Nanoparticulated Systems Based on Natural Polymers Loaded with Miconazole Nitrate and Lidocaine for the Treatment of Topical Candidiasis.

People with weakened immune systems are at risk of developing candidiasis which is a fungal infection caused by several species of Candida genus. In this work, polymeric nanoparticles containing miconazole nitrate and the anesthetic lidocaine clorhydrate were developed. Miconazole was chosen as a typical drug to treat buccopharyngeal candidiasis whereas lidocaine may be useful in the management of the pain burning, and pruritus caused by the infection. Nanoparticles were synthesized using chitosan and gelatin at different ratios ranging from 10:90 to 90:10. The nano-systems presented nanometric size (between 80 and 300 nm in water; with polydispersion index ranging from 0.120 to 0.596), and positive Z potential (between 20.11 and 37.12 mV). The determined encapsulation efficiency ranges from 65 to 99% or 34 to 91% for miconazole nitrate and lidocaine clorhydrate, respectively. X-ray diffraction and DSC analysis suggested that both drugs were in amorphous state in the nanoparticles. Finally, the systems fitted best the Korsmeyer-Peppas model showing that the release from the nanoparticles was through diffusion allowing a sustained release of both drugs and prolonged the activity of miconazole nitrate over time against Candida albicans for at least 24 h.

Composite Microparticles Based on Natural Mucoadhesive Polymers with Promising Structural Properties to Protect and Improve the Antifungal Activity of Miconazole Nitrate.

Oropharyngeal candidiasis is a recurrent oral infection caused by Candida species. Gel formulation containing miconazole nitrate is the most common approach for treating oral candidiasis. However, traditional oral topical antifungal therapies have many limitations, including short contact time with the oral mucosa and the necessity to administrate various doses per day. Thus, the aim of this work was to formulate composited microparticulated systems based on combinations of mucoadhesive cationic, anionic, and nonionic polymers that could protect and modify the drug release rate and therefore avoid a fast dilution of the drug by saliva. Microparticulated systems were prepared by the spray drying method employing chitosan, gelatin, and hydroxypropyl methylcellulose. The morphology of the systems was investigated by scanning electron microscopy; drug crystallinity was studied by X-ray, while interactions between polymers were analyzed by infrared spectroscopy. Drug release and halo zone test were employed to analyze the release and activity of the systems loaded with miconazole against Candida albicans cultures. The most appropriate microparticulated system was the one based on chitosan and gelatin which showed homogeneous morphology (mean size of 1.7 ± 0.5 µm), a protective effect of the drug, and better antifungal effect against Candida culture than miconazole nitrate and the other assayed systems. Taking into account these results, this approach should be seriously considered for further evaluation of its safety and in vivo efficacy to be considered as an alternative therapeutic system for the treatment of oral candidiasis.

Histological evaluation of ureteral involvement in women with deep infiltrating endometriosis: analysis of a large series.

STUDY QUESTION: In women with deeply infiltrating endometriosis (DIE) what is the prevalence of involvement of endometriotic tissue and fibrosis in ureteral endometriosis (UE), as assessed by histological staining? SUMMARY ANSWER: In women with DIE, ureteral involvement is more often due to endometriotic tissue rather than fibrosis. WHAT IS KNOWN ALREADY: In the current literature, histological evaluation of ureteral endometriosis is mainly based on the degree of wall infiltration by endometriosis instead of the tissue composition. A few studies reported ill-defined and contradictory histological data on the tissue composition of UE. STUDY DESIGN, SIZE, DURATION: Retrospective observational study based on clinical records of women affected by DIE, laparoscopically treated for UE at a tertiary referral center, between January 2010 and March 2013. All cases of ureteral nodule excision or ureterectomy with histological examination of the specimens were included. Exclusion criteria were other identified causes of hydroureteronephrosis, medical therapy for a period of at least 3 months before surgery and previous surgery for DIE. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 77 patients were included in the study and among them seven (9%) presented with bilateral ureteral involvement, giving a total of 84 cases of UE available for analysis. All patients had stage IV endometriosis. According, respectively, to the presence of endometrial glands and/or stroma cells or of fibrotic tissue only, the endometriotic UE and fibrotic UE groups were compared with regard to hydroureteronephrosis at pre-operative urinary tract computerized tomography scan, type of surgical procedure performed to treat UE (nodule removal or ureterectomy), association with other locations of the disease and post-operative complications (ureteral fistula or stenosis). MAIN RESULTS AND THE ROLE OF CHANCE: For the 84 cases of UE, 65 (77%) and 19 (23%), respectively, showed endometriotic tissue and fibrotic tissue only. Presence of hydroureteronephrosis and endometriotic pattern of UE showed a significant association [endometriotic UE 44/65 (68%) versus fibrotic UE 8/19 (42%); P = 0.04]. Fibrotic pattern of UE and presence of concomitant recto-vaginal endometriosis showed a significant association [endometriotic group: 29/65 (45%) versus fibrotic group 18/19 (95%); P < 0.001]. LIMITATIONS, REASONS FOR CAUTION: The retrospective and monocentric (tertiary referral center) study design. WIDER IMPLICATIONS OF THE FINDINGS: Besides the distinction between extrinsic and intrinsic UE based on the degree of wall infiltration by endometriosis, a new classification according to the histological pattern of UE could be useful for clinicians, both in the diagnostic and therapeutic fields. STUDY FUNDING/COMPETING INTERESTS: None.

Detection of new genetic profiles and allelic variants in improperly classified grapevine accessions.

Thirty-seven grapevine accessions, collected in Central Italy, were characterized by morphological and genetic analysis, according to guidelines developed by European Union programs of grapevine research and standardization. Traditional denominations of some sampled varieties were revealed to be incorrect; moreover, 10 synonymies and 12 homonymies were recognized. Ampelographic and ampelometric measurements of leaf characters were performed. These data generated a phenotypic similarity matrix and a relative diagram showing morphological differences between specimens. Many samples presented different morphology even in the presence of the same genotype, probably as a result of various environmental pressures. Grapevines were typed by 12 microsatellite loci and then compared with the CRA-VIT genetic resource database. Twenty-five SSR profiles were clearly identified as well-known cultivars, while nine genotypes did not find a direct correspondence: these samples could represent putative new autochthonous Latial Vitis vinifera cultivars or hybrid varieties. The genetic approach also detected three new (169 and 173 in VVMD27 locus; 179 in ISV2 locus) and seven rare allelic variants. Plant sample classification by oral history, morphological observations, and molecular results were compared and discussed. Scions of samples were planted in the Botanic Garden of the University of Rome "Tor Vergata", to preserve grapevine biodiversity and to protect possible new autochthonous varieties.

Effectiveness of ProTaper, D-RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material.

AIM: To assess the efficacy of different retreatment rotary files in removing gutta-percha and endodontic sealer from canals. METHODOLOGY: Ninety straight single-rooted premolars were prepared up to a size 30 and filled with gutta-percha and sealer and then randomly assigned to six retreatment groups (n = 15). Groups I, III, and V were retreated using rotary systems ProTaper Universal Retreatment (PTUR), D-RaCe, and Mtwo Retreatment, respectively. Groups II, IV, and VI were retreated using the additional instruments F4, size 40, .04 taper RaCe, and size 40, .04 taper Mtwo, respectively. The roots were split vertically, and images of the halves were obtained using a high-resolution scanner and evaluated with AutoCAD software to calculate the percentage of residual material. Data were analyzed with Kruskal-Wallis and Student-Newman-Keuls tests using a 5% significance cutoff (P < 0.05). RESULTS: There were no statistically significant differences (P > 0.05) between groups when additional instruments were used. The percentage of residual material was lowest in the PTUR group and was statistically significant only when compared to the D-RaCe system (P = 0.0038). CONCLUSIONS: All root canals had residual filling material after retreatment even when additional instruments were used.

From Caries Progression and Restoration Failures to Periapical Lesions in the Era of Precision.

KNOWLEDGE TRANSFER STATEMENT: Dental research can be thought of as a continuum of clinical observations that are dissected in the laboratory with answers that can be brought back to the clinic to change patient management. We believe this is the case for the use of adhesive systems and outcomes of dental treatment. Clinical observations related to negative outcomes have been tested in the laboratory and solutions have been proposed, with more precise implementation of these solutions possible when genomic approaches are added. Here we elaborate on this process based on the observations that lead to an attempt to inactivate metalloproteinase activity by dentin crosslinking.

Effect of drug incorporation technique and polymer combination on the performance of biopolymeric antifungal buccal films.

Numerous films with a dissolved or dispersed active principle within a polymeric matrix have been described in literature. However, the incorporation of solid crystals into the films may influence several relevant properties. Additionally, it has been reported that different polymeric matrices lead to films presenting a different performance. The aim of this work was to evaluate the effect of the combination of chitosan with carrageenan (κ-, λ-, and ι-) as matrices, and of the miconazole nitrate incorporation method, on the films behavior. Mechanical properties, drug release and antifungal activity were evaluated. The state of the drug in the films was analyzed by different techniques. Films showed a homogeneous surface and a thermal protective effect on the drug. The combination of chitosan and λ-carrageenan leads to films with the highest values of tensile and mucoadhesive strength. Films with solubilized drug displayed slightly higher elongation at break, tensile and mucoadhesive strength and faster drug release than those with suspended miconazole nitrate. However, no differences were found regarding the antifungal activity of the different formulations including time-to-kill curves.

Succinyl-ß-cyclodextrin: Influence of the substitution degree on albendazole inclusion complexes probed by NMR.

Succinyl-ß-CD derivatives were obtained by green synthesis with degrees of substitution (DS) 1.3 and 2.9. The spray-drying technique was used to obtain albendazole (ABZ):succinyl-ß-CD inclusion complexes. Phase solubility diagrams indicated that both succinyl-ß-CD derivatives formed 1:1 molar ratio ABZ complexes, but the complex with DS 2.9 has a lower formation constant. The presence of stable inclusion complexes in aqueous solution was confirmed by NMR. For both complexes the aromatic moiety is encapsulated into the host cavity. In the solid-state, 13C and 15N NMR spectral differences between ABZ and ABZ included in spray-dried systems showed that strong structural changes occurred in the systems. At least two different ABZ amorphous species were identified based on DS. ABZ species were stable over more than six months based on spectral data. Finally, the influence of DS in the number and type of the inclusion complexes was elucidated.

Formulation and in-vitro efficacy of antifungal mucoadhesive polymeric matrices for the delivery of miconazole nitrate.

Oral candidiasis is the most common opportunistic infection affecting patients with the human immunodeficiency virus. Miconazole buccal tablets or miconazole gel are approved for the treatment of oropharyngeal candidiasis. However, buccal films present more flexibility and also offer protection for the wounded mucosa, reducing pain. Due to their small size and thickness, buccal films may improve patients' compliance, compared to tablets. Additionally, they may increase the relatively short residence time on the mucosa of oral gels, which are easily removed by saliva. Polymeric films loaded with miconazole nitrate were prepared by a casting/solvent evaporation methodology using chitosan, carbopol, gelatin, gum arabic, and alginate to form the polymeric matrices. The morphology of films was investigated by scanning electron microscopy; interactions between polymers were analyzed by infrared spectroscopy and drug crystallinity by differential thermal analysis and X-ray diffraction. Films were characterized in terms of thickness, folding endurance, tensile properties, swelling, adhesiveness, and drug release. Finally, the antifungal activity against cultures of the five most important fungal opportunistic pathogens belonging to Candida genus was investigated. The more appropriate formulations were those based on chitosan-gelatin and chitosan-carbopol which showed good mechanical properties and adhesiveness, a relative low swelling index, improved drug release, and showed better in vitro activity against Candida cultures than miconazole nitrate raw material. Thus, it will be possible to produce a new pharmaceutical form based on polymeric films containing chitosan and miconazole nitrate, which could be loaded with low drug concentration producing the same therapeutic effect against Candida cultures.

(13)C and (15)N solid-state NMR studies on albendazole and cyclodextrin albendazole complexes.

(13)C and (15)N solid-state nuclear magnetic resonance (NMR) spectra were recorded from albendazole (ABZ) and from ABZ:ß-cyclodextrin, ABZ:methyl-ß-cyclodextrin, ABZ:hydroxypropyl-ß-cyclodextrin and ABZ:citrate-ß-cyclodextrin, which were prepared by the spray-drying technique. ABZ signals were typical of a crystalline solid for the pure drug and of an amorphous compound obtained from ABZ:cyclodextrin samples. Relevant spectral differences were correlated with chemical interaction between ABZ and cyclodextrins. The number and type of complexes revealed a strong dependence on the cyclodextrin group substituent. Solid-state NMR data were consistent with the presence of stable inclusion complexes.

Repeated course of interferon treatment in chronic hepatitis B in childhood.

Ten children affected by HBV chronic hepatitis, not responding to a previous treatment with interferon (IFN), have been treated with a reiterated IFN therapy. The response obtained is not encouraging and only one patient became negative for HBeAg and HBV-DNA.

Physicochemical, nutritional, and microstructural characteristics of chickpeas (Cicer arietinum L.) and common beans (Phaseolus vulgaris L.) following microwave cooking.

Microwave cooking of legumes such as chickpeas and common beans was evaluated by assessing the cooking quality (cooking time, firmness, cooking losses, and water uptake) and the physicochemical, nutritional, and microstructural modifications in starch and nonstarch polysaccharides. Compared to conventional cooking, microwave cooking with sealed vessels enabled a drastic reduction in cooking time, from 110 to 11 min for chickpeas and from 55 to 9 min for common beans. The solid losses, released in the cooking water, were significantly less after microwave cooking than after conventional cooking (6.5 vs 10.6 g/100 g of dry seed in chickpeas and 4.5 vs 7.5 g/100 g of dry seed in common beans). Both cooking procedures produced a redistribution of the insoluble nonstarch polysaccharides to soluble fraction, although the total nonstarch polysaccharides were not affected. Increases in in vitro starch digestibility were similar after both cooking processes, since the level of resistant starch decreased from 27.2 and 32.5% of total starch in raw chickpeas and beans, respectively, to about 10% in cooked samples and the level of rapidly digestible starch increased from 35.6 and 27.5% to about 80%. SEM studies showed that the cotyledons maintained a regular structure although most of the cell wall was broken down and shattered by both cooking procedures. In addition, the ultrastructural modifications in the cotyledon's parenchima and cells are consistent with the chemical modifications in NSP and the increase in starch digestibility after cooking.

Child burn: accident, neglect or abuse. A case report.

The authors report a case of a child who has suffered three episodes of burn injuries in a short period of time, probably provoked by neglect or abuse from the parents. This mode of injury is of great importance because of the high mortality, as well as the physical, psychological and social sequelae that it causes. The absence of care and attention from the parents or caretakers contribute to the high frequency of this kind of trauma. In these cases, the admission of the child to the hospital is justifiable, regardless of the size or depth of the burn wound. Aspects concerning the epidemiology are discussed in this article, as are comments based on the literature about infant abuse and neglect.

Burns as a complication of the use of diathermy.

Surgical diathermy is an invaluable aid in modern surgery, and most contemporary diathermy machines are considered safe. The literature has proven to be very sparse in terms of reference to complications, although prolonged courses of treatment are required in individual cases. We report a case of burns that occurred during a saphenous vein coronary bypass graft caused by the inadequate use of the electrosurgical materials. Care should be taken in the use of these resources to avoid complications of this kind.

[Echographic aspects of kidney diseases and comparisons with needle biopsy]. / Aspetti ecografici delle nefropatie mediche e confronti con agobiopsia.

A study of 38 patients who underwent renal biopsy was designed to correlate the sonographic features of the kidney with the histologic changes in various renal parenchymal diseases. This research was performed in order to determine if sonography could be useful in the diagnosis and differentiation of renal parenchymal diseases. The ultrasound examination was based on the evaluation of some codified parameters: renal dimension, parenchymal thickness, cortical echogenicity and medullary dimension. There was no correlation between the specific sonographic features and the type of renal medical disease. In 28 patients (74%) with clinical and histological signs, sonography showed morphostructural alterations of the kidney.

An exploration of the dimensions of illness behavior.

Illness behavior is typically studied from the perspective of medical care practitioners. Problems for which people seek medical care are often deemed to be the universe of such ailments whereas actually they represent a small percentage of total illness experienced. This paper describes the rest of the iceberg of health problems. By using a health diary, all problems recorded by 107 participants over a three-week period were analyzed. A total of 348 problems (3.25 per person) were recorded with less than six percent of the problems receiving professional medical care. Stated differently, individuals were experiencing at least one health problem on approximately half of all study days. Health beliefs regarding selected problems were also obtained, along with non-orthodox practitioner (eg, chiropractors and naturopaths) utilization patterns.

[The nephropathic patient in ambulatory surgical practice]. / Il paziente nefropatico nella pratica chirurgica ambulatoriale.

The aim of this study was to define a correct preoperative approach to be used in patients affected by chronic renal insufficiency in order to neutralise possible risks associated with the pathology in question.

Effects of benznidazole:cyclodextrin complexes on the drug bioavailability upon oral administration to rats.

Benznidazole (BZL) is the drug of choice for the treatment of Chagas' disease, a neglected parasitic infection. It is poorly soluble in water, which may have a direct impact into its bioavailability. Thus, the aim of this study was to evaluate the impact of stoichiometric and non-stoichiometric BZL-cyclodextrins (CDs) complexes on the bioavailability of BZL. The interaction of BZL with the CDs was investigated using differential scanning calorimetry (DSC), scanning electron microscopy (SEM), X-ray diffractometry (XRD), phase solubility and dissolution studies. The oral bioavailability of BZL from these complexes was examined in rats. Both BZL solubility and dissolution increased by CD complexation. The inclusion complexes were found to improve the dissolution rate of BZL by 4.3-fold in comparison with BZL alone. Complexation of BZL with CDs derivatives increased its plasma concentrations when fed to rats, with AUC0-5 values increasing up to 3.7-fold and Cmax increasing 2.5-fold in comparison with BZL alone. It should be note that a remarkable increase in these parameters was observed in the case of the non-stoichiometric complexes. Thus, these CDs complexes could be used to efficiently deliver BZL in patients suffering from Chagas' disease.

Glutathione-S-transferase (GST) polymorphisms are associated with relapse after radical prostatectomy.

BACKGROUND: Organ confined prostate cancer (PCa) can be cured by radical retropubic prostatectomy (RRP); however, some tumors will still recur. Current tools fail to identify patients at risk of recurrence. Glutathione-S-transferases (GSTs) are involved in the metabolism of carcinogens, hormones and drugs. Thus, genetic polymorphisms that modify the GST activities may modify the risk of PCa recurrence. METHODS: We retrospectively recruited Argentine PCa patients treated with RRP to study the association between GST polymorphisms and PCa biochemical relapse after RRP. We genotyped germline DNA in 105 patients for: GSTP1 c.313A>G (p.105 Ile>Val, rs1695) by PCR-RFLP; and GSTT1 null and GSTM1 null polymorphisms by multiplex PCR. Kaplan-Meier curves and Cox proportional hazard models were used to evaluate these associations. RESULTS: Patients with GSTP1 c.313GG genotype showed shorter biochemical relapse-free survival (BRFS) (P = 0.003) and higher risk for recurrence in unadjusted (Hazard ratio (HR) = 3.16, 95% confidence interval (95% CI) = 1.41-7.06, P = 0.005) and multivariate models (HR = 3.01, 95% CI = 1.13-8.02, P = 0.028). We did not find significant associations for GSTT1 and GSTM1 genotypes. In addition, we found shorter BRFS (P = 0.010) and increased risk for recurrence for patients having two or more risk alleles when we combined the genotypes of the three GSTs in multivariate models (HR = 3.06, 95% CI = 1.20-7.80, P = 0.019). CONCLUSIONS: Our results give support to the implementation of GSTs genotyping for personalized therapies as a novel alternative for PCa management for patients who undergo RRP. To the best of our knowledge, this is the first study that examined GST polymorphisms in PCa progression in Argentine men. Replication of our findings in larger cohort is warranted.

Low-carbohydrate and high-fat diets on the promotion of hepatic steatosis in rats.

AIM: The present work looked for to evaluate in rats the impact of different diets (high-lipid and high-lipid+high-protein) on liver, verifying the occurrence of oxidative stress and steatosis. METHODS: The animals were treated with the respective diets (Group HLS: high-lipid diet with 50% of saturated fat; Group HPLS: high-lipid and high-protein diet with 50% of saturated fat and 40% of protein; Group Control: control diet AIN-93) for 28 days. After this period the animals were sacrificed for hepatic determinations of MDA, reduced GSH, vitamin E, steatosis and glycemia. RESULTS: The results showed higher glycemia in the group HPLS, high concentration of MDA and GSH in the group Control and decreased hepatic vitamin E concentration in the groups that received the high-lipid diets. The hepatic fat was higher in the groups HPLS and HLS in relation to the Group Control, however HPLS presenting high level of fat concentration, showing similar results as the steatosis. CONCLUSION: the fat increase in the diet promoted increase of the oxidative stress, evidenced by the decrease in the hepatic concentration of vitamin E, showing its antioxidant role against the probable generated free radicals, the ones which possibly exercised a role in the steatosis occurrence.