Viral hepatitis is one of the infectious diseases with an overall increasing mortality rate. The global burden of acute viral hepatitis remains substantial, with hepatitis A, B, C, D, and E responsible for millions of new cases annually and significant morbidity, especially in resource-limited settings and among travelers to endemic regions. People living with chronic viral hepatitis, especially with advanced liver disease, may face specific health risks and management challenges during travel, which makes preparing for travel especially important. Travel-related gastroenteritis or febrile syndromes can lead to more severe clinical outcomes due to limited hepatic reserve. Newly acquired hepatitis A and E significantly increase the risk of liver failure and mortality in patients with chronic liver disease. This review emphasizes the critical importance of checking the immunization status of patients with chronic viral hepatitis before travel, managing antiviral medications, assessing risk of complications, evaluating the health infrastructure of the destination country, and applying food and water safety precautions. Safe travel for patients with chronic viral hepatitis can be facilitated through an appropriate risk assessment and a personalized travel plan.

The Chikungunya virus (CHIKV) has emerged as a public health concern around the world as they have large epidemics. These epidemics are associated not just with mild but also with severe clinical manifestations. CHIKV was first discovered in Tanzania in 1952. Because of climate change, urbanization, and international travel, it has expanded. The rising incidence of diseases primarily transmitted by Aedes aegypti and Aedes albopictus mosquitoes highlights the urgent need for better surveillance, vector control, and therapeutics. CHIKV is an RNA virus that mutates frequently leading to genetic diversity and complicating disease management. In this review, we present how genomic variations of CHIKV can affect clinical presentation and transmission dynamics. We discuss the mutations in CHIKV that were analyzed in various outbreaks. We examine the structural and lifecycle characteristics of CHIKV, followed by a detailed exploration of important genomic modifications in structural (E1, E2) and nonstructural (nsP3) proteins, and their consequences for viral propagation, immune evasion, and pathogenicity. Mutations in the E1 protein, for instance, enhance entry into host cells, while mutations in the E2 protein reduce antibody neutralization. Changes in nsP3 are connected to more replication and disease problems. It is difficult to diagnose, treat, and make vaccines for them. The continuous genetic monitoring of viruses is important to check the new variants that are emerging. A comprehensive approach including better diagnostics, selective vector control, vaccine development, and community-based management would help mitigate CHIKV impact. Through illuminating the link between viral evolution and clinical outcomes, the current review aims to stimulate future research and reinforce preparedness against this ever-evolving virus.

Introduction: Due to non-availability or non conduction of viral diagnostic test, diarrhea often misinterpreted to be bacterial in nature leading to irrational antibiotics usage. Thus, study focuses on clinical prole and risk factors association with viruses using Multilpex PCR. Material And Methods: The study was conducted between July 2021 to July 2022 including 150 stool samples of under 5 year children, presented with acute diarrhea and tested with Multiplex RT-PCR. Results: 18.7% of viral diarrhea was detected with highest prevalence of Rotavirus 57.1% in infants with 53.6% Majority cases presented with diarrhea with vomiting and fever with 46.4%. Severe dehydration 28.6% was present in rotavirus infection and severe acute malnutrition (SAM) in mixed viral infection. Conclusion: The common presentation in virus positive cases was diarrhea with vomiting and fever of moderate severity. Multiplex PCR increases diagnostic yield in diarrhea of similar clinical presentation by different etiological agents.

Chikungunya virus (CHIKV) has emerged as a significant public health concern due to its tendency to re-emerge, causing massive outbreaks in India and globally. Recent outbreaks demonstrate the virus's ability to spread rapidly, evade the host's immune responses, and lead to debilitating illnesses. Despite advances in public health surveillance and vector control, the cyclical, unpredictable resurgence of CHIKV underscores gaps in our understanding of its molecular dynamics and epidemiological patterns that vary by region. This study investigates the molecular and phylogenetic characteristics of CHIKV infections from 2020 to 2023 at an advanced regional tertiary care facility in Central India. A total of 1,021 serum samples were collected from patients presenting exhibiting symptoms consistent with chikungunya infection. Of these, 178 tested positive for CHIKV IgM, and 16 were confirmed positive for CHIKV by reverse transcription-polymerase chain reaction (RT-PCR). The PCR-positive samples were then sequenced to analyze the entire viral genome. Genome annotation was performed using the Bacterial and Viral Bioinformatics Resource Center (BVBRC) database, and multiple sequence alignment (MSA) was performed using Molecular Evolutionary Genetics Analysis (MEGA) Version 11.0 (Pennsylvania State University, University Park, PA, United States). Phylogenetic analysis revealed that the circulating strains belonged to a single clade within the East-Central-South-African (ECSA) genotype. By comparing these strains with previously reported sequences from India, we identified notable mutations in the E1 region, such as S72N, K211E, M269V, D284E, A315V, and I317V, previously found strains from Central India and New Delhi. Mutations such as M31I, I54V, and S105T, as well as the A226V mutation previously reported in India, were absent, suggesting that the currently circulating CHIKV strains in our region are primarily transmitted through Aedes aegypti . In contrast, mutations previously observed in the nonstructural region before 2014, such as nsP2-E145D and nsP3-V376T, re-emerged in our isolates. These findings enhance our understanding of CHIKV's genetic diversity, delineating the evolution of local CHIKV clades and their implications for regional epidemiology and public health in Central India.

Background: HBsAg positivity in India ranges from 1.1 to 2.2%, with an average prevalence of 3-4%. Pregnant women who are positive for HBsAg have nearly a 10-40% risk of transmitting HBV infection to their infants. If pregnant women are seropositive in terms of both HBsAg and HBeAg, the ratio of the risk of transmitting infection increases to 70- 90% to their neonates. Material And Method: This prospective study was conducted in the Microbiology Department of BMC, SAGAR (MP), for one Year from May 2023 to April 2024. HBsAg was determined to be the serological marker for Hepatitis B infection among Pregnant women. Serum samples of pregnant women who were attending ANC clinics at the obstetrics & gynecology department were subjected to HBsAg detection by using rapid antigen card test (RAT) and positive results conrmed by ELISA test. ELISA test positive mothers' baby samples were taken in the early neonatal period and were subjected to ELISA test for detection of vertical transmission of infection. Result:Among the 9022 cases, 50 pregnant women were found to be seropositive for HBsAg by Rapid card test. & after conrmation 47 were found seropositive for HBsAg and 3 were found to be seronegative. The estimated Sero-prevalence is 0.52% and Vertical transmission was found in 20.45 % of cases, perinatal mortality was found in 2.12% % of cases, and miscarriage was found in 4.2 % of cases. Conclusion: The aim of the study was to estimate the seroprevalence, to determine the mother-to-child transmission, and to study the Fetomaternal outcome of Pregnancy of HBsAg Positive women. HBs Ag positive women are mostly asymptomatic, Screening of all pregnant women irrespective of risk factors will denitely help to know the correct prevalence and reduce the transmission of hepatitis B infection. Prevention of perinatal transmission is possible with Immuno-prophylaxis of babies shortly after birth. If the pregnant women remain undiagnosed and are not managed in time, the future burden of the disease on society and healthcare resources would be very high.

Scope: Hepatitis E virus (HEV) is a significant global health issue, impacting both low- and middle- income countries and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in low- and middle-income countries, whereas genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, whereas chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programmes remain limited. Methods: This position paper was developed by the European Society of Clinical Microbiology and In- fectious Diseases Viral Hepatitis Study Group through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts to formulate strategies for wider HEV vaccination use. Questions addressed in the position paper: The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programmes, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally.Implications: European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine lo- gistics, integrating diagnostics, and educational outreach can enhance uptake. Susanne Dudman, Clin Microbiol Infect 2025;31:201 (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND OBJECTIVES:With an annual prevalence of 2000 cases, India has the highest global burden of Japanese encephalitis (JE). However, the distribution of the disease is not uniform across the country, wherein the states and districts considered endemic are prioritized for vaccination and other control measures. The central Indian state of Madhya Pradesh (MP), which is not yet considered JE-endemic, possesses multiple agents, hosts, and environmental risk factors and is geographically close to several hotspots of transmission. In this study, we explored the potential endemicity of JE in MP by estimating its prevalence in acute encephalitis syndrome (AES) cases, examining its geospatial and temporal distribution, and demonstrating evidence of viremia in known animal reservoirs. METHODS:A total of 761 human samples were analyzed using an ELISA kit to detect anti-JEV IgM antibodies. Nested and hemi-nested RT-PCR targeting the C-prM region were employed for 93 ELISA-positive human samples, as well as 100 swine and 99 equine samples. RESULTS:We observed a prevalence of 13% (99 out of 761) of JE in AES cases, predominantly affecting the pediatric population (73.74%) without any gender predisposition. We found JE viremia in 7% of swine and 8% of equine samples as potential animal reservoirs. INTERPRETATION CONCLUSION:The study revealed a geospatial distribution of the virus in reservoirs and/or hosts across 22 districts, with high- and intermediate-burden districts clustering near the state's border with other JE-endemic states. The temporal distribution indicated that the virus circulated throughout the year.

Background And Objective: Diarrhea is a major public health problem in developing countries and despite of high morbidity and mortality in under 5 year children, the laboratory diagnosis is largely neglected and cause of infective diarrhea remains undiagnosed. This study aims to assess the use of Multiplex PCR and Conventional PCR assay for detection of six viruses, including rotavirus, norovirus, adenovirus, astrovirus, sapovirus and enterovirus, responsible for acute diarrhea in children. Stool Method: samples obtained from 150 cases of under 5 year children presented with acute diarrhea at Bundelkhand Medical College, Associated hospital, Sagar (M.P) in between July 2021 and July 2022. The identication of causative agents was carried using Conventional PCR and Multiplex PCR. Result: Out of 150 samples, 28 samples were positive for viral pathogens by Multiplex RT-PCR with prevalence of 18.7%. Single viral infection was present in 57% (16/28) and mixed infection in 43% (12/28). Whereas, in conventional PCR single infection was detected in 39% (11/28). The highest number of positive samples was seen in infants (1month- <12 months) with 53.6% (15/28) and least in early childhood with 21.4%. Conclusion: Multiplex PCR systems allow simultaneous, expeditious amplication of several targets with good sensitivity and specicity along with detection of co-infections. Multiplex molecular assays can give quick results and powerful approach for detection of enteric viral pathogens from clinical specimens, and minimize the subjective errors in interpretation. This helps in avoidance of unnecessary antibiotic intake, targeted and early treatment initiation especially in pediatric cases.

Background Chikungunya is a mosquito -borne re-emerging disease that has caused a significant number of outbreaks recently in diverse geographic settings across the globe. It leads to severe debilitating illness in a significant proportion of persons who are infected. Measures to limit the impact produced by recurrent outbreaks of the disease are limited and there is an urgent clinical need for early identification of those predisposed to develop severe disease. A comprehensive understanding regarding the proportion of individuals predisposed to developing severe disease is lacking as its correlation with detectable viremia is hinted at by some studies. In this context, we hypothesized that detectable viremia reflected in the diagnostic RT-PCR assay could be significantly associated with the development of severe disease in Chikungunya among those diagnosed on the basis of seroconversion. Our study aims to confirm the same in relation to disease severity among the suspected patients of Chikungunya in the setting of a tertiary care center. Methods In a prospective observational study at a tertiary care center, a total number of 1021 Chikungunya suspects presenting within seven days of illness were screened with Chikungunya Virus IgM ELISA from 2021 to 2023. Those having positive IgM results were further tested with RT-PCR in a blinded manner. According to the information entered into the predesigned form and the hospital follow-up/discharge data, the cases where symptoms like fever and joint pain persisted beyond two weeks were classified as severe versus those resolving within two weeks as mild. The patients in each group were compared for their clinical symptoms and association with the disease severity with detectable viremia (RT-PCR positivity). Results We identified a total of 178 (17.4%) lab -confirmed Chikungunya IgM-positive cases amongst the recruited patients. Here a total of 31 (18.9%) cases could be classified as severe and 133 (74.7%) as mild illness, the remaining 14 patients were excluded from analysis due to insufficient clinical data. Severe illness was significantly higher in elderly individuals belonging to more than 60 years (p = 0.01). Viremia was detected in 16 (9%), those with detectable viremia had higher odds (OR = 4.1) of manifesting as severe disease. Among the severe cases, the proportion of cases with RT-PCR positivity (8, 25.8%) at presentation was significantly higher (P = 0.01) versus those who presented with mild disease (7, 5.5%). Conclusion Our study reveals a correlation between detectable viremia in Chikungunya virus (CHIKV) patients and an increased risk of manifesting into a severe disease, where severe cases exhibited a significantly higher proportion of viremia, indicated by RT-PCR positivity. This study hints at the presence of viremia, joint symptoms, and elderly age as potentially useful clinical predictors of disease outcomes, these may serve as indicators for closer monitoring among individuals seeking medical attention due to Chikungunya infection. However, we need to validate these findings in future longitudinal studies incorporating multiple, time -bound follow-up data on clinical outcomes, viral titers, and its long-term complications.

Background Although the pediatric population has largely remained free of severe COVID-19 symptoms, in some cases, SARS-CoV-2 infection has been associated with complications such as multiple inflammatory syndrome in children (MIS-C). We identified another a unique form of hepatitis occurring subsequent to asymptomatic SARS-CoV-2 infection, designated by us as COVID-19–associated hepatitis in children (CAH-C), in a subset of children who presented with hepatitis. Objective Our study describes the clinical presentations, temporal association, and viral parameters of the CAH-C cases and compares them to those of MIS-C cases or other known forms of hepatitis in children. Methods In an ambispective (retrospective and follow-up) observational study, records from April to July 2021 were reviewed for all children aged ≤14 years who were previously healthy and presented with a sudden onset of hepatitis, elevated transaminases, and nonobstructive jaundice. After performing all routine tests, those lacking marked inflammatory responses and without evidence of (1) other known causes of acute hepatitis or previous underlying liver disease and (2) multisystem involvement were classified as having CAH-C. Their characteristics were compared to those of children with MIS-C or other known forms of hepatitis. Results Among the 5539 children tested for SARS-CoV-2, a total of 475 (8.6%) tested positive and 47 (0.8%) presented with hepatitis. Among the 47 children with hepatitis, 37 (79%) had features of CAH-C: having symptoms of hepatitis only, without protracted illness (mean length of stay 5 d), and an uneventful recovery following supportive treatment. In contrast, the remaining 10 (21%) had features of MIS-C–associated hepatitis: multiple system involvement; protracted illness (mean length of stay 8 d); and requiring admission to critical care, with a mortality rate of 30% (3/10). Conclusions Our data suggest that CAH-C might be one of the new clinical complications associated with the emergence of newer variants of concern of SARS-CoV-2, which often result in changing presentations. Our findings should facilitate its early identification and thorough workup and aid its differentiation from other emerging syndromes in children, which would help initiate appropriate measures, enable better resource prioritization, and thus limit adversities.

Background:Although the pediatric population has largely remained free of severe COVID-19 symptoms, in some cases, SARS-CoV-2 infection has been associated with complications such as multiple inflammatory syndrome in children (MIS-C). We identified another a unique form of hepatitis occurring subsequent to asymptomatic SARS-CoV-2 infection, designated by us as COVID-19-associated hepatitis in children (CAH-C), in a subset of children who presented with hepatitis. Objective:Our study describes the clinical presentations, temporal association, and viral parameters of the CAH-C cases and compares them to those of MIS-C cases or other known forms of hepatitis in children. Methods:In an ambispective (retrospective and follow-up) observational study, records from April to July 2021 were reviewed for all children aged ≤14 years who were previously healthy and presented with a sudden onset of hepatitis, elevated transaminases, and nonobstructive jaundice. After performing all routine tests, those lacking marked inflammatory responses and without evidence of (1) other known causes of acute hepatitis or previous underlying liver disease and (2) multisystem involvement were classified as having CAH-C. Their characteristics were compared to those of children with MIS-C or other known forms of hepatitis. Results:Among the 5539 children tested for SARS-CoV-2, a total of 475 (8.6%) tested positive and 47 (0.8%) presented with hepatitis. Among the 47 children with hepatitis, 37 (79%) had features of CAH-C: having symptoms of hepatitis only, without protracted illness (mean length of stay 5 d), and an uneventful recovery following supportive treatment. In contrast, the remaining 10 (21%) had features of MIS-C-associated hepatitis: multiple system involvement; protracted illness (mean length of stay 8 d); and requiring admission to critical care, with a mortality rate of 30% (3/10). Conclusions:Our data suggest that CAH-C might be one of the new clinical complications associated with the emergence of newer variants of concern of SARS-CoV-2, which often result in changing presentations. Our findings should facilitate its early identification and thorough workup and aid its differentiation from other emerging syndromes in children, which would help initiate appropriate measures, enable better resource prioritization, and thus limit adversities.

To study the seroprevalence in dengue and its correlation with hematological parameters. A retrospective analysis of 718 seropositive cases was done for one year from January 2021-December 2021. The rapid diagnostic test kit showing NS1 Ag, IgM Ab, and IgG Ab reactivity toward dengue was used. The dengue seropositive cases were divided into 7 serogroups (NS1Ag), (IgM Ab), (IgG Ab), (NS1 Ag IgM Ab), (NS1 Ag IgG Ab), (IgM Ab IgG Ab), (NS1Ag IgM Ab IgG Ab). The hematological data were analyzed. And the correlation between serological and hematological parameters was calculated using the ANOVA test. The dengue-positive cases were observed highest between 19-60 years of age (48.7%), along with male predominance and peak during October month (49.72%). The highest Seroprevalence was observed with NS1Ag (59.05%) followed by IgG Ab (22.42%) in outdoor patients and adults, whereas NS1Ag IgM Ab (6.55%) followed by IgM Ab (4.18%) was predominantly seen in indoor patients and children (0-12 yrs). The maximum affected hematological variable were platelet count (thrombocytopenia in 55.8%) and total leucocyte count (leucopenia in 38.0%) having a strong association with NS1Ag positivity followed by lymphocytosis (17.1%) and neutropenia (11.6%) which were in concordance with other studies. Both (NS1Ag and IgM Ab) detection in the active stage has a probable diagnosis of primary dengue infection and IgG detection in secondary infection. Thrombocytopenia and leucopenia are early markers of dengue in view of NS1Ag association. Thus, serological markers together with hemograms help in the early detection, treatment, and ascertaining prognosis of the disease.

In India, diarrhea prevalence among under 5 years children remains high and is associated with a wide range of bacteria, parasites, and viruses, transmitted through contaminated food and water. The present study aimed at the detection of enteric pathogens in children with diarrhea and its relationship to the source of drinking water. Fecal samples were collected from 157 children from July 2021 to July 2022. Among 157 children, parasitic and bacterial pathogens were detected in 4.5% (7/157). Parasites were detected in 2% (Giardia 67%, H nana in 33%) and bacteria in 2.5% (Ecoli O157 in 75% and salmonella in 25%) cases. Specic sources of drinking water more often associated with diarrhea were hand pumps (43%), house tap water (28.6%), bore well (14.2%), and well (14.2%) cases. Thus, demonstrating the persistence of signicant pathogens and re-emphasizing that diarrheal illnesses are preventable through safe drinking water practices.

Complete spectrum of covid 19 infection in children as well as its sequaele is still unknown to the world even after two years of ongoing pandemic. Many manifestations of covid 19 have been missed and are yet to be identified. In this study, we aim to hypothesize hepatitis as a probable late manifestation of COVID-19 infection in children. It was a descriptive retrospective study, in which we have included twenty patients who presented with hepatitis in the pediatric department of a secondary level care centre in Sagar from May to July 2021. And we investigated them further to find out the cause of Hepatitis. Among the 20 patients with HEPATITIS, 15 were tested for covid antibody levels, out of them 14 had raised level of SARS-CoV-2 antibody titre. Pediatricians should recognize that the clinical spectrum of COVID-19 in children can be wider than previously described, often with hepatitis as late manifestation of COVID-19 in children, apart from MIS-C.

AbstractTwo of the most infamous viruses, the Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) have similar transmission routes. Consequently, some individuals might get co-infected with both viruses resulting in increased deaths and prolonged disease. Even among healthy (Non-immunocompromised) persons, chances of getting persistent HBV infection are 5-10%, however among persons harboring HIV, HBV the persistence rates might escalate up to 15 %. Such increased suffering might occur despite the longevity provided by starting highly active anti-retroviral therapy (HAART), which is the current standard treatment.Our pioneering study, in our region aims to assess the prevalence of HIV-HBV co-infection, clearance rates of HBV, demographic characteristics of affected individuals, and long-term outcomes. By shedding light on these aspects, we hope to gain valuable insights into the impact of such co-infections and pave the way for better management and care of individuals facing this dual challenge.We studied 1808 persons enrolled for HIV treatment from amongst 170,019 persons screened. Higher co-infection of HIV-HBV was observed in males as compared to females, with the age group of 31-40 years being most affected. The most common route of infection, was heterosexual contact accounting for 86% of cases, accounting for majority co-infections. Over the years, we noticed a decline in the number of HIV-HBV co-infected cases, with the nadir occurring in 2015. Seroprevalence of co-infections was 2.37%, but despite this observed low sero-prevalence HBV clearance was relatively poor among the co-infected, as only 4 (9.3%) able to clear the infection after initiation of HAART. Our study highlights that chances of HBV clearance among the co-infected are worse than that observed among otherwise heathy populations thus also highlighting the urgent need for universal HBV vaccination in all HIV-affected persons, underscoring the importance of providing special attention to them.

Background False-negative results derived from RT-PCR tests for diagnosing coronavirus disease (COVID-19) have raised questions about whether to consider them the gold standard for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Using an imperfect gold standard to assess other diagnostic tests would never let the other tests show better diagnostic performance. The best strategy in such cases is to do an agreement analysis, and this study aims to estimate the agreement between real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and rapid antigen test (RAT) for COVID-19 detection. Methods A retrospective study was done using paired data of individuals tested for COVID-19, both by RT-PCR and RAT, obtained from the virology laboratory of Government Bundelkhand Medical College, Sagar, Madhya Pradesh, India. A sample size of 93 was calculated, and the data were abstracted in a data abstraction sheet. Variables included were results of RT-PCR and RAT, age, gender, presence of symptoms, test kit used, and the time duration between sampling for RT-PCR and RAT. Apart from descriptive statistics, keeping in mind the binary outcome of RT-PCR and RAT, Cohen's kappa was calculated for agreement analysis. A p-value of <0.05 was considered significant. Results The data on 100 participants suspected to be infected with COVID-19 (58 male and 42 female) with a mean age of 39.8 (±19.0) years were analysed. The number of discordant pairs was eight. Cohen's kappa showed substantial agreement between RT-PCR and RAT, κ=0.646, (95% CI 0.420 to 0.871), p<0.001. Conclusion Considering the ease of conducting RAT with quick results and substantial agreement with RT-PCR, RAT could be a better choice in detecting SARS-CoV-2 and, hence, COVID-19 disease on a large scale.

The transplacental route of vertical transmission of Hepatitis B Virus (HBV) has been known for over a decade. Here we present evidence which suggest HBV can replicate in placenta. Forty-one HBsAg positive and 10 control pregnant women were enrolled in the study after obtaining informed consent. HBV positives were further divided in the High Viral Load (HVL) Group and Low Viral Load (LVL) Group according to INASL guidelines 2018. The Presence of the HBV DNA and expression of NTCP in the placenta was analyzed by qPCR/RT-qPCR and/or immunohistochemistry (IHC). The presence of cccDNA was assessed using Digital Droplet PCR while the presence of pre-genomic (pg) RNA was assessed through qRT-PCR and sequencing. The presence of HBeAg and HBcAg in the placenta was assessed by IHC. Immunostaining of NTCP, HBeAg and HBcAg on trophoblasts along with the presence of total HBV DNA, cccDNA and pgRNA indicated, that these cells are not only susceptible to HBV infection but may also support viral replication. This is further supported by the finding that trophoblasts of the several HBeAg seronegative samples harbored the HBeAg. Although, we did not find any correlation in NTCP expression and viral markers with viral load indicates placental replication may not aping hepatocytes. The presence of the HBV receptor, NTCP along with the presence of cccDNA, pgRNA, and HBeAg in placenta of HBV infected females without circulating HBeAg suggest that placenta act as a replication host.

Background:Timely screening, early suspicion and accurate diagnostic measures are needed at primary care level to prevent catastrophe by events such as the recent and sudden emergence of COVID-19 associated mucormycosis (CAM). This entity which was observed during the second wave of this pandemic in India had caused severe chaos by its sudden appearance and frequent devastating outcomes. To identify the underlying risk factors, clinical characteri Objectives: stics and presentation in CAM cases enabling an early diagnostic approach by use of screening tools at primary care. A retrospect Methods: ive case-control study (April to June 2021) among those fullling the diagnostic criteria of mucormycosis with a prior COVID-19 infection. 50 patients with mucormycosis as cases and Results: 100 without as controls were enrolled in the study. The median duration from COVID-19 till the onset of CAM was 15 days. The mean age was 50 years and male preponderance, with most commonly reported infection sites nose and sinus (90%) and pansinusitis a predominant nding in CECT (contrast enhanced computed tomography). About 84% (42/50) CAM patients had diabetes mellitus and 60% had received corticosteroid treatment for COVID19. 13/50 (26%) cases had history of hypertensions. History of previous hospitalization was present in 60% (30/50) patients during COVID 19 infection and 26% patients had received oxygen therapy. Serum ferritin levels were available for 19, with elevated level s in 8/19 cases, 11/19 had normal range, 5/50 cases had received Remdesivir injection, only 10/50CAM patients had received a single dose of COVID-19 vaccine, others were non-vaccinated. Current study unveiled thatuncontrolled diabe Summary : tes mellitus and those who inadvertently receive corticosteroid therapy are at increased risk of CAM. With the ongoing pandemic and increasing number of CAM cases, patients positive for these risk factors during COVID management need regular screening at primary care level in order to prevent this deadly and often fatal secondary infection.

COVID-19 has a wide disease spectrum. Different presentations may be seen in different people, with uncertain long-term fate. The amount and longevity of immunity provided among the infected also vary from person to person which might in turn affect the chances of re-infection. Current study tries to uncover the incidence, disease severity and outcomes amongst those who have been previously hospitalized for COVID-19. A prospective cohort study where all patients admitted to intensive care facility at the tertiary care center were followed up for any occurrences of re-infection for more than one year. All cases were followed up telephonically and at scheduled visits to the hospital by trained personnel. A total of 410 cases with a mean age of 59.8 years, including 310 (75.6%) males and 100 (24.4%) females. Among these 410 patients 287 remained alive till the end of study period. Re-infection rates among recovered ICU admitted seriously ill patients were 1.4% whereas the rate of ICU re-admission due to COVID-19 re-infection was only 0.7%. Re-infection among female was 1.1% whereas in male was 1.5%. ICU readmission rate among female was 1.1% while in male was 0.5% only. The chances of re-infection in female were seen less than that in males, but the severity of re-infection in females was found to be higher. COVID-19 re-infection in previously severely infected COVID-19 patient is not so common. The chances of a severe disease among such cases are even rarer.

Background– COVID 19 is associated with high prevalence of diabetes along with other comorbidities which also increase the severity and mortality risk in COVID 19 disease. Recently many studies have shown the association between COVID 19 and new onset diabetes. This study was done with objectives1.To nd out the incidence of new onset of hyperglycemia/diabetes in COVID 19 patients and 2.To develop screening policy for detection of new onset hyperglycemia in COVID-19 patients. Materials And Methods- This study is a hospital based observational cross sectional and prospective, cohort study conducted in the COVID ICU of Dedicated COVID Hospital, Bundelkhand Government Medical College, Sagar (M.P.) India, a teaching tertiary care centre. Out of 1562 COVID 19 positive patients admitted with moderate to severe pneumonia from JULY 2020 to JANUARY 2021, 487 patients were hyperglycemic at the time of admission. Patients were categorized into two subgroups: 1.Patients with previously conrmed diabetes or Prediabetes and 2.Hyperglycemia with no existing diabetes. Patients in this later subgroup were our follow up subjects for this study; their blood sugar level was monitored regularly during their stay in hospital & a correlation of COVID 19 and hyperglycemia was observed. In present study Incidence of newResults- onset hyperglycemia was 16.8%; 262 out of 1562. Of all 1562 patients admitted in hospital, 660 (44.7%) were found to be hyperglycemic. Among 660 patients, 436 (66.06%) patients were already known diabetic or pre-diabetic and 262 (16.8) were with newly onset hyperglycemia. 15 out of 262 (5.7%) patients were expired during their disease course, 157(60%) remained hyperglycemic while 90 (34.3) had attained normoglycemia without anti-diabetic drugs. COVID 19 disease is causative factor for new onset hyperglycemia /new onsetConclusion- diabetes.