Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Relationship of body mass index and abdominal obesity in rural population of Krasnodarsky kray taken

The aim was to study the relationship of body mass index (BMI) and abdominal obesity with the frequency of comorbid pathology in rural population of Krasnodarsky kray.Materials and methods. The study included 700 rural workers (18 years of age and older) who underwent a preventive medical examination (57,2% of women and 42,8% of men, mean age 49,11±16,57 years).Results. In rural population of Krasnodarsky kray the proportion of the individuals with BMI 25.0–29.9 kg/m2 was 34.7% (statistically more significant in men than in women, р<0.0001), the proportion of the individuals with BMI ≥ 30.0 kg/m2 was 39.7% (statistically more significant in women than in men, р<0.0001). Abdominal obesity was found in 70.1% of individuals (77.3% of women and 60.5% of men, p=0.0001). In the group of patients with increased BMI, abdominal obesity was more common in women than in men (p=0.0001). In the group of patients with BMI ≥ 30.0 kg/m2 abdominal obesity was revealed in 100% of cases. Risk factors for chronic non-infectious diseases such as hypercholesterolemia (26.7%), hyperglycemia (16.4%), and arterial hypertension (26.1%) were statistically more frequent in the individuals with BMI ≥ 30.0 kg/m2 than in those with normal and increased BMI. The diseases that can be enhanced by the presence of abdominal obesity were registered more often in patients with BMI ≥ 30.0 kg/m2 (97.8%) in comparison with patients with elevated BMI (23.5%; р<0,0001) and with normal BMI (4%; р<0,0001).Conclusions. Elevated BMI, abdominal obesity and high frequency of comorbid pathology is prevalent in Krasnodarsky kray

SARS-CoV-2 escape from cytotoxic T cells during long-term COVID-19

Here, the authors report accelerated intrahost evolution of SARS-CoV-2 in an immunocompromised patient with non-Hodgkin’s lymphoma with 318 days long COVID-19, and show that changes in the viral genome resulted in escape from T cellular immune response