Gelatin-PVP dissolving microneedle-mediated therapy for controlled delivery of nifedipine for rapid antihypertension treatment.

Nifedipine has exhibited to be the oldest primary drug having promising therapeutic potential for hypertension, angina pectoris, and pre-eclampsia treatment which are the most emergency serious complications worldwide. Moreover, for long-term treatment transdermal route of delivery using polymeric dissolving microneedles (DMNs) patches has shown greater advantages, thus enhancing treatment compliance, painless, reducing the daily number of doses, prolonged release in a controlled manner, and variable bioavailability making this an ideal candidate for the transdermal therapeutic system. Here, we fabricated DMN patches made of gelatin and PVP using PDMS molds loaded with nifedipine drugs for a controlled painless delivery for a longer stable duration. The prepared gelatin-PVP (gel-PVP) DMN patches loaded with nifedipine were fabricated by centrifugation casting method. The characterization results displayed excellent mechanical strength of the needles to penetrate the skin. SEM and confocal microscopy showed penetration of the needles up to 567-600 µm using rhodamine B applied to the hairless punctured skin site. FTIR study exhibited no degradation of the drug was observed while fabricating the DMNs patch at different pH 7.4 and 4. Skin resealing test proved that there was immediate resealing of the skin observed within 10-15 min. Further in-vitro drug release profile study was carried out by dissolution method at different pH 7.4 and 4 showed sustained release of the drug up to 96 ± 2% till 48-72 h avoiding polymer or drug loss which was quantified by UV vis spectrophotometer at 235 nm absorbance showed stable release of the drug upto 48-72 h. A stability study carried out by the HPLC method showed the DMN patches loaded with the drug were found to be stable for up to 30 days at 25 °C. This novel preliminary data are the first study to our knowledge introducing these fabricated nifedipine gel-PVP DMN patches were found to be very efficient and showed prolonged controlled release up to 48-72 h thereby treating hypertension in a convenient, painless manner. This DMN patch-formulated design might act as a potential approach leading to a controllable, self-administrative, and rapid transdermal delivery system.

ICA Bifurcation Aneurysms: Clinical Features and Surgical Outcome in a Tertiary Referral Center in South India.

AIM: To study the clinical profile, imaging features, intra-operative findings, post-operative outcome at discharge and at 6 months in patients with internal carotid artery (ICA) bifurcation aneurysm. MATERIAL AND METHODS: Present study is a retrospective analysis of data of patients who underwent surgery for ICA bifurcation aneurysm between the period of 1st January 2011 to 31st December 2015 at our institute. Demographic variable, clinical grade, radiological finding was assessed. Outcome was measured using modified Rankin score (mRs) at discharge and at 6 months follow up. All ICA bifurcation aneurysms were clipped using a standard pterional craniotomy. RESULTS: A total of 28 patients were included in the study out of which 4 had bilateral ICA bifurcation aneurysms. Mean age was 44.15 (age range 14-65) years, with 43.75% of patient were < 40yrs. Multiple aneurysms were seen in 11 (39.28%) patients, with superior projection being the most common in 53.12%. Vasospasm was seen in 12 (42.85%) with 4 patients undergoing chemical angioplasty. At discharge good outcome (mRs < 3) was seen in 4/5 (80%) patients in the un-bled category, whereas 18/23 (78.2%) in bled category. At 6 months follow up, mRs < 3 was seen 4 (100%) patients in unbled category, and 84.21% (16 of 19) patients in bled group. CONCLUSION: The findings of the present study have shown an increased incidence of bilaterality and multiplicity for ICA bifurcation aneurysms. The direction of the dome of aneurysm and temporary clipping do not affect the treatment outcomes. These aneurysms have excellent outcomes following surgery.

Lateral Mass Screw Fixation in the Cervical Spine: Introducing a New Technique.

STUDY DESIGN: This was designed as a randomized double blind study to compare the classical Magerl technique of insertion of lateral mass screws with the authors' technique. The observations regarding length, outcome, and radiology was done by a group blinded to the technique used. PURPOSE: The present study was designed with the objective of identifying the optimal technique for introducing the lateral mass screws that uses the maximum possible dimension of the lateral mass. OVERVIEW OF LITERATURE: Lateral mass screw fixation is a common surgery that is performed in the cervical spine. Various modifications for the procedure have been described, such as changes in the entry point, angulation of the screws, and modifications in the exit point. These do not allow the insertion of longer screws that can give more purchase on the bone. METHODS: From January 1, 2009 to December 31, 2018, 176 patients who were scheduled to undergo lateral mass screw fixation were enrolled. They were randomized into two groups; we inserted lateral mass screws using our new technique for one group and by using the classical Magerl technique for the other group. Intraoperative measurements were used to assess the bone-screw interface length. Postoperative radiography and postoperative computed tomography were performed to assess the trajectory of the screws. RESULTS: Total 88 patients were included in the study group, including 68 men. The control group included 65 men. The most common indication for surgery was cervical spondylotic myelopathy. The average bi-cortical length that was measured intraoperatively was 19.9 mm in the study group and 16.3 mm in the control group. This was significantly different from the average lengths of screws in the control group. CONCLUSIONS: The trajectory that involves an entry point as close as possible to the posterior inferior medial angle of the lateral mass cuboid and traverses a distance of about 20 mm to obtain a bi-cortical purchase in the diagonally opposite angle may provide a much better and firmer bony purchase in the lateral mass than conventional points of entry and trajectories.

A Study of the Developing Paediatric Skullbase Anatomy and its Application to Endoscopic Endonasal Approaches in Children.

OBJECTIVE: The sinonasal anatomy in growing children undergoes change in size along with progressive pneumatization, this is of particular significance in endoscopic endonasal surgery. We aim to measure and quantify the sinonasal dimensions in the Indian paediatric population, which are relevant to skull base surgeons. MATERIAL AND METHODS: This is a retrospective radio anatomical study of sinonasal measurements and volumetric analysis of the sphenoid sinus performed on archived CT images of children less than 18 years of age. RESULTS: CT scan images of 110 patients (male, 68; female, 42) were included for the study. The number of patients in each age groups was as follows [0-6 years, 17; 7-9 years, 20; 10-12 years, 27; 13-15 years, 29; 16-18 years, 17]. The distance from the nares to the sphenoid and from the sphenoid to the sella was significantly greater in children of 13-15 years (69.4 ± 5.2 mm) as compared to children less than six years (62.6 ± 6.7 mm) (P < 0.003). The volume of the sphenoid in children between 0 and 6 years was 4641.4 ± 1924.7 mm3. The pneumatized sphenoid volume in the same age group was 1655 ± 1631.1 mm3. In older children between 13 and 15 years, the total volume of sphenoid sinus was 11732.8 ± 2614.4 mm3. The volume of pneumatization in the sphenoid sinus in this group was 6287.5 ± 2157.9 mm3. The total volume of the sphenoid sinus (Pearson coefficient (r) = 0.704, P < 0.001) and the volume of pneumatization of the sphenoid sinus was also seen to have a positive correlation to the age of the child (r = 0.62, P < 0.0001). The narrowest distance between both the internal carotid arteries was seen at the level of the proximal dural ring. In children less than six years of age it was 13.4 ± 2.0 mm, a significant change was seen by the age of 10-12 years where this distance was 15.6 ± 2.2 mm (P = 0.036). CONCLUSION: The sinonasal anatomy shows progressive development between the age of 6 to 15 years after which it plateaus. The pneumatization in young children may be incomplete, which necessitates drilling in the sphenoid sinus. The intercarotid distance was not seen to be a hindrance for endoscopic endonasal surgery. None of the measurements of the skull-base, made in this study appear to restrict endoscopic endonasal surgery in children. However, a meticulous preoperative assessment of the CT scan may be needed for optimal surgical outcome.

Chiari malformation and atlantoaxial instability: problems of co-existence.

BACKGROUND: Association of Chiari malformation and atlantoaxial subluxation varies. There is a complex relationship between the two, bony and soft tissue pathologies. METHODS: This is a review of various articles available from the literature on the management of Chiari and its association with atlantoaxial instability. RESULTS: We have an experience of operating on 86 cases of paediatric atlantoaxial subluxation, of which 12 had Chiari malformation diagnosed preoperatively (13.95%). Of the 76 children with Chiari malformations operated on by us, 11 had associated atlantoaxial subluxation diagnosed on imaging (14.47%). CONCLUSIONS: Re-alignment and reduction with fixation may be effective in achieving decompression in cases where reduction is possible from posterior approach. In these cases, posterior fixation is all that is required. If reduction is not possible from posterior and there is "fixed" ventral compression, anterior decompression needs to be combined with posterior fixation. In most cases, direct posterior decompression is warranted.

A Rare Case of an Extensive Multi-compartment Epidermoid Presenting with Pure Motor Trigeminal Neuropathy, Case Report and Review of Literature.

Epidermoid cysts are benign slow-growing tumors, clinical signs and symptoms at the time of presentation are related to the location and extent of the lesion. The motor fibers of the trigeminal nerve are fairly resistant to extraneous compression. Intracranial lesions in the vicinity of the trigeminal nerve usually present with sensory symptoms without affecting the motor component. We report a rare case of a middle cranial fossa epidermoid presenting with pure motor trigeminal neuropathy.

A Case of Evolving Bilateral Sphenoidal Meningoencephaloceles: Case Report and Review of the Literature.

BACKGROUND: The evolution of sphenoid sinus meningoencephaloceles and cerebrospinal fluid (CSF) rhinorrhea is poorly understood. CASE DESCRIPTION: We present a case demonstrating the gradual evolution of encephaloceles from both the lateral walls of a previously normal sphenoid sinus in a patient with dural arteriovenous fistula; the CSF leak that developed after staged embolization of the dural arteriovenous fistula was managed by an endoscopic endonasal transpterygoid approach. CONCLUSIONS: We suggest that over a period of time, chronic elevation of intracranial pressure can result in gradual erosion of the lateral wall of the sphenoid with development of meningoencephaloceles and CSF leaks.

Clavicular osteomyelitis: a rare presentation of extra pulmonary tuberculosis.

Clavicular tuberculosis is a rare entity, an unusual case of skeletal tuberculosis. We report a case of rare presentation of clavicular tuberculosis as a non-healing ulcer in the medial two-third and lateral one-third of the clavicle. The clinical picture was confusing because of the development of foul-smelling discharge due to secondary infection. The diagnosis is rarely suspected before biopsies because tumours are much more frequent than infections in this bone. With worldwide resurgence of tuberculosis, clinicians should maintain a high index of suspicion as more infection at unusual sites is being reported.