SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score

Background: The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. Methods: We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. Results: Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =—0.162). Interpretation: Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications

Presenting Symptoms in Newly Diagnosed Myeloma, Relation to Organ Damage, and Implications for Symptom-Directed Screening: A Secondary Analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) Trial.

Multiple myeloma (MM) patients risk diagnostic delays and irreversible organ damage. In those with newly diagnosed myeloma, we explored the presenting symptoms to identify early signals of MM and their relationships to organ damage. The symptoms were recorded in patients' own words at diagnosis and included diagnostic time intervals. Those seen by a haematologist >6 months prior to MM diagnosis were classified as precursor disease (PD). Most (962/977) patients provided data. Back pain (38%), other pain (31%) and systemic symptoms (28%) predominated. Patients rarely complain of 'bone pain', simply 'pain'. Vertebral fractures are under-recognised as pathological and are the predominant irreversible organ damage (27% of patients), impacting the performance status (PS) and associated with back pain (odds ratio (OR) 6.14 [CI 4.47-8.44]), bone disease (OR 3.71 [CI 1.88-7.32]) and age >65 years (OR 1.58 [CI 1.15-2.17]). Renal failure is less frequent and associated with gastrointestinal symptoms (OR 2.23 [CI1.28-3.91]), age >65 years (OR 2.14 [CI1.28-3.91]) and absence of back pain (OR 0.44 [CI 0.29-0.67]). Patients with known PD (n = 149) had fewer vertebral fractures (p = 0.001), fewer adverse features (p = 0.001), less decline in PS (p = 0.001) and a lower stage (p = 0.04) than 813 with de novo MM. Our data suggest subgroups suitable for trials of 'symptom-directed' screening: those with back pain, unexplained pain, a general decline in health or low-impact vertebral compression fractures