Use of strontium isotope ratios in potential geolocation of Ajnala skeletal remains: a forensic archeological study.

Stable isotope methods for provenance of unidentified human remains are relatively a newer field of enquiry in forensic archeology. It is of great interest for forensic experts these days. The application of strontium isotope analyses for estimating geolocation of archeological remains is of great interest in bioarcheology and modern forensics. The strontium (Sr) isotope composition of human bones and teeth has been widely used to reconstruct an individual's geo-affiliation, residential mobility, and migration history. Thousands of unknown human remains, reportedly belonging to 282 Indian soldiers of 26th Native Bengal regiment and killed in 1857, were exhumed non-scientifically from an abandoned well situated underneath a religious structure at Ajnala (Amritsar, India). Whether these remains belonged to the individuals, local or non-local to the site, was the important forensic archeological question to be answered by doing their thorough forensic anthropological examinations. In the present study, 27 mandibular teeth (18 s molars, 6 first molars, and 3 premolars) collected from the Ajnala skeletal assemblage were processed for strontium isotope analysis, and the measured ratios were compared with published isotope baseline data to estimate the locality status of these remains. The Sr isotopic values were concentrated in the range of 0.7175 to 0.7270. The comparative analysis of isotopic ratios revealed that most individuals buried in the Ajnala well have 87Sr/86Sr values close to the river as well as groundwater of the Gangetic plain (less radiogenic 87Sr/86Sr ~ 0.716); most likely originated near Varanasi (Uttar Pradesh, India) region, whereas the individuals with higher 87Sr/86Sr ratios (~ 0.7200) probably resided in the West Bengal and Bihar areas where the river as well as groundwater of the Gangetic plain is relatively more radiogenic. Thus, the strontium isotope results reveal that the Ajnala individuals did not grow up or live in the Amritsar region during their childhood, and this observation complemented the previous forensic anthropological and molecular findings. There is very little Indian data on the bioavailable strontium, so the inferences from the present study estimating Sr isotope abundances are expected to provide baseline data for future forensic provenance studies that will contribute to the global efforts of mapping Sr isotope variations by the isotope community.

Role of bronchoscopy and imaging in long-standing foreign body bronchus presenting as recurrent or non-resolving lower respiratory tract infection.

INTRODUCTION: A long-standing retained foreign body in the bronchus is unusual. In majority of cases, an adequate history is not obtained, the clinical picture is usually clouded by superadded pathological changes. CASE SERIES: We report three cases of long-standing foreign body in the airway who presented with recurrent lower respiratory tract infection. Examination of respiratory system revealed no significant abnormality. Chest radiograph was normal. CT scan of the chest was useful to indicate endobronchial opacity in the airway suggestive of a foreign body. The patients underwent rigid bronchoscopy under general anesthesia for successful removal of the foreign body. CONCLUSION: So the patients with non-resolving or recurrent lower respiratory symptoms in spite of medical treatment and without any obstructive findings must undergo diagnostic bronchoscopy evaluation and imaging.

Investigations on melamine-based uric acid kidney stone formation and its prevention by inhibitors.

Melamine (Mel) as a milk powder adulterant came to light in September 2008, when a kidney stone disease (KSD) outbreak struck China. The mechanism of the formation of Mel-associated uric acid (UA) stones is relatively unknown. Therefore, in the present study, Mel's influence was explored at comparatively higher and lower concentrations in artificial urine. The parameter optimization performed when the Mel concentration in artificial urine was low, which revealed that higher pH values and lower UA concentration considerably delayed the induction of UA crystallization. When Mel concentration was increased relative to UA concentration, the induction time of UA crystallization decreased dramatically. At the highest concentration of Mel investigated (at UA-Mel molar ratio 1:1), PXRD analysis and SEM revealed a change in crystalline structure of the samples. Based on FTIR analysis, it was determined that UA-Mel interactions are essentially physical, because no new characteristic bands developed. Two inhibitors, namely tri-potassium citrate (TPC) and 3, 7-dimethylxanthine (DMX), were investigated for their inhibitory action on UA crystallization in the presence of Mel. DMX was observed to be more promising than TPC in delaying the induction of crystallisation and hence inhibiting crystal formation.

Human tooth enamel carbon and oxygen stable isotope dataset from chalcolithic Inamgaon (India).

The tooth enamel from the human remains of ten archaeological individuals belonging to a chalcolithic site at Inamgaon, District Pune, Maharashtra, were analysed for stable carbon and oxygen isotope compositions. The human remains of the involved individuals come from three consecutive periods: Period I (1600-1400 BC; n = 2), Period II (1400-1000 BC; n = 4), and Period III (1000-700 BC; n = 4). Enamel carbonate of twenty teeth (n = 20), two from each individual, were analysed to understand the inter- and intra-individual variations in isotope ratios across the three habitational periods. The acquired dataset will help in understanding isotope baseline values for the region in the prehistoric context. The subsequent research works in the region can reuse our data in collation with other datasets for comparative investigations.

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.

A 37-Year-Old Man With Bronchial Asthma and Unexplained Hypoxemia.

CASE PRESENTATION: A 37-year-old man presented with breathlessness and wheeze of 3 weeks' duration. There was no chest pain, cough, palpitation, pedal edema, or fever. For the past 12 years, he had been experiencing episodic breathlessness and wheeze, which improved with inhaled salbutamol. He also had symptoms of nasal obstruction, nasal discharge, and sneezing. There was no history of smoking, substance abuse, or the use of any over-the-counter medication. The current episode of bronchial asthma exacerbation was managed with bronchodilators and systemic glucocorticoids. Despite symptomatic relief and clinical improvement, his oxygen saturation remained at 75% to 80%, and he was referred to our facility for further evaluation.

A comprehensive calibrated phytolith based climatic index from the Himalaya and its application in palaeotemperature reconstruction.

Past climate reconstructions from palaeoecological records require an understanding of relationships between modern vegetation and climate. Phytoliths are being used widely to reconstruct variations in C3/C4 grasses in the past vegetation and corresponding climate. However, little understanding is available on their relationships with the climate driver(s). Even though, the driver(s) regulating C3/C4 grass distributions vary regionally, while reconstructing the past distributions, a grass phytolith-based climatic index (Ic) has often been found to be used globally without assessing its regional consistency. In the Himalaya, the working potential of Ic has proven to be unsatisfactory when compared to other regions of the globe. To improve the efficacy of Ic, we have identified the redundant grass phytolith morphs and revised it by including four exclusive C3-grass indicator morphotypes (bilobate trapezoidal, bilobate scooped, saddle tall and saddle plateaued) to the existing Ic calculation. Thus, a new climatic index, revised Ic (rIc) is proposed in this article. We have compared the rIc with modern climate variables and a relationship with mean annual temperature (MAT) is established with statistical validation. To assess the working potential of the proposed calibration function in the past temperature reconstructions, we have estimated the late Holocene MAT variations in the Himalaya using rIc. We infer that in the mountainous regions like the Himalaya, even with irregular precipitation distribution, variability in C3/C4 grass distributions and their phytolith spectra seem to be a primary function of temperature. Further, we recommend that rIc can be satisfactorily used to reconstruct past temperature variations in the Himalaya and similar mountainous regions where soil water availability is not a limiting factor.

An algorithm for early diagnosis of cervicofacial necrotising fasciitis.

Cervicofacial necrotising fasciitis (CNF) is a potentially fatal infection which can occasionally present in the head and neck. An early diagnosis and aggressive treatment is imperative for minimising the associated mortality and morbidity. The early clinical features are usually non-specific which makes it difficult to differentiate it from other less serious infections. Necrosis of the skin is a late feature. Although it is more common in the immunocompromised, it can also affect normal individuals. We discuss our experience of five patients with CNF, review of literature and algorithm for early diagnosis of CNF. With experience, we were able to diagnose the subsequent cases early and minimise the mortality and morbidity. In conclusion, the incidence of CNF has increased in the last decade partly due to an increased clinical awareness. Early intervention is essential to minimise the mortality and morbidity. It should be managed by a team of at least otolaryngologists, intensivist, microbiologist and plastic surgeons; cardiothoracic surgeons may be required. Treatment involves early aggressive surgical debridement/fasciotomy, intravenous antibiotics and general metabolic support in the intensive care unit.

Tuberculous mastoiditis in a 2-month-old infant presenting with facial nerve palsy.

We present a rare case of tuberculous mastoiditis in a 2-month-old infant. The patient presented with facial nerve palsy, fever and otorrhoea and was subsequently confirmed to have a Mycobacterium tuberculosis infection. Mastoiditis was confirmed with a CT scan of the head, and gastric aspirate analysis with the Xpert MTB/RIF assay (Cepheid, USA) rapidly confirmed tuberculosis (TB), allowing prompt initiation of anti-TB therapy. The patient is now recovering, with the initial facial nerve palsy resolved.

Respiratory epithelial adenomatoid hamartoma: a diagnostic challenge in sinonasal lesions.

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare lesion in nasal cavity first reported by Wenig and Heffner in 1995. Most commonly seen in men in third to ninth decade of life. Majority of cases presents as a polypoidal mass in one or both nasal cavities. We experienced such a case of REAH originating from the nasal septum, in posterior aspect, treated by endoscopic approach. It is important to differentiate REAH from other sinonasal pathologies like inverted papilloma and low grade sinonasal adenocarcinoma. Complete surgical resection is the treatment of choice.

High frequency abrupt shifts in the Indian summer monsoon since Younger Dryas in the Himalaya.

In order to quantify the Indian summer monsoon (ISM) variability for a monsoon dominated agrarian based Indian socio-economy, we used combined high resolution δ13C, total organic carbon (TOC), sediment texture and environmental magnetic data of the samples from a ~3 m deep glacial outwash sedimentary profile from the Sikkim Himalaya. Our decadal to centennial scale records identified five positive and three negative excursions of the ISM since last ~13 ka. The most prominent abrupt negative ISM shift was observed during the termination of the Younger Dryas (YD) between ~11.7 and 11.4 ka. While, ISM was stable between ~11 and 6 ka, and declined prominently between 6 and 3 ka. Surprisingly, during both the Medieval Warm Period (MWP) and Little Ice age (LIA) spans, ISM was strong in this part of the Himalaya. These regional changes in ISM were coupled to southward shifting in mean position of the Intertropical Convergence Zone (ITCZ) and variations in East Asian monsoon (EAM). Our rainfall reconstructions are broadly in agreement with local, regional reconstructions and PMIP3, CSIRO-MK3L model simulations.

Necrosis predicts benefit from hypoxia-modifying therapy in patients with high risk bladder cancer enrolled in a phase III randomised trial.

BACKGROUND AND PURPOSE: Addition of carbogen and nicotinamide (hypoxia-modifying agents) to radiotherapy improves the survival of patients with high risk bladder cancer. The study investigated whether histopathological tumour features and putative hypoxia markers predicted benefit from hypoxia modification. MATERIALS AND METHODS: Samples were available from 231 patients with high grade and invasive bladder carcinoma from the BCON phase III trial of radiotherapy (RT) alone or with carbogen and nicotinamide (RT+CON). Histopathological tumour features examined were: necrosis, growth pattern, growing margin, and tumour/stroma ratio. Hypoxia markers carbonic anhydrase-IX and glucose transporter-1 were examined using tissue microarrays. RESULTS: Necrosis was the only independent prognostic indicator (P=0.04). Necrosis also predicted benefit from hypoxia modification. Five-year overall survival was 48% (RT) versus 39% (RT+CON) (P=0.32) in patients without necrosis and 34% (RT) versus 56% (RT+CON) (P=0.004) in patients with necrosis. There was a significant treatment by necrosis strata interaction (P=0.001 adjusted). Necrosis was an independent predictor of benefit from RT+CON versus RT (hazard ratio [HR]: 0.43, 95% CI 0.25-0.73, P=0.002). This trend was not observed when there was no necrosis (HR: 1.64, 95% CI 0.95-2.85, P=0.08). CONCLUSIONS: Necrosis predicts benefit from hypoxia modification in patients with high risk bladder cancer and should be used to select patients; it is simple to identify and easy to incorporate into routine histopathological examination.

Cystoid macular oedema in Cogans syndrome-a case report.

INTRODUCTION: Cogan's Syndrome is typically characterised by a non syphilitic interstitial keratitis (IK), with or without conjunctivitis, iritis or subconjunctival bleeding and progressive sensorineural hearing loss within two years of ocular signs. Atypical ocular manifestations include episcleritis, scleritis, posterior scleritis, retinal artery occlusion, choroiditis, retinal vasculitis, and optic disc oedema. We report a case of Cogan's syndrome in with recurrent cystoid macular oedema was the main feature. CASE PRESENTATION: A patient was diagnosed with Cogan's syndrome nearly 2 years after first presentation. He had cystoid macular edema which failed to respond initially to steroid, methotrexate and azothiaprine however resolved after treatment with mycophenolate mofetil. CONCLUSION: Cogan's syndrome is rare and presents a challenge in terms of diagnosis and treatment. Recurrent cystoid macular oedema is a unique finding in this condition and can be difficult to control. Multidisciplinary management of this multisystem disorder is vital.