Neurofibromatosis type 1, hyperparathyroidism, and osteosarcoma: interplay?

Neurofibromatosis type 1 (NF 1) is a syndrome with a predisposition for benign and malignant tumor development. Of the malignant neoplasms, osteogenic sarcomas are rare but have been described. There are some reports of patients with neurofibromatosis type 1 with a parathyroid adenoma and hyperparathyroidism. Also, there are studies that imply that the parathyroid hormone plays a role in the regulation and modulation of oseogenic sarcomas in vitro. We report about a 50-year-old female suffering from neurofibromatosis type 1, with a 3-year documented history of untreated hyperparathyroidism and a parathyroid adenoma. The patient developed a mandibular osteogenic sarcoma. To our knowledge, this is the first reported case occurring in the mandible. The unusual tumor site for a patient with neurofibromatosis type 1, the conjugation with hyperparathyroidism and the rapid growth of an osteogenic sarcoma are intriguing.     

The Impact of Pre-exposure Prophylaxis on Sexual Well-Being Among Men Who Have Sex with Men

Archives of Sexual Behavior - Pre-exposure prophylaxis (PrEP) is a promising strategy to reduce HIV incidence among men who have sex with men (MSM). How and when PrEP is used could in part be...     

Meta‐Analysis of P‐Wave Dispersion Values in Healthy Individuals: The Influence of Clinical Characteristics

Background: P‐wave dispersion (Pd) is an appealing marker for predicting the risk of developing atrial fibrillation. At present, no definitive cutoff value has been determined as to the diagnosis of high‐risk patients. Our aims were to evaluate P‐wave parameters of healthy subjects published in the literature, determine normal range and weighted means of Pd and P‐wave parameters, and investigate the influences of gender, age, and BMI on the weighted results. Methods: A systematic search of studies published in PubMed was conducted. Only studies which included control groups of healthy individuals were included. Results: Of the 657 studies initially identified, 80 were eligible for inclusion. The total number of participants was 6,827. The highest reported Pd values were 58.56 ± 16.24  ms; the lowest were 7 ± 2.7  ms. The weighted mean was 33.46 ± 9.65  ms; weighted median was 32.2  ms. Gender and age were not found to be associated with significant influences on P‐wave parameter values. High‐normal BMI was not found to be associated with increased P‐wave parameter values. Conclusions: Pd, Pmax, and Pmin span a wide range of values in healthy individuals. Seemingly, abnormal values were often reported in healthy adults. The high variability of P‐wave parameters in healthy individuals, and overlapping of the results with those reported for patients with increased risk for atrial fibrillation, might suggest that this technique has limited sensitivity and specificity. The variability between studies may stem from methodological issues and, therefore, there is a definite need for methodological standardization of Pd measurements. Ann Noninvasive Electrocardiol 2012;17(1):28–35     

Concern and death anxiety during an ongoing terror wave: The moderating role of direct vs. indirect exposure

ABSTRACT

The current study examined whether emotional concern over one’s security situation is connected with death anxiety during an ongoing terror wave, and whether type of exposure (media exposure vs. contact with witnesses) moderates this connection. A total of 345 individuals, aged 18–70, were sampled during an ongoing wave of terror in Israel and filled out scales measuring death anxiety, concern over security situation, and type of exposure. Results indicated that increased concern was connected with enhanced death anxiety. Moreover, this connection was more pronounced among individuals exposed to the events through the media, in comparison with individuals who had first-hand contact with witnesses.     

The Clinical and Diagnostic Significance of Anti-myosin Autoantibodies in Cardiac Disease

Autoimmunity is influenced by genetic, immune, hormonal, and environmental factors. Viral infections may trigger autoimmunity. It has been established that autoimmunity may be a contributing factor in the pathogenesis of heart disease. Anti-heart autoantibodies have been identified in the sera of patients with heart diseases, as well as in low titers in certain healthy individuals. Nevertheless, the role of humoral immunity in the development of autoimmune heart disease has not been fully established. Anti-myosin autoantibodies appear in several heart diseases such as myocarditis, dilated cardiomyopathy, Chagas' heart disease, Kawasaki disease, rheumatic fever, and ischemic myocardium. The pathogenic role of anti-myosin autoantibodies in heart disease is not fully understood. Moreover, little is known concerning the clinical implications of anti-myosin autoantibodies in heart disease and its prognostic significance. Anti-cardiac myosin autoantibodies were found to cross-react with the β-adrenergic receptor. Studies have reported the effective use of the anti-myosin directed immune-modulating approach in animals with heart disease, although no specific anti-myosin autoantibody therapeutic approach has been attempted in humans. Herein, we review the current knowledge of anti-myosin autoantibodies and the use of targeted immune-modulating therapy in different heart diseases.     

Evaluating reliability of ultra-short ECG indices of heart rate variability in diabetes mellitus patients

Our aim was to investigate the reliability of ultra-short HRV in patients with DM. A good correlation was found between the 1 minute and 5 minute parameters for maximal-RR, minimal-RR, average-RR, SDNN, RMSSD, pNN50, and total power. Also, a good correlation between 10 second and 5 minute parameters was found for maximal-RR, minimal-RR, average-RR, and RMSSD. We suggest that certain ultra-short HRV parameters can be used efficiently in DM patients for autonomic evaluation.     

Applying REWIND cardiovascular disease criteria to SUSTAIN 6 and PIONEER 6: An exploratory analysis of cardiovascular outcomes with semaglutide

In the REWIND trial, dulaglutide reduced cardiovascular (CV) risk versus placebo in patients with type 2 diabetes in both the “established CV disease” (CVD) and “CV risk factor” subgroups. The SUSTAIN 6 and PIONEER 6 trials of semaglutide used different criteria for established CVD from those used in REWIND. The present post hoc analysis assessed the effect of semaglutide on major adverse CV events (MACE) in a pooled population of SUSTAIN 6 and PIONEER 6 patients, re-categorized into CV risk subgroups using the REWIND CVD criteria. In the pooled analysis (n = 6480), a lower percentage of patients were in the established CVD subgroup, when using the REWIND CVD criteria, compared with the original trial CVD criteria (66.5% vs. 83.8%, respectively). After re-categorization, the risk of MACE was significantly lower with semaglutide versus placebo in the established CVD subgroup (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.59, 0.92) and nonsignificantly lower in the CV risk factor subgroup (HR 0.84, 95% CI 0.55, 1.28) (P-interaction = 0.60). These results suggest that the CV effects of semaglutide may extend to patients with type 2 diabetes across the CV risk continuum.     

High awareness of hepatitis C virus (HCV) but limited knowledge of HCV complications among HIV-positive and HIV-negative men who have sex with men

Hepatitis C virus (HCV) has emerged as a sexually transmitted infection among HIV-positive men who have sex with men (MSM) in high-income countries. Little is reported about HCV awareness among MSM, although this is essential for developing targeted prevention strategies. We, therefore, studied HCV awareness and knowledge among HIV-positive and HIV-negative MSM from the Amsterdam Cohort Studies (ACS). During two visits, 1 year apart and starting in October 2007, MSM from the ACS answered questions regarding HCV awareness, knowledge of HCV transmission (7 items), complications (8 items) and sexual risk behaviour. We examined the percentage of HCV awareness and correctly answered knowledge items, and whether awareness and knowledge improved significantly over time. Using logistic regression, we studied whether HIV status and sexual risk behaviour were associated with awareness. Seventy percent (312/444) of HIV-negative and 80% (74/92) of HIV-positive MSM reported to have ever heard of HCV on the first visit. Overall, awareness increased with 9% between the first and second visit (p < 0.001). In multivariate analysis the association of group sex with HCV awareness was borderline significant (OR 1.49, 95% CI 0.97–2.30). Compared with knowledge of transmission routes, knowledge of complications appeared to be limited. In the ACS, awareness of HCV is high, particularly among those reporting group sex, an important risk factor for HCV transmission. The majority of participants had good knowledge of transmission routes, but limited knowledge of complications of chronic HCV infection. HCV prevention messages could be strengthened, therefore, by further addressing the complications of HCV infection.