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

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

A brown dwarf orbiting an M-dwarf: MOA 2009–BLG–411L

peer reviewedContext. Caustic crossing is the clearest signature of binary lenses in microlensing. In the present context, this signature is diluted by the large source star but a detailed analysis has allowed the companion signal to be extracted. Aims: MOA 2009-BLG-411 was detected on August 5, 2009 by the MOA-Collaboration. Alerted as a high-magnification event, it was sensitive to planets. Suspected anomalies in the light curve were not confirmed by a real-time model, but further analysis revealed small deviations from a single lens extended source fit. Methods: Thanks to observations by all the collaborations, this event was well monitored. We first decided to characterize the source star properties by using a more refined method than the classical one: we measure the interstellar absorption along the line of sight in five different passbands (VIJHK). Secondly, we model the lightcurve by using the standard technique: make (s,q,α) grids to look for local minima and refine the results by using a downhill method (Markov chain Monte Carlo). Finally, we use a Galactic model to estimate the physical properties of the lens components. Results: We find that the source star is a giant G star with radius 9 R[SUB]&sun;[/SUB]. The grid search gives two local minima, which correspond to the theoretical degeneracy s ≡ s[SUP]-1[/SUP]. We find that the lens is composed of a brown dwarf secondary of mass M[SUB]S[/SUB] = 0.05 M[SUB]&sun;[/SUB] orbiting a primary M-star of mass M[SUB]P[/SUB] = 0.18 M[SUB]&sun;[/SUB]. We also reveal a new mass-ratio degeneracy for the central caustics of close binaries. Conclusions: As far as we are aware, this is the first detection using the microlensing technique of a binary system in our Galaxy composed of an M-star and a brown dwarf. Appendix is available in electronic form at http://www.aanda.org</A

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 &lt; 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

Développement ou dispersion : l’université à l’épreuve de son évolution

peer reviewe

De quoi Radius est-il le nom? Enjeux et enseignements de la création d'une cellule de reporting institutionnel dans une université

Contemporary universities are under a good deal of pressure to adopt ways of functioning and organization taken from business. It is encouraged to reconcile goals of efficiency and profitability in a context of competition between institutions. Based on a case study carried out in a Francophone Belgian university, we consider how its Management Dashboards and institutional reporting allowed the university to respond to injunctions to change, in what ways they furnished a strategic support for management, as well as the effects of their implementation within the administrative organization. We will explain why the Radius cell was created at the university, as well as its structure and functioning. We will see that its impact on the institution’s personnel has been considerable. Creation of the Radius cell, which elicited misgivings on the part of administrations deprived of some their prerogatives, testifies to a reinforcement and relocalization of administrative prerogatives, some of whose powers are now concentrated in the hands of governing boards.L’université contemporaine subit une importante pression pour adopter un mo­de de fonctionnement et d’organisation issu de l’entreprise. Elle est incitée à concilier des objectifs d’efficacité et de rentabilité dans un contexte de concurrence entre institutions. Sur base d’une étude de cas réalisée dans une université belge francophone, nous abordons la manière dont les tableaux de bord et le reporting institutionnel permettent à l’université de répondre aux injonctions de changement, en quoi ils constituent un support de gestion stratégique, ainsi que les effets de leur implémentation dans l’organisation administrative. Nous expliquerons les raisons de la création de la cellule Radius à l’université, ainsi que sa structure et son fonctionnement. Nous verrons que son impact a été considérable sur le personnel de l’institution. La création de la cellule Radius, qui a suscité des réticences de la part d’administrations privées de certaines de leurs prérogatives, témoigne d’un renforcement et d’une relocalisation des prérogati­ves administratives, dont une partie des pouvoirs est à présent concentrée dans les mains des autorités

Prolégomènes à une philosophie de la médiation

peer reviewe