Sex Reassignment Research Articles

46 XY disorder of sex development (DSD) due to 5 alpha (SRD5A2) deficiency – Experience from a multidisciplinary Pediatric Gender Clinic

SRD5A2 deficiency leads to incomplete masculinization of individuals with a 46 XY karyotype. A definitive diagnosis in early infancy facilitates decisions concerning choice of sex of rearing and management. To review the clinical presentation, diagnosis, treatment and outcome of children with 46 XY DSD due to SRD5A2 deficiency at a Paediatric Gender Clinic. Retrospective review of cases of SRD5A2 deficiency (2000-15) managed with a standard protocol at a multidisciplinary clinic. Demographic data, clinical presentation, physical findings, investigations (hormonal profile, imaging, genitoscopy), psychological evaluation (child, family), medical and surgical management, outcome and follow up were collated and analyzed. There were 12 cases aged 3 days-14 years at presentation, 3 had parental consanguinity. Eight were reared as males and 4 as females. Specialist referral was sought for hypospadias (5), atypical genitalia (5) or incongruent pubertal masculinization (2). All had chordee, symmetrical inguinoscrotal gonads, rugose labioscrotum and proximal hypospadias (perineoscrotal -9, perineal -3). Both pubertal cases had significant masculinization and no gynecomastia. The median testosterone/dihydrotestosterone ratio was 22.1(IQR-8.6-55.7). Despite a classical phenotype, four (2 prepubertal, 2 pubertal) had a ratio <10. Genitoscopy showed urogenital sinus remnant (4) and hypoplastic verumontanum (5). Sex reassignment was done in 4. Surgical management was staged and completed by 4 years in those with infantile presentation. Besides correction of chordee and urethroplasty in 11, other procedures included orchidopexy (5), excision of a urogenital sinus remnant (4) and correction of penoscrotal transposition (4). The urethroplasty was single staged in 3. All operated cases were followed up (mean age at last follow up - 10.63 years, mean follow up period - 7.25 years). The overall cosmetic result was satisfactory, but the phallic structure remained relatively small across prepubertal period. Uroflowmetry curves were normal in 9. All showed penile tumescence/erection and two peripubertal cases had typical secondary sexual characters. All cases, including those with sex reassignment, have a well-adjusted male psyche. The diagnosis, management and longitudinal follow up of cases of SRD5A2 deficiency at a multidisciplinary gender clinic is presented. Diagnostic dilemmas with low T/DHT ratios remained in a third of cases. Most were diagnosed in infancy and assigned a male sex of rearing, all underwent staged masculinizing genitoplasty. Those with sex reassignment also fared well with comprehensive management after family counseling.

The intersection of sexual orientation with race and ethnicity in cervical cancer screening.

Cervical cancer screening is recommended for those with a cervix who are 21 to 65 years old, with specific timelines being dependent on individual risk. This study compared rates of ever undergoing Papanicolaou (Pap) testing at the intersection of self-reported sexual minority (SM) status and race/ethnicity. Data from the National Health Interview Survey (2015 and 2018) were used to examine cervical cancer screening disparities. Natal females without a history of hysterectomy who were 21 to 65 years old and had reported their sexual orientation and Pap testing history were included. Demographic and health characteristics were summarized with descriptive statistics. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. IPTW-adjusted multivariable logistic regression models estimated odds of ever undergoing a Pap test by sexual orientation alone and with race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic). SM persons (n = 877) had significantly reduced odds of ever undergoing Pap testing (odds ratio, 0.54; 95% confidence interval, 0.42-0.70) in comparison with heterosexual persons (n = 17,760). When the intersection of sexual orientation and race/ethnicity was considered, non-Hispanic White SM participants and Hispanic SM participants had reduced odds of ever undergoing Pap testing in comparison with non-Hispanic White heterosexual participants. No significant differences were observed between non-Hispanic White heterosexual participants and participants of non-Hispanic Black SM or Hispanic heterosexual identities. SM participants were significantly less likely to have ever undergone a Pap test in comparison with heterosexual participants, with Hispanic SM participants having the lowest uptake. Future studies should further examine the roles of systemic discrimination and other key drivers of these disparities.

Caught in the Middle: The Care of Transgender Youth in Texas.

In the US, approximately 0.7% of adolescents identify as transgender or gender fluid.1 Many pediatric centers now provide multidisciplinary care to assist in the transition from a child's or adolescent's assigned sex at birth (or natal sex) to their affirmed (or preferred) gender. During early puberty, therapy is available that results in the suppression of sex steroid production and secretion, followed later in adolescence by the administration of supraphysiologic doses of sex hormones appropriate for their gender identity.1-3 The duration of pubertal suppression with gonadotropin hormone releasing hormone agonists (GnRHa) varies, but can extend up to 4 years for younger patients who are not able to provide consent until age 16 for receipt of gender-affirming therapy. Puberty blockers represent an invaluable intervention for these children and adolescents, to reduce anxiety and "buy time" until final decisions can be made about gender assignment.

Establishment of New Genetic Markers and Methods for Sex Determination of Mouse and Human Cells using Polymerase Chain Reactions and Crude DNA Samples.

Background: The currently available methods for sexing human or mouse cells have weaknesses. Therefore, it is necessary to establish new methods. Methods: We used bioinformatics approach to identify genes that have alleles on both the X and Y chromosomes of mouse and human genomes and have a region showing a significant difference between the X and Y alleles. We then used polymerase chain reactions (PCR) followed by visualization of the PCR amplicons in agarose gels to establish these genomic regions as genetic sex markers. Results: Our bioinformatics analyses identified eight mouse sex markers and 56 human sex markers that are new, i.e. are previously unreported. Six of the eight mouse markers and 14 of the 56 human markers were verified using PCR and ensuing visualization of the PCR amplicons in agarose gels. Most of the tested and untested sex markers possess significant differences in the molecular weight between the X- and Y-derived PCR amplicons and are thus much better than most, if not all, previously-reported genetic sex markers. We also established several simple and essentially cost-free methods for extraction of crude genomic DNA from cultured cells, blood samples, and tissues that could be used as template for PCR amplification. Conclusion: We have established new sex genetic markers and methods for extracting genomic DNA and for sexing human and mouse cells. Our work may also lend some methodological strategies to the identification of new genetic sex markers for other organismal species.

The Epidemiology of Gender Dysphoria in Iran: The First Nationwide Study.

Gender dysphoria (GD) is defined as a persistent and distressful incongruence between one's gender identity and one's at-birth-assigned sex. Sex reassignment has been religiously accepted for transgender individuals in postrevolutionary Iran since 1987; however, very little is known about how many individuals seek and receive such treatment annually. This study provides the first nationwide effort to assess the prevalence of GD in Iran as a function of diagnosis. The medical records of all transgender individuals referred to the Iranian Legal Medicine Organization between March 2012 and March 2017 were reviewed. All individuals diagnosed with GD were contacted. A total of 839 medical records meeting study criteria were received and evaluated. The prevalence of transgender individuals was estimated to be 1.46 per 100,000 Iranians with a transwoman (TW)/ transman (TM) ratio of 1:2. The mean age of individuals with GD at the time of referral was 25.22 (SD = 6.25) years for TW and 25.51 (SD = 5.66) years for TM. The findings are twofold. First, gender dysphoria is less prevalent in Iran than has been reported in Western countries. Second, the sex ratio is skewed toward at-birth-assigned females, which differs from what has been reported in Western countries. These findings have been interpreted in light of Iran's legal system, which is based on Islamic penal codes. These findings are of utmost importance for both health providers and legislators, as it can illustrate a more accurate picture of the transgender population in Iran.

Severity parameters for asphyxia or hypoxic-ischemic encephalopathy do not explain inter-individual variability in the pharmacokinetics of phenobarbital in newborns treated with therapeutic hypothermia.

The current study uses a population modeling approach to evaluate and quantify the impact of severity of asphyxia and hypoxic-ischemic encephalopathy (HIE) on the pharmacokinetics of phenobarbital in asphyxiated newborns treated with therapeutic hypothermia. Included newborns received phenobarbital (the TOBY trial protocol). 120 plasma samples were available from 50 newborns, median (IQR) weight 3.3 (2.8-3.5) kg and gestational age 39 (39-40) weeks. NONMEM® version 7.2 was used for the data analysis. Age, body weight, sex, concomitant medications, kidney and liver function markers, as well as severity parameters of asphyxia and HIE were tested as potential covariates of pharmacokinetics of phenobarbital. Severe asphyxia was defined as pH of arterial umbilical cord blood ≤7.1 and Apgar 5 ≤5, and severe HIE was defined as time to normalization of amplitude-integrated electroencephalography (aEEG) >24 h. Weight was found to be the only statistically significant covariate for the volume of distribution. At weight of 1 kg volume of distribution was 0.91 L and for every additional kg it increased in 0.91 L. Clearance was 0.00563 L/h. No covariates were statistically significant for the clearance of phenobarbital. Phenobarbital dose adjustments are not indicated in the studied population, irrespective of the severity of asphyxia or HIE.

CA 15-3 prognostic biomarker in SARS-CoV-2 pneumonia

The severity of lung involvement is the main prognostic factor in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Carbohydrate antigen 15-3 (CA 15-3), a marker of lung damage and fibrosis, could help predict the prognosis of SARS-CoV-2 pneumonia. This was a retrospective and observational study. CA 15-3 was analyzed in the blood samples of patients consecutively admitted for SARS-CoV-2 pneumonia and whose blood samples were available in the biobank. Other prognostic markers were also measured (interleukin 6 [IL6], C-reactive protein [CRP], D-dimer, troponin T, and NT-ProBNP). The occurrence of in-hospital complications was registered, including death, the need for medical intensive care, and oxygen therapy at discharge. In this study, 539 patients were recruited (54.9% men, mean age: 59.6 ± 16.4 years). At admission, the mean concentrations of CA 15-3 was 20.5 ± 15.8 U/mL, and the concentration was correlated with male sex, older age, and other severity markers of coronavirus disease of 2019 (COVID-19) (IL6, CRP, D-dimer, troponine T, and NT-ProBNP). CA 15-3 levels were higher in patients who died (n = 56, 10.4%) (35.33 ± 30.45 vs. 18.8 ± 12.11, p < 0.001), who required intensive medical support (n = 78, 14.4%; 31.17 ± 27.83 vs. 18.68 ± 11.83; p < 0.001), and who were discharged with supplemental oxygen (n = 64, 13.3%; 22.65 ± 14.41 vs. 18.2 ± 11.7; p = 0.011). Elevated CA 15-3 levels (above 34.5 U/mL) were a strong predictor of a complicated in-hospital course, in terms of a higher risk of death (adjusted odds ratio [OR] 3.74, 95% confidence interval [CI]: 1.22–11.9, p = 0.022) and need for intensive care (adjusted OR 4.56, 95% CI: 1.37–15.8) after adjusting for all other risk factors. The degree of lung damage and fibrosis evaluated in terms of CA 15-3 concentrations may allow early identification of the increased risk of complications in patients with SARS-CoV-2 pneumonia.

Sex reassignment surgery and wellbeing of India’s transgender community

The research focuses on determining "the role of sex reassignment surgery in Hijra culture in India and what motivates people to undergo sex reassignment surgery." The transgender community that creates the shape of the body through gender reassurance relies on modern medicine. However, there are financial, physical, and institutional impediments to undergo sex reassignment surgery and transitioning into a woman or a man. The cultural background of the Hijra, the link between the ancient Hijra culture and modern transgender communities, and the policy implications for the protection of civil rights among transgender people are highlighted as significant subjects during the research study. The study draws on data from primary sources of transgender people, including MtF (Male to Female) and transgender (Hijra) activists, from various community-based organisations across India, implementing a qualitative research approach and contacting transgender people through primary and secondary sources. Intentional and snowball sampling techniques are used to undertake in-depth interview guides with the transgender community and for further research, evaluation, and data collection. Interviews involve transgender individuals who are not primarily involved in the organization. Secondary sources such as the Internet, newspapers, and NGO reports evaluate the content.

Social and medical practices of gender transition in Russia

AIM. To examine the social and medical aspects of gender transition practices in Russia.&#x0D; MATERIAL AND METHODS. An anonymous online survey of people living in Russia whose gender experience differed from the sex marker determined at birth was conducted. The final sample consisted of 588 respondents (aged 24.016.70), of whom 69.9% (n=409) were transgender male, 23.1% (n=136) were transgender female, and 7.3% (n=43) had a different gender identity.&#x0D; RESULTS. There was a high frequency of social disadaptation among respondents (15.5% of the sample). Most respondents first reflected that their gender identity did not match their sex at birth and/or did not fit into the social framework during childhood or adolescence, with a peak at age 1114 (39.8% of the entire sample). The age at which respondents began gender transition was overwhelmingly after adulthood, with a peak at age 1825 (32.0% of the entire sample). More than half of the respondents (59.4%) who had medical body changes associated with gender transition initiated them on their own. Less than half of the respondents who were on hormone therapy (41.0%) had been monitored by an endocrinologist. The study showed a large proportion of people who already had medical body changes but had not changed sex marker on their IDs, with transgender women having the largest rate in this indicator.&#x0D; CONCLUSION. The data obtained determine the relevance of developing a system of specialized medical care for transgender people with essential destigmatizing psychotherapeutic and psychiatric care for these people, as well as emphasize the need to study the availability of medical (psychiatric) care for transgender people living in Russia.

Circulating Metabolic Biomarkers Are Consistently Associated With Type 2 Diabetes Risk in Asian and European Populations.

While Asians have a higher risk of type 2 diabetes (T2D) than Europeans for a given body mass index (BMI), it remains unclear whether the same markers of metabolic pathways are associated with diabetes. We evaluated associations between metabolic biomarkers and incidence of T2D in 3 major Asian ethnic groups (Chinese, Malay, and Indian) and a European population. We analyzed data from adult males and females of 2 cohorts from Singapore (n = 6393) consisting of Chinese, Malays, and Indians and 3 cohorts of European-origin participants from Finland (n = 14 558). We used nuclear magnetic resonance to quantify 154 circulating metabolic biomarkers at baseline and performed logistic regression to assess associations with T2D risk adjusted for age, sex, BMI and glycemic markers. Of the 154 metabolic biomarkers, 59 were associated with higher risk of T2D in both Asians and Europeans (P < 0.0003, Bonferroni-corrected). These included branched chain and aromatic amino acids, the inflammatory marker glycoprotein acetyls, total fatty acids, monounsaturated fatty acids, apolipoprotein B, larger very low-density lipoprotein particle sizes, and triglycerides. In addition, 13 metabolites were associated with a lower T2D risk in both populations, including omega-6 polyunsaturated fatty acids and larger high-density lipoprotein particle sizes. Associations were consistent within the Asian ethnic groups (all Phet ≥ 0.05) and largely consistent for the Asian and European populations (Phet ≥ 0.05 for 128 of 154 metabolic biomarkers). Metabolic biomarkers across several biological pathways were consistently associated with T2D risk in Asians and Europeans.

A male-specific sex marker for the endangered western sawshelled turtle (Myuchelys bellii) using in silico whole-genome subtraction

Artificial incubation of eggs for the mass release of hatchlings is a common conservation intervention for imperilled turtle species. Programs designed to reinforce wild populations need to ensure that they are releasing appropriate male to female ratios into the wild. In many turtle species, the sex of juveniles cannot be identified using external morphology until they approach sexual maturity. For the endangered western sawshelled turtle, Myuchelys bellii, sexual dimorphism does not occur until at least 6 years of age. We aimed to develop a molecular test to identify the sex of M. bellii during the life stages where they cannot be sexed morphologically—embryos, hatchlings and small juveniles. We used in silico whole-genome subtraction of a female M. bellii (XX) from a male (XY) to identify a Y chromosome-specific sequence which we characterized and developed into a PCR sex test. Our research is the first to use a whole-genome subtraction method in-silico to successfully establish sex chromosome markers in a freshwater turtle species. Developing this technology provides an opportunity for conservation programs to ensure that populations are supplemented with a proportionate number of male and female hatchlings. Further, it allows large scale measurement of naturally occurring sex ratios in hatchlings and small juveniles, which in turn enables estimates of sex ratios within wild populations free from age-at-maturity bias. The application of sex-specific marker technology also provides an opportunity to quantify the influence of sex on behaviour, movement and survival in the segment of populations that cannot be morphologically sexed.

Low-Cost Sex Reassignment Synthetic Model

Low-Cost Sex Reassignment Synthetic Model

Association of Patient Characteristics, Diabetes, BMI, and Obesity With Severe COVID-19 in Metropolitan Detroit, MI.

Identification of specific risk factors for severe coronavirus disease 2019 (COVID-19) is crucial for prevention of poor outcomes and mortality. This retrospective cohort study of patients hospitalized with COVID-19 demonstrated that older age, male sex, Black race, diabetes, elevated BMI, and elevated inflammatory markers were correlated with critical illness in COVID-19. Older age, male sex, diabetes, and inflammatory markers, but not elevated BMI, were associated with mortality. Despite having greater odds of critical illness, Black patients had lower odds of death than White patients. Older age, male sex, diabetes, and elevated inflammatory markers were significantly associated with venous thromboembolism. These findings suggest a need to aggressively identify and manage modifiable risk factors (i.e., diabetes and elevated BMI) and encourage vaccination of at-risk individuals to prevent poor outcomes from COVID-19.

Profils de personnalité chez les personnes transgenres

Within the framework of the setting up of the “Transgenre 87” network, for the care of people with diagnosis of gender dysphoria in partnership between Esquirol Hospital (Psychiatric Hospital) and the University Hospital of Limoges, we carried out a retrospective observational study to improve the quality of care. 45 medical records of transgender (MtF=28/FtM=17) aged 17 to 69 years old were analysed. The participant inclusion criteria were to have a gender dysphoria according to the DSM-5, an eligibility for a standardized sex reassignment procedure before hormonal therapy and presence of Minnesota Multiphasic Personality Inventory 2 results in medical record. The main objective of this study was to determine the personality profile(s) in transgender. The secondary objectives looked for relationships between elements of vulnerability possible comorbidities and MMPI personality dimensions. Overall, in two groups combined, we noted pathological T-score (T-score above 70) in the following MMPI-2 scales: Schizophrenia (Sc), Paranoia (Pa), Social Introversion (Si), Psychopathic Deviation (Pd), Depression (D). For MtF, we noted more pathological levels in the Schizophrenia (Sc), Depression (D) and Conversion Hysteria (Hy) subscales and for FtM, in the Paranoia (Pa), Social Introversion (Si), Psychopathic Deviation (Pd) MMPI-2 subscales. Comorbidity elements were found such as anxiety/anguish (60%), depression (35.6%), history of psychotropic treatment (35.6%), history of self-harm attempts in the past (26.7%), addictive behaviors (22.2%), sexual dissatisfaction (17.8%) in our population. Vulnerability elements were found such as dysfunctional attachment (35.6%), social isolation/relational/professional difficulties (48.9%). Our results suggested that these comorbidities, psychopathological vulnerability and personality should be taken into consideration to ensure better quality of care in this transgender population and accompany the sex reassignment procedure.

Prawnoczłowiecze aspekty funkcjonowania osób transpłciowych we współczesnym świecie

The gender that is officially assigned at birth (male or female) is based on physical characteristics. However, it may not be compatible with gender identity – this is the way we feel and think about our gender. A transgender person is someone who has or manifests a different gender identity from the gender identity assigned to him at birth. A transgender person may choose to manifest their gender identity in a variety of ways. To make more permanent physical activity it is essential to use surgery and hormone therapy. This is a time-consuming and costly process that does not always involve complete gender reassignment. Transgender people experience transphobia and discrimination because of their gender identity, which is mistakenly associated with sexual orientation. The misunderstood concept of transgender causes that transgender people encounter intolerance, a lack of empathy, and the non-existence of safe social and legal spaces. This is mainly due to a lack of knowledge on the fundamental issues of transgenderism. Complex judicial procedures for sex reassignment, lack of funding for hormonal treatment and surgical genital correction, and the inability to marry are the cause of depression and a still high percentage of suicide attempts and suicides in this social group. Hence, it is important to draw social attention to the problems faced by transgender people and to disseminate knowledge about transgenderism.

The Most-Cited Publications in Gender-Affirming Surgery: A Cross-Sectional Bibliometric Analysis.

Background: Gender-affirming surgery is becoming more common among reconstructive surgeons. Bibliometric analyses are statistical evaluations of published scientific correspondence and are a validated method of measuring influence in the scientific community. As no such bibliometric analysis has been done as of yet, the purpose of this study is to identify the characteristics of the 50 most-cited peer-reviewed articles on gender-affirming surgery. Methods: The Scopus abstract and citation database was utilized in April 2020 to search for English-language publications related to gender-affirming surgery. The 50 most-cited publications that met inclusion criteria were reviewed for various metric tabulations. Results: The 50 publications have been cited a total of 4402 times. Thirty-one (62%) were published in 2000 or later. Phalloplasty was the most discussed surgical technique, and 18 of the articles focused on female-to-male (FtM) patients. Case series (46%) and review articles (24%) were most common and there were no Level I or Level II studies. The Netherlands contributed the most, with 13 articles. Among the most frequent keywords in the 50 abstracts were "flap" and "complication". The earliest author keywords used were "transsexual" and "sex reassignment". Conclusions: The keyword usage in these abstracts over time seems to follow the trend of a more socially inclusive lexicon. A focus on studies with a higher level of evidence may optimize surgeon education and more appropriately guide clinical practice. This study reveals that the most influential and commonly referenced studies may not be sufficient to appropriately guide clinical practices.

Self-administration of gender-affirming hormones and supratherapeutic dosing are relatively common in Japanese transgender women.

This study was performed to determine the proportion of transgender women with self-adjusted hormone administration and excess dosing. The medical records of 87 transgender women who visited our gender clinic from 2010 through 2019 were reviewed. The complete blood count and serum concentrations of D-dimer, gonadotropins, and sex steroids were compared between transgender women who were self-administering gender-affirming hormones and women not using such hormones. Fifty-eight of 87 (66.7%) transgender women had contravened the guideline and self-adjusted their hormone administration. The hormonal data of one woman with hypopituitarism were eliminated from the analyses. The serum gonadotropin and testosterone levels were significantly lower in the self-administration group than in the hormone-naïve group. Gonadotropin levels below the lower limit of normal were found in 32/86 (37.2%) transgender women. The testosterone levels in six transgender women were not analyzed because these women had undergone sex reassignment surgery before visiting our hospital. Testosterone levels below the lower limit of normal men were found in 36/80 (45.0%) transgender women. Unexpectedly, 29/36 (80.6%) transgender women who were classified as having suppressed serum testosterone levels had testosterone levels of <0.6ng/mL, which corresponds to the levels in cisgender women. The white blood cell count and hemoglobin concentration were significantly different between the groups. Self-initiated hormonal treatments seem to affect the serum concentrations of gonadotropin and sex steroids and the complete blood count. The prevalence of transgender women with self-adjusted use of gender-affirming hormones is high, and an excess dose of hormones occasionally occurs.

The Importance of Surgical Sex Reassignment in TheOpinion of Female-To-Male Transsexuals.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; The term transsexualism determines people whose gender identity is contrary to their genetic sex and physical features. This condition leads to a discrepancy between the psychological gender preferred by transsexuals and their biological sex. Transsexuals experience a feeling of being incarcerated in a foreign body and therefore wish to alter their sex by hormone therapy and surgical treatment.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to describe the opinions of female-to-male transsexuals concerning sex reassignment surgery with selecting the most important stage.&lt;/br&gt;&lt;br&gt;&lt;b&gt;Method:&lt;/b&gt; The questionnaire studies were performed among a group of 82 female-to-male transsexuals with a mean age 25.2 years. Patients were at different stages of treatment. Results: More than 90% of the questionnaired transsexuals expect to complete their treatment with hope. For 86.6% of transsexuals, the most important stage in surgical treatment is the phalloplasty, the second panhysterectomy (70.7%), and the third breast reduction (69.5%).&lt;/br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Phalloplasty is the most important stage in sex reassignment surgery in the opinion of transsexuals. Each stage of treatment improves the mental comfort of female-to-male transsexuals.&lt;/br&gt.

Stress Hyperglycemia Is Associated With an Increased Risk of Subsequent Development of Diabetes Among Bacteremic and Nonbacteremic Patients.

Stress hyperglycemia is associated with an increased risk of diabetes among survivors of critical illness. We investigated whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress hyperglycemia would have a higher risk of subsequent diabetes development compared with those who remained normoglycemic. This retrospective observational study was conducted on 224,534 in-patients with blood culture records. Stress hyperglycemia was defined based on the highest random glucose level ≥7.8 mmol/L during the index admission period. Diagnosis of diabetes, as the primary end point of interest, was defined based on diagnostic codes, blood test results, or medication records. Differences in cumulative incidence and hazard ratios (HRs) of diabetes between groups were assessed using the Kaplan-Meier estimator and Cox regression. After exclusion of patients with preexisting or undiagnosed diabetes or indeterminate diabetes status and propensity score matching, bacteremic patients with stress hyperglycemia had a significantly higher cumulative incidence of diabetes (HR 1.7, 95% CI 1.2-2.4) compared with those who remained normoglycemic. Stress hyperglycemia was further confirmed to be a diabetes predictor independent of age, sex, comorbidity, and other serological markers. For the nonbacteremic patients, stress hyperglycemia was similarly associated with a higher cumulative incidence of diabetes (HR 1.4, 95% CI 1.2-1.7). Hospitalized patients with transient stress hyperglycemia had a higher risk of subsequent diabetes development compared with their normoglycemic counterparts. Recognition of an increased risk of diabetes in these patients can allow early detection and monitoring in their subsequent follow-ups.

Estimation of Bait Uptake by Badgers, Using Non-invasive Methods, in the Perspective of Oral Vaccination Against Bovine Tuberculosis in a French Infected Area.

Although France is officially declared free of bovine tuberculosis (TB), Mycobacterium bovis infection is still observed in several regions in cattle and wildlife, including badgers (Meles meles). In this context, vaccinating badgers should be considered as a promising strategy for the reduction in M. bovis transmission between badgers and other species, and cattle in particular. An oral vaccine consisting of live Bacille Calmette–Guérin (BCG) contained in bait is currently under assessment for badgers, for which testing bait deployment in the field and assessing bait uptake by badgers are required. This study aimed to evaluate the bait uptake by badgers and determine the main factors influencing uptake in a TB-infected area in Burgundy, north-eastern France. The baits were delivered at 15 different setts located in the vicinity of 13 pastures within a TB-infected area, which has been subject to intense badger culling over the last decade. Pre-baits followed by baits containing a biomarker (Rhodamine B; no BCG vaccine) were delivered down sett entrances in the spring (8 days of pre-baiting and 4 days of baiting) and summer (2 days of pre-baiting and 2 days of baiting) of 2018. The consumption of the marked baits was assessed by detecting fluorescence, produced by Rhodamine B, in hair collected in hair traps positioned at the setts and on the margins of the targeted pastures. Collected hairs were also genotyped to differentiate individuals using 24 microsatellites markers and one sex marker. Bait uptake was estimated as the proportion of badgers consuming baits marked by the biomarker over all the sampled animals (individual level), per badger social group, and per targeted pasture. We found a bait uptake of 52.4% (43 marked individuals of 82 genetically identified) at the individual level and a mean of 48.9 and 50.6% at the social group and pasture levels, respectively. The bait uptake was positively associated with the presence of cubs (social group level) and negatively influenced by the intensity of previous trapping (social group and pasture levels). This study is the first conducted in France on bait deployment in a badger population of intermediate density after several years of intensive culling. The results are expected to provide valuable information toward a realistic deployment of oral vaccine baits to control TB in badger populations.