Hepatitis C virus (HCV) infection is a blood borne and transfusion-transmitted infection (TTI). It has emerged as one of the major health challenges worldwide. In India, around 12-18 million peoples are infected with HCV, but in terms of prevalence percentage, its looks moderate due to large population. The burden of the HCV infection increases due to lack of foolproof screening of blood and blood products before transfusion. The qualified screening and quantification of HCV play an important role in diagnosis and treatment of HCV-related diseases. If identified early, HCV infection can be managed and treated by recently available antiviral therapies with fewer side effects. However, its identification at chronic phase makes its treatment very challenging and sometimes ineffective. The drugs therapy for HCV infection treatment is also dependent on its genotype. Different genotypes of HCV differ from each other at genomic level. The RNA viruses (such as HCV) are evolving perpetually due to interaction and integration among people from different regions and countries which lead to varying therapeutic response in HCV-infected patients in different geographical regions. Therefore, proper diagnosis for infecting virus and then exact determination of genotype become important for targeted treatment. This review summarizes the general information on HCV, and methods used for its diagnosis and genotyping.

Tuberculosis (TB) remains a leading cause of death globally among infectious diseases that has killed more numbers of people than any other infectious diseases. Animal models have become the lynchpin for mimicking human infectious diseases. Research on TB could be facilitated by animal challenge models such as the guinea pig, mice, rabbit and non-human primates. No single model presents all aspects of disease pathogenesis due to considerable differences in disease resistance/susceptibility between these models. Availability of a wide range of animal strains, Mycobacterium tuberculosis strains, route of infection and doses affect the disease progression and intervention outcome. Different animal models have contributed significantly to the drug and vaccine development, identification of biomarkers, understanding of TB immunopathogenesis and host genetic influence on infection. In this review, the commonly used animal models in TB research are discussed along with their advantages and limitations.

Background & objectives: Peripheral T cell lymphomas (PTCLs) are a heterogeneous group of non-Hodgkin's lymphomas (NHLs), with universally poor outcome. This study was undertaken to provide data on demographics and outcomes of patients with PTCL who underwent treatment in a single tertiary care centre in southern India. Methods: Retrospective study was done on all patients (age ≥18 yr) diagnosed with PTCL from January 2007 to December 2012. The diagnosis of PTCL was made according to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Results: A total of 244 adult patients were diagnosed with PTCL (non-cutaneous). The most common subtype was PTCL-not otherwise specified (35.7%), followed by anaplastic large cell lymphoma (ALCL), ALK negative (21.3%), natural killer/T cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), ALCL, ALK positive, hepatosplenic T cell lymphoma (HSTCL) and adult T cell leukaemia/lymphoma followed in frequency with 13.1, 11.5, 8.6, 8.2 and 1.6 per cent cases, respectively. The three-year Kaplan-Meier overall survival (OS) and event-free survival (EFS) for the patients who received chemotherapy (n=122) were 33.8±5.0 and 29.3±4.7 per cent, respectively. Various prognostic indices developed for T cell lymphomas were found to be useful. Interpretation & conclusions: Except for ALCL, ALK positive, all other PTCLs showed poor long-term outcome with CHOP-based chemotherapy. Novel therapies are needed to improve the outcome.

Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification. Methods: In this study, adult patients with BMI more than 30 kg/m² with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively. Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m² was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively. Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.

Background & objectives: The peripherally inserted central catheter (PICC) has the advantages of higher safety, lower infection rate and longer retention time than peripherally inserted catheter. This study was aimed to evaluate the accuracy and safety of bedside electrocardiograph (ECG)-guided tip location technique in PICC in cancer patients, and compared with traditional chest radiography tip location technique. Methods: Patients were randomly assigned into two groups: The ECG test group patients underwent PICC insertion with ECG-guided tip location, while the control group patients had PICC insertion by the conventional method. The precision of tip location was verified by chest radiography in both groups. The groups were compared with regard to the accuracy of tip placement, anxiety levels before and after the procedure; medical cost and incidence of complications at one week, three months and six months after PICC insertion. Results: Accurate tip location was achieved in 99.30 per cent in the ECG test group vs 92.30 per cent in the control group (P<0.001). At 24 h after the procedure, the anxiety level was significantly lower in the ECG test group. The presence of thrombogenesis was significantly lower in the ECG test group at both three months and six months after the procedure (P=0.04 and P=0.03, respectively). Interpretation & conclusions: The ECG-guided PICC tip location technique was accurate and caused fewer procedure-related complications and less anxiety in patients compared to chest radiography tip location technique. Radiographic confirmation of PICC tip position may not be needed when ECG guidance is used and thus it can help avoid radiation exposure.

Background & objectives: Data on bone mineral density (BMD) and sarcopenia are scant from young females with HIV. This study was conducted to determine occurrence, predictors and impact of body composition alterations on osteoporosis in pre-menopausal women with HIV. Methods: A total of 214 females with serologically documented HIV infection were screened, of whom 103 pre-menopausal women, 25-45 yr age, clinically stable, having at least one year follow up data, underwent hormonal and dual-energy X-ray absorptiometry analysis for BMD and body composition. Seventy five matched controls were also evaluated. Results: Females with HIV had significantly lower BMD and Z-score at lumbar spine (LS), total femur, neck of femur (NOF), and radius ultra-distal (UD) compared to controls. Osteoporosis at least at one site was observed in 34.95 per cent patients, compared to eight per cent in controls (P<0.001). Most common site of osteoporosis in females with HIV was radius UD (24.27%), followed by radius 33 per cent (17.48%), radius total (15.53%) and greater trochanter, NOF and LS (6.80% each). HIV patients had significantly lower bone mineral content, lean mass (LM), fat per cent, android (A) fat, gynoid (G) fat, and A/G ratio. LM and fat mass (FM) were −15.65 and −11.54 per cent lower in HIV patients, respectively. Osteoporosis patients had significantly higher use of antiretroviral therapy and lower LM, FM and fat per cent. On logistic regression, LM followed by A/G ratio and BMI were the best predictors of osteoporosis. Sarcopenia was observed in 17.5 per cent patients. Interpretation & conclusions: Our results showed that osteoporosis and sarcopenia were significant problems in young women with HIV. HIV was associated with greater LM loss, which was critical for bone health. Sarcopenia may predict low BMD in HIV.

Background & objectives: Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count. Methods: This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year i.e., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART. Results: Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P<0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions. Interpretation & conclusions: Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.

Background & objectives: Karnataka is a high HIV prevalent State in India. Although benefits have been shown by disclosing the HIV status to the child, information regarding HIV status disclosure in Karnataka is limited. Hence, this study was conducted to estimate the proportion of children who had been disclosed of their HIV status and its pattern among those who visited the district antiretroviral therapy (ART) centre in coastal Karnataka. Methods: A cross-sectional study was conducted in an ART centre in a district hospital in coastal Karnataka between October 2014 and July 2015. Caregivers of paediatric HIV patients were approached and willing participants were administered a pre-formed, pre-tested semi-structured questionnaire developed for the study. Results: A total of 185 caregivers of the HIV-positive children were interviewed. Mean age of the children was 11±4 years. Only 107 (57.8%) children were aware of their HIV status. Of these, 95 were disclosed fully. Counsellors in rehabilitation centres were the most probable person to disclose and planned events. Children were told of their HIV status for their knowledge and were more likely to be disclosed if they were around 11-15 yr of age and staying in rehabilitation centres. Interpretation & conclusions: Older children were more likely to be disclosed of their HIV status by counsellors. Steps need to be taken to counsel and encourage caregivers to fully disclose the HIV status to the children at least when they attain the age more than 11 years.

Background & objectives: Hepatitis A virus (HAV) infection is a major cause of childhood hepatitis, prevalent worldwide. HAV is classified into seven genotypes I-VII; genotypes III and I are the most common among humans. The present work was carried out to identify the genotypes prevalent in children suspected to have acute viral hepatitis (AVH), hospitalized at a tertiary care centre in northwest India. Methods: A total of 1269 blood samples from children (0-15 yr of age) clinically suspected of viral hepatitis were screened for anti-HAV IgM. Acute phase serum was processed for RNA extraction and amplified by nested polymerase chain reaction (PCR) followed by sequencing of representative samples. Results: Among the 1269 samples tested, 642 (50.59%) were positive for anti-HAV IgM; among the positive samples, 171 patients having a history of less than seven days were tested by PCR, of whom 141 (82.45%) were found to be PCR positive. Nucleotide sequencing of a representative 44 samples showed high homology; all the samples were found to be of genotype IIIA. Interpretation & conclusions: Hepatitis A was prevalent during July to September and in predominantly children less than five years age. Only genotype IIIA was detected in all the samples.

Background & objectives: The ante-mortem diagnosis of rabies is of great significance in establishing the status of infection in dogs, especially since they are involved in exposure to human beings. The present study was, therefore, undertaken to elucidate the most appropriate secretion/tissue for reliable diagnosis of rabies in 26 living dogs suspected to be rabid. Methods: In the present study 26 dogs suspected to have rabies were included for ante-mortem diagnosis of rabies in clinical samples of skin and saliva by molecular approach viz. heminested reverse-transcriptase polymerase chain reaction (HnRT-PCR). Skin and saliva samples were collected from 13 dogs each. Results: Of the 13 clinically suspected dogs, fluorescent antibody technique (FAT) confirmed rabies in nine cases of dogs. Of these nine true-positive dogs, eight cases could be confirmed by HnRT-PCR from skin. Of the other 13 dogs clinically suspected for rabies, FAT confirmed rabies in 10 cases. Of these 10 true-positive dogs, rabies was detected ante-mortem by HnRT-PCR from the saliva in seven dogs. Thus, rabies was detected from skin with 90 per cent sensitivity, 100 per cent specificity and 92.85 per cent accuracy. With saliva, rabies was detected with a sensitivity of 76.92 per cent, specificity of 100 per cent and accuracy of 62.50 per cent. The positive predictive values were 100 per cent for both skin and saliva samples while negative predictive values were 80 and 50 per cent, respectively. Interpretation & conclusions: Skin biopsy may be more appropriate clinical sample as compared to saliva for ante-mortem diagnosis of rabies in dogs. HnRT-PCR can be employed for molecular diagnosis of rabies from skin in live dogs.