The impact of gender differences on pulmonary diseases and their clinical implications

Male and female patients are usually considered clinically equivalent from a diagnostic and treatment point of view, and no relevance is given to the differences in morphometry and physiology of the respiratory system between the two sexes. This is a major limitation in the understanding of the pathology and effective management of multiple respiratory ailments. The present review analyses the available literature on the major respiratory diseases from a gender-difference perspective. We performed our research using the PubMed Advanced Browser. The research for each clinical condition was conducted by using the key words "gender" OR "sex." For example, considering asthma, the search criteria were "asthma" AND "gender" OR "sex." All the respiratory diseases considered in this review are deeply influenced by the sex of the patient in diverse ways. For example, in women, estrogens could play a protective role in some conditions, like IPF, while in others they are associated with increased risk of disease development, as in some types of severe asthma. Psychological symptoms are more frequent in women with obstructive conditions such as OSAS, COPD, and asthma. Despite the available evidence, current therapeutic strategies largely ignore these differences, and data on gender-weighted interventions are still scarce. Sex differences are common in respiratory diseases. They have largely been ignored in clinical approaches towards these diseases. Evidence has been generated in the last few decades in favor of gender-based diagnostic and therapeutic strategies.

Self-Reported Adverse Events of COVID-19 Vaccines in Polish Healthcare Workers and Medical Students. Cross-Sectional Study and Pooled Analysis of CoVaST Project Results in Central Europe.

BACKGROUND: Optimization of COVID-19 vaccination rate among healthcare personnel is of utmost priority to secure provision of uninterrupted care and to protect the most vulnerable patients. This study, as part of the global CoVaST project, aimed to assess the occurrence of short-term adverse events (SRAEs) of two most administered COVID-19 vaccines, mRNA-based (Pfizer-BioNTech and Moderna) and viral vector-based (AstraZeneca) in healthcare sector workers (HWs). METHODS: A cross-sectional survey-based study was carried out for the first time among 317 Polish healthcare sector personnel and medical students using a validated and pre-tested questionnaire. The online questionnaire included 25 pre-tested, validated questions concerning demographic data, medical parameters, COVID-19-related anamneses, and local or systemic reactions (reactogenicity) associated with COVID-19 vaccination. Descriptive statistics, inferential tests and binary logistic regression were performed. RESULTS: Out of the 247 participating HWs, 79.8% were females, and 77.5% received mRNA-based vaccines, while 24.5% received a viral vector-based vaccine. Cumulatively, 78.9% and 60.7% of the participants reported at least one local and one systemic SRAE respectively, following their COVID-19 first or second dose of vaccine. A wide array of SRAEs was observed, while pain at injection site (76.9%) was the most common local SRAE, and fatigue (46.2%), headache (37.7%), muscle pain (31.6%) were the most common systemic SRAEs. The vast proportion of local (35.2%) and systemic (44.8%) SRAEs subsided up to 1 day after inoculation with both types of vaccines. The mRNA-based vaccine versions seem to cause higher prevalence of local SRAEs, mainly pain within injection site (81.3% vs. 71.7%; p = 0.435), while the viral vector-based vaccine was linked with increased incidents of mild systemic side effects (76.7% vs. 55.3%; p = 0.004) after both doses. Pooled analysis revealed uniform results while comparing the prevalence of SRAEs in HWs as recipients in four central European countries (OR = 2.38; 95% CI = 2.03-2.79). CONCLUSIONS: The study confirmed the safety of commonly administered vaccines against COVID-19, which were associated with mild, self-resolving adverse events. No major vaccine-related incidents were reported which would affect every day functioning, significantly. The younger age group (below 29 y.o.) were associated with an increased risk of adverse events generally. The results enhanced current data regarding COVID-19 vaccination active surveillance in selected occupational groups.

Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis.

Since the outbreak of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) discovered in December 2019, the disease has emerged as a global pandemic (Shi et al., 2020; World Health Organization, 2020). Several studies have shown a higher incidence of COVID-19, as well as related poor outcomes in patients with malignancies as compared with those without them (Liang et al., 2020; Tian et al., 2020). The impact of cancer on COVID-19 may be attri­buted to the use of antitumor treatments that may disturb the host response to SARS-CoV-2 infection (Wang et al., 2020), while the current studies on this topic have drawn controversial conclusions. Some implied that anticancer treatments might elevate the risk of death (García-Suárez et al., 2020; Liu et al., 2020). On the contrary, others pointed out that this association is not significant (Brar et al., 2020; Lee et al., 2020a). Although previous systematic reviews have investigated this important issue (Wang and Huang, 2020), the heterogeneity of findings is obvious and the general conclusion has remained unclear. Considering this ambiguity, it is difficult for clinicians to make therapeutic decisions when facing patients with both cancer and COVID-19; therefore, a high-quality and accurate evaluation of the impact of anticancer treatments on COVID-19 patients is necessary. Accordingly, we conducted a pooled analysis with the original data of each patient for the first time to provide a comprehensive perspective into the association between anticancer regimens and the outcomes of cancer patients with COVID-19.

Predictors of nurses' intention to accept COVID-19 vaccination: A cross-sectional study in five European countries.

AIMS AND OBJECTIVES: To investigate nurses' intention in accepting COVID-19 vaccination and the factors affecting their decision. BACKGROUND: COVID-19 vaccination has started in most European countries with healthcare personnel being the first group receiving the vaccine shots. Their attitude towards vaccination is of paramount significant as their role in the frontline could help in the awareness of general population. METHODS: A study was conducted in Albania, Cyprus, Greece, Spain and Kosovo with the use of an online questionnaire. The Fear of COVID-19 Scale was used. The STROBE checklist was followed for this cross-sectional study. RESULTS: Study population consisted of 1135 nurses. Mean age of the participants was 38.3 years, while most of them were female gender (84.7%) and married (53.1%). Acceptance of a safe and effective COVID-19 vaccine was higher among Greek (79.2%) and Spanish (71.6%) nurses, followed by Cypriot (54%), Albanian (46.3%) and Kosovo (46.2%) nurses. Key factors for willingness to get vaccinated were male gender, living in a country with a high mortality rate in comparison with low mortality, being not infected with COVID-19, having high level of knowledge about COVID-19 vaccines and having been vaccinated for influenza in the last 2 years. Moreover, trusting the government and doctors regarding the information about the COVID-19 and having high level of fear about this virus were key factors for willingness to get vaccinated. CONCLUSION: Vaccination of healthcare personnel is a crucial issue not only for their own safety but also for their patients'. Healthcare acceptance to get vaccinated can work as a role model for general population. RELEVANCE TO CLINICAL PRACTICE: Gender, country, mortality rate, trust in government and health professionals and the level of fear were key factors that should be managed in clinical practice.

Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19.

INTRODUCTION: The world is currently facing the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The total number of cases of coronavirus disease 2019 (COVID-19) is rising daily and no vaccine has yet been approved. While the pathophysiology behind the virus is still being studied, many possible several risk factors using small sample sizes have been found. MATERIAL AND METHODS: We conducted a pooled analysis using several databases such as Medline, Scopus, Wangfang, Web of Science, Research Square, medrxiv, and Google Scholar to identify studies reporting severe and non-severe groups of COVID-19 patients. The odds ratios as well as the 95% confidence intervals for hypertension, diabetes, and cerebrovascular disease leading to severe COVID-19 were calculated using R-software. RESULTS: Fifty-three articles were used for our analysis and they involved 30,935 confirmed cases of COVID-19 from several countries across the world. The odds ratio for severe COVID-19 in hypertensive patients, diabetics, and patients with a history of cerebrovascular disease was 2.58 (95% confidence interval (CI): 2.16-3.08, from 53 studies), 2.17 (95% CI: 1.72-2.74, from 44 studies), and 2.63 (95% CI: 1.80-3.85, from 25 studies), respectively. CONCLUSIONS: Our analysis confirms that patients with hypertension, diabetes, or cerebrovascular disease are at a higher risk of a severe outcome of COVID-19. It is thus vital for physicians to identify the main risk factors for a severe outcome of this disease.

A reduction of the number of assays and turnaround time by optimizing polymerase chain reaction (PCR) pooled testing for SARS-CoV-2.

Early detection of the severe acute respiratory syndrome coronavirus 2 infection can decrease the spread of the disease and provide therapeutic options promptly in affected individuals. However, the diagnosis by reverse-transcription polymerase chain reaction is costly and time-consuming. Several methods of group testing have been developed to overcome this problem. The proposed strategy offers optimization of group testing according to the available resources by decreasing not only the number of the assays but also the turnaround time. The initial classification of the samples would be done according to the intention of testing defined as diagnostic or screening/surveillance, achieving the best possible homogeneity. The proposed stratification of pooling is based on branching (divisions) and depth (levels of re-pooling) of the original group in association with the estimated probability of a positive sample. The dilutional effect of the grouped samples has also been considered. The margins of minimum and maximum conservation of assays of pooled specimens are calculated and the optimum strategy can be selected in association with the probability of positive samples in the original group. This algorithm intends to be a useful tool for group testing offering a choice of strategies according to the requirements.

Reduced risk of COVID-19 hospitalization in asthmatic and COPD patients: a benefit of inhaled corticosteroids?

Background: The comorbidities and clinical signs of coronavirus disease 2019 (COVID-19) patients have been reported mainly as descriptive statistics, rather than quantitative analysis even in very large investigations. The aim of this study was to identify specific patients' characteristics that may modulate COVID-19 hospitalization risk.Research design and methods: A pooled analysis was performed on high-quality epidemiological studies to quantify the prevalence (%) of comorbidities and clinical signs in hospitalized COVID-19 patients. Pooled data were used to calculate the relative risk (RR) of specific comorbidities by matching the frequency of comorbidities in hospitalized COVID-19 patients with those of general population.Results: The most frequent comorbidities were hypertension, diabetes mellitus, and cardiovascular and/or cerebrovascular diseases. The RR of COVID-19 hospitalization was significantly (P < 0.05) reduced in patients with asthma (0.86, 0.77-0.97) or chronic obstructive pulmonary disease (COPD) (0.46, 0.40-0.52). The most frequent clinical signs were fever and cough.Conclusion: The clinical signs of hospitalized COVID-19 patients are similar to those of other infective diseases. Patients with asthma or COPD were at lower hospitalization risk. This paradoxical evidence could be related with the protective effect of inhaled corticosteroids that are administered worldwide to most asthmatic and COPD patients.

Prevalence of Cardiovascular Comorbidities in Coronavirus Disease 2019, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome: Pooled Analysis of Published Data.

Background Coronavirus disease 2019 (COVID-19) is spreading widely around the world. We conducted this meta-analysis to explore the prevalence of cardiovascular comorbidities in COVID-19, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS) cases. Methods and Results Relevant reports updated to April 17, 2020, were searched from PubMed, Embase, Web of Science, and the Cochrane Library with no restriction on language. A random-effects model was used in this meta-analysis to obtain pooled proportions of cardiovascular comorbidities in COVID-19, SARS, and MERS. A total of 22 studies (12 for COVID-19, 4 for SARS, and 6 for MERS) were included in this analysis, and the average age of patients with COVID-19, SARS, and MERS was 46.41±1.79, 39.16±2.25, and 52.51±4.64 years, respectively. Proportions of cardiovascular comorbidities in coronavirus diseases were as follows: COVID-19: proportion of hypertension was 17.1% (95% CI, 13.2%-20.9%), proportion of cardiac disease was 4.5% (95% CI, 3.6%-5.5%) and proportion of diabetes mellitus was 8.5% (95% CI, 5.5%-11.4%); SARS: proportion of hypertension was 4.5% (95% CI, 2.0%-7.0%), proportion of cardiac disease was 2.1% (95% CI, 0.6%-3.7%) and proportion of diabetes mellitus was 3.7% (95% CI, 1.0%-6.4%); MERS: proportion of hypertension was 30.3% (95% CI, 18.3%-42.2%), proportion of cardiac disease was 20.9% (95% CI, 10.7%-31.1%), and proportion of diabetes mellitus was 45.4% (95% CI, 27.3%-63.5%). Conclusions The prevalence of cardiovascular comorbidities varies among different coronavirus-associated diseases. With the development of time, proportions of cardiovascular comorbidities in COVID-19 need further attention.

Sample pooling for SARS-CoV-2 RT-PCR screening.

OBJECTIVE: To evaluate the efficacy of sample pooling compared to the individual analysis for the diagnosis of coronavirus disease 2019 (COVID-19) by using different commercial platforms for nucleic acid extraction and amplification. METHODS: A total of 3519 nasopharyngeal samples received at nine Spanish clinical microbiology laboratories were processed individually and in pools (342 pools of ten samples and 11 pools of nine samples) according to the existing methodology in place at each centre. RESULTS: We found that 253 pools (2519 samples) were negative and 99 pools (990 samples) were positive; with 241 positive samples (6.85%), our pooling strategy would have saved 2167 PCR tests. For 29 pools (made out of 290 samples), we found discordant results when compared to their correspondent individual samples, as follows: in 22 of 29 pools (28 samples), minor discordances were found; for seven pools (7 samples), we found major discordances. Sensitivity, specificity and positive and negative predictive values for pooling were 97.10% (95% confidence interval (CI), 94.11-98.82), 100%, 100% and 99.79% (95% CI, 99.56-99.90) respectively; accuracy was 99.80% (95% CI, 99.59-99.92), and the kappa concordant coefficient was 0.984. The dilution of samples in our pooling strategy resulted in a median loss of 2.87 (95% CI, 2.46-3.28) cycle threshold (Ct) for E gene, 3.36 (95% CI, 2.89-3.85) Ct for the RdRP gene and 2.99 (95% CI, 2.56-3.43) Ct for the N gene. CONCLUSIONS: We found a high efficiency of pooling strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA testing across different RNA extraction and amplification platforms, with excellent performance in terms of sensitivity, specificity and positive and negative predictive values.