Introduction:
Sex is a known predictor of outcome after acute ischemic stroke. However, the effect of sex on outcome after subarachnoid hemorrhage (SAH) is not well studied.
Methods:
Five studies from the SAH International Trialists repository were included (4 randomized trials and 1 prospective study). Patients were divided into groups based on sex. The primary outcome was favorable outcome which was defined as Glasgow Outcome Score (GOS) of 4 or 5 and the secondary outcome was delayed cerebral ischemia (DCI). Binary logistic regression was done to assess the association between sex and outcomes.
Results:
A total of 8015 patients (2186 males and 5829 females) were included. Female patients were older (mean age 53 vs 50 years, p<0.001) and had more severe neurological deficit on presentation (median World Federation of Neurosurgical Societies [WFNS] grade 2 vs.1; p<0.001). Favorable outcome was achieved less frequently in females in univariate analysis (51% vs. 62%; p<0.001). In a multivariable model adjusted for age, WFNS, Fisher score, aneurysm location, and aneurysm size, female was associated with lower odds of favorable outcome (OR= 0.82; 95% CI:0.73-0.92). DCI occurred more frequently in females (25% vs. 18%; p<0.001). In addition, women had higher risk of DCI after adjusting for potential confounders (women vs. men, OR 1.43; 95%CI: 1.26-1.63). We did not find an interaction between age and sex for both favorable outcome and clinical vasospasm.
Conclusion:
Female patients had worse functional outcome and higher risk of DCI after subarachnoid hemorrhage when compared to men.
We present a case of elderly patient aged 65 years who is suffering with severe mitral stenosis associated with atrial fibrillation, pulmonary artery hypertension and renal failure posted for right subtrochanter DHS fixation under continuous low dose segmental epidural anesthesia. Atrial fibrillation, pulmonary artery hypertension and renal failure carry high morbidity and mortality during surgery. General anesthesia is associated with high morbidity and mortality in patients with severe mitral stenosis associated atrial fibrillation, pulmonary hypertension and renal failure. In order to avoid high mortality associated with general anesthesia, we opted for continuous low dose segmental epidural anesthesia, which provided excellent Intraoperative hemodynamic stability and postoperative analgesia. This case highlights the advantage of continuous low dose segmental epidural anesthesia over general anesthesia in patients with severe mitral stenosis with atrial fibrillation and renal failure.
Formoterol and Salmeterol are long acting β2 agonists with duration of action greater than 12 hours making them suitable for twice daily treatment and for protection against nocturnal symptoms. MATERIALS AND METHODS PATIENTS Forty two non-smoking patients admitted in the Department of Medicine, KMCH, Katihar (29 women, 13 men, mean age 45±2; mean FEV1; 61.8% of predicted) took part in the trial. INCLUSION CRITERIA All patients were receiving treatment with dosage of at least 1500 µg of an inhaled steroid (e.g. beclomethasone dipropionate, budesonide or fluticasone propionate) or regular oral steroid. All patients had an FEV1 80% of predicted. All patients reported daily asthma symptoms and were using their rescue inhaler on most days. All patients were at step 4 or 5 of the British Thoracic Society Guidelines. EXCLUSION CRITERIA All patients who had an exacerbation of asthma requiring change in maintenance treatment, patients with history of smoking. RESULTS The morning PEF was greater in patients receiving formoterol (mean increase 14.4 L/min) or salmeterol (mean increase 14.8 L/min) compared with those receiving placebo, but there was no difference between these treatments. There was no significant treatment effects for any of the secondary outcome variables (i.e. FEV1, FVC, mean evening PEF, mean daytime symptom score or night time symptom score). CONCLUSION LONG ACTING β 2 agonists salmeterol and formoterol improve morning PEF in patients with severe asthma, but there is no significant difference in efficacy between these two drugs.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.