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Background: COVID-19 pandemic causes severe acute respiratory syndrome and requires rapid action. The development of effective safe vaccines become a global priority for achieving herd immunity. Vaccination is expected to form specific antibodies against the SARS-CoV-2 spike protein which can neutralize the virus, preventing the virus from binding with ACE 2 receptors. Objective: Evaluating and to know if there any differences of kinetics antibody levels from recipient’s anti-IgG S-RBD and NAb with complete second dose CoronaVac Vaccine, to determine the antibody response in preventing SARS-CoV-2. Method: A prospective-cohort study using observational analytics was conducted from January-April 2021 at Dr. Soetomo Hospital, Surabaya. A total of 50 subjects are healthcare workers who received two doses of CoronaVac. The IgG S-RBD and NAb levels were measured on Maglumi 800 device (SNIBE, China). Differences in IgG S-RBD and NAb levels before vaccination and after second dose CoronaVac vaccination on 14th day, on 28th day, ware tested using Friedman and Wilcoxon tests. Result: Mean values of IgG S-RBD and NAb have fluctuated. There was a significant difference between IgG S-RBD and NAb levels on day-0 (0.090 vs 18.630; p < 0.001) and day-28 (141.266 vs 116.640; p = 0.037). The median value showed the IgG S-RBD level on day-28 was much better than NAb value (141,266 v 116,640). Conclusion: CoronaVac will form persistent antibodies. Despite antibody development, the acquired humoral immunity decreased at 28 days after full CoronaVac immunization. Kinetics of antibody NAb decreased more rapidly than IgG S-RBD.

Exogenous Cushing's syndrome is a collection of symptoms and clinical signs due to elevated levels of glucocorticoids (cortisol) in the blood because of prolonged consumption of glucocorticoid drugs. Glucocorticoids were introduced in the 1950s and have been used for anti-inflammatory treatment. Withdrawal of glucocorticoids can lead to complications of secondary adrenal insufficiency caused by suppression of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Male, 28 years old, with weakness in both hands and feet throughout 3 days before admission to hospital. Other complaints include nausea (+), vomiting (+), diarrhea (-). He had been taking dexamethasone daily in the past 3 years until one month ago when he suddenly stopped. Physical examination revealed moon facies (+), striae (+) in the abdomen, and motor strength of 2 in all four extremities. Laboratory: K 2.0 mmol/L, Mg 0.8 mg/dL, GDA 64 mg/dL, Total cholesterol 240 mg/ dL, cortisol 18.67 ng/mL, ACTH 2.1 pg/mL. The patient was diagnosed with exogenous Cushing's syndrome based on a history of long-term use of dexamethasone. Physical examination revealed moon face, buffalo hump, purplish striae, and hypertension. The patient stopped dexamethasone consumption suddenly and is consequently experiencing secondary adrenal insufficiency at the present time. As evidenced by laboratory values, there was a decrease in serum cortisol (18.67 ng/mL), as well as a decrease in serum ACTH (2.1 pg/ mL). Based on the history of dexamethasone use, physical examination, and laboratory results, this patient had exogenous Cushing's syndrome. Sudden discontinuation of dexamethasone results in withdrawal symptoms in the form of secondary adrenal insufficiency as indicated by low cortisol and ACTH values.

Introduction: Studies evaluating the levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike protein receptor-binding domain (S-RBD) immunoglobulin G (IgG) antibodies in vaccinated healthcare workers in Indonesia are limited. Objectives: Evaluating time-dependent levels of anti-IgG S-RBD antibodies and monitoring the response of healthcare workers in a tertiary hospital in Indonesia after vaccination. Materials and methods: This prospective cohort observational study was conducted from January to December 2021. A total of 50 healthcare workers participated in the study. Blood samples were collected at five time points. Antibody levels were measured using a CL 1000i analyzer (Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China). Antibody levels between groups were analyzed using the Wilcoxon signed-rank test with P less than 0.05. Results: The median levels of SARS-CoV-2 anti-S-RBD IgG antibody on days 14, 28, 90, and 180 were significantly higher than the levels on day 0 ( P <0.001). After the second dose, peak levels were observed on day 14; the levels decreased gradually after day 28. Despite receiving two doses of the vaccine, 10 out of 50 participants (20%) were infected with COVID-19 (coronavirus disease 2019). However, symptoms were mild, and antibody levels were significantly higher than in noninfected participants ( P <0.001). Conclusion: SARS-CoV-2 anti-S-RBD IgG antibody levels increased significantly until day 14 after the second dose; the levels decreased gradually after day 28. Ten participants (20%) were infected with SARS-CoV-2, with mild symptoms.

Determination of myeloid and lymphoid strains of hematological malignancies is often difficult when determination is solely based on morphology. ADVIA hematology analyzer and WPC channels are said to have the ability to differentiate acute leukemia strains. There is no data regarding the diagnostic values of WPC channels in determining the strain of both acute and chronic hematological malignancies. This study aims to analyze the diagnostic value of WPC channels in determining myeloid and lymphoid strains in both acute and chronic hematological malignancies in comparison to immunophenotyping, which is considered as the gold standard in strain identification. Peripheral blood and BMA specimens from patients with suspected acute and chronic hematological malignancies were subjected to immunophenotyping and testing using WPC Sysmex XN-1000 simultaneously. The strains of hematological malignancies produced from the two examinations were then statistically analyzed to determine their sensitivity and specificity. There was a total of 86 samples of hematological malignancies used in this research. With WPC channel-based strain interpretation, results showed that 54 samples were in accordance with the results obtained from immunophenotyping, meanwhile 25 samples could not be interpreted/inconclusive. Inconclusive samples were further analyzed by examining the dominant abnormal population contained in the WPC scattergram, which resulted in a lower number of inconclusive samples, namely 5 samples. After further analysis was carried out on the inconclusive samples, the results of the diagnostic test for WPC channel-based strain identification showed sensitivity of 85.71% and specificity of 91.89% in determining hematological malignancies of myeloid and lymphoid strains, with diagnostic accuracy reaching 91.65% in comparison to immunophenotyping. In conclusion, the WPC channels have the ability determine strains of both acute and chronic hematological malignancies with high diagnostic value in comparison to strain identification using immunophenotyping.