Adsorption Characterization of Lactobacillus sp. for Di-(2-ethylhexyl) phthalate

Di-(2-ethylhexyl) phthalate (DEHP) is the widely detected plasticizer in foods whose exposure is associated with a myriad of human disorders. The present study focused on identifying Lactobacillus strains with high adsorption potential towards DEHP and further elucidating the mechanism of binding using HPLC, FTIR and SEM. Two strains, Lactobacillus rhamnosus GG and Lactobacillus plantarum MTCC 25,433, were found to rapidly adsorb more than 85% of DEHP in 2 h. Binding potential remained unaffected by heat treatment. Moreover, acid pre-treatment enhanced the DEHP adsorption. Chemical pre-treatments, such as NaIO4, pronase E or lipase, caused reduction in DEHP adsorption to 46% (LGG), 49% (MTCC 25,433) and 62% (MTCC 25,433), respectively, attributing it to cell wall polysaccharides, proteins and lipids. This was also corroborated by stretching vibrations of C = O, N-H, C-N and C-O functional groups. Furthermore, SDS and urea pre-treatment, demonstrated the crucial role of hydrophobic interactions in DEHP adsorption. The extracted peptidoglycan from LGG and MTCC 25,433 adsorbed 45% and 68% of DEHP, respectively, revealing the imperative role of peptidoglycan and its integrity in DEHP adsorption. These findings indicated that DEHP removal was based on physico-chemical adsorption and cell wall proteins, polysaccharides or peptidoglycan played a primary role in its adsorption. Owing to the high binding efficiency, L. rhamnosus GG and L. plantarum MTCC 25,433 were considered to be a potential detoxification strategy to mitigate the risk associated with the consumption of DEHP-contaminated foods.

Ameliorative potential of synbiotic combination of Lactobacillus sp. and polyphenols against Benzo[a]pyrene-induced toxicity in Caco-2 cell line

Exposure to benzo[a]pyrene (B[a]P), a major global food safety concern, is often associated with increasing incidence of colorectal cancers. This in-vitro study was focused on the identification of potential B[a]P-adsorbing Lactobacillus strains and evaluation of the ameliorative effect of synbiotic combination of selected Lactobacillus sp. and polyphenols (quercetin or resveratrol) against B[a]P-induced intestinal toxicity in Caco-2 cells. Preliminary studies lead to the selection of Lactiplantibacillus plantarum MTCC 25433 strain that showed 86% of B[a]P adsorption in 2 h as compared to L. rhamnosus GG that showed 74% of B[a]P adsorption. B[a]P adsorption by MTCC 25433 was reduced to 9%, 16% and 20% upon pre-treatment with SDS, NaIO4 and mutanolysin, attributing the involvement of cell wall proteins and polysaccharides in the adsorption. Additionally, peptidoglycan of both strains adsorbed >50% of B[a]P. In-vitro assays revealed that the selected LAB mitigated the B[a]P-induced epithelial cell damage. Among the polyphenols, quercetin, resveratrol and curcumin, varied in their potency to mitigate B[a]P-induced oxidative stress, with curcumin being least effective. Combinations of selected Lactobacillus sp. and polyphenols were more potent in averting B[a]P-induced toxicity via increase in GSH (17-30 %), SOD (50-88 %), catalase (19-45 %), and reduction in IL-8 secretion (14-28 %) and barrier dysfunction. Principal component analysis affirmed the superior potency of combination of L. plantarum MTCC 25433 and quercetin in averting B[a]P-induced toxicity. Overall, this study highlighted a novel promising strategy of synbiotic combination of Lactobacillus sp. and polyphenols (quercetin or resveratrol) in alleviating the B[a]P-induced toxicity in intestinal epithelial cells.

An insight into the critical role of gut microbiota in triggering the phthalate-induced toxicity and its mitigation using probiotics

Exposure to phthalates, a major food safety concern, has been implicated in various chronic human disorders. As dietary exposure serves as a primary exposure route for phthalate exposure, understanding the detrimental impact on the gastrointestinal tract and resident gut microbiota is indispensable for better managing public health risks. Various reports have explored the intricate interplay between phthalate exposure, gut microbiota dysbiosis and host pathophysiology. For instance, oral exposure of dibutyl phthalate (DBP) or di-(2-ethylhexyl) phthalate (DEHP) affected the Firmicutes/Bacteroidetes ratio and abundance of Akkermansia and Prevotella, ensuing impaired lipid metabolism and reproductive toxicity. In some cases, DEHP exposure altered the levels of gut microbial metabolites, namely short-chain fatty acids, branched-chain amino acids or p-cresol, resulting in cholesterol imbalance or neurodevelopmental disorders. Conversely, supplementation of gut-modulating probiotics like Lactococcus or Lactobacillus sp. averted the phthalate-induced hepatic or testicular toxicity through host gene regulation, gut microbial modulation or elimination of DEHP or DBP in faeces. Overall, the current review revealed the critical role of the gut microbiota in initiating or exacerbating phthalate-induced toxicity, which could be averted or mitigated by probiotics supplementation. Future studies should focus on identifying high-efficiency probiotic strains that could help reduce the exposure of phthalates in animals and humans.

Enhancing bioflavor production by solid-state fermentation using Kluyveromyces marxianus and l-phenylalanine

This study includes the utilization of sweet lemon peel (SLP) and sugarcane bagasse (SB) in solid-state fermentation using Kluyveromyces marxianus for bioflavor compounds production adopting response surface methodology. The major flavor compounds, 2-phenylethanol (2-PE) and 2-phenylethyl acetate (2-PEA) were quantified using gas chromatography-mass spectrometry with and without adding any supplements. Quantification of flavor compounds indicated that without adding any accessory in the substrate, the concentration of 2-PE using SLP and SB was 0.15 ± 0.003 mg/g and 0.14 ± 0.002 mg/g, respectively. Whereas 2-PEA concentration using SLP and SB was observed as 0.01 ± 0.008 mg/g and 0.02 ± 0.001 mg/g, respectively. The addition of l-phenylalanine (l-phe) in the substrates showed 30%-75% enhancement in the production of 2-PE and 2-PEA. The present study indicates that the K. marxianus is a potential microbial cell factory for the production of 2-PE and 2-PEA with the addition of synthetic l-phe having a plethora of applications in food and pharmaceutical industries.

An intelligent hybrid technique for optimal generator rescheduling for congestion management in a deregulated power market

Congestion not only affects the power flow, but also leads certain issues, like market power, market inefficiency and security. When the transmission line exceeds their limits congestion is occurred (voltage, thermal, stability). Congestion management is a technique that helps to deal the issue corresponding to congestion. Many methods have been developed to manage congestion, and also several countries execute various strategies for the smooth functioning of their network. In this manuscript, the rescheduling of congestion management in a deregulated environment using DA-MRFO is proposed. The proposed hybrid technique is the combined execution of both the dragonfly algorithm (DA) and manta ray foraging optimization (MRFO). Dragonfly algorithm is enhanced using Manta ray Foraging optimization (MRFO), hence it is named DA-MRFO technique. The proposed method is used to alleviate transmission grid congestion on group-based electricity market via reprogramming active power of generators and also to reprogram the generator power. Congestion is the major Independent System Operator (ISO) concern on deregulated electricity market that is traditionally controlled by reprogramming generator output power. However, the effects of changes in the generator output power on the overloaded line flow are not identical. All the generators do not represent a desirable approach for congestion management. Here, a generator sensitivity factor is adapted for supporting the optimal generator selection in a congestion management (CM). In a congestion relief process, it is provided at the lowest possible cost. The reduction of power flow with collection of congested lines is probable through coordinated response of reactive energy dispatch as wind farms. The proposed approach is executed in modified IEEE 30 bus system and IEEE 57 bus system, then the efficiency is compared with the various existing optimization approaches.

Polyphenols of Edible Macroalgae: Estimation of In Vitro Bio-Accessibility and Cytotoxicity, Quantification by LC-MS/MS and Potential Utilization as an Antimicrobial and Functional Food Ingredient

Macroalgae are a rich source of polyphenols, and their ingestion promotes various health benefits. However, information on factors contributing to health benefits such as antioxidants, antimicrobial properties, bioaccessibility, and cytotoxicity is less explored and often unavailable. Therefore, this study aims to investigate the above-mentioned parameters for the brown and green macroalgae Sargassum wightii and Ulva rigida, respectively, collected from the southeast coast of India. S. wightii exhibited higher antioxidant activity and moderate antimicrobial activity against major food pathogens in an agar well diffusion assay and in the broth microdilution method (MIC50 being <0.5 mg/mL for all microorganisms tested). Both macroalgae extracts exhibited significantly high bioaccessibility of polyphenols. To evaluate the safety of the extracts, in vitro cytotoxicity by a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was carried out on the primary cells: mouse splenic lymphocytes. An almost complete decline in the cell viability was seen at considerably high concentration (50 mg/mL), expressing the reasonably high safety of the extracts. The extracts of both macroalgae were quantified for polyphenols, wherein fucoxanthin (9.27 ± 2.28 mg/kg DW) and phloroglucinol (17.96 ± 2.80 mg/kg DW) were found to be greater in the S. wightii apart from other phenolics, like gallic acid, quercetin, vanillin, and ferulic acid. The results signify the tremendous scope for the value addition of S. wightii through extraction and purification of polyphenols for its potential exploitation in functional foods and nutraceuticals or as an antimicrobial ingredient in active or smart packaging.

GROUNDWATER AND DRINKING WATER RADON CONCENTRATIONS IN THE COASTAL AND INTERIOR AREAS OF CHENNAI METRO CITY AND ITS IMPACT ON PUBLIC HEALTH

One hundred forty-eight water samples were collected from in and around Chennai and 222Rn concentrations were measured using radon emanometry method. The average 222Rn concentration was estimated to be 6.88, 2.01, 1.17, 0.19 and 0.10 Bq L-1 for borewell water, openwell water, tank water, metro water and lake water, respectively, which were within the U.S. Environmental Protection Agency's (USEPA) Standard limit of 11.1 Bq L-1 and World Health Organization (WHO) global average 10 Bq L-1. The total effective dose obtained has varied from 0 to 157.57 μSv y-1 with ±10% standard deviation. The mean values were 19.608, 8.092, 4.692, 0.761 and 0.423 μSv y-1 for closed borewell, open well water, tank water, metro water and for lake water, respectively. All these values were below the reference point 0.1 mSv y-1 (100 μSv y-1) set by WHO.

Solvent Dependency of Sorghum Bran Phytochemicals Acting as Potential Antioxidants and Antibacterial Agents

Research background

Sorghum bran, although considered as an agricultural waste, is an abundant source of various bioactive compounds. These bioactive compounds require specific extraction with particular solvents and therefore ionic liquid and three different conventional solvents, viz. anhydrous methanol, acidified methanol and water were used in this work.

Experimental approach

To evaluate the phytochemicals in the different sorghum bran extracts, total phenol content, flavonoids, condensed tannins and anthocyanins were determined as per standard protocols. Liquid chromatography with tandem mass spectrometryanalysis of extracts was also performed for their phenolic profiling. The antioxidant activity of the extracts was estimated via three assays: 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging assay, 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical cation decolourization assay and Cu²⁺ reducing antioxidant capacity (CUPRAC) method. The antibacterial activity against two most opportunistic foodborne pathogens: Escherichia coli and Staphylococcus aureus was measured by agar well diffusion assay and minimum inhibitory concentration (MIC) was determined by serial dilution method.

Results and conclusions

Ionic liquid extract of sorghum bran gave the highest yield ((14.9±0.7) %), which indicated that various possible interactions like Van der Waals forces, H-bonding, hydrophobic and cation-π bonding can occur when ionic liquid is used as an extractant compared to other conventional solvents, although total phenol mass fraction expressed as gallic acid equivalents on dry mass basis was only (7.4±0.7) mg/g. The hydrophobicity of the ionic liquid also helped in efficient extraction of condensed tannins ((63.2±2.1) mg/g expressed on dry mass basis), which resulted in significant antioxidant activity of the ionic liquid extract ((85.2±1.2) µmol/g in DPPH assay, (100.8±0.9) µmol/g in ABTS assay and (63.2±1.9) µmol/g in CUPRAC). An interesting revelation reported in this work is the inability of DPPH assay to evaluate the antioxidant activity in acidic environment. The anhydrous methanolic extract of sorghum bran displayed pH sensitivity, making the extract beneficial for certain applications. Qualitative analysis of extracts revealed greater number of phenolic compounds to be present in methanol and distilled water extracts. Moreover, various derivatives of apigenin and luteolin were also observed in all four extracts. In addition, the acidified methanol extract of the sorghum bran exhibited antimicrobial property at a concentration of 12 mg/mL. A larger inhibition zone was observed against Escherichia coli than Staphylococcus aureus, while the MIC against these two bacteria was 2.2 and 1.1 mg/mL, respectively.

Novelty and scientific contribution

This paper presents the first information on the application of ionic liquids as extracting phase for sorghum bran polyphenols and the quantification of such extracts. As evident from the study, each solvent has its own role in the extraction of bioactive compounds. This work also proves that sorghum bran imparts antibacterial activity against foodborne pathogens.

Maxillary brown tumor due to secondary hyperparathyroidism in a Hemodialysis patient: A case report and literature review

Hemodialysis is one of the commonly used renal replacement therapies in treating end-stage renal failure patients. Patients with long-term dialysis may develop frequently complications such as secondary hyperparathyroidism (SHPT), bone diseases, amyloidosis, endocrinal disturbances, cardiovascular complications and infections. Brown tumors (BTs) are erosive giant cell bony lesions that arise in some patients as a result of primary or SHPT. About 2% of all the reported cases showed involvement of facial skeleton, of which the mandible is the favorite site. A complete clinical, biochemical, radiological and histopathological correlation is required for definitive diagnosis. We report here a case of BT in 37-year-old female hemodialysis patient with SHPT.

IMPACT OF THREE DIFFERENT MATCHING METHODS ON PATIENT SET-UP ERROR IN X-RAY VOLUMETRIC IMAGING FOR HEAD AND NECK CANCER

Impact of three different matching methods for delivery of Volumetric Modulated Arc Therapy (VMAT) in Cone-beam computed tomography (CBCT) on patient set-up error. As per institutional imaging protocol, 300 CBCT scans of 20 VMAT head and neck cancer patients treated with 60 Gy/30 fractions were chosen for the present study. Approved CT images of the plan were registered as a reference with the CBCT images on board. Grey-scale matching (GM), manual matching (MM), and bone matching (BM) between on-board CBCT and reference CT images were used to assess patient translation errors. Patient positioning verification was evaluated using the Clip-box registration in all three matching methods. Using the GM approach as a reference point, two additional matchings were rendered in offline mode using BM and MM. For analysis, random error (σ), systematic error (∑), maximum error (E) mean set-up error (M), mean displacement vector (R), matching time (Mt), and multiple comparisons using Post hoc Tukey's HSD test were performed. In MM, less random and systematic errors were found than in GM and BM with an insignificant difference (p > 0.05) Compared to BM and GM, the maximum error, mean set-up error, and displacement vector were marginally less in MM (p > 0.05). In MM, an increased Mt relative to BM and GM was observed (p > 0.05). Furthermore, an insignificant difference in set-up error was revealed in a multiple comparison test (p > 0.05). Any of the three matching methods can be used during CBCT to check patient translation errors for the delivery of the VMAT head and neck patients.

GC-HRMS screening of bioactive compounds responsible for antimicrobial and antioxidant activities of blood fruit (Haematocarpus validus Bakh. F. Ex Forman) of North-East India

The aims of this study are to evaluate phytochemical composition, antimicrobial and antioxidant activities of different solvent-assisted blood fruit pulp extracts. The extracts of blood fruit were prepared with various solvents namely, water, ethyl acetate, methanol and acetone. These extracts were divided into two groups, first group of extract were thermosonicated (treated) and the second group were not exposed to thermosonication (untreated). The sample extracts were then evaluated for their antimicrobial properties against various microorganisms. The results revealed that the antimicrobial activity of thermosonicated ethyl acetate extracts at 12 mg/mL concentration exhibited the highest inhibition zone of 19.4 mm against Staphylococcus aureus. The phenolic content of ethyl acetate extract was found to be the highest as compared to that of other solvent extracts and the values were 1508.08 and 1478.34 mg GAE/100 g for treated and untreated samples, respectively. The treated ethyl acetate extract antioxidative activity by DPPH, ORAC, ABTS, and FRAP assay were 1627.68, 2119.82, 938.11, and 2360.18 µmol TE/g, respectively. The minimum bactericidal concentration (MBC - 1.5 mg/mL) against the selected foodborne pathogens was obtained with thermosonicated ethyl acetate blood fruit extract. In the present study, it was observed that the thermosonicated ethyl acetate extract exhibits maximum antioxidant and antimicrobial activities than any other examined solvent extracts. The major bioactive volatile compounds found in treated ethyl acetate extracts were 2-bromotetradecane, tetracosane, heptadecane, eicosane and palmitic acid. These bioactive compounds can be utilizable for the development of functional, nutraceutical and pharmacological products.

Influence of pressure on the transport, magnetic, and structural properties of superconducting Cr0.0009NbSe2 single crystal

We investigate the superconducting critical current density (J _c), transition temperature (T _c), and flux pinning properties under hydrostatic pressure (P) for Cr_0.0009NbSe₂ single crystal. The application of P enhances T _c in both electrical resistivity (∼0.38 K GPa^-1: 0 ≤ P ≤ 2.5 GPa) and magnetization (∼0.98 K GPa^-1: 0 ≤ P ≤ 1 GPa) measurements, which leads to a monotonic increase in J _c and flux pinning properties. The field-dependent J _c at various temperatures under P is analyzed within the collecting pinning theory and it shows that δT _c pinning is the crossover to δl pinning above the critical pressure (P _c ∼0.3 GPa). Our systematic analysis of the flux pinning mechanism indicates that both the density of pinning centers and pinning forces greatly increase with the application of P, which leads to an enhancement in the vortex state. Structural studies using synchrotron X-ray diffraction under pressure illustrate a stable hexagonal phase without any significant impurity phase and lattice parameter reduction with P shows highly anisotropic nature.

Emergence and era of ultrasonic's in fruit juice preservation: A review

Ultrasonic's has emerged to an unconditional extent in the last decade. It has found its application in fruit juice and beverage industry due to its multifunctional desired effects. The technology is inexpensive, simple, reliable, and environmentally friendly and highly effective in the preservation of juices with enhanced quality attributes. This review will enlighten your knowledge in understanding the basic concept of ultrasonic's with the principle, mechanism, and application in the food sector. It specifically reviews the explored effect of ultrasonication on different juices. It explores the influence of technology in enzyme inactivation, microbial inactivation and different quality attributes of fruit juices. It gives you an in-depth insight into the technology.

Comparison of Different Registration Methods on Patient Set-Up Error During Volumetric Modulated Arc Therapy Using Cone-Beam CT Imaging for Lung Cancer

Background: The three-dimensional image-guided radiation therapy is very important in volumetric modulated arc therapy (VMAT) to enhance accuracy throughout the course of a patient's radiation treatment. The image guidance can ensure the safe administration of prescribed radiation dose to the patient. Aim: This study investigated patient set-up uncertainties based on three different registration methods in cone bean CT (CBCT) using volumetric modulated arc therapy (VMAT) for different clinical sites. Methods: A total of 396 CBCT performed for lung VMAT plan for patient set-up verification as per institution image guidance protocol. The approved CT images were transferred from treatment planning system (TPS) to x-ray volumetric imaging system (XVI) for reference image registration. The set-up errors in mediolateral (ML), craniocaudal (CC) and anterioposterior (AP) direction were determined using grayscale matching between the reference CT image and onboard CBCT images. For the current study, patient set-up verification was performed based on clip-box registration (CBR) for image matching. By considering clip-box registration as a reference, other two registration methods of mask registration (MR) and dual registration (DR) (clip-box and mask) were performed for comparison. To compare three registration methods, systematic error (∑), random error (σ), mean displacement, mean set-up error and maximum error were analyzed. Results: The systemic and random errors were less in clip-box registration as compared with other two registration ( P > 0.05). Similarly, maximum error, mean displacement error and mean set-up errors were observed less in clip-box registration as compared with mask and dual registration ( P > 0.05). However, statically no significant difference was observed between three different registration methods ( P > 0.05). Conclusion: All three registration methods can be used for patient set-up accuracy for lung VMAT plan. However, the current study suggested that clip-box method will be more efficient as compared with mask and dual registration methods.

Study to Compare the Effect of Different Registration Methods on Patient Setup Uncertainties in Cone-beam Computed Tomography during Volumetric Modulated Arc Therapy for Breast Cancer Patients

PURPOSE

This study compared three different methods used in registering cone-beam computed tomography (CBCT) image set with planning CT image set for determining patient setup uncertainties during volumetric modulated arc therapy (VMAT) for breast cancer patients.

MATERIALS AND METHODS

Seven breast cancer patients treated with 50 Gy in 25 fractions using VMAT technique were chosen for this study. A total of 105 CBCT scans were acquired by image guidance protocol for patient setup verification. Approved plans' CT images were used as the reference image sets for registration with their corresponding CBCT image sets. Setup errors in mediolateral, craniocaudal, and anteroposterior direction were determined using gray-scale matching between the reference CT images and onboard CBCT images. Patient setup verification was performed using clip-box registration (CBR) method during online imaging. Considering the CBR method as the reference, two more registrations were performed using mask registration (MR) method and dual registration (DR) (CBR + MR) method in the offline mode. For comparison, systematic error (∑), random error (σ), mean displacement vector (R), mean setup error (M), and registration time (R t) were analyzed. Post hoc Tukey's honest significant difference test was performed for multiple comparisons.

RESULTS

Systematic and random errors were less in CBR as compared to MR and DR (P > 0.05). The mean displacement error and mean setup errors were less in CBR as compared to MR and DR (P > 0.05). Increased R t was observed in DR as compared to CBR and MR (P < 0.05). In addition, multiple comparisons did not show any significant difference in patient setup error (P > 0.05).

CONCLUSION

For breast VMAT plan delivery, all three registration methods show insignificant variation in patient setup error. One can use any of the three registration methods for patient setup verification.

Assessing Prevalence of Temporomandibular Disorders among University Students: A Questionnaire Study

Aim:

The aim of this study is to assess the prevalence of temporomandibular disorders (TMDs) among university students.

Objectives:

The etiology of TMD is of multifactorial, and our study is designed to assess the prevalence of TMD in an institution within a university. Various parameters including trauma, malocclusion, stress assessment - its correlation with the timing, the duration of TMD in meeting the deadlines, and examinations have been assessed.

Materials and Methods:

A standard questionnaire-based study with modified Fonseca anamnestic index is used. The questionnaire study was conducted with a statistically calculated sample size of 402 students within a university. The data were analyzed statistically for significance and correlations. Statistical analysis was performed using SPSS for Windows release 14.0 (SPSS Inc., Chicago, IL, USA). Differences at the 5% level were accepted as being statistically significant.

Results:

TMD and its associated symptoms are frequent among students of health and science studies. Female predominance is seen. There was also an increased prevalence of symptoms in people who described themselves as being tense. The relationship between orthodontic therapy and TMDs were also evaluated, and the duration of therapy is found to be significant. There was a significant association between history of trauma and presence of TMDs.

Conclusions:

TMD and its associated symptoms are frequent among students of health and science studies. A simple anamnestic index is of use in identifying and classifying temporomandibular joint and TMD symptoms in patients according to the severity of the disorder. Females showed a greater prevalence of signs and symptoms of TMD than males. Longitudinal studies are recommended to identify and follow-up the prevalence and health-care needs of patients with TMDs.

Comparative study on attitudes and psychological problems of mothers towards their children with developmental disability

OBJECTIVE

Parents' positive attitudes and psychological wellbeing play an important role in the development of the children with developmental disability. This study aimed to measure the prevalence of psychological problems among mothers of children with autism disorder, intellectual disability, and Down syndrome. The second aim was to assess the differences in mothers' attitudes and psychological problems among their children with intellectual disability, autism disorder, and Down syndrome. The third aim was to identify whether negative attitude was a predictor of psychological problems in these mothers.

METHODS

In this study, 112 mothers of children having mild and moderate levels of autism disorder, Down syndrome, and intellectual disability were assessed using the Parental Attitude Scale and General Health Questionnaire-28.

RESULTS

Overall, mothers of children with intellectual disability were found to have the most negative attitude towards their child. Mothers of children with autism disorder exhibited higher scores on somatic symptoms, anxiety, and social dysfunction when compared with their counterparts with Down syndrome and intellectual disability. Negative attitude was a significant predictor of psychological problems.

CONCLUSION

Parental attitudes and psychological problems would vary among mothers of children with different types of developmental disability.

Osteopetrosis of the mandible masquerading as tubercular osteomyelitis

Osteopetrosis is a rare congenital (autosomal type) disorder of the skeletal system. Several variants have been described in the literature with grossly variant prognosis and clinical behaviour. Several reports of intractable osteomyelitis of the jaw bones secondary to osteopetrosis, particularly the mandible, have been published widely. However, there is no published report of the complete mandible sequestrating de novo, in the literature. An overview of this spectrum of sclerotic bone disease, its presentation in the oro-facial region, the diagnostic challenge it poses and the management dilemma it offers to the maxillofacial surgeon is discussed and a protocol for managing this disease effectively is presented. A clinical illustration of the complexities of management of osteopetrosis-induced osteomyelitis of jaw bones is demonstrated with a very rare case in which the entire mandible had sequestrated.