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Spekker O, Kiss P. A, Kis L, Király K, Varga S, Marcsik A, Schütz O, Török T, Hunt DR, Tihanyi B. White plague among the "forgotten people" from the Barbaricum of the Carpathian Basin-Cases with tuberculosis from the Sarmatian-period (3rd-4th centuries CE) archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Hungary). PLoS One 2024; 19:e0294762. [PMID: 38198442 PMCID: PMC10781108 DOI: 10.1371/journal.pone.0294762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
Tuberculosis (TB) is a bacterial infection that is well-known in the palaeopathological record because it can affect the skeleton and consequently leaves readily identifiable macroscopic alterations. Palaeopathological case studies provide invaluable information about the spatio-temporal distribution of TB in the past. This is true for those archaeological periods and geographical regions from when and where no or very few TB cases have been published until now-as in the Sarmatian period (1st-5th centuries CE) in the Barbaricum of the Carpathian Basin. The aim of our paper is to discuss five newly discovered TB cases (HK199, HK201, HK225, HK253, and HK309) from the Sarmatian-period archaeological site of Hódmezővásárhely-Kenyere-ér, Bereczki-tanya (Csongrád-Csanád county, Hungary). Detailed macromorphological evaluation of the skeletons focused on the detection of bony changes likely associated with different forms of TB. In all five cases, the presence of endocranial alterations (especially TB-specific granular impressions) suggests that these individuals suffered from TB meningitis. Furthermore, the skeletal lesions observed in the spine and both hip joints of HK225 indicate that this juvenile also had multifocal osteoarticular TB. Thanks to the discovery of HK199, HK201, HK225, HK253, and HK309, the number of TB cases known from the Sarmatian-period Carpathian Basin doubled, implying that the disease was likely more frequent in the Barbaricum than previously thought. Without the application of granular impressions, the diagnosis of TB could not have been established in these five cases. Thus, the identification of TB in these individuals highlights the importance of diagnostics development, especially the refinement of diagnostic criteria. Based on the above, the systematic macromorphological (re-)evaluation of osteoarchaeological series from the Sarmatian-period Carpathian Basin would be advantageous to provide a more accurate picture of how TB may have impacted the ancestral human communities of the Barbaricum.
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Affiliation(s)
- Olga Spekker
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Szeged, Hungary
- Institute of Archaeological Sciences, Eötvös Loránd University, Budapest, Hungary
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Attila Kiss P.
- Department of Early Hungarian and Migration Period Archaeology, Pázmány Péter Catholic University, Budapest, Hungary
| | - Luca Kis
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
| | - Kitty Király
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeology, Móra Ferenc Museum, Szeged, Hungary
| | - Sándor Varga
- Department of Archaeology, Móra Ferenc Museum, Szeged, Hungary
| | - Antónia Marcsik
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
| | - Oszkár Schütz
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
- Department of Genetics, University of Szeged, Szeged, Hungary
| | - Tibor Török
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
- Department of Genetics, University of Szeged, Szeged, Hungary
| | - David R. Hunt
- Virginia Office of the Chief Medical Examiner, Northern District, Manassas, Virginia, United States of America
| | - Balázs Tihanyi
- Department of Biological Anthropology, University of Szeged, Szeged, Hungary
- Department of Archaeogenetics, Institute of Hungarian Research, Budapest, Hungary
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Spekker O, Kis L, Lukács N, Patyi E, Tihanyi B. The first probable case with tuberculous meningitis from the Hun period of the Carpathian Basin - How diagnostics development can contribute to increase knowledge and understanding of the spatio-temporal distribution of tuberculosis in the past. Tuberculosis (Edinb) 2023; 143S:102372. [PMID: 38012930 DOI: 10.1016/j.tube.2023.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 11/29/2023]
Abstract
The aim of our paper is to demonstrate and discuss in detail the endocranial bony changes suggestive of tuberculous meningitis (TBM) that were recorded in an adult female's (SPF15) skeleton. The bone remains were uncovered from a solitary grave from the Hun period (5th-century-CE) archaeological site of Solt-Polya-fok (Bács-Kiskun county, Hungary). During the macromorphological examination of the very incomplete and poorly preserved skeleton of SPF15, the inner surface of the skull displayed abnormally pronounced digital impressions (APDIs) and granular impressions (GIs). Recently, it was confirmed that endocranial GIs can be considered as specific signs of TBM; and thus, they are sufficient enough on their own to make a definitive diagnosis of the disease in the palaeopathological practice. On the other hand, APDIs are not specific to TBM but can be tuberculous in origin; their concomitant presence with GIs in SPF15 makes their tuberculous origin very likely. Based on the above, it seems that the adult female from the 5th-century-CE archaeological site of Solt-Polya-fok suffered from TBM. SPF15 is the first reported probable case with tuberculosis (TB) from the Hun period of the present-day territory of Hungary, who gives us invaluable information about the spatio-temporal distribution of the disease in the past. Furthermore, it highlights the paramount importance of diagnostics development, especially the identification and refinement of diagnostic criteria, as without the application of APDIs and GIs, the diagnosis of TB could not have been established in SPF15.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary; Ancient and Modern Human Genomics Competence Centre, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Nikoletta Lukács
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Eszter Patyi
- Kecskeméti Katona József Museum, Bethlen körút 1, H-6000, Kecskemét, Hungary.
| | - Balázs Tihanyi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
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Holloway-Kew KL, Henneberg M. Dynamics of tuberculosis infection in various populations during the 19th and 20th century: The impact of conservative and pharmaceutical treatments. Tuberculosis (Edinb) 2023; 143S:102389. [PMID: 38012934 DOI: 10.1016/j.tube.2023.102389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 11/29/2023]
Abstract
Humans and Mycobacterium tuberculosis have co-evolved together for thousands of years. Many individuals are infected with the bacterium, but few show signs and symptoms of tuberculosis (TB). Pharmacotherapy to treat those who develop disease is useful, but drug resistance and non-adherence significantly impact the efficacy of these treatments. Prior to the introduction of antibiotic therapies, public health strategies were used to reduce TB mortality. This work shows how these strategies were able to reduce TB mortality in 19th and 20th century populations, compared with antibiotic treatments. Previously published mortality data from historical records for several populations (Switzerland, Germany, England and Wales, Scotland, USA, Japan, Brazil and South Africa) were used. Curvilinear regression was used to examine the reduction in mortality before and after the introduction of antibiotic treatments (1946). A strong decline in TB mortality was already occurring in Switzerland, Germany, England and Wales, Scotland and the USA prior to the introduction of antibiotic treatment. This occurred following many public health interventions including improved sanitation, compulsory reporting of TB cases, diagnostic techniques and sanatoria treatments. Following the introduction of antibiotics, mortality rates declined further, however, this had a smaller effect than the previously employed strategies. In Japan, Brazil and South Africa, reductions in mortality rates were largely driven by antibiotic treatments that caused rapid decline of mortality, with a smaller contribution from public health strategies. For the development of active disease, immune status is important. Individuals infected with the bacterium are more likely to develop signs and symptoms if their immune function is reduced. Effective strategies against TB can therefore include enhancing immune function of the population by improving nutrition, as well as reducing transmission by improving living conditions and public health. This has been effective in the past. Improving immunity may be an important strategy against drug resistant TB.
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Affiliation(s)
- K L Holloway-Kew
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.
| | - M Henneberg
- Biological Anthropology and Comparative Anatomy Research Unit, School of Biomedicine, University of Adelaide, Australia; Institute of Evolutionary Medicine, University of Zurich, Switzerland.
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Papa V, Galassi FM, Varotto E, Gori A, Vaccarezza M. The Evolution of Diagnostic Techniques in the Paleopathology of Tuberculosis: A Scoping Review. Pathog Immun 2023; 8:93-116. [PMID: 37900966 PMCID: PMC10603826 DOI: 10.20411/pai.v8i1.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/21/2023] [Indexed: 10/31/2023] Open
Abstract
Tuberculosis (TB) is an ancient chronic infectious disease that remains a global health concern. In human remains, the most common and characteristic clinical signs are the skeletal modifications involving the spine, such as in Pott's disease. Diagnosing TB in ancient human remains is challenging. Therefore, in this systematic review, the authors investigated the studies assessing molecular diagnosis of Pott's disease in ancient human remains with the intention to survey the literature, map the evidence, and identify gaps and future perspectives on TB in paleopathology. Our systematic review offers a full contextualization of the history of Pott's disease in ancient times. Our search strategy was performed between August 2022 and March 2023. The authors initially identified 340 records, and 74 studies were finally included and assessed for qualitative analysis. Due to non-specific clinical signs associated with TB, how best to diagnose tuberculosis in human remains still represents a central point. Nevertheless, ancient DNA (aDNA) analysis, lipid biomarkers, and spoligotyping might be extremely useful tools in the study of TB in human remains. Moreover, we propose the extraction and study of immune response genes involved in innate and adaptive immunity versus Mycobacterium spp. as an innovative and vastly overlooked approach in TB paleopathology. Complementary methodologies should be integrated to provide the best approach to the study of TB in human remains.
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Affiliation(s)
- Veronica Papa
- Forensic Anthropology, Paleopathology and Bioarchaeology (FAPAB) Research Center, Avola, Italy
- Department of Economics, Law, Cybersecurity, and Sports Sciences, University of Naples “Parthenope,” Naples, Italy
- School of Science, Engineering and Health, University of Naples “Parthenope,” Naples, Italy
| | - Francesco M. Galassi
- Forensic Anthropology, Paleopathology and Bioarchaeology (FAPAB) Research Center, Avola, Italy
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, 90-237, Lodz, Poland
| | - Elena Varotto
- Forensic Anthropology, Paleopathology and Bioarchaeology (FAPAB) Research Center, Avola, Italy
- Archaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, SA, Australia
| | - Andrea Gori
- I Division of Infectious Diseases, “Luigi Sacco” Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; Department of Pathophysiology and Transplantation, Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Mauro Vaccarezza
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Perth, 6102 Western Australia, Australia
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, Bentley, Perth, 6102 Western Australia, Australia
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Spekker O, Hunt DR, Király K, Kis L, Madai Á, Szalontai C, Molnár E, Pálfi G. Lumbosacral tuberculosis, a rare manifestation of Pott's disease - How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis. Tuberculosis (Edinb) 2023; 138:102287. [PMID: 36450192 DOI: 10.1016/j.tube.2022.102287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - David R Hunt
- Northern Virginia District Office of the Chief Medical Examiners, 10850 Pyramid Place, Manassas, VA, 20110, USA.
| | - Kitty Király
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Móra Ferenc Museum, Roosevelt tér 1-3, H-6720, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Ágota Madai
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Anthropology, Hungarian National History Museum, Ludovika tér 2-6, H-1083, Budapest, Hungary.
| | - Csaba Szalontai
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
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Spekker O, Váradi OA, Szekeres A, Jäger HY, Zink A, Berner M, Pany-Kucera D, Strondl L, Klostermann P, Samu L, Király K, Bereczki Z, Molnár E, Pálfi G, Tihanyi B. A rare case of calvarial tuberculosis from the Avar Age (8th century CE) cemetery of Kaba-Bitózug (Hajdú-Bihar county, Hungary) - Pathogenesis and differential diagnostic aspects. Tuberculosis (Edinb) 2022; 135:102226. [PMID: 35759869 DOI: 10.1016/j.tube.2022.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/27/2022] [Accepted: 06/19/2022] [Indexed: 11/26/2022]
Abstract
The aim of our paper is to present and discuss in detail the bony changes indicative of tuberculosis (TB) that were identified in a skeleton (KB67), unearthed from grave 67 of the 8th-century-CE cemetery of Kaba-Bitózug (Hungary). Furthermore, to provide the differential diagnoses of the observed alterations, with special attention to the cranial osteolytic lesions. During the macro- and micromorphological examinations of KB67, the skull revealed three small, well-circumscribed, punched-out osteolytic lesions accompanied by endocranial granular impressions, abnormal blood vessel impressions, periosteal appositions, and cortical erosion. The postcranial skeleton exhibited osteolytic lesions, cortical remodelling and erosion, and signs of hypervascularisation in the spine. Based on the differential diagnosis of the cranial osteolytic lesions and their co-occurrence with endocranial and vertebral bony changes indicative of TB, they most likely resulted from tuberculous involvement of the frontal and left parietal bones. The morphologically established diagnosis was confirmed by a PCR analysis that provided evidence for the presence of Mycobacterium tuberculosis DNA in KB67. KB67, the first reported archaeological case with calvarial TB from the present-day territory of Hungary, gives us a unique insight into the occurrence of a rare manifestation of TB in the Avar Age of the Great Plain.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - Orsolya Anna Váradi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary; Department of Microbiology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - András Szekeres
- Department of Microbiology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Heidi Yoko Jäger
- Institute for Mummy Studies, Eurac Research, Viale Druso 1, I-39100, Bolzano, Italy.
| | - Albert Zink
- Institute for Mummy Studies, Eurac Research, Viale Druso 1, I-39100, Bolzano, Italy.
| | - Margit Berner
- Department of Anthropology, Natural History Museum Vienna, Burgring 7, A-1010, Vienna, Austria.
| | - Doris Pany-Kucera
- Department of Anthropology, Natural History Museum Vienna, Burgring 7, A-1010, Vienna, Austria.
| | - Liesa Strondl
- Department of Anthropology, Natural History Museum Vienna, Burgring 7, A-1010, Vienna, Austria.
| | - Paul Klostermann
- Department of Anthropology, Natural History Museum Vienna, Burgring 7, A-1010, Vienna, Austria.
| | - Levente Samu
- Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - Kitty Király
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Zsolt Bereczki
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Balázs Tihanyi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
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Metagenomic Research of Infectious Diseases in Archaeological Contexts: Evidence from the Hospital Real de Todos-os-Santos (Portugal). APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Syphilis is one of the most exciting diseases explored in paleopathology and, therefore, tracing back its origin and development has provided a prolific debate. The combination of paleopathological data with historical sources, iconography, and archaeological contexts were the primary sources used to reconstruct its historical path. However, there are some limitations to paleopathological diagnosis due to the nature of bone reaction to stimuli. In addition, historical sources are subjected to a bias of social and cultural nature and the knowledge of those who wrote them. Hence, ancient DNA analysis offers the possibility of acquiring proof of cause by identifying pathogens in an organism. We undertook a metagenomic study of a skeleton exhumed from the Royal Hospital of All Saints (Portugal), renowned for treating syphilis from the 16th century onwards. The skeleton had previously been diagnosed with syphilis according to paleopathological analysis. However, the metagenomics analysis showed no presence of the pathogen associated with syphilis (i.e., Treponema pallidum) but revealed pathogenic microorganisms related to respiratory diseases (pneumonia), nonspecific bone infections (osteomyelitis), and oral bacterial pathologies as well as Hansen’s disease (also known as leprosy). The results are exciting and demand a reappraisal of the observed bone changes, recontextualizing their characterization as syphilis related. They prove that past reconstruction of health and disease diagnoses based on assessing human osteological remains of known context (such as a syphilitic hospital) may bias interpretations and, therefore, caution is recommended, not forgetting that the absence of evidence is not evidence of absence (in this case of syphilis) in life.
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An ancient cranium from Dmanisi: Evidence for interpersonal violence, disease, and possible predation by carnivores on Early Pleistocene Homo. J Hum Evol 2022; 166:103180. [DOI: 10.1016/j.jhevol.2022.103180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
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Prospects of Using Pharmacologically Active Compounds for the Creation of Antimycobacterial Drugs. Pharm Chem J 2022. [DOI: 10.1007/s11094-021-02544-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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