Systemic mastocytosis associated with Hodgkin's lymphoma in a 4-year-old child.

Systemic mastocytosis with associated clonal hematologic non-mast cell lineage disease (SM-AHN) represents a specific subtype of mastocytosis and is extremely rare in children. We describe a 4-year-old child with systemic mastocytosis associated with Hodgkin's lymphoma. The child had cutaneous mastocytosis and lymphadenopathy without other clinical features of SM, which was diagnosed only by bone marrow examination.

Synthesis of non-toxic As and Cr nanoparticles through redox activity of highly flexible layered coordination polymer of Ni(II).

A simple method for the sequestration of As(III) and Cr(VI) from water has been demonstrated by utilizing a highly flexible porous coordination polymer (PCP) of Ni(II) in its as synthesized form or without solvent removal. This PCP reduces the high toxicity of As(III) and Cr(VI) ions into non-toxic As(0) and Cr/Cr2O3/CrO2 (zero, tri and tetravalent) nanoparticles (NPs) within its pores, and this is characterized by powder x-ray diffraction, x-ray photoelectron spectroscopy and high-resolution transmission electron microscopy analysis. The high functionality of this polymer is due to the presence of monodentate carboxylate groups of a benzenetricarboxylate linker, which provide anchoring sites to the metal ions of the metal precursors. Due to the highly oxidising nature of these toxic ions, a redox reaction takes place between the framework metal ions and toxic metal ions, which is explained by an electron paramagnetic resonance study. This is the first report to synthesize non-toxic, as well as useful, NPs of As and Cr from their highly toxic ions within the cavities of a PCP for remediation of the toxic waste stream and contaminated waste water.

Mutagenicity and Cytotoxicity of Particulate Matter Emitted from Biodiesel-Fueled Engines.

Biodiesel engines produce several intermediate species, which can potentially harm the human health. The concentration of these species and their health risk potential varies depending on engine technology, fuel, and engine operating condition. In this study, experiments were performed on a large number of engines having different configurations (emissions norms/fuel used), which were operated at part load/full load using B20 (20% v/v biodiesel blended with mineral diesel) and mineral diesel. Experiments included measurement of gaseous emissions, and physical, chemical, and biological characterization of exhaust particulate matter (PM). Chemical characterization of PM was carried out for detecting polycyclic aromatic hydrocarbons (PAH's) and PM bound trace metals. The biological toxicity associated with PM was assessed using human embryonic kidney 293T cells (HEK 293T). The mutagenic potential of the PM was tested at three different concentrations (500, 100, and 50 µg/mL) using two different  Salmonella strains, TA98 and TA100, with and without liver S9 metabolic enzyme fraction. PM samples exhibited cytotoxic effect on HEK 293T cells (IC50 < 100 µg/mL) and there was significant potential for reactive oxygen species (ROS) generation. Comparison of different engines showed that modern engines (Euro-III and Euro-IV compliant) produced relatively cleaner exhaust compared to older engines (Euro-II compliant). Biodiesel-fueled engines emitted lower number of particles compared to diesel-fueled engines. However, chemical characterization revealed that biodiesel-fueled engines exhaust PM contained several harmful PAHs and trace metals, which affected the biological activity of these PM, as reflected in the biological investigations. Mutagenicity and cytotoxicity of PM from biodiesel-fueled engines were relatively higher compared to their diesel counterparts, indicating the need for exhaust gas after-treatment.

Efficacy and Functional Outcomes of Platysma Myocutaneous Flap in Oral and Maxillofacial Reconstruction.

INTRODUCTION: Maxillofacial reconstruction strives to restore the form and function of the maxillofacial region in patients with deformities caused by trauma, disease, cancer, or congenital malformations. An array of surgical procedures has been advised for restoring soft tissues in the oral cavity, with varied degrees of efficacy. This prospective study seeks to provide a thorough understanding of the success rate, complications, functional outcomes, and patient satisfaction associated with the utilization of platysma myocutaneous flap (PMF) in this specialized domain. AIM: This study aims to elaborate on the PMF surgical technique, along with the flap design, outcomes, and intricacies associated with age, gender, the recipient site, and defect size. MATERIALS AND METHODS: The study included 30 patients with oral malignancies who intervened under general anesthesia with wide local excision and reconstruction with PMF at a single tertiary care center. RESULTS:  The results showed that the PMF is an efficient flap in the context of its ease of harvest, minimal donor site morbidity, low complication rates (infection - 26.67%, flap dehiscence - 16.67%, and flap necrosis - 6.77%), and ability to rehabilitate both form and function. CONCLUSION: In conclusion, the PMF stands as a viable alternative in oral and maxillofacial reconstruction, offering a combination of versatility, reliable blood supply, and potential for functional restoration.

Application of calcium sulfate as graft material in implantology and maxillofacial procedures: A review of literature.

Calcium sulphate (plaster of Paris) has been used since 1892 to fill bone defects and as a good bone graft substitute. Calcium sulphate is an osteoconductive, inorganic substance. Following 75 years, many other authors reported variable and a better result in grafting of bone defects and in several cases of immediate and delayed dental implants for good osseointegrations, with no complications attributed to the calcium sulphate. Early results were variable, because of its conflicting crystalline structure, purity, and quality of the calcium sulphate. Apart from this, calcium sulphate also shows predictable resorption rate in vivo, presence of minimal trace elements and extremely uniform crystalline structure. Calcium sulphate is a bio-inert material and get resorbed over a period of weeks and fibrovascular tissue takes its place which eventually allows neovascularization and bone formation within the area. Use During the conventional surgical treatment addition of calcium sulphate as a bone graft of in case of placement of dental implants and pathological bony defects it improves the clinical outcome. Calcium sulphate also act as a barrier and filling material for the treatment of "through and through" bony lesions. Use of calcium sulphate as a bone graft substitute avoids the complications and morbidity associated with autograft like infection, second surgery.

Atypical Mumps; are We Heading Towards an Outbreak?

Mumps, caused by the mumps virus, is a contagious disease primarily affecting children and young adults. While typically presenting with salivary gland swelling and systemic symptoms, mumps can lead to various complications including SNHL, orchitis/ oophoritis, aseptic meningitis. Recent observations suggest atypical features in mumps cases, raising concerns of a potential outbreak in India. To discuss the etiopathogenesis and clinical presentation in cases of atypical mumps with increasing number of cases, a prospective multicentric study was conducted across five major centers - SMS Medical College Jaipur, RDBP Jaipuria Hospital, Jaipur, Shri Ashwini Saxena ENT Hospital Rewari, AIIMS Bhubaneswar and SP Medical College Bikaner, in India to evaluate patients with acute salivary gland swellings. Clinical and laboratory data were collected, including demographics, presenting symptoms, history of vaccination, imaging findings, and treatment outcomes. Patients were followed for four weeks post-treatment to monitor for delayed complications. Among 53 patients, a bimodal age distribution was observed, with peaks in early adolescents and middle-aged individuals. Vaccination status was recorded based on recall. Fever and salivary gland swelling were predominant symptoms, with a significant proportion experiencing submandibular gland involvement. Elevated serum amylase and CRP levels correlated with disease severity and prolonged symptomatic resolution. Notably, cases of sensorineural hearing loss (SNHL) and airway complications emerged as significant concerns. The study highlights a shift in mumps demographics, with higher age groups affected and increased incidence of complications like SNHL and airway compromise. International trends also suggest periodic outbreaks and evolving clinical manifestations post-COVID-19 pandemic. Factors contributing to mumps resurgence include lack of vaccination or vaccine efficacy, population immunity, and seasonal variations. India appears to be facing a potential mumps outbreak, characterized by atypical features and increased risk of complications like SNHL and airway compromise. Serum amylase and CRP serve as valuable markers for disease severity. Early recognition and management of complications are crucial, emphasizing the importance of mumps immunization to mitigate the impact of the disease. ENT specialists should remain vigilant for emerging complications, particularly SNHL, advocating for comprehensive immunization strategies.

Delphi Consensus Statement on the Role of Probiotics in the Treatment of Atopic Dermatitis.

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense itching and recurrent eczematous lesions. Important factors in the etiopathogenesis of AD include genetic predisposition, epidermal barrier dysfunction, immune dysregulation, and gut and skin dysbiosis. Probiotics could be a potential preventive strategy for allergies including AD through immune system modulation as well as enhancement of the epithelial barrier integrity. To further understand the role of probiotics in the management of AD, a Knowledge, Attitude, and Practices (KAP) survey was conducted. Materials and methods A steering committee comprising nine experts formulated consensus recommendations on the role of probiotics in the management of AD and associated flare-ups through the use of the Knowledge, Attitude, and Practices questionnaire while analyzing literature reviews and responses from a national panel consisting of 175 members. The evidence strength and quality were evaluated based on the Agency for Healthcare Research and Quality (AHRQ) criteria. The acceptance of expert opinions as recommendations was considered upon receiving an endorsement from ≥70% of the panelists, as indicated by a Likert scale. Results The national panel emphasized that the improvement in nutritional status, immunomodulatory properties, and beneficial effects on the gastrointestinal (GI) tract and skin support the use of probiotics in AD. The panel agreed that probiotics should be a part of the complementary therapy in the management of AD and associated flare-ups. Mostly, a probiotics supplementation duration of eight to 12 weeks is preferred by dermatologists. Probiotics, when used as an adjuvant therapy, may serve as a strategy to reduce steroid usage or maintenance therapy in high-risk cases with flares. Conclusion A Delphi-mediated KAP response provides a real-life approach to the use of probiotics in the management of AD. It suggests that probiotics could be useful as an adjuvant therapy in the management of AD and associated flare-ups when used along with traditional treatment.

Orthopaedic Diagnoses in the Black Pediatric Population.

The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care.

Comparison of the Efficacy of Amniotic Membrane Versus Buccal Fat Pad in Treatment of Oral Submucous Fibrosis.

Background: Oral and maxillofacial surgery deals with wide range of oral defects, wound closure, tissue resection, and tissue reconstruction. The purpose of our study is to use amniotic membrane for closure of post surgery defect in patient of oral submucous fibrosis to utilize its growth factor and scaffold nature for effective healing and to evaluate effectiveness of amniotic membrane in treatment outcome. The objectives are to compare post-operative mouth opening, healing of amniotic membrane and buccal fat pad. Material and Method: Diagnosed patients with OSMF are divided into two surgical site Group I (n = 5patients)-Left side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with BFP. Group II-Right side buccal mucosa in which resection of fibrous band with coronoidectomy followed by reconstruction of the mucosal defect with freeze dried irradiated amniotic membrane. Result: This study suggested that in comparison to buccal fat pad flap, the HAM graft is a better option for oral reconstruction in terms of infection, graft failure, MMO, inflammation, pain. Outcome indicated that the HAM is biologically ideal graft for oral wounds and could be used as clinical alternative for various repair surgery for oral defects. Conclusion: The amniotic membrane was found easy to handle and easy to use with inherent hemostatic property which is observed in all patients. No patients had shown any evidence of any complications. Good pain control observed in patients throughout postoperative period.

A Proposed Grading System and Experience of COVID-19 Associated Rhino Orbito Cerebral Mucormycosis from an Indian Tertiary Care Center.

Mucormycosis is an opportunistic fungal infection. India faced an unprecedented increase in patients with post coronavirus disease 2019 (COVID-19) associated rhino-orbito-cerebral mucormycosis (ROCM). This study proposes a grading system which correlates the extent of the disease with the management plan. An observational study was conducted January 2021-June 2021. We identified 65 patients. Eleven patients had mild disease, 27 patients had moderate, 16 patients were severe and 11 patients were graded as very severe. The management was planned based on this grading system. Early diagnosis, aggressive surgical debridement and antifungal drug therapy is the key to improve survival in ROCM. Procedures such as endoscopic orbital clearance, sublabial maxillectomy, and modified endoscopic Denkers (MED) approach facilitate access and surgical debridement. The new grading system proposed assists in planning the approach and extent of surgical debridement.

Quantitative determination of gibberellins by high performance liquid chromatography from various gibberellins producing Fusarium strains.

High performance liquid chromatographic (HPLC) method was developed for analysis of seven gibberellins, i.e., GA3, GA4, GA7, GA3 methyl ester, GA7 methyl ester 3,13 diacetate, GA7 methyl ester, and fusaric acid, using an isocratic system. Method was used for estimation of gibberellins from different Fusarium strains. Gibberellins were extracted from 28 strains of Fusarium, out of which six strains of Fusarium were isolated from soil of different parts of India and 22 strains were procured from the Indian Type Culture Collection, Indian Agricultural Research Institute, New Delhi. Extracts were analyzed for qualitative and quantitative estimation of gibberellins by thin layer chromatography and HPLC, respectively. On the basis of quantitative analysis of produced gibberellins by HPLC, they were categorized as low, moderate, and high gibberellin producing strain. For the first time, Fusarium solani was also reported as high GA3 producing strain.

Toxicity of exhaust particulates and gaseous emissions from gasohol (ethanol blended gasoline)-fuelled spark ignition engines.

In the last couple of decades, blending of oxygenated additives with gasoline has been advocated to reduce dependence on fossil fuels and to reduce hazardous health effects of gaseous emissions and particulate matter (PM) emitted by internal combustion (IC) engines in the transport sector worldwide. The primary objective of this research was to carry out a comparative analysis of exhaust PM emitted by gasohol (gasoline blended with 10% ethanol, v/v)-fulled spark ignition (SI) engine with that of baseline gasoline-fuelled SI engine. To assess the PM toxicity, physical, chemical and biological characterizations of PM were carried out using the state-of-the-art instruments and techniques. Measurements of regulated and unregulated gaseous species were also carried out at part/full loads. The results showed that the gasohol-fuelled engine emitted relatively lower concentrations of unregulated gaseous species such as sulfur dioxide (SO2), isocyanic acid (HNCO), etc. Physical characterization of exhaust particles revealed that the gasohol-fuelled engine emitted a significantly lower number of particles compared to the gasoline-fuelled engine. The presence of harmful polycyclic aromatic hydrocarbons (PAHs) and higher trace metal concentrations in PM emitted from the gasoline-fuelled engine was another important finding of this study. Biological characterizations showed that PM emitted from the gasohol-fuelled engine were less cytotoxic and had lower reactive oxygen species (ROS) generation potential. Mutagenicity of PM emitted from the gasohol-fuelled engine was also lower compared to that from the gasoline-fuelled engine. Overall, this study demonstrated that utilization of gasohol in SI engines led to the reduction in emissions, and lowering of PM toxicity, in addition to partial replacement of fossil fuels with renewable fuels.

Prevalence of vitamin D deficiency and its relationship with thyroid autoimmunity in Asian Indians: a community-based survey.

25-Hydroxy vitamin D (25(OH)D) deficiency is linked with predisposition to autoimmune type 1 diabetes and multiple sclerosis. Our objective was to assess the relationship between serum 25(OH)D levels and thyroid autoimmunity. Subjects included students, teachers and staff aged 16-60 years (total 642, 244 males, 398 females). Serum free thyroxine, thyroid-stimulating hormone (TSH), and thyroid peroxidase autoantibodies (TPOAb), intact parathyroid hormone and 25(OH)D were measured by electrochemiluminescence and RIA, respectively. Thyroid dysfunction was defined if (1) serum TSH > or = 5 microU/ml and TPOAb>34 IU/ml or (2) TSH > or = 10 microU/ml but normal TPOAb. The mean serum 25(OH)D of the study subjects was 17.5 (sd 10.2) nmol/l with 87 % having values < or = 25 nmol/l. TPOAb positivity was observed in 21 % of subjects. The relationship between 25(OH)D and TPOAb was assessed with and without controlling for age and showed significant inverse correlation (r - 0.08, P = 0.04) when adjusted for age. The prevalence of TPOAb and thyroid dysfunction were comparable between subjects stratified according to serum 25(OH)D into two groups either at cut-off of < or = 25 or >25 nmol/l or first and second tertiles. Serum 25(OH)D values show only weak inverse correlation with TPOAb titres. The presence of such weak association and narrow range of serum 25(OH)D did not allow us to interpret the present results in terms of quantitative cut-off values of serum 25(OH)D. Further studies in vitamin D-sufficient populations with wider range of serum 25(OH)D levels are required to substantiate the findings of the current study.

Overnight Alopecia: A Subtype of Acute Diffuse and Total Alopecia?

Acute diffuse and total alopecia (ADTA) is a variant of alopecia areata which lacks the typical patchy hair loss seen in classical alopecia areata and presents with an acute onset of diffuse hair loss commonly reported in young females with the duration from disease onset to diffuse hair loss ranging from 2 to 20 weeks. Although the clinical features of ADTA resemble telogen effluvium, dermoscopy can prove to be a useful tool for differentiating these two conditions and avoiding unnecessary investigations as specific dermoscopic findings of alopecia areata are invariably present along the disease course. Herein, we report a case of ADTA in a 42-year-old Indian female who presented with sudden onset of diffuse hair loss of only 1-day duration.

Sternoclavicular Graft Versus Costochondral Graft In Reconstruction of Ankylosed Temporomandibular Joint.

INTRODUCTION: The temporo-mandibular joint (TMJ) is a complex anatomical structure that is concerned with mastication, deglutition, and speech. Ankylosis of the TMJ occurs when the condyle gets fused to glenoid fossa by bony or fibrous tissue. It is an incapacitating problem, commonly occurring in children and is usually associated with trauma or infection. MATERIALS AND METHODS: A total of ten patients with written informed consent having TMJ ankylosis (unilateral/bilateral) fulfilling the inclusion criteria were selected for the study and were operated under general anaesthesia with arthrectomy followed by reconstruction of ramal condylar unit with SCG (Group I) or CCG (Group II). Pre-operative and post-operative evaluation assessments were done at regular intervals for maximum mouth opening, range of mandibular movements, and height of ramus. RESULTS: Statistical analysis shows that the increase in maximum mouth opening was found 1.1% higher in Group II (75.9%) as compared to Group I (74.9%). The increase in lateral excursion at affected side was found 1.3% higher in Group I (84.6%) as compared to Group II (83.3%). The increase in lateral excursion at non-affected side was found 10.3% higher in Group I (76.9%) as compared to Group II (66.7%). The increase in protrusive movement was found 17.5% higher in Group II (88.9%) as compared to Group I (71.4%). Six months post-operative height of ramus was found 10.5% higher in Group II as compared to Group I. CONCLUSION: The present study concludes the superiority of costochondral graft over sternoclavicular graft in terms of growth and function. Continued deliberation between the two grafts with larger sample size and a longer follow-up with multicentric consensus will be required to draw definitive indications of the two grafts.

Toxicity and mutagenicity of exhaust from compressed natural gas: Could this be a clean solution for megacities with mixed-traffic conditions?

Despite intensive research carried out on particulates, correlation between engine-out particulate emissions and adverse health effects is not well understood yet. Particulate emissions hold enormous significance for mega-cities like Delhi that have immense traffic diversity. Entire public transportation system involving taxis, three-wheelers, and buses has been switched from conventional liquid fuels to compressed natural gas (CNG) in the Mega-city of Delhi. In this study, the particulate characterization was carried out on variety of engines including three diesel engines complying with Euro-II, Euro-III and Euro-IV emission norms, one Euro-II gasoline engine and one Euro-IV CNG engine. Physical, chemical and biological characterizations of particulates were performed to assess the particulate toxicity. The mutagenic potential of particulate samples was investigated at different concentrations using two different Salmonella strains, TA98 and TA100 in presence and absence of liver S9 metabolic enzyme fraction. Particulates emitted from diesel and gasoline engines showed higher mutagenicity, while those from CNG engine showed negligible mutagenicity compared to other test fuels and engine configurations. Polycyclic aromatic hydrocarbons (PAHs) adsorbed onto CNG engine particulates were also relatively fewer compared to those from equivalent diesel and gasoline engines. Taken together, our findings indicate that CNG is comparatively safer fuel compared to diesel and gasoline and can offer a cleaner transport energy solution for mega-cities with mixed-traffic conditions, especially in developing countries.