Platelet Rich Plasma: Efficacy in Treating Trophic Ulcers in Leprosy.

INTRODUCTION: Trophic ulcers secondary to leprosy pose a great stigma to the patients and remain a challenge to the treating dermatologists. The discovery of Platelet Rich Plasma (PRP) with its favourable role in wound healing is a boon for the patients. PRP introduces the growth factors directly into the wound and aids in rapid healing. AIM: To study the efficacy and safety of PRP in the healing of trophic ulcers secondary to Hansen's disease in a tertiary care centre in Southern India. MATERIALS AND METHODS: Based on inclusion and exclusion criteria, 50 patients were enrolled in the study. PRP was prepared by manual double spin method. After wound bed preparation, activated PRP was sprayed over the ulcer and occlusive dressings were applied. Same procedure was repeated every week until complete re-epithelisation or up to six sittings whichever occurred earlier. RESULTS: In our study, 46 patients (92%) showed complete healing. In 4 patients (8%), there was marked reduction in wound size with partial re-epithelization. In 88%, complete healing was seen after the fourth sitting. Mean time for ulcer healing was around 4.38 weeks. CONCLUSION: PRP therapy leads to faster rate of induction of granulation tissue with rapid healing. Healing had no direct statistical correlation with the size, site and duration of ulcer, the leprosy spectrum and associated motor deformities. It is a simple, safe and cost effective in-office procedure, albeit requiring an optimal set-up and expertise.

Periodontitis and bone mineral density among pre and post menopausal women: A comparative study.

AIM: The aim of the study was to assess the relationship between bone mineral density and periodontitis in premenopausal and postmenopausal women. MATERIALS AND METHODS: Twenty women between the age group of 45-55 years were selected for this study. Ten premenopausal women with healthy periodontium constituted the control group and 10 postmenopausal women with ≥2mm of clinical attachment loss in >30% of sites constituted the study group. All patients were assessed for plaque index, probing depth and clinical attachment loss. Radiographs (six IOPA and two posterior bitewing) were taken and assessed for interproximal alveolar bone loss. The patients were scanned to assess the bone mineral density of lumbar spine (L2) and femur using dual energy X-ray absorptiometry (DEXA). RESULTS: The bone mineral densities of lumbar spine (L2) and femur were significantly lower in the study group than the control group. Osteopenia of the lumbar spine and femur was observed in 60% whereas osteoporosis of lumbar spine was observed in 30% of cases in study group. CONCLUSION: Increased proportion of osteopenia and osteoporosis cases of lumbar spine and femur in postmenopausal women with periodontitis suggests that there is association between bone mineral density and periodontitis.

High radioactive concentration of 99mTc from a zirconium [99Mo]molybdate gel generator using an acidic alumina column for purification and concentration.

BACKGROUND: Newer applications of radiopharmaceuticals in nuclear medicine require pertechnetate of moderate to high radioactive concentration. Hence there is a need to develop simple procedures for the concentration of pertechnetate, and such a procedure is given in this paper. METHODS: Ten to 20 ml of sodium [Tc]pertechnetate eluted in de-ionized water from a zirconium [Mo]molybdate (ZrMo) gel column generator was passed through 2 g of an acidic alumina bed (35 x 8 mm) in order to remove the co-eluted traces of Mo and to retain the pertechnetate. The retained pertechnetate was then re-eluted, quantitatively, in 3 ml of normal saline, from the alumina column. RESULTS: About a 4-fold increase in radioactive concentration of Tc was obtained (cf. approximately 10-12 ml normal saline is required for the elution of Tc from the gel column). Generators containing up to 22.2 GBq (600 mCi) Mo in 6-7 g ZrMo gel column (35 x 13 mm) were prepared and a radioactive concentration of Tc up to 4 GBq x ml (110 mCi x ml) was obtained on the first day of use. The overall recovery of Tc was >90%, Mo breakthrough was 10 to 10% and the duration of concentration was 3-5 min. The chemical impurity in terms of Al, Mo and Zr was <10 ppm each. The same procedure for the concentration of pertechnetate was applied to generators with 12-15 g ZrMo gel beds to obtain a higher capacity Tc gel generator, with similar findings.

A novel 99mTc delivery system using (n,gamma)99Mo adsorbed on a large alumina column in tandem with Dowex-1 and AgCl columns.

99Mo of specific activity 7.4-14.8GBq (200-400mCi)/g was adsorbed on a 'jumbo' alumina column (40g, 90mm(H) x 20mm (dia.); 50g, 65mm(H) x 35mm(dia.). [99mTc]TcO4-, eluted with 50-70ml normal saline and applied to a tiny column of a strong anion exchanger, Dowex-1 x 8, 10-15 mg, 8-12 mm(H) x 1 mm(dia.). Pertechnetate was eluted from the Dowex-1 column with 5-6 ml of 0.2M Nal followed by washing with 1.5-1.8 ml water. Iodide was removed from this eluate by passage through a 1 g AgCl column (12 mm (H) x 8 mm (dia.)). The final product, pertechnetate, was recovered in 6.5-7.8 ml, while the NaCl content was close to that of normal saline. Each elution operation was complete in approximately 45 min. The mean practical yield was approximately 86% (n = 5). Closed cycle operation with sterile connecting tubes and multi-way stop-cocks was practised. The quality of the [99mTc]NaTcO4 thus obtained complies with the specifications applicable for radiopharmaceutical use. The major merit over other post-elution concentration methods is that the new procedure can function nearly independently of the volume of the primary eluate (in normal saline) from the alumina column generator (ACG). 99mTc generators containing as much as 80-100 g alumina for holding 14.8-18.5GBq (400-500 mCi) 99Mo (at the reference time) are feasible using approximately 15 mg Dowex-1 bed mass. A relatively user-friendly--cum--producer-friendly 99mTc generator system has been demonstrated making use of the inexpensive and easy to prepare (n,gamma)99Mo. The method is also applicable for the more costly 188W-188Re generator.

Production logistics and radionuclidic purity aspects of 153Sm for radionuclide therapy.

153Sm, an attractive therapeutic radionuclide, was produced by neutron activation of both natural Sm2O3 and 98% enriched 152Sm2O3 targets. The production logistics and radionuclidic purity aspects of 153Sm obtained using both these targets are discussed with respect to the intended end use for metastatic bone pain palliation (MBPP) in terminal cancer patients and radiation synovectomy (RS) of medium size joints. The specific activity of 153Sm obtained was around 11 GBq x mg(-1) (approximately 300 mCi x mg(-1)) and 44 GBq x mg(-1) (approx. 1200 mCi x mg(-1)) from natural and enriched targets, respectively. The level of the long-lived radionuclidic impurity burden in 153Sm obtained from the natural Sm2O3 targets, namely, due to 154Eu (5 Bq x MBq(-1) 153Sm (5 nCi x mCi(-1) 153Sm)) and 155Eu (75 Bq x MBq(-1) 153Sm (75 nCi x mCi(-1) 153Sm)), appears low enough not to pose a problem, both in the palliative treatment of terminal cancer patients (at 1.85-2.22 GBq (50-60 mCi) dose) as well as in RS (at 74 MBq (2 mCi) dose). The 154Eu content in 153Sm from the enriched target was comparable, while, as expected, the level of 155Eu was nearly two orders of magnitude lower. There is a notable overall advantage of 153Sm over the use of 186Re, the other radionuclide of interest for the same purposes.

Post-elution concentration of 99mTcO4- by a single anion exchanger column. I: Feasibility of extending the useful life of column chromatographic 99mTc generator.

99mTc eluate in 0.7/0.35 M acetic acid and in 1:1 v/v 0.7 M acetic acid: 0.025 M ammonium acetate (30-40 ml) was conveniently concentrated by passing through a small column of a readily available weak anion exchanger, DEAE cellulose, (200 mg, 6 x 8 mm) and subsequent elution with 3 ml normal saline, with greater than 90% recovery. The quality of pertechnetate thus obtained and its compatibility for preparing 99mTc compounds were satisfactory. This method was successfully applied to the alumina column chromatographic generator produced in-house and to a commercial 99Mo-99mTc generator after extensive clinical use. Potential for much higher concentration factors with compacted anion exchanger cartridges as well as applicability for 188W-188Re generator are discussed.

Post-elution concentration of 99TcmO4- by a single anion exchanger column: II. Preparation and evaluation of jumbo alumina column chromatographic generator for 99Tcm.

We report on the preparation and evaluation of a large size (jumbo) alumina column (approximately 40 g, 90 x 20 mm) chromatographic generator and post-elution concentration of 99Tcm using a single column of a weak anion exchanger. The generator was eluted with approximately 40 ml of a modified single salt buffer solution of 1:1 v/v 0.025 M or 0.05 M NH4OAc:0.7 M AcOH. This eluate was then passed through a small column of DEAE cellulose, a common weak anion exchanger, to trap 99TcmO4-, which was recovered by elution in 6 ml of normal saline. This amounts to a 5- to 7-fold increase in radioactive concentration (RAC) of 99Tcm, when compared to the RAC on direct elution with normal saline from the same jumbo alumina column generator. The overall yield of 99Tcm was in the range of 70-90%. 99Mo breakthrough was 10(-3)-10(-4)%, radiochemical purity was > 98%, and chemical purity, in terms of Al and Mo content, < 10 ppm each. The compatibility of pertechnetate obtained by this method for preparing 99Tcm labelled formulations such as Tc-MDP and 99Tcm-ethyl cysteinate dimer was found to be satisfactory. These promising results open up the feasibility of using (n, gamma) 99Mo adsorbed on a large (40-60 g) alumina column as a relatively more user-friendly source of 99Tcm in comparison to methyl ethyl ketone extraction, and as a producer-friendly process in comparison to the zirconium molybdate gel method.