Emergency management of maxillary dentoalveolar fracture: A case report

Dentoalveolar trauma occurs in relation to injuries of fall, road traffic accidents, sports injury or physical violence. There may be injury limited to the tooth, or may involve the periodontium around, or in severe cases, alveolar bone or oral mucosa may be traumatised. There can be myriad injuries of the same structure depending upon the severity of impact. The injuries of tooth most commonly being crown fractures, followed by root fractures, luxation or complete avulsion of the tooth. Every type of dentoalveolar injury requires a specific set of clinical protocols to be followed in order to successfully diagnose and manage the particular case.We hereby report a case of a 29-year-old male patient with a history of fall under the influence of alcohol, who had fallen flat on his face and had suffered intrusive luxation of permanent maxillary right central incisor and avulsion of permanent maxillary left central and lateral incisors. The exarticulated teeth still had slight soft tissue attachment to the socket. On the patients first visit to dental OPD, being a dental emergency, the avulsed teeth were immediately restored back into the socket under local anaesthesia after adequately irrigating and debriding the socket, followed by repositioning of the internally luxated tooth, so that all were in their correct anatomical position. After checking for occlusion, they were splinted in position with Erich’s arch bar and 26 gauge SS wire and after giving post-operative instructions patient was asked to follow up after 6 weeks. At 6 weeks, the affected teeth were found to be firm and so arch bar were removed. Patient was advised to follow up further. At periodic follow ups, the patient was asymptomatic and maintained adequate oral functioning of the injured teeth, thus with good patient compliance and proper diagnosis and treatment, dentoalveolar fractures can be managed successfully. The main purpose of this article is to lay emphasis on the timing of treatment of the dentoalveolar injuries. The earlier they are managed, the better is the outcome.

Development and Optimisation of Mucoadhesive Films for Enhanced Drug Delivery in Treatment of Lichen Planus

Introduction: Mucoadhesive buccal films are most recently developed and preferred over buccal tablet because of the flexibility, better bioavailability, cost effectiveness, and good patient compliance it offers Objective: The study aimed to formulate mucoadhesive films of Clobetasol Propionate with reduced side effects, controlled release and better patient compliance, suitable for the management of oral lichen planus. Methods: Clobetasol Propionate Buccal Films were prepared by the incorporation of the Clobetasol Propionate along with polymers like Hydroxy Propyl Methyl Cellulose (HPMC) K4M, polyethylene glycol 400 and glycerol by solvent casting method. Results: The drug content of all the formulations was found to be 85.04% to 93.14%. The swelling index of all formulations of Clobetasol Propionate mucoadhesive buccal film was found to be 82% to 94.07%. Formulation F14 which contains Hydroxy Propyl Methyl Cellulose K4M (1%), and polyeth­ylene glycol 400 (1%) exhibited better results compared to other combination of polymers in different concentration. It showed swelling index of 94.07%. Drug content was found to be 91% and showed release of drug up to 95.05% in 12 hours. The optimised formula showed no significant changes on stability studies when stored at 40ºC/75% RH for three months. Conclusions: The application of mucoadhesive buccal film containing Clobetasol Propionate appeared to be effective, avoiding the side effects and the data obtained in the study suggested that buccal films can be successfully designed to give controlled drug delivery.

Hepatocellular carcinoma with extrahepatic adrenal metastasis: an atypical case report

<p class="abstract">Hepatocellular carcinoma with extrahepatic metastasis are a threat to public health worldwide. Lung, bones and abdominal lymph nodes are the major sites of metastasis from liver primary, adrenal metastasis being a less common site. Here we present an old male presented with upper abdominal pain diagnosed as advanced, unresectable hepatocellular carcinoma with right adrenal metastasis. Patient was treated with multi-kinase inhibitor sorafenib and outcome was acceptable with good patient compliance.</p>

A Glance on Mucoadhesive System - Still more to Understand

Most popular and useful route of administration is oral one, among that mucoadhesive system is also preferable. This system is interact with mucus layer containing epithelial cell and mucin molecules which improves the contact time of dosage form, leading to improvement in both local and systemic effects. There are various routes of mucoadhesive drug delivery system, oral route is the most oldest and preferred by patient being convenient to use. However peroral route has some disadvantages such as hepatic first pass metabolism and enzymatic degradation in GIT which is a hindrance to the absorption of most proteins and peptides groups of drugs. The mucosa of the oral cavity contains an intimidating barrier to drug penetration, and one method of optimizing drug delivery is by the use of adhesive dosage forms and the mucosa is connected with various blood supplies by which it is permeable. This route has quick action, and good patient compliance with pediatric and old age patients. The buccal cavity is very easier for a bioadhesion system because of a smooth and relatively immobile surface and accessibility. Mucoadhesion can be achieved by using various mucoadhesive polymers. There are various types of mucoadhesive polymers which improves bioadhesion. Also various theories are referred to clear the concept of mucoadhesion, such as diffusion, facture, electronic and adsorption theories. This article contains definition, mechanism, advantage, and disadvantage. In this article we are going to overlook basic knowledge about mucoadhesion and its formulations.

Development of Porous Polyurethane Implants Manufactured via Hot-Melt Extrusion

Implantable drug delivery systems (IDDSs) offer good patient compliance and allow the controlled delivery of drugs over prolonged times. However, their application is limited due to the scarce material selection and the limited technological possibilities to achieve extended drug release. Porous structures are an alternative strategy that can overcome these shortcomings. The present work focuses on the development of porous IDDS based on hydrophilic (HPL) and hydrophobic (HPB) polyurethanes and chemical pore formers (PFs) manufactured by hot-melt extrusion. Different PF types and concentrations were investigated to gain a sound understanding in terms of extrudate density, porosity, compressive behavior, pore morphology and liquid uptake. Based on the rheological analyses, a stable extrusion process guaranteed porosities of up to 40% using NaHCO3 as PF. The average pore diameter was between 140 and 600 µm and was indirectly proportional to the concentration of PF. The liquid uptake of HPB was determined by the open pores, while for HPL both open and closed pores influenced the uptake. In summary, through the rational selection of the polymer type, the PF type and concentration, porous carrier systems can be produced continuously via extrusion, whose properties can be adapted to the respective application site.

Design development and evaluation of novel ophthalmic nano lipid in situ gel-forming solution using timolol hydrochloride

The present research work was aimed to design, develop and evaluate the nano lipid-based drug delivery system by incorporating timolol hydrochloride drug for ocular therapy and improve the release of the drug through the ocular route. Nanolipids in situ gels were prepared by film hydration method involving two steps. First nano lipids were formulated with the help of organic solvents, and then they were incorporated into a gel by using gelling agents. FTIR spectrum studies were carried out for drug and the formulations which reveal that there was no interaction between the drug and excipients used. The various formulations prepared were subjected for the different evaluation parameters, which showed good and effective results for visual appearance, pH, gelation study, viscosity and ocular irritation studies. It was further observed from this research work that formulation TF2 (HPMC K-15M 0.2%w/v and Carbopol 940 0.4%w/v) had a maximum entrapment efficiency of 97.30%, drug content of about 97.67% and drug release of about 84.29% for 10 hrs. Stability studies were carried out for TF2 formulation, and they found that they were stable throughout the study period. It was finally concluded from the present work that formulations prepared were more suitable and had good patient compliance compared to the eye drops.

Rivaroxaban Treatment for Heparin-Induced Thrombocytopenia: A Case Report and a Review of the Current Experience

Heparin-induced thrombocytopenia is a life-threatening complication of exposure to heparin. Heparin-induced thrombocytopenia results from an autoantibody directed against platelet factor 4 in complex with heparin. Heparin-induced thrombocytopenia is traditionally treated with bivalirudin, argatroban, danaparoid, or fondaparinux. Recently, direct oral anticoagulants administration to treat heparin-induced thrombocytopenia has been reported. Direct oral anticoagulants do not cause platelet activation in the presence of heparin-platelet factor 4 antibodies, nor do they provoke autoantibody production. Direct oral anticoagulants offer advantages such as consistent and predictable anticoagulation, oral administration with good patient compliance, and a good safety profile. We report a case of heparin-induced thrombocytopenia with deep venous thrombosis successfully treated with rivaroxaban and review the current experience with rivaroxaban for the treatment of heparin-induced thrombocytopenia.

Evaluation of functional recovery after upper limb replantation

Background: Although it is not possible always, reconstruction of defects with tissue such as defect in the original tissue usually results in best functions and esthetic outcomes. Therefore, replantation of an amputated part is superior to any other method of reconstruction mainly when the condition of the amputated part is good. The goal of replantation after amputation is function. Returning of circulation to an amputated part does not, by itself, mean success. Therefore, replantation that will not lead to a useful activity should be avoided. This is usually the case with severely crushed and extensively avulsed limbs. Objectives: evaluation of functions’ outcome after replantation. Patients and Methods: This study deals with 18 patients (14 males, 4 females) with different injuries. Severely crushed and extensively avulsed limbs have been excluded from repair. The level of injury involved an arm in two patients, an elbow in one, a forearm in two, a palm in two, a thumb in two, and fingers in nine. The patients’ age ranged between 2 and 55 years, during the period between January 2012 and February 2016. Results: In all the cases, replantation of the amputated part was successful; however, there were variations in functional recovery among the cases: in three cases, the functional recovery was very good, in five, it was good, in eight, it was fair, and in two, it was poor. Conclusions: Replantation should be tried for most amputation cases, as it has a superior aesthetic and functional result and serves a major psychological benefit for the patients. High success in a rat can be achieved when one chooses to replant an amputated part in good condition, all the structures are repaired at the time of the primary operation, and there exist excellent post-surgery physiotherapy and good patient compliance. Keywords: Replantation; amputation; vascular repair, limb trauma, revascularization, microsurgery.

A clinicopathological study of cervical lymphadenopathy

Background: Lymphadenopathy is a very common clinical manifestation of many diseases. It is defined as an abnormality in the size of character of lymph nodes, caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node. The study intends to find out systematically the various pathological conditions presenting with enlarged lymph nodes in the neck, also the various nodes of clinical presentations and behaviors of these conditional.Methods: The clinical material consists of all inpatients and outpatients presenting to department of General Surgery. The study was conducted during the period from January 2017 to June 2018. This study consisted of 50 consecutive cases and diagnosis was made on the basis of clinical and histopathological findings. Patients, in whom FNAC and/or biopsy of enlarged node could not be carried out, were excluded.Results: Out of 50 cases in the study, 76% were non-neoplastic. 44% of the cases were due to tuberculosis. Majority of the cases were in 3rd and 4th decade of age. After swelling in the neck, pain and fever were the most common presentation.Conclusions: In the present study, non-neoplastic accounted for 76% of cases, 44% turned out to be tuberculosis and 30% reactive lymphadenitis. Among the neoplastic lesions, malignant secondaries accounted for 16% while non-Hodgkin’s lymphoma and Hodgkin’s lymphoma accounted for 6% and 2% respectively. In this present study, fine needle aspiration cytology was found to be reliable and cheapest method of diagnosis without any significant morbidity and with good patient compliance.

Investigation of Permeation of Theophylline through Skin Using Selected Piperazine-2,5-Diones

Transdermal administration of drugs that penetrate, in this case directly into the blood circulation, has many advantages and is promising for many drugs thanks to its easy application and good patient compliance. (S)-8-Methyl-6,9-diazaspiro[4.5]decan-7,10-dione (alaptide), has been studied as a potential chemical permeation enhancer. Based on its structure, four selected piperazine-2,5-diones were synthesized by means of multi-step synthetic pathways. All the compounds were investigated on their ability to enhance the permeation of the model drug theophylline from the hydrophilic medium propylene glycol:water (1:1). In vitro experiments were performed using vertical Franz diffusion cells at constant temperature 34 ± 0.5 °C and using full-thickness pig (Sus scrofa f. domestica) ear skin. Withdrawn samples were analyzed by RP-HPLC for determination of the permeated amount of theophylline. All the compounds were applied in ratio 1:10 (w/w) relative to the amount of theophylline. One hour after application, the permeated amount of theophylline from formulations with alaptide and (3S,6S)-3,6-dimethylpiperazine-2,5-dione, was ca. 15- and 12-fold higher, respectively, than from the formulation without the tested compounds. Despite the enhancement ratio of both enhancers in a steady state was ca. 2.3, the pseudo-enhancement ratio in the time range from 1 to 3 h was 4.4. These enhancement ratios indicate that the compounds are able to enhance the permeation of agents through the skin; however, the short-term application of both compound formulations seems to be more advantageous. In addition, the screening of the cytotoxicity of all the prepared compounds was performed using three cell lines, and the compounds did not show any significant toxic effect.