L-asparaginase immobilization in supramolecular nanogels of PEG-grafted poly HPMA and bis(α-cyclodextrin) to enhance pharmacokinetics and lower enzyme antigenicity

L-asparaginase (ASNase) enzyme has limited therapeutic use due to its poor pharmacokinetics and immunogenicity. To overcome these obstacles, we immobilized ASNase in biocompatible poly hydroxypropyl methacrylamide (P(HPMA))-based nanogels simply formed through the host-guest inclusion complex of ASNase-conjugated random copolymer of HPMA and polyethylene glycol (PEG) acrylate (P(HPMA-MPEGA)) and α-cyclodextrin dimer (bisCD) using cystamine as a linker. The effects of bisCD and polymer concentrations on particle size, gelation time, and recovery of enzyme activity were investigated. The ASNase-conjugated bisCD nanogels were discrete, homogeneous, and spherical with a mean projected diameter of 148 ± 41 nm. ASNase immobilized in the bisCD nanogels caused cytotoxicity on HL-60 cell line with IC₅₀ of 3 IU/ml. In-vivo rat study revealed that the immobilized ASNase reduced the enzyme antigenicity and resulted in 8.1 folds longer circulation half-life than the native enzyme. Conclusively, immobilization of ASNase in P(HPMA-MPEGA) and bisCD supramolecular nanogels could enhance the therapeutic value of ASNase in cancer chemotherapy.

Nanotechnology-based cell-mediated delivery systems for cancer therapy and diagnosis

The global prevalence of cancer is increasing, necessitating new additions to traditional treatments and diagnoses to address shortcomings such as ineffectiveness, complications, and high cost. In this context, nano and microparticulate carriers stand out due to their unique properties such as controlled release, higher bioavailability, and lower toxicity. Despite their popularity, they face several challenges including rapid liver uptake, low chemical stability in blood circulation, immunogenicity concerns, and acute adverse effects. Cell-mediated delivery systems are important topics to research because of their biocompatibility, biodegradability, prolonged delivery, high loading capacity, and targeted drug delivery capabilities. To date, a variety of cells including blood, immune, cancer, and stem cells, sperm, and bacteria have been combined with nanoparticles to develop efficient targeted cancer delivery or diagnosis systems. The review paper aimed to provide an overview of the potential applications of cell-based delivery systems in cancer therapy and diagnosis.

An Evidence-Based Review on Selected Traditional Formulations against Pediculosis

Pediculosis is a growing social problem in both developed and undeveloped countries. Resistance to chemical treatments and toxicity of insecticidal compounds are reasons why alternative medications should be proposed for this parasitic infestation. This study attempted to investigate traditional anti-lice treatments, and draw together scientific insights into lice management through the study of Persian Medicine manuscripts. Lice infestation formulations were searched in seven traditional textbooks (al-Manṣuri fi al-ṭibb, al-Qanun fi al-ṭibb, Kamil al-ṣina‘ah al-ṭibbiyah, Qarabadin  Kabir, Qarabadin Salehi, Makhzan al-Adviyeh, Eksir Azam) pertaining to one millennium period, from the 9th to 19th century. Twenty multi-component medications were selected for the study of ingredients and their active compounds. PubMed, Google Scholar, and Scopus were searched to find pediculicidal or insecticidal evidence. In vitro studies and clinical trials reporting anti-lice and/or insecticidal activities were summarized. Formulations had four kinds of base (oil, vinegar, alcohol, or water). Oils act through occluding the respiratory spiracles of lice. Vinegar loosens the attachment between nits and hair shaft, improving the removal of nits from hair. Essential oil- and tannin-containing plants made up the majority of anti-lice components in the current study. Seventeen out of twenty-seven medicinal plants were reported to have pediculicidal and/or insecticidal activity. Considering the results, further investigation leads to the designing new treatments against pediculosis.  

Nanoencapsulation of saffron crocin into chitosan/alginate interpolyelectrolyte complexes for oral delivery: A Taguchi approach to design optimization

Crocin, as a nutraceutical component of saffron (Crocus sativus L.), possesses numerous therapeutic effects. In the current study, a crocin-loaded chitosan/alginate (CS/ALG) nanocarrier was developed for oral delivery. The influence of preparation variables including pH and the concentrations of CS, ALG, and calcium chloride (CaCl₂ ) on encapsulation efficiency (EE%) and loading efficiency (LE%) of CS/ALG nanoparticles (NPs) was evaluated by L9 Taguchi orthogonal array (OA). The results showed that at 0.25% w/v CS, 0.1% w/v ALG, pH 4.5, and absence of CaCl₂ , crocin was loaded into CS/ALG NPs with EE% and LE% of 91.5% and 27.4%, respectively. Ultrasonication reduced the particle sizes (PSs) up to 100 nm, and freeze-dried NPs reproduced the particles with average size of 90 nm. Scanning electron microscopy (SEM) was successfully used to characterize the structure and morphology of freeze-dried NPs, confirming very fine NPs having sizes less than 100 nm. Crocin loaded into NPs showed higher stability in simulated gastric pH 2 compared to free crocin (2.1% and 7.5% degradation at 60 min, respectively). Furthermore, a pH-dependent sustained crocin release was observed with faster release at pH 2. Overall, the very small PS along with high encapsulation efficiency and stability can enhance crocin oral bioavailability making CS/ALG nanovehicles promising as an effective delivery system. PRACTICAL APPLICATION: Crocin as a functional component of Saffron is not sufficiently stable in gastrointestinal tract and its absorption is not complete. Chitosan/Alginate nanoparticles can encapsulate it efficiently, protect it and enhance its absorption orally. The availability and simplicity of the materials and equipments employed in current research provide the possibility to industrial scale up of the Crocin nanoparticles.

Novel self-assembled nanogels of PEG-grafted poly HPMA with bis(α-cyclodextrin) containing disulfide linkage: synthesis, bio-disintegration, and in vivo biocompatibility

Synthesis of self-assembled nanogels of PEG-grafted poly HPMA with bis(α-cyclodextrin) containing disulfide linkage.

Design of ultra-fine carvedilol nanococrystals: Development of a safe and stable injectable formulation

Carvedilol (CAR) is a strategic beta-blocker agent which its application has been limited by its very low water solubility. The present study describes a soluble form of drug based on nano-cocrystal (NCC) anti-solvent precipitation technique. The COSMOquick software was employed to select the optimum coformer (tartaric acid, TA) and organic solvent (acetone) relying on the enthalpy changes of cocrystallization and solubilization. Central Composite Design (CCD) considering the impact of CAR, TA, poloxamer 188 (stabilizer) concentrations, and anti-solvent/solvent ratio on CAR NCCs particle size (PS) could produce ultra-fine NCCs (about 1 nm). The lyophilization of NCCs investigating slow/fast freezing rates, various types and concentrations of cryprotectants and lyoprotectants indicated that PEG and trehalose (5 % w/vconcentration) under slow freezing rate could re-produce the initial PSs successfully. CAR NCCs indicated about 2000 fold increase in solubility compared with pure CAR. DSC and PXRD experiments proved that the formulations containing trehalose led to more crystalline and the ones comprising PEG led to more amorphous structures. Interestingly, the slow freezed PEG protected NCCs were physically stable for at least 18 months. In conclusion, the NCC technology could produce the first safe soluble form of CAR for treating hypertension urgencies easy for industrial scale-up.

Curcumin-incorporated crosslinked sodium alginate-g-poly (N-isopropyl acrylamide) thermo-responsive hydrogel as an in-situ forming injectable dressing for wound healing: In vitro characterization and in vivo evaluation

Sodium alginate products have been extensively used for wound-dressing. In present study, a series of thermo-sensitive cross-linked poly(N-isopropylacrylamide) grafted sodium alginate (Alg-g-pNIPAM) copolymers were synthesized for delivery of curcumin to wound. FTIR, ¹H NMR, elemental analysis and DSC showed successful polymerization and precise structure of copolymers. Thermogelation at 27-42 °C depending on the copolymer concentration, chain-length of pNIPAM and pH was observed. The optimum copolymer with proper rheological and syringeability properties showed excellent thermogelling at a wide range of pH and concentration, and could prolong the release of curcumin up to 72 h. In-vivo wound contraction and histopathological evaluations revealed that in addition to the higher efficacy in wound contraction, the curcumin formulation (Cur-F) significantly reduced the inflammation, enhanced the collagenesis and resulted in increased number of fibroblasts. Well-known anti-oxidant and anti-inflammatory properties of curcumin and in situ-forming nature of Alg-g-pNIPAM can make the system an excellent candidate for further investigations.

Paclitaxel-loaded polypeptide-polyacrylamide nanomicelles overcome drug-resistance by enhancing lysosomal membrane permeability and inducing apoptosis

The aim of the current project was to investigate the in vitro properties of Paclitaxel (PTX)-loaded pHPMA_5kD -pHis_5kD -pLeu_3kD nanomicelles (NMs) on multidrug resistance cell line. Circular dichroism analysis was done to investigate the effect of pH on the secondary structure of the copolymer. Cytotoxicity assay together with fluorescence imaging and flow cytometry were performed to get an insight about toxicity and cellular uptake mechanism of NMs. Acridine orange assay, rhodamine 123 (Rh123) accumulation assay, and apoptosis analysis were conducted for further investigation. It was found that the secondary structure of the copolymer changed in response to pH, PTX-loaded NMs had higher cytotoxicity on both drug-sensitive (MES-SA and MCF-7) and multidrug resistant cells (MES-SA/DX5) compared to free PTX, and interestinly free copolymer inhibited the growth of MES-SA/DX5 cells while it was nontoxic on drug-sensitive cells. Moreover, the copolymer was able to induce lysosome membrane permeation and increase Rh123 accumulation inside cells indicating inhibition of the P-gp efflux pumps. Finally, apoptosis was strongly induced in MES-SA/DX5 cells upon treatment with PTX-loaded NMs. It can be concluded that the designed hybrid copolymer is a good candidate for in vivo assay and developing a powerful system against multidrug resistance tumors.

Freeze-Drying of Pharmaceutical and Nutraceutical Nanoparticles: The Effects of Formulation and Technique Parameters on Nanoparticles Characteristics

Nanoparticles (NPs) are of the most interesting novel vehicles for effective drug delivery to humans. Freeze drying is known as an engaging process to improve the long lasting stability of NPs formulations. This study aims to elucidate the importance of various parameters involving in freeze-drying of the most common pharmaceutical/nutraceutical NPs including nanosuspensions, nanocrystals (NCs), cocrystals/nanococrystals, nanoemulsions (NEs), nanocapsules (NCPs) and nanospheres (NSPs). Regarding this, the therapeutic goals of NPs and specifications of drug must be considered. According to our survey, the most influential factors for achieving optimum results include type and concentration of cryoprotectant/lyoprotectant, stabilizer structure and concentration, the NPs concentration in solution, freezing, annealing, and drying rate, the interaction between protectants and stabilizer, solvent type and antisolvent to solvent ratio. The study shows that for each class of NPs, specific variables are of highest significance and should be optimized. For instance, about NCs, freezing rate and antisolvent/solvent ratio should be particularly considered and for emulsified NPs, the best results have been obtained by 5-20% of saccharides as cryoprotectants. These findings suggest that to obtain a product with the lowest aggregation and particle size (PS), optimization of the effective factors in formulation and lyophilization process are essential.

Efficacy of oral administration of licorice as an adjunct therapy on improving the symptoms of patients with Parkinson's disease, A randomized double blinded clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Licorice preparations are used as neuroprotective remedies in Persian ethnomedicine, in order to prevent from disabilities in neurodegenerative conditions like Parkinson's disease (PD).

AIM OF THE STUDY

This study was designed to determine the licorice (root of Glycyrrhiza glabra L.) effectiveness as an adjunct treatment in the PD management.

MATERIAL AND METHODS

In this double-blinded trial, 128 patients were assessed for eligibility criteria. Seventy-eight patients were ineligible and 11 of them refused from participating. Thirty-nine PD patients (YAHR staging ≤ 3) were divided into two groups by random. The patients received oral licorice or placebo syrups with a dose of 5 cc, twice a day for 6 months. High-performance liquid chromatography and spectrophotometric instruments determined licorice syrup constituents. The patients' situation for Unified Parkinson's rating scale (UPDRS) was assessed every 6 weeks for the duration of six months. In addition, patients' blood pressure, blood glucose, sodium and potassium levels, quality of life and dizziness were determined.

RESULTS

Six weeks after intervention, total UPDRS, daily activities and tremor were significantly improved with a considerable effect size. A significant better motor test and rigidity scores were observed 4 months after licorice intake (p > 0.05). No electrolyte abnormality, significant changes in blood pressure or blood glucose levels were observed during the study. Each 5cc of syrup contained 136 mg of licorice extract with 12.14 mg glycyrrhizic acid, and also 136 μg of polyphenols.

CONCLUSION

The licorice intake could improve the symptoms in PD patients without serious adverse events.

A randomized controlled double blinded trial to evaluate efficacy of oral administration of black strap molasses (sugarcane extract) in comparison with polyethylene glycol on pediatric functional constipation

ETHNOPHARMACOLOGICAL RELEVANCE

As a significant health issue, Functional Constipation (FC) has a high prevalence of 0.7%-29% worldwide. In Persian ethnomedicine, several formulations of sugarcane extracts including faniz, shekar-e- sorkh and black strap molasses have been used to treat pediatric constipation.

AIM OF THE STUDY

To evaluate efficacy and safety of oral intake of black strap molasses syrup (BSM) on FC in children.

MATERIALS AND METHODS

A randomized controlled double blinded trial was performed on children aged 4-12 years diagnosed with FC according to ROMIII Constipation Measurement Questionnaire. Ninety-two patients were randomly divided in two groups of BSM or PEG syrups (40%) with a dose of 1 mL/kg body weight/day for 1 month. Symptoms were evaluated every two weeks. Possible serological side-effects and changes in children's body weight were investigated. BSM syrup constituents were determined by pharmacognostic methods.

RESULTS

Treatment was successful with both interventions with no significant difference between the groups. Defecation per week was significantly improved in both groups. Symptoms including volitional stool retention, large diameter stool, painful or hard stool and large fecal mass in the rectum decreased significantly two and four weeks after intervention (P < 0.05). There was no significant difference between groups except for the rate of large diameter stool. No side -effects were observed. The BSM naturally contained polyphenols (960 μg/mL), potassium (12430 μg/mL), iron (80 μg/mL) and calcium (3320 μg/mL).

CONCLUSION

BSM and PEG syrups had similar efficacy on FC. Compared with PEG, BSM syrup contained different natural micronutrients.

Biosurfactant Production by Lactic Acid Bacterium Pediococcus dextrinicus SHU1593 Grown on Different Carbon Sources: Strain Screening Followed by Product Characterization

The present study focused on producing and characterizing a type of biosurfactant (BS) derived from lactic acid bacteria (LAB) and its potential applications in pharmaceutical and food industries due to the preference of employing nonpathogenic organisms in bioprocesses. To this aim, several screening approaches were applied to identify an efficient BS-producing strain from a set of LAB, and Pediococcus dextrinicus SHU1593 was selected as the most operative one. The BS produced by P. dextrinicus was isolated and structurally characterized as a lipoprotein with an approximately equal ratio of lipids (~52% (w/w)) and proteins (47% (w/w)). It reduced the surface tension (ST) of phosphate-buffered saline (PBS) from 72.80 ± 0.10 to 39.01 ± 0.32 mN/m. The results also indicated the potential of developing low-cost strategies aimed at the production of efficient LAB-derived BSs which are structurally and quantitatively similar to the ones obtained from conventional media. Finally, given the physical and functional characterization (i.e. critical micelle concentration (CMC), emulsification index (%E₂₄), stability, as well as antimicrobial and anti-adhesive activities) of the BS produced in the present study, it can be introduced as a promising candidate to be employed in plenty of areas in pharmaceutical and food industries.

Applications of RAFT polymerization for chemical and enzymatic stabilization of l-asparaginase conjugates with well-defined poly(HPMA)

HPMA RAFT polymerization and activation with variable linker chemistry for stabilization of l-asparaginase against pH, temperature, freeze–thaw and proteolytic stresses.

Effect of PEGylation on assembly morphology and cellular uptake of poly ethyleneimine-cholesterol conjugates for delivery of sorafenib tosylate in hepatocellular carcinoma

Introduction: Sorafenib (SFB) is an FDA-approved chemotherapeutic agent with a high partition coefficient (log P = 4.34) for monotherapy of hepatocellular carcinoma (HCC). The oral bioavailability is low and variable, so it was aimed to study the application of the polymeric nanoassembly of cholesterol conjugates of branched polyethyleneimine (PEI) for micellar solubilization of SFB and to investigate the impact of the polymer PEGylation on the physicochemical and cellular characteristics of the lipopolymeric dispersions. Methods: Successful synthesis of cholesterol-PEI lipopolymers, either native or PEGylated, was confirmed by FTIR, ¹H-NMR, pyrene assay methods. The nanoassemblies were also characterized in terms of morphology, particle size distribution and zeta-potential by TEM and dynamic light scattering (DLS). The SFB loading was optimized using general factorial design. Finally, the effect of particle characteristics on cellular uptake and specific cytotoxicity was investigated by flow cytometry and MTT assay in HepG2 cells. Results: Transmission electron microscopy (TEM) showed that PEGylation of the lipopolymers reduces the size and changes the morphology of the nanoassembly from rod-like to spherical shape. However, PEGylation of the lipopolymer increased critical micelle concentration (CMC) and reduced the drug loading. Moreover, the particle shape changes from large rods to small spheres promoted the cellular uptake and SFB-related cytotoxicity. Conclusion: The combinatory effects of enhanced cellular uptake and reduced general cytotoxicity can present PEGylated PEI-cholesterol conjugates as a potential carrier for delivery of poorly soluble chemotherapeutic agents such as SFB in HCC that certainly requires further investigations in vitro and in vivo.

Pharmacokinetics and Biodistribution of Pegylated Methotrexate after IV Administration to Mice

The efficacy of methotrexate (MTX) as an antimetabolite chemotherapeutic agent highly depends on its blood circulation half-life. In our previous study, different conjugates of MTX (MTX-PEG) were synthesized, their physicochemical properties were investigated and MTX-PEG5000 was finally selected as optimum drug-conjugate for further investigations. In the current work, first the stability of MTX-PEG5000 was studied at 37 °C and the results indicated its high stability in plasma (T_1/2 = 144 h) and a relatively rapid degradation in tissue homogenate (T_1/2 = 24 h). The study of protein binding pointed out that the conjugate was highly protein-bound (95%). The results of pharmacokinetic studies in mice indicated that MTX-PEG5000 had longer plasma distribution and elimination half-lives compared to free MTX (T_{1/2 α} 9.16 min for MTX-PEG5000 versus 2.45 min for MTX and T_{1/2 β} 88.44 for MTX-PEG5000 versus 24.33 min for MTX). Pharmacokinetic parameters also showed higher area under the curve (AUC) of conjugate compared to parent drug (12.33 mg.mL^-1.min for MTX-PEG5000 versus 2.64 mg.mL^-1.min for MTX). The biodistribution studies demonstrated that MTX-PEG5000 did not highly accumulate in liver and intestine and had a mild and balanced distribution to other organs. Also, the conjugate was measurable in tissues up to 48 h after injection and was detected in the brain, suggesting the possibility of delivering drug to brain tumors.

"Grafting-from" synthesis and characterization of poly (2-ethyl-2-oxazoline)-b-poly (benzyl L-glutamate) micellar nanoparticles for potential biomedical applications

Introduction: Recent advances in the field of poly (2-oxazolines) as bio-inspired synthetic pseudopeptides have proven their potential biomedical applications such as drug delivery and tissue engineering.

Methods: In order to fabricate a biodegradable micellar nanoparticle of poly (2-ethyl 2-oxazoline)-b-poly (benzyl L-glutamate) or pEOx-b-pBLG, "grafting-from" synthesis approach was used involving consecutive steps of cationic ring-opening polymerization of 2-ethyl-2-oxazoline, amine functionalization of pEOx using 1-Boc-piperazine and N-carboxyanhydride polymerization of γ-benzyl- L-glutamate. Following hydrolysis of the copolymer, the protecting γ-benzyl groups were removed yielding a double-hydrophilic block ionomer of pEOx-b-poly (L-glutamic acid). The polymers were characterized by FTIR, ¹H-NMR, size exclusion chromatography and differential scanning calorimetry (DSC). Aqueous assembly of the polymers was investigated by pyrene assay, dynamic light scattering, and transmission electron microscopy. MTT cytotoxicity assay was also performed to determine the cytocompatibility in various tumor cell lines.

Results: The polymeric micelles presented a uni-modal size distribution with mean hydrodynamic diameter of 149.8 ± 10.6 nm and critical aggregation concentration of 60 µg/mL. The average molecular weight of pEOx increased from ~ 14 to 20 kDa for pEOx-b-poly (L-glutamic acid) as determined by light scattering (Debye plot), indicating a successful copolymerization. MTT assay showed little to no practical cytotoxicity at concentrations below 1 mg/mL.

Conclusion: Multi-step synthesis of pEOx-b-pBLG and subsequent alkaline hydrolysis were performed to obtain the block ionomer pEOx-b-poly (L-glutamic acid). Both pEOx-based copolymers can be considered for various potential applications such as loading and delivery of drugs, genes, and contrast agents either by chemical conjugation or physical loading.

Physicochemical and Immunomodulatory Properties of Gum Exudates Obtained from Astragalus myriacanthus and Some of Its Isolated Carbohydrate Biopolymers

Plants gums are complex mixtures of different polysaccharides with a variety of biological activities and pharmaceutical applications. Few studies have focused on physicochemical and biological properties of gums obtained from different plants. This study was designed to determine potential pharmaceutical and pharmacological values of the gum exudates and its isolated biopolymers obtained from Astragalus myriacanthus Boiss [syn. Astracantha myriacantha (Boiss.) Podlech] (Fabaceae). The physicochemical, rheological, and mucoadhesion properties of the gum and its fractions was measured at 7, 27, and 37 °C with and without the presence of NaCl (1%). Also, the structural and immunomodulatory properties of several water soluble biopolymers isolated using ion exchange and size exclusion chromatographic methods were investigated on Jurkat cells at concentrations of 31.25, 62.5, 125, 250, 500 and 1000 μg/mL. The consistency and shear-thinning property of the gum and its fractions decreased as temperature increased. In the presence of NaCl, the consistency increased but no regular pattern was observed regarding to shear-thinning behavior. The mucoadhesion strength was 40.66 ± 2.08 g/cm² which is suitable for use as a formulary mucoadhesive polymer. The isolated biopolymers had proteo-arabinoglycan structure. Their molecular weight was calculated to be 1.67-667 kDa. One biopolymer had a proliferative effect and others had dose dependent cytotoxic/proliferative properties. The crude gum and its insoluble fraction showed suitable mucoadhesion, swellability and rheological properties which makes them suitable for designing drug delivery systems. The gum proteo-arabinoglycans with different molecular weight and structures had different immunomodulatory properties.

Formulation and in vitro evaluation of a fast-disintegrating/sustained dual release bucoadhesive bilayer tablet of captopril for treatment of hypertension crises

Hypertension crisis is one of the main health problems and its effective treatment is of high importance. For this purpose, fast-disintegrating and sustained release formulations of captopril, as a drug of choice, were prepared using conventional mucoadhesive polymers hydroxypropyl methylcellulose (HPMC), sodium carboxymethyl cellulose (Na-CMC), hydroxypropyl cellulose (HPC), Carbopol 934 (CP934) and sodium alginate (Na-alg). The optimum sustained release formulations were selected based on mean dissolution time (MDT). The swellability and mucoadhesive properties of selected formulations were assessed and compared. A direct relationship between swelling and release rates/adhesiveness of sustained release formulations was observed. The results showed that formulations containing combination of CP934 and cellulose-based polymers had the highest swellability, sustainability and adhesion strength. These formulations prolonged drug release up to 8 h showing good fitness to Korsemeyer-Peppas model. Moreover, the adopted fast-disintegrating tablet could release up to 100% of drug within 3 min in oral pH. Finally, a dual fast-disintegrating/sustained release bucoadhesive bilayer tablet consisting of optimized formulations was prepared releasing 30% of the drug initially within 15 min and the remaining up to 8 h which could be considered as an appropriate formulation for the treatment of hypertension crises.

The Effect of Black Tea (Camellia sinensis (L) Kuntze) on Pediatrics With Acute Nonbacterial Diarrhea: A Randomized Controlled Trial

We aimed to evaluate the antidiarrheal effect of black tea in pediatric patients with acute nonbacterial diarrhea. This single-blind randomized clinical trial study was performed on 2 to 12-year-old patients, with acceptable criteria for acute nonbacterial diarrhea in Shiraz, Iran. In total, 120 patients took part in this study. Blocked randomization method was used to allocate them into 2 groups of intervention (black tea tablet + standard treatment) and control group (standard treatment; 60 patients in each). Frequency of defecation, volume, and consistency of stool were registered on arrival and 24 hours later. We used χ² test, t test, and Mann-Whitney U test. After a 24-hour follow-up, the proportion of patients with formed stool was higher in the intervention group when compared with the control group (P < .001). There was a significant difference between the mean number of defecations per 24 hours in both groups, after treatment (P < .001). We found a possible antidiarrheal effect of black tea.

A Review of Herbal Medicine in Iranian Traditional Manuscripts for Treatment of Participatory Gastric Headache

BACKGROUND

Participatory gastric headache is a type of headache described in Iranian traditional medicine. It is defined as a headache not originated from the head and neck disorders; rather the pain in the head is caused by gastric dysfunction and its disorders. Treatment of this type of headache is completely reliant on the treatment of the gastric complaint. Reviewing Iranian traditional medicine (ITM) literature, a broad spectrum of herbal medicines that could be useful in the treatment of this type of headache is described. Accordingly, this review was performed to gather and discuss the therapeutic management of this disorder in ITM and evaluating related characteristics of each medicinal herb.

METHODS

In this study, medicinal plants prescribed for gastric headache from different ancient Iranian literature is documented. The botanical name, family name, part used, temperaments, rout of administration and dosage forms are provided in this article.

RESULTS

About 40 plants, mainly used orally, were prescribed for the treatment of participatory gastric headache. Most of them have the astringent effect, which is related to their dryness temperament. Therefore, they could strengthen the stomach and prevent ascending vapors into the brain that in turn helps to get relief from headache. In addition, they possess reinforcement effect on the brain.

CONCLUSION

In general, herbal medicines with tonic characteristics could be effective in participatory gastric headache.

Sublingual versus Vaginal Misoprostol for the Induction of Labor at Term: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial

BACKGROUND

We sought to compare the effectiveness and safety of sublingual versus vaginal misoprostol for the termination of pregnancy with a live full-term fetus.

METHODS

This randomized, triple-blind, placebo-controlled clinical trial was performed on 200 primiparous women with normal, singleton, full-term pregnancies candidated for the induction of labor. Sublingual and vaginal tablets containing misoprostol (25 mcg) or placebo in similar shapes were administered every 4 hours until the Bishop score reached above 8. Maternal and neonatal complications and outcomes were compared.

RESULTS

There were 100 parturient women in each group. The mean maternal age, gestational age, and Bishop score at the commencement of misoprostol had no statistical differences between the sublingual and vaginal groups. The mean time interval between misoprostol commencement and delivery was 497.10±291.49 and 511.67±08.46 minutes for the sublingual and vaginal groups, correspondingly. Twenty-two women had Cesarean deliveries in the sublingual group versus 14 in the vaginal group. Meconium-stained amniotic fluid was seen in 12 women in the sublingual group and 4 in the vaginal group (P=0.03). Late fetal heart rate deceleration was observed in 8 women in the sublingual group and 4 in the vaginal group (P=0.22). The mean neonatal birth weight, blood gas value at birth, Apgar score, and length of admission time in the neonatal intensive care unit were not different between the 2 groups.

CONCLUSION

Sublingual and vaginal misoprostol had similar effectiveness; however, meconium-stained liquor was observed considerably more frequently with sublingual misoprostol than with vaginal misoprostol.

TRIAL REGISTRATION NUMBER

IRCT201402096541N3.

Effect of a traditional syrup from Citrus medica L. fruit juice on migraine headache: A randomized double blind placebo controlled clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

In Persian ethnomedicine several herbal remedies and functional foods have been used to treat migraine headache which are mostly summarized in Qarabadin-e-kabir (Aghili-Shirazi MH, 1773). One of them is Citron syrup (Sharbat-e-Balang) containing edible Citrus medica L. fruit juice and sugar. The present study was designed to assess the efficacy and safety of Citron syrup on patients with migraine headache.

MATERIALS AND METHODS

Citron syrup was prepared as described in Qarabadin-e-kabir. In this double blind randomized placebo-controlled clinical trial, ninety patients with migraine headache were allocated to three parallel groups (Citron syrup, propranolol or placebo). Patients received 15ml of Citron syrup, placebo syrup or 20mg of propranolol tablet three times daily after a meal for 4 weeks. Primary outcomes were obtained from three measures: the frequency (per month), mean duration (hour) and mean intensity (visual analogue scale "VAS" 0-10 score) of headache attacks evaluated prior to and following 4 weeks of the intervention.

RESULTS

Citron syrup was superior to placebo in reduction of headache attacks intensity (P<0.01) and duration (p<0.0001) and as effective as propranolol in patients with migraine headache (P>0.05). However, unlike propranolol, Citron syrup could not significantly reduce the frequency of attacks compared to placebo. No indication of any serious side effects from Citron syrup was observed.

CONCLUSION

According to obtained results, Citron syrup as a traditional Persian remedy can be suggested as an effective treatment for decreasing pain intensity and duration of attacks in migraine headache and the effectiveness is comparable to propranolol. However, the syrup did not show significant effect on frequency of attacks.

Croup as Unusual Presentation of Post-transplantation Lymphoproliferative Disorder after Liver Transplantation in an 18-month-old Child

Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation that occurs due to immunosuppression and other risk factors. PTLD may present with involvement of other organs and with unusual presentation. The presentation is often extranodal (e.g., in the gastrointestinal tract, lung, or the central nervous system). Herein, we report on a 1.5-year-old girl who underwent liver transplantation almost 5 months prior to admission. She was on medications such as tacrolimus and prednisolone. Her presentation was started with symptoms of the upper respiratory infection followed by croupy cough and respiratory distress with no response to usual treatments. She had respiratory arrest during broncoscopy. Therefore, emergency tracheostomy was done. Biopsy from the paratracheal mass revealed large B cell non-Hodgkin lymphoma (PTLD, monomorphic and high grade). This case presentation shows that persistent upper airway symptoms, particularly stridor and croupy cough, in children who underwent liver transplant should be further evaluated; the physician needs to have a high degree of clinical suspicion for the diagnosis of PTLD in this situation.

Randomized clinical trial of peganum oil for knee osteoarthritis

Osteoarthritis affects about 50% of people aged older than 65 years. Pain is the most important symptom in this disease. Today public interest in the use of complementary medicine, especially traditional herbal medicines has increased. The present study was designed to investigate the efficacy of traditional preparation of Peganum harmala L oil on patients with knee osteoarthritis. The product has been analyzed and standardized by high-performance liquid chromatography. A double blind controlled randomized clinical trial consisting of 54 patients were performed. Patients rubbed the drug or control (olive oil) on the knee 4 drops 3 times a day for 4 weeks. The patients were asked to fill out the Western Ontario and McMaster Universities Arthritis Index and Visual Analogue Scale questionnaires at week 0 and 4. The adapted results from the questionnaires showed that pain and difficulty in function were significantly decreased in Peganum oil group after 4 weeks. There was no significant difference in stiffness change between 2 groups.

Sequential optimization of methotrexate encapsulation in micellar nano-networks of polyethyleneimine ionomer containing redox-sensitive cross-links

A functional polycation nanonetwork was developed for delivery of water soluble chemotherapeutic agents. The complexes of polyethyleneimine grafted methoxy polyethylene glycol (PEI-g-mPEG) and Zn(2+) were utilized as the micellar template for cross-linking with dithiodipropionic acid, followed by an acidic pH dialysis to remove the metal ion from the micellar template. The synthesis method was optimized according to pH, the molar ratio of Zn(2+), and the cross-link ratio. The atomic force microscopy showed soft, discrete, and uniform nano-networks. They were sensitive to the simulated reductive environment as determined by Ellman's assay. They showed few positive ζ potential and an average hydrodynamic diameter of 162±10 nm, which decreased to 49±11 nm upon dehydration. The ionic character of the nano-networks allowed the achievement of a higher-loading capacity of methotrexate (MTX), approximately 57% weight per weight, depending on the cross-link and the drug feed ratios. The nano-networks actively loaded with MTX presented some suitable properties, such as the hydrodynamic size of 117±16 nm, polydispersity index of 0.22, and a prolonged swelling-controlled release profile over 24 hours that boosted following reductive activation of the nanonetwork biodegradation. Unlike the PEI ionomer, the nano-networks provided an acceptable cytotoxicity profile. The drug-loaded nano-networks exhibited more specific cytotoxicity against human hepatocellular carcinoma cells if compared to free MTX at concentrations above 1 μM. The enhanced antitumor activity in vitro might be attributed to endocytic entry of MTX-loaded nano-networks that was found in the epifluorescence microscopy experiment for the fluorophore-labeled nano-networks.

Meloxicam transdermal delivery: effect of eutectic point on the rate and extent of skin permeation

OBJECTIVE(S)

Drug delivery through the skin can transfer therapeutic levels of drugs for pharmacological effects. Analgesics such as NSAIDs have gastrointestinal side effects and topical dosage forms of these drugs are mainly preferred, especially for local pains. Meloxicam is one of NSAIDs with no topical form in the market. In this research, we attempted to quantify the skin permeation of a meloxicam topical preparation and to show how permeation would be increased by using thymol as an enhancer. The effect of eutectic point of drug and thymol mixture on rate and extent of skin permeation was also studied.

MATERIALS AND METHODS

Different mixtures of thymol and meloxicam (2:8, 4:6, 5:5, 6:4, 8:2) were prepared and their melting point were obtained by differential scanning calorimetry. Then drug permeation was measured using diffusion cells and the Guinea pig skin.

RESULTS

Mixtures in ratios 5:5 and 4:6 of meloxicam / thymol showed a new endotherm at 149 and 140°C in DSC thermograms. The permeability of meloxicam from the creams containing 6:4, 5:5 and 4:6 ratios of meloxicam to thymol were 4.71, 15.2, 22.06 µg/cm(2) respectively. This was significantly different from the cream of pure meloxicam (3.76 µg/cm(2)).

CONCLUSION

This study set out to determine that thymol plays as a skin permeation enhancer and increases the meloxicam skin absorption and this enhancement is significant at the eutectic point of drug-enhancer mixture.