The “Vitaminic-strategy” Against the Oral Bacteria S. Mutans and F. Nucleatum, Agents of Caries and Halitosis

BackgroundThe oral cavity is one of the most complex human body environments. Indeed, the continuous variation of this habitat conditions reflects the high dynamism of the resident microbial community. Two key actors in the oral diseases are the bacteria Streptococcus mutans and Fusobacterium nucleatum, both implicated in the formation of oral biofilms and consequently in the generation of common pathologies such as caries and various gingival and soft tissue inflammation diseases. In addition, F. nucleatum is also implicated in the halitosis phenomenon, thanks to its demonstrated ability to produce as second metabolite the hydrogen sulphide (H2S), one of the volatile sulphur compounds (VSCs) that, with methyl mercaptan (CH3SH) and the dimethyl sulphide (CH3SCH3)24, is produced by periodontopathic anaerobic bacteria and causes the awkward bad breath in halitosis patients.MethodsIn this study, the oral preparation Vea® Oris constituted only by vitamin E and capric/caprylic acid was evaluated as a potential treatment of caries and periodontal diseases; the effect of the product at different concentrations on the growth and the ability of both strains to form biofilm was investigated. Regarding to F. nucleatum also the influence of Vea® Oris on the production of H2S was evaluated. ResultsOur in vitro results suggested that the Vea® Oris treatment could considerably reduce the growth and biofilm formation of both S. mutans and F. nucleatum. For F. nucleatum an appreciable reduction of the H2S production can be also obtained. ConclusionsOverall, this study highlighted the potential of Vea® Oris as a more “natural” adjuvant to prevent the biofilm and plaque formation and to reduce the smelly odour of halitosis.

Study on pharmacokinetics of nimodipine nano-controlled release agent modified by host-guest reaction of β-cyclodextrin in rats

Nimodipine (NIMO) has been identified as a second-generation dihydropyridine calcium channel antagonist. NIMO’s specificity for the cerebrovascular smooth muscle contributes to its broad usage in treating ischemic cerebrovascular diseases in the elderly. Therefore, enhancing NIMO’s therapeutic effect and reducing its adverse reactions caused by short-term repeated use have become a focus of research. As a result, a new controlled-release preparation of NIMO, the carboxymethyl chitosan/nimodipine-hydroxypropyl-β-cyclodextrin nanoparticle (Nano-NIMO), was constructed based on hydroxypropyl-β-cyclodextrin. The novel composite Nano-NIMO preparation could significantly improve the stability of NIMO in rat plasma, achieving an absolute bioavailability as high as 62.3%, which is three times that of the traditional NIMO oral preparation. Therefore, Nano-NIMO is expected to provide a new direction for the preparation of modified controlled-release Nano- NIMO agents.

POS0227 SHOULD ALL PATIENTS TRIAL SUBCUTANEOUS METHOTREXATE PRIOR TO COMMENCING BIOLOGIC THERAPY – A REAL WORLD STUDY

Background:Methotrexate (MTX) is the bed rock of inflammatory arthritis management. However intolerance is a major limiting factor for drug optimisation and retention. There is data to suggest that subcutaneous (SC) MTX is tolerated better and is now being recommended in several guidelines including ACR’s. It is less clear though whether this strategy is effective in those where oral preparation is inefficacious and its potential to avoid escalation to biologic therapy.Objectives:Our aim was to analyse the reasons for switching to SC formulation in a real world setting, clinical outcomes achieved and proportion requiring biologic prescription.Methods:We undertook a retrospective survey of all patients prescribed SC MTX in a large university teaching hospital between 1983 and Apr 2019. We had access to full patient records including details on co-morbidities, drugs and disease management. We analysed demographics, reasons for SC MTX initiation, clinical outcomes and impact on biologic prescription.Results:352 patients were identified during the study period. The mean age of the cohort was 54 yrs (3-87). 192 (70%) were women. 260 (74%) were Caucasian, 64 (18%) Asian, 21 (6%) Afro-Caribbean and remaining of other ethnicity. Two most common diagnoses were RA [n=243 (69%)] and pSpA [n=66 (18%)]. Average disease duration was 74 months (11-324) with mean of three comorbidities (0-11).284 (80%) had switched from oral to SC MTX. 137 (49%) stopped oral MTX due to side effects. Mean duration of oral MTX prior to switching was 26 months (0.25-167). Follow up period for SC MTX ranged from two to 132 months (mean 29) until the data cut-off date of Apr 2019. 103 (29%) patients progressed to biologic therapy.Amongst RA patients, DAS28 improved from mean 4.16 (0.63-8.06) to 2.83 (0.14-7.32) following the switch. pSpA cohort’s mean TJC and SJC improved from mean seven (0-42) and two (0-26) to two (0-25) and one (0-6) respectively.Conclusion:Our study confirms that SC MTX is an effective solution irrespective of whether oral MTX is inefficacious or intolerable. This applies to people with both RA and pSpA. In accordance with prior published data, our findings support the utility of SC MTX for those intolerant of enteral option. Additionally, it shows that even in instances where oral MTX was ineffective, a switch to SC formulation achieved low disease activity despite multi-morbidity, long disease course and protracted oral MTX exposure. This intervention also prevented over two-thirds of patients progressing to biologic therapy with significant financial savings. SC MTX therefore remains a durable strategy with excellent disease outcomes and confers substantial economic benefits to healthcare.Disclosure of Interests:None declared

DEVELOPING ORAL PREPARATION MATERIALS USING EXPERIENCE-BASED MEDIA

Preparation of oral presentation is one of the materials in the Indonesian language course. This material is a speaking skill material. This material helps students prepare for public speaking, such as providing health education to the public. The purpose of this study was to describe the preparation of experience-based oral presentation preparation materials.This research method uses qualitative research methods with data sources in the form of a book by Gorys Keraf entitled composition published by Nusa Indah and a book by Trianto entitled Designing an innovative-progressive learning model published by Kencana Prenada Media Group. The data in this study are the words, sentences or paragraphs in the two books. The data collection technique used by researchers was document study by collecting documents related to the preparation of materials and materials for oral presentation preparation. Meanwhile, for data analysis techniques, what the researchers did were: (1) data reduction. (2) displaying data by compiling relevant data, (3) drawing conclusions to get a meaning that scattered symptoms have deep meaning. The results of this study indicate that the preparation of oral presentation preparation materials using experience-based media produces a material concept map which in its presentation can be given examples through experience-based media. The existence of making a concept map for the preparation of oral presentation material makes the flow of oral presentation preparation clear and easy to understand, that in preparation for oral presentation there are three main components that must be done, namely 1) examining the problem where this point includes determining the intent, analyzing the listener and the situation, and selecting and narrowing the topic, 2) compiling a description. This point includes gathering material, drawing up a description outline, and describing it in detail, and 3) conducting an exercise. Powerful words are the key words at this point, that the speaker's knowledge of the topic and the needs of the listener, being able to position himself to be closer to the listener, speaking according to facts and speaking honestly, and having the same line of thought as the listener are components that must be mastered by the speaker. , so that the material conveyed to listeners really hits and impresses.

Improving metronidazole prescription practices in surgical patients: a full cycle audit

IntroductionMetronidazole is commonly prescribed for intra-abdominal infections. Oral metronidazole has high bioavailability (>95%) and intravenous metronidazole should be reserved for patients not suitable for oral preparations.Methods and materialsThis full cycle audit evaluated the type of metronidazole preparation prescribed in adult emergency surgical patients requiring first-line empirical antimicrobial therapy for intra-abdominal infections. The criterion for audit was the proportion of patients who were prescribed intravenous metronidazole when the oral route was available. The first cycle included all consecutive eligible patients between 20 April and 14 May 2020. After an intervention phase educating prescribers about the similar pharmacokinetic properties of oral and intravenous metronidazole, clinical practice was reaudited between 22 June and 16 July 2020. Data were collected by case note and drug chart review.ResultsA total of 54 patients were included in the first audit cycle. Of these, 11 (20.4%) were prescribed oral metronidazole and 43 (79.6%) were prescribed intravenous metronidazole. In the majority of cases (35/43, 81.4%), intravenous metronidazole was prescribed in the absence of clear contraindications to the oral preparation. Of the 61 patients included in the reaudit cycle, 23 (37.7%) were prescribed oral metronidazole and 38 (62.3%) were prescribed intravenous metronidazole. The proportion of patients prescribed intravenous metronidazole despite being suitable for oral preparation decreased from 81.4% in the first cycle to 34.2% (13/38) in the reaudit cycle (risk ratio 0.42, 95% CI: 0.26 to 0.67, p<0.0001). Prescribing oral metronidazole when suitable saved up to £10.53/day per patient.ConclusionThis full cycle audit led to a significant improvement in the use of oral metronidazole in suitable patients, as well as a considerable reduction in healthcare costs.

Lower endoscopic delivery of freeze-dried intestinal microbiota results in more rapid and efficient engraftment than oral administration

Fecal microbiota transplantation (FMT) is a highly effective treatment for recurrent Clostridioides difficile infection (rCDI). However, standardization of FMT products is essential for its broad implementation into clinical practice. We have developed an oral preparation of freeze-dried, encapsulated microbiota, which is ~ 80% clinically effective, but results in delayed engraftment of donor bacteria relative to administration via colonoscopy. Our objective was to measure the engraftment potential of freeze-dried microbiota without the complexity of variables associated with oral administration. We compared engraftment of identical preparations and doses of freeze-dried microbiota following colonoscopic (9 patients) versus oral administration (18 patients). Microbiota were characterized by sequencing of the 16S rRNA gene, and engraftment was determined using the SourceTracker algorithm. Oligotyping analysis was done to provide high-resolution patterns of microbiota engraftment. Colonoscopic FMT was associated with greater levels of donor engraftment within days following the procedure (ANOVA P = 0.035) and specific increases in the relative abundances of donor Lachnospiraceae, Bacteroidaceae, and Porphyromonadaceae (P ≤ 0.033). Lower relative abundances of Bacteroidaceae, Lachnospiraceae, and Ruminococcaceae families were associated with clinical failures. These results suggest that further optimization of oral capsule FMT may improve its engraftment efficiency and clinical efficacy.

Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population

Background and study aim Pre-endoscopic use of a preparation with tensioactive and mucolytic agents improved gastric mucosa visualization in Eastern studies. Data on Western population are scanty. Patients and methods This prospective, endoscopist-blinded, randomized study enrolled patients who underwent esophagogastroduodenoscopy in a single center. Before endoscopy patients, were randomized to receive or not receive an oral preparation with simethicone and N-acetylcysteine in water. A pretested score (Crema Stomach Cleaning Score [CSCS]) for gastric mucosa cleaning evaluation was used. In detail, the stomach was divided into the antrum, body, and fundus and a score of 1 to 3 was assigned to each part (the higher the score, the better the preparation), and a total value ≤ 5 was considered as insufficient. Time between endoscope insertion and clean achievement (mouth to clean time) or the end of examination (mouth to mouth time) was recorded. Results A total of 197 patients were enrolled. The mean overall CSCS value and mucosal cleaning in all parts was better in treated patients than in controls. Prevalence total score ≤ 5 was significantly lower in patients treated before endoscopy. Need for water flush occurred less frequently in treated patients (P < 0.0001). The mouth to clean time was lower in the treated than in the control group (2.3 ± 1.6 vs 3.8 ± 1.6 min; P < 0.001), whereas no significant difference in mouth to mouth time emerged. Conclusions Data from this study show that premedication with simethicone and N-acetylcysteine results in significantly better endoscopic visualization of gastric mucosa, and the proposed CSCS could be useful for standardizing this evaluation.

Effect of an oral preparation containing hyaluronic acid, chondroitin sulfate, hydrolyzed collagen type II and hydrolyzed keratin on synovial fluid features and clinical indices in knee osteoarthritis. A pilot study

The aim of this study was to evaluate the effect of an oral preparation containing a naturally occurring matrix of hydrolyzed collagen type II, chondroitin sulfate (CS), and hyaluronic acid (HA), and bioactive oligopeptides of natural hydrolyzed keratin (K) in patients affected by knee OA through the evaluation of synovial fluid (SF) and clinical changes before and after treatment. Thirty patients with knee OA and swollen joint were included in the study and submitted to arthrocentesis. Patients were randomized in two groups: 1) the treatment group (N.15) took a dietary supplement containing 120 mg HA, 240 mg CS and 300 mg K once a day for 4 weeks; 2) the control group (N.15) was only submitted to arthrocentesis. Patient symptoms were evaluated at the beginning and at the end of the study by the WOMAC self-assessment questionnaire, the Lequesne algofunctional index, and the VAS forms. SF changes were evaluated by measuring local inflammatory indices, cytokines IL-1β, IL-8, IL-6, IL-10 and GM-CSF. The group of patients treated with the oral supplement showed an improvement in the clinical indices WOMAC (p<0.01), Lequesne (p=0.014) and VAS pain (p<0.01). On the contrary, no significant changes were found in the control group. The SF collected from the treated group showed a reduction of IL-8 (p=0.015), IL-6 and IL-10 levels, while no changes in cytokines were observed in the control group. This pilot study suggests that an oral administration of a preparation containing a combination of HA, CS and K can improve some clinical parameters and affect cytokine concentrations in SF in patients with knee OA.