Ear Inflammation Research Articles

INHIBITORY EFFECTS ON TUMOR NECROSIS FACTOR ALPHA AND INTERLEUKIN 12 USING CLOBETASOL PROPIONATE LOADED TEA TREE OIL NANOEMULSION GEL ON ANIMAL MODEL

Objective: The main objective of our study is to explore anti-inflammatory activity at its molecular level like tumor necrosis factor alpha (TNF-α), interleukin 12 (IL-12) expression, and histopathological study.Methods: As per solubility/miscibility of clobetasol propionate (CP) with tea tree oil (TTO), surfactant and cosurfactant (Smix), and water in a ratio of oil:Smix:water (15:35:50) taken in milliliter for the preparation of nanoemulsion. Induced allergic contact dermatitis (ACD) with dinitrofluorobenzene (DNFB) was used for the study. TNF-α and interleukin 12 (IL-12) were estimated with rabbit antimouse TNF-α and rat antimouse IL-12 antibodies in 1% of bovine serum albumin in phosphate buffer.Results: Topical application of CP loaded nanoemulsion gel inhibits ear inflammation and erythema in DNFB-induced ACD in mice and significantly reduces the intracellular edema and infiltration with inflammatory mediator cells involving of mononuclear cells and neutrophils. CP loaded nanoemulsion gel reduces expression of protein level of TNF-α and IL-12.Conclusion: CP loaded nanoemulsion gel confirmed that anti-inflammatory effects showed more rapidly than the placebo and marketed gel preparation. However, the animals treated with placebo nanoemulsion gel showed a somehow comparable reduction of their inflammation during treatment compared with the marketed gel. This effect may be due to anti-inflammatory effect of TTO. This result suggested that anti-inflammatory activity of placebo nanoemulsion gel may be due to TTO present in nanoemulsion as vehicle.

Isolation and antimicrobial drug susceptibility pattern of bacterial pathogens from pediatric patients with otitis media in selected health institutions, Addis Ababa, Ethiopia: a prospective cross-sectional study

BackgroundOtitis media is inflammation of the middle ear and tympanic membrane, which often occurs after an acute upper respiratory tract infection. It is the most common episode of infection in children and the second most important cause of hearing loss affecting 1.23 billion people, thus ranked fifth global burden of disease with a higher incidence in sub-Saharan Africa. Thus, the aim of this study was to determine the isolation rate of bacterial pathogens from pediatric patients with otitis media.MethodologyInstitutional based cross-sectional study was conducted from January 2013–June 2014 in Addis Ababa among 210 pediatrics patients. Demographic, clinical and associated factors data was obtained in face to face interview with guardians/parents by 5 trained nurse data collectors using structured questionnaire. Middle ear drainage swab was collected following all aseptic procedures and transported to the microbiology laboratory. Culture and Antimicrobial sensitivity test were performed according to the standards. The data quality was assured by questionnaire translation, retranslation and pretesting. Reference strains were used as a positive and negative control for biochemical tests, and culture results were cross checked. Data was checked for completeness, consistency and then entered into Epi Info v3.5.1 and analyzed by SPSS v20. Data interpretation was made using graphs, tables, and result statements.ResultA total of 196 middle ear drainage swab samples were analyzed from pediatric patients and of those 95 (48.5%) samples were positive for pathogenic organisms. The major isolate was S. aureus (15.8%) followed by P. aeruginosa (10.9%), Viridians streptococcus (9.9%), S. pneumoniae (8.9%) and S. pyogenes (7.9%). Upper respiratory tract infection history and living in the rural area have shown significant association with the isolation of pathogenic organism, (p-value = 0.035) and (p-value = 0.003) respectively. Most of the isolates show a high level of resistance to Trimethoprim-Sulfamethoxazole, Penicillin G, Ampicillin, Amoxicillin, and Chloramphenicol.ConclusionS. aureus and P. aeruginosa are the most common pathogens that contribute to otitis media as well most of the isolates show a high level of resistance to commonly used drugs to treat otitis media. Therefore, culture and susceptibility testes have paramount importance for the better management of otitis media and drug-resistant infections.

TOPICAL CO-DELIVERY OF INDOMETHACIN AND NIGELLA SATIVA L. ESSENTIAL OIL IN POLY- -CAPROLACTONE NANOPARTICLES: IN VIVO STUDY OF ANTI-INFLAMMATORY ACTIVITY.

Indomethacin is a potent, nonselective Non-steroidal Antiinflammatory Drug (NSAID) but its low water-solubility precludes its use as topical dosage form. As with other NSAIDs, the systemic delivery is associated with high risk of serious gastrointestinal adverse events including bleeding, ulceration and perforation of stomach and intestines. Here we demonstrate a safer way of administration i.e via topical demonstrating synergistic effects when co-delivered with Nigella sativa L. seeds essential oil (NSSEO) in the form of coencapsulated particles (~200 nm) of poly--caprolactone. The particles showed penetrability across stratum corneum to dermis layer in ex-vivo human skin. Further study in the xyline-induced ear edema in mice was performed, and co-encapsulated particles demonstrated highest antiinflammatory effect compared to indomethacin particles and indomethacin gels. Despite slower onset compared to indomethacin gels, the inflamed ear continued to show reduction in thickness over 8 hours of observation demonstrating synergistic and pro-longed effect contributed by NSSEO. In immunohistochemistry study of CD45+, the mice ears treated with co-encapsulated particles showed considerable reduction in lesions, epidermal-dermal separation and inflammatory cells (lymphocytes and neutrophils) infiltration as compared to other formulation. Based on microscopic evaluation, the anti-inflammatory inhibition effect of co-encapsulated particles is the highest (90%) followed by indomethacin particles (79%) and indomethacin gel (49%). The findings suggest not only skin permeability of indomethacin significantly improved but also the therapeutic effects, all provided by the presence of NSSEO in the particles. This study paves the way to more co-encapsulation of any other contemporary medicines in combination with this wholesome natural oil, NSSEO.

Labyrinthitis Ossificans in a Cynomolgus Macaque (Macaca fascicularis).

Labyrinthitis is inflammation of the membranous and bony labyrinth of the inner ear. Typical portals of entry include hematogenous spread from the cochlear vasculature, passage of otitis media pathogens through the round window, and most commonly, meningogenic spread from the subarachnoid space. The sequela of chronic inner ear inflammation is labyrinthitis ossificans, in which inner ear structures are replaced by fibrous and osseous tissues. Labyrinthitis in humans has been reported concurrently with infection due to various viruses (for example, varicella–zoster, measles, mumps) and bacteria (for example, Treponema pallidum, Streptococcus pneumoniae) and may be associated with vertebrobasilar ischemia and meningitis. Profound sensorineural hearing loss is a common, serious complication of this disease. Here, we report a case of labyrinthitis ossificans in a cynomolgus macaque (Macaca fascicularis) with a potential infectious etiology. Historically, this animal had an indwelling femoral intravenous catheter for more than 4 y. He presented with a right-sided head tilt and incoordination of 2 mo duration. The macaque was treated with NSAID and antibiotics, which corrected the incoordination but not the head tilt. MRI revealed right-sided labyrinthitis, and euthanasia was elected due to clinical signs that were refractory to treatment. Gross pathology was unremarkable, but histopathology revealed chronic labyrinthitis ossificans with local fibroplasia and vestibuloauditory neuritis. We describe here the clinical features, imaging, and histologic lesions of labyrinthitis in a macaque.

The influence of the inflammatory process on immunologic factors in type 2 diabetic patients with rhinosinusitis and inflammation of middle ear

The influence of the inflammatory process on immunologic factors in type 2 diabetic patients with rhinosinusitis and inflammation of middle ear

The cytokine profile of blood in dependence on polymorphism of cytokine genes in patients with chronic purulent otitis media

The goal is to reveal features of changes in the ratio of cytokines IL-1β, IL-6, TNF-α and IL-10 in blood depending on polymorphism of genes IL1В, IL6, TNFА and IL10 at different clinical forms of chronic inflammation of the middle ear in the stage of exacerbation before treatment and on the 10th day of treatment. Materials and methods. A total of 299 patients (129 men and 170 women) with chronic purulent otitis media were examined: 146 with tubotympanic form and 153 with epitympanoantral form. The control group included 183 relatively healthy donors, comparable to those of 299 patients by sex and age. Human genomic DNA was isolated from the blood by a standard method and was analyzed with the use of the polymerase chain reaction (PCR) in real-time. The concentration of cytokines IL-1β, IL-6, TNF-α and IL-10 in blood was measured by solid-phase enzyme-linked assay before and after 10 days of treatment. Statistical processing of the obtained data was performed using software package STATISTICA 6.0 (StatSoft Inc., USA). The critical level of significance when testing statistical hypotheses was taken to be less than 0.05. Results. In patients with chronic purulent otitis media, an increase in the concentration of IL-1β, IL-6 and TNF-α in the blood varies depending on polymorphism of genes IL1В (-3953, -511, -31), IL6 (-174), TNFА (-308) and the clinical form of the disease. The concentration of IL-10 in the blood depends more on the polymorphism of the IL10 gene (-1082, -592) than on the clinical form of the disease. The combined increase of concentration of IL-10 and proinflammatory cytokines in the blood before the beginning and on the 10th day of combined treatment of patients with tubotympanic and epitympanoantral forms of chronic purulent otitis media, in carriers of high-producing alleles inflammatory cytokines of polymorphic variants of genes IL1B, IL6 and TNFA, indicates a genetic predisposition to hyperergic the course of inflammation.

Sea cucumber (Isostichopus badionotus) body-wall preparations exert anti-inflammatory activity in vivo

Sea cucumbers contain many bioactive compounds with potential health benefits. Their widespread use in East Asia, in traditional medicines and as food supplements, are depleting many local stocks and thus increasing their harvest worldwide. In recent years this has included heavy fishing of Isostichopus badionotus from the Yucatan Peninsula. The bioactivities in sea cucumber are known to vary greatly with species and growth conditions. Despite this, little study has been done on the capacity of I. badionotus captured from Yucatan to modulate health in vivo. Sea cucumbers were harvested from the Yucatan coast and body wall prepared, freeze dried and ground. The anti-inflammatory properties were evaluated using a hen’s egg test – chorioallantoic membrane (HET-CAM) assay, a rat feeding trial, and with a mouse ear inflammation model. Additional analysis was done by histology and qRT-PCR. Extracts of lyophilized I. badionotus exerted a strong anti-inflammatory activity in each of the assays. They attenuated histological disruption caused by inflammatory agents, repressed the expression of pro-inflammatory genes including TNFα, iNOS, COX2, NFκB or IL-6, and slightly enhanced the expression of anti-inflammatory or survival genes. Our study demonstrates that sea cucumber I. badionotus from the Yucatan Peninsula exhibits potent anti-inflammatory activity in vivo.

Anti-inflammatory hybrids of secondary amines and amide-sulfamide derivatives

The CXCR4/CXCL12 chemokine axis can chemotactically accumulate inflammatory cells to local tissues and regulate the release of inflammatory factors. Developing novel CXCR4 modulators may provide a desirable strategy to control the development of inflammation. A series of novel hybrids were designed by integrating the key pharmacophores of three CXCR4 modulators. The majority of compounds displayed potent CXCR4 binding affinity. Compound 7a exhibited 1000-fold greater affinity than AMD3100 and significantly inhibited invasion of CXCR4-positive tumor cells. Additionally, compound 7a blocked mice ear inflammation by 67% and suppressed the accumulation of inflammatory cells in an in vivo mouse ear edema evaluation. Western blot analyses revealed that 7a inhibited the CXCR4/CXCL12-mediated phosphorylation of Akt and p44 in a dose-dependent manner. Moreover, compound 7a had no observable cytotoxicity and displayed a favorable plasma stability in our preliminary pharmacokinetic study. These results confirmed that this is a feasible method to develop CXCR4 modulators for the regulation and reduction of inflammation.

Neutralization of IL-17C Reduces Skin Inflammation in Mouse Models of Psoriasis and Atopic Dermatitis

IL-17C is a functionally distinct member of the IL-17 family that was believed to play a role in the pathogenesis of psoriasis. Here we confirmed that IL-17C is involved in psoriasis and explored potential roles for IL-17C in atopic dermatitis (AD). An anti-IL-17C antibody, MOR106, was generated that potently and selectively binds to human and mouse IL-17C, thereby inhibiting the binding of IL-17C to its IL-17RE receptor. The antibody inhibited cutaneous inflammation in an IL-23-induced psoriatic-like skin inflammation model. In lesional skin of patients with AD, IL-17C expression levels were increased and localized to keratinocytes and infiltrating immune cells. To determine the contribution of IL-17C to AD pathogenesis, MOR106 was tested in two distinct invivo models. In the calcipotriol-induced AD model, ear skin inflammation, TSLP, and IL-33 protein production in ears was suppressed by MOR106. Consistently, in the flaky tail strain mouse model, spontaneous development of AD-like skin inflammation was reduced by MOR106. Moreover, serum IgE levels, number of mast cells in skin and T helper type 2-related cytokines IL-4 and CCL17 in serum were all reduced. Overall, our resultsindicate that IL-17C is a central mediator of skin inflammation beyond psoriasis and is relevant in particular in AD.

Starch nanocapsules containing a novel neutrophil elastase inhibitor with improved pharmaceutical performance

Psoriasis and atopic dermatitis patients show an excessive amount of elastase in peripheral blood neutrophils due to an imbalance between this proteolytic enzyme and its endogenous inhibitors, the search for new human neutrophil elastase (HNE) inhibitors are required. The HNE is an attractive therapeutic target and inhibitors with new molecular architectures have been extensively investigated. In this context a promising novel synthetic human neutrophil elastase inhibitor (ER143) was associated to a starch-based nanoparticulate system (StNC) with improved pharmaceutical performance, using a quality by design approach to support product development and optimization. The resulting formulation was characterized in terms of and in vitro release, permeation and retention studies in newborn pig skin, using Franz diffusion cells revealing the StNC have the ability to control the drug release rate and contribute to a high skin retention and/or permeation profiles. The anti-inflammatory activity accessed in vivo using the croton oil-induced ear inflammation model in mice showed that erythema and edema were attenuated in 98% following local application. These observations suggest the association of ER143 to the StNC promotes a deeper skin penetration and retention, also confirming StNC as a potential topical delivery system.

Subcutaneous immunotherapy with purified Der p1 and 2 suppresses type 2 immunity in a murine asthma model.

BackgroundAllergen‐specific immunotherapy can induce long‐term suppression of allergic symptoms, reduce medication use, and prevent exacerbations of allergic rhinitis and asthma. Current treatment is based on crude allergen extracts, which contain immunostimulatory components such as β‐glucans, chitins, and endotoxin. Use of purified or recombinant allergens might therefore increase efficacy of treatment.AimsHere, we test application of purified natural group 1 and 2 allergens from Dermatophagoides pteronyssinus (Der p) for subcutaneous immunotherapy (SCIT) treatment in a house dust mite (HDM)‐driven mouse model of allergic asthma.Materials and methods HDM‐sensitized mice received SCIT with crude HDM extract, a mixture of purified Der p1 and 2 (DerP1/2), or placebo. Upon challenges, we measured specific immunoglobulin responses, allergen‐induced ear swelling response (ESR), airway hyperresponsiveness (AHR), and inflammation in bronchoalveolar lavage fluid (BAL) and lung tissue.Results ESR measurement shows suppression of early allergic response in HDM‐SCIT– and DerP1/2‐SCIT–treated mice. Both HDM‐SCIT and DerP1/2‐SCIT are able to suppress AHR and eosinophilic inflammation. In contrast, only DerP1/2‐SCIT is able to significantly suppress type 2 cytokines in lung tissue and BAL fluid. Moreover, DerP1/2‐SCIT treatment is uniquely able suppress CCL20 and showed a trend toward suppression of IL‐33, CCL17 and eotaxin levels in lung tissue.DiscussionTaken together, these data show that purified DerP1/2‐SCIT is able to not only suppress AHR and inflammation, but also has superior activity toward suppression of Th2 cells and HDM‐induced activation of lung structural cells including airway epithelium.ConclusionsWe postulate that treatment with purified natural major allergens derived from HDM will likely increase clinical efficacy of SCIT.

Locacorten Vioform Ototoxicity Upon Guinea Pig Middle Ear Application.

Background and ObjectivesLocacorten Vioform (Novartis UK) is frequently prescribed for otomycosis. Its component, Clioquinol, also has anti-bacterial properties. Up to this point, its ototoxic potential has not been evaluated. Our objective aims to evaluate Locacorten Vioform’s potential ototoxicity when applied directly to the middle ear cavity. Materials and MethodsWe performed an experimental prospective animal study in our animal research center with 20 Hartley guinea pigs divided into 2 groups. The first group (experimental) was treated with Locacorten Vioform in one ear and with a physiologic saline solution in the other. The second group (positive control) was treated with concentrated gentamycin in one ear and physiologic saline in the other. Auditory brainstem response measurements were obtained before and after three sets of injections. Statistics were analyzed using a variance analysis with repeated measures. The histological state of cochlear outer hair cells was compared between the two groups using scanning electron microscopy.ResultsAverage hearing loss in ears treated with Locacorten Vioform was 32.1 dB, compared with a 2.5 dB average loss in the saline-treated ears. Ears treated with gentamycin lost an average of 33.0 dB. There were clinically and statistically significant differences between the two ears of the guinea pigs in both groups (p<0.001). Scanning electron microscopy revealed severe pericochlear and cochlear inflammation and ossification in the Locacorten Vioform-treated ears. Gentamycin caused significant destruction of outer hair cell architecture. ConclusionsLocacorten Vioform induces a hearing loss similar to that caused by gentamycin when applied directly to the middle ear of a guinea pig model. Electron microscopy indicates a pericochlear and cochlear inflammatory reaction with ossification.

Otitis media in children

Otitis media is a spectrum of diseases associated with middle ear infection. Acute otitis media is one of the most common acute infections in childhood, with a peak incidence in the second half of infancy. A diagnosis of acute otitis media is often challenging and requires three criteria to be met - acute onset of symptoms, signs of middle ear inflammation, and effusion. Otitis media with effusion is the presence of middle ear effusion without signs or symptoms of ear inflammation such as pain and fever as a result of impaired middle ear ventilation. Features of middle ear effusion in the absence of features of inflammation helps to make the diagnosis of otitis media with effusion. Most cases are self-resolving with 75%–90% showing complete resolution within 3 months.

Povidone-iodine and glycerine for treatment of acute otitis externa

Introduction: Acute otitis externa (AOE) is the inflammation of the external ear. It usually presents with severe pain in the ear. The treatment of AOE should aim in relieving pain at the earliest. Out of the various treatment options, topical treatment should be considered as prescribing oral antibiotics without local treatment can cause antibiotic abuse. Due to unavailability, cost, and compliance issues of other topical measures, we observed and proved the effectiveness of a new modality glycerine and povidone-iodine wick in the treatment of AOE. Objectives: The objective of this study is to study the efficacy of new modality treatment-glycerine and povidone-iodine wick for AOE. Materials and Methods: Three hundred and forty-seven cases with AOE due to exclusive bacterial infection were included in the study. Otitis externa was graded as per Brighton grading scheme. Pain score was assessed using Wong and Baker pain assessment scale. Patients were treated by performing a thorough aural toilet, keeping a glycerine and povidone iodine wick in the EAC and prescribing a nonsteroidal anti-inflammatory drug. Few severe cases were administered the systemic antibiotic. Score of pain, canal edema, and the presence of ear fullness on D1, D3 (48 h later), and D5 was noted. Further assessment and repacking with a fresh wick was done if required until the pain and edema subsides completely. Results: It was seen that canal edema and tragal tenderness subsided significantly (P < 0.001) on follow-up visits. The severity of pain scale on D1 decreased significantly (P ≤ 0.001) on D3. On D3 or the first follow-up visit, 68 (19.5%) of patients required repacking, whereas there was no need for repacking on D5, i.e., second follow-up visit. Average duration of the clinical resolution was 3 days. Conclusions: The treatment method was readily available, easy to perform, cost-effective and had a better patient compliance. Povidone-iodine scores with no proven microbial resistance until date. To enhance delivery of drug locally specialist ear cleaning followed by wick insertion should be done. Use of glycerine and povidone-iodine ear pack is definitely effective with the good clinical outcome by 3 days maximum duration is 7 days. Use of oral antibiotics only for selected cases along with topical treatment for otitis externa is advisable. The outcome regarding pain relief and edema reduction were analyzed with satisfactory outcome at the earliest.

The modern approaches to the evaluation of the importance of chronic inflammation in the mucous membrane of the middle ear

Despite the ever growing progress in antibiotic therapy and the advent of the new methods for this purpose, the number of patients suffering from chronic focal infection of the ENT organs has not decreased during the last decades which turns the problem of chronization of inflammation into a serious challenge for the physicians as exemplified by chronic inflammation in the mucous membrane of the middle ear. Pathological changes in the middle ear make up a large fraction of ENT diseases of importance not only for otorhinolaryngologists but also for the specialists in the related medical disciplines. The present article is an overview of etiological, pathogenetic, and pathomorphological aspects of chronization of the inflammation process that are known to occur in the mucous membrane of the middle ear. In the overwhelming majority of the cases, the main cause of the conversion of acute inflammation in the middle ear into the chronic condition is the inadequate (incorrect), inopportune or incomplete treatment of the acute inflammatory process in the middle ear.

The peculiar clinical features of different types of acquired cholesteatoma of the middle ear

We have undertaken the analysis of the specific clinical manifestations of acquired cholesteatoma of the middle ear in 437 chronic patients suffering from this pathology. 96.1% of them presented with primarily acquired cholesteatoma of the middle ear (including 53.3% having attic cholesteatoma, 22.8% with sinus cholesteatoma, and 19.9% of tensa retraction cholesteatoma). 3.9% of the patients exhibited a different mechanism of development of cholesteatoma. The secondary acquired mesotympanic cholesteatoma formed in association with the long-term chronic inflammation of the middle ear, concomitant perforation of the tympanic membrane and epithelial invasion from the edge of the tympanic membrane perforation and middle ear cavity. Typmanosclerosis of different degree and localization played an important role in the enhancement of the prevalence of this condition. All types of acquired cholesteatoma were found to extend beyond the point of origin of the disorder. The maximum destruction of the ossicular chain was documented in the patients presenting with sinus cholesteatoma. Those with secondary acquired cholesteatoma showed the worst functional capacity as a result of rigid fixation of the auditory ossicles. The overall cholesteatoma relapse rate (including both residual and recurrent cholesteatoma) was estimated to be 15.6%. It is concluded that the surgical strategy should be chosen on an individual basis for each concrete patient. The long-term observation of the treated patients with the application of the up-to-date radiological techniques is believed to be the indispensable prerequisite for the successful management of the complicated pathology under consideration.

Expression of tumor necrosis factor - α (TNF-α) and interleukin 1-β (IL1-β) in chronic tubotympanic suppurative otitis media

Chronic Suppurative Otitis Media (CSOM) is a common public health problem worldwide and a major cause of hearing impairment. It is also one of the neglected disease especially in developing countries. Cytokines are a group of glycoproteins that play a role in strengthening the immune and inflammatory reactions in various diseases, including inflammation of the middle ear. Some of the important inflammatory mediators found in middle ear fluids are Tumor Necrosis Factor-α (TNF-α) and Interleukin-1β (IL-1β). Cytokines are thought to play a role in the ongoing inflammatory regulation. The aim of this study was to compare the expression of TNF-α and IL-1β in tubotympanic CSOM and in healthy control group. The mean of TNF-α serum level in tubotympanic CSOM was 0,553±1,59 pg/ ml, and 0,587±2,13 pg/ ml in control group. There was no statistically different of TNF-α between two groups (P > 0,05). Mean of IL-1β serum level in the tubotympanic CSOM and control group were 0,633±0,92 and 0,302±0,48, respectively. Although IL-1β levels were higher in the patient group, the difference was not statistically significant (P > 0,05).

Otomycosis: the modern view of etiology and management

This article deals with the modern approaches to the diagnostics and treatment of fungal ear infection depending on the localization of the inflammatory process and the species of the causative fungal agent with special reference to the factors underlying the development of otomycosis under the present-day conditions based on the results of the analysis of the studies carried out during the period from 2010 to 2014. The materials of the examination of 2152 patients who applied for the medical care to various clinical departments of the Institute and were found to present with chronic inflammatory ear pathology were available for the analysis. Fungal lesions were diagnosed in 495 (23%) patients with this condition. Fungal lesions of the external ear were the predominant form of pathology; they were documented in 331 (67%) patients. Fungal otitis media was diagnosed in 85 (17%) patients and fungal lesions of the postoperative cavity in 79 (16%) patients suffering from otomycosis. 65% of the patients presenting with external fungal otitis, 20% of those with fungal otitis media, and 95% of the patients with inflammation of the postoperative cavity were infected with mold fungi dominated by the genus Aspergillus spp. 79 (16%) patients suffering from otomycosis. In 35% of the patients presenting with fungal external otitis, 80% of those with fungal otitis media, and 5% of the patients with inflammation of the postoperative cavity of the middle ear, the causative agents of the disease were the fungi Candida spp. The authors describe the modern schemes for the treatment of otomycosis elaborated at the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology.

Bacteriological study and antibiotic sensitivity profile in patients with ear discharge visiting ENT OPD at tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Otitis media (OM) is a big menace in countries like India. Chronic suppurative otitis media (CSOM) is chronic inflammation of middle ear, which affects the tympanic membrane, middle ear mucosa and other middle ear structures characterised by the presence of persistent perforation or persistent mucoid or muco-purulent discharge for at least 8 weeks. Variety of organisms founds in patients suffering from chronic otitis media like, &lt;em&gt;Pseudomonas&lt;/em&gt;, &lt;em&gt;Staphylococcus aureus&lt;/em&gt;, &lt;em&gt;Proteus mirabilis&lt;/em&gt;, &lt;em&gt;Klebsiella pneumonia&lt;/em&gt; and &lt;em&gt;Escherichia coli&lt;/em&gt; found. The pattern of organisms varies in different geographical areas. The objectives of the study were to isolate bacteria from patients with ear discharge, to find out antibiotic sensitivity of isolated organisms&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This is an observational cross sectional study done in the OPD department of otorhinolaryngology, at P.D.U medical college and hospital, Rajkot, for a period of six months from January 2017 to June 2017. A total number 200 patients of both gender between 5 to 74 years who visited the OPD department of otorhinolaryngology with chronic ear discharge taken for study. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Out of 200 patients of 5-74 years with chronic suppurative otitis media were examined and out of this Hundred and twelve (54%) of the patients were males with mean age of 33.44. &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; was the commonest identified organisms the sensitivity pattern highly favoured Pipercillin, Amikacin and Polymyxin B, Cefoparazone. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Chronic otitis media is more prevalent in males than females. Commonest organisms found were &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; followed by &lt;em&gt;Staphylococcus aureus. &lt;/em&gt;Piperacillin, Amikacin, Gentamicin, Polymyxin B and Cefoperazone were found most effective agents against &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt;.&lt;/span&gt;&lt;/p&gt;

Development of triptolide-nanoemulsion gels for percutaneous administration: physicochemical, transport, pharmacokinetic and pharmacodynamic characteristics

BackgroundThis work aimed to provide useful information on the use of nanoemulsions for the percutaneous administration of triptolide. Lipid nanosystems have great potential for transdermal drug delivery. Nanoemulsions and nanoemulsion gels were prepared to enhance percutaneous permeation. Microstructure and in vitro/in vivo percutaneous delivery characteristics of triptolide (TPL)-nanoemulsions and TPL-nanoemulsion gels were compared. The integrity of the nanoemulsions and nanoemulsion gels during transdermal delivery and its effects on the surface of skin were also investigated. The penetration mechanisms of nanoemulsions and nanoemulsion gels were investigated by differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR). The transport characteristics of fluorescence-labelled nanoemulsions were probed using laser scanning confocal microscopy. A chronic dermatitis/eczema model in mice ears and the pharmacodynamic of the TPL-nanoemulsion gels were also investigated.ResultsCompared to TPL gels, significantly greater cumulative amounts of TPL-nanoemulsion gels and TPL-nanoemulsions penetrated rat skin in vitro. The in vivo microdialysis showed the concentration–time curve AUC0–t for TPL-NPs is bigger than the TPL-gels. At the same time, TPL-NPs had a larger effect on the surface of skin. By hydrating keratin and changing the structure of both the stratum corneum lipids and keratin, nanoemulsions and nanoemulsion gels influence skin to promote percutaneous drug penetration. Both hairfollicles and the stratum corneum are also important in this transdermal drug delivery system. Moderate and high dosages of the TPL-nanoemulsion gels can significantly improve the symptoms of dermatitis/eczema inflammation and edema erythematic in mice ears and can reduce the expression of IFN-γ and IL-4. Moreover, the TPL-nanoemulsion gels cause less gastrointestinal damage than that of the Tripterygium wilfordii oral tablet does.ConclusionsNanoemulsions could be suitable for transdermal stably releasing drugs and maintaining the effective drug concentration. The TPL-nanoemulsion gels provided higher percutaneous amounts than other carriers did. These findings suggest that nanoemulsion gels could be promising percutaneous carriers for TPL. The TPL-nanoemulsion gels have a significant treatment effect on dermatitis/eczema in the mice model and is expected to provide a new, low-toxicity and long-term preparation for the clinical treatment of dermatitis/eczema in transdermal drug delivery systems.