Genome-wide mining of diversity and evolutionary signatures revealed selective hotspots in Indian Sahiwal cattle

The Sahiwal cattle breed is the best indigenous dairy cattle breed, and it plays a pivotal role in the Indian dairy industry. This is due to its exceptional milk-producing potential, adaptability to local tropical conditions, and its resilience to ticks and diseases. The study aimed to identify selective sweeps and estimate intrapopulation genetic diversity parameters in Sahiwal cattle using ddRAD sequencing-based genotyping data from 82 individuals. After applying filtering criteria, 78,193 high-quality SNPs remained for further analysis. The population exhibited an average minor allele frequency of 0.221 ± 0.119. Genetic diversity metrics, including observed (0.597 ± 0.196) and expected heterozygosity (0.433 ± 0.096), nucleotide diversity (0.327 ± 0.114), the proportion of polymorphic SNPs (0.726), and allelic richness (1.323 ± 0.134), indicated ample genomic diversity within the breed. Furthermore, an effective population size of 74 was observed in the most recent generation. The overall mean linkage disequilibrium (r2) for pairwise SNPs was 0.269 ± 0.057. Moreover, a greater proportion of short Runs of Homozygosity (ROH) segments were observed suggesting that there may be low levels of recent inbreeding in this population. The genomic inbreeding coefficients, computed using different inbreeding estimates (FHOM, FUNI, FROH, and FGROM), ranged from -0.0289 to 0.0725. Subsequently, we found 146 regions undergoing selective sweeps using five distinct statistical tests: Tajima's D, CLR, |iHS|, |iHH12|, and ROH. These regions, located in non-overlapping 500 kb windows, were mapped and revealed various protein-coding genes associated with enhanced immune systems and disease resistance (IFNL3, IRF8, BLK), as well as production traits (NRXN1, PLCE1, GHR). Notably, we identified interleukin 2 (IL2) on Chr17: 35217075-35223276 as a gene linked to tick resistance and uncovered a cluster of genes (HSPA8, UBASH3B, ADAMTS18, CRTAM) associated with heat stress. These findings indicate the evolutionary impact of natural and artificial selection on the environmental adaptation of the Sahiwal cattle population.

Stable isotope labeling as a promising tool for rapid drug susceptibility testing in Neisseria gonorrhoeae

The world is heading towards an era of intractable and impending untreatable N. gonorrhoeae, thereby underlining the significance of rapid and accurate prediction of drug resistance as an indispensable need of the hour. In the present study, we optimized and evaluated a stable isotope labeling-based approach using the MALDI-TOF MS (Matrix-Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry) for rapid and reliable detection of ciprofloxacin and azithromycin resistance in N. gonorrhoeae. All the isolates were cultured under three varied condition setups viz. medium supplemented with normal lysine, heavy lysine (isotope), and heavy lysine along with the antibiotics (ciprofloxacin/azithromycin), respectively. After incubation, spectra were acquired using the MALDI-TOF MS which were further screened for unique patterns (media-specific spectra) to differentiate drug-susceptible and resistant isolates. The results of the stable isotope labeling assay were comparable to the results of phenotypic methods used for susceptibility testing.

Diffuse large B-cell lymphoma: An uncommon diagnosis at the cerebellopontine angle - A case report

Primary central nervous system lymphoma (PCNSL), a rare variant of extranodal non-Hodgkin's lymphoma, has shown an increased incidence over the last 3-4 decades in both immunocompromised and immunocompetent individuals. Only <20 cases of cerebellopontine (CP) angle lymphoma have been reported so far in the literature. Hereby, we report a case of primary lymphoma of the CP angle mimicking vestibular schwannoma and other common pathologies at the CP angle. Hence, while evaluating a lesion at CP angle, PCNSL should always be considered in the differential diagnosis.

Remote ischaemic conditioning: defining critical criteria for success-report from the 11th Hatter Cardiovascular Workshop

The Hatter Cardiovascular Institute biennial workshop, originally scheduled for April 2020 but postponed for 2 years due to the Covid pandemic, was organised to debate and discuss the future of Remote Ischaemic Conditioning (RIC). This evolved from the large multicentre CONDI-2-ERIC-PPCI outcome study which demonstrated no additional benefit when using RIC in the setting of ST-elevation myocardial infarction (STEMI). The workshop discussed how conditioning has led to a significant and fundamental understanding of the mechanisms preventing cell death following ischaemia and reperfusion, and the key target cyto-protective pathways recruited by protective interventions, such as RIC. However, the obvious need to translate this protection to the clinical setting has not materialised largely due to the disconnect between preclinical and clinical studies. Discussion points included how to adapt preclinical animal studies to mirror the patient presenting with an acute myocardial infarction, as well as how to refine patient selection in clinical studies to account for co-morbidities and ongoing therapy. These latter scenarios can modify cytoprotective signalling and need to be taken into account to allow for a more robust outcome when powered appropriately. The workshop also discussed the potential for RIC in other disease settings including ischaemic stroke, cardio-oncology and COVID-19. The workshop, therefore, put forward specific classifications which could help identify so-called responders vs. non-responders in both the preclinical and clinical settings.

Deep Learning for Discrimination Between Fungal Keratitis and Bacterial Keratitis: DeepKeratitis

PURPOSE

Microbial keratitis is an urgent condition in ophthalmology that requires prompt treatment. This study aimed to apply deep learning algorithms for rapidly discriminating between fungal keratitis (FK) and bacterial keratitis (BK).

METHODS

A total of 2167 anterior segment images retrospectively acquired from 194 patients with 128 patients with BK (1388 images, 64.1%) and 66 patients with FK (779 images, 35.9%) were used to develop the model. The images were split into training, validation, and test sets. Three convolutional neural networks consisting of VGG19, ResNet50, and DenseNet121 were trained to classify images. Performance of each model was evaluated using precision (positive predictive value), sensitivity (recall), F1 score (test's accuracy), and area under the precision-recall curve (AUPRC). Ensemble learning was then applied to improve classification performance.

RESULTS

The classification performance in F1 score (95% confident interval) of VGG19, DenseNet121, and RestNet50 was 0.78 (0.72-0.84), 0.71 (0.64-0.78), and 0.68 (0.61-0.75), respectively. VGG19 also demonstrated the highest AUPRC of 0.86 followed by RestNet50 (0.73) and DenseNet (0.60). The ensemble learning could improve performance with the sensitivity and F1 score of 0.77 (0.81-0.83) and 0.83 (0.77-0.89) with an AUPRC of 0.904.

CONCLUSIONS

Convolutional neural network with ensemble learning showed the best performance in discriminating FK from BK compared with single architecture models. Our model can potentially be considered as an adjunctive tool for providing rapid provisional diagnosis in patients with microbial keratitis.

A single - center retrospective observational study on patients undergoing Encephalo-Duro-Arterio -Myo-Synangiosis in patients with moyamoya disease

BACKGROUND:

Many cases of moyamoya disease are refractory to conventional medical therapy, hence surgical revascularization techniques have emerged as one of the primary choices of treatment. In this study, we present the functional and angiographic outcomes of patients undergoing encephalo-duro-arterio-myo-synangiosis (EDAMS).

METHODS:

This is a retrospective observational cohort study, done over 8 years (2012–2020) in a neurological center in Eastern India. Data were retrieved from the hospital's electronic system, recorded in a standard data abstract sheet, and analyzed.

RESULTS:

This study included 75 patients, with a male (n = 42; 56.0%) preponderance. Majority belonged to the pediatric age group (≤18 years) (n = 70; 93.3%); remaining adult population included 5 (6.6%) patients. The most common presenting complaint was that of an ischemic cerebrovascular accident (CVA) (n = 57; 76.0%). Symptomatic hemispheres (n = 69; 92.0%) were treated and later followed if they had progressed to bilateral disease formation. Preoperative DSA showed 50 (71.4%) to have Suzuki grade 3 type of angiographic findings. Postoperative complications included worsening unilateral hemiparesis 4 (40%), slurring of speech (n = 2; 20.0%), hematoma (n = 2; 20.0%), and surgical site infection (n = 2; 20.0%). One patient succumbed to his illness on the second postoperative day. A postoperative angiogram showed regression of moyamoya vessels in the majority (n = 69; 93.3%) of patients. All (n = 74; 100%) had an intensification of transdural vessels; none had a regression. None of the study participants showed an intensification of moyamoya vessels. Many of our patients (83.8%) had a good grade of revascularization (modified Matsushima and Inaba A and B), while 16.2% had low-grade revascularization (grade C). On assessing outcomes using a modified Rankin Score, a large number of our patients had an excellent (n = 45, 60%) neurological outcomes.

CONCLUSION:

There was a bimodal age distribution with most of them presenting with ischemic CVA. This procedure (EDAMS) had good angiographic (Matsushima and Inaba) and functional (modified Rankin Score) outcomes.

Effects of emollient therapy with sunflower seed oil on neonatal growth and morbidity in Uttar Pradesh, India: a cluster-randomized, open-label, controlled trial

BACKGROUND

Newborn oil massage is a widespread practice. Vigorous massage with potentially harmful products and forced removal of vernix may disrupt skin barrier integrity. Hospitalized, very-preterm infants treated with sunflower seed oil (SSO) have demonstrated improved growth but community-based data on growth and health outcomes are lacking.

OBJECTIVES

We aimed to test whether SSO therapy enhances neonatal growth and reduces morbidity at the population level.

METHODS

We conducted an open-label, controlled trial in rural Uttar Pradesh, India, randomly allocating 276 village clusters equally to comparison (usual care) and intervention comprised of promotion of improved massage practices exclusively with SSO, using intention-to-treat and per-protocol mixed-effects regression analysis.

RESULTS

We enrolled 13,478 and 13,109 newborn infants in demographically similar intervention and comparison arms, respectively. Adherence to exclusive SSO increased from 22.6% of intervention infants enrolled in the first study quartile to 37.2% in the last quartile. Intervention infants gained significantly more weight, by 0.94 g · kg-1 · d-1 (95% CI: 0.07, 1.82 g · kg-1 · d-1, P = 0.03), than comparison infants by intention-to-treat analysis. Restricted cubic spline regression revealed the largest benefits in weight gain (2-4 g · kg-1 · d-1) occurred in infants weighing <2000 g at birth. Weight gain in intervention infants was higher by 1.31 g · kg-1 · d-1 (95% CI: 0.17, 2.46 g · kg-1 · d-1; P = 0.02) by per-protocol analysis. Morbidities were similar by intention-to-treat analysis but in per-protocol analysis rates of hospitalization and of any illness were reduced by 36% (OR: 0.64; 95% CI: 0.44, 0.94; P = 0.02) and 44% (OR: 0.56; 95% CI: 0.40, 0.77; P < 0.001), respectively, in treated infants.

CONCLUSIONS

SSO therapy improved neonatal growth, and reduced morbidities when applied exclusively, across the facility-community continuum of care at the population level. Further research is needed to improve demand for recommended therapy inside hospital as well as in community settings, and to confirm these results in other settings.This trial was registered at www.isrctn.com as ISRCTN38965585 and http://ctri.nic.in as CTRI/2014/12/005282.

Association of ischemic electrocardiographic changes in high-altitude areas with coronary angiography

Background

Soldiers native to lowlands, while sojourning at high altitude (HA), are referred to tertiary care centers with electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying coronary artery disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma. This study sought to correlate the presence of CAD on coronary angiography (CAG) with a putative diagnosis of CAD based on clinical findings and ECG.

Methods

A prospective study was conducted on patient's from HA areas, referred for evaluation for CAD to a single center at near-sea-level. Thirty-five minimally symptomatic/asymptomatic soldiers with ECG changes suggestive of CAD, underwent CAG. Correlation was sought between ECG and CAG evidence of CAD.

Results

The association of CAD on CAG with clinical and ECG diagnosis of CAD was not significant, 4 of the 35 soldiers (11.4%) showing CAG evidence of CAD (chi square 3.849, p = 0.697). The association between symptoms and coronary artery lesions was, also, not significant, only four of twenty-three (17.4%) minimally symptomatic subjects having CAD on CAG.

Conclusion

Insignificant numbers of previously healthy persons, who present with minimal symptoms and ECG changes suggestive of CAD while sojourning at HA, have coronary artery involvement on CAG. Those with incidental ECG changes, without symptomatology, do not have CAD on CAG.

Association between overcrowded households, multigenerational households, and COVID-19: a cohort study

OBJECTIVES

The role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households and COVID-19 in New York City (NYC).

STUDY DESIGN

Cohort study.

METHODS

We conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as the proportion of the estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was an adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), the prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering.

RESULTS

39,923 suspected COVID-19 cases were presented to emergency departments across 173 ZCTAs in NYC. Adjusted COVID-19 case rates increased by 67% (IRR 1.67, 95% CI = 1.12, 2.52) in ZCTAs in quartile four (versus one) for percent overcrowdedness and increased by 77% (IRR 1.77, 95% CI = 1.11, 2.79) in quartile four (versus one) for percent living in multigenerational housing. Interaction between both exposures was not significant (β_interaction = 0.99, 95% CI: 0.99-1.00).

CONCLUSIONS

Overcrowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of the surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.

Effect of sunflower seed oil emollient therapy on newborn infant survival in Uttar Pradesh, India: A community-based, cluster randomized, open-label controlled trial

BACKGROUND

Hospitalized preterm infants with compromised skin barrier function treated topically with sunflower seed oil (SSO) have shown reductions in sepsis and neonatal mortality rate (NMR). Mustard oil and products commonly used in high-mortality settings may possibly harm skin barrier integrity and enhance risk of infection and mortality in newborn infants. We hypothesized that SSO therapy may reduce NMR in such settings.

METHODS AND FINDINGS

This was a population-based, cluster randomized, controlled trial in 276 clusters in rural Uttar Pradesh, India. All newborn infants identified through population-based surveillance in the study clusters within 7 days of delivery were enrolled from November 2014 to October 2016. Exclusive, 3 times daily, gentle applications of 10 ml of SSO to newborn infants by families throughout the neonatal period were recommended in intervention clusters (n = 138 clusters); infants in comparison clusters (n = 138 clusters) received usual care, such as massage practice typically with mustard oil. Primary analysis was by intention-to-treat with NMR and post-24-hour NMR as the primary outcomes. Secondary analysis included per-protocol analysis and subgroup analyses for NMR. Regression analysis was adjusted for caste, first-visit weight, delivery attendant, gravidity, maternal age, maternal education, sex of the infant, and multiple births. We enrolled 13,478 (52.2% male, mean weight: 2,575.0 grams ± standard deviation [SD] 521.0) and 13,109 (52.0% male, mean weight: 2,607.0 grams ± SD 509.0) newborn infants in the intervention and comparison clusters, respectively. We found no overall difference in NMR in the intervention versus the comparison clusters [adjusted odds ratio (aOR) 0.96, 95% confidence interval (CI) 0.84 to 1.11, p = 0.61]. Acceptance of SSO in the intervention arm was high at 89.3%, but adherence to exclusive applications of SSO was 30.4%. Per-protocol analysis showed a significant 58% (95% CI 42% to 69%, p < 0.01) reduction in mortality among infants in the intervention group who were treated exclusively with SSO as intended versus infants in the comparison group who received exclusive applications of mustard oil. A significant 52% (95% CI 12% to 74%, p = 0.02) reduction in NMR was observed in the subgroup of infants weighing ≤1,500 g (n = 589); there were no statistically significant differences in other prespecified subgroup comparisons by low birth weight (LBW), birthplace, and wealth. No severe adverse events (SAEs) were attributable to the intervention. The study was limited by inability to mask allocation to study workers or participants and by measurement of emollient use based on caregiver responses and not actual observation.

CONCLUSIONS

In this trial, we observed that promotion of SSO therapy universally for all newborn infants was not effective in reducing NMR. However, this result may not necessarily establish equivalence between SSO and mustard oil massage in light of our secondary findings. Mortality reduction in the subgroup of infants ≤1,500 g was consistent with previous hospital-based efficacy studies, potentially extending the applicability of emollient therapy in very low-birth-weight (VLBW) infants along the facility-community continuum. Further research is recommended to develop and evaluate therapeutic regimens and continuum of care delivery strategies for emollient therapy for newborn infants at highest risk of compromised skin barrier function.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN38965585 and Clinical Trials Registry-India (CTRI/2014/12/005282) with WHO UTN # U1111-1158-4665.

Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries

BACKGROUND

Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa.

METHODS AND FINDINGS

This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman's self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes.

CONCLUSIONS

Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths.

TRIAL REGISTRATION

The study is not a clinical trial.

Roles of Re-entrant cluster glass state and spin-lattice coupling in magneto-dielectric behavior of giant dielectric double perovskite La1.8Pr0.2CoFeO6

La based Co-Fe combined double perovskite (La1.8Pr0.2CoFeO6) was synthesized and the dielectric (zero-field and in-field), magnetic, x-ray absorption and Raman spectroscopy measurements have been investigated for La1.8Pr0.2CoFeO6 double perovskite. The existence of re-entrant cluster glass state is observed. The magneto-dielectric (MD) is found in two temperature regions (25-80 K and 125-275 K). It has been demonstrated that the observed MD at low and high temperatures are respectively due to the spin freezing and the spin-lattice coupling. Furthermore, the very large dielectric constant and the low loss suggest that La1.8Pr0.2CoFeO6 is very important from the application point of view.

Extraordinary magnetic properties of double perovskite Eu2CoMnO6 wide band gap semiconductor

Some novel magnetic behaviours in double perovskite Eu2CoMnO6 (ECMO) have been reported. The x-ray photoemission spectroscopy study shows the presence of mixed valence states of transition metal ions. The UV-visible absorption spectroscopic study suggests that the ECMO has a direct wide band gap. A second-order magnetic phase transition as a sudden jump in the magnetization curve has been observed around 124.5 K. The large bifurcation between the zero field cooling and field cooling, suggests existence of strong spin frustration in the system. The inverse DC susceptibility confirms the presence of the Griffiths like phase. Sharp steps in magnetization have been observed in the M-H curve at 2 K, which vanishes on increasing temperature. The AC susceptibility study demonstrates the Hopkinson like effect as well as the presence of volume spin-glass-like behaviour. The temperature dependent Raman spectrum shows the presence of spin-phonon coupling.

Anomalous Hall effect in Cu doped Bi2Te3 topological insulator

The angle resolved photo-emission spectroscopy (ARPES) study and magneto-transport properties of Bi2Cu x Te3-x have been investigated. ARPES study indicates the clear existence of surface states in the as-prepared samples. The estimated bandgap from ARPES is found to be ∼5 meV and 16 meV respectively for x = 0.03 and x = 0.15 samples. Presence of larger Cu concentration (x = 0.15) introduces magnetic ordering. Observed non-linearity in the Hall data is due to the existence of anomalous Hall effect which can be attributed to the 2D transport. The observed magneto-transport features might be related to the surface carriers which is confirmed by ARPES study.

Complications following Encephalo-Duro-Arterio-Myo-Synangiosis in a case of Moyamoya disease

We report a case of an 18-year-old girl diagnosed to have Moyamoya disease (MMD), who underwent bilateral encephalo-duro-arterio-myo-synangiosis. Literature search has clearly inferred that in comparison to an adult patient, children with MMD can have a good prognosis if early diagnosis and active surgical intervention are achieved. Evidence has demonstrated that active surgical management, including indirect bypass surgery, may improve the cerebral circulation on a relatively larger scale than direct bypass surgeries, which can only improve the cerebral circulation in the area of the vascular reconstruction.

P680The clinical value of CMR in the management of Cardio-Oncology patients - a tertiary centre experience

Background

There is increasing awareness of cardiotoxicity arising from cancer treatments. Early diagnosis and treatment is key, to ensure patients receive optimal oncological management. Cardiovascular magnetic resonance (CMR) offers gold standard measurement of cardiac function, alongside tissue characterisation and myocardial perfusion, thereby potentially providing additive value in the context of cardio-oncology.

Purpose

We sought to understand the clinical value of CMR in cardio-oncology at a tertiary cardio-oncology centre.

Methods

We retrospectively reviewed CMR scans requested in cardio-oncology patients at our institution within a ten-month period. We categorised clinical indications and assessed the impact on clinical management using previously-published criteria.

Results

102 CMR studies were requested in 93 cardio-oncology patients (mean age 56 (range 18 to 82), 49% male) between (March to December 2018). 41% of patients had haematological malignancies, 59% solid tumours.

15% of requests were for risk stratification prior to initiation of cancer therapy, 21% for screening for cardio-toxicity in patients currently receiving cardiotoxic agents (3% anthracyclines, 13% HER2 monoclonal antibodies, 4% fluoropyrimidines), 15% for investigation of patients with cardiac complications during cancer treatment, 35% assessment for late effects post cancer treatment, and 14% for cardiac malignancies/ infiltration.

The most common indications for CMR were monitoring of left ventricular ejection fraction (LVEF) in patients where quantification by echocardiography was non-diagnostic or significantly different between imaging studies (39%) and ischaemia assessment including for patients due to receive fluoropyrimidines (26%). Others were aetiology of LV dysfunction/cardiomyopathy (13%) and tissue characterisation (23%), including assessment for cardiac AL amyloid (11 patients), myocarditis (2), cardiac metastases (1), cardiac masses (6), and cardiac iron loading (1).

CMR findings had clinical impact in 61% of patients and assisted in adjudicating a new diagnosis in 29% of patients. 88% of patients were able to continue anthracycline/anti-HER2 therapies based on CMR findings of stable LVEF (93% of whose echocardiograms had suggested reductions). LVEF had reduced significantly in 12% of patients meaning chemotherapy was held/discontinued. 3 patients were recommended to receive non-fluoropyrimidine chemotherapy based on perfusion CMR (pCMR) findings, with one patient permitted to receive capecitabine following normal pCMR.

Conclusion

CMR provides a comprehensive assessment of myocardial structure and function with utility within the context of cardio-oncology for risk stratification pre-chemotherapy, screening for cardiotoxicity during treatment and investigation of cardiac complications of cancer treatment. The additional information derived from CMR generally provides reassurance enabling administration of optimal cancer therapies.

Investigation of multi-mode spin-phonon coupling and local B-site disorder in Pr2CoFeO6 by Raman spectroscopy and correlation with its electronic structure by XPS and XAS studies

Electronic structure of Pr₂CoFeO₆ (at 300 K) was investigated by x-ray photoemission spectroscopy (XPS) and x-ray absorption spectroscopy techniques. All three cations, i.e. Pr, Co and Fe were found to be trivalent in nature. XPS valance band analysis suggested the system to be insulating in nature. The analysis suggested that Co³⁺ ions exist in low spin state in the system. Moreover, Raman spectroscopy study indicated the random distribution of the B-site ions (Co/Fe) triggered by same charge states. In temperature-dependent Raman study, the relative heights of the two observed phonon modes exhibited anomalous behaviour near magnetic transition temperature T _N ~ 270 K, thus indicating towards interplay between spin and phonon degrees of freedom in the system. Furthermore, clear anomalous softening was observed below T _N which confirmed the existence of strong spin-phonon coupling occurring for at least two phonon modes of the system. The line width analysis of the phonon modes essentially ruled out the role of magnetostriction effect in the observed phonon anomaly. The investigation of the lattice parameter variation across T _N (obtained from the temperature-dependent neutron diffraction measurements) further confirmed the existence of the spin-phonon coupling.

Identification of Malassezia species by MALDI-TOF MS after expansion of database

The taxonomy of Malassezia species is evolving with introduction of molecular techniques, and difficulty is faced to identify the species by phenotypic methods. Among 15 known Malassezia species, the present Bruker database could identify only 2 species. The present study was aimed to improve Matrix -assisted laser desorption ionization time-flight mass spectrometry (MALDI-TOF MS) based identification of Malassezia species. A total of 88 isolates (DNA sequencing confirmed) for database preparation and, for the validation of database, 190 isolates confirmed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) were used. The main spectrum profile dendrogram showed the sufficient discrimination between all the species by MALDI-TOF MS. The updated Malassezia database could identify 94.7% and 5.3% strains to the species and genus level, respectively. MALDI-TOF MS is a significantly reliable technique, and results were comparable with PCR-RFLP with kappa value 0.9. In conclusion, MALDI-TOF MS could be a possible alternative tool to other molecular methods for rapid and accurate identification of Malassezia species.

Biosynthesis and characterization of gold nanoparticles: Kinetics, in vitro and in vivo study

This study reports a facile, cost effective, nontoxic and eco-friendly method for the synthesis of gold nanoparticles. In this paper, leaf extract of Mentha piperita was successfully used to reduce chloroauric acid, leading to synthesis of gold nanoparticles (AuNPs). The synthesized nanoparticles were further characterized by UV-visible spectroscopy, Fourier transform infrared spectroscopy, dynamic light scattering, transmission electron microscopy and field emission scanning electron microscopy. Kinetics studies like effect of volume of leaf extract, precursor, pH, temperature for the synthesis of AuNPs were studied spectrophotometrically. Synthesized AuNPs were found to possess hexagon structure where size of nanoparticles was ~78nm in diameter. These biologically synthesized AuNPs exhibited significant activity against cancerous cell lines MDA-MB-231 and A549 and was compared with the normal 3T3-L1 cell line. Anti-inflammatory and analgesic activities were studied on a Wistar rat model to gauge the impact of AuNPs for a probable role in these applications. AuNPs gave positive results for both these activities, although the potency was less as compared to the standard drugs. These results suggested that the leaves extract of Mentha piperita is a very good bioreductant for the synthesis of AuNPs and have potential for various biomedical and pharmaceutical applications.

Large power factor and anomalous Hall effect and their correlation with observed linear magneto resistance in Co-doped Bi2Se3 3D topological insulator

Magnetoresistance (MR), thermo power, magnetization and Hall effect measurements have been performed on Co-doped Bi2Se3 topological insulators. The undoped sample shows that the maximum MR as a destructive interference due to a π-Berry phase leads to a decrease of MR. As the Co is doped, the linearity in MR is increased. The observed MR of Bi2Se3 can be explained with the classical model. The low temperature MR behavior of Co doped samples cannot be explained with the same model, but can be explained with the quantum linear MR model. Magnetization behavior indicates the establishment of ferromagnetic ordering with Co doping. Hall effect data also supports the establishment of ferromagnetic ordering in Co-doped Bi2Se3 samples by showing the anomalous Hall effect. Furthermore, when spectral weight suppression is insignificant, Bi2Se3 behaves as a dilute magnetic semiconductor. Moreover, the maximum power factor is observed when time reversal symmetry (TRS) is maintained. As the TRS is broken the power factor value is decreased, which indicates that with the rise of Dirac cone above the Fermi level the anomalous Hall effect and linearity in MR increase and the power factor decreases.

Dynamics of microvesicle generation in B-cell chronic lymphocytic leukemia: implication in disease progression

Previously, we reported that B-cell chronic lymphocytic leukemia (CLL) patients contained elevated levels of microvesicles (MVs). However, given the quiescent nature of CLL B-cells and the relative indolence of the disease, the dynamics of MV generation and their unique phenotypes are not clearly defined. In this study, we find that CLL B-cells generate MVs spontaneously and can be further induced by B-cell receptor-ligation. Most interestingly, CLL B-cells predominantly generate CD52⁺ MVs, but not CD19⁺ MVs in vitro, suggesting preferential usage of CD52 into leukemic-MVs and that the CLL plasma MV phenotypes corroborate well with the in vitro findings. Importantly, we detected increased accumulation of CD52⁺ MVs in previously untreated CLL patients with progressive disease. Finally, sequential studies on MVs in pre- and post-therapy CLL patients demonstrate that while the plasma CD52⁺ MV levels drop significantly after therapy in most and remain at low levels in some patients, a trend of increased accumulation of CD52⁺ MVs was detected in majority of post-therapy CLL patients (25 of 33). In total this study emphasizes that dynamic accumulation of CD52⁺ MVs in plasma can be used to study CLL progression and may be a useful biomarker for patients as they progress and require therapy.

Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England

Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16–24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity, calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.

The prevalence of abnormal ECG in trained sportsmen

BACKGROUND

Competitive sports training causes structural and conductive system changes manifesting by various electrocardiographic alterations. We undertook this study to assess the prevalence of abnormal ECG in trained Indian athletes and correlate it with the nature of sports training, that is endurance or strength training.

METHODS

We evaluated a standard resting, lying 12 lead Electrocardiogram (ECG) in 66 actively training Indian athletes. Standard diagnostic criteria were used to define various morphological ECG abnormalities.

RESULTS

33/66 (50%) of the athletes were undertaking endurance training while the other 33 (50%) were involved in a strength-training regimen. Overall 54/66 (81%) sportsmen had significant ECG changes. 68% of these changes were considered as normal training related features, while the remaining 32% were considered abnormal. There were seven common training related ECG changes-Sinus Bradycardia (21%), Sinus Arrhythmia (16%), 1st degree Atrioventricular Heart Block (6%), Type 1 2nd-degree Atrioventicular Heart Block (3%), Incomplete Right bundle branch block (RBBB) (24%), Early Repolarization (42%), Left Ventricular Hypertrophy (LVH) (14%); while three abnormal ECG changes--T-wave inversion (13%), RBBB(4%), Right ventricular hypertrophy (RVH) with strain (29%) were noted. Early repolarization (commonest change), sinus bradycardia, and incomplete RBBB were the commoner features noticed, with a significantly higher presence in the endurance trained athletes.

CONCLUSION

A high proportion of athletes undergoing competitive level sports training are likely to have abnormal ECG recordings. Majority of these are benign, and related to the physiological adaptation to the extreme levels of exertion. These changes are commoner during endurance training (running) than strength training (weightlifting).

Enculturating science: Community-centric design of behavior change interactions for accelerating health impact

Despite significant advancements in the scientific evidence base of interventions to improve newborn survival, we have not yet been able to "bend the curve" to markedly accelerate global rates of reduction in newborn mortality. The ever-widening gap between discovery of scientific best practices and their mass adoption by families (the evidence-practice gap) is not just a matter of improving the coverage of health worker-community interactions. The design of the interactions themselves must be guided by sound behavioral science approaches such that they lead to mass adoption and impact at a large scale. The main barrier to the application of scientific approaches to behavior change is our inability to "unbox" the "black box" of family health behaviors in community settings. The authors argue that these are not black boxes, but in fact thoughtfully designed community systems that have been designed and upheld, and have evolved over many years keeping in mind a certain worldview and a common social purpose. An empathetic understanding of these community systems allows us to deconstruct the causal pathways of existing behaviors, and re-engineer them to achieve desired outcomes. One of the key reasons for the failure of interactions to translate into behavior change is our failure to recognize that the content, context, and process of interactions need to be designed keeping in mind an organized community system with a very different worldview and beliefs. In order to improve the adoption of scientific best practices by communities, we need to adapt them to their culture by leveraging existing beliefs, practices, people, context, and skills. The authors present a systems approach for community-centric design of interactions, highlighting key principles for achieving intrinsically motivated, sustained change in social norms and family health behaviors, elucidated with progressive theories from systems thinking, management sciences, cross-cultural psychology, learning and social cognition, and the behavioral sciences. These are illustrated through a case study of designing effective interactions in Shivgarh, India, that led to rapid and substantial changes in newborn health behaviors and reduction in NMR by half over a span of 16 months.

Structural, transport and optical properties of (La0.6Pr0.4)0.65Ca0.35MnO3 nanocrystals: a wide band-gap magnetic semiconductor

(La0.6Pr0.4)0.65Ca0.35MnO3 system has been synthesized via a sol-gel route at different sintering temperatures. Structural, transport and optical measurements have been carried out to investigate (La0.6Pr0.4)0.65Ca0.35MnO3 nanoparticles. Raman spectra show that Jahn-Teller distortion has been decreased due to the presence of Ca and Pr in A-site. Magnetic measurements provide a Curie temperature around 200 K and saturation magnetization (MS) of about 3.43μB/Mn at 5 K. X-ray photoemission spectroscopy study suggests that Mn exists in a dual oxidation state (Mn(3+) and Mn(4+)). Resistivity measurements suggest that charge-ordered states of Mn(3+) and Mn(4+), which might be influenced by the presence of Pr, have enhanced insulating behavior in (La0.6Pr0.4)0.65Ca0.35MnO3. Band gap estimated from UV-Vis spectroscopy measurements comes in the range of wide band gap semiconductors (∼3.5 eV); this makes (La0.6Pr0.4)0.65Ca0.35MnO3 a potential candidate for device application.

Matrix-assisted laser desorption ionization time-of-flight mass spectrometry for the rapid identification of yeasts causing bloodstream infections

Few studies have systematically standardised and evaluated matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for identification of yeasts from bloodstream infections. This is rapidly becoming pertinent for early identification of yeasts and appropriate antifungal therapy. We used 354 yeast strains identified by polymerase chain reaction (PCR) sequencing for standardisation and 367 blind clinical strains for validation of our MALDI-TOF MS protocols. We also evaluated different sample preparation methods and found the on-plate formic acid extraction method as most cost- and time-efficient. The MALDI-TOF assay correctly identified 98.9% of PCR-sequenced yeasts. Novel main spectrum projections (MSP) were developed for Candida auris, C. viswanathii and Kodamaea ohmeri, which were missing from the Bruker MALDI-TOF MS database. Spectral cut-offs computed by receiver operating characteristics (ROC) analysis showed 99.4% to 100% accuracy at a log score of ≥ 1.70 for C. tropicalis, C. parapsilosis, C. pelliculosa, C. orthopsilosis, C. albicans, C. rugosa, C. guilliermondii, C. lipolytica, C. metapsilosis, C. nivariensis. The differences in the species-specific scores of our standardisation and blind validation strains were not statistically significant, implying the optimal performance of our test protocol. The MSPs of the three new species also were validated. We conclude that MALDI-TOF MS is a rapid, accurate and reliable tool for identification of bloodstream yeasts. With proper standardisation, validation and regular database expansion, its efficiency can be further enhanced.

Spinigerin induces apoptotic like cell death in a caspase independent manner in Leishmania donovani

Antimicrobial peptides (AMPs) are multifunctional components of the innate immune system. Chemotherapeutic agents used for treatment of visceral leishmaniasis (VL) are now threatened due to the emergence of acquired drug resistance and toxicity. AMPs are attractive alternative to conventional pharmaceuticals. In this study, first time we explored the antileishmanial activity of spinigerin originally derived from Pseudacanthotermes spiniger. Leishmania donovani promastigotes present apoptosis-like cell death upon exposure to spinigerin (IC50, 150 μM). The infection rate was reduced by 20% upon exposure to 150 μM spinigerin but no cytotoxicity on host macrophages was observed. Elevation of intracellular ROS level and down-regulation of two ROS detoxifying enzymes, ascorbate peroxidase (APx) and trypanothione reductase (TR) suggested essential role of ROS machinery during spinigerin mediated cell death. About 97% cell population was found to be Annexin-V positive; 44% cells being highly Annexin-V positive. Moreover, we observed morphological changes like cell rounding, nuclear condensation, oligonucleosomal DNA degradation and TUNEL positive cells without loss of membrane integrity upon spinigerin exposure, suggests apoptosis-like death. Interestingly, collapse in mitochondrial membrane potential and increased level of intracellular ROS and calcium were not associated with caspase like activity. Computational analysis suggests spiningerin interacts with trypanothione reductase and thus probably interferes its function to detoxify the toxic ROS level. Therefore, spinigerin induces apoptosis-like cell death in L. donovani in a caspase-independent manner. The study elucidates the antileishmanial property of spinigerin that may be considered for future chemotherapeutic option alone or adjunct with other drug regimens for improved treatment of visceral leishmaniasis.

Determination of anthelmintic activity of the leaf and bark extract of tamarindus indica linn

The aim of the present study was to evaluate the anthelmintic activity of ethanolic and aqueous extract of leaves and bark of Tamarindus indica Linn using Pheretima posthuma and Tubifex tubifex as test worms. The time of paralysis and time of death were studied and the activity was compared with piperazine citrate as reference standard. The alcohol and aqueous extract of bark of Tamarindus indica exhibited significant anthelmintic activity as evidenced by decreased paralyzing time and death time. The results thus support the use of Tamarindus indica as an anthelmintic agent.

The levels of zinc and molybdenum in hair and food grain in areas of high and low incidence of esophageal cancer: a comparative study

The outcome of different studies on the role of Zn & Mo in esophageal cancer (EC) is conflicting. Here, the levels of those elements in hair as well as food grain of two different ethnic populations across two continents have been studied to explore their role in EC. Two different ethnic populations are taken from (i) Eastern Cape, South Africa (RSA), an area of very high incidence of EC and (ii) West Bengal, India, an area of low incidence of that disease. Each ethnic population is divided into two groups: case and control (n=30 for all groups). Hair samples from all groups and food grains from RSA and India are analyzed for Zn & Mo content. This study shows a strong correlation between reduced levels of those elements in hair and the development of EC in RSA (both Zn & Mo: p<0.0001), though it is only suggestive in Indian context (both Zn & Mo: p≥0.05). Interestingly, control group of RSA shows significantly reduced level of those elements in hair even with respect to Indian case group (Zn: p<0.001 & Mo: p<0.00001). Food grain from RSA has significantly reduced level of those elements with respect to India (both Zn & Mo: p<0.0001). This deficiency of Zn & Mo in food grains can be correlated to the deficiency of those elements in hair of RSA population. The deficiency of Zn & Mo can be correlated to the development of EC.

Anaerobic capacity of physically active eumenorrheic females at mid-luteal and mid-follicular phases of ovarian cycle

AIM

The present study was undertaken to evaluate the anaerobic capacity in repeated sprint cycling bouts during mid-luteal (ML) and mid-follicular (MF) phases of ovarian cycle.

METHODS

Twelve physically active females aged 22.41±1.68 years, with normal regular menstrual cycle and VO2max of 34.92±4.85 mL·kg-1·min-1 volunteered as subjects in this study. The menstrual phases were verified through daily basal body temperature recording and serum progesterone analysis. Anaerobic capacity was quantified by measuring maximal accumulated oxygen deficit (MAOD). In this study, MAOD was measured following well established method. Initially, the VO2max of the subjects was measured following a graded exercise protocol on a cycle ergometer. On separate days, the subjects performed sub-maximal cycling exercise at 50%, 60%, 70% and 80% of VO2max for 10 minutes. The linear regression determined from the sub-maximal VO2-power relationship was used to estimate the supra-maximal power output at 120% VO2max. The subjects performed repeated sprint cycling for 3 times at 120% of VO2max with 20 minutes rest between consecutive sprints during MF and ML phases.

RESULTS

Results indicated there was no significant difference in maximal accumulated oxygen deficit (MAOD) and sprint performance between MF and ML phases in repeated sprint cycling. Serum progesterone was significantly lower in luteal phase after repeated sprints.

CONCLUSION

Hence, it is concluded that the anaerobic capacity is unaffected by ovarian phases in women with regular menstrual cycle. Lower serum progesterone after repeated sprints might be due to the repeated anaerobic activity.

A comparative study of oral tramadol and ibuprofen in postoperative pain in operations of lower abdomen

The objective of this study was to assess efficacy and safety of oral tramadol in postoperative pain in operations of lower abdomen as compared to oral ibuprofen. Eighty patients undergoing operations in the lower abdomen under spinal anaesthesia were randomly assigned to two parallel groups--ibuprofen 400 mg thrice daily and tramadol 100 mg thrice daily, both orally after food. Treatment was given single-blind for 5 days in the postoperative period. Patient's perception of pain scored byvisual analogue scale (VAS) and wound tenderness assessed by a 3-point ordinal scale were the primary efficacy parameters. A steady decline in VAS pain score from baseline to study end (99.7 +/- 2.75 to 54.4 +/- 9.71 in the ibuprofen group and 97.3 +/- 3.14 to 52.5 +/- 9.95 in tramadol group) indicated good analgesic efficacy in both groups. Within groups, comparisons showed highly significant difference in VAS score between baseline and each of the subsequent assessment time points (p < 0.001). Between groups differences were not significant at any point. There were no intergroup differences in wound tenderness at baseline or at study end. Rescue medication was needed by 6 subjects on ibuprofen but none on tramadol (p = 0.011). Both regimens were well tolerated. It can be thus concluded that oral tramadol is safe, effective and comparable to ibuprofen as analgesic for relieving pain in the postoperative period in patients undergoing operations in the lower abdomen. The need for rescue medication for breakthrough pain may be less with tramadol.

Effects of Petroleum Ether Extract of Amorphophallus paeoniifolius Tuber on Central Nervous System in Mice

The central nervous system activity of the petroleum ether extract of Amorphophallus paeoniifolius tuber was examined in mice, fed normal as well as healthy conditions. The petroleum ether extract of Amorphophallus paeoniifolius tuber at the doses of 100, 300 and 1000 mg/kg showed significant central nervous system activity in mice.

Questionnaire survey of physicians: Design and practical use in nephrology

As medicine grows in complexity, it is imperative for physicians to update their knowledge base and practice to reflect current standards of care. Postgraduate training offers a golden opportunity for resident physicians to create a strong foundation of concepts in medicine. There is a need for assessing the knowledge of residents regarding established clinical practice guidelines and their perceptions regarding patient care and management. In this paper, we review how questionnaire surveys can be designed and applied to identify significant gaps in resident knowledge and inappropriate attitudes and beliefs. This evaluation has important implications for program directors who can then initiate measures to improve resident education. Such efforts during residency training have the potential of improving patient outcomes. We discuss the design of the questionnaire, its pre-testing and validity measures, online distribution, efficient response collection, data analysis, and possible future research. Finally, we illustrate this method of educational research with a questionnaire survey designed to measure the awareness of chronic kidney disease among internal medicine residents.

Importance of ischaemic time as a predictor of LV systolic function in Indians

OBJECTIVE

Sucessful reperfusion therapy in AMI improves LV systolic function. Success in thrombolytic therapy is directly related to the ischaemic time. Our aim in the present study was to observe the importance of ischaemic time as a predictor of left ventricular systolic function in patients undergoing PPCI. In addition, the contribution of presentation delay in determining the ischaemic time in the Indian scenario was also observed.

MATERIALS & METHODS

The present pilot study was carried out on 48 Indian patients (Male-40) of STEMI (Killip class I & II) undergoing primary PCI in last 2 yrs. Suggestive chest pain, ECG evidence of STEMI coming within 12 hrs were the inclusion criteria. Patients coming after 12 hours without ongoing chest pain, Killip class III & IV, the patients who were thrombolysed outside and the patients with prior PCland/or CABG were excluded from the study. Cardiac echodoppler study was done in every patient during followup at one month.Every patient received pre and peri procedural abciximab infusion and thrombosuction was done in all before deployment of BMS during the transfemoral primary PCI.

RESULTS

Data analysis revealed mean age was 57.6 yrs, male preponderance (80%),diabetes (35%),hypertension (61%), Smoking (61%), average total ischaemic time 7.6 +/- 3.78 hours, average presentation delay 6.26 +/- 3.77 hrs, average door to balloon time 60 +/- 14 mins, SVD (69%), LAD involvement(60%). Multivariate regression analysis without considering any other factor showed predicted LV Systolic function one month post PPCI to be 74.08%. Mean LVEF: 58.2%. Most interesting observation is 0.63% reduction of predicted LVEF for each hour increment of ischaemic time. Also LAD occlusion is associated with 4.91% reduction of predicted LVEF compared to other vessel(s) involvement. All the 48 patients who underwent PPCI not only survived but also had good LV Systolic function one month post PPCI.

CONCLUSION

Ischaemic time is an important predictor of LV Systolic function even after PPCI. lncrease in ischaemic time by one hour reduces predicted LVEF by 0.63%.Presentation delay is mostly responsible for total ischaemic time in India.

Pulmonary carcinosarcoma masquerading as a cryptic disseminated malignancy

Pulmonary carcinosarcoma is an aggressive rare malignant tumor comprising a mixture of carcinoma and sarcoma components containing differentiated mesenchymal elements, such as malignant cartilage, bone, and skeletal muscle. We report a case which presented with unusual clinical features and proved cryptic until death. At autopsy, it was a stage IV lung malignancy and histopathology revealed a carcinosarcoma comprising an adenocarcinoma and an osteosarcoma with metastasis to the heart, lymph nodes, and both adrenals. To our knowledge, this is the first case of this subtype with metastasis to the heart. The present case had an unusual clinical presentation and its elusive nature towards diagnosis despite dissemination is noteworthy and unique in the literature.