Systematic approach for the formulation and optimization of atorvastatin loaded solid lipid NANOAPARTICLES using response surface methodology.

Atorvastatin is a lipid lowering agent with poor oral bioavailability (12%) because of poor solubility and extensive first pass hepatic metabolism. In order to overcome these issues, atorvastatin loaded solid lipid nanoparticles (ATOR-SLNs) were prepared by using glyceryl tripalmitate as lipid carrier, poloxamer 407 as surfactant and soya lecithin as emulsifier. The purpose of this work was to optimize the formulation with the application of response surface methodology to improve the physicochemical properties. The central composite rotatable design consisting of three factored factorial design with three levels was used for the optimization of the formulations. The optimized formulation was composed of drug/lipid ratio of 1:3.64, surfactant concentration of 1.5% with 5 min time for sonication. Fourier transforms infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC) studies confirmed the compatibility of drug and lipid in the formulation. The optimized ATOR- SLNs showed almost spherical shape with a mean particle size of 338.5 nm, zeta potential of -24.7mV, DL of 17.7% and EE of 81.06% respectively. The in vitro drug release study showed a burst release at the initial stage followed by the prolongation of drug release from lipid matrix. Stability study revealed that ATOR-SLNs were more stable at 4±2˚C when compared with storage at 25±2˚C/60±5% RH during the six months storage period. These results indicated that the developed ATOR-SLNs is a promising approach for increment of bioavailability by improving the physicochemical properties.

Synthesis and evaluation of MePEG-PCL diblock copolymers: surface properties and controlled release behavior.

The amphiphilic block copolymers are composed of various combinations of hydrophilic and hydrophobic block unimers. The variation in unimer ratio alters the surface as well as micelle-forming properties of the block copolymers. These nanoscopic micelles have the ability to encapsulate hydrophobic compounds and act as potential drug carrier. MePEG-PCL copolymers with various block lengths were synthesized by ring-opening polymerization and characterized by 1HNMR, GPC, WXRD and DSC. The number average molecular weight of the block copolymer was found to vary from 7511 to 21,270 as determined by GPC and 1HNMR studies. The surface topology of the polymer films was determined by AFM analysis, which shows a smoother surface with increased MePEG contents in the block copolymers. The protein-binding assay indicates a better biocompatibility of the block copolymers in comparison to MePEG or PCL alone. The CMC of the block copolymer provides the information about micelle formations for encapsulation of hydrophobic materials and affects the in vitro release.

Use of fluoroscopic guidance to remove a migrating esophageal foreign body.

Ingested foreign bodies that migrate extraluminally are rare. In such cases, exploration of the neck via an external approach is the recommended procedure to remove the object. However, locating such a foreign body can be a difficult task. We report what we believe is the first adult case of fluoroscopically guided localization of an accidentally ingested foreign body that had migrated into the soft tissues of the neck. We also review the other methods used to locate a migrating foreign body.

Tracheo-bronchial foreign bodies: a retrospective study and review of literature.

Tracheobronchial foreign body aspiration is a common emergency in childhood constituting major cause of mortality. Although ample studies regarding airway foreign bodies are present in western literature, studies in Indian context are however lacking. The aim of the study is to present an epidemiological data regarding airway foreign bodies in Indian context thereby helping to analyze the situation with regard to our socio-economic condition. Retrospective file review of all case (n = 82) that underwent rigid bronchoscopy for suspected tracheo-bronchial foreign body over a period of 7 years (2001-2008) in the department of otolaryngology of a tertiary care centre of eastern India. Patient characteristics, history, clinical, radiographic and bronchoscopic findings were noted in an attempt to define the epidemiology, clinical presentation, management and associated morbidity. Most common age of presentation was between 1 and 3 years (56.4%). Most common symptom in our study was Cough, wheezing and respiratory distress (63.4%). Most common clinical signs at presentation were diminished breath sound in unilateral lung field seen in 36.6% cases. Most common radiological finding on chest radiograph was collapse seen in 41.65% cases. Most common type of foreign body below 3 years of age was food material (seeds, beans) removed in 48.78%. Complications were encountered in 14.6% cases of which most common complication was bronchospasm and acute respiratory distress seen in 41.6% cases.

Preparation and characterization of nebivolol nanoparticles using Eudragit® RS100.

Nebivolol, a beta-blocker, has been widely used for the treatment of hypertension and cardiovascular diseases; but has drawbacks like poor solubility and bioavailability requiring frequent dosing. The present study attempts to overcome these issues through nanoparticulate delivery system using widely used carrier Eudragit(®) RS100. The solvent evaporation (single emulsion) technique was used for developing nanoparticles. The impact of formulation and process variables on particle size and entrapment efficiency was studied to optimize the formulation. The physico-chemical characterization confirmed the particle size in nano range with smooth and spherical morphology. Further, Fourier transforms infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC) studies confirm compatibility of drug-polymer combination. The in vitro drug release study of the prepared nanoparticles showed prolongation of drug release with reduced burst release in comparison with pure drug powder.

An unusual case of recurrent stridor in a child.

A two-year-old child presented with history recurrent attacks of stridor. Initially he was thought to have laryngomalasia and treated accordingly but the symptoms did not improve with age. The child was symptomatic only during episodes of respiratory tract infection. There was no feeding difficulty, growth was normal. CT thorax showed moderate compression of trachea just above the carina. CT angiography showed an incomplete double aortic arch. As the child was symptomatic only during intercurrent infections and there was no feeding difficulty, respiratory distress and growth problems conservative management was opted. Parents were advised to observe the patient and review after six months.

Patterns of cancer occurrence in different regions of West Bengal--a hospital based study.

The incidence of cancer has been rising steadily in the third world countries including India. The patterns of cancer incidence reflect the racial, cultural and pharmacogenomic diversity within populations and nowhere is this diversity more striking than in the Indian subcontinent. This article shows the diversity in patterns of incidence of major cancers across three medical college hospitals in the state of West Bengal in India. All the data were collected from the period between 2001 and 2005. The results show a striking variation of incidence of major cancers in the urban, semi-urban and rural parts of the same state. Indeed the differences of the patterns are explainable by the cultural and socioeconomic differences within the populations from which the study samples are drawn. This constitutes the largest single hospital based data collected from this part of the world till date and will help in re-evaluation of cancer control programmes promulgated by the health authorities of the region.

The effect of honey on mucositis induced by chemoradiation in head and neck cancer.

The aim of this study was to evaluate the effect of pure natural honey on radiation-induced mucositis. Fifty-five patients diagnosed with head and neck cancer requiring radiation to the oropharyngeal mucosal area were divided into two groups (study arm-28 and control arm-27) to receive either chemoradiation or chemoradiation plus topical application of honey. Patients were treated using a telecobalt machine at 2 Gy per day, five times a week up to a total dose of 66 Gy. in the study arm, patients were advised to take 20 ml of honey 15 minutes before, 15 minutes after and similar amount at bed time. Patients were evaluated every week for the development of radiation mucositis using the WHO grading system. There was significant reduction in the symptomatic grades 3 and 4 mucositis in honey-treated patients compared to controls ie, 18% versus 41% for grade 3 and 4% versus 22% for grade 4 mucositis. Seventy-one per cent of patients treated with topical honey showed no change or a positive gain in body weight. In the control group also 22% had no weight loss, though none showed weight gain. Furthermore, it didn't affect blood sugar level when initial fasting blood sugar level was < 150 mg%. Honey is a cheap, simple, easily available and effective agent in reducing radiation-induced mucositis. Within the limits of this study the results showed the application of natural honey is effective in managing radiation induced mucositis, which warrants further multicentric randomised trials to validate the findings.

Comparison of the effectiveness and safety of cefpodoxime and ciprofloxacin in acute exacerbation of chronic suppurative otitis media: A randomized, open-labeled, phase IV clinical trial.

OBJECTIVE: To compare the effectiveness and safety of cefpodoxime and ciprofloxacin for the treatment of mild to moderate cases of acute exacerbation of chronic suppurative otitis media (AECSOM). MATERIALS AND METHODS: Adult patients diagnosed with AECSOM were screened and patients fulfilling the inclusion criteria were randomized to receive either cefpodoxime 200 mg twice daily or ciprofloxacin 500 mg twice daily orally for 7 days. The primary outcome of this randomized, open-labeled, phase IV clinical trial (Registration Number - CTRI/2011/10/002079) was clinical success rate at day 14 visit and the secondary outcome was incidence of adverse events (AEs). Forty-six patients were enrolled: 23 in the cefpodoxime group and 23 in the ciprofloxacin group. RESULTS: The clinical success rates were 95.6% in the cefpodoxime group versus 90.9% in the ciprofloxacin group. These rates are comparable, but no statistically significant difference was observed between the groups. Few mild and self-limiting AEs were observed and the tolerability of both the drugs was also good. CONCLUSION: The results of this randomized, open-labeled phase IV clinical trial showed that a 7-day course of cefpodoxime is therapeutically comparable to ciprofloxacin in terms of both clinical effectiveness and safety for the treatment of patients with AECSOM.

Dysphagia--an uncommon presentation of unnoticed snakebite.

Snakebite cases do not always present with classical features of bite, resulting in delay in diagnosis and treatment with disastrous consequences, especially when bite occurs during sleep at night. Ptosis is the most common early symptom. Dysphagia, though not uncommon in cases of snakebite but presenting solely with this, is very rare. Here a case of a young man with complaints of only severe dysphagia without any history of bite is reported. He was treated as a case of neurotoxic snakebite poisoning and found to have recovered.

Fallopian canal dehiscence: can it be pridicted.

The aim of the study is to give an idea about true incidence and most common location of fallopian canal dehiscence and to identify predictive factors associated with fallopian canal dehiscence based on preoperative and peroperative clinical correlates so as to facilitate preemptive prediction of the condition. The study design pertains to a prospective study. The setting of the study was tertiary referral hospital and a total of 146 patients underwent radical and modified radical mastoidectomy as primary procedure between Jan. 2003 to Dec. 2004. The site of dehiscence and associated pre-operative and per-operative findings were noted. Our results showed the incidence of fallopian canal dehiscence among cases undergoing radical and modified radical mastoidectomy was 82/1000 per year. Around 66.6% dehiscence was located in tympanic segment. The preoperative factors significantly associated with the fallopian canal dehiscence (p< 0.05) were Aural polyp, Extra-cranial complications, Cholesteatoma and Facial palsy. Per-operative findings were Cholesteatoma, All ossicles necrosed except stapes footplate and Lateral semicircular canal fistula.

Simultaneous complete branchial and thyroglossal fistula - a rare presentation.

The anomalies of branchial cleft and thyroglossal tract accounts for the majority of fistulas in head neck region. A simultaneous presentation of both type of fistula in a same patient is very rare with no such cases reported in Indian literature till date. Here we present a case of simultaneous complete branchial and thyroglossal fistula in a 13-year-old girl with radiologically demonstrable internal opening on fistulogram managed surgically.

Paranasal sinus mucoceles: a comprehensive retroprospective study in Indian perspective.

Paranasal sinus mucoceles are the most common expansile lesion of the paranasal sinuses. Hereby we present a comprehensive retroprospective study on the paranasal sinus mucoceles in our geographic area which is very significantly lacking till now which we hope would immensely help comparative analysis and management in near future.

Chondrosarcoma of nose and paranasal sinus - a rare presentation.

Chondrosarcoma, the most malignant cartilageneous tumor, constitute only 4% of non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, making it one of the rarest malignancies. Here we present a case of Grade 1 chondrosarcoma involving nose, maxillary sinus, ethmoids and sphenoid sinus managed surgically by wide excision. 12 months follow-up reveled no recurrence or complication.

Surgical management of parapharyngeal tumors - our experience.

Fifteen cases of parapharyngeal tumors treated surgically in ENT department of Calcutta National Medical College in last 2 years were included, 80% cases were of benign tumors, most common being schwannomas. Most important investigation was found to be CT scan. The study gives an overview regarding the surgical approach, based upon the extent and histology of the tumor and transcervical approach was found to be most efficient for all practical purpose.

Benign osteoblastoma of maxillary sinus: A rare presentation.

Benign osteoblastoma of paranasal sinuses is a rare tumor of the 2(nd) decade of life with only few cases reported till date. It arises most commonly from the ethmoid sinus and present as an intra-nasal mass leading to broadening of the nasal bridge. Here we present a case of benign osteoblastoma in a 8 year old girl presenting with a large intranasal mass seen through nostril and leading to facial deformity.

Frontal sinus osteomyelitis with midline fistula.

Chronic osteomyelitis of frontal sinus is a rare complication of recurrent sinusitis. The pent-up secretions in the sinus may result in pressure necrosis of the containing wall of frontal sinus resulting in persistently discharging fistula. Here we present a case of chronic osteomyelitis of frontal sinus with persistent midline fistula over forehead in a 30 year old male managed surgically by osteoplastic flap procedure and frontal sinus obliteration with abdominal fat.

Preauricular malignant lymphoma masqurading as benign pleomorphic adenoma - A rare tricky presentation.

Lymphoma in the head neck area most commonly present as cervical lymph node swelling followed by tonsillar enlargement but the presentation as sole preauricular swelling without systemic involvement is a very rare finding. Here we present a case of malignant lymphoma Grade I, presenting as a single prauricular swelling masquerading as a benign pleomorphic adenoma, in a 24 year old girl.

Fistula of submandibular gland-a rare presentation.

Salivary fistulas commonly affect parotid gland. Sabmandibular fistulas are very rare. Most of them are congenital in origin and may be associated with abnormalities of the branchial apparatus. Traumatic submandibular fistulas on the other hand are very rare entities with only few cases reported till date.

Nasopharyngeal carcinoma presenting as Gradenigo's syndrome.

Nasopharyngeal carcinoma usually has an insidious onset and non-specific features in the initial stages. This makes early diagnosis difficult. The most usual presenting features are cervical lymphadenopathy, otological symptoms (serous otitis media) and involvement of adjacent cranial nerves. We report a case of Gradenigo's syndrome in a patient of undifferentiated nasopharyngeal carcinoma.