A repeating fast radio burst source in a globular cluster.

Fast radio bursts (FRBs) are flashes of unknown physical origin1. The majority of FRBs have been seen only once, although some are known to generate multiple flashes2,3. Many models invoke magnetically powered neutron stars (magnetars) as the source of the emission4,5. Recently, the discovery6 of another repeater (FRB 20200120E) was announced, in the direction of the nearby galaxy M81, with four potential counterparts at other wavelengths6. Here we report observations that localized the FRB to a globular cluster associated with M81, where it is 2 parsecs away from the optical centre of the cluster. Globular clusters host old stellar populations, challenging FRB models that invoke young magnetars formed in a core-collapse supernova. We propose instead that FRB 20200120E originates from a highly magnetized neutron star formed either through the accretion-induced collapse of a white dwarf, or the merger of compact stars in a binary system7. Compact binaries are efficiently formed inside globular clusters, so a model invoking them could also be responsible for the observed bursts.

A repeating fast radio burst source localized to a nearby spiral galaxy.

Fast radio bursts (FRBs) are brief, bright, extragalactic radio flashes1,2. Their physical origin remains unknown, but dozens of possible models have been postulated3. Some FRB sources exhibit repeat bursts4-7. Although over a hundred FRB sources have been discovered8, only four have been localized and associated with a host galaxy9-12, and just one of these four is known to emit repeating FRBs9. The properties of the host galaxies, and the local environments of FRBs, could provide important clues about their physical origins. The first known repeating FRB, however, was localized to a low-metallicity, irregular dwarf galaxy, and the apparently non-repeating sources were localized to higher-metallicity, massive elliptical or star-forming galaxies, suggesting that perhaps the repeating and apparently non-repeating sources could have distinct physical origins. Here we report the precise localization of a second repeating FRB source6, FRB 180916.J0158+65, to a star-forming region in a nearby (redshift 0.0337 ± 0.0002) massive spiral galaxy, whose properties and proximity distinguish it from all known hosts. The lack of both a comparably luminous persistent radio counterpart and a high Faraday rotation measure6 further distinguish the local environment of FRB 180916.J0158+65 from that of the single previously localized repeating FRB source, FRB 121102. This suggests that repeating FRBs may have a wide range of luminosities, and originate from diverse host galaxies and local environments.

Artificial lighting reduces the effectiveness of wildlife-crossing structures for insectivorous bats.

In an attempt to improve cost-effectiveness, it has become increasingly popular to adapt wildlife crossing structures to enable people to also use them for safe passage across roads. However, the required needs of humans and wildlife may conflict, resulting in a structure that does not actually provide the perceived improvement in cost-effectiveness, but instead a reduction in conservation benefits. For example, lighting within crossing structures for human safety at night may reduce use of the structure by nocturnal wildlife, thus contributing to barrier and mortality effects of roads rather than mitigating them. In this study, we experimentally evaluated the impact of artificial light at night on the rate of use of wildlife crossing structures, specifically underpasses, by ten insectivorous bat species groups in south-eastern Australia. We monitored bat activity before, during and after artificially lighting the underpasses. We found that bats tended to avoided lit underpasses, and only one species consistently showed attraction to the light. Artificial light at night in underpasses hypothetically increases the vulnerability of bats to road-mortality or to the barrier effect of roads. The most likely outcomes of lighting underpasses were 1. an increase in crossing rate above the freeway and a decrease under the underpasses, or 2. a reduction in crossing rate both above freeways and under the underpasses, when structures were lit. Our results corroborate those of studies on terrestrial mammals, and thus we recommend that underpasses intended to facilitate the movement of wildlife across roads should not be lit.

Inoculation leprosy and HIV co-infection: a rare case with nerve involvement preceding development of skin patch and type 1 reaction as immune reconstitution syndrome following antiretroviral therapy.

The transmission of leprosy has been universally accepted to be primarily, through nasal dissemination from multibacillary patients to the susceptible persons. However, the possibility of leprosy transmission through prolonged skin contact with abraded leprous skin or through skin inoculation can not be ruled out. We report a case of development of a paucibacillary leprosy patch close to the site of a local trauma, after an interval of about 13-14 years, in a HIV positive subject. Also discussed are the various hypotheses in the aetiopathogenesis of leprosy like entry route of lepra bacilli into the body, viability of lepra bacilli in the environment and evolution of skin and nerve lesions of leprosy.

Annular vesiculobullous eruptions in type 2 reaction in borderline lepromatous leprosy: a case report.

An untreated case of BL presented with clinical features of type 2 reaction (T2R) confirmed by histopathology. The case was a 18-year-old female with borderline lepromatous leprosy who developed annular vesiculobullous eruptions oversome of the pre-existing plaques on arms and upper back along with fever and severe neuritis after a short course of ofloxacin intake prescribed for urinary tract infection. In addition to the above lesions, some of the existing lesions showed acute exacerbation characterized by erythema, oedema, tenderness and vesiculobullous eruption. This can be considered as an example of leprous exacerbation as described in older literature. T2Rs are common in lepromatous leprosy and not so uncommonly are observed in borderline lepromatous leprosy. The vesiculobullous and crusted lesions developing over the existing borderline plaques, some of them presenting in an annular pattern in T2R in the form of leprous exacerbation, have been reported rarely in the literature.

Systemic sarcoidosis in a case of lepromatous leprosy: a case report.

The clinical features of cutaneous sarcoidosis and leprosy are some times difficult to differentiate and there have been many reports where pulmonary sarcoidosis was treated as pulmonary tuberculosis or a case of sarcoidosis was treated with anti-leprosy multidrug therapy, before a correct diagnosis was made. So far there has been only one published case report of leprosy and sarcoidosis co-infection, where tuberculoid leprosy developed in a case of sarcoidosis, known for over a decade. We are reporting a case of dual affliction, where sarcoidosis was discovered (on routine screening) in a case of lepromatous leprosy, after administration of 2 years of multidrug therapy. The role of mycobacterial antigens (among a vast array of different animate or inanimate particles) in causation of sarcoidosis, is still speculative, as reviewed from literature.

Epidemiology of animal bites and rabies cases in India. A multicentric study.

Rabies, a disease of antiquity continues to be a major public health problem in India. Multiple factors contribute to high mortality and morbidity due to animal bites. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. The study was carried out as a part of Agreement for Performance of Work (APW) from World Health Organization (WHO) during the period April 2001 to September 2002. Two sets of proformae were developed and used after field testing to interview cases of animal bites and get retrospective information about rabies cases. The study was carried out at six selected centres across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry and was co-ordinated by National Institute of Communicable Diseases (NICD), Delhi. The officials engaged in the study work were thoroughly trained in the study methodology before the start of the study itself. To maintain quality and uniformity supervisory checks were done during the survey. A total of 1357 fresh animal bite victims were interviewed (exit interview) from the anti-rabies centres (ARCs). Dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%) etc. Most bites (64.3%) were unprovoked bites by stray (64.7%) animals. In this study 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years. 63% had Category III exposure as per the WHO classification. Before coming to ARCs 58.5% people had washed the wound with water/soap or water alone. Some of the bite victims (10.8%) had also applied chillies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid, ash given by Peer Baba (magician) etc. These practices varied from one region to another. The practice of wound washing at the ARC which is an important component of animal bite management was being practiced at only one of the six centres. Of the six centres, Rabies Immunoglobulin (RIG) was available and was being used at only two centres. The study was conducted in public sector ARCs where Nervous Tissue Vaccine (NTV) was available free of cost. All the centres were using NTV except Coonoor, which is using indigenously produced Tissue Culture Vaccine along with NTV. Analysis of 192 case records of rabies cases, from two centres, revealed that dog bites caused maximum mortality (96.9%). Nearly 40% were children below 15 years of age and 78.6% were males indicating that it is an exposure related disease. In all cases, failure to seek timely and appropriate treatment led to development of disease. This paper provides an overview of epidemiology of animal bites and retrospective information about rabies patients. There is a need to strengthen Information, Education and Communication (IEC) programme regarding merits of local wound management including "do's and don'ts". ARCs should be strengthened in terms of facilities and availability of safe and effective anti rabies immunobiologicals. There is a need to create awareness regarding epidemiology and at-home and hospital management of animal bites among the service providers and general community.

Immunohistochemical and molecular genetic study on epithelioid glioblastoma: Series of seven cases with review of literature.

Epithelioid glioblastoma (e-gbm) is a recently described variant of glioblastoma (GBM) which is associated with short survival and now added as a provisional entity to WHO 2016 classification of CNStumors. About half of these tumors show characteristic BRAF-V600E mutation. However, unlike conventional GBMs, e-gbm lack specific diagnostic and prognostic markers. Hence, we aimed to molecularly characterize these tumors. An extensive review of literature was performed.In a multi-institutional effort, all the cases of glioblastoma of year 2017 were reviewed. Cases with predominant epithelioid morphology were analysed. Seven cases of e-gbm (adults:4 and pediatric: 3) were identified. Duration of symptoms varied from 2 weeks to one month. Radiologically, all cases were supratentorial, contrast enhancing with solid and cystic appearance. Majority of the cases were immunopositive for GFAP (71%), EMA (71%), S100 (71%) and vimentin (85%). All the cases showed ATRX, INI-1 and H3K27me3 expression. BRAFV600Emutation was seen in 28% of cases. TERT mutation was seen in 40% cases, while one case showed EGFR amplification. H3F3A mutations and PTEN deletions were seen in none. Although e-gbms are rare, epithelioid morphology of a CNS tumor in a young adult or children with areas of necrosis needs thorough histomorphological and genetic workup.

Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient.

Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz, visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent and more significantly from a non-endemic area.

Reproducibility of radiographic stage assessment of third molars.

UNLABELLED: The aim of this study was to determine intra- and inter-observer variability of the developing third molar from panoramic radiographs. Formation of third molars was assessed according to stages described by modified Demirjian et al.'s methods: Moorrees et al. [C.F.A. Moorrees, E.A. Fanning, E.E. Hunt, Age variation of formation stages for ten permanent teeth, J. Dent. Res. 42 (1963) 1490-1502] and Solari and Abramovitch [A.C. Solari, K. Abramovitch, The accuracy and precision of third molar development as an indicator of chronological age in Hispanics, J. Forensic Sci. 47 (2002) 531-535]; in addition, data were also analysed unmodified, i.e. Haavikko [K. Haavikko, The formation and alveolar and clinical eruption of the permanent teeth, an orthopantomograph study, Proc. Finn. Dent. Soc. 66 (1970) 104-170] and Demirjian et al. [A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211-227]. The sample was a random selection of 73 panoramic radiographs from patients aged 8-24 years. After training, the left maxillary and mandibular third molars were scored on two separate occasions without knowledge of previous scores. Cohen's Kappa and percentage agreement were calculated for each method, for maxillary, for mandibular third molars and combined. Percentage agreement for stages was also calculated. Intra-observer agreement was greater for mandibular third molars compared to maxillary third molars, and better for methods with fewer stages. Kappa values indicated good agreement for most methods; the best was Demirjian et al.'s method for mandibular third molar with very good agreement (K = 0.80) for the first author, good agreement for the second author (K = 0.75) and good agreement between observers (K = 0.75). The stages with best agreement were Demirjian's stage E [A. Demirjian, H. Goldstein, J.M. Tanner, A new system of dental age assessment, Hum. Biol. 45 (1973) 211-227] and Moorrees et al.'s stage Cc and R1/4 [C.F.A. Moorrees, E.A. Fanning, E.E. Hunt, Age variation of formation stages for ten permanent teeth, J. Dent. Res. 42 (1963) 1490-1502]. CONCLUSIONS: Having clearly defined stages and fewer stages allowed better reproducibility of third molar formation.

Co-existence of classic familial lecithin-cholesterol acyl transferase deficiency and fish eye disease in the same family.

We report a family with a rare genetic disorder arising out of mutation in the gene that encodes for the enzyme lecithin-cholesterol acyltransferase (LCAT). The proband presented with nephrotic syndrome, hemolytic anemia, cloudy cornea, and dyslipidemia. Kidney biopsy showed certain characteristic features to suggest LCAT deficiency, and the enzyme activity in the serum was undetectable. Mother and younger sister showed corneal opacity and dyslipidemia but no renal or hematological involvement. These two members had a milder manifestation of the disease called fish eye disease. This case is presented to emphasize the importance of taking family history and doing a good clinical examination in patients with nephrotic syndrome and carefully analyze the lipid fractions in these subset of patients.

Attitude of medical students towards occupational safety and health: a multi-national study.

BACKGROUND: Work-related diseases contribute immensely to the global burden of diseases. Better understanding of attitudes of health care workers towards occupational safety and health (OSH) is important for planning. OBJECTIVE: To assess the attitude of medical students towards OSH around the globe. METHODS: A questionnaire assessing the attitude towards OSH was administered to medical and paramedical students of 21 Medical Universities across the globe. In the current study 1895 students, aged 18-36 years, from 17 countries were included. After having performed a principal components analysis, the associations of interest between the identified components and other socio demographic characteristics were assessed by multivariate linear regression. RESULTS: Principal component analysis revealed 3 components. Students from lower and lower-middle-income countries had a more positive attitude towards OSH, but the importance of OSH was still rated higher by students from upper-income countries. Although students from Asian and African continents showed high interest for OSH, European and South-Central American students comparatively rated importance of OSH to be higher. Paramedical students had more positive attitude towards OSH than medical students. CONCLUSION: The attitude of students from lower-income and lower-middle-income towards importance of OSH is negative. This attitude could be changed by recommending modifications to OSH courses that reflect the importance of OSH. Since paramedical students showed more interest in OSH than medical students, modifications in existing health care system with major role of paramedics in OSH service delivery is recommended.

Neurological evaluation and intelligence testing in the child with operated congenital heart disease.

BACKGROUND: The immediate and intermediate-term neurodevelopmental outcome in infants undergoing open heart procedures using deep hypothermic cardiopulmonary bypass was assessed prospectively. METHODS: One hundred consecutive infants (age 2 to 174 days) were operated on using either deep hypothermic bypass only (group A, n = 28), or with associated circulatory arrest (group B, n = 72). Early neurological outcome was recorded. Survivors underwent mental development evaluation after 31 to 55 months. Fifty other children of similar demographic profile but without heart disease were also tested as controls. RESULTS: In group A, there were two neurological deaths. In group B, 5 patients had clinical seizures, 1 had monoparesis and 1 had hyperkinetic syndrome with decreased attention span. Mean mental performance quotient was 90.0+/-8.2 in group A, and 89.1+/-6.8 in group B, (group A vs. B, p = 0.60). Mean mental performance quotient in the control group was 101.4+/-8.4, which was significantly higher than the patient population (p << 0.001). No correlation was found between duration of circulatory arrest and postoperative mental performance quotient. CONCLUSIONS: There was significant retardation of mental development in infants operated with deep hypothermic cardiopulmonary bypass. However, use of total circulatory arrest and its duration did not affect clinical outcome up to preschool age.

Isonicotinic acid hydrazide induced anagen effluvium and associated lichenoid eruption.

A 32 year-old woman developed generalised lichenoid eruptions on her body followed by diffuse loss of scalp hair of the anagen effluvium type. She was receiving several anti-tubercular drugs, including rifampicin, isonicotinic acid hydrazide (INH), pyrazinamide, and ethambutol, for abdominal tuberculosis. INH, which is a leading cause of drug eruptions in the above group of drugs was withdrawn. However, the other antitubercular drugs were continued along with 40 mg of prednisolone in a single daily morning dose. The latter was discontinued slowly over a period of 10 weeks. There was complete recovery of hair loss and the regrowth started after 12 weeks of alopecia. Such anagen effluvium with lichenoid eruption following INH therapy has not been observed previously. The complete recovery from anagen effluvium is difficult to explain, but it could have been because of the early initiation of corticosteroid.

Odontotrichodysplasia: a case report with a review of conditions combining ectodermal dysplasia (subgroup 1-2) with skin manifestations.

We report a 5-year-old girl with partial anodontia, hypotrichosis, hyperpigmentation of the skin, absence of pilosebaceous structures, and long thin fingers. There has as yet been, to the best of our knowledge, no report of such a combination of features. A review of conditions combining ectodermal dysplasia (subgroup 1-2) with skin manifestations is presented.

Isolated collagenoma: a case report with a review of connective tissue nevi of the collagen type.

A 22-year-old male had had five skin colored tumorous growths on the mid-palm, ring and little fingers of the right hand for the last 15 years. Histopathological examination with hematoxylin and eosin and special stains confirmed the diagnosis of connective tissue nevi of collagen type. There were no associated cutaneous or systemic findings; thus the case was designated as isolated collagenoma. A review of connective tissue nevi of the collagen type is presented.

The quality of life in successful live-related renal allograft recipients in India.

BACKGROUND: The high cost of maintenance of haemodialysis makes most patients in India and elsewhere opt for a renal transplant. The degree of rehabilitation can best be assessed by evaluating the quality of life in successful recipients. METHODS: We studied vocational rehabilitation, social relations, sexual and married life, psychological status and life satisfaction in 51 successful live-related renal allograft recipients using Schwab's depressive scale, Bigot's life satisfaction index and the Kamofsky physical scale. RESULTS: Eight-four per cent of our patients had returned to their original jobs. Ninety-eight per cent of patients had a Kamofsky scale of 90-100 and 81% were leading a normal married life. Ninety-four per cent of them led an active social life. CONCLUSION: Successful live-related renal transplantation is associated with a good quality of life and should be the treatment of choice for patients with end-stage renal disease.

Isolated common bile duct tuberculosis.

We report a patient with isolated involvement of common bile duct by tuberculosis. The diagnosis was established by histological examination of the resected specimen. Surgery and antitubercular chemotherapy resulted in complete recovery.

Immunogenicity and feasibility of purified chick embryo cell vaccine.

Two hundred seventy-one children reported at the WHO Collaborative Centre for Rabies Epidemiology for South-East Asia at National Institute of Communicable Diseases, Delhi, for advice and antirabies antibody assessment after post-exposure prophylaxis with purified chick embryo cell (PCEC) antirabies vaccine from January 1986 to October 1992. Vaccine was very well tolerated by these children and only 7% complained about mild to moderate side reactions like pain, induration, fever or rash. On an average, every year 50-55 children had reported at this Centre after post-exposure vaccination with PCEC vaccine excepting years 1986 and 1987. One hundred and forty-four children underwent complete course of post-exposure prophylaxis, i.e., 5 or 6 doses on day 0, 3, 7, 14, 30 and 90 (optional) of PCEC vaccine were administered, forty-three (43) children received 4 doses on day 0, 7, 14 and 30 (day 3 dose was omitted) and eighty-four (84) children received 2 to 3 doses as the biting animals were alive for 10 days in these cases. Two hundred and twenty-nine children (84.5%) were bitten by dogs and in 10%, the dog was proven rabid by laboratory examination of dog brain. One hundred and forty-nine (55%) had Class III bite. Serological response, i.e., antirabies antibody titre in all these children were satisfactory (> 0.5 IU/ml) with mean titre of 1.98 IU/ml irrespective of doses of PCEC vaccine administered. No vaccine failure was observed in this study.