Estradiol- and progesterone-associated changes in microRNA-induced silencing and reduced anti-seizure efficacy of an antagomir in female mice

About one third of individuals living with epilepsy have treatment-resistant seizures. Alternative therapeutic strategies are thus urgently needed. One potential novel treatment target is microRNA-induced silencing, which is differentially regulated in epilepsy. Inhibitors (antagomirs) of specific microRNAs have shown therapeutic promise in preclinical epilepsy studies; however, these studies were mainly conducted in male rodent models, and research into microRNA regulation in females and by female hormones in epilepsy is scarce. This is problematic because female sex and the menstrual cycle can affect the disease course of epilepsy and may, therefore, also alter the efficacy of potential microRNA-targeted treatments. Here, we used the proconvulsant microRNA miR-324-5p and its target, the potassium channel Kv4.2, as an example to test how microRNA-induced silencing and the efficacy of antagomirs in epilepsy are altered in female mice. We showed that Kv4.2 protein is reduced after seizures in female mice similar to male mice; however, in contrast to male mice, microRNA-induced silencing of Kv4.2 is unchanged, and miR-324-5p activity, as measured by the association with the RNA-induced silencing complex, is reduced in females after seizure. Moreover, a miR-324-5p antagomir does not consistently reduce seizure frequency or increase Kv4.2 in female mice. As a possible underlying mechanism, we found that miR-324-5p activity and silencing of Kv4.2 in the brain were differentially correlated with plasma levels of 17β-estradiol and progesterone. Our results suggest that hormonal fluctuations in sexually mature female mice influence microRNA-induced silencing and could alter the efficacy of potential future microRNA-based treatments for epilepsy in females.Significance StatementMicroRNA-induced silencing is currently investigated in preclinical studies as a potential novel class of treatment target for epilepsy; however, surprisingly little is known about if and how microRNA-induced silencing is regulated by biological sex and if microRNA therapeutics are as effective in females as they are in males. This study shows that microRNA silencing of the potassium channel Kv4.2 and the functional activity of its targeting microRNA, miR-324-5p, change with plasma levels of estrogens and progesterone and that an inhibitor of miR-324-5p is less effective in female mice to suppress seizures. These findings are significant as they suggest microRNA-induced silencing as a novel molecular mechanism contributing to sex differences in epilepsy that could impact future therapy development.

1551 Patient Safety Audit: Adherence to The ENT Referral Proforma

Medway Hospital’s ENT on-call team triages referrals according to the local ENT Emergency referral guideline. Recently, a poor referral and handover resulted in a patient with post-tonsillectomy bleeding collapsing while on an immovable trolley in ED minors. Following reflection, a referral proforma was formulated to help the on-call ENT doctor ensure safe patient management through a traffic light system. The proforma includes patient and referrer detail along with four referral outcomes or colours, depending on patient stability, each with prompts for initial management. This audit aims to measure adherence to the ENT referral proforma.

We performed a retrospective cohort analysis of compliance to the new ENT referral pathway. Proformas completed between 18th October and 17th November 2020 were included. A quasi-random method of sampling was utilized, every two of three paper forms. The data was inputted on Excel. Each proforma was marked for documentation of ten aspects.

Of the total seventy-seven proformas, one scored 100%. On average, proformas were 80% completed. The most documented, at 100%, was patient detail. While the least documented, at 8%, was stating if ED were informed of the plan. 5% of referrals required potential resuscitation in ED, of which none met all criteria for a safe handover.

The audit shows that the referral proforma is currently not adequately completed. This provides a basis for further intervention to improve patient safety for ENT referrals. The next step would be to inform the department to discuss why adherence is poor and maximize future documentation.

Supremum, infimum and hyperlimits in the non-Archimedean ring of Colombeau generalized numbers

It is well-known that the notion of limit in the sharp topology of sequences of Colombeau generalized numbers R ~ does not generalize classical results. E.g. the sequence 1 n ↛ 0 and a sequence ( x n ) n ∈ N converges if and only if x n + 1 - x n → 0 . This has several deep consequences, e.g. in the study of series, analytic generalized functions, or sigma-additivity and classical limit theorems in integration of generalized functions. The lacking of these results is also connected to the fact that R ~ is necessarily not a complete ordered set, e.g. the set of all the infinitesimals has neither supremum nor infimum. We present a solution of these problems with the introduction of the notions of hypernatural number, hypersequence, close supremum and infimum. In this way, we can generalize all the classical theorems for the hyperlimit of a hypersequence. The paper explores ideas that can be applied to other non-Archimedean settings.

600 ESCALATION DECISIONS DURING THE COVID-19 PANDEMIC AMONGST OLDER ADULTS

Introduction

NICE guidance recommends that during the COVID-19 pandemic all adults are assessed for frailty, suitability for resuscitation and escalation to critical care on admission to hospital. Risks, benefits and likely outcomes should be discussed with patients/relatives.

Aim

To investigate impact of intervention on treatment escalation plan (TEP) use during the first wave (W1) and second wave (W2) of pandemic.

Intervention

W1: An ethically approved TEP and a Critical Care Decision Aid (CCDA) was added to the admission booklet.

W2: The TEP update included a ‘confirm discussed with patient/relatives’ section.

Method

W1: We conducted retrospective review of 62 case-notes of patients admitted through COVID-19 pathway and grouped into >80 and ≤ 80 years old. Resuscitation, TEP, CCDA and communication with patient/relatives were collected.

W2: 60 further case-notes of patients with COVID-19 admitted in January 2021 were analysed.

Results

W1: 100% patients had resuscitation decisions and 95% had TEPs in both groups. Significantly higher proportions of Frailty scores were calculated in >80s (58% vs 35% p = 0.04). On average resuscitation and TEPs were made within 13.8 hours of admission (range 1–72 hours). 53.2% of resuscitation decisions and 30% TEPs were discussed with patients of whom higher proportions were discussed in younger age group, majority were discussed at the time of deterioration.

W2: 98.3% patients had resuscitation decisions made and 96.7% had TEPs across both groups. On average resuscitation decisions were made within 14.9 hours of admission. In the >80s, 86.7% of resuscitation decisions were discussed and 63.3% of the TEPs were discussed with patient/relatives. In the <80s, 82.8% of resuscitation decisions were discussed and 71.4% of TEPs were discussed with the patient/relatives.

Conclusion

We significantly improved Treatment Escalation planning during W1 and W2 of pandemic by introducing the TEP in W1 and adding prompt to improve communication with patients/relatives in W2 (p = 0.02).

146 Improving Outcomes in Aspiration Pneumonia: A Collaborative Approach

Introduction

Aspiration pneumonia is a major cause of morbidity and mortality especially in older adults. Our Trust recorded higher than expected mortality ratios in this group of patients. Aim To investigate reasons behind higher than expected mortality and improve outcomes. Intervention We developed a collaborative approach of investigating mortality in aspiration pneumonia with joint input from Speech and Language (SALT) specialists.

Method

We conducted structured retrospective review of annual mortality in aspiration pneumonia in 3 PDSA (plan, do, study, and act) cycles in 2015/18/20. We collected data on clinical care, diagnostic accuracy, SALT referral/input, feeding at risk discussion, communication with primary care. We monitored mortality ratios on national systems.

Results

We improved clinical and nursing care by auditing mouth care, bed elevation and safe feeding. We also developed electronic-SALT referral form to improve timings for the reviews (first PDSA cycle). SALT team developed “feeding at risk proforma” to formalise risk feeding where safe swallow plan was not possible (second PDSA cycle). We modified discharge summaries and made this a multidisciplinary document in the Trust so that SALT can communicate feeding plans to primary care (third PDSA cycle). Mortality ratios improved significantly in this period from Relative risk of 152 (higher than expected range) in 14/15 to 86 (within expected range) in 19/20.

Conclusion

We have demonstrated significant improvement in hospital mortality ratios from aspiration pneumonia and therefore improved care by collaboratively working with SALT team and bringing changes in stepwise manner. Multidisciplinary mortality reviews are key to improving outcomes for our patients.

Perception Regarding Care of Attempted Suicide Patients among Nursing Students in Kathmandu University School of Medical Sciences

Background Suicide is an act of deliberately killing oneself. It is a global health problem and is the second leading cause of death in 15 to 29 years. Thus, studying nursing students' perception towards suicide attempters has paramount importance in understanding and addressing the existing gaps in healthcare delivery system. Objective To assess the nursing students' perception towards attempted suicide and to find out the association between perception and selected variables. Method A descriptive, cross sectional design was carried out to assess the nursing students' perception towards suicide attempters in Kathmandu University School of Medical Sciences. The respondents were 193 nursing students. A structured questionnaire was used in order to collect data. Descriptive statistics including frequency, percentage, mean and standard deviation were calculated to summarize the data and inferential statistics, Mann Whitney-U test was used for the association between perception and selected variables. Result A total 193 nursing students participated in this study. The scores between 1 and 2.4 were considered 'positive', 'unsure' or 'uncertain', between 2.5 and 3.4 and negative for 3.5 and above' over all nurses showed relatively negative perception towards suicide attempters. According to results from eight domains of perception, those who did not attend the courses on psychiatry nursing presented higher score, which was found to have significant association with permissiveness, unpredictability and incomprehensibility. A younger nursing student shows significant association with incomprehensibility. Younger nursing student showed statistically significant association with duration of suicide process. Conclusion Nursing students are frequently encountered with attempted suicide patients. Therefore, they must be aware of their attitudes toward this group of patients as part of their professional and therapeutic role. Thus a nurse's positive perception towards attempted suicide can play a key role in communicating and preventing a future suicide attempt.

16 Comparison of Characteristics and Outcomes for Older Adults Admitted to Specialty Wards Versus Outlying Wards at Royal Bournemouth and Christchurch Hospitals

Background

At Royal Bournemouth and Christchurch Hospitals (RBCH) elderly patients are admitted to either the acute medical unit or the older person’s assessment unit. If the inpatient stay is likely to be longer than 72 hours, then patients are transferred to one of three elderly care wards. If these wards are at capacity, then patients must be outlied to other wards.

Introduction

GMC guidance June 2014, states hospital inpatients should have a named consultant. Studies have shown that length of stay and outcomes can be affected when the patient is on an outlying ward. This issue affects many hospitals and specialties, and also impacts older frail patients at RBCH. During winter elderly care admission rates increase, and more patients are outlied. Our aim was to improve the care and outcomes for elderly care patients treated on outlying wards.

Methods

The notes of 50 specialty ward patients and 50 outlying patients were compared from the first two weeks of January and February 2019 using scanned electronic records where elderly care was responsible for their treatment. We studied demographic characteristics, length of stay, mortality, readmission within 30 days of discharge, frequency of consultant review, escalation plans, discharge destination and ward moves.

Interventions

A dedicated outlying team was created for the 2018/2019 winter to attempt to improve outcomes for outlying elderly care patients. This team consisted of a geriatrician, registrar, SHO and allied health care professionals including a physiotherapist and discharge coordinator.

Results

Our results showed that outlying patients had a significantly longer average length of stay compared to patients on specialty ward (13.8 days vs 8.2 days, p=0.01). A significantly higher proportion of patients in outlying wards did not have a consultant review every 72 hours (66% vs 8.3% specialty ward patients, p=0.001). However the specialty ward patients had a significantly higher number of readmissions within 30 days (30.6% vs 16%, p=0.04).

Conclusions

We found that despite a dedicated team, outlying patients had a significantly longer length of stay and were seen by a consultant less often than patients on a specialty ward. Further work is needed to ensure equality of care for these patients. Patients with complex medical needs are generally triaged to specialty wards, which may account for their higher readmission rate.

Amitraz Poisoning Treated Successfully with Atropine

Very few cases have been reported with Amitraz as a suicidal agent from India. Here we present such a case treated successfully with atropine sulphate.

Over 75% incident-photon-to-current efficiency without solid electrodes

The highest IPCE value recorded for nanoparticles electrically decoupled from solid electrodes is presented. The highly versatile concept underpinning this work, based on polarizable interfaces between two immiscible electrolyte solutions, can be extended to a wide range of photoactive colloidal systems.

Pattern of Pediatric Admissions in a Tertiary Care Hospital of Central Nepal

INTRODUCTION

An understanding of the epidemiological trend in hospital admissions, including morbidity and mortality patterns and the economic impact, is critical for healthcare planning and appropriate resource allocation. As we find very few literature on the pattern of paediatric admissions outside Kathmandu Valley, it is essential to conduct studies in the various parts of the country to determine the paediatric inpatient burden as well resource allocations.

METHODS

A retrospective study was carried out at Department of Pediatrics, College of Medical Sciences-Teaching Hospital, Bharatpur, Chitwan, Nepal over a period of one year. All the admissions were analyzed for age, sex, address, seasonal variation, frequency of diseases according to the organ system involved, duration of hospital stay, and the outcome.

RESULTS

Out of the total 814 cases admitted 68.8% of the patients were younger than five years. There was male preponderance with male to female ratio of 1.9:1. Majority (43.6%) admissions were from Chitwan itself. Respiratory, gastrointestinal and neurologic conditions were the main cause for admission. The mean duration of hospital stay was 5.28 days and the mortality was only 0.1%.

CONCLUSIONS

In this study under five-year patients contributed to 2/3rd of the hospital admissions. Respiratory, gastrointestinal and neurologic conditions were the main cause for admission with pneumonia, URTI and acute gastroenteritis being the most common diseases.

CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin

Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (*1/*3). This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin.

Clinical Profile of Neonates with Perinatal Asphyxia in a Tertiary Care Hospital of Central Nepal

INTRODUCTION

Birth asphyxia is a serious clinical problem worldwide. It claims approximately 9 million deaths each year. It can lead to serious neurological sequaele, such as cerebral palsy, mental retardation, and epilepsy.

METHODS

All babies admitted in College of Medical Sciences Teaching Hospital, Chiwan, Nepal, NICU from January 2013 to December 2013 with a diagnosis of birth asphyxia (5 min Apgar<7 or those with no spontaneous respirations after birth) were included in the study (n=125). This was a descriptive observational study. Clinical information was collected (gravida, hour at presentation, mode of delivery, sex of baby, gestational age of the baby, requirement of resuscitation). Neonates were admitted to NICU, observed for complications and managed as per hospital protocol.

RESULTS

Among the 722 neonates admitted to NICU, 125 had perinatal asphyxia (17.3%). Babies with Hypoxic ischemic encephalopathy(HIE) Grade I had a very good outcome but HIE III was associated with a poor outcome. Outborn neonates had higher grades of perinatal asphyxia as compared to inborns (p=0.018). Term gestation, Males and Multigravida were associated with a higher rate of birth asphyxia. 22.4% neonates were delivered via caesarean section and 74.4% required bag and mask ventilation at birth.

CONCLUSIONS

Birth asphyxia was one of the commonest causes of admission NICU. Babies with HIE Grade III had a very poor prognosis. Outborn neonates with birth asphyxia had a higher mortality. Males were frequently affected than females.

A clinical comparison of high dose and low dose of Suxamethonium

Background: Suxamethonium having its rapid onset and short duration of action makes this drug unique amongst the neuromuscular blocking drugs described so far. However, use of suxamethonium is associated with a large number of undesirable side effects. Objective: To evaluate clinical effects of high and low dose of suxamethonium and to determine whether lower dose of suxamethonium can be used for any beneficial effects in terms of its various adverse effects e.g. cardiovascular responses, post-operative muscle pains and intraocular pressure. Methods: A total of 100 patients were included in this prospective study. All these patients on preoperative clinical evaluation were assessed to have adequate airway. All the patients were divided in two groups, low dose group (group I) and High dose group (group II) with 50 patients in each at random. A standard anesthetic technique was adhered to all the patients and following parameters were observed on comparative basis: a. Fasciculation and post operative myalgia. b. Cardiovascular effects, c. Intraocular pressure. Observation: The incidence of post Suxamethonium pain was significantly greater in group II. Increase in heart rate from baseline was significant in both groups. There was no significant difference between the two groups in the diastolic pressure but rise in systolic blood pressure was significant at all assessment times in both groups. This rise from control was statistically significant. Conclusion: Suxamethonium can be used in lower doses (0.5 mg/kg) in elective cases without airway compromise. It gives benefits of reduced muscle pains, cardiovascular responses and intraocular hypertension. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 1-8 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9677

A comparison of serum potassium level between high dose and low dose of Succinylcholine

Aims: Succinylcholine is a depolarizing type of neuromuscular blocking drug. Aim of this study is to evaluate and compare serum potassium level with upper dose limit of succinylcholine (1.5mg/kg), which is used normally in anesthetic practice with low dose of succinylcholine (0.5mg/kg). Materials and methods: A total of 100 patients attending for elective surgery in College of Medical Sciences -Teaching Hospital( CMSTH)), Bharatpur, Chitwan, Nepal were studied. Two blood samples were collected, one before surgery and another at 4 min after injection of succinylcholine and send to central lab for estimation of serum potassium level. Result: The serum potassium levels recorded during the study showed that there were neither significant differences observed within the groups nor was there any difference between the groups. Conclusion: In absence of pathological conditions related to raised serum potassium level, both high and low doses of succinylcholine can be used safely as there is no statistically significant differences in serum potassium level between high and low dose of succinylcholine. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 19-22 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9669

Efficient ELISA for diagnosis of active tuberculosis employing a cocktail of secretory proteins of Mycobacterium tuberculosis

Rapid and accurate diagnosis is important for preventing transmission of Mycobacterium tuberculosis. Currently available tuberculosis (TB) diagnostic methods lack desired sensitivity and specificity, and require sophisticated equipment and skilled workforce including weeks' long duration to yield results. In this study, extracellular proteins or secretory protein antigens of M. tuberculosis H37Rv have been isolated using ion exchange chromatography, immunocharacterized and exploited for the development of efficient enzyme-linked immunosorbent assay (ELISA) for diagnosis of active TB with enhanced specificity and sensitivity. Apparent molecular masses for purified proteins were found to be 6, 27, 30, 38 and 64 kDa. Out of five purified proteins, one (64 kDa) was found to be novel. Of the five proteins, four (6, 27, 30 and 38 kDa) were found significant to be used in the development of ELISA for pulmonary and extra-pulmonary TB. The immune responses of serum samples of TB patients and other healthy subjects against the above-mentioned antigens' cocktail were evaluated. Critical parameters of newly developed ELISA were optimized and it was observed that the cocktail antigens have a greater specificity (98.06 %) and sensitivity (98.67 %) as compared to other commercially available diagnostic tests. The present findings suggest that the developed ELISA is an effective tool for routine screening and early-stage diagnosis of TB.

Application of Fe(VI) in the treatment of Zn(II)-NTA complexes in aqueous solutions

The higher oxidation state of iron, i.e. Fe(VI), was exploited to treat the synthetic wastewater containing Zn(II)-NTA. The decomposition of Zn(II)-NTA by Fe(VI) was investigated with the help of analytical data obtained for the change in Fe(VI) concentration, dissolved organic carbon (DOC) and total soluble Zn(II) concentration as a function of time at various concentrations of Zn(II)-NTA and at constant Fe(VI) concentration. The UV-Visible data was used to explain the reaction kinetics for redox reactions between Fe(VI) and Zn(II)-NTA. The pseudo-first-order rate constant was calculated keeping the Zn(II)-NTA concentration in excess and hence the overall second-order-rate constant was obtained. Fe(VI) reduction was almost unaffected with the 1000 times increase in ionic strength (NaNO3), as well as in the presence of completely oxidized background electrolytes. However, Fe(VI) reduction was greatly affected in the presence of both SO3(2-) and NO2(-) especially at higher concentrations, indicating a competitive reduction took place between Zn(II)-NTA and Na2SO3 or NaNO2 in the Fe(VI) treatment. These results were again supported by the dissolved organic carbon observations since relatively very low removal of the dissolved organic carbon occurred in the presence of Na2SO3 and NaNO2.

Prognostic significance of early lymphocyte recovery after post-autografting administration of GM-CSF in non-Hodgkin's lymphoma

The purpose of this study was to analyze the prognostic significance of early lymphocyte recovery after autologous SCT (ASCT) in the setting of routine post transplant administration of GM-CSF in patients with non-Hodgkin's lymphoma (NHL). This is a single institution retrospective comparative outcome analysis in a cohort of 268 relapsed chemosensitive NHL patients divided into two groups (early and late lymphocyte recovery) based on absolute lymphocyte counts (ALC) obtained on post transplant day +15 (ALC > or = 500, n=151 (56%) and ALC < 500, n=117 (44%)). Patient's characteristics were well-balanced between the two groups with regard to age, sex, preparative regimen, prior therapy, time from diagnosis to transplant and number of CD34+ cells infused. Post transplant complications were comparable in the two groups. Late lymphocyte recovery (ALC < 500 on day +15) was independently associated with a delay in platelet recovery (29 vs 21 days, P=0.0003) in patients who have not received pre-transplant rituximab. With a median follow-up of 22 months, no associations between early lymphocyte recovery and improvement of disease-free and overall survival were observed for either low- or intermediate-grade NHL. In conclusion, in this large single-centered retrospective analysis, where patients received routine post transplant GM-CSF, early lymphocyte recovery was not associated with favorable outcomes.

Symmetric peripheral gangrene with mixed malaria

Symmetric peripheral gangrene (SPG) in a case of mixed malaria (P. falciparum and P. vivax) is a rare and relatively unknown complication of malaria. We report a case of 10-yr-old female with mixed malaria infection and SPG (Symmetric Peripheral Gangrene) of foot, which is most likely due to interaction between parasite factors (P. Falciparum and P. viavx) and host factors.

Potential application of manganese coated sand in the removal of Mn(II) from aqueous solutions

The aim of this study was to explore the applicability of manganese coated sand (MCS) in the presence and absence of sodium hypochlorite for the removal of Mn(II) (2 mg/L) from aqueous solutions. Sand itself is widely used as a filter media for the treatment of wastewaters and it was reported that during the treatment, Mn(II), which is present in the wastewater, is to be deposited on the surface of sand in the form of manganese dioxide. The present investigation dealt with various MCS samples, prepared in the laboratory by various doses of Mn(II) (i.e. from 0.05 to 0.2 mol/L) and the samples were obtained from the pilot plant and naturally coated in the water treatment plant for the removal of Mn(II) in the batch and column studies. Moreover, it was realised that the role of hypochlorite is multifunctional as it not only enhances the uptake of Mn(II) on the surface of MCS through oxidation of Mn(II) into Mn(IV) and hence the formation of manganese dioxide, but it was also supposed to disinfect the bacteria or harmful pathogens from the waste/surface waters. The results obtained clearly inferred that various MCS samples used for the removal of Mn(II) from aqueous solutions showed comparable removal efficiency. However, the presence of sodium hypochlorite greatly enhanced the removal of Mn(II) as more than 80% Mn(II) was removed in the presence of sodium hypochlorite at around pH 6.5. Similarly, while comparing the column data it was again noted that the breakthrough points occurred after the 4,100 and 6,500 bed volumes, respectively, in the absence and in the presence of sodium hypochlorite (2 mg/L).

Identification and sub-typing of Mycobacterium avium subsp. paratuberculosis and Mycobacterium avium subsp. avium by randomly amplified polymorphic DNA

A commercially available kit consisting of twenty 10-mer random primers was evaluated to allow selection of a suitable primer that would permit identification and sub-typing of Mycobacterium avium subsp. paratuberculosis and Mycobacterium avium subsp. avium by randomly amplified polymorphic DNA (RAPD). A primer OPE-20 (5'-AAC-GGT-GAC-C-3') was identified to be the most suitable primer when tested with four ATCC reference strains of M. paratuberculosis and eight well characterized field strains each of M. paratuberculosis and M. avium. Primer OPE-20 was further tested for its ability to identify and subtype 200 field isolates of M. paratuberculosis. The fingerprint patterns of M. paratuberculosis (n=212) consisted of five unique common fragments (620, 450, 310, 230, 180bp) and nine variable fragments resulting in six distinct genotypes. The DNA fingerprints of M. avium (n=8) consisted of a single common fragment of 620bp, and 15 variable fragments resulting in six different genotypes. The cattle, human and goat isolates of M. paratuberculosis were genetically similar, but a sheep isolate had a different RAPD profile as compared to RAPD profiles from other species. RAPD was observed to be a rapid, reproducible and reliable technique for identification and sub-typing of M. paratuberculosis.

In vitro-in vivo evaluation of a controlled release buccal bioadhesive device for oral drug delivery

PURPOSE

To investigate the use of buccal bioadhesive device in targeting controlled drug delivery to the gastrointestinal tract.

METHODS

A three-leg crossover study was designed to evaluate the application of buccal bioadhesive device for providing controlled drug delivery to the gastrointestinal tract of a model drug cyanocobalamin in four healthy adult male beagle dogs.

RESULTS

In vitro dissolution studies using deionized water as the medium indicated that 100% of the drug was released within 15 min from a immediate release oral capsule formulation, whereas 90% of the drug was released within a period of 18 hrs from a buccal bioadhesive device formulation. Drug release from the buccal bioadhesive devices appeared to follow Higuchi's square root of time dependent model. The terminal half-life of the drug following I.V. administration in four dogs was found to be 16.4+/-2.4 hrs. Following immediate release oral capsule administration of the drug Cmax, tmax and bioavailability were 2333+/-1469 ng/L, 2.5+/-1.0 hrs and 14.1+/-7.9%, respectively. Following buccal bioadhesive device administration of the drug Cmax, t(max) and bioavailability were 4154+/-1096 ng/L, 11+/-1.2 hrs and 35.8+/-4.1%, respectively. Significantly higher bioavailability of the drug was observed with the buccal bioadhesive device administration when compared to the immediate release oral capsule.

CONCLUSIONS

The buccal bioadhesive device appears to improve the oral bioavailability of cyanocobalamin by providing controlled delivery of the drug to the gastrointestinal tract.

Evaluation of polyoxyethylene homopolymers for buccal bioadhesive drug delivery device formulations

Our objective was to evaluate the application of polyoxyethylene homopolymers in buccal bioadhesive drug (BBD) delivery device formulations. The bioadhesive strength of four different molecular weight (MW) polyoxyethylene polymers was measured by Instron tensile tester using glass plate and bovine sublingual tissue as substrate surfaces. Several BBD device formulations containing polyoxyethylene polymer (MW 7,000,000) were prepared by direct compression and compression molding processes. The prepared BBD devices were evaluated for their elasticity, in vitro adhesion and drug release characteristics. The in vivo bioadhesion characteristics of a placebo compression molded device were examined in 3 adult healthy male beagle dogs. The bioadhesive strength of polyoxyethylene polymers appeared to be directly related to their molecular weights. When bovine sublingual mucosa or a glass plate was used as model mucosal substrate surface, the rank order of bioadhesive strength of different molecular weight polyoxyethylene polymers was similar. The bioadhesive strength of devices prepared by the compression molding process was greater than those prepared by direct compression, but the kinetics of drug release were independent of the process used for the preparation of the devices. The drug release and the bioadhesive strength of the similarly prepared device formulations appeared to be dependent on the drug:polymer ratios. The elasticity of the BBD devices prepared by compression molding was improved by the inclusion of polyisobutylene polymer in the formulations. When adhered to the oral cavity of the dogs, the compression molded placebo BBD device exhibited adhesion for at least 4 hours and appeared to show no signs of local irritation. In conclusion, BBD devices containing polyoxyethylene polymer (MW 7,000,000) can be prepared by direct compression or compression molding process in order to provide controlled drug release to the oral cavity while maintaining appropriate bioadhesive characteristics.

Formulation and evaluation of albuterol metered dose inhalers containing tetrafluoroethane (P134a), a non-CFC propellant

This study was undertaken to evaluate tetrafluoroethane (P134a) as a possible chlorofluorocarbon (CFC) replacement for albuterol metered dose inhaler (MDI) formulations. Preformulation studies using three conventional (oleic acid, sorbitan trioleate, lecithin) and a nonconventional (oleyl alcohol) surfactant indicated that P134a is a poor solvent for these surfactants. A slight improvement in the solubility of oleic acid and oleyl alcohol was observed by the addition of low concentrations of a nonconventional cosolvent diethyl ether (< or = 0.5% w/w). Formulation screening of the prepared albuterol formulations indicated that suspensions containing oleyl alcohol and diethyl ether had a slower rate of separation. Product performance of four albuterol formulations containing oleyl alcohol, diethyl ether, and P134a was evaluated and compared to a leading commercial formulation containing CFC propellants (Ventolin). Ventolin showed excellent agreement between the emitted dose and the expected dose but only a reasonable agreement was observed with one of the better P134a-containing formulations. P134a formulations showed higher internal pressure in comparison to the CFC formulation. The concentrations of the surfactant, drug, and cosolvent appeared to have a significant impact on the uniformity of the emitted dose. Determination of particle size using the time-of-flight and the laser diffraction analyzer revealed that P134a formulations had equal or smaller particle size than the formulation containing CFC. However, the CFC formulation showed a higher respirable fraction than the P134a formulation when measured by the two inertial impaction methods. The observed particle size distribution of the formulation appeared to depend on the measuring method used.

Compatibility evaluation of metered-dose inhaler valve elastomers with tetrafluoroethane (P134a), a non-CFC propellant

Compatibility of propellants, excipients, and solvents with the components of the valve greatly influences performance of metered-dose inhalers (MDIs). Ozone-friendly hydrofluoroalkane propellant 134a has potential for use as a chlorofluorocarbon (CFC) replacement. No suitable replacement for propellant 11 and 114 has yet been found and the problems arising from this may be overcome by use of ethanol as a solvent. In this study, compatibility of MDI valve elastomers Dowty Nitrile 0117, White Buna, and Type 674 (B) with P134a placebo formulations having different concentrations of ethanol was investigated. The results indicate that formulations containing no ethanol adversely affected the functioning of the valves. Higher concentrations of ethanol improved valve performance, but showed increased leakage. Physical characteristics of the valve elastomers evaluated by determining swelling caused after exposure to the P134a placebo formulations exhibited increased swelling with increasing concentrations of ethanol in the formulation.

The uptake behaviour of rice (Jaya) husk in the removal of Zn(II) ions--a radiotracer study

Sequestering of Zn(II) ions at the surface of rice husk has been studied as a function of contact time, adsorptive concentration, temperature and pH, using the radiotracer technique employing a 65Zn radiotracer. A relatively slow uptake of metal ion increasing with bulk dilution (10(-2) to 10(-7) mol/dm3) was seen, which obeys the first-order rate law and agrees well with the classical Freundlich adsorption isotherm. The removal of metal ions from the bulk increases with the increase in pH (3.2-10.2) and temperature (293-323K) and evaluation of the thermodynamic data shows that the process involved is endothermic and apparently irreversible in nature, suggesting an ion exchange mechanism along with surface complexation. On the other hand Cd(II) was not adsorbed on the surface of the rice husk at pH 6.2.

Electrocardiographic diagnosis of infarction of the right ventricular anterior wall

Fifty cases of acute myocardial infarction manifesting in anterior chest leads were studied. The site of infarction was determined by detailed two-dimensional echocardiography. Isolated left ventricular anteroseptal infarction was found in 32 patients, infarction of the anterior wall of the left as well as the right ventricle in 12, and infarction localized to the right ventricular anterior wall in 6. ST-segment depression followed by deep symmetrical T wave inversion, increasing in depth from lead V1 to lead V3 without loss of the R wave in these leads, was highly sensitive and specific in detecting isolated right ventricular anterior wall infarction. ST-segment elevation in right-sided chest leads was not useful. Concomitant ST-segment depression in inferior leads was highly specific and sensitive in diagnosing infarction of the right ventricular anterior wall in the presence of left ventricular anterior infarction.

Clinical and Lipid Profile Studies in Xanthelasma Palpebrarum

The clinical cand lipid abnormalities in 45 cases of xanthelasma are reported. Their findings suggest that xanthelasma is seen in some patients as an isolated clinical symptom with normal serum lipid level% representing a local derangement of cellular lipid metabolism. Nevertheless it is noted in many patients with moderate elevation of different serum lipid fractions without any other clinical manifestations, occurring probably as a resultof benign derangement of systemic lipid metabolism. Less frequently, it is observed with significant elevation of serum lipid levels in association with certain grave abnormalities like hypertension, ischaemic heart disease,' familial hypercholesterolemia, familial xanthomatosis, diabetes etc. Thus it is inferred that the symptom xanthelasma signifies disturbed lipid metabolism of several and the, patient needs thorough investigation.