Randomized controlled study comparing simultaneous modulated accelerated radiotherapy versus simultaneous integrated boost intensity modulated radiotherapy in the treatment of locally advanced head and neck cancer

Objectives

Comparison of two fractionation schedules of intensity modulated radiotherapy (IMRT) for locally advanced head and neck cancer – simultaneous integrated boost (SIB-IMRT) and simultaneous modulated accelerated radiotherapy (SMART) boost in terms of toxicity and survival end-point measures.

Formulation, characterization, and in vitro evaluation of bioadhesive gels containing 5-Fluorouracil

The objective of this study was to prepare and evaluate in vitro the bioadhesive gels of 5-Fluorouracil (FU) for the treatment of oropharyngeal cancer. In preformulation study, the physicochemical interactions between FU and polymers were investigated by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectrophotometry, and differential scanning calorimetry (DSC). According to FTIR, XRD, and DSC studies, the drug did not show any evidence of an interaction with the polymers used and was present in an unchanged state. The gel formulations containing FU were prepared by using Poloxamer 407, HPMC K 15 M, and Gantrez S-97 (polymethylvinylether-co-maleic anhydride). The formulations contained Poloxamer 407 (16-18% w/w) either alone or in combination with HPMC K 15 M and Gantrez S-97. The bioadhesiveness of the gels was found to increase with increasing proportion of HPMC K 15 M and Gantrez S-97. In vitro release studies indicated that release could be sustained up to 8 hr. The permeability coefficients (Kp) of gel across cellulose membrane and buccal mucosal membrane were 1.06 x 10(-4) cm/s and 3.94 x 10(-5) cm/s, respectively, and differed significantly ( p < 0.05). Increasing temperature increased the drug release by increasing drug diffusion despite increase in viscosity. The pH of the release medium showed a very slight effect on the release of FU. Mathematical modeling of in vitro dissolution data indicated the best fitting with Korsemeyer-Peppas model and the drug release kinetics primarily as non-Fickian diffusion.     

Topical Ocular Delivery of NSAIDs

In ocular tissue, arachidonic acid is metabolized by cyclooxygenase to prostaglandins which are the most important lipid derived mediators of inflammation. Presently nonsteroidal anti-inflammatory drugs (NSAIDs) which are cyclooxygenase (COX) inhibitors are being used for the treatment of inflammatory disorders. NSAIDs used in ophthalmology, topically, are salicylic-, indole acetic-, aryl acetic-, aryl propionic- and enolic acid derivatives. NSAIDs are weak acids with pKa mostly between 3.5 and 4.5, and are poorly soluble in water. Aqueous ophthalmic solutions of NSAIDs have been made using sodium, potassium, tromethamine and lysine salts or complexing with cyclodextrins/solubilizer. Ocular penetration of NSAID demands an acidic ophthalmic solution where cyclodextrin could prevent precipitation of drug and minimize its ocular irritation potential. The incompatibility of NSAID with benzalkonium chloride is avoided by using polysorbate 80, cyclodextrins or tromethamine. Lysine salts and alpha-tocopheryl polyethylene glycol succinate disrupt corneal integrity, and their use requires caution. Thus a nonirritating ophthalmic solution of NSAID could be formulated by dissolving an appropriate water-soluble salt, in the presence of cyclodextrin or tromethamine (if needed) in mildly acidified purified water (if stability permits) with or without benzalkonium chloride and polyvinyl alcohol. Amide prodrugs met with mixed success due to incomplete intraocular hydrolysis. Suspension and ocular inserts appear irritating to the inflamed eye. Oil drop may be a suitable option for insoluble drugs and ointment may be used for sustained effect. Recent studies showed that the use of colloidal nanoparticle formulations and the potent COX 2 inhibitor bromfenac may enhance NSAID efficacy in eye preparations.     

Tendo-Achilles injury: An observational study in a tertiary care hospital

Objective: To report demographic and injury characteristics of tendo-Achilles (TA) injury, and determine its association with the use of Indian style commode seat (ISCS), the clinical and functional outcomes. Methods: This observational study was conducted between 1 January 2016 and 31 December 2019, and a total of 44 patients with TA injury were included in the study. Their demographic profile, etiology, operative details, and functional outcomes were studied. All patients underwent primary repair followed by standard postoperative management and follow-up for 6 months. Results: Out of 44 patients, 7 (15.9％) sustained closed injuries while 37 (84.1％) sustained open injuries. In open injury cases, 30 (81％) patients suffered an injury due to slipping in ISCS, 4 (11％) from road traffic accidents, and 3 (8％) due to falling of a heavy object. Besides, 20.45％ of cases of ISCS injury had associated neurovascular injury. Twenty (45％) patients took more than 90 days to start independent ambulation. At 6 months follow-up, no one could reach pre-injury fitness status. Conclusions: Open TA injury by ISCS is an important, under-reported, and preventable cause of loss of physically active manpower in institutional setups.     

Post-operative Abdominal Wall Mucormycosis—a Case Series

Mucormycosis is caused by saprophtytic fungi which cause acute invasive zygomycosis. It clinically presents with necrosis, and on histopathology, acute and chronic infiltrates are seen. It rarely infects a healthy host, but is devastating in an immunocompromised host. We studied five cases with post-operative abdominal wall mucormycosis, three females and two males. Three patients were post-operative while the other two had mucormycosis following trauma and infection was found in sutured wound. All were initially diagnosed as cases of necrotizing fasciitis. Two patients eventually survived after intensive medical therapy and extensive debridements.     

Relationship between Pressure and Output Parameters in Belt Grinding of Steels and Nickel Alloy

Belt grinding of flat surfaces of typical parts made of steel and alloys, such as grooves, shoulders, ends, and long workpieces, is a good alternative to milling. Several factors can influence the belt grinding process of flat surfaces of metals, such as cutting speed and pressure. In this work, the importance of pressure in the belt grinding was investigated in terms of technological and experimental aspects. The grinding experiments were performed on structural alloy steel 30KhGSN2/30KhGSNA, structural carbon steel AISI 1045, corrosion-resistant and heat-resistant stainless steel AISI 321, and heat-resistant nickel alloy KHN77TYuR. The performance of the grinding belt was investigated in terms of surface roughness, material removal rate (MRR), grinding belt wear, performance index. Estimated indicators of the belt grinding process were developed: cutting ability; reduced cutting ability for belt grinding of steels and heat-resistant alloy. It was found that with an increase in pressure p, the surface roughness of the processed surface Ra decreased while the tool wear VB and MRR increased. With a decrease in plasticity and difficulty of machinability, the roughness, material removal rate, reduced cutting capacity (Performance index) qper, material removal Q decreased, and the tool wear VB increased. The obtained research results can be used by technologists when creating belt grinding operations for steels and alloys to ensure the required performance is met.     

In vitro evaluation of microbiological flora of orofacial infections

Objective  

To assess the most common micro-organisms causing odontogenic infections and their antimicrobial susceptibility.     

Sepsis: the inflammatory foundation of pathophysiology and therapy

Sepsis, defined as an infection accompanied by inflammation, is a complex disease process wherein the body's response to a pathogen is amplified far beyond the initial site of infection. The process begins when pathogen-associated molecular patterns on the bacteria or other pathogens induce an inflammatory cascade in the host. In the United States, it is estimated that every minute a patient with severe sepsis or septic shock presents to an emergency department and that > 751 000 cases of severe sepsis occur annually, resulting in an estimated 215 000 deaths. A rapid progression of illness severity from sepsis to severe sepsis to septic shock frequently occurs, driven by the body's inflammatory and anti-inflammatory responses to a pathogen, making sepsis a condition requiring timely intervention. The clinical management of severe sepsis and septic shock has evolved dramatically over the past decade and these new therapeutic approaches have been built on a deeper understanding of the natural evolution of sepsis. This article examines the underlying pathophysiological mechanisms of sepsis to help explain the clinical signs and symptoms manifested by severe sepsis patients. It also examines the significance of current proposed treatment strategies, including early goal-directed therapy, from a pathophysiological and inflammatory perspective.     

Formulation and evaluation of metformin oro-dispersible tablets

The purpose of this research was to develop oro-dispersible tablets of metformin by direct compression method using super disintegrants approach, effervescent approach and sublimation approach. Powder blend was evaluated for angle of repose, bulk density, tapped density, compressibility index, Hausner's ratio and bulkiness. The tablets were evaluated for uniformity of weight, friability test, hardness, drug content, wetting time, water absorption ratio, disintegration time and in vitro dissolution. Higher dissolution rates were achieved in selected batches (A5, B4, C4, and D3) as compared to marketed product. Batch C4 prepared by effervescent approach was found to have the least disintegration time and maximum in vitro dissolution profile.