Oral Gel Research Articles

Oral glucose gel in the prevention of neonatal hypoglycemia: A systematic review and meta-analysis.

Neonatal hypoglycemia (NH) is the most prevalent metabolic disorder in neonates and glucose gel in oral solution is a relatively new treatment option for NH. We aimed to determine whether oral glucose gel can prevent NH. We conducted an open literature search using PubMed, Embase, Cochrane Library, and Web of Science. We used relative risk as the statistical data, expressed each outcome effect as a 95% confidence interval, and conducted a heterogeneity test. If heterogeneity statistics indicated that I2 was ≥ 50%, the random effects model analysis was used; otherwise, the fixed effects model analysis was conducted, and sensitivity analyses were conducted for all outcomes. In this review, we included a total of 10 studies involving 4801 neonates. Meta-analysis revealed that there were no significant differences between the preventive oral glucose gel group and the control group in terms of blood glucose concentration, glucose concentration 30 minutes after the first breastfeeding, length of stay, Bayley-III composite score, subsequent need for intravenous injection of glucose, 24-hour glucose > 50 mg/dL, separation from mother for treatment of hypoglycemia/admitted to neonatal intensive care unit for hypoglycemia, normoglycemia after 1 to 2 treatments, or normoglycemia after more than 2 treatments, breastfeeding at discharge, delayed feeding, neurosensory impairment, parental satisfaction, developmental delay, and seizure. The subsequent intake was significantly lower in the glucose gel group compared to the control group. The use of oral glucose gel as a preventative measure may not reduce the incidence of NH. In order to assess the efficacy of glucose gel in preventing NH, a more high-quality, large-sample, and rigorously designed randomized controlled trial is required.

Preliminary clinical study of mucoadhesive propolis gel to gingival disorders control in patients with fixed orthodontic appliances.

Aims: Gingival hyperplasia (GH) etiology is diverse and ranges from acute or chronic inflammatory processes and is commonly observed in patients with fixed orthodontic appliances. Propolis has been globally studied and has anti -inflammatory and antimicrobial properties, however, there are few clinical studies involving orthodontics. Study design: This clinical study aims to obtain preliminary evidence of an oral gel containing 5% Brazilian propolis (BPG) in GH and gingivitis control on patients with fixed orthodontic appliances. Place and Duration study: Clinic Orthodontics, Faculty of Dentistry/UFMG, Belo Horizonte, Brazil, from March to October 2013. Methodology: Thirty patients were selected, but only 10 participated and reached the end of the study. The patients were submitted to questionnaire and a complete prophylaxis of dental structures before initiating the gel use(T0) and they were instructed to use the gel two times daily after brushing (morning and evening) during 30 days (T30). Patients were evaluated considering plaque and gingival index and photographs collection of first premolars - measuring gingiva of the clinical crown area. The SPSS version 18.0 statistical program, Shapiro Wilk normality test, presenting a normal or parametric distribution and all analyzes were performed using Student's t Test for paired samples. Results: BPG show statistically significant reduction of GBI and GSI (GB1 p =0.207; GB2 p = 0.122), respectively. Conclusion: Considering this study model, 5% propolis gel had effective in reducing GH and gingivitis. However, a double blind and randomized clinical studies with higher number of patients should be made to give greater credibility for gel use.

Oral dextrose gel to prevent hypoglycaemia in at-risk neonates.

Neonatal hypoglycaemia is a common condition that can be associated with brain injury. Current practice usually includes early identification of at-risk infants (e.g. infants of diabetic mothers; preterm, small- or large-for-gestational-age infants), and prophylactic measures are advised. However, these measures often involve use of formula milk or admission to the neonatal unit. Dextrose gel is non-invasive, inexpensive and effective for treatment of neonatal hypoglycaemia. Prophylactic dextrose gel can reduce the incidence of neonatal hypoglycaemia, thus potentially reducing separation of mother and baby and supporting breastfeeding, as well as preventing brain injury. This is an update of a previous Cochrane Review published in 2021. To assess the effectiveness and safety of oral dextrose gel in preventing hypoglycaemia before first hospital discharge and reducing long-term neurodevelopmental impairment in newborn infants at risk of hypoglycaemia. We searched CENTRAL, MEDLINE, Embase and Epistemonikos in April 2023. We also searched clinical trials databases and the reference lists of retrieved articles. We included randomised controlled trials (RCTs) and quasi-RCTs comparing oral dextrose gel versus placebo, no intervention, or other therapies for the prevention of neonatal hypoglycaemia. We included newborn infants at risk of hypoglycaemia, including infants of mothers with diabetes (all types), high or low birthweight, and born preterm (< 37 weeks), age from birth to 24 hours, who had not yet been diagnosed with hypoglycaemia. Two review authors independently extracted data and assessed the risk of bias. We contacted investigators to obtain additional information. We used fixed-effect meta-analyses. We used the GRADE approach to assess the certainty of evidence. We included two studies conducted in high-income countries comparing oral dextrose gel versus placebo in 2548 infants at risk of neonatal hypoglycaemia. Both of these studies were included in the previous version of this review, but new follow-up data were available for both. We judged these two studies to be at low risk of bias in 13/14 domains, and that the evidence for most outcomes was of moderate certainty. Meta-analysis of the two studies showed that oral dextrose gel reduces the risk of hypoglycaemia (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95; risk difference (RD) -0.06, 95% CI -0.10 to -0.02; 2548 infants; high-certainty evidence). Evidence from two studies showed that there may be little to no difference in the risk of major neurological disability at two years of age after oral dextrose gel (RR 1.00, 95% CI 0.59 to 1.68; 1554 children; low-certainty evidence). Meta-analysis of the two studies showed that oral dextrose gel probably reduces the risk of receipt of treatment for hypoglycaemia during initial hospital stay (RR 0.89, 95% CI 0.79 to 1.00; 2548 infants; moderate-certainty evidence) but probably makes little or no difference to the risk of receipt of intravenous treatment for hypoglycaemia (RR 1.01, 0.68 to 1.49; 2548 infants; moderate-certainty evidence). Oral dextrose gel may have little or no effect on the risk of separation from the mother for treatment of hypoglycaemia (RR 1.12, 95% CI 0.81 to 1.55; two studies, 2548 infants; low-certainty evidence). There is probably little or no difference in the risk of adverse effects in infants who receive oral dextrose gel compared to placebo gel (RR 1.22, 95% CI 0.64 to 2.33; two studies, 2510 infants; moderate-certainty evidence), but there are no studies comparing oral dextrose with other comparators such as no intervention or other therapies. No data were available on exclusive breastfeeding after discharge. Prophylactic oral dextrose gel reduces the risk of neonatal hypoglycaemia in at-risk infants and probably reduces the risk of treatment for hypoglycaemia without adverse effects. It may make little to no difference to the risk of major neurological disability at two years, but the confidence intervals include the possibility of substantial benefit or harm. Evidence at six to seven years is limited to a single small study. In view of its limited short-term benefits, prophylactic oral dextrose gel should not be incorporated into routine practice until additional information is available about the balance of risks and harms for later neurological disability. Additional large follow-up studies at two years of age or older are required. Future research should also be undertaken in other high-income countries, low- and middle-income countries, preterm infants, using other dextrose gel preparations, and using comparators other than placebo gel. There are three studies awaiting classification and one ongoing study which may alter the conclusions of the review when published.

Evaluation of the prophylactic efficacy of oral calcium gel in preventing milk fever relapse and hypocalcemia in post-calved dairy cows

Oral Calcium Gel (OCG) is a promising prophylactic and supportive supplement for milk fever and Downer syndrome in postcalved dairy cows. This study evaluated the efficacy of OCG supplementing in improving rumen motility, feed intake, parturition/calving, Retention of Placenta (ROP), and product performance and safety. A total of 30 postcalved dairy cows were randomly divided into three groups: G1, cows selected immediately after calving (n = 7); G2, cows with milk fever (n = 14); and G3, cows with milk fever and Downer syndrome (n = 9). The cows in G1 and G2 were supplemented with OCG 300 g; 8 – 12 h apart; repeat 2 – 4 supplementation for 1 – 2 days only. Conversely, the cows in G3 were supplemented with 300 g of OCG + IV calcium injection; + 8 – 12 h apart; repeat 1 – 3 supplementation of OCG (300 g). OCG supplementation improved rumen motility, feed intake, parturition/calving, and ROP in all three groups. The mean product performance and safety scores were also good. Notably, OCG supplementation was effective in preventing ROP, which is a common postpartum complication in dairy cows. Overall, the findings of this study suggest that OCG supplementation is a promising prophylactic and supportive agent for milk fever and Downer syndrome in postcalved dairy cows.

Presurgical Oral Tamoxifen vs Transdermal 4-Hydroxytamoxifen in Women With Ductal Carcinoma In Situ

Oral tamoxifen citrate benefits women with ductal carcinoma in situ (DCIS), but concern about toxic effects has limited acceptance. Previous pilot studies have suggested transdermal 4-hydroxytamoxifen gel has equivalent antiproliferative efficacy to oral tamoxifen, with low systemic exposure. To demonstrate that 4-hydroxytamoxifen gel applied to the breast skin is noninferior to oral tamoxifen in its antiproliferative effect in DCIS lesions. This randomized, double-blind, phase 2 preoperative window trial was performed at multicenter breast surgery referral practices from May 31, 2017, to January 27, 2021. Among 408 women with estrogen receptor-positive DCIS who were approached, 120 consented and 100 initiated study treatment. The most common reasons for nonparticipation were surgical delay, disinterest in research, and concerns about toxic effects. Data were analyzed from January 26, 2021, to October 5, 2022. Random assignment to oral tamoxifen citrate, 20 mg/d, and gel placebo or 4-hydroxytamoxifen gel, 2 mg/d per breast, and oral placebo, for 4 to 10 weeks, followed by DCIS resection. The primary end point was absolute change in DCIS Ki-67 labeling index (Ki67-LI). Secondary end points included 12-gene DCIS Score, breast tissue tamoxifen metabolite concentrations, tamoxifen-responsive plasma protein levels, and patient-reported symptoms. Noninferiority of Ki67-LI reduction by 4-hydroxytamoxifen gel was tested using analysis of covariance; within- and between-arm comparisons were performed with paired t tests for mean values or the Wilcoxon rank sum test for medians. Of 90 participants completing treatment (mean [SD] age, 55 [11] years; 8 [8.9%] Asian, 16 [17.8%] Black, 8 [8.9%] Latina, and 53 [58.9%] White), 15 lacked residual DCIS in the surgical sample, leaving 75 evaluable for the primary end point analysis (40 in the oral tamoxifen group and 35 in the 4-hydroxytamoxifen gel group). Posttreatment Ki67-LI was 3.3% higher (80% CI, 2.1%-4.6%) in the 4-hydroxytamoxifen gel group compared with the oral tamoxifen group, exceeding the noninferiority margin (2.6%). The DCIS Score decreased more with oral tamoxifen treatment (-16 [95% CI, -22 to -9.4]) than with 4-hydroxytamoxifen gel (-1.8 [95% CI, -5.8 to 2.3]). The median 4-hydroxytamoxifen concentrations deep in the breast were nonsignificantly higher in the oral tamoxifen group (5.7 [IQR, 4.0-7.9] vs 3.8 [IQR, 1.3-7.9] ng/g), whereas endoxifen was abundant in the oral tamoxifen group and minimal in the 4-hydroxytamoxifen gel group (median, 13.0 [IQR, 8.9-20.6] vs 0.3 [IQR, 0-0.3] ng/g; P < .001). Oral tamoxifen caused expected adverse changes in plasma protein levels and vasomotor symptoms, with minimal changes in the transdermal group. In this randomized clinical trial, antiproliferative noninferiority of 4-hydroxytamoxifen gel to oral tamoxifen was not confirmed, potentially owing to endoxifen exposure differences. New transdermal approaches must deliver higher drug quantities and/or include the most potent metabolites. ClinicalTrials.gov Identifier: NCT02993159.

SAT134 CGM Use During Pregnancy Complicated By CF-Induced Diabetes

Abstract Disclosure: A.Y. Mazori: None. E.S. Markovic: None. C.J. Levy: Advisory Board Member; Self; Dexcom, Eli Lilly &amp; Company. Research Investigator; Self; Abbott Laboratories, Insulet Corporation, Tandem Diabetes Care, Dexcom. Introduction: Glycemic control remains challenging in pregnancies complicated by diabetes mellitus. Strict glycemic targets are required to optimize maternal and neonatal outcomes, but euglycemia is hindered by fluctuating insulin sensitivity and the need for frequent blood-glucose monitoring (BGM). Consensus guidelines recommend therapeutic continuous glucose monitoring (CGM) for pregnant and nonpregnant individuals with type 1 and type 2 diabetes, but current data support therapeutic CGM use in cystic fibrosis (CF)-related diabetes (CFRD) only outside of pregnancy. We report the case of a patient with CFRD who achieved recommended glycemic targets with a therapeutic CGM during a singleton pregnancy. Methods: A case report and literature review are presented. Results: A 32-year-old nulliparous woman with CF became pregnant via frozen-embryo transfer. Prior CF complications included CFRD, pancreatic insufficiency, and recurrent pancreatitis. A therapeutic Dexcom G6 CGM and intermittent BGM were used to monitor glycemic control before and during pregnancy; sensor use exceeded 96%. Pressure-induced sensor attenuations yielded sporadic hypoglycemic values discordant with simultaneous BGM. CGM analysis for the 90 days preceding conception revealed: time in range of 63-140 mg/dL (TIR) was 90.8%, time above range (TAR) 6.3%, and time below range (TBR) 2.9%. Throughout pregnancy, TIR was 92.9%, TAR 3.4%, and TBR 3.6%; no severe hypoglycemia occurred. Daytime (6AM to midnight) and nighttime hypoglycemia were 4.6% and 2.2%, respectively. In the first trimester, TIR was 90.8%, TAR 3.7%, and TBR 5.5%. During the second trimester, the patient achieved TIR 94.2%, TAR 2.6%, and TBR 3.2%. In the third trimester, TIR was 95.7%, TAR 0.9%, and TBR 3.4%. The pregestational CFRD regimen consisted of insulin glargine 12 units and lispro 3-8 units. The basal-insulin dose was 10 units at 13 weeks’ gestation, 9 units at 27 weeks’ gestation, and 8 units at 38 weeks’ gestation. The prandial-insulin doses varied between 1.5-5 units at 13 weeks’ gestation, 0-7 units at 27 weeks’ gestation, and 0-5 units at 38 weeks’ gestation. After an uncomplicated vaginal delivery at 38 weeks and six days’ gestation, maternal fasting hypoglycemia occurred after one dose of glargine 3 units. Euglycemia was obtained without basal, prandial, or correctional insulin. The neonate experienced mild hypoglycemia that resolved with oral glucose gel and feeding. The neonate was neither macrosomic nor large for gestational age (birth weight, 3.54 kg, 71st percentile) and did not require intensive-care unit management. Both the patient and neonate were discharged on postpartum day two. Conclusion: Therapeutic CGM use in a pregnancy complicated by CFRD was effective for maternal and neonatal outcomes. Further study is warranted to examine CGM use and efficacy in this population. Presentation: Saturday, June 17, 2023

Edible Gels with Cranberry Extract: Evaluation of Anthocyanin Release Kinetics.

The bioactive compounds found in cranberry fruit are natural antioxidants, and their consumption reduces the risk of diabetes, cardiovascular disease, cancers, and urinary tract infections. Oral gels with cranberry fruit extract are a promising product that can ensure accurate dosage and release of the active compounds and are suitable for people with dysphagia. The aim of this study was to determine the effect of polymeric materials on the dissolution kinetics of cranberry fruit anthocyanins from gel formulations. Gel formulations were prepared using freeze-dried cranberry fruit extract with different gelling excipients: chitosan (G1-G3), sodium carboxymethylcellulose (G4-G6), and sodium carboxymethylcellulose combined with carbomers (G7-G9). The dissolution test showed that the release of anthocyanins from gel formulations G1-G6 and G9 was most intense within the first 10 min, with little change in the anthocyanin content of the acceptor medium afterwards. For the formulations based on carboxymethyl cellulose and carbomers G7 and G8, the amount of anthocyanins released into the acceptor medium gradually increased, which prolonged the release time of the active compounds. The test for the release of anthocyanins from the semi-solid systems through a hydrophilic membrane revealed that within the first hour, the total amount of anthocyanins released from the modeled gel formulations (G1-G9) was within the range of 6.02%-13.50%. The 1% chitosan (G1) gel formulation released the fastest and highest amount of anthocyanins (70% within 6 h). The other formulations showed a slower release of anthocyanins, and after 6 h, the amount of anthocyanins released from formulations G2-G9 was <57%.

Midwife or doctor leader to implement a national guideline in babies on postnatal wards (DesIGN): A cluster-randomised, controlled, trial.

The aim of this trial was to determine if midwives or doctor leaders are more effective at implementing a clinical practice guideline for oral dextrose gel to treat neonatal hypoglycaemia. This was a cluster-randomised, controlled, trial. New Zealand maternity hospitals were randomised to guideline implementation by a midwife or doctor implementation leader. The primary outcome was the change in the proportion of hypoglycaemic babies (blood glucose concentration <2.6 mmol/L in the first 48 hours after birth), treated with dextrose gel from before, to three months after, implementation. Twenty-one maternity hospitals that cared for babies at risk of hypoglycaemia consented to participate, of which 15 treated babies with hypoglycaemia at both time points (7 randomised to midwifery led, 8 randomised to doctor led implementation). The primary outcome included 463 hypoglycaemic babies (292 midwifery led, 171 doctor led implementation). There was no difference in the primary outcome between hospitals randomised to midwifery or doctor led implementation (proportion treated with gel, mean(SD); midwifery led: before 71 (38)%, 3 months after 87 (12)%; doctor led: before 63 (43)%, 3 months after 86 (16)%; adjusted mean change in proportion (95%CI); 19.3% (-4.5-43.1), p = 0.11). There was an increase in the proportion of eligible babies treated with oral dextrose gel from before to 3 months after implementation of the guideline (122/153 (80%) v 144/163 (88%), OR (95%CI); 3.42 (1.67-6.98), p<0.001). Implementation of a clinical practice guideline improved uptake of oral dextrose gel. There was no evidence of a difference between midwife and doctor implementation leaders for implementing this guideline for treatment of hypoglycaemic babies. The trial was prospectively registered on the ISRCTN registry on the 20/05/2015 (ISRCTN61154098).

Antibacterial Activities of Oral Care Products Containing Natural Plant Extracts from the Thai Highlands against Staphylococcus aureus: Evaluation and Satisfaction Studies

In this research, we aimed to assess antibacterial activity and develop oral care products from three natural plant extracts from the Thai highlands. The plants, including Camellia sinensis var. assamica, Zanthozylum limonella Alston, and Acorus calamus L., were extracted using two traditional extraction techniques: maceration and hydrodistillation methods. The extracts were characterized by percentage yield, total phenolic, and total flavonoid contents. Antibacterial activity against Staphylococcus aureus, which play a role in oral health and disease, was investigated. C. sinensis var. assamica extract had the highest content of phenolic acid (38.15 ± 4.12 mg GAE/g extract) and flavonoids (44.91 ± 2.76 mg QE/g extract). Interestingly, a combination of C. sinensis with Z. limonella and A. calamus provides a greater inhibitory effect against S. aureus. Furthermore, oral care products were prepared as a natural product mixture in two preparations: (i) oral ulcers gel and (ii) oral spray. Apart from antibacterial efficiency, volunteer satisfaction after the usage of oral care products containing traditional plant extracts was investigated via organoleptic evaluation. The findings of the volunteer surveys indicated positive feedback for both oral care products with high satisfaction levels. Hence, these oral care products could potentially be natural antimicrobial agents and can be further developed and applied for oral applications in the pharmaceutical and cosmetic industries.

Evaluation of clinical, histology, TNF-α, and collagen expressions on oral ulcer in rats after treatment with areca nut and chrysanthemum oral gel

Background: Areca nut (Areca catechu Linn.) is the seed of the fruit of the oriental palm that is commonly used among Southeast Asian communities. Chrysanthemum (Dendrathema grandiflora) is a flowering plant originating from East Asia and dominantly grows in China. Both of these plants have strong antioxidant activities. To investigate the mechanism of their wound healing activities, we prepared areca nut and chrysanthemum polyethylene oral gel and performed several in vivo assays using Sprague–Dawley rats. Methods: Sprague–Dawley rats were divided into six groups: Negative control group (rats with base gel treatment), positive control group (rats treated with triamcinolone acetonide), F1 (treatment with 20% areca nut:80% chrysanthemum), F2 (treatment with 50% areca nut:50% chrysanthemum), F3 (treatment with 80% areca nut:20% chrysanthemum), and normal group (without ulcer and treatment). Traumatic ulcers were performed on the buccal mucosa of all experimental animals that received topical oral gel and triamcinolone acetonide twice a day for seven days. The clinical and histological characteristics were analyzed and scored. Results: During the six days, the ulcerated area receded linearly over time and was completely cicatrized in F2, F3, and the positive control group (Dependent t-test, p&lt;0.05). There were significant increases in body weight in F2 and positive control groups. There were no significant differences between groups in histology examination (Kruskal Wallis test, p&lt;0.05). The moderate score of TNF-α levels was seen in F2 and positive control groups (ANOVA/Tukey test, p&lt;0.05). In the collagenases assay, a high concentration of areca nut (F3) induced the abundance of collagen during the ulcer healing process. Conclusions: The combination of areca nut and chrysanthemum extract in the oral gel can optimize the healing of traumatic oral ulcers in Sprague-Dawley rats through the increase of TNF-α and collagen deposition.

Antimicrobial effect of oral care gel containing hinokitiol and 4-isopropyl-3-methylphenol against intraoral pathogenic microorganisms.

Deterioration of oral hygiene is closely related to an increase in severity and mortality of corona virus disease-19 (COVID-19), and also contributes to the development of various diseases such as aspiration pneumonia or Alzheimer's. Oral care is attracting high interest in Japan, which has entered a super-aging society. In this study, we aimed to investigate whether commercially available Hinora® (HO), an oral care gel containing hinokitiol and 4-isopropyl-3-methylphenol (IPMP), has biofilm formation inhibitory and antimicrobial activities against various intraoral pathogen microorganisms. Candida species, Aggregatibacter actinomycetemcomitans, Staphylococcus aureus, and Pseudomonas aeruginosa were selected during the study period, all of which were analyzed using antimicrobial disc, microorganism turbidity, and crystal violet assays. In addition, the germ tube test using Candida albicans (C. albicans) was performed with a modification of Mackenzie's method. Images for morphological observation of the germ tubes were acquired using an inverted microscope. For comparison between products, we used Refrecare® (RC), which only contains hinokitiol (not containing IPMP). All the intraoral pathogenic microorganisms showed drug susceptibility against undiluted forms of HO and/or RC. In particular, HO was more effective at lower concentrations than RC. In the HO-added group, inhibition circles were observed in all bacteria except P. aeruginosa when added at a concentration of 0.5 g/mL or more. The optical density values at 590 nm (crystal violet) and/or 600 nm (microorganism turbidity) of all the fungi and bacteria were significantly lower when cultured in medium with HO. Inhibition of growth or biofilm formation was observed when HO was added at a concentration of 0.05 g/mL or higher. To investigate the action mechanism of HO, germ tube tests were performed in C. albicans. The results showed that culturing C. albicans in soybean-casein digest broth with HO (0.05 g/mL) significantly suppressed germ tube formation. These data suggest that oral care gel-containing hinokitiol and IPMP has strong biofilm formation inhibitory activity, as well as antifungal and antimicrobial effects against Candida fungi and multiple intraoral pathogenic microorganisms. Therefore, it may be a promising treatment option for oral infections.

Development of a Pharmaceutical Formulation Containing Clove (Syzygium aromaticum) Extract for the Management of Oral Candidiasis

Introduction: Oral candidiasis is a common fungal infection caused by various yeast species, including Candida albicans, Candida krusei, Candida parapsilosis, Candida tropicalis, and Candida glabrata. Clove, a well-known plant in traditional medicine, has been used as an antiseptic remedy for diverse infections, including those affecting the oral cavity induced by yeasts and bacteria. The emergence of resistance to numerous antifungal agents among Candida species necessitates exploring alternative treatments. Hence, this study aims to evaluate the antimicrobial activities of clove extract and develop a suitable pharmaceutical formulation containing clove extract for managing oral candidiasis. Method: The antimicrobial culture and sensitivity test were conducted using the agar-well diffusion assay, evaluating different concentrations of clove extract against Candida albicans. The minimum effective concentration was then formulated into a gel dosage form, and its antimicrobial activity was assessed, comparing it with miconazole oral gel. Result: The results showed that the prepared clove extract gel had antifungal effects on Candida albicans that were similar to those of the miconazole oral gel. The zone of inhibition for the clove extract gel was measured at 25 mm, while the miconazole gel showed a zone of inhibition of 27 mm. Conclusion: The results of this study show that clove extract gel may be an effective antifungal agent, especially against Candida albicans. This suggests that it may be a promising herbal alternative to conventional medicines for treating oral candidiasis.

Lycium barbarum polysaccharide-glycoprotein ameliorates ionizing radiation-induced epithelial injury by regulating oxidative stress and ferroptosis via the Nrf2 pathway.

Radiation-induced oral mucositis (RIOM) is considered to be the most common acute side effect of radiation therapy and occurs during intentional or accidental radiation exposure. Antioxidant synthesis agents have been reported to protect against or alleviate the development of mucositis, but the resulting side effects of chemical synthesis agents limit their use in clinical practice. Lycium barbarum polysaccharide-glycoprotein (LBP), a polysaccharide extract of the Lycium barbarum fruit, has superior antioxidant capacity and biosafety and is a potential option for radiation prevention and treatment. Here, we aimed to investigate whether LBP conferred radioprotection against ionizing radiation-induced oral mucosal damage. We found that LBP exerted radioprotective effects in irradiated HaCaT cells, improving cell viability, stabilizing mitochondrial membrane potential, and decreasing cell death. LBP pretreatment reduced oxidative stress and ferroptosis in radioactivity-damaged cells by activating the transcription factor Nrf2 and promoting its downstream targets, such as HO-1, NQO1, SLC7A11, and FTH1. Knockdown of Nrf2 eliminated the protective effects of LBP, implying the essential role of Nrf2 in LBP activity. Additionally, the topical application of LBP thermosensitive hydrogel on rat mucosa resulted in a significant decrease in ulcer size in the irradiated group, suggesting that LBP oral mucoadhesive gel may be a potential tool for the treatment of irradiation. In conclusion, we demonstrated that LBP attenuates ionizing radiation-induced oral mucosa injury by reducing oxidative stress and inhibiting ferroptosis via the Nrf2 signaling pathway. LBP may be a promising medical countermeasure against RIOM.

Median rhomboid glossitis as a sign of undiagnosed diabetes mellitus - a case report

Background: Median Rhomboid Glossitis (MRG) is included in the group of nodular-plaque-like candidiasis, a subtype of chronic hyperplastic candidiasis. A lot of literature suggests that MRG is a manifestation of Diabetes Mellitus (DM), but the association between DM and MRG is unclear until now. This article reports an MRG found in an undiagnosed diabetes mellitus patient. &#x0D; Case: In October 2019, A 71-year-old man came to RSGM Universitas Jember to fix his loose denture. In the oral examination, we found a well-bordering, atrophic oval area surrounded by thick- soft white plaque. In his leg, we found itchy papule, ulcer, and crust multiple lesions. The microscopic examination of the white plaque swab showed that the spore and hyphae were found to fill all fields of view. The direct sugar blood level test showed that the sugar blood level was 390 mg/dL. We diagnosed the patient as having an MRG associated with suspected DM. &#x0D; Case Management: The patient was given miconazole oral gel and recommended to use it after cleaning the tongue three times a day. For diabetes management, the patient was referred to the Unit Medical Center University of Jember. The patient was diagnosed with diabetes mellitus and given oral-antidiabetics. After two weeks, the atrophic area had improved, and the white plaque had disappeared.&#x0D; Conclusion: General practitioners must be aware if they find the MRG in their patients caused a probability of underlying undiagnosed systemic disease, particularly diabetes mellitus on them.

In-situ fast-prepared mucoadhesive oral gel for palliative treatment of chemotherapy-induced mucositis: preparation, characterizations and pre-post study

In-situ fast-prepared mucoadhesive oral gel for palliative treatment of chemotherapy-induced mucositis: preparation, characterizations and pre-post study

Development of 2% w/w sodium fluoride oral gels for prevention of dental caries in patients with xerostomia

For prevention of dental caries in xerostomic patients, 2% w/w sodium fluoride oral gel is frequently prescribed; however, the product has not been officially approved for clinical use in Thailand. Therefore, this study aimed to develop 2% w/w sodium fluoride oral gels dispensed specifically to patients in Rajavithi Hospital. Both single and combined gel bases were prepared from different gelling agents, including gelatin, xanthan gum, hydroxypropyl methylcellulose, sodium carboxymethylcellulose, and Carbopol 940P. They were subsequently characterized according to their physicochemical properties, i.e., clarity, spreadability, pH values, and apparent viscosity. All the gel bases were clear viscous liquids of good spreadability, except the xanthan gum gel bases, which were slightly cloudy. The pH values indicate that the gelatin, xanthan gum, and Carbopol 940P gel bases were acidic, while the cellulose gel bases were neutral. The apparent viscosity ranged from 3 to 11.5 x 105 cPs, depending mainly on type and concentration of the gelling agents. After preparation, the gel bases were then incorporated with 1 M pH 7.4 phosphate buffer solution to the final concentration of 5% w/w. Macroscopic characteristics of the buffered gel bases were generally unchanged, except for the apparent viscosity, which decreased slightly. Sodium fluoride was subsequently added to the selected buffered gel bases. The resulting sodium fluoride gels were neutral and transparent viscous liquids of good spreadability and exhibited good stability against the heating-cooling cycle and accelerated testing. Thus, it is conceivable that 2% w/w sodium fluoride oral gels with acceptable physicochemical characteristics and excellent stability were successfully developed.

Amelioration of acute radiation dermatitis in patients with breast cancer by a bioadhesive barrier-forming oral gel (Episil): A single-center, open, parallel, randomized controlled trial.

e12519 Background: Episil is a bioadhesive barrier-forming oral liquid gel that can relieve mucositis caused by radiotherapy (RT) and hence relieves pain effectively.The purpose of this trial is to compare the efficacy and safety of Episil in improving acute radiation dermatitis in breast cancer patients. Methods: Key eligibility criteria were as follows: Pathologically confirmed breast cancer; female ≥18 years of age; planning to receive postoperative radiation therapy; surgery with modified radical or breast-conserving surgery; fully healed surgical incision; intact skin in the irradiated area; KPS score ≥80; no severe endocrine or metabolic disease; voluntary participation and signed informed consent; ability to read and understand and good compliance. The primary endpoint was the grading of radiation dermatitis during treatment. Results: A total of 102 patients were included from January 2022 to December 2022. The patients were grouped in a 2:1 ratio by randomized number table method, 67 patients received Episil combined with conventional skin care and 35 patients served as the control group receiving conventional skin care only. Two patients in the Episil group dropped out halfway. According to the RTOG grading, the skin reaction rate and the degree were significantly better in the Episil group than control group (24.62%, 72.31%, 3.08, 0, 0 VS 0, 85.71%, 14.29%, 0, 0, 0) in the 0, 1, 2, 3 and 4 grades respectively (P&lt;0.001). And the pruritus score was significantly lower in the Episil group than in the control group (P&lt;0.05). The results of the EORTC QLQ-C30 Quality of Life Questionnaire showed that the overall health (P&lt;0.05) and overall quality of life (P&lt;0.05) were better in the Episil group than control group after radiotherapy. Relative to the control group, the Episil group produced significantly lower rates of stress, anxiety, and depression (P&lt;0.05) and had less impact on family life and social activities (P&lt;0.05). Most importantly, the Episil group produced fewer pain reactions after the end of radiotherapy. Conclusions: In breast cancer patients receiving radiotherapy, Episil may significantly reduce the grading of acute radiation dermatitis, reduce patient symptoms, and improve patient quality of life. Clinical trial information: ChiCTR2200059646 .

Comparison of Combination-Vaginal Clindamycin with Oral Metronidazole and Oral Metronidazole Alone in the Treatment of Bacterial Vaginosis

Introduction: Bacterial vaginosis is the most common vaginal infection of sexually active woman. Bacterail vaginosis has been associated with preterm labour, amniotic fluid infection, chorioamniotiss and postpartum endometritis. Objective: To compare the efficacy of combination oral metronidazole-vaginal clindamycin gel with oral metronidazole alone in the treatment of bacterial vaginosis. Material and methods: This Randomized Controlled Trial was conducted in Gynaecology and Obstetrics Department, District Headquarter Hospital, Faisalabad. Approval from hospital Ethical Review Committee was taken after formulation of synopsis. 422 Patients fulfilling the inclusion criteria enrolled in the study. Informed consent was taken from each participant of the study. Patients was randomized into Group A and Group B using computer generated random number table. Results: Data was collected from 422 patients with mean gestational age 38.67 ± 1.69 weeks. The cumulative cure rate in the oral metronidazole group was 87% and 89.6% in the oral clindamycin group. There was no statistical difference in the efficacy of the two medications (p = 0.639). Nine (13%) of the women who received oral metronidazole and seven (10.4%) of the women in the oral clindamycin group had treatment failures following the test of cure, with an overall failure rate of 11.8%. Conclusion: It is concluded that both medications have comparable efficacy and similar pregnancy outcomes in the treatment of bacterial vaginosis. Keywords: Vaginosis, Prevalence, Woman, Postpartum

Natural antibacterial gel to fight tooth decay: An in-silico modeling approach

This study developed an antibacterial oral gel to inhibit Streptococcus mutans, a bacterium that causes tooth decay. The gel was formulated using methanol extract of Piper betel leaves, hydroxypropyl methylcellulose and glycerin at different concentrations. The formulated gel was evaluated for pH, viscosity and antibacterial activity against S. mutans using standard methods. The methanol extract showed potent antibacterial activity, supporting its use in the gel formulation. In silico molecular docking studies targeted key S. mutans protein residues involved in substrate binding. Eleven bioactive compounds identified in the Piper betel extract via GC-MS analysis were docked against protein 1EUH, an NADP-dependent aldehyde dehydrogenase from S. mutans. All 11 compounds exhibited favorable docking scores, suggesting strong binding affinity for the target protein. The docking results correlated with the antibacterial activity of the formulated gel, which inhibited S. mutans growth more effectively than sodium fluoride, a standard dental product.

Using Social Media to Better Understand Parents’ Experiences Managing Teething Pain

Teething in infants is a natural process that is associated with a variety of signs and symptoms. Many teething pain management strategies exist, yet there is a lack of research investigating which strategies are used by parents and whether they are evidence based. Using an established social media initiative, this study sought to better understand parents’ experiences managing teething pain and to determine which strategies are evidence based. Methods: Parents’ experiences with managing teething pain were gathered through a Facebook post in partnership with researchers and a Canadian digital publisher, YummyMummyClub.ca. This Facebook post, part of a larger social media initiative called #ItDoesntHaveToHurt, asked the following question: “What do you do when you think your baby has teething pain?” Comments underwent descriptive thematic analysis to identify common management approaches. An evidence review of literature was undertaken to determine if the most frequently used pain management strategies reported by parents are supported by research. Results: The post received 163 comments. Analysis identified that the most frequently mentioned strategies were frozen/chilled objects, over-the-counter oral analgesics, frozen fruits/vegetables, oral anesthetic gels, and teething necklaces. The evidence review findings suggest a lack of research in the area of teething pain management. Professional dental associations recommend rubbing the gums with a clean finger or using chilled teething toys and over-the-counter analgesics as effective management strategies. Evidence indicates that oral anesthetic gels and teething necklaces are unsafe. Conclusion: Parents use a variety of teething pain management strategies for their infants, many of which are unsafe and not supported by evidence. What information is used by parents and how they select teething pain management strategies is an area that requires further research.