independent predictive factors of renal survival. Conclusions: The combination of serum IgA/C3 and C3 staining may contribute to improved optimization of the prognostic model in IgAN patients, especially patients with different sexes and degrees of disease. However, further study is required for validation in the future. [ABSTRACT FROM AUTHOR]

The hormone adiponectin has many beneficial effects in atherosclerosis, as gene deficiency in adiponectin or its receptor has shown detrimental effects on plaque burden in mice. Our objective was to understand the potential roles adiponectin deficiency has on aortic plaque content, inflammation, and markers of cardiovascular disease according to sex and age. To study the influence of adiponectin status on sex and atherosclerosis, we used young male and female adipoq−/−apoe−/−, adipoq+/−apoe−/−, and apoe−/− mice, which were given a high-fat diet (HFD). Even a 50% reduction in the expression of adiponectin led to a plaque reduction in males and an increase in females compared with apoe−/− controls. Changes in plaque were not attributed to changes in cholesterol or cardiovascular disease markers but correlated with inflammatory markers. Plaque reduction in males was associated with reduced monocyte chemoattractant protein 1 (MCP1) and increased colony stimulating factor 3 (CSF3), while the increase in plaque in females correlated with the opposite effect in these markers. In old mice, both adiponectin-deficient genotypes and sexes accumulated more plaque than their respective apoe−/− controls. The increase in plaque with adiponectin deficiency according to age was not explained by a worsening lipid profile but correlated with increased levels of C-C motif chemokine ligand 5 (CCL5). Overall, our study uncovered genotype-specific effects that differed by sex and age of adiponectin deficiency in atherosclerosis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyse the spatial and temporal patterns of disease burden attributed to high BMI (DB-hBMI) from 1990 to 2019 in Belt and Road Initiative (BRI) countries, in light of increasing hBMI prevalence worldwide. Design: The study was a secondary analysis of Global Burden of Disease 2019 (GBD 2019) that analysed (using Joinpoint regression analysis) numbers and the age-standardised rate of mortality and disability-adjusted life years (DALY) of hBMI-induced diseases and their trends from 1990 to 2019 and in the final decade. Setting: GBD 2019 study data for BRI countries were categorised by country, age, gender and disease. Participants: GBD 2019 data were used to analyse DB-hBMI in BRI countries. Results: In 2019, China, India and Russia reported the highest mortality and DALY among BRI countries. From 1990 to 2019, the age-standardised DALY increased in Southeast Asia and South Asia, whereas many European countries saw declines. Notably, Bangladesh, Nepal and Vietnam showed the steepest increases, with average annual percentage change (AAPC) values of 4·42 %, 4·19 % and 4·28 %, respectively (all P  < 0·05). In contrast, Israel, Slovenia and Poland experienced significant reductions, with AAPC values of –1·70 %, –1·63 % and –1·58 %, respectively (all P  < 0·05). The most rapid increases among males were seen in Vietnam, Nepal and Bangladesh, while Jordan, Poland and Slovenia recorded the fastest declines among females. Across most BRI countries, the burden of diabetes and kidney diseases related to hBMI showed a significant uptrend. Conclusion: DB-hBMI varies significantly by region, age, gender and disease type across BRI countries. It can pose a substantial threat to public health. [ABSTRACT FROM AUTHOR]

Background Hyperkalemia is common among patients with chronic kidney disease (CKD) but there is scarce information on differential risk factors and outcomes for men and women. For instance, smoking has been suggested to be a risk factor for hyperkalemia, but specific analysis of the sex-specific impact of smoking on hyperkalemia in CKD is lacking. Methods We studied serum potassium levels in 2891 participants from the NEFRONA cohort: 483 controls (47% women) and 2408 CKD patients (38% women) without prior cardiovascular disease (CVD), assessing whether smoking is a risk factor for hyperkalemia, and if hyperkalemia is associated with outcomes separately for men and women. Results Median potassium levels and prevalence of hypo and hyperkalemia were higher in CKD participants than in controls. Serum potassium levels were higher and hyperkalemia and severe hyperkalemia more prevalent in men than in women with non-dialysis CKD (G3–G5). The highest prevalence of hyperkalemia for each gender was found in CKD G4-G5 and hemodialysis patients for men (46%) and in hemodialysis (54%) for women. Gender-specific etiological multivariate analysis identified current smoking as a risk factor for hyperkalemia only in men. Hyperkalemia was independently associated with stopping RAASi, an outcome which was more common in women. Hyperkalemia was also associated to higher risk of cardiovascular events within 4 years in men. In conclusion, hyperkalemia is common among men and women with CKD, but the prevalence, risk factors and outcomes may differ by gender. Specifically, current smoking is a driver of hyperkalemia in men. [ABSTRACT FROM AUTHOR]

Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations. Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups. Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males. Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive. [ABSTRACT FROM AUTHOR]

Objective: To evaluate autoinflammatory diseases (AID) according to age at diagnosis and sex, and response to therapy in a large population. Methods: This is a cross-sectional observational study of a Latin American registry using a designed web system for data storage, collected between 2015 and 2018. Any altered findings during follow-up were recorded. The forms were translated into Portuguese and Spanish, including demographic, clinical, laboratory, genetic and treatment characteristics. Results: We included 152 patients, 51.3% male and 75% Caucasian. The median age at disease onset was 2.1 years (0–15.6 years) and median age at diagnosis 6.9 years (0–21.9 years); 111 (73%) were children (0–9 years old), and 41 (27%) were adolescents and young adults (AYA) (10–21 years old). Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) occurred in 46/152 (30%), chronic non-bacterial osteomyelitis (CNO) in 32/152 (21%), and familial Mediterranean fever (FMF) in 24/152 (15.7%). PFAPA was significantly higher in young children than in AYA (38.7% vs. 7.3%, p<0.001), while CNO were lower (13.5% vs. 41.5%, p<0.001). The frequency of females was significantly higher in CNO (28.4% vs. 14.1%, p=0.031) and lower in FMF (8.1% vs. 23.1%, p=0.011). The most used drugs were glucocorticoids, non-steroidal anti-inflammatory drugs (NSAID), and colchicine. Glucocorticoids and colchicine treatment were used in all AID with good to moderate response. However, cryopyrinassociated periodic syndromes (CAPS) seemed unresponsive to glucocorticoids. NSAIDs and methotrexate were the main medications used to treat CNO. Conclusions: Differences among AID patients were observed in the LA population regarding sex and age at disease diagnosis. [ABSTRACT FROM AUTHOR]

This article discusses a study conducted in Egypt on the genetic variations and mutations found in hepatocellular carcinoma (HCC), a type of liver cancer. The study used next-generation sequencing to analyze the BRAF gene in HCC patients. The results showed that almost half of the patients had BRAF gene mutations, suggesting that targeting these mutations could be a potential treatment for HCC. The study also explored other risk factors and characteristics associated with HCC. However, more research is needed to fully understand the genetic changes in HCC. [Extracted from the article]

Cardiovascular diseases are a leading cause of morbidity and mortality worldwide. In Bulgaria, there is no study of the risk factors, the clinical picture, the accompanying diseases and the outcome of the disease in patients with peripheral arterial disease depending on gender. The aim of the study is to evaluate risk factors, clinical characteristics and comorbidity of patients with peripheral arterial disease of the extremities depending on gender, with an emphasis on concomitant carotid pathology and experienced cerebrovascular events. Material and methodology: The study included 200 patients -- 100 women and men each with diagnosed peripheral arterial disease (PAD). For each patient, the PAD stage according to Fontaine's clinical classification was determined, anamnestic data on past and accompanying diseases and risk factors for atherosclerosis with an emphasis on cerebrovascular disease (CVD) were recorded: experienced ischemic stroke (IS), transient ischemic attack (TIA) ), vascular interventions, and degree of carotid involvement, which was assessed by color-coded duplex sonography. Results: No statistical difference was found in the frequency of the registered risk factors by gender, with the exception of the smoking factor, where a significant preponderance was found among men compared to women (66% and 33%, p=0.001). No statistically significant differences were found regarding the presence of IS, previous IS or TIA (p=0.237). The frequency of carotid artery involvement in female patients is higher -- 63%, compared to male patients -- 40% (p=0.001). The relative share of women with atherosclerotic plaques up to 2 mm is also higher -- 41% compared to that of men -- 17% and carotid artery stenosis below 70% (21% women compared to 14% men, p=0.001). In men, the relative share of patients with chronic thrombosis of the carotid artery is higher -- 9% versus 0%. A significantly greater risk of CVD was found in women with dyslipidemia and PAD compared to women with PAD without dyslipidemia, OR=4.5 (p=0.006). No dependence of the carotid intervention carried out in the past on gender was found. Conclusion: In patients with PAD, no gender-dependent differences were observed regarding experienced cerebrovascular accidents, previous carotid intervention, as well as the type of intervention. The frequency of involvement of the carotid artery in the female gender is greater, with the exception of chronic thrombosis, which prevails among the male gender. [ABSTRACT FROM AUTHOR]

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We recently reported that messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination was associated with flares in 9% of patients with systemic lupus erythematosus (SLE). Herein, we focused our analysis on patients from a multi-ethnic Southeast Asian lupus cohort with the intention of identifying distinct phenotypes associated with increased flares after mRNA COVID-19 vaccination. Methods: Six hundred and thirty-three SLE patients from eight public healthcare institutions were divided into test and validation cohorts based on healthcare clusters. Latent class analysis was performed based on age, ethnicity, gender, vaccine type, past COVID-19 infection, interruption of immunomodulatory/immunosuppressive treatment for vaccination, disease activity and background immunomodulatory/immunosuppressive treatment as input variables. Data from both cohorts were then combined for mixed effect Cox regression to determine which phenotypic cluster had a higher risk for time to first SLE flare, adjusted for the number of vaccine doses. Results: Two clusters were identified in the test (C1 vs. C2), validation (C1′ vs. C2′) and combined (C1″ vs. C2″) cohorts, with corresponding clusters sharing similar characteristics. Of 633 SLE patients, 88.6% were female and there was multi-ethnic representation with 74.9% Chinese, 14.2% Malay and 4.6% Indian. The second cluster (C2, C2′ and C2″) was smaller compared to the first. SLE patients in the second cluster (C2 and C2′) were more likely to be male, non-Chinese and younger, with higher baseline disease activity. The second cluster (C2″) had more incident flares (hazard ratio = 1.4, 95% confidence interval 1.1–1.9, p = 0.014) after vaccination. A higher proportion of patients in C2″ had immunomodulatory/immunosuppressive treatment interruption for vaccination as compared to patients in C1″ (6.6% vs. 0.2%) (p < 0.001). Conclusion: We identified two distinct phenotypic clusters of SLE with different patterns of flares following mRNA COVID-19 vaccination. Caution has to be exercised in monitoring for post-vaccination flares in patients with risk factors for flares such as non-Chinese ethnicity, young age, male gender and suboptimal disease control at the time of vaccination. [ABSTRACT FROM AUTHOR]

Background and Objectives: Kidney transplant recipients (KTRs) are at a higher risk of severe COVID-19 development. The course of the infection may vary. Long-term consequences for graft function are still being studied. We investigate whether the clinical course of SARS-CoV-2 infection among KTRs had a long-term effect on graft function. Patients and method: 128 KTRs with confirmed SARS-CoV-2 infection were included in the study. They were divided into two groups: mild (without the need for oxygen therapy; n = 91) and severe (with the need for oxygen therapy; n = 21). Baseline characteristics and medical data, especially creatinine level, estimated glomerular filtration rate (eGFR) CKD-EPI, and proteinuria, were analyzed. The main outcomes were the absolute and relative change in eGFR during the one-year follow-up after COVID-19. In the final models, sex, age, smoking, presence of diabetes mellitus (DM), and cardiovascular disease (CVD) were included. Results: KTRs with severe COVID-19 were older, more likely to smoke, and had DM and CVD more frequently. Our analysis reveals that COVID-19 severity was associated with a significantly more pronounced relative eGFR decline one year after recovery only in males [−13.94 (95% CI: −25.13 to −2.76, p = 0.015) percentage points]. One year after the disease onset, males with a severe course of the infection had a higher eGFR decline than those with a mild one. The COVID-19 severity did not affect eGFR loss in females. Conclusions: In KTRs suffering from COVID-19, deterioration of graft function was noticed. The eGFR decline was associated with disease severity and sex. It indicates a need for further research, observation, and preventive actions for KTRs, especially males. [ABSTRACT FROM AUTHOR]

Objective: Fibrosis around the dura is a concern in spinal surgery, affecting outcomes. Ligamentum flavum (LF) sparing and anti-adhesion barrier gel are potential strategies. This study aimed to compare LF-sparing and anti-adhesion barrier gels in reducing dural fibrosis in spinal surgery patients. Materials and Methods: Fifty patients underwent surgery at the thoracic/lumbar levels (T1 to S1). Twenty five received LF sparing and 25 received anti-adhesion barrier gels. Postoperative magnetic resonance imaging was performed 6 months post-surgery, using Ross classification for fibrosis assessment. Median fibrosis degree was computed, and surgical levels' impact on fibrosis was analyzed. Results: The anti-adhesion barrier gel group had a higher mean age (53.68±7.54) than the LF-sparing group (48.36±8.03) (p<0.05, t-test). Gender distribution showed no significant difference (p=0.777, Chi-square test). The LF-sparing group had a lower mean degree of fibrosis (1.091.09±0.16) than the anti-adhesion barrier gel group (2.28±0.53) (p<0.001, Mann-Whitney U test). The LF sparing group's mean fibrosis had no significant variance among spinal levels (p>0.05), while the anti-adhesion barrier gel group showed significant differences (p=0.004, p<0.01) with the highest fibrosis at L4-S1, followed by T12-L1 and L2-L3, and the lowest at T1-T11. Conclusion: LF sparing is more effective in reducing dural fibrosis than anti-adhesion barrier gel. Surgical level influence fibrosis, with LF sparing advantageous in the lower lumbar and thoracolumbar transitional zones. [ABSTRACT FROM AUTHOR]

The prevalence of anatomic variations has been variously described, ranging from pure anatomic descriptions to descriptions based on CT examinations. These variations compromise already narrow drainage pathways and produce significant obstruction. CT examination of PNS will provide an anatomic road map of the PNS to identify the presence of significant anatomic abnormalities, the locations and severity of the disease and exact location of the obstruction. All the patients who satisfied the inclusion criteria of the study were subjected to history taking and physical examination to identify clinical signs at presentation. Then the patients were subjected to CT scan of nose and paranasal sinus region and the anatomy of the sinonasal region was thoroughly assessed after a probable diagnosis was made. There was no significant difference in Association between Anatomical Variations of Sinus and Age distribution. In the present study there was a significant difference in Association between Agger Nasi Cells (p value-0.030), Paradoxical Curvature (p value- 0.024), Haller cells (p value-0.045) and Frontoethmoidal Cell Variations-Type 1 (p value- 0.048) and Sex distribution. In the present study aggernasi cells were more commonly seen in males and paradoxical middle turbinate and type I frontoethmoidal cell variation were found to be more common in females. [ABSTRACT FROM AUTHOR]