Alginate based biomaterials for hemostatic applications: Innovations and developments.

Development of the efficient hemostatic materials is an essential requirement for the management of hemorrhage caused by the emergency situations to avert most of the casualties. Such injuries require the use of external hemostats to facilitate the immediate blood clotting. A variety of commercially available hemostats are present in the market but most of them are associated with limitations such as exothermic reactions, low biocompatibility, and painful removal. Thus, fabrication of an ideal hemostatic composition for rapid blood clot formation, biocompatibility, and antimicrobial nature presents a real challenge to the bioengineers. Benefiting from their tunable fabrication properties, alginate-based hemostats are gaining importance due to their excellent biocompatibility, with >85 % cell viability, high absorption capacity exceeding 500 %, and cost-effectiveness. Furthermore, studies have estimated that wounds treated with sodium alginate exhibited a blood loss of 0.40 ± 0.05 mL, compared to the control group with 1.15 ± 0.13 mL, indicating its inherent hemostatic activity. This serves as a solid foundation for designing future hemostatic materials. Nevertheless, various combinations have been explored to further enhance the hemostatic potential of sodium alginate. In this review, we have discussed the possible role of alginate based composite hemostats incorporated with different hemostatic agents, such as inorganic materials, polymers, biological agents, herbal agents, and synthetic drugs. This article outlines the challenges which need to be addressed before the clinical trials and give an overview of the future research directions.

Tracing the COVID-19 spread pattern in India through a GIS-based spatio-temporal analysis of interconnected clusters.

Spatiotemporal analysis is a critical tool for understanding COVID-19 spread. This study examines the pattern of spatial distribution of COVID-19 cases across India, based on data provided by the Indian Council of Medical Research (ICMR). The research investigates temporal patterns during the first, second, and third waves in India for an informed policy response in case of any present or future pandemics. Given the colossal size of the dataset encompassing the entire nation's data during the pandemic, a time-bound convenience sampling approach was employed. This approach was carefully designed to ensure a representative sample from advancing timeframes to observe time-based patterns in data. Data were captured from March 2020 to December 2022, with a 5-day interval considered for downloading the data. We employ robust spatial analysis techniques, including the Moran's I index for spatial correlation assessment and the Getis Ord Gi* statistic for cluster identification. It was observed that positive COVID-19 cases in India showed a positive auto-correlation from May 2020 till December 2022. Moran's I index values ranged from 0.11 to 0.39. It signifies a strong trend over the last 3 years with [Formula: see text] of 0.74 on order 3 polynomial regression. It is expected that high-risk zones can have a higher number of cases in future COVID-19 waves. Monthly clusters of positive cases were mapped through ArcGIS software. Through cluster maps, high-risk zones were identified namely Kerala, Maharashtra, New Delhi, Tamil Nadu, and Gujarat. The observation is: high-risk zones mostly fall near coastal areas and hotter climatic zones, contrary to the cold Himalayan region with Montanne climate zone. Our aggregate analysis of 3 years of COVID-19 cases suggests significant patterns of interconnectedness between the Indian Railway network, climatic zones, and geographical location with COVID-19 spread. This study thereby underscores the vital role of spatiotemporal analysis in predicting and managing future COVID-19 waves as well as future pandemics for an informed policy response.

Development of κ-carrageenan-PEG/lecithin bioactive hydrogel membranes for antibacterial adhesion and painless detachment.

The issue of wound dressing adherence poses a substantial challenge in the field of wound care, with implications both clinically and economically. Overcoming this challenge requires the development of a hydrogel dressing that enables painless removal without causing any secondary damage. However, addressing this issue still remains a significant challenge that requires attention and further exploration. The present study is focused on the synthesis of hydrogel membranes based on κ-carrageenan (CG), polyethylene glycol (PEG), and soy lecithin (LC), which can provide superior antioxidant and antibacterial attachment properties with a tissue anti adhesion activity for allowing an easy removability without causing secondary damage. The (CG-PEG)/LC mass ratio was varied to fabricate hydrogel membranes via a facile approach of physical blending and solution casting. The physicochemical properties of (CG-PEG)/LC hydrogel membranes were studied by scanning electron microscopy (SEM), Fourier transforms infrared spectroscopy (FTIR), X-ray diffraction (XRD), differential scanning calorimetry (DSC), and mechanical analyses. The membranes showed significantly enhanced mechanical properties with excellent flexibility and had high swelling capacity (˃1000 %), which would provide a moist condition for wound healing. The membranes also exhibited excellent free radical scavenging ability (>60 %). In addition, the (CG-PEG)/LC hydrogel membranes showed reduced peel strength 26.5 N/m as a result of weakening the hydrogel-gelatin interface during an in vitro gelatin peeling test. Moreover, the membrane showed superior antibacterial adhesion activity (>90 %) against both S. aureus and E. coli due to the presence of both PEG and LC. The results also suggested that the hydrogel membranes exhibit NIH3T3 cell antiadhesion property, making them promising material for easy detachment from the healed tissue without causing secondary damage. Thus, this novel combination of (CG-PEG)/LC hydrogel membranes have immense application potential as a biomaterial in the healthcare sector.

Development of sodium alginate/glycerol/tannic acid coated cotton as antimicrobial system.

Present study aims at developing antimicrobial cotton gauze by dip coating of sodium alginate (SA), glycerol (Gly) and tannic acid (TA) blend. SA blends were prepared with varying concentration of glycerol in the range of 10-40 %. Blended films were fabricated and characterized by Fourier transform-infrared (FTIR) spectroscopy, X-ray diffraction (XRD), tensile studies, and contact angle analysis. The mechanical behavior of films indicated significant decrease in the tensile strength and modulus with the increase in the glycerol content due to the plasticization effect. The hydrophilicity of the blend films increased with increase in the glycerol content. TA was added to the blend as an antimicrobial agent. These blends were coated on the cotton gauze by dip coating method and their characterizations were carried out by the scanning electron microscopy (SEM) which revealed a smooth coating of SA:Gly:TA blend on cotton gauze. Antimicrobial analysis of TA coated gauzes was carried out which showed >95 % viable colony reduction against E. coli and S. aureus. Cytocompatibility studies indicated excellent cell-compatible activity. These results implicated that such coated gauzes are promising candidate that hold the great potential to be utilized as infection-resistant material in the health care sector.

Crude Extracts of Bacopa Monnieri Induces Dendrite Formation in Rodent Neural Stem Cell Cultures-A Possible Use in Neuronal Injury.

Background Repair of nervous tissue injury impairs positive functional outcome. Major challenges involved are formation of new neuronal cells at the site of injury, growth and development of existing or stem cell-derived neuronal cells, and proper anatomical alignment of the cells required for the functional organization of the nervous system. Stem cells and various agents have been tried to overcome the above challenges yielding only limited positive results. Bacopa has been in frequent usage for cognitive impairment in Ayurvedic medicine. The assumption that Bacopa monnieri (BM) extracts may lead to certain specific changes at the cellular structural level benefitting the central nervous system repair, prompted us for the present study. Objective This is an in vitro study evaluating the effect of BM extracts (bacopasides and analogues) on the neuronal stem cells (NSC) culture in various concentrations. The study investigates the possibility of BM as an agent for the regeneration and differentiation of nervous tissue injury. This may have clinical and therapeutic implications. Materials and Methods NSC were harvested from the newborn albino rats, Rattus norvegicus, and the BM extracts were obtained from product "brahmi" manufactured by Himalaya Drug Company. Aqueous suspension of 2 µL of alcoholic extract of BM was locally added to the culture plates of NSC in concentrations of 5, 10, and 20 µg/mL after development of NSC in the media. The control NSC (without BM) and BM-rich NSC were simultaneously observed at regular unit intervals after inoculation. The morphological change in the NSC were observed and recorded. Result NSC could be successfully cultured from the newborn rat's brain harvested at 3 and 6 hours of birth. NSCs derived at 3 hours of birth were more primitive (predominantly neurospheres) than derived those at 6 hours of birth. BM had significant positive effect on the neurospheres, that is, dendritic formation was seen in the NSC predominating when 2 µL of suspensions containing 5 and 10 µg/mL concentration of the extracts were used but showed relatively lesser effect at concentration of 20 µg/mL. The positive effect was biologically significant. Conclusion NSC can be cultured from brain of the newborn rodent. BM and its extracts act positively on NSC in terms of dendritic formation when used in proper appropriate concentration. The study opens up a new area of research and explores newer avenues in nervous tissue injury repair. It may have future clinical implication in the treatment of injury of central and peripheral nervous tissue. However, the hypothesis needs to be validated by adequate number of experimental runs as well as in vivo studies to know the reproducibility of the findings in other centers.

Preparation of thyme oil loaded κ-carrageenan-polyethylene glycol hydrogel membranes as wound care system.

The present study is aimed at fabricating thyme oil loaded hydrogel membranes composed of κ-carrageenan (CG) and polyethylene glycol (PEG), which can provide moist environment and prevent infections for rapid wound healing. Membranes were prepared with different amounts of PEG via solvent casting technique under ambient conditions. Physicochemical properties of CG-PEG membranes as a function of the PEG content were investigated. The surface morphology of membranes displayed smoother surfaces with increasing PEG content up to 40%. In addition, the interaction of PEG with CG polymer chains was evaluated in terms of Free and bound PEG fraction within the membrane matrix. Furthermore, thyme oil (TO) was added to enhance the antibacterial properties of CG-PEG membranes. These membranes showed >95% antimicrobial activity against both gram-positive and gram-negative bacteria depending on the TO content. Suggesting the great potential of these membranes as a strong candidate for providing an effective antimicrobial nature in human healthcare.

Scar free healing mediated by the release of aloe vera and manuka honey from dextran bionanocomposite wound dressings.

Scar preventive dextran based bionanocomposite dressings containing aloe vera (AV) and manuka honey (MH) were developed as wound care devices. This work was a challenge to fabricate herbal dressing that promotes healing, which at the same time is biocompatible, non-toxic, biodegradable, and cost effective in terms of the simplicity of application in complex chronic wound situations. With this aim, we synthesized in-situ crosslinked dextran/nanosoy/glycerol/chitosan (DNG/Ch) nanocomposite membranes via solvent casting technique followed by subsequent addition of AV and MH to obtain DNG/Ch/AV and DNG/Ch/MH herbal dressings. The drug release kinetics of the bionanocomposite dressings indicated an initial burst release of AV and MH, followed by controlled release when examined in-vitro using non-fickian and quasi-fickian model. Antibacterial studies confirmed >99% antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) and bacterial adherence test demonstrated its efficacy for arresting microbial invasion. Wound healing analysis conducted in-vivo showed enhanced epithelialization in the terms scar prevention and aesthetics with absolute wound contraction for the mice treated with AV loaded dressings after 14th post wounding day. Histological features displayed ordered deposition of collagen with a thin epidermis layer. Hence, the present herbal dressing could function without many cytotoxicity and biocompatibility issues.

Dextran based herbal nanobiocomposite membranes for scar free wound healing.

Dextran based bionanocomposite membranes encapsulating clove oil (CO) and sandalwood oil (SO) that are capable of preventing infection due to their inherent virtue of antibacterial activity and modifying the wound healing cascade for accelerated scar free healing, were developed. A facile solvent casting technique was used to fabricate dextran/nanosoy/glycerol/chitosan (DNG/Ch) nanocomposite membranes followed by subsequent addition of CO and SO to obtain DNG/Ch/CO and DNG/Ch/SO herbal nanodressings. Dressings exhibited >98% antibacterial activity against both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) at extremely low loadings of 5% and 10% for CO and SO, respectively. This encapsulation strategy allowed controlled diffusion of EO over a period of 72h which was measured in terms of drug efficacy using bacterial reduction count test and serial plate transfer disk diffusion test (SPTDDT). Swelling behavior and mechanical properties were also examined. Bacterial adherence study was performed to demonstrate the efficiency of dressings for arresting microbial invasion. In vivo wound healing studies were conducted using male swiss albino mice of BALB/c strain and DNG/Ch/CO dressings exhibited complete healing within 14days with remarkable efficacy in scar prevention. Histological analysis revealed that CO and SO treatment led to deposition of ordered collagen along with fibroblast migration.

Skin compatibility and antimicrobial studies on biofunctionalized polypropylene fabric.

The aim of this study was the development of antimicrobial fabric which can be used as skin contacting material. The nanosilver loaded bioactive nanogels of polyacrylamide were prepared by gamma irradiation process and the particle size was observed to be in the range of 10-50nm. In this study, we used polyethylene glycol as carrier for the combination of functional nanogel and essential oils together. Plasma functionalized polypropylene fabric was used as the base material for the bio-immobilization. Bioactive emulsion was coated on the fabric which exhibited excellent antimicrobial activity against Staphylococcus aureus and Escherichia coli. Skin irritation studies were carried out over a period of 3d on Swiss albino mice. Histopathology studies of the fabric did not show adverse inflammatory response in contact with the skin. The biofunctionalized fabric offers appear to be promising material for skin contacting applications.

Development of novel wound care systems based on nanosilver nanohydrogels of polymethacrylic acid with Aloe vera and curcumin.

This study is aimed at the development of a composite material for wound dressing containing nanosilver nanohydrogels (nSnH) along with Aloe vera and curcumin that promote antimicrobial nature, wound healing and infection control. Nanosliver nanohydrogels were synthesized by nanoemulsion polymerization of methacrylic acid (MAA) followed by subsequent crosslinking and silver reduction under irradiation. Both the polymerization and irradiation time had significant influence on the nanoparticle shape, size and its formation. Polyvinyl alcohol/polyethylene oxide/carboxymethyl cellulose matrix was used as gel system to blend with nSnH, A. vera, curcumin and coat it on the hydrolysed PET fabric to develop antimicrobial dressings. The cumulative release of silver from the dressing was found to be ~42% of the total loading after 48h. The antimicrobial activity of the dressings was studied against both Staphylococcus aureus and Escherichia coli. In vivo wound healing studies were carried out over a period of 16d on full-thickness skin wounds created on Swiss albino mice. Fast healing was observed in Gel/nSnH/Aloe treated wounds with minimum scarring, as compared to other groups. The histological studies showed A. vera based dressings to be the most optimum one. These results suggest that nSnH along with A. vera based dressing material could be promising candidates for wound dressings.

Study of acute transfusion reactions in a teaching hospital of Sikkim: A hemovigilance initiative.

OBJECTIVE: Blood transfusions are inherently associated with risks ranging in severity from minor to life-threatening. Continuous monitoring of transfusion related complications can promote understanding of factors contributing to transfusion reactions and help to formulate necessary remedial measures. This study was designed to analyze the frequency and nature of transfusion reactions reported to the blood bank of a remote North East Indian teaching hospital. MATERIALS AND METHODS: All acute transfusion reactions (ATRs) reported to the blood bank over a period of 20 months (May 2013 to January 2015) were reviewed and analyzed. The risk of transfusion reactions associated with each individual component was assessed. RESULTS: A total of 3455 units of whole blood and component transfusions were carried out of which a total of 32 (0.92%) ATRs were encountered. Packed red blood cells (PRBCs) (n = 15, P = 0.06) and whole blood (WB) (n = 13, P = 0.83) were most commonly implicated. Allergic reaction was the most frequent transfusion reaction encountered (65.6%), seen most commonly with PRBC (risk of 0.76%, P = 0.42), and WB (risk of 0.68%, P = 0.63) transfusions. This was followed by febrile reactions (28.1%), which were seen more commonly with PRBCs (risk of 0.57%, P = 0.016). No reactions were observed with platelet transfusions. CONCLUSION: The overall incidence of transfusion reactions in this hospital is slightly higher than those having more advanced transfusion facilities in India. The lack of leukoreduction facilities in our hospital could be a likely cause for the same. The use of leukoreduced WB and PRBCs could possibly reduce the overall incidence of ATRs in general and febrile nonhemolytic transfusion reactions in particular.

Gastric xanthelasma: an unusual endoscopic finding.

Gastric xanthelasma is a rarely encountered finding in upper gastrointestinal (GI) endoscopy. It is characterised by yellowish-white plaque in the stomach especially in the antrum or the pyloric region. Histologically it consists of foamy macrophages in the lamina propria. It is a benign condition but its appearance mimics malignancy and it is found to be associated with various conditions, some of which are considered premalignant so, histological confirmation is necessary. We present a case of a 44-year-old man who presented to the medicine outpatient department for intermittent pain in epigastrium for the last 2 years. His physical examination was normal. His haematological and biochemical investigations were also normal. His upper GI endoscopy revealed yellowish-white plaque in fundus of the stomach, which was diagnosed as gastric xanthelasma by histological examination with associated chronic gastritis.

Multifocal childhood cutaneous tuberculosis: report of two interesting cases from Sikkim, India.

Cutaneous tuberculosis is an important health problem in developing countries such as India. Poverty, overcrowding, malnutrition, and ignorance are predisposing factors. The commonly seen variants of cutaneous tuberculosis are scrofuloderma, lupus vulgaris, and tuberculosis verrucosa cutis. Malnourished children may present with unusual forms of cutaneous tuberculosis. Herein we report two interesting cases of multifocal cutaneous tuberculosis in malnourished children.

Ascaris lumbricoides causing infarction of the mesenteric lymph nodes and intestinal gangrene in a child: a case report.

Ascaris lumbricoides or round worm infestation is quite common in the developing world. It affects all age groups but is more common in children. Most of the cases remain asymptomatic. The usual presentation is an intestinal obstruction. The physicians should be aware of this condition and consider it in the differential diagnosis when faced with such a case. The rare fatal complications include bleeding, perforation and gangrene.

Microparticulated anti-HIV vaginal gel: in vitro-in vivo drug release and vaginal irritation study.

The aim of this study was to develop and evaluate a Zidovudine (AZT)-loaded microparticulated bioadhesive vaginal gel (MBVG) in order to obtain a controlled releasing, safe gel delivery system. AZT microparticles (ZMPs) were evaluated for encapsulation efficiency, drug loading, surface morphology and in vitro drug release profiles and drug release mechanism and optimized. The optimized ZMPs were then encompassed in bioadhesive gel using different bioadhesive polymers and evaluated for the drug encapsulation efficiency, drug loading, in vitro and in vivo drug release profiles, drug release mechanism and vaginal irritancy study. From the dissolution data of ZMP4 and MBVG4 showed a zero-order diffusion pattern and Fickian diffusion case I transport mechanism in 24 and 36 h, respectively. On the basis of a pharmacokinetic study of MBVG4 (containing ZMP: Carbopol 1:4), it was found to have better bioavailability, larger AUC and T(max) in comparison to an oral pure suspension of AZT.

An attempt to define the type of biopsy in a sinonasal lesion showing bony erosion.

OBJECTIVES: To present a case of sino-nasal destructive mass initially diagnosed as an inflammatory lesion following punch biopsy from the lesion however the post surgical histopathology was diagnostic of Grade 2 angiocentric immunoproliferative lesion (AIL). The reasons for the initial misdiagnosis are analyzed. MATERIALS AND METHODS: A 76-year-old male patient presenting with progressive bilateral nasal obstruction for 1 year. Repeated punch biopsies from the mass were suggestive of an inflammatory lesion. RESULT: The patient underwent surgical exenteration of the mass and the final histopathology report suggested AIL Grade 2. The patient was thereafter treated with chemotherapy and radiotherapy. CONCLUSION: Initial superficial punch biopsies lead to incorrect diagnosis leading to an unnecessary surgical exenteration. The explanations for the initial misdiagnosis are given below and appropriate diagnostic protocols, mode and depth of biopsy are suggested based on the case study.

Fourth branchial pouch sinus - an unusually late initial presentation.

OBJECTIVE: Here we present an unusual case of a male patient with 4th branchial pouch sinus with an initial presentation of pseudothyroiditis at an unusually late age of 20 years. METHOD: Case report and a review of the world literature concerning 4th branchial pouch sinus is presented. RESULT: The patient was diagnosed by radiology and endoscopy and treated surgically. Histopathology revealed chronic inflammatory changes, which pointed towards recurrent sub clinical low-grade inflammations over the years keeping the condition occult till 20 years of age. CONCLUSION: According to available literature it almost always presents in the first decade of life when it might be misdiagnosed. However our report shows it may also exist with sub clinical inflammations or infections and present at a much later stage in life, when the possibility of such a sinus shouldn't be ruled out on the basis of lack of history of recurrent neck inflammations.