A comparative evaluation of prasugrel and clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

OBJECTIVE: Primary objective of this study was to compare the efficacy of Prasugrel vs. Clopidogrel in the patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) by measuring inhibition of platelet aggregation after loading and maintenance dose of both the drugs. The patients were also assessed for safety of the drugs. METHODS: This was a randomised, double-blind, double-dummy, comparative, multicentric clinical trial in patients with acute coronary syndrome (unstable angina, non-ST elevation MI and ST elevation MI) undergoing PCI. The patients were randomly assigned to receive prasugrel (loading dose of 60 mg followed by maintenance dose of 10-mg once daily) or clopidogrel (loading dose of 300 mg followed by maintenance dose of 75 mg once daily) for a period of 12 weeks. All the patients were co-prescribed aspirin 325 mg with both the drugs. The primary efficacy end point in this study was percentage inhibition of ADP induced platelet aggregation (IPA) at 4 +/- 1 hours after the loading dose and at 30 +/- 3 days during maintenance treatment. The platelet aggregation of both the drugs was measured by whole blood aggregometer using 10 mmol of ADP as an aggregant. Though this study was not powered to see the difference in clinical efficacy parameters, the patients were observed for the incidence of nonfatal MI, nonfatal stroke, re-hospitalization, death, or need for urgent revascularization due to a cardiac ischemic event at days 30 and 90 during the study. The safety of study drugs were evaluated by incidence of major bleeding, reported adverse drug reaction and alterations of any laboratory parameters. RESULT: A total of 220 patients were enrolled at 11 centres across India. Ten patients were given the loading dose of prasugrel or clopidogrel but did not underwent PCI due to change in investigator's decision to go for PCI. Out of 210 eligible patients, 21 patients were discontinued during the study. 157 patients were evaluated for platelet inhibition after loading dose at 4 hours and 150 patients at day 30 during maintenance phase of antiplalelet therapy. The investigators could not perform this test in remaining patients due to urgency and criticality of the patients. 189 patients were observed for the incidence of nonfatal MI, nonfatal stroke, rehospitalisation, urgent revascularisation or death due to a cardiac ischemic event. All eligible patients who received at least a loading dose were evalauted for safety. In prasugrel group, 85 and 77 patients were evaluated for IPA at 4 hours and day 30 respectively whereas in clopdogrel group 72 and 73 patients were tested for IPA at 4 hours and at 30 days. Patients in prasugrel group have demonstrated significantly higher inhibition of platelets as compared to clopidogrel group (82.5% vs 71.1%) at 4 hours and at 30 days (84.1% vs 67.4%). The difference in inhibition of platelets between prasugrel and clopidogrel after loading dose and maintenenace dose was statistically significant (p < or = 0.01). The patients were also evaluated for drug hyporesponsiveness to antiplatelet therapy if IPA was < 20% at day 30 from the baseline. More patients on prasugrel have shown response to antiplatlet therapy than on clopidogrel (97.4% vs 87.6%). The difference between the two groups was statistically significant (p < 0.05). There was no difference observed during the study in the incidence of nonfatal MI, nonfatal stroke, death, rehospitalisation or need for urgent revascularisation due to a cardiac event between prasugrel and clopidogrel. Both the drugs were found to be to be well tolerated and have comparable safety profile. CONCLUSION: This study suggests that prasugrel is more effective than clopidogrel as an anti platelet drug as evident by inhibition of platelet aggregation. More patients on clopidogrel are likely to have poor response to therapy as compared to prasugrel. Both the drugs were well tolerated and have comparable safety profile.

Assessment of the effects of hydrogen water on human gingival fibroblast cell culture in patients with chronic periodontitis.

Background: Activated inflammatory cells produce reactive oxygen species (ROS) to eliminate pathogens. Under normal conditions, the pathogens are taken care of, and tissues are repaired. However, in periodontal disease, persistent inflammation causes increased ROS release and impaired healing. Therefore, removal of overproduced ROS using antioxidants is necessary. Hydrogen water has an antioxidative effect on cells and impedes oxidative stress-related disorders. Aim: To study the effect of hydrogen water on cell viability, migration, and its antioxidative potential in fibroblasts obtained from chronic periodontitis patients. Materials and Methods: The gingival tissue samples were obtained from 26 subjects (13 periodontally healthy individuals and 13 chronic periodontitis patients) and processed. The human gingival fibroblasts were cultured and the assays were commenced once adequate growth was detected. The effect of hydrogen water on cell viability was checked by neutral red assay, while the migration potential was assessed by transwell migration assay. The antioxidative potential of hydrogen water was evaluated by CUPRAC assay. Statistical Analysis: Intergroup comparison was done using Mann-Whitney U-test. Intragroup comparison was done using Wilcoxon signed-rank test. Results: Hydrogen water was nontoxic to the fibroblasts at 24 h and 48 h. The intergroup comparison of the cell viability between hydrogen water-treated periodontally healthy gingival fibroblasts (HF) and fibroblasts from patients with chronic periodontitis (CF) showed a statistically significant (P = 0.00) difference at 24 h and 48 h. Hydrogen water also positively influenced the migratory capacity. Hydrogen water-treated fibroblasts obtained from chronic periodontitis patients showed more migration in comparison to the healthy group (P = 0.00). Hydrogen water showed an antioxidative potential. The maximum potential was seen in relation to the fibroblasts obtained from chronic periodontitis patients at 48 h. Conclusion: Hydrogen water was nontoxic, increased the migratory capacity, and showed an antioxidative potential on human fibroblasts obtained from periodontally healthy individuals and patients with chronic periodontitis.

Assessment of antibacterial effect of hydrogen water on plaque from patients with chronic periodontitis.

BACKGROUND: Periodontitis is an inflammatory disease causing destruction of tissues surrounding the teeth. The primary etiological factor for periodontitis is plaque. An inference could be drawn that an overall reduction in microorganisms halts disease progression. It is desirable to have natural agents with minimal side effects to reduce the microbial load. AIM: The aim of the study is to assess the effect of hydrogen water on microbial count in plaque obtained from chronic periodontitis patients and to determine the antibacterial activity of hydrogen water at various time intervals. MATERIALS AND METHODS: A total of twenty chronic periodontitis patients were included after obtaining approval from the institutional ethical committee. Written informed consent was obtained from all the twenty participants. Plaque samples were collected and exposed to hydrogen water at baseline, 1 min, 2 min 30 s, and 5 min. Samples were then cultured on blood agar and incubated in aerobic and anaerobic conditions. The colony forming units and total bacterial count were recorded after 24-48 h. STATISTICAL ANALYSIS: Intragroup pair-wise comparison was done using Wilcoxon sign-ranked test. RESULTS: Hydrogen water showed antibacterial activity against aerobic and anaerobic organisms associated with chronic periodontitis. There was a statistically significant difference in the number of colony forming units from baseline to 1 and 2.5 min for the aerobic culture and also for baseline to 1, 2.5, and 5 min for the anaerobic culture. CONCLUSION: The data of the present study indicate that hydrogen water has an antibacterial effect on microorganisms associated with chronic periodontitis.

Idiopathic first bite syndrome - A rare case report with review of literature.

First bite syndrome (FBS) is a condition that classically presents as severe pain in the preauricular region, initiated on the first bite of a meal. In most of the cases reported, it is associated with a history of upper neck surgery or tumor of the parotid salivary gland or parapharyngeal space (PPS). Some propose that FBS arises due to damage to the cervical sympathetic trunk leading to the loss of sympathetic innervations to the parotid salivary gland. Literature also showed occurrence of this syndrome in individuals who had no history of parotid tumor, PPS tumor or surgery of the upper neck, and such cases are referred to as idiopathic FBS (IFBS). There are very few case reports reported on IFBS. We report the one such rare case of IFBS in a 35-year-old male, referred to the outpatient department, with a 5-month history of severe, sharp pain and bilateral swelling in the parotid region occurring only on the first bite of eating and would diminish over few minutes.

Comparison of Frontozygomatic versus Sigmoid Notch Approach for Extraoral Maxillary Nerve Block Anesthesia: A Prospective Clinical Trial.

BACKGROUND: With definitive indications, extraoral techniques of achieving regional nerve blocks are a boon to oral and maxillofacial surgical practice. Though less commonly practiced, since general anesthesia is more favored, certain medical conditions favor the use of regional nerve blocks over general anesthesia. To block the maxillary nerve extraorally, sigmoid notch approach and frontozygomatic approach have been previously described in the literature, but a clinical trial comparing these techniques is sparse. This study attempts to compare both the approaches for their efficacies while paying an equal attention to the associated complications. MATERIALS AND METHODS: Two hundred patients aged between 40-90 years of ASA 1 and 2 category were equally divided into two groups and underwent extraction of maxillary teeth under local anesthesia using 2% lignocaine with 1:80,000 adrenaline. Frontozygomatic approach to reach the foramen rotundum was employed in group A (n = 100) and sigmoid notch approach in group B (n = 100). Pain during injection, time required for onset of subjective and objective symptoms of anesthesia and duration of anesthesia were the study parameters. Associated complications were documented and discussed. Student's unpaired t test was used for statistical evaluation. RESULTS: Although both the techniques were found to be feasible, statistical evaluations favored the frontozygomatic approach with respect to faster onset and a longer duration of the anesthetic effect. The anatomical considerations in either techniques suggested that the incidence of potential complications of accidental entry of the needle into the orbit, skull and vessel injuries was higher when using sigmoid notch approach as against the frontozygomatic approach. CONCLUSION: Though sigmoid notch approach, described widely in the literature, can be employed successfully, certain anatomical considerations and technical modifications in the frontozygomatic approach have made the latter a more practical and feasible approach. When both the maxillary and the mandibular nerves need to be blocked simultaneously, sigmoid notch may be employed, but isolated maxillary nerve block is better achieved using frontozygomatic approach.

Analysis of Morphologic Attributes in Dental Esthetics: A New Concept.

An interdisciplinary approach to esthetics requires a comprehensive treatment plan formulated through evaluation of several restorative and periodontal parameters that influence the esthetic zone. A total of 25 subjects (13 women and 12 men, with an age range of 18 to 23 years) participated in the study. Parameters such as gingival biotype on the labial aspect, crown width to crown length ratio, and interdental papilla proportion, with respect to the maxillary anterior teeth, were determined. An attempt was made to establish a correlation between these components, and a positive correlation was found. A careful preoperative diagnosis of these parameters is thus essential, especially in the esthetic zone.

Evaluation of variation in the palatal gingival biotypes using an ultrasound device.

BACKGROUND: The dimensions of gingiva and different parts of the masticatory mucosa have become a subject of considerable interest in Periodontics. Studies assessing the thickness of the facial gingiva are often seen in the literature. The thickness of the palatal gingiva is a subject still less researched in periodontal therapy and implantology. OBJECTIVES: To measure the thickness of the palatal gingiva using an ultrasound device 'Biometric A- Scan' and to evaluate the variation in the thickness of the palatal gingiva at the sites examined. MATERIALS AND METHODS: In the 50 subjects examined, the thickness of the palatal gingiva was assessed at the maxillary anteriors, premolars and molars by an ultrasound device 'Biometric A-Scan'. The results were subjected to statistical analysis using one-way ANOVA test and Newman-Keuls multiple post hoc procedure. RESULTS: Statistically significant variations existed in the palatal gingival thickness. The thickness was highest at the lateral incisor region, followed by canine, premolars, molars and central incisor. INTERPRETATION AND CONCLUSION: In the subjects assessed, the thickness of the palatal gingiva at the lateral-canine area was the highest followed by the premolar area. In periodontal root coverage procedures and during implant therapy, we suggest the inclusion of the lateral incisor area, apart from the canine and premolar area, as a potential donor site for harvesting soft tissue grafts from the palatal area. However, the effect of several factors like age and sex of the patient, the anatomy of the palatal area, the influence of rugae patterns and racial and geographical differences should be taken into consideration prior to harvesting a graft from these sites. Apart from this, the study suggests that, the ultrasonographic measurements provide an elegant means of obtaining the measurements of gingival and mucosal tissues rapidly, accurately and non-invasively. Our endeavour in this research project attempts to open more avenues for studies in the field of advanced periodontal diagnosis, with the use of ultrasound, and expand the horizons of periodontal plastic surgery and implant therapy as well.

Evaluation of anti-microbial activity of spore powder of Ganoderma lucidum on clinical isolates of Prevotella intermedia: A pilot study.

AIM: This study aimed at evaluating the anti-microbial activity of spore powder of Ganoderma lucidum on Prevotella intermedia isolated from subgingival plaque from chronic periodontitis patients. SETTINGS AND DESIGN: Written informed consent was obtained from each subject enrolled in the study. The Institutional Ethics Committee granted the ethical clearance for the study. MATERIALS AND METHODS: This study included 20 patients diagnosed with chronic periodontitis. Pooled subgingival plaque samples were collected using sterile curettes from the deepest sites of periodontal pockets. The collected samples were then transported in 1 mL of reduced transport fluid. The organisms were cultured and confirmed. These organisms were then used for minimum inhibitory concentration (MIC) procedure. STATISTICAL ANALYSIS: Mean of the MIC value obtained was calculated. RESULTS: Thirteen out of the 20 clinical samples were tested that showed sensitivity at various concentrations. Five samples showed sensitivity at all concentrations. Twelve samples showed sensitivity at 8 mcg/ml. Eleven samples showed sensitivity at 4 mcg/ml, 8 samples showed sensitivity at 2 mcg/ml, and 5 samples showed sensitivity even at 1 mcg/ml. Mean MIC value of G. lucidum spore powder for P. intermedia obtained was 3.62 mcg/ml. CONCLUSION: G. lucidum with its multipotential bioactivity could be used as an anti-microbial, in conjunction with conventional therapy in periodontal disease.

Effect of Azadirachta indica (Neem) and Aloe vera as compared to subantimicrobial dose doxycycline on matrix metalloproteinases (MMP)-2 and MMP-9: An in-vitro study.

BACKGROUND: A critical outcome of periodontal diseases is degradation of collagen in the periodontal tissues, by enzymes such as Matrix Metallo-Proteinases (MMPs). Doxycycline is known to down-regulate the activity of MMPs. Azadirachta indica (Neem) and Aloe vera are herbs known to have an anti-inflammatory effect. The present study was designed to evaluate the anti-inflammatory effect of Neem and Aloe vera by way of its inhibitory effect on MMP-2 and MMP-9 activity in cases of chronic periodontitis and compare it with doxcycline. MATERIALS AND METHODS: A total of 30 subjects were enrolled in this study. Gingival tissue samples were obtained from patients diagnosed with the chronic periodontitis. The tissue extracts were treated with the said drug solutions and inhibition of MMP-2 and MMP-9 was analyzed. Enzymatic activity was detected by electrophoresis. The data was subjected to Student's paired t-test. RESULTS: The results showed that the activity of MMP-2 and MMP-9 was significantly decreased by the use of doxycycline, Neem and Aloe vera. A 53.5% reduction in the MMP-2 and 52.5% reduction in the MMP-9 activity was seen when samples were subjected to Neem treatment at the concentration of 1500 µg/ml. Tissues treated with Aloe vera in the concentration of 2000 µg/ml showed a 20.09% reduction in the MMP-2 and 20.4% reduction in the MMP-9 activity. Doxycycline in the concentration of 300 µg/ml, showed an 82.1% reduction in the MMP-2 and 82.6% reduction in the MMP-9 activity. CONCLUSION: The present study demonstrated an inhibitory effect of Neem and Aloe vera on MMP-2 and MMP-9, which are involved in the extracellular matrix degradation during periodontitis.

Dysesthesia with pain due to a broken endodontic instrument lodged in the mandibular canal--a simple deroofing technique for its retrieval: case report.

This article presents a simple deroofing technique to retrieve a broken endodontic file lodged in the mandibular canal and causing dysesthesia with pain. Many unsuccessful attempts were made to retrieve the broken instrument. The deroofing technique described is simple, requiring local anesthesia and done on an outpatient basis with minimum morbidity. A brief review of the literature on dysesthesia of the inferior alveolar nerve caused by endodontic materials is also presented.

A comparison of the efficacy of topical application of Lignocaine Hydrochloride 5% gel and Bupivacaine Hydrochloride 5% gel for extraction of teeth.

BACKGROUND: With the advancements in dentistry the treatments are done with high perfections and patient comfort. Noninvasive, methods reduce fear and anxiety of the patient on phobia of syringes and injections. Topical anesthesia satisfies all the above criteria. AIM AND OBJECTIVE: Comparison of the efficacy of topical application of lignocaine hydrochloride 5% gel and bupivacaine hydrochloride 5% gel for extraction of teeth. MATERIALS AND METHODS: Lignocaine hydrochloride 5% gel and bupivacaine hydrochloride 5% gel are prepared with carbopol (thickening agent). 510 extractions with lignocaine hydrochloride gel 5% and bupivacaine hydrochloride gel 5% in equal numbers was undertaken. Parameters of onset of anesthesia, peak effects, pain, and disappearance of numbness, local irritation, bleeding and periodontal status of teeth to be extracted were taken into consideration. RESULTS: Onset and peak effect were faster with 5% lignocaine hydrochloride gel. 5% bupivacaine hydrochloride gel had longer duration of analgesia. Patients experienced more pain with bupivacaine. Grade 1 mobile posterior teeth were painful during extraction. CONCLUSION: 5% lignocaine hydrochloride gel is better than 5% bupivacaine hydrochloride gel as a topical anesthetic for extraction of grade II and grade III mobile teeth.