Clinical Features and Outcomes of Patients with Idiopathic Inflammatory Myositis-Associated Interstitial Lung Disease in Rural Appalachia: A Cross-Sectional Study

BACKGROUND

Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune disorders often complicated by interstitial lung disease (ILD). The clinical characteristics and outcomes of IIM-associated ILD have been reported variably, but the literature on rural populations is scarce.

METHODS

A retrospective cross-sectional study was conducted at a rural tertiary academic medical center. Twenty-nine patients met the final inclusion criteria. The primary outcome was to assess the disease state and immunological and radiographic features of IIM-associated ILD. Secondary outcomes included disease progression, ILD exacerbation, mortality rate, and factors associated with poor outcome.

RESULTS

Dermatomyositis (n = 15, 51.72%) followed by polymyositis (n = 8, 27.58%) were predominant myopathies. The most common autoantibodies were anti-Jo1 antibodies (n = 11, 37.93%). Indeterminate usual interstitial pneumonitis (41.30%, n = 12) was the most common radiographic pattern followed by non-specific interstitial pneumonia (n = 5, 17.24%). ILD exacerbation (n = 14, 66.66%) and mortality rate (n = 6, 20.69%) were high. Albumin levels were significantly lower in patients who died.

CONCLUSIONS

The clinical characteristics of patients with IIM-associated ILD in rural Appalachia exhibit notable distinctions, and outcomes are worse compared to other populations. Larger studies are needed to investigate other prognostics factors and longitudinal trends of clinical characteristics and outcomes of IIM-associated ILD in rural populations.

Musicians in the marsh: a new species of music frog (Anura: Ranidae: Nidirana) from Arunachal Pradesh, India

We describe a new species of ranid frog of the genus Nidirana from northeast India based on morphological, molecular and acoustic evidence. The new species is phenotypically distinct from its congeners by a combination of morphological characters: body robust with SVL 46.559.1 mm (n= 3) in adult males and SVL 60.666.0 mm (n= 2) in adult females; a pair of subgular vocal sacs and two patches of nuptial pad on the first finger in adult males; toe tips slightly dilated and oval; circum-marginal grooves present on all toes; dorsal skin with scattered small tubercles. A pale cream-coloured mid-dorsal line from the snout tip to the vent is present. Phylogenetically, the new species differs from its congeners by a genetic divergence of 3.48.0% and 7.712.4% in 16S and COI genes respectively. Furthermore, the new species can be differentiated from its congeners by its advertisement call, which consists of two different types of notes, call duration (0.580.92 s) and dominant frequency of the call (473.7 Hz). The discovery of a new species validates the presence of the genus Nidirana from India and emphasizes the importance of exploring specialized habitats such as marshlands, which are often overlooked.

Rediscovery and systematics of Rhinophis fergusonianus Boulenger, 1896 (Serpentes: Uropeltidae) from Indias Western Ghats

The shieldtail snake Rhinophis fergusonianus Boulenger, 1896 was previously known only from the holotype specimen collected approximately 130 years ago from an imprecise Indian locality (Cardamom Hills). We report the rediscovery of this species from four localities, from low-elevation hills on both sides of the Palghat Gap in the southern part of the Western Ghats of peninsular India. We document new specimens of R. fergusonianus and provide a reassessment of the systematics of the species based on external morphology and DNA-sequence data. We also provide a revised key to the identification of Indian species of Rhinophis.

Identity of the holotype and type locality of Rhabdophis leonardi (Wall, 1923) (Colubridae: Natricinae), with notes on the morphology and natural history of the species in southwestern China

The original description of Natrix leonardi (currently Rhabdophis leonardi) by Frank Wall in 1923, based on a specimen from the "Upper Burma Hills," lacked important morphological details that have complicated the assignment of recently collected material. Furthermore, although the holotype was never lost, its location has been misreported in one important taxonomic reference, leading to further confusion. We report the correct repository of the holotype (Natural History Museum, London), together with its current catalog number. We also describe key features of that specimen that were omitted from the original description, and provide new details on the morphology of the species, including sexual dichromatism unusual for the genus, based upon specimens from southern Sichuan, China. Rhabdophis leonardi is distinguished from its congeners by the following characters: 15 or 17 DSR at midbody and 6 supralabials; distinct annulus around the neck, broad and red in males, and narrow and orange with a black border in females; dorsal ground color light green or olive; some lateral and dorsal scales possessing black edges, the frequency of black edges gradually increasing from anterior to posterior, forming irregular and ill-defined transverse black bands; eye with prominent green iris; black ventral spots with a red edge, most numerous at midbody but extending halfway down the length of the tail. In southwestern China, this species is frequently found at 1730-2230 m elevation. It has been documented to prey upon anuran amphibians, including toads. A recently published phylogenetic analysis showed this species to be deeply nested with the genus Rhabdophis, as a member of the R. nuchalis Group. That analysis also revealed the existence of two closely related but geographically distinct subclades in the molecular analysis, one of which may represent an unnamed taxon.

Cigarette Smoking, and Blood Monocyte Count Correlate with Chronic Lung Injuries and Mortality

Background

Cigarette smoking (CS)-related monocytosis contributes to the development of chronic lung injuries via complex mechanisms. We aim to determine correlations between measures of CS and monocytes, their capacities to predict chronic lung diseases, and their associations with mortality.

Methods

A single-center retrospective study of patients undergoing surgical resection for suspected lung nodules/masses was performed. CS was quantified as cigarettes smoked per day (CPD), duration of smoking, composite pack years (CPY), current smoking status, and smoking cessation years. A multivariate logistic regression analysis was performed.

Results

Of 382 eligible patients, 88% were ever smokers. In this group, 45% were current smokers with mean CPD of 27.2±40.0. CPY and duration of smoking showed positive linear correlations with percentage monocyte count. Physiologically, CPY was associated with progressive obstruction, hyperinflation, and reduced diffusion capacity (DL_CO). Across the quartiles of smoking, there was an accumulation of radiologic and histologic abnormalities. Anthracosis and emphysema were associated with CPD, while lung cancer, respiratory bronchiolitis (RB), emphysema, and honeycombing were statistically related to duration of smoking. Analysis using consecutive CPY showed associations with lung cancer (≥10 and <30), fibrosis (≥20 and <40), RB (≥50), anthracosis and emphysema (≥10 and onwards). Percentage monocytes correlated with organizing pneumonia (OP), fibrosis, and emphysema. The greater CPY increased mortality across the groups. Significant predictors of mortality included percentage monocyte, anemia, GERD, and reduced DL_CO.

Conclusion

Indices of CS and greater monocyte numbers were associated with endpoints of chronic lung disease suggesting a participation in pathogenesis. Application of these easily available metrics may support a chronology of CS-induced chronic lung injuries. While a relative lesser amount of smoking can be associated with lung cancer and fibrosis, greater CPY increases the risk for emphysema. Monocytosis predicted lung fibrosis and mortality. Duration of smoking may serve as a better marker of monocytosis and associated chronic lung diseases.

Glycemic Control in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

Background: Given the mortality risk in COVID-19 patients, it is necessary to estimate the impact of glycemic control on mortality rates among inpatients by designing and implementing evidence-based blood glucose (BG) control methods. There is evidence to suggest that COVID-19 patients with hyperglycemia are at risk of mortality, and glycemic control may improve outcomes. However, the optimal target range of blood glucose levels in critically ill COVID-19 patients remains unclear, and further research is needed to establish the most effective glycemic control strategies in this population. Methods: The investigation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Data sources were drawn from Google Scholar, ResearchGate, PubMed (MEDLINE), Cochrane Library, and Embase databases. Randomized controlled trials, non-randomized controlled trials, retrospective cohort studies, and observational studies with comparison groups specific to tight glycemic control in COVID-19 patients with and without diabetes. Results: Eleven observational studies (26,953 patients hospitalized for COVID-19) were included. The incidence of death was significantly higher among COVID-19 patients diagnosed with diabetes than those without diabetes (OR = 2.70 [2.11, 3.45] at a 95% confidence interval). Incidences of death (OR of 3.76 (3.00, 4.72) at a 95% confidence interval) and complications (OR of 0.88 [0.76, 1.02] at a 95% confidence interval) were also significantly higher for COVID-19 patients with poor glycemic control. Conclusion: These findings suggest that poor glycemic control in critically ill patients leads to an increased mortality rate, infection rate, mechanical ventilation, and prolonged hospitalization.

Diet and habit explain head-shape convergences in natricine snakes

The concept of ecomorphs, whereby species with similar ecologies have similar phenotypes regardless of their phylogenetic relatedness, is often central to discussions regarding the relationship between ecology and phenotype. However, some aspects of the concept have been questioned, and sometimes species have been grouped as ecomorphs based on phenotypic similarity without demonstrating ecological similarity. Within snakes, similar head shapes have convergently evolved in species living in comparable environments and/or with similar diets. Therefore, ecomorphs could exist in some snake lineages, but this assertion has rarely been tested for a wide-ranging group within a single framework. Natricine snakes (Natricinae) are ecomorphologically diverse and currently distributed in Asia, Africa, Europe and north-central America. They are primarily semiaquatic or ground-dwelling terrestrial snakes, but some are aquatic, burrowing or aquatic and burrowing in habit and may be generalist or specialist in diet. Thus, natricines present an interesting system to test whether snakes from different major habit categories represent ecomorphs. We quantify morphological similarity and disparity in head shape among 191 of the ca. 250 currently recognized natricine species and apply phylogenetic comparative methods to test for convergence. Natricine head shape is largely correlated with habit, but in some burrowers is better explained by dietary specialism. Convergence in head shape is especially strong for aquatic burrowing, semiaquatic and terrestrial ecomorphs and less strong for aquatic and burrowing ecomorphs. The ecomorph concept is useful for understanding natricine diversity and evolution, though would benefit from further refinement, especially for aquatic and burrowing taxa.

On the taxonomic validity of Boiga whitakeri Ganesh et al., 2021 with new insights on Boiga dightoni (Boulenger, 1894) (Reptilia: Squamata: Colubridae)

Colour polymorphism has been previously reported in several colubrid snakes including Boiga spp. In this paper, we report colour variations within the poorly known southern Indian Boiga dightoni, provide the first molecular data for this species, from two localities (including the type locality) and compare them with data from other congeners. Additionally, we provide detailed dentition and hemipenis descriptions for B. dightoni. Molecular data for B. dightoni show very little difference (0.2–0.4% 16S; 0.9–1.2% cyt b) to the recently described Boiga whitakeri, also from southern India. We have re-examined and present new information on the pholidosis of the type specimens of B. whitakeri and reconsider its taxonomic status. On the basis of molecular data and overlapping morphological characteristics, we argue that Boiga whitakeri and Boiga dightoni are conspecific, and place B. whitakeri under the subjective synonymy of the latter. Furthermore, we show that colour polymorphism in B. dightoni is a gender-independent character and that both colour morphs are found in high as well as low elevations and partly in sympatry. A revised key to the Boiga ceylonensis complex is provided.

Ancient DNA elucidates the lost world of western Indian Ocean giant tortoises and reveals a new extinct species from Madagascar

Before humans arrived, giant tortoises occurred on many western Indian Ocean islands. We combined ancient DNA, phylogenetic, ancestral range, and molecular clock analyses with radiocarbon and paleogeographic evidence to decipher their diversity and biogeography. Using a mitogenomic time tree, we propose that the ancestor of the extinct Mascarene tortoises spread from Africa in the Eocene to now-sunken islands northeast of Madagascar. From these islands, the Mascarenes were repeatedly colonized. Another out-of-Africa dispersal (latest Eocene/Oligocene) produced on Madagascar giant, large, and small tortoise species. Two giant and one large species disappeared c. 1000 to 600 years ago, the latter described here as new to science using nuclear and mitochondrial DNA. From Madagascar, the Granitic Seychelles were colonized (Early Pliocene) and from there, repeatedly Aldabra (Late Pleistocene). The Granitic Seychelles populations were eradicated and later reintroduced from Aldabra. Our results underline that integrating ancient DNA data into a multi-evidence framework substantially enhances the knowledge of the past diversity of island faunas.

Isolated pulmonary amyloidoma: A rare cause of solitary pulmonary nodule

Pulmonary nodules are a frequent finding on imaging, especially given screening guidelines for lung cancer with low dose computed tomography (CT) scan. Here, we report a case with a single pulmonary nodule in a patient exposed to coal dust and asbestos. The nodule had benign features, but it showed an increase in size on repeated imaging. A CT-guided biopsy followed by mass spectrometry of the sample identified the nodule as the AL subtype of amyloidoma. A bone marrow biopsy was without evidence for malignancy including lymphoma. Nodular pulmonary amyloidosis (NPA) is rare, and a biopsy is required to establish the diagnosis. NPA generally does not affect lung function or impact survival; thus NPA does not require specific therapy. This case is the first documented case associated with coal-dust exposure. High-risk patients need to be followed longitudinally due to association of amyloidosis with lymphoma and other systemic conditions.

Peribronchiolar Metaplasia: A Marker of Cigarette Smoke-Induced Small Airway Injury in a Rural Cohort

Background

Peribronchiolar metaplasia (PBM) is considered a reaction to injury characterized by the proliferation of bronchiolar epithelium into immediately adjacent alveolar walls. While an association of PBM with diffuse interstitial lung diseases has been recognized, the clinical significance of PBM remains uncertain.

Methods

A cohort (n = 352) undergoing surgical resection of a lung nodule/mass in a rural area was retrospectively reviewed. Multivariate logistic regression analysis was performed to determine the association of PBM with clinical, physiological, radiographic, and histologic endpoints.

Results

In the total study cohort, 9.1% were observed to have PBM as a histologic finding in resected lung tissue (n = 32). All but one of these patients with PBM were ever-smokers with a median of 42 pack years. Clinical COPD was diagnosed in two-thirds of patients with PBM. Comorbid gastroesophageal reflux disease (GERD) was significantly associated with PBM. All patients with PBM demonstrated radiologic and histologic evidence of emphysema. Measures of pulmonary function were not impacted by PBM. Mortality was not associated with the histologic observation of PBM. In a logistic regression model, centrilobular-ground glass opacity interstitial lung abnormality and traction bronchiectasis on the CT scan of the chest and histologic evidence of fibrosis, desquamative interstitial pneumonia and anthracosis all strongly predicted PBM in the cohort.

Conclusion

A constellation of radiologic and histologic smoking-related abnormalities predicted PBM in study cohort. This confirms a co-existence of lung tissue responses to smoking including PBM, emphysema, and fibrosis. Acknowledging the physiologically "silent" nature of small airway dysfunction on pulmonary function testing, our findings support PBM as a histologic marker of small-airway injury associated with cigarette smoking.

Redox imbalance in COVID-19 pathophysiology

Background

The pathophysiologic significance of redox imbalance is unquestionable as numerous reports and topic reviews indicate alterations in redox parameters during corona virus disease 2019 (COVID-19). However, a more comprehensive understanding of redox-related parameters in the context of COVID-19-mediated inflammation and pathophysiology is required.

Methods

COVID-19 subjects (n = 64) and control subjects (n = 19) were enrolled, and blood was drawn within 72 h of diagnosis. Serum multiplex assays and peripheral blood mRNA sequencing was performed. Oxidant/free radical (electron paramagnetic resonance (EPR) spectroscopy, nitrite-nitrate assay) and antioxidant (ferrous reducing ability of serum assay and high-performance liquid chromatography) were performed. Multivariate analyses were performed to evaluate potential of indicated parameters to predict clinical outcome.

Results

Significantly greater levels of multiple inflammatory and vascular markers were quantified in the subjects admitted to the ICU compared to non-ICU subjects. Gene set enrichment analyses indicated significant enhancement of oxidant related pathways and biochemical assays confirmed a significant increase in free radical production and uric acid reduction in COVID-19 subjects. Multivariate analyses confirmed a positive association between serum levels of VCAM-1, ICAM-1 and a negative association between the abundance of one electron oxidants (detected by ascorbate radical formation) and mortality in COVID subjects while IL-17c and TSLP levels predicted need for intensive care in COVID-19 subjects.

Conclusion

Herein we demonstrate a significant redox imbalance during COVID-19 infection affirming the potential for manipulation of oxidative stress pathways as a new therapeutic strategy COVID-19. However, further work is requisite for detailed identification of oxidants (O₂^•-, H₂O₂ and/or circulating transition metals such as Fe or Cu) contributing to this imbalance to avoid the repetition of failures using non-specific antioxidant supplementation.

Assessment of condyle-coronoid angle and gonial angle for gender determination: A digital panoramic study in Bagalkot population

Background

The determination of gender is of utmost importance for forensic science and medico-legal purposes. The mandibular bone may play a vital role in gender determination as it is the most dimorphic bone of the skull that is often recovered intact. In this respect, orthopantomograms are of great value in accurate age and sex estimation. The mandibular angles, especially the gonial angle is an important parameter of the craniofacial complex giving an indication about the vertical parameters and symmetry of the facial skeleton. The purpose of the current study was to evaluate the usefulness of mandibular gonial and coronoid-condyle angle measurements on digital panoramic images as an indicator for gender determination in the Bagalkot population.

Materials and Methods

A total of 200 panoramic images (100 males and 100 females) of Bagalkot district patients aged (18-58) yrs old were selected. Two mandibular parameters 1) gonial angle and 2) condyle-coronoid angle were analyzed using trophy DICOM 6.1.2.0, masterview 4.2.0. Two-way analysis of variance (ANOVA) test and Tukey's multiple post hoc procedures were used to compare the gender and two sides (left and right) with respect to gonial angle and condyle-coronoid angle.

Results

The analysis of the present study confirmed a statistically significant difference between the right and left sides of the gonial angle and condyle-coronoid angle in both genders. The mean comparison also shows a variation between males and females, based on gonial angle and condyle-coronoid values; females have statistically significant higher mean values than males. Based on the analysis, the present study concludes that this difference between males and females from both sides suggests that the gonial angle and condyle-coronoid angle help in gender determination.

Conclusion

The results of the study show that greater mandibular angle aids in gender dimorphism and proves to be beneficial in gender estimation. Gonial angle and condyle-coronoid angle can be used to differentiate gender with high accuracy.

Multilocus phylogeny, natural history traits and classification of natricine snakes (Serpentes: Natricinae)

Natricine snakes are geographically widespread, species rich (with ~250 extant species) and both morphologically and ecologically diverse. We present a multilocus DNA sequence phylogeny for 249 natricine specimens representing 189 named species, including 69 specimens and 21 species not previously sampled. Our inferred Bayesian and maximum likelihood trees form the basis for evaluations of genus-level classification, historical biogeography, lineage diversification, and dietary, habit and reproductive-mode diversity and evolution, although several, mostly deeper, relationships remain poorly resolved. The optimal trees support natricine origins in Asia, with dispersals to Australo-Melanesia, sub-Saharan Africa (including Seychelles Archipelago, excluding Aldabra), Europe and North Africa and into North and Central America. Viviparity appears to have evolved independently three times in Natricinae but was not significantly associated with an aquatic habit. We found limited associations between habit and diet categories. We propose generic reallocations for four natricine species and highlight other points of uncertainty in natricine classification.

Phylogenetic relationships of xenodermid snakes (Squamata: Serpentes: Xenodermidae), with the description of a new genus

Xenodermidae is a generally poorly known lineage of caenophidian snakes found in South, East and Southeast Asia. We report molecular phylogenetic analyses for a multilocus data set comprising all five currently recognised genera and including new mitochondrial and nuclear gene sequence data for the recently described Stoliczkia vanhnuailianai. Our phylogenetic results provide very strong support for the non-monophyly of Stoliczkia, as presently constituted, with S. borneensis being more closely related to Xenodermus than to the Northeast Indian S. vanhnuailianai. Based on phylogenetic relationships and morphological distinctiveness, we transfer Stoliczkia borneensis to a new monotypic genus endemic to Borneo, Paraxenodermusgen. nov. We also present new morphological data for P. borneensis.

Hidden in the plain sight: a new species of Rhabdophis (Serpentes: Natricinae) from the Rhabdophis himalayanus complex

A new species of natricine snake of the genus Rhabdophis is described from Northeast India. Morphologically the new species is similar to Rhabdophis himalayanus but it can be distinguished from it by lacking a nuchal groove and nuchal glands, being relatively smaller, and having a distinct neck, ventral, and subcaudal coloration. In overall coloration it resembles R. chrysargos, from which it is distinguished by several aspects of its morphology and genetic differences. The discovery of Rhabdophis bindi sp. nov. reveals that forested regions in the northeastern part of India needs further biological exploration.

A new species of Stoliczkia Jerdon, 1870 (Serpentes: Xenodermidae) from Mizoram, India

We describe a new species of Stoliczkia from Mizoram, India. Stoliczkia vanhnuailianai sp. nov. is identified as a member of the genus Stoliczkia by distinct scale arrangements on the posterior of the head, and by scales on the body being separated by scaleless skin, and it differs from the two known congeners in body and head scalation. This is only the third specimen of Stoliczkia collected from India, and the sixth reported specimen for the genus. A revised key to the identification of the species of Stoliczkia is provided.

On the identity, nomenclatural status and authorship of Coluber monticolus Cantor, 1839 (Reptilia: Serpentes)

Currently, Coluber monticolus Cantor is considered a junior synonym of the Common kukri snake, Oligodon arnensis Shaw. In this work, we analyzed long time disregarded, unpublished original drawings and manuscripts concerning South Asian snakes. Additionally we recall the hitherto little-noticed contact and exchange between B. H. Hodgson and T. E. Cantor. We correct erroneous assumptions regarding the authorship and identity of C. monticolus and, in accordance with Art. 23.9 of the "Code" (ICZN 1999), we declare Dipsas multifasciata Blyth a nomen protectum with priority over Coluber monticolus Hodgson in Cantor (nomen oblitum).

Contributions to ophiology in Zootaxa 20012020: patterns and trends

There are currently 3,900 recognized, extant snake species belonging to 529 genera globally (Uetz et al. 2021; this study), making snakes one of the most diverse major groups of squamates. Of the 665 currently recognized species that were described between 2001 and 2020 (a ~17% increase in total species), ~34% of these (226 species) were described in Zootaxa. This number does not include species resurrected from synonymy. The other ~66% (439) species were described in 105 other journals, bulletins or books (Fig.1a). Overall, the number of new snake species described every year is gradually increasing, and 40% of the new species described since 2011 were published in Zootaxa. Following Zootaxa, the second ranked journal, with 37 described species since 2001, is Herpetologica (Fig. 2). Anecdotally, the choice of Zootaxa as a publication outlet for new species descriptions by most authors is based on speed of publication post-acceptance, publication free of charge, relatively unconstrained number of papers published per year, relatively unconstrained manuscript length, expert section editors and reviewers, and consolidated scientometric parameters.

A looming exotic reptile pet trade in India: patterns and knowledge gaps

Commercial trade of exotic reptiles through CITES (the Convention on International Trade in Endangered Species of Wild Fauna and Flora) in India is relatively recent (<2 decades).  Social media platforms and web portals are known to be used for pet trade.  Exotic pet trade is not legally regulated within India.  Therefore, little is known on the scale at which this trade is carried out in India.  We conducted a two-year study between 2018 and 2020 gathering information of exotic reptile pet trade online and summarized CITES documentation of the yearly import export records from 1976 to 2018 by CITES secretariat.  This manuscript provides a baseline for the extent of the trade, invasive species and the species traded in mainland India.  We found that there is an extensive trade of exotic reptiles in the country, comprising 84 species including the highly venomous species such as Bitis gabonica.  According to CITES records of 1976–2018, 98.6% of the reptile imports into India have not been reported to the CITES management authorities in India.  We also found some evidence of trade in protected native species through the exotic pet trade network.  Furthermore, some highly threatened reptile species including many listed in Appendix I of CITES are traded in India. 

Systematic status of the rare Himalayan wolf snake Lycodon mackinnoni Wall, 1906 (Serpentes: Colubridae)

Lycodon mackinnoni is a poorly known Himalayan endemic snake known from Western Himalaya. Since the original description of L. mackinnoni almost 112 years ago, this species was not reported from its type locality and its phylogenetic position remain unknown. We herein, provide detail morphological description, comparison with type material, phylogenetic relationship with its congeners and new natural history information.

Morphological and genetic variation in populations of Sitana/ marudhamneydhal/ and the validity of Sitana attenboroughii/

Dewlap morphology and body ratios are two of the main morphological characters used in delimiting Sitana spp. It becomes a statistical limitation when small samples are used in species descriptions, as outliers can be picked to be described as a distinct species. Genetic data has been used to support the distinctness of a species in Sitana. However, species with shallow genetic divergence becomes a problem if not thoroughly examined. We examine and report our findings on morphological and genetic differences in two populations of Sitana marudhamneydhal and one population of S. attenboroughii. The shallow genetic divergence and overlapping morphology shows that Sitana attenboroughii is a junior synonym of Sitana marudhamneydhal.

5-Fluorouracil Induced Takotsubo Cardiomyopathy Complicated by Left Ventricular Thrombosis

A 42-year-old woman with a remote history of smoking and recently diagnosed anorectal cancer presented with typical anginal chest pain, dyspnea, palpitations, and hallucinations. She was started on continuous 5-flurouracil (5-FU) infusion five days before presentation. Her physical examination was significant for bilateral bibasilar crackles and tachycardia. Her bloodwork was significant for an increased troponin and brain natriuretic peptide (BNP). Electrocardiogram (EKG) showed sinus tachycardia with ST elevation in multiple contiguous leads, whereas transthoracic echocardiogram (TTE) showed estimated ejection fraction of 17% with severe global hypokinesis with apical akinesis and matted thrombus at the apex. Coronary angiogram showed 20% occlusion of the left anterior descending artery. She was diagnosed with 5-FU induced Takotsubo cardiomyopathy complicated by left ventricular (LV) thrombosis. 5-FU was discontinued, uridine triacetate was given as reversal agent. Aspirin and apixaban were started for three months for LV thrombosis. Her six-week TTE showed return of normal heart function with resolution of LV thrombosis.

A new species of Sitana (Squamata: Agamidae) from the Deccan Peninsula Biogeographic Zone of India

We describe a new species of fan-throated lizard of the genus Sitana from the Deccan peninsula of India. The new species is from the Sitana sivalensis clade and can be readily diagnosed morphologically from S. sivalensis, S. fusca and S. schleichi by having the dewlap extending beyond forearm insertion. The new species differs from all other congeners in the combination of morphological characters such as a feebly serrated dewlap with a dark blue line on the throat in adult males (versus  a well serrated dewlap with a bright blue patch and orange spots in S. ponticeriana complex), small body size (versus a large body size in S. gokakensis and S. thondalu) and a relatively smaller dewlap size (relatively larger in S. laticeps, S. spinaecephalus, S. dharwarensis, S. gokakensis, S. thondalu, S. marudhamneydhal, S. ponticeriana and S. visiri). The new species was found to be commonly distributed in arid and open habitats as well as in farmlands and plantations in northern Andhra Pradesh, eastern Madhya Pradesh and most parts of Chhattisgarh and Odisha states.

Molecular phylogenetics of sub-Saharan African natricine snakes, and the biogeographic origins of the Seychelles endemic Lycognathophis seychellensis

Phylogenetic relationships of sub-Saharan African natricine snakes are understudied and poorly understood, which in turn has precluded analyses of the historical biogeography of the Seychelles endemic Lycognathophis seychellensis. We inferred the phylogenetic relationships of Seychelles and mainland sub-Saharan natricines by analysing a multilocus DNA sequence dataset for three mitochondrial (mt) and four nuclear (nu) genes. The mainland sub-Saharan natricines and L. seychellensis comprise a well-supported clade. Two maximally supported sets of relationships within this clade are (Limnophis,Natriciteres) and (Afronatrix,(Hydraethiops,Helophis)). The relationships of L. seychellensis with respect to these two lineages are not clearly resolved by analysing concatenated mt and nu data. Analysed separately, nu data best support a sister relationship of L. seychellensis with (Afronatrix,(Hydraethiops,Helophis)) and mt data best support a sister relationship with all mainland sub-Saharan natricines. Methods designed to cope with incomplete lineage sorting strongly favour the former hypothesis. Genetic variation among up to 33 L. seychellensis from five Seychelles islands is low. Fossil calibrated divergence time estimates support an overseas dispersal of the L. seychellensis lineage to the Seychelles from mainland Africa ca. 43-25 million years before present (Ma), rather than this taxon being a Gondwanan relic.

Assessment of knowledge of oral pathologists and postgraduate students on safe laboratory practices during the COVID-19 pandemic

Background:

Oral pathologists are involved in laboratory diagnosis and receive specimens of biopsy, oral cytologic smears and samples for hematology, biochemistry and microbiology and thus are at a risk for laboratory-acquired infections, which may occur inadvertently and can be considered as an occupational hazard.

Aim and Objectives:

This study was conducted during the coronavirus disease (COVID-19) pandemic to assess the knowledge of oral pathologists and oral pathology postgraduate students regarding the safe laboratory practices, procedures and guidelines.

Materials and Methods:

The study was a cross-sectional online questionnaire-based study. Questions were framed to evaluate the knowledge on specimen/sample collection, its handling, disposal and protective measures for laboratory personnel. The study population comprised oral pathologists and oral pathology postgraduate students of various dental colleges in India. A Google Doc format was used to create an effective computerized questionnaire system, and the link was forwarded to around 500 participants. The survey was fielded online between August 29, 2020, and September 5, 2020. Three hundred and twelve responses were received, which were downloaded as spreadsheets for subsequent data analysis.

Results:

Mean value of right answers for the oral pathologists was 8.11 ± 2.02 and for postgraduate students was 7.38 ± 1.75. When the knowledge score between the two groups was compared, a statistically significant difference was found.

Conclusion:

This article compares and highlights the knowledge lacunae among the oral pathologists and oral pathologists postgraduate students in relation to guidelines to be followed for safety in the laboratory. Adhering to these biosafety regulations reduces occupational health hazards and enhances a safe working environment in the laboratory.

Reliability of palatal rugae patterns in individual identification

Background:

Dental identification plays a major role in mass disaster identification of human remains. Palatal rugae can be used as a substitute for a comparative method of identification.

Materials and Methods:

The present cross-sectional study was done with 137 pre- and post-orthodontically treated casts of patients, which were divided into 50 cases each of extraction and nonextraction and 37 cases of palatal expansion involving both extraction and nonextraction. Hydrocolloid (alginate) impression of the upper jaw of the patient was taken and then cast in the dental plaster of Paris material. Palatal rugae pattern was classified according to Lysellm, and Thomas and Kotze classification. Two Observers recorded the data, mean of two were taken for analysis.

Results:

On the right side, there was no significant difference between the extraction and nonextraction groups; however, there was a rise in length in the nonextraction and palatal expansion groups. On the left side, there was little change between the nonextraction and palatal expansion groups, but the extraction group had a modest increase in length. Mean lengths compared within three groups revealed insignificant difference.

Conclusion:

Palatal rugae pattern can be used in establishing identity in forensic medicine provided antemortem data are available. Orthodontic treatment has an impact on stability of palatal rugae. Most reliable and stable points being third rugae, they could be used as reference points to evaluate tooth movements

Intrathecal iodinated contrast-induced transient spinal shock

Transient spinal shock is a previously unreported complication of intrathecal contrast. A 63-year-old man presented with the chief complaint of worsening back pain. Computed topography of lumbar spine without contrast showed a lytic lesion. After international normalized ratio (INR) correction, patient was sent for CT myelogram. After intrathecal contrast injection, the patient dropped his blood pressure profoundly and developed clinical manifestations of spinal shock. Emergent intravenous bolus fluids were initiated resulting in improvement in blood pressure. Patient's spinal shock resolved within hours. CT myelogram was normal except previously known lytic lesion. It was concluded that the transient shock was most likely due to contrast injection. We believe that this is the first reported case of transient spinal shock following CT myelogram using water-soluble iodinated non-ionic contrast agent administered intrathecally.

Description of a new species of Smithophis Giri et al. 2019 (Serpentes: Colubridae: Natricinae) from Arunachal Pradesh, India

A new species of the natricine snake genus Smithophis Giri et al. 2019 is described based on three specimens collected from Arunachal Pradesh, India. An additional three referred specimens are documented. Smithophis arunachalensis sp. nov. differs from all known congeners by a combination of 4-5 (rarely 6) small scales around the eye (excluding labial scales), presence of temporal scales, and a distinctive colour pattern of a blackish dorsum and bright yellow venter that form a sharply-defined zigzag border. The new species is known only from ca. 100 km2 in Lower Dibang Valley and Changlang Districts in eastern Arunachal Pradesh. A revised key to the identification of the species of Smithophis is presented.

Description of a new species of Xylophis Beddome, 1878 (Serpentes: Pareidae: Xylophiinae) from the Western Ghats, India

We reassessed the systematics of the Indian (semi)fossorial snake Xylophis perroteti (Duméril, Bibron Duméril, 1854) based on morphological and DNA sequence data for type, historical, and new specimens. A population from the Anamalai Hills is distinct from broadly topotypic X. perroteti from the Nilgiri Hills (from which they are separated geographically by the lowland Palghat Gap) on the basis of both external morphology and DNA sequence data. We describe the Anamalai form as a new species, Xylophis mosaicus sp. nov. The new species is more closely related to X. perroteti than to X. stenorhynchus and X. captaini. A new key to identify the species of Xylophis is presented.

Diversification in the mountains: a generic reappraisal of the Western Ghats endemic gecko genus Dravidogecko Smith, 1933 (Squamata: Gekkonidae) with descriptions of six new species

The monotypic genus Dravidogecko, represented by its type-species D. anamallensis, is singular amongst peninsular Indian gekkonid lineages in its endemism to the Western Ghats. Molecular species delimitation approaches reveal at least seven species-level lineages within the genus from its distribution range across the mid-high elevations of the southern Western Ghats of India. These lineages, albeit superficially cryptic, are patently diagnosable from each other by employing a limited but precise set of morphological characters. Six of these lineages that were obscured under the nomen D. anamallensis are herein recognized as distinct species. A reappraisal of the genus Dravidogecko is provided based on external morphology and osteological characters, along with a detailed redescription of the holotype of D. anamallensis. A key to the species based on diagnostic characters is presented. Gene-trees based on mitochondrial and nuclear DNA data recovered marginally disparate topologies and were consequently coalesced into a species-tree for phylogenetic inference. Timetree analysis reveals late Miocene cladogenesis in this group and establishes late Palaeocene divergence from its sister genus, Hemidactylus, making Dravidogecko one of the earliest, extant lizard lineages to have colonized peninsular India.

Metformin-associated Lactic Acidosis Successfully Treated with Continuous Renal Replacement Therapy

Metformin-associated lactic acidosis (MALA) is a potentially lethal condition that can result from the use of metformin in the setting of the risk factors such as renal insufficiency or hypoperfusion. We present a case of metformin-associated lactic acidosis incited by pyelonephritis-induced septic shock where use of continuous renal replacement therapy (CRRT) led to good recovery. A 51-year-old female with confusion and abdominal pain was brought to the emergency department (ED). She had a significant past medical history of type ll diabetes mellitus and recurrent urinary tract infections. Prior to the arrival to the hospital, she was conscious but confused and noted to have a low blood glucose level, which was managed with glucose per orally by emergency medical services. While in ED patient was dehydrated and hemodynamically unstable. She failed to respond to intravenous fluids hence vasopressors along with ceftriaxone were initiated. Intubation for mechanical ventilation was performed for respiratory failure and evolving septic shock, sodium bicarbonate for severe metabolic acidosis was started and antibiotics were stepped up to vancomycin and cefepime. The patient was transferred to the medical intensive care unit. Her kidney function continued to worsen, and she remained profoundly acidotic despite aggressive measures. A diagnosis of concomitant MALA was made since vasopressor requirement was less than expected considering the severity of acidosis. Emergent CRRT was initiated, resulting in improvement of acidosis in 24 hours. After she was stabilized vasopressors were stopped, she was extubated, and antibiotics were de-escalated to the oral regimen. MALA is rare but life-threatening complication of metformin use, especially in critically ill patients. CRRT should be considered as the first line in the treatment of metformin-related lactic acidosis, especially in the setting of hemodynamic instability.

On the systematic status of the genus Oriocalotes Günther, 1864 (Squamata: Agamidae: Draconinae) with the description of a new species from Mizoram state, Northeast India

The montane agamid lizard genus Oriocalotes is currently considered monotypic, represented by the species, O. paulus. The systematic status of this taxon has remained questionable since its initial descriptions in the mid-1800s. A detailed molecular and morphological study was carried out to assess the validity of this genus, and its systematic position within the Asian agamid subfamily, Draconinae. Freshly collected and historical museum specimens from the type locality of O. paulus were examined morphologically, along with additional samples collected from localities in Mizoram state, Northeast India. Utilising newly generated molecular sequences (two mitochondrial and three nuclear genes), combined with those previously published for representative genera from the subfamilies Draconinae and Agaminae, Maximum Likelihood and Bayesian phylogenetic trees were constructed. Phylogenetic results suggest that Oriocalotes is part of the widespread South and Southeast Asian radiation of Calotes. Comparative morphological studies (including external morphology, hemipenis and osteology) between Oriocalotes and related genera further support this systematic placement. Oriocalotes is herein regarded as a junior subjective synonym of Calotes. Calotes paulus comb. nov. is also assigned a lectotype and given a detailed redescription based on the lectotype, paralectotypes and additional topotypic material. Furthermore, the specimens collected from Mizoram populations are found to be morphologically and genetically distinct from Calotes paulus comb. nov., and are described herein as a new species, Calotes zolaiking sp. nov.

A new genus and species of natricine snake from northeast India

Based on the first molecular phylogenetic analyses of samples from northeast India, specimens referred to Rhabdops from this region are more closely related to the southeast and east Asian natricine genera Opisthotropis Günther, 1872 and Sinonatrix Rossman Eberle, 1977 (as well as to New World and western Palearctic natricines) than to peninsular Indian (true) Rhabdops. Morphologically, these northeast Indian populations differ from other natricines by having a single ('fused' or unpaired) internasal shield and a single prefrontal shield. Given the morphological and phylogenetic distinctiveness of these northeast Indian populations, we refer them to a new genus, Smithophis gen. nov., and transfer Rhabdops bicolor (Blyth, 1854) to Smithophis bicolor comb. nov. Based on morphological and molecular variation within our northeast Indian sample, we additionally describe Smithophis atemporalis sp. nov. from the state of Mizoram.

Evaluation of canine sexual dimorphism in deciduous and permanent dentition

Introduction:

Teeth are an excellent material in living and nonliving populations for anthropological, genetic, odontologic and forensic investigations. Among the various calcified structures in the human body, teeth have gained lot of popularity in estimating the sex of an individual as they are highly resistant to destruction and decomposition. The present study aims to assess the importance of canines in sexual dimorphism in both primary and permanent dentition as well as to describe the dimensional characteristics of canines among the population of Bagalkot district of Karnataka, India.

Materials and Methods:

One hundred and fifty participants belonging to Bagalkot district of Karnataka population, 100 adults (50 males and 50 females) in the age group of 17–30 years and 50 children (25 boys and 25 girls) in the age group of 3–6 years were included in the study. Impressions were made using alginate and study models were prepared using dental stone. Clinical crown height (CCH), maximum mesiodistal diameter (MMD) and maximum buccolingual width (MBL) of maxillary and mandibular canines of both dentitions were measured using digital vernier caliper.

Results:

In deciduous dentition, significant differences were noted between maxillary and mandibular deciduous canines in male and female children using three dimensions, except mandibular canine, i.e., CCH did not show a significant difference. In permanent dentition, CCH and MMD showed significant differences except mandibular canines not showing significant differences in MBL (P < 0.05).

Conclusion:

Thus, canines can act as a valuable tool in gender determination as there is significant sexual dimorphism in maxillary and mandibular deciduous and permanent dentition.

Assessment of the antimicrobial efficacy of hydroalcoholic fruit extract of cranberry against Socransky complexes and predominant cariogenic, mycotic and endodontic climax communities of the oral cavity: An extensive in-vitro study

Background and Objective:

Contemporary global complementary and alternative practices in dentistry envisage to manipulate the molecules from traditionally used plant derivatives as adjuncts. The aim of this study was to assess the in-vitro antimicrobial efficacy of hydro-alcoholic fruit extract of cranberry against Socransky complexes and predominant cariogenic, mycotic and endodontic climax communities of the oral cavity.

Materials and Methods:

An extract of Vaccinium macrocarpon was prepared using a hydro-ethanolic solvent (water – 30%: ethanol – 70%) using the standardized maceration protocol. Standard American Type Cell Culture and Microbial Type Culture Collection and Gene Bank strains of Streptococcus mutans, Lactobacillus acidophilus, Candida albicans, Enterococcus faecalis, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were used. The minimum inhibitory concentration was determined by the serial broth dilution. The minimum bactericidal concentration was obtained by subculturing method.

Results:

The extract showed satisfactory inhibitory and bactericidal effects against all test pathogens.

Conclusion:

V. macrocarpon can prove to be an adjunct to the existing antimicrobial complexes being routinely used to combat pathogenic oral climax community.

A systematic revision of Calotes Cuvier, 1817 (Squamata: Agamidae) from the Western Ghats adds two genera and reveals two new species

Lizards of the genus Calotes are geographically restricted to South Asia, Indo-China and parts of Southeast Asia. The greatest diversity of the genus is from the biodiversity hotspots in South Asia: Western Ghats (Peninsular India), Sri Lanka and Indo-Burma. Here, we present a systematic revision of members of the genus Calotes from Peninsular India using a combination of molecular phylogeny, geographical distribution and morphological characters. We show that Calotes from the Western Ghats is paraphyletic and consists of three major clades, one of which is widely distributed in South and Southeast (SE) Asia, while the others are restricted to Peninsular India. The Peninsular Indian clade is composed of two sister clades: Psammophilus, with a wider distribution and a second clade, composed of two extant species, Calotes rouxii and Calotes ellioti and two new species, all restricted to the Western Ghats region. Based on morphological differences, we retain the generic status of Psammophilus and assign its sister clade to a new genus Monilesaurus gen. nov. and transfer the following species, C. rouxii and C. ellioti, to this new genus. We also provide diagnoses and descriptions for two new species recognized within Monilesaurus gen. nov. In addition, Calotes aurantolabium from the Western Ghats was observed to be deeply divergent and to share a sister-relationship with the clade composed of Calotes, Monilesaurus gen. nov., and Psammophilus. Based on its phylogenetic position and morphological attributes, we assign this species to a new genus Microauris gen. nov. These new discoveries highlight the evolutionary significance of the Western Ghats in housing novel lizard diversity.

Descriptions of two new endemic and cryptic species of Sitana Cuvier, 1829 from peninsular India

Two new cryptic species of the agamid genus Sitana Cuvier, 1829 from Peninsular India are described herein. Sitana gokakensis sp. nov. from Gokak, Karnataka closely resembles Sitana thondalu sp. nov. from Nagarjuna Sagar, Andhra Pradesh. The two species can be distinguished based on their subtle morphological differences, genetic difference and geographic distribution. Sitana gokakensis sp. nov. have a relatively depressed head compared to Sitana thondalu sp. nov. Additionally, the vertebral scale counts differ in females of the two new species (Sitana gokakensis sp. nov. 45-47 vs Sitana thondalu sp. nov. 49-53). Genetic divergence between them is comparable to those between previously described Sitana species. Furthermore, the two new species are distributed ca. 500 km apart and are endemic to their respective landscapes that lie in similar latitudes of peninsular India. We urge the use of large sample size in new species descriptions especially those dealing with cryptic species like Sitana. The discovery of the two new cryptic species from these rocky terrains in peninsular India highlights need for more herpetological exploration in this region.