Preparation and Evaluation of Chitosan and PLGA Based Implants for the Delivery of Cefotaxime

The poor bioavailability of cefotaxime and limitation of conventional system limits the delivery of antibacterial drug cefotaxime for bone infection treatment. In the current study in situ chitosan implant containing cefotaxime was developed. Injectable implantable drug delivery system containing Cefotaxime was prepared by physically mixing β-glycerophosphate with chitosan in different concentrations. The objective of this study was to standardize the concentrations of the ingredients so as to develop formulation that remains liquid when stored at 4ºC but forms a gel, in minimum time, when injected or when its temperature is raised to 37oC. Injectable in-situ implant before injection was clear and transparent. Gelation temperature significantly increase from 32.6°C ±0.1 to 48.43°C ±0.1 of all formulation. Percentage drug content of all formulation were found in the range of 82.42±1.93 to 99.43±0.55. The syringeability of the final solutions greatly decreased with the increase of chitosan concentration. The release pattern for all formulations was biphasic, comprising an initial burst effect followed by an almost sustained continuous phase. After an initial burst release, the drug entrapped into the chitosan/Gp gel was released slowly. Local delivery of chemotherapeutic agent by controlled- release polymers is a new strategy with the potential to maximize the antibacterial effect of a drug to treat bone infection. The system formulated with cefotaxime was found to be stable and the release profiles of a formulation with chitosan and beta-GP showed almost Higuchi equation release kinetics. The drug release of chitosan imlant containing cefotaxime was found to be more as compare to PLGA implant

A Scoping review of challenges, scope and assessment approaches of teledentistry: an Indian perspective

Context: In India, COVID-19 pandemic has limited the utilization and access to dental services owing to the risk of infections transmission. In this context, tele-dentistry could be useful but there is paucity of literature which provides guidance on the scope and challenges for using tele-dentistry in India. Aims: To identify challenges, scope and assessment approaches of tele-dentistry from an Indian perspective. Settings and Design: Scoping Review. Methods and Material: Scoping review was conducted using the Arksey and O’Malley framework. Databases were searched in July from April to August 2020. Studies concerning challenges and scope of tele-dentistry in India were included. Additionally, literature about assessment approaches used for tele-dentistry programs were also reviewed Results: A total of 64 studies were reviewed, out of which 26 articles were included in the final review. Scoping review reveled that tele-dentistry can act as a seamless tool for diagnosing, training and screening. Few studies suggested the relevance of smartphone technology for specialist consultations and proper diagnosis. Majority of studies revealed shortage of basic infrastructure as a major challenge for tele-dentistry in India. Assessment studies were mainly focused on economic perspective and cost-effectiveness of the programs. Conclusions: This review provide guidance for using tele-dentistry in India. It is also reflected that there is a need for further research about the assessment of tele-dentistry in terms of safety, clinical outcomes, and patient perception

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

Background: Recent trends of hospitalizations and in‐hospital mortality are not well defined in sarcoidosis. We examined aforementioned trends and prevalence of cardiovascular manifestations and explored rates of implantable cardioverter‐defibrillator implantation in hospitalizations with sarcoidosis. Methods and Results: Using data from the National Inpatient Sample, a retrospective population cohort from 2005 to 2014 was studied. To identify sarcoidosis, an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis code was used. We excluded hospitalizations with myocardial infarction, coronary artery disease, and ischemic cardiomyopathy. Cardiovascular manifestations were defined by the presence of diagnosis codes for conduction disorders, arrhythmias, heart failure, nonischemic cardiomyopathy, and pulmonary hypertension. A total of 609 051 sarcoidosis hospitalizations were identified, with an age of 55±14 years, 67% women, and 50% black. The number of sarcoidosis hospitalizations increased from 2005 through 2014 (138 versus 175 per 100 000, P trend<0.001). We observed declining trends of unadjusted in‐hospital mortality (6.5 to 4.9 per 100 sarcoidosis hospitalizations, P trend<0.001). Overall ≈31% (n=188 438) of sarcoidosis hospitalizations had coexistent cardiovascular manifestations of one or more type. Heart failure (≈16%) and arrhythmias (≈15%) were the most prevalent cardiovascular manifestations. Rates of implantable cardioverter‐defibrillator placement were ≈7.5 per 1000 sarcoidosis hospitalizations (P trend=0.95) during the study period. Black race was associated with 21% increased risk of in‐hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.16–1.27 [P<0.001]). Conclusions: Sarcoidosis hospitalizations have increased over the past decade with a myriad of coexistent cardiovascular manifestations. Black race is a significant predictor of in‐hospital mortality, which is declining. Further efforts are needed to improve care in view of low implantable cardioverter‐defibrillator rates in sarcoidosis

Relative Predictive Value of Circulating Immune Markers in US Adults Without Cardiovascular Disease: Implications for Risk Reclassification

OBJECTIVE: To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. METHODS: We analyzed data of participants enrolled in the National Health and Nutrition Examination Survey from January 1, 1999, to December 31, 2010, with the total leukocyte count within a normal range (4000-11,000 cells/μL [to convert to cells ×10 RESULTS: Among 21,599 participants eligible for this analysis, the median age was 47 years (interquartile range, 34-63 years); 10,651 (49.2%) participants were women, and 10,713 (49.5%) were self-reported non-Hispanic white. During a median follow-up of 9.6 years (interquartile range, 6.8-13.1 years), there were 627 cardiovascular deaths. MLR had the best predictive value for cardiovascular mortality. The addition of elevated MLR (≥0.3) to the 10-year ASCVD risk score improved the classification by 2.7%±1.4% (P=.04). Elevated MLR had better predictive value than C-reactive protein and several components of the 10-year ASCVD risk score. CONCLUSION: Among ambulatory US adults without preexisting cardiovascular disease, we found that MLR had the best predictive value for cardiovascular mortality among circulating immune markers. The addition of MLR to the 10-year risk score significantly improved the risk classification of participants

Trauma from Occlusion: Practical Management Guidelines

Occlusal trauma is trauma to the periodontium from functional or parafunctional force’s causing damage to the teeth and its attachment apparatus by exceeding its adaptive and reparative capacities. Occlusal instability is a common cause for trauma from occlusion, resulting in numerous complications. It often leads to interference which reflexively shifts or slides the jaw forward on one or both the side to find a spot where most teeth come together. This action protects the teeth from injury caused by chewing on just one tooth. Overtime, this shift can cause a whole host of problems from TMJ pain, post restorative complications, headache, tooth sensitivity, recession, broken and loss of teeth and orofacial pain. These occlusal interferences and bite discrepancies are treatable with minimally invasive dentistry. Occlusal equilibration is a therapy that is used when the cause of trauma is due to occlusal instability. This involves the reshaping of the teeth where the improper biting surfaces are located. The key lies in decoding the cause, but often treatment is only directed towards the effects. Only a thorough evaluation and occlusal analysis will lead to a definitive diagnosis that will help in better anticipation of the damages

Epstein-Barr Virus Nuclear Antigen 3C Facilitates G1-S Transition by Stabilizing and Enhancing the Function of Cyclin D1

EBNA3C, one of the Epstein-Barr virus (EBV)-encoded latent antigens, is essential for primary B-cell transformation. Cyclin D1, a key regulator of G1 to S phase progression, is tightly associated and aberrantly expressed in numerous human cancers. Previously, EBNA3C was shown to bind to Cyclin D1 in vitro along with Cyclin A and Cyclin E. In the present study, we provide evidence which demonstrates that EBNA3C forms a complex with Cyclin D1 in human cells. Detailed mapping experiments show that a small N-terminal region which lies between amino acids 130–160 of EBNA3C binds to two different sites of Cyclin D1- the N-terminal pRb binding domain (residues 1–50), and C-terminal domain (residues 171–240), known to regulate Cyclin D1 stability. Cyclin D1 is short-lived and ubiquitin-mediated proteasomal degradation has been targeted as a means of therapeutic intervention. Here, we show that EBNA3C stabilizes Cyclin D1 through inhibition of its poly-ubiquitination, and also increases its nuclear localization by blocking GSK3β activity. We further show that EBNA3C enhances the kinase activity of Cyclin D1/CDK6 which enables subsequent ubiquitination and degradation of pRb. EBNA3C together with Cyclin D1-CDK6 complex also efficiently nullifies the inhibitory effect of pRb on cell growth. Moreover, an sh-RNA based strategy for knock-down of both cyclin D1 and EBNA3C genes in EBV transformed lymphoblastoid cell lines (LCLs) shows a significant reduction in cell-growth. Based on these results, we propose that EBNA3C can stabilize as well as enhance the functional activity of Cyclin D1 thereby facilitating the G1-S transition in EBV transformed lymphoblastoid cell lines

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Production and partial characterization of alkali-tolerant xylanase from an alkalophilic <i style="">Streptomyces</i> sp. CD3

688-697Of the 30 isolates screened, Streptomyces sp CD3, an alkalophilic isolate, showed maximum xylanase production. Organism efficiently used wheat bran and bagasse as substrates and produced 2.211 and 1.896 U/ml of xylanase, respectively. Soybean meal supplementation enhanced xylanase production substantially, while yeast extract and gelatin did so moderately. Although, optimum enzyme activity was at pH 8 and temperature (50oC), but enzyme retained considerable activity at higher pH (80% at 9-10) and temperature (60 % at 70-90oC). The enzyme was strongly inhibited by Hg2+, while Fe3+, Ca2+ and Zn2+ were slight inducers of xylanase. Zymogram analysis suggested the presence of three xylanases (mol wt, 69.18, 63.09 & 43.65 kDa). Purification (108-fold) was achieved by carboxymethyl sephadex chromatography. Enzyme obeyed Michaelis-Menten kinetics (Km 3.9 mg/ml). Industrially desirable characteristics of the enzyme like thermostability and alkali-stability, and highly alkalophilic nature of the organism, and its ability to grow and produce enzyme on low value agricultural by-products reflects the potential commercial importance of this study