Hepatitis C Virus Diagnosis for Clinicians- Genotype Testing

In our earlier blog you read about Hepatitis C Virus (HCV) Diagnosis for Clinicians- RNA Testing: http://bit.ly/1PWC2yo

HCV genotype testing

Geno-type testing is pivotal to determine the duration and dosage of therapy with drugs and in predicting the efficacy of the treatment. While a variety of techniques are used, the gold standard for HCV genotyping is nucleotide sequencing, which can be done by using core (C), envelope (E1), or the non-structural (NS5) regions which can be amplified by polymerase chain reaction. Most diagnostic assays commonly target the 5′ untranslated region (5’UTR).

However, some genotype 6 variants found in Southeast Asia have 5’UTR sequences identical to those of genotype 1a or 1b. Hence, currently used 5’UTR-based assays are unlikely to be very accurate in high-diversity areas.


Interleukin-28B  polymorphisms

There has been increasing data regarding the significance of the interleukin-28B (IL-28B) polymorphism in the response to treatment and in spontaneous clearance of acute HCV infection. Multiple studies have shown that patients with the CC genotype at the single nucleotide polymorphism (SNP) rs12979860 polymorphic site have higher sustained virologic response (SVR) rates than patients with the CT or TT genotype. Similarly, patients with the TT genotype at the SNP rs8099917 polymorphic site have higher SVR rates than patients with the GT or GG genotype.

Assessment of fibrosis and role of liver biopsy

Assessment of hepatic fibrosis is important, as it establishes the status of hepatic injury and is helpful in taking the decision to start therapy as well as in predicting outcome of therapy. Assessment of liver fibrosis can be done by liver biopsy or by non-invasive tests for fibrosis which include serologic panels of tests and radiologic tests. Serological markers include the aspartate aminotransferase-platelet ratio index (APRI) ratio, which can be easily calculated using data available from  routine  laboratory  tests,  or  commercially a v a i l a b l e s e r u m m a r k e r s y s t e m s s u c h a s t h e FibroTest/FibroSure, Hepascore, FibroSpect, and the European Liver Fibrosis Study Group panel. The most widely used imaging modality is transient elastography (Fibroscan®). However liver biopsy remains the gold standard for assessment of fibrosis.



Prior, cleared HCV infection Accute HCV infection Chronic HCV infection
      Antibody Test Positive Negative; becomes positive within 6 to 24 weeks Positive
    Viral Load Test(HCVG RNA) Undetectable on two tests, performed at least six months apart Detectable within 1 to 2 weeks, usually very high Detectable
ALT Test(Alanine Aminotransferase, a liver enzyme) May be normal, fluctuate, or be persistently raised May be up to 7 to 10 times above the normal level

May be persistently normal, fluctuate, or be persistently raised



HCV antibody tests are useful screening tests for diagnosis of HCV infection. HCV core antibody is emerging as useful new test that can save overall cost of diagnosis. However, plan of treatment is often dependent on HCV RNA load, genotype of the virus and  stage  of  hepatic  fibrosis. So m e t i m e s , h o s t g e n e t i c f a c t o r s s u c h a s I L 2 8 b polymorphism are helpful in predicting response to interferon therapy.


Workplace Safety: Preventing Infection at Workplace

Monsoon is a beautiful season with a lot of greenery, great weather and fun. But, it is also the season of infectious diseases because the moisture is at its highest during this season. It brings a number of contagious diseases with it like common cold, cholera, diarrhoea, dengue, etc.

315 MDU5XzA5SkFOMTIuanBnAs people spend quite a number of hours in their office, they are more exposure to viruses and bacteria at their workplace. Employees can catch the infection from various sources such as people they are working with, things they are using and the food they are eating. In fact, it is one of the major reason of absenteeism among employees during this season. It affects not only the efficiency of the employees but also the overall outcome of the company.  However, there are some steps that one can take to prevent such infections and diseases.

Take Precautions

It starts with the assumption that everyone is potentially at risk of getting an infection. Once we assume that, we can take steps in advance that would help us prevent contagious diseases. At any workplace, an employer should ensure that a first aid kit is always available and a few staff members trained in first aid.

Take Care of Personal Hygiene

Regularly wash hands: Most of the germs can be prevented from entering the body by just taking care of the cleanliness of your hands. Employees should be encouraged to adopt the habit of washing hands at regular intervals such as, before eating your food, after travelling by public transport, after visiting the toilet, using any equipment, etc. One can even keep a sanitizer at their desk to avoid infections.

Take care of open wounds:  An open wound or bruise may develop bacterial infection. Employees should pay attention to such wounds and should avoid working in such conditions. If they are still working like this, proper waterproof dressing should be given to such wounds.

Not to share personal things: People should not share their personal things like handkerchiefs, tissues or hand towels to prevent germs from spreading.

Stay at home while you are sick: If employees are seen coughing and sneezing at the workplace then they should be advised to stay at home. They might be suffering from a viral or bacterial illness which is contagious and can infect their co-workers also.

Keep the Workplace Clean

There should be regular washing of floors. Employee’s workstation, floor, and bathroom must be properly cleaned every day. The office walls and ceiling should be washed at regular interval. Mops, brushes and dusters should be thoroughly washed and dried after every use. Drying mops & cloths is particularly important since many pathogens rely on moisture to thrive. There should be proper cleaning and care of equipment used at the workplace.

How-to-avoid-infection-at-workplace_info (1)

Some Tips to Follow During this Season

  • Avoid getting wet in the rains, since it can harm your health and lower your productivity at work.
  • Keep a spare set of clothes and shoes at work to change when you get drenched in rains. Try to stay warm and dry most of the time.
  • Always dry your feet and hair after getting wet in the rains.
  • Wash feet and hands with disinfectants a couple of times every day. If cold or fever persists for more than 2 days, see a doctor.
  • Avoid eating fried or junk food.
  • Include foods that boost your immunity, for example, more of green leafy vegetables in your diet.

Since monsoon is such a lovely weather, no one can really avoid getting drenched in rains. A little prior preparation and preventive steps go a long way in keeping you healthy at your workplace during the monsoon.

Hepatitis C Virus Diagnosis for Clinicians – RNA Testing

Dr. A. C. Anand, President, Indian Society of Gastroenterology

Introduction of a new magic drug Sofosbuvir for HCV infection at an affordable price has led to renewed interest in treatment of this disease. Treatment regimen to be used is dependent on the proper diagnosis of various aspects of HCV infection. Investigations for diagnosis of HCV infection include serological assays for antibodies to hepatitis C (anti- HCV) and molecular assays for detection of viral RNA. In addition, investigations for stage of hepatic fibrosis, determining genotype of the virus and IL28b polymorphism are also required.


Serological assays

Presence of anti-HCV antibodies indicates prior exposure to HCV infection. However, the assay may be negative early in acute HCV infection, in immunosuppressed individuals. Anti-HCV antibodies can be detected by rapid immunoassays, enzyme-linked immunosorbent assays (ELISA), or chemiluminescent immunoassays. Quality of some of the test kits for anti-HCV may be a reason for concern.

Rapid immunoassay tests use a unique combination of modified HCV antigens conserved across all genotypes. However, some studies have demonstrated that rapid tests cannot be solely relied upon in screening patients from high- risk population in India. ELISA tests indicate presence of antibodies against HCV core, NS3 and NS5 regions. A study in North India has demonstrated the value of blood banks screening using two ELISA kits concurrently to improve detection of contaminated blood.

Enhanced chemiluminescence immunoassay (ECi) a quantitative assay based on chemiluminescent reaction, which is as good as ELISA.

HCV core-antigen

Detection of HCV core-antigen, a protein with highly conserved sequence, by enzyme-immunoassays may be a simpler alternative to RNA detection. Its major role may be in identification of blood donors who are in the pre- seroconversion window. It has been shown to be more cost- effective than nucleic acid testing for early diagnosis of HCV infection. Its cost has been estimated to be around 4-10 times lesser than the in-house reverse transcription-polymerase (RT-PCR) assays. It has the potential as an alternative to detect active HCV infection where HCV RNA testing may not be feasible.

HCV RNA testing

HCV nucleic acid detection relies on either amplification of the detection signal or amplification of the nucleic acid target. The branched DNA method (bDNA assay) for signal amplification detects HCV RNA and has a lower limit of quantification of 615 IU/mL. This level of sensitivity is generally inadequate for measuring response to antiviral therapy where the goal is viral eradication. Quantitative assays using RT-PCR methods have a lower limit of detection of 50 IU/mL (Amplicor v2.0® and Cobas v2.0®, Roche). A broader dynamic range allows for better quantification of HCV RNA at the highest levels of viremia prior to initiation of treatment.

HCV RNA testing is recommended for:

  • For confirmation of viremia if anti-HCV test is positiv
  • For confirmation of a strong suspicion of HCV infection where HCV antibodies may be negative g. acute HCV infection with exposure to HCV within the  last  6 months, immunocompromised patients or in those with HIV infection.
  • The diagnosis of HCV infection in babies born to HCV positive mothers since antibody testing may be fallacious due to presence of maternal anti-HCV antibodies up to 18 months of During this period HCV RNA should be done to confirm the diagnosis.
  • At baseline, prior to commencing treatment and for monitoring of viral kinetics during therapy and to guide therapy.

HCV RNA testing should be done using a sensitive method (lower limit of detection of<50 IU/ml) and the results should be expressed in a standardized format as IU/mL.

Read our next blog on HCV Genotype Testing.


5 Great Exercises You Can Do On Your Chair

Don’t have enough time to work out? Or too tired to work out after work? Long working hours and unhealthy eating habits are causing adverse effects on everyone’s health. Lack of exercise in their daily life is making them unfit and vulnerable to many diseases. Efforts should be made so that their health, as well as their performance, is not compromised. Employers should motivate their employees to stay healthy by doing physical activities even at the workplace. In this article, we bring to you 5 exercises that you can do on your chair at the workplace. They won’t take much of your time and will keep you active whole day.OW1

  1. Seated Toe Stretch – Sitting on a chair; start with the right leg by stretching it. Now lean forward and try to touch that extended leg. Keep the leg straight as much as you can. You don’t need to go all the way down to touch your foot, just try to stretch your legs and arms as far as you are comfortable. Switch to left leg after 30 seconds and do this 5 times with each leg.
  2. High knees and lateral raise – Take up one leg at a time as high as your knees can go above the ground. As you do so, raise your hands sideways at your shoulder’s height. You can even use dumbbells to make it more difficult. Remember to keep your back straight. Repeat this exercise 10 times with each leg alternatively.
  3. Seated leg extension and overhead presses – This one is little similar to the above exercise. Seating at the edge of a chair, press your hands in the upward direction and at the same time raise your leg straight at the level of your hips. Try to keep your legs parallel to the ground and straighten as much as you possibly can. Repeat this 10 times with each leg alternatively.
  4. Seated side bends – Bring your right hand behind your head and extend your left hand directly out in a straight line from your shoulders. Slowly crunch towards your right side, then get back to your sitting position and then crunch towards left. Do this side crunches 5 times on each side. And repeat the same by putting the left hand behind your head and straightening your right hand.
  5. Seated Russian twists – Firstly sit sideways on your chair to do this one. Now keep the back flat, lean just a little bit as far as you can control without letting the feet come above the ground. Now keep your hands in front of chest and rotate your shoulders from left to right and right to left. Try not to let any other body part move. Repeat this exercise 10 times on each side.

Since employers have begun to realise that the employees are the most important assets to the company, they have started developing their workplace into a fitness-friendly place. This would help employees to stay fit and bring the best of them to their job every day.

Common Water-borne Diseases to Watch Out for in Monsoon

1Monsoon doesn’t just bring in greenery and relief from the scorching heat but also swarms of unwanted and harmful viruses that can infect people. There is a rise in the cases of certain diseases such as common cold, malaria, dengue, typhoid, cholera etc. Most of the diseases are waterborne. Read on to know more about them and be cautious.

1. Malaria
malaria_2695307bMonsoon is the perfect breeding season for mosquitoes and mosquito-borne diseases. Malaria is one such serious disease caused by a parasite known as plasmodium. It is carried by the female mosquito Anopheles which is an early morning and evening time biter. The parasite first travels to the human’s liver where it grows and multiplies. It then travels to the bloodstream to infect and destroy red blood cells.

Symptoms: The initial symptoms of malaria are similar to those of flu.

  • High Fever
  • Chills
  • Body ache
  • Sweating
  • Nausea
  • Vomiting

Prevention: Here are some tips to prevent Malaria:

  • Stay inside when it is dark outside.
  • When going out, wear full sleeves clothes to protect yourself from mosquitoes.
  • Use mosquito repellent or cream to keep mosquitoes at bay.
  • Make sure there is no stagnant water near your house as it would help mosquitoes to breed.
  1. Typhoid
    images (1)Typhoid fever is caused by the bacteria Salmonella typhi. This bacteria is found in contaminated water and food; enters our body when we consume such food and water. After they enter the intestine through the food we eat, they travel through the blood to body’s other parts like lymph nodes, gall bladder, liver, etc.

Symptoms: Symptoms of Typhoid usually develop after 1-2 weeks of exposure to the bacteria.

  • Headache
  • High fever with chills
  • Abdominal pain
  • Nosebleed
  • Diarrhoea

Prevention: Getting a vaccination is the best thing one can do. Other than vaccines, following tips should be followed:

  • Keep your hands clean. You can prevent most of the germs and bacteria from entering the body just by taking good care of hands and washing them regularly.
  • Drink water only after boiling it or purifying it with the water purifier.
  • Eat a nutritional diet by including fruits and vegetable that boost immunity
  1. Cholera
    Typhoid-FeverCholera is an acute intestinal infection which is caused when we ingest contaminated food or water. It is spread by the bacterium known as Vibrio Cholerae. It causes severe watery diarrhoea, which may lead to dehydration. This disease is very common to areas with poor sanitation; crowded areas, war and famine affected zones are worse affected.

Symptoms: The common symptoms are:

  • Rapid heart rate
  • Loss of skin elasticity
  • Low blood pressure
  • Muscle cramps
  • A dry mucous membrane including the inside of the mouth, throat, nose and eyelids.


  • Keep your surrounding clean.
  • Drink clean water.
  • Eat home cooked food.
  1. Filariasis
    FilariasisFilariasis is a parasitic disease which affects people living near unsanitary water bodies or sewages. These parasites are transmitted to humans through the bite of an infected mosquito that breeds in fresh and stagnant water bodies. The water becomes the host of filarial nematode worm and affects humans and leads to elephantiasis. Elephantiasis causes pain and swelling in the legs and genital organs. Filariasis can lead to blindness and rapid skin pigmentation.


  • Skin rashes
  • Abdominal pain
  • Arthritis
  • Hyper or hypo pigmented macules


  • Stay prevented from mosquito bites.
  • Wear full sleeves clothes.
  • Use mosquito repellent sprays or cream.

Since the rainy season is the perfect season for germs and bacteria to grow and spread diseases, we should pay extra attention to our health. Children fall sick very often in this weather as they have a larger exposure to germs and bacteria. Even employees take many leaves due to their poor health. Follow tips that help you to stay away from infection and prevent spreading of diseases. This monsoon, ensure good health for yourself and your loved ones but don’t forget to enjoy the rains too!



How Breast Cancer is Treated?

The earlier patient gets treatment, the better she become. But before making treatment decisions, one should research different options.


Surgery for Breast Cancer

The treatment options for breast cancer depend on how advanced the cancer is, how old the woman is, and how healthy she is otherwise. If possible, breast cancer is treated surgically, followed usually by some combination of radiation therapy, chemotherapy, or hormone therapy.

The standard surgery for breast cancer was once modified radical mastectomy – – removal of the entire breast and lymph nodes in the breast and under the arm. For many women whose breast cancer is detected early and is still localized, lumpectomy — removal of the cancerous lump and testing key lymph nodes — is now the preferred treatment. Followed by appropriate radiation therapy, chemotherapy, and hormone therapy, lumpectomy has proven as effective as mastectomy for early breast cancer and is much less disfiguring.

For breast cancer that has metastasized and for breast cancer that has come back, radiation therapy and chemotherapy are the main treatments. Hormone therapy may also be beneficial for cancers that are hormone-responsive. In addition, biologic modifiers such as trastuzumab (Herceptin) may be useful in helping patients whose cancer carries the her-2- neu oncogene. Surgery may still be an option depending upon the site of recurrence and the extent of other sites of disease.

BRCA 1 and BRCA 2 Gene Mutation Test is Available at Oncquest Laboratories Ltd. Details mentioned below:


Chemotherapy for Breast Cancer

When breast cancer is limited to the breast or lymph nodes, adjuvant chemotherapy and/or endocrine therapy may be given after a lumpectomy or mastectomy. This is done to help reduce the chance of breast cancer coming back.

Radiation Therapy for Breast Cancer

Radiation therapy is usually given after a lumpectomy and sometimes after a mastectomy to reduce the risk of cancer coming back in the same breast. The radiation treatments generally start several weeks after the surgery so the area has some time to heal. If doctor recommends chemotherapy along with radiation therapy, the chemotherapy should be given before one starts radiation therapy.










Read our blog ‘Who is at risk of Breast Cancer’ by clicking http://blog.oncquest.net/?p=100 .