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Impact of Gender-Affirming Hormonal Therapy on Cardiovascular Risk Factors in Transgender Health: An Updated Meta-Analysis
No full textBACKGROUND: Gender-affirming hormone therapy (GAHT) is common among transgender individuals, but its impact on lipid profile and cardiovascular health is not well studied.
OBJECTIVES: The authors performed a systematic review and meta-analysis of existing literature to assess the impact of GAHT on lipid profiles and metabolic cardiovascular risk factors in transgender individuals.
METHODS: Online databases including MEDLINE/PubMed, Embase, and Cochrane Central registry were searched to find studies on lipid profile changes in women who are transgender, also referred to as transfeminine (TF), and men who are transgender, also referred to as transmasculine (TM) before and after GAHT. Baseline comorbidities were analyzed using descriptive statistics, and R-statistical software was used to analyze the mean difference in lipid profile change between the two cohorts (pre- and post-GAHT therapy) including transgender patients.
RESULTS: Overall, 1,241 TM and 992 TF patients were included from 12 observational studies and 12 randomized controlled trials. The mean age among TM and TF was 28 years and 30 years, respectively. The mean follow-up duration (including pre- and post-GAHT therapy) was 28 months in TM patients and 39 months in TF patients. When compared to baseline measures, TM patients had a significant increase in low-density lipoprotein, triglyceride levels, and total cholesterol while high-density lipoprotein levels decreased. In TF patients, there was a significant increase in triglyceride levels.
CONCLUSIONS: GAHT affects lipid profiles in transgender patients; however, additional studies are needed to determine how these changes impact clinical outcomes
Role of Influenza Vaccination in Cardiovascular Disease: Systematic Review and Meta-Analysis
No full textInfluenza vaccination has shown great promise in terms of its cardioprotective effects. The aim of our analysis is to provide evidence regarding the protective effects of influenza vaccination in patients with cardiovascular disease. We conducted a systematic literature search to identify trials assessing the cardiovascular outcomes of influenza vaccination. Summary effects were calculated using a DerSimonian and Laird fixed effects and random effects model as odds ratio with 95% confidence intervals (CIs) for all the clinical endpoints. Fifteen studies with a total of 745,001 patients were included in our analysis. There was lower rates of all-cause mortality [odds ratio (OR) = 0.74, 95% CI 0.64-0.86], cardiovascular death (OR = 0.73, 95% CI 0.59-0.92), and stroke (OR = 0.71, 95% CI 0.57-0.89) in patients who received the influenza vaccine compared to placebo. There was no significant statistical difference in rates of myocardial infarction (OR = 0.91, 95% CI 0.69-1.21) or heart failure hospitalizations (OR = 1.06, 95% CI 0.85-1.31) in the 2 cohorts. In patients with cardiovascular disease, influenza vaccination is associated with lower all-cause mortality, cardiovascular death, and stroke
Welcome to the Future: Challenges and Opportunities Discussed in the Vision 2048 Task Force Open Forums 2021-2023
No full textRefractory Antimelanoma Differentiation-Associated Gene 5 Antibody Negative Ulcerative Dermatomyositis Responsive to Mycophenolate Mofetil
No full textSIBO and the Effectiveness of Treatment via Diet and Medication
Get PDFThis study delves into small intestinal bacterial overgrowth (SIBO), exploring its origins, diagnosis, and treatment methods. The research illuminates the complexities of SIBO, a condition characterized by an abnormal surge of bacteria in the small intestine. Factors contributing to SIBO include impaired motility, anatomical abnormalities, and digestive system dysfunctions. Diagnosing SIBO proves challenging due to its nonspecific symptoms which often overlap with other conditions like irritable bowel syndrome (IBS). Various diagnostic approaches, including lactulose breath testing, blood tests, stool analysis, and imaging, aim to identify SIBO and its underlying causes. Treatment involves dietary modifications—such as low FODMAP, biphasic, or fast track diets— antibiotics like rifaximin, and herbal therapies. However, concerns arise regarding extreme dietary restrictions causing potential malnutrition and eating disorders. This study highlights qualitative insights from women diagnosed with SIBO, revealing diverse treatment experiences. Understanding this connection empowers women to manage symptoms by adapting diets and stress management strategies. Overall, this comprehensive review unveils the intricate nature of SIBO, urging personalized approaches to its treatment and management
Walnut Consumption May Contribute to Healthy Cardiovascular/Endothelial Function by Maintaining Membrane Integrity
No full textCardiovascular diseases (CVDs) are the leading causes of death worldwide. A healthy diet has an important role in delaying the development of many modifiable risk factors of CVD, including abdominal obesity, high blood pressure, high plasma levels of cholesterol, and glucose. The consumption of various nuts, especially walnuts, may benefit both primary and secondary prevention due to their bioactive components. This review focuses on (1) the protective role of walnut consumption on CVD at large (2) and the potential cellular and molecular mechanisms by which they have beneficial effects on vascular endothelial function. Walnuts contain many essential ingredients (such as polyunsaturated fatty acids, phenolic compounds, and vitamin E) necessary for the healthy functioning of membranes. Since membranes are involved in nearly all processes associated with life-related function, the main underlying mechanism of walnut-improved cardiovascular function is likely based on improving membrane composition and function by providing all of the substrates necessary for membranes, such as cell, mitochondria, Golgi, nucleus, and so on. In addition to endothelial cell function, all other cells and membranes are likely to benefit from walnut consumption, suggesting that incorporating walnuts into the human diet is essential, for example, during higher physical and mental demand, such as exercise, and may mitigate the risk for the development of cardiovascular diseases and compensate for the sedentary lifestyle, especially in those of an older age
Efficacy of Xanomeline and Trospium Chloride in Schizophrenia: Pooled Results From Three 5-Week, Randomized, Double-Blind, Placebo-Controlled, EMERGENT Trials
No full textIn the 5-week, randomized, double-blind, placebo-controlled EMERGENT-1 (NCT03697252), EMERGENT-2 (NCT04659161), and EMERGENT-3 (NCT04738123) trials, xanomeline and trospium chloride (formerly known as KarXT) significantly improved symptoms of schizophrenia and was generally well tolerated. We pooled data from the EMERGENT trials to further characterize the efficacy of xanomeline/trospium and provide sufficient statistical power to analyze responses in participant subgroups. In pooled analyses, xanomeline/trospium significantly improved Positive and Negative Syndrome Scale (PANSS) total score at week 5 versus placebo (least squares mean difference, –9.9; 95% confidence interval, –12.4, –7.3; p \u3c 0.0001; Cohen’s d effect size, 0.65). PANSS subscale and Clinical Global Impression–Severity scores also improved significantly with xanomeline/trospium versus placebo. Subgroup analyses consistently favored xanomeline/trospium over placebo regardless of differences in participant age, sex, race, body mass index, and baseline PANSS total score. These results add to existing evidence demonstrating robust and reliable improvements in symptoms with xanomeline/trospium across a broad spectrum of people with schizophrenia
Tumor Necrosis Factor Receptors and C-C Chemokine Receptor-2 Positive Cells Play an Important Role in the Intraerythrocytic Death and Clearance of Babesia Microti
No full textBabesia microti is an Apicomplexan parasite that infects erythrocytes and causes the tick-transmitted infection, babesiosis. B. microti can cause a wide variety of clinical manifestations ranging from asymptomatic to severe infection and death. Some risk factors for severe disease are well-defined, an immune compromised state, age greater than 50, and asplenia. However, increasing cases of severe disease and hospitalization in otherwise healthy individuals suggests that there are unknown risk factors. The immunopathology of babesiosis is poorly described. CD4+ T cells and the spleen both play a critical role in parasite clearance, but few other factors have been found that significantly impact the course of disease. Here, we evaluated the role of several immune mediators in B. microti infection. Mice lacking TNF receptors 1 and 2, the receptors for TNFα and LTα, had a higher peak parasitemia, reduced parasite killing in infected red blood cells (iRBCs), and delayed parasite clearance compared to control mice. Mice lacking CCR2, a chemokine receptor involved in the recruitment of inflammatory monocytes, and mice lacking NADPH oxidase, which generates superoxide radicals, demonstrated reduced parasite killing but had little effect on the course of parasitemia. These results suggest that TNFR-mediated responses play an important role in limiting parasite growth, the death of parasites in iRBCs, and the clearance of iRBCs, and that the parasite killing in iRBCs is being primarily mediated by ROS and inflammatory monocytes/macrophages. By identifying factors involved in parasite killing and clearance, we can begin to identify additional risk factors for severe infection and newer therapeutic interventions
Mobilization of Endogenous CD34+/CD133+ Endothelial Progenitor Cells by Enhanced External Counter Pulsation for Treatment of Refractory Angina
No full textAdult stem cell therapy via intramyocardial injection of autologous CD34+ stem cells has been shown to improve exercise capacity and reduce angina frequency and mortality in patients with refractory angina (RA). However, the cost of such therapy is a limitation to its adoption in clinical practice. Our goal was to determine whether the less costly, less invasive, and widely accessible, FDA-approved alternative treatment for RA patients, known as enhanced external counterpulsation (EECP), mobilizes endogenous CD34+ stem cells and whether such mobilization is associated with the clinical benefits seen with intramyocardial injection. We monitored changes in circulating levels of CD34+/CD133+ and CD34+/KDR+ cells in RA patients undergoing EECP therapy and in a comparator cohort of RA patients undergoing an exercise regimen known as cardiac rehabilitation. Changes in exercise capacity in both cohorts were monitored by measuring treadmill times (TT), double product (DP) scores, and Canadian Cardiovascular Society (CCS) angina scores between pre- and post-treatment treadmill stress tests. Circulating levels of CD34+/CD133+ cells increased in patients undergoing EECP and were significant (β = −2.38, p = 0.012) predictors of improved exercise capacity in these patients. CD34+/CD133+ cells isolated from RA patients could differentiate into endothelial cells, and their numbers increased during EECP therapy. Our results support the hypothesis that mobilized CD34+/CD133+ cells repair vascular damage and increase collateral circulation in RA patients. They further support clinical interventions that can mobilize adult CD34+ stem cells as therapy for patients with RA and other vascular diseases