ABSTRACT
BACKGROUND AND AIMS: Haemodialysis (HD) patients tend to be old, have weakened immune systems and suffer from multiple comorbidities, making them particularly prone to infections and death by the Coronavirus disease 2019 (COVID-19). Global vaccination against SARS-CoV2 has been underway, but long-term data in dialysis patients are still scant. We aimed to study the seroconversion with the Pfizer BNT162b2 vaccine in HD patients of 5 Dialysis Centres after the first 2 doses and monitor the immune responses and clinical data during the following 7 months. We also investigated the security of the vaccine. METHOD: We included 404 patients on chronic HD. All patients received 2 shots of the Pfizer BNT162b2 vaccine, separated by 21 days. Serologic tests were run using Quant II IgG anti-Spike SARS-CoV-2 assay by Abbott. Blood was drawn 21 days after the first dose (D22), 21 days after the second dose (D43), 3 and 6 months after the first dose (M3 and M6, respectively). We asked the patients to answer written questionaries about the symptoms reported during the 7 days after each vaccination. RESULTS: 60.6% of our patients were male and the median age was 70 years (min 19, max 97). 26 patients (6.4%) had previously been infected with COVID-19. 6 of them (23.1%) needed hospitalization. At 7 months follow-up, there were 3 new cases and 1 death (the one who died had negative antibody counts at M3). Maximum response to the vaccine was seen at D43, with 97.3% of the patients showing positive antibody titers. At 6 months, 91.5% still had positive antibodies. As is reported in Table 1, the following patients had higher antibody titers at D43 and M6: patients with COVID-19 before the first vaccine, younger patients, patients with higher albumin levels, patients on HDF versus HD. Patients on HDF had higher titers at all moments during the 6 months (Figure 1). Patients with cancer without antineoplasic treatment in the last 6 months showed lower rates of seroconversion at D43: OR: 0.117 [95% confidence interval (95% CI) 0.016-0.863]} and M6 (OR: 0.203, 95% CI 0.049-0.842]. Patients whose levels of C-reactive protein was ≤ 2.8 mg/dL had more probability of seroconversion at D43 (OR: 7.840, 95% CI 1.839-33.419;P < 0.005) as well as those with a higher (better) Karnofsky scale (OR 1.062, 95% CI 1.016-1.110). 43.4% of the patients reported at least one side effect after the first shot and 64.6% after the second shot. A total of 69.1% had at least one-side effect on the first or second shot. All the reported reactions were mild and transitory. CONCLUSION: Patients on HD respond surprisingly well to anti-COVID-19 vaccination and present only mild side effects. Further studies should analyze the impact of HDF on immune responses, since our work suggests that this type of dialysis may have a positive and protective long-term role on this population.
ABSTRACT
Currently, several hundreds of Terabytes of COVID-19 single-cell RNA-seq (scRNA-seq) data are available in public repositories. This data refers to multiple tissues, comorbidities, and conditions. We expect this trend to continue, and it is realistic to predict amounts of COVID-19 scRNA-seq data increasing to several Petabytes in the coming years. However, thoughtful analysis of this data requires large-scale computing infrastructures, and software systems optimized for such platforms to generate biological knowledge. This paper presents CellHeap, a portable and robust workflow for scRNA-seq customizable analyses, with quality control throughout the execution steps and deployable on supercomputers. Furthermore, we present the deployment of CellHeap in the Santos Dumont supercomputer for analyzing COVID-19 scRNA-seq datasets, and discuss a case study that processed dozens of Terabytes of COVID-19 scRNA-seq raw data. © 2021, Springer Nature Switzerland AG.
ABSTRACT
Objetivos: Descrever as caracteristicas clinicas e desfechos de pacientes com doencas hematologicas e com diagnostico confirmado de SARS-CoV-2. Material e metodos: Estudo de coorte retrospectivo, realizado em hospital publico terciario de Sao Paulo-SP. Foram incluidos consecutivamente pacientes adultos com doenca hematologica cronica entre 01 de marco a 01 de agosto de 2020 que apresentaram RT-PCR para SARS-CoV-2 positivo em swab nasofaringeo. Resultados: Foram incluidos 45 pacientes, com idade media de 56,6 anos e predominio de sexo masculino (56,6%). Trinta e cinco (77,8%) apresentavam neoplasia hematologica, sendo mieloma multiplo (22,9%), linfoma nao Hodgkin (20%) e leucemia mieloide cronica (17,1%) os mais frequentes. Entre os diagnosticos nao neoplasicos, observamos maior proporcao de anemia aplasica (30%). As comorbidades associadas mais frequentes foram cardiopatia (33,3%), diabetes mellitus (26,7%), tabagismo (15,6%) e doenca renal cronica (13,3%).A maioria dos casos teve origem comunitaria (77,8%) e desconhecia contato com caso suspeito/confirmado (82,2%). Os principais sintomas relatados foram febre (66,7%), tosse (55,6%) e dispneia (48,9%). Dois pacientes eram assintomaticos no momento do diagnostico, com pesquisa realizada na triagem pre-TMO.Quarenta e dois (93,3%) pacientes necessitaram de internacao hospitalar. Entre os pacientes internados, 26 (61,9%) necessitaram de admissao em UTI, 20 (47,6%) de ventilacao mecanica (VM) e 7 (16,7%) de terapia renal substitutiva. Quatro (8,9%) pacientes permanecem internados. A taxa de letalidade geral foi 37,8% (17/45) e entre os hospitalizados foi 40,5% (17/42). A taxa de letalidade no subgrupo de pacientes com neoplasia hematologica foi 40% (14/35). Cinco pacientes apresentaram coinfeccao bacteriana confirmada no momento do diagnostico da COVID-19, com letalidade de 80%.Entre os fatores de risco para obito, Diabetes Mellitus (p = 0,014) e Doenca Renal Cronica (p = 0,024) apresentaram maior frequencia. Presenca de choque (p = 0,005), lesao renal aguda (p = 0,005) ou insuficiencia respiratoria com necessidade de VM (p=0,009) no momento do diagnostico tambem teve relacao com obito. Identificamos maior proporcao de aquisicao de COVID-19 intra-hospitalar nos pacientes que foram a obito, com diferenca estatisticamente significativa (p = 0,004). Discussao: No nosso estudo, descrevemos serie de casos de pacientes com doencas hematologicas e infeccao por SARS-CoV-2. Observamos taxa geral de letalidade de 37,8%, chegando a 40% nos pacientes com neoplasia hematologica. Esse dado se assemelha as primeiras series de casos de COVID-19 em pacientes com neoplasias hematologicas, que encontraram taxa de letalidade variando entre 32,4-61,5%. Os sintomas iniciais e comorbidades mais frequentes foram semelhantes aos ja descritos na literatura. Diabetes mellitus e DRC foram observados com maior proporcao nos pacientes que evoluiram a obito, alem de apresentacao clinica mais grave no momento do diagnostico. Aquisicao intra-hospitalar de COVID-19 tambem foi mais frequente nos casos que evoluiram a obito. Conclusao: Encontramos taxa elevada de letalidade em pacientes com doencas hematologicas. Alem dos fatores de risco ja observados, a aquisicao intra-hospitalar de COVID-19 pode estar relacionada reforcando a importancia de medidas de prevencao de transmissao nos servicos de saude.Copyright © 2020