Risk of Glans Dehiscence Associated with Vascular Flap Coverage of the Glanular Neourethra during Primary Urethroplasty: A Randomised Controlled Trial.

BACKGROUND: Hypospadias is one of the common congenital anomalies of male genitalia. Although over 300 different operative techniques have been described, post-operative complications are still common, of which glans dehiscence (GD) is the most severe complication requiring redo urethroplasty. Some surgeons use the vascular flap to cover the glanular part of the neourethra to prevent GD, but there are controversies regarding its usefulness. There is a paucity in the literature, about articles evaluating the risk of GD associated with vascular flap coverage of the glanular neourethra during primary urethroplasty. MATERIALS AND METHODS: We planned a single-blinded, parallel-design, randomised controlled trial involving 56 cases of hypospadias treated with single-stage urethroplasty amongst the admitted cases of hypospadias for primary urethroplasty in the Department of Paediatric Surgery, AIIMS, Bhubaneswar, from November 2017 to December 2019 as an M.Ch. thesis project. This was approved by the Institutional Ethics Committee and enrolled in the national registry of clinical trial. 28 patients were randomised into Group A (without flap coverage of the glanular part of the neourethra) and 28 patients were randomised into Group B (with flap coverage of the glanular neourethra). RESULTS: Only 2 (7.1%) cases amongst the Group A patients developed GD, while 9 (32.1%) cases of Group B had GD (P = 0.013). CONCLUSIONS: Extending the vascular flap coverage up to the glanular part of the neourethra till the neo-meatus during primary urethroplasty is significantly associated with GD.

Predictive Value of the Postural Difference in Antero-Posterior Diameter of Renal Pelvis on Ultrasonography of Unilateral Ureteropelvic Junction Obstruction in Determining the Need For Surgery.

BACKGROUND: Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients. MATERIALS AND METHODS: We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson's correlation (if the data were normally distributed) and Spearman's correlation (for non-normally distributed data). RESULTS: We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings. CONCLUSION: We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant.

Inguinal Lipoblastoma Masquerading as Obstructed Omentocele in a Girl.

Lipoblastoma in the inguinal regional is a rare occurrence in children and can present as a surgical surprise during pediatric herniotomies. Irreducible inguinal hernia is one of the most common surgical problems dealt by pediatric surgery residents in emergency. We report a case of inguinal lipoblastoma presenting as irreducible groin swelling. Complete excision of the mass was done with no recurrence till date.

Social and biological evaluation of antimicrobial resistance (SOBEAR) in rural India: a study protocol.

Background: Antimicrobial resistance (AMR) has been one of the biggest global health threats in recent years, mostly in low- and middle-income countries, which requires urgent research using a multidisciplinary research approach. The use of large quantities of antimicrobial drugs inappropriately for humans, poultry and agriculture has been recognized as a leading cause of antibiotic resistance and the predominance of drug-resistance pathogens in the environment. This protocol aims to describe the use/misuse of antibiotics (ABs) in the community and evaluate clinical samples from healthcare settings to detect genes associated with antimicrobial resistance. Methods: We will conduct a community-level survey in different villages of the Tigiria block to assess knowledge and awareness on ABs and AMR. We will conduct in-depth interviews (IDIs) with doctors, pharmacists, nurses and drug sellers, as well as focus group discussions (FGDs) with ASHA and ANM workers who are involved in antibiotic supplies to the community. Quantitative data from the community survey and qualitative data of IDIs and FGDs will be linked and analyzed using statistical modeling and iterative thematic content analysis. Specimens (stool, urine, blood and wound/pus) will be collected from clinically diagnosed patients of different healthcare centers of Tigiria block. The samples will be cultured for bacterial isolation and antibiotic sensitivity testing. Genomic DNA will be isolated from positive bacterial cultures and sequenced using PCR to evaluate high-threat multi-drug resistance organisms (MDROs), screening of plasmid-mediated quinolone resistance (PMQR) genes, antimicrobial genes responsible for MDR and quinolone resistance-determining regions (QRDRs). Conclusion: This is the community-based protocol to evaluate the knowledge, attitudes, awareness and practices regarding ABs and AMR. The study protocol establishes a foundation for evaluating population-based prevalence and risk factors for AMR and MDROs in rural areas of the Odisha state, India.

Investigation of human anthrax outbreak in Koraput district of Odisha, India.

BACKGROUND: Anthrax is a zoonotic infection resulting from the bacteria Bacillus anthracis. Humans contract cutaneous anthrax by coming into contact, and gastrointestinal (GI) anthrax by consumption of infected animals or animal products. An outbreak investigation was conducted to confirm the occurrence of the anthrax outbreak, comprehend its extent, understand the epidemiological characteristics, identify the outbreak's cause, and propose control measures. METHODS: A descriptive epidemiology was carried out for this outbreak investigation. We defined a suspected human cutaneous anthrax case as appearance of skin lesions and symptoms (itching/redness/swelling) and a suspected case of GI anthrax as appearance of diarrhoea/abdominal pain/vomiting in a resident of Koraput district after being associated with slaughtering and/or consumption of carcass during 5th April to 15th May 2023. The etiological hypothesis was formulated using descriptive epidemiological methods. Laboratory confirmation was performed by real-time polymerase chain reaction (RT-PCR). Statistical analyses were conducted using SPSS 25. RESULTS: A total of 47 clinically suspected anthrax cases were identified during the outbreak in five villages of Koraput district in Odisha. The epidemic curve indicated multiple point-source exposures starting from 13th April 2023. About 10 cases were identified by RT-PCR testing as confirmed cases of anthrax. No death was recorded in this outbreak investigation. CONCLUSIONS: Based on a thorough examination of epidemiological survey results and laboratory findings, we conclude that the outbreak was of human cutaneous and GI anthrax. Exposures from handling dead animals were associated with cutaneous anthrax, whereas eating uncooked meat of dead sheep was associated with gastrointestinal anthrax.

Prevalence of Pancreato-Biliary Maljunction in Children with Choledochal Cyst - A Prospective Observational Study.

Background: Pancreatico-biliary maljunction (PBM) is often found to be associated with choledochal cysts (CCs). According to a European multicenter study, the prevalence of PBM in cases of CC is found to be 72.2%, however, there is no Indian study depicting the prevalence of PBM in Indian children with CCs, which is one of the main postulated factors in the etiopathogenesis of CC. In this study, we have attempted to observe prospectively the prevalence of PBM in children with CC and correlate this to its morphological and biochemical parameters. The association between the presence of PBM and histopathological findings such as epithelial changes of the mucosa of the CC, inflammation, metaplasia or dysplasia, and histopathology of the liver has also been evaluated. Materials and Methods: We carried out a single center, prospective observational study with a single arm study group. We prospectively selected all patients of CC admitted for surgery from November 2018 to October 2020. Data on biochemical, radiological, and histopathological parameters were collected and analyzed. Results: We included a total of 20 patients in our study. The mean age of the participants was 6.22 ± 4.32 years. Among them, 11 (55.0%) were male and 9 (45%) were female. Abdominal pain was the most common presenting complaint among our patients (75.0%) and had a significant association with the presence of a PBM (P = 0.001). In symptomatic children, the mean duration of symptoms was 4.50 ± 2.26 months for jaundice, 4.50 ± 1.98 months for abdominal distension, and 5.07 ± 2.02 months for abdominal pain. Among the 3 children with cholangitis, the mean number of episodes was 3.33 ± 2.08, with a median of four episodes. Fourteen (70.0%) of the children had type I a CC, 1 (5.0%) participant each for types I b, I c, II and IV a and 2 (10.0%) of them had type IV b cyst. The mean size of the cyst (cm) was 7.41 ± 3.03 with a median of 6.85 cm. Among the children, 9 (45%) showed the presence of PBM on magnetic resonance cholangiopancreatography (MRCP), with 7 (77.8%) showing Komi's C-P type and 2 (22.2%) showing Komi's PC type. The mean common channel length (mm) on MRCP was 8.11 ± 2.47 with a median length of 8.00 mm. The biochemical analysis of a bile fluid amylase and lipase is the functional indicator of the presence of a PBM. Histopathological examination showed the presence of ulceration in the walls of the CC in 10 (50.0%) of the specimens. There was a significant association of the presence of PBM and ulceration in the mucosa of the CC (P ≤ 0.001), with the median levels being the highest in the PBM present group. Conclusion: Abdominal pain is the most common complaint in a child with CC, and when present, it is significantly associated with the presence of a PBM. MRCP is the gold standard tool to detect CCs and find out the morphology of PBM. The prevalence of PBM in children with CC of 45% with a mean common channel length of 8.11 mm. The biochemical analysis of a bile amylase and lipase is the functional indicator of the presence of a PBM and there is a significant association of their higher levels and presence of PBM. The presence of chronic inflammation and microscopic ulcers is significant histologic parameters depicting the presence of a PBM.

Hepatitis B virus infection among the tribal and particularly vulnerable tribal population from an eastern state of India: Findings from the serosurvey in seven tribal dominated districts, 2021-2022.

The Global Health Sector Strategy on viral hepatitis (2016-2021) endorsed by the World Health Assembly in 2016, called for the elimination of viral hepatitis as a public health threat by 2030. Odisha, an eastern state of India, has the third-highest percentage of tribal population in the country and limited information is available regarding the prevalence of HBsAg among them. The present study was undertaken to estimate the seroprevalence of hepatitis B surface antigen as well as HBV DNA almost after 12 years of the first prevalence study of HBsAg among the tribal community of Odisha. The present study attempted to estimate the prevalence of HBsAg among the 35 Scheduled tribal (ST) communities and 5 Particularly Vulnerable Tribal Group (PVTG) using the 2,737 number of sera collected as part of a statewide COVID-19 serosurvey, among the tribal populations of Odisha (residing in 7 districts) aged 6-75 years. HBsAg positivity ranged between 1.79 and 2.94% across various age groups. 42.9% of HBsAg positive individuals showed the presence of HBV DNA and the high viral load was 0.10 × 102-6.84 × 108 IU/mL, indicating a high potential to transmit the virus. The HBsAg positivity was 14.18 and 6.06% among the PVTGs, Kutia Khond and Paudi Bhuyan, who were first time surveyed for HBsAg prevalence. The present study documents the prevalence of HBsAg among the major tribal population residing in the eastern state of the country and highlights the need for a statewide survey of Hepatitis B infection and risk factors, coverage and impact of the Hepatitis B vaccination program introduced in 2010-2011 in Odisha among the ST and PVTG population of the state.

Scrub typhus seroprevalence from an eastern state of India: findings from the state-wide serosurvey.

BACKGROUND: Scrub typhus is a mite-borne infectious disease caused primarily by the obligate intracellular bacteria Orientia tsutsugamushi, which is transmitted by chigger mites. The objective of this study was to determine the prevalence of scrub typhus among adults in Odisha, an eastern state of India. METHODS: A descriptive cross-sectional study was conducted to analyse 1840 serum samples from five districts (Khordha, Cuttack, Ganjam, Malkangiri and Sundargarh) of Odisha collected during 2020-2021. Both immunoglobulin G (IgG) and IgM antibodies against scrub typhus were tested using commercial enzyme-linked immunosorbent assay kits. Point estimates of the 95% confidence interval and adjusted odds ratio were calculated. RESULTS: Of 1840 participants, the prevalence of IgG positivity was 1034 (56.19%) and that of IgM was 523 (28.42%). The majority of participants were in the 18-45 y age group (53.7%). Cuttack had the highest IgG positivity (64.54%) and Malkangiri had the lowest (29.32%). The highest and lowest positivity for IgM were found in Malkangiri (40.84%) and Cuttack (25.30%), respectively. CONCLUSIONS: With an increasing number of infections detected in the state, scrub typhus is emerging as a public health threat. Increasing awareness among the general public and healthcare professionals through health education campaigns regarding scrub typhus is essential. Early detection of the disease through the establishment of a laboratory surveillance system is required to control the transmission of scrub typhus.

Biliary Cystadenoma in a Child: A Rare Entity.

Biliary cystadenoma, a rare potentially malignant hepatic cystic lesion, is characterized by multiloculations and septations. It is common in middle-aged females (about 5% of nonparasitic liver cysts); only 12 cases are described in children. We report a rare case of hepatic biliary cystadenoma in a 3-year-old girl, with a gradually increasing lump in the right upper abdomen. Complete excision with a healthy liver margin was done.

Seroprevalence of human brucellosis among the tribal and non-tribal population residing in an eastern state of India: Findings from the state-wide serosurvey.

Background: Brucellosis is a neglected zoonotic disease found predominantly in lower- and middle-income countries (LMICs), causing significant public health concern in India. The objective of this study was to assess the prevalence of human brucellosis in Odisha, India among community members involved in animal husbandry as a common practice. Method: This cross-sectional study included 817 adult participants from 11 districts in Odisha. Four districts from the Northern division, four districts from the Central division, and three districts from the Southern division were selected for the study. Blood samples were collected during a COVID-19 serosurvey in Odisha conducted from 1st to 17th September 2021. Immunoglobulin-G (IgG) antibodies were measured against Brucella using a commercial ELISA kit. Point estimates at 95% confidence intervals (CIs) and adjusted odds ratio were calculated. Results: The overall prevalence of anti-Brucella IgG antibodies was calculated at 16.65% (95% CI: 14.19-19.42). The highest seropositivity was found in Sambalpur district (29.73%; 95% CI: 16.43-47.16) and the lowest was determined in Mayurbhanj district (4.44%; 95% CI: 0.99-15.60). Compared to males, females were more prone to contracting the disease (AOR: 1.13; 95% CI: 1.05-1.67). Participants from rural settings had higher prevalence of anti-Brucella IgG antibodies than urban dwellers (AOR: 4.53; 95% CI: 1.73-11.86). Conclusion: This study revealed that human brucellosis was associated with sociodemographic factors like gender, living settings, and household numbers. To prevent brucellosis, screening should be initiated, infected humans should be treated early, and the public should be educated about risk factors and preventive measures.

Dynamicity and persistence of severe acute respiratory syndrome coronavirus-2 antibody response after double dose and the third dose with BBV-152 and AZD1222 vaccines: A prospective, longitudinal cohort study.

Introduction: Vaccines are available worldwide to combat coronavirus disease-19 (COVID-19). However, the long-term kinetics of the vaccine-induced antibodies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have not been sufficiently evaluated. This study was performed to investigate the persistence and dynamicity of BBV-152 (Covaxin)- and AZD1222 (Covishield)-induced immunoglobulin-G (IgG) antibodies over the year and neutralizing antibodies' status after 1-month of booster dose. Materials and methods: This 52-week longitudinal cohort study documented antibody persistence and neutralizing antibodies status among 304 healthcare workers (HCWs) from six hospitals and research facilities in Odisha, enrolled during January 2021 and continued till March 2022. IgG antibodies against spike receptor-binding domain (RBD) of SARS-CoV-2 were quantified in an automated chemiluminescence immune assay-based (CLIA) platform and a surrogate virus neutralization test (sVNT) was performed by enzyme-linked immunosorbent assay (ELISA). Results: Among these 304 HCWs vaccinated with double doses, 154 HCWs (50.66%) were Covaxin recipients and the remaining 150 (49.34%) were Covishield recipients. During the follow-ups for seven times, a total of 114 participants were identified as vaccine breakthrough cases. In 190 non-infected HCWs, the median antibody titer was significantly waned from DD2 to DD10, both for Covaxin (231.8 vs. 42.7 AU/ml) and Covishield (1,884.6 vs. 369.2 AU/ml). No statistically significant differences in antibody titers were observed based on age, gender, comorbidities, and blood groups. The median inhibition activity of sVNT increased from 23.8 to 91.3% for Covaxin booster recipients and from 41.2 to 96.0% for Covishield booster recipients. Among 146 booster dose recipients, 48 were breakthrough cases after booster and all were contracted by the omicron variant. Conclusion: This year-long follow-up study found a 7- and 5-fold antibody waning in Covaxin and Covishield recipients, respectively, without any breakthrough infection history. However, individuals with booster breakthrough had mild symptoms and did not require hospital admission. The data also indicate the possible escape of omicron variants despite the presence of vaccine-induced neutralizing antibodies.

Phimosis - Are we on right track?

Background: Phimosis, a common paediatric condition, is defined as the inability to retract the preputial skin behind the glans. Current practice shows there is some confusion among the paediatricians towards this common condition and in differentiating it from the more common physiological preputial adhesion; leading to frequent referrals to a paediatric surgeon or a general surgeon, which can be addressed by the parents and the child physicians themselves. Aim: To find out the awareness towards the management of phimosis among the paediatricians. Materials and Methods: A questionnaire on this topic was generated using 'Google Forms' and was circulated among junior and senior residents, faculty in various medical colleges and consultants in private practice all over India and their response was collected and analysed. Results: We received a total of 221 responses from all over India from paediatric medicine trainees and consultants. Among them, majority (48%) were senior residents. According to the survey participants, the most (46%) find inability to retract the prepuce as the major presenting complaint. A straight away reference to a paediatric surgeon was preferred by majority of paediatricians (62.9%), though most of them were aware of them were aware of physiological adhesions and conservative management (94.2%). There was a belief among 43% about counselling each and every patient presenting with phimosis for circumcision. Among the respondents, 60.2% advised ultrasound of kidneys, ureter, and bladder to their patients and believed that backpressure changes alter the management of the child. A urine routine examination was advised by 70.1% of participants, with 46.6% believing that the presence of urinary tract infection changes the management of phimosis. Waiting up to 1 year of age before going for surgery was advocated by 71.5%. A major proportion of respondents (76%) believed all cases of phimosis should be referred to a surgeon, only 58.8% would voluntarily follow them up. There is still a belief among 69.7% of participants that all cases of phimosis should be referred to a paediatric surgeon and only few of them, 5.4% feel referring only indicated cases. Conclusion: Physiological phimosis is a common condition which can be addressed by the paediatricians themselves. Awareness is to be increased among them, especially during the training period regarding the proper management of this common condition, avoiding unnecessary circumcisions.

Pedunculated cavernous lymphangioma of the newborn oral cavity.

Oral swellings and ulcers in neonates are a spectrum of diseases often creating a sense of anxiety among parents. Early detection, high index of suspicion, proper investigations, and prompt diagnosis can aid in accurate management of the same. Lymphangiomas are benign hamartomas which are basically malformed lymphatics do not drain into other lymphatics or veins and hence there is lymphatic accumulation and enlargement following cystically dilated spaces. We hereby present a rare case of a neonate born with a cystic mucosal swelling at the upper gingival sulcus since birth.

Rectal Inflammatory Myoglandular Polyp with Osseous Metaplasia in a Child.

Background: Inflammatory myoglandular polyp (IMGP) combines the histopathological features of juvenile polyp and Peutz-Jegher's polyp. Osseous metaplasia can be occasionally seen in various benign, adenomatous, and malignant polyps. Case report: A nine-year-old girl with hematochezia had a rectal polyp with histological features of IMGP with additional stromal osseous metaplasia. Conclusion: Benign osseous metaplasia can be found in IMGP.

Perception and determinants leading to antimicrobial (mis)use: A knowledge, attitude, and practices study in the rural communities of Odisha, India.

Background: Antimicrobial resistance (AMR) has emerged as one of the major public health issues globally. This cross-sectional study determined knowledge, attitudes and practices (KAP) regarding antimicrobial use and AMR among rural communities of Tigiria (Odisha), India. Methods: A semi-structured questionnaire based on socio-demographic characteristics, antibiotics usage, awareness of antimicrobial resistance, healthcare utilization and quality of life were asked to the participants using an electronic device with Open Data Kit. Descriptive statistics, independent t-test and ANOVA were performed to analyze the variables. Results: A total of 1,003 participants were surveyed in the study from 25 villages of Tigiria. About 44.47% (95% CI: 41.36-47.60) of study participants have heard about antimicrobial medicines and 14.75% (95% CI: 12.65-17.13) of participants were involved in buying antibiotics without prescription over the counter. Around 20.14% (95% CI: 17.72-22.78) of participants, stopped taking antibiotics before completing the full course. The physical domain was the most affected with low scores compared to other domains of quality of life (QOL). The QOL scores were found significant (p < 0.05) across age, gender, education and ethnicity. Conclusion: The study documented a significant level of KAP regarding antimicrobial (mis)use in the study. It is essential that antimicrobial stewardship programs for various stakeholders and educational programmes must be initiated to increase awareness of people on antimicrobial resistance.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis Associated with Mature Ovarian Teratoma in a Young Adolescent: A Case Report.

BACKGROUND: Ovarian teratoma has an uncommon association with anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. This is a life-threatening condition, and here, we describe a case of an adolescent girl with anti-NMDAR encephalitis caused by an ovarian teratoma. CASE: A 14-year-old girl presented with acute features of fever, severe headache, altered behavioral changes, delirium, autonomic instability, episodes of seizure, and involuntary movement over a period of 1 month. Upon investigation, electroencephalogram (EEG), computed tomography (CT), and magnetic resonance imaging (MRI) of her brain showed normal findings. Her serum and cerebrospinal fluid were positive for anti-NMDARs, and a diagnosis of anti-NMDAR encephalitis was made, so she received a course of intravenous methyl prednisolone and immunoglobulin and was discharged after her neurological status improved. Upon further workup, she was suspected to have a left ovarian dermoid cyst on transabdominal ultrasonogram, which was an incidental finding. Her tumor marker panel showed normal serum lactate dehydrogenase, beta human chorionic gonadotropin, inhibin, alpha-fetoprotein, and carcinoembryonic antigen and a cancer antigen 125 level of 71.5 U/L. She eventually underwent laparoscopic left ovarian cystectomy and received immunotherapy in the postoperative period. She was discharged in stable condition on postoperative day 4. On histopathological examination, the specimen revealed a mature cystic teratoma with glial component. One year after surgery, the patient has recovered completely and has no residual psychiatric or neurological symptoms. CONCLUSION: Complete recovery after surgery in cases of anti-NMDAR encephalitis with ovarian teratoma emphasizes the need for early recognition of the entity, search for underlying tumor, and tumor removal to improve the prognosis.

IgG antibody response against nucleocapsid and spike protein post-SARS-CoV-2 infection.

OBJECTIVES: Coronavirus disease-19 (COVID-19) pandemic became the greatest public health challenge globally. Study of dynamicity and durability of naturally developed antibodies against SARS-CoV-2 are of great importance from an epidemiological viewpoint. METHODS: In this observational cohort study, we have followed up the 76 individuals who tested positive for SARS-CoV-2 infection by real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) for 16 weeks (post-enrolment) to record the periodic changes in titre, concentration, clinical growth and persistence of naturally developed SARS-CoV-2 antibodies. We collected serum samples from these individuals for 16 weeks with a frequency of weekly and fortnightly during each follow-up and tested them in two CLIA-based platforms (Abbott Architect i1000SR and Roche Cobas e411) for testing SARS-CoV-2 antibodies both qualitatively and quantitatively. RESULTS: We recorded the antibody magnitude of these individuals 10 times between September 2020 and February 2021. We found a waning of antibodies against nucleocapsid antigen protein but not a complete disappearance by the end of 16 weeks. Out of 76 cases, 30 cases (39.47%) became seronegative in qualitative assay, although all the sera samples (100%) remained positive when tested in quantitative assay. CONCLUSION: The lower persistence of anti-nucleocapsid SARS-CoV-2 antibody may not be the exact phenomenon as those cases were still seropositive against spike protein and help in neutralising the virus.