Inhibitory Effect of Oral Thin Films (OTFs) Containing Xylitol Against Streptococcus mutans

Dental Caries is a chronic disease affecting half of the global population, causing pain and discomfort due to progressive damage to the teeth. Whilst xylitol has been studied for its effect on dental caries prevention, current practices present few limitations for its successful oral delivery, including short residence time in the mouth and poor patient compliance. Recently, oral thin films (OTFs) emerged as an alternative to delivering xylitol in the oral cavity. This research aims to develop novel OTFs containing xylitol with extended-release properties (as determined by the disintegration time) and to investigate its effect on a cariogenic bacterial strain, Streptococcus mutans. The minimum inhibitory concentration (MIC) of xylitol was determined. Employing the microdilution broth method, the antibacterial activity of the oral thin films containing xylitol for oral S. mutans was performed with simulated salivary fluid, incubated at 1, 4, and 10 h. The MIC of xylitol was found at 10%. Meanwhile, there was no significant difference in the inhibition of S. mutans (p > 0.05) between the control, OTFs (10 h), and xylitol-OTF (1 h), with the latter, demonstrated only 16.58% inhibition. Interestingly, when compared to xylitol-OTF (1 h), xylitol-OTF showed significant inhibition (p < 0.05) to S. mutans after four h (+53.24 %) and almost a complete inhibition after ten h (-92.58 %). These results suggest that the OTFs demonstrated a gradual release of xylitol and inhibited oral biofilm formation by decreasing the growth of S. mutans in a time-dependent manner. Most importantly, the study indicated the successful development of a novel xylitol-OTF with potential as an oral health biotherapeutic agent.

Application of Nanoemulsion in Tuberculosis Treatment

Tuberculosis is commonly called TB and considered to be the most contagious disease. This disease is caused by a causative agent known as Mycobacterium tuberculosis within the host body cells. Emergence incidence of XDR and MDR of tuberculosis are due to high dose intake and prolonged treatment of antibiotics. In this era, only one vaccine called as BCG is available which is ineffective against infected tuberculosis adults. Though several antibiotics have been produced to overcome drug resistance and even enhance the patient compliance towards treatment and reduce the treatment regimen, we require a novel strategy that can improve the potency of therapeutic synthetic drugs. This approach can be achieved by the application of nanotechnology associated with conventional therapy. Nanotechnology has attributed the promising effects associated with optimized treatment against chronic diseases. This novel technology has the ability to reduce the dose frequency and even resolves the poor patient compliance.

Co-Entrapment of Sorafenib and Cisplatin Drugs and iRGD Tumour Homing Peptide by Poly[ε-caprolactone-co-(12-hydroxystearate)] Copolymer

The drug-loaded nanocarriers have overcome various challenges compared with the pure chemotherapeutic drug, such as limited bioavailability, multiple drug resistance, poor patient compliance, and adverse drug reactions, offering advantages such as protection from degradation in the blood stream, better drug solubility, and improved drug stability. One promising group of controlled and targeted drug delivery systems is polymer-based nanoparticles that can sustain the release of the active agent by diffusion and their degradation. Sorafenib is the only drug that can prolong the life of patients suffering from hepatocellular carcinoma. Cisplatin remains one of the most widely used broad-spectrum anticancer drugs for the treatment of a variety of solid tumours. Nanoformulations can exert a synergistic effect by entrapping two drugs with different modes of action, such as sorafenib and cisplatin. In our study, polymeric nanoparticles were prepared with a good production yield by an improved double emulsion solvent evaporation method using the copolymer of 12-hydroxystearic acid with ε-caprolactone (12CL), a biocatalytically synthesised biocompatible and biodegradable carrier, for the co-entrapment of sorafenib and cisplatin in nanotherapeutics. A bovine serum albumin (BSA) model compound was used to increase the cisplatin incorporation; then, it was successfully substituted by a iRGD tumour penetrating peptide that might provide a targeting function of the nanoparticles.

Comparative Outcomes of Standard Perioperative Eye Drops, Intravitreal Triamcinolone Acetonide-Moxifloxacin, and Intracameral Dexamethasone-Moxifloxacin-Ketorolac in Cataract Surgery

Background: Since the advent of cataract surgery, topical eye drops have been the mainstay of postoperative prophylaxis and treatment. Due to factors such as high expenses and poor patient compliance, there has been a growing interest and acceptance of “dropless” alternatives. The purpose of this study is to compare the effectiveness of intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac to a standard eye drop regimen in controlling postoperative inflammation, corneal edema, and intraocular pressure (IOP) among cataract patients.Methods: A retrospective longitudinal comparative study among 619 consecutive eyes receiving either a standard eye drop regimen, intraoperative triamcinolone acetonide-moxifloxacin or dexamethasone-moxifloxacin-ketorolac was performed between October 2016 and December 2020. Primary endpoints at postoperative day one (POD1), week one (POW1), and month one (POM1) included corneal edema, anterior chamber inflammation (ACI), and IOP.Results: Throughout the postoperative time points, there were no significant differences in corneal edema between intravitreal triamcinolone acetonide-moxifloxacin versus the standard eye drop therapy (OR [95%CI]: 1.09 [0.82, 1.45], P = .54) and intracameral dexamethasone-moxifloxacin-ketorolac versus the standard eye drop treatment (OR [95% CI]: 1.22 [0.89, 1.67], P = .22). The postoperative ACI severity was lower in the dexamethasone-moxifloxacin-ketorolac group compared to the triamcinolone acetonide-moxifloxacin group by 35% on postoperative day 1 (P = .01). The differences at subsequent postoperative time points were not statistically significant (P = .27 and P = 1.00 for POW1 and POM1 respectively). IOP at POM1 follow up visit was statistically significantly higher for the triamcinolone acetonide-moxifloxacin group [mean (±SD): 15.64 (4.26)] compared to the dexamethasone-moxifloxacin-ketorolac [mean (±SD): 14.16 (4.02)] (P < .01). There was no statistical difference in rates of CME (P = .16) and there were no cases of endophthalmitis.Conclusions: Intravitreal triamcinolone acetonide-moxifloxacin and intracameral dexamethasone-moxifloxacin-ketorolac demonstrate similar levels of efficacy to a standard eye drop regimen after cataract surgery. This study reinforces them as viable alternatives to traditional postoperative drops.

The Application of Pendulum as a Space Regainer in Orthodontic Treatment

Background: The process of distalization in orthodontic treatment is often very difficult. The most common method is the use of cervical headgear. However, due to poor patient compliance, it leads to poor treatment outcomes. Treatment alternatives that require minimal compliance include Jones jig, magnets, and pendulum. Objective: This study aimed to perform distalization of a maxillary molars on a bilateral Class II molar relationship patient with a crowded maxillary arch. Case Report: A 10-year-old female with a Class II molar relationship, bilateral posterior crossbite, and nonerupted upper canines was treated with a rapid palatal expander (RPE), pendulum appliance, and fixed appliance. The crowding in the maxillary arch and spacing in the mandibular arch were eliminated, and transverse discrepancies were corrected. Conclusion: Pendulum appliance is very effective in creating spaces for the eruption of canines and ectopic premolars. Pendulum appliances have been introduced for a long time and have proven successful for molar distalization and space regainer and require minimal patient cooperation. Like other distalization appliances, distal tipping of the molars and mesial movement of the premolars could be observed.

Safe and appropriate use of laxatives for colonoscopy

Background: Appropriate bowel preparation is essential for effective colonoscopy. Inadequate use of bowel preparation solutions reduces patient compliance, makes the detection of lesions such as adenoma difficult, and increases the risk of complication such as perforation. Current Concepts: A 4-L polyethylene glycol (PEG) solution can be safely used for bowel preparation, even in most individuals with underlying diseases. However, it requires a high preparation-volume intake and has poor patient compliance due to its unpleasant taste. Therefore, a 2- or 1- L sulfate-free, PEG-based laxative was developed to, reduce the amount of PEG and improve the taste. Furthermore, simethicon-containing laxative formulation was developed to eliminate gas bubbles. In addition, oral bowel preparation solutions with enema agents and prokinetics were used to improve bowel preparation, but no improvement was observed. Various alternative laxatives are available; however, PEG-based bowel preparation solutions are still recommended in most cases due to their stability. Discussion and Conclusion: Although a 4-L PEG solutions recommended for bowel preparation in most cases, several laxatives have been introduced to overcome its disadvantages. The laxative agent must be selected according to each patient’s specific characteristics. Moreover, the method of taking bowel preparation solutions and additional bowel preparation medications must be carefully chosen. In addition, patient education via various methods, such as using a smartphone, when taking a bowel preparation agent may help improve bowel preparation quality.

Detection of endocrine disorders in young children with multi-transfused thalassemia major

Background Beta thalassemia major (TM) is the most common inherited genetic disorder worldwide. Patients are at risk of iron overload, which leads to various forms of tissue damage, including endocrinopathies. The aim of this study was to evaluate the prevalence and risk factors of endocrine disorders in young patients with multi-transfused TM receiving iron chelation therapy. Methods The inclusion criteria included all known cases of TM according to hemoglobin electrophoresis data, aged 12 years or younger, during the study period. The patient’s age, gender, parent’s consanguinity, clinical examination, and types of iron chelating agents used were recorded. Serum ferritin level, complete blood count (CBC), blood glucose homeostasis, thyroid, and parathyroid functions were determined. Results One hundred twenty patients met the inclusion criteria; 70% of them had malnutrition. The presence of endocrine disorders was observed in 28/120 (23.33%) patients. The most common endocrine disorders were thyroid disorders, either subclinical or clinical hypothyroidism in 11/120 (9.17%) patients, followed by abnormalities in glucose homeostasis 9/120 (7.5%). The prevalence of impaired glucose tolerance, impaired fasting glucose, and diabetes mellitus in the present study was 5 (4.17%), 4 (3.33%), and 0 (00%), respectively, while the least frequent endocrine disorder seen in our patients was hypoparathyroidism in 8/120 (6.66%). We noted that high serum ferritin levels and poor patient compliance to therapy were significantly associated with increased endocrine disorders (OR 0.98, 95% CI 0.96–0.99, P = 0.003 and OR 0.38, 95% CI 0.16:0.93, P = 0.03, respectively). Combined chelating iron agents significantly decreased the prevalence of endocrine disorders when compared with monotherapy (OR 0.40, 95% CI 0.16:0.97, P = 0.04). Conclusion Endocrine disorders could occur in TM patients early before or equal to 12 years of life in about one-fourth of the patients. A high serum ferritin level and poor patient compliance to therapy were significantly associated with increased endocrine disorders. Combined iron-chelating agents were associated with a decreased prevalence of endocrine disorders when compared with monotherapy.

Orally Disintegration Tablet (ODT) Formulation of Candesartan Cilexetil With Croscarmellose Sodium and Crospovidone as Superdisintegrant

Candesartan cilexetil is a group of selective AT1 hypertension drugs (angiotensin II receptor antagonist 1). The drawback of candesartan cilexetil in conventional tablets is that it cannot be used for geriatric patients who have difficulty swallowing tablets, patients with developmental disorders of the muscle and nervous system (tremors), and in schizophrenic patients that lead to poor patient compliance, so to overcome this problem alternative dosage forms are made new namely ODT candesartan cilexetil. This study aims to determine the effect of the combination of superdesintegrant croscarmellose sodium and crospovidone on the quality test of the physical properties of tablets. Candesartan cilexetil ODT tablets bolted by direct compression method with variations in levels of superdesintegrant croscarmellose sodium and crospovidone 2: 3,5%, 2,75: 2,75%, 5: 0,5%, 4,25: 1,25 %, 3,5: 2%. Tests conducted to determine the physical quality of candesartan cilexetil ODT, namely organoleptic, weight uniformity, size uniformity, hardness, brittleness, disintegration time, wetting time and water absorption ratio. Showed an increase in the use of crospovidone (5%) and a decrease in croscarmellose sodium (0.5%) had a greater effect on the disintegration time because it could make the tablet porous when in contact with water so that it would accelerate the disintegration time of 29.167 seconds and increase the speed of wetting the tablets 25.33 seconds. The combination of superdisintegrant croscarmellose sodium and crospovidone (0.5: 5%) in formula 3 can provide physical properties that meet the best quality ODT requirements for candesartan cilexetil.

Challenges And Opportunities Of Nanotechnological Based Approach For The Treatment Of Tuberculosis

: Mycobacterium tuberculosis, because of its unique biochemical behavior and a complex host relationship, successfully evades the host immune system. Therefore, chemotherapy appears to be the first-line option for patients with tuberculosis. However, poor patient compliance with anti-tubercular treatment and variability in anti-tubercular drug pharmacokinetics are among the major driving factors for the emergence of drug resistance. The rising cases of extrapulmonary TB, cross-resistance patterns, high prevalence of tuberculosis and HIV co-infections make tuberculosis treatment more complicated than conventional multidrug therapy. Due to their distinct advantages like higher solubility, increased payload, controlled release profiles, tissue-specific accumulation, and lack of toxicity, Nanoscale materials have immense potential for drug delivery applications. An appropriate selection of polymer and careful particle engineering further improves therapeutic outcomes with opportunities to overcome conventional anti-tubercular drugs' challenges. The present review introduces the prospect of using nanotechnology in tuberculosis (TB) chemotherapy and provides a comprehensive overview of recent advances in nanocarriers implied for delivering anti-tubercular drugs.

A robotic pill for oral delivery of biotherapeutics: safety, tolerability, and performance in healthy subjects

Biotherapeutics are highly efficacious, but the pain and inconvenience of chronic injections lead to poor patient compliance and compromise effective disease management. Despite innumerable attempts, oral delivery of biotherapeutics remains unsuccessful due to their degradation in the gastrointestinal (GI) environment and poor intestinal absorption. We have developed an orally ingestible robotic pill (RP) for drug delivery, which protects the biotherapeutic drug payload from digestion in the GI tract and auto-injects it into the wall of the small intestine as a safe, pain-free injection since the intestines are insensate to sharp stimuli. The payload is delivered upon inflation of a balloon folded within the RP, which deflates immediately after drug delivery. Here we present results from two clinical studies demonstrating the safety, tolerability and performance of the RP in healthy humans. In the first study, three versions of the RP (A, B and C) were evaluated, which were identical in all respects except for the diameter of the balloon. The RP successfully delivered a biotherapeutic (octreotide) in 3 out of 12 subjects in group A, 10 out of 20 subjects in group B and 16 out of 20 subjects in group C, with a mean bioavailability of 65 ± 9% (based on successful drug deliveries in groups A and B). Thus, reliability of drug delivery with the RP ranged from 25 to 80%, with success rate directly related to balloon size. In a separate study, the deployment of the RP was unaffected by fed or fasting conditions suggesting that the RP may be taken with or without food. These promising clinical data suggest that biotherapeutics currently administered parenterally may be safely and reliably delivered via this versatile, orally ingestible drug delivery platform. Graphical abstract