Pinpointing the Geographic Origin of 165-Year-Old Human Skeletal Remains Found in Punjab, India: Evidence From Mitochondrial DNA and Stable Isotope Analysis

In 2014, 157 years after the Sepoy Mutiny of 1857, several unidentified human skeletons were discovered in an abandoned well at Ajnala, Punjab. The most prevailing hypothesis suggested them as Indian soldiers who mutinied during the Indian uprising of 1857. However, there is an intense debate on their geographic affinity. Therefore, to pinpoint their area of origin, we have successfully isolated DNA from cementum-rich material of 50 good-quality random teeth samples and analyzed mtDNA haplogroups. In addition to that, we analyzed 85 individuals for oxygen isotopes (δ¹⁸O values). The mtDNA haplogroup distribution and clustering pattern rejected the local ancestry and indicated their genetic link with the populations living east of Punjab. In addition, the oxygen isotope analysis (δ¹⁸O values) from archaeological skeletal remains corroborated the molecular data and suggested the closest possible geographical affinity of these skeletal remains toward the eastern part of India, largely covering the Gangetic plain region. The data generated from this study are expected to expand our understanding of the ancestry and population affinity of martyr soldiers.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Clinical and Biochemical Correlation With Cytomorphological Findings of Lymphocytic Thyroiditis: An Experience at a Tertiary Centre in the Himalayan Foothills

Introduction

Lymphocytic thyroiditis is an autoimmune disorder and one of the major causes of hypothyroidism. On cytomorphology, it is characterized by follicular destruction by lymphocytes with elevated biochemical markers, including a panel of autoantibodies against thyroid antigens. This study aimed to determine the prevalence of various cytological features of lymphocytic thyroiditis and their correlation with clinical presentation and biochemical parameters.

Materials and methods

We conducted a hospital-based cross-sectional study of 105 patients diagnosed with lymphocytic thyroiditis on cytology at our tertiary care center in the Himalayan foothills from December 2018 to December 2019. We recorded and analyzed baseline demographic characteristics, clinical features, and biochemical parameters to assess correlations between cytological findings and grades.

Results

The study included 105 patients with lymphocytic thyroiditis (90 females, 15 males). The study population age ranged from 11 years to 80 years, with the disease most common in patients aged 21 to 40 years. Grade II was the most common cytological presentation (n=65, 62%). Thyroid-stimulating hormone levels were elevated in 33.3% of cases, and anti-thyroid peroxidase levels were elevated in all 25 cases for whom data were available (p>0.05).

Conclusion

Cytological diagnosis of lymphocytic thyroiditis was compatible in all cases in the study. However, cytological grading did not correlate with the clinical presentation and biochemical parameters. The diagnosis of lymphocytic thyroiditis could be missed if clinicians use clinical findings and biochemical parameters alone.

Primary Neuroendocrine Tumor of Urinary Bladder: A Case Report of an Unusual Occurrence

Pheochromocytomas are tumors arising from catecholamine secreting cells of adrenal glands. Extra adrenal gland pheochromocytomas are called paragangliomas. They account for 15% of all pheochromocytomas. Paraganglioma arising in the urinary bladder is extremely rare accounting for 0.06% of all urinary bladder tumor cases. We present a case of a 55-year-old female patient who complained of pain in abdomen and intermittent haematuria subsequently. Magnetic resonance imaging (MRI) pelvis was done which gave the possibility of paraganglioma. An excision of bladder mass was done and sent for histopathology. On histopathology accompanied by immunohistochemistry, a final diagnosis of paraganglioma was given. The patient is on regular follow-up.

Clinical Correlation and Role of Cyclin D1 Expression in Glioblastoma Patients: A Study From North India

Background/Aims

Glioblastoma multiforme (GBM) is the most aggressive primary brain tumor. Cyclin D1 is a protein that in humans is encoded by the CCND1 gene. Cyclin D1 protein is frequently overexpressed in malignant gliomas.

Methods

It is an observational study comprising 40 biopsy-proven cases of GBM in a span of one and half years. Immunohistochemistry (IHC) was used with Cyclin D1 monoclonal antibody. Cyclin D1 on the outcome was assessed using the Kaplan-Meier survival estimate and compared by log-rank test.

Results

Cyclin D1 was expressed in 60% of patients. The majority (72.5%) of patients expired during the study period, out of which 69% showed immune-expression in contrast to living subjects, out of which only 45.5% of patients exhibited expression. The maximum number of glioblastoma patients were aged between 41 and 50 years (40%), followed by those aged between 31 and 40 years (20%). The male to female ratio of study subjects was 3.44:1.

Conclusion

The study concluded that there is no significant association between Cyclin D1 expression status and different demographic, clinical, and outcome variables.

Personalized E-Learning Based on Ant Colony Optimization

With the advancement in technology, the approach to learning has also been modified. “Standardization” and “One-size-fits-all” has become an outdated concept. To adjust to the changing learning approaches, e-learning came into being, but this was not as per the knowledge and intelligence of users. This created a hurdle in the achievement of better learning and acquisition of skills. This calls for the provision of personalization in e-learning. Successful implementation of personalized e-learning in the present education system will lead to better and faster learning by adapting as per the preferences and knowledge of students. The core idea behind this research is to make an application using Android, which provides a personalized and adaptable route of e-learning using Ant Colony Optimization and recommendations from similar peers. This research will cater to the needs of many students, and it will help in decreasing the time taken to complete any subject or course. It will also help in attaining better and efficient learning as the learning route is determined as per the user. Also, the collection of records of every user will help in improving efficiency and accuracy in the determination of the learning path. The developed app aiming for adaptative e-learning can act as a promising solution during the Covid-19 scenario.

Supplemental aerobic, anaerobic and strength training positively affects autonomic functioning, anaerobic capacity, and immune cell homeostasis of male judo athletes

The present study aimed to investigate the effect of additional package of aerobic, anaerobic and strength training (AAS training), along with the conventional judo specific training, on autonomic nervous system balance, anaerobic capacity, exercise adaptation, phenotype of different blood mononuclear cells and cellular inflammatory signalling of university judo athletes. Thirty male judokas were randomly allocated to a control group/conventional judo specific training group (performing Uchi-komi, Nage komi, and Randori) or to an experimental group/conventional judo specific training + additional AAS training group. Physiological data including recovery ANS variables and anaerobic capacity were obtained by using wireless heart rate variability and anaerobic cycle ergometer, respectively, at two different time points (T1-pre, T3-post). Serum and primary mononuclear cells were prepared at three different time points (T1-pre, T2-acute, T3-post) and processed further as per the experimental requirement. For measuring the expression level of genes, and proteins biomarkers related to immune health, we have performed advanced qPCR array technique, flow cytometry, ELISA and zymosan-fluorescein assays. The additional training modality enhanced athletes’ anaerobic performance, parasympathetic functioning, and exercise adaptation. On the other hand, it decreased fatigue index, stress index, number of reactive immune cells, and intensity of inflammatory signalling. Overall, the present study, for the very first time, exhibited the positive effect of four weeks long additional AAS training on autonomic functioning, anaerobic capacity, and immune cell homeostasis of male judo athletes. This additional training package might also help the judo coaches to optimise training schedule for the competitive session.

Isolation and Characterization of Endophytes Bacterial Strains of Momordica charantia L. and Their Possible Approach in Stress Management

In the present study, eight endophytic bacterial strains, namely Bacillus licheniformis R1, Bacillus sp. R2, Agrobacterium tumefaciens R6, uncultured bacterium R11, Bacillus subtilis RS3, Bacillus subtilis RS6, uncultured bacterium RS8 and Lysinibacillus fusiformis RS9, were isolated from the root of Momordica charantia L. All the strains, except R6 exhibited positive for IAA production, siderophore production, and phosphate solubilization during plant growth-promoting traits analysis. Strains invariably utilized glucose and sucrose as a carbon source during substrate utilization, while yeast extract, ammonium sulphate, ammonium chloride, glycine, glutamine, and isoleucine as nitrogen sources. In addition, Spectinomycin was found as the most effective during antibiotic sensitivity TEST, followed by Chloramphenicol, Erythromycin, Rifampicin and Kanamycin, while Polymixin B was found least effective, while strains R1, R6, and RS8 were sensitive to all the antibiotics. Strains R1 and RS6 were able to withstand tolerance up to 10% of NaCl. The strains showing resistance against broad-spectrum antibiotics, especially chloramphenicol, can be used in hospital waste management. In addition, strains with a tolerance of 10 % of NaCl can improve plant growth in the saline affected area.

Maternal death due to COVID-19, truth or a myth: A narrative review and experience from a teaching hospital in India

The course of coronavirus disease-2019 (COVID-19) in pregnancy is unpredictable with outcome trends ranging from milder disease with zero mortality to severe forms and deaths in different parts of the world. We did a comprehensive review of the literature to understand maternal deaths due to COVID-19 in detail. The search was conducted in the PubMed, Embase, and Google Scholar databases, using the keywords “maternal mortality”, “maternal death”, “COVID-19”, “septic shock” and “DIC”. The search included original articles, review articles, case reports published till date. We found varying case fatality rates ranging from 0.1% to 12.9%. There are various predictors of maternal death, notably the presence of symptoms, comorbidities, severe disease with cytokine storm and multi-organ dysfunction. We also report higher maternal deaths from low-resource regions owing to gaps in expected and delivered maternal care. While reviewing our institutional data, we found 3 maternal deaths related to COVID-19 in pregnancy. We discussed our experience at our institute of three COVID-19 related maternal mortalities to add evidence to the present data. Most maternal deaths occurred in postpartum period. Late referral, loss to follow-up and inadequate care were important determinants of maternal mortality. We concluded that pregnancy cases with or without complications must be considered high risk and addressed judiciously beginning from infection prevention, early diagnosis, disease categorization, and multidisciplinary approach of management to prevent morbidity and mortality. We strongly suggest strengthening the health care delivery system to save pregnant women from dying, particularly in low-resource countries.

Introducing Clinical Pathology Course to Fourth Year Medical Students as a Bridge between Pre-clinical and Clinical Medical Sciences

There isn't any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students' achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pretest and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science.

Insulin resistance in moderate to severe acne vulgaris

INTRODUCTION

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit usually affects adolescents. It is seen on the face, neck, trunk and arms. The main pathogenic factors of acne are high sebaceous gland secretion, follicular hyper proliferation, high androgen effects, propionibacterium acnes colonization and inflammation.

OBJECTIVES

To determine the presence of insulin resistance in moderate to very severe acne vulgaris.

MATERIAL AND METHODS

One hundred sixty subjects were enrolled in the study consisting of 80 patients with moderate to very severe acne vulgaris and 80 age and sex-matched controls without acne. Fasting serum insulin and glucose levels were measured and insulin resistance was calculated by Homeostasis Model Assessment- Insulin Resistance (HOMA-IR) Index. The values were compared with the healthy control group.

RESULTS

Significant difference was observed in HOMA values and fasting insulin among the two groups (P < 0.001). The levels were significantly higher in the patient group than in the control group, whereas no significant difference was present in fasting glucose levels between the two group.

CONCLUSIONS

In conclusion, insulin resistance was seen in majority of patients with acne. These results can add to the evidence regarding a potential association between metabolic dysregulation and acne.

STATIN trial: predictive performance of competing-risks model in screening for pre-eclampsia at 35-37 weeks' gestation

OBJECTIVE

To examine the predictive performance of a previously reported competing-risks model of screening for pre-eclampsia (PE) at 35-37 weeks' gestation by combinations of maternal risk factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1) in a validation dataset derived from the screened population of the STATIN study.

METHODS

This was a prospective third-trimester multicenter study of screening for PE in singleton pregnancies by means of a previously reported algorithm that combines maternal risk factors and biomarkers. Women in the high-risk group were invited to participate in a trial of pravastatin vs placebo, but the trial showed no evidence of an effect of pravastatin in the prevention of PE. Patient-specific risks of delivery with PE were calculated using the competing-risks model, and the performance of screening for PE by maternal risk factors alone and by various combinations of risk factors with MAP, UtA-PI, PlGF and sFlt-1 was assessed. The predictive performance of the model was examined by, first, the ability of the model to discriminate between the PE and no-PE groups using the area under the receiver-operating-characteristics curve (AUC) and the detection rate at a fixed false-positive rate of 10%, and, second, calibration by measurements of calibration slope and calibration-in-the-large.

RESULTS

The study population of 29 677 pregnancies contained 653 that developed PE. In screening for PE by a combination of maternal risk factors, MAP, PlGF and sFlt-1 (triple test), the detection rate at a 10% false-positive rate was 79% (95% CI, 76-82%) and the results were consistent with the data used for developing the algorithm. Addition of UtA-PI did not improve the prediction provided by the triple test. The AUC for the triple test was 0.923 (95% CI, 0.913-0.932), demonstrating very high discrimination between affected and unaffected pregnancies. Similarly, the calibration slope was 0.875 (95% CI, 0.831-0.919), demonstrating good agreement between the predicted risk and observed incidence of PE.

CONCLUSION

The competing-risks model provides an effective and reproducible method for third-trimester prediction of term PE. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Targeted specific inhibition of bacterial and Candida species by mesoporous Ag/Sn–SnO2 composite nanoparticles: in silico and in vitro investigation

Invasive bacterial and fungal infections have notably increased the burden on the health care system and especially in immune compromised patients. These invasive bacterial and fungal species mimic and interact with the host extracellular matrix and increase the adhesion and internalization into the host system. Further, increased resistance of traditional antibiotics/antifungal drugs led to the demand for other therapeutics and preventive measures. Presently, metallic nanoparticles have wide applications in health care sectors. The present study has been designed to evaluate the advantage of Ag/Sn–SnO₂ composite nanoparticles over the single oxide/metallic nanoparticles. By using in silico molecular docking approaches, herein we have evaluated the effects of Ag/Sn–SnO₂ nanoparticles on adhesion and invasion responsible molecular targets such as LpfD (E. coli), Als3 (C. albicans) and on virulence/resistance causing PqsR (P. aeruginosa), RstA (Bmfr) (A. baumannii), FoxA (K. pneumonia), Hsp90 and Cyp51 (C. albicans). These Ag/Sn–SnO₂ nanoparticles exhibited higher antimicrobial activities, especially against the C. albicans, which are the highest ever reported results. Further, Ag/Sn–SnO₂ NPs exhibited interaction with the heme proionate residues such as Lys143, His468, Tyr132, Arg381, Phe105, Gly465, Gly464, Ile471 and Ile304 by forming hydrogen bonds with the Arg 381 residue of lanosterol 1 4α-demethylase and increased the inhibition of the Candida strains. Additionally, the Ag/Sn–SnO₂ nanoparticles exhibited extraordinary inhibitory properties by targeting different proteins of bacteria and Candida species followed by several molecular pathways which indicated that it can be used to eliminate the resistance to traditional antibiotics.

Mesoporous Ag/Sn–SnO₂ composite nanoparticles exhibits extraordinary inhibitory properties by targeting different proteins of bacteria and Candida species which can be used to eliminate the resistance of traditional antibiotics.