Development and Validation of a UPLC Method for Determination of Mirabegron in Tablet Dosage Forms

Mirabegron is a drug that is used to treat an overactive bladder. Mirabegron activates the β3 adrenergic receptor in the bladder's detrusor muscle, causing muscular relaxation and bladder capacity expansion. A few measurement procedures have been discovered, but they are inconvenient and time-consuming. The current study developed a simple, exact, precise, and practical UPLC technique for determining the amount of Mirabegron in tablet dosage forms. For the verification of Mirabegron, a simple and specific UPLC approach is applied. On an Acquity BEH C18 (50*3.0mm. 1.7m), chromatographic separation was achieved using a versatile stage containing Potassium di hydrogen phosphate: Methanol(70:30) v/v with a detection wavelength of 254 nm. Mirabegron (r2 = 0.997) showed linearity in the 50-150 g/ml range. The amount of Mirabegron to be employed by the suggested technique matches the label exactly. The proposed technique was validated according to ICH guidelines and used to ensure that the correct amount of medication was present in the dosage form.

Assessment and Management of the High-Risk Dental Patient with Active Substance Use Disorder

Every dentist cares for patients with a history of substance use disorder (SUD), regardless of a patient's socioeconomic status, education, or ethnicity. SUD is a global epidemic, with approximately 8% of the general US population meeting diagnostic criteria for a SUD and more than 20% of the global population experiencing a SUD. The importance of understanding how to identify substance use, manage patients with a SUD, and offer appropriate referral is essential for all dental professionals. In 2005, the American Dental Association published, "Statement on Provision of Dental Treatment for Patients with Substance Use Disorders."

Occlusal Instability Results in Increased Complication Rates After Treatment of Mandibular Fractures

PURPOSE

It is important to understand the factors that can increase the incidence of complications after mandibular fracture (MF) treatment. The objective of the present study was to investigate whether occlusal stability influences the occurrence of postoperative complications in MFs treated with internal rigid fixation.

PATIENTS AND METHODS

We performed a prospective cohort study of patients treated for MF by osteosynthesis with plate and screw fixation. The primary predictor variable was the occlusal stability (yes vs no). Occlusion was scored as stable (group 1) if the patients had all their teeth and no free ends in either dental arch. Occlusion was coded as unstable (group 2) if the patients were partially edentulous with free ends in either dental arch or had edentulism involving more than 6 dental elements. The primary outcome variable was postoperative complication (yes vs no). The secondary outcome variables were the osteosynthesis system used (2.0 or 2.4 mm), local factors, age, and gender. Statistical analysis was performed using the χ² statistical test at 5% significance.

RESULTS

Of 115 patients with 121 MFs, 73 (63.48%) had stable occlusion (group 1) and 42 (36.52%) had unstable occlusion (group 2). The mean age was 34.11 years, and 71.3% were men. The postoperative complication rate was 8.70% (10 patients). Of the 10 patients with complications, 3 (2.6%) were in group 1 and 7 (6.1%) were in group 2 (P = .021 and P < .05, respectively). The 2.0-mm system was used in 107 cases (93%). All the complications were associated with use of the 2.0-mm osteosynthesis plates, occurring in 3 of 69 patients in group 1 (4.34%) and 7 of 38 patients in group 2 (18.42%; P = .032 and P < .05, respectively). The greatest number of complications was associated with unilateral MF (9 of 109). The occurrence of postoperative complications in angle and symphysis/parasymphysis fracture sites was equal.

CONCLUSIONS

The results of the present study suggest that unstable occlusion could increase the rate of postoperative complications in MFs treated with plates and screws. Future studies are required with occlusal stability included as a variable.

Does Pre-Emptive Administration of Intravenous Ibuprofen (Caldolor) or Intravenous Acetaminophen (Ofirmev) Reduce Postoperative Pain and Subsequent Narcotic Consumption After Third Molar Surgery?

PURPOSE

Pre-emptive analgesia is known to reduce postoperative pain after third molar removal. The purpose of this study was to compare postoperative pain in patients receiving either preoperative intravenous (IV) ibuprofen or preoperative IV acetaminophen for third molar surgery.

PATIENTS AND METHODS

This study was a randomized, single-blinded clinical study conducted in patients undergoing surgical extraction of 2 or more impacted third molars under deep sedation. This study compared 2 interventions: 800 mg of IV ibuprofen (Caldolor; Cumberland Pharmaceuticals, Nashville, TN) and 1,000 mg of IV acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom). The primary outcome variable was postoperative pain measured on a visual analog scale at different time points. The secondary outcome variable was the amount of postoperative analgesic (narcotic and over-the-counter) medication taken in both groups. The Mann-Whitney U test was used to compare groups in terms of outcomes, the χ² test was used to assess associations between nominal variables, and Spearman correlations were used to assess associations between continuous variables. Significance was set at P < .05.

RESULTS

The study sample consisted of 58 patients (39 female and 19 male patients). A total of 41 patients (IV ibuprofen, n = 19; IV acetaminophen, n = 22) completed the study. Equal distributions of age, gender, and number of impacted teeth were noted between the groups. At 4 hours postoperatively, the pain level in the ibuprofen group was significantly lower than that in the acetaminophen group (P = .004). This trend continued at 24 hours (P = .019) and 48 hours (P = .017). The average amount of narcotic medication taken in the ibuprofen group (2.68 ± 2.26 doses) was lower than that in the acetaminophen group (7.32 ± 6.68 doses), and the result was statistically significant (P = .005).

CONCLUSIONS

Pre-emptive analgesia with IV ibuprofen is more effective than IV acetaminophen in reducing postoperative pain and opioid use for third molar surgery.

A prospective study of screening for musculoskeletal pathology in the child with a limp or pseudoparalysis using erythrocyte sedimentation rate, C-reactive protein and MRI

PURPOSE

To determine if the detection of musculoskeletal pathology in children with a limp or acute limb disuse can be optimized by screening with blood tests for raised inflammatory markers, followed by MRI.

METHODS

This was a prospective observational study. Entry criteria were children (0 to 16 years of age) presenting to our emergency department with a non-traumatic limp or pseudoparalysis of a limb, and no abnormality on plain radiographs. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) blood tests were performed. Children with ESR > 10 mm/hr or CRP > 10 mg/L underwent a MRI scan. When the location of the pathology causing the limp was clinically unclear, screening images (Cor t1 and Short Tau Inversion Recovery) of both lower limbs from pelvis to ankles ('legogram') was undertaken. Data was gathered prospectively from 100 consecutive children meeting the study criteria.

RESULTS

In all, 75% of children had a positive finding on their MRI. A total of 64% of cases had an infective cause for their symptoms (osteomyelitis, septic arthritis, pyomyositis, fasciitis, cellulitis or discitis). A further 11% had positive findings on MRI from non-infective causes (juvenile idiopathic arthritis, cancer or undisplaced fracture). The remaining 25% had either a normal scan or effusion due to transient synovitis. ESR was a more sensitive marker than CRP in infection, since ESR was raised in 97%, but CRP in only 70%.

CONCLUSION

In our opinion MRI imaging of all children with a limp and either raised ESR or CRP is a sensitive method to minimize the chance of missing important pathology in this group, and is an effective use of MRI resources. We advocate the use of both blood tests in conjunction.

LEVEL OF EVIDENCE

Level II.

Most American Association of Oral and Maxillofacial Surgeons Members Have Not Adopted the American Society of Anesthesiologists-Recommended Nil Per Os Guidelines

PURPOSE

The purpose of this study was to determine if American Association of Oral and Maxillofacial Surgeons members have integrated the current American Society of Anesthesiologists (ASA) nil per os (NPO) guidelines into their preoperative instructions.

MATERIALS AND METHODS

We designed and implemented a cross-sectional study and enrolled a random sample of private-practice American Association of Oral and Maxillofacial Surgeons members who practice in the United States. The predictor variables were year of graduation from residency, dual degree (MD and DDS or DMD) or single degree, and region. The primary outcome variable was adoption of the ASA NPO guidelines, defined as recommending fasting times of 2 hours for clear liquids and 6 hours for solid foods. To collect data, a systematic online search was implemented. Appropriate univariate and bivariate statistics were computed, and the level of significance was set at .05; in addition, 95% confidence intervals were calculated.

RESULTS

The study sample was composed of 431 oral and maxillofacial surgeons (OMSs). Almost all of the study sample (99.1%) did not adopt the ASA guidelines. The fasting recommendations were different from 2 hours for clear liquids and 6 hours for solid foods. However, recommendations of 2 hours or greater for clear liquids were made by 99.8% of OMSs, and recommendations of 6 hours or greater for solid foods were made by 99.3%. Only 4.4% of OMSs made different recommendations for clear liquids and solid foods. No substantial association was found between whether OMSs adopted the most current ASA guidelines and the year they graduated from residency or the obtainment of dual degrees.

CONCLUSIONS

OMSs in private practice are overwhelmingly recommending longer fasting times for clear liquids and solid foods on their Web sites when compared with the current ASA guidelines before ambulatory anesthesia. The ASA guidelines are based on meta-analysis; therefore, deviations in practice, although not incorrect, may call for discussion.

Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?

Hip arthroscopy for joint preservation surgery has grown immensely over the last two decades. There is now an increasing trend to try and expand the role of hip arthroscopy to include patients of an older age or perhaps even with signs of arthritis, instead of the established patient group of young adults with mechanical symptoms or serious athletes. But how much of this growth is really justified? Once arthritis is apparent, the arthroscopic procedures needed to try and limit progression of the disease are likely to be different to those needed in young adult non-arthritic hips. Similarly, the expectation of results following an arthroscopic procedure in an older adult with arthritis must also be different. With an almost 5-fold increase in conversion rate from arthroscopy to arthroplasty in the over 50s population, arthroscopy in arthritis is a different procedure, with a different outcome, to arthroscopy in young adults with no evidence of osteoarthritis. This article takes a closer inspection at outcomes following hip arthroscopy in the older population particularly in those with evidence of early arthritis. This paper does not attempt to make recommendations in other diagnoses such as inflammatory arthritis or other secondary arthritides. It must be considered that hip arthroscopy is not a benign intervention: as well as the surgical risks, the lengthy rehabilitation period should be factored into the equation. Although the nature of surgeons is to find new techniques and push boundaries, we highlight the need for caution in undertaking arthroscopic intervention when arthritis is already apparent at presentation.

The correlation between body mass index, limb circumferences and blood pressure cuff fit in bariatric surgical patients

Introduction:

The purpose of this study was to determine the correlation between body mass index (BMI) and upper and lower arm as well as lower leg circumferences and the frequency of correct blood pressure (BP) cuff fit. We explored recommendations for the most likely BP cuff size and location for the three BMI categories.

Materials and Methods:

Following IRB approval we retrospectively analyzed a research database of bariatric surgical patients with a BMI of ≥40 kg/m². Data included patients’ characteristics, upper and lower arm as well as lower leg circumferences. Patients were divided into three groups based on BMI (kg/m², Group I: <45, Group II: 45-55, and Group III: >55). Appropriate cuff fit using a standard or large adult BP cuff (CRITIKON^®, GE Healthcare, Waukesha, Wisconsin, USA) on the upper and lower arm, and lower leg was determined. We analyzed the percent proportion of proper cuff fit for cuff sizes and locations between groups using appropriate nonparametric testing.

Results:

Limb circumference correlated significantly with BMI (P = 0.01), and the upper arm correlated most closely (r = 0.76). A standard adult BP cuff on the lower arm fit properly in >90% and >80% and in Groups I and II, respectively. A large cuff on the lower arm was appropriate in 87% of Group III. In two participants, a large cuff fit properly on the lower leg.

Discussion:

Limb circumference significantly correlated with BMI. Recommendations for proper cuff fit in different BMI categories can be made.

Obstructive sleep apnea: awakening the hidden truth

Obstructive sleep apnea (OSA) is a common type of sleep apnea and is caused by obstruction of upper airway. Sleep apnea is clinically defined as frequent episodes of apnea, hypopnea and symptoms of functional impairment, which could be life-threatening and associated with extreme daytime hyper somnolence, dysfunction, discrements in health-related quality of life, automobile accidents, and cardiovascular morbidity and mortality. Etiopathogenic factors that contribute to OSA include reduced upper-airway dilator muscle activity during sleep, upper-airway anatomical features, ventilatory control insufficiency, lung volume, and rostral fluid shifts. The presence of risk factors such as age, gender and obesity increases the incidence of OSA. The repetitive nocturnal hypoxemia experienced by patients with OSA is associated with activation of a number of neural, humoral, thrombotic, metabolic, and inflammatory disease mechanisms, all of which have also been implicated in the pathophysiology of various systemic diseases. This article summarizes the etiopathogenesis, epidemiology, associated systemic diseases such as cardiovascular diseases, diabetes, and dental diseases with OSA and the influence of tongue on oropharyngeal airway in OSA patients.

Magnetically retained silicone facial prosthesis

Patients with orocutaneous fistulas suffer from discomfort in terms of facial esthetics, food spill over and lack of psychological confidence to present them socially. Prosthetic camouflaging of facial defects and use of silicone maxillofacial material are the alternatives to the surgical retreatment. Silicone elastomers provide more options to clinician for customization of the facial prosthesis which is simple, esthetically good when coupled with bio magnets for retention.

Trigeminal Nerve Injury Following Accidental Airbag Deployment and Assessment with Quantitative Sensory Testing

High velocity motor vehicle accidents are associated with an increase in mortality rates and a significant number of facial injuries. Accidental deployment of airbags and the associated release of hot gases can result in both thermal and mechanical injuries. The more commonly reported maxillofacial injuries include temporomandibular joint fractures and dislocations, dental trauma, facial nerve paralysis, and other orofacial pain complaints. The following case report describes a patient with facial trauma from the accidental deployment of an airbag resulting in complaints consistent with a neurological injury for which quantitative sensory testing was used in confirming the diagnosis.

Self-reported oral cancer screening by smoking status in Maryland: trends over time

OBJECTIVES

The study aims to examine whether a higher proportion of current and former smokers reported having an oral cancer screening (OCS) exam in the past year compared with never smokers in Maryland between 2002 and 2008.

METHODS

Secondary analysis of the Maryland Cancer Surveys (conducted in 2002, 2004, 2006, and 2008), population-based, random-digit-dial surveys on cancer screening among adults age 40 years and older. Of 20,197 individuals who responded to the surveys, 19,054 answered questions on OCS and smoking. Results are weighted to the Maryland population.

RESULTS

Self-reported OCS in the past year increased from 33 percent in 2002 to 40 percent in 2008. Screening among never and former smokers increased from about 35 percent to 42 percent and from 35 percent to 43 percent, respectively; screening among current smokers remained between 23 percent and 25 percent. In the adjusted analysis, current smokers had decreased odds of screening compared with never smokers; no significant difference was observed between former and never smokers. When the variable dental visit in the last year was included in the adjusted analysis, it became the strongest predictor of OCS.

CONCLUSIONS

Between 2002 and 2008, self-reported OCS in the last year increased among former and never smokers, but remained unchanged for current smokers. A visit to a dental professional attenuated the difference in OCS between current and never smokers. Dental visit in the last year was the strongest predictor of OCS.

Anthranilamide-pyrazolo[1,5-a]pyrimidine conjugates as p53 activators in cervical cancer cells

A library of new anthranilamide-pyrazolo[1,5-a]pyrimidine conjugates were designed, synthesized, and evaluated for their anticancer activity in cervical cancer cells such as HeLa and SiHa that possess low levels of p53. All 24 conjugates showed antiproliferative activity, while some of them exhibit significant cytotoxicity. In assays related to cell-cycle distribution, these conjugates induced G(2) /M arrest in HeLa cells and G(1) cell-cycle arrest in SiHa cells. Immunocytochemistry assays revealed that these compounds cause nuclear translocation of p53, thereby indicating the activation of p53. In cervical cancer cells, the p53 protein is degraded by E6 oncoprotein. Immunoblot and RT-PCR analyses proved the presence of mitochondria-mediated apoptosis with involvement p53 target genes such as BAX, Bcl2, and p21 (CDKI). Moreover, these compounds increased the phosphorylated forms of p53 and provide signals for apoptosis induction. Interestingly, one of the conjugates, (2-phenyl-7-(3,4,5-trimethoxyphenyl)pyrazolo[1,5-a]pyrimidin-5-yl)(4-(2-(thiophen-2-ylmethylamino)benzoyl)piperazin-1-yl)methanone, is the most promising candidate in this series and has the potential to be taken up for further detailed studies.

Synthesis and anticancer activity of oxindole derived imidazo[1,5-a]pyrazines

A series of oxindole derivatives of imidazo[1,5-a]pyrazines were prepared and confirmed by 1H NMR, mass and HRMS data. These compounds were evaluated for their anticancer activity against a panel of 52 human tumor cell lines derived from nine different cancer types: leukemia, lung, colon, CNS, melanoma, ovarian, renal, prostate and breast. Among them compound 7l showed significant anticancer activity with GI50 values ranging from 1.54 to 13.0 μM. Cell cycle arrest was observed in G0/G1 phase upon treatment of A549 cells with 6.5 μM (IC50) concentration of compound 7l and induced apoptosis. This was confirmed by Annexin V-FITC as well as DNA fragmentation analysis and interestingly this compound (7l) did not affect the normal cells.

Synthesis and anti-cancer activity of chalcone linked imidazolones

A series of novel chalcone linked imidazolones were prepared and evaluated for their anti-cancer activity against a panel of 53 human tumour cell lines derived from nine different cancer types: leukemia, lung, colon, CNS, melanoma, ovarian, renal, prostate and breast. Some of these hybrids (6, 7 and 8) showed good anti-cancer activity with GI(50) values ranging from 1.26 to 13.9 microM. When breast carcinoma cells (MCF-7) were treated with 10 microM concentration of compounds TMAC, CA-4, 6 and 8 cell cycle arrest was observed in G2/M phase. Surprisingly, the increased concentration of the same compound to 30 microM caused accumulation of cells in G0/G1 phase of the cell cycle.