Monoclonal gammopathy in COVID-19 pregnant patients

Monoclonal gammopathies (MG) are a group of disorders ranging from the benign to the malignant plasma cell dyscrasias to the lymphoproliferative disorders, typically characterized by the presence of a monoclonal component (MC) at serum protein electrophoresis (SPE). This condition has been also observed in association with a spectrum of acute and chronic inflammatory diseases, including viral infections. We selected for this study pregnant patients hospitalized from 2018 at the Department of Gynecology of the AOU Federico II of Naples (that include from March 2020 a section dedicated to pregnant patients with Sars-Cov2 infection), who presented a MC at the SPE (Capillarys 2, Sebia), at prenatal checks. Our population has involved 20 pregnant patients (average age of 35yo, from 22 to 47), 8 of which tested positive for COVID-19 by real-time reverse-transcriptase polymerase chain reaction of nasopharyngeal swabs. It should be considered that 3 patients came in the prepandemic period. The MC characterization revealed: 7 patients with IgG k ranging from 1 to 10 g/L;5 with IgG k<3 g/L;1 with IgM k 7,7 g/L;5 with IgG k and IgG lambda<2 g/L;1 with 2 IgG lambda 6,7 g/L and 2,0 g/L;1 with 2 IgA k 9,6 g/L and 1,3 g/L. At hospitalization, 2 patients already had a diagnosis of MGUS, while for the others the MC presence was an occasional finding. It should be noted that 2 COVID-19 patients underwent therapy with casirivimab and imdevimab and one non COVID-19 patient to anti-D immunoprophylaxis after having already identified the MC. For 5 patients MC was detected during the second trimester and 4 of these had Sars-Cov2 infection;in the other 15 at the end of pregnancy. We observed that in the pregnant population, where in the pre COVID-19 era in our laboratory the MGUS percentage was of 0.3/year, the incidence increased to 0.6/year since February 2020. The presence of these MGUS must be investigated over time to understand the transience of the MC linked to viral infection. Previous studies hypothesized that the presence of MC during the inflammatory phase could reflect the degree of immune system hyperactivation in patients with severe COVID-19 disease. Further studies are needed to evaluate its frequency in pregnancy, longterm evolution, and prognostic role in this clinical setting.

Impact of Early Pandemic SARS-CoV-2 Lineages Replacement with the Variant of Concern P.1 (Gamma) in Western Bahia, Brazil.

BACKGROUND: The correct understanding of the epidemiological dynamics of COVID-19, caused by the SARS-CoV-2, is essential for formulating public policies of disease containment. METHODS: In this study, we constructed a picture of the epidemiological dynamics of COVID-19 in a Brazilian population of almost 17000 patients in 15 months. We specifically studied the fluctuations of COVID-19 cases and deaths due to COVID-19 over time according to host gender, age, viral load, and genetic variants. RESULTS: As the main results, we observed that the numbers of COVID-19 cases and deaths due to COVID-19 fluctuated over time and that men were the most affected by deaths, as well as those of 60 or more years old. We also observed that individuals between 30- and 44-years old were the most affected by COVID-19 cases. In addition, the viral loads in the patients' nasopharynx were higher in the early symptomatic period. We found that early pandemic SARS-CoV-2 lineages were replaced by the variant of concern (VOC) P.1 (Gamma) in the second half of the study period, which led to a significant increase in the number of deaths. CONCLUSIONS: The results presented in this study are helpful for future formulations of efficient public policies of COVID-19 containment.

Worldwide COVID-19 spreading explained: traveling numbers as a primary driver for the pandemic.

The spread of SARS-CoV-2 and the distribution of cases worldwide followed no clear biogeographic, climatic, or cultural trend. Conversely, the internationally busiest cities in all countries tended to be the hardest hit, suggesting a basic, mathematically neutral pattern of the new coronavirus early dissemination. We tested whether the number of flight passengers per time and the number of international frontiers could explain the number of cases of COVID-19 worldwide by a stepwise regression. Analysis were taken by 22 May 2020, a period when one would claim that early patterns of the pandemic establishment were still detectable, despite of community transmission in various places. The number of passengers arriving in a country and the number of international borders explained significantly 49% of the variance in the distribution of the number of cases of COVID-19, and number of passengers explained significantly 14.2% of data variance for cases per million inhabitants. Ecological neutral theory may explain a considerable part of the early distribution of SARS-CoV-2 and should be taken into consideration to define preventive international actions before a next pandemic.