Contrasting Distribution of SARS-CoV-2 Lineages across Multiple Rounds of Pandemic Waves in West Bengal, the Gateway of East and North-East States of India.

The evolution of viral variants and their impact on viral transmission have been an area of considerable importance in this pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We analyzed the viral variants in different phases of the pandemic in West Bengal, a state in India that is important geographically, and compared the variants with other states like Delhi, Maharashtra, and Karnataka, located in other regions of the country. We have identified 57 pango-lineages in 3,198 SARS-CoV-2 genomes, alteration in their distribution, as well as contrasting profiles of amino acid mutational dynamics across different waves in different states. The evolving characteristics of Delta (B.1.617.2) sublineages and alterations in hydrophobicity profiles of the viral proteins caused by these mutations were also studied. Additionally, implications of predictive host miRNA binding/unbinding to emerging spike or nucleocapsid mutations were highlighted. Our results throw considerable light on interesting aspects of the viral genomic variation and provide valuable information for improved understanding of wave-defining mutations in unfolding the pandemic. IMPORTANCE Multiple waves of infection were observed in many states in India during the coronavirus disease 2019 (COVID19) pandemic. Fine-scale evolution of major SARS-CoV-2 lineages and sublineages during four wave-window categories: Pre-Wave 1, Wave 1, Pre-Wave 2, and Wave 2 in four major states of India: Delhi (North), Maharashtra (West), Karnataka (South), and West Bengal (East) was studied using large-scale virus genome sequencing data. Our comprehensive analysis reveals contrasting molecular profiles of the wave-defining mutations and their implications in host miRNA binding/unbinding of the lineages in the major states of India.

Band of cacophony - abdominal catastrophe caused by the fibrous band of Meckel's diverticulum: a case report.

INTRODUCTION: This report calls attention to small bowel necrosis resulting as a complication of formation of an obstructive loop of small bowel around a band of Meckel's diverticulum. CASE PRESENTATION: We report a case of an adult in his 5th decade presenting with sharp, colicky abdominal pain. On presentation his vitals were within normal limits, abdomen was non-distended but tender and rigid all over, more on left lower quadrant without any rebound tenderness. Bowel sounds were hypoactive. Rectal exam showed an empty vault. White blood cell count was 9.0 x 10(3)/mm(3) with 94.5% neutrophils, Hb of 9.0 gm/dl and Hct of 31.3%, liver and pancreatic enzymes were not elevated. Arterial blood gas did not show any acidosis and lactic acid level was not elevated. X-ray showed a non-obstructive bowel pattern without any free air. Abdominal computed tomography with oral and intravenous gastrograffin showed findings consistent with complete mid to distal small bowel obstruction secondary to a closed loop obstruction. Emergent laparotomy showed a Meckel's diverticulum that had formed a band around a portion of small bowel causing it to twist upon itself and become necrotic. CONCLUSION: Histopathology revealed Meckel's diverticulum and benign intestinal tissue with hemorrhagic necrosis.