Cerumenolytic Effects of Carbamide Peroxide in Patients with Ear Wax Obstruction.

Introduction: Accumulated and compacted ear wax or cerumen can cause conductive hearing loss, discomfort and vertigo, and infection. This study investigates the effect of Carbamide peroxide (CP) compared with Phenol glycerin (PG) ear drops on cerumen. Materials and Methods: This experimental study investigated the effect of PG and CP ear drops on cerumen in ex vivo and in vivo phases. In the ex vivo phase cerumen degredation was scored following PG and CP treatments. In the in vivo phase, 29 patients with bilateral cerumen impaction were randomly entered the study. PG and CP were applied 3 times a day (each time 5 drops) for 4 days by patients. After treatments, the time of cerumen removal was measured. Results: Instant changes showing degredation of cerumen (grade 1) was evident when it was exposed to CP, on the other hand degredation changes (grade 1) in cerumen treated with PG was only evident after 20 min incubation at 37 oC, while grade 3 degredation was evident in cerumen treated with CP after the same time incubation. Although the time needed for removal of cerumen was lower in CP treatment (54.10±31.77) compared to PG treatment (67.10±35.54), the difference was not statistically significant. Conclusion: Based on the literature and our results, carbamide peroxide is suggested as a proper treatment for patients with EAC obstruction caused by cerumen compaction, because not only it is significantly effective in cerumen degredation, but also no side effects have been reported.

Impact of Rose Water Mouthwash on Prevention of Ventilator-Associated Pneumonia in Intensive Care Unit: A Randomized Controlled Trial.

Background: Preventing Ventilator- Associated Pneumonia (VAP) is an important strategy to increase the quality of provided care for patients under mechanical ventilation. Rose water is the main product of Rosa damascena which is a popular medicinal plant and has been widely used in alternative medicine. It has antibacterial activity against gram-negative and gram-positive bacteria which can potentially cause VAP. Materials and Methods: This study was a randomized, controlled, single-center trial. 88 patients in a 21-bed surgical Intensive Care Unit (ICU) who were under mechanical ventilation met the inclusion criteria, and 80 patients fulfilled the study. Based on receiving either rose water and chlorhexidine solution or chlorhexidine solution alone, the patients were divided into two groups of control and intervention. The incidence of VAP up to 14 days was the primary outcome. Duration of mechanical ventilation, the ICU length of stay, and mortality in ICU were the secondary outcomes. Results: There was no significant difference in demographic data, the incidence of VAP, the incidence of late-onset VAP, mechanical ventilation days, length of the ICU stay, and mortality between the two groups. However, the incidence of early-onset VAP in the intervention group was significantly lower than in the control group (p= 0.021). Conclusion: Rose water mouthwash significantly reduced the risk of early-onset VAP without any effect on late-onset VAP.

The Impact of Chlorhexidine Mucoadhesive Gel in the Prevention of Ventilator-Associated Pneumonia: A Randomized Clinical Trial.

Objective: Ventilator-associated pneumonia is the common cause of morbidity and mortality in the intensive care unit. Due to the antimicrobial effect of chlorhexidine, and the long-lasting result of mucoadhesive drugs, this study aimed to determine the effect of chlorhexidine mucoadhesive gel on the prevention of ventilator-associated pneumonia in critical patients. Method: In this clinical trial, 64 ventilated patients were selected and randomly allocated into two groups. The first group received 0.2% chlorhexidine mucoadhesive gel and the second group received 0.2% chlorhexidine solution as a mouthwash. Every three days, the incidence of ventilator-associated pneumonia was evaluated by the clinical score of pulmonary infection. The data were analyzed by SPSS statistical software version 20. Results: There was no statistically significant difference in demographic characteristics between the two groups. In the control group, 25% of the patients had ventilator-associated pneumonia, while it was only 15.6% in the intervention group; however, the incidence of ventilator-associated pneumonia revealed no significant difference between the two groups (HR ratio, 0.86; 95% confidence interval, 0.49 to 1.83 p =0.356).In addition, there was no statistically significant difference between the number of days connected to the ventilator (p =0.854), the number of days hospitalized in the intensive care unit (p =0.423), and the death rate (p =0.634) between the two groups. Conclusion: Although no significant statistical difference was detected between chlorhexidine mucoadhesive gel and chlorhexidine solution in the prevention of ventilator-associated pneumonia, the incidence of pneumonia in the mucoadhesive gel group was clinically less than in the control group. It is better to repeat the study with a larger statistical population.

A Hydrogen-Bonded Extracellular Matrix-Mimicking Bactericidal Hydrogel with Radical Scavenging and Hemostatic Function for pH-Responsive Wound Healing Acceleration.

Generation of reactive oxygen species, delayed blood clotting, prolonged inflammation, bacterial infection, and slow cell proliferation are the main challenges of effective wound repair. Herein, a multifunctional extracellular matrix-mimicking hydrogel is fabricated through abundant hydrogen bonding among the functional groups of gelatin and tannic acid (TA) as a green chemistry approach. The hydrogel shows adjustable physicochemical properties by altering the concentration of TA and it represents high safety features both in vitro and in vivo on fibroblasts, red blood cells, and mice organs. In addition to the merit of facile encapsulation of cell proliferation-inducing hydrophilic drugs, accelerated healing of skin injury is obtained through pH-dependent release of TA and its multifaceted mechanisms as an antibacterial, antioxidant, hemostatic, and anti-inflammatory moiety. The developed gelatin-TA (GelTA) hydrogel also shows an outstanding effect on the formation of extracellular matrix and wound closure in vivo via offered cell adhesion sites in the backbone of gelatin that provide increased re-epithelialization and better collagen deposition. These results suggest that the multifunctional GelTA hydrogel is a promising candidate for the clinical treatment of full-thickness wounds and further development of wound dressing materials that releases active agents in the neutral or slightly basic environment of infected nonhealing wounds.

Effect of Intermittent Subglottic Irrigation with 5% NaCl on the Prevention of Ventilator Associated Pneumonia in Critically Ill Patients.

BACKGROUND: Ventilator-Associated Pneumonia (VAP) is one of the common causes of mortality and morbidity. Subglottic secretion suction decreases the incidence of VAP. In this study, the effect of 5% sodium chloride (NaCl) in subglottic area in addition to secretion suction in VAP prevention was investigated in patients who were admitted to the intensive care unit. MATERIALS AND METHODS: All patients were intubated by an intubation tube with subglottic suction. In the intervention group, subglottic area was washed with 10 ml of 5% sodium chloride solution, and in the control group the subglottic area was washed with 10 ml distilled water. Patients were monitored for a maximum of two weeks, and the incidence of VAP was monitored by a Clinical Pulmonary Infection Score (CPIS). RESULTS: There was no significant difference between the two groups in terms of age and sex. Four (27%) patients in the intervention group, and 7 (37%) in control group were diagnosed with VAP, which was not statistically significant between the two groups (P=0.225). The duration of hospitalization, duration of intubation and mortality did not show any significant difference between the two groups. CONCLUSION: It was expected that in this study the rate of VAP became significantly lower with the intervention of using antimicrobial solution in addition to suction. Although the rate decreased clinically, it was not statistically significant, which may be due to the low number of patients.

In vitro and in vivo effects of chitosan-praziquantel and chitosan-albendazole nanoparticles on Echinococcus granulosus Metacestodes.

Cystic echinococcosis (CE), which is caused by the metacestode of Echinococcus granulosus, is one of the most important zoonoses affecting humans. Benzimidazoles (in particular albendazole) and praziquantel (PZQ) are effective against CE, but poor water solubility of these agents often leads to inadequate results. Here, we evaluate the effects of chitosan-albendazole (ChABZ) and chitosan-praziquantel (ChPZQ) nanoparticles as a new formulation on hydatid cysts both in vitro and in vivo. Developed microcysts in culture were treated with different concentrations of ChABZ and ChPZQ nanoparticles (either alone or in combination), and ABZ + PZQ suspension. The viability rate of microcysts was used to evaluate the drug efficacies. In addition, the prophylactic and therapeutic effects of the drugs were studied on infected DBA/2 mice. Transmission electron microscopy was used to observe the ultra-structural changes. The viability rate of microcysts and differences in cyst weights were compared by ANOVA, and the cyst numbers were compared using the Kruskal-Wallis test. The combination of ChABZ + ChPZQ nanoparticles was more effective than the ABZ + PZQ suspension in vitro (p < 0.05). In prophylaxy, a significant reduction was observed both in size and in number of the cysts in ChABZ + ChPZQ nanoparticle groups compared with the control group (p < 0.05). In the therapeutic stage, however, this treatment only reduced the cyst numbers. Degeneration of the microcysts treated with the drugs was evident in the ultra-structural imaging. Overall, the nanoparticulate drugs were more effective than their suspension counterparts, but further studies are recommended to evaluate the full potential of these nanoparticles in the treatment of human CE.

Inflammation and Outcome in Traumatic Brain Injury: Does Gender Effect on Survival and Prognosis?

INTRODUCTION: Traumatic Brain Injury (TBI) accounts for the majority of trauma deaths and there has been increased interest in the understanding the role of prognostic factors. C-Reactive Protein (CRP) level increases rapidly in response to trauma. AIM: Aim of the present study was to indicate the role of CRP as a predictor of outcome in TBI patients based on their gender category. MATERIALS AND METHODS: A prospective cohort study in a surgical Intensive Care Unit (ICU) in one of the Zanjan University of Medical Science hospital was designed. Fifty nine head trauma patients were divided into two groups based on their gender. Serum CRP was measured 48 hours after trauma. All data including the length of ICU stay, the duration of mechanical ventilation, the Glasgow Coma Scale (GCS) at discharge, and mortality were collected. The relationship between the clinical features and serum CRP level was also studied. RESULTS: In the male group, CRP level was not significantly correlated with the length of ICU stay, the duration of mechanical ventilation and GCS at discharge. In the female group, CRP level was positively correlated with the length of ICU stay and the duration of mechanical ventilation; however, CRP level was not significantly correlated with GCS at discharge. These results remain constant in female sub group with severe head injury contrast to female with mild injury. CONCLUSION: The GCS level can predict the outcome of females with severe head injury better than females with mild head injury and males.

Simvastatin's effects on survival and outcome in traumatic braininjury patients: a comparative study.

BACKGROUND/AIM: Mortality and morbidity still remain high in patients with traumatic brain injuries. Understanding the role of new treatments in these patients is critical. The aim of this study was to determine the effect of simvastatin on survival and outcome in traumatic brain injury patients. MATERIALS AND METHODS: Forty-four patients were assigned to receive either simvastatin or a placebo. The serum interleukin-6 and C-reactive protein levels were measured at the first 24 h and 48 h after trauma. All data, including the Glasgow Coma Scale score, survival at discharge, length of intensive care unit stay, and duration of mechanical ventilation, were collected. The effect of simvastatin on the collected data was then investigated. RESULTS: The Glasgow Coma Scale level at discharge was significantly higher in the simvastatin group. The overall mortality rate, duration of mechanical ventilation, and length of intensive care unit stay were similar between the 2 groups. The C-reactive protein concentration 48 h after trauma was significantly lower in the simvastatin group, but there was no significant difference according to the interleukin-6 level 48 h after trauma between the 2 groups. CONCLUSION: Simvastatin could be suggested as an adjunctive therapy in traumatic brain injury patients.

Comparison between intrathecal and intravenous betamethasone for post-operative pain following cesarean section: a randomized clinical trial.

OBJECTIVE: Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section. METHODOLOGY: Ninety-nine patients undergoing cesarean section were assigned to one of three groups. Group 1 (Control) patients received intrathecal bupivacaine, Group 2 patients received intrathecal bupivacaine plus preservative free betamethasone and Group 3 patients received betamethasone intravenously with intrathecal bupivacaine. After surgery, diclofenac in suppository form was administered as needed for analgesia. Postoperative diclofenac requirements, time to first analgesic administration and visual analogue scale pain scores were recorded by a blinded observer. RESULTS: Supplemental analgesic dose requirement with diclofenac for the first 24 hours were significantly less in both groups that received betamethasone compared to the control group (P <0.0001). The mean duration of postoperative analgesia was 336.8±86 min in Intrathecal group and 312.4±106 min in Intravenous group compared with 245.4±93 min in control group (P =0.001). Visual analogue scale scores were significantly less at 4 hours (P<0.0001) and 6 hours (P<0.0001) after surgery in groups that received betamethasone in comparison to control group. The pain scores at 6 hours after surgery were higher in the Intravenous group compared with the Intrathecal group (P = 0.001); However visual analogue scale was not different at 12 and 24 hours after surgery between groups (p > 0.05). CONCLUSION: Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section.

Preparation and characterization of gelatin nanoparticles containing pDNA encoding IL-12 and their expression in CT-26 carcinoma cells.

AIM: Gelatin as a biodegradable, nontoxic and biocompatible natural protein is a good candidate for gene delivery. In this study, pDNA-loaded gelatin nanoparticles were prepared and characterized for the expression of the cytokine IL-12 and anti-tumor effects. MATERIALS & METHODS: Gelatin-pUMVC3-hIL-12 nanoparticles were prepared by the ethanol precipitation technique and evaluated for physicochemical characteristics, cytotoxiciy and transfection efficiency. RESULTS: The prepared particles were spherical in shape with sizes varying from 344.27 to 826.23 nm, ζ-potentials between -944 and -165 mV, and greater than 97% encapsulation efficiency. The particles were nontoxic to CT-26 carcinoma cells. The nanoparticles prepared using 0.5% gelatin solution (G14) with a mean particle size of 816.87 nm (polydispersity index = 0.56 ± 0.01) demonstrated maximum transfection efficiency with 2.5-times higher expression compared with the naked plasmid. CONCLUSION: Gelatin-DNA nanoparticles using 0.5% gelatin solution had minimal cytotoxicity and can be used as a suitable candidate for further gene delivery studies and applications.

Preparation of chitosan-plasmid DNA nanoparticles encoding interleukin-12 and their expression in CT-26 colon carcinoma cells.

PURPOSE: Interleukin-12 (Il-12) as a cytokine has been proved to possess antitumor effects via stimulating the immune system. Non-viral gene delivery systems exhibit low toxicity and are easier to prepare compared to their viral counterparts. In this study, we aimed to prepare plasmid DNA loaded chitosan nanoparticles for expression of Il-12 and to evaluate their physicochemical characteristics, cytotoxicity and transfection efficiency in Murine CT-26 colon carcinoma cells. METHODS: Nanoparticles were prepared using a complex coacervation process at different N/P ratios and characterized in terms of size, zeta potential, polydispersity index, morphology, encapsulation efficiency and polyplex formation. The cytotoxicities and transfection efficiencies of the prepared polyplexes were evaluated by MTT assay and ELISA (for hIL-12, p70), respectively. RESULTS: Size and zeta potential varied from 76.73 to 867.03 nm and between 5.68 and 16.77 mV, respectively. Strong attachment of the DNA to chitosan was observed after polyplex preparation. Encapsulation efficiencies were high (72.97-94.87%). The transfection efficiencies of the prepared complexes were obviously higher than those of naked pDNA when N/P ratios were between 16 and 60. Maximum level of phIL-12 expression was obtained at (N/P = 16) with mean particle size of 381.83±82.77 nm (polydispersity index=0.44) indicating the improved transfection of pUMVC3-hIL12 about 2.80 times compared to that of the naked pUMVC3-hIL12. Prepared polyplexes were nontoxic to CT-26 cells. CONCLUSIONS: Chitosan-DNA nanoparticles at N/P = 16 with minimal cytotoxicity, can be used as suitable candidate for Il-12 delivery. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Immunotherapy with Imiquimod increases the efficacy of Glucantime therapy of Leishmania major infection.

BACKGROUND: Leishmaniasis is a complex disease which presents as visceral, cutaneous and mucocutaneous forms. The current treatment options for this infection are very limited and the immunological state of the host appears to play an important role in the efficacy of the treatment. Immunostimulation through immune response activating agents such as Imiquimod is another rational approach for this purpose. OBJECTIVE: We assessed the efficacy of immunotherapy with Imiquimod alone or combined with Glucantime for treatment of Leishmania major infection in BALB/c mice. METHODS: Treatment efficacy was monitored by determination of thickness and parasite load of infected footpad of mice. RESULTS: The footpad thickness revealed that treatment with Imiquimod plus Glucantime has the highest efficacy. The results were confirmed by parasite load of infected footpad. Our data shows that treatment of Leishmania major infection in BALB/c mice by the combined Imiquimod and Glucantime is more efficient than each drug alone. CONCLUSION: The combination of Imiquimod with chemotherapy may offer a way for more efficient treatment of leishmaniasis.

Adjuvanticity effect of sodium alginate on subcutaneously injected BCG in BALB/c mice.

Bacillus Calmette-Guerin (BCG) is the only available vaccine against tuberculosis. The research for an improved vaccine is currently a very active field of investigation. In the present study, adjuvanticity effect of sterile sodium alginate on subcutaneous BCG vaccination in BALB/c mice was investigated. Mice were vaccinated subcutaneously with BCG plus alginate and the immune response and protective effect were compared to those of mice vaccinated with BCG alone by the same route. Proliferative and delayed-type hypersensitivity responses, IFN-gamma, specific anti-mycobacterium total IgG, IgG1 and IgG2a production were significantly higher in mice immunized subcutaneously with BCG plus alginate in comparison with results of mice immunized with BCG alone. Following systemic infection with BCG, mice vaccinated with BCG plus alginate had lower mean bacterial count compared to those vaccinated with BCG alone. The immune responses induced by subcutaneous administration of BCG plus alginate were significantly better than the responses induced by standard BCG vaccination.

Oral administration of BCG encapsulated in alginate microspheres induces strong Th1 response in BALB/c mice.

Bacille Calmette-Guerin (BCG) is one of the first vaccines administered to the newborns in developing countries. As an alternative to parenteral administration of vaccines, oral vaccines offer significant logistical advantages. Successful oral immunization, however, requires that vaccine antigens be protected from gastric secretions. In the present study, BALB/c mice were vaccinated orally with BCG encapsulated in alginate microspheres and the immune responses and protective effect were compared with those of mice vaccinated with free BCG by subcutaneous and oral routes. Proliferative and delayed-type hypersensitivity (DTH) responses and IFN-gamma production were significantly higher in mice immunized orally with encapsulated BCG in comparison with results of mice immunized orally with free BCG. Following systemic infection with BCG, mice vaccinated with encapsulated BCG had lower mean bacterial count compared to those vaccinated orally with free BCG. The immune responses induced by oral administration of encapsulated BCG were equal to or better than the responses induced by standard BCG vaccination.

Immune Response Following Oral Immunization with BCG Encapsulated in Alginate Microspheres.

BACKGROUND: Different methods have been used for BCG vaccination. Alginate microspheres are useful in delivery of vaccines to the gastrointestinal tract by oral route. OBJECTIVE: To compare the immune response following oral microencapsulated and subcutaneous (SC) route administration of BCG vaccine in BALB/c mice. METHODS: Alginate microspheres were produced by an internal emulsification method within olive oil. Four groups of mice were studied, including two groups receiving oral gavages of microencapsulated and free BCG, one receiving SC injection of BCG, and a control group. T cell proliferation, specific anti-BCG total IgG, and IgG subclasses (IgG1 and IgG2a) were compared between groups 5 and 12 weeks after vaccination. RESULTS: The best result was achieved using oral microencapsulated form in comparison with oral BCG alone. CONCLUSION: Delivery of oral BCG with alginate microspheres is an effective way to induce immune response in BALB/c mice.