Clinical profile of hemodialysis patients attending a tertiary care hospital in Delhi, India

Background: CKD (chronic kidney disease) is one of the major complications of diabetes and hypertension. With increase in prevalence of non-communicable diseases, the patients presenting with the symptoms of CKD are also rising. Most of the patients suffering from CKD eventually land up on renal replacement therapy, putting extra burden economically as well as psychologically to the self and their family. The aim of the study is to find out the socio demographic and clinical profile of the patients suffering from CKD attending a tertiary care hospital in Delhi.Methods: It was a record based descriptive analysis, conducted between January 2019 and June 2019 in one of the ESIC (Employee State Insurance Corporation) hospital of Delhi. Medical Records of the only those patients were considered whose complete data were present in the record file. Data about Socio demographic profiles , clinical data, duration of CKD, duration of haemodialysis, viral markers, number of blood transfusions, vascular access, number of failed AV fistula etc. were entered in MS Excel and analysed through SPSS 11.Results: Hospital records of 473 CKD patients undergoing hemodialysis were analyzed. It was found that 315 (67%) were males and 158 (33%) were females. Majority of the patients i.e. 245 were in the age group of 41-60 years followed by 166 who were in the age group of 21 to 40. Out of total patients, 195 (41.2%) participants were undergoing hemodialysis twice a week, 276 (58.4%) thrice a week, 2 (0.4) patients were undergoing hemodialysis session four times a week. Majority of the participants i.e. 414 (88%) were Hindu. Out of total 473 participants, 439 (93%) participants had sero negative for viral marker (i.e. HbsAg, HCV, HIV I and II) and 33 (7%) participants were sero positive for viral marker. Most common etiology of CKD was found to be hypertension in our study followed by diabetes.Conclusions: Patients suffering from chronic kidney diseases are increasing day by day with increasing prevalence of hypertension. Most of the patients of CKD patients were middle aged males. Most of the patients have to visit 3 times a week to any health care institution for hemodialysis. Many of the patients are getting infected with viral hepatitis during course of the illness.

The Complex Regulatory Role of Cytomegalovirus Nuclear Egress Protein pUL50 in the Production of Infectious Virus

The regulation of the nucleocytoplasmic release of herpesviral capsids is defined by the process of nuclear egress. Due to their large size, nuclear capsids are unable to traverse via nuclear pores, so that herpesviruses evolved to develop a vesicular transport pathway mediating their transition through both leaflets of the nuclear membrane. This process involves regulatory proteins, which support the local distortion of the nuclear envelope. For human cytomegalovirus (HCMV), the nuclear egress complex (NEC) is determined by the pUL50-pUL53 core that initiates multicomponent assembly with NEC-associated proteins and capsids. Hereby, pUL50 serves as a multi-interacting determinant that recruits several viral and cellular factors by direct and indirect contacts. Recently, we generated an ORF-UL50-deleted recombinant HCMV in pUL50-complementing cells and obtained first indications of putative additional functions of pUL50. In this study, we produced purified ΔUL50 particles under both complementing (ΔUL50C) and non-complementing (ΔUL50N) conditions and performed a phenotypical characterization. Findings were as follows: (i) ΔUL50N particle preparations exhibited a clear replicative defect in qPCR-based infection kinetics compared to ΔUL50C particles; (ii) immuno-EM analysis of ΔUL50C did not reveal major changes in nuclear distribution of pUL53 and lamin A/C; (iii) mass spectrometry-based quantitative proteomics showed a large concordance of protein contents in the NIEP fractions of ΔUL50C and ΔUL50N particles, but virion fraction was close to the detection limit for ΔUL50N; (iv) confocal imaging of viral marker proteins of immediate early (IE) and later phases of ΔUL50N infection indicated a very low number of cells showing an onset of viral lytic protein expression; and, finally (v) quantitative measurements of encapsidated genomes provided evidence for a substantial reduction in the DNA contents in ΔUL50N compared to ΔUL50C particles. In summary, the results point to a complex and important regulatory role of the HCMV nuclear egress protein pUL50 in the maturation of infectious virus.

Extraintestinal Amoebiasis in Women after 6th Day of Delivery

Background. Extraintestinal amoebiasis is more common in countries with lower socioeconomic status. Complication related to amoebiasis is common in pregnant patients with malnutrition and others. Severe cases can be associated with high fatality rates. We would like to report a patient with a presumptive diagnosis of extraintestinal amoebiasis who was on the 6th postpartum day after intrauterine fetal death (IUFD). Case Presentation. The patient was a 31 year-old female who was on 6th postpartum day after IUFD after the 9th month of amenorrhea. She presented with severe epigastric pain, hiccups, and bloody vomiting of ingested matter for 5 days. She also had right upper quadrat pain and fatigue. In addition, she had generalized body weakness and yellowish discoloration of the eyes for one week. Moreover, she had pruritus, fever, and a history of watery diarrhea 6 days ago which got subsided during the presentation. Laboratory investigation indicated leukocytosis and increased level of alkaline phosphatase and direct and total bilirubin. Trophozoite of E. histolytica was seen on stool microscope, negative for viral marker and Helicobacter pylori. Abdominal ultrasonography showed normal liver parenchyma and biliary system. She was treated onsite with 500 mg metronidazole and 500 mg ceftriaxone for five days and discharged with metronidazole 500 mg PO three times a day and cloxacillin 500 mg PO four times a day for 7 days. Conclusions. Extraintesinal amoebiasis can be resolved if it is diagnosed early and treated with metronidazole. Clinicians should not neglect amoebiasis in patients presenting with jaundice and right upper quadrant pain.

Phylogenetic and Mutational Analysis of Lassa Virus Strains Isolated in Nigeria: Proposal for an In Silico Study

Background In 2018, the total number of Lassa fever cases in Nigeria was significantly higher than that observed in previous years. Hence, studies had attempted to determine the underlying cause. However, reports using phylogenetic methods to analyze this finding ruled out the emergence of potentially more transmissible Lassa virus strains or an increase in human-to-human viral transmission as the cause underlying the increase in cases. Two years later, the situation seems even worse as the number of confirmed cases has reached an all-time high according to situational reports released by the Nigerian Center for Disease Control. Objective Considering the increasing trend of Lassa fever cases and related mortality, the major objective of this study is to map mutations within the genomes of Lassa virus isolates from 2018 and 2019 using the reference sequence available at the National Center for Biotechnology Information as a benchmark and compare them to the genomes of viruses isolated during 1969-2017. This study would also attempt to identify a viral marker gene for easier identification and grouping. Finally, the time-scaled evolution of Lassa virus in Nigeria will be reconstructed. Methods After collecting the sequence data of Lassa virus isolates, Bayesian phylogenetic trees, a sequence identity matrix, and a single nucleotide polymorphism matrix will be generated using BEAST (version 2.6.2), Base-By-Base, and DIVEIN (a web-based tool for variant calling), respectively. Results Mining and alignment of Lassa virus genome sequences have been completed, while mutational analysis and the reconstruction of time-scaled maximum clade credibility trees, congruence tests for inferred segments, and gene phylogeny analysis are ongoing. Conclusions The findings of this study would further the current knowledge of the evolutionary history of the Lassa virus in Nigeria and would document the mutations in Nigerian isolates from 1969 to 2019. International Registered Report Identifier (IRRID) DERR1-10.2196/23015

CUTANEOUS MANIFESTATION IN CHRONIC KIDNEY DISEASE PATIENTS UNDER HAEMODIALYSIS

Background- This study aimed to evaluate and analyze the patternof cutaneous manifestations in CKD patients under hemodialysis. Methodology- The present study was conducted as a prospective observational study at Department of Medicine, Hamidia Hospital, Bhopal for a period of 2 years on 100 patients with CKD on maintenance hemodialysis. A detailed history was taken and a complete dermatological examination was performed.Digital photograph of skin lesions were taken and all the patients were then subjected to relevant investigation. Viral marker was performed when clinically indicated. Mean age of patients was 40.85±14.58 years and Results- majority of patients were males (70%). Mean duration of hemodialysis was 1.59±1.50 years. Most common cutaneous manifestations in patients with CKD was xerosis (26%) followed by pruritis (12%), eczema (12%) and scabies (8%). Other less common cutaneous manifestations. Cutaneous manifestations are Conclusioncommon in patients with CKD. Among various manifestations, most common cutaneous manifestations of CKD were xerosis, pruritis, eczema and scabies. Prophylactic preventive measures can reduce the adverse effects of cutaneous symptoms. Early recognition of cutaneous manifestations in CRF can improve outcome and reduce patient sufferings.

“Covalent Biosensing” Enables a One-Step, Reagent-Less, Low-Cost and Highly Robust Assay of SARS-CoV-2

We have established a new protocol for detecting severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) using a peptidomimetic to covalently detect a viral marker protease.

Differences of Methods of Searching Primary Site of Carcinoma Unknown Primary between Traditional and Standard Guideline

Background: Trends of searching primary has been changed as etiological backup are changing. PET- CT and other viral molecular markers has been included in most recent protocols for searching primary of carcinoma unknown primary (CUP). Despite of the exhaustive effort with traditional tool many unknown primaries are not known. Patients with CUP without localizing primary, are subjected to radical surgery, wide-field radiation and chemotherapy during treatment. Objectives: To determine the effectiveness of localization of the primary tumor by using conventional technique and to compare the outcome of it to the standard guideline. Methods:This was a prospective study. In conventional search, after thorough clinical examination and diagnostic workup, Panendoscopy with bilateral Tonsillectomy and excision of tongue base mucosa in selective cases is done. Biopsy from nasopharynx, Larynx and hypopharynx is done only when clinically suspected. PET-CT and other viral/molecular markers has been done for recent standard protocol group. Results: In conventional method, Out of 29 patient, 6 primaries found. 5 in tonsil and 1 in base of the tongue base. In standard protocol method, out of 34 cases with PET-CT and viral marker 8 primaries detected, 5 in tonsil and 2 in tongue base and 1 in nasopharynx. Conclusion: Unknown head and neck primaries present a diagnostic challenge that outcome in the search of primary for CUP may be improved by digital examination and appropriate tissue examination in traditional detection protocols. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 142-146

Hepatitis E associated fulminant hepatic failure and its outcome in pregnancy.

Objectives: To determine the clinical features and outcome of hepatitis E associated fulminant hepatic failure in pregnancy. Study Design: Observational Retrospective study. Setting: Department of Obstetrics & Gynecology at Isra University Hospital Hyderabad. Period: Three years from 1st January 2015 to 31st December 2017. Material & Methods: Total 3596 obstetric patients were admitted whom 168 pregnant women who were positive for hepatitis E viral marker have been included in the study. Results: Their age was between 18 to 47 years with mean age 26.04±6.40 years; majority of patients had not received antenatal care 123 (73.2%). Out of 168, 27 (16%) presented in the first trimester, 45 (26.7%) presented in the second trimester, while 96 (57.1%) patients developed fulminant hepatic failure in their 3rd trimester of pregnancy. Out of 168, 111(66%) patients delivered and 57 (33.9%) were undelivered. Fetal and perinatal outcome of delivered patients showed miscarriage 45 (40.5%), stillborn 25(14.8%), preterm delivery 17(15.3%), neonatal death 7 (6.3%) and 17 (15.3%) new born remained alive. Overall maternal mortality was 51 (30.3%). Conclusion: Hepatitis – E related fulminant hepatic failure in pregnancy is a troublesome clinical issue and connected with exceptionally high maternal and fetal mortality. Appropriate diagnosis, early timely intervention can considerably diminish the morbidity and mortality associated with (HEV) Fulminant hepatic failure.

PROGNOSTIC SIGNIFICANCE OF VIRAL MARKER DETECTION IN PROGRESSION OF HIGH RISK HUMAN PAPILLOMA VIRUS ASSOCIATED CANCER CERVIX

The objective was to detect the viral marker HPV16 L1 capsid protein in cervical neoplasia to analyse its association with different grades of cervical lesions and its implication as a prognostic marker. Detection of L1 capsid protein of HPV16 by immunostaining was done using anti-HPV16 mouse monoclonal antibody against L1 fusion protein in cervical scraping or biopsy specimens obtained from the subjects. Total 84 cases of cervical cancerous lesions in a graded spectrum were observed for expression of L1 capsid protein of HPV16, among which 30 cases showed L1 expression and 54 cases did not. The expression rates of L1 protein among ASCUS, ASC-H, LSIL and HSIL were 33.33%, 62.50%, 80% and 36.36% respectively. Among invasive lesions, the L1 expression rates were 23.53%, 14.29% and 7.69% in well, moderately and poorly differentiated SCC respectively. Overall the L1 positivity rate was 35.71%. The expression of L1 proteins decreased with increase in lesion grade. This declining trend of L1 positivity rate with increasing grade of lesion was extremely significant (p value for chi squared for trend is 0.0002). The difference of L1 expression between preinvasive and invasive group was also significant (p<0.0001).Expression of L1 capsid protein of HPV16 was high in lower grade preinvasive lesions and it steadily declined with increasing grade of lesion. Therefore, detection of viral marker HPV16 L1 Protein can be used as a prognostic tool and a marker of immune response against HPV16.