Effects Of Sex Research Articles

Sex differences in chest electrical impedance tomography findings

Objective. Electrical impedance tomography (EIT) has been used to determine regional lung ventilation distribution in humans for decades, however, the effect of biological sex on the findings has hardly ever been examined. The aim of our study was to determine if the spatial distribution of ventilation assessed by EIT during quiet breathing was influenced by biological sex. Approach. 219 adults with no known acute or chronic lung disease were examined in sitting position with the EIT electrodes placed around the lower chest (6th intercostal space). EIT data were recorded at 33 images/s during quiet breathing for 60 s. Regional tidal impedance variation was calculated in all EIT image pixels and the spatial distribution of the values was determined using the established EIT measures of centre of ventilation in ventrodorsal (CoVvd) and right-to-left direction (CoVrl), the dorsal and right fraction of ventilation, and ventilation defect score. Main results. After exclusion of one subject due to insufficient electrode contact, 218 data sets were analysed (120 men, 98 women) (age: 53 ± 18 vs 50 ± 16 yr (p = 0.2607), body mass index: 26.4 ± 4.0 vs 26.4 ± 6.6 kg m−2 (p = 0.9158), mean ± SD). Highly significant differences in ventilation distribution were identified between men and women between the right and left chest sides (CoVrl: 47.0 ± 2.9 vs 48.8 ± 3.3% of chest diameter (p < 0.0001), right fraction of ventilation: 0.573 ± 0.067 vs 0.539 ± 0.071 (p = 0.0004)) and less significant in the ventrodorsal direction (CoVvd: 55.6 ± 4.2 vs 54.5 ± 3.6% of chest diameter (p = 0.0364), dorsal fraction of ventilation: 0.650 ± 0.121 vs 0.625 ± 0.104 (p = 0.1155)). Ventilation defect score higher than one was found in 42.5% of men but only in 16.6% of women. Significance. Biological sex needs to be considered when EIT findings acquired in upright subjects in a rather caudal examination plane are interpreted. Sex differences in chest anatomy and thoracoabdominal mechanics may explain the results.

Association between heat and upper urinary tract stones morbidity and medical costs: A study in the subtropical humid climate zone

Urolithiasis is a heat-specific disease. Exploring heat-related urolithiasis susceptibility subtypes, economic burden, and modifying factors could assist governments in targeting interventions to reduce the heat-related health risks of urolithiasis morbidity. We collected data on 23,492 patients with upper urinary tract stones (main subtypes of urolithiasis) from 2013 to 2017 in Nanjing, China. We adopted generalized additive quasi-Poisson models to examine the associations between daily mean temperatures and morbidity of upper urinary tract stones, while generalized additive Gaussian models were used to explore the relationships between temperatures and log-transformed medical costs. We examined the modification effects of disease subtypes (kidney and ureteral calculus), sex, and age through stratified analyses and the modification effects of other meteorological factors by introducing interaction terms in the models. We found that short-term summer heat exposure has a statistically significant effect on ureteral calculus morbidity but not on kidney calculus morbidity. For ureter calculus, a 1 °C temperature increase was associated with a 4.36% (95% confidence interval [CI]: 1.94%, 6.83%) increase in daily hospitalization and a 5.44% (95% CI: 2.71%, 8.25%) increase in daily medical costs. The attributable fraction associated with heat (greater than the median value of daily mean temperature, 26.8 °C) was 7.85% (95% empirical confidence interval [eCI]: 3.64%, 11.44%) for hospitalization and 9.36% (95% eCI: 4.91%, 13.14%) for medical costs. The effects of heat on ureter calculus morbidity were significantly higher among the males and those with high sunshine duration than females and those with low sunshine duration. Short-term summer heat exposure was associated with increased morbidity and medical costs of ureteral calculus. Relevant government organizations should take effective intervention measures, including community health education, to reduce the health hazards and economic losses caused by heat.

Prevalence of latent and overt polyautoimmunity in type 1 diabetes: A systematic review and meta-analysis

BackgroundPatients afflicted by type 1 diabetes (T1D) exhibit polyautoimmunity (PolyA). However, the frequency and distribution of PolyA in T1D is still unknown. ObjectiveWe conducted a systematic review and meta-analysis to define the prevalence of latent and overt PolyA in individuals with T1D. MethodsFollowing PRISMA guidelines, a comprehensive search across medical databases identified studies on latent and overt PolyA in T1D. Two researchers independently screened, extracted data, and assessed study quality. A random effects model was utilized to calculate the pooled prevalence, along with its corresponding 95 % confidence interval (CI), for latent PolyA and overt PolyA. Meta-regression analysis was conducted to study the effect of study designs, age, sex, and duration of disease on pooled prevalence. ResultsA total of 158 articles, encompassing a diverse composition of study designs were scrutinized. The analysis included 270,890 individuals with a confirmed diagnosis of T1D. The gender was evenly distributed (50.30 % male). Notably, our analysis unveiled an overt PolyA prevalence rate of 8.50 % (95 % CI, 6.77 to 10.62), with North America having the highest rates (14.50 %, 95 % CI, 7.58 to 24.89). This PolyA profile was further characterized by a substantial incidence of concurrent autoimmune thyroid disease (7.44 %, 95 % CI, 5.65 to 9.74). Moreover, we identified a notable prevalence of latent PolyA in the T1D population, quantified at 14.45 % (95 % CI, 11.17 to 18.49) being most frequent in Asia (23.29 %, 95 % CI, 16.29 to 32.15) and Oceania (21.53 %, 95 % CI, 16.48 to 27.62). Remarkably, this latent PolyA phenomenon primarily featured an array of autoantibodies, including rheumatoid factor, followed by Ro52, thyroid peroxidase antibodies, and thyroglobulin antibodies. Duration of the disease was associated with a highest frequency of latent (β: 0.0456, P-value: 0.0140) and overt PolyA (β: 0.0373, P-value: 0.0152). No difference in the pooled prevalence by study design was observed. ConclusionThis meta-analysis constitutes a substantial advancement in the realm of early detection of PolyA in the context of T1D. Individuals with T1D should regularly undergo assessments to identify potential concurrent autoimmune diseases, especially as they age.

Epigenetic developmental mechanisms underlying sex differences in cancer.

Cancer risk is modulated by hereditary and somatic mutations, exposures, age, sex, and gender. The mechanisms by which sex and gender work alone and in combination with other cancer risk factors remain underexplored. In general, cancers that occur in both the male and female sexes occur more commonly in XY compared with XX individuals, regardless of genetic ancestry, geographic location, and age. Moreover, XY individuals are less frequently cured of their cancers, highlighting the need for a greater understanding of sex and gender effects in oncology. This will be necessary for optimal laboratory and clinical cancer investigations. To that end, we review the epigenetics of sexual differentiation and its effect on cancer hallmark pathways throughout life. Specifically, we will touch on how sex differences in metabolism, immunity, pluripotency, and tumor suppressor functions are patterned through the epigenetic effects of imprinting, sex chromosome complement, X inactivation, genes escaping X inactivation, sex hormones, and life history.

Investigating food production-associated DNA methylation changes in paleogenomes: Lack of consistent signals beyond technical noise.

The Neolithic transition introduced major diet and lifestyle changes to human populations across continents. Beyond well-documented bioarcheological and genetic effects, whether these changes also had molecular-level epigenetic repercussions in past human populations has been an open question. In fact, methylation signatures can be inferred from UDG-treated ancient DNA through postmortem damage patterns, but with low signal-to-noise ratios; it is thus unclear whether published paleogenomes would provide the necessary resolution to discover systematic effects of lifestyle and diet shifts. To address this we compiled UDG-treated shotgun genomes of 13 pre-Neolithic hunter-gatherers (HGs) and 21 Neolithic farmers (NFs) individuals from West and North Eurasia, published by six different laboratories and with coverage c.1×-58× (median = 9×). We used epiPALEOMIX and a Monte Carlo normalization scheme to estimate methylation levels per genome. Our paleomethylome dataset showed expected genome-wide methylation patterns such as CpG island hypomethylation. However, analyzing the data using various approaches did not yield any systematic signals for subsistence type, genetic sex, or tissue effects. Comparing the HG-NF methylation differences in our dataset with methylation differences between hunter-gatherers versus farmers in modern-day Central Africa also did not yield consistent results. Meanwhile, paleomethylome profiles did cluster strongly by their laboratories of origin. Using larger data volumes, minimizing technical noise and/or using alternative protocols may be necessary for capturing subtle environment-related biological signals from paleomethylomes.

Neuroprotection or Sex Bias: A Protective Response to Traumatic Brain Injury in the Females

Traumatic brain injury (TBI) is a major healthcare problem and a common cause of mortality and morbidity. Clinical and preclinical research suggests sex-related differences in short- and long-term outcomes following TBI; however, males have been the main focus of TBI research. Females show a protective response against TBI. Female animals in preclinical studies and women in clinical trials have shown comparatively better outcomes against mild, moderate, or severe TBI. This reflects a favorable protective nature of the females compared to the males, primarily attributed to various protective mechanisms that provide better prognosis and recovery in the females after TBI. Understanding the sex difference in the TBI pathophysiology and the underlying mechanisms remains an elusive goal. In this review, we provide insights into various mechanisms related to the anatomical, physiological, hormonal, enzymatic, inflammatory, oxidative, genetic, or mitochondrial basis that support the protective nature of females compared to males. Furthermore, we sought to outline the evidence of multiple biomarkers that are highly potential in the investigation of TBI's prognosis, pathophysiology, and treatment and which can serve as objective measures and novel targets for individualized therapeutic interventions in TBI treatment. Implementations from this review are important for the understanding of the effect of sex on TBI outcomes and possible mechanisms behind the favorable response in females. It also emphasizes the critical need to include females as a biological variable and in sufficient numbers in future TBI studies.

Sex disparity in liver allocation within Eurotransplant

In Eurotransplant, relatively more females than males die while waiting for liver transplantation, and relatively fewer females undergo transplantation. With adult liver transplantation candidates listed between 2007 and 2019 (n = 21 170), we study whether sex disparity is inherent to the model for end-stage liver disease (MELD) scoring system, or the indirect result of a small candidate body size limiting access to transplantation. Cox proportional hazard models are used to quantify the direct effect of sex on waitlist mortality, independent of the effect of sex through MELD scores, and the direct effect of sex on the transplantation rate, independent of the effect of sex through MELD and candidate body size. Adjusted waitlist mortality hazard ratios (HRs) for female sex are insignificant (HR: 1.03, 95% CI: 0.88-1.20). We thus lack evidence that MELD systematically underestimates waitlist mortality rates for females. Transplantation rates are 25% lower for females than males in unadjusted analyses (HR: 0.74, 95% CI: 0.71-0.77), but HRs become insignificant with adjustment for mediators (HR: 0.98, 95% CI: 0.93-1.04), most importantly candidate body size. Sex disparity in Eurotransplant thus appears to be largely a consequence of lower transplantation rates for females, which are explained by sex differences in body size.

Real-world experience of thrombopoietin receptor agonists in pediatric immune thrombocytopenia: a report from a Chinese tertiary children's hospital.

Primary immune thrombocytopenia (ITP) is the most common bleeding disorder in children. There are approximately 20% pediatric ITP patients respond poor to corticosteroids as first-line treatment. Recently thrombopoietin receptor agonists (TPO-RAs) have been used to treat refractory ITP and have achieved certain therapeutic effects. To investigate the efficacy and safety of TPO-RAs in the treatment of pediatric ITP, we conducted this real-world study. Fifty-three pediatric patients with ITP who did not respond well to corticosteroids were treated with TPO-RAs. Clinical data, including therapeutic response rate, changes in platelet (PLT) count, and adverse events (AEs) were collected. Of the 51 evaluable patients, 37 (72.5%) responded to TPO-RAs. Patients aged >4 years had a higher response rate than those aged ≤4 years (81.1% vs. 50.0%, P=0.04). There was no effect of sex, duration of disease, prior therapy, Mycoplasma pneumoniae (MP) immunoglobulin M (IgM) positivity, antinuclear antibody (ANA) positivity, CD4/CD8 ratio or baseline PLT count on the response rate (P>0.05). Other than 10 patients with PLT counts that exceeded the upper limit of normal, AEs were sporadic, including increased aminotransferase levels, cough, headache, and vomiting. TPO-RAs exhibited good clinical efficacy in pediatric ITP patients who failed to respond to first-line treatment, especially patients aged >4 years, and the side effects were minor.

Sex Differences on the Pharmacokinetics of Drugs for Children with Chronic Kidney Disease: A Narrative Review.

Effective optimal pharmacotherapy requires a comprehensive understanding of the drug's pharmacokinetic properties. Chronic kidney disease (CKD) influences medication pharmacokinetics. However, whether sex differences exist in the pharmacokinetics of drugs for children with CKD is unknown. The primary aim of this article was to evaluate the effect of sex on pharmacokinetics of drugs commonly used for CKD treatment in children. Secondary outcome was to address the impact of sex in CKD disease progression. Electronic databases, PubMed, EMBASE, Google Scholar, and Web of Science were searched from inception, using Mesh terms in English for sex differences in the pharmacokinetics of drugs in children with CKD. No studies have documented sex-related differences in the pharmacokinetics of drugs for the treatment of CKD in children. As a consequence, it is difficult to predict the effect of sex on pharmacokinetics by extrapolating data from adult studies to children. Evidence to date suggests that girls generally have a higher prevalence and disease progression of CKD when compared to boys regardless of age. Understanding the pharmacokinetics and pharmacodynamics of drugs provides practical consideration for dosing optimal medication regimens. Future kinetic studies are needed evaluating the effect of sex on the pharmacokinetics and pharmacodynamics of drugs in children with CKD.

The Impact of Birth Season and Sex on Motor Skills in 2-Year-Old Children: A Study in Jinhua, Eastern China.

This study investigates the effects of birth season and sex on the development of gross and fine motor skills in 2-year-old children in Jinhua, Eastern China. Conducted in Jinhua, a city in central Zhejiang Province, Eastern China, this research involved 225 children, assessing their gross and fine motor skills using the Peabody Developmental Motor Scales, Second Edition. Scores were adjusted for age in months to avoid the relative age effect. Statistical analyses included MANOVA to evaluate the impacts of season and sex. Sex had no significant impact on overall motor development scores (p > 0.05). However, the season of birth significantly affected fine motor quotient (FMQ) and total motor quotient (TMQ) (p < 0.05). Boys' motor skills were generally unaffected by season, whereas girls born in winter exhibited superior fine motor skills compared to those born in summer. Seasonal environmental factors significantly influence early motor development, particularly fine motor skills in girls. These findings highlight the importance of considering seasonal variations in early childhood interventions aimed at enhancing exercise physiology and sports performance.

Dopamine transmission at D1 and D2 receptors in the nucleus accumbens contributes to the expression of incubation of cocaine craving.

Relapse represents a consistent clinical problem for individuals with substance use disorder. In the incubation of craving model of persistent craving and relapse, cue-induced drug seeking progressively intensifies or 'incubates' during the first weeks of abstinence from drug self-administration and then remains high for months. Previously, we and others have demonstrated that expression of incubated cocaine craving requires strengthening of excitatory synaptic transmission in the nucleus accumbens core (NAcc). However, despite the importance of dopaminergic signaling in the NAcc for motivated behavior, little is known about the role that dopamine (DA) plays in the incubation of cocaine craving. Here we used fiber photometry to measure DA transients in the NAcc of male and female rats during cue-induced seeking tests conducted in early abstinence from cocaine self-administration, prior to incubation, and late abstinence, after incubation of craving has plateaued. We observed DA transients time-locked to cue-induced responding but their magnitude did not differ significantly when measured during early versus late abstinence seeking tests. Next, we tested for a functional role of these DA transients by injecting DA receptor antagonists into the NAcc just before the cue-induced seeking test. Blockade of either D1 or D2 DA receptors reduced cue-induced cocaine seeking after but not before incubation. We found no main effect of sex in our experiments. These results suggest that DA contributes to incubated cocaine seeking but the emergence of this role reflects changes in postsynaptic responsiveness to DA rather than presynaptic alterations.

Genetic, environmental, and phenotypic trends in a registered brahman herd

This study aimed to estimate the genetic, environmental, and phenotypic trends for 18-month weight (P540) in Brahman cattle. The research was conducted using 3,558 electronic records from the "La Cumaca" experimental station, part of the Faculty of Veterinary Sciences at the Central University of Venezuela. Genetic trends were estimated using three methods: a) by doubling the difference between the regression slopes estimated with the annual population means and the within-sire slope for the trait over years; b) using weighted regression analysis with the annual means derived from models adjusted with half-sibling or full-sibling groupings; and c) simple animal model. The models included the effects of sex, year and month of weight recording, and the effectsof the sire and dam, with variations involving the exclusion of ancestors to obtain trend estimates through differences in regression slopes. The genetic trend according to the first method was 1.2614 kg/year. Using half-sibling groups, the estimate was 3.0308 kg/year, while using full-sibling groups, the genetic change was 2.5332 kg/year. All three methods overestimated the annual genetic change, which was 0.829 kg/year using the animal model. The changes in reference to the population mean for the trait were less than 1%. Consequently, a revision of the selection procedure is suggested.

Bayesian varying‐effects vector autoregressive models for inference of brain connectivity networks and covariate effects in pediatric traumatic brain injury

AbstractIn this article, we develop an analytical approach for estimating brain connectivity networks that accounts for subject heterogeneity. More specifically, we consider a novel extension of a multi‐subject Bayesian vector autoregressive model that estimates group‐specific directed brain connectivity networks and accounts for the effects of covariates on the network edges. We adopt a flexible approach, allowing for (possibly) nonlinear effects of the covariates on edge strength via a novel Bayesian nonparametric prior that employs a weighted mixture of Gaussian processes. For posterior inference, we achieve computational scalability by implementing a variational Bayes scheme. Our approach enables simultaneous estimation of group‐specific networks and selection of relevant covariate effects. We show improved performance over competing two‐stage approaches on simulated data. We apply our method on resting‐state functional magnetic resonance imaging data from children with a history of traumatic brain injury (TBI) and healthy controls to estimate the effects of age and sex on the group‐level connectivities. Our results highlight differences in the distribution of parent nodes. They also suggest alteration in the relation of age, with peak edge strength in children with TBI, and differences in effective connectivity strength between males and females.

Sex and caste effects on the vibrational sensitivity in honey bees (Apis mellifera)

In the darkness of their nests, most social insect species communicate relying on chemical, tactile, electrical and mechanical signals. In honeybees, vibrational signals play a role not only in worker communication but also in communication among virgin queens in the process of swarming. Whereas the sensitivity to vibrations has been well studied in worker bees, vibrational sensitivity of queens and drones has never been investigated. We therefore studied the sensitivity to vibrations comparatively in workers, virgin and laying queens and in drones, focusing on the frequency range mainly used by virgin queens (350–500 Hz). Bees were tested behaviorally for responses to pulses of substrate borne vibrations in arenas placed on vibrational exciters. Vibrational amplitudes were measured using (LDV-calibrated) accelerometers. Real stimuli and sham stimuli were presented in a pseudorandom order. The threshold was defined as the lowest tested amplitude at which significantly more behavioral reactions were shown to real stimuli than to sham stimuli. Workers and virgin queens respond to amplitudes down to 0.25 m/s2. The thresholds of laying queens are substantially higher and they respond to minimum amplitudes of 0.55 m/s2. Drones show responses to amplitudes down to 0.6 m/s2. We conclude that sex and caste have effects on vibrational sensitivity in honeybees: virgin queens are significantly more sensitive than laying queens, indicating that a high sensitivity is crucial for survival during the process of swarming; workers are likewise highly sensitive to execute efficient everyday work; drones are significantly the least sensitive.

Age and sex effects on histological features and invitro culturing of Antillean manatee (Trichechus manatus manatus, Linnaeus 1758) dermis.

The biobanks from dermal biopsies represent an interesting strategy for biodiversity conservation. Nevertheless, the morphological and cellular patterns of the dermis can be influenced by the age and sex of the individual. Therefore, evaluating these factors is interesting for forming biobanks of Antillean manatees. These animals, representatives of marine fauna, have had their population reduced, and biobanks are essential for their conservation. Then, we evaluated the effects of age (3.5 years vs. 3.6-16 years vs. 23.6 years) and sex (males vs. females) on morphological and cellular parameters using histological and invitro culture techniques. Regardless of age, no differences were observed for dermal thickness, collagen fibres, tissue proliferative activity and viable cell recovery. Nonetheless, fibroblast reduction was observed in groups aged 23.6 years compared to other animals (p < 0.05). Additionally, cells from animals aged 3.6-16 years showed more significant mitochondrial damage than the other groups (p < 0.05). Regardless of sex, no differences were observed for dermal thickness, collagen fibres, tissue proliferative activity and viable cell recovery; however, females had fewer fibroblasts than males (p < 0.05). Cells from females showed lower mitochondrial damage when compared to cells from males. In summary, although age and sex do not influence dermal thickness and cell recovery, variations in the number of fibroblasts and mitochondrial characteristics were observed among the groups. These differences may be significant for understanding the dermis aspects to be correlated to biobank systems.

Why people make friends: Evidence from 12 nations

People make friends for a variety of reasons. The current study aimed to explore these reasons and the role of the Dark Triad in predicting them, using self-report questionnaires in a sample drawn from 12 countries. We found that the most important reasons for making friends were having people around with desirable traits such as compatibility, who could provide support and be relied upon in times of need, and with whom one could frequently socialize. Less important reasons included achieving self-serving goals such as career advancement and securing an intimate partner. We found small effects of age, sex, and relationship status. Furthermore, higher scores in Machiavellianism and Narcissism were associated with a greater emphasis on all reasons, particularly on achieving self-serving goals. Conversely, higher Psychopathy scores were associated with a lower importance placed on all reasons except mating, where they were associated with higher importance.

Sex and Equipment Impact on Lifting Velocity and the Maximum Repetitions in Bench Press.

This study investigated how equipment and sex affect the prediction accuracy of the maximum number of repetitions performed to failure (RTF) using the fastest mean velocity of the set (MVfastest). Sixteen men and twelve women completed four sessions (two using free-weight equipment and two sessions using the Smith machine). Each session involved three sets of repetitions to failure against the 65%, 75%, and 85% of the one-repetition maximum, interspersed by 10-min of rest. The goodness-of-fit of the individualized RTF-MVfastest relationships was comparable between both equipment types and sexes (P≥0.510). Moreover, there were not significant differences in the MVfastest associated with RTF between equipment types (P≥0.258). However, the MVfastest associated with RTF was higher for men than for women in repetitions 6 to 15 (P≤0.043; ES≥0.69). In addition, the absolute errors when predicting RTF showed no significant differences between equipment types and loads (P<0.444). Specifically, these RTF estimates were within an acceptable range for men (<2 repetitions), but not for women (≥2 repetitions) (main effect of sex: P≤0.018; ES≥0.58). These findings suggest that individualized RTF-MVfastest equations estimate the RTF with an acceptable precision in men during bench press exercises in both equipment types but exhibit lower precision for women.

Assessment of sex, nut weight, germination vigour, stem growth, and development traits of pistachio cultivars (Pistacia vera L.) used as rootstock

ABSTRACT Pistacia vera L. is the only edible plant with economic importance within Pistacia genus. In the current study, rootstock traits such as growth and development of major pistachio cultivars were evaluated in plants used as rootstock for pistachios in Turkey. The sex of 1008 individuals was determined using a molecular sex marker with HRM analysis. From the eight cultivars, the number of female and male plants were 453 and 413, respectively; and then used for phenotypic measurements. For each measurement period, analysis of variance established that there were no significant ‘cultivar x sex’ interactions or sex effects for stem diameter or stem height. However, the differences among cultivars were highly significant (P < 0.0001) at all measurement times. The maximum stem length and width values were in the progeny of the Ohadi cultivar, with the lowest values recorded for progeny of the Uzun and Kırmızı cultivars. The nut weights and stem properties of the plants were correlated with high positive coefficients, although the germination vigour was not statistically correlated with any other trait. The results of the current paper will aid the selection of candidates for future pistachio rootstock breeding programmes.

Sex disparity in stroke risk among patients with insomnia: a 19-year prospective cohort study.

Considering the increased prevalence and more severe manifestations of insomnia among females along with established sex differences in ischemic stroke (IS) occurrence, this research aimed to examine the potential effects of the interaction between insomnia and sex on the incidence and outcome of IS. We used data from the Korean Genome and Epidemiology Study (KoGES). The main exposure variables were insomnia history and sex. The main outcome was the occurrence of IS observed in biennial follow-up surveys. Cox proportional regression analysis was performed to estimate the effects of insomnia and sex on IS incidence. We also conducted interaction analysis to investigate the interaction effects between insomnia and sex on IS incidence. During 19 years of follow-up involving 8,933 individuals, we documented 370 cases of new-onset stroke (2.88 cases per 1,000 person-years). Cox proportional regression analysis showed that insomnia and female sex did not increase the risk of IS (HR: 1.13 [95% CI: 0.86-1.51] and HR: 0.86 [95% CI: 0.63-1.17], respectively). Interaction analysis demonstrated that stroke risk was increased only among females with insomnia (HR: 1.34 [95%: 1.05-1.80]) compared with those without insomnia. Our study highlights the significance of considering sex-specific factors when evaluating the relationship between insomnia and IS risk, particularly emphasizing the unique role of insomnia in IS risk among females.

Sex Differences in COVID-19 Mortality: A Meta-Analysis with E-COVID Study

Background: COVID-19 disease spreads rapidly and becomes more widespread with the emergence of new variants. The ratio of death cases due to the Coronavirus (COVID-19) in men is greater than in women. Recent research has found that men are more likely to have COVID-19 with severe symptoms and more at risk of death. This study aimed to examine the effect of sex on mortality in COVID-19 patients without comorbidities. Methods: This research was a systematic review and meta-analysis. The articles were obtained from several electronic databases including Google Scholar, PubMed, Scilit, Emerald Insight, Plos One, Sage Journal, JSTOR, World Cat, and ProQuest. The articles used in this study were articles that had been published from 2010-2019. The keywords to search for articles were as follows: gender and COVID-19 and HR, "gender and COVID-19 mortality and HR", "sex and COVID-19 mortality and HR", and "gender and COVID-19 mortality and HR". The articles included were full-text with an observational study design/cohort study. The articles were collected using PRISMA diagrams and analyzed using the Review Manager 5.3 application. Results: Males have 1.42 times the risk of dying from COVID-19 compared to females (in non-comorbid conditions) (aHR=1.42; CI 95%=1.27 to 1.59; p&lt;0.001). Conclusion: Male sex is associated with an increased risk of mortality.