HLA typing for post-transfused patient: comparison between blood and buccal swab sample

Background: The polymorphic Human Leukocyte Antigens (HLA) play an important role in determining the best matched donor in a haematopoietic stem cell transplant (HSCT). Hence, accurate HLA typing results are crucial to determine the successfulness of a transplant. Most of the patients of hematologic diseases will receive blood transfusion regularly. There is a potential discrepancy result or ambiguous results when a patient already received non-leukoreduced blood component prior to blood sampling for HLA typing. Aims: To determine differences between the HLA typing result from the DNA extracted from blood sample and buccal swab sample. Methods: Blood sample and buccal swab sample were collected from a total of 66 patients with different hematologic diseases and plan to go for haematopoietic stem cell transplant. These patients received at least one pack of red blood cell or platelet between 1 and 14 days prior to blood sample taken. DNA was extracted from all 66 blood samples and 66 buccal swab samples. All samples were typed for six loci (HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1 and HLA-DPB1) with Next Generation Sequencing (NGS). NGS was performed in all those samples using the NGSgo-MX6-1 kit. After the library preparation by using NGSgo-LibrX ligation reagents and the NGSgoIndX adapter, it was sequenced in iSeq 100. The results were then analysed with NGSengine software. The results for blood sample and buccal swab sample were then compared. Results: Out of 66 patients, 25 patients received either red blood cell or platelet component prior to blood sample taken for HLA typing. One patient received red blood cell and plasma and the others received red blood cell and platelets before the sample was taken. There are no differences between the HLA typing result from the DNA extracted from blood sample or buccal swab sample for all the 66 patients. The sequencing noise level for both DNA extracted from blood and buccal swab was well separated from the alleles as we can see from the base variation plot. Summary/Conclusions: This preliminary study only focus on the adult patients with hematologic diseases (ALL, AML, CML, MDS, multiple myeloma, DLBCL, hemophagocytic lymphohistiocytosis, NKT Cell lymphoma and severe aplastic anaemia) for the past 1 year. From the findings of this study, blood samples from the patient who underwent blood transfusion can be used for HLA typing instead of using buccal swab samples. This will lower the risk of Covid-19 infection among the healthcare worker who performs the buccal swab sampling from the patient with unknown status of Covid-19 infectivity. However, an extensive study with the appropriate number of samples needed to confirm this finding in the near future.

Understanding of Coronavirus Disease 2019 (COVID-19) and the practice of preventive measures among doctors and nurses in a university teaching hospital- A cross-sectional study

INTRODUCTION: Knowledge and adequate practice of preventive measures among health care workers (HCWs) are important to reduce the risk of COVID-19 transmission. METHODS: A cross-sectional study was conducted among doctors and nurses in the medical department in Pusat Perubatan Universiti Kebangsaan Malaysia between November 18, 2020 and December 18, 2020 during the third wave of COVID-19 epidemic in Malaysia. We studied the knowledge and practice of preventive measures of COVID-19 among doctors and nurses in the COVID-19 or sudden acute respiratory infection (SARI) wards and general medical wards. Data was collected using a validated self-designed google form online-questionnaire. RESULTS: A total of 407 subjects completed the study and 80.8% were females;55.8% were aged between 30-39 years;46.4% were medical doctors. The main source of COVID-19 knowledge was the Ministry of Health Malaysia (MOH) website (35.1%). Majority (97%) had sufficient knowledge and 82% practiced proper preventive measures. Doctors had a higher mean knowledge score compared to nurses (p < 0.001). HCWs working in COVID-19 or SARI wards scored higher in knowledge questions compared to those in the general medical wards (p = 0.020). Nurses practiced better preventive measures (p < 0.001). Good knowledge could not be predicted based on professions (OR: 0.222, 95% CI: 0.048 - 1.028, p = 0.054). Majority were unable to recall the proper steps of donning (85.8%) and doffing (98.5%). CONCLUSIONS: Although majority had good knowledge and practiced proper preventive measures, there was a poor recall in donning and doffing steps regardless of place of practice. The MOH website is a useful platform for tailored continuous medical education and regular updates on COVID-19. Regular training and retraining on donning and doffing of PPE is needed to bridge this gap.

A descriptive study of the psychological experience of health care workers in close contact with a person with COVID-19.

BACKGROUND: COVID-19 has the potential to affect the mental health of health care workers (HCWs). It is known that HCWs who serve as front-liners during the COVID-19 pandemic experience stress and have the fear of contracting the infection. Little is known of how being a positive contact affects HCWs. OBJECTIVE: We examined the experience of HCWs who were quarantined following a close unprotected contact with a COVID-19 positive colleague and explore the psychological impact especially as the timing of the quarantine coincided with the Eid (annual Muslim festival) celebration in Malaysia. METHODS: This was a cross-sectional on-line questionnaire study, involving HCWs exposed to a COVID-19 positive colleague in Universiti Kebangsaan Malaysia Medical Centre, a teaching hospital. Data on demographics, levels of depression, anxiety and stress using a validated depression, anxiety, and stress scale (DASS-21) questionnaire, aspects of quarantine, wearing of masks, hand hygiene practice and swab experience were collected. RESULTS: Twenty-two HCWs participated. Eighteen (81.8%) were between 30-39 years and 17 (77.3%) were women. Majority 19 (86.3%) were Malays. There were twelve (54.5%) medical officers, 5 (22.7%) specialists and 5(22.7%) allied health staff. Eighteen out of 22 (81.8%) felt they were able to do home quarantine adequately. All tested negative with a mean (Standard Deviation) hour of contact of 2.56±2.38 hours. Eighteen reported their biggest concern was infecting their families. CONCLUSION: HCWs undergoing contact swabbing and quarantine are vulnerable to depression, anxiety and stress. The ability of the HCW to adequately home quarantine should not be taken for granted. Psychological support should be offered to HCWs who are positive contacts.

Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur

BACKGROUND AND OBJECTIVE: Coronavirus Disease 2019 (COVID- 19) was first reported in Malaysia in March 2020. We describe here the clinical characteristics and computed tomography (CT) patterns in asymptomatic young patients who had laboratory-confirmed COVID-19. METHODS: This is a retrospective observational study where 25 male in-patients with laboratory-confirmed COVID-19 in Hospital Canselor Tuanku Muhriz. Demographics, clinical data and CT images of these patients were reviewed by 2 senior radiologists. RESULTS: In total there were 25 patients (all males;mean age [±SD], 21.64±2.40 years;range, 18-27 years). Patients with abnormal chest CT showed a relatively low normal absolute lymphocytes count (median: 2.2 x 109/L) and absolute monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase was elevated in 5 (20%) of the patients. The procalcitonin level was normal while elevated levels of alanine aminotransferase, total bilirubin, platelet and C-reactive protein were common. Baseline chest CT showed abnormalities in 6 patients. The distribution of the lesions were;upper lobe 3 (12%) lower lobe 3 (12%) with peripheral distribution 4 (16%). Of the 25 patients included, 4 (16%) had ground glass opacification (GGO), 1 (4%) had a small peripheral subpleural nodule, and 1 (4%) had a dense solitary granuloma. Four patients had typical CT features of COVID-19. CONCLUSION: We found that the CT imaging showed peripheral GGO in our patients. They remained clinically stable with no deterioration of their respiratory symptoms suggesting stability in lung involvement. We postulate that rapid changes in CT imaging may not be present in young, asymptomatic, non-smoking COVID-19 patients. Thus the use of CT thoraxfor early diagnosis may be reserved for patients in the older agegroups, and not in younger patients.