A cross sectional analysis of medical device associated adverse events with radiotherapy devices - A materiovigilance study.

BACKGROUND: Materiovigilance is a method for tracking, documenting, and analyzing the causal factors of adverse outcomes or complications associated with the use of medical devices. In addition, it recommends that the Indian regulatory authority takes necessary steps with the aim of enhancing patient safety. The present study was taken up as there are hardly any studies available in the public domain on adverse events due to radiotherapy. OBJECTIVE: The objective of the study is to analyze the pattern of adverse events due to medical devices used in the department of radiation oncology. METHODS: It was a cross-sectional study carried out from June to September, 2022. The patients who were treated with the medical devices in radiation oncology at Victoria Hospital affiliated with Bangalore Medical College and Research Institute, Bengaluru, were included. The medical device used on the patients causes adverse events. The data were collected from the patient's health records available in the department of radiotherapy. RESULTS: Total 40 adverse events collected as per inclusion and exclusion criteria were analyzed. All the adverse events associated with medical devices were filled in the medical device adverse event reporting form and submitted to materiovigilance program, which also included the causality assessment. All the adverse events were caused due to external beam radiotherapy/teletherapy device. Dermatitis was the most common adverse event found in the reported cases (n = 20, 50%). CONCLUSION: Materiovigilance program is in budding stage. It was observed that the adverse events in patients were due to medical devices used in radiation oncology. Medical devices with skin-sparing effect (radiation is converged onto tumor) should be promoted and more research and engineering are required in designing of advanced medical devices for the treatment of cancer across the globe.

Spin-dependent electrified protein interfaces for probing the CISS effect.

Bio-spinterfaces present numerous opportunities to study spintronics across the biomolecules attached to (ferro)magnetic electrodes. While it offers various exciting phenomena to investigate, it is simultaneously challenging to make stable bio-spinterfaces as biomolecules are sensitive to many factors that it encounters during thin-film growth to device fabrication. The chirality-induced spin-selectivity effect is an exciting discovery, demonstrating an understanding that a specific electron's spin (either up or down) passes through a chiral molecule. The present work utilizes Ustilago maydis Rvb2 protein, an ATP-dependent DNA helicase (also known as Reptin), to fabricate bio-spintronic devices to investigate spin-selective electron transport through the protein. Ferromagnetic materials are well-known for exhibiting spin-polarization, which many chiral and biomolecules can mimic. We report herein spin-selective electron transmission through Rvb2 that exhibits 30% spin polarization at a low bias (+0.5 V) in a device configuration, Ni/Rvb2 protein/indium tin oxide measured under two different magnetic configurations. Our findings demonstrate that biomolecules can be put in circuit components without any expensive vacuum deposition for the top contact. The present study holds a remarkable potential to advance spin-selective electron transport in other biomolecules, such as proteins and peptides, for biomedical applications.

Zn2+-Induced Conformational Change Affects the SAM Binding in a Mycobacterial SAM-Dependent Methyltransferase.

Zinc is a cofactor for enzymes involved in DNA replication, peptidoglycan hydrolysis, and pH maintenance, in addition to the transfer of the methyl group to thiols. Here, we discovered a new role of Zn2+ as an inhibitor for S-adenosyl methionine (SAM) binding in a mycobacterial methyltransferase. Rv1377c is annotated as a putative methyltransferase that is upregulated upon the mitomycin C treatment of Mycobacterium tuberculosis. Sequence analysis and experimental validation allowed the identification of distinct motifs responsible for SAM binding. A detailed analysis of the AlphaFold-predicted structure of Rv1377c revealed four cysteine residues capable of coordinating a Zn2+ ion located in proximity to the SAM-binding site. Further, experimental studies showed distinct conformational changes upon Zn2+ binding to the protein, which compromised its ability to bind SAM. This is the first report wherein Zn2+-driven conformational changes in a methyltransferase undermines its ability to bind SAM.

Ectodysplasin pathogenic variants affecting the furin-cleavage site and unusual clinical features define X-linked hypohidrotic ectodermal dysplasia in India.

Hypohidrotic ectodermal dysplasia (HED) is a rare genetic disorder caused by mutational inactivation of a developmental pathway responsible for generation of tissues of ectodermal origin. The X-linked form accounts for the majority of HED cases and is caused by Ectodysplasin (EDA) pathogenic variants. We performed a combined analysis of 29 X-linked hypohidrotic ectodermal dysplasia (XLHED) families (including 12 from our previous studies). In addition to the classical triad of symptoms including loss (or reduction) of ectodermal structures, such as hair, teeth, and sweat glands, we detected additional HED-related clinical features including facial dysmorphism and hyperpigmentation in several patients. Interestingly, global developmental delay was identified as an unusual clinical symptom in many patients. More importantly, we identified 22 causal pathogenic variants that included 15 missense, four small in-dels, and one nonsense, splice site, and large deletion each. Interestingly, we detected 12 unique (India-specific) pathogenic variants. Of the 29 XLHED families analyzed, 11 (38%) harbored pathogenic variant localized to the furin cleavage site. A comparison with HGMD revealed significant differences in the frequency of missense pathogenic variants; involvement of specific exons and/or protein domains and transition/transversion ratios. A significantly higher proportion of missense pathogenic variants (33%) localized to the EDA furin cleavage when compared to HGMD (7%), of which p.R155C, p.R156C, and p.R156H were detected in three families each. Therefore, the first comprehensive analysis of XLHED from India has revealed several unique features including unusual clinical symptoms and high frequency of furin cleavage site pathogenic variants.

Characterization and biocontrol potential of a naturally occurring isolate of Metarhizium pingshaense infecting Conogethes punctiferalis.

An entomopathogenic fungus was isolated from an infected larva of Conogethes punctiferalis (Guenée) (Crambidae: Lepidoptera), a highly polyphagous pest recorded from more than 120 plants and widely distributed in Asia and Oceanic countries. The fungus was identified as Metarhizium pingshaense Q.T. Chen & H.L. Guo (Ascomycota: Hypocreales) based on morphological characteristics and molecular studies. Scanning electron microscopic studies were conducted to study the infection of C. punctiferalis by M. pingshaense. Bioassay studies with purified conidial suspension proved that the isolate was highly virulent to C. punctiferalis, causing more than 86 % mortality to fifth instar larvae at 1 × 108 spores/mL, under laboratory conditions. The median lethal concentration (LC50) of the fungus against late instar larvae was 9.1 × 105 conidia/mL and the median survival time (MST) of late instar larvae tested at the doses of 1 × 108 and 1 × 107 conidia/mL were 4.7 and 6.4 days, respectively. The optimal temperature for fungal growth and sporulation was found to be 25 ± 1 °C. This is the first report of M. pingshaense naturally infecting C. punctiferalis. Isolation of a highly virulent strain of this fungus holds promise towards development of a potential mycoinsecticide against this pest.

Genome Sequence of Bacillus subtilis subsp. subtilis Strain IITK SM1, Isolated from Kitchen Waste Compost.

We report here the complete genome sequence of Bacillus subtilis subsp. subtilis strain IITK SM1, isolated from kitchen waste compost. We have sequenced the whole genome of this strain to identify and characterize the enzymes that participate in efficient composting activity.

Reversal of intramyocellular lipid accumulation by lipophagy and a p62-mediated pathway.

We have previously observed the reversal of lipid droplet deposition in skeletal muscle of morbidly obese patients following bariatric surgery. We now investigated whether activation of autophagy is the mechanism underlying this observation. For this purpose, we incubated rat L6 myocytes over a period of 6 days with long-chain fatty acids (an equimolar, 1.0 mM, mixture of oleate and palmitate in the incubation medium). At day 6, the autophagic inhibitor (bafilomycin A1, 200 nM) and the autophagic activator (rapamycin, 1 µM) were added separately or in combination for 48 h. Intracellular triglyceride (TG) accumulation was visualized and quantified colorimetrically. Protein markers of autophagic flux (LC3 and p62) and cell death (caspase-3 cleavage) were measured by immunoblotting. Inhibition of autophagy by bafilomycin increased TG accumulation and also increased lipid-mediated cell death. Conversely, activation of autophagy by rapamycin reduced both intracellular lipid accumulation and cell death. Unexpectedly, treatment with both drugs added simultaneously resulted in decreased lipid accumulation. In this treatment group, immunoblotting revealed p62 degradation (autophagic flux), immunofluorescence revealed the colocalization of p62 with lipid droplets, and co-immunoprecipitation confirmed the interaction of p62 with ADRP (adipose differentiation-related protein), a lipid droplet membrane protein. Thus the association of p62 with lipid droplet turnover suggests a novel pathway for the breakdown of lipid droplets in muscle cells. In addition, treatment with rapamycin and bafilomycin together also suggested the export of TG into the extracellular space. We conclude that lipophagy promotes the clearance of lipids from myocytes and switches to an alternative, p62-mediated, lysosomal-independent pathway in the context of chronic lipid overload (*P<0.05, **P<0.01, ***P<0.001, ****P<0.0001).

Heavy Metal Contamination in Groundwater around Industrial Estate vs Residential Areas in Coimbatore, India.

INTRODUCTION: Water is the vital resource, necessary for all aspects of human and ecosystem survival and health. Depending on the quality, bore water may be used for human consumption, irrigation purposes and livestock watering. The quality of bore water can vary widely depending on the quality of ground water that is its source. Pollutants are being added to the ground water system through human and natural processes. Solid waste from industrial units is being dumped near the factories, which react with percolating rainwater and reaches the ground water. The percolating water picks up a large number of heavy metals and reaches the aquifer system and contaminates the ground water. The usage of the contaminated bore water causes the diseases. Mercury, Arsenic and Cadmium are used or released by many industries. AIM: This study was conducted to investigate the pollution of bore water in the industrial region (Kurichi Industrial Cluster) of Coimbatore, in the state of Tamilnadu, India. MATERIALS AND METHODS: Four samples were taken from residential areas around Kurichi Industrial Cluster and analysed to find the concentrations of Mercury, Arsenic and Cadmium. Four more samples were taken from other residential regions far from the industrial estate and served as control. Samples were analysed using Atomic absorption spectrophotometry method. RESULTS: We found that the ground water of the areas surrounding the industrial cluster does not contain significant amount of those metals. Instead, Heavy metal contamination of ground water were observed in some residential areas of coimbatore. CONCLUSION: The regulatory measures to contain and prevent ground water contamination by industries undertaken by Tamilnadu pollution control board may have lead to absence of heavy metal contamination in Kurichi Industrial cluster, Coimbatore, India.

Comparison of compressive strength among three different intracanal post materials in primary anterior teeth: An in vitro study.

OBJECTIVE: The objective of our study was to compare the fracture resistance and the mode of failure among three different post materials in primary anterior teeth. MATERIALS AND METHODS: A total of sixty extracted primary anterior teeth were selected for the study. The samples were divided into three groups of twenty teeth each: Group I (Ribbond), Group II (Omega loop), and Group III (Glass fiber post). Pulp therapy was followed by intracanal post and crown buildup. The samples were mounted in self-cure acrylic and subjected to compressive strength test using universal testing machine (Instron). The maximum force at which the tooth fractured was recorded. RESULTS: The values were subjected to one-way analysis of variance. The mean compressive strength values of Ribbond, omega loop, and glass fiber post were found to be 83.25 N, 61.60 N, and 75.55 N, respectively. The P value was found to be 0.220. CONCLUSION: Group I (Ribbond) showed the highest fracture resistance values followed by Group III (Glass fiber post) and Group II (Omega loop). Although there is difference in mean values, they were nonsignificant.

Dexmedetomidine as an Anesthetic Adjuvant in Patients Undergoing Transsphenoidal Resection of Pituitary Tumor.

BACKGROUND: Transnasal transsphenoidal (TNTS) resection of pituitary tumors involves wide fluctuation in hemodynamic parameter and causes hypertension and tachycardia due to intense noxious stimuli during various stages of surgery. None of routinely used anesthetic agents effectively blunts the undesirable hemodynamic responses, and therefore usually there is a need to use increased doses of anesthetic agents. Dexmedetomidine (DEX) an α-2 adrenergic receptor agonist, because its sympatholytic and antinociceptive properties may ensure optimal intraoperative hemodynamic stability during critical moments of surgical manipulation. In addition, DEX reduced the anesthetic requirement with rapid recovery at the end of surgery. The main aim of our study was to evaluate the effect of DEX on perioperative hemodynamics, anesthetic requirements, and recovery characteristics in patients undergoing TNTS resection of pituitary tumors. MATERIALS AND METHODS: Forty-six patients scheduled for elective TNTS resection of pituitary tumor were randomized to receive a continuous infusion of DEX (group D) or 0.9% saline (group C). Patients in both the groups were subjected to a standardized anesthesia comprising of induction with propofol, fentanyl, vecuronium, and positive pressure ventilation with O2/air (1:1)/isoflurane. The response entropy target range during maintenance of anesthesia was 40 to 60. The hemodynamic variables at various stages of surgery, intraoperative anesthetic, and analgesic and recovery characteristics were recorded. RESULTS: Total fentanyl consumption during the study period was significantly lower in group D compared with group C (4.7 and 7.7 µg/kg, respectively; P<0.01). End-tidal isoflurane concentration requirement was found to be significantly reduced in group D compared with group C throughout the surgical period. Fentanyl and end-tidal isoflurane concentration requirement was reduced in group D compared with group C by 40% and 33.3%, respectively. Heart rate and mean arterial pressure were significantly higher in the group C compared with group D after intubation, during various stages of surgery and immediately after extubation. The group D had excellent surgical conditions and lesser bleeding in comparison to group C. Emergence time and extubation time were significantly shorter in group D compared with group C. CONCLUSIONS: DEX as an anesthetic adjuvant improved hemodynamic stability and decreased anesthetic requirements in patients undergoing TNTS resection of pituitary tumor. In addition, DEX provided better surgical field exposure conditions and early recovery from anesthesia.

Molecular detection of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis in subgingival plaque of healthy young children.

OBJECTIVE: The aim of the present study was to evaluate the presence of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) and Porphyromonas gingivalis (P. gingivalis) in subgingival plaque of healthy young children aged between 3 and 15 years using Polymerase Chain Reaction (PCR) and to compare their presence in children in their primary, mixed and permanent dentitions. METHOD: Subgingival plaque samples were collected from 120 healthy children and were grouped as Group I-Deciduous dentition, Group II- Mixed dentition and Group III- Permanent dentition, and were subjected to PCR assay. RESULTS: Binomial test and Proportions test were used for statistical analysis. A. actinomycetemcomitans and P. gingivalis were detected in 5% and 35%, 12.5% and 20%, and 0% and 27.5% samples in group I, II and III respectively. CONCLUSION: Both the microorganisms were present in group I and II. In group III only P. gingivalis was present. The results from this study do not necessarily pertain to differences in dentition but possibly to inter-individual differences.

Fracture reattachment in an immature permanent incisor with talon's cusp. A rare case report.

AIM: To report the successful and conservative management of a fractured immature permanent maxillary incisor tooth with talon cusp by fracture reattachment. SUMMARY: Coronal fractures of the maxillary anterior teeth are common dental injuries. Among these, the complicated fractures especially in immature teeth require an unambiguous treatment without any delay. When the tooth fragment is available and there is no (or minimal) violation of the biological width, reattachment is the preferable choice. It is a conservative procedure in which the original anatomic form, color, tooth contour, surface texture and aesthetics are preserved. The prognosis of this procedure depends on the patient's cooperation, good understanding about the treatment limitations and periodic follow up. This report emphasises the management of coronal fracture in immature teeth by reattachment.

Case report: management of crown-root fracture in lower first primary molar caused by injury to the chin: report of an unusual case.

BACKGROUND: Dental traumas are highly prevalent lesions in primary teeth, but crown-root fractures are seldom observed in primary molars. When trauma is sustained to the chin, the posterior primary teeth are at increased risk of trauma. The treatment of fractured teeth can be complicated, sometimes because of difficulties with the final restoration. CASE REPORT: A 4-year-old girl was referred to a Specialty Dental clinic by a general dental practitioner with complaints of pain in her left mandibular posterior teeth region while biting. History revealed that she had fallen ten days before while playing. Chin laceration was sutured in the trauma centre, but no dental treatment was carried out. She was subsequently discharged. Later, she had pain while biting for which she was referred to the clinic by her general dental practitioner. Extra-oral examination demonstrated a healing laceration on the chin. Radiographic examination showed the presence of an unusual complicated crown-root fracture of the left mandibular first primary molar. Pulpectomy was carried out and the fracture was stabilised with glass ionomer cement and a preformed metal crown was placed. FOLLOW-UP: Patient was reviewed after 3, 6 and 12 months both radiographically and clinically. Though radiographically it was found that the obturating material was resorbed completely at the 12 month visit, clinically the patient was asymptomatic until now (after 15 months). The patient is still under review. CONCLUSION: This case highlights the need for a systematic history and examination in all cases of dental trauma. It also demonstrates that conservative management is possible and not all primary teeth with crown-root fractures need to be extracted.

Elevated Strain and Structural Disarray Occur at the Right Ventricular Apex.

The right ventricular apex (RVA) is a potential hot spot for development of cardiac rhythm anomalies. Many conditions, including arrhythmogenic right ventricular cardiomyopathy and Brugada's syndrome affect the RVA, and further, the RVA remains an incompletely characterized pacing region. Whether there are structural reasons underlying these conduction properties remains unsettled. In the current study, we characterize the mechanical strains and structural attributes of the right ventricular wall, and test the hypothesis that the right ventricular apex experiences heterogeneous strain distributions and altered fiber organization, and is thus susceptible to conduction alterations. Electromechanical wave imaging (EWI), or elastography, of hearts was used to quantify mechanical strains occurring through a cardiac cycle. Histological and immunofluorescence imaging techniques were used to examine cardiac wall structure and arrangement of junctional proteins. Right ventricular mechanical strains were elevated and sustained throughout systole, compared to the left ventricle and septum. Heterogeneous strain distributions, myocardial fiber disarray, and altered junctional protein localization occured at the RVA. Disarray and altered strain distributions suggest decreased structural strength at the right ventricular apex in particular and increased mechanical impositions in the right ventricle, respectively. Thus, these data demonstrate why the right ventricular apex may be particularly vulnerable to conduction abnormalities.

Esthetic splint--a novel concept for the management of bilateral condylar fracture.

Mandibular condyle is one of the most common sites of injury in the facial skeleton. But many condylar injuries remain undiagnosed. In rare situations, these injuries may result in serious adverse sequel in the patient's growth and development that are more difficult to treat at a later stage. In growing individuals, conservative management results in better functional outcome and good remodelling of the condyle. The aim of this article is to present a case report of a bilateral sub-condylar injury in a young child with a novel concept--an esthetic splint.

Enamel thickness in primary teeth.

OBJECTIVE: The aim of this study was to determine the enamel thickness of all primary teeth in both maxilla and mandible. STUDY DESIGN: An in vitro study was performed with fifty primary teeth including five each of central and lateral incisor, canine, first and second primary molars in both maxillary and mandibular region. Samples were mounted on wax sheets and scanned using a 64-slice CT scanner which were then 3D reconstructed. Three serial slices were obtained from the middle of the coronal portion of each tooth. Volume rendering was done to differentiate three distinct zones of enamel, dentin and the pulp from each slice. A box was constructed touching the borders of the image on all the surfaces and the mid-point of each side was taken to measure the enamel thickness. RESULTS: Tests used were ANOVA, Post-hoc Tukey's test and student's paired t-test. Enamel thickness was not the same on all the sides. Intergroup comparisons between maxillary anterior and posterior teeth showed difference in enamel thickness. On comparing the mandibular anterior and posterior teeth, the posteriors showed a greater value of enamel thickness on all the sides (p < 0.05). CONCLUSION: Primary enamel does not follow the same thickness patterns on all sides. It is also different in each primary tooth. There was an increase in enamel thickness in posterior teeth on comparison to their anterior counterparts in both maxilla and mandible. Enamel thickness was more on the distal aspect compared to mesial in all samples.

Synthesis of polyethylene glycol (PEG) assisted tungsten oxide (WO3) nanoparticles for L-dopa bio-sensing applications.

Nanocrystalline tungsten oxides (WO(3-δ)) are currently receiving a lot of attention because of their interesting electrical, magnetic, optical and mechanical properties. In this report, we present the synthesis of PEG assisted tungsten oxide (WO(3)) nanoparticles by simple household microwave irradiation (2.45 GHz) method. The samples were characterized using powder X-ray diffraction (XRD), thermal analysis (TG/DTA), transmission electron microscopy (TEM), UV-visible diffusion reflectance spectroscopy (UV-VIS-DRS), cyclic voltammetry and electrochemical impedance spectroscopy. Powder XRD results revealed that both the samples prepared with and without surfactant crystallize in the orthorhombic structure corresponding to WO(3) · H(2)O phase. Subsequent annealing under identical conditions (600°C/air/6h) led to significantly different products i.e. monoclinic W(17)O(47) from surfactant free sample and orthorhombic WO(3) from PEG assisted sample. Blue emission was observed through UV-VIS-DRS with blue shift and the band gap energy was estimated as 2.7 and 3.28 eV for PEG assisted as prepared (WO(3) · H(2)O) and annealed samples (WO(3)) respectively. Electrochemical measurements have been performed on all the samples deposited on the surface of glassy carbon (GC) electrode which showed high sensitivity and good selectivity for PEG assisted sample (WO(3) · H(2)O) for the direct detection of L-dopa.

Dental management of hemophiliac child under general anesthesia.

Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

Efficacy of various root canal irrigants on removal of smear layer in the primary root canals after hand instrumentation: a scanning electron microscopy study.

AIM: The purpose of this in-vitro study is to determine the efficacy of various irrigants in removing the smear layer in primary teeth root canals after hand instrumentation. MATERIALS AND METHODS: The present study consisted of 30 human primary incisors which were sectioned at the cementoenamel junction horizontally. The specimens were divided randomly into four experimental and one control group having six teeth each and each group was treated with the specific irrigant. 5.25% NaOCl, 5.25% NaOCl + 10% EDTA, 6% citric acid, 2% chlorhexidine, saline (control) were the irrigants evaluated for efficacy in removal of smear layer. The specimens were split along the longitudinal axis using a chisel after placing superficial grooves in cementum not extending to the root canal. The exposed surface was subjected to scanning electron microscopic analysis to reveal the efficacy of irrigants in removal of smear layer. The representative areas were evaluated twice at 15 days interval by a single evaluator. The scale for the smear layer removal by Rome et al was modified and used in the present study. RESULTS: The pictures from the scanning electron microscopy showed that among the tested irrigants, citric acid has the best efficacy to remove the smear layer without altering the normal dentinal structures, which was supported by the lowest mean smear scores. The pictures from the 10%EDTA + 5.25% sodium hypochlorite group showed that even though it removed the smear layer, it adversely affected the dentine structure. SEM pictures of the other groups like sodium hypochlorite, chlorhexidine revealed that these irrigants does not have the capacity to remove the smear layer in primary teeth. CONCLUSIONS: The results of the present study clearly indicate the superior efficacy of 6% citric acid than the other tested irrigants on removing the smear layer in primary teeth root canals.