Role of Pregabalin in Pre-Operative and Post-Operative Pain Management of Lower Limb Orthopedic Surgeries.

Introduction: Post-operative pain after orthopedic surgery has remained a challenging problem, which prolongs hospital stay and early rehabilitation. Pregabalin comes under the class of gabapentinoids that have been used in postoperative pain in arthroplasty and spine surgeries but studies regarding its role as pre-emptive analgesia in orthopedic limb surgeries are very few. Aims: To compare the efficacy of pre-operative pregabalin with a placebo drug in early post-operative pain management for lower limb orthopedics surgeries. Materials and Methods: A randomized double blinded prospective study was undertaken. Sixty patients were enrolled with age between 18 and 70 years and were divided into 2 groups. Group A - received 150 mg of oral pregabalin capsule, and Group B - received matched color empty capsules. Standard spinal anesthesia was given. Breakthrough analgesia was given with an injection of tramadol 50 mg intravenous. Assessment of pain was done with a Visual Analog Scale (VAS) at 6, 12, 24, and 48 h. Results: In comparison to Group B, Group A had a significantly lower postoperative VAS score and required much less breakthrough analgesia within the 1st 24 h after surgery. Conclusion: In orthopedic lower limb fracture surgeries, pre-emptive pregabalin of 150 mg provides adequate postoperative analgesia with relatively few unfavorable side effects.

Chitosan-coated probiotic nanoparticles mitigate acrylamide-induced toxicity in the Drosophila model.

Acrylamide (ACR) with its extensive industrial applications is a classified occupational hazard toxin and carcinogenic compound. Its formation in fried potatoes, red meat and coffee during high-temperature cooking is a cause for consideration. The fabrication of chitosan-coated probiotic nanoparticles (CSP NPs) aims to enhance the bioavailability of probiotics in the gut, thereby improving their efficacy against ACR-induced toxicity in Drosophila melanogaster. Nanoencapsulation, a vital domain of the medical nanotechnology field plays a key role in targeted drug delivery, bioavailability, multi-drug load delivery systems and synergistic treatment options. Our study exploited the nanoencapsulation technology to coat Lactobacillus fermentum (probiotic) with chitosan (prebiotic), both with substantial immunomodulatory effects, to ensure the stability and sustained release of microbial load and its secondary metabolites in the gut. The combination of pre-and probiotic components, called synbiotic formulations establishes the correlation between the gut microbiota and the overall well-being of an organism. Our study aimed to develop a potent synbiotic to alleviate the impacts of heat-processed dietary toxins that significantly influence behaviour, development, and survival. Our synbiotic co-treatment with ACR in fruit flies normalised neuro-behavioural, survival, redox status, and restored ovarian mitochondrial activity, contrasting with several physiological deficits observed in the ACR-treated model.

Lateral Epicondylitis Treated with Platelet-Rich Plasma Injection and Corticosteroid Injection.

Introduction: Lateral epicondylitis, or tennis elbow, affects 1%-3% of adults aged 35-50, causing pain and weakness in the dominant elbow due to chronic inflammation of the extensor tendon. While corticosteroid injections (CSI) are commonly used for treatment, they offer only short-term relief. Platelet-rich plasma (PRP) is a promising alternative with potential for long-term benefits. This study compares the efficacy of PRP and CSI in treating lateral epicondylitis. Materials & Methods: A randomized controlled trial was conducted at Chettinad Hospital and Research Institute from February 2020 to March 2021, involving patients with lateral epicondylitis unresponsive to non-invasive treatments. Patients were randomly assigned to receive either PRP or CSI, with pre- and post-treatment pain and function assessed using VAS, PSFS, and PRTEE scores. Results: PRP showed better long-term pain reduction and functional improvement than CSI. At 6 months, PRP-treated patients had significantly lower VAS and PRTEE scores, indicating superior outcomes. Discussion: Although CSI provided quicker initial relief, PRP demonstrated sustained benefits at 3 and 6 months. PRP's effectiveness in promoting tissue healing may explain its long-term success. Conclusion: PRP is more effective than CSI for long-term management of lateral epicondylitis, offering superior pain relief and functional improvement.

Bone Preservation in Femoral Intercondylar Box Cut - A Comparative Study between Older and Newer Generation Implants.

Introduction: This study was conducted to compare the quantity of intercondylar bone removed during femoral box osteotomy for implantation of three contemporary newer generation posterior stabilized (PS) total knee arthroplasty designs Attune PS (DePuy), Anthem (Smith and Nephews), and NexGen Legacy (Zimmer) with the older version from the same manufacturers. Materials and Methods: We compared the maximum volumetric bone resection required for the housing of the PS mechanism of these six designs. Bone removal by each PS box cutting jig was three-dimensionally measured. The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test was used for pairwise comparisons. The level of significance was set at P < 0.05. Results: The newer generation implants save approximately 33% of bone that was resected from the box cut as compared to the older versions. DePuys Attune PS saved 27.1% bone as compared to Sigma PS resecting 6.96 cm3 of bone, and Zimmers Persona saved 40.57% bone as compared to NexGen from the intercondylar box cut resecting 6.18 cm3. Smith and Nephew s Anthem and Genesis have no difference in their box volume with both resecting 7.8 cm3 of bone. Conclusion: Irrespective of implant size, the Attune PS (DePuy) and Nexgen Legacy (Zimmer) cutting jigs always resected significantly less bone than did the jigs of older generations. There was no significant difference in the bone removed during femoral box osteotomy in the newer and older generations of Smith and Nephew.

A Comparative Study on Correlation between Magnetic Resonance Imaging and Arthroscopic Findings in the Knee Joint Injuries.

Introduction: The knee joint primarily allows for flexion and extension and is essentially a hinge joint. The knee joint, like all hinge joints, is strengthened by collateral ligaments - one on each side of the joint. Objective: Our study sought to investigate potential correlations between arthroscopy and magnetic resonance imaging (MRl) examination in the diagnosis of traumatic diseases of the knee. Methods and Materials: A prospective study was conducted on 30 persons who showed signs of having traumatic knee disease. Following a comprehensive evaluation of the patient s medical history and current state of health, we opted to undergo an arthroscopic evaluation and knee MRL. Results: The sensitivity of the MRI was 93.87%, the specificity was 91.54%, the accuracy was 92.50%, and the negative predictive value was 95.58% when compared to arthroscopic inspection as the gold standard. Conclusion: This study demonstrates that MRIs frequently misdiagnose individuals with multiple knee injuries or fail to detect a lesion while doing a diagnostic evaluation. Therefore, if the MRI comes out normal, there is no reason to deny the patient arthroscopy. Due to this MRI flaw, researchers have determined that arthroscopy can be performed following a comprehensive clinical assessment without the need for an MRI.

Single Stance Radiography of the Knee Joint - A Novel Approach to Assess the Degree of Knee Osteoarthritis.

Introduction: Conventional radiography has always been cited as the gold standard for assessing the structural changes associated with osteoarthritis (OA) of the knee. The purpose of the study was to compare the joint space width between both leg-standing and one-leg-standing radiographs in an assessment of the severity of OA of the knee. Materials and Methods: Fifty patients with medial compartment OA were deployed for the study. Patients underwent both leg standing radiographs and one-leg standing radiograph on the affected leg. Kellgren-Lawrence (KL) radiographic classification was used to assess the severity of OA using joint space width. Conclusion: The mean medial joint space width decreased from 3.26 mm in both legs of the standing radiograph to 1.98 mm in the one-leg standing radiograph. Patients on both leg standing radiographs appreciated an increase in grade during the single leg radiograph. Nearly 52% of patients with both leg standing radiographs have changed the KL grading to a more severe grade when undergone a single leg standing radiograph. One-leg standing radiograph was found to be a better representation of joint space width than both-leg standing radiographs.

A systematic review on the effects of acrylamide and bisphenol A on the development of Drosophila melanogaster.

The current global scenario has instigated a steady upsurge of synthetic chemicals usage thereby creating a toxic environment unsuitable for animals and humans. Acrylamide and bisphenol A are some of the most common toxins found in the atmosphere due to their extensive involvement in numerous industrial processes. Acrylamide, an occupational hazard toxin has been known to cause severe nerve damage and peripheral neuronal damage in both animals and humans. General sources of acrylamide exposure are effluents from textile and paper industries, cosmetics, and thermally processed foods rich in starch. Bisphenol A (BPA) is generally found in food packaging materials, dental sealants, and plastic bottles. It is highly temperature-sensitive that can easily leach into the food products or humans on contact. The genotoxic and neurotoxic effects of acrylamide and bisphenol A have been widely researched; however, more attention should be dedicated to understanding the developmental toxicity of these chemicals. The developmental impacts of toxin exposure can be easily understood using Drosophila melanogaster as a model given considering its short life span and genetic homology to humans. In this review, we have discussed the toxic effects of acrylamide and BPA on the developmental process of Drosophila melanogaster.

Role of cerium oxide nanoparticles in improving oxidative stress and developmental delays in Drosophila melanogaster as an in-vivo model for bisphenol a toxicity.

Bisphenol A (BPA) is an endocrine-disrupting chemical used commonly in the manufacture of plastic bottles, beverage cans, consumer products, and medical devices. It has a high risk of disrupting hormone-mediated processes which are critical for the growth and development of an infant. In the present study, the flies are exposed to different concentrations of BPA (0.05 and 0.5 mM), which represented the federally regulated LOAEL (50 mg/kg bw/day) and a higher dose of 1 mM, to study the change in cell death, nuclear instability oxidative stress, and behavioral anomalies leading to complex behavioral disorders like Autism. Effects of BPA doses (0.05, 0.5, 1 mM) were studied and the flies showed deficits in social interaction, locomotion, and enhanced oxidative stress that was found to be deteriorating among the flies. Automated tracking and robust MATLAB analysis of behavioral paradigms like position, movement, velocity, and courtship have given us an insight into a detrimental change in development and behavior when exposed to BPA. The flies were also co-treated with Cerium Oxide nanoparticles (CeO2 NP), well known for its antioxidant properties due to their antioxidant enzyme biomimetic nature, resulted in low oxidative stress, genotoxicity, and an improvement in behavior. In this work, we have tested our hypothesis of oxidative stress and nuclear instability as a potent cause for improper development in Drosophila when exposed to EDCs like BPA which is a potential hazard for both health and environment and might lead to various developmental disorders in children.

Investigation of therapeutic potential of cerium oxide nanoparticles in Alzheimer's disease using transgenic Drosophila.

In the current study, the therapeutic potential of cerium oxide nanoparticles (nCeO2) was investigated in a human tau (htau) model of Alzheimer's disease (AD), using Drosophila melanogaster as an in vivo model. nCeO2 synthesised via the hydroxide-mediated approach were characterised using Fourier transform infrared (FTIR), transmission electron microscopy (TEM), X-ray diffraction (XRD) analyses and Raman spectroscopy. Characterisation studies confirmed the formation of pure cubic-structured nCeO2 and showed that the particles were spherically shaped, with an average size between 20 and 25 nm. The synthesised nCeO2 were then administered as part of the diet to transgenic Drosophila for one month, at 0.1 and 1 mM concentrations, and its effect on the biochemical levels of superoxide dismutase (SOD), acetylcholinesterase (AChE), and the climbing activity of flies were studied in a pan-neuronal model (elav; htau) of AD. Using an eye-specific model of htau expression (GMR; htau), the effect of nCeO2 on htau and autophagy-related (ATG) gene expression was also studied. Dietary administration of nCeO2 at a concentration of 1 mM restored the activity of SOD similar to that of control, but both concentrations of nCeO2 failed to modulate the level of AChE, and did not elicit any significant improvements in the climbing activity of elav; htau flies. Moreover, nCeO2 at a concentration of 1 mM significantly affected the climbing activity of elav; htau flies. nCeO2 also elicited a significant decrease in htau gene expression at both concentrations and increased the mRNA expression of key autophagy genes ATG1 and ATG18. The results therefore indicate that nCeO2 aids in replenishing the levels of SOD and tau clearance via the activation of autophagy.

Investigation on photo-induced mechanistic activity of GO/TiO2 hybrid nanocomposite against wound pathogens.

Pathogenic microorganism delays wound-healing process by causing infection. In recent years, researchers have developed various kinds of photo-active nanomaterials with enhanced antibacterial properties. This work focus on the preparation of graphene oxide and TiO2 nanocomposites (GO/TiO2) as a visible light-induced high efficiency antibacterial material. The hydrothermal method was used for the synthesis of GO/TiO2 nanocomposites at 180 oC for 3 h with different loading percentages of GO (10, 20, 30, 40 and 50 wt. %). The systematic characterization tools including X-ray diffraction analysis, FT-IR, UV-vis, Raman and TEM which were used to understand the physicochemical properties of the prepared GO/TiO2 nanocomposites. Furthermore, GO/TiO2 nanocomposites were used as photocatalytic active materials against wound infection-causing bacteria in the presence of visible light irradiation. The possible antibacterial mechanism under presence and absence of light were depicted. The antibacterial mechanism of the GO/TiO2 nanocomposite was investigated on wound infection-causing bacteria such as Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis. The high hemocompatibility and the cellular biocompatibility of the nanocomposite aids in using it for wound-healing application. Overall, the results suggest that the GO/TiO2 nanocomposite could be developed as a photo-active nanomaterial against pathogenic microorganisms that are present in wound.

Developmental and behavioural toxicity induced by acrylamide exposure and amelioration using phytochemicals in Drosophila melanogaster.

Acrylamide, an environmental pollutant, is known to occur in food substances cooked at high temperatures. Studies on various models indicate acrylamide to cause several physiological conditions such as neuro- and reproductive toxicity, and carcinogenesis. In our study, exposure of Drosophila melanogaster (Oregon K strain) to acrylamide via their diet resulted in a concentration and time-dependent mortality, while the surviving flies exhibited significant locomotor deficits, most likely due to oxidative stress-induced neuronal damage. Also, Drosophila embryos exhibited signs of developmental toxicity as evidenced by the alteration in the migration of border cells and cluster cells during the developmental stages, concomitant to modulation in expression of gurken and oskar genes. Curcumin, a known antioxidant has been widely studied for its neuroprotective effects against acrylamide; however; very few studies focus on thymoquinone for its role against food toxicant. Our research focuses on the toxicity elicited by acrylamide and the ability of the antioxidants: thymoquinone, curcumin and combination of thereof, in reversing the same.

Poly herbal formulation with anti-elastase and anti-oxidant properties for skin anti-aging.

BACKGROUND: Skin forms an important part of human innate immune system. Wrinkles, thinning and roughening of skin are some of the symptoms that affect the skin as it ages. Reactive oxygen species induced oxidative stress plays a major role in skin aging by modulating the elastase enzyme level in the skin. Extrinsic factors that affect skin aging such as UV radiation can also cause malignant melanoma. Here we selected four medicinal plant materials, namely, leaves of Nyctanthes arbor-tristis, unripe and ripe Aegle marmelos fruit pulp and the terminal meristem of Musa paradisiaca flower and investigated their anti-aging properties and cytotoxicity in vitro individually as well as in a poly herbal formulation containing the four plant extracts in different ratios. METHODS: The phytochemical contents of the plant extracts were investigated for radical scavenging activity and total reducing power. Based upon its anti-oxidant properties, a poly herbal formulation containing leaves of Nyctanthes arbor-tristis, unripe and ripe fruit pulp of Aegle marmelos, and the terminal meristem of Musa paradisiaca flower in the ratio 6:2:1:1 (Poly Herbal Formulation 1) and 1:1:1:1 (Poly Herbal Formulation 2), respectively were formulated. RESULT: It has been observed that the Poly Herbal Formulation 1 was more potent than Poly Herbal Formulation 2 due to better anti-oxidant and anti-elastase activities in NIH3T3 fibroblast cells. In addition Poly Herbal formulation 1 also had better anti-cancer activity in human malignant melanoma cells. CONCLUSION: Based on these results these beneficial plant extracts were identified for its potential application as an anti-aging agent in skin creams as well as an anti-proliferation compound against cancer cells.

Nontoxic singlet oxygen generator as a therapeutic candidate for treating tauopathies.

Methylene blue (MB) inhibits the aggregation of tau, a main constituent of neurofibrillary tangles. However, MB's mode of action in vivo is not fully understood. MB treatment reduced the amount of sarkosyl-insoluble tau in Drosophila that express human wild-type tau. MB concurrently ameliorated the climbing deficits of transgenic tau flies to a limited extent and diminished the climbing activity of wild-type flies. MB also decreased the survival rate of wild-type flies. Based on its photosensitive efficacies, we surmised that singlet oxygen generated through MB under light might contribute to both the beneficial and toxic effects of MB in vivo. We identified rose bengal (RB) that suppressed tau accumulation and ameliorated the behavioral deficits to a lesser extent than MB. Unlike MB, RB did not reduce the survival rate of flies. Our findings indicate that singlet oxygen generators with little toxicity may be suitable drug candidates for treating tauopathies.

Rats with metabolic syndrome resist the protective effects of N-acetyl l-cystein against impaired spermatogenesis induced by high-phosphorus/zinc-free diet.

Consumption of relatively high amounts of processed food can result in abnormal nutritional status, such as zinc deficiency or phosphorus excess. Moreover, hyperphosphatemia and hypozincemia are found in some patients with diabetic nephropathy and metabolic syndrome. The present study investigated the effects of high-phosphorus/zinc-free diet on the reproductive function of spontaneously hypertensive rats/NDmcr-cp (SHR/cp), a model of the metabolic syndrome. We also investigated the effects of antioxidant, N-acetyl-l-cysteine (NAC), on testicular dysfunction under such conditions. Male SHR/cp and control rats (Wistar Kyoto rats, WKY) were divided into three groups; rats fed control diet (P 0.3%, w/w; Zn 0.2%, w/w), high-phosphorus and zinc-deficient diet (P 1.2%, w/w; Zn 0.0%, w/w) with vehicle, or high-phosphorus and zinc-deficient diet with NAC (1.5mg/g/day) for 12 weeks (n=6 or 8 rats/group). The weights of testis and epididymis were significantly reduced by high-phosphate/zinc-free diet in both SHR/cp and WKY. The same diet significantly reduced caudal epididymal sperm count and motility and induced histopathological changes in the testis in both strains. Treatment with NAC provided significant protection against the toxic effects of the diet on testicular function in WKY, but not in SHR/cp. The lack of the protective effects of NAC on impaired spermatogenesis in SHR/cp could be due to the more pronounced state of oxidative stress observed in these rats compared with WKY.

Increased susceptibility of Nrf2-null mice to 1-bromopropane-induced hepatotoxicity.

1-Bromopropane (1-BP) was introduced as an alternative to ozone-depleting solvents. However, it was found to exhibit neurotoxicity, reproductive toxicity, and hepatotoxicity in rodents and neurotoxicity in human. However, the mechanisms underlying the toxicities of 1-BP remain elusive. The present study investigated the role of oxidative stress in 1-BP-induced hepatotoxicity using nuclear factor erythroid 2-related factor 2 (Nrf2)-null mice. Groups of 24 male Nrf2-null mice and 24 male wild-type (WT) C57BL/6J mice were each divided into three groups of eight and exposed to 1-BP at 0, 100, or 300 ppm for 8 h/day for 28 days by inhalation. Liver histopathology showed significantly larger area of necrosis in Nrf2-null mice relative to WT mice at the same exposure level. Nrf2-null mice also had greater malondialdehyde (MDA) levels, higher ratio of oxidized glutathione/reduced form of glutathione, and lower total glutathione content. The constitutive level and the increase in ratio per exposure level of glutathione S-transferase (GST) activity were lower in the liver of Nrf2-null mice than WT mice. Exposure to 1-BP at 300 ppm increased the messenger RNA levels of heme oxygenase-1 (HO-1), glutamate-cysteine ligase modifier subunit (GcLm), glutamate-cysteine synthetase (GcLc), glutathione reductase, and NAD(P)H: quinone oxidoreductase 1 (NQO1) in WT mice but not in Nrf2-null mice except for GST Yc2. Nrf2-null mice were more susceptible to 1-BP-induced hepatotoxicity. That oxidative stress plays a role in 1-BP hepatotoxicity is deduced from the low expression levels and activities of antioxidant enzymes and high MDA levels in Nrf2-null mice.