Relative Consolidation of the Kappa Variant Pre-Dates the Massive Second Wave of COVID-19 in India.

India experienced a tragic second wave after the end of March 2021, which was far more massive than the first wave and was driven by the emergence of the novel delta variant (B.1.617.2) of the SARS-CoV-2 virus. In this study, we explored the local and national landscape of the viral variants in the period immediately preceding the second wave to gain insight into the mechanism of emergence of the delta variant and thus improve our understanding of the causation of the second wave. We randomly selected 20 SARS-CoV-2 positive samples diagnosed in our lab between 3 February and 8 March 2021 and subjected them to whole genome sequencing. Nine of the 20 sequenced genomes were classified as kappa variant (B.1.617.1). The phylogenetic analysis of pan-India SARS-CoV-2 genome sequences also suggested the gradual replacement of the α variant with the kappa variant during this period. This relative consolidation of the kappa variant was significant, since it shared 3 of the 4 signature mutations (L452R, E484Q and P681R) observed in the spike protein of delta variant and thus was likely to be the precursor in its evolution. This study demonstrates the predominance of the kappa variant in the period immediately prior to the second wave and underscores its role as the "bridging variant" between the α and delta variants that drove the first and second waves of COVID-19 in India, respectively.

Immunosuppression strategies after liver transplantation: a single centre experience in 57 liver transplant recipients.

CONTEXT: The art of administering immunosuppression lies in the ability to achieve a delicate balance between rejection and infection, thus maximizing patient survival and minimizing morbidity. AIMS: To analyze the effect of immunosuppression strategies following liver transplant on the incidence of acute rejection, bile leak, renal dysfunction and posttransplant graft unrelated infection. SETTINGS AND DESIGN: A retrospective analysis of immunosuppression regimens in 57 liver transplant recipients between Jan 1998 to July 2004 at a single institution. METHODS AND MATERIAL: For the purpose of study, the patients were divided into two groups: A - Cyclosporine based therapy (n=37), and B - Tacrolimus based therapy (n=20). In addition, both groups received Azathioprine or Mycophenolate mofetil with steroids. There were two subgroups in each Group A and B: Group C - Received induction using IL2Rab (n=5), and D - Where Sirolimus was used instead of Mycophenolate mofetil (N=7). The subgroups were equally distributed among the basic groups. The regimen was started based on one of the standard protocols but changes were made according to the clinical status of each patient. STATISTICAL ANALYSIS USED: The statistical analysis was done using Chi square test on SPSS12. RESULTS: A lower incidence of rejection was observed in Tacrolimus group compared to Cyclosporine group. There was an unacceptably high incidence of bile leak in patients where Sirolimus was used as an adjunct. IL2Rab enabled us to maintain a lower trough level of Tacrolimus for maintenance and enabled us to discontinue steroids earlier. CONCLUSIONS: Based on this study we dropped Sirolimus from our immunosuppression protocol and the encouraging results obtained with tacrolimus based therapy have supported its use as standard therapy in our immunosuppression regimens.