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Rapid diagnostic tests (RDTs) can serve as good alternatives to standard serological assays for hepatitis C virus (HCV) detection in limited resource settings. Aim of this study was to evaluate performance of three Indian manufactured RDTs with chemiluminescent microparticle immunoassay (CLIA) for screening of HCV infection with further evaluation using HCV RNA. Serum samples tested for anti-HCV by CLIA (Architect i1000SR, Abbott Diagnostics, IL, USA) were retrieved from − 80 °C and retested for anti-HCV by three RDTs: Alere Trueline (SD Bioline; Haryana, India) (RDT 1), Benesphera HCV Rapid card test (Avantor Performance Materials India Limited; Uttarakhand, India) (RDT 2), AccuTest HCV (Accurex Biomedical Pvt. Ltd.; Mumbai, India) (RDT 3). HCV RNA results were obtained from hospital information system and anti-HCV reactive but RNA negative cases without treatment were considered as either ‘false positives’ or ‘spontaneous clearance of HCV RNA’. Among 86 samples, 75 (87.2%), 49 (57%), 58 (67.4%) and 51 (59.3%) were reactive by CLIA, RDT1, RDT2 and RDT3, respectively. Taking CLIA as reference standard, RDT 1, 2 and 3 demonstrated sensitivity of 65.30%, 77.33% and 68% respectively. Specificity of all three RDTs was 100% with sensitivity of 97.6–100% above signal/cut-off ratio (S/Co) of 6 by CLIA and 88–100% in all HCV RNA positive cases. Sensitivity of RDTs increased from 65.30–77.33 to 72–82.4% when RNA negative/anti-HCV reactive results were considered as non-reactive. The three RDTs have acceptable sensitivity and specificity in anti-HCV detection especially in RNA positive patients that would require treatment for HCV. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13337-019-00542-5) contains supplementary material, which is available to authorized users.

Quantitative Real-time PCR (qPCR) based Hepatitis B virus (HBV) DNA load estimation is crucial for the initiation of treatment and serves as a strong predictor of liver disease progression in HBV infected individuals. HBV DNA quantification has been ever evolving with the addition of new qPCR based kits on a regular basis. The study was carried with an objective to evaluate the performance characteristics of a commercially available qPCR kit (TRUPCR®, 3B Black Bio Biotech, India Ltd.) and compare with CE approved qPCR kit (Artus HBV Real-time PCR, Qiagen, Germany). 121 HBV infected patients were prospectively enrolled from July to December 2016. Aliquots of serum samples were tested in parallel by TRUPCR® and Artus for HBV DNA levels. Genotype D was most predominant genotype in 36.9% (38/121) of patients followed by genotype A in 14.6% (15/121) patients. Median viral load as seen by Artus was log10IU/ml 3.37 (interquartile range log10IU/ml 2.10–10.89) as compared to TRUPCR® where it was log10IU/ml 3.54 (interquartile range log10IU/ml 2.67–11.52). A very good correlation was seen between the two assays (R2 = 0.964) with a concordance rate of 92.6% (112/121). The TRUPCR® qPCR HBV kit is capable of providing reliable and rapid HBV DNA quantitation and together with its much lower costs, presents itself as a good alternative.

Dried blood spot (DBS) is a minimally invasive sampling method suitable for sample collection, storage and transportation in resource limited areas. Aim of this study was to compare the diagnostic utility of DBS with plasma sample for HCV RNA quantitation and genotyping using commercial systems. Plasma and DBS card spotted samples were collected from 95 HCV seropositive patients. Both types of samples were subjected to HCV RNA by real-time PCR (Abbott m2000rt, USA). Genotyping was performed using Abbott HCV genotype II kit (Abbott diagnostics, USA) in samples with viral load > 3 log(10) IU/ml. In both plasma and DBS, 14 (14.7%) samples were negative and 81 (85.3%) were positive for HCV RNA. Median viral load in plasma (3.78; range 0–7.43) log(10) IU/ml was comparable to DBS (3.93; range 0–7.24) log(10) IU/ml. DBS demonstrated sensitivity and specificity of 97.5 and 85.7% respectively, with positive predictive value (PPV) of 97.5% and negative predictive value (NPV) of 85.7%. DBS showed good correlation (r(2) = 0.866) and agreement (93.5%) with plasma. Genotyping in 20 patients showed 100% concordance between DBS and plasma samples. DBS showed good sensitivity and specificity as a sampling method for HCV RNA quantitation and genotyping. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13337-018-0441-9) contains supplementary material, which is available to authorized users.

A series of 4-anilinoquinoline triazine derivatives were designed, synthesized and screened for in vivo antimalarial activity against a chloroquine-sensitive strain of Plasmodium berghei. The compounds were further subjected to in vitro antimalarial activity against chloroquine-resistant W2 strain of Plasmodium falciparum and β-haematin inhibition studies. All the compounds exhibited in vivo antimalarial activity better than that shown by the standard drug, chloroquine. Twelve out of fifteen compounds showed better inhibition than that of chloroquine against chloroquine-resistant W2 strain of Plasmodium falciparum. Ten compounds showed β-haematin inhibition, better than that of chloroquine, with IC50 values in the range of 18-25µM. One compound, 3k, was found to be better than artemisinin against W2 strain of Plasmodium falciparum and also displayed the best β-haematin inhibitory activity, thereby becoming eligible to be explored as a potential lead for antimalarial chemotherapy.

Background: Prion disease research and surveillance can be challenging due to the disease’s difficulty to diagnose, rapid progression, and geographic dispersion. Improving accessibility through teleneurology could improve the ability to conduct these activities. Objectives: The aim of this study was to determine the feasibility of conducting teleneurology assessments for research and surveillance of prion diseases. Method: Participants were offered in-person visit, medical record review, or teleneurology assessment. Standardized histories and assessments evaluating cognition, functional ability, and neuropsychiatric symptoms were collected. Data regarding participants’ satisfaction with teleneurology were collected. Results: From April 2017 to July 2018, the study received 114 referrals. 45 and 5 participants consented for the teleneurology and medical record review arms of the study, respectively. 29 subjects participated in at least one teleneurology visit. Participants expressed satisfaction with teleneurology and found it easy to participate. Some aspects of the examination were hindered or interrupted due to technological reasons. Conclusions: We demonstrate the feasibility and preference of teleneurology as a modality in which subjects with prion disease can partake in clinical research. Technological aspects sometimes interfered with research assessments.

OBJECTIVES: Postdate pregnancy is the most common indication for Antepartum . F etal heart rate testing because of its increased perinatal morbidity and perinatal mortality. Complications are stillbirth , meconium aspiration , asphyxia , and the dysmaturity syndrome , is increased in post - term pregnancies. The most recent ACOG review of the subject of "post - term" pregnancy cites estimates of 3 - 14 % of all pregna n cies . MATERIALS AND METHODS: 55 patients with pregnancy beyond 40 weeks attending antenatal out - patient department of the Rajiv Gandhi medical college in the period between October 2014 to March 2015 were included. In present study , patients were monitored with twice weekly NST and once a week Doppler. In those with either NST nonreactive or Doppler abnormal , induction was done. Cases with normal results were monitored till 42 weeks when routine induction was done . RESULTS: A reactive non stress test in prolonged pregnancy has good negative predictive value – i.e. adverse outcomes are unlikely to occur in the setting of a reactive non - stress test – but that the positive predictive values are low . W eekly measurement of Doppler waveforms from umbilical artery (PI p=0.02 for Apgar

Incidence of Extrapulmonary TB (EPTB) is increasing in young women throughout the world. We report a case of young woman apparently having no sings & symptoms of Tuberculosis. CASE REPORT: 18 years young female patient was referred to us as a case of Primary Amenorrhea. She had Normal secondary sexual characters & normal Breast Development (Tanner staging of Breast - IV.) She had negative Progesterone Cha llenge Test (PCT). Estrogen & Progesterone Challenge Test was negative. Diagnosis of End Organ Problem was done. Diagnosis of Genital Tuberculosis was confirmed by hysterolaparoscopy. She was given AKT for six months. DISCUSSION: Hysterolaparoscopy is impo rtant investigation in a case of Primary Amenorrhea with negative Estrogen & Progesterone Challenge Test. Tuberculosis with its varied presentation can present as primary amenorrhea in young unmarried female.

Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or “dystextia,” which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported.

Purpose of review The sudden emergence of a change in cognitive abilities or behavior is an important symptom that warrants medical evaluation and may represent the early stages of a rapidly progressive dementia (RPD). To correctly ascertain the cause of RPD in a given patient, the clinician must be methodical and knowledgeable about the range of potential causes and must move forward with supportive treatment, and in some cases empiric treatment, based on clinical features alone. Recent findings Significant advances in prion disease biomarkers, the molecular features of rapidly progressive Alzheimer's disease, and new detection of autoimmune limbic encephalitis disease entities have caused a shift in the diagnostic and treatment framework of RPD. Additionally, in the past decade, emerging retrospective data have led to suggested treatments in autoimmune encephalitis that, if instituted early, can protect patients against residual deficits and disease relapse. Summary Here, we provide an integrative clinical and diagnostic treatment approach that is applicable to the various forms of RPD. We have highlighted the clinical features of selected types of RPD that have experienced advances in the last 10-15 years.

Needle stick injury (NSI) is a common occupational injury among healthcare workers (HCWs) and it is important that individuals in the health care field become well informed about the exposure risks and are educated regarding the appropriate response. But the disadvantage with the current reporting system is that it most often records only cases with an important exposure, thus leading to under-reporting of sharp injury cases with wide variation in the prevalence of NSI among HCWs both worldwide as well as in India (30–80%). HCWs need to be familiar with immediate management both for themselves if they become injured and for assisting injured colleagues. Hence, this review presents a summary of the prevalence, risk factors, prevention and management of NSIs among HCWs inside hospitals. A step-wise approach to post-exposure prophylaxis (PEP) for HCWs according to different guidelines has also been summarized.

The enoyl acyl carrier protein reductase (InhA) of Mycobacterium tuberculosis (MTB) is an attractive target for developing novel antitubercular agents. A series of gallic acid formazans, were computationally designed and docked into the active site of InhA to understand their binding mode and potential to inhibit InhA. Nine compounds from the designed series were identified as potential InhA inhibitors, on the basis of good Glide score. These compounds were synthesized in the laboratory and evaluated for in vitro antitubercular activity against drug-sensitive and multi-drug resistant strains of MTB. Out of nine compounds, three compounds exhibited the most promising MIC of

A 37-year-old previously healthy right-handed woman presented with sudden onset of left facial droop, left hemiparesis, and headache after a water park ride. She was evaluated within 3 hours of symptoms and received intravenous tissue-type plasminogen activator. Computed tomographic angiography demonstrated right internal carotid artery dissection, and she underwent emergent carotid stenting. The following day, computed tomography revealed infarction in the right superior temporal gyrus, insula, and caudate head. At discharge, she had a 4/5 left hemiparesis and left hemisensory loss. She was described as having normal mental status. Subsequent outpatient evaluation showed continued motor recovery but persistent cognitive dysfunction with superimposed depression and anxiety. Neuropsychiatric testing 1 year poststroke showed her performance on the Wechsler Adult Intelligence Scale was in the 47th percentile, mildly reduced attention and executive function, borderline visual construction skills, and abnormal prosody of speech. Depression and anxiety were noted. Vocational and rehabilitation training was recommended with hopes she would return to work with gradually increased responsibility. She declined training and remained unemployed. During the following years, she complained of persistent cognitive and sensory deficits. Her husband complained of her altered personality and failure to resume her normal activities. Her marriage eventually failed. Repeat neuropsychiatric testing 3 years later showed worsened attention and executive function scores, including abstract reasoning, weakness in encoding of auditory information, and persistent sensory aprosodia. She reported increased psychological stress and anhedonia and was taking an antidepressant and seeing a psychologist. Repeat neuropsychiatric testing in 2010 showed that her Wechsler Adult Intelligence Scale had declined to the 19th percentile. It was felt that her worsening score was because of increased depression in the …

Background In view of the potentially serious side-effects of standard isotretinoin (0.5-1.0 mg/kg per day) therapy for acne, we studied the safety and efficacy of low-fixed dose isotretinoin plus topical 1%clindamycin gel in the treatment of moderate grade of acne. Methods In this prospective, non-comparative study, 320 adult patients, with moderately severe acne were enrolled and treated with fixed-dose isotretinoin at 20 mg every alternate day (approximately 0.15 mg/kg/day to 0.28 mg/kg/day) for 6 months along with topical clindamycin gel. All female patients were assessed for polycystic ovarian disease. Patients were followed up for 6 months. Results A total of 305 patients completed the study. Overall, patients received a mean of 38.4 mg/kg cumulative dose of isotretinoin, and very good results were observed in 208 (68.20%), while good response was seen in 59 (19.34%) of patients. Failure of the treatment occurred in 38 (12.46%), while relapses occurred in 50 (16.39%) of patients. Relapses were commoner in females, and 37 of 43 (86.04%) patients had polycystic ovarian disease. Though mild chelitis (91%) and xerosis (43%) were common, laboratory abnormalities in the form of elevated hepatic enzymes (5%) and elevated serum lipids (6%) were rare. Conclusion Six months of treatment with fixed-dose, alternate-day isotretinoin (20 mg) plus topical 1%clindamycin gel was found to be effective in the treatment of moderate acne in adult patients, with a low incidence of side-effects.

Skin diseases in children are encountered frequently and their characterization is essential for the preparation of academic, research and health plans. A retrospective study was designed to evaluate the epidemiologic features of pediatric dermatoses in India. The setting was a tertiary care referral center in India (Kalawati Saran Children's Hospital, New Delhi) during January 1997 to December 2003. A total of 30,078 children less than 12 years of age with 32,341 new dermatoses were recorded, with a male to female ratio of 1.07:1. Most of the disease was seen in the 1- to 5-year age group (44.94%). The most common skin diseases were infections and infestations (47.15%) consisting of bacterial infections (58.09%) and scabies (21.54%), followed by eczemas (26.95%), infantile seborrheic dermatitis, scabies, and pityriasis alba. Other unique dermatoses in our settings were papular uticaria (3.59%), miliaria (5.46%), postinflammatory pigmentary abnormalities (1.68%), and nutritional deficiency dermatoses (0.45%). A majority of patients were diagnosed clinically and special diagnostic tests were conducted in 2.6% of patients. The most common diagnostic test used was KOH mount (59.2%), followed by skin biopsy (39%). Nearly 90% of patients were seen without any referral and in the remaining, a majority were referred by pediatricians (75%). A majority of patients were diagnosed to have infection followed by dermatitis in our setting.

Primate models are commonly used in Parkinson's disease research to study stereotaxic strategies that demand accurate localization of the structures in basal ganglia. We demonstrate a method to construct an extensive tabular database of 3D stereotaxic co-ordinates of various basal ganglia structures from high-quality magnetic resonance (MR) images of 47 adult female 3-5 kg rhesus monkeys. For each animal, the structures in the basal ganglia were traced as they appeared on the axial MR images. Their maximal outlines were projected in the axial plane to create a stack of images and X, Y, Z co-ordinates were calculated for margins of each structure. These co-ordinates and the outlines of the individual nuclei help delineate a "common area," which was further narrowed down to a point that represents the 'most reliable target point' (MRTP) in subthalamic nucleus, globus pallidum, caudate and putamen on both sides. Common area and MRTP represent the region that can most definitely be associated with a structure and hence the most definite target for a given structure. The goal of this study is to demonstrate the method of construction, discuss the feasibility and usefulness of such a tabular database that could potentially add to accuracy of localization while using atlas-based stereotaxy. Though use of MRI remains a standard practice and advances in imaging have made targeting for functional surgery more accurate, in developing countries that implies prohibitive costs per procedure. Population based human databases similar to the monkey database described here, when used along with less expensive imaging modalities can reduce the costs considerably as well as add to the accuracy of targeting.

A 69-year-old black man with vascular risk factors, including hypertension, hyperlipidemia, and poorly controlled diabetes mellitus, who was treated with the vascular endothelial growth factor inhibitor, bevacizumab, for macular degeneration, experienced sudden onset horizontal diplopia associated with fatigue. His deficits did not prevent him from driving. The next morning he noticed right eye ptosis obscuring his vision. Because of worsening symptoms, the patient presented to the emergency department where he was found to have bilateral ptosis, right greater than left, and left internuclear ophthalmoplegia (INO). Pupils were equal and reactive to light. General neurological examination revealed peripheral neuropathy with decreased pinprick/light touch and vibration/joint position sense distally in the lower extremities with associated difficulty with tandem walk and positive Romberg sign. Initial National Institutes of Health Stroke Scale was 2 for partial gaze palsy and sensory deficits. He did not qualify for thrombolysis because of minor deficits and symptoms lasting longer than 4.5 hours. The patient was admitted to the neurology service with suspected stroke. MRI of the brain revealed a midbrain midline diffusion restriction with apparent diffusion coefficient correlate just ventral to the aqueduct of Sylvius slightly more extended to the right consistent with subacute ischemic stroke involving the nucleus of oculomotor nerve and adjacent medial longitudinal fasciculus (MLF) likely secondary to small-vessel disease. MR angiography of the head and neck did not show significant intracranial or extracranial vascular disease. Transthoracic echocardiogram revealed normal heart function and no patent foramen ovale. The patient was started on aspirin and a statin and provided an eye patch for comfort. His diplopia improved, and he was eventually discharged with follow-up with ophthalmology, balance rehabilitation clinic, and his primary care physician for management of his risk factors. This patient presented with acute onset painless horizontal diplopia and was found on examination to have …

Summary Kaposis sarcoma (KS) occurs as four types; classic, endemic, immunosuppression-associated, and AIDS-associated. The presence of KS-associated herpesvirus (human herpesvirus 8) DNA in the tissue samples of 95% of all variants of KS has confirmed its role in the aetiopathogenesis of KS. It is now believed that these clinical variants most likely represent different manifestations of the same pathological process. Our case represents the first case of classic KS from our region.

A 30-year-old male presented with multiple, yellowish to skin-colored, firm to soft nodules on the forehead, temple, postauricular area and neck for the previous seven years. Examination of the scalp revealed a single, soft, cystic swelling on the occiput and the patient complained of occasional discharge from two, 0.1 x 0.1 cm, openings in front of both ears. Histopathology of the facial lesion was suggestive of steatocystoma multiplex, while that of the scalp revealed a pilar cyst. An otorhinolaryngeal evaluation confirmed the presence of bilateral pre-auricular sinus. We present this previously unreported pilosebaceous hamartoma, constituting facial steatocystomas and pilar cyst, associated with bilateral preauricular sinus.

We present a case of infantile herpes zoster without clinical evidence of varicella infection in the mother or apparent exposure in the child; our patient's diagnosis was confirmed by serology and by Tzanck smear. We briefly review the etiopathogenesis factors of this condition. We emphasize the benign course and spontaneous uneventful resolution.

A 14-year-old boy had segmental vitiligo (L3−4) on the right thigh and leg for 4 years, and was advised to apply topical clobetasol propionate, 0.05%, in the night, with daily sun exposure for 10 min, as he refused to comply with topical psoralens. As there was no response to therapy even after 3 months, the patient stopped the steroid cream but continued with the sun exposure. Subsequently, the patient noticed gradual-onset, itchy, violaceous, pigmented, raised lesions superimposed on the vitiligo macules. Cutaneous examination revealed violaceous, polygonal papules, 0.5 × 0.5 cm in size, some of which coalesced to form discrete violaceous plaques, confined to areas of vitiligo, with a clear-cut demarcation from normal skin (Fig. 1). The scalp, palms, soles, nails, and mucosa were normal. Histopathology of the polygonal papules revealed hyperkeratosis, wedge-shaped hypergranulosis, irregular acanthosis with saw toothing of the rete ridges, basal cell liquefaction, and a band-like lymphocytic infiltrate (Fig. 2), consistent with lichen planus. The patient was subsequently prescribed fluticasone propionate (0.05%) ointment once daily for the lesions of lichen planus. There was a marked improvement in the lesions of lichen planus after 1 month. Figure 1. Violaceous papules of lichen planus colocalized on vitiligo macules with associated leukotrichia seen on the right leg Download figure to PowerPoint Figure 2. Histopathology reveals hyperkeratosis, wedge-shaped hypergranulosis, irregular acanthosis with saw toothing of the rete ridges, basal cell liquefaction, and a band-like lymphocytic infiltrate (hematoxylin and eosin, × 40) Download figure to PowerPoint

Tuberculosis of the vulva is a rare condition usually seen by a gynecologist. We report a case of chronic ulcer on the vulva of four months duration, which, on detailed investigation, turned out to be a case of primary inoculation tuberculosis. The patient was subsequently put on antitubercular therapy with a good the therapeutic response. The rarity of this presentation in dermato-venereology is emphasized.