Novel EGFR mutations in diffuse midline gliomas using cost-effective strategies: A report of 2 cases.

Background: Diffuse midline gliomas (DMGs) are malignant tumors predominantly affecting children, often leading to poor outcomes. The 2021 World Health Organization classification identifies 3 subtypes of DMGs, all characterized by the loss of H3K27 trimethylation. Here, we report 2 cases of DMG with Epidermal Growth Factor Receptor (EGFR) mutations within exon 20, contributing to the understanding of the molecular complexity of these pediatric brain tumors. Methods: An economical immunohistochemical panel was designed to aid in the diagnosis of most DMGs in resource-constrained regions. Sanger sequencing was employed to identify rare EGFR mutations in exon 20 of 2 cases. Results: Molecular analyses of 2 cases of DMG revealed novel EGFR mutations within exon 20. These mutations were identified using cost-effective diagnostic approaches. The presence of EGFR mutations expands the molecular landscape of DMGs and highlights the genetic heterogeneity within this tumor entity. Conclusions: These findings underscore the molecular heterogeneity of DMGs and the significance of identifying novel mutations, such as EGFR mutations in exon 20. Further research into the molecular mechanisms underlying DMGs is warranted to advance therapeutic strategies and improve outcomes for pediatric patients.

The Synthesis, Characterization, and Assessment of Antibacterial Properties of an Orthodontic Adhesive Containing Cerium-Substituted Hydroxyapatite Nanoparticles: An In Vitro Study.

Introduction White spot lesions (WSLs) are early enamel caries lesions often seen in individuals receiving fixed orthodontic treatment. These lesions occur due to the buildup of plaque and the colonization of bacteria. WSL formation can be prevented by adequate oral hygiene measures and by the incorporation of antimicrobial nanoparticles (NPs) in orthodontic appliances and bonding systems. The aim of this research was to synthesize cerium-substituted hydroxyapatite nanoparticles (Ce-HAp NPs), characterize them, and assess their antimicrobial activity. Materials and methods This in vitro investigation involved the preparation of Ce-HAp NPs using the co-precipitation method, followed by their characterization using scanning electron microscope (SEM), energy-dispersive X-ray (EDAX), and Fourier transform infrared (FTIR). The NPs were prepared and subsequently added to an orthodontic adhesive. Antibacterial testing was conducted using the disc diffusion method against common oral pathogens (Staphylococcus aureus, Lactobacillus acidophilus, and Streptococcus mutans). The zones of inhibition were measured for two different concentrations of the adhesive. Results  The Ce-HAp NPs were successfully prepared and had an irregular agglomerated shape, measuring 63 nm in size. The major characteristic chemical groups of Ce-HAp were PO43-, OH-, and CO32-, and it was confirmed by the FTIR spectrum. The EDAX results of the synthesized NPs showed theoretical weight percentages (Wt%) of O, 52.6%; Ca, 20.9%; P, 11.8%; C, 10.3%; and Ce, 4.3%. A higher concentration of 40 µg/mL (30 mm for S. aureus and L. acidophilus and 25 mm for S. mutans) showed good antibacterial activity against the tested bacterial strains, compared to control antibiotics. Conclusion Cerium oxide (CeO2)-HAp NPs were prepared and incorporated into an orthodontic adhesive. The prepared adhesive exhibited effective antibacterial activity against prevalent oral pathogens.

Assessment of pathogen removal efficiency of vertical flow constructed wetland treating septage.

Septage refers to the semi-liquid waste material that accumulates in septic tanks and other onsite sanitation systems. It is composed of a complex mixture of human excreta, wastewater, and various solid particles. Septage is a potential source of water pollution owing to presence of high organic content, significant pathogen concentrations, and a range of nutrients like nitrogen and phosphorus. The harmful impacts of septage pollution poses significant risks to public health through the contamination of drinking water sources, eutrophication of water bodies and spread of water borne diseases. Conventional septage treatment technologies often face limitations such as high operational costs, energy requirements, and the need for extensive infrastructure. Therefore, with an aim to treat septage through an alternative cost effective and energy-efficient technology, a laboratory-scale constructed wetland (CW) system (0.99 m2) consisting of a sludge drying bed and a vertical flow wetland bed was utilized for the treatment of septage. The sludge drying bed and vertical flow beds were connected in series and filled with a combination of gravel with varying sizes (ranging from 5 to 40 mm) and washed sand. Canna indica plants were cultivated on both beds to facilitate phytoremediation process. The system was operated with intermittent dosing of 30 Ltrs of septage every day for 2 months. The HRT of the system was fixed at 48 h. The average inlet loads of Biochemical Oxygen Demand (BOD5), Chemical Oxygen Demand (COD), and Total Suspended Solids (TSS) were measured as 150 ± 65.7 g m-2 day-1, 713 ± 443.9 g m-2 day-1, and 309 ± 66.3 g m-2 day-1, respectively. After treatment, the final effluent had an average load of 6 g m-2 day-1 for BOD5, 15 g m-2 day-1 for COD, and 51 g m-2 day-1 for TSS, indicating that the CW system achieved an average removal efficiency of 88% for BOD, 87% for COD, and 65% for TSS. The average load of total coliforms and helminthes eggs in the influent was recorded as 4 × 108 Colony-Forming Units (CFU) m-2 day-1 and 3 × 107 eggs m-2 day-1, respectively. However, the CW system demonstrated significant effectiveness in reducing microbial contamination, with an average removal efficiency of 99% for both total coliforms and helminthes eggs. The vertical flow constructed wetland system, equipped with pretreatment by sludge drying bed, has proven to be efficient in treatment of septage.

Non-invasive Tear Film Assessment in Normal Population: Effect of Age, Sex, and Interparametric Relationship.

Purpose: To investigate age- and sex-related differences in tear film parameters of normal Indian population and study interparametric relationships. Methods: Healthy subjects with no ocular disease (median ocular surface disease index = 0) were subjected to an automated evaluation of tear meniscus height (TMH), non-invasive tear breakup time (NIBUT) using Keratograph 5M (OCULUS GmbH, Wetzlar, Germany), and tear osmolarity using the TearLab Osmolarity System (TearLab Corporation, California, USA). A mixed-effects model with random intercepts at the patient level was used to evaluate the relationships between explanatory (age, gender, and tear osmolarity) and outcome variables (TMH and NIBUT). Results: A total of 237 subjects (474 eyes; 150 males) were enrolled with a mean age of 40 ± 17 years (range, 10-78 years). The mean values (± standard deviation) of TMH, NIBUT, and tear osmolarity were 0.34 ± 0.07 mm, 10.95 ± 2.02 s and 289.0 ± 5.8 mOsm/L, respectively. Age had a significant positive relationship with TMH (p < 0.0001; 0.002 mm/year; r = 0.12), but there was no effect on NIBUT (p = 0.26) and tear osmolarity (p = 0.27). There were no sex-based differences in tear film parameters. Interparametric relationship revealed no significant association between TMH and NIBUT (p = 0.12) or tear osmolarity and TMH (p = 0.83) or tear osmolarity and NIBUT values (p = 0.48). Conclusions: In a normal Indian population, TMH is weakly affected by age and is independent of sex, NIBUT, and tear osmolarity. Tear breakup time and osmolarity show no significant age- and sex-related variation.

Assessment of sal (Shorea robusta) forest phenology and its response to climatic variables in India.

Remote sensing-based observation provides an opportunity to study the spatiotemporal variations of plant phenology across the landscapes. This study aims to examine the phenological variations of different types of sal (Shorea robusta) forests in India and also to explore the relationship between phenology metrics and climatic parameters. Sal, one of the main timber-producing species of India, can be categorized into dry, moist, and very moist sal. The phenological metrics of different types of sal forests were extracted from Moderate Resolution Imaging Spectroradiometer (MODIS)-derived Enhanced Vegetation Index (EVI) time series data (2002-2015). During the study period, the average start of season (SOS) was found to be 16 May, 17 July, and 29 June for very moist, moist, and dry sal forests, respectively. The spatial distribution of mean SOS was mapped as well as the impact of climatic variables (temperature and rainfall) on SOS was investigated during the study period. In relation to the rainfall, values of the coefficient of determination (R2) for very moist, moist, and dry sal forests were 0.69, 0.68, and 0.76, respectively. However, with temperature, R2 values were found higher (R2 = 0.97, 0.81, and 0.97 for very moist, moist, and dry sal, respectively). The present study concluded that MODIS EVI is well capable of capturing the phenological metrics of different types of sal forests across different biogeographic provinces of India. SOS and length of season (LOS) were found to be the key phenology metrics to distinguish the different types of sal forests in India and temperature has a greater influence on SOS than rainfall in sal forests of India.

A "flexible tripod" mounted video camera: An economical and effective method to record oculoplastic surgeries.

Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.

Recombinant interferon alpha 2b for ocular surface squamous neoplasia: An efficient and cost-effective treatment modality in Asian Indian patients.

PURPOSE: The purpose was to study the efficacy of interferon alpha 2b (INF α2b) in the treatment of ocular surface squamous neoplasia (OSSN) and analyze its cost-effectiveness in India. STUDY DESIGN: This was a retrospective study of thirty patients with OSSN treated with topical INF α2b (1 MIU/cc) ± perilesional INF α2b (5 MIU/cc). RESULTS: The tumor involved cornea (n = 9, 30%), conjunctivo-limbal-corneal surface (n = 19, 63%), or bulbar conjunctiva (n = 2, 7%). The mean basal dimension of the tumor was 16 mm. The tumors belonged to Tis (n = 6, 20%) or T3 (n = 24, 80%) based on the American Joint Committee Classification, 7th edition. In the six patients with Tis, three cycles of topical INF α2b were used for immunoprevention. In the remaining 24 patients, INF α2b was advised for immunoreduction, but served as immunotherapy with 100% tumor regression in 22 (92%) cases, and resulted in 95% immunoreduction in 2 (6%) cases. Complete tumor regression by immunotherapy (n = 22) was achieved with a mean number of three topical INF α2b cycles and two perilesional injections. All these 22 patients received three additional topical INF α2b cycles after complete tumor regression. For immunoreduction (n = 2), both patients received six cycles of topical INF α2b which was three perilesional INF α2b injections. The mean total treatment cost per patient with INF α2b was INR 9164 ($US 137). Based on maximum basal diameter of tumor at presentation, the mean total treatment cost per patient with INF α2b was INR 4866 ($US 73) for eyes with microscopic evidence of tumor residue (n = 6), INR 9607 ($US 143) for tumors ≤10 mm (n = 13), and INR 10,985 ($US 164) for tumors >10 mm (n = 11), with two patients needing additional surgical excision for complete tumor control. CONCLUSION: INF α2b can be used for immunoreduction, immunotherapy, or immunoprevention of OSSN. INF α2b is a cost-effective treatment modality for OSSN at an average total treatment cost of INR 9164 ($US 137) per patient.