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Premenopausal women are much less prone to develop cardiovascular disease than men of similar age, but this advantage no longer applies after menopause. We previously found that male mice have a significantly higher rate of cardiac rupture than females during the acute phase of myocardial infarction (MI); however, the effects of sexual hormones on chronic remodeling are unknown. We hypothesized that estrogen (E) may protect the heart from chronic remodeling and deterioration of function post-MI, whereas testosterone (T) may have adverse effects. Mice (4 wk old) of both genders were divided into four groups: female groups consisted of 1) sham ovariectomy (S-Ovx) + placebo (P) (S-Ovx + P), 2) S-Ovx + T, 3) Ovx + P, and 4) Ovx + T; and male groups consisted of 1) sham castration (S-Cas)+ P (S-Cas + P), 2) S-Cas + 17[beta]-estradiol (E), 3) Cas + P, and 4) Cas + E. MI was induced 6 wk later. Echocardiography was performed to assess cardiac function and left ventricular dimensions (LVD). Myocyte cross-sectional area (MCSA) was measured at the end of the study. In females, both testosterone and ovariectomy decreased ejection fraction (EF) and increased LVD, and when combined they aggravated cardiac function and remodeling further. Testosterone significantly increased MCSA. In males, castration or estrogen increased EF and reduced LVD, whereas castration significantly reduced MCSA. Our data suggest that estrogen prevents deterioration of cardiac function and remodeling after MI, but testosterone worsens cardiac dysfunction and remodeling and has a pronounced effect when estrogen levels are reduced. sexual hormones; cardiac dysfunction

Researchers used meta-analysis to evaluate 127 studies on community-acquired pneumonia (CAP) covering 33,148 patients that were published from 1966 to 1995. The overall mortality rate was 13.7%, but rates in individual studies ranged from 5.1% in hospitalized and ambulatory patients to 36.5% in an intensive care unit. Eleven factors were found to predict mortality and included male sex, chest pain, hypothermia, hypotension and pulmonary infiltrate. Most of these factors are known at the time of admission and could be used to predict mortality. Mortality was also associated with the type of bacterium involved, being highest in patients infected with Pseudomonas, Klebsiella, E. coli and Staphylococcus aureus. Only one-third of the studies reported any other complications of CAP and less than 10% reported on functional outcomes such as return to work or regular activities., Objective. - To systematically review the medical literature on the prognosis and outcomes of patients with community-acquired pneumonia (CAP). Data Sources. - A MEDLINE literature search of English-language articles involving human subjects and manual reviews of article bibliographies were used to identify studies of prognosis in CAP. Study Selection. - Review of 4573 citations revealed 122 articles (127 unique study cohorts) that reported medical outcomes in adults with CAP. Data Extraction. - Qualitative assessments of studies' patient populations, designs, and patient outcomes were performed. Summary univariate odds ratios (ORs) and rate differences (RDs) and their associated 95% confidence intervals (CIs) were computed to estimate a summary effect size for the association of prognostic factors and mortality. Data Synthesis. - The overall mortality for the 33 148 patients in all 127 study cohorts was 13.7%, ranging from 5.1 % for the 2097 hospitalized and ambulatory patients (in six study cohorts) to 36.5% for the 788 intensive care unit patients (in 13 cohorts). Mortality varied by pneumonia etiology, ranging from less than 2% to greater than 30%. Eleven prognostic factors were significantly associated with, mortality using both summary ORs and RDs: male sex (OR=1.3; 95% CI, 1.2 to 1.4), pleuritic chest pain (OR=0.5; 95% CI, 0.3 to 0.8), hypothermia (OR=5.0; 95% CI, 2.4 to 10.4), systolic hypotension (OR=4.8; 95% CI, 2.8 to 8.3), tachypnea (OR=2.9; 95% CI, 1.7 to 4.9), diabetes mellitus (OR=1.3; 95% CI, 1.1 to 1.5), neoplastic disease (OR=2.8; 95% CI, 2.4 to 3. 1), neurologic disease (OR=4.6; 95% CI, 2.3 to 8.9), bacteremia (QR=2.8; 95% CI, 2.3 to 3.6), leukopenia (OR=2.5; 95% CI, 1.6 to 3.7), and multilobar radiographic pulmonary infiltrate (OR=3.1; 95% CI, 1.9 to 5.1). Assessments of other clinically relevant medical outcomes such as morbid complications (41 cohorts), symptoms resolution (seven cohorts), return to work or usual activities (five cohorts), or functional status (one cohort) were infrequently performed. Conclusions. - Mortality for patients hospitalized with CAP was high and was associated with characteristics of the study cohort, pneumonia etiology, and a variety of prognostic factors. Generalization of these findings to all patients with CAP should be made with caution because of insufficient published information on medical outcomes other than mortality in ambulatory patients.