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Research Detail

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M. A. Milon
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. M. Rahman
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. L. Rana
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. L. Khatun
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. R. Karim
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. E. Ali
Department of Biochemistry, Faculty of Sciences, Rajshahi University, Rajshahi, Bangladesh.

A. K. M. N. Huda
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. A. Islam
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

M. M. Rahman
Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Islamic University, Kushtia-7003, Bangladesh.

Sex and gender are recognized as a vital factor in the infectious disease epidemiology, and disease outcomes, and these two factors also appear to hold for severe acute respiratory syndrome (SARS-CoV-2) infection. Evidence from COVID-19 infection in Bangladesh showed that a variation number of cases and deaths between the sex differences in immune responses to viruses and gender related risk factors among the male and female, but more severe outcomes in aged men of cases and deaths in 31~40 and 61~70 years respectively than female. However, the previous research dataset in the different parts of world evidenced that the men's are vulnerable compare to women's. Similar trends to observe in Bangladesh datasets in COVID-19 epidemiology. Male and female represented 71% and 29% of total reported confirmed COVID-19 cases in Bangladesh, respectively. Moreover, different levels of angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMRSS2) enzymes play important role in COVID-19 infection of men and women. In addition, the effects of testosterone on ACE2 levels and the presence of ACE2 genes on the specific X-chromosome should not be ignored. In fine, this mini-review focuses on sex and gender variations in patients with an infectious disease of COVID-19 epidemiology in Bangladesh. The information of sex differences and age dependence might contribute to proper management and treatment of COVID-19 in Bangladesh. 

  COVID-19, SARS-CoV-2, Sex, Gender, ACE2, TMPRSS2
  In Bangladesh
  
  
  Risk Management in Agriculture
  Diseases, Micro organism

To addressing Sex and Gender Bias in COVID-19 Epidemiology in Bangladesh

According to 31 January 2021 confirmed cases for male and female, seven age groups had been categorized to describe the infection rate of COVID-19. In male, 0.9, 2.5, 11.8, 19.7, 14.3, 12, and 19.7% cases were confirmed respectively in the age group of 1-9, 10-19, 20-29, 30-39, 40-49, 50-59 and 60-69 years . On the other hand 0.7, 2.2, 6.2, 6.7, 5.3, 4.6 and 0.6% cases were found respectively in female. The highest case for male 19.7% was reported in the age group of 30 to 39 years old and in female highest case 6.7% was reported in the same age group. Male and female represented 71 and 29% of the of total reported confirmed COVID-19 cases, respectively. In both male and female active cases, hospitalizations, recover and mortality records are presented. Among them the highest death rate was reported at 24.7% in the 60 to 69-year-old age group in males, while the highest death rate was reported at 7.0% in females in the same age group. Furthermore, 0.2% of death cases in both male and females were found in the age group of 1-9 years, 0.4 and 0.3% found in the age group of 10-19, 0.8 and 0.7% found in the age group of 20-29, 2.7 and 1.5% found in the age group of 30-39, 6.2 and 2.2% found in the age group of 40-49, 15.6 and 5.2% found in the age group of 50-59, 18 and 4.7% found in the age group of 70-79% respectively in male and female. Furthermore, 2.4% death occurs in the age group above 80 years old male. Male and female represented 76 and 24% of the of total reported confirmed COVID-19 deaths respectively (https://www.who.int/bangladesh/emergencies/coronavirusdisease-(covid-19)-update). The highest 72,314 COVID-19 survey in China recorded that cases of suspected or confirmed death were considerably higher for men than in women (men: 63.8% women: 36.2%). Another study in Italy, among first 827 COVID-19 deaths, 80% were men and 20% were women. Similar findings have been identified in a sample of 3,912 English and Wales’s patients died of SARSCoV-2 (Scully et al., 2020). Besides, in China the fatality rate reported the infected men (2.8%) compare to women (1.7%) with severity and fatality rate was high men versus women (Gebhard et al., 2020). While age progression is linked to a higher death risk in both sexes, male discrimination remains apparent. The COVID-19 study from Italy, Spain, Germany, Switzerland, Belgium and Norway indicates men fatality rates are greater than women among all age groups older than 20 years (Marina et al., 2020).  The entry receptor and hormone genes are the responsible factor for the sex-related of COVID-19 disease severity such as the encoding genes of hormone-regulated expression, angiotensin converting enzyme (ACE) 2 receptor and TMPRSS2 as well as sex hormone-driven innate and adaptive immune responses, immunoaging and so on (Gebhard et al., 2020). SARS-CoV-2 uses angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMRSS2) enzyme as receptor to bind with a cell. As this ACE2 gene is on the X-chromosome, females may be heterozygous about the enzyme and males are homozygous (Gemmati et al., 2020). ACE2 is an outer membrane protein which is found in different types of cells; adipose tissue, heart, spleen, blood vessels, kidneys, liver, lungs, and bladder (Jia et al., 2016, Li et al., 2020). The spike (S) protein of SARS-CoV-2 binds to the ACE2 receptor of the cell and invades the target cell. In both healthy and diabetic states, women have higher levels of circulating ACE2 than men, according to recent research. Other studies have discovered that older women have higher ACE2 serum activity than younger women (Li et al., 2020).  Sex differences in immune responses to viruses: The susceptibility of men and women to viral infections varies, leading to sexual disparities in disease severity and seriousness (Barna et al., 1996). Gender and sex may have a variety of effects on men and women's unequal vulnerability to infectious diseases caused by viruses. Humans, for example, discovered that women with human immunodeficiency virus (HIV) proliferate at a rate that is more than 40% lower than men. Despite having less transmitting HIV RNA than men, women have 1.6 times the risk of developing AIDS when their HIV RNA loads are compared to men's (Klein et al., 2015). Even if the sensitivity to influenza A is frequently greater in men, fatalities are noticed to be higher in women's results of exposure to pathogenic influenza A viruses (WHO; 2010). By contrast, the prevalence of surface antigen serum hepatitis B virus (HBV), titers of HBV-DNA, and hepatocellular carcinoma development are higher amongst men than women (Tsay et al., 2009). Gender-related risk factors and impact: During this COVID-19 pandemic, women have a lower fatality rate in serious cases than men. Coronavirus affects men more than it affects women. Though the exact cause is unknown, some gender-related risk factors play a significant role in these disparities (Dana et al., 2020). Men and women are distinguished by the human sex chromosomes X and Y. Men have only one copy of the X chromosome and one copy of the Y chromosome, while women have two copies of the X chromosome (Schurz et al., 2019). Because some genes encoded by the X chromosome are related to immune responses, women have less inflammation and a lower viral load than men. Women's immune cells can be activated more than men's, and this is linked to INF (interferon) production and TLR-7 stimulation (toll-like receptor-7). In comparison to men, women have a higher level of T cell activation, which results in a faster immune response to coronavirus (Takahashi et al., 2020). The X chromosome is more functional in women which are highly dense with immune-associated cells, this makes women greatly stronger in rapid immune responses (innate and adaptive) compared to men (Sharma et al., 2020).

  http://journal.safebd.org/index.php/jafe; Vol 2 No 1 March 2021 Pages 125-129 e-ISSN 2708-5694
  http://doi.org/10.47440/JAFE.2021.2121
Funding Source:
  

Studies performed in Bangladesh by COVID-19 patients found that men are more vulnerable compared to women to develop the disease. In addition, cases of death in male patients are higher than in female ones. Sex as a significant variable should also be given more consideration. By looking at COVID-19 literature, it can be inferred that some sexrelated variables are used to determine the outcomes of the patients. Older age, male sex with acute illness severity has been with increased mortality risk. This study shows that different levels of male and female sex hormone enhances or protective immune response, receptor protein such as ACE2 in men and women, the effects of testosterone on ACE2 levels, and the ACE2 gene location on the X-chromosome should not be ignored. However, findings or draw hypothesis in this area are limited and further studies are required to draw a conclusion. 

  Journal
  


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