Maxillofacial rehabilitation of orbital rhabdomyosarcoma exenteration: A clinical report.

ABSTRACT: Maxillofacial rehabilitation of an orbital defect plays a crucial role in enhancing the esthetics of the facial defect. The eye is a vital organ, the loss of which requires a customized approach for post-defect rehabilitation. Advanced treatment option such as implant-supported orbital prosthesis has a superior outcome in terms of retention and esthetics, but due to economic factor, it is not affordable for all patients. This case report describes a simplified rehabilitation technique for a patient with an orbital defect where retention is achieved by spectacles and satisfactory esthetics are obtained.

Vertex-Oriented Cube-Connected Pattern in CsPbBr3 Perovskite Nanorods and Their Optical Properties: An Ensemble to Single-Particle Study.

The design of cube-connected nanorods is accomplished by connecting seed nanocrystals of a defined shape in a particular orientation or by etching selective facets of preformed nanorods. In lead halide perovskite nanostructures, which retain mostly a hexahedron cube shape, such patterned nanorods can be designed with the anisotropic direction along the edge, vertex, or facet of seed cubes. Combining the Cs-sublattice platform for transforming metal halides to halide perovskites with facet-specific ligand binding chemistry, herein, vertex-oriented patterning of nanocubes in one-dimensional (1D) rod structures is reported. By tuning the length of host metal halides, their lengths could also be tuned from 100 nm to nearly 1000 nm. The symmetry of the hexagonal phase of host halide CsCdBr3 and product orthorhombic CsPbBr3 helped in maintaining the vertex [201] as the anisotropic direction. Neutral exciton recombination rates, extracted from photoluminescence blinking traces, showed a systematic increase from isolated cubes to cube-connected nanorods of various lengths. Efficient coupling of wave functions in vertex-oriented cube assemblies permits exciton delocalization. Our findings on carrier delocalization in cube-connected nanorods along their vertex direction having minimum interfacial contacts provide valuable insights into the fundamental chemistry of assembling anisotropic halide perovskite nanostructures as conducting wires.

Preparation, Characterization and Evaluation of a Novel Drug Carrier for the Controlled Release of Curcumin.

The upsurge of cancer demands intense, rapid and effective intervention from the scientific society. Even though nanoparticles helped achieving this, maintaining its size without using toxic capping agents is challenging. Phytochemicals having reducing properties is a proper substitute and the efficiency of such nanoparticles could be further improved by grafting with suitable monomers. It could be further protected from rapid biodegradation by coating with suitable materials. This approach was utilized wherein, the green synthesized silver nanoparticles (AgNps) were initially functionalized with -COOH to couple with -NH2 groups of ethylene diamine. It was then coated with polyethylene glycol (PEG) and hydrogen bonded with curcumin. The formed amide bonds could effectively uptake drug molecules and sensed environmental pH. Swelling studies and release profiles confirmed selective drug release. All these results along with those obtained from MTT assay, suggested the potential applicability of the prepared material in pH sensitive drug delivery of curcumin.

Zirconia surface infiltration with low-fusing glass: A surface treatment modality to enhance the bond strength between zirconia and veneering ceramic.

Background: The pursuit of esthetics and superior mechanical properties prompted the layering of Yttrium stabilized Zirconia with ceramic material. However, the bioinert nature of zirconia causes the chipping off of this ceramic layer. Selective infiltration etching (SIE) of zirconia provides good bond strength between zirconia and veneering ceramic. Materials and Methods: One hundred and fifty zirconia specimens of dimensions 5 × 5 × 10 mm were divided into 5 groups. Group 1: Air abrasion with 30 µ Al2O3 for 15 s with 0.4 bar pressure. Group 2: SIE and heat-induced maturation (HIM) as demonstrated by Abousheilb. Group 3: Sintered zirconia specimens were taken up for air abrasion followed by SIE/HIM. Group 4: Air abrasion and SIE performed on unsintered specimens followed by heat treatment at 1500°C. Group 5: Air abrasion performed on unsintered zirconia specimens followed by heat treatment at 1500°C followed by SIE/HIM. The samples were then layered with ceramic and subjected to shear bond strength (SBS) analysis. Results: The mean and standard deviation were calculated for the data. The mean SBS among the groups was compared using ANOVA. The post hoc Bonferroni test was applied to compare between the groups. The mean SBS was highest for Group 5 (47.89 ± 6.53) followed by Group 2 (34.94 ± 3.04), Group 3 (32.56 ± 6.04), Group 1 (29.12 ± 7.37), and Group 4 (27.56 ± 7.54). ANOVA test showed statistically significant differences among the groups (F = 48.86, P = 0.00). Conclusion: SIE/HIM when combined with sandblasting with appropriate heat treatment demonstrated a significant increase in bond strength. This prolongs the longevity of the restoration, thereby meeting the clinical needs.

A Shift to Synergistic Surface Treatment Using Laser to Enhance the Bonding of Zirconia to Veneering Ceramic: An In Vitro Study.

AIM: The aim of this study was to evaluate the effect of combination of surface treatment using laser along with other modalities of surface treatment on shear bond strength of zirconia to veneering ceramic. MATERIALS AND METHODS: Milled and sintered zirconia cylinders (n = 150) were used in the study which were divided into six groups that were subjected to various surface treatments. Samples in group I were subjected to sandblasting. In group II Laser (Er: YAG) surface treatment was performed. Samples in group III were subjected to sandblasting followed by laser ablation. In group IV laser ablation was carried out followed by liner application, and samples in group V were subjected to laser ablation followed by argon plasma treatment. Instron machine was used to test the shear bond strength (SBS). One-way ANOVA and Bonferroni test were used for statistical analysis. RESULT: Samples in group III showed highest values for SBS followed by groups I, IV, and V with less SBS value for group II. CONCLUSION: Thus, the results conclude the use of combination of surface treatment using laser to be an effective modality to enhance the shear bond strength of zirconia. CLINICAL SIGNIFICANCE: Synergistic surface treatment using laser increases the bond strength of zirconia prosthesis to veneering ceramic improving its clinical longevity.

Comparative evaluation of bond strength of resin cements with and without 10-methacryloyloxydecyl dihydrogen phosphate (mdp) to zirconia and effect of thermocycling on bond strength - An in vitro study.

Background: To compare bond strength of resin cements with and without 10-Methacryloyloxydecyl Dihydrogen Phosphate (MDP) to zirconia and evaluate effect of thermocycling on bond strength. Material and Methods: Standardised test specimens were fabricated as per ADA specification 131. Each Zirconia specimen was mounted in autopolymerzing acrylic resin material. The specimens were divided into 2 groups: Group 1 - specimens bonded with resin cement containing 10-MDP and Group II - specimens bonded with resin cement without 10-MDP. Forty samples of resin cement cylinders were prepared with dimensions of 6mm height and 4mm diameter in line with ADA specification 27 were cured onto the zirconia surface of 10mm x10mm x5mm using customised moulds. Specimens from each cement group were further divided into 2 subgroups: Subgroup A - Specimens that were not thermocycled and Subgroup B - Specimens that were thermocycled. Specimens were then subjected to tensile bond testing by using a Universal testing machine, the data were analysed using independent sample t test for bond strength and paired t test for effect of thermocycling. Statistical analysis used: Data was subjected to normalcy test (Shapiro-wilk test). Data showed normal distribution. Hence parametric test paired t test were applied. Results: Paired t test revealed that the thermocycling affected the bond strength to zirconia. The highest bond strength was achieved for the resin cement with 10-MDP before thermocycling, whereas the lowest bond strength values were recorded for resin cement without 10-MDP after thermocycling. Conclusions: Resin cement with 10-MDP showed superior bond strength to Zirconia than resin cement without 10-MDP. Adhesive failure was predominant at Zirconia and resin cement interface. Thermocycling had a significant effect on the bond strength of resin cements to zirconia, showing decreased bond strength. Key words:10-MDP, Tensile Strength, Zirconia.

Scrutiny of COVID-19 response strategies among severely affected European nations.

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.

Social media, vaccine hesitancy and trust deficit in immunization programs: a qualitative enquiry in Malappuram District of Kerala, India.

BACKGROUND: With increased penetration of the internet and social media, there are concerns regarding its negative role in influencing parents' decisions regarding vaccination for their children. It is perceived that a mix of religious reasons and propaganda by anti-vaccination groups on social media are lowering the vaccination coverage in Malappuram district of Kerala. We undertook a qualitative study to understand the factors responsible for generating and perpetuating vaccine hesitancy, the pathways of trust deficit in immunization programs and the interaction between various social media actors. METHODS: In-depth interviews and focus group discussions were conducted among parents/caregivers, physicians, public sector health staff, alternative system medical practitioners, field healthcare workers and teachers in areas with highest and lowest vaccination coverage in the district, as well as with communication experts. RESULTS: The trust deficit between parents/caregivers and healthcare providers is created by multiple factors, such as providers' lack of technical knowledge, existing patriarchal societal norms and critical views of vaccine by naturopaths and homeopaths. Anti-vaccine groups use social media to influence caregivers' perceptions and beliefs. Religion does not appear to play a major role in creating vaccine resistance in this setting. CONCLUSIONS: A long-term, multipronged strategy should be adopted to address the trust deficit. In the short to medium term, the health sector can focus on appropriate and targeted vaccine-related communication strategies, including the use of infographics, soft skills training for healthcare workers, technical competency improvement through a mobile application-based repository of information and creation of a media cell to monitor vaccine-related conversations in social media and to intervene if needed.

Determinants of Willingness for COVID-19 Vaccine: Implications for Enhancing the Proportion of Vaccination Among Indians.

Objective To assess willingness for the coronavirus disease 2019 (COVID-19) vaccine and identify the factors attributing to the willingness. Design A cross-sectional study was conducted, adopting an exponential, non-discriminative snowball sampling technique. The questionnaire collected the socio-demographic profile, history of COVID-19 infection, presence of co-morbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease (COPD), asthma, cancer), willingness, and preference of vaccine among participants. An online platform (Google Forms) was used to collect data from all over India. A total of 2032 Indian adults aged above 18 years were included in the study. Results Around 1598 (78.6%) expressed willingness to receive the COVID vaccine, and among the healthcare providers (HCPs), 579 (80.3%) were willing for COVID vaccination. Factors like the belief that the vaccine is necessary (aOR=1.68, 95% CI =1.34 to 2.11), respondents having no history of COVID infection (aOR=0.71, 95% CI: 0.52 to 0.97), having trust in the government (aOR=6.09, CI: 4.59 to 7.98), people who felt the cost of the vaccine didn't matter (aOR=4.92, CI: 3.80 to 6.37), and respondents with no perceived risk of COVID infection (aOR=0.63; CI: 0.47 to 0.83) were more associated with willingness for COVID vaccination. Conclusions An effective vaccine should be well-received by the public. The responsibility lies with the government, health authorities, and manufacturers to take appropriate steps to dispel rumors in order to ensure people's understanding and acceptance.

Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants.

INTRODUCTION: Meta-analyses have shown concurrent chemoradiotherapy (CCRT) provides no survival benefit over radiotherapy in patients of head and neck squamous cell carcinoma (HNSCC) aged over 70 years. This study was performed to determine the adverse-effect profile, compliance, functional and oncological outcomes in patients of HNSCC over 70 years of age treated with CCRT. MATERIALS AND METHODS: Retrospective analysis of stage III/IV HNSCC in patients above 70 years of age who received CCRT at our institution (n = 57). Cox-proportional hazards regression model was used for statistical analysis. RESULTS: There were 57 patients of stage III/IV HNSCC who underwent curative CCRT. 61% completed chemotherapy with no deaths and acceptable toxicity. The predictors of recurrence were poorer performance status (P = 0.031) and treatment breaks (P = 0.04). Tube dependence was associated with 2.7 times higher risk of mortality (P = 0.005). CONCLUSION: CCRT should be considered standard of care in those over seventy with good performance status. Patients with tube dependence have a higher risk of persistent disease or treatment related mortality.

PCR-based detection of three anaerobic bacteria associated with endodontic-periodontic lesions in type-2 diabetic and nondiabetic subjects.

AIM: The aim of this study is to clinically isolate and detect three anaerobic bacteria associated with endodontic-periodontal lesions in type-2 diabetic and nondiabetic patients using polymerase chain reaction (PCR). MATERIALS AND METHODS: Sixty patients presenting endodontic-periodontal lesions were divided into two groups. Thirty patients with type-2 diabetics (Group 1) and 30 nondiabetic patients (Group 2) were evaluated for the presence of three anaerobic bacteria. Clinical examinations, periapical radiographs, and microbiological sampling from the canal system and periodontal pockets were performed. Qualitative evaluation of bacteria was performed using a multiplex PCR for Porphyromonas gingivalis and Prevotella intermedia. Statistical analysis was performed using Pearson's Chi-square test and Fischer's exact test. RESULTS: Enterococcus faecalis (73.3%) was the predominant bacteria isolated from the root canal in type 2 diabetic patients, followed by P. gingivalis (70%) and P. intermedia (36%) compared to 53.3%, 43.3%, and 23.3%, respectively, among nondiabetic patients. P. gingivalis (73.3%) was the predominant bacteria isolated from periodontal pockets in type II diabetic patients followed by P. intermedia 50% and E. faecalis 30% compared to 36.6%, 33.3%, and 30%, respectively, among nondiabetics. P. gingivalis was detected in the root canal and periodontal pocket in almost similar numbers (70% and 73%), respectively, among type-2 diabetics. CONCLUSION: Detection of P. gingivalis, P. intermedia, and E. faecalis in both root canal and periodontal pocket samples confirm a viable pathway for the spread of infection through dual sites. Since in the present study, P. gingivalis was found to be present in similar numbers in dual sites among type 2 diabetic patients, importance should be given in treating such anaerobic bacteria in immune-compromised patients.

Comparative Evaluation of Cytotoxicity and Genotoxicity of Two Bioceramic Sealers on Fibroblast Cell Line: An in vitro Study.

AIM: The purpose of this study was to evaluate and compare the cytotoxicity and genotoxicity of two bioceramic root canal sealers: EndoSequence BC and iRoot SP with zinc oxide eugenol sealers on fibroblast cell line. MATERIALS AND METHODS: The sealers tested were zinc oxide eugenol, EndoSequence BC, and iRoot SP. Each material was mixed according to the manufacturer's instructions and mounted into sterile polyethylene color-coded rings, for cytotoxicity and genotoxicity evaluation. After 48 hours, the set materials were transferred to previously marked wells and cytotoxicity evaluation to L929 murine fibroblast cells was done by 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. The percentages of viable cells were then calculated and values were statistically analyzed by Kruskal-Wallis test. The evaluation of genotoxicity of the materials to L929 murine fibroblast cells was carried out by Comet assay. To quantify deoxyribonucleic acid (DNA) damage, the following comet parameters were evaluated in the assay using Comet scoring software: tail length, tail moment, and Olive moment. The values were statistically analyzed using Kruskal-Wallis test with a significance value set to p < 0.05. RESULTS: The results of the study showed that both cytotoxicity and genotoxicity evaluation by MTT assay and Comet assay can be done on L929 murine fibroblast cell line. Among the three tested materials, zinc oxide eugenol showed maximum cytotoxicity to the cells (30.64% viable cells), followed by EndoSequence BC (71.33% viable cells) and iRoot SP (75.11% viable cells). The evaluation of DNA damage by genotoxicity assessment showed iRoot SP to be least genotoxic followed closely by EndoSequence BC. Zinc oxide eugenol was genotoxic and induced more DNA damage on the fibroblast cell line studied. The statistical analyses for both the assays were nonsignificant. CONCLUSION: All the three tested sealers showed varying degrees of cytotoxicity and genotoxicity while using fibro-blast cell line. Zinc oxide eugenol was most toxic in both the assays and iRoot SP showed least toxicity, followed closely by EndoSequence BC.

The role of biopolymer matrix films derived from carboxymethyl cellulose, sodium alginate and polyvinyl alcohol on the sustained transdermal release of diltiazem.

Due to changing lifestyles of modern world, cardiac failures are increasing day by day. Drug delivery systems that can overcome the drawbacks of conventional drug administration are highly desired. Diltiazem hydrochloride (DTZ) is a common and effective drug used for cardiac failures. However, its efficient loading, high bio availability and sustained transdermal release from polymer matrix are of high demand. Herein, the main objective was to fabricate a transdermal drug delivery system (TDDS) capable of efficient DTZ loading with sustained release. Owing to the high hydrophilicity of DTZ, a hydrophilic matrix comprising of poly ethylene glycol coated vinyl trimethoxy silane-g-chitosan (PEG@VTMS-g-CS) was developed. DTZ encapsulated copolymer was dispersed in matrices like sodium alginate (ALG), carboxy methyl cellulose (CMC) and poly vinyl alcohol (PVA). Economic viability and cosmetic attractiveness of the films were evaluated and optimum results were obtained for PVA matrix. The in vitro skin penetration study of DTZ on rat skin further demonstrated the efficacy of PVA based film which yielded more than 40.0% cell viability on HaCaT and PBMC cell line with no histological changes on the skin which further confirmed the practical utility of the prepared film.

Temperature and ultrasound sensitive gatekeepers for the controlled release of chemotherapeutic drugs from mesoporous silica nanoparticles.

With the advent of smart biomaterials, environmental stimuli have always been the trigger for targeted drug delivery. Conventional routes of drug administration suffer from serious drawbacks like first pass metabolism, less patient compliance and the requirement of trained personnel. Of the many well-established non-conventional routes, transdermal drug delivery systems (TDDSs) seem to be promising as they do not enter directly into the bloodstream and hence, side effects can significantly be reduced. Researchers around the world are trying to incorporate environmental sensitivity into TDDSs. Herein, we report the design and fabrication of a dual sensitive TDDS: (tetrahydropyranyl methacrylate-co-amino ethyl methacrylate)-grafted-mesoporous silica nanoparticles, (THPMA-co-AEMA)-g-MSNs, that could simultaneously sense temperature and an external stimulus - ultrasound (US). Temperature sensitivity was imparted by the conformational changes adopted by the system above and below the lower critical solution temperature (LCST). Below the LCST (4 °C), the polymer would exist as linear chains allowing drug molecules to enter the mesopores of silica, and at physiological temperatures the copolymer collapses preventing premature drug leakage. This sensitivity could be complemented by the inclusion of mechanophores like tetrahydropyran (THP), which could cleave bonds on exposure to US. At physiological temperatures, the TDDS can be placed at malignant sites and on US exposure, the chemotherapeutic agents could be leached out, resulting in better targeting, efficient drug release and minimal side effects. US can act as a potential penetration enhancer making it ideal even for targeting internal organs. All reaction procedures were monitored with the aid of FTIR, XRD, 1H NMR and FE-SEM techniques. Temperature sensitivity was analysed by encapsulating 5-flurouracil (5-FU) and analysing with a UV-Visible spectrophotometer. US sensitivity was monitored as a function of scattering light intensity. Pore opening and closure was verified by nitrogen adsorption isotherms. The dual responsiveness of the material was confirmed by confocal images of the sample before and after exposure to US. The physiological acceptance and practical efficacy of the material in real life situations were confirmed by histological studies on rat skin, MTT assay in HeLa cell lines and in vivo CAM assay. The results suggest the potential applicability of the material in site selective transdermal delivery of chemotherapeutic drugs.

Nanoparticle assisted solvent selective transdermal combination therapy of curcumin and 5-flurouracil for efficient cancer treatment.

Skin cancer is one among the many prominent diseases of the modern world and millions of people are suffering due to the lack of proper medication. Even though transdermal drug delivery systems (TDDS) provide an efficient route of drug administration, the advantages of combination chemotherapy have rarely been extended into TDDS. In the present work, a polymer capable of simultaneously encapsulating two anti-cancer drugs: 5-flurouracil (5-FU) and curcumin (CUR), and releasing them with varying kinetics as a function of the leaching solvent was developed. The prepared TDDS had two copolymers: alginate coated aminated nanodextran (ALG@AND) and chitosan coated folate decorated aminated ß-CD nano particles (CS@FA-g-AßCD). After inducing surface charges, both copolymers were coupled together by electrostatic forces. All the synthetic procedures for the preparation of TDDS were monitored using FTIR, DLS, Zeta Potential, SEM and TEM. The final TDDS was then evaluated for its solvent selectivity. Sustained release of 5-FU and CUR was observed with ethanol (EtOH) and 1-butanol (BuOH) respectively. However, these solvents could also release a small amount of the second drug which led to combinatorial therapy. The in vitro solvent selective drug permeation profiles were evaluated using Franz diffusion cell on rat skin. In order to evaluate the economic feasibility of the prepared TDDS, in vivo skin adhesion tests, skin irritation analysis, water vapour permeability and average visible transmittance were performed. Results proved that solvents could not only elute the drugs in a sustained manner, but could also act as penetration enhancers. Biological and histological studies carried out on skin and cancer cell lines suggested the potential usefulness of the prepared material in combinatorial chemotherapy.

Radical radiotherapy for carcinoma of the larynx in the elderly: Functional and oncological outcomes from a tertiary cancer care center in India.

INTRODUCTION: It is estimated that around 10% of all head and neck cancer patients in India are aged over 70 years. Elderly patients are often subjected to palliative or inadequate treatment for head and neck cancers in spite of being candidates for curative intent therapy. In this study we evaluated our use of radical radiotherapy in carcinoma larynx for patients over seventy years of age to determine morbidity, likelihood of completing therapy, functional and oncological outcomes. MATERIALS AND METHODS: 132 patients of squamous cell carcinoma of the larynx treated between 2005-2015 at Amrita Institute of Medical Sciences, Kochi who were seventy years of age or older were included. The endpoint for analysis was overall survival. Survival curves were generated using Kaplan Meier method and univariable analysis was performed using log rank test. RESULTS: The median age of patients was 77 years (range 70-102). All patients (100%) completed radiotherapy with 6 (5%) requiring treatment breaks. All patients had at least minor (grade I/II) toxicities. Grade III toxicities were seen in 10 (8%) of patients. No grade IV reactions or treatment related deaths occurred. When a univariate analysis was performed for determinants of major toxicities with age range, performance status, smoking, number of co-morbidities or TNM stage, no determinants were statistically significant. 2-year disease free survival for stage I, II, III and IV was 100%, 98%, 80% and 64% respectively, and the 2-year overall survival for all four stages was 100%. CONCLUSION: Patients over seventy years tolerate radical radiotherapy for treatment of laryngeal cancer. In spite of minor toxicities, all patients completed treatment and had good oncological outcomes. Patients with stage III/IV unfit for concomitant chemotherapy administration treated with radiotherapy alone had a good disease free survival. Curative intent therapy should not be withheld from elderly patients on the basis of age.