Impact of subgingival instrumentation on systemic inflammation and serum bone resorption marker in premenopausal women with periodontitis: a prospective interventional study.

OBJECTIVES: Inflammatory disorders including periodontitis have been investigated for their impact on systemic inflammation and bone health. The present study was conducted with an aim to evaluate impact of control of periodontal inflammation through subgingival instrumentation on serum interleukin 6 and serum C-terminal telopeptide of type I collagen (CTX) in premenopausal females with stage II and III periodontitis. METHOD AND MATERIALS: In this single-arm prospective study, periodontal parameters, serum interleukin 6, serum CTX, and hematologic parameters (total leukocyte count, differential leukocyte count, platelet count, mean platelet volume, and platelet distribution width) were assessed at baseline. Subgingival instrumentation was done, and oral hygiene instructions were given. At week 4, professional plaque control was performed, and oral hygiene instructions were reinforced. Serum and hematologic parameters were reassessed at 8 weeks after subgingival instrumentation, in individuals meeting the clinical endpoints (ie, bleeding on probing < 10%). RESULTS: There was significant reduction in serum interleukin 6 of 0.168 ± 0.164 pg/mL (P = .000), and serum CTX of 17.459 ± 4.363 pg/mL (P = .000) at 8 weeks after subgingival instrumentation. There was significant decrease in eosinophil count (P = .018) and mean platelet volume (P = .016) at 8 weeks after subgingival instrumentation; however, no significant change was found in other hematologic parameters. CONCLUSION: Following subgingival instrumentation, biomarkers of both systemic inflammation (interleukin 6) and bone turnover (CTX) were observed to reduce significantly. This finding hints towards a positive impact of periodontal intervention on bone health.

Impact of supragingival scaling on the outcomes of subgingival instrumentation completed after 1 week: a split-mouth randomized clinical trial.

OBJECTIVE: To investigate the impact of supragingival scaling on the clinical outcomes of subgingival instrumentation completed after 1 week. METHOD AND MATERIALS: In 27 patients with Stage II and Stage III periodontitis, pairs of contralateral quadrants were randomly assigned into test group 1 (single sitting scaling and root planing) and test group 2 (supragingival scaling followed by subgingival instrumentation after 1 week). Periodontal parameters were recorded at baseline, 2, 4, and 6 months; Gingival crevicular fluid vascular endothelial growth factor (VEGF) estimation was done at baseline in both groups and 7 days after supragingival scaling in test group 2. RESULTS: At 6 months, significantly better improvement in test group 1 at sites with periodontal probing depth (PPD) > 5 mm; (∆PPD = 2.32 mm vs 1.41 mm, P = .001; ∆clinical attachmen level [CAL] = 2.34 mm vs 1.39 mm, P = .001) was observed. Supragingival scaling resulted in significant reduction in gingival crevicular fluid VEGF (42.46 to 27.88 pg/site) after 1 week. Regression analysis explained 14% variance in VEGF to baseline PPD at sites with PPD > 4 mm; and 21% variance in CAL improvement to VEGF at sites with PPD > 5 mm. The percentage of sites with PPD = 5 to 8 mm reaching the clinical endpoint was 52% and 40% for test group 1 and test group 2, respectively. Better results were noticed in bleeding on pocket probing-positive sites in both groups. CONCLUSION: The sites with PPD > 5 mm where supragingival scaling was followed by subgingival instrumentation after 1 week resulted in less favourable treatment outcomes. (Clinical trial registry NCT05449964).

Mental health outcomes in health care providers during the COVID-19 pandemic: an umbrella review.

As we head into the third year of the COVID-19 pandemic, there is an increasing need to consider the long-term mental health outcomes of health care workers (HCWs) who have experienced overwhelming work pressure, economic and social deprivation, burnout, and post-traumatic stress disorder (PTSD). This scoping umbrella review summarizes the mental health outcomes of published evidence syntheses on HCWs worldwide. We analyzed 39 evidence syntheses representing the findings from 1297 primary studies. We found several persistent fears and concerns (job-related fears, fear of stigmatization, worries about the pandemic, and infection-related fears) that shaped HCW experiences in delivering health care. We also describe several risk factors (job-related, social factors, poor physical and mental health, and inadequate coping strategies) and protective factors (individual and external factors). This is the first scoping umbrella review comprehensively documenting the various risk and protective factors that HCWs have faced during the COVID-19 pandemic. HCWs continue to fear the risk that they may infect their family and friends since they regularly interact with COVID-19 patients. This places HCWs in a precarious situation requiring them to balance risk to their family and friends and potential social deprivation from isolation.

This review summarizes the mental health outcomes of health care workers (HCWs) during the COVID-19 pandemic, including their worries and concerns. The fear of infecting loved ones was one of the essential fears faced by HCWs. Job-related fears included job instability, career uncertainty, the fear of losing control in the workplace, and increased workload. Furthermore, HCWs expressed concerns about stigmatization and uncertainty associated with the pandemic's magnitude, duration, and effects. Several risk factors and protective factors for the mental health of HCWs were identified in this review. Risk factors included the lack of personal protective equipment (PPE), the increased workload, the lack of timely information regarding the pandemic, involuntary conscription, social restrictions, pre-existing physical and mental illnesses, and improper coping strategies. In contrast, protective factors included personal characteristics such as altruism and humor, perceived control and self-efficacy, adequate training and education regarding the pandemic, adequate supply of PPE, and favorable work environments. These findings can serve as a basis for the formulation of interventions by governing bodies that promote the mental health of HCWs.

Effect of antibiotics as an adjuvant to subgingival instrumentation on systemic inflammation in patients with periodontitis: a randomized clinical trial.

OBJECTIVES: The aim of the present study was to evaluate the effect on systemic inflammation of subgingival instrumentation (SI) with or without antibiotics. Moreover, systemic parameters were compared between periodontally healthy (PH) individuals and periodontitis patients. METHOD AND MATERIALS: Patients with generalized periodontitis: stage III and PH individuals were recruited. Forty eight periodontitis patients were randomly allocated to each treatment group; systemic antibiotics for seven days after completion of SI (AB group), or SI alone (SI group). Periodontal parameters, serum high-sensitivity C-reactive protein (hsCRP), and hematological parameters were assessed at baseline and at week 8. Multivariate analysis was applied to analyze predictive effect of treatment allocated and improvement in periodontal parameters on change in systemic parameters. RESULTS: At baseline, hsCRP, total leukocyte count (TLC), neutrophil, and monocyte count were significantly higher in periodontitis patients. There was comparable reduction in neutrophil count in both treatment groups. At week 8, change in periodontal parameters was similar in treatment groups, except for probing pocket depth (PPD). Improvement in both PPD and clinical attachment level (CAL) and CAL alone was predictive of change in TLC and lymphocyte count, respectively. CONCLUSION: This study failed to demonstrate the significant benefit of systemic antibiotics as an adjuvant to SI on improvement in periodontal inflammation and systemic inflammatory parameters, despite significantly higher reduction in PPDs.

Clinical evaluation of root coverage in Miller class III/RT2 labial gingival recession treated with interdisciplinary periodontal-orthodontic therapy: a randomized controlled clinical trial.

PURPOSE: The aim of current study was to evaluate percentage root coverage (RC%) in isolated Miller class III/RT2 labial gingival recession (GR) associated with malaligned mandibular anteriors, using interdisciplinary periodontal-orthodontic treatment as compared to mucogingival surgery alone. METHODS: Thirty-six systemically healthy patients having isolated Miller class III/RT2 GR with respect to malaligned mandibular anteriors, were randomly divided into test group: mucogingival surgery using subepithelial connective tissue graft followed by orthodontic treatment and control group: mucogingival surgery alone. Primary clinical parameters included (RC%), recession depth, keratinized tissue width, mid-labial clinical attachment level, interdental clinical attachment level (iCAL), periodontal phenotype (PP), gingival thickness (GT), root coverage esthetics score (RES) and hypersensitivity. Total duration of follow up was 12 months. RESULTS: Mean RC% was significantly more achieved in test group (66.67%±40.82%) in comparison to control group (39.93%±31.41%) at the end of study (P=0.049). Further, complete root coverage was attained in 5/8 cases of test group versus 1/2 cases of control group after 3/12 months respectively. RES and hypersensitivity, showed statistically significant improvement after complete follow up period in both the groups. An ideal RES score of 10 was achieved in 4/7 cases of test group while in 1/2 cases of control group after 3/12 months respectively. Correlation analysis revealed significant negative correlation between RC% and iCAL. Correlation of RC% with GT and PP was non-significant. CONCLUSIONS: Interdisciplinary periodontal-orthodontic approach may be more beneficial in terms of achieving improved RC%, esthetic and resolution of hypersensitivity in the management of Miller class III/RT2 GR in malaligned mandibular anteriors. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04255914.

Impact of scaling and root planing on association of site- and tooth-specific factors with bleeding on pocket probing.

OBJECTIVES: This study was conducted to elucidate the link of site-specific, tooth-related, and patient-associated factors with bleeding on pocket probing (BOPP) and the impact of scaling and root planing over these factors. METHOD AND MATERIALS: This cross-sectional study comprised of 50 untreated periodontitis patients and 50 periodontitis patients who had received scaling and root planing in the last 6 to 12 months and were on supportive periodontal therapy. Multilevel modeling was applied to data, with BOPP being the dichotomous outcome variable. Variables that revealed a significant association with BOPP in multilevel modeling were analyzed further to find the influence of the treatment group (untreated periodontitis and treated periodontitis) on the association between predictor variables and BOPP. RESULTS: Odds ratio (OR) for BOPP in untreated periodontitis versus treated periodontitis was 1.493, and in molars versus anterior teeth this was 1.439. Untreated periodontitis had an OR of 3.500 compared to treated periodontitis, in anterior teeth with Plaque Index 0. This was 2.795 and 7.734 in treated periodontitis and 5.106 and 12.762 in untreated periodontitis at Plaque Index 1 and 2, respectively. Bleeding on marginal probing had an OR of 6.984 for BOPP. Bleeding on marginal probing negative sites had higher OR in untreated periodontitis irrespective of the probing pocket depth. CONCLUSION: Plaque control is more effective in controlling periodontal inflammation after scaling and root planing. The probability of BOPP in the absence of bleeding on marginal probing is higher in untreated patients. The scope of influence of marginal inflammation on periodontal inflammation in shallow pockets is more in untreated periodontitis as compared to treated periodontitis; however, the trend reverses in deep pockets.

Risk of Acute Kidney Injury After Hypertensive Disorders of Pregnancy: A Population-Based Cohort Study.

RATIONALE & OBJECTIVE: Even though studies have demonstrated a relationship between hypertensive disorders of pregnancy (HDPs) and chronic kidney disease, there are limited data on the risk of acute kidney injury (AKI) following HDPs. We examined the risk of AKI following the occurrence of HDPs. STUDY DESIGN: Retrospective population-based cohort study. SETTING & PARTICIPANTS: Pregnant women in Ontario, Canada, aged 14-50 years, who delivered at ≥20 weeks' gestation between April 1, 2002, and March 31, 2015. EXPOSURE: Preeclampsia, gestational hypertension, or neither. OUTCOMES: The primary outcome was AKI with receipt of dialysis (AKI-D) ≥90 days after delivery. The main secondary outcome was AKI based on a hospitalization with a diagnostic code for AKI ≥90 days after delivery. ANALYTICAL APPROACH: Time-dependent Cox proportional and cause-specific hazards models were used to evaluate the relationship between HDP and outcomes of interest. Models were adjusted for baseline and time-varying covariates. RESULTS: Our cohort comprised 1,142,656 women and 1,826,235 deliveries, of which 1.7% were associated with gestational hypertension and 4.4% with preeclampsia. After a mean follow-up of 6.7 years, there were 322 episodes of AKI-D (0.41 per 10,000 person-years) and 1,598 episodes of AKI based on diagnostic codes (2.04 per 10,000 person-years). After adjustment, neither preeclampsia nor gestational hypertension was associated with AKI-D. Preeclampsia was associated with AKI (HR, 1.22 [95% CI, 1.03-1.45]), but gestational hypertension was not. LIMITATIONS: Retrospective design and possible unmeasured confounding. Cases of HDPs and AKI may have been undetected. CONCLUSIONS: Preeclampsia was a risk factor for AKI occurring ≥90 days after delivery. Our findings suggest the potential importance of obtaining a pregnancy history as part of a comprehensive risk profile for acute kidney disease and suggest that women with a history of HDP may benefit from monitoring of kidney function.

Assessment of the effect of orthodontic treatment on the stability of pre-orthodontic recession coverage by connective tissue graft: a randomized controlled clinical trial.

OBJECTIVE: To compare the changes in periodontal parameters after orthodontic treatment in patients having isolated gingival recession treated with and without pre-orthodontic gingival recession coverage. METHOD AND MATERIALS: Thirty-six patients requiring orthodontic treatment with a facially positioned mandibular anterior tooth with labial recession were randomly allocated to either test group: root coverage by subepithelial connective tissue graft (SCTG) followed by orthodontic treatment, or control group (orthodontic treatment only). Primary clinical parameters included recession depth, keratinized tissue width, root coverage, root esthetic score, and gingival phenotype. The patients were followed up for at least 1 year. RESULTS: Level of gingival margin attained in test group teeth after SCTG were maintained at end of orthodontic treatment (P = .727). Root coverage achieved was 69.33 ± 30.74% versus 22.36 ± 27.70% in test and control group, respectively (P = .000), and gain in keratinized tissue width was 1.59 ± 0.73 mm in test versus 0.41 ± 0.49 mm in control group (P = .000). The number of teeth with improved gingival phenotype and decreased hypersensitivity was also observed to be statistically significant in the test group (P = .049, P = .002). CONCLUSION: Root coverage procedure may be performed before the planned orthodontic treatment as graft stability is preserved throughout the course of orthodontic treatment.

Clinical evaluation of impact of periodontal phenotype on the outcome of open flap debridement in patients with chronic periodontitis: A comparative interventional study.

BACKGROUND: Several studies have implicated the role of periodontal phenotype (PP) in the outcome of various periodontal interventions. However investigations have not been performed to estimate such impact on the outcome of open flap debridement (OFD) for the management of chronic periodontitis. METHODS: A total of 73 individuals with chronic periodontitis underwent scaling and root planing (SRP). Eight weeks following SRP, modified Widman flap (MWF) surgery was performed in 40 patients (20 of either PP) presenting with probing depth (PD) ≥4 mm and gingival index (GI) ≥1 at ≥4 sites distributed over ≥2 anterior teeth with radiographic evidence of horizontal bone loss. PD, clinical attachment level (CAL), gingival recession, plaque index, GI, and bleeding on probing (BOP) were recorded at baseline, 3 and 6 months. PP was assessed using transparency of periodontal probe through the gingival margin at midfacial level. RESULTS: A total of 34 patients were re-evaluated after intervention. All periodontal parameters improved in both groups after periodontal surgery. PD & PP were found to have positive correlation with CAL gain in ≥7 mm probing sites. Attachment gain of >2 mm was observed in more percentage of sites in thick PP than in thin PP. CONCLUSION: PP can be an important factor influencing CAL gain in OFD.

Safety and Assisted Reproductive Technology Outcomes of Hysteroscopic Tubal Microinserts Versus Laparoscopic Proximal Tubal Occlusion or Salpingectomy for Hydrosalpinges Treatment.

OBJECTIVE: This study sought to answer the following question: What are the complications and assisted reproductive technology outcomes among women with hydrosalpinges managed by hysteroscopic microinsert tubal occlusion compared with women with hydrosalpinges managed by laparoscopic proximal tubal occlusion or salpingectomy? METHODS: This was a retrospective cohort study conducted from January 2009 to December 2014 at two academic, tertiary care, in vitro fertilization centres in Toronto, Ontario. All patients (n = 52) who underwent hysteroscopic tubal occlusion for hydrosalpinges were identified. Patients who proceeded with embryo transfer cycles after hysteroscopic microinsert (n = 33) were further age matched to a cohort of patients who underwent embryo transfer after laparoscopic proximal tubal occlusion or salpingectomy (n = 33). Main outcome measures were clinical pregnancy rate per patient and per embryo transfer cycle. RESULTS: Among 33 patients, there were 39 fresh and 37 frozen embryo transfer cycles in the hysteroscopic group (group A); among 33 patients in the laparoscopic group (group B), there were 42 fresh and 29 frozen embryo transfer cycles. The cumulative clinical pregnancy rate in group A and group B was similar (66.7% vs. 69.7%, respectively; P = 0.8). The clinical pregnancy rate per embryo transfer cycle was also similar in both groups (28.9% in group A vs. 32.4% in group B; P = 0.6). There were two incidents of ectopic pregnancy in the laparoscopic group and no ectopic pregnancy in the hysteroscopic group. There were three major complications: tubo-ovarian abscess, distal migration of the coil after microinsert placement, and an acute abdomen following the hysteroscopic procedure. CONCLUSION: Pregnancy outcomes after hysteroscopic placement of a microinsert for hydrosalpinx management before embryo transfer were comparable to those following laparoscopic proximal tubal occlusion or salpingectomy. However, caution is advised regarding microinsert placement for hydrosalpinges before proceeding with assisted reproductive technology.

Assessment of the oral health seeking behavior of patients with premalignant lesions.

BACKGROUND: Before choosing/visiting any dental facility for their treatment, patients consider several factors. These factors may be related to the patient or service provider. The health-seeking behavior of a society defines how health services are used. AIMS: To assess the health seeking behavior of patients with premalignant lesions. MATERIAL AND METHOD: A cross sectional study using questionnaire was done among the patients who consulted in the Department of Oral Medicine and Radiology, of age 18 and above suffering from precancerous lesions. The questionnaire included 25 close-ended questions which collected information about the demographic details, oral hygiene habits, oral health issues, deleterious habits. The responses were either on dichotomous scale (yes and no) or on the frequency habits. A total of 218 subjects were included in the study. The data were analyzed using the Chi-square test. The acceptable level of significance was reduced to P < 0.05. RESULT: Slightly over 50% of study participants visited the dentist for their dental problems. Most of the participants visited dental clinic whenever needed. Maximum positive health seeking behavior is seen in fourth and fifth decade and minimum seen in second and third decade. CONCLUSION: The oral premalignant lesions have high chances of transformation into malignancies. The progression of these lesions can be prevented by stopping the progression at an early stage and thus instilling positive health seeking behavior serves as an important key to it.

Injectable-Platelet-Rich Fibrin-Smart Blood with Stem Cells for the Treatment of Alopecia: A Report of Three Patients.

Hair loss or alopecia in males is very common, and so is its treatment. Until now, platelet-rich plasma has been in use for hair regeneration, which has shown results but lacks regenerative potential as compared to platelet-rich fibrin (PRF). Injectable-PRF (i-PRF) is advanced version of PRF in liquid form which can be injected and contains stem cells with high regenerative potential. Hair regeneration in Type VI and Type VII was observed which are difficult to treat. Hair growth with i-PRF has better regenerative potential. All cases reported showed improvement in hair growth.

Re-invigoration of Pink Esthetics by a Novel Minimally Invasive Technique: A Report of Two Cases.

The importance of pink esthetics as well as increased patient comfort has been gaining its pace in dentistry. Moreover, when it comes to the treatment of gingival recession, the ideologies of the periodontists have changed over time, i.e., from "extension to prevention;" it has now become "conserve to preserve." Utilizing this same principle, pinhole technique was introduced comprising sutureless surgery with minimal surgical intervention, thus providing maximum comfort to the patient while undergoing treatment and postoperatively. This article presents a case report of two cases who were treated with a minimally invasive pinhole surgical technique, with complete root coverage and minimal complications.

Methimazole-Induced Neutropenic Gingival Ulcerations and Necrosis in a Middle-Aged Female: A Case Report with Clinical Management.

One of the major manifestations of methimazole-induced neutropenia or agranulocytosis is diffuse gingival ulceration and necrosis. The aim of this case report is to be familiar with drug-induced neutropenia and its associated oral manifestations and the healing of the gingiva after proper treatment.

Progesterone, progesterone/estradiol and ART outcomes in day-5 transfer cycles.

The objective of this study was to assess the effects of elevated luteal-phase progesterone levels (PE) and high progesterone/estradiol ratio ('P/E2' ratio) on IVF outcomes, exclusively in GnRH-antagonist cycles with day-5 embryo transfer. PE was not found to have a significant effect on implantation or clinical pregnancy rate (CPR) (OR 0.56, 95% CI 0.25-1.25, p = .16). Elevated 'P/E2' ratio (≥0.55) on trigger day was associated with a poorer response to stimulation and lower clinical pregnancy rates (OR 0.58, 95% CI 0.34-1.00, p = .05). Patients with PE and low 'P/E2' ratio yielded significantly more oocytes than patients with PE and high 'P/E2' ratio. The mean implantation rate per patient decreased by 60% in the group with PE and high 'P/E2' ratio in comparison to the group with PE and low 'P/E2' ratio (17.9%±36.6 vs. 45.5%±47.2, p = .06), although no statistical significance was observed. The detrimental effect of PE may be mitigated by culturing embryos to day-5 before embryo transfer. Combined assessment of serum progesterone and 'P/E2' ratio may predict pregnancy outcome better than progesterone levels alone.

Recurrence of a Peripheral Ossifying Fibroma as a Pyogenic Granuloma Within 1 Week: A Case Report.

INTRODUCTION: Peripheral ossifying fibromas (POFs) and pyogenic granulomas (PGs) are non-neoplastic reactive lesions of gingiva that usually affect young females and are usually located in the anterior maxilla. It is possible to misdiagnose POF as PG, peripheral giant cell granuloma, or odontogenic tumors. Histopathologic examination is recommended and is essential for an accurate diagnosis of such lesions, and differential diagnosis is also important because POFs have a tendency to recur. CASE PRESENTATION: A clinical case of gingival swelling in the mandibular left second premolar and first molar region on the lingual side, which was diagnosed as a POF on histopathologic examination, is reported. Recurrence of the lesion was seen within 1 week of its excision. The recurrent overgrowth was again excised, thoroughly curetted, and histopathologically confirmed as a PG. No signs of recurrence were seen at the 6-month follow-up. CONCLUSION: This case shows the importance of complete excision of the lesion to the entire depth with curettage of the adjacent tissues for prevention of recurrence.

Supracrestal gingival tissue: assessing relation with periodontal biotypes in a healthy periodontium.

This cross-sectional study assessed the variability in supracrestal gingival tissue (SGT) dimensions in a healthy periodontium. SGT dimensions were evaluated for differences across various locations, tooth types, and periodontal biotypes. All measurements were made with a vernier caliper to the nearest 0.1 mm. A total of 1,932 sites in 366 teeth were statistically analyzed. Median overall SGT was recorded as 3.50 mm with a range from 1.80 to 6.20 mm. The thick-flat biotype exhibited greater median SGT than the thinscalloped biotype. When planning crown lengthening surgery, periodontal biotype may have a significant role in determining SGT dimensions.

Evaluation of supracrestal gingival tissue after surgical crown lengthening: a 6-month clinical study.

BACKGROUND: Previous studies on crown lengthening (CL) report contradictory results regarding stability of crown length gained at the time of surgery. The "3-mm rule" has dictated the amount of alveolar bone to be removed during CL surgery for decades. With the current understanding of wide variations in supracrestal gingival tissue (SGT) dimensions, bone removal can be customized to the situation. The purpose of this study is to assess alterations in periodontal tissue levels 6 months after CL surgery and to evaluate factors that may influence stability of CL achieved over time. METHODS: Sixty-four patients requiring CL surgery on 64 teeth are included in this study. Clinical parameters were recorded along six surfaces of treated tooth and neighboring teeth. Sites were labeled as treated sites, adjacent sites, and non-adjacent sites. Bone was reduced based on the minimal amount of tooth structure required for restorative purpose and SGT dimensions at each site. Patients were re-evaluated at 3 and 6 months. RESULTS: Significant soft-tissue rebound (0.77 ± 0.58 mm) was observed 6 months after CL surgery. This rebound was found to be significantly correlated with periodontal biotype (r = 0.325, P = 0.000) and post-suturing flap position (r = -0.601, P = 0.000). SGT was not reestablished to its preoperative dimensions by the end of 6 months (P = 0.001). CONCLUSIONS: Crown length gained during surgery significantly decreased 6 months post-surgery. Suturing the flap ≤3 mm from the osseous crest and thick-flat biotype were associated with greater tissue rebound.

Transfersomes: a novel vesicular carrier for enhanced transdermal delivery of sertraline: development, characterization, and performance evaluation.

The aim of the present study was to investigate transfersomes as a transdermal delivery system for the poorly soluble drug, sertraline, in order to overcome the troubles associated with its oral delivery. Different transfersomal formulations were prepared with non-ionic surfactant (span 80), soya lecithin, and carbopol 940 by the rotary evaporation sonication method. The prepared formulations were characterized for light microscopy, particle size analysis, drug entrapment, turbidity, drug content, rheological studies, in vitro release, ex vivo permeation, and stability studies. The optimized formulation was evaluated for in vivo studies using the modified forced swim model test. FTIR studies showed compatibility of the drug with excipients. The result revealed that sertraline in all of the formulations was successfully entrapped with uniform drug content. Transfersomal gel containing 1.6% of the drug and 20% of span 80 was concluded to be the optimized formulation (EL-SP4), as it showed maximum drug entrapment (90.4±0.15%) and cumulative percent drug release(73.8%). The ex vivo permeation profile of EL-SP4 was compared with the transfersomal suspension, control gel, and drug solution. The transfersomal gel showed a significantly higher (p<0.05) cumulative amount of drug permeation and flux along with lower lag time than the drug solution and drug gel. It also owed to better applicability due to the higher viscosity imparted by the gel rather than the transfersomal suspension, and no skin irritation was observed. The modified forced swim test in mice revealed that the transfersomal gel had better antidepressant activity as compared to the control gel. Thus, the study substantiated that the transfersomal gel can be used as a feasible alternative to the conventional formulations of sertraline with advanced permeation characteristics for transdermal application.

Formulation design and evaluation of a self-microemulsifying drug delivery system of lovastatin.

Self-microemulsifying drug delivery system (SMEDDS) of lovastatin was aimed at overcoming the problems of poor solubility and bioavailability. The formulation strategy included selection of oil phase based on saturated solubility studies and surfactant and co-surfactant screening on the basis of their emulsification ability. Ternary phase diagrams were constructed to identify the self-emulsifying region. Capryol 90 (20%) as oil, Cremophore RH40 (40%) as surfactant and Transcutol P (40%) as co-surfactant were concluded to be optimized components. The prepared SMEDDS was characterized through its droplet size, zeta potential, emulsification time, rheological determination and transmission electron microscopy. The optimized formulation exhibited 94% in vitro drug release, which was significantly higher than that of the drug solution. In vivo studies using the Triton-induced hyperlipidemia model in Wistar rats revealed considerable reduction in lipid levels compared to pure lovastatin. The study confirmed the potential of lovastatin SMEDDS for oral administration.