ABSTRACT
Context: Patients with hematologic malignancies have an increased risk of SARS-CoV-2 infection, severe COVID-19, and higher mortality rates. Objective(s): We investigated the immunological response to SARS-CoV-2 after infection and/or vaccination and explored the impact of treatment response on antibody levels. Design(s): We added a cohort of CML patients to the ongoing study SPARTA. We collected saliva and peripheral blood to measure levels of SARS-CoV-2 antigen and antibodies. Result(s): From 10-1-2021 to 3-31-2022, we prospectively enrolled 69 participants (32 with CML, 37 non-cancer) with similar sociodemographic characteristics. There was a significant difference in the frequency of previous SARS-CoV-2 infections, where the control group had a higher percentage of patients previously diagnosed with COVID-19 (18.8% vs. 84%). Nevertheless, there was no difference in the detection of SARS-CoV-2 at the time of enrollment (0% vs. 5.6%). SARS-CoV-2 antibodies, either IgG or neutralizing (nAB), were detected in most of the participants regardless of cancer status (IgG, 84.4% in the CML cohort and 91.7% in the non-cancer cohort;nAB, 84.4% vs. 88.9%). The two groups had comparable IgG (mean 160.8 vs. 157.5 Ru/mL) and nAB (mean 1,473 vs. 1,509 ng/ml) levels. Overall, IgG and nAB levels were significantly higher in subjects who received the last vaccine dose within 6 months compared to those who received it >=6 months previously (IgG, CML, mean 177.7 vs. 113.2, control 190.5 vs. 134.4;nAB, CML 1,784 vs. 951.9, control 2,066 vs. 1,335). Both groups had comparable mean antibody levels according to the time since the last dose (IgG, <=6 months, 177.7 vs. 190.5, >=6 months, 113.2 vs. 134.4;nAB, <=6 months, 1,784 vs. 2,066, >=6 months 951.9 vs. 1,335). There was no difference in the detection and levels of antibodies according to therapy with TKIs (IgG, mean 158.8 vs. 185.2;nAB, 1,515 vs. 1,883) or achieving MMR (IgG, mean 152.4 vs. 177.5;nAB, 1,447 vs. 1,686). Conclusion(s): The immunological response to SARS-CoV-2 among CML patients is comparable to that in non-CML subjects. TKI therapy and the response to treatment did not impact the development of antibodies. Moreover, antibody levels decreased over time, with the most significant drop after 6 months since the last immunization dose. Copyright © 2022 Elsevier Inc.
ABSTRACT
SESSION TITLE: Critical Complications of Cancer Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Glomus tumors are rare, benign neoplasms made up of cells resembling modified smooth muscle cells of glomus bodies. Glomus bodies are a type of arteriovenous anastomosis located primarily in dermal soft tissue and responsible for thermoregulation (1). Glomus tumors are suspected when presenting with a classic triad of severe pain, pinpoint tenderness, and hypersensitivity to cold (2). A vast majority of glomus tumors are benign with less than 1% demonstrating malignant pathology. Extradigital glomus tumors can occur, but often lack the typical presentation, making them difficult to diagnose. Treatment is surgical excision. CASE PRESENTATION: We report a case of a 35 year old female with past medical history of diabetes mellitus and morbid obesity who presented with a large 4cmX5cm fungating mass of the left posterior thigh (Figure 1 and 2). The patient was admitted to the ICU for concurrent acute hypoxemic respiratory failure secondary to COVID-19 pneumonia. The patient never received full dose anticoagulation. Due to the patient's instability, surgical evaluation was initially deferred until the patient began experiencing significant hemorrhage from the fungating mass (Figure 3), which correlated with a precipitous drop in hemoglobin requiring multiple transfusions. The mass was surgically excised (Figure 4), but continued bleeding, necessitating blood transfusions. Further evaluation of the mass by pathology established the mass as "Malignant glomus tumor showing chiefly spindle cell morphology, arising from a pre existing benign glomus tumor… showing some stromal oncocytic change as well as degenerative-appearing nuclear atypia and calcification.” The patient remained under ICU care through the remainder of her hospital stay for COVID-19 and sequela. Despite treatment, her clinical status worsened, the patient decompensated secondary to COVID-19, and the decision was made by the family to proceed with comfort measures. DISCUSSION: This patient presented with an abnormal fungating mass without symptoms typically consistent with glomus tumor. The mass displayed a malignant transformation, making it particularly unique. The case was further distinguished by hemorrhage and hemorrhagic shock directly related to the mass. Although this patient experienced a complicated course due to the hemorrhage requiring multiple postoperative transfusions, the patient was eventually stabilized and hemostasis was obtained. While it remains unclear if her malignant glomus tumor conferred increased risk of mortality from COVID-19, it is the author's belief that more research should be done to identify if a relationship between all type cancer and COVID-19 mortality exists. CONCLUSIONS: This case represents a unique case of malignant glomus tumor with previously undescribed presenting symptoms. Reference #1: 1. Gombos, Z., & Zhang, P. J. (2008). Glomus tumor. Archives of Pathology & Laboratory Medicine, 132(9), 1448–1452. https://doi.org/10.5858/2008-132-1448-gt Reference #2: 2. Sbai, M. A., Benzarti, S., Gharbi, W., Khoffi, W., & Maalla, R. (2018). Glomus tumor of the leg: A case report. Pan African Medical Journal, 31. https://doi.org/10.11604/pamj.2018.31.186.9706 Reference #3: 3. Aiba, M., Hirayama, A., & Kuramochi, S. (1988). Glomangiosarcoma in a glomus tumor. An immunohistochemical and ultrastructural study. Cancer, 61(7), 1467–1471. https://doi.org/10.1002/1097-0142(19880401)61:7<1467::aid-cncr2820610733>3.0.co;2-3 DISCLOSURES: No relevant relationships by Syed Akbarullah No relevant relationships by Devin Bradshaw No relevant relationships by LLOYD Del Mundo No relevant relationships by Gerard DiChiara No relevant relationships by Dushawn Harley No relevant relationships by Jerome Hruska No relevant relationships by Ian Ogurek No relevant relationships by Xenia Schneider No relevant relationships by Paul Stewart No relevant relationships by Joseph Telliard No elevant relationships by Ilya Yegudkin
ABSTRACT
Background: The rapid spread of SARS-CoV-2 has elicited an equally rapid development of effective vaccines, leading to a reduction of COVID-19 severity and deaths. There is limited data on COVID-19- related immunity in chronic myeloid leukemia (CML) patients. Methods: SPARTA (SARS2 SeroPrevalence And Respiratory Tract Assessment) is an ongoing observational study for participants age ≥18 years to investigate immunity to SARS-CoV-2 after infection and/or vaccination. We included patients with CML and compared them with a non-cancer group. We collected saliva and peripheral blood to measure antigen levels by RT-PCR and antibodies (secretory IgG antibodies and neutralizing antibodies). Results: From October 1, 2021, to February 4, 2022, we prospectively enrolled 49 participants (23 CML, 26 non-cancer). Most were male (56.5%) in the CML group and female in the control group (61.5%), mean age 56.39 y vs. 51.96 y, respectively, and self-identified as white (87% vs. 76.9%). In the CML group, 11 (47.8%) had ≥1 comorbidities, vs 13 (50%) in the control group. Twenty-one (91.3%) CML patients were receiving tyrosine-kinase inhibitors;4 (18.2%) non-cancer subjects reported taking any medication. Most participants in both groups had received at least one dose of COVID- 19 vaccine (73.9% vs. 73.1%);100% of CML patients received two doses vs. 84.2% of controls;the CML group had a higher percentage of subjects fully vaccinated (66.7% vs. 25%). The CML group had a lower percentage of patients previously diagnosed with COVID-19 (8.8% vs. 57.7%). However, there was no difference in the detection of SARS-CoV-2 antigen at the time of enrollment (0% vs. 4%). SARS-CoV-2 IgG antibodies were detected in most of the participants regardless of cancer status (78.3% in the CML cohort and 88% in the non-cancer cohort), and neutralizing antibodies were detected in 82.6% and 95.6%, respectively. The two groups had comparable IgG (mean 146.3 Ru/ml vs. 148.9 Ru/ml) and neutralizing (mean 1329.1 ng/ml vs. 1112 ng/ml) antibody levels. Conclusions: Our preliminary data comparing concomitant cohorts with similar socio-demographic characteristics and medical history indicate that a diagnosis of CML did not impact the development of antibodies against SARS-CoV-2. We are conducting continuous analysis of antibodies levels over time to assess the evolution of antibody immunity and functional studies including cellular immunity assessments.
ABSTRACT
Background. The impacts on mortality of both the SARS-CoV-2 epidemic and the interventions to manage it differ between countries. The Rapid Mortality Surveillance System set up by the South African Medical Research Council based on data from the National Population Register (NPR) provides a means of tracking this impact on mortality in South Africa. Objectives. To report on the change in key metrics of mortality (numbers of deaths, life expectancy at birth, life expectancy at age 60, and infant, under-5, older child and adolescent, young adult, and adult mortality) over the period 2015 - 2020. The key features of the impact are contrasted with those measured in other countries. Methods. The numbers of registered deaths by age and sex recorded on the NPR were increased to account for both registered deaths that are not captured by the NPR and an estimate of deaths not reported. The estimated numbers of deaths together with estimates of the numbers in the population in the middle of each of the years were used to produce life tables and calculate various indicators. Results. Between 2019 and 2020, the number of deaths increased by nearly 53-000 (65% female), and life expectancy at birth fell by 1 year for females and by only 2.5 months for males. Life expectancy at age 60 decreased by 1.6 years for females and 1.2 years for males. Infant mortality, under-5 mortality and mortality of children aged 5 - 14 decreased by 22%, 20% and 10%, respectively, while that for older children and adolescents decreased by 11% for males and 5% for females. Premature adult mortality, the probability of a 15-year-old dying before age 60, increased by 2% for males and 9% for females. Conclusions. COVID-19 and the interventions to manage it had differential impacts on mortality by age and sex. The impact of the epidemic on life expectancy in 2020 differs from that in most other, mainly developed, countries, both in the limited decline and also in the greater impact on females. These empirical estimates of life expectancy and mortality rates are not reflected by estimates from agencies, either because agency estimates have yet to be updated for the impact of the epidemic or because they have not allowed for the impact correctly. Trends in weekly excess deaths suggest that the drop in life expectancy in 2021 will be greater than that in 2020.
ABSTRACT
The effectiveness of measures introduced to minimise the spread of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2 or COVID-19) depends on compliance from all members of society. The Irish response to COVID-19 has been framed as a collective effort, fostering national solidarity. However, dominant representations of the national community often unreflexively reaffirm the prototypicality of majority group members, implicitly marginalizing minority group members. This may have implications for adherence behaviours. We propose that majority/minority membership of the national community predicts adherence to COVID-19 health advice via prototypicality and national solidarity. In Study 1, we collected data online from Irish residents (N = 1,185) during the first wave of restrictions in Ireland's response. In Study 2, we collected data from Irish residents (N = 537) during the second wave of restrictions, with more targeted sampling of minority groups. Based on these two studies, there is no difference between minority and majority group members' adherence behaviours. However, mediation analysis showed that greater adherence to COVID-19 health advice is shown when group members perceive themselves to be prototypical of the Irish national community, and thereby show greater national solidarity. In Study 3, we manipulated an appeal to adhere to restrictions (N = 689) and show that an inclusive solidarity appeal increased reported intentions to adhere to COVID-19 restrictions compared to an exclusive solidarity appeal among minority group members. These findings suggest that appeals to national solidarity in response to COVID-19 will be most successful when they reference the diversity of the nation.
ABSTRACT
BACKGROUND: Coronavirus disease-19 (COVID-19) restrictions, particularly relating to the sale of alcohol and hours of curfew, have had a marked effect on the temporal pattern of unnatural deaths in South Africa. Methods. Death data were collected over 68 weeks from January 2020 to April 2021, together with information on the nature of restrictions (if any) on the sale of alcohol, and hours of curfew. Data were analysed using a simple ordinary least square (OLS) regression model to estimate the relative contribution of restrictions on the sale of alcohol and hours of curfew to the pattern of excess unnatural deaths. Results. The complete restriction on the sale of alcohol resulted in a statistically significant reduction in unnatural deaths regardless of the length of curfew. To the contrary, periods where no or limited restrictions on alcohol were in force had no significant effect, or resulted in significantly increased unnatural deaths. Conclusions. The present study highlights an association between alcohol availability and the number of unnatural deaths and demonstrates the extent to which those deaths might be averted by disrupting the alcohol supply. While this is not a long-term solution to addressing alcohol-related harm, it further raises the importance of implementing evidence-based alcohol control measures.
Subject(s)
Alcohol Drinking/legislation & jurisprudence , Alcoholic Beverages/legislation & jurisprudence , COVID-19 , Commerce/legislation & jurisprudence , Alcoholic Beverages/economics , Cause of Death , Humans , Social Control, Formal , South Africa , Time FactorsABSTRACT
BACKGROUND: Producing timely and accurate estimates of the impact of COVID-19 on mortality is challenging for most countries, but impossible for South Africa (SA) from cause-of-death statistics. Objectives. To quantify the excess deaths and likely magnitude of COVID-19 in SA in 2020 and draw conclusions on monitoring the epidemic in 2021. Methods. Basic details of deaths registered on the National Population Register by the Department of Home Affairs (DoHA) are provided to the South African Medical Research Council weekly. Adjustments are made to the numbers of weekly deaths to account for non-registration on the population register, as well as late registration of death with the DoHA. The weekly number of deaths is compared with the number predicted based on the Holt-Winters time-series analysis of past deaths for provinces and metropolitan areas. Excess deaths were calculated for all-causes deaths and natural deaths, using the predicted deaths as a baseline. In addition, an adjustment was made to the baseline for natural deaths to account for the drop in natural deaths due to lockdown. Results. We estimated that just over 550 000 deaths occurred among persons aged ≥1 year during 2020, 13% higher than the 485 000 predicted before the pandemic. A pronounced increase in weekly deaths from natural causes peaked in the middle of July across all ages except <20 years, and across all provinces with slightly different timing. During December, it became clear that SA was experiencing a second wave of COVID-19 that would exceed the death toll of the first wave. In 2020, there were 70 000 - 76 000 excess deaths from natural causes, depending on the base. Using the adjusted base, the excess death rate from natural causes was 122 per 100 000 population, with a male-to-female ratio of 0.78. Deaths from unnatural causes halved for both males and females during the stringent lockdown level 5. The numbers reverted towards the predicted number with some fluctuations as lockdown restrictions varied. Just under 5 000 unnatural deaths were averted. Conclusions. Tracking the weekly numbers of deaths in near to real time has provided important information about the spatiotemporal impact of the pandemic and highlights that the ~28 000 reported COVID-19 deaths during 2020 substantially understate the death toll from COVID-19. There is an urgent need to re-engineer the system of collecting and processing cause-of-death information so that it can be accessed in a timely way to inform public health actions.
Subject(s)
COVID-19/mortality , Mortality/trends , Population Surveillance/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cause of Death/trends , Child , Child, Preschool , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Female , Humans , Infant , Male , Middle Aged , South Africa/epidemiologyABSTRACT
Background. Understanding the pattern of deaths from COVID-19 in South Africa (SA) is critical to identifying individuals at high risk of dying from the disease. The Minister of Health set up a daily reporting mechanism to obtain timeous details of COVID-19 deaths from the provinces to track mortality patterns. Objectives. To provide an epidemiological analysis of the first COVID-19 deaths in SA. Methods. Provincial deaths data from 28 March to 3 July 2020 were cleaned, information on comorbidities was standardised, and data were aggregated into a single data set. Analysis was performed by age, sex, province, date of death and comorbidities. Results. SA reported 3 088 deaths from COVID-19, i.e. an age-standardised death rate of 64.5 (95% confidence interval (CI) 62.3 - 66.8) deaths per million population. Most deaths occurred in Western Cape (65.5%) followed by Eastern Cape (16.8%) and Gauteng (11.3%). The median age of death was 61 years (interquartile range 52 - 71). Males had a 1.5 times higher death rate compared with females. Individuals with two or more comorbidities accounted for 58.6% (95% CI 56.6 - 60.5) of deaths. Hypertension and diabetes were the most common comorbidities reported, and HIV and tuberculosis were more common in individuals aged <50 years. Conclusions. Data collection for COVID-19 deaths in provinces must be standardised. Even though the data had limitations, these findings can be used by the SA government to manage the pandemic and identify individuals who are at high risk of dying from COVID-19.