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Myeloproliferative neoplasms (MPNs) are caused by somatic pathogenic variants that stimulate increased production and clonal expansion of CD34 multipotent hematopoietic stem cells. Recent World Health Organization (WHO) diagnostic criteria for the diagnosis of Philadelphia chromosome (Ph) negative MPNs includes detection of mutations in the Janus Kinase 2 (), myeloproliferative leukemia (), and calreticulin () genes. The purpose of this study was to demonstrate the clinical utility of an in-house next-generation sequencing (NGS) assay targeting only these canonical genes for the molecular diagnosis of patients with Ph-negative MPNs. We tested 274 samples of patients clinically suspected of having Ph-negative MPNs using an in-house developed NGS panel. The assay consists of two parts, a multiplexed PCR and a highly multiplexed NGS workflow capable of handling diverse samples. The assay is capable of simultaneously detecting mutations in exons 12 and 14, exon 9, and exon 10. Of the 274 samples tested, 49 samples harbored mutations in the gene (48 for the V617F and 1 for exon 12), 31 harbored mutations in the gene, and two harbored mutations in the gene. One sample harbored a mutation each in the and genes. Here, we present the distribution of mutations in an Indian cohort of 274 patients from India with Ph-negative MPNs. Moreover, we have successfully demonstrated the clinical utility of our in-house multiplexed NGS assay for the molecular diagnosis of MPNs with varying mutation depths

Traumatic injuries to maxillary anterior teeth while playing are common in children and adolescents. Sequelae of such trauma include broken, lost, aspirated, and swallowed tooth. At times, the broken tooth fragments get embedded in the adjoining soft tissue and frequently get neglected during diagnosis. The present case report discusses the case of a 13-year-old adolescent who had broken tooth fragment emerged in the lower lip and its surgical excision to prevent detrimental reactions and scarring.

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Introduction Fungal pneumonia is a known complication in immunocompromised patients. However fungal infection leading to organizing pneumonia (OP) is a rare entity. Here we present two cases of co-occurrence of OP with Aspergillus lung infection Case 1: A 33-year-old male with a history of recurrent oral-genital ulcerations and low-grade fever for the last 3 months presented with shortness of breath and high-grade fever for 10 days. On presentation he was hypotensive, tachycardic, and tachypneic, examination revealed bilateral crackles. His initial investigations were hemoglobin (Hb) 8.8, total leucocyte counts (TLC) 13 000, platelet 190 000, liver function test (LFT), and kidney function test (KFT) were normal. High-resolution commuted tomography (HRCT) revealed multifocal areas of interlobular septal thickening with ground glass opacity and patchy areas of consolidation seen in bilateral lung fields (Fig. 1). He was initially managed with broad-spectrum antibiotics and oxygen support by a high flow nasal cannula (HFNC); as the condition deteriorated, he was mechanically ventilated. Fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) was performed. Investigations for tuberculosis, nocardia, pneumocystis carinii, and bacterial infection in BAL was negative. Galactomannan index (GMI) in BAL was 3.15 and grew Aspergillus flavus. Transbronchial biopsy revealed features consistent with organizing pneumonia. He was started on voriconazole and steroids. He was diagnosed with undifferentiated connective tissue disorder. As the patient's condition improved in due course of time, he was extubated and discharged in stable condition on voriconazole and steroids and is currently doing fine. Case 2: A 56-year-old male known case of mantle cell lymphoma on consolidation therapy, presented with 15 days history of shortness of breath and high-grade fever. Chest examination revealed decreased breath sounds bilaterally in the lower lung zones with lower zone crackles. Initial investigations showed Hb 10.9, TLC 3.90, platelet 150000, KFT and LFT were normal. HRCT scan revealed multilobular areas of consolidation showing air bronchogram with ground glass opacities in bilateral lung (Fig. 1). Bronchoalveolar lavage fluid (BALF) revealed the growth of Aspergillus flavus and was GMI 1.97. Investigations for tuberculosis, nocardia, pneumocystis carinii and bacterial infection was negative. Transbronchial biopsy revealed features consistent with organizing pneumonia. He was started on combination therapy with voriconazole and micafungin along with steroids. Initially, he was managed with oxygen support but his oxygenation gradually worsened, he was mechanically ventilated, and received multiple pruning sessions. Patient had refractory organizing pneumonia, did not show any improvement even after 1 month, and left against medical advice. Conclusion Bacterial and viral infections are the common causes of secondary OP. Fungal infections implicated in secondary OP are rarely described, of which there are reports of Pneumocystis jiroveci (PJP) and Penicillium infection leading to secondary OP. Aspergillus flavus is a ubiquitous fungal agent and is considered as pathogenic in immunocompromised settings can lead to secondary organizing pneumonia. High index of suspicious for OP is always to be kept in mind while treating Aspergillus flavus pneumonia.

Atypical haemolytic uremic syndrome (aHUS) is a clinically and genetically heterogeneous condition caused by a complex interplay between genomic susceptibility factors and environmental influences. Pathogenic variants in the DGKE gene are recently identified in cases with infantile-onset autosomal recessive aHUS. The presence of low serum C3 levels, however, has rarely been described in cases of DGKE-associated aHUS. Molecular genetic testing was performed by a commercial next-generation sequencing (NGS) panel as well and by an in-house developed targeted NGS for DGKE gene. Copy number variations (CNVs) were computed from NGS data by calculating a normalised copy number ratio of aligned number of reads at targeted genomic regions against multiple reference regions of the same sample and multiple controls. We report here two such novel clinically relevant variants (c.727_730delTTGT and c.251_259delGCGCCTTC) in the DGKE gene, in two families of infantile aHUS with low serum C3 levels.

Digit sucking or thumb sucking is one of the most common habits usually seen in children. These habits habitually lapse in mid-childhood. The continued persistence of these habits will bring about harmful unbalanced pressures to alveolar ridges, changes in the position of teeth, and occlusion which may result in abnormality if they are continued for a long time. This case report presents a case of a 5-year-old male child patient with a habit of thumb sucking that was successfully ceased by a modified RURS elbow guard appliance. How to cite this article: Anand S, Jyoti D, Shukla JN, et al. Modified RURS Elbow Guard: An Alternative Approach for Thumb Sucking. Int J Clin Pediatr Dent 2021;14(4):590–592.

Beta thalassemia major is a common genetic disorder characterized by the reduced production or absence of beta globin, a product of the haemoglobin subunit beta (HBB) gene. Every year, approximately 10,000–12,000 children with thalassemia major are born in India. Molecular methodologies like ARMS (amplification-refractory mutation system)-PCR (polymerase chain reaction) and capillary sequencing are used to detect HBB gene mutations. It is, however, challenging to achieve comprehensive coverage of the HBB gene by these methods. Next-generation sequencing (NGS) can be used to circumvent these problems. Commercial NGS panels are prohibitively expensive and hence are not routinely implemented in most laboratories. We have developed a cost-effective, highly sensitive and specific, indigenous targeted NGS assay for detecting mutations in the HBB gene. Using this custom NGS assay, we processed 1530 samples (3017 alleles), in which we detected a spectrum of 48 pathogenic/likely pathogenic variants (mutations); IVS-I-5 (c.92+5G>C) was the most common mutation detected (allele frequency (AF) 44.55%), followed by the 619-bp deletion (AF 10.74%), c.92+1G>T (AF 6.99%), c.27_28insG (AF 6.23%), c.47G>A (AF 5.77%) and c.126_129delCTTT (AF 4.71%). Additionally, we discovered a novel mutation (c.7delC) that was submitted to the HbVar database (HbVar ID 3193) as a variant of unknown significance (VUS), probably pathogenic. The targeted NGS assay developed during this study was validated using orthogonal methods and showed excellent correlation with currently available molecular methods. Additionally, this targeted NGS assay was used to analyse the mutation spectrum of the largest beta thalassemia cohort from India.

Background Mycobacterium tuberculosis (Mtb) drug resistance is a global concern. Moreover, multiple drug resistant (MDR), extensively drug resistant (XDR), and totally drug resistant (TDR) Mtb cases are on the rise in developing countries like India. Most of these cases are identified only 3–6 months after initiation of treatment owing to incomplete/failed clinical response and incomplete information from phenotypic drug resistance assays and/or targeted Mtb mutation analysis. Here, we report the development of an in-house whole genome sequencing (WGS) assay and bioinformatics pipeline that helped resolve the phenotype-genotype discrepancy in a clinical isolate. Methodology and results A sample from a suspected drug resistant Mtb case tested by line probe assay (LPA) showed the absence of both the mutant and wild type alleles for an rpoB gene mutation site. An in-house next generation sequencing (NGS) assay was used for WGS of this isolate. Bioinformatics analysis revealed that the isolate harboured a novel insertional mutation in the 81-bp hotspot region of the rpoB gene and a S315T mutation in the katG gene, which could explain resistance to rifampicin and isoniazid, respectively. These results correlated with the clinical diagnosis, LPA, solid culture drug susceptibility testing, and pyrosequencing carried out on the sample. The WGS data also provided information regarding the isolate’s lineage and indicated an absence of known mutations conferring resistance to other antitubercular drugs. Conclusion WGS is a highly sensitive, specific, and unbiased approach for identification of all possible drug resistance-conferring mutations, which can help clinicians make more informed treatment-related decisions.

Objectives: The aim of the study was to assess the salivary IgA (immunoglobulin A) and alpha amylase levels in the unstimulated whole saliva samples of caries-free and caries-active children and correlate it with the caries status and age. Study design: The salivary IgA and amylase was investigated in 100 children in the range of 8–12 years divided in two groups, control group (DMFT and/or deft = 0) and study group (DMFT/deft score ≥5). The salivary IgA was measured using kit based on two-site sandwich enzyme immunoassay principle and amylase was estimated using the vitro amyl slides. Results :The mean salivary IgA and amylase levels in the saliva of the children in the control group was found to be significantly increased (p=.001 and p=.014 respectively) whereas the relationship between salivary IgA and amylase levels in the saliva of the children was found to be insignificant with the age (p=.392 and p=.306 respectively). Conclusions: The results indicated that salivary IgA and amylase levels in saliva increased significantly in caries free children and the level of salivary IgA and alpha amylase has no significant relation with the age of the children.

Dental trauma to anterior maxillary teeth is a frequent incidence in young patients. Pediatric dentists have to deal with such dental traumatic injuries on a regular basis in their daily routine practice. Several studies have reported reattachment of traumatized fractured tooth segment with or without post placement using dentine bonding agent and adhesive resin cement. This case report presents a comprehensive and multidisciplinary management of maxillary anterior teeth with complicated crown fracture and its reattachment with prefabricated glass-reinforced composite fiber post and dual-cure adhesive resin followed by a permanent restoration. How to cite this article Pallawi, Mukherjee CG, Anand S, et al. A Comprehensive Management of Complicated Anterior Maxillary Crown Fracture in a 15-year-old Adolescent. Int J Clin Pediatr Dent 2020;13(3):303–305.

Philadelphia-negative myeloproliferative neoplasms (MPNs) are a group of clonal disorders that are characterized by excessive proliferation of abnormal myeloid precursors and mature cells. Somatic driver mutations in the JAK2, CALR, and MPL genes serve as major diagnostic criteria in the classification of the MPNs, namely polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Although initially thought to be mutually exclusive, recent studies have reported the co-existence of JAK2, MPL, and CALR mutations. In this case report, we describe a case of a Philadelphia-negative myeloproliferative neoplasm harboring mutations in the CALR [NM_004343.3:c.1092_1143del52 (NP_004334.1:p.Leu367Thrfs)] and MPL [NM_005373.2:c.1543T>A (NP_005364.1:p.Try515Arg)] genes. Given the rarity of documented co-occurrence of driver mutations in these two genes and the concomitant paucity of data regarding management of patients harboring mutations in both these genes simultaneously, there are no clear guidelines for the treatment of patients with these mutation patterns and hence it is difficult to assess the true relevance of this genotype. The fact that both the MPL and CALR genes are a part of the JAK-STAT pathway could, however, assist in the clinical decision-making process.

Aim: The aim of this study was to evaluate and to compare the clinical efficacy of two compounds (hydrochloric acid and phosphoric acid) in microabrasion in terms of degree of stain removal (DSR) and improvement of appearance for the different severities of dental fluorosis. The mean time and number of applications required by the two experimental compounds were also compared. Methodology: Children between the age group of 9–14 years with dental fluorosis to two or more fluorozed anterior permanent teeth were included in the study. The Dean's Fluorosis Index was used to classify each tooth, and they were randomly selected into mild (Group I), moderate (Group II), and severe (Group III) groups of fluorosis. Ten teeth from each of these groups were randomly allotted for undergoing microabrasion using 18% HCl with pumice and other 10 teeth using 37% phosphoric acid with pumice. Colored preoperative and postoperative photographs were taken for each patient and analyzed for improvement in appearance and DSR. Time and number of applications and parent–patient response with both the compounds were also recorded. The results were tabulated and statistically analyzed. Results: The results of the present study showed that a nonsignificant difference existed in DSR and improvement in appearance between the two compounds of microabrasion for all the three degrees of dental fluorosis. Significantly lesser time was taken by HCl in mild and moderate fluorosis. Significantly lesser number of applications was required with HCl for moderate fluorosis. Nonsignificant difference existed for parent-patient response with both the compounds for all the severities of dental fluorosis. Conclusion: 18% HCl with pumice and 37% phosphoric acid with pumice both can be used for microabrasion for all the severities of dental fluorosis. The time and number of applications using HCl were lesser; therefore, it should be preferred over H3PO4 for all the severities of fluorosis.

Familial hypercholesterolaemia (FH) is associated with severely elevated serum low-density lipoprotein cholesterol (LDL-C) levels that lead to premature onset coronary artery disease (CAD) and is r...

The potential of powdered roots of Water Hyacinth (WH) for decolourization of Congo red (CR) dye has been studied, in both batch as well as continuous packed bed systems. The suitable conditions for the CR removal (pH 7.4, contact time 180 min, adsorbent dosage 10 g/L and temperature 323 K) were studied, through detailed evaluation of parameters. The kinetic evaluation of the process revealed that the data best adhered to pseudo-first-order kinetics. Freundlich, Langmuir, Dubinin–Radushkevich and Temkin isotherms were utilized for modelling the CR removal at equilibrium, the results of which have described the adsorption of CR as a monolayer process following the Langmuir Isotherm. Maximum adorption capacity was found to be 93.82 mg/g at 323 K. Continuous packed bed studies were also carried out for different bed heights on 100 mg/L of CR solution and the respective breakthrough curves were studied. The above studies have demonstrated WH to be an effective adsorbent for the treatment of water contaminated by Congo red dye.

To screen for variants in the MC4R and LEP genes in 46 patients with clinical suspicion of non-syndromic early onset severe obesity (NEOSO). Children with early onset obesity satisfying WHO criteria of obesity were studied. The MC4R and LEP genes were sequenced using a PCR amplicon based NGS on Illumina MiSeq next generation sequencer using an in-house developed protocol. Of the 46 children tested, four were found to have novel pathogenic/likely-pathogenic variants (one in the MC4R gene and three in the LEP gene). In three out of the 4 families, the presence of the variants was confirmed using standard bidirectional capillary sequencing in the probands. Four children with novel likely pathogenic variants in the MC4R and LEP genes are reported. Genetic analysis is crucial in children with early onset obesity and should be considered.

A large number of organisms are known to cause acute encephalitic syndrome (AES). A number of diagnostic tests have to be performed in order to arrive at a probable pathogen causing AES thus making it a very time consuming, laborious and expensive. The problem is further compounded by the lack of availability of sufficient volume of Cerebrospinal fluid (CSF). Thus, there is an urgent need of a diagnostic tool for the simultaneous detection of all probable pathogens responsible for causing AES. Here we report the development of a novel diagnostic method, Syndrome Evaluation System (SES) for the simultaneous detection of 22 pathogens including RNA and DNA Viruses, bacteria, fungi, and parasite all endemic to India and Southeast Asia in a single sample using a novel multiplexing strategy. Syndrome Evaluation System (SES) involves isolation of nucleic acid, multiplex amplification of the DNA, and cDNA followed by identification of the amplified product by sequence specific hybridization on SES platform with the final read out being a visually recordable colored signal. The total time required to carry out this diagnostic procedure is 7 h. The SES was standardized using the commercially available vaccines, panels and cell culture grown quantified viruses/bacteria/fungi. The limit of detection (LOD) of SES ranged between 0.1 and 50 viral particles per ml of CSF and 100 to 200 bacterial cells or 5 parasites per ml of CSF, along with 100% specificity. Precision studies carried out as per the Clinical Laboratory Improvement Amendments (CLIA) guidelines, using two concentrations of each pathogen one the LOD and the other double the LOD, clearly demonstrated, that inter/intra assay variability was within the limits prescribed by the guidelines. SES is a rapid molecular diagnostic tool for simultaneous identification of 22 etiological agents of AES encountered both in sporadic and outbreak settings.

Graphene nano ribbon based terahertz patch antenna on polyimide substrate is designed and its radiation characteristics are investigated in the 725–775 GHz band. The terahertz communication system consists of higher data rate transmission, low transmit power with secured wireless communication. The proposed antenna consists of graphene nano ribbon as radiating patch and also the ground plane separated by a 20 μm thin polyimide substrate. The antenna has achieved the broad impedance bandwidth (>5%) in the band of operation. The design has yielded a peak gain of 5.71dB at 750 GHz. The antenna is simulated by using the finite element method based simulator Ansys - HFSS.

An optically transparent microstrip patch antenna is designed on photonic bandgap structures and its radiation characteristics are computed and analyzed in the visible spectrum region. The proposed antenna consists of indium tin oxide, a transparent conducting material used both as a radiating patch and a ground plane separated by the 5 μm thin glass substrate. The introduction of periodic cylindrical air cavity structures in the glass substrate leads to the formation of photonic band gap. The patch thickness is carefully selected based on the analysis of the optical transmission coefficient with respect to patch thickness. The effective dielectric constant of the photonic band gap loaded glass substrate is computed using the effective medium approach. The refractive index of the proposed antenna is presented and discussed. The radiation efficiency of the antenna is shown to improve significantly due to insertion of proposed photonic band gap structures. The proposed design has yielded a bandwidth of 2–2.3 THz for a return loss ( S 11 ) of less than −15dB and achieved a peak gain of 4.97dB at 2.27 THz.

This paper presents the design of a Labyrinth shaped antenna, with a dual operating frequency of 9 and 11 GHZ in the X band region. The structure being designed has an impressive Voltage Standing Wave Ratio (VSWR) of 1.38 at the operating frequency. As the X band demarcation of the microwave radio region is widely used in numerous communication based applications, the antenna being presented in this work gives us a viable alternative that can be used with an impressive performance in this region of microwave radio. Rogers RT/duroid 5880 (TM) is used as the substrate material. The Voltage Standing Wave Ratio (VSWR) plot obtained has been examined and elaborated in the subsequent sections of the paper.

This paper presents a novel design of a rectangular patch antenna loaded with artificial magnetic conductor designed for WLAN applications. The proposed Artificial Magnetic Conductor (AMC) lends provision for operating at both the popular ISM bands. However, here the antenna is designed to operate at 6 GHz with a bandwidth of around 160 MHz which is suitable for the intended applications. The antenna has been analyzed for its performance in terms of return loss and VSWR. The performance of antenna loaded with the AMC is observed to possess better properties in comparison to the one without AMC. AMC loaded antenna shows 90.79 % improvement in VSWR at 6 GHz compared to its counterpart. For better comparison, their respective directivities, gains and 3D polar plots have been obtained and presented.

Trauma to the maxillary anterior teeth is a common incidence in young patients. Pediatric dentists have to deal with such dental traumatic injuries on a regular basis in their daily routine practice. Some clinical studies have reported reattachment of fractured tooth segment using adhesive resin cement and dentine bonding agent with or without postplacement. This case report presents a comprehensive management of complicated crown fracture in the maxillary anterior teeth with reattachment of the fractured tooth segment with dual-cure adhesive resin and a prefabricated glass-reinforced composite fiber post followed by a permanent restoration.

Digit sucking is the most common oral fixation seen in children. Some situations that stimulate digit sucking are fatigue, boredom, excitement, hunger, fear, physical, and emotional stress. If these habits persist beyond the preschool age when permanent teeth start to erupt, they may be implicated as an important environmental etiological factor associated with the development of malocclusion. This article presents a case report of a 9-year-old female patient with thumb sucking habit since childhood and describes the steps in the fabrication of the modified RURS' elbow guard appliance for more efficient function.

In this paper, the ground plane of a microstrip patch antenna is loaded with periodic array of complementary K-shaped metamaterial structure designed to behave as an artificial magnetic conductor (AMC). Unit cell of K-shaped AMC is designed to provide in-phase reflection at 2.4 GHz. A microstrip patch antenna is designed to resonate at 2.4 GHz in the band 2.386–2.414 GHz with 1.17% impedance bandwidth and peak gain of 7.94 dB. The effect of loading the ground plane of antenna with repetitive complementary K-shaped AMCs on antenna characteristics such as gain, bandwidth and radiation efficiency is studied. On loading complementary K-shaped AMCs in antenna ground plane, antenna resonates at 2.4 GHz in the band 2.379–2.436 GHz with 2.38% impedance bandwidth and peak gain of 6.37 dB. Both K-shaped AMC unit cell and antenna are designed and simulated by using finite element method based electromagnetic solver - Ansys HFSS. Compared to the antenna without K-shaped AMC loaded ground, the antenna with K-shaped loaded ground achieved wider bandwidth and better radiation efficiency.

An optically transparent microstrip patch antenna is designed and its radiation characteristics are analyzed in 706 - 794 GHz band. Terahertz communication systems offer advantages such as broad bandwidth, low transmit power, secured wireless communication and compactness. It has applications in various fields like hidden object detection, imaging and sensing. In the proposed antenna, transparent conducting indium tin oxide thin film is used as a radiating patch and a ground plane material. The entire antenna structure is optically transparent in the visible spectrum region. The proposed antenna is simulated using Ansoft – HFSS, a finite element method (FEM) based electromagnetic solver.

Aim: If a relation exists between salivary IPHA, buffer capacity and caries experience, then this relationship could be used as screening chair side test for caries risk assessment. Study design: One hundred ninety seven children aged 4 to 6 years were examined. Data was collected by interview and clinical examination. They were divided into low, moderate and high caries experience group of 20 children each. Two ml of each sample was used to measure the pH value with pH meter. Regarding the buffering capacity, freshly prepared hydrochloric acid (HCl) was titrated into saliva and pH was recorded. The collected saliva samples were sent to Laboratory for measurement of calcium and phosphorus. IPHA was calculated and the negative logarithms of IPHA were used to determine the enamel solubility. The correlation between salivary IPHA, buffering capacity and caries experience were evaluated. Results: There was a significant relation between pH, log IPHA and dental caries experience, it could be considered as a predictor of dental caries. Conclusion: pH measurement after HCl titration in saliva could be used as chair side screening test for the assessment of caries risk.