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      La estratificación de la información por sexo en la COVID-19: un eslabón importante en la identificación de riesgos Translated title: The stratification of information by gender in COVID-19: an important link in the identification of risks

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          Sex-derived attributes contributing to SARS-CoV-2 mortality

          Epidemiological data in COVID-19 mortality indicate that men are more prone to die of SARS-CoV-2 infection than women, but biological causes for this sexual dimorphism are unknown. We discuss the prospective behavioral and biological differences between the sexes that could be attributed to this sex-based differentiation. The female sex hormones and the immune stimulatory genes, including Toll-like receptors, interleukins, and micro-RNAs present on X-chromosome, may impart lesser infectivity and mortality of the SARS-CoV-2 in females over males. The sex hormone estrogen interacts with the renin-angiotensin-aldosterone system, one of the most critical pathways in COVID-19 infectivity, and modulates the vasomotor homeostasis. Testosterone on the contrary enhances the levels of the two most critical molecules, angiotensin-converting enzyme 2 (ACE2) and the transmembrane protease serine-type 2 (TMPRSS2), transcriptionally and posttranslationally, thereby increasing viral load and delaying viral clearance in men as compared with women. We propose that modulating sex hormones, either by increasing estrogen or antiandrogen, may be a therapeutic option to reduce mortality from SARS-CoV-2.
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            The Role of Genetic Sex and Mitochondria in Response to COVID-19 Infection

            The difference between the female and male immune response to COVID-19 infection, and infections in general, is multifactorial. The well-known determiners of the immune response, such as X and Y chromosomes, sex hormones, and microbiota, are functionally interconnected and influence each other in shaping the organism's immunity. We focus our commentary on the interplay between the genetic sex and mitochondria and how this may affect a sex-dependent immune response in COVID-19 infection. Realizing the existence of these interactions may help in designing novel methods or fine-tuning the existing and routine therapies to fight COVID-19 and other infections.
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              Las estadísticas sanitarias y la invisibilidad por sexo y de género durante la epidemia de COVID-19

              RESUMEN Los informes sobre la COVID-19 del Ministerio de Sanidad en España son valiosos, pero incompletos, con el efecto perverso de que la susceptibilidad al virus según el sexo está poco clara. La prevalencia de COVID-19 por sexo difiere entre países. España muestra un patrón desigual: inicialmente más frecuente en los hombres, las mujeres los superaron a partir del 31 de marzo, tras 2 semanas de confinamiento, con contagios más frecuentes en las mujeres en contacto con casos de COVID-19. Concordando con los fallecimientos, los hombres son hospitalizados con mayor frecuencia. Las diferencias significativas por sexo en signos/síntomas pueden conducir a este patrón, observado también en otras enfermedades. A finales de abril, el exceso de mortalidad es la misma en las mujeres (67%) que en los hombres (66%). No obstante, la falta de información exhaustiva sobre las muertes por COVID-19 en no hospitalizados/as puede contribuir a la menor notificación de fallecimientos en las mujeres. La invisibilidad de los datos por sexo y de género probablemente está afectando de manera negativa más a las mujeres que a los hombres.
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                Author and article information

                Journal
                Gac Sanit
                Gac Sanit
                Gaceta Sanitaria
                SESPAS. Published by Elsevier España, S.L.U.
                0213-9111
                1578-1283
                15 January 2021
                15 January 2021
                Affiliations
                [0005]Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Lima, Perú
                Author notes
                [* ]Autor para correspondencia.
                Article
                S0213-9111(21)00006-6
                10.1016/j.gaceta.2020.12.032
                7831459
                771e2756-5bdb-4299-aeda-7dc03c99fa72
                © 2021 SESPAS. Published by Elsevier España, S.L.U.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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