Monkeypox Diagnosis in Clinical Settings: A Comprehensive Review of Best Laboratory Practices.

An outbreak of monkeypox (Mpox) was reported in more than 40 countries in early 2022. Accurate diagnosis of Mpox can be challenging, but history, clinical findings, and laboratory diagnosis can establish the diagnosis. The pre-analytic phase of testing includes collecting, storing, and transporting specimens. It is advised to swab the lesion site with virus transport medium (VTM) containing Dacron or polyester flock swabs from two different sites. Blood, urine, and semen samples may also be used. Timely sampling is necessary to obtain a sufficient amount of virus or antibodies. The analytical phase of infectious disease control involves diagnostic tools to determine the presence of the virus. While polymerase chain reaction (PCR) is the gold standard for detecting Mpox, genome sequencing is for identifying new or modified viruses. As a complement to these methods, isothermal amplification methods have been designed. ELISA assays are also available for the determination of antibodies. Electron microscopy is another effective diagnostic method for tissue identification of the virus. Wastewater fingerprinting provides some of the most effective diagnostic methods for virus identification at the community level. The advantages and disadvantages of these methods are further discussed. Post-analytic phase requires proper interpretation of test results and the preparation of accurate patient reports that include relevant medical history, clinical guidelines, and recommendations for follow-up testing or treatment.

CD4+ and CD8+ cell counts are significantly correlated with absolute lymphocyte count in hospitalized COVID-19 patients: a retrospective study.

Background: Coronavirus disease 2019 (COVID-19) is a contagious respiratory illness that was declared a pandemic in March 2020. Lymphopenia is one of the specific laboratory results disturbance in COVID-19 patients. Such findings are frequently associated with substantial changes in T-cell counts, particularly CD4+ and CD8+ T-cells. This study aimed to examine the correlation between CD4+ and CD8+ cell counts and absolute lymphocyte count (ALC) in COVID-19 patients and analyze its difference based on the COVID-19 patients' severity. Methods: From March 2022 to May 2022, we conducted a retrospective cohort study using medical records and laboratory data from patients diagnosed with COVID-19 at our hospital who met the inclusion and exclusion criteria. The total sampling method was used to recruit study participants. We conducted bivariate analysis, which consisted of correlation and comparative analysis. Results: Thirty-five patients met the inclusion and exclusion criteria and were divided into two severity groups (mild-moderate and severe-critical). The findings of this study revealed a significant correlation between CD4+ cell count and ALC on admission (r = 0.69, p < 0.001) and the tenth day of onset (r = 0.559, p < 0.001). Similarly, there was a correlation between CD8+ and ALC at admission (r = 0.543, p = 0.001) and on the tenth day of onset (r = 0.532, p = 0.001). Individuals with severe-critical illness had lower ALC, CD4+, and CD8+ cell counts than those with mild-moderate illness. Conclusion: According to the findings of this study, there is a correlation between CD4+ and CD8+ cell counts and ALC in COVID-19 patients. All lymphocyte subsets also showed a lower value in severe forms of the disease.

The polymorphisms of TNF-α related-gene and antibody production following third dose of COVID-19 vaccination: A pilot study.

Introduction: Vaccination is one of the most pertinent prevention strategies for the Coronavirus Disease 2019 (COVID-19) pandemic. Several factors, both intrinsic (particularly genetic) and extrinsic, can influence vaccine efficacy. However, very little research has been conducted into the genetic component's impact on immunogenicity following COVID-19 vaccination. Therefore, we present the antibody formation in thirteen people who received a third vaccination (booster) dose of the Moderna mRNA-1273 vaccine and the differences in the polymorphism Tumor Necrosis Factor-Alpha (TNF-α) related genes in this population. Methods: Our study included 13 participants with no comorbidities or a history of COVID-19 infection. The Chemiluminescent Microparticle Immunoassay (CMIA) was used to measure antibody production in serum. Polymorphism was recognized using the polymerase chain reaction (PCR) amplification technique. Results: In this study, TNF-α related gene (GG) significantly influenced the formation of the antiSARS-CoV-2 spike protein IgG antibody level (p = 0.005) in our sample. Conclusion: Although the polymorphism of the cytokine gene, particularly TNF-α, seems to influence antibody levels in our study population, a more comprehensive analysis is required for better generalization due to the nature of our pilot study.

Introducción: La vacunación es una de las estrategias de prevención más pertinentes ante la pandemia de Enfermedad del coronavirus 2019 (COVID-19). Varios factores, tanto intrínsecos (particularmente genéticos) como extrínsecos, pueden influir en la eficacia de la vacuna. Sin embargo, se ha realizado muy poca investigación sobre el impacto del componente genético en la inmunogenicidad después de la vacunación contra el COVID-19. Por lo tanto, presentamos la formación de anticuerpos en trece personas que recibieron una tercera dosis de vacunación (refuerzo) de la vacuna Moderna mRNA-1273 y las diferencias en los genes relacionados con el polimorfismo el factor de necrosis tumoral alfa (TNF-α) en esta población. Métodos: Nuestro estudio incluyó a 13 participantes sin comorbilidades o antecedentes de infección por COVID-19. Se utilizó el inmunoanálisis de micropartículas quimioluminiscentes (CMIA) para medir la producción de anticuerpos en suero. El polimorfismo se reconoció utilizando la técnica de amplificación de la reacción en cadena de la polimerasa (PCR). Resultados: En este estudio, el gen relacionado con TNF-α (GG) influyó significativamente en la formación del nivel de anticuerpos IgG de proteína de punta antiSARS-CoV-2 (p = 0,005) en nuestra muestra. Conclusiones: Aunque el polimorfismo del gen de la citoquina, particularmente el TNF-α, parece influir en los niveles de anticuerpos en nuestra población de estudio, se requiere un análisis más completo para una mejor generalización debido a la naturaleza de nuestro estudio piloto.

D-Dimer as a Sensitive Biomarker of Survival Rate in Patients with COVID-19.

OBJECTIVE: The global case fatality rate of coronavirus disease 2019 is 2.16% as announced by the World Health Organization. In Indonesia, according to the Ministry of Health, the number is even higher, reaching a 2.8% case fatality rate. D-dimer levels were found to affect coronavirus disease 2019 patient's survival in several studies. The study aimed to determine whether the amount of D-dimer predicted survival in coronavirus disease 2019 patients. MATERIALS AND METHODS: This research was performed in a retrospective cohort design and used survival analysis. From March 1, 2020, to August 31, 2020, the samples were collected from polymerase chain reaction-confirmed coronavirus disease 2019 patients at Mohammad Hoesin General Hospital in Palembang, South Sumatera, Indonesia. We used electronic medical records to obtain demographic (age and gender), coexisting condition, laboratory (coagulation and hematologic test), and outcome (non-survivors or survivors) data. The chi-square and Mann-Whitney tests were used to evaluate the results. The Kaplan-Meier method and the Mantel-Haenszel log-rank test were used to examine D-dimer levels and patient outcomes. Youden index was calculated to determine the optimal cut-off value of D-dimer. RESULTS: There were 52 non-survivors and 235 survivors among the 287 patients who met the inclusion criterion. Non-survivors had D-dimer levels of more than 1.49 mg/L in 82.69%of cases. Males had lower cut-off compared to females (>1.49 mg/L vs. >2.2 mg/L). The researchers discovered a highly significant correlation between D-dimer levels and coronavirus disease 2019 mortality (P=.001). The c-index analysis showed that D-dimer (0.79, 95% CI: 0.73-0.83) ability for mortality prediction was the second-best compared with other laboratory markers. CONCLUSION: D-dimer can be used as a predictor of coronavirus disease 2019 in-hospital mortality for early identification of coagulopathy.

A systematic review on neutrophil extracellular traps and its prognostication role in COVID-19 patients.

Neutrophil extracellular traps (NETs) are extracellular webs composed of neutrophil granular and nuclear elements. Because of the potentially dangerous amplification circuit between inflammation and tissue damage, NETs are becoming one of the investigated components in the current Coronavirus Disease 2019 (COVID-19) pandemic. The purpose of this systematic review is to summarize studies on the role of NETs in determining the prognosis of COVID-19 patients. The study used six databases: PubMed, Science Direct, EBSCOHost, Europe PMC, ProQuest, and Scopus. This literature search was implemented until October 31, 2021. The search terms were determined specifically for each databases, generally included the Neutrophil Extracellular Traps, COVID-19, and prognosis. The Newcastle Ottawa Scale (NOS) was then used to assess the risk of bias. Ten studies with a total of 810 participants were chosen based on the attainment of the prerequisite. Two were of high quality, seven were of moderate quality, and the rest were of low quality. The majority of studies compared COVID-19 to healthy control. Thrombosis was observed in three studies, while four studies recorded the need for mechanical ventilation. In COVID-19 patients, the early NETs concentration or the evolving NETs degradations can predict patient mortality. Based on their interactions with inflammatory and organ dysfunction markers, it is concluded that NETs play a significant role in navigating the severity of COVID-19 patients and thus impacting their prognosis.

Lymphocyte Levels in Predicting the Outcome of COVID-19 Patient: A Prognostic Study from Single Center in Indonesia.

BACKGROUND: Several laboratory parameters have been linked to Corona Virus Disease 2019 (COVID-19), with lymphocytes being one of the most important. Lymphopenia is frequently linked to a worsening of clinical symptoms and an increased risk of death in COVID-19. This study aimed to determine the role of lymphocyte levels in predicting COVID-19 patient mortality. METHODS: This is a prognostic study that is conducted from March 1 to August 31, 2020. Data from medical records and laboratory findings of COVID-19 patients were used in the study. Patient distribution and complete blood count were among the information gathered. ROC curve analysis, bivariate analysis (Chi-Square and Mann Whitney), in addition to survival analysis (Kaplan-Meier) were used to analyze the data. RESULTS: In a total of 318 patients, 59 were non-survivors and 259 were survivors. Besides, a cut-off value of ?1460 cells/µL (P<0.05) was used for lymphocyte levels. Lymphopenia also has a 4.35-fold increase in the risk of mortality. Furthermore, the survival analysis revealed differences in the probability of survival within 30 days between COVID-19 patients with lymphopenia and those without (HR: 5.5722 (3.2509-9.5510), 95% CI; p<0.0001). A lymphocyte count of ?1460 cell/µL can increase the risk of death by fourfold. CONCLUSIONS: The findings of this study indicated a significant difference in outcome between lymphopenia and non-lymphopenia patients. Lymphopenia plays an important role in estimating COVID-19 patient mortality.