Evaluation of safety and efficacy of polyglactin 910 suture in surgical incision closure: clinical study protocol for a randomized controlled trial

Background: Surgical site infection (SSI) occurs in a considerable portion of patients after closure of surgical incision. The newer synthetic absorbable sutures consistently display proven advantages for wound healing over naturally derived suture. The study is planned to evaluate the safety and efficacy of MITSU™ Polyglactin 910 Suture with Coated Vicryl® Polyglactin 910 Suture in a closure of surgical incision.Methods: This is a prospective, multicentric, post-marketing, randomized, controlled, single-blinded, comparative study in a closure of surgical incision where general soft tissue approximation and/or ligation is required during an elective surgery. Patients are randomized to 1:1 ratio in the test (MITSU Polyglactin 910 Suture) and reference (Coated Vicryl Polyglactin 910 Suture) groups. Patients are monitored for safety and efficacy outcomes, viz. the rate of SSI, hospital length of stay, overall wound dehiscence and any adverse events/serious adverse events at post-procedural, 14 days, 30 days and 6 months of surgery. The rate of SSI for each group will be analyzed using one sided T-test. The effect of type of suture on SSI and overall wound dehiscence will be evaluated with chi-square test. Length of stay in hospital will be evaluated with student’s t-test.Conclusions: The study has been designed to compare the safety and efficacy of MITSU Polyglactin 910 Suture versus Coated Vicryl Polyglactin 910 Suture in a closure of surgical incision. Trial registration: The trial protocol has been registered with the clinical trial registry of India (CTRI/2017/01/007717; registered on 17/01/2017).

“Ovate Pontic”- Esthetic Enhancement of the Anterior Restorations.

Esthetics is of prime concern when replacing any anterior tooth. The prosthesis should resemble the adjacent natural tooth closely. Out of many types of pontic designs, ovate pontic may serve the purpose of providing good esthetics and phonetics. It will maintain interdental papilla and help to maintain good gingival health. In addition to it ovate pontic has an advantage of immediately replacing the missing anterior tooth.

Changes in clinical & biochemical presentations of primary hyperparathyroidism in India over a period of 20 years.

Background & objectives: With the advent of serum chemistry autoanalyzer and routine estimation of serum calcium as a part of annual physical examination, there has been a dramatic change in the presentation of primary hyperparathyroidism (PHPT) from symptomatic to asymptomatic disease in the United States. However, such trend has not been documented from India. We carried out this retrospective study to analyse the changes in clinical presentations of PHPT patients over a period of two decades in a tertiary care centre in north India. Methods: This retrospective study included patients with PHPT treated at a single centre of north India between March1990 and October 2010. Two decades were divided into four different time periods, i.e. 1990 to 1994, 1995 to 1999, 2000 to 2004 and 2005 to 2010. Clinical presentations, biochemical parameters and surgical outcomes were compared between different time periods using appropriate statistical methods. Results: Data of 202 patients with PHPT with male: female ratio of 3:7 were analyzed. There was a rise in the number of cases of PHPT diagnosed in the last decade compared to the previous decade (28 cases vs 174 cases, P<0.001). Change in the mean age, male: female ratio, lag time for the diagnosis of PHPT and clinical presentations of PHPT (predominance of bone and stone symptoms) did not differ across different time periods. Non-significant decrease in serum calcium levels at the time of diagnosis of PHPT and a significant, decline in the serum alkaline phosphatase levels (P<0.01) were found in the last decade, however, iPTH levels were higher in the last decade (pP<0.05). There was no change in the site and size of parathyroid adenoma in the two decades, however, postoperative symptomatic hypocalcemia was less frequent in the last decade. Interpretation & conclusions: The findings of this retrospective analysis show that the PHPT still remains symptomatic disease with increasing awareness over the last two decades in our center. There was not much change in the clinical presentation, in the past two decades.

Neurodegenrative Disorders: Past, Present and Future.

In neuroscientific research the field of neurodegeneration is most active in respect to both medical and associated social issues. Neurodegenration is a broad term used for the progressive loss of structure or function of neurons, including neural death. Neurodegenration can be found in many different levels of neuronal circuitry ranging from molecular to systemic. Many neurodegenerative disorders (NDD) occurs as a result of neurodegenerative process. According to National Institute of Neurological disorders and stroke there are more than 600 neurological disorders. Over last few decades there has been great progress with respect to understanding the triggers of most neurodegenerative diseases. Recent advancements in the basic knowledge of such diseases have led to speculation of new therapeutical approaches, to illustrate one, if we look at NDD as proteinopathy, it can be extrapolated that curing one of the disease could probably contribute to a cure of entire group of diseases related to given proteinopathy. The purpose of this article is to overview the history, epidemiology, etiology, leading pathways and possible treatment of neurodegenerative disorders which would possibly reinvigorate efforts to conduct researches in neuroscientific area for the ultimate benefit of the human community.

Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism.

Background & objectives: Information on gastrointestinal manifestations and then response after curative parathyroid surgery is scarce in symptomatic primary hyperparathyroidism (PHPT). This study was carried out to analyse gastrointestinal manifestations in patients with PHPT and their associations with biochemical parameters. Methods: This retrospective study included 153 patients with symptomatic primary hyperparathyroidism (PHPT). The signs and symptoms pertaining to gastrointestinal system were analyzed. The difference of symptoms between men and women and difference in biochemical parameters in presence of different symptoms were evaluated. The relationship between serum calcium, phosphate and parathyroid hormone (PTH) levels with presence of gallstone and pancreatitis was also studied. Result: Of the 153 patients, 46 (30%) were men. The mean age was 39.2 ± 13.9 yr. Nearly 80 per cent of PHPT patients had at least one symptom/ sign related to gastrointestinal system. The most common gastrointestinal manifestations were abdominal pain 66 (43%), constipation 55 (36%), and nausea/or vomiting 46 (30%). Nearly one-fourth 34 (22%) of patients had a history of either gallstone disease or cholecystectomy or both. The prevalence of gallstone disease was higher in women (P<0.05). Imaging and biochemical evidence of pancreatitis was found in 27 (18%) patients. Pancreatitis was more common in men compared to women (P<0.05) despite the higher prevalence of gallstones in women. Serum calcium, phosphate or PTH levels were not associated with high risk for gallstone disease, however, serum calcium (P<0.05) was associated with 1.3 times higher risk of developing pancreatitis. In majority of patients, gastrointestinal manifestations resolved within three months of curative parathyroidectomy. Except two patients, none had recurrence of pancreatitis. Interpretation & conclusions: The study revealed that the gastrointestinal symptoms were common in patients with symptomatic PHPT. There was not much gender difference in gastrointestinal symptoms except higher occurrence of gallstones in women and pancreatitis in men. There was no difference in biochemical profile between those who had and did not have gastrointestinal symptoms.

Trends of malaria situation in Jamnagar District.

Introduction: Five out of eight districts of Saurashtra region are declared hyper endemic for malaria in the year 2011-12 & 2012-13 and given priority by World Bank Project for Malaria control activity in these districts. Burden of malaria contributed by these districts is more than 40% of total burden of Gujarat state, and Jamnagar is one of those districts. By Studying trend of Malaria in Jamnagar district will give an opportunity to identify particular seasonal trends and thus by effective surveillance mechanism, future out-breaks can be prevented. Aim & Objectives: 1) To study the trend of malaria situation in various Talukas of Jamnagar District. 2) To compare the trends for last four years. Materials & Method: Present record base study was carried out in 10 Talukas of Jamnagar district to analyzed the trend of malaria situation in the Jamnagar district by department of community medicine, Shri M.P.Shah Medical College, Jamnagar during the month of September 2012 to analyze the trend from the year 2009 to 2012 (up to September month). This was based on the monthly and progressive data format (monthly reports) was collected form District Malaria Officer of Jamnagar district and analyzed by using Microsoft excel 2007 and the result was presented in Table and graph. Results: Total numbers of cases were decreasing over the period of last 3 years. ABER is >10% in most of the Talukas which is indicated the surveillance activity is done properly over the period of years. Conclusion: In the year 2012 all parasitological indicators showing decreasing trend of malaria in comparison with previous years i.e. API, ABER, SPR, PF, and no malarial deaths at all. Continuous surveillance is effective in reduce the morbidity and mortality of vector borne disease like malaria. Seasonal trend of malaria follows the same pattern of distribution showing peak in months of Jun-July.

PLGA/PLA microparticulate system: A boon for hydrophobic drug delivery.

Controlling In-vitro drug release profiles for a system of PLGA/PLA microparticles encapsulating a hydrophobic drug. Challenges with the diversity of drug properties, microencapsulation methods, are evaluated with a focus on decreasing the time to lab-scale encapsulation of water-insoluble drug candidates in the drug development stage. The development of biodegradable microparticles systems that combined the beneficial properties of polymeric microparticles for hydrophobic drug delivery were reviewed here. Injectable biodegradable and biocompatible copolymers of lactic and glycolic acid are important advanced delivery system for week too month controlled release of hydrophobic drug (e.g., from biopharmaceutical classification system class IV), which often display poor oral bioavailability. Finally, three important properties affecting release behavior were identified as: polymer hydrophobicity, particle size and particle coating, . This review focuses on the microencapsulation of hydrophobic drugs, describes a variety of techniques for their preparation and analytics.

Oro-mandibular manifestations of primary hyperparathyroidism.

Aims and Objective : To determine the effects of Primary Hyperparathyroidism on oral cavity in a symptomatic contemporary Indian population by taking note of the following parameters: (1) Radiological alteration of lamina dura, (2) mandibular cortical width, (3) prevalence of brown tumor, and (4) mandibular tori. Study Design : Twenty-six patients of Primary Hyperparathyroidism were examined clinically and radiologically for extra- and intraoral abnormalities. Loss of lamina dura, mandibular cortical width, presence of mandibular tori, and brown tumors were assessed and correlated with serum Calcium, Phosphate, Parathormone, and Alkaline phosphatase. The results were compared with twenty-six age- and gender-matched control subjects. The data was expressed as mean ± SD, and a probability (p) value of < 0.05 was considered significant. Pearson's statistical method was used to assess the significant correlation between radiological measurements and biochemical values. Results : Generalized absence of the lamina dura was the most consistent finding and there was a significant correlation between its loss and altered parathormone, alkaline phosphatase, and inorganic phosphate, but not with serum calcium or the duration of the disease. Mean values (in mm) for the cortical indices were significantly lower in the patients compared to the controls and correlated significantly with parathormone and alkaline phosphatase. None of the patients had mandibular tori and only one patient had a brown tumor. Conclusion : Loss of lamina dura, ground glass appearance, and mandibular cortical width reduction are common findings in primary hyperparathyroidism and these are significantly correlated with elevated parathormone and alkaline phosphatase. However, the presence of brown tumors and oral tori are less commonly encountered features.