Silver Nanoparticles As Drug Delivery Systems

The goal of this project is to study the potential applications of silver nanoparticles (SNPs) in the medical device and pharmaceutical industries. Bone cements have been used in the orthopedic surgeries for many years to anchor prosthetics while filling up the spaces between the prostheses and bone. Antibiotics are an active component of bone cements but the increasing bacterial resistance to these antibiotics and difficulty of shaping and molding the bone cements increases the need for new antimicrobial biomaterials. Adult stem cell based regenerative therapies have been one of the most widely researched areas of tissue engineering. This is due to the recent success of in vitro differentiation of stem cells and a high demand to replace damaged organs and tissues from autologous and allogenic source using regenerative methods. In bone regeneration, growth fact based surgeries have lead to the calcification bones outside the surgical site. Here, we test a SNP based osteogenic drug delivery system, both in vitro and in vivo, that will provide clinicians and health care providers control of the activation stem cell differentiation leading to the formation of bone. We will evaluate the in vitro osteogenic differentiation of human adipose stem cells with light mediated miR-148b-Nanoparticle conjugates. We will functionalize SNPs with osteogenic miR-14b with a UV sensitive photocleavble group and a TAMRA 563 molecule. The SNP-miR-148b conjugates will be added to hASCs and activated with UV radiation that will release the miR-148 from the conjugate. The released miRNA will differentiation stem cells into osteoblast. The upregulation of early and late stage osteogenic differentiation markers like ALPL, OCN and Runx2 will be analyzed by qRT-PCR and histological stains (ALPL stain and Alizarin Red). Also, we will evaluate the healing of critical size mouse calvarial defects with light activated miR-148b-Nanoparticle conjugates. After testing the in vitro differentiation of hASCs, we will evaluate the healing of calvarial size defects with SNP-miR-148b. A 4 mm critical size defect (non-healing) will be drilled on the skull of mice and filled with non-osteogenic Polycaprolactone (PCL) scaffolds. Prior to implantation, the scaffolds will be seeded with hASCs, transfected with SNP-miR-148b conjugates and radiated with UV. The healing of the defect will be analyzed with micro-CT and histological staining after 4 and 12 weeks post implantation

Biocompatible/ Bioresorbable Polymer Based Silver Nanaomaterial Coatng for Chronic Indwelling Medical Devices and Bioscaffolds for Tissue Regrowth

The objective of this study is to synthesize and characterize antimicrobial, bio-polymer based silver nanomaterials composite coatings, for use in chronic indwelling medical devices, and bioscaffolds. The coatings and bioscaffolds are comprised of novel biomass mediated silver nano particles (SNP) that are biocompatible, highly concentrated, highly pure, cost-effective, polydispersed and compatible with a range of polymer systems applicable for use with existing chronic indwelling medical devices. This thesis is divided into three main chapters. In Chapter 1, detailed review on the need for antimicrobial nanocomposite coatings for chronic indwelling medical devices along with different SNP synthesis and characterization methods is provided. In Chapter 2 a comprehensive description of biocompatible/bioresorbable poly (L-lactide) (PLLA) based thin film coatings comprised of novel 25-75 nm silver nano particles SNP is provided. The particle and film morphology is characterized using Transmission Electron Microscopy (TEM), Atomic Force Microscopy (AFM) and UV-Visible Spectroscopy. The release rate of SNP is profiled by Thermogravimetric Analysis (TGA) and Inductively Coupled Plasma Optical Emission Spectrometer (ICP-OES). These coatings, suitable for chronic indwelling devices, drastically reduce the microbial biofilm formed by Staphylococcus aureus and Escherichia coli by 3-5 log reduction. This chapter details the synthesis of PLLA cast-coatings and the procedure to embed SNP, an antimicrobial agent, at a range of concentrations to identify an optimal SNP concentration of 700-800 ppm that efficacious and non-cytotoxic to human epithelial carcinoma cells (HeLa). Chapter 3 explains the procedure of making biocompatible/bioresorbable PLLA-PEG co-polymer block bioscaffolds designed to degrade and resorb at a controlled rate while providing a suitable substrate for tissue regrowth. The antimicrobial properties of these porous bioscaffolds are tested across varying concentrations of biomass mediated SNP, to determine an efficacious antimicrobial concentration. The bioscaffolds are efficacious as it reduces the Staphylococcus aureus and Escherichia coli biofilm by 92.5- 99.9%, respectively, at an antimicrobial SNP concentration of 800ppm

A case review of a Morel Lavellee Lesion with Delayed Presentation

A Morel Lavellee lesion is a relatively rare post traumatic condition which is missed at the time of early presentation. It involves a closed internal degloving injury where the subcutaneous tissue is torn away from the underlying fascia and thus creating a cavity containing hematoma and necrotic fat. It occurs most commonly over the greater trochanter. The lesion can be treated conservatively and surgically. Here we report an unusually delayed presentation of a Morel Lavellee lesion that was treated by incisions, drainage and primary closure

A case review of a Morel Lavellee Lesion with Delayed Presentation

A Morel Lavellee lesion is a relatively rare post traumatic condition which is missed at the time of early presentation. It involves a closed internal degloving injury where the subcutaneous tissue is torn away from the underlying fascia and thus creating a cavity containing hematoma and necrotic fat. It occurs most commonly over the greater trochanter. The lesion can be treated conservatively and surgically. Here we report an unusually delayed presentation of a Morel Lavellee lesion that was treated by incisions, drainage and primary closure

Frequency to Non-Compliance to Oral Iron Therapy in Pregnancy and Common Factors Leading to it

OBJECTIVES: The objective of this study was to determine frequency of non-compliance to oral iron therapy in pregnancy and common factors leading to it. METHODOLOGY: It was a cross-sectional study done in the Department of Obstetrics and Gynecology of Lady Willington Hospital Lahore, Pakistan. The duration of this study was six months i.e., 3rd October 2019 to 2nd March 2020. All antenatal patients between ages of 18 to 45 years presented in the obstetrics outdoors or admitted in the ward were included in this study. A total of 245 patients were included in this study by consecutive non-probability sampling. Patients with gynecological problems, patients dependent on others for their medication cost, patients with psychiatric illness or physical disability were excluded. Post stratification Chi-square test was applied keeping P-value ≤0.05 as significant RESULTS: Among 245 patients, mean age was 27±2.16 years. Iron supplement used by 245 patients was analyzed as 159 (65%) patients had used the iron supplement while 86 (35%) patients didn’t use iron supplements (P-value 0.001). Iron supplement used by 245 patients was analyzed and only 93 (38%) patients had used the iron supplement while 152 (62%) patients didn’t use iron supplements. CONCLUSION: The coverage of antenatal iron and folic acid supplements is very low in the surveyed districts of Pakistan due to lack of parental education and older aged women belonging to poor households

Impact of Internal Practices on Organizational Performance: A Review and Research Agenda in the Pakistan Banking Sector

Investigation in organizational performance issues is becoming an important research agenda in the recent times.Considering this research agenda, the aim of the current study is to propose the novel conceptual model signifying the impact of organizational internal practices like organizational culture and organizational internal market orientation on the organizational performance in the perspective of organizational commitment as a mediator.Based on the relevant literature review, five research propositions have been framed.Also, the current study indicated the linkages and interactions that take place between organizational behavior and marketing concepts and its consideration at the organizational level which affects the organizational commitment leading to organizational performance.The two underpinning theories (i) Resource Based View (RBV) and (ii) Social Exchange Theory (SET) underpinned the proposed conceptual model.This investigation recommends that the Pakistan banking organizations should focus on their organizational culture and organizational internal market orientation as a strategy and implement them to meet their employees and bank goals. This implementation of the strategies will influence the organizational commitment and in turn enhance the organizational performance.Considering the current situation of the Pakistan banking sector, this study is expected to generate very useful insight for the future researchers, policy makers, branch managers and the regulatory authorities

Cerebral Angiography Can Demonstrate Changes in Collateral Flow During Induced Hypertension

AbstractA 52-year-old woman with a large left-hemispheric stroke was transferred to our hospital for possible endovascular treatment. The patient underwent a cerebral angiogram at 7 hours after symptom onset with intent to treat and was found to have occlusion of the proximal M1-segment of the left middle cerebral artery (MCA). At that time it was felt that this was a high-risk patient for mechanical clot retrieval and it was decided to treat her with induced hypertension. The diagnostic catheter was left in place in the left internal carotid artery (ICA) and hypertension was induced in the angiography suite by means of an infusion of neosynephrine. Ten minutes after the goal blood pressure levels had been reached, a repeat left ICA injection was performed, which demonstrated more extensive collateralization of the MCA territory from anterior cerebral artery branches. Mean transit times (MTT) for the left ICA circulation improved from 9.5 seconds prior to induced hypertension to 6.0 seconds. The neosynephrine infusion was continued for a total of 24 hours and the patient showed neurological improvement. We suggest that induced hypertension led to the improved collateralization to the left MCA as evidenced by the improved MTT and augmentation of leptomeningeal collaterals, which in turn led to the patient's clinical improvement

Optimizing quality of care by patient satisfaction for the department of Orthopaedics - A survey study

Introduction: Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) has provided a standardized survey method in order to evaluate the patient’s satisfaction on the care they are provided. While overall patient satisfaction is clearly a multidimensional concept, the HCAHPS survey covers 8 domains of health care. This study tries to identify and establish the main determinants to patient’s level of satisfaction during their visit to Cabell Huntington Hospital Orthopaedics department. Methods: Data was collected from surveys handed in 3 consecutive months; June, July and August of 2013. Sixteen questions were selected from HCAHPS that were appraised to be relevant for the use in orthopaedics department. The main dependent questions that allowed patients to rate their overall satisfaction were (1) how much is the patient likely to recommend the department is and (2) how would they rate their overall satisfaction in their visits. We then studied each of the other 14 questions (independent questions) the patients were made to answer and how much they determined the overall patient satisfaction. We also divided the questionnaire into those questions the health care provider had control over (modifiable) and those where that were not under their control (non-modifiable). Data was then gathered and step-wise multi variable regression analysis was performed. All analyses were performed using SAS version 9.3. Results: 1138 patients answered the survery. The independent questions that had the maximum impact on the overall patient satisfaction was whether the nurses treated them with respect (OR = 11.5, 95% CI 3.1-43.12. Conclusion: We determined that how the nurses treat the patients and whether the doctors listened to their patients carefully had the highest impact on determining patient’s overall satisfaction and their likelihood of recommending the doctors to their relatives or friends respectively. Our study depicts the patients’ experience of their visit to the orthopedic office is dependent on a variety of factors, which can be modified by the healthcare providers in order to improve the patient’s satisfaction

A Review of Mesenchymal Stem Cell Injections for Osteoarthritis

Mesenchymal stem cell (MSC) injections for osteoarthritis is reviewed. Methods- PubMed search identifying articles in English from 2003-2018 that used intra- articular injection (IA), cartilage repair, cartilage regeneration, chondral injury, adipose stem cells, bone marrow stem cells, mesenchymal stem cells, or autologous stem cells. Results – 388 patients receiving IA MSC injections are discussed with data obtained from 10 case reports or case series, 4 randomized clinical trials (RCT), 1 cohort study, and 3 case controlled therapeutic studies. Conclusions – MSC injections may be an effective adjunct in the management of osteoarthritis and a variety of cartilage related pathologies

Scleraxis‐Lineage Cells Contribute to Ectopic Bone Formation in Muscle and Tendon

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136325/1/stem2515_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136325/2/stem2515.pd