Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after COVID-19 hospitalization: an international multicenter prospective observational study

Although it is known that coronavirus disease 2019 can present with a range of neurological manifestations and in-hospital complications, sparse data exist on whether these initial neurological symptoms of coronavirus disease 2019 are closely associated with post-acute neurological sequelae of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2; PANSC) and whether female versus male sex impacts symptom resolution. In this international, multi-centre, prospective, observational study across 407 sites from 15 countries (30 January 2020 to 30 April 2022), we report the prevalence and risk factors of PANSC among hospitalized adults and investigate the differences between males and females on neurological symptom resolution over time. PANSC symptoms included altered consciousness/confusion, fatigue/malaise, anosmia, dysgeusia and muscle ache/joint pain, on which information was collected at index hospitalization and during follow-up assessments. The analysis considered a time to the resolution of individual and all neurological symptoms. The resulting times were modelled by Weibull regression, assuming mixed-case interval censoring, with sex and age included as covariates. The model results were summarized as cumulative probability functions and age-adjusted and sex-adjusted median times to resolution. We included 6862 hospitalized adults with coronavirus disease 2019, who had follow-up assessments. The median age of the participants was 57 years (39.2% females). Males and females had similar baseline characteristics, except that more males (versus females) were admitted to the intensive care unit (30.5 versus 20.3%) and received mechanical ventilation (17.2 versus 11.8%). Approximately 70% of patients had multiple neurological symptoms at the first follow-up (median = 102 days). Fatigue (49.9%) and myalgia/arthralgia (45.2%) were the most prevalent symptoms of PANSC at the initial follow-up. The reported prevalence in females was generally higher (versus males) for all symptoms. At 12 months, anosmia and dysgeusia were resolved in most patients, although fatigue, altered consciousness and myalgia remained unresolved in >10% of the cohort. Females had a longer time to the resolution (5.2 versus 3.4 months) of neurological symptoms at follow-up for those with more than one neurological symptom. In the multivariable analysis, males were associated with a shorter time to the resolution of symptoms (hazard ratio = 1.53; 95% confidence interval = 1.39–1.69). Intensive care unit admission was associated with a longer time to the resolution of symptoms (hazard ratio = 0.68; 95% confidence interval = 0.60–0.77). Post-discharge stroke was uncommon (0.3% in females and 0.5% in males). Despite the methodological challenges involved in the collection of survey data, this international multi-centre prospective cohort study demonstrated that PANSC following index hospitalization was high. Symptom prevalence was higher and took longer to resolve in females than in males. This supported the fact that while males were sicker during acute illness, females were disproportionately affected by PANSC

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Pourquoi et comment repenser les pratiques d’allotement des broutards en vue de l’engraissement ?

International audienceAfter being weaned, beef calves are transported to sorting centres, and grouped into batches of similar live weight for fattening. This practice aims to facilitate the feeding of young cattle and is expected to improve and homogenize their growth performance. However, it also leads to other practices affecting the welfare, health and performance of weaned calves. This study was carried out to identify such practices and quantify their impact on young bulls’ performance during the fattening period. The impact of batch characteristics on the growth and performance of young bulls indicated by their average daily gain (ADG) and fattening period duration was analysed using a dataset of 15,735 Charolais young bulls belonging to 740 different batches operated by the beef producers’ organization Ter’Elevage in 2014 and 2015. The transportation distance of the calves was negatively correlated with ADG (−11 g/d for each additional 120 km travelled), while weight homogeneity had no effect. Besides, the average weight in the batch and the proportion of animals vaccinated for bovine respiratory disease before batch creation were positively correlated with ADG. In the present study, the transportation distance was identified as an important factor affecting young bulls’ performance and is a factor on which it is possible to act. That is why we then developed an algorithm to minimize the transportation distance, without modifying the batch, the origin or the fattening farm of destination of young bulls but by selecting the sorting centre they should go through. We tested the efficiency of the algorithm using a dataset of 129,756 grazers sorted by Ter'Elevage into 9,383 batches via 13 different sorting centres between 2010 and 2018. The results showed a decrease in transportation distances of 29 km per calf on average, and 84 km per calf transported over more than 300km. In addition, the distribution of calves across sorting centres recommended by the algorithm differs significantly from the actual distribution, showing the relative usefulness of each sorting centre to reduce transportation distances. This study shows that it is possible for the beef cattle sector to reconsider which criteria should be used for batch constitution in particular thanks to decision support tools such as the present algorithm to improve the animal welfare, health and performanceEn vue de leur engraissement, les broutards sont transportés après leur sevrage vers des centres de tri et regroupés en lots de poids vifs similaires. Cette pratique vise à faciliter la conduite alimentaire des jeunes bovins et permettrait d’améliorer et d’homogénéiser leurs performances de croissance. Elle conduit toutefois à d’autres pratiques affectant le bien-être, la santé et la performance des broutards. Dans cette étude nous avons cherché à identifier ces pratiques et à quantifier leur impact sur les performances de croissance des jeunes bovins à l’engrais. L’impact des caractéristiques de lots de broutards sur leur performance de croissance en terme de gain moyen quotidien (GMQ) et de durée d’engraissement a été évalué sur un jeu de données de 15 735 broutards charolais appartenant à 740 lots différents mis en place en 2014 et 2015 par le groupement Ter’Elevage. La distance de transport était associée négativement au GMQ (-11 g/j pour 120 km supplémentaires parcourus), tandis que l’homogénéité de poids n’avait aucun effet. De plus, le poids moyen du lot et la proportion d’animaux vaccinés contre les maladies respiratoires avant dans le lot étaient positivement associées au GMQ. Dans la présente étude, la distance de transport des bovins a été identifiée comme impactant fortement les performances de croissance et est un facteur sur lequel la filière peut agir, c’est pourquoi nous avons développé algorithme d’optimisation des distances de transport. Cet algorithme vise à minimiser les distances de transport des broutards sans modifier leur lot, origine ou destination, mais en sélectionnant le centre de tri par lequel ils transitent. Nous avons testé l’efficacité de cet algorithme avec un jeu de données de 129 756 broutards mis en place dans 9 383 lots par Ter’Elevage dans 13 centres de tri distincts entre 2010 et 2018. Les résultats montrent une diminution des distances de transport de 29 km par bovin en moyenne, et de 84 km par bovin pour les trajets de plus de 300km. De plus, la répartition des broutards entre les centres de tri recommandés par l’algorithme diffère sensiblement de la répartition réelle, révélant ainsi l’utilité relative de chaque centre de tri pour réduire les distances de transport. Cette étude montre qu’il serait donc possible pour la filière jeunes bovins français de repenser les critères de constitution des lots notamment à l’aide d’outils d’aide à la décision tel que l’algorithme développé dans cette étude pour améliorer le bien-être, la santé et les performances des animau

Impact on disease mortality of clinical, biological, and virological characteristics at hospital admission and overtime in COVID‐19 patients

International audienc

Long-term neurological symptoms after acute COVID-19 illness requiring hospitalization in adult patients: insights from the ISARIC-COVID-19 follow-up study

in this study we aimed to characterize the type and prevalence of neurological symptoms related to neurological long-COVID-19 from a large international multicenter cohort of adults after discharge from hospital for acute COVID-19

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities