Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study.

In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques has been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients. The 100mm 10 point Visual Analog Scale/Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to, or during, extraction, and one hour postoperatively. Although the buccal injection alone resulted in lower pain while injecting the anaesthetic, it did not result in the absence of pain before tooth extraction as has been suggested by various studies. A total of 74% patients required a palatal injection on the study side. We conclude that in most cases, when using a buccal injection alone, one cannot rely on the diffusion of articaine for effective palatal anaesthesia. Despite this, we suggest that as an initial option in young patients, the operator can consider avoiding the painful palatal injection by the use of articaine to prevent aversion to dental treatment. Postoperatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites.

Efficacy and safety of sorafenib in advanced renal cell cancer and validation of Heng criteria.

INTRODUCTION: Sorafenib is an established upfront treatment option for metastatic RCC (mRCC). There is no published literature regarding its performance in Indian Patients. We present an analysis of Sorafenib use in our institute and attempt to validate the Heng criteria as a prognostic score in these patients. MATERIALS AND METHODS: Patients who received Sorafenib as first line treatment for advanced RCC from June 2012 to December 2015 were prognosticated by Heng criteria and retrospectively analysed for baseline demographics, toxicity, response and outcomes. RESULTS: 82 patients (65 males, 17 females) with a median age of 57 years were included for final analysis. Median ECOG PS was 1, 95.2 % of the patients had Stage IV disease and clear cell was the predominant histology (79.4%). 23.2%, 42.7% and 34.1% of patients were classified as low, intermediate and high risk by Heng's criteria, respectively. Dose reduction was required in 24.4% of patients, while 14.6% required permanent cessation of Sorafenib due to intolerable or recurrent side effects. Common adverse events included HFS (68.2%), mucositis (35.3%), fatigue (35.3%), rash (32.9%) and hypertension (25.6%). Response rate observed was 18.2%, while clinical benefit rate was 57.2% in the 57 patients where response was evaluable. Median progression free survival was 7.75 months (5.45-10.05) and median overall survival (OS) was 12.18 months (9.61 - 14.76). Median OS was 19.6, 16.1 and 10.3 months respectively for low, intermediate and high risk patients by Heng criteria and the criteria was statistically discriminatory for the 3 groups for OS (p=0.045, chi-square test). CONCLUSION: Sorafenib is a viable upfront treatment option for metastatic RCC in Indian patients with acceptable PFS, although a high incidence of HFS, mucositis and rash is observed. The Heng score has discriminatory value in mRCC with Sorafenib and can be considered for routine use in the clinic.

Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma.

OBJECTIVE: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients. MATERIALS AND METHODS: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1) surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion) or (2) organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes). RESULTS: The mean age of this population was 55 years. Most (83%) of the patients had pyriform sinus (PFS) involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33) and organ preservation protocol was planned after NACT in 73% (19/26) patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%), mucositis 5%, diarrhea 5%. The median progression free survival was 20 months. CONCLUSIONS: NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.

Intravenous lipid emulsion - rescued at LAST.

The accidental overdose of local anaesthetics may prove fatal. The commonly used amide local anaesthetics have varying adverse effects on the myocardium and beyond a certain dose all are capable of causing death. Local anaesthetics are the most frequently used drugs in dentistry and although uncommon, local anaesthetic systemic toxicity (LAST) accounts for a high proportion of mortalities in the dental office, with local anaesthetic-induced cardiac arrest particularly resistant to standard resuscitation methods. Over the last decade there has been convincing evidence of using intravenous lipid emulsions as a rescue in local anaesthetic - cardiotoxicity and anaesthetic organisations over the globe have developed guidelines on the use of this drug. Despite this, however, awareness among practitioners appears to be lacking. All who use local anaesthetics in their practice should have an appreciation of patients at high risk of toxicity, early symptoms and signs of toxicity, preventative measures when using these drugs and the initial management of systemic toxicity with intravenous lipid emulsion. In this review we intend to discuss the pharmacology and pathophysiology of local anaesthetic toxicity, and the rationale for intravenous lipid emulsion therapy.

Inhibition of Propionibacterium acnes lipase by extracts of Indian medicinal plants.

Lipases play an important role in pathogenesis of acne by hydrolysing sebum triglycerides and releasing irritating free fatty acids in the pilosebaceous follicles. Lipase is a strong chemotactic and proinflammatory antigen. Therefore, lipase has generated a high interest as a pharmacological target for antiacne drugs. The aim of this study was to identify inhibitory effects of plant extracts on the lipase activity of Propionibacterium acnes. Colorimetric microassay was used to determine lipase activity. Extracts from Terminalia chebula and Embelia ribes showed lower IC(50) value (1 µg mL(-1) ) for lipase inhibition as compared to Vitex negundo and Picrorhiza kurroa (19 and 47 µg mL(-1) , respectively). The active component responsible for lipase inhibition was isolated. This study reports for the first time the novel antilipase activity of chebulagic acid (IC(50) : 60 µmol L(-1) ) with minimum inhibitory concentration value of 12.5 µg mL(-1) against P. acnes. The inhibitory potential of plant extracts was further confirmed by plate assay. The organism was grown in the presence of subinhibitory concentrations of extracts from P. kurroa, V. negundo, T. chebula, E. ribes and antibiotics such as clindamycin and tetracycline. Extract from T. chebula showed significant inhibition of lipase activity and number of P. acnes.

Pharmacognostic study of Chlorophytum tuberosum Baker.

Chlorophytum tuberosum Baker belongs to family Liliaceae and is being used in the indigenous systems of medicine as a galactogogue and aphrodisiac. It is being sold in the market under the common name safed musali. The white tuberous roots of this plant are the medicinally useful parts. The tuberous roots of other species of Chlorophytum, Asparagus, Bombax and Orchids are also sometimes called safed musali leading to confusion. In order to ensure correct botanical standardization to remove the controversy, a detailed pharmacognostic study on tuberous roots of Chlorophytum has been carried out in this study .

First Report of Aspergillus niger as a Plant Pathogen on Zingiber officinale from India.

Zingiber officinale Rosc., belonging to the Zingiberaceae family, is medicinally important. It is commonly known as ginger and has been extensively cultivated for many centuries for use as a spice and traditional medicine in India. During a survey in September of 2007, leaves of Z. officinale showed a necrotic leaf spot disease on a plant growing in Kolhapur, India. Symptoms of the disease appeared as small (10 to 15 mm), rectangular to irregular, yellow spots on the leaves that covered a major area of the leaf when severe. The infection caused defoliation. Symptomatic leaves were collected and isolations from infected leaves were made on Czapek's Dox agar supplemented with streptomycin sulfate (30 mg/l). Plates were incubated at 28 to 30°C for 6 to 7 days. The fungal colonies were colorless to pale on the reverse side and covered with a dense layer of dark brown-to-black conidial heads. Conidia were globose to subglobose (3.5 to 5.0 µm in diameter), dark brown to black, and rough walled. 16S rRNA of isolates was amplified and sequenced (EMBL Accession No. AM941157) and compared with sequences of known Aspergillus species obtained from GenBank. The closest matches (99% identity) were with A. niger. On the basis of morphological and molecular approaches, the pathogen was confirmed as A. niger. Of five isolates, AN-5 was used for pathogenicity study. Koch's postulates were satisfied after reisolating the fungus from leaves inoculated with a conidial suspension that showed symptoms (6 days after inoculation) similar to the lesions observed on the leaves collected from Z. officinale. The tests were repeated three times in the greenhouse. Healthy, potted Z. officinale plants were grown in isolation after artificial inoculation with a suspension of spores (10,000 conidia per ml), which was prepared in 100 ml of sterile distilled water and then sprayed on the abaxial and adaxial surface of leaves. Noninoculated plants served as controls. These results confirmed the pathogenicity of A. niger on Z. officinale. To our knowledge, this is the first report of A. niger causing a disease on ginger (1). Reference: (1) G. N. Dake. J. Spices Aromatic Crops. 4:40, 1995.

Training course in local anaesthesia of the airway and fibreoptic intubation using course delegates as subjects.

BACKGROUND: We describe a practical method of training anaesthetists in the technique of awake fibreoptic intubation. This is performed on a training course using the delegates as subjects. METHODS: The first 15 subjects underwent cardiovascular monitoring during airway fibreoptic endoscopy performed by other course members. They were subsequently interrogated by use of a questionnaire. RESULTS: Evidence from questionnaires suggests this method of instruction is acceptable in this self-selected group of individuals. Gagging was the commonest unpleasant side-effect of airway endoscopy, although only one delegate rated this as uncomfortable. Fifty-four per cent of subjects found the procedure slightly painful; 46% reported no pain at all. Overall, the procedure was rated as acceptable by 85% of subjects and enjoyable by 15% of subjects. No delegate found endoscopy or intubation distressing. Cardiovascular monitoring revealed pulse rate and arterial pressure changes of less than 25% of baseline values. Paraesthesia developed in one individual and nasal bleeding in two cases, neither of which was clinically significant and did not interfere with endoscopy. CONCLUSIONS: The use of course delegates as subjects for training was acceptable to anaesthetists and is associated with a low level of discomfort and morbidity.

Compatibility studies between carbamazepine and tablet excipients using thermal and non-thermal methods.

Proper formulation is an important aspect of any dosage form design. As a part of preformulation studies, differential scanning calorimetry (DSC) was used to investigate the physicochemical compatibility between Carbamazepine and various excipients commonly used in tablet manufacturing, supported by Fourier transform infrared (FTIR) and x-ray powder diffraction (XRPD) studies. Compatibility studies were conducted on samples kept at room temperature and at an elevated temperature of 55 degrees C for 3 weeks. Carbamazepine was found to be compatible with all lactose-based components, such as Granulac 230, Flowlac 100, and Microcelac 100. Differential scanning calorimetry studies indicated incompatibility with mannitol, microcrystalline cellulose, starch, and stearic acid. However, XRPD and FTIR studies implied that all the above excipients are compatible with Carbamazepine. X-ray powder diffraction demonstrated incompatibility with stearic acid for samples stored at 55 degrees C for 3 weeks, indicative of formation of a solid solution. Thus, DSC being a thermal method of analysis should not be used singly to detect any inherent incompatibility. It has to be supported sufficiently by other non-thermal techniques, such as XRPD and FTIR.

5,7-Dihydroxytryptamine: regional brain concentrations following intraventricular administration to rats.

The concentrations of 5,7-dihydroxytryptamine (5,7-DHT) and serotonin (5-HT) were measured in brainstem, hypothalamus and cerebral cortex 0, 2, 6, 12, and 24 hours following the bilateral, lateral ventricular injection of 5,7-DHT (100 microg/each ventricle) into adult male rats. At 6 hours, 5,7-DHT levels had decreased 99% from 0 hr values in all brain regions. Thereafter, 5,7-DHT levels continued to decline in cortex, but not in hypothalamus or brainstem; at 24 hr, but not 48 hr, 5,7-DHT peaks were still measurable in each brain region examined. Serotonin levels in all three regions also fell markedly by 2-6 hours after 5,7-DHT administration. At 24 hours, hypothalamus and brainstem 5HT levels had declined >70% and cerebral cortex approximately 50% below control values. The relevance of these findings to the protective action of monoamine reuptake blockers is discussed.