Elevated lipoprotein(a) and lipoprotein-associated phospholipase A2 are associated with unfavorable functional outcomes in patients with ischemic stroke

Background The association of lipoprotein(a) [Lp(a)] and stroke functional outcomes was conflicting. The aim of the study was to clarify whether high Lp(a) is associated with unfavorable functional outcomes in patients with ischemic stroke. Methods A total of 9709 individuals from the third China National Stroke Registry cohort were recruited. Plasma level of Lp(a) at admission was measured with enzyme-linked immunosorbent assay. The cut-off was set at the median for Lp(a). Functional outcome was assessed using the modified Rankin scale (mRS) at 3 months and 1 year after ischemic stroke. The association between Lp(a) and functional outcomes was evaluated using a logistic regression model. Results The median age was 63.0 years, and 31.1% participants were women. Patients in higher Lp(a) group had higher incidences of unfavorable functional outcomes at 3 months. In logistic regression model, elevated Lp(a) levels were associated with unfavorable functional outcomes at 3 months (Q4 vs. Q1: odds ratio 1.33, 95% confidence interval 1.11–1.61). Subgroup analysis showed that in the lower Lp-PLA2 group, Lp(a) level was not associated with functional outcomes, but in the higher Lp-PLA2 group, Lp(a) level was significantly associated with functional outcomes. After grouped by different levels of Lp(a) and Lp-PLA2, the Lp(a) high/ Lp-PLA2 high group showed the highest incidence of unfavorable functional outcomes at 3 months and 1 year. Conclusions Elevated Lp(a) level is associated with unfavorable functional outcomes in patients with ischemic stroke. The increment in both Lp(a) and Lp-PLA2 are associated with unfavorable functional outcomes at 3 months and 1 year after ischemic stroke.

Blood, Sweat and Tears: Women as Nurses Nursing Women in the Gynaecology Ward - a Feminist Interpretive Study

<p>This feminist study is an exploration of the subjectivity of women working as nurses within the gynaecological ward. Gynaecology has a long history as a unique area of concern to the health practitioners of any given period. However, recently with the development of modern gynaecology, this specialty has become based on male knowledge and male texts, women either as patients or nurses appear voiceless within this canon. Major texts within nursing mirror a medical construction of gynaecology, with the women involved in the discourse again absent from the literature. To explore the nurses' reality within the gynaecological ward I have undertaken a feminist interpretive study. Feminist research is gaining recognition within nursing and the contribution that such research can make to the development of nursing knowledge is acknowledged within the profession. However, it is within the work of nurse-scholars from Australia that feminist and postmodern ideas are most commonly debated. Their work provides an innovative approach to the exploration of nurses' work. To contribute to this debate I drew on certain specific notions from feminist and postmodern epistemologies to inform my work. These notions of the Other, difference, the body and discourse provided a unique way of viewing the practice of the nurses in this gynaecological setting. These epistemological concepts were then interwoven with feminist strategies to undertake my research. Through the process of feminist praxis, which included my working alongside the nurses and conducting in-depth interviews, three areas of general concern to the nurses emerged. Firstly the relationships, that is their relationships with each other as nurses and with their women patients. Secondly, the difficulties inherent in nurses' practice in this setting due to the nature of the experiences of the women they were nursing. These difficulties arose in relation to two particular situations, nursing women experiencing a mid-trimester termination and nursing women with cancer. Thirdly, the relationship with/in the medical discourse and individual doctors which, according to the nurses, had a major impact on their work. This study contributes to nursing knowledge by providing a forum for the voices of women as nurses, who nurse women in the gynaecological ward, to be heard. Using concepts from both feminist and postmodern theorising enabled the surfacing of the voices of nurses and interpretation of their experiences from a position of embodied reality. The diversity of the practice of nurses and the importance of recognising and working with this diversity became evident. Writing the text has been an important part of this research. Seeing writing as a political act in the way that many feminists do requires careful attention to the written word. Considering our fundamental nursing texts from a feminist perspective shows that many reflect a medical construction of gynaecological conditions and their treatment. Making explicit the voices of women as nurses is an important step in making women visible within the discourse of gynaecology. Nursing and feminism have much to offer each other and share an emancipatory goal of positive action to support and assist people in their lives.</p>

Blood, Sweat and Tears: Women as Nurses Nursing Women in the Gynaecology Ward - a Feminist Interpretive Study

<p>This feminist study is an exploration of the subjectivity of women working as nurses within the gynaecological ward. Gynaecology has a long history as a unique area of concern to the health practitioners of any given period. However, recently with the development of modern gynaecology, this specialty has become based on male knowledge and male texts, women either as patients or nurses appear voiceless within this canon. Major texts within nursing mirror a medical construction of gynaecology, with the women involved in the discourse again absent from the literature. To explore the nurses' reality within the gynaecological ward I have undertaken a feminist interpretive study. Feminist research is gaining recognition within nursing and the contribution that such research can make to the development of nursing knowledge is acknowledged within the profession. However, it is within the work of nurse-scholars from Australia that feminist and postmodern ideas are most commonly debated. Their work provides an innovative approach to the exploration of nurses' work. To contribute to this debate I drew on certain specific notions from feminist and postmodern epistemologies to inform my work. These notions of the Other, difference, the body and discourse provided a unique way of viewing the practice of the nurses in this gynaecological setting. These epistemological concepts were then interwoven with feminist strategies to undertake my research. Through the process of feminist praxis, which included my working alongside the nurses and conducting in-depth interviews, three areas of general concern to the nurses emerged. Firstly the relationships, that is their relationships with each other as nurses and with their women patients. Secondly, the difficulties inherent in nurses' practice in this setting due to the nature of the experiences of the women they were nursing. These difficulties arose in relation to two particular situations, nursing women experiencing a mid-trimester termination and nursing women with cancer. Thirdly, the relationship with/in the medical discourse and individual doctors which, according to the nurses, had a major impact on their work. This study contributes to nursing knowledge by providing a forum for the voices of women as nurses, who nurse women in the gynaecological ward, to be heard. Using concepts from both feminist and postmodern theorising enabled the surfacing of the voices of nurses and interpretation of their experiences from a position of embodied reality. The diversity of the practice of nurses and the importance of recognising and working with this diversity became evident. Writing the text has been an important part of this research. Seeing writing as a political act in the way that many feminists do requires careful attention to the written word. Considering our fundamental nursing texts from a feminist perspective shows that many reflect a medical construction of gynaecological conditions and their treatment. Making explicit the voices of women as nurses is an important step in making women visible within the discourse of gynaecology. Nursing and feminism have much to offer each other and share an emancipatory goal of positive action to support and assist people in their lives.</p>

Abstract 1122‐000042: Demographic and Pharmacological Characteristics of Dementia Patients with Parkinson’s Disease Stratified by Gender

Introduction : Gender differences in dementia patients and Parkinson’s Disease have been investigated extensively; however, factors that contribute to gender differences in Parkinson’s Disease with Dementia patients (PDD) is not fully understood. In this study, we tested the hypothesis that specific, demographic, and pharmacological factors may be associated with men and women patients with PDD, and contribute to gender differences. Methods : Data collected for 5 years from 7594 PDD patients was analyzed using univariate analysis to determine different factors associated with men or women with PDD. Multicollinearity interactions between independent variables in the model were examined using variance inflation factors Results : Overall, 55.22% of the PDD patients were men while 44.77% were women. In the adjusted analysis, Aripiprazole (OR = 0.581, 95% CI, 0.302‐1.118, P = 0.104), ETOH (OR = 0.371, 95% CI, 0.260‐0.531, P<0.001) African American (0.249, 95% CI, 0.088‐0.703, P = 0.009) with PD were more likely to be men. The use of Aripiprazole (OR = 0.195, 95% CI, 0.06‐0.631, P = 0.006), Escitalopram (OR = 0.651, 95% CI, 0.468‐0.906, P = 0.011), and Tobacco (OR = 0.620, 95% CI, 0.444‐0.866, P = 0.005) were associated with women. Conclusions : This study showed that women presented fewer cases of PDD than men. The current study reveals gender differences in PDD patients associated with specific demographic and pharmacological factors

Abstract 1122‐000026: Factors Associated with Gender Differences in Patients with Lewy Body Dementia

Introduction : Several studies have investigated gender differences in patients with Lewy Body Dementia (LBD), however, whether the observed differences are associated with demographic and pharmacological factors is not fully understood. The current study tested the hypothesis that specific demographic or pharmacological factors may contribute to the observed gender difference. Methods : A 5‐year data collected from a regional registry from 608 LBD patients including 332 men and 276 women were analyzed. Factors associated with men and women patients with LBD were determined using the logistic regression model. Multicollinearity was evaluated using variance inflation factors (VIFs), with values greater than five suggestive of multicollinearity Results : The results indicate that Caucasian men (94.3% vs 83.3%) were more likely to present with LBD. In the adjusted analysis, increasing age (OR = 1.042, 95% CI, 1.025‐ 1.058, P ˂ 0.001) was more likely to be associated with women with LBD, while olanzapine (OR = 2.871, 95% CI, 1.902‐4.334, P˂ 0.001), buspirone (OR = 2.388, 95% CI, 1.527‐3.735, P˂ 0.001), escitalopram (OR = 1.444, 95% CI, 1.079‐1.932, P = 0.014) and tobacco use (OR = 1.424, 95% CI, 1.075‐1.887, P = 0.014) were associated with men with LBD Conclusions : More men presented with LBD compared to women. Our findings reveal specific demographic and pharmacological factors that contribute to gender differences among LBD patients.

Diagnostic and the surgical treatment tactics in the rectal mucosa prolapse with the anal sphincter insufficiency

Objective. To improve the results of diagnosis and surgical treatment of rectal mucosa prolapse, complicated by the anal sphincter insufficiency. Materials and methods. Analysis of the diagnosis and surgical treatment results in the rectal mucosa prolapse with the anal sphincter insufficiency was done in 23 patients, ageing 31 - 65 yrs old and the age median (41.5 ± 1.8) yrs old, of them 17 women-patients. Results. There was revealed, that most frequently and in mostly progressive forms the rectal mucosa prolapse with the anal sphincter insufficiency occurs in women, aged more than 36 yrs old. Conclusion. Miniinvasive transanal operations, submucosal injection procedures and sphincteroplasty “end-to-end” were used predominantly, owing less morbidity potency (26.1%), favorable remote functional results - the recurrence rate lowering (4.3%), the fecal incontinence degree lowering (78.6%), and the patients’ quality of life improvement.

Determination of coagulopathy complicating severe preeclampsia and eclampsia with platelet count

Background: Preeclampsia is a dangerous complication which occurs potentially in pregnancy and is characterised by high blood pressure. It effects maternal and perinatal health and is complicated by abnormalities of coagulation. The aim of the study was to determine platelet count which predicted coagulopathy in patients with severe preeclampsia and eclampsia.Methods: Prospective cohort study done in all patients were admitted with diagnosis of severe preeclampsia and eclampsia and admitted for stabilisation. Blood samples were collected from all patients for detecting bleeding, clotting time, electrolytes, urea and creatinine, liver functions tests, full blood count, platelet count, prothrombin time, activated partial thromboplastin time and plasma fibrinogen level in 100 patients in total. Using chi square test, univariate analysis was conducted.Results: Out of 100 women patients, 70 (70%) patients had severe preeclampsia and 30 (30%) patients had eclampsia out of which 15 patients had thrombocytopenia. The incidence of thrombocytopenia among patients was 16.6%. Biochemical coagulopathy was noted in 7%. Patients with severe preeclampsia had platelet count of 185000±61289 per µl, PT was 13.52±1.48 sec, APTT was 34.52±2.49 sec and fibrinogen was 3.16±0.22 g/dl. Patients with eclampsia (with thrombocytopenia) had platelet count of 79528±14897 per µl, PT was 19.25±5.28 sec, APTT was 37.08±5.33 sec and fibrinogen was 2.67±0.53 g/dl. Thrombocytopenia was complicated with eclampsia and it was associated with biochemical coagulopathy which made the condition more severe.Conclusions: 80000 cells/µl is the thrombocytopenia level which is considered to be critical in severe preeclampsia and eclampsia. This will help to reduce maternal and perinatal mortality and morbidity rates.

Dependence of Heart Rate Variability Indices on the Mean Heart Rate in Women with Well-Controlled Type 2 Diabetes

Heart rate variability (HRV) is a method used to evaluate the presence of cardiac autonomic neuropathy (CAN) because it is usually attributed to oscillations in cardiac autonomic nerve activity. Recent studies in other pathologies suggest that HRV indices are strongly related to mean heart rate, and this does not depend on autonomic activity only. This study aimed to evaluate the correlation between the mean heart rate and the HRV indices in women patients with well-controlled T2DM and a control group. HRV was evaluated in 19 T2DM women and 44 healthy women during basal supine position and two maneuvers: active standing and rhythmic breathing. Time-domain (SDNN, RMSSD, pNN20) and frequency-domain (LF, HF, LF/HF) indices were obtained. Our results show that meanNN, age, and the maneuvers are the main predictors of most HRV indices, while the diabetic condition was a predictor only for pNN20. Given the known reduced HRV in patients with T2DM, it is clinically important that much of the HRV indices are dependent on heart rate irrespective of the presence of T2DM. Moreover, the multiple regression analyses evidenced the multifactorial etiology of HRV.