OBJECTIVE: To evaluate sex differences in the risk of developing long COVID among adults with SARS-CoV-2 infection.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)-Adult cohort, which consists of individuals enrolled in and prospectively followed up at 83 sites in 33 US states plus Washington, DC, and Puerto Rico. Data were examined from all participants enrolled between October 29, 2021, and July 5, 2024, who had a qualifying study visit 6 months or more after their initial SARS-CoV-2 infection.
EXPOSURE: Self-reported sex (male, female) assigned at birth.
MAIN OUTCOMES AND MEASURES: Development of long COVID, measured using a self-reported symptom-based questionnaire and scoring guideline at the first study visit that occurred at least 6 months after infection. Propensity score matching was used to estimate risk ratios (RRs) and risk differences (95% CIs). The full model included demographic and clinical characteristics and social determinants of health, and the reduced model included only age, race, and ethnicity.
RESULTS: Among 12 276 participants who had experienced SARS-CoV-2 infection (8969 [73%] female; mean [SD] age at infection, 46 [15] years), female sex was associated with higher risk of long COVID in the primary full (RR, 1.31; 95% CI, 1.06-1.62) and reduced (RR, 1.44; 95% CI, 1.17-1.77) models. This finding was observed across all age groups except 18 to 39 years (RR, 1.04; 95% CI, 0.72-1.49). Female sex was associated with significantly higher overall long COVID risk when the analysis was restricted to nonpregnant participants (RR, 1.50; 95%: CI, 1.27-1.77). Among participants aged 40 to 54 years, the risk ratio was 1.42 (95% CI, 0.99-2.03) in menopausal female participants and 1.45 (95% CI, 1.15-1.83) in nonmenopausal female participants compared with male participants.
CONCLUSIONS AND RELEVANCE: In this prospective cohort study of the NIH RECOVER-Adult cohort, female sex was associated with an increased risk of long COVID compared with male sex, and this association was age, pregnancy, and menopausal status dependent. These findings highlight the need to identify biological mechanisms contributing to sex specificity to facilitate risk stratification, targeted drug development, and improved management of long COVID.
METHODS: A Malaysian clinical embedding, based on Word2Vec model, was developed using 29,895 electronic discharge summaries. The embedding was compared against conventional rule-based and FastText embedding on two tasks: abbreviation detection and abbreviation disambiguation. Machine learning classifiers were applied to assess performance.
RESULTS: The Malaysian clinical word embedding contained 7 million word tokens, 24,352 unique vocabularies, and 100 dimensions. For abbreviation detection, the Decision Tree classifier augmented with the Malaysian clinical embedding showed the best performance (F-score of 0.9519). For abbreviation disambiguation, the classifier with the Malaysian clinical embedding had the best performance for most of the abbreviations (F-score of 0.9903).
CONCLUSION: Despite having a smaller vocabulary and dimension, our local clinical word embedding performed better than the larger nonclinical FastText embedding. Word embedding with simple machine learning algorithms can decipher abbreviations well. It also requires lower computational resources and is suitable for implementation in low-resource settings such as Malaysia. The integration of this model into MyHarmony will improve recognition of clinical terms, thus improving the information generated for monitoring Malaysian health care services and policymaking.
METHODS: Publicly available consular assistance data (2014-2023) were analysed descriptively. Consular missions were listed under 16-19 categories.
RESULTS: A total of 26,378 consular assistance missions were recorded. The greatest proportion of missions related to COVID-19 repatriations (26.9 %, n = 7097), deaths overseas (10 %, n = 2650), and medical illness/mental health emergency abroad (11.6 %, n = 3047). Forensic incidents (arrests/victims of crime) accounted for 12.9 % (n = 3392) of consular assistance episodes.
CONCLUSION: This study highlights the characteristics and trends of consular assistance requests received by a national governmental agency. Future studies should explore traveller awareness of consular procedures and the extent to which they are addressed in travel medicine consultations.
METHODS: This was a multicenter, prospective, single-blinded, randomized controlled noninferiority trial. The noninferiority margin was set at 15%. One hundred sixty-seven patients were recruited and randomized to either the LREF group or the standard diet (SD) group using a 3L PEG preparation regimen.
RESULTS: The LREF group results in comparable satisfactory preparation rating to the standard diet group with a mean BPPS score of 6.87 (SD 1.59) versus 7.14 (SD 1.54) (95% CI[-0.86; 0.32] and p = 0.367). The mean difference (MD) of the BBPS total score between the two groups was -0.27 (95% CI [-0.764 and 0.224]). Equivalence were demonstrated using the two one-sided test (alpha = 5%) with the lower t-value of 2.682 (p = 0.0042) and the upper t-value of -4.493 (p
METHODS: A total of 13 047 eligible participants were selected from 119 560 The Malaysian Cohort participants. Of these, 750 who developed diabetes were selected as cases, while 3750 controls were chosen randomly from healthy participants. This nested case-control study included 4500 eligible participants from The Malaysian Cohort, with a 1:5 case-to-control ratio. Participants were stratified into four groups based on Cre/BW ratio quartiles. The Cox proportional hazards model evaluated the effect of Cre/BW ratio on developing incident diabetes. The association between Cre/BW ratio and body composition was assessed using the Pearson correlation coefficient.
RESULTS: Of the 13 047 eligible participants followed up over 5.3 years, 5.75% (n = 750) developed diabetes. Diabetes incidence decreased with increasing Cre/BW ratios. The Cre/BW ratio was inversely correlated with diabetes risk (HR: 0.403, 95% CI: 0.315-0.515, p
METHODS: A literature search was conducted through PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up until August 10, 2024. The eligibility criteria focused on observational studies that evaluated hospitalization rates among mpox cases, distinguishing between HIV-positive and HIV-negative individuals. Newcastle-Ottawa Scale was used for evaluating study quality. The meta-analysis used a random-effects model to accommodate expected study heterogeneity using R software (V. 4.4).
RESULTS: The search yielded 686 records, with 14 studies meeting the inclusion and exclusion criteria after screenings and full-text assessments. The pooled analysis revealed a 56.6% increased risk of hospitalization among HIV-positive mpox cases compared to HIV-negative individuals (95% CI: 18.0-107.7%). Notable heterogeneity (I² = 76%) was observed, likely reflecting variations in study settings and methodologies. Sensitivity analysis confirmed the robustness of these findings, and no significant publication bias was detected (Egger's test p-value = 0.733).
CONCLUSION: HIV infection is associated with a statistically significant increased risk of hospitalization in mpox cases. There is a critical need for integrated care and enhanced surveillance, especially in populations with high HIV prevalence. Our findings emphasize the importance of ongoing research to better understand HIV and mpox co-infection and to refine management strategies for this vulnerable group. Future studies should focus on long-term outcomes and the effectiveness of various management strategies across different healthcare settings.
METHODS: A hospital-based prospective quasi-experimental pre-post intervention study was conducted from November 2023 to February 2024 among 346 healthcare professionals (medical doctors, pharmacists and nurses) practicing in King Saud Hospital (KSH), Unayzah, Saudi Arabia. The subjects were recruited using the convenience sampling method.An educational intervention workshop was conducted among the healthcare professionals. The KAP was assessed before and after the educational intervention using a content and face validated self-administered questionnaire. The statistical analyses were conducted using the Statistical Package for Social Sciences (SPSS). Wilcoxon Signed Rank Test was used to differentiate the mean response scores for knowledge, attitude, and practice domains, between pre and post intervention. Kruskal Wallis Test followed by Dunn's post hoc test was used to compare the mean response scores for knowledge, attitude and practice domains based on educational qualification and practicing experience for the pre and post-test period. The level of significance is determined at P
OBJECTIVES: To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation.
METHODS: Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorized into overarching principles, and short- and long-term treatment goals. A global panel of 30 dermatologists and 3 patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥ 80% approval by the panellists.
RESULTS: Consensus was reached in the first round of voting and ≥ 90% agreement was reached for 23 of 26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (-4 or more points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritize GPP. Long-term treatment goals should include minimizing disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals (e.g. avoiding hair and/or nail loss to improve QoL), reflect the complexity of assessing treatment goals and emphasize the need for a patient-centred approach.
CONCLUSIONS: In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, and short- and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of patients and physicians in the treatment of GPP.