buccal

The purpose of this study was to compare the effectiveness of Buccal, Vaginal, and Sublingual misoprostol for induction of labor in term pregnancy.

The research was done as an RCT from 2017 to 2018. About 300 participants were randomly allocated to obtain 50 µg Buccal, 25 µg Vaginal, and 50 µg Sublingual misoprostol in Kosar Hospital, Qazvin, Iran. The maternal and fetal complications, Bishop score hour 1, and hour 6 were observed.

There were no differences between fetal complications (p>0.05) and maternal complications (p>0.05) among the three groups. Bishop score hour 1 (P = 0.146), Bishop Score hour 6 (P = 0.704), and total dose (P = 0.15) also were no differences among these groups. Our study found a difference between the three groups (P = 0.015) in achieving standard vaginal delivery within 24 hours, as Buccal, Sublingual and Vaginal groups were performed respectively. The use of Oxytocin in the Buccal group was higher than that of other groups (P = 0.022).

This study found that there is no difference in terms of fetal complications and maternal complications in the three groups, but there was a significant difference in Oxytocin use and vaginal delivery within 24 h from the start of induction.

 Different histochemical stains have been applied to demonstrate the cytotoxic and genotoxic effects of cigarette smoking on cells. Feulgen and Papanicolaou were the most popular stains to demonstrate nuclear abnormalities. The aim of this study was to compare Feulgen and Papanicolaou stains in demonstrating the cytotoxic and genotoxic effects of cigarette smoking on exfoliated oral mucosa cells.

 A total of 31 cigarette smokers and 15 non-smokers were included in this case-control study. Using a wooden spatula, two samples were taken from each participant. The samples from the left buccal mucosa were stained with Feulgen and the right mucosa with Papanicolaou. The mean number of micronuclei and the number of cells with pyknosis, karyorrhexis, and karyolysis were determined on Feulgen and Papanicolaou-stained slides. The number of counted cells with pyknosis, karyorrhexis, and karyolysis in 1000 cells/subject was recorded. The mean number of micronuclei was determined by the number of counted micronuclei per 1000 cells per subject.

 The number of micronuclei was not significantly different between Feulgen and Papanicolaou stained samples (P=0.27). Demonstration of karyolysis (P=0.73) and karyorrhexis (P=0.24) was not significantly different between Feulgen and Papanicolaou staining methods. The Feulgen was significantly more effective in demonstrating pyknosis compared to Papanicolaou (P=0.02).

 Feulgen and Papanicolaou stains had similar effectiveness in demonstrating DNA alterations (micronucleus) and cellular death features (karyorrhexis and karyolysis). Feulgen was preferable to display pyknosis than Papanicolaou.

Pleomorphic adenoma is a benign salivary gland tumor that is frequently seen in the parotid gland. It is very rare in minor salivary glands. The case we present is a case of pleomorphic adenoma originating from the buccal minor salivary gland, which is very rare in this localization.

Misoprostol can be used by different routes in the medical management of abortion. This study aimed to compare the efficacy and safety of buccal and vaginal administration of misoprostol for the completion of first-trimester abortions.

This study was a randomized clinical trial in which women with first-trimester abortion referred to Imam Hossein Medical Center in 2018 were studied. Women were randomly divided into two groups of buccal or vaginal misoprostol treatment. From the time of drug administration to complete abortion, side effects, duration of drug use until tissue excretion, need for blood transfusion and need for surgical evacuation were recorded and compared in two groups.

One-hundred women (each group, 50 patients) were evaluated in this study. There was a significant difference between the two groups regarding the duration of misoprostol use (p-value = 0.028), and it was longer in the buccal group. Besides, there was a significant difference between the two groups in terms of the dose required until the tissue discharge (p-value = 0.034). In the buccal group, patients received higher doses of misoprostol. The rate of fever had a significant difference between the two groups and was more frequent in the vaginal group (p-value=0.023).

Vaginal misoprostol can be more effective in treating first-trimester abortions compared to buccal misoprostol and may be associated with longer duration of use and lower required doses.

Ketamine is a commonly used medicine for reducing pain and stress in patients, including children in emergency department (ED). The intravenous (IV) injection of ketamine is gold standard though difficult in children, but other routes are also possible. 

This study was conducted to compare the effects of the submucosal at different doses versus IV injections of ketamine on sedation with proper consciousness in children candidates for diagnostic-therapeutic procedures in ED. 

This randomized clinical trial was conducted with 4 groups; groups 1, 2 and 3 respectively received 4, 3 and 2 mg/kg of submucosal ketamine and group four 1.5 mg/kg of IV ketamine. Eligible subjects selected from 46 patients of children’s age as the candidates for subcutaneous wound healing were randomly assigned to the four groups and followed up 5, 10, 15 and 30 minutes after the injection. The Ramsay score was obtained by measuring the heart rate, the breathing rate, the time to start affecting and duration of the effect. The data were ultimately analyzed in SPSS and Excel. 

The baseline data were matched and confounding variables eliminated included age, gender, weight and hemodynamics. Compared to other doses of submucosal ketamine, 4 mg/kg was found to exert its effect the fastest (4.08±1.01 minutes) (p<0.05) and for the longest duration (23.09±1.12 minutes) (p<0.05). The Ramsay score in groups 1 and 4, i.e. 5.9, was significantly higher than that in groups 2 and 3 (p<0.05). 

The results showed that 4 mg/kg and 3 mg/kg of submucosal ketamine are appropriate alternatives to IV ketamine. Although the time to start affecting was shorter in the intravenous group compared to in the other groups, the duration of the effect was the longest with 4 mg/kg of submucosal ketamine. Surgeon satisfaction scores were found to be very good and not significantly different between groups 1, 2 and 4. Vomiting was also prevalent with no significant differences between the four groups.

Repaglinide (REP) is an antihyperglycemic drug having low bioavailability due to its extensive first-pass metabolism. The present study aimed to develop and pharmacokinetic investigte the thiolated chitosan (TC) based buccal tablets of REP for improved bioavailability.

TC was prepared by conjugation of L-cysteine with chitosan. The amount of free thiol groups present in TC was determined by UV-spectrophotometry using Ellman’s reagent. TC based REP buccal tablets were prepared by two layers co-compression method and characterized for in vitro and ex vivo parameters. The in vivo performance of prepared REP buccal tablets was assessed by the pharmacokinetic study in New Zealand white rabbits.

The prepared TC resulted in 87%w/w yield with 52.3±3.2 μM free thiol functional groups per 10 mg of TC. The prepared formulations have good flow nature and compressibility, acceptable thickness (2.02 to 2.1 mm), weight (60.11 to 61.06 mg), surface pH (6.59 to 6.81) and drug content (98.92 to 101.08 %w/w). The presence of TC significantly improved the mucoadhesion strength, sustained the in vitro release and enhanced the ex vivo permeation of REP buccal tablets. The shelf life of REP buccal tablets was found to be 15.07 months in accelerated storage conditions. The prepared REP buccal tablets (V5) have area under the curve (712.22±15.91 ng/mL/h) and mean residence time (4.66±0.25 h) was 1.89 and 1.83 folds higher than oral bolus respectively.

TC based REP buccal tablets are capable of controlled transbuccal release of REP for a prolonged time and have better bioavailability than oral bolus.

Gutkha is a cheap and convenient betel quid substitute, which is popular among all age groups. Various studies reveal its carcinogenic nature that leads to oral submucosus fibrosis and increases the chances of oral cancer. The micronucleus (MN) assay in exfoliated mucosal cells is a useful method for observing genetic damage in humans.

To observe the genotoxic effect of gutkha on human buccal epithelial cells.

The MN assay was performed to assess the frequency of MN in human buccal epithelial cells. The study comprises 60 individuals of which 30 individuals were gutkha chewers and another 30 were nonusers (control). The MN frequency was scored to estimate the genotoxic damage.

In gutkha users, the frequency of MN was highly significant (17.4 ± 0.944) as compared with nonusers (control) groups (4.53 ± 0.331) (P < 0.001).

The MN assay in human buccal epithelial cells is a useful and minimally invasive method for monitoring genetic damage in humans. A significantly higher frequency of micronucleated cells are found among gutkha users.