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56
Address for CorrespondenCe:
The New ArmeNiAN medicAl JourNAl
Vol.15 (2021), Nо 2, p. 56-63
ABSTrAcT
Background: The emergency, labor and delivery conditions in obstetric cases need a clinical
decision in a timely manner. The identication of Covid-19 especially in asymptomatic obstetric
cases with ease and rapid antibody test need further investigation.
Objective: To analyze the usability and performance of rapid antibody test in obstetric cases.
Methods: Case control study using medical record on Covid-19 obstetric cases over 9 months
with paired nasopharyngeal reverse transcriptase polymerase chain reaction severe acute respi-
ratory syndrome coronavirus 2 and rapid antibody test results.
Results: There were 92 Covid-19 obstetric cases (incidence: 17.4%) and 210 reactive rapid
antibody test (seroprevalence: 39.6%). The sensitivity, specicity, positive predictive value and
negative predictive value of rapid antibody tests was 89%, 24%, 40%, 80%. Symptomatic cases
have lower sensitivity (73% vs. 96%) and higher specicity (48% vs. 20%). The presence of
Covid-19 symptoms (p<0.05) and reactive rapid antibody test (p<0.001) were associated with
Covid-19. Rapid antibody test will identify larger Covid-19 obstetric cases compare with the
presence of symptom only (89.4% vs. 27.7%.
Conclusion: Screening by rapid antibody test had a high sensitivity but low specicity. This
test will identify more Covid-19 cases compared by symptoms only due to majority asymptomatic
obstetric cases. This simple, cheap and rapid antibody test still has a place in initial screening to
help identify Covid-19 in areas with widespread transmission and has limited capacity to carry
out universal screening.
KeywordS: . Covid-19 infection, pregnant, perinatal
Received 29.09.2020; accepted for printing 15.12.2020
nant women [Rasmussen SA et al., 2020]. The ob-
stetric case population has unique characteristics
in that emergency, labor and delivery conditions
can appear suddenly, unpredictably and cannot be
postponed like some other health services so all
clinical decisions and treatments must be made in
a timely manner.
Studies from Vintzileos and also Sutton showed
that the majority of pregnant women who were ad-
mitted to hospital were asymptomatic [Sutton D et
al., 2020; Vintzileos WS et al.,2020]. Identification
of Covid-19 cases in obstetric patients who require
hospitalization were very important to prevent the
spread of infection transmission to the newborn
and also inside the hospital and this process will
iNTro ducTioN
It has been a year since the first notification of
a new type of pneumonia in Wuhan on December
31, 2019 [Adhikari SP el al, 2020], but there is no
sign that we can overcome this Coronavirus Dis-
ease (Covid-19) pandemic which currently con-
tributes to around half a million new cases every
day [WHO-CD, 2020]. This fast-spreading Covid-
19 pandemic can affect various types of groups,
without exception the vulnerable population, preg-
SARS-COV-2 ANTIBODY TEST FOR THE HOSPITALISED EMERGENCY
OBSTETRIC CASES: USEFUL OR WASTEFUL
Wardhana M.P.1,2, aditiaWarMan1, ErnaWati1, Maniora n.C.1, aditya r.1,
GuM i l ar K.E.1, WiCaKsono B.1, aK B a r M.i.a.1, sulistyono a.1,
JuWono h.t.1, daChlan E.G.1,2*
1Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Airlangga – Dr Soetomo
Academic General Hospital, Indonesia
2Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Indonesia
Erry Gumilar Dachlan
Department of Obstetrics and Gynaecology, Faculty of
Medicine, Universitas Airlangga Jl. Mayjen Prof. Dr.
Moestopo No.47, Surabaya East Java, Indonesia 60132
Tel: +62818509014
Email: errygumilar@yahoo.com
57
The New ArmeNiAN medicAl JourNAl, Vol. 15 (2021), No 2, p. 56-63 Wardhana M.P. et al.
cases performed by nasopharyngeal RT-PCR
SARS-CoV-2 paired with a rapid antibody exami-
nation of SARS-CoV-2 on the whole blood sam-
ples. This examination was carried out at Aca-
demic Soetomo General Hospital as a tertiary re-
ferral hospital and also a Covid-19 referral hospital
in East Java, Indonesia. Admitted obstetric patient
for 9 months from March to November 2020 in
which both examinations were car-
ried out were included in this study.
The RT-PCR SARS-CoV-2 ex-
amination was performed using
The Abbott m2000 with Abbott
Real Time SARS-CoV-2 assay for
the qualitative detection of nucleic
acids from SARS-CoV-2, the re-
sults were reported positive when
become more problematic in identifying asymp-
tomatic cases. Although the reverse transcriptase
polymerase chain reaction (RT-PCR) of severe
acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) is still the gold standard, the limited capac-
ity especially in the developing country potentially
delay obstetric care which often requires quick de-
cision and action. The use of antibody testing is no
longer recommended in the detection of Covid-19
by food and drug administration (FDA) with in-
conclusive results [Kontou PI et al.,2020; CDC-
OT, 2021], but the ease and speed of this tests and
its use in assessing seroprevalence in certain popu-
lations will certainly be very interesting for further
investigation especially in the obstetric cases in
hospital. Will it be useful or wasteful?
mATeriAl ANd MEth ods
Retrospective cross sectional design study
using data from medical records were used in this
study. We conducted an analysis of all obstetric
19
C
O
V
I
D
To overcome it
is possible, due to the
uniting the knowledge and
will of all doctors in the world
36 cases without rapid antibody test examination
88 cases without RT-PCR SARS-CoV-2 examination
4 cases with incomplete data
Antibody test Antibody test
84 cases
Reactive 10 cases
Non reactive 126 cases
Reactive 41 cases
Non reactive
167 cases Negative
RT-PCR SARS-CoV-2
94 cases Positive
RT-PCR SARS-CoV-2
261 cases
included in study
383 Covid-19
suspected cases
530 obstetric cases
figure 1. Study Population Description
58
The New ArmeNiAN medicAl JourNAl, Vol.15 (2021), No 2, p. 56-63Wardhana M.P. et al.
RdRp or N-gene tested positive, while the exami-
nation of Rapid antibodies test were performed
using an immunochromatographic assay with lat-
eral flow method in detecting qualitative total
SARS-CoV-2 antibody. All examinations and ethi-
cal approvals were carried out at the Academic
Soetomo General Hospital. Other data included in
this study were basic maternal data (maternal age,
gestational age, parity, referral status) and Covid-
19 infection related data (comorbidity, symptoms).
Categorical variables were expressed as numbers
(percentage) and continuous variables were ex-
pressed as means (Standard Deviation / SD) or me-
dians (interquartile ranges /IQRs). SPSS version
24.0 software for windows (IBM Corp., Armonk.
N.Y., USA) was used for statistical analysis. Chi-
square and Fisher exact test as an alternative were
used to compare the difference in the categorical
variables, independent T-test and Mann-Whitney
test as an alternative were used to compare the con-
tinuous variables between groups. A p value of <
0.05 was taken to signify statistical significance. We
extracted 2x2 contingency table data and calculat-
ing the sensitivity, specificity, positive predictive
value (PPV), and negative predictive value (NPV),
likelihood ratio and accuracy to evaluate the perfor-
mance of SARS-CoV-2 antibody test compared
with RT-PCR SARS-CoV-2 result. We calculated
the antibody performance on all cases and also di-
vided based on the presence of symptoms.
reSulT S
During our study period, there were 530 obstet-
ric cases admitted to our emergency obstetric
room. Since March until now, we have been unable
to carry out universal RT-PCR tests due to capacity
limitations. There were several changes in the
screening method from our center, starting from
only evaluating symptoms and history of Covid-19
contact to expanding by examining the neutrophil
to lymphocyte ratio, X-ray thorax and rapid anti-
body test for every patient who came. For all pa-
tients who are suspected of Covid-19 from the ini-
tial screening, a SARS-CoV-2 RT-PCR swab ex-
amination will be carried out. There were 261 ob-
stetric cases who had paired RT-PCR and rapid
TABle 1.
Sample characteristic of the study
Sample
characteristics Swab RT-PCR SARS-CoV-2
Total
(n=261) Negative
(n=167) Positive
(n=94) p
Material age
Mean ±SD y.o 29.9±6 30.4±6.2 28.8±5.6 0.062
Gestational age (n=259)
Mean ±SD y.o 35.8±6 35.4±6.4 36.7±5.1 0.069
Gestational age classication- n(%)
postpartum 2
(0.8%) 0 (0%) 2
(2.1%)
0.062
<20 weeks 12
(4.6%) 10 (6%) 2
(2.1%)
preterm 76
(29.1%) 53
(31.7%) 23
(24.5%)
aterm 171
(65.5%) 104
(62.3%) 67
(71.3%)
Parity – n(%)
nulipara 105
(40.2%) 65
(38.9%) 40
(43.5%) 0.329
multipara 156
(59.8%) 102
(61.1%) 54
(56.5%)
Referral tastus – n(%)
by herself 71
(27.2%) 42
(25.1%) 29
(30.9%)
0.474
rejected by
other hospital 78
(29.9%) 49
(29.3%) 29
(30.9%)
referred 112
(42.9%) 76
(45.5%) 36
(38.3%)
Comorbid – n(%)
No 149
(57.1%) 93
(55.7%) 56
(59.6%) 0.603
Yes 112
(42.9%) 74
(44.3%) 38
(40.4%)
Covid-19 symptom-(%)
No 208
(79.7%) 140
(83.8%) 68
(72.3%) 0.027
Yes 53
(20.3%) 27
(16.2%) 26
(27.7%)
Rapid antibody test
non reactive 51
(19.5%) 41
(24.6%) 10
(10.6%) 0.006
reactive 210
(80.5%) 126
(75.4%) 84
(89.4%)
59
The New ArmeNiAN medicAl JourNAl, Vol. 15 (2021), No 2, p. 56-63 Wardhana M.P. et al.
antibody tests with 92 (35.2%) confirmed Covid-
19 cases (figure 1). We had an incidence of 17.4%
from all obstetric cases admitted during our study
period. All samples characteristics can be found in
table 1. A high proportion of Covid-19 symptoms
(p=0.027) and reactive antibody tests (p=0.006)
were associated with confirmed covid-19 cases.
We had a total of 210 (80.5%) obstetric cases
with reactive rapid antibody test or 39.6% of se-
roprevalence in our obstetric cases population.
The antibody examination carried out in this
study was intended to perform an initial screen-
ing for the possibility of acute Covid-19 infection
when the patient was admitted to the obstetric
emergency room. The ability of this examination
to detect Covid-19 is compared to the results of
the SARS-CoV-2 RT-PCR examination which can
be seen in table 2. We also classify the perfor-
mance of this rapid antibody test based on the
presence of Covid-19 symptoms experienced by
patients. There was a higher sensitivity in the as-
ymptomatic group (95.59% vs. 73.08% whereas
the specificity was higher in the symptomatic
group (48.15% vs. 20%).
diScuSSioN
To date, all health facilities have tried to adapt,
especially in terms of Covid-19 testing and identi-
fication for patients who need hospitalization. Par-
ticularly in obstetric patients, which of course can-
not be postponed like some other services in this
pandemic era. The majority of obstetric cases with
Covid-19 who were admitted to hospital in our
study were cases of term pregnancy (65.5%) for
labor and delivery purposes. Zaigham’s systematic
review also showed the same results where the ma-
jority of cases were in the 3rd trimester and deliv-
ery occurred in 80% of cases [Zaigham M, Anders-
son O. 2020]. Our study revealed many referral
cases and rejection from other hospitals for obstet-
ric cases with suspicion of Covid-19 infection be-
cause of the rapid spread in our area and many
other health facilities that are not yet ready princi-
pally in identifying Covid-19 cases due to limited
testing capacity [Cahya Laksana MA et al., 2020].
Emergency obstetric, labor and delivery cases
which are very time-related have become prob-
lematic conditions in this pandemic era. Accu-
rate and fast identification is noteworthy for de-
termining the need of isolation room, allocating
personal protective equipment and how to treat-
ing patients which is very important to prevent
the transmission of Covid-19 in the hospital for
the newborn, other patients, their surrounding
families and also health workers. Although in
this study, the Covid-19 symptoms clearly asso-
ciated with Covid-19 cases (p <0.05), it should
be underlined that the majority of Covid-19
cases identified in this study were asymptomatic
(72.3%). This is in line with Igbinosa study
which found 63% proportion of asymptomatic
cases [Igbinosa I et al., 2020] and Sutton which
revealed 87.9% women who were admitted for
delivery had no Covid-19 symptom [Sutton D et
al., 2020]. Several other studies have shown the
opposite results, such as in Kayem’s study which
showed the proportion of symptomatic cases up
to 80.6% [Kayem G et al., 2020], but this hap-
pened due to the differences in Covid-19 identi-
fication strategy because the two previous stud-
TABle 2.
Performance of the rapid antibody test compared with
RT-PCR SARS-CoV-2 test in admitted obstetric cases
Total Obstetric Cases Swab
RT-PCR SARS-CoV-2
Rapid Antibody Test Positive
(n = 92) Negative
(n = 167)
Reactive n(%) 84 (89.4%) 126 (75.4%)
Non Reactive n(%) 10 (10.6%) 41 (24.6%)
Screening Test
Evaluation %95% CI
Sensitivity 89.36 81.30 - 94.78
Specicity 24.55 18.23 - 31.80
Positive Predictive Value 40.00 37.36 - 42.69
Negative Predictive Value 80.39 68.30 - 88.64
Positive likelihood ratio 1.18 1.06-1.32
Negative likelihood ratio 0.43 0.23 - 0.82
Accuracy 47.89 41.69 - 54.14
60
The New ArmeNiAN medicAl JourNAl, Vol.15 (2021), No 2, p. 56-63Wardhana M.P. et al.
ies used universal screening. Based on these
findings, screening based on symptoms alone
will not be effective enough to identify Covid-
19 cases in obstetric conditions. Some literature
suggests the use of universal RT-PCR screening
especially in areas with widespread transmission
[Sutton D et al., 2020].
It is not easy to implement universal screening,
the limited capacity, expensive price, need of spe-
cial personnel for sampling and the long duration
of the results were the main problems, especially
as fast decisions are needed and often cannot be
postponed in obstetric cases [Kontou PI et
al.,2020]. The need for screening test that is easy,
cheap, valid and reliable is clearly needed in this
condition [Akobeng AK 200]. Rapid antibody test
that is fast, easy to do without the need of special
personnel for sampling and inexpensive [Tang YW
et al.,2020] may be used as an alternative for
Covid-19 screening. Our study revealed the higher
proportion of reactive rapid antibody test in Covid-
19 Cases (p<0.01). However, it should be under-
stood that this rapid antibody test does not con-
stantly indicate an active Covid-19 condition, re-
search shows that antibodies are formed mostly
1-3 weeks after infection onset where theoretically
the infectious period begins to decrease and im-
munity begins to build [CDC-IG, 2021]. Therefore
the RT-PCR SARS-CoV-2 is absolutely necessary
if a rapid reactive antibody result was obtained, to
confirm the presence of acute Covid-19 infection
in the patient.
The sensitivity of the rapid antibody test is
quite high (89%). The sensitivity was higher in as-
ymptomatic cases than in symptomatic cases, but
vice versa for its specificity was higher in symp-
tomatic cases. Other studies from larger samples
(1.293 parturient) showed lower sensitivity, there
were 46 positive PCR tests from 72 seropositive
women (sensitivity 64%) [Flannery DD et al.,
2020]. Other evidence showed that the antibody
test had lower sensitivity in the first week (30.1%)
and also second weeks (72.2%) from the infection
onset [Deeks JJ, et al., 2020; Watson J et al.,
2020]. The low specificity in this study is due to
the high false negatives, which in theory can be
due to cross reactivity with rheumatoid factor and
other viral infection such as influenza A, respira-
tory syncytial virus and some other coronavirus
[CDC-IG, 2021; Okba NMA, et al., 2020]. In addi-
tion, as previously explained, this rapid antibody
test can not always detect acute cases, but it also
shows that patients who came may have previously
been infected with Covid-19 without being noticed
so that antibodies can be detected in their bodies
[Deeks JJ, et al., 2020].
The predictive value will be higher in cases
which have a high probability such as Covid-19
symptoms [CDC-IG, 2021], and this is consistent
with our study result. Fabre`s study also reported
low PPV (50%) for rapid antibody test in preg-
nancy [Fabre M et al., 2020]. Although the overall
positive predictive value and the accuracy is not
too high, the decision to use this rapid antibody
test is very important. In a situation where we were
unable to perform universal screening due to limi-
tations, using only symptom-based screening
would only identify 26 cases of Covid-19 (28% of
total positive obstetric cases) and we will abso-
lutely miss the asymptomatic cases. Evidence
showed the infectious ability of asymptomatic pa-
tients can be very long up to 14 days and samples
isolated from the respiratory tract can also have the
same viral load as symptomatic patients [Lee S et
al., 2020]. The rapid antibody test will actually
help to find such asymptomatic cases, where the
rapid antibody can detect 84 true positive cases
(89.4%) in this study. So that regardless of the ac-
curacy, if this test is good enough to separate in-
fected patients to prevent wider transmission.
Another advantage that can be taken from the
antibody examination is gaining seroprevalence
data of immunity status from our population study
[Tang YW et al.,2020], it is interesting to know
that the seroprevalence in our place reaches
39.6%. More than the reports obtained by Savi-
ron-Cornudella that only revealed 6.7% positive
serological test. However, there were differences
in this method since they carried out universal
screening and obtained only a low incidence of
SARS-CoV-2 (6 Covid-19 positive from 266 pa-
tients; 2.2%) [Savirón-Cornudella R, et al.,
61
The New ArmeNiAN medicAl JourNAl, Vol. 15 (2021), No 2, p. 56-63 Wardhana M.P. et al.
2021]. Study from Crovetto revealed 14% of
SARS-CoV-2 seroprevalence in pregnancy (14%)
with a comparable proportion of seroprevalence
in 1st and 3rd trimester. Sixty percent of pregnant
women with positive antibody had never com-
plained about any Covid-19 symptoms at all
[Crovetto F et al., 2020]. The highest previous
seroprevalence reported was 16.1% [Haizler-Co-
hen L et al., 2021]. Apart from the risk of false
positivity as described earlier, the high seroprev-
alence in our study showed that there were prob-
ably many asymptomatic obstetric cases which
can certainly further expand the spread in com-
munity because they never feel sick, and identifi-
cation of the cases when this patient is admitted
to hospital is very important and absolutely nec-
essary. In addition, the appearance of this immu-
nity cannot always be in line with the protective
condition, the presence of this antibody does not
always indicate the presence of a high neutraliz-
ing antibody titer so that the patient is immune
from infection [Wu F et al., 2020]. Viral load also
does not always decrease rapidly after serocon-
version so that some people can remain infectious
even after they get a positive antibody test [Wöl-
fel R et al., 2020].
Some of the weakness of this study is that we
did not apply universal screening so that we can-
not anticipate some Covid-19 cases that were
not identified. There is still a chance of false
negatives from this rapid antibody test due to the
possibility of some cases that were not forming
Covid-19 antibodies even though they are in-
fected. Some other possibility is the time of col-
lection, if it is too fast during an acute infection,
the antibodies have not been formed or too slow
so that the antibody levels have started to fall
[Kontou PI et al.,2020]. Although the produc-
tion of IgM and IgG increases, especially at 2-3
weeks, they can be found more quickly from
day-4 [Sethuraman N et al., 2020]. Guo’s study
even showed 85.4% IgM has appeared in the
first 7 days of symptoms [Guo L et al., 2020].
This research was also conducted at tertiary re-
ferral centers, which although serving the ma-
jority of obstetric cases with covid-19 in the
East Java area, are not necessarily generalizable
in the community.
However, the important points to get from this
study are the high possibility of obstetric Covid-19
asymptomatic cases and the importance of several
simple alternative tests to identify, such as rapid
antibody test. This examination can help identify
groups at high risk of infection and also previously
infected individuals, even if they are asymptom-
atic as they show a viral humoral immune response.
This of course can help support the diagnosis in
the Covid-19 case that came some time after being
infected with Covid-19 especially in asymptomatic
and mild symptoms [CDC-IG, 2021; Sethuraman
N et al., 2020]. Some protocols from Zullo also
stated that reactive rapid antibody test will first be
isolated and planned to do RT-PCR SARS-CoV-2
test. If it is impossible to postpone for the RT-PCR
result, then the patient will be treated as a Covid-
19 patient [Zullo F et al., 2020]. The complexity of
the immune response to Covid-19 especially in ob-
stetric cases of course. Deep understanding and
caution must always be taken to interpret the re-
sults if we use antibody testing in part of our ser-
vices protocol [Fabre M et al., 2020].
ConClusion
There were an association between both symp-
toms and rapid antibody test with SARS-CoV-2
RT-PCR result in admitted obstetric cases. Screen-
ing by rapid antibody test will identify more
Covid-19 cases compared by symptoms only due
to majority asymptomatic cases. The rapid anti-
body test had a high sensitivity but low specificity;
the asymptomatic cases group had higher sensitiv-
ity and lower specificity than symptomatic. The
strategy of using a rapid antibody test that is sim-
ple, cheap and fast, by all means still has a place in
initial screening to help identify Covid-19 in areas
with quite extensive transmission and has limited
capacity to carry out universal screening. This test
should not solely be used for diagnosis and the cli-
nician should understand the risks and benefits of
antibody testing and always provide information
about the limitations of this test.
62
The New ArmeNiAN medicAl JourNAl, Vol.15 (2021), No 2, p. 56-63Wardhana M.P. et al.
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3
THE NEW ARMENIAN MEDICAL JOURNAL
Vol.15 (2021). No 2
CONTENTS
4.
19.
35.
42.
46.
56.
64.
69.
82.
86.
92.
AvAgyAN S.A., murAdyAN A.A., ZilfyAN A.v.
CERTAIN APPROACHES WHILE CHOOSING THE STRATEGY OF COVID-19
PATHOGENETIC THERAPY AND IMMUNOPROPHYLAXIS
AvAgyAN S.A., ZilfyAN A.v. , murAdyAN A.A.
THE NEED TO ADD A “POLYAMINE-FREE” DIET IN THE FOOD REGISTRY OF COVID-
19 PATIENTS
chili NgAryAN T.g., PoghoSyAN h.v., SArgSyAN K.m., hovhANNiSyAN h.B., KArAPeTyAN K.h.,
NiAZyAN l.g., hAyrAPe TyAN h.g.
THE ROLE OF ANTICOAGULATION IN PREVENTING MYOCARDIAL INFARCTION
AND IMPROVING THE OUTCOMES AMONG COVID-19 PATIENTS
SiSAKiAN h.S., hAruT yuNyAN g.h., hovAKimyAN m.h., hovhANNiSyAN m.r., AghAyAN S.A.
PACEMAKER LEAD-ASSOCIATED PULMONARY EMBOLISM IN PATIENT WITH COVID-
19 INFECTION
SuPiT v.d., heleNA m.g., AlfAreS m.A.T, ANgKy v.S., SAPuTrA A.
HEMATOLOGIC PARAMETERS AS POTENTIAL DIAGNOSTIC TOOLS FOR COVID-19 IN
EMERGENCY SETTING
Wardhana M.P., aditiaWarMan, ErnaWat i, Maniora n.C., aditya r., GuMilar K.E.,
WiCaKsono B., aKBar M.i.a., sulistyono a., JuWono h.t., daChlan E.G.
SARS-COV-2 ANTIBODY TEST FOR THE HOSPITALISED EMERGENCY OBSTETRIC
CASES: USEFUL OR WASTEFUL
muTle q A., AlghA Zo m., Al-fAouri i., AlArSAN S.
BURNOUT AMONG JORDANIAN FRONTLINE PHYSICIANS AND NURSES DURING
COVID-19 OUTBREAK
meliK -NuBAryAN d.g.*, SAKANyAN g.g., TAdevoSyAN A.e., ZeyNAlyAN N.A
STRENGTHENING THE ROLE OF THE PRIMARY HEALTH CARE IN THE COVID-19
RESPONSE: EVIDENCE FROM YEREVAN
vArdA NyAN l.v., Kh AchATryAN S.g.,
A CASE OF PROBABLE TOLOSA-HUNT SYNDROME CO-OCCURRED WITH COVID-19
INFECTION
Natali a a.F., Bioladwiko, wiB awa S.R., Muliawati Y., HutagaluNg a.F., PuRNoMo H.d.
CLINICAL FEATURES OF DEATH CASES PATIENTS COVID-19
Rebić N., MiRković S., MiRković M., ilić v.
THE EFFECTS OF A LOW-CARBOHYDRATE DIET ON OBESITY AND ASSOCIATED
COMORBIDITIES
Our journal is registered in the databases of Scopus,
EBSCO and Thomson Reuters (in the registration process)
Scopu S EBSCO Tho mSon
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EMERGING
SOURCES
CITATION
INDEX
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Yerevan State Medical University
2 Koryun Street, Yerevan 0025,
Republic of Armenia
(+37410) 582532 YSMU
(+37410) 580840 Editor-in-Chief
Fax: (+37410) 582532
E-mail: namj.ysmu@gmail.com, ysmi@mail.ru
URL: http//www.ysmu.am
Copy editor: Tatevik R. Movsisyan
Arto V. Zilfyan (Yerevan, Armenia)
Hovhannes M. Manvelyan (Yerevan, Armenia)
Hamayak S. Sisakyan (Yerevan, Armenia)
Stepan A. Avagyan (Yerevan, Armenia)
Armen A. Muradyan (Yerevan, Armenia)
Drastamat N. Khudaverdyan (Yerevan, Armenia)
Levon M. Mkrtchyan (Yerevan, Armenia)
Carsten N. Gutt (Memmingen, Germay)
Muhammad Miftahussurur (Surabaya, Indonesia)
Alexander Wood Man (Dharhan, Saudi Arabia)
Muhammad Miftahussurur (Surabaya, Indonesia)
Ara S. Babloyan (Yerevan, Armenia)
Aram Chobanian (Boston, USA)
Luciana Dini (Lecce, Italy)
Azat A. Engibaryan (Yerevan, Armenia)
Ruben V. Fanarjyan (Yerevan, Armenia)
Gerasimos Filippatos (Athens, Greece)
Gabriele Fragasso (Milan, Italy)
Samvel G. Galstyan (Yerevan, Armenia)
Arthur A. Grigorian (Macon, Georgia, USA)
Armen Dz. Hambardzumyan (Yerevan, Armenia)
Seyran P. Kocharyan (Yerevan, Armenia)
Aleksandr S. Malayan (Yerevan, Armenia)
Mikhail Z. Narimanyan (Yerevan, Armenia)
Levon N. Nazarian (Philadelphia, USA)
Yumei Niu (Harbin, China)
Linda F. Noble-Haeusslein (San Francisco, USA)
Eduard S. Sekoyan (Yerevan, Armenia)
Arthur K. Shukuryan (Yerevan, Armenia)
Suren A. Stepanyan (Yerevan, Armenia)
Gevorg N. Tamamyan (Yerevan, Armenia)
Hakob V. Topchyan (Yerevan, Armenia)
Alexander Tsiskaridze (Tbilisi, Georgia)
Konstantin B. Yenkoyan (Yerevan, Armenia)
Peijun Wang (Harbin, Chine)
The Journal is founded by
Yerevan State Medical
University after M. Heratsi.
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