Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial

Abstract The antimicrobial activity of metallic nanoparticles (NPs) has been confirmed to fight a broad spectrum of microorganisms, through antimicrobial effects that are amplified when these particles are irradiated with light of the proper wavelength. This is the first study to use phytoconjugated Zinc oxide (ZnO) NPs containing traces of active biomolecules derived from Emblica officinalis (E. officinalis) plant extract in antimicrobial photocatalysis (PCT) during non-surgical periodontal therapy. Objectives This study aimed to evaluate the effects of repeated PCT application in the treatment of periodontitis, using a gel containing bio-hydrothermally synthesized ZnO NPs and visible light as an adjunct to scaling and root planing (SRP). Methodology In total, 16 systemically healthy volunteers with stage 3 grade B generalized periodontitis were recruited for this prospective double blind, randomized placebo-controlled trial. After receiving SRP, the subjects received the following interventions in a split-mouth design at baseline, 1 week and 1 month: Group 1 - Placebo gel + Sham PCT; Group 2 - Nano ZnO gel + Sham PCT; Group 3 - Placebo gel + PCT; and Group 4 - Nano ZnO gel + PCT. The site-specific profile of Porphyromonas gingivalis in the subgingival plaque and clinical parameters (Plaque Index, Gingival Index, Gingival Bleeding Index, Probing pocket Depth and Clinical Attachment Level) were assessed at baseline, 1 month and 3 months. Results All interventions tested caused participants' clinical and microbiological parameters to generally improve after 3 months. Subjects who received the Nano ZnO gel + PCT combination showed a sustained and progressive improvement in their treatment outcomes, a result that presented statistically significant differences from the outcomes obtained through the remaining interventions, at all time points during the study period. Conclusions The repeated application of PCT using bio-hydrothermally synthesized ZnO NPs can effectively complement SRP in the non-surgical treatment of Periodontitis.

Locked-in syndrome in snakebite.

Two young patients are described who made complete recovery from locked-in syndrome (LIS) after snakebites. LIS was a presenting feature in a patient of presumed snake bite who showed complete response to polyvalent Anti-snake venom (ASV). This case suggests that elapid snake bite should be suspected in unresponsive patient found in early morning in endemic areas of snake bite in monsoon season. The second case was admitted in complete LIS state with history of rapidly progressive ptosis, diplopia, ophthalmoplegia, bulbar symptoms and quadriparesis, 6 hours after snake bite. Complete improvement by ASV in second patient highlights the need of differentiation of complete LIS from coma and brain death in patient of snake bite, as former have good prognosis.

Large thrombus in the pulmonary arteries in a case of atrial septal defect-Eisenmenger syndrome.

A 41-year-old man with atrial septal defect-Eisenmenger syndrome presented with progressively worsening breathlessness. The echocardiogram, computerized tomographic scan and magnetic resonance imaging of the thorax showed dilated pulmonary arteries and large thrombi in the right and left pulmonary arteries. Contrast-enhanced computerized tomographic scan was better than magnetic resonance imaging in picking up the thrombus. The possibility of in situ thrombus formation was considered more likely than thromboembolism, as there were none of the acute symptoms expected with the embolization of such large thrombi.

A case of cerebral toxoplasmosis.

A histopathologically proven case of cerebral toxoplasmosis in a young HIV positive patient has been presented. The clinical problems in management are highlighted.

Ankylosing spondylitis in females. Similarities and differences with male spondylitics.

Ten female and seventy two male patients suffering from ankylosing spondylitis were studied to evaluate differences between the two sexes. Low lumbar backache and inactivity stiffness were the commonest presenting complaints in females (8/10) as compared to males (34/72). They also had a later age of onset (25.4 + 6.16 yrs) compared to males (20.56 + 6.57 yrs). Females were found to be symptomatically milder with a more benign course of the disease. There were no significant differences in the frequency of extra-articular features and HLA B27 between males and females. A positive family history was more often seen in female ankylosing spondylitis (50%) than male (31.94%) patients.