Genetic and functional characterization of human immunodeficiency virus type 1 VprC variants from north India: presence of unique recombinants with mosaic genomes from B, C and D subtypes within the open reading frame of Vpr.

The human immunodeficiency virus type 1 (HIV-1) epidemic in India is predominantly caused by genetic subtype C, though other minor subtypes have also been reported. One of the major accessory proteins of HIV-1, namely Vpr, is known to influence key steps in viral replication, cell cycle progression, promoter activation, apoptosis and pathogenesis. Therefore, we carried out a genetic and functional analysis of the Vpr variants from eight HIV-1-infected individuals from north India. The sequence analyses revealed that six of eight samples clustered with ancestral subtype C. Remarkably, five of these showed a conserved and region-specific L64P mutation, located in the predicted third alpha-helix. This change adversely affected their ability to activate the HIV-1 long terminal repeat promoter without compromising their ability to cause apoptosis. Bootscan, phylogenetic and SimPlot analysis of the remaining two samples (VprS2 and A6) revealed very interesting mosaic genomes derived from B, C and D subtypes. The N-terminal half of the VprS2 gene consisted of genomic segments derived from subtypes B/D, C and D but the C-terminal half was derived predominantly from subtype C. Interestingly the N-terminal half of sample A6 also showed similar B/D, C and D inter-subtype recombinant structure but the C-terminal half was entirely derived from the consensus B subtype. Multiple breakpoints in a short stretch of 291 nt encoding the Vpr gene strongly suggest that this region is a potential hot-spot for the formation of inter-subtype recombinants and also highlight the importance of the rapidly evolving HIV-1 epidemic in the north Indian region due to multiple genetic subtypes.

Profile of childhood poisoning at a tertiary care centre in North India.

OBJECTIVES: To determine the profile and outcome (discharge from emergency room after observation, admission or death) of pediatric patients presenting with acute poisoning to a tertiary care centre in north India. METHODS: We retrospectively reviewed the last 2 year (July, 2004 to July, 2006) hospital records of pediatric emergency room to profile all cases of pediatric poisoning during that period and noted their outcome. All cases age < or = 12 years with definite history of poisoning were included. RESULTS: 111 patients presented to the pediatric emergency during the study period. Mean age of our patients was 3.12 +/- 2.04 yrs (SD). Majority of our patients (63.9%) was in the 1-3 yr age group. Males outnumbered females by a factor of two; majority of our patients resided in urban areas. Kerosene (27.9%), drugs (19.8%) and insecticides (11.7%) were the agents most frequently implicated. Almost all (96.9%) ingestions were accidental in nature. Thirty six patients (32.4%) were asymptomatic after 6 hr of observation in the emergency ward; 75 patients (67.6%) developed symptoms related to toxic ingestion. The common serious symptoms included altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns; three patients required intubation and mechanical ventilation. Almost one third of our patients underwent gastric lavage; no patient with kerosene poisoning or any other inappropriate indication underwent the same. CONCLUSION: The trends for pediatric poisoning noted at our centre are not very different from those observed in hospital-based studies conducted more than a decade ago, despite the rapid socioeconomic development in our country. In sharp contrast to developing countries, where majority of poisonings are due to common non-toxic household products, most of our patients require hospitalization because of severe symptoms related to dangerous nature of toxins ingested. Consultation with the poison cell results in improved patient management.

Acute acalculous cholecystitis associated with malarial infection in children: report of two cases.

Acute acalculous cholecystitis (AAC) is a serious condition that has rarely been reported in association with malaria. It is particularly rare in pediatric malaria patients and only one case has been reported till date. We report AAC in association with falciparum and vivax malaria in one pediatric patient each.