Sex, Gender, and Women's Heart Health: How Women's Heart Programs Address the Knowledge Gap.

This article aims to bridge existing knowledge gaps that impact clinical cardiovascular care and outcomes for women in Canada. The authors discuss various aspects of women's heart health, emphasizing the efficacy of multidisciplinary care in promoting women's well-being. The article also identifies the impact of national women's heart health campaigns and the value of peer support in improving outcomes. The article addresses the particular risks that women face, such as pregnancy-related complications and hormone replacement therapy, all of which are associated with cardiovascular events, and highlights the differences in ischemic symptoms between men and women. Despite improvements in acute event outcomes, challenges persist in accessing timely ambulatory care, particularly for women. Canada has responded to these challenges by introducing Women Heart Programs, which offer tailored programs, support groups, and specialized testing. However, these programs remain few in number and are found only in urban settings. Overall, this review identifies sex and gender factors related to women's heart health, underscoring the importance of specialized programs and multidisciplinary care in improving women's cardiovascular health.

Cet article vise à répondre aux incertitudes actuelles qui se répercutent sur les soins cardiovasculaires et les issues cliniques chez les femmes au Canada. Les auteurs abordent différents aspects de la santé cardiaque des femmes, mettant l'accent sur l'efficacité des soins multidisciplinaires pour améliorer le bien-être des femmes. L'article présente également l'effet des campagnes nationales sur la santé cardiaque des femmes et l'importance de l'entraide entre collègues pour améliorer les résultats. L'article traite des risques particuliers touchant les femmes, comme les complications liées à la grossesse et l'hormonothérapie substitutive, qui sont toutes associées à des événements cardiovasculaires, et il souligne les différences entre les hommes et les femmes pour ce qui est des symptômes ischémiques. Bien que des améliorations aient été observées quant à l'issue des événements aigus, des difficultés persistent sur le plan de l'accès rapide à des soins ambulatoires, surtout pour les femmes. Le Canada a répondu à ces difficultés en créant des programmes pour la santé cardiaque des femmes, qui offrent des services adaptés, des groupes de soutien et des analyses spécialisées. Cependant, ils sont encore peu nombreux et accessibles seulement en milieu urbain. Dans l'ensemble, cette analyse définit les facteurs liés au sexe et au genre qui interviennent dans la santé cardiaque des femmes, soulignant l'importance de mettre en place des programmes spécialisés et des soins multidisciplinaires pour améliorer la santé cardiovasculaire des femmes.

One-Year Prospective Follow-up of Women With INOCA and MINOCA at a Canadian Women's Heart Centre.

BACKGROUND: Many women with cardiac chest pain and ischemia or myocardial infarction have no obstructive coronary artery disease (INOCA or MINOCA). Studies suggest that these patients have a decreased quality of life and are at increased risk of cardiovascular events. Our study reports 1-year quality of life, frequency of angina, and outcomes following entry into a multidisciplinary Women's Heart Centre (WHC). METHODS: Patients with INOCA and MINOCA completed questionnaires on baseline demographics and clinical presentation. At 1-year, frequency of chest pain, quality of life, depression and anxiety symptoms, and cardiovascular outcomes were reported and compared with baseline. RESULTS: A total of 154 women with nonobstructive coronary artery disease were included in this study (112 patients with INOCA and 42 with MINOCA). Median age was 59 years, and the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). At baseline, 64% of patients with INOCA and 43% of patients with MINOCA did not have specific diagnoses. Following investigations in the WHC, 71.4% of patients with INOCA established a new or a changed diagnosis (most common was coronary microvascular dysfunction at 68%), whereas 60% of patients with MINOCA established new or changed diagnoses (the most common of which was coronary vasospasm at 60%). At 1-year, participants had significantly decreased chest pain, improved quality of life, and improved mental health. CONCLUSIONS: A multidisciplinary WHC significantly increases the yield of a specific diagnosis in patients with INOCA and MINOCA. Further, attending a WHC could significantly improve the clinical and psychological outcomes of women with INOCA and MINOCA.

Rituximab for Adults With Multi-Drug Resistant Focal Segmental Glomerulosclerosis: A Case Series and Review of the Literature.

Background: Adults with primary focal segmental glomerulosclerosis (FSGS) are frequently resistant to multiple immunosuppressive agents, which is associated with ongoing complications of nephrotic syndrome and a high risk of progression to end-stage renal disease (ESRD). Rituximab, a monoclonal antibody against the B cell CD20 antigen, has shown some preliminary evidence in treating nephrotic syndrome. Objectives: Describe the usage and the efficacy of rituximab for adults with FSGS in British Columbia (BC) (Canada) and perform a literature review of multi-immunosuppressive drug resistant FSGS in adult patients treated with rituximab to estimate the overall response rate. Design: Case series report and a literature review. Patients: For the case-series, all BC patients who received rituximab for a diagnosis of primary FSGS were included. The literature review included all cases of immunosuppressive-resistant FSGS patients treated with rituximab. We excluded transplant and pediatric patients in both groups. Methods: We describe all cases of adults with native-kidney FSGS resistant to conventional immunosuppressive medications from our provincial health database who were treated with rituximab from 2014 to 2018. A review of the existing literature was performed via PubMed, MEDLINE, and Embase using the following keywords: rituximab, focal segmental glomerulosclerosis, and FSGS up to August 2019. Results: We characterize four immunosuppressive-resistant FSGS patients who were treated with rituximab as part of our provincial program, all of whom showed a response to rituximab with a sustained remission. We found 29 specific cases in the literature of adults with native-kidney FSGS treated with rituximab after being resistant to other immunosuppressive medications, of whom 15 cases showed a response to rituximab. This has increased the total response rate from 15/29 (52%) to 19/33 (58%). Limitations: Literature on this topic is coming predominantly from case series. Prospective trials are needed to confirm efficacy, tolerability, and duration of remission. Conclusions: Due to the low number of currently reported cases and variable response rates, these four cases provide critical data to generate a more accurate understanding of the role of rituximab in adults with resistant FSGS. Adding these results to the confirmed literature cases of multiple-immunosuppressive-resistant FSGS patients treated with rituximab results in a total remission rate of 19/33 cases.

Contexte: Il arrive fréquemment que les adultes atteints d'une glomérulosclérose segmentaire focale primaire (focal segmental glomerulosclerosis­FSGS) soient résistants à de multiples agents immunosuppresseurs. Cette résistance est associée à des complications du syndrome néphrotique et à un risque élevé de progression vers l'insuffisance rénale terminale (IRT). Le rituximab, un anticorps monoclonal contre l'antigène CD20 des lymphocytes B, a montré quelques résultats préliminaires prometteurs pour le traitement du syndrome néphrotique. Objectifs: Décrire l'utilisation du rituximab et son efficacité chez les adultes atteints de FSGS en Colombie-Britannique (C.-B.) (Canada) et estimer le taux de réponse global par le biais d'une revue de la littérature portant sur les cas de FSGS résistante à plusieurs agents immunosuppresseurs chez des patients adultes traités par rituximab. Conception de l'étude: Rapport de série de cas et revue de la littérature. Sujets: Ont été inclus pour la série de cas tous les patients britanno-colombiens qui recevaient du rituximab pour un diagnostic de FSGS primaire. La revue de la littérature a porté sur tous les cas de patients atteints de FSGS résistante aux immunosuppresseurs et traités par rituximab. Les patients transplantés et les enfants ont été exclus des deux groupes. Méthodologie: Nous décrivons tous les cas répertoriés d'adultes atteints d'une FSGS résistante aux immunosuppresseurs conventionnels dans un rein natif et traités par rituximab dans la base de données de santé provinciale entre 2014 et 2018. Une revue de la littérature existante a été réalisée dans PubMed, Medline et Embase en utilisant les mots-clés suivants: Rituximab, focal segmental glomerulosclerosis (glomérulosclérose segmentaire focale) et FSGS jusqu'en août 2019. Résultats: Nous caractérisons les cas de quatre patients atteints de FSGS résistante aux immunosuppresseurs et traités par rituximab dans le cadre de notre program provincial; tous ont répondu au rituximab avec une rémission durable. Dans la littérature, nous avons répertorié 29 cas particuliers d'adultes atteints d'une FSGS de rein natif ayant été traités par rituximab après avoir été résistants à d'autres médicaments immunosuppresseurs. De ces 29 cas, 15 ont répondu au rituximab. Le taux de réponse total est ainsi passé de 52 % (15/29) à 58 % (19/33). Limites: La littérature sur ce sujet provient principalement de séries de cas. Des essais prospectifs sont nécessaires pour confirmer l'efficacité, la tolérance et la durée de la rémission. Conclusion: Compte tenu du faible nombre de cas actuellement signalés et des taux de réponse variables, ces quatre cas fournissent des données cruciales qui permettent de mieux comprendre le rôle du rituximab chez les adultes atteints de FSGS résistante aux agents immunosuppresseurs. L'ajout de ces résultats confirmés dans la littérature aux cas de patients atteints de FSGS résistante à plusieurs immunosuppresseurs traités par rituximab a entraîné un taux de rémission total de 19 cas sur 33.

Microvessel density in follicular cysts, keratocystic odontogenic tumours and ameloblastomas.

PURPOSE: Multicystic ameloblastoma is a benign epithelial odontogenic tumor that exhibits a more aggressive behavior than follicular cyst and keratocystic odontogenic tumor (KCOT). The aim of this study was to perform an immunohistochemical evaluation of the mean microvessel density (MVD) effect on clinical behavior of odontogenic lesions and to determine whether peritumoral or intratumoral MVD has a more prominent role in clinical behavior of odontogenic lesions. METHODS: In a descriptive-analytic cross-sectional study, 45 paraffin blocks of mentioned lesions were selected and stained immunohistochemically with CD34. Mean MVD, peritumoral and intratumoral MVD for each odontogenic lesion was investigated and compared with each other. ANOVA and Kruskal Wallis were used for the statistical analysis of the results. RESULTS: Mean MVD was 40.8 ± 15.9, 25.3 ± 5.4, and 9.4 ± 3.52 in ameloblastoma, keratocystic odontogenic tumor , and follicular cyst, respectively. Mean MVD difference between the above mentioned lesions was statistically significant. (p < 0.001) In all the odontogenic lesions, Intratumoral MVD was higher than peritumoral (pericystic) areas. (p = 0.001) CONCLUSION: There was an increase of mean MVD in multicystic ameloblastoma in comparison to keratocystic odontogenic tumor and follicular cyst and it may be concluded as one of the main factors in multicystic ameloblastoma aggressive behavior. Intratumoral (intracystic MVD) has a more prominent role in growth and clinical behavior of mentioned odontogenic lesions. This supports the hypothesis that the early stages of growth and development of follicular cyst, KCOT and multicystic ameloblastoma may share some similarities regarding angiogenesis.