Effect of aromatic substituents on thermoresponsive functional polycaprolactone micellar carriers for doxorubicin delivery.

Amphiphilic functional polycaprolactone (PCL) diblock copolymers are excellent candidates for micellar drug delivery. The functional groups on the backbone significantly affect the properties of PCL. A systematic investigation of the effect of aromatic substituents on the self-assembly of γ-functionalized PCLs and the delivery of doxorubicin (DOX) is presented in this work. Three thermoresponsive amphiphilic diblock copolymers with poly(γ-benzyloxy-ε-caprolactone) (PBnCL), poly(γ-phenyl- ε-caprolactone) (PPhCL), poly(γ-(4-ethoxyphenyl)-ε-caprolactone) (PEtOPhCL), respectively, as hydrophobic block and γ-tri(ethylene glycol) functionalized PCL (PME3CL) as hydrophilic block were prepared through ring-opening polymerization (ROP). The thermoresponsivity, thermodynamic stability, micelle size, morphology, DOX-loading, and release profile were determined. The LCST values of amphiphilic diblock copolymers PME3CL-b-PBnCL, PME3CL-b-PPhCL, and PME3CL-b-PEtOPhCL are 74.2°C, 43.3°C, and 37.3°C, respectively. All three copolymers formed spherical micelles in phosphate-buffered saline (PBS, 1×, pH = 7.4) at low concentrations ranging from 8.7 × 10-4 g/L to 8.9 × 10-4 g/L. PME3CL-b-PBnCL micelles showed the highest DOX loading capacity of 3.01 ± 0.18 (wt%) and the lowest drug release, while PME3CL-b-PEtOPhCL micelles exhibited the lowest DOX loading capacity of 1.95 ± 0.05 (wt%) and the highest drug release. Cytotoxicity and cellular uptake of all three micelles were assessed in vitro using MDA-MB-231 breast cancer cells. All three empty micelles did not show significant toxicity to the cells at concentrations high up to 0.5 mg/mL. All three DOX-loaded micelles were uptaken into the cells, and DOX was internalized into the nucleus of the cells.

Reversible Cross-linked Thermoresponsive Polycaprolactone Micelles for Enhanced Stability and Controlled Release.

Thermoresponsive amphiphilic poly(ε-caprolactone)s (PCL)s are excellent candidates for drug delivery due to their biodegradability, biocompatibility, and controlled release. However, the thermoresponsivity of modified PCL can often lead to premature drug release because their lower critical solution temperature (LCST) is close to physiological temperature conditions. To address this issue, we developed a novel approach that involves functionalizing redox-responsive lipoic acid to the hydrophobic block of PCL. Lipoic acid has disulfide bonds that undergo reversible cross-linking after encapsulating the drug. Herein, we synthesized an ether-linked propargyl-substituted PCL as the hydrophobic block of an amphiphilic copolymer along with unsubstituted PCL. The propargyl group was used to attach lipoic acid through a postpolymerization modification reaction. The hydrophilic block is composed of an ether-linked, thermoresponsive tri(ethylene glycol)-substituted PCL. Anticancer drug doxorubicin (DOX) was encapsulated within the core of the micelles and induced cross-linking in the presence of a reducing agent, dithiothreitol. The developed micelles are thermodynamically stable and demonstrated thermoresponsivity with an LCST value of 37.5 °C but shifted to 40.5 °C after cross-linking. The stability and release of both uncross-linked (LA-PCL) and cross-linked (CLA-PCL) micelles were studied at physiological temperatures. The results indicated that CLA-PCL was stable, and only 35% release was observed after 46 h at 37 °C while LA-PCL released more than 70% drug at the same condition. Furthermore, CLA-PCL was able to release a higher amount of DOX in the presence of glutathione and above the LCST condition (42 °C). Cytotoxicity experiments revealed that CLA-PCL micelles are more toxic toward MDA-MB-231 breast cancer cells at 42 °C than at 37 °C, which supported the thermoresponsive release of the drug. These results indicate that the use of reversible cross-linking is a great approach toward synthesizing stable thermoresponsive micelles with reduced premature drug leakage.

Recent Advances in Polycaprolactones for Anticancer Drug Delivery.

Poly(ε-Caprolactone)s are biodegradable and biocompatible polyesters that have gained considerable attention for drug delivery applications due to their slow degradation and ease of functionalization. One of the significant advantages of polycaprolactone is its ability to attach various functionalities to its backbone, which is commonly accomplished through ring-opening polymerization (ROP) of functionalized caprolactone monomer. In this review, we aim to summarize some of the most recent advances in polycaprolactones and their potential application in drug delivery. We will discuss different types of polycaprolactone-based drug delivery systems and their behavior in response to different stimuli, their ability to target specific locations, morphology, as well as their drug loading and release capabilities.

Development of a Nickel-Catalyzed N-N Coupling for the Synthesis of Hydrazides.

A nickel-catalyzed N-N cross-coupling for the synthesis of hydrazides is reported. O-Benzoylated hydroxamates were efficiently coupled with a broad range of aryl and aliphatic amines via nickel catalysis to form hydrazides in an up to 81% yield. Experimental evidence implicates the intermediacy of electrophilic Ni-stabilized acyl nitrenoids and the formation of a Ni(I) catalyst via silane-mediated reduction. This report constitutes the first example of an intermolecular N-N coupling compatible with secondary aliphatic amines.

Expert Opinion by Clinicians on the Use of Insulin Therapy in People with Hepatic Impairment.

People with type 2 diabetes mellitus (T2DM) have a higher risk of developing chronic liver disease (CLD) and its complications. T2DM, obesity, and insulin resistance are all strongly associated with nonalcoholic fatty liver disease (NAFLD). Conversely, people suffering from cirrhosis have reduced glucose tolerance in approximately 60% of cases, diabetes in 20% of cases, and insulin-mediated glucose clearance is lowered by 50% as compared with those who do not have cirrhosis. An exploratory review was conducted using existing published evidence from clinical studies on dosing and titrations of individual insulin formulations in people with CLD to optimize insulin dosage titration for minimizing hypoglycemia risk.pThis article discusses current hyperglycemia treatment techniques for patients with CLD as well as the consensus recommendations on insulin use in special populations with T2DM and hepatic impairment. Based on available evidence and expert diabetologists' recommendations, careful insulin dose titration, customized glycemic targets, and frequent glucose screening are recommended for optimal glycemic management without hypoglycemia in CLD. Long-acting insulin should be avoided or used when short-acting insulin fails to provide adequate glycemic control with raised fasting blood sugar levels. While the patient's glucose profile is being evaluated, the prandial insulin dose can be lowered by 25% initially. The dose can be titrated based on the patient's postprandial glycemic expression and whether their food intake meets the Child-Pugh scores A and B categories. Titrating premixed insulins is difficult for patients in class C since their appetite and overall health are constantly compromised and in flux.

Treatment outcomes and associated factors among patients with drug-sensitive tuberculosis on daily fixed-dose combination drugs: A cohort study from Ahmedabad, India.

Background and Aim: The National Tuberculosis Elimination Program (NTEP) has been progressive in addressing the issues related to tuberculosis (TB) control in the country, with constant programmatic changes based on evidence available from operational research. Our objectives were 1. to assess the sociodemographic and clinical characteristics, and the treatment outcomes of patients on fixed-dose combination (FDC) daily regimen and 2. to assess the factors associated with unsuccessful treatment outcomes among patients with DS-TB. Materials and Methods: A retrospective cohort study was conducted based on record review. The study population included all patients with drug-sensitive TB, registered and initiated on treatment under NTEP "new category" from January to June 2018 and under "previously treated category" from January to March 2018. Quantitative data downloaded from Nikshay in Excel format was imported. Results: A total of 8301 patients with DS-TB registered under NTEP. Mean (standard deviation [SD]) age of DS-TB patients was 35.3 + 16.9 years, and 63.2% were in the age group of 15-44 years. Also, 60.1% were male, 2.5% were human immunodeficiency virus (HIV) positive, 65.3% were pulmonary TB cases, and 70.4% obtained treatment from public providers. Proportion of "successful" and "unsuccessful" outcomes was 87.9% and 12.1%, respectively, in the new treatment category and 78.3% and 21.7%, respectively, in the previously treated category. Among the patients classified under new category, the unsuccessful treatment outcome remained significantly high after adjustments with known confounders among patients aged 45-54 years (adjusted relative risks [aRR] 1.59, 95% confidence interval [CI] 1.31-1.93) and 55-64 years (aRR 1.67, 95% CI 1.36-2.05) compared to patients aged <15 years. Conclusion: Unsuccessful treatment outcome was significantly high among patients aged 45-54 years. Various adherence mechanisms implemented can be evaluated for further upscaling and improving the program effectiveness.

Radiomics-based evaluation and possible characterization of dynamic contrast enhanced (DCE) perfusion derived different sub-regions of Glioblastoma.

BACKGROUND: Glioblastoma (GB) is among the most devastative brain tumors, which usually comprises sub-regions like enhancing tumor (ET), non-enhancing tumor (NET), edema (ED), and necrosis (NEC) as described on MRI. Semi-automated algorithms to extract these tumor subpart volumes and boundaries have been demonstrated using dynamic contrast-enhanced (DCE) perfusion imaging. We aim to characterize these sub-regions derived from DCE perfusion MRI using routine 3D post-contrast-T1 (T1GD) and FLAIR images with the aid of Radiomics analysis. We also explored the possibility of separating edema from tumor sub-regions by extracting the most influential radiomics features. METHODS: A total of 89 patients with histopathological confirmed IDH wild type GB were considered, who underwent the MR imaging with DCE perfusion-MRI. Perfusion and kinetic indices were computed and further used to segment tumor sub-regions. Radiomics features were extracted from FLAIR and T1GD images with PyRadiomics tool. Statistical analysis of the features was carried out using two approaches as well as machine learning (ML) models were constructed separately, i) within different tumor sub-regions and ii) ED as one category and the remaining sub-regions combined as another category. ML based predictive feature maps was also constructed. RESULTS: Seven features found to be statistically significant to differentiate tumor sub-regions in FLAIR and T1GD images, with p-value < 0.05 and AUC values in the range of 0.72 to 0.93. However, the edema features stood out in the analysis. In the second approach, the ML model was able to categorize the ED from the rest of the tumor sub-regions in FLAIR and T1GD images with AUC of 0.95 and 0.89 respectively. CONCLUSION: Radiomics-based specific feature values and maps help to characterize different tumor sub-regions. However, the GLDM_DependenceNonUniformity feature appears to be most specific for separating edema from the remaining tumor sub-regions using conventional FLAIR images. This may be of value in the segmentation of edema from tumors using conventional MRI in the future.

Quantification of Radiomics features of Peritumoral Vasogenic Edema extracted from fluid-attenuated inversion recovery images in glioblastoma and isolated brain metastasis, using T1-dynamic contrast-enhanced Perfusion analysis.

The peritumoral vasogenic edema (PVE) in brain tumors exhibits varied characteristics. Brain metastasis (BM) and meningioma barely have tumor cells in PVE, while glioblastoma (GB) show tumor cell infiltration in most subjects. The purpose of this study was to investigate the PVE of these three pathologies using radiomics features in FLAIR images, with the hypothesis that the tumor cells might influence textural variation. Ex vivo experimentation of radiomics analysis of T1-weighted images of the culture medium with and without suspended tumor cells was also attempted to infer the possible influence of increasing tumor cells on radiomics features. This retrospective study involved magnetic resonance (MR) images acquired using a 3.0-T MR machine from 83 patients with 48 GB, 21 BM, and 14 meningioma. The 93 radiomics features were extracted from each subject's PVE mask from three pathologies using T1-dynamic contrast-enhanced MR imaging. Statistically significant (< 0.05, independent samples T-test) features were considered. Features maps were also computed for qualitative investigation. The same was carried out for T1-weighted cell line images but group comparison was carried out using one-way analysis of variance. Further, a random forest (RF)-based machine learning model was designed to classify the PVE of GB and BM. Texture-based variations, especially higher nonuniformity values, were observed in the PVE of GB. No significance was observed between BM and meningioma PVE. In cell line images, the culture medium had higher nonuniformity and was considerably reduced with increasing cell densities in four features. The RF model implemented with highly significant features provided improved area under the curve results. The possible infiltrative tumor cells in the PVE of the GB are likely influencing the texture values and are higher in comparison with BM PVE and may be of value in the differentiation of solitary metastasis from GB. However, the robustness of the features needs to be investigated with a larger cohort and across different scanners in the future.

Successful Use of Subcutaneous Stimulation for Bilateral Sacroiliac Joint Pain.

Sacroiliac joint pain (SIJP) has been difficult to properly manage in the medical field. Patients are initially managed with medications and physical therapy but may require further interventions including intra-articular corticosteroid injections, radiofrequency ablation, and sacroiliac joint fusion. Although peripheral nerve stimulation (PNS) and peripheral field nerve stimulation (PFNS) have been used with varying success, subcutaneous spinal cord stimulation (SCS) has not yet been utilized. We present the case of a patient with bilateral SIJP who had successful resolution with the use of subcutaneously-implanted SCS electrode leads. A 74-year-old female patient with a history of lumbar stenosis status post epidural steroid injection and minimally invasive lumbar decompression presented with year-long chronic low back pain (LBP) with unsuccessful pain relief from medical management and physical therapy. On physical exam, pain elicited with tenderness over both sacroiliac joints with positive Patrick's and Gaenslen's test bilaterally. After successful pain relief from a diagnostic SI joint injection, the patient underwent an SCS trial. Trial SCS leads were placed epidurally at T7 and subcutaneously next to bilateral SI joints. Epidural stimulation provided no pain relief after three days. Stimulation was then changed to the subcutaneous leads, with subsequent 90% pain relief. The patient then underwent a permanent implant with subcutaneous lead placement without complications. She reported pain relief ongoing for two years. SIJP is a difficult condition to treat despite various modalities. Recent advances in neuromodulation have shown anecdotal success with PNS. SCS involves electrode leads placed in the epidural space to provide axial back and radicular pain coverage. In this case, however, SCS leads were placed subcutaneously with excellent pain relief. Our case showcases the successful use of subcutaneous-implanted SCS which can provide another viable minimally invasive treatment option in the management of this pain source.

Successful Dorsal Root Ganglion Stimulation for Chronic Pancreatitis: A Case Report.

Chronic pancreatitis represents an inflammatory condition occurring from repetitive pancreatic inflammation episodes ultimately causing patients intractable pain alongside pancreatic insufficiency and as a result, reduced quality of life. In addition to alcohol and smoking cessation, patients with chronic pancreatitis are treated conservatively with anti-depressants, anti-convulsant and analgesic medications including paracetamol and celecoxib - with limited success. Alternative to surgical resection, patients can opt for endoscopic treatment options including sphincterotomy or removal of calculi which have shown limited success. Celiac plexus blocks have had positive outcomes as well, however, are not long-lasting and carry significant risks, such as gastroparesis or organ damage. Evidence has shown alterations in the peripheral and central nervous system which causes these patients to often experience dysfunctional and neuropathic pain. The advent of this knowledge has introduced neuromodulation into the field with successful cases of spinal cord stimulation treating the pain associated with chronic pancreatitis. Dorsal root ganglion stimulation is similarly based upon the gate theory of pain but with more precision as it strictly targets the dorsal root ganglion. There have been no cases reported in the literature of this form of stimulation in treating chronic pancreatitis. We present a case of a patient with chronic pancreatitis who obtained 80% abdominal pain relief for two years after undergoing dorsal root ganglion stimulation.

Economy-wide evaluation of CO2 and air quality impacts of electrification in the United States.

Adopting electric end-use technologies instead of fossil-fueled alternatives, known as electrification, is an important economy-wide decarbonization strategy that also reduces criteria pollutant emissions and improves air quality. In this study, we evaluate CO2 and air quality co-benefits of electrification scenarios by linking a detailed energy systems model and a full-form photochemical air quality model in the United States. We find that electrification can substantially lower CO2 and improve air quality and that decarbonization policy can amplify these trends, which yield immediate and localized benefits. In particular, transport electrification can improve ozone and fine particulate matter (PM2.5), though the magnitude of changes varies regionally. However, growing activity from non-energy-related PM2.5 sources-such as fugitive dust and agricultural emissions-can offset electrification benefits, suggesting that additional measures beyond CO2 policy and electrification are needed to meet air quality goals. We illustrate how commonly used marginal emissions approaches systematically underestimate reductions from electrification.

Efficacy and safety of polyherbal formulation as an add-on to standard-of-care in mild-to-moderate COVID-19: A randomized, double-blind, placebo-controlled trial.

Background: Novel corona virus disease-2019 (COVID-19) pandemic is a significant contributor to morbidity and mortality in affected individuals. Modulating the immune response in COVID-19 is now an established treatment approach. Polyherbal formulations have long been assessed for their potential immune modulating effects and are expected to be beneficial on COVID-19. Methods: This study aims at assessing the efficacy and safety of polyherbal formulation (referred as IP) in comparison to placebo, as add on to the standard of care (SOC), in patients with mild to moderate COVID-19 patients. Hospitalized RT-PCR positive patients were randomized to either SOC + IP or SOC + Placebo arm. The viral load (VL) was assessed using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Immunological parameters were also assessed. The clinical improvement was assessed using a numeric rating scale (NRS) and WHO ordinal scale, and follow-up period was 30 days. Results: Seventy-two patients were randomized to SOC + IP (n = 39) and SOC + Placebo (n = 33) arms. There was significant reduction in VL in SOC + IP arm from day 0-4 (p = 0.002), compared to SOC + Placebo arm (p = 0.106). Change in the NRS score and WHO score was significant in both arms, however, the difference between the two arms was statistically significant in favour of IP arm. The increase in Th1 response was significant in SOC + IP arm (p = 0.023), but not in SOC + Placebo arm. COVID-19 specific antibodies were numerically higher in the SOC + IP arm. Conclusion: The study finds that polyherbal formulation significantly reduces VL and contributes to immunomodulation and improvement in clinical conditions without side effects.

The Importance of Differentiating Parsonage-Turner Syndrome From Cervical Radiculopathy: A Case Report.

Parsonage-Turner syndrome (PTS) is a rare disease process in which one develops acute-onset shoulder pain, followed by progressive weakness of the upper arm and shoulder girdle musculature. PTS is difficult to diagnose as it mimics similar presenting pathologies, most commonly, cervical radiculopathy (CR). Clinical presentation and diagnostic tests are particularly important to identify this rare syndrome, as the treatment for similar conditions may be more invasive. We present an interesting case of a 32-year-old female with severe unilateral shoulder pain, followed by weakness of her upper extremity musculature. The etiology of her symptoms cannot be concluded for certain; however, the aim of this case report is to increase awareness of this rare but potentially debilitating syndrome while also educating providers on the importance of differentiating PTS from the more commonly diagnosed CR.

Sodium-glucose Cotransporter-2 Inhibitors in Primary and Secondary Prevention of Cardiovascular and Renal Outcomes in Patients with Type 2 Diabetes Mellitus: A Meta-analysis.

BACKGROUND: The available evidence was systematically reviewed to evaluate the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2i) on cardiovascular (CV) and renal outcomes in people with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) or multiple risk factors (MRF), with or without heart failure (HF), and per estimated glomerular filtration rate (eGFR) rate at baseline. METHODS: We comprehensively searched three electronic databases to retrieve publications up to 30th November 2019, which were screened for inclusion. The data extracted for the outcomes according to baseline ASCVD, HF, and eGFR levels were meta-analyzed using fixed effects model. RESULTS: Of the 735 screened citations, 15 primary and secondary publications from five CV or renal outcome trials were included. SGLT2is reduced the risk of CV death or hospitalization for HF (HHF), HHF alone, and composite renal-specific outcome, irrespective of ASCVD and HF at baseline. The three-point major adverse cardiovascular events (3P-MACE) risk was reduced by 14% (p<0.001) in patients with ASCVD and by 10% (p = 0.018) in those without baseline HF compared with their counterparts. SGLT2is significantly reduced the risk of MACE (18%) in patients with mild kidney dysfunction (eGFR within the range of 60-<90 mL/min/1.73 m2 and <60 mL/min/1.73 m2 ). CONCLUSION: SGLT2is are effective for both secondary and primary prevention of composite CV outcomes, and secondary prevention of MACE. The upcoming evidence may strengthen the primary prevention benefits of SGLT2is.

Susceptibility-weighted imaging: an emerging technique for evaluation of the spine and spinal cord.

We present the application of three-dimensional susceptibility-weighted imaging technique for evaluation of pathologies of the spine and spinal cord. This work focuses on the advantage of this imaging technique as an adjunct to the conventional imaging to evaluate various disorders of the spine and spinal cord like trauma, degenerative diseases, vascular malformations, and tumours, where susceptibility-weighted imaging may offer valuable harmonising evidence that may be helpful in the diagnosis and management of the patients with these pathologies.

Prevalence and Determinants of Depression among Multi Drug Resistant (MDR) TB cases registered under National Tuberculosis Elimination Program in Ahmedabad City.

Background: Multidrug-resistant tuberculosis (MDR-TB) increases the risk of depression, lowers treatment compliance leading to poor outcomes. Objectives: To (1) document the prevalence of depression among MDR-TB cases registered at tuberculosis units (TUs) of Ahmedabad city and (2) assess determinants of depression. Methodology: Adult MDR-TB patients registered at all (23) TUs of Ahmedabad city, were studied using semi-structured questionnaire along with Gujarati translated version of the Hamilton Depression Rating Scale (HAM-D) to assess the severity of depression based on 17 items. The sample size at 95% level of significance, was 251. Probability proportional to size sampling was adopted for selecting participants from each of the 23 TUs. Proportions and odds ratio with confidence interval with probability value were calculated. Results: Of 251, only 185 (73.7%) cases could be contacted. Mortality proportion among selected cases was 18.7%. More than one-fifth (22%) had ≥1 comorbidity and 9.7% had another active TB case in the family. 161 (87.1) experienced ≥1 adverse event. Financial, social, or psychological stressors were reported by 22% of cases. Based on the HAM-D scale, 16.2% suffered from depression, determinants of depression by univariate analysis showed significant association with recent family issues, discrimination, financial/other troubling issues, and the presence of adverse drug event. Conclusion: MDR-TB cases are more vulnerable for developing depression as the prevalence was 16.2% among them. Hence, cases need to be monitored closely for depression at TU as well at community level.

Predictors Associated with In-hospital Mortality among COVID-19 Patients during the Second Wave in a Tertiary Care Hospital, Gujarat, India: A Retrospective Observational Study.

BACKGROUND: Fatalities due to coronavirus disease 2019 (COVID-19) have already crossed to more than 5 million globally so far. Hence, it is crucial for us to identify the risk factors associated with hospital deaths starting from first contact which can help to give timely treatment to the targeted population. OBJECTIVES: This retrospective cohort study was conducted to identify various factors related to in-hospital mortality related to COVID-19 in our region. MATERIALS AND METHODS: The present study was a single-center, retrospective cohort study of 675 adult patients, admitted with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between 1st April and 25th May 2021 in our tertiary care hospital. Baseline demographic profile, comorbidities, clinical characteristics, and investigatory findings were analyzed for increased odds of mortality. RESULTS: A total of 181 (26.8%) patients died and 494 (73.2%) survived. There were 65.4% of males and no difference was found between genders in terms of mortality. Comorbidities associated with in-hospital death in our cohort were age group ≥50 years (p<0.001), diabetes (p<0.0007), and renal injury (p<0.0001). More than half of the patients died during the first week of admission. Breathlessness (83%) was the most common symptom in non-survivors. Neutrophil-to-lymphocyte ratio (NLR), S. creatinine, D-dimer, ferritin, and C-reactive protein (CRP) were increased significantly among the patients who died. Multivariate logistic regression revealed age ≥50 years [adjusted odds ratio (AOR) 2.30, 95% confidence interval (CI) 1.45-3.64] and oxygen (O2) saturation <94% at the time of admission (AOR 2.62, 95% CI 1.75-3.93) were associated with mortality. CONCLUSION: Overall in-hospital mortality was 26.8%. Higher age and low O2 saturation were the major risk factors associated with in-hospital mortality.

Situational Analysis of Rashtriya Kishor Swasthya Karyakram at One of the Districts of Gujarat.

Background: Rastriya Kishor Swasthya Karyakram (RKSK) is a holistic approach implemented for betterment of adolescent health. Barriers in the implementation can be identified by conducting the situational analysis of any program. The present study is a part of the multi-centric study conducted at Sabarkantha district for situational analysis of RKSK. To assess the implementation of various components under RKSK at various levels of health facilities, 2) to identify the barriers faced by services providers in RKSK implementation, and 3) to identify the perception of beneficiaries regarding RKSK. Materials and Methods: A Cross-sectional study using a mixed method approach was conducted to review the implementation of the RKSK program at Sabarkantha district. In-depth interview of health personnel involved in implementation of RKSK was conducted using pre-structured and pre-tested interview guide. Ongoing sessions of Adolescent Friendly Health Clinics (AFHCs) were examined, and exit interview of adolescents was conducted. Adolescents residing within limits of the defined facility were also interviewed. Frequency and percentages were used for descriptive analysis, and a thematic qualitative analysis approach was used for qualitative aspects. Results: RKSK was implemented successfully at Primary Health Centers. Infrastructure for AFHC was inadequate particularly at higher care facilities. Weekly Iron Folic Acid Supplementation (WIFS) was successfully implemented in the district. Overall sessions conducted at AFHC were found to be satisfactory. Adolescents interviewed in the community were satisfied with the services delivered to them under RKSK. Conclusion: For better implementation of RKSK, there is a need to focus on certain issues such as inadequate infrastructure of AFHCs, the lack of trained counselors, unavailability of sanitary pads, and inadequate participation of adolescents from the community in availing RKSK services.

Seroprevalence of Immunoglobulin-G Antibody Among Confirm Cases of COVID-19.

Background Sero-surveillance to find the presence of IgG antibodies among COVID-19 cases helps in the better understanding of the immune response after COVID-19 infection. Objectives To estimate seropositivity among confirmed COVID-19 cases and to correlate the seropositivity with various factors affecting seropositivity. Methods Population-based sero-surveillance among COVID-19 cases was carried out during the second half of August 2020 in Ahmedabad using the COVID KAVACH, Immunoglobulin-G (IgG) Antibody Detection Enzyme-Linked Immunosorbent Assay (ELISA) kits. Seropositivity among cases was measured and compared with various other factors to understand the immunity status among COVID-19 cases. Results With 1073 positive for IgG antibodies from 1720 samples, the seropositivity among COVID-19 cases is 62.38% [95%CI 60.07-64.64%]. The difference in seropositivity based on gender was statistically not significant (Z=0.26, P=0.79). Children have the highest seropositivity (94.44%) and from young adults, to the elderly, the proportion of positivity among cases shows an increasing trend. Time gap analysis from the date of diagnosis shows that the proportion of cases with IgG antibodies increases gradually reaching its peak at around 10 weeks (third month) and then declines gradually. Conclusion Seropositivity among COVID-19 cases is 62.38%. The proportion of cases with IgG antibodies reaches its peak at around 10 weeks (third month) after diagnosis and then declines gradually. This fall indicates that the detected antibodies may not be long-lasting and may become undetectable/absent over a period of time. The reason for seronegative results in COVID-19 cases needs further in-depth scientific research.