Comparison of laryngeal mask airway supreme™ versus endotracheal intubation in positive pressure ventilation with muscle relaxant for intraoperative and postoperative conditions

Background: Laryngeal Mask Airways are increasingly being used now a day as an option to endotracheal intubation, as it is less invasive and causes less discomfort in the postoperative period. The aim of this study was to evaluate the clinical use of the laryngeal mask airway SupremeTM in patients undergoing elective gynaecological surgeries under general anaesthesia and compare it with endotracheal intubation.Methods: 60 ASA I and II females, having BMI <30kg.m-2 in the range of 20-50 years of age, scheduled for elective gynaecological surgeries were randomly allocated to one of the two groups according to the device used (LMAS or ETT). Time required for insertion, number of attempts, hemodynamic response to insertion/removal and incidence of immediate and late postoperative complications such as coughing, laryngospasm, sore throat, dysphagia etc. were assessed.Results: Number of attempts for successful insertion was similar but time required for LMA Supreme™ insertion was significantly less (25.40±12.90 versus 33.27±14.82 sec) similarly, time required for nasogastric tube insertion was significantly more in ETT group (30.28±16.22 versus 21.93±12.64 sec). No episode of failed ventilation or hypoxia was recorded. The changes in hemodynamic parameters were significantly higher after endotracheal intubation and during extubation. Incidence of postoperative complications was significantly higher after endotracheal intubation (p<0.05).Conclusions: The LMA Supreme™ is a suitable alternative to endotracheal intubation during general anaesthesia for elective gynaecological surgeries with the added advantage of less hemodynamic response during airway management and lower incidence of postoperative complications

MUCOADHESIVE MICROSPHERES: AN EMINENT ROLE IN CONTROLLED DRUG DELIVERY

ABSTRACT Mucoadhesion is simply known as interfacial force interactions between polymeric materials and mucosal tissues. In the last two decades mucoadhesive microspheres have received considerable attention for design of novel drug delivery systems due to their ability to prolong the residence time of dosage forms and to enhance drug bioavailability. Mucoadhesive microspheres have advantages like efficient absorption and enhanced bioavailability of the drugs due to a high surface to volume ratio, a much more intimate contact with the mucus layer, controlled and sustained release of drug from dosage form and specific targeting of drugs to the absorption site. Microspheres are the carrier linked drug delivery system in which particle size is ranges from 1-1000 μm range in diameter having a core of drug and entirely outer layers of polymer as coating material. Keywords: mucoadhesion, microspheres, controlled release, residence time. INTRODUCTION Since many years several kinds of diseases that may be acute or chronic diseases can be treated by using pharmaceutical dosage form like solutions, tablets, capsules, syrups, suspension, emulsion, ointments, creams, gels which can be used as orally, topically, or intravascular route. To get the proper therapeutic effect of these pharmaceutical dosage forms they should be administered several times a day, this results consequently undesirable toxicity, fluctuation in drug level and poor efficiency or therapeutic effect. Controlled release dosage form plays eminent role to overcome the problems which are discussed above. The most important example of controlled drug delivery system is mucoadhesive microspheres which can improve the therapeutic effect of administered drug. Also bioavailability of drug is also better than other conventional system because mucoadhesive microspheres remain close to the mucous membrane and absorption tissue. Drug delivery systems (DDS) that can precisely control the release rates or target drugs to a specific body site have had an enormous impact on the healthcare system. The last two and developing novel delivery systems referred to as &quot;mucoadhesive microspheres&quot;. [1] Physiology of mucin Mucus is produced in the eye, ear, nose and mouth. It also lines the respiratory, gastrointestinal and reproductive tracts. Its primary functions are the protection and lubrication of the underlying epithelium. Human cervical mucus, for instance, plays an integral role in both conception and contraception. It is essential to understand the structure and physical chemistry of mucus if the latter is to be exploited as a site for bioadhesive controlled drug release. Since the gastrointestinal tract is the primary site for drug absorption, the physiology of this site will be the focus of this discussion. The gelling properties which are essential to the function of mucus are the direct result of the glycoprotein present in the mucosal secretion. This glycoprotein is generally the same for various secretion sites within the body; however, specific and subtle biochemical differences have been identified. Mucus may be either constantly or intermittently secreted. The amount of mucus secreted also varies. The glycoproteinic component of mucus is a high molecular weight, highly glycosylated macromolecular system. This polydisperse natural polymer makes up between 0.5 and 5% of the fully hydrated mucus secretion. [10] The size of the intact molecule is approximately 1.8 x 10 6 , but the molecular weight of undegraded gastric mucin is as high as 4.5 x 10 7 . These macromolecules are highly expanded random coils made up of monomeric glycoproteins which for humans range from 5.5 x 1o 5 in the stomach to 2.4 x lo 5 in the small intestine. Oligosaccharide branches are attached to 63% of the protein core while the remainder of There are 34 disulphide bridges per molecule of rat goblet cell mucin, which has a molecular weight of 2 x 10 6 , while porcine intestinal mucin has 28 bridges per molecule. Human mucin has a similar density of disulphide bonds. The protein spine of the macromolecule has about 800 amino acid residues. Sugar chains are attached at about every three residues along the glycosylated regions; this results in approximately 200 side chains per molecule. This molecule is resistant to proteolytic attack in the glycosylated regions only. Thus, charge interactions may have a significant effect on the behaviour of mucus glycoproteins. The mucous gel covering the epithelium varies in thickness. In the human stomach, the mean thickness is 192 pm, while in the duodenum the thickness ranges from 10 to 400 pm In the gastrointestinal tract, mucus facilitates the passage of food and boluses through the alimentary canal. It also helps shield the epithelium from shear forces induced by peristaltic waves, and resists auto digestion. These functions are promoted by the constant secretion of mucus to replenish losses from turbulence and degradation. In response to an irritant, the amount of acidic side chains in the glycoprotein increases from 50 to 80%, making the macromolecule more negatively charged. The submucosal gland layer increases in depth and the number of goblet cells increases. The total content of non dialysable solids and pH also increase. In the GI tract, DNA and albumin thicken mucus in the diseased state. Mucosal irritation, such as exposure to alcohol or bile salts, elicits accelerated mucin release. Disease can significantly alter the nature and thickness of the mucus. This may lead to a change in the behaviour of the delivery system. Any drug delivery system which is intended to adhere to the mucus epithelium will need to adapt to a substrate which varies in depth and consistency, and may also change biochemically. Hypersecretion, which is more common than hyposecretion during disease, increases the transit rate through the GI tract, and thus reduces the residence time of a mucoadhesive device. Thus, it is essential to consider the physiology of the system when optimizing the formulation of an adhesive controlled release device. CLASSIFICATION OF MUCOADHESIVE POLYMERS Mucoadhesion is defined as interfacial force interactions between polymeric materials and mucosal tissues. In the last two decades mucoadhesive polymers have received considerable attention for design of novel drug delivery systems due to their ability to prolong the residence time of dosage forms and to enhance drug bioavailability. Various administration routes, such as ocular, nasal, gastrointestinal, vaginal and rectal, make mucoadhesive drug delivery systems attractive and flexible in dosage forms development. Mucoadhesive polymers can be classified as,- I. Traditional non-specific first-generation mucoadhesive polymers First-generation mucoadhesive polymers may be divided into three main subsets, namely: (1) Anionic polymers:-Anionic polymers are widely employed for its greatest mucoadhesive strength and low toxicity. These polymers are characterised by the presence of sulphate and carboxyl group that gives rise to net negative charge at PH values exceeding the pka of polymer. Example:-polyacrylic acid (PAA) &amp; its weakly cross linked derivatives, Sodium carboxymethyl cellulose (NACMC) [30] (2) Cationic polymers: -The most conveniently and widely used cationic polymer is chitosan which is produced by deacetylation of chitin. Chitin is a natural polysaccharide found predominantly in the shells of crustaceans such as crabs and shrimp, the cuticles of insects, and the cell walls of fungi. It is one of the most abundant biopolymers next to cellulose Most of the naturally occurring polysaccharides, e.g. cellulose, dextran, pectin, alginic acid, agar, agarose and carrageenans, are neutral or acidic in nature, whereas chitin and chitosan are examples of highly basic polysaccharides. The unique properties include II.Novel second-generation mucoadhesive polymers: The major disadvantage in using traditional nonspecific mucoadhesive systems (first generation) is that adhesion may occur at sites other than those intended. Unlike first-generation non-specific platforms, certain second-generation polymer platforms are less susceptible to mucus turnover rates, with some species binding directly to mucosal surfaces; more accurately termed &apos;&apos;cytoadhesives&quot;. Furthermore as surface carbohydrate and protein composition at potential target sites vary regionally, more accurate drug delivery may be achievable. MUCOADHESION Due its relative complexity, it is likely that the process of mucoadhesion cannot be described by just one of these theories. In considering the mechanism of mucoadhesion, a whole range &apos;scenarios&apos; for in-vivo mucoadhesive bond formation are possible. These include: A). Dry or partially hydrated dosage forms contacting surfaces with substantial mucus layers (typically particulates administered into the nasal cavity). B). fully hydrated dosage forms contacting surfaces with substantial mucus layers (typically particulates of many &apos;First Generation&apos;mucoadhesives that have hydrated in the luminal contents on delivery to the lower gastrointestinal tract). C). Dry or partially hydrated dosage forms contacting surfaces with thin/discontinuous mucus layers (typically tablets or patches in the oral cavity or vagina). D). fully hydrated dosage forms contacting surfaces with thin/discontinuous mucus layers (typically aqueous semisolids or liquids administered into the oesophagus or eye). It is unlikely that the mucoadhesive process will be the same in each case. In the study of adhesion generally, two steps in the adhesive process have been identified Step 2 -Consolidation stage: Various physicochemical interactions occur to consolidate and strengthen the adhesive joint, leading to prolonged adhesion. THEORIES ON MUCOADHESION [4, 5] Various kinds of theories are there which can explain the mechanism of mucoadhesion they are discussed below, TYPES OF MICROSPHERES Mucoadhesive microspheres:-Adhesion can be defined as sticking of drug to the membrane by using the sticking property of the water soluble polymers. Adhesion of drug delivery device to the mucosal membrane such as buccal, ocular, rectal, nasal etc can be termed as bio -adhesion. These kinds of microspheres exhibit a prolonged residence time at the site of application and causes intimate contact with the absorption site and produces better therapeutic action. [26] Magnetic microspheres:-This kind of delivery system is very much important which localises the drug to the disease site. In this larger amount of freely circulating drug can be replaced by smaller amount of magnetically targeted drug. Magnetic carriers receive magnetic responses to a magnetic field from incorporated materials that are used for magnetic microspheres are chitosan, dextran etc. The different type are, Therapeutic magnetic microspheres: Are used to deliver chemotherapeutic agent to liver tumour. Drugs like proteins and peptides can also be targeted through this system.6 Diagnostic microspheres: Can be used for imaging liver metastases and also can be used to distinguish bowel loops from other abdominal structures by forming nano size particles supramagnetic iron oxides. Floating microspheres:-In this type of microspheres the bulk density is less than the gastric fluid and so remains buoyant in stomach without affecting gastric emptying rate. The release rate of drug is slow at the desired rate, if the system is floating on gasteric content and increases gastric residence and increases fluctuation in plasma concentration

Bone Tissue Response to Porous and Functionalized Titanium and Silica Based Coatings

Background: Topography and presence of bio-mimetic coatings are known to improve osseointegration. The objective of this study was to evaluate the bone regeneration potential of porous and osteogenic coatings. Methodology: Six-implants [Control (CTR); porous titanium coatings (T1, T2); thickened titanium (Ti) dioxide layer (TiO2); Amorphous Microporous Silica (AMS) and Bio-active Glass (BAG)] were implanted randomly in tibiae of 20-New Zealand white rabbits. The animals were sacrificed after 2 or 4 weeks. The samples were analyzed histologically and histomorphometrically. In the initial bone-free areas (bone regeneration areas (BRAs)), the bone area fraction (BAF) was evaluated in the whole cavity (500 mm, BAF-500), in the implant vicinity (100 mm, BAF-100) and further away (100–500 mm, BAF-400) from the implant. Bone-to-implant contact (BIC-BAA) was measured in the areas where the implants were installed in contact to the host bone (bone adaptation areas (BAAs)) to understand and compare the bone adaptation. Mixed models were used for statistical analysis. Principal Findings: After 2 weeks, the differences in BAF-500 for different surfaces were not significant (p.0.05). After 4 weeks, a higher BAF-500 was observed for BAG than CTR. BAF-100 for AMS was higher than BAG and BAF-400 for BAG was higher than CTR and AMS. For T1 and AMS, the bone regeneration was faster in the 100-mm compared to the 400-mm zone. BIC-BAA for AMS and BAG was lower after 4 than 2 weeks. After 4 weeks, BIC-BAA for BAG was lower than AMS and CTR. Conclusions: BAG is highly osteogenic at a distance from the implant. The porous titanium coatings didn’t stimulate bone regeneration but allowed bone growth into the pores. Although AMS didn’t stimulate higher bone response, it has a potential of faster bone growth in the vicinity compared to further away from the surface. BIC-BAA data were inconclusive to understand the bone adaptation.status: publishe

Modulation of implants with dense, porous, and functionalized surfaces to promote osseointegration

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/* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}Implants of different sizesand shapes are inserted in a human body for improving structural or biologicalfunction. For improving structural functions of oral implants, integration in skeletaltissue (generally termed as osseointegration) is important. The surface of animplant plays an important role due to direct contact with its biological environmentduring healing and functioning. This project dealt with overall improvement ofimplant osseointegration. According to the current knowledge, osseointegrationof an implant depends on the implant s surface topography and chemicalcomposition. Based on this knowledge, titanium surfaces were modified foroptimization of their bone regeneration potential and to improveosseointegration. Titanium surface modifications were carried out by silica based micro-porous andglass coatings, particulate titanium based porous and dense coatings, bonemorphogenetic protein 2 (BMP-2) and polyphosphate functionalization. The thesisconsists of two parts: (1) the silica based material, amorphous microporoussilica (AMS) was evaluated for its potential use as growth factor (BMP-2) deliveryvehicle and (2) the other aforementioned surfaces (bioactive glass, particulatetitanium-based porous and dense coatings, BMP-2 and polyphosphatefunctionalization) were evaluated for their biological response in vitro and in vivo. Forthe evaluation of the potential of AMS as a protein delivery vehicle,interaction of bovine serum albumin and enhanced green fluoresecent proteinused as model proteins was determined. Specifically, adsorption and releasebehavior of the model proteins on and from AMS was determined by calorimetrictechniques. The release pattern was also confirmed by the real time qualitativeanalysis by fluorescence microscopy at the initial stages. These experimentssuggested the future use of AMS as a protein delivery vehicle with apossibility of controlling the protein release. As a next step, a new techniqueof micro positron emission tomography was explored to evaluate the in vivo release behavior of the proteinadsorbed on AMS. This technique can indeed be used for monitoring proteinmolecules and determine their concentration qualitatively in vivo. The in vivoprotein release pattern was in line with the in vitro release. As the secondary structure of the proteinmolecules in adsorbed state - as in the application of AMS as a deliveryvehicle - is important to understand its functional behavior in a broad sense,Fourier transform infra red spectroscopy was used. From these results, AMS wasfound to protect most of the protein s secondary structure in the adsorbedstate.For the initial biological responseevaluation of the modified surfaces the approach of in vitro cell culture experiments was employed. Proliferation anddifferentiation of human mesenchymal stromal cells on the test surfaces wasstudied. Ca. 10-fold cell proliferation was observed on AMS and BMP-2immobilized on AMS and titanium along with the control titanium surface. Thecells could not survive on other surfaces. The differentiation of the cellstowards osteogenic lineage was observed for AMS surface with immobilized BMP-2.For AMS though, the cell response towards osteogenic differentiation wassimilar to the control. For evaluating the bone tissue response to modifiedsurfaces, in vivo experiments werecarried out in a rabbit model. The bone regeneration effect of AMS and BMP-2immobilized on AMS was similar to the control. On the other hand bio-activeglass resulted in a higher bone regeneration compared to the titanium surface. Nevertheless,this surface did not improve osteoconduction. Although porous titanium coatingsdid not improve the bone regeneration potential, these coatings supported bonegrowth into the pores. BMP-2 immobilized on titanium caused resorption of thehost bone initially in contact with the surface. For polyphosphatefunctionalized surfaces, poly phosphoric acid treatment supports bone growthover the implant surface and phosphorylated poly-saccharide treatment induceshigher bone regeneration compared to the control titanium surfaces.In vitro and in vivo evaluation of biological response to modified surfacesshowed contradictory results and need further investigation for bettercomprehension.status: publishe

Development of Surface Acoustic Wave Sensors Using Nanostructured Palladium for Hydrogen Detection

This thesis addresses the development of new gas sensor using surface acoustic wave (SAW) technology. SAW sensors detect the change in mass, modulus, and conductivity of a sensing layer material via absorption or adsorption of an analyte. The advantage of SAW sensor includes low cost, small size, high sensitivity. We investigated the use of nano-crystalline palladium film for sensing hydrogen gas. We also investigated SAW fabrication for radio frequency (RF) range operation where high signal-to-noise ratios can be achieved. A test-bed consisting of a gas dilution system, a temperature-controlled test cell, a network analyzer, and computer-based measurement system was used for evaluating the performance of SAW gas sensors at very low concentrations. Both single and dual delay line SAW devices were fabricated by means of photolithography on a lithium niobate substrate. Tests are carried to determine response speed, resolution, reproducibility, and linear characteristics, over a range of analyte concentrations

Cryptochromes regulate IGF-1 production and signaling through control of JAK2-dependent STAT5B phosphorylation

Insulin-like growth factor (IGF) signaling plays an important role in cell growth and proliferation and is implicated in regulation of cancer, metabolism, and aging. Here we report that IGF-1 level in blood and IGF-1 signaling demonstrates circadian rhythms. Circadian control occurs through cryptochromes (CRYs)—transcriptional repressors and components of the circadian clock. IGF-1 rhythms are disrupted in Cry-deficient mice, and IGF-1 level is reduced by 80% in these mice, which leads to reduced IGF signaling. In agreement, Cry-deficient mice have reduced body (~30% reduction) and organ size. Down-regulation of IGF-1 upon Cry deficiency correlates with reduced Igf-1 mRNA expression in the liver and skeletal muscles. Igf-1 transcription is regulated through growth hormone–induced, JAK2 kinase–mediated phosphorylation of transcriptional factor STAT5B. The phosphorylation of STAT5B on the JAK2-dependent Y699 site is significantly reduced in the liver and skeletal muscles of Cry-deficient mice. At the same time, phosphorylation of JAK2 kinase was not reduced upon Cry deficiency, which places CRY activity downstream from JAK2. Thus CRY\u27s link the circadian clock and JAK-STAT signaling through control of STAT5B phosphorylation, which provides the mechanism for circadian rhythms in IGF signaling in vivo

Nanocomposite based drug delivery for periodontal disease

Periodontal disease is the term used to describe some pathological conditions characterized by degeneration and inflammation of gums, periodontal ligaments, alveolar bone, and dental cementum. Periodontal disease involves destruction of alveolar bone around the teeth leading to defects or rather loss of the tooth if left untreated. This condition is caused by a chronic, mixed infection of Gram-negative and Gram-positive bacteria. Chlorhexidine (CHX) gluconate is an antiseptic, antifungal and bactericidal agent. CHX inhibits plaque formation by binding to anionic salivary glycoproteins and bacteria. Nano Hydroxyapatite (nHAP) is calcium phosphate in morphology and composition like the human hard tissues. Delivery of medications directly into the periodontal pockets alters the inflammatory response and reduces the pathogenic microbiota, an aspect which has attracted great interes. Result: The CHX Nanocomposites were non-toxic to human cells and promoted cell adhesion, proliferation, and spreading. The CHX Nanocomposites were found to be satisfactory in all respects, and CHX encapsulated in nanocomposites may be attractive candidates for the treatment of periodontal disease

Replay Attack Detection Using Integrated Glottal Excitation Based Group Delay Function and Cepstral Features

The automatic speaker verification system is susceptible to replay attacks. Recent literature has focused on score-level integration of multiple features, phase information-based features, high frequency-based features, and glottal excitation for the detection of replay attacks. This work presents glottal excitation-based all-pole group delay function (GAPGDF) features for replay attack detection. The essence of a group delay function based on the all-pole model is to exploit information from the speech signal phase spectrum in an effective manner. Further, the performance of integrated high-frequency-based CQCC features with cepstral features, subband spectral centroid-based features (SCFC and SCMC), APGDF, and LPC-based features is evaluated on the ASVspoof 2017 version 2.0 database. On the development set, an EER of 3.08% is achieved, and on the evaluation set, an EER of 9.86% is achieved. The proposed GAPGDF features provide an EER of 10.5% on the evaluation set. Finally, integrated GAPGDF and GCQCC features provide an EER of 8.80% on the evaluation set. The computation time required for the ASV systems based on various integrated features is compared to ensure symmetry between the integrated features and the classifier

Comparison of laryngeal mask airway supreme™ versus endotracheal intubation in positive pressure ventilation with muscle relaxant for intraoperative and postoperative conditions

Background: Laryngeal Mask Airways are increasingly being used now a day as an option to endotracheal intubation, as it is less invasive and causes less discomfort in the postoperative period. The aim of this study was to evaluate the clinical use of the laryngeal mask airway SupremeTM in patients undergoing elective gynaecological surgeries under general anaesthesia and compare it with endotracheal intubation.Methods: 60 ASA I and II females, having BMI &lt;30kg.m-2 in the range of 20-50 years of age, scheduled for elective gynaecological surgeries were randomly allocated to one of the two groups according to the device used (LMAS or ETT). Time required for insertion, number of attempts, hemodynamic response to insertion/removal and incidence of immediate and late postoperative complications such as coughing, laryngospasm, sore throat, dysphagia etc. were assessed.Results: Number of attempts for successful insertion was similar but time required for LMA Supreme™ insertion was significantly less (25.40±12.90 versus 33.27±14.82 sec) similarly, time required for nasogastric tube insertion was significantly more in ETT group (30.28±16.22 versus 21.93±12.64 sec). No episode of failed ventilation or hypoxia was recorded. The changes in hemodynamic parameters were significantly higher after endotracheal intubation and during extubation. Incidence of postoperative complications was significantly higher after endotracheal intubation (p&lt;0.05).Conclusions: The LMA Supreme™ is a suitable alternative to endotracheal intubation during general anaesthesia for elective gynaecological surgeries with the added advantage of less hemodynamic response during airway management and lower incidence of postoperative complications

Epidural Butorphanol : Comparison of two different doses in Lower abdominal surgery.

Background:For lower abdominal surgeries, nowadays epidural anaesthesia is preferred. To cover the pain after surgery is the anaesthesiologist work. Butarphanol is synthetic opioid which has better effect on post-operative analgesia. The study participants were divided into Control group, Group A receiving 1mg of butarphanol&amp; Group B receiving 2mg of butarphanol. Objectives: The study was conducted to compare two doses 1mg &amp; 2mg of butarphanol for quality of anaesthesia, quality of motor blockade, duration of post-operative analgesia etc. Methods – It was cross sectional studywas conducted at Department of Anaesthesiology, Government Medical College, over a period extending from January 2007 to November 2008. Results:The onset of sensory blockade was found to occur in less than 1 minutes in group B receiving 2mg of butarphanol. In group B, complete motor blockade in about 10.15±0.86 minutes followed by in group A in 13.27±1.67 minutes. Group B patients had maximum sensory blockade for 3.8±0.40 hours &amp; motor blockade for 2.72±0.32 hours. About 82.5% &amp; 77% patients in Group B &amp; A respectively has excellent quality of anaesthesia. Somnolence was the commonest adverse effect seen in about 70% of group B &amp; 40% of group A patients. Conclusion:Butarphanol through epidural route in different doses can provide you better sensory &amp; motor blockade, better quality of anaesthesia, maximum duration of post-operative analgesia