The CD6/ALCAM pathway promotes lupus nephritis via T cell–mediated responses

T cells are central to the pathogenesis of lupus nephritis (LN), a common complication of systemic lupus erythematosus (SLE). CD6 and its ligand, activated leukocyte cell adhesion molecule (ALCAM), are involved in T cell activation and trafficking. Previously, we showed that soluble ALCAM is increased in urine (uALCAM) of patients with LN, suggesting that this pathway contributes to disease. To investigate, uALCAM was examined in 1038 patients with SLE and LN from 5 ethnically diverse cohorts; CD6 and ALCAM expression was assessed in LN kidney cells; and disease contribution was tested via antibody blockade of CD6 in murine models of SLE and acute glomerulonephritis. Extended cohort analysis offered resounding validation of uALCAM as a biomarker that distinguishes active renal involvement in SLE, irrespective of ethnicity. ALCAM was expressed by renal structural cells whereas CD6 expression was exclusive to T cells, with elevated numbers of CD6⁺ and ALCAM⁺ cells in patients with LN. CD6 blockade in models of spontaneous lupus and immune-complex glomerulonephritis revealed significant decreases in immune cells, inflammatory markers, and disease measures. Our data demonstrate the contribution of the CD6/ALCAM pathway to LN and SLE, supporting its use as a disease biomarker and therapeutic target.     

Hormonal therapy in undescended testes

A clinical study trial of HCG therapy in 78 selected prepubertal cryptorchids (40 unilateral and 38 bilateral) haveing a total of 116 undescended gonads revealed that complete descent occurred in 12.5% gonads (13% in unilateral and 12% in bilateral group). Good response was observed in only those gonads which were located in the inguinal canal and at the external ring, irrespective of it being right or left sided gonad. In patients with impalpable testes, though there was no complete descent, yet partial descent was noted in 18% (21/116 gonads). The response was better in the older children.     

Foreign body sensation: A rare case of dysphagia lusoria in a healthy female

Dysphagia lusoria is a rare disease due to an aberrant right subclavian artery that passes posteriorly between the esophagus and the spine. David Bayford coined the term itself meaning "freak or jest of nature" in 1761 describing a case in which the patient had long term dysphagia that eventually led to death. Most cases of dysphagia are due to an aberrant right subclavian artery running posterior to and causing esophageal compression, but only 20-40% of aberrant arteries actually lead to trachea-esophageal symptoms, including dysphagia. The majority of patients with an aberrant right subclavian artery are asymptomatic. Treatment for dysphagia lusoria varies depending on the severity of the symptoms. Dietary modifications are recommended in patients with mild to moderate symptoms while vascular reconstruction is necessary for patients with severe symptoms. We present a 44-year-old female who was diagnosed with dysphagia lusoria due to a right-sided aortic arch and aberrant left subclavian artery (ALSA) with aneurysmal dilation. Right aortic arch with ALSA is an uncommon arch anomaly, and only occurs in about 0.05% of the population. Prior case reports of dysphagia lusoria differ in that they did not report patients with an uncommon presentation of dysphagia lusoria with aneurysmal dilatation nor was the patient diagnosed in the emergency department.     

Serum‐derived hepatitis C virus 1a infection of human astrocyte cell line SVG

Neuroinvasion of hepatitis C virus (HCV) is evidenced by recent clinical studies. In this study, serum‐derived HCV infection of astrocytes was analysed. Astrocytes were infected with HCV‐positive serum, and viral replication was assessed on different days postinfection. RT‐PCR was positive for HCV‐negative strand on 5th and 7th day postinfection in the HCV‐positive serum‐infected astrocytes. Real‐time RNA count in the cell culture supernatant was steadily increasing from day 3 to day 7. To reconfirm the viral replication, astrocytes were treated with an antiviral before the serum infection, and the antiviral treatment significantly reduced the viral RNA count. Further, the virus‐infected cells stained positive for the presence of viral core protein. Electron microscopy revealed the presence of HCV‐like particles in the astrocyte cell culture supernatant. In conclusion, serum‐derived HCV replicates in human astrocyte cell line SVG.     

A new interventional home care model for COVID management: Virtual Covid IP

AimAmidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management.MethodsThe Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms.ResultsAmong the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience.ConclusionsWith similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.