Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini review scopes the evidence base for efficacy, effectiveness, and safety of COVID-19 vaccines from both experimental and observational research, and asks whether (1) women and men were equally recruited and represented in vaccine research, (2) the outcomes of studies were presented or analysed by sex and/or gender, and (3) there is evidence of sex and/or gender differences in outcomes. Following a PubMed search, 41 articles were eligible for inclusion, including seven randomised controlled trials (RCTs), 11 cohort studies, eight cross-sectional surveys, eight routine surveillance studies, and seven case series. Overall, the RCTs contained equal representation of women and men; however, the observational studies contained a higher percentage of women. Of 10 studies with efficacy data, only three (30%) presented sex/gender-disaggregated results. Safety data was included in 35 studies and only 12 (34%) of these presented data by sex/gender. For those that did present disaggregated data, overall, the majority of participants reporting adverse events were women. There is a paucity of reporting and analysis of COVID-19 vaccine data by sex/gender. Research should be designed in a gender-sensitive way to present and, where possible analyse, data by sex/gender to ensure that there is a robust and specific evidence base of efficacy and safety data to assist in building public confidence and promote high vaccine coverage.

Background: Early diagnosis through symptom recognition is vital in the management of acute stroke. However, women who experience stroke are more likely than men to be initially given a nonstroke diagnosis and it is unclear if potential sex differences in presenting symptoms increase the risk of delayed or missed stroke diagnosis. Aims: To quantify sex differences in the symptom presentation of stroke and assess whether these differences are associated with a delayed or missed diagnosis. Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched up to January 2021. Studies were included if they reported presenting symptoms of adult women and men with diagnosed stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) and were published in English. Mean percentages with 95% confidence intervals (CIs) of each symptom were calculated for women and men. The crude relative risks (RRs) with 95% CI of symptoms being present in women, relative to men, were also calculated and pooled. Any data on the delayed or missed diagnosis of stroke for women compared to men based on symptom presentation were also extracted. Results: Pooled results from 21 eligible articles showed that women and men presented with a similar mean percentage of motor deficit (56% in women vs 56% in men) and speech deficit (41% in women vs 40% in men). Despite this, women more commonly presented with nonfocal symptoms than men: generalized nonspecific weakness (49% vs 36%), mental status change (31% vs 21%), and confusion (37% vs 28%), whereas men more commonly presented with ataxia (44% vs 30%) and dysarthria (32% vs 27%). Women also had a higher risk of presenting with some nonfocal symptoms: generalized weakness (RR 1.49, 95% CI 1.09–2.03), mental status change (RR 1.44, 95% CI 1.22–1.71), fatigue (RR 1.42, 95% CI 1.05–1.92), and loss of consciousness (RR 1.30, 95% CI 1.12–1.51). In contrast, women had a lower risk of presenting with dysarthria (RR 0.89, 95% CI 0.82–0.95), dizziness (RR 0.87, 95% CI 0.80–0.95), gait disturbance (RR 0.79, 95% CI 0.65–0.97), and imbalance (RR 0.68, 95% CI 0.57–0.81). Only one study linking symptoms to definite stroke/TIA diagnosis found that pain and unilateral sensory loss are associated with lower odds of a definite diagnosis in women compared to men. Conclusion: Although women showed a higher prevalence of some nonfocal symptoms, the prevalence of focal neurological symptoms, such as motor weakness and speech deficit, was similar for both sexes. Awareness of sex differences in symptoms in acute stroke evaluation, careful consideration of the full constellation of presenting symptoms, and further studies linking symptoms to diagnostic outcomes can be helpful in improving early diagnosis and management in both sexes.

andmark trials of intravenous thrombolysis 1 and endovascular thrombectomy 2 have transformed acute stroke care in recent years. As the efficacy of these treatments is highly time-dependent, rapid pre-hospital assessment is critical for optimising outcomes, and emergency medical services play a major role in realising their potential benefits.Differences in pre-hospital activation of emergency medical services for men and women with stroke have been examined in several studies (Supporting Information, table 1). Some investigators found no sex differences, 3 others that women were more likely to be transported to hospital by ambulance, 4 or that the mean time between symptom onset and presenting to hospital was longer for women than men. 5 However, most studies were not population-based and sample sizes were small. As many investigations were not designed to detect sex differences in pre-hospital activation of emergency medical services, they did not consider important confounding factors, such as age. [3][4][5] It is recognised that atypical clinical manifestations of stroke on initial presentation are more frequent in women. 6 Further, a large United States study found that the proportion of missed stroke diagnoses was nearly seven times as large for patients aged 18-44 years presenting to emergency departments (4.0%) as for those aged 75 years or more (0.6%). 7In our population-based study, we examined the pre-hospital care and management provided by emergency medical services to people admitted to hospital in New South Wales with stroke diagnoses. We investigated whether pre-hospital emergency medical services care was different for women and men, and whether any sex differences were influenced by age. MethodsWe analysed linked administrative data for women and men admitted to NSW hospitals during 1 July 2005 -31 December 2018 with a principal diagnosis and one additional diagnosis code for stroke at separation (International Classification of Diseases, tenth revision, Australian modification [ICD-10-AM] codes I60-68, G45) and no previous admissions with a stroke diagnosis in any diagnosis field after 31 July 2001 (ie, lookback period of four years).The NSW Admitted Patient Data Collection (APDC) includes hospital records from all NSW public and private hospitals and day procedure centres. APDC records include demographic data

Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03–1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.

Objectives We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. Methods We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle–Ottawa scale. Where possible, data were pooled using random‐effects meta‐analysis. Results We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%–68%), and 68% (95% CI: 58%–79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%–93%). It was reported that 11% (95% CI: 2%–19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%–89%), 71% (95% CI: 57%–84%), and 73% (95% CI: 59%–86%), respectively. Conclusion In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.

Background: Early diagnosis through symptom recognition is vital in acute stroke management. However, women who experience stroke are more likely than men to receive a missed or delayed diagnosis. Aims: To assess sex differences in the symptom presentation of stroke and whether these differences are associated with a delayed or missed diagnosis. Methods: PubMed, EMBASE and the Cochrane Library were systematically searched up to January 2021 for all studies that reported on symptoms in both adult women and men with diagnosed stroke (ischaemic or haemorrhagic) and transient ischaemic attack and were published in English. Sex-stratified proportions for each symptom were extracted and pooled. The relative risk (RR) of a symptom being present in women relative to men with 95% confidence intervals (CI) was also calculated and pooled, as well as the RR of a delayed or missed stroke diagnosis. Results: Pooled results from 21 eligible articles showed that the top three symptoms were similar between women and men - limb weakness (72% vs. 66%), hemiparesis (56% vs. 55%), and weakness of the face, arm or leg (55% vs. 55%). However, the top 4th and 5th symptoms found in women were generalised non-specific weakness (49%) and motor deficit (46%), whereas in men these were motor deficit (46%) and ataxia (44%). In addition, crude RR showed that women were more likely to have higher risk than men of presenting with confusion (RR 1.16, CI 1.01-1.32), dysphagia (RR 1.29, CI 1.13-1.48), dysphasia (RR 1.11, CI 1.00-1.24), fatigue (RR 1.42, CI 1.05-1.92), generalised weakness (RR 1.56 CI 1.23-1.98), headache (RR 1.14, CI 1.01-1.30), urinary incontinence (RR 1.25, CI 1.17-1.33), loss of consciousness (RR 1.30, CI 1.12-1.51), and mental status change (RR 1.37, CI 1.18-1.58), and lower risk of presenting with dizziness (RR 0.87, CI 0.80-0.95), dysarthria (RR 0.89, CI 0.82-0.95), imbalance (RR 0.68, CI 0.57-0.81), paraesthesia (RR 0.74, CI 0.58-0.93), and trouble walking (RR 0.83, CI 0.70-0.99). Finally, pooled RR of delayed or missed diagnosis for women compared to men was not statistically significant (RR 1.19, CI 0.94-1.49). Conclusion: Though women and men commonly presented with similar symptoms, some sex differences were present which needs consideration in stroke evaluation.

BackgroundStudies of sex differences in the use and outcomes of endovascular treatment (EVT) for acute ischemic stroke report inconsistent resultsMethodsWe systematically searched PubMed and Embase databases for studies examining sex-specific utilization of EVT for acute ischemic stroke published before 31 December 2021. Estimates were compared by study type: randomized clinical trials (RCTs) and non-RCTs (hospital-based, registry-based or administrative data). Random effects odds ratios (ORs) were generated to quantify sex differences in EVT use. To estimate sex differences in functional outcome on the modified Rankin scale after EVT, the female:male ratio of ORs and 95% confidence intervals (CIs) were obtained from ordinal or binary analysis.Results6,396 studies were identified through database searching, of which 594 qualified for a full review. A total of 51 studies (36 non-RCT and 15 RCTs) reporting on sex-specific utilization of EVT were included, and of those 10 estimated the sex differences of EVT on functional outcomes. EVT use was similar in women and men both in non-RCTs (OR: 1.03, 95% CI: 0.96–1.11) and RCTs (1.02, 95% CI: 0.89–1.16), with consistent results across years of publication and regions of study, except that in Europe EVT treatment was higher in women than men (1.15, 95% CI: 1.13–1.16). No sex differences were found in the functional outcome by either ordinal and binary analyses (ORs 0.95, 95% CI: 0.68–1.32] and 0.90, 95% CI: 0.65–1.25, respectively).ConclusionsNo sex differences in EVT utilization or on functional outcomes were evident after acute ischemic stroke from large-vessel occlusion. Further research may be required to examine sex differences in long-term outcomes, social domains, and quality of life.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226100, identifier: CRD42021226100.

Introduction: COVID-19 pneumonia is a viral infection that has been shown to affect numerous organ systems causing diagnostic and treatment dilemmas. Previous literature shows that 17% of patients with COVID-19 were found to have acute pancreatitis without any additional risk factors. However, the role of hypertriglyceridemia has not yet been examined. We present a case of acute pancreatitis secondary to triglyceridemia in the setting of COVID-19 infection. Case Report: A 31 year old man with morbid obesity (body mass index of 41.5 kg/m 2 ) and no other past medical history presented with abdominal pain at the periumbilical region radiating to the back associated with nausea and vomiting for five days. He also complained of polyuria and polydipsia for one week. He denied any history of diabetes mellitus (DM), high triglycerides, alcohol use, and gallstones. He also denied any family history of hyperlipidemia. Of note, the patient's wife was sick with COVID-19 3 weeks prior and he tested negative at that time. His vitals were remarkable for sinus tachycardia of 140/minute. Labs were notable for positive PCR for COVID-19 pneumonia, lipase of 520, elevated triglycerides of 7265, and evidence of pancreatitis on computed tomography (CT) scan of abdomen and pelvis. His arterial blood gas was significant for a pH of 7.191 and lactate of 1.9. His chemistry revealed a glucose of 377, anion gap of 26, and a bicarbonate of 8, consistent with a diagnosis of diabetic ketoacidosis (DKA). He was admitted to intensive care unit (ICU) for management of acute pancreatitis and DKA. He was managed with intravenous (IV) insulin drip, Atorvastatin, Niacin, Gemfibrozil and isotonic IV fluids. Following a 10 day ICU course he had complete resolution of DKA and hypertriglyceridemia and was subsequently transferred to the medical floor. Discussion:The proposed mechanism of acute pancreatitis in COVID-19 infection is the entry of the virus via angiotensin II receptor that causes damage to pancreatic cells. This results in decreased insulin production leading to increased peripheral lipolysis and hypertriglyceridemia. The breakdown of triglycerides then often results in DKA. In the case of our patient it is possible that COVID-19 infection is a coincidence but the timing of symptoms, lack of prior history of triglyceridemia, and lack of family history makes COVID 19 the most likely cause. Therefore, in COVID-19 patients with abdominal pain, acute pancreatitis should be considered.