Sex-based clinical and immunological differences in COVID-19

Background Males and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take the sex factor into consideration. Methods We performed a sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and severe acute respiratory syndrome coronavirus (SARS-CoV-2) specific antibody levels of 1558 males and 1499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. The total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence. Results We found that male patients had approximately two-fold rates of ICU admission (4.7% vs. 2.7% in males and females, respectively, P = 0.005) and mortality (3% vs. 1.4%, in males and females, respectively, P = 0.004) than female patients. Survival analysis revealed that the male sex is an independent risk factor for death from COVID-19 (adjusted hazard ratio [HR] = 2.22, 95% confidence interval [CI]: 1.3–3.6, P = 0.003). The level of inflammatory cytokines in peripheral blood was higher in males during hospitalization. The renal (102/1588 [6.5%] vs. 63/1499 [4.2%], in males and females, respectively, P = 0.002) and hepatic abnormality (650/1588 [40.9%] vs. 475/1499 [31.7%], P = 0.003) were more common in male patients than in female patients. By analyzing dynamic changes of lymphocyte subsets after symptom onset, we found that the percentage of CD19+ B cells and CD4+ T cells was generally higher in female patients during the disease course of COVID-19. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in female patients, while gradually increased and reached a peak in the seventh week after symptom onset in male patients. Conclusions Males had an unfavorable prognosis, higher inflammation, a lower percentage of lymphocytes, and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients.

Osteonecrosis of the Femoral Head in Patients with Hypercoagulability—From Pathophysiology to Therapeutic Implications

Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the early stages, ONFH has devastating consequences and leads to mandatory total hip arthroplasty. The pathophysiology of non-traumatic ONFH is very complex and not fully understood. While multiple risk factors have been associated with secondary ONFH, there are still many cases in which a clear etiology cannot be established. Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. Hereditary thrombophilia and hypofibrinolysis are associated with thrombotic occlusion of bone vessels. Anticoagulant treatment can change the natural course of the disease and improve patients’ quality of life. The present work focused on highlighting the association between hereditary thrombophilia/hypofibrinolysis states and ONFH, emphasizing the importance of identifying this condition. We have also provided strong arguments to support the efficiency and safety of anticoagulant treatment in the early stages of the disease, encouraging etiological diagnosis and prompt therapeutic intervention. In the era of direct oral anticoagulants, new therapeutic options have become available, enabling better long-term compliance.

Caregiver burden in Buruli ulcer disease: Evidence from Ghana

Background Buruli ulcer disease (BUD) results in disabilities and deformities in the absence of early medical intervention. The extensive role of caregiving in BUD is widely acknowledged, however, associated caregiver burden is poorly understood. In this paper we assessed the burden which caregivers experience when supporting patients with BUD in Ghana. Method/ principal findings This qualitative study was conducted in 3 districts in Ghana between August and October 2019. 13 semi-structured interviews were conducted on caregivers of BUD patients in the local language of Twi. Data was translated into English, coded into broad themes, and direct content analysis approach was used to analyse results. The results show the caregivers face financial, psychological and health issues as a consequence of their caregiving role. Conclusion/ significance This study found significant caregiver burden on family members. It also highlighted the psychological burden caregivers experience and the limited knowledge of the disease within endemic communities. Further research is needed to quantify the caregiver burden of BUD at different economic levels in order to better understand the impact of possible caregiver interventions on patient outcomes.

Case Report: Acute Kidney Failure due to Massive Envenomation of a Two-Year-Old Child Caused by Killer Bee Stings

A hybrid species of Brazilian bee has proliferated on the South American continent since 1956. We describe a “killer bee” swarm attack on a 2-year-old girl in French Guiana. The patient weighed 10 kg, and approximately hundreds of bees’ stingers were removed, that is, 10 stings/kg. Our patient survived without long-term sequelae. The management of her condition required admission into intensive care for renal failure due to acute tubular necrosis and severe rhabdomyolysis. We emphasize the importance of early medical intervention, clinical surveillance, and biological monitoring at the hospital to prevent a toxic chain reaction that could prove fatal within 72 hours.

Gender incongruence and gender dysphoria in childhood and adolescence—current insights in diagnostics, management, and follow-up

Gender incongruence (GI) is defined as a condition in which the gender identity of a person does not align with the gender assigned at birth. Awareness and more social acceptance have paved the way for early medical intervention about two decades ago and are now part of good clinical practice although much robust data is lacking. Medical and mental treatment in adolescents with GI is complex and is recommended to take place within a team of mental health professionals, psychiatrists, endocrinologists, and other healthcare providers. The somatic treatment generally consists of the use of GnRH analogues to prevent the progression of biological puberty and subsequently gender-affirming hormonal treatment to develop sex characteristics of the self-identified gender and surgical procedures. However to optimize treatment regimens, long-term follow-up and additional studies are still needed. What is known• The prevalence of gender dysphoria increased significantly in the past years and can lead to significant complaints and burdens especially during puberty.• Pubertal suppression and gender-affirmed treatment can be effectively used in adolescence with gender dysphoria.What is new• Transgender mental and medical healthcare is a long-lasting process during which not only the child/adolescent with GI but also their parents/family have to be counseled in making choices about their social, medical, and legal transitions.• There are an increasing number of transgender persons defining as nonbinary. Therefore, an individualized approach by an experienced team is necessary.

Advanced therapies in Eisenmenger syndrome

Background This is a case report of a patient diagnosed with Eisenmenger syndrome in adult life. Case presentation The patient had a large secundum atrial septal defect diagnosed incidentally in her twenties, with established pulmonary vascular disease and thus the defect was not closed. Over several years the patient showed signs of progressive disease with premature right ventricular dysfunction, preceding any significant symptomatic decline. Her medical therapy was escalated with the addition of intravenous epoprostenol, resulting in both objective and symptomatic improvement. Conclusions Early medical intervention and treatment can positively impact on the outcome of patients with pulmonary arterial hypertension associated with congenital heart disease.

Sex-based clinical and immunological differences in COVID-19

Background Males and females differ in their immunological responses to foreign pathogens. However, most of the current COVID-19 clinical practices and trials do not take sex as consideration. Methods We performed an unbiased sex-based comparative analysis for the clinical outcomes, peripheral immune cells, and SARS-CoV-2 specific antibody levels of 1,558 males and 1,499 females COVID-19 patients from a single center. The lymphocyte subgroups were measured by Flow cytometry. Total antibody, Spike protein (S)-, receptor binding domain (RBD)-, and nucleoprotein (N)- specific IgM and IgG levels were measured by chemiluminescence. Results We found that the mortality and ICU admission rates were approximately 2-fold higher in males than that in females (P < 0.005). Survival analysis revealed that sex is an independent prognostic factor for COVID-19 (Hazard ratio = 2.2, P = 0.003). The concentration of inflammatory factors in peripheral blood was significantly higher in males. Besides, the renal and hepatic abnormality induced by COVID-19 was more common in males during the hospitalization. The analysis of lymphocyte subsets revealed that the percentage of CD19 + B cell and CD4 + T cell was significantly higher in females (P < 0.001) during hospitalization, indicating the stronger humoral immunity in females than males. Notably, the protective RBD-specific IgG against SARS-CoV-2 sharply increased and reached a peak in the fourth week after symptom onset in females, while gradually increased and reached a peak in the seventh week in males. Conclusions The unfavorable prognosis of male COVID-19 patients may result from the weak humoral immunity and indolent antibody responses during SARS-CoV-2 infection and recovery. Early medical intervention and close monitoring are important, especially for male COVID-19 patients. Convalescent plasma therapy may help improve the immunity of males to fight against SARS-CoV-2 infection.

Rhabdomyolysis in a Civil Aviation Pilot

BACKGROUND: Rhabdomyolysis is a potentially fatal disease caused by trauma, infections, and toxins. Rhabdomyolysis has not been reported in Chinese civil aircrew, but in our case report a male civil copilot contracted rhabdomyolysis after excessive exercise, showing potential for morbidity in pilots.CASE REPORT: After excessive exercise, a 29-yr-old male civil aviation copilot complained of serious myalgia and weakness in lower limb muscles and gross hematuria, whose values of alanine transaminase (ALT), aspartate transaminase (AST), myohemoglobin (Mb), creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), and -hydroxybutyrate dehydrogenase (-HBDH) were conspicuously increased. Magnetic resonance imaging showed abnormal signal intensities in the lower limbs. The patient was diagnosed with rhabdomyolysis. He was treated with hydration and urine alkalinization. When his condition was stabilized, the patient was discharged. After remaining asymptomatic for 3 mo and getting documentation of normalized lab results, he was granted a first-class medical certificate and returned to work.DISCUSSION: This was the first case of rhabdomyolysis reported in Chinese civil aircrew. Excessive exercise in an overweight pilot may induce rhabdomyolysis. This condition can be controlled and cured by early and effective treatment. Rhabdomyolysis could occur in a population suffering from overweight, obesity, or hyperlipidemia. This case fits in with several other cases of military pilots exercising excessively. The progression could lead to acute kidney injury without prompt and effective intervention. And common symptoms like muscular weakness or myalgia may induce sudden in-flight incapacitation, so early medical intervention should be adopted. Moreover, recurrence of rhabdomyolysis should be considered when resuming flying duties.Liu X, Meng X, Zhang C, Chen J, Li P, Wu X, Fan H. Rhabdomyolysis in a civil aviation pilot. Aerosp Med Hum Res. 2020; 91(11):901903.

The application of viral nucleic acid detection and lung CT in COVID-19 diagnosis

The Corona Virus Disease 2019 (COVID-19) has the characteristics of fast propagation speed and strong pathogenicity and has attracted wide attention of people, medical workers, and researchers around the world. Accurate, rapid, and timely screening and diagnosis of COVID-19 is of great significance to control the development of the epidemic situation and save the lives of patients. Currently, the detection of viral nucleic acid and lung CT is the main screening and diagnostic methods of COVID-19. Nucleic acid detection has the advantages of fast, strong specificity and high sensitivity, but there is a certain false-negative rate. CT result of lung examination is visual, but it is not typical due to the uncertain time of clinical symptoms and the early medical intervention. Therefore, the diagnosis of COVID-19 should include a combination of epidemiological history, clinical symptoms, imaging, and laboratory tests.