Acellular Scaffolds as Innovative Biomaterial Platforms for the Management of Diabetic Wounds

Diabetic wound (DW) is one of the leading complications of patients having a long history of uncontrolled diabetes. Moreover, it also imposes an economic burden on people suffering from wounds to manage the treatment. The major impending factors in the treatment of DW are infection, prolonged inflammation and decreased oxygen levels. Since these non-healing wounds are associated with an extended recovery period, the existing therapies provide treatment for a limited period only. The areas covered in this review are general sequential events of wound healing along with DW’s pathophysiology, the origin of DW and success, as well as limitations of existing therapies. This systematic review’s significant aspect is to highlight the fabrication, characterization and applications of various acellular scaffolds used to heal DW. In addition to that, cellular scaffolds are also described to a limited extent.

Acellular Scaffolds as Innovative Biomaterial Platforms for the Management of Diabetic Wounds

Diabetic wound (DW) is one of the leading complications of patients having a long history of uncontrolled diabetes. Moreover, it also imposes an economic burden on people suffering from wounds to manage the treatment. The major impending factors in the treatment of DW are infection, prolonged inflammation and decreased oxygen levels. Since these non-healing wounds are associated with an extended recovery period, the existing therapies provide treatment for a limited period only. The areas covered in this review are general sequential events of wound healing along with DW’s pathophysiology, the origin of DW and success, as well as limitations of existing therapies. This systematic review’s significant aspect is to highlight the fabrication, characterization and applications of various acellular scaffolds used to heal DW. In addition to that, cellular scaffolds are also described to a limited extent.

Evaluation of the Effect of Ondansetron on Haemodynamics under Spinal Anaesthesia

Spinal anaesthesia related hypotension and bradycardia is not rare. One of the causes for post spinal hypotension is thought to be bezold-jarisch reflex (BJR) which is mediated by serotonergic 5-HT3 receptors. Ondansetron, one of the reliable drugs for nausea and vomiting, is 5-HT3 antagonist. Effect of ondansetron to attenuate hypotension has been studied in caesarean section but there is paucity of literature for general population. Aim and Objectives: In this study we aimed at evaluating the efficacy of ondansetron on haemodynamics of patients undergoing spinal anaesthesia. Methods: This prospective study enrolled 200 ASA I and II patients assigned into 2 groups: Group O (Ondansetron group, n=100) received injection ondansetron 0.1mg/kg intravenous, diluting the drug to make volume 10 ml 5 minutes prior to spinal anaesthesia(SA). Group P (Placebo group, n=100) received injection normal saline 10 ml intravenous 5 minutes prior to spinal anaesthesia. Results: Demographic data were comparable in both the groups. There was no significant difference in MAP (mean arterial pressure), HR(heart rate) & SpO2 (oxygen saturation) values in group O whereas in group P statistically significant variations in MAP, HR & SpO2 values were observed. Fewer interventions using intravenous atropine & ephedrine were required in group O as compared to group P. Conclusion: In conclusion, intravenous administration of ondansetron 5 minutes before spinal anaesthesia attenuates the decrease in mean arterial pressure.

Post Dural Puncture Headache (PDPH) - A Prospective Study in Tertiary Care Hospital in Solan District (HP)

Spinal Anaesthesia is widely practiced anaesthetic technique for sub - umbilical surgical procedures. However the technique is not without complications and Post Dural Puncture Headache (PDPH) remains important amongst such complications. Aims and Objectives: The present study was prospective , was conducted to study the overall incidence of PDPH using 26 G Quincke type spinal needle and to establish its relations( if any) with the age of patient, type of surgery and time to ambulate following the surgery. Methods: A total of 500 patients of ASA I and II were studied. These patients underwent various orthopaedic, general surgical, obstetrical/ gynaecological surgical procedures under Spinal Anaesthesia using 26 G Quincke type spinal needle. All the patients were followed upto 72 hours post operatively for evaluation of PDPH. Results: The incidence of PDPH in the present study was 1.6%. The incidence was higher in female patients (75%). Among the female patients, 50% of patients were those who underwent Caesarean Section. Conclusion: The present study concludes free and widespread use of 26 G Quincke type needle in all patients who require Spinal Anaesthesia irrespective of type of surgery

A hybrid method for fundamental heart sound segmentation using group-sparsity denoising and variational mode decomposition

Segmentation of fundamental heart sounds–S1 and S2 is important for automated monitoring of cardiac activity including diagnosis of the heart diseases. This pa-per proposes a novel hybrid method for S1 and S2 heart sound segmentation using group sparsity denoising and variation mode decomposition (VMD) technique. In the proposed method, the measured phonocardiogram (PCG) signals are denoised using group sparsity algorithm by exploiting the group sparse (GS) property of PCG signals. The denoised GS-PCG signals are then decomposed into subsequent modes with specific spectral characteristics using VMD algorithm. The appropriate mode for further processing is selected based on mode central frequencies and mode energy. It is then followed by the extraction of Hilbert envelope (HEnv) and a thresholding on the selected mode to segment S1 and S2 heart sounds. The performance advantage of the proposed method is verified using PCG signals from benchmark databases namely eGeneralMedical, Littmann, Washington, and Michigan. The proposed hybrid algorithm has achieved a sensitivity of 100%, positive predictivity of 98%, accuracy of 98% and detection error rate of 1.5%. The promising results obtained suggest that proposed approach can be considered for automated heart sound segmentation.

Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial

BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.

Thoracolumbar Vertebral Injuries with Neurological Deficit Treated with Posterior Decompression, Short Segment Pedicle Screw Fixation, and Interlaminar Fusion

STUDY DESIGN: Prospective clinical study. PURPOSE: The purpose of this study was to evaluate the effect of interlaminar fusion and short segment pedicle screw fixation on thoracolumbar vertebral injuries for preventing pain and post-traumatic kyphosis. OVERVIEW OF LITERATURE: The treatment of thoracolumbar injuries continues to be one of the most controversial areas in spine care. The main aim of surgical treatment is to decompress the spinal cord or nerve roots, realign the spine, and correct or prevent post-traumatic kyphosis. We evaluated the outcome of interlaminar fusion along with posterior decompression and short segment pedicle screw fixation in patients with thoracolumbar fractures with neurological deficit. METHODS: Twenty-two patients with traumatic thoracolumbar vertebral injuries and neurological deficit underwent short segment pedicle screw fixation above and below the fractured vertebrae, posterior decompression, and interlaminar fusion using a bone graft. RESULTS: All patients were followed up for 12 months postoperatively. The average operative time and blood loss was 142 minutes and 214 mL, respectively. Of the 22 patients, 14 recovered completely. Of the nine patients with American Spinal Injury Association (ASIA) grade A disease, two improved by 1 grade, whereas one each improved by grades 2, 3, and 4, and four did not recover. Radiologically, vertebral kyphosis angle improved from 20.91 preoperatively to 15.73 postoperatively, sagittal index improved from 24.77 to 18.73, the sagittal plane kyphosis angle improved from 17.45 to 11.41, regional angle kyphosis improved from 14.73 to 10.14, the superior inferior end plate angle from 16.14 to 13.00, and mean anterior body compression improved from 36.26 to 27.64 postoperatively. No implant failed and no patient had neurological deterioration. CONCLUSIONS: Short segment pedicle screw fixation with posterior decompression and interlaminar fusion provided considerable reduction in kyphosis, restored the vertebral height of patients with thoracolumbar vertebral injuries and neurological deficit, and prevented development of delayed kyphotic deformity.

Study of regulatory requirements for the conduct of bioequivalence studies in US, Europe, Canada, India, ASEAN and SADC countries: Impact on generic drug substitution.

In the last one decade, due to expiry of patented products as well as their exclusivity period, a drastic decline of branded pharmaceutical products and up streaming of generic drug market has been observed in developed as well as developing nations. This up rise in generic drug market is expected to rise in future till the arrival of new brand in market. This prevailing conditions could result in proliferation of generic drug manufacturing companies. The fact that generics do not undergo thorough extensive trials like innovator drugs, fuels further fears regarding their inferiority. Moreover, due to the hard competition amongst various companies to market their generics, the frequency of fraud and corruption have embarked doubts in consumers mind to reality. In order to blow away the doubts and re-establishing the credibility of generics in market, bioequivalence (BE) guidelines with stricter regulation should be the demand. The present study highlights the relevant regulatory guidelines for the conduct of bioequivalence studies in US, Europe, Canada, India, South Africa and South East Asian Nations. A comparative study of the differences in study design and specifications have also been addressed.

Synthesis, antimicrobial evaluation and QSAR studies of N'-benzylidene/(1-phenylethylidene)undec-10-enehydrazides.

A series of N'-benzylidene/(1-phenylethylidene)undec-10-enehydrazide was synthesized starting from undec-2-enoic acid through multi-step reactions. Synthesized derivatives were evaluated for their in vitro antimicrobial activities against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Aspergillus niger and Candida albicans by tube dilution method. The preliminary results showed the significance of o-NO2, m-NO2 and m-OCH3 groups at phenyl ring in describing antimicrobial activity of synthesized compounds. QSAR studies revealed that second order molecular connectivity index (2χ) and Balaban topological index (J) are the key parameters for antimicrobial activity of synthesized hydrazide derivatives and can be cosidered as important factors for interaction with target site of different microorganisms. It is pertinent to note that multi-target QSAR models were more significant in demonstrating the antimicrobial activity than one-target QSAR models.

Antibacterial, antitussive, antioxidant and toxicological evaluation of Joshanda lozenges.

Joshanda, a Greco-urban formulation comprising seven herbs has been used since centuries for the treatment of cold, cough and associated allergic reactions. Conventionally, it is used in the form of an extemporaneously prepared decoction. However, in the current scenario, lozenges happen to be the dosage form of choice for antitussive drugs. In case of polyherbal drugs, the dosage form assumes a great importance in order to ensure that all the phyto-components exert their pharmacological effect to the maximum. Based on the popularity of lozenges, conventional decoction form of Joshanda was formulated in the form of lozenges. Lozenges were evaluated for routine quality control tests. The most remarkable feature of the formulation was that excellent compression, hardness, friability and disintegration properties could be achieved without the addition of any external binder. The prepared formulation was subjected to in vitro antioxidant activity, antibacterial activity against common respiratory tract pathogens, in vivo antitussive activity and acute toxicity studies using Albino Wistar mice. Accelerated stability studies were conducted as per ICH guidelines. The performance of lozenges was found to be satisfactory in all the tested aspects. Our study proposes the use of lozenges as a preferred dosage form of the conventionally used decoction of Joshanda.

Formulation and characterization of ternary complex of poorly soluble duloxetine hydrochloride.

Duloxetine hydrochloride (DXH) suffers from poor solubility and thereby poor absorption, which ultimately leads to poor bioavailability. In present study, an attempt has been made to formulate and characterize duloxetine hydrochloride (DXH) complex, using β-cyclodextrin (β-CD) and different hydrophilic polymers in order to enhance its solubility and dissolution rate. Phase solubility study was used to investigate the interaction of the drug in binary systems (DXH-β-CD) as well as ternary systems (DXH-β-CD-hydrophilic polymer). It was observed that solubilization of DXH by β-CD was further enhanced by using HPMC K4M at 0.1% w/v concentration. Several methods were used to prepare ternary complex of DXH-β-CD-HPMC K4M. Ternary complex prepared by co-evaporation method containing DXH-β-CD-HPMC K4M in the ratio of 1:1.10:0.01 has shown the fastest dissolution rate (53.65 ± 2.83% in 5 min) as compared to pure DXH (3.03 ± 1.88% in 5 min) as well as other methods used to prepare these complexes. The prepared ternary complex system was characterized by the help of X-ray powder diffraction studies, differential scanning calorimetry and scanning electron microscopy. It was observed that enhancement in solubility as well as dissolution rate of DXH was due to formation of ternary complex system.

Synthesis, molecular docking and QSAR studies of 2, 4-disubstituted thiazoles as antimicrobial agents.

In present study a series of 2,4-disubstituted thiazole derivatives was synthesized and evaluated for their in vitro antibacterial and antifungal activities against B. subtilis, E. coli, S. aureus, C. albicans and A. niger by tube dilution method. The analysis of antimicrobial activity results indicated that the presence of NO2 and OCH3 groups at para position of phenyl group improved the antimicrobial activity significantly. Molecular docking studies also supported in vitro activity results and showed that NO2 and OCH3 groups containing compounds have greater affinity towards the target glucosamine-6-phosphate synthase. QSAR studies indicated that molecular connectivity index (2χv) and Kier’s shape index (α3) are the key parameters for antimicrobial activity of synthesized thiazole derivatives and can be cosidered as important factors for interaction with target site of different microorganisms. It is pertinent to note that multi-target QSAR models were more effectual in demonstrating the antimicrobial activity than one-target QSAR models.

Role of C.T. Scanning in Characterization of USG Detected Solid and Cystic Lesion of Liver.

The exact nature i.e. neoplastic vs. benign of USG detected space occupying lesions are confirmed by computed tomography. In this study we do CECT of 45 cases of sonographically detected space occupying lesions in liver. Some of cases which is very confusing in regards either it is benign or malignant, the computed tomography is more sensitive.

Role of Ultrasonography in the Diagnosis of Intrahepatic Space Occupying Lesions.

Ultrasonography is safe, non- invasive, cost-effective, less time-consuming, easily repeatable and simple investigation for the diagnosis and follow up of intrahepatic space occupying lesions. In these study ninety patients with a probable diagnosis of space occupying lesions of liver were studied. The diagnosis of intrahepatic space occupying lesions was confirmed in eighty-two patients. Ultrasonography had sensivity of 91%.

Role of CT in the Evaluation of Adult Brain Tumor.

Imaging plays an important role in the evaluation of patients with brain tumors. CT is an important and commonly used modality. They have a significant impact on patient modalities and care. The technical improvement of CT and the utility of contrast material in the imaging of brain tumors improved significantly the detection and the evaluation of brain neoplasms.Once a brain tumor is clinically suspected, radiologic evaluation is required to determine the location, the extent of the tumor and its relationship to the surrounding structures. This information is very important & critical in deciding among different forms of therapy such as surgery, radiation and chemotherapy. In this article we will give an overview of the role of CT in the diagnosis of brain tumors.

Study of Systolic/Diastolic Ratios of the Umbilical Artery Flow Velocity Waveforms in Pregnant Women.

Analysis of umbilical artery flow velocity waveforms of systolic/diastolic (S/D) ratio of 58 patients, who had accurately uncomplicated pregnancies with a normal spontaneous vaginal delivery, were studied. This study includes conventional ultrasonography, color flow mapping and duplex Doppler flow. There was a significant decrease in the S/D ratio over each week of the third trimester of pregnancy. The study present the mean, range and upper limit of the data obtained in this population.

A Missed Malignant Right Coronary Artery Anomaly Detected Post-Cardiac Event in an Adult Patient.

Aims: We present this case to raise awareness of this unusual presentation of a malignant anomalous right coronary artery arising from the left coronary cusp in a patient older than 50 years. We describe a useful imaging modality and discuss therapy. Presentation of the Case: We report a case of a 63-year-old male with an interarterial coursing right coronary artery arising from the left coronary cusp with a history of a mechanical aortic valve replacement. The patient presented to our emergency department after being resuscitated from a cardiac arrest and later had a normal coronary angiogram. High suspicion of his right coronary artery angulation, he underwent a computed tomography with angiogram that revealed his anomalous course and anatomy. Discussion: We discuss the importance of coronary artery anomaly detection in the young at risk population (athletics), pathophysiology, diagnostic modalities, and treatment recommendations. Surgical revascularization has been advocated in malignant coronary anomalies, however, the lack of large randomized clinical trials for patients older than 50- year-old left this topic controversial. Medical therapy augmented with implanted cardioverter defibrillator (ICD) was utilized in this case. Medical management could be considered in centers that don’t have surgical experience or in adult patients who are a poor surgical candidate because of other comorbidities or life expectancy. Conclusion: Computed tomography with angiogram seems to be the best noninvasive modality to delineate coronary course and anatomy. There is a need for randomized clinical trials to determine the best management of anomalies arising from opposite sinus with an interarterial course in adults >50-year-old.