Migraine Headache and Ischemic Stroke Risk: An Updated Meta-analysis

Background

Observational studies, including recent large cohort studies that were unavailable for prior meta-analysis, have suggested an association between migraine headache and ischemic stroke. We performed an updated meta-analysis to quantitatively summarize the strength of association between migraine and ischemic stroke risk.

Methods

We systematically searched electronic databases, including MEDLINE and EMBASE, through February 2009 for studies of human subjects in the English language. Study selection using a priori selection criteria, data extraction, and assessment of study quality were conducted independently by reviewer pairs using standardized forms.

Results

Twenty-one (60%) of 35 studies met the selection criteria, for a total of 622,381 participants (13 case-control, 8 cohort studies) included in the meta-analysis. The pooled adjusted odds ratio of ischemic stroke comparing migraineurs with nonmigraineurs using a random effects model was 2.30 (95% confidence interval [CI], 1.91-2.76). The pooled adjusted effect estimates for studies that reported relative risks and hazard ratios, respectively, were 2.41 (95% CI, 1.81-3.20) and 1.52 (95% CI, 0.99-2.35). The overall pooled effect estimate was 2.04 (95% CI, 1.72-2.43). Results were robust to sensitivity analyses excluding lower quality studies.

Conclusions

Migraine is associated with increased ischemic stroke risk. These findings underscore the importance of identifying high-risk migraineurs with other modifiable stroke risk factors. Future studies of the effect of migraine treatment and modifiable risk factor reduction on stroke risk in migraineurs are warranted.     

Development of a risk score for colorectal cancer in men

Background

Colorectal cancer is a common and preventable disease for which screening rates remain unacceptably low.

Methods

We developed a risk scoring system for the development of colorectal cancer among participants in the Physician’s Health Study, a prospective cohort of 21,581 US male physicians who were all free of cancer. Predictors of colorectal cancer were self-reported and identified from the baseline questionnaire. Logistic regression was used to determine the independent predictors of incident colorectal cancer over the follow-up period. Risk scores were created from the sum of the odds ratios of the final predictors and used to divide the cohort into categories of increasing relative risk.

Results

During 20 years of follow-up, 381 cases of colon cancer and 104 cases of rectal cancer developed in the cohort. Age, alcohol use, smoking status, and body mass index were independent significant predictors of colorectal cancer. The point scores were used to define 10 risk groups. Those in the highest risk group (9-10 points) had an odds ratio of 15.29 (6.19-37.81) for colorectal cancer compared with those with the lowest risk. We further stratified scores into 3 risk classes. Compared with those at the lowest relative risk, the odds ratio for colorectal cancer was 3.07 (2.46-3.83) in the intermediate risk group and 5.75 (4.44-7.44) in the highest risk group.

Conclusions

We developed a simple scoring system for colorectal cancer that identifies men at increased relative risk on the basis of age and modifiable factors. This tool should be validated in other populations.     

Temporal changes in the prevalence of diabetes, impaired fasting glucose and its associated risk factors in the rural area of Baluchistan

Aims

To observe temporal changes in the prevalence of diabetes, impaired fasting glucose and its associated risk factors in the rural area of Baluchistan province of Pakistan according to American Diabetes Association criteria by comparing the two surveys done in 2002 and 2009.

Methodology

This community based survey of 1264 subjects aged 25 years and above was conducted from February 2009 to February 2010 in sixteen villages of southern Baluchistan. The temporal changes were assessed in comparison with a similar survey conducted seven years previously. Data from 2002 survey was also re-analyzed according to the latest ADA criteria.

Results

A two-fold increase in the prevalence of diabetes (from 7.2% to 14.2%) was seen in 2009 survey and the prevalence of impaired fasting glucose also increased significantly (6.5-11.0%). An important finding was the number of hypertensives and subjects with positive family history of diabetes also increased significantly (p < 0.000) from the previous survey.

Conclusion

Coordinated National Programs for primary prevention to counteract the increasing prevalence of diabetes are the need of time. Further large scale studies with proper risk factor assessment are needed to ascertain the reasons of rising prevalence of glucose intolerance.     

Independent prognostic value of elevated high-sensitivity C-reactive protein in chronic heart failure

Background

The serum concentration of C-reactive protein (CRP) is mildly elevated in patients with chronic congestive heart failure (CHF), but this level falls well within the range found in healthy subjects. Standard clinical assays for CRP lack sensitivity within the low reference range and thus cannot be used effectively for routine clinical risk prediction. Because assays for high-sensitivity CRP (hsCRP) are now available, we can measure hsCRP to determine its predictive value for the prognosis of patients with CHF.

Methods

Serum levels of hsCRP in 108 patients with CHF and left ventricular ejection fraction (LVEF) <50% were examined. Major adverse cardiac events (death, heart transplantation, or hospitalization with worsening heart failure) during a median follow-up period of 403 days were determined.

Results

The concentrations of hsCRP in this study population were significantly increased with the severity of CHF. In a multivariate analysis, LVEF and serum levels of hsCRP were independent significant predictors for adverse outcomes in these patients (hazard ratio, 3.714, P = .024, and hazard ratio, 2.584, P = .047, respectively). However, hsCRP was minimally correlated with LVEF (r = −0.167, P = .084). Further analysis indicated that hsCRP might identify a different high-risk group and could improve risk stratification beyond that of LVEF.

Conclusions

These findings suggest that an elevated level of hsCRP is an independent predictor of prognosis in CHF and can provide additional prognostic information for the risk stratification and treatment in patients with chronic CHF.     

Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women

Background

Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid factor (RF) seropositive versus seronegative RA are still unclear.

Methods

We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses’ Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.

Results

The RR of RA was significantly elevated among current (RR 1.43 [95% confidence interval 1.16-1.75]) and past smokers (RR 1.47 [95% confidence interval 1.23-1.76]), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.

Conclusions

In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.     

Risk Factors for Heart Failure: A Population-Based Case-Control Study

Background

The relative contribution of risk factors to the development of heart failure remains controversial. Further, whether these contributions have changed over time or differ by sex is unclear. Few population-based studies have been performed. We aimed to estimate the population attributable risk (PAR) associated with key risk factors for heart failure in the community.

Methods

Between 1979 and 2002, 962 incident heart failure cases in Olmsted County were age and sex-matched to population-based controls using Rochester Epidemiology Project resources. We determined the frequency of risk factors (coronary heart disease, hypertension, diabetes mellitus, obesity, and smoking), odds ratios, and PAR of each risk factor for heart failure.

Results

The mean number of risk factors for heart failure per case was 1.9 ± 1.1 and increased over time (P <.001). Hypertension was the most common (66%), followed by smoking (51%). The prevalence of hypertension, obesity, and smoking increased over time. The risk of heart failure was particularly high for coronary disease and diabetes with odds ratios (95% confidence intervals) of 3.05 (2.36-3.95) and 2.65 (1.98-3.54), respectively. However, the PAR was highest for coronary disease and hypertension; each accounted for 20% of heart failure cases in the population, although coronary disease accounted for the greatest proportion of cases in men (PAR 23%) and hypertension was of greatest importance in women (PAR 28%).

Conclusion

Preventing coronary disease and hypertension will have the greatest population impact in preventing heart failure. Sex-targeted prevention strategies might confer additional benefit. However, these relationships can change, underscoring the importance of continued surveillance of heart failure.     

Prevalence and long-term glucose metabolism evolution of post-transplant diabetes mellitus in Chinese renal recipients

Aim

To assess the prevalence and predictors of post-transplant diabetes mellitus (PTDM) in Chinese renal recipients and describe their long-term evolution of glucose metabolism.

Methods

887 non-diabetic Chinese adult renal recipients were studied retrospectively, with a median follow-up of 7 years. PTDM patients were categorized into transient PTDM and permanent PTDM. The cumulative incidence and risk factors of PTDM were estimated by Kaplan-Meier and Cox regression.

Results

The cumulative incidence of PTDM at 3 months, 1, 3, 5, 10, 15 and 20 years post-transplant was 10.4%, 11.4%, 13.4%, 15.2%, 22.7%, 27.9% and 38.3%, respectively. 61.9% of PTDM cases were diagnosed within the first three months and 61.6% of them developed persistent diabetes in the future. Risk factors for all PTDM included older age, body mass index (BMI) ≥ 25 kg/m², triglycerides ≥ 1.5 mmol/L, rejection, the use of tacrolimus and diltiazem. The predictors of permanent PTDM included age >50 years (RR = 2.322, 95% CI 1.255-4.296, P = 0.007), BMI ≥ 25 kg/m² (RR = 1.699, 95% CI 1.014-2.846, P = 0.044) and the use of tacrolimus (RR = 1.835, 95% CI 1.181-2.851, P = 0.007).

Conclusions

Patients were most susceptible to PTDM within the first three months post-transplant and more than half of them developed persistent diabetes in the future. Age >50 years, overweight and tacrolimus application were risk factors for both PTDM and permanent PTDM.     

Alteraciones del metabolismo óseo en 100 pacientes con enfermedad inflamatoria intestinal

Objectives

To evaluate the prevalence of osteopenia and osteoporosis in patients with inflammatory bowel disease (IBD) and to study the factors involved in their pathogenesis.

Methods

One hundred consecutive patients with IBD (57 women, mean age 41 years) were included in this study. Data were collected about their life habits, disease characteristics of medication use (mainly corticosteroids). Bone turnover markers were analyzed and the presence of osteoporosis or osteopenia was assessed with total hip and lumbar spine bone densitometry (DXA).

Results

Osteopenia percentages ranged from 37% (t-score measured by lumbar spine DXA) to 39% (hip DXA t-score). The prevalence of osteoporosis ranged from 2% (t-score measured by hip DXA) to 15% (lumbar spine DXA t-score). In the multivariate analysis, diagnosis of Crohn's disease (vs. ulcerative colitis; odds ratio 2.9, 95% CI 1-8.7) and the number of flares controlled by the cumulative dose of steroids (number of flares ≥3: odds ratio 8.7; 95%CI 1.6-45) were associated with a higher risk of osteopenia/osteoporosis. None of the analytical parameters significantly correlated with bone mineral density values.

Conclusions

The prevalence of osteopenia/osteoporosis is higher in patients with IBD (mainly those with Crohn's disease) than in the general population. Changes in bone metabolism seem to be more closely related to the inflammatory activity of IBD than to the steroid dose per se. Bone turnover markers did not correlate with the presence of osteopenia and osteoporosis.     

Monosensitization and polysensitization in allergic rhinitis

Background

Polysensitization is common in patients with allergic rhinitis (AR) and may affect clinical feature. However, there are patients who remain monosensitized.

Objective

This cross-sectional study aimed at evaluating a large cohort of AR patients to define the percentage and the features of mono- and poly-sensitized subjects.

Methods

This observational cross-sectional study included a large group of AR patients: 2415 subjects (1958 males, mean age 24.6 ± 5 years) were consecutively evaluated. Symptom severity, type and number of sensitizations, and AR duration were considered.

Results

621 patients (25.7%) were monosensitized: 377 to Parietaria, 194 to house dust mites, 19 to birch, 17 to grasses, 12 to molds, 2 to olive, and 1 to cypress. There was no difference between mono- and polysensitized patients concerning the duration of rhinitis (6 ± 2.14 years vs 6 ± 3.7).Severity of symptoms was higher in polysensitized patients than in monosensitized (p < 0.05); in addition, there was a difference among monosensitized patients: Parietaria-allergy induces the most severe symptoms.

Conclusion

This study conducted in a large AR population might suggest that monosensitized and polysensitized AR patients could constitute two different categories. In addition, the specific type of allergy may condition the clinical feature.     

Depressive symptoms and poor social support have a synergistic effect on event-free survival in patients with heart failure

Background

Depressive symptoms and poor social support are predictors of increased morbidity and mortality in patients with heart failure (HF). However, the combined contribution of depressive symptoms and social support event-free survival of patients with HF has not been examined.

Objective

To compare event-free survival in 4 groups of patients with HF stratified by depressive symptoms and perceived social support (PSS).

Method

A total of 220 patients completed the Beck Depression Inventory-II and the Multidimensional Perceived Social Support Scale and were followed for up to 4 years to collect data on death and hospitalizations.

Results

Depressive symptoms (hazard ratio = 1.73, P = .008) and PSS (hazard ratio = 1.51, P = .048) were independent predictors of event-free survival. Depressed patients with low PSS had 2.1 times higher risk of events than non-depressed patients with high PSS (P = .003).

Conclusion

Depressive symptoms and poor social support had a negative additive effect on event-free survival in patients with HF.     

Evaluation of a scoring scheme, including proinsulin and the apolipoprotein B/apolipoprotein A1 ratio, for the risk of acute coronary events in middle-aged men: Uppsala Longitudinal Study of Adult Men (ULSAM)

Background

In recent years, the importance of circulating levels of proinsulin and apolipoproteins as risk factors for myocardial infarction (MI) has been highlighted. The aims of the current study were to investigate whether introduction of these new markers of coronary risk could improve the performance of a risk prediction score and to compare this new score with traditional scoring schemes, such as the Framingham Study and the Prospective Cardiovascular Munster (PROCAM) Study schemes.

Methods

From 1970 to 1973 all 50-year-old men in Uppsala, Sweden, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease (the Uppsala Longitudinal Study of Adult Men [ULSAM] cohort). The current study investigated metabolic characteristics at baseline and the incidence of fatal and nonfatal MI (n = 251) during 28.7 years of follow-up in 1108 men who were free of coronary heart disease at baseline.

Results

The risk prediction score was derived from one half of the population sample from the ULSAM cohort and included systolic blood pressure, smoking, family history of MI, serum proinsulin, and the ratio between apolipoprotein B and apolipoprotein A1.The score was highly predictive for future MI (hazard ratio, 1.77 for a 1 SD increase; 95% CI, 1.49 to 2.10, P < .0001) in the other half of the population that was not used for generating the score. The ULSAM score performed slightly better than the Framingham and PROCAM scores (evaluated as areas under the receiver operating curves; Framingham, 61%; PROCAM, 63%; ULSAM, 66%; P = .08).

Conclusions

A risk prediction score for MI including proinsulin and the ratio between apolipoprotein B and apolipoprotein A1 was developed in middle-aged men. This score was highly predictive for future fatal and nonfatal MI and proved to be at least as good as the Framingham and the PROCAM scores, being based on traditional risk factors.     

Necessities of Interferon Therapy in Elderly Patients with Chronic Hepatitis C

Background

The significance of antiviral therapy for elderly patients with chronic hepatitis C virus (HCV) infection has not been elucidated.

Patients and Methods

Among 5645 patients with HCV-related chronic liver disease, the prognosis of 1917 elderly patients aged 60 years or more was analyzed. A total of 454 patients underwent interferon (IFN) therapy. By using multivariate analysis, carcinogenesis and survival were analyzed according to initial findings.

Results

At 10 and 15 years, cumulative survivals in untreated elderly patients were 90.7% and 72.7% in the high platelet (≥150,000/mm³) group, 78.6% and 47.8% in the intermediate (100,000-149,000/mm³) group, and 52.5% and 25.0% in the low platelet group (<100,000/mm³), respectively. At 5 and 10 years, hepatocarcinogenesis rates in the intermediate and low platelet groups were 10.9% and 21.6% in the IFN group (N = 217) and 19.5% and 43.0% in the untreated group (N = 459), respectively (P = .0005). IFN independently decreased carcinogenesis risk with a hazard ratio of 0.56 (P = .035). In the high platelet group, 5- and 10-year carcinogenesis rates were 3.7% and 8.3% in the IFN-treated group (N = 228) and 5.1% and 14.0% in the untreated group (N = 585), respectively (P = .69). IFN treatment significantly increased cumulative survivals in the lower platelet subgroup (P = .0001) but did not affect the higher platelet subgroup (P = .08). IFN was independently associated with a longer survival in the lower platelet subgroup (hazard ratio 2.33, P = .005).

Conclusion

In elderly patients with chronic HCV, IFN for a subgroup with intermediate and low platelet counts had significant advantages in regard to hepatocarcinogenesis and survival.     

Elevated resting heart rate is associated with greater risk of cardiovascular and all-cause mortality in current and former smokers

Background

Elevated resting heart rate is associated with mortality in general populations. Smokers may be at particular risk. The association between resting heart rate (RHR), smoking status and cardiovascular and total mortality was investigated in a general population.

Methods

Prospective study of 16,516 healthy subjects from the Copenhagen City Heart Study. 8709 deaths, hereof 3821 cardiovascular deaths, occurred during 33 years of follow-up.

Results

In multivariate Cox models with time-dependent covariates RHR was significantly associated with both cardiovascular and total mortality. Current and former smokers had, irrespective of tobacco consumption, greater relative risk of elevated RHR compared to never smokers. The relative risk of all-cause mortality per 10 bpm increase in RHR was (95% CI): 1.06 (1.01-1.10) in never smokers, 1.11 (1.07-1.15) in former smokers, 1.13 (1.09-1.16) in moderate smokers, and 1.13 (1.10-1.16) in heavy smokers. There was no gender difference. The risk estimates for cardiovascular and all-cause mortality were essentially similar.In univariate analyses, the difference in survival between a RHR in the highest (> 80 bpm) vs lowest quartile (< 65 bpm) was 4.7 years in men and 3.6 years in women. In multivariate analyses, the difference was about one year in never smokers and about two years in current and former smokers.

Conclusions

In a healthy population resting heart rate is associated with total and cardiovascular mortality. Elevated resting heart rate is associated with greater risk in subjects with a history of smoking than in never smokers.     

Heart rate turbulence and other autonomic risk markers for arrhythmia risk stratification in dilated cardiomyopathy

Background

Noninvasive arrhythmia risk stratification in patients with nonischemic dilated cardiomyopathy (DCM) using autonomic markers have yielded disappointing results. Heart rate turbulence is a new method to assess cardiac autonomic function.

Aim

The aim of the study was to compare the predictive value of heart rate turbulence with those of conventional autonomic risk markers for ventricular tachyarrhythmic events in patients with DCM.

Methods

The predictive value of heart rate turbulence, baroreflex sensitivity (phenylephrine method), and heart rate variability was assessed in patients with symptomatic congestive heart failure due to DCM who were in sinus rhythm and had a 24-hour Holter recording. Patients were followed for a combined end point of ventricular tachyarrhythmic events.

Results

A total of 114 patients (mean left ventricular ejection fraction, 28 ± 11%), included in the Frankfurt DCM database between 1996 and 2000, fulfilled the criteria for inclusion in this study. Determinate test results were obtained for heart rate variability in 98%, for baroreflex sensitivity in 90%, and for heart rate turbulence in 75% of patients (P = .008). Correlation between the different autonomic markers were only modest (r values, 0.36-0.43). During a follow-up of 22 ± 17 months, an end point event occurred in 15 patients. On univariate analysis, left ventricular ejection fraction and baroreflex sensitivity were significant predictors of arrhythmic events. On multivariate analysis, only baroreflex sensitivity remained an independent predictor (χ² = 3.17; P = .07).

Conclusion

Reliable analysis of heart rate turbulence is possible in approximately 75% of eligible patients with DCM. Whereas blunted baroreflex sensitivity is a predictor of arrhythmic events, heart rate variability and turbulence do not yield predictive power in these patients.     

Kidney disease, Framingham risk scores, and cardiac and mortality outcomes

Background

The Framingham equations were developed to predict incident coronary heart disease. It remains unknown how the presence of chronic kidney disease affects their performance.

Methods

Individuals without preexisting cardiovascular disease aged 45 to 74 years from the Atherosclerosis Risk in Communities and Cardiovascular Health Studies were analyzed. Using sex- and race-specific Cox models, we evaluated the 5-year risk of coronary heart disease and mortality events associated with both chronic kidney disease and Framingham risk score, the absolute risk of events caused by kidney disease, and model discrimination.

Results

Among 15,717 subjects, 756 (4.8%) had kidney disease. The Framingham risk score independently predicted cardiac and mortality events in all subgroups, whereas kidney disease predicted events in all subgroups except cardiac events in white women. After adjustment for traditional risk factors, the increase in cardiac and mortality events per 1000 person-years attributable to kidney disease was 4.3 and 13.7 for white men, 16.1 and 40.5 for African American men, 1.2 and 5.8 for white women, and 13.6 and 14.2 for African American women, respectively. This represented an additional 17,000 and 12,000 cardiac events and 63,000 and 19,000 deaths per year among whites and African Americans, respectively. Mortality rates attributable to kidney disease, diabetes, and smoking were comparable. Accounting for kidney disease improved discrimination for only mortality outcomes in white men and African American women.

Conclusions

Chronic kidney disease in a community-based population is an important predictor of cardiac and mortality events, particularly in African Americans, but it does not improve discrimination of Framingham equations.     

Racial disparity in long-term mortality rate after hospitalization for myocardial infarction: the Atherosclerosis Risk in Communities study

Background

The underlying reasons why African American patients have a significantly higher mortality rate than European American patients after a myocardial infarction (MI) remain unclear. This study examined the racial disparity in mortality rates after MI and possible explanatory factors.

Methods

A prospective analysis was conducted within the Atherosclerosis Risk in Communities (ARIC) study, a community-based study of 15,792 middle-aged adults. From 1987 to 1998, 642 patients (471 European American and 171 African American) hospitalized for MI without prior history of MI were identified. Of these 642 patients, 129 (82 European American and 47 African American) died during follow-up.

Results

Cox proportional hazard models were used to analyze the racial difference in mortality rate after MI. After adjusting for age and sex, the relative hazard (RH) comparing African American patients to European American patients was 1.80 (95% CI, 1.24-2.61). The RH decreased after adjusting for vascular risk factors (1.29; 95% CI, 0.83-2.00), socioeconomic position (1.31; 95% CI, 0.83-2.09), severity of MI (1.60; 95% CI, 1.05-2.45), and treatment (1.36; 95% CI, 0.92-2.00). In the final model, which included all factors aforementioned, the RH for race was 1.00 (95% CI, 0.56-1.77).

Conclusions

Our findings suggested that vascular risk factors, socioeconomic position, and treatment play major roles in the racial disparity in mortality rate after MI.     

Ablation of left atrial tachycardia with cycle length alternans after atrial fibrillation ablation: significance of fractionated electrogram mapping

Introduction

Atrial tachycardia (AT) with cycle length alternans occurring after atrial fibrillation ablation has not been previously described.

Methods

Among 66 patients with left AT, stable AT with 2 alternating cycles was registered in 5 cases. Activation mapping of both alternating cycles was performed in all 5 patients. Entrainment and fractionated electrogram mappings were also carried out.

Results

Among 10 AT cycles, activation maps suggested underlying mechanism of 5 cycles (50%) in 3 patients. Entrainment pacing was helpful in 2 patients (confirmed mechanism of 2 AT cycles). Catheter ablation successfully terminated AT in all 5 patients: ablation of sites with fractionated potentials in 4 patients and mitral isthmus ablation in 1 patient.

Conclusion

Consecutive activation mapping of both AT cycles is feasible for mechanism determination in some patients. The results of our small study suggest that fractionated electrogram-guided ablation might be a reasonable approach for termination of this type of AT.     

Comparison of 5 methods of QT interval measurements on electrocardiograms from a thorough QT/QTc study: effect on assay sensitivity and categorical outliers

Introduction

We studied moxifloxacin-induced QT prolongation and proportion of categorical QTc outliers when 5 methods of QT measurement were used to analyze electrocardiograms (ECGs) from a thorough QT study.

Methods

QT interval was measured by the threshold, tangent, superimposed median beat, automated global median beat, and longest QT methods in a central ECG laboratory in 2730 digital ECGs from 39 subjects during placebo and moxifloxacin treatment.

Results

All 5 methods were able to demonstrate statistically significant moxifloxacin-induced QTcF prolongation. However, lower bound of 95% 1-sided confidence interval of QTcF prolongation did not exceed 5 milliseconds with the longest QT method. More QTcF outliers were observed with the longest QT and tangent methods, whereas the other 3 methods were comparable. QTcF values greater than 500 milliseconds were observed only with moxifloxacin by the tangent method, and with moxifloxacin and placebo by the longest QT method.

Conclusion

The method of QT measurement must be considered when interpreting individual thorough QT/QTc studies.     

L’hormone antimüllérienne sérique n’est pas prédictive de la qualité ovocytaire en fécondation in vitro

Objectives

The assessment of the ovarian reserve is mandatory in women undergoing assisted reproduction. Anti-Müllerian hormone (AMH), produced by granulosa cells from pre-antral and early antral follicles, is a promising indicator of ovarian reserve. However, few studies have evaluated the predictive value of AMH on oocyte quality.

Patients and methods

A retrospective study was undertaken at the Bretonneau University Hospital of Tours. A total of 559 women undergoing in vitro fertilization treatment between January and December 2007 were included in the study. Serum AMH levels were determined by using an ultrasensitive Elisa test. Total number of oocytes, rate of mature oocytes, fertilization rate, embryo quality and clinical pregnancy rate were recorded.

Results

Serum AMH was significantly lower in groups of patients with few oocytes collected. However, serum AMH was not predictive of nuclear maturity of oocytes, fertilization rate and quality of early embryos. Additionally, low levels of AMH do not preclude clinical pregnancy in in vitro fertilization.

Conclusion

At the moment, serum AMH is a relatively predictive indicator of the ovarian reserve, in terms of quantity but not in terms of quality. Moreover, it is still not possible to determine serum AMH cut-off value to predict clinical pregnancy in IVF programmes.     

Tubercular mastitis in men: case report and systematic review

Background

Tuberculous mastitis is usually reported in multiparous postpartum women and is an unusual cause of gynecomastia in adolescent men.

Methods

We describe an illustrative case and review all cases of tubercular mastitis reported in men in the English literature.

Results

Our search yielded 24 cases of male tubercular mastitis. Most presented with an isolated breast lump. Constitutional symptoms were rare (21.4%), and associated tuberculosis foci, mostly inactive, were seen in 43.8%. Breast parenchymal involvement, chest wall masses, pectoral muscle abscesses, cold abscesses tracking through the chest wall, and empyema necessitatis presented as breast lumps. Fine-needle aspiration cytology was the most common diagnostic modality, and acid-fast bacilli were demonstrable in a minority (33%). A combination of granulomatous mastitis, necrosis, and clinical response to antitubercular therapy was the most common mode of establishing the diagnosis. Most patients responded to antitubercular therapy alone.

Conclusion

Tubercular mastitis is a rare cause of breast masses in men, and a high index of suspicion can prevent diagnostic delays. Most patients respond to antitubercular therapy alone.