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Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03–1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.

Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini review scopes the evidence base for efficacy, effectiveness, and safety of COVID-19 vaccines from both experimental and observational research, and asks whether (1) women and men were equally recruited and represented in vaccine research, (2) the outcomes of studies were presented or analysed by sex and/or gender, and (3) there is evidence of sex and/or gender differences in outcomes. Following a PubMed search, 41 articles were eligible for inclusion, including seven randomised controlled trials (RCTs), 11 cohort studies, eight cross-sectional surveys, eight routine surveillance studies, and seven case series. Overall, the RCTs contained equal representation of women and men; however, the observational studies contained a higher percentage of women. Of 10 studies with efficacy data, only three (30%) presented sex/gender-disaggregated results. Safety data was included in 35 studies and only 12 (34%) of these presented data by sex/gender. For those that did present disaggregated data, overall, the majority of participants reporting adverse events were women. There is a paucity of reporting and analysis of COVID-19 vaccine data by sex/gender. Research should be designed in a gender-sensitive way to present and, where possible analyse, data by sex/gender to ensure that there is a robust and specific evidence base of efficacy and safety data to assist in building public confidence and promote high vaccine coverage.

Studies of sex differences in the use and outcomes of endovascular treatment (EVT) for acute ischemic stroke report inconsistent results. We systematically searched PubMed and Embase databases for studies examining sex-specific utilization of EVT for acute ischemic stroke published before 31 December 2021. Estimates were compared by study type: randomized clinical trials (RCTs) and non-RCTs (hospital-based, registry-based or administrative data). Random effects odds ratios (ORs) were generated to quantify sex differences in EVT use. To estimate sex differences in functional outcome on the modified Rankin scale after EVT, the female:male ratio of ORs and 95% confidence intervals (CIs) were obtained from ordinal or binary analysis. 6,396 studies were identified through database searching, of which 594 qualified for a full review. A total of 51 studies (36 non-RCT and 15 RCTs) reporting on sex-specific utilization of EVT were included, and of those 10 estimated the sex differences of EVT on functional outcomes. EVT use was similar in women and men both in non-RCTs (OR: 1.03, 95% CI: 0.96-1.11) and RCTs (1.02, 95% CI: 0.89-1.16), with consistent results across years of publication and regions of study, except that in Europe EVT treatment was higher in women than men (1.15, 95% CI: 1.13-1.16). No sex differences were found in the functional outcome by either ordinal and binary analyses (ORs 0.95, 95% CI: 0.68-1.32] and 0.90, 95% CI: 0.65-1.25, respectively). No sex differences in EVT utilization or on functional outcomes were evident after acute ischemic stroke from large-vessel occlusion. Further research may be required to examine sex differences in long-term outcomes, social domains, and quality of life. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226100, identifier: CRD42021226100.

Objectives We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. Methods We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle–Ottawa scale. Where possible, data were pooled using random‐effects meta‐analysis. Results We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%–68%), and 68% (95% CI: 58%–79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%–93%). It was reported that 11% (95% CI: 2%–19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%–89%), 71% (95% CI: 57%–84%), and 73% (95% CI: 59%–86%), respectively. Conclusion In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors. Graphical  

Background and aims Aside from elevated mean systolic blood pressure (BP), additional measures such as variability, pulse pressure (PP), or mean-arterial pressure (MAP), could be important targets for dementia prevention. This study aimed to investigate these associations in participants with stroke or transient ischaemic attack from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial. Methods Logistic regression models were used to estimate associations of BP parameters with a composite of cognitive decline according to Mini-Mental State Examination scores and/or adjudicated dementia outcomes. Subgroup analysis was conducted by mild cognitive impairment (MCI) at baseline, sex and stroke subtype. Results After 4 (median) years of follow-up of 5,128 participants, 567 (11.1%) developed cognitive decline/dementia. For systolic BP (SBP), the mean, maximum, cumulative load and last measure were associated with higher odds of cognitive decline/dementia. Higher mean SBP conferred the highest odds (odds ratio [OR] 1.23, 95% confidence intervals [CI] 1.08-1.39). For diastolic BP, higher mean, maximum, variability, cumulative load, slope and last measure were associated, but the strongest association was for load (OR 1.29, 95% CI 1.15-1.45). Only the mean PP was associated (OR 1.14, 95% CI 1.00-1.30). For MAP, MAP load showed the strongest association (OR 1.26, 95% 1.13-1.41). Finally, systolic, diastolic and MAP variability showed higher odds in those without MCI (p interaction <0.001). Conclusions Besides higher mean SBP, alternative measures such as variability, cumulative load, slope and last measures of diastolic BP, PP and MAP were associated with cognitive decline/dementia and need further consideration in cognitive decline/dementia prevention. Conflict of interest Sultana Shajahan: nothing to disclose. Mark Woodward: nothing to disclose. Craig S Anderson has received grants from the NHMRC, the Medical Research Foundation (MRF) of the UK, and AstraZeneca paid to his institution; is a consultant to Auzone BioTech Shanghai; reports membership of data and safety monitoring boards for several investigator-initiated clinical trials, and is the Editor-in-Chief of Cerebrovascular Diseases and President-elect of the World Stroke Organisation. Cheryl Carcel is supported by an NHMRC Investigator Grant, Emerging Leadership 1 (APP2009726), Heart Foundation Vanguard grant, and receives research support from Bayer. Linan Chen: nothing to disclose. Ruth Peters is supported by funding from NHMRC paid to her institution. Karin Rådholm: nothing to disclose. Stephen Harrap: nothing to disclose. John Chalmers: nothing to disclose. Katie Harris: nothing to disclose.

The essential oil of Zingiber officinale Rosc. was extracted from China and Bangladeshi varieties and yielded 0.21% and 0.23 % by hydro-distillation method on fresh weight basis respectively. Fifteen compounds were identified and quantified by GC-MS. The major constituents of China and Bangladeshi ginger essential oils were zingiberene 38.10 % and 41.49%, β-phellandrene 12.0% and 9.92%, α-citral 11.48% and 9.76 %, α-curcumene 9.22% and 11.58%, camphene 5.94% and 4.60% , β-bisabolene 4.39% and 5.0% respectively. The IC50 (DPPH method ) values were found 61.18 µg/mL and 56.71 µg/mL with the highest inhibition of 78.49 % and 80.77% and the LC50 values in the brine shrimp lethality cytotoxicity bioassay were found 0.4842 µg/mL and 0.7151 µg/mL in China and Bangladeshi ginger essential oil respectively. Both the essential oils showed significant activities against some gram positive, gram negative bacteria and fungi. The proximate composition of the China and Bangladeshi variety showed the ash (7.12±0.151, 8.15±0.18%), protein (5.47±0.19, 6.60±0.16%), crude fibre (4.32±0.10, 4.61±0.12%), carbohydrate (16..06±0.35, 18.38±0.41) and food energy (70.50±0.89, 81.74±1.01 kcal/100g.) respectively. The elemental compositions of the both varieties were found rich in Ca, Mg, Fe, Al, Se, Na and K. These results indicate the quality composition of the two varieties may find interest in spice and culinary industries as well as in medicinal preparation.