Can low dose of intratracheal dexmedetomidine be used to attenuate peri-extubation cough? - A prospective, double-blinded, randomized clinical trial

Background

Peri-extubation cough is an undesirable event during extubation, prevention of which has been studied with multiple drugs, amongst which intravenous dexmedetomidine has emerged as one of the favourable drugs. Intratracheal route is attractive because of its ease of administration, provided it avoids the hypotension and bradycardia that occurs during intravenous bolus administration. There is a paucity of data exploring the utility, doses, and adverse effect of intratracheal dexmedetomidine.

Methods

After obtaining ethical committee approval, 60 eligible, consenting adult patients undergoing surgery under general anesthesia in a tertiary teaching hospital were recruited and randomised into three groups-DEX0.3, DEX0.5, and NS. The plan of general anesthesia was standardized. Half an hour prior to extubation, study drug was instilled intratracheally-dexmedetomidine 0.3 mic/kg, 0.5 mic/kg, and NS in groups DEX0.3, DEX0.5, and NS, respectively. 4-point cough score was used to assess extubation response. Hemodynamic response and time to Ramsay sedation score 3 was also recorded.

Results

Majority of patients in DEX0.3 (60%) and DEX0.5 (85%) group had no cough (cough score 0), while majority of the patients in the NS group (70%) had either mild or moderate cough (cough score 1, 2). Kruskal Wallis test followed by post-hoc pairwise comparison showed statistically significant difference in 4-point cough score between GroupDEX0.3 and GroupNS (P < 0.001) and between GroupDEX0.5 and GroupNS (P = 0.038). DEX0.5 group, compared to DEX0.3 group, had significantly higher time from reversal to extubation (P < 0.001) and time to achieve Ramsay sedation score of 3 (P < 0.001).

Conclusion

We conclude that both 0.3 mic/kg and 0.5 mic/kg of dexmedetomidine when given intratracheally are effective in preventing peri-extubation cough. Further, 0.3 mic/kg dexmedetomidine showed a better recovery profile compared to 0.5 mic/kg dexmedetomidine when administered intratracheally.

Multifunctional applications of natural polysaccharide starch and cellulose: An update on recent advances

The emergence of clinical complications and therapeutic challenges for treating various diseases necessitate the discovery of novel restorative functional materials. Polymer-based drug delivery systems have been extensively reported in the last two decades. Recently, there has been an increasing interest in the progression of natural biopolymers based controlled therapeutic strategies, especially in drug delivery and tissue engineering applications. However, the solubility and functionalisation due to their complex network structure and intramolecular bonding seem challenging. This review explores the current advancement and prospects of the most promising natural polymers such as cellulose, starch and their derivatives-based drug delivery vehicles like hydrogels, films and composites, in combating major ailments such as bone infections, microbial infections, and cancers. In addition, selective drug targeting using metal-drug (MD) and MD-based polymeric missiles have been exciting but challenging for its application in cancer therapeutics. Owing to high biocompatibility of starch and cellulose, these materials have been extensively evaluated in biomedical and pharmaceutical applications. This review presents a detailed impression of the current trends for the construction of biopolymer-based tissue engineering, drug/gene/protein delivery vehicles.

Fabrication of tri-layered electrospun polycaprolactone mats with improved sustained drug release profile

Modulation of initial burst and long term release from electrospun fibrous mats can be achieved by sandwiching the drug loaded mats between hydrophobic layers of fibrous polycaprolactone (PCL). Ibuprofen (IBU) loaded PCL fibrous mats (12% PCL-IBU) were sandwiched between fibrous polycaprolactone layers during the process of electrospinning, by varying the polymer concentrations (10% (w/v), 12% (w/v)) and volume of coat (1 ml, 2 ml) in flanking layers. Consequently, 12% PCL-IBU (without sandwich layer) showed burst release of 66.43% on day 1 and cumulative release (%) of 86.08% at the end of 62 days. Whereas, sandwich groups, especially 12% PCLSW-1 & 2 (sandwich layers-1 ml and 2 ml of 12% PCL) showed controlled initial burst and cumulative (%) release compared to 12% PCL-IBU. Moreover, crystallinity (%) and hydrophobicity of the sandwich models imparted control on ibuprofen release from fibrous mats. Further, assay for cytotoxicity and scanning electron microscopic images of cell seeded mats after 5 days showed the mats were not cytotoxic. Nuclear Magnetic Resonance spectroscopic analysis revealed weak interaction between ibuprofen and PCL in nanofibers which favors the release of ibuprofen. These data imply that concentration and volume of coat in flanking layer imparts tighter control on initial burst and long term release of ibuprofen.

Green synthesis of anisotropic zinc oxide nanoparticles with antibacterial and cytofriendly properties

Zinc oxide nanoparticles (ZnONPs) exhibit abundant biomedical applications. Anisotropic ZnONPs with a defined shape and size were synthesized using Bacillus megaterium (NCIM 2326) cell free extract as a bio-reductant. The study investigated the multidimensional effect of ZnONPs on Helicobacter pylori strains and assessed its biosafety in normal human mesenchymal stem cells (hMSc). The highly stable ZnONPs were produced using B. megaterium and Zinc nitrate as a precursor. The phase of ZnONPs formation and structural characterization were performed by UV- visible (UV-Vis), Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD) and Field Emission Scanning electron microscopy (FESEM) analysis. Furthermore, the ZnONPs exhibited higher biocompatibility against human mesenchymal stem cells (hMSC) and proved to be potentially safe in mammalian cells. Corroborating the current investigation, we described the anti-H. Pylori dosage of ZnONPs was safe to hMSC and could efficiently use as nano-antibiotic.

AKT is indispensable for coordinating Par-4/JNK cross talk in p21 downmodulation during ER stress

The double-edged role of p21 to command survival and apoptosis is emerging. The current investigation highlights ER stress-mediated JNK activation that plausibly triggers cell death by attenuating endogenous p21 level. Here, we demonstrated that ER stress activator 3-AWA diminishes the p21 levels in cancer cells by averting the senescent phenotype to commence G2/M arrest. In essence, the deceleration in p21 level occurs through ER stress/JNK/Caspase-3 axis via activation/induction of proapoptotic Par-4 and inhibition of AKT. The molecular dynamics studies identified important interactions, which may be responsible for the AKT inhibition and efficacy of 3-AWA towards AKT binding pocket. Interestingly, the p21 deceleration was rescued by incubating the cells with 3-AWA in the presence of an ER stress inhibitor, Salubrinal. Furthermore, we demonstrated that p21 expression decreases solitarily in Par-4^+/+ MEFs; albeit, ER stress-induced JNK activation was observed in both Par-4^+/+ and Par-4^−/− MEFs. Par-4 knockdown or overexpression studies established that ectopic Par-4 along with ER stress are not sufficient to downregulate p21 in PC-3 cells but are adequate for DU-145 cells and that the ER stress inflicted activation of JNK, inhibition of AKT and Par-4 induction are all crucial to p21 downmodulation by 3-AWA. By using isogenic cell lines, such as HCT-116 p53^+/+ and HCT-116 p53^−/−, we found that deceleration in p21 expression due to ER stress is p53 independent. Moreover, in orthotopic carcinogen-induced rat colorectal carcinoma model, we found that 3-AWA inhibits colorectal tumor growth and formation of colorectal polyps at a tolerable dose, similar to the first-line drug for colorectal cancer-5-fluorouracil.

In vitro toxicity, apoptosis and antimicrobial effects of phyto-mediated copper oxide nanoparticles

Herein, copper oxide nanoparticles (CuONPs) are proposed for widespread use in emerging biomedical applications.

Synthesis and characterization of polyethylene glycol (PEG) coated Fe3O4 nanoparticles by chemical co-precipitation method for biomedical applications

Polyethylene glycol (PEG) coated Fe3O4 nanoparticles were synthesized by chemical co-precipitation method. With polyethylene glycol (PEG) as a stabilizer and dispersant. The X-ray diffraction and selected area electron diffraction (SAED) results show that the cubic inverse spinel structure of pure phase polycrystalline Fe3O4 was obtained. The scanning electron microscopy (SEM) and field emission transmission electron microscopy (FE-TEM) results exhibited that the resulted Fe3O4 nanoparticles were roughly spherical in shape with narrow size distribution and homogenous shape. Fourier transform infrared spectroscopy (FT-IR) results suggested that PEG indicated with Fe3O4 via its carbonyl groups. Results of vibrating sample magnetometer (VSM) indicated that the prepared Fe3O4 nanoparticles exhibit superparamagnetic behavior and high saturation magnetization at room temperature. Such Fe3O4 nanoparticles with favorable size and tunable magnetic properties are promising biomedical applications.

Co-relating HbA1c and serum IgA in diabetic and non-diabetic patients with and without periodontitis

Objective: Diabetics are more susceptible to the infections than the non-diabetics (healthy) one, suggesting that the immunologic capability may be unbalanced in diabetics. Periodontitis is associated with alterations in immune responses in both diabetic and non-diabetic subjects. Till date various attempts has been taken to monitor host immunological response of diabetic individuals. Therefore the need to study the local immune response in inflamed gingival showing Periodontitis is apparent. Since till date there are no well documented and significant baseline studies are available on the functional capacities of the lymphoid cells present in gingiva of the periodontitis patients, a study to check the level of immunoglobulin was investigated.   Methodology: A study was carried out where HbA1c, Random Blood Sugar and Serum IgA level were assessed in 60 patients from the OPD of RCDSR. 15 patients each belonging to the four groups diabetic with periodontitis, diabetic without periodontitis, non-diabetic with periodontitis and non- diabetic without periodontitis (control) were analysed for the quantitative estimation of Serum Immunoglobulin A by Turbidometric Immunoassay and HbA1c was done by using Nyco card Reader.Result: The data thus obtained were compared with the level of immunoglobulin found in clinically healthy gingival of the control group. The levels of IgA were found to be high in group ‘A’ (Diabetic patients suffering from Periodontitis) group ‘B’ (Diabetic patients not suffering from Periodontitis) and group ‘C’ (Non-diabetic patients suffering from Periodontitis) but the values are not differing statistically from each other. But, the values of all these groups are statistically highly differed from the value obtained against the normal/healthy controlled group ‘D’.  Conclusion: In our study it can be concluded that there was positive co-relation between the two parameters: elevated HbA1c and Immunoglobulin level with periodontitis. This co-relates to the possibility of an underlying immuno-inflammatory abnormality to be the cause for the elevated level of immunoglobulin in our patients with elevated sugar level. DOI: http://dx.doi.org/10.3126/ajms.v6i2.11096Asian Journal of Medical Sciences Vol.6(2) 2015 72-77

Treatment of drug-induced gingival overgrowth by full-mouth disinfection: A non-surgical approach

BACKGROUND

Drug-induced gingival overgrowth is a common finding in the modern era. These gingival overgrowths are usually treated by various modalities namely substitution of drugs, surgical, and non-surgical treatment. The recent concept mainly involves full-mouth scaling and root planing (the entire dentition in two visits within 24 hours, i.e., two consecutive days) followed by chair side mouth rinsing by the patient with a 0.2% chlorhexidine solution for 2 minutes and brushing the tongue of the patient with 1% chlorhexidine gel. This is followed by an additional subgingival irrigation (three times, repeated within 10 minutes) of all pockets with a 1% chlorhexidine gel.

MATERIALS AND METHODS

Twenty patients between the ages of 20 and 50 years with drug-induced gingival overgrowth were treated using the full-mouth disinfection approach. The patients were evaluated at 3 months and 6 months after therapy. The data obtained for plaque index, bleeding on probing index, probing pocket depth, and gingival overgrowth scores were tabulated and compared statistically using the one sample unpaired t test.

STATISTICAL ANALYSIS

Statistically significant difference (P < 0.05) was found in PI GBI, PPD, and GO score between baseline, 3 months, and 6 months.

RESULTS

All clinical parameters improved significantly after therapy without the need of further surgical treatment.

CONCLUSIONS

Full-mouth disinfection might be a beneficial treatment concept in patients with drug-induced gingival overgrowth, thus decreasing the need for surgical therapy.

Clinical and radiographic evaluation of regenerative potential of GTR membrane (Biomesh®) along with alloplastic bone graft (Biograft®) in the treatment of periodontal intrabony defects

BACKGROUND AND OBJECTIVES

The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of GTR membrane and alloplastc bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects.

METHODS

Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD, GTR membrane+bone graft (test) or OFD alone (control). The clinical efficacy of two treatment modalities was evaluated at 6 months postoperatively by clinical, radiographical parameters. The measurements included probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), bone fill (BF), bone density (BD).

RESULTS

The mean reduction in PD at 0 to 6 months was 3.20±0.82 mm and CAL gain of 3.10±1.51 mm occurred in the GTR membrane+bone graft (test) group; corresponding values for OFD (control) were 2.10±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographically postoperative evaluation was made. All improvement in different parameters was statistically significant (p<0.01).

CONCLUSION

Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to open flap debridement alone.

Extracellular biosynthesis of silver nanoparticles using Bacillus sp. GP-23 and evaluation of their antifungal activity towards Fusarium oxysporum

In last few decades nanoparticles have attracted and emerged as a field in biomedical research due to their incredible applications. The current research was focused on extracellular synthesis of silver nanoparticles (AgNPs) using cell free culture supernatant of strain GP-23. It was found that the strain GP-23 belonged to Bacillus species by 16S rRNA sequence analysis. Biosynthesis of AgNPs was achieved by addition of culture supernatant with aqueous silver nitrate solution, after 24 h it turned to brown color solution with a peak at 420 nm corresponding to the Plasmon absorbance of AgNPs by UV-Vis Spectroscopy. The nanoparticles were characterized by FTIR, XRD, HRTEM, EDX and AFM. The synthesized nanoparticles were found to be spherical in shape with size in the range of 7-21 nm. It was stable in aqueous solution for five months period of storage at room temperature under dark condition. The biosynthesized AgNPs exhibited strong antifungal activity against plant pathogenic fungus, Fusarium oxysporum at the concentration of 8 μg ml(-1). The results suggest that the synthesized AgNPs act as an effective antifungal agent/fungicide.

Oral hygiene practices and habits among dental professionals in Chennai

AIMS AND OBJECTIVES

The present study was carried out to assess the oral hygiene practices and habits among practicing general dentists.

MATERIALS AND METHODS

The study was carried out in four dental schools with the help of a self administered questionnaire. The questionnaire covered dentists' oral self care, smoking habits, professional reading and oral health concepts. A total of 700 dentists responded, of which 457 were males. Recommended oral self care (ROSC) included tooth brushing one per day, eating sugary snacks daily or rarely and regularly using fluoride tooth paste.

RESULTS

The data obtained was then subjected to statistical analyses and evaluated using chi-square tests and logistic regressions.It was found that 55.9% of all respondents brushed twice a day, 59.4% consumed sugar containing snacks less than once daily and 55.1% of them used fluoride containing paste regularly while brushing. 81.1% of the 700 dentists never used tobacco products. In all, 19.6% of the practicing general dentists followed recommended oral self care.

CONCLUSION

From the present study, it can be concluded that only 19.6% of south Indian dentists follow recommended oral self care and hence awareness programs and continuous dental education programs among dentists is essential to improve the present scenario and to increase the number of dental professionals following ROSC.

Effect of a controlled release device containing minocycline microspheres on the treatment of chronic periodontitis: A comparative study

INTRODUCTION

Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes. The aim of this study was to evaluate the efficacy and safety of locally administered minocycline microspheres (Arestin) in the treatment of chronic periodontitis.

MATERIALS AND METHODS

A total of 60 sites from 15 patients in the age group of 35-50 years, who had periodontal pockets measuring 5-8 mm and had been diagnosed with chronic periodontitis, were selected for the study. The selected groups were randomly assigned to either the control group (group A) or the treatment/test group (group B). Only scaling and root planing were done at the base line visit for the control sites followed by local application of Arestin (1 mg). Clinical parameters such as plaque index, gingival index, and gingival bleeding index were recorded at baseline, day 30, day 90, and day 180 in the selected sites of both the groups. Probing pocket depth also was recorded at baseline, day 90, and day 180 for both the groups.

RESULTS

A statistically significant reduction was observed in both groups. Group B showed better results than Group A and these differences were statistically significant.

CONCLUSION

The results of this study clearly indicate that treatment with scaling and root planing plus minocycline microspheres (Arestin) is more effective and safer than scaling and root planing alone in reducing the signs of chronic periodontitis.