Prevalence and correlates of social networking addiction and its association with adult ADHD and stress among students of a medical college

Introduction: Repeated use of social network is said to cause addiction. Attention deficit hyperactivity disorder (ADHD) is disorder found in childhood. Studies have shown that such children continue to have the symptoms of ADHD as adults. The aim of this study was to find the prevalence of social networking addiction and Internet addiction and their relationship with ADHD. Also, to assess the relationship between perceived stress and sociodemographic factors with social networking and internet addiction. Material and Methods: A cross-sectional study was conducted among 150 undergraduate and postgraduate students of BMCRI after ethical clearance. Medical students who gave consent were included through stratified random sampling. Those who were taking treatment for psychiatric illness were excluded. Scales like the Young Internet addiction test (IAT); Bergen’s Facebook Reporting Scale, ADHD Self-Reporting Scale, and Wender Utah Brief Rating Scale for ADHD, and Cohen Perceived Stress Scale (PSS) for perceived stress have been used. Results: The mean age was found to be 21.56 ± 3 years. 62.6% were males and 37.33% of were females. The prevalence of Internet addiction was found to be 23.3% (n = 35), with 2% (n = 3) were having severe addiction, 6.6% (n = 10) were having moderate Internet and 14.6% (n = 22) having mild internet addiction according to modified Young’s criteria (2011). The prevalence of social networking addiction as per the Bergen Facebook Addiction Scale (BFAS) score was 4.66% and adult ADHD was 15%. There was a strong positive correlation (0.76) between Internet Addiction and Facebook addiction scores and between BFAS score and IAT score. A moderate positive correlation (0.46 and 0.47) between Internet addiction and Facebook addiction with perceived stress and ADHD and IAT score with PSS score and ASRS score, weak positive correlation with PSS score and ASRS score was observed. Conclusion: A significant proportion of medical students develop Internet addiction and minority develops social network addiction. Furthermore, perceived stress and ADHD scores are positively correlated with internet and social networking addiction.

Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients

Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

Working Capital Management Of Hindustan Unilever Limited

This project aims to analyze the working capital management practices of Hindustan Unilever Limited, and identify opportunities for improvement. The project will involve an in-depth analysis of the company's financial statements, cash flow projections, inventory management, and accounts receivable processes. The results of the analysis will be used to develop a comprehensive working capital management strategy that focuses on optimizing cash flow and reducing working capital requirements. The project will also involve the implementation of best practices in working capital management and the development of a monitoring system to track progress. Ultimately, the project aims to improve the company's financial health, increase profitability, and enhance shareholder value.

Simultaneous measurement of HbA1C and Hemoglobin by Turbidimetric inhibition immunoassay from a single punch of dried blood spot samples

Hemoglobin and glycosylated hemoglobin (HbA1C) are frequently monitored health indicators in population based studies for information about the status of nutrition and diabetes control. We present here possibly for the first time the findings of simultaneous estimation of Hemoglobin and HbA1C on Dried blood spot (DBS) samples by a single test. Validation was done by turbidimetric inhibition immunoassay (TINIA) using Roche Integra 400 plus instrument. Paired whole blood and DBS samples were tested for HbA1C estimation by Integra 400 plus. Total hemoglobin values obtained during HbA1C estimation were compared with hemoglobin values estimated by Coulter AcT 5 Diff CP Hematology counter. Agreement in HbA1C and hemoglobin values between paired whole blood and DBS samples was found to be high with R2 values of 0.994 and 0.9349, respectively. Intra- and inter- assay precision was found to be within 10% for both parameters. Values obtained after assaying DBS samples prepared by spotting proficiency samples on Whatman 903 protein saver cards demonstrated acceptable standard deviation indices resulting in successful participation in EQAS programs for both these parameters. The results reveal the potential of TINIA for simultaneous estimation of hemoglobin and HbA1C from a single punch of the DBS samples.

Mesenchymal tumours of the head and neck: a 10-year institutional archival study / Tumores mesenquimales de cabeza y cuello: estudio de archivo institucional de 10 años de duración

Introduction: Histopathological characterisation of benign and malignant lesions of the head and neck in a systematic and coherent way is an essential part of Oral Pathology and Oral Medicine. Objective: To describe the frequency and histopathological profile of connective tissue tumours in the head and neck region reported in an Indian institute. Methods: A retrospective analysis was made of the 10-year records of reports of biopsy samples of patients maintained by the department of oral pathology showing histopathological diagnosis of connective tissue neoplasms. The data obtained was compiled for age, gender, site and histopathology of the lesions. Results: Majority of the tumours were benign and patients were found to be in the 2nd or 4th decade of life with female preponderance. The most common benign tumour was fibroma where buccal mucosa was the commonest location and malignant tumour was osteosarcoma where mandible was the commonest site. While fibromas were seen among general adult population, osteosarcomas were more in the males (7.2 percent) and in the younger population (< 20 years). The uncommon tumours among benign variety were leiomyoma and teratoma while in malignant category 1 case of undifferentiated sarcoma was reported. Conclusion: The findings in this study may be of help to oral and maxillofacial surgeons and general dentists in formulating diagnosis and rendering patient care in the existing local population(AU)

Introducción: La caracterización histopatológica de las lesiones benignas y malignas de cabeza y cuello de forma sistemática y coherente es una parte esencial de la Patología Oral y la Medicina Oral. Objetivo: Describir la frecuencia y el perfil histopatológico de los tumores del tejido conjuntivo de la región de cabeza y cuello notificados en un instituto indio. Métodos: Se realizó un análisis retrospectivo de los registros de 10 años de informes de muestras de biopsia de pacientes mantenidos por el departamento de patología oral que mostraban diagnóstico histopatológico de neoplasias del tejido conectivo. Se recopilaron los datos obtenidos en cuanto a edad, sexo, localización e histopatología de las lesiones. Resultados: La mayoría de los tumores eran benignos y los pacientes se encontraban en la 2ª o 4ª década de la vida, con preponderancia del sexo femenino. El tumor benigno más frecuente fue el fibroma, cuya localización más frecuente fue la mucosa bucal, y el tumor maligno fue el osteosarcoma, cuya localización más frecuente fue la mandíbula. Mientras que los fibromas se observaron entre la población adulta general, los osteosarcomas fueron más frecuentes en los varones (7,2 por ciento) y en la población más joven (< 20 años). Los tumores menos frecuentes en la variedad benigna fueron el leiomioma y el teratoma, mientras que en la categoría maligna se registró un caso de sarcoma indiferenciado. Conclusiones: Los hallazgos de este estudio pueden ser de ayuda para los cirujanos orales y maxilofaciales y los odontólogos generales en la formulación de diagnósticos y la prestación de atención al paciente en la población local existente (AU)

Antibiotic safety among neonates and paediatrics in a public hospital: KwaZulu-Natal

Background: The World Health Organization (WHO) guidelines recommend the empiric treatment of infections before definitive treatment begins. However, ethical concerns limit the availability of clinical trials in neonates and paediatrics to fully ascertain the safety profile of antibiotics in these populations. Aim: This study aimed to quantify the use of antibiotics among neonates and paediatrics and commented on the use, rationale and appropriateness of antibiotics prescribed. Setting: A secondary level public sector hospital located in Durban, KwaZulu-Natal. Methods: Demographic and treatment information of neonates and paediatrics were collected retrospectively from January 2022 to June 2022. Data were obtained from patient files and extracted for analysis using Microsoft Excel®. Analytical and descriptive statistics were used to analyse patient demographics and treatment variables. Results: A total of 568 antibiotics, issued to 389 patients, were reviewed. Penicillins (40.1%), aminoglycosides (24.3%) and combination penicillin-beta-lactam inhibitors (23.3%) were identified as the most frequently prescribed antibiotics for inpatients. Most antibiotics prescribed to inpatients were for complications associated with pre-term birth (66.9%). Combination penicillin-beta-lactam inhibitors (34.7%), penicillins (29.5%) and cephalosporins (29.5%) were the most frequently prescribed antibiotics to outpatients. A correlation was found between the route of administration and the duration of therapy; the intravenous route (63.6%) was preferred over the oral route (36.4%) for administration. Conclusion: Many broad-spectrum antibiotics were prescribed, thus increasing the risk of resistance. Antibiotics were being prescribed according to the guidelines; however, there is still a need for therapeutic drug monitoring to ensure the continuation of rational drug use. Contribution: There was evidence of rational use of antibiotics in the public hospital (KwaZulu-Natal), in keeping with economic and availability factors.

Anterior segment optical coherence tomography characteristics and management of a unique spectrum of foreign bodies in the cornea and anterior chamber

Purpose: To report anterior?segment optical coherence tomography (ASOCT) characteristics of different types of corneal and anterior chamber (AC) foreign bodies (FBs) and their usefulness in diagnosis and management. Methods: This is a retrospective descriptive clinical study involving 11 eyes of 11 patients who presented at the outpatient department of a tertiary ophthalmic care center from January 2017 to January 2022. All patients had a diagnosed or suspected corneal FB. All participants underwent a comprehensive ophthalmological examination, followed by slit?lamp photography and ASOCT. FB removal was done where required by an external, internal, or combined approach. Results: The mean age of patients was 28.2 (7–53) years. Ten were male, and one was female. Seven patients had a definitive positive history of injury; in one, there was a history suggestive of trauma, one had the post?operative complication of scleral buckling surgery, and two patients had a history of insect fall in the eyes. Three patients had acute, four had sub?acute, and four had chronic presentations. Descemet’s membrane (DM) breach was suspected in three cases of deep FB, which was later confirmed on ASOCT. In two cases, DM was presumed to be intact clinically, but ASOCT showed an AC penetration. The FB was removed in seven patients, one via slit?lamp, one via an external approach, two via an internal approach, and three via a combined approach. Conclusion: ASOCT facilitates non?invasive rapid imaging of ocular tissue at various depths, provides an accurate assessment of FB characteristics, and thereby serves as an additional tool in our armamentarium for diagnosis and management of deep corneal and AC Fbs

Histochemical characterization of duodenum at early, mid and late prenatal period in goats

Goats [Capra aegagrus hircus (L.)] play a significant role in providing supplementary income and livelihood to humans. The intestine plays a major role in foetus development and growth, and duodenum, as the part of small intestine, is responsible for breakdown of food. As there is not much studies available in literature on this aspect, here, we investigated the developing duodenum of 30 goat embryos/foeti irrespective of breed and sex. The tissues were fixed in 10% neutral buffered formalin and in cold acetone. Different histochemical techniques were applied for the detection and localization of neutral mucopolysaccharides, acid mucopolysaccharides, bound lipids, alkaline phosphatase enzymes, acid phosphatase enzymes, and DNA. The intensity of reactions increased as the age of foeti advanced. The goblet cells of the intestinal gland showed moderate reaction for Periodic acid schiff (PAS) and Acid mucopolysaccharides (AMPs) in the mid prenatal period (Gr. II) and intense to highly intense reaction in the late prenatal period (Gr. III). The cytoplasm of the epithelial cells exhibited negative to mild reaction for bound lipids in Gr. I, mild to moderate in Gr. II and mild to intense reaction in Gr. III. The luminal border of epithelial cells exhibited mild reaction in Gr. I & II, and moderate to intense reaction in Gr. III. The luminal border showed weak acid phosphatase reaction in Gr. I & II, and mild to moderate reaction in Gr. III. The nuclei of the epithelial cells showed mild to moderate Feulgen reaction in Gr. I & II, and intensely positive reaction in Gr. III.

A case of superior vena cava syndrome

Superior Vena Cava Syndrome is the clinical manifestation of the Superior Vena Cava obstruction, with severe reduction in venous return from the head, neck and upper extremities. More than 80% cases of SVCS is nearly attributable to advanced malignancy, most commonly lung cancer. SVC syndrome is characterized by congestion and swelling of the face and upper thorax, with distended superficial chest veins. The most severe complications of SVC syndrome include Glottic edema and venous thrombosis in the central nervous system. We represent a case SVC syndrome due to Small Cell Cancer of the lung.

Neutrophil to lymphocyte ratio and C- protein level as markers to predict deterioration in stable COVID-19 patients

The new Corona virus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). It is a highly communicable infectious disease [1]. Clinical manifestations of COVID-19 vary from asymptomatic to ARDS leading to death, it is important to differentiate between severe and non-severe cases. Early warning signs can be identified by several laboratory tests which are often expensive, time taking. Neutrophil-lymphocyte ratio (NLR), C- reactive protein (CRP) are two simple tests that can be used as markers for clinical outcome in COVID-19 patients. The aim and objectives of the study were to correlate patients clinical severity and CRP, NLR levels and to assess direct correlation between CRP levels and NLR. 101 patients who fulfilled the inclusion criteria were taken into the study. Patients are divided into mild, moderate severity based on WHO criteria and CBP, CRP were sent on the 6th/ 7th day of illness. Among the 101 patients, 93 were in mild group, 8 were in moderate group. The study group included subjects who aged between 18 years to 80 years of age. Plasma CRP levels were higher in moderate cases than in mild cases, and this difference was significant (p < 0.001). The mean NLR of moderate severity were significantly higher than those of mild cases (p-0.00003). Results showed that NLR was positively correlated with CRP levels.NLR and CRP are potential, reliable and easy-to-use predictors for deteriorating covid-19 infection. The integration of NLR and CRP may lead to improved predictions and help to triage patients at the time of hospital admission.

Arsenic toxicity following Ayurvedic medication

Alternative forms of medicine like Ayurveda have witnessed a rise in global popularity over the recent decades. Drugs used in Ayurveda, particularly those of mineral origin can lead to toxic effects due to heavy metal overdose. Here, we report the case of a 53-year-old woman who presented with glove-and-stocking paresthesia and scaly plaques following the institution of Ayurvedic drugs containing arsenic for dermatitis. She also had a loss of distal proprioception and a hyperesthetic response to pinprick. Her blood analysis showed elevated arsenic levels; 12 times the acceptable upper limit, with normal lead, cadmium, mercury, and chromium levels. The drug was immediately stopped and there was a gradual but incomplete resolution of the paresthesia and distal weakness over the next several months. The risk of heavy metal toxicity should be briefed to the patient before the start of mineral Ayurvedic drugs. Monitoring serum levels while on these medications might help identify toxicities early and can result in the commencement of therapy at an early stage

Progress and future challenges in gene vectors, gene therapy systems and gene expressions

Genetic engineering has made sizeable contributions to technical innovation, agriculture, and the development of pharmaceuticals. Various approaches were evolved to control the genetic cloth of cells using both viral and nonviral vector architectures. Gene therapy aims to reverse pathological traits with the aid of the use of viral and nonviral gene shipping mechanisms. Gene transfer motors have made massive strides in becoming more environmentally pleasant, much less risky, and nonimmunogenic, as well as making an allowance for lengthy-time period transgene expression. One of the most tough components of correctly enforcing gene healing treatments in the clinical putting is adjusting gene expression extremely tightly and constantly as and while it's required. This research work will cognizance on using viral vectors for gene concentrated on biological applications with various gene expressions. Due to improvements in viral vector engineering and superior gene regulatory systems to permit and adjust tightly therapeutic gene expression, the technology for using genes to offer a preferred treatment has confirmed to be an effective approach

Effect of Musthadi Rajayapana Vasti in Parkinson’s Disease

Parkinson’s disease is a progressive neurodegenerative disorder, affecting the older adult. It is a syndrome consisting of classical triad of resting tremor, bradykinesia and rigidity. The triad does not include the equally important gait and postural instability problem which also constitute syndrome. Lakshanas of Vata prakopa can be seen in Parkinson’s Disease. Madhavanidana, Vangasena, Sarngadhara samhita, Basavatrajiya has quoted the pathology Kampavata- a disease condition that explains Parkinson’s disease in similar way. In short Parkinson’s disease can be compared to Kampavata. Vasti is Paramoushadha of Vata. To be specific, Musthadi rajayapana vasti is Brimhana and Vatahara in nature. So it is the best choice for a Vatavikara like Parkinson’s disease. Brimhana type of vasti plays an important role, hence Rajayapana vasti. The study is pre-post study. participants registered in IPD and OPD of Govt Ayurveda Panchakarma Hospital, Poojappura satisfying inclusion criteria were selected. After collecting baseline data, detailed history and examination were done using clinical case proforma. 15 participants were selected for the study. Musthadi rajayapana vasti was done continuously for 7 days. Assessment of efficacy was done before Vasti, after Vasti on 8th day and after follow up on 14th day by Unified Parkinson’s Disease Rating Scale. Quantitative and qualitative assessment of Vasti dravya was also done. Data were analysed according to ‘Wilcoxon signed rank test’. Based on statistical analysis Musthadi rajayapana vasti was found to be significant in reducing symptoms. Musthadi rajayapana vasti is effective in reducing severity of symptoms of Parkinson’s disease

Metabolic Syndrome– An Ayurvedic Perspective

The prevalence of lifestyle diseases like hypertension, diabetes mellitus, dyslipidemia, and obesity, has been exponentially increasing. Metabolic Syndrome (MS) is a lifestyle disorder that has become a major public-health challenge around the world, owing to rising obesity and sedentary lifestyles. Abdominal obesity, insulin resistance, hypertension, and hyperlipidaemia were the common pathological conditions involved in MS. Ayurveda is the science intended for employing the measures of healthy life. There is no direct reference of metabolic syndrome in Ayurveda classics. Different scholars have different opinion about the nearest possible diseases. Some scholars included it in Medapradooshaja vikaras, while others classified it as Sthoulya upadravas or Avaranajanya vikaras. In Charaka Samhita, lack of physical activity and unhealthy eating habits which are the causes of lifestyle diseases are mentioned in Santharpaneeyam adhyayam. Aetiology and symptomatology of Santharpanajanya vikaras shows a remarkable similarity with metabolic syndrome, since it includes sedentary lifestyle and dietary factors. Therefore, MS can be included under the broad umbrella of Santhartanajanya vikaras and Ayurveda can put forward a better management strategy by reassessing the metabolic syndrome on the basis of Santharpanajanya vikaras

Histological Variants of Leiomyoma: A Great Impersonator posing a Diagnostic Challenge - Three year Study in Delhi NCR

Background: Objectives: Uterine smooth muscle tumours are diagnostically challenging as well as scientifically intriguing with leiomyoma being the most common. On review of literature there are numerous studies on audit of hysterectomy specimens worldwide, however, studies focusing on detailed histopathologi cal analysis of leiomyomas are limited. Thereby, this study was conducted to identify the secondary changes as well as histological variants of leiomyoma, their frequency of occurrence and other associated clinicopathological factors Methods: A retrospecti ve audit of all the hysterectomy and myomectomy specimens was conducted over a period of 3 years (Jan 2016 to Dec 2018) comprising of a total of 155 cases with 388 leiomyomas (LM). The clinical details were retrieved, and histopathological slides reviewed for cellularity, mitosis, atypia, necrosis, any secondary changes or specific variants. Results: On histopathology, 19.1% LM showed degenerative changes and histologic variants were observed in 6.18% LM. Hyaline change was the most frequent degenerative ph enomenon in 82.43% (60/74) while cellular leiomyoma was the most common variant in 37.5% (9/24) LM. Conclusion: Certain histological variants make the differentiation from malignant tumors challenging. A thorough tissue sampling and strict adherence to histologic criteria coupled with a ncillary techniques like immunohistochemistry can help in excluding malignancy in most of the cases. Awareness regarding these is very important amongst youn g pathologists to avoid misdiagnosis and overtreatment leading to unwarranted stress to the patient.

THE ASSOCIATION IN SERUM VITAMIN D3 LEVELS IN PATIENTS WITH EARLY PREGNANCY LOSS

AIM: To find out the association between vitamin D levels in normal pregnancy and pregnancy loss in the first trimester. METHODOLOGY: -The present study was a hospital based comparative study conducted in 40 pregnant (7-9 weeks) women having pregnancy loss (Group I) and 40 pregnant (7-9 weeks) women having normal pregnancy coming to department of Obstetrics and Gynaecology, SMS medical college and associated hospitals, Jaipur, Rajasthan. The mean Vitamin D3 level in pregnancy loss cases RESULTS: was 17.77±6.56 ng/ml and in normal pregnancy group was 24.85±7.55 ng/ml. So the results showed that the mean Vitamin D3 level was significantly higher in normal pregnancy group compare to early pregnancy loss cases. Pre CONCLUSION: sent study concluded that vitamin D has a significant role during pregnancy started from early implantation and decidulization phase till late pregnancy.

Effects on ocular aberration and contrast sensitivity after implantation of spherical and aspherical monofocal intraocular lens - A comparative study

Purpose: Phacoemulsification with intraocular lens (IOL) implantation is the standard of care for cataractous eyes. Monofocal IOLs are spherical or aspheric. The aspheric design of IOLs reduces the spherical and higher-order aberrations and impacts contrast sensitivity post cataract surgery. There are some studies, but data in the Indian setting with the IOLs we used is lacking. We aimed to compare the effect of implantation of spheric and aspheric foldable intraocular lenses on postoperative quality of vision, spherical aberration, and contrast sensitivity. Methods: This prospective observational study was conducted at a tertiary care hospital with an ophthalmology specialty, data collection from January 2017 to May 2018 in 100 patients. Patients meeting the inclusion criteria were selected. Their preoperative and postoperative data were collected and divided into groups based on whether spherical or aspheric IOL was implanted after cataract surgery. Variables assessed were visual acuity on days 7 and 30, spherical aberrations, and contrast sensitivity was assessed at 1?month postoperative. Results: The mean age of the patients in this study was 64 ± 8 years with a majority of patients (60%) being females. There is no significant difference in postoperative visual acuity between the two groups. Internal SA was significantly lower (~50%) in eyes implanted with aspheric IOLs (P value = 0.004, 0.0001) compared with the spherical group. Contrast sensitivity of patients of the aspheric group was significantly better (P value <0.05). Conclusion: The optical design of the aspheric IOLs reduced spherical aberrations and increased contrast sensitivity.

The undesirable wink

Background: Marin-Amat syndrome is a rare acquired oculofacial synkinesis first reported in 1918. It manifests as involuntary eyelid closure on jaw opening or on lateral movement of the jaw following a peripheral facial nerve palsy. The increased orbicularis tone due to aberrant connections between the cranial nerve (CN) V and CN VII results in an undesirable wink with major psychosocial impact. Purpose: Most cases in literature were either observed or administered botulinum toxin injection to the orbicularis muscle. There are few sporadic reports of surgical interventions with successful outcomes.Hence there was a need to generate awareness regarding various modes of management of this rare entity. Synopsis: We present a video on the clinical presentation and management of six such patients, of whom one was bilateral. Five patients were females. Traumatic facial nerve paralysis and Bell’s palsy was previously diagnosed in one and five patients respectively. The mean age was 52 ± 9.48 years. The mean MRD (margin reflex distance) 1 and MRD 2 was 3.17 ± 0.60 and 5.33± 0.65 mm respectively. On smiling or on movement of the jaw the MRD 1 and 2 was reduced by 2. 50±0.40 and 1.50+/-0.40 mm respectively. Of the six patients four patients opted for nil intervention. Highlights: Botulinum toxin injection and preseptal orbicularis resection in the upper and lower eyelid along with blepharoplasty was performed in 1 patient each. Satisfactory reduction in the synkinetic movement was achieved in both. Marin-Amat syndrome is a rare often underdiagnosed synkinetic disorder following peripheral facial nerve palsy. Botulinum toxin injection and preseptal orbicularis resection are viable management options

Understanding the dynamics of IgM & IgG antibodies in COVID-19-positive patients

Background & objectives: The pandemic caused by the SARS-CoV-2 has been a threat to humankind due to the rapid spread of infection and appearance of multiple new variants. In the present study, we report the dynamics and persistence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in asymptomatic and symptomatic COVID-19 patients by chemiluminescent assay. Methods: A total of 463 serum samples from 218 SARS-CoV-2 PCR-positive patients were collected over a period of 124 days post-onset of disease (POD). Antibody levels were measured by chemiluminescence bioanalyzer. Neutralizing antibody titres were assessed by plaque reduction neutralization test (PRNT) for SARS-CoV-2. Results: Both IgM and IgG started appearing from day five post-infection in symptomatic and asymptomatic patients. IgM antibody response peaked around day 35 POD and rapidly diminished thereafter, with the last IgM-positive sample observed at 90 days POD. IgG antibody response peaked around 45 days POD and persisted till 124 days. The chemiluminescence immunoassay (CLIA) results showed a moderate correlation (R=0.5846, P<0.001) compared with PRNT. Additional analysis indicated a neutralizing titre of 250 corresponded to 12.948 AU/ml of YHLO iFlash SARS-CoV-2 IgG units. Interpretation & conclusions: Both symptomatic and asymptomatic COVID-19 patients seem to initiate production of antibody responses from day five of onset of disease. Although the CLIA gives high sensitivity and specificity and also its binding IgG antibody titres may correlate moderately with protective immunity, our results indicate that the values of binding antibody alone may not be a perfect guide to represent virus neutralization titre during donor selection for plasma therapy. However, IgM and IgG antibody detection may help in monitoring the status of disease progression and burden in the community.