Could The “Modified 8 D’s of Stroke Care” Improve Sex Disparities in Door-to-Needle Time in Acute Ischemic Stroke?

Background and objectiveDoor-to-needle (DTN) time is an important factor in stroke settings for which studies have reported delays in women, resulting in worse stroke outcomes. We aimed to evaluate whether our modified algorithm could reduce sex disparities, especially in DTN.MethodsThis longitudinal cohort study was conducted between September 1, 2019, and August 31, 2021, at a comprehensive stroke center. Previously we utilized the conventional “D’s of stoke care” for timely management. The “modified 8 D’s of stroke care” was designed by our team in September 2020. Patients were analyzed in two groups: group 1, before, and group 2, after employing the modified algorithm. Sex as the main variable of interest along with other selected covariates were regressed towards the DTN, using univariable and multivariable logistic regressions.ResultsWe enrolled 47 and 56 patients who received intravenous thrombolysis (IVT) in groups 1 and 2, respectively. Although there was a significant difference in DTN≤ 1 hour in group 1 (36% of females vs. 52% of males, p= 0.019), it was not significantly different in group 2 anymore (48% of females vs. 48.4% of males, p= 0.97). Furthermore, regression analysis showed being female was a significant predictor of DTN> 1 hour in group 1 (aOR= 6.65, p= 0.02), while after the modified algorithm gender was not a predictor of delayed DTN anymore.ConclusionAlthough we have a long way to achieve performance measures in developed countries, we seem to have succeeded in reducing gender disparities in DTN using the modified algorithm.

Sex disparities in COVID-19 mortality vary considerably across time: The case of New York State

In order to characterize how sex disparities in COVID-19 mortality evolved over time in New York State (NY), we analyzed sex-disaggregated data from the US Gender/Sex COVID-19 Data Tracker from March 14, 2020 to August 28, 2021. We defined six different time periods and calculated mortality rates by sex and mortality rate ratios, both cumulatively and for each time period separately. As of August 28, 2021, 19 227 (44.2%) women and 24 295 (55.8%) men died from COVID-19 in NY. 72.7% of the cumulative difference in the number of COVID-19 deaths between women and men was accrued between March 14 and May 4, 2020. During this period, the COVID-19 mortality rate ratio for men compared to women was 1.56 (95% CI: 1.52-1.61). In the five subsequent time periods, the corresponding ratio ranged between 1.08 (0.98-1.18) and 1.24 (1.15-1.34). While the cumulative mortality rate ratio of men compared to women was 1.34 (1.31-1.37), the ratio equals 1.19 (1.16-1.22) if deaths during the initial COVID-19 surge are excluded from the analysis. This article shows that in NY the magnitude of sex disparities in COVID-19 mortality was not stable across time. While the initial surge in COVID-19 mortality was characterized by stark sex disparities, these were greatly attenuated after the introduction of public health controls.

Corona Virus Disease 2019 (COVID-19) as a System-Level Infectious Disease With Distinct Sex Disparities

The current global pandemic of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) causing COVID-19, has infected millions of people and continues to pose a threat to many more. Angiotensin-Converting Enzyme 2 (ACE2) is an important player of the Renin-Angiotensin System (RAS) expressed on the surface of the lung, heart, kidney, neurons, and endothelial cells, which mediates SARS-CoV-2 entry into the host cells. The cytokine storms of COVID-19 arise from the large recruitment of immune cells because of the dis-synchronized hyperactive immune system, lead to many abnormalities including hyper-inflammation, endotheliopathy, and hypercoagulability that produce multi-organ dysfunction and increased the risk of arterial and venous thrombosis resulting in more severe illness and mortality. We discuss the aberrated interconnectedness and forthcoming crosstalks between immunity, the endothelium, and coagulation, as well as how sex disparities affect the severity and outcome of COVID-19 and harm men especially. Further, our conceptual framework may help to explain why persistent symptoms, such as reduced physical fitness and fatigue during long COVID, may be rooted in the clotting system.