ABSTRACT
BACKGROUND: High performance liquid chromatography in a newborn girl with congenital cyanosis and a unilateral cleft palate revealed a variant hemoglobin with retention time of 4.8 min, similar to hemoglobin Q-India. Since hemoglobin Q-India did not explain the cyanosis, further investigations were initiated. METHODS: Sequencing of α-globin genes revealed hemoglobin M-Iwate ([α87 (F8) His â Tyr]) that was confirmed on restriction enzyme analysis. RESULTS: Hemoglobin M-Iwate is a rare methemoglobinemic variant formed due to a point mutation in the α-globin gene. Primarily reported from the Iwate prefecture of Japan, there have been occasional case reports from other regions as well. Inherited methemoglobinemia finds only rare mention in Indian literature while hemoglobin M-Iwate has not been reported from India. CONCLUSIONS: This case illustrates the step-wise logical diagnostic approaches necessary to elucidate the cause of methemoglobinemia in an otherwise healthy child with cyanosis.
Subject(s)
Cleft Palate/genetics , Cyanosis/genetics , Hemoglobin M/genetics , Methemoglobinemia/genetics , Point Mutation , alpha-Globins/genetics , Amino Acid Substitution , Cleft Palate/diagnosis , Cleft Palate/pathology , Cyanosis/diagnosis , Cyanosis/pathology , Female , Gene Expression , Histidine/metabolism , Humans , India , Infant, Newborn , Methemoglobinemia/diagnosis , Methemoglobinemia/pathology , Tyrosine/metabolismABSTRACT
In this study, the biomechanical perspective of fracture predilection in post-core restored teeth is investigated using computational, experimental, and fractographic analyses. The computational finite element analysis and the experimental tensile testing are used to evaluate the stress-strain response in structural dentine. The fractographic evaluations are conducted using laser scanning confocal microscopy and scanning electron microscopy to examine the topography of dentine from experimentally fractured specimens, and clinically fractured post-core restored teeth specimens. These experiments aided in correlating the stress-strain response in structural dentine with cracks and catastrophic fractures in post-core restored teeth. It was observed from these experiments that the inner dentine displayed distinctly high strains (deformations), while the outer dentine demonstrated high stresses during tensile loading. This implies that the energy fed into the material as it is extended will be spread throughout the inner dentine, and there is less possibility of local increase in stress at the outer dentine, which can lead to the failure of dentine structure. During post-endodontic restoration with increase in loss of inner dentine, the fracture resistance factor contributed by the inner dentine is compromised, and this in turn predisposes the tooth to catastrophic fracture.
