Differences in mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine immunogenicity among patients undergoing dialysis.

BACKGROUND: Differences in immunogenicity between mRNA SARS-CoV-2 vaccines have not been well characterized in patients undergoing dialysis. We compared the serologic response in patients undergoing maintenance hemodialysis after vaccination against SARS-CoV-2 with BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna). METHODS: We conducted a prospective observational cohort study at 2 academic centres in Toronto, Canada, from Feb. 2, 2021, to July 20, 2021, which included 129 and 95 patients who received the BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines, respectively. We measured SARS-CoV-2 immunoglobulin G antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD) and nucleocapsid protein (anti-NP) at 6-7 and 12 weeks after the second dose of vaccine and compared those levels with the median convalescent serum antibody levels from 211 controls who were previously infected with SARS-CoV-2. RESULTS: At 6-7 weeks after 2-dose vaccination, we found that 51 of 70 patients (73%) who received BNT162b2 and 83 of 87 (95%) who received mRNA-1273 attained convalescent levels of anti-spike antibody (p < 0.001). In those who received BNT162b2, 35 of 70 (50%) reached the convalescent level for anti-RBD compared with 69 of 87 (79%) who received mRNA-1273 (p < 0.001). At 12 weeks after the second dose, anti-spike and anti-RBD levels were significantly lower in patients who received BNT162b2 than in those who received mRNA-1273. For anti-spike, 70 of 122 patients (57.4%) who received BNT162b2 maintained the convalescent level versus 68 of 71 (96%) of those who received mRNA-1273 (p < 0.001). For anti-RBD, 47 of 122 patients (38.5%) who received BNT162b2 maintained the anti-RBD convalescent level versus 45 of 71 (63%) of those who received mRNA-1273 (p = 0.002). INTERPRETATION: In patients undergoing hemodialysis, mRNA-1273 elicited a stronger humoral response than BNT162b2. Given the rapid decline in immunogenicity at 12 weeks in patients who received BNT162b2, a third dose is recommended in patients undergoing dialysis as a primary series, similar to recommendations for other vulnerable populations.

Evaluation of the SARS-CoV-2 Antibody Response to the BNT162b2 Vaccine in Patients Undergoing Hemodialysis.

Importance: Patients undergoing hemodialysis have a high mortality rate associated with COVID-19, and this patient population often has a poor response to vaccinations. Randomized clinical trials for COVID-19 vaccines included few patients with kidney disease; therefore, vaccine immunogenicity is uncertain in this population. Objective: To evaluate the SARS-CoV-2 antibody response in patients undergoing chronic hemodialysis following 1 vs 2 doses of BNT162b2 COVID-19 vaccination compared with health care workers serving as controls and convalescent serum. Design, Setting, and Participants: A prospective, single-center cohort study was conducted between February 2 and April 17, 2021, in Toronto, Ontario, Canada. Participants included 142 patients receiving in-center hemodialysis and 35 health care worker controls. Exposures: BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Main Outcomes and Measures: SARS-CoV-2 IgG antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD), and nucleocapsid protein (anti-NP). Results: Among the 142 participants undergoing maintenance hemodialysis, 94 (66%) were men; median age was 72 (interquartile range, 62-79) years. SARS-CoV-2 IgG antibodies were measured in 66 patients receiving 1 vaccine dose following a public health policy change, 76 patients receiving 2 vaccine doses, and 35 health care workers receiving 2 vaccine doses. Detectable anti-NP suggestive of natural SARS-CoV-2 infection was detected in 15 of 142 (11%) patients at baseline, and only 3 patients had prior COVID-19 confirmed by reverse transcriptase polymerase chain reaction testing. Two additional patients contracted COVID-19 after receiving 2 doses of vaccine. In 66 patients receiving a single BNT162b2 dose, seroconversion occurred in 53 (80%) for anti-spike and 36 (55%) for anti-RBD by 28 days postdose, but a robust response, defined by reaching the median levels of antibodies in convalescent serum from COVID-19 survivors, was noted in only 15 patients (23%) for anti-spike and 4 (6%) for anti-RBD in convalescent serum from COVID-19 survivors. In patients receiving 2 doses of BNT162b2 vaccine, seroconversion occurred in 69 of 72 (96%) for anti-spike and 63 of 72 (88%) for anti-RBD by 2 weeks following the second dose and median convalescent serum levels were reached in 52 of 72 patients (72%) for anti-spike and 43 of 72 (60%) for anti-RBD. In contrast, all 35 health care workers exceeded the median level of anti-spike and anti-RBD found in convalescent serum 2 to 4 weeks after the second dose. Conclusions and Relevance: This study suggests poor immunogenicity 28 days following a single dose of BNT162b2 vaccine in the hemodialysis population, supporting adherence to recommended vaccination schedules and avoiding delay of the second dose in these at-risk individuals.

Volumen del hematoma subcoriónico en el primer trimestre y riesgo de aborto espontáneo / Subchorionic hematoma volume in first trimester and risk of spontaneous abortion

Objetivo: establecer la asociación entre el volumen del hematoma subcoriónico en el primer trimestre y riesgo de aborto espontáneo. Métodos: se incluyeron pacientes con embarazos intrauterinos viables entre 6 y 13 semanas y diagnóstico de hematoma subcoriónico con o sin sangrado genital y frecuencia cardiaca visible por ultrasonido. Las pacientes fueron posteriormente divididas en dos grupos dependiendo de la interrupción o no del embarazo: pacientes que presentaron abortos espontáneos y pacientes que continuaron con el embarazo más allá de la primera mitad de este. Resultados: se seleccionaron 200 pacientes. La edad gestacional al momento de la evaluación ecográfica de 9,2 +/- 2,0 semanas y el volumen promedio del hematoma subcoriónico de 22,4 +/- 12,2 cm3. La tasa de aborto espontáneo en el grupo de pacientes seleccionadas fue de 33,5%. Las pacientes que presentaron abortos no presentaron diferencias significativas en edad materna y edad gestacional al momento de la evaluación ecográfica comparado con las pacientes que continuaron con el embarazo (p = ns). Las pacientes con abortos presentaron valores promedio mayores del volumen del hematoma subcoriónico (p = 0,05). El riesgo relativo fue significativo para los grupos que presentaron hematomas considerados grandes (riesgo relativo = 1,74; intervalo de confianza 95%, 1,20 - 2,44) y muy grandes (riesgo relativo = 4,19; intervalo de confianza 95%, 2,51-7,02; p < 0,05). Conclusión: existe asociación entre el volumen del hematoma subcoriónico en el primer trimestre y aumento del riesgo de aborto espontáneo (AU)

Objective: To establish association between subchorionic hematoma volume and risk of spontaneous abortion. Methods: There were included patients with viable intrauterine pregnancy between 6 and 13 weeks and diagnosis of subchorionic hematoma with or without genital bleeding and visible heart rate by ultrasound. Patients were divided y two groups depending of pregnancy interruption or not: patients who presented spontaneous abortion and patients who continued with their pregnancy beyond first trimester of it Results: Two hundred patients were selected. Gestacional age at moment of ultrasound evaluation was 9.2 +/- 2.0 weeks and mean value of subchorionic hematoma volume was 22.4 +/- 12.2 cm3. Rate of spontaneous abortion in gtroup was 33.5%. Patients who presented spontaneous abortion did not show significant differences in maternal age and gestacional age at moment of ultrasound evaluation compared with those who continue with their pregnancy (p = ns). Patients with spontaneous abortion presented higher mean values of subchorionic hematoma volume (p = 0.05). Relative risk were significant for groups who presented hematomas considered huge (relative risk = 1.74; interval confidence 95%, 1.20-2.44) and very huge (relative risk = 4.19, interval confidence 95%, 2.51-7.02; p < 0.05). Conclusion: There is an association between first trimester subchorionic hematoma volume and an increased risk of spontaneous abortion (AU)

Encefalopatía de Wernicke como complicación de hiperémesis gravídica / Wernicke’s encephalopathy as complication of hyperemesis gravidarum

Los hallazgos de la encefalopatía de Wernicke han sido descritos como una combinación de confusión, anomalías oculares y ataxia. La encefalopatía puede complicar la hiperémesis gravídica debido a que esta altera la absorción correcta de una cantidad adecuada de tiamina y puede causar alteraciones electrolíticas. Se presenta el caso de una primigesta de 22 años de edad que fue hospitalizada por presentar letargia, debilidad generalizada, oftalmoplejía, alteraciones del lenguaje y pérdida de peso a las 12 semanas de embarazo. Tenía antecedentes de hiperémesis gravídica tres semanas antes de la hospitalización. El examen físico reveló una paciente letárgica con nistagmos horizontales, ataxia e hiporeflexia simétrica. Se inició tratamiento con tiamina. La paciente se recuperó de las alteraciones neurológicas 6 semanas después del tratamiento (AU)

The features of Wernicke’s encephalopathy have been described as a combination of confusion, ocular abnormalities, and ataxia. Encephalopathy can complicate hyperemesis gravidarum because it impairs correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. We present the case of a 22-year-old primipara who was admitted to hospital due to lethargy, generalized weakness, ophthalmoplegia, language disturbance, and weight loss in her 12th week of pregnancy. The patient had a history of hyperemesis gravidarum three weeks before admission. Physical examination revealed a lethargic patient with horizontal nystagmus, ataxia, and symmetric hyporeflexia. Parenteral thiamine therapy was started. The patient recovered from the neurological deficits after 6 weeks of treatment (AU)

Síndrome de Alagille. Reporte de un caso / Alagille syndrome. A case report

Introducción: el síndrome de Alagille es un desorden autosómico dominante caracterizado por colestasis crónica debido a hipoplasia biliar intrahepática, anomalías cardiacas y esqueléticas y alteraciones faciales específicas. Caso clínico y discusión: se presenta un caso de primigesta de 25 años de edad que fue remitida a la Consulta Prenatal de Alto Riesgo a las 28 semanas por presentar restricción del crecimiento intrauterino del feto, ascitis fetal y polihidramnios. La evaluación ecográfica demostró marcada cifosis de la columna toracolumbar en T11/L2 y anomalías cardiacas. La necropsia demostró la presencia de tetralogía de Fallot, fusión de los cuerpos vertebrales toracolumbares (vértebras en mariposa) y agenesia de la vesícula biliar. El patrón de anomalías fetales fue coherente con aquellas asociadas con el síndrome de Alagille (AU)

Background: Alagille syndrome is an autosomal dominant disorder characterised by chronic cholestasis due to intrahepatic biliary hypoplasia, cardiac and skeletal abnormalities and specific facial dysmorphias. Case report and discussion: We report the case of a 25-year-old primigravida referred to the high-risk pregnancy unit at 28 weeks of gestation due to intrauterine growth restriction, foetal ascites and polyhydramnios. Ultrasound examination showed marked thoracolumbar kyphosis at T11/L2 and cardiac anomalies. Necropsy demonstrated the presence of tetralogy of Fallot, fusion of the thoracic and lumbar vertebral bodies (butterfly vertebrae) and agenesis of the gallbladder. The pattern of foetal anomalies was consistent with those associated with Alagille syndrome (AU)

Concentraciones de quimiocina RANTES en preeclámpticas y embarazadas normotensas sanas / Chemokine RANTES concentration in pre-eclampsia and healthy normotensive pregnant women

Objetivo. Comparar las concentraciones de quimiocina RANTES en gestantes con preeclampsia y embarazadas normotensas sanas. Método. Se seleccionó un total de 100 pacientes. Se incluyeron 50 gestantes con preeclampsia como los casos (grupo A) y un grupo control seleccionado por tener una edad y un índice de masa corporal similares al grupo de estudio que consistió en 50 embarazadas normotensas sanas (grupo B). Las muestras de sangre se recogieron en todas las pacientes antes del parto e inmediatamente después del diagnóstico en el grupo B para determinar las concentraciones de RANTES. Resultados. No se encontraron diferencias significativas con relación a la edad materna, edad gestacional e índice de masa corporal en el momento de la toma de la muestra (p = ns). Se encontraron diferencias estadísticamente significativas en las concentraciones de RANTES entre las pacientes en el grupo de estudio (grupo A; 2484,6 ± 113,7 pg/ml) y las pacientes del grupo control (grupo B; 2002,8 ± 62,6 pg/ml; p < 0,05). Se observó una correlación moderada, positiva y significativa con los valores de presión arterial sistólica (r = 0,283; p < 0,05) y con los valores de presión arterial diastólica (r = 0,322; p < 0,05). Conclusiones. Las gestantes con preeclampsia presentaron concentraciones significativamente más altas de la quimiocina RANTES al compararlas con embarazadas normotensas sanas (AU)

Objective. To compare concentrations of chemokine RANTES in pre-eclampsia patients and healthy normotensive pregnant women. Method. A total of 100 patients were selected. We included 50 pre-eclamptic patients as cases (group A) and a control group of 50 healthy normotensive women with the same age and body mass index as the study group (group B). Blood samples were collected in all patients before labor and immediately after diagnosis in group B to determine RANTES concentrations. Results. There were no significant differences in maternal age, gestational age, or body mass index when the samples were taken (P = ns). RANTES concentrations showed statistically significant differences between cases (group A; 2484.6 ± 113.7 pg/mL) and controls (group B; 2002.8 ± 62.6 pg/mL; P < .05). There was a moderate, positive and significant correlation with systolic blood pressure values (r = .283; P < .05) and with diastolic blood pressure values (r = .322; P < .05). Conclusions. Chemokine RANTES concentrations were significantly higher in pre-eclampsic patients than in healthy normotensive pregnant women (AU)

Gonadotropina coriónica en flujo vaginal para el diagnóstico de rotura prematura de membranas / Chorionic gonadotrophin in vaginal discharge for diagnosis of premature rupture of membranes

Objetivo: Establecer la eficacia diagnóstica de la determinación de gonadotropina coriónica en flujo vaginal para el diagnóstico de la rotura prematura de membranas. Método: Investigación de tipo prospectiva en muestra de 270 embarazadas que asistieron al Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Los grupos consistieron en pacientes con rotura prematura de membranas (grupo A; n = 135) y embarazadas con membranas integras (grupo B; n = 135), consideradas como controles. Se evaluaron las características generales, valores de gonadotropina coriónica en flujo vaginal y efectividad diagnóstica. Resultados: La edad gestacional al momento de la determinación de las concentraciones de gonadotropina coriónica en flujo vaginal fue de 32,9 +/- 1,6 semanas para el grupo A y 33,1 +/- 1,9 semanas para el grupo B (p = ns). No se encontraron diferencias estadísticamente significativas en la edad materna y la frecuencia de paridad entre ambos grupos de tratamiento (p = ns). Las pacientes del grupo A presentaron concentraciones significativamente más altas de gonadotropina coriónica en flujo vaginal (697,4 +/- 382,4 mUI/mL) comparado con las embarazadas del grupo B (91,4 +/- 47,1 mUI/mL; p < 0,0001). Un valor de corte de 100 mUI/mL presentó un valor por debajo de la curva de 0,96 con una sensibilidad del 97,0 por ciento, especificidad del 51,1 por ciento, valor predictivo positivo del 66,5 por ciento y valor predictivo negativo del 94,5 por ciento. Conclusión: La determinación de las concentraciones de gonadotropina coriónica en el flujo vaginal es una técnica diagnóstica útil para la rotura prematura de membranas.

Objective: To establish the diagnostical efficacy of chorionic gonadotropin in vaginal fluid determination for diagnosis of premature rupture of membranes. Method: A prospective research type was done with a sample of 270 pregnant women who assisted to obstetrics emergency at Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Groups consisted in patients with premature rupture of membranes (group A; n = 135) and pregnant women with intact membranes (group B; n = 135), considered as controls. General characteristics, values of chorionic gonadotropin in vaginal fluid and diagnostic efficacy were evaluated. Results: Gestational age at the moment of determination chorionic gonadotropin in vaginal fluid was 32.9 +/- 1.6 weeks in group A and 33.1 +/- 1.9 weeks in group B (p = ns). There were no significant differences in maternal age and frequency of parity between groups (p = ns). Patients in group A showed significant higher concentrations of chorionic gonadotropin in vaginal fluid (697.4 +/- 382.4 mUI/mL) compared with pregnant women in group B (91.4 +/- 47.1 mUI/mL; p < 0.0001). A cut-off point of 100 mUI/mL showed a under the curve value of 0.96 with a sensitivity of 97.0 percent, specificity of 51.1 percent, positive predictive value of 66.5 percent and negative predictive value of 94.5 percent. Conclusions: Determination of chorionic gonadotropin concentrations in vaginal fluid is a useful diagnosis tool for premature rupture of membranes.