BACKGROUND: The diagnosis and treatment monitoring of hepatitis C is quite challenging. The screening test, i.e. antibody assay, is unable to detect acute cases, while the gold standard hepatitis C virus (HCV) reverse transcriptase polymerase chain reaction (RTPCR) assay is not feasible in resource-limited countries such as India due to high cost and infrastructure requirement. European Association for the Study of the Liver and World Health Organization have approved a new marker, i.e. HCV core antigen (HCVcAg) assay, as an alternative to molecular assay. In this study, we have evaluated HCVcAg assay for diagnosis and treatment monitoring follow-up in Indian population infected with hepatitis C.
METHODS: Blood specimen of 90 clinically suspected cases of acute hepatitis C were tested simultaneously for anti-HCV antibody assay via ELISA (enzyme-linked immunoassay), HCVcAg assay by chemiluminescence immune assay (CLIA) and HCV RTPCR VL (viral load) assay. Thirty-four HCV RTPCR positive patients were further enrolled in treatment monitoring group whose blood samples were tested at the beginning of treatment, two weeks, four weeks and 12 weeks via HCV core Ag assay and HCV RTPCR Viral Load assay.
RESULTS: Considering HCV RTPCR as gold standard, diagnostic performance of HCV core Ag assay and anti-HCV antibody assay was evaluated. The sensitivity and specificity of HCV core Ag assay were higher than that of anti-HCV Antibody assay, i.e. 88.3% and 100% vs. 23.3% and 83.3%, respectively. The overall diagnostic accuracy of HCV core Ag assay was 92.20%. Among treatment follow-up group, HCV core Ag levels correlated well with HCV viral load levels, at the beginning of treatment (baseline) till 12 weeks showing highly significant Spearman rank correlation coefficient of > 0.9 with HCV viral load levels.
CONCLUSIONS: HCV core Ag assay is a cost-effective, practically feasible substitute of HCV RTPCR viral load assay for diagnosis as well as long duration treatment monitoring of hepatitis C infection in resource-limited settings.

BACKGROUND: Nearly 70.1 million individuals have been infected by the pandemic viral disease known as coronavirus disease 2019 (COVID-19), which was first discovered in China and is caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). This disease is responsible for the deaths of 6 million people. India ranks third in the total number of cases. The purpose of this study was to classify COVID-19 patients according to several criteria and to determine which clinical, hematological, and radiological indicators were most important in their care.
METHODS: An analytical cross-sectional study was conducted on a total of 70 symptomatic patients who tested positive for COVID-19 reverse transcription polymerase chain reaction (RT-PCR) and were hospitalized at the Saveetha Medical College and Hospital in Chennai, Tamil Nadu, India, for the duration of the study. Comorbidities and oxygen reliance were taken into consideration while classifying patients into one of three categories. Initial symptoms, as well as hematological (interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), D-dimer, serum ferritin, and total cell counts) and radiographic (X-ray and computed tomography (CT) of the thorax) characteristics, were taken and analyzed among the different groups.
RESULTS: According to our research, the symptom of fever was the most common, accounting for 84.3% of all cases. This was followed by breathlessness (55.7%), myalgia (31.4%), dry cough (27.1%), sore throat (24.3%), cough with expectoration (20%), loose stools (12.9%), loss of taste (12.9%), and smell (11.4%). Although there was a large amount of variation in D-dimer, with Category C having the highest values, there was only a minor amount of variation in ESR and CRP. The X-ray and CT scans of the chest showed substantial differences between the groups, with CT findings such as COVID-19 Reporting and Data System (CO-RADS) and CT severity score, consolidation, crazy paving pattern, and vascular dilatation showing a wide range of differences between the groups.
CONCLUSIONS: To facilitate easier treatment and place more attention on radiological characteristics using D-dimer, treating physicians are required to categorize COVID-19 patients into several groups. Patients who need oxygen support were included in this category.

Coxsackievirus and adenovirus receptor (CAR) homologs have been identified in many species, and their proteins appeared to be highly conserved in evolution. While most of the human studies are about pathological conditions, the animal studies were more about the physiological and developmental functions of receptors. The expression of CAR is developmentally regulated, and its tissue localization is complex. Hence, we planned to study CAR expression in five different human organs at autopsy in different age groups. CAR expression was analyzed in the pituitary, heart, liver, pancreas, and kidney by immunohistochemistry, and CAR mRNA expression in the heart and pituitary by real-time PCR.  In the current study, CAR expression was strong in cells of the anterior pituitary, hepatocytes, and bile ducts in the liver, acini, and pancreas and distal convoluted tubule/collecting duct in the kidney, with uniform expression in all age groups. We have noted high CAR expression in fetuses and infantile hearts, which get reduced drastically in adults due to its presumed developmental role in intrauterine life studied in animal models. In addition, the receptor was expressed in glomerular podocytes around the period of fetus viability (37 weeks) but not in early fetuses and adults. We have hypothesized that this intermittent expression could be responsible for the intercellular contact normally formed between the podocytes during the developmental phase. Pancreatic islets also showed increased expression after the emergence of the viability period but not in early fetuses and adults, which might be related to an increase in fetal insulin secretion at that particular age group.

Background: Hypoxanthine-guanine phosphoribosyltransferase (HPRT1) deficiency is an inborn error of purine metabolism responsible for Lesch-Nyhan syndrome (LNS). The disease is inherited in an X-linked recessive manner and predominantly affects male individuals. Female individuals can carry a mutation as heterozygotes, but typically, they are asymptomatic because of the random inactivation of the affected allele. Nevertheless, although rare, heterozygote female individuals may manifest LNS with full characteristics. Herein, we describe a female patient from Saudi Arabia with LNS. Results: The patient (a 4-year-old girl) presented with typical characteristics of the disease, which include global developmental delay, self-mutilation, hyperuricemia, hypotonia, speech delay, spasticity, and seizures. Her general biochemical laboratory results were normal except for high levels of uric acid. The abdominal MRI\\MRS, mostly unremarkable, showed bilateral echogenic foci within the renal collecting system. Genetic testing (whole-exome sequencing, iterative variant filtering, segregation analysis, and Sanger sequencing) pointed a novel de novo frameshift variant in HPRT1. X-inactivation assay using HpaII showed the presence of a 100% skewed X chromosome carrying the affected allele. RT-PCR of the cDNA indicated complete loss of the expression of the normal allele. Conclusion: Our study presents a female patient who has a severe case of LNSand found to be the 15th female patient with the disease in the world. The study emphasizethe need for a streamlined protocol that will help an early and accurate diagnosis of female LNS patients to avoid unnecessary interventions that lead to costly patient care.

BACKGROUND: The recent second wave and the latest third wave of coronavirus disease 2019 (COVID-19) in India caused havoc on health infrastructure. However, there is a scarcity of studies from India and abroad that compare the second and third waves of the COVID-19 pandemic. We aimed to assess the factors like age, sex, and death comparison among diagnostically proven COVID-19 patients of the Meerut district in both waves.
METHODS: A total of 297554 samples during the second wave (1st March 2021 to 30th June 2021) and 240655 during the third wave (1st January 2022 to 30th April 2022) were tested for reverse transcription polymerase chain reaction (RT-PCR) in the Department of Microbiology, Lala Lajpat Rai Medical College, using The Indian Council of Medical Research (ICMR) approved RT-PCR testing kits. The data like age, sex, place, follow-ups, etc. were recorded and data were analyzed statistically.
RESULTS: The RT-PCR positivity of 8.24% for COVID-19 in the second wave while 5.66% of patients in the third wave have been reported. The proportion of positive cases in children ≤10 years in the second and third wave were quite similar i.e., 3.59% and 3.40% respectively, whereas the proportion of positive cases in adolescents (10-20 years) was significantly higher (12.96%) in the third wave in contrast to the second wave (10.15%), while age group (41-60 years) is significantly less (26.65%) in proportion during the third wave in comparison to the second wave (29.50%). The proportion of positivity in young males has significantly increased in the third wave as compared to the second wave. The mortality also decreased significantly by 1/3rd of the second wave.
CONCLUSIONS: The third wave showed low overall positivity (5.66%) as compared to the second wave (8.24%), while the brunt on young children was comparable to the second wave which was assumed to be higher. The mortality and hospitalization also decreased significantly in the second wave. Regular surveillance and analysis should continue to combat this pandemic.

Pentacyclic triterpenes, such as betulinic, ursolic, and oleanolic acids are efficient and selective anticancer agents whose underlying mechanisms of action have been widely investigated. The introduction of N-bearing heterocycles (e.g., triazoles) into the structures of natural compounds (particularly pentacyclic triterpenes) has yielded semisynthetic derivatives with increased antiproliferative potential as opposed to unmodified starting compounds. In this work, we report the synthesis and biological assessment of benzotriazole esters of betulinic acid (BA), oleanolic acid (OA), and ursolic acid (UA) (compounds 1-3). The esters were obtained in moderate yields (28-42%). All three compounds showed dose-dependent reductions in cell viability against A375 melanoma cells and no cytotoxic effects against healthy human keratinocytes. The morphology analysis of treated cells showed characteristic apoptotic changes consisting of nuclear shrinkage, condensation, fragmentation, and cellular membrane disruption. rtPCR analysis reinforced the proapoptotic evidence, showing a reduction in anti-apoptotic Bcl-2 expression and upregulation of the pro-apoptotic Bax. High-resolution respirometry studies showed that all three compounds were able to significantly inhibit mitochondrial function. Molecular docking showed that compounds 1-3 showed an increase in binding affinity against Bcl-2 as opposed to BA, OA, and UA and similar binding patterns compared to known Bcl-2 inhibitors.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous rare presentations of common diseases. The diseases that were prevalent for a long time like tuberculosis (TB) have been reported in cases of COVID-19. The reports of drug-sensitive, multidrug-resistant, and pre-extensively drug-resistant TB with COVID-19 are available in the medical literature. The situation in high TB burden countries where TB is a great contributor to morbidity and mortality is grisly. Herein, a case of primary isoniazid mono-resistant pulmonary tuberculosis in a COVID-19-positive Indian male is reported. As far as the literature is concerned, no case similar to our index case is ever reported.

Among emerging threats to the Arctic is the introduction, spread, or resurgence of disease. Marine brucellosis is an emerging disease concern among free-ranging cetaceans and is less well-studied than terrestrial forms. To investigate marine-origin Brucella sp. exposure in two beluga stocks in Alaska, USA, this study used serological status as well as real-time polymerase chain reaction (rtPCR) and bacterial culture. In total, 55 live-captured-released belugas were tested for Brucella exposure in Bristol Bay (2008-2016) and 112 (8 live-captured; 104 subsistence-harvested) whales were tested in the eastern Chukchi Sea (2007-2017). In total, 73% percent of Bristol Bay live captures, 50% of Chukchi Sea live captures, and 66% of Chukchi Sea harvested belugas were positive on serology. Only 10 of 69 seropositive belugas were rtPCR positive in at least one tissue. Only one seropositive animal was PCR positive in both the spleen and mesenteric lymph node. All animals tested were culture negative. The high prevalence of seropositivity detected suggests widespread exposure in both stocks, however, the low level of rtPCR and culture positive results suggests clinical brucellosis was not prevalent in the belugas surveyed. Continued detection of Brucella exposure supports the need for long-term monitoring of these and other beluga populations.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. It was declared a public health emergency by WHO in January 2020. The definitive diagnostic test for COVID-19 is a real time polymerase chain reaction test (RT-PCR) which is highly specific, but sensitivity is variable. COVID-19 typically presents clinically with respiratory and systemic symptoms. The majority of the infected patients are asymptomatic during the course of the disease, which we have not included in our study. Imaging findings on high-resolution computed tomography (HRCT) chest are important to diagnose the disease in early stage, for treatment planning and to predict the patient prognosis. The purpose of our study was to characterize typical and atypical pulmonary and extra-pulmonary HRCT findings in patients with COVID-19 infection and to help in the management of patients.  In this retrospective study, we have included 70 patients who had undergone HRCT examination of the chest in the Radiodiagnosis Department, Maharishi Markandeshwar Medical College, Kumarhatti, Solan, Himachal Pradesh, India. The HRCT findings of the chest of these patients in the study will be evaluated and data will be statistically analyzed.

OBJECTIVE: The aim was to assess the expression stability of three commonly used reference genes, namely, β-actin (ACTB), 18S ribosomal RNA (18S), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH), in placental tissue obtained from pregnant women with polycystic ovary syndrome (PCOS) and healthy controls.
METHODS: mRNA was isolated after delivery from the placentae of 10 PCOS and 10 control women with term, uncomplicated, singleton pregnancies. The expression of ACTB, 18S, and GAPDH was analyzed using real-time polymerase chain reaction (RT-PCR). Gene expression stability was evaluated with the RefFinder, GeNorm, Normfinder, BestKeeper, and Delta-Ct tools.
RESULTS: ACTB was ranked as the most stably expressed gene, followed by 18S. The expression of GAPDH varied considerably in both studied groups, while it was increased in PCOS versus controls (5.3-fold, p < 0.05).
CONCLUSIONS: ACTB is an appropriate reference gene for placental gene expression studies in women with PCOS, whereas GAPDH is unfit for such a role, as its placental expression is increased in PCOS.