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PURPOSE@#Students joining medical studies may be motivated by many factors. However, there may also be some factors which may concern them. Although, it can be assumed that those joining medical studies would have largely been influenced positively, how the factors interact in different groups of students has not been studied adequately.@*METHODS@#We conducted a questionnaire-based survey in first-year medical students. Besides the demographics and intentions about their future career plans, students rated a list of positively influencing items and a list of negatively affecting items relevant to our context that influenced their decision. We performed factor analysis followed by clustering of study participants.@*RESULTS@#Ninety-seven students participated in the survey which comprised of 59% females with mean age of 18.6 years. The factors extracted were named as 'personal growth factor,' 'professional calling factor,' 'personal concerns factor,' and 'professional concerns factor.' Four distinct clusters of participants differing in their average ratings to each of the above factors were identified.@*CONCLUSION@#This study provides information on the factors that influence students to join medical studies from an Indian context. The motivational patterns were varied in different sub-groups of students. The data obtained from this study may provide pointers to educators to plan training of students, changes in curricular structure that takes into account the expansion of medical education into specialties and beyond.

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Purpose@#The study aimed to identify the motivational factors and demographic variables influencing the career preferences of medical students in India. @*Methods@#We conducted a questionnaire-based survey at Christian Medical College, Vellore, India. The participants were 368 of the 460 medical students and interns enrolled at the institution from October 2015 to August 2016. We designed the questionnaire to collect demographic data, students’ preferences for career specialties, and the motivational factors influencing them. Then, we analyzed the influence of these factors and demographic variables on career preferences using regression analysis. @*Results@#Of the 368 respondents, 356 (96.7%) expressed their intention to pursue a residency program after the Bachelor of Medicine and Bachelor of Surgery (MBBS) program, and about two-thirds indicated their preference to do so in India. The specialties most preferred by students were general surgery, general medicine (internal medicine), and pediatrics, while the least preferred were anatomy, obstetrics and gynecology, and community medicine. Factor analysis yielded three motivational factors, which we named ‘personal growth,’ ‘professional growth,’ and ‘personal satisfaction’ based on the items loaded in each. The motivational factors were predicted by demographic variables (gender, geographical background, current stage in the MBBS program, and the presence of relatives in the health professions). Demographic variables and the motivational factors also had significant influences on career preferences. @*Conclusion@#This study provides insights into the motivational factors that influence the career preferences of Indian medical students and interns. A robust longitudinal study would be required to study intra-individual variations in preferences and the persistence of choices.

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PURPOSE: Students joining medical studies may be motivated by many factors. However, there may also be some factors which may concern them. Although, it can be assumed that those joining medical studies would have largely been influenced positively, how the factors interact in different groups of students has not been studied adequately. METHODS: We conducted a questionnaire-based survey in first-year medical students. Besides the demographics and intentions about their future career plans, students rated a list of positively influencing items and a list of negatively affecting items relevant to our context that influenced their decision. We performed factor analysis followed by clustering of study participants. RESULTS: Ninety-seven students participated in the survey which comprised of 59% females with mean age of 18.6 years. The factors extracted were named as 'personal growth factor,' 'professional calling factor,' 'personal concerns factor,' and 'professional concerns factor.' Four distinct clusters of participants differing in their average ratings to each of the above factors were identified. CONCLUSION: This study provides information on the factors that influence students to join medical studies from an Indian context. The motivational patterns were varied in different sub-groups of students. The data obtained from this study may provide pointers to educators to plan training of students, changes in curricular structure that takes into account the expansion of medical education into specialties and beyond.

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Disease progression in HIV-1 infected children is faster than in adults. Less than 5% of the infected children maintain stable CD4 counts beyond 7 years of infection and are termed long-term nonprogressors (LTNPs). Delineating the host immune response in antiretroviral naïve (ART) and treated HIV-1 infected children at different disease stages will help in understanding the immunopathogenesis of the disease.A total of 79 asymptomatic, perinatally HIV-1 infected children (50 ART naïve and 29 ART treated) and 8 seronegative donors were recruited in this study. T- and B-cell activation PCR arrays were performed from the cDNA, using total RNA extracted from the peripheral blood mononuclear cells (PBMCs) of 14 HIV-1 infected children at different stages of the disease. The differentially expressed genes were identified. Quantitative RT-PCR was performed for the (interleukin-8) IL-8 gene and its transcriptional mediators, that is, SHP2, GRB2, and IL-8R (IL-8 receptor/CXCR1). Plasma levels of IL-8 were measured by flow cytometry.Gene array data revealed a higher expression of IL-8 in the ART naïve HIV-1 infected progressors and in ART nonresponders than LTNPs and ART responders, respectively. Quantitative RT-PCR analysis demonstrated a significant higher expression of IL-8 (P < 0.001), its receptor CXCR1 (P = 0.03) and the upstream signaling molecule SHP2 (P = 0.04) in the progressors versus LTNPs. Plasma levels of IL-8 were significantly higher in progressors versus LTNPs (P < 0.001), and ART nonresponders versus ART responders (P < 0.001). A significant negative correlation of plasma levels of IL-8 with CD4 counts (cells/µL) was observed in HIV-1 infected ART naïve subjects (r = -0.488; P < 0.001), while the IL-8 levels positively correlated with viral load in the ART treated children (r = 0.5494; P < 0.001). ART naïve progressors on follow up demonstrated a significant reduction in the mRNA expression (P = 0.05) and plasma levels of IL-8 (P = 0.05) post 6 months of ART initiation suggesting the beneficial role of ART therapy in reducing inflammation in infected children.Our data suggest that IL-8 may serve as a potential prognostic marker in adjunct with CD4 counts to monitor disease progression in the HIV-1 infected children and the efficacy of ART.

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The success of highly active antiretroviral therapy (HAART) is challenged by the emergence of resistance-associated mutations in human immunodeficiency virus-1 (HIV-1). In this study, resistance associated mutations in the reverse transcriptase (RT) and protease (PR) genes in antiretroviral therapy (ART) naïve and treated HIV-1 infected pediatric patients from North India were evaluated. Genotyping was successfully performed in 46 patients (30 ART naive and 16 treated) for the RT gene and in 53 patients (27 ART naive and 26 treated) for PR gene and mutations were identified using Stanford HIV Drug Resistance Database. A major drug resistant mutation in RT gene, L74I (NRTI), and two such mutations, K101E and G190A (NNRTI), were observed in two ART naïve patients, while M184V was detected in two ART treated patients. Overall, major resistance associated mutations in RT gene were observed in nine (30%) and seven (36%) of ART naïve and treated children respectively. Minor mutations were identified in PR gene in five children. Few non-clade C viral strains (≈30%) were detected, although subtype C was most predominant. The screening of ART naïve children for mutations in HIV-1 RT and protease genes, before and after initiation of ART is desirable for drug efficacy and good prognosis.

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BACKGROUND: Production of human monoclonal antibodies that exhibit broadly neutralizing activity is needed for preventing HIV-1 infection, however only a few such antibodies have been generated till date. Isolation of antibodies by the hybridoma technology is a cumbersome process with fewer yields. Further, the loss of unstable or slowly growing clones which may have unique binding specificities often occurs during cloning and propagation and the strongly positive clones are often lost. This has been avoided by the process described in this paper, wherein, by combining the strategy of EBV transformation and recombinant DNA technology, we constructed human single chain variable fragments (scFvs) against the third variable region (V3) of the clade C HIV-1 envelope. RESULTS: An antigen specific phage library of 7000 clones was constructed from the enriched V3- positive antibody secreting EBV transformed cells. By ligation of the digested scFv DNA into phagemid vector and bio panning against the HIV-1 consensus C and B V3 peptides followed by random selection of 40 clones, we identified 15 clones that showed V3 reactivity in phage ELISA. DNA fingerprinting analysis and sequencing showed that 13 out of the 15 clones were distinct. Expression of the positive clones was tested by SDS-PAGE and Western blot. All the 13 anti-V3 scFvs showed cross-reactivity against both the clade C and B V3 peptides and did not show any reactivity against other unrelated peptides in ELISA. Preliminary neutralization assays indicated varying degrees of neutralization of clade C and B viruses. EBV transformation, followed by antigen selection of lines to identify specific binders, enabled the selection of phage from un-cloned lines for scFv generation, thus avoiding the problems of hybridoma technology. Moreover, as the clones were pretested for antigen binding, a comparatively small library sufficed for the selection of a considerable number of unique antigen binding phage. After selection, the phage clones were propagated in a clonal manner. CONCLUSIONS: This strategy can be efficiently used and is cost effective for the generation of diverse recombinant antibodies. This is the first study to generate anti-V3 scFvs against HIV-1 Clade C.

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We assessed the anti-V3 antibody content and viral neutralization potential of the plasma of 63 HIV-1-infected patients (antiretroviral naïve=39, treated=24) against four primary isolates (PIs) of clade C and a tier 1 clade B isolate SF162. Depletion and inhibition of anti-V3 antibodies in the plasma of five patients with high titers of anti-V3 antibodies led to modest change in the neutralization percentage against two PIs (range 0-21%). The plasma of antiretroviral-treated patients exhibited higher neutralization potential than that of the drug-naïve plasmas against the four PIs tested which was further evidenced by a follow-up study.

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Abstract We assessed the viral envelope (V3-V5 region) sequence diversity from 13 HIV-1-infected Indian children from north India. All of the 13 children were found to be infected with subtype C viruses. One of the viral sequences exhibited usage of the CXCR4 coreceptor predicted by Web PSSM and Geno2pheno tools. This virus also had a longer V3 sequence with 37 amino acids, a GRGQ motif, and a methionine residue before it (AIIMS_307). A unique finding was the complete deletion of the V4 region of another virus (AIIMS_363). High sequence diversity was observed in the envelope of the HIV-1-infected Indian children.

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