Exploration, Development And Optimization Of Ecofriendly Novel Dosage Form – Pastilles

Background:

Now-a-day, there is the need to explore the concept of green chemistry in every field. Many existing conventional and novel drug delivery systems have problems related to green chemistry. To overcome the existing limitations of the different dosage forms, a newer untouched dosage form pastilles was explored.

Objective:

The present study aims to optimize the Glipizide (GPZ) matrix pastilles using waxy erodible polymers integrating the concept of quality by design (QbD) and green chemistry.

Methods:

The pastilles were formulated using the fabricated lab-scale pastillator. GPZ was used as a model drug. The concern related to the drug is low aqueous solubility and short variable half-life. The solubility of the drug was improved by formulating a complex between GPZ and chemically modified ß –cyclodextrin (β-CD) - hydroxypropyl-ß-cyclodextrin (HP- ß -CD). The complex was prepared using the kneading method. The complex was formulated incorporated different stoichiometric ratios of GPZ: complexing agent. Sustained-release pastille formulated using Gelucire 43/01 (GC 43/01) as release retardant polymer. The central composite design had been used to obtain an optimum batch, using the amount of GC 43/01 and temperature as independent variables, while drug release at 2h, 6h, and 10h was chosen as dependent variables. Design batches were evaluated for post-and preformulation parameters. An optimum formulation was evaluated for the influence of hydroalcoholic media on drug release.

Results:

The complex formulated using HP- ß –CD (1:1) shown better solubility (36.5mg/ml) and dissolution. The complex was incorporated in the pastilles with erodible polymer GC 43/01. The formulation was found robust with optimum pre and post formulation parameters. Optimized batch was chosen from the design space of central composite design. The drug release of the optimized formulation was found 29.13%, 57.29% and 85.70% at 2, 6 and 10 hrs respectively which was similar to the drug release of the marketed formulation. As the amount of alcohol increased from 5 to 40 %, the drug release also increased but did not show a dose dumping effect. It is just due to the altered solubility of GPZ in alcohol.

Conclusion:

The untouched formulation, Pastilles of GPZ were developed incorporating the waxy erodible polymer. Pastilles were capable to control drug release up to 12 h. The amount of GC 43/01 and temperature had a significant effect on the formulation of GPZ sustained-release pastille. The newer approach of formulating pastilles might apply to the industry as it is an eco-friendly, single-step process and uses fewer excipients.

Proline synthesis through PYCR1 is required to support cancer cell proliferation and survival in oxygen-limiting conditions

The demands of cancer cell proliferation alongside an inadequate angiogenic response lead to insufficient oxygen availability in the tumor microenvironment. Within the mitochondria, oxygen is the major electron acceptor for NADH, with the result that the reducing potential produced through tricarboxylic acid (TCA) cycle activity and mitochondrial respiration are functionally linked. As the oxidizing activity of the TCA cycle is required for efficient synthesis of anabolic precursors, tumoral hypoxia could lead to a cessation of proliferation without another means of correcting the redox imbalance. We show that in hypoxic conditions, mitochondrial pyrroline 5-carboxylate reductase 1 (PYCR1) activity is increased, oxidizing NADH with the synthesis of proline as a by-product. We further show that PYCR1 activity is required for the successful maintenance of hypoxic regions by permitting continued TCA cycle activity, and that its loss leads to significantly increased hypoxia in vivo and in 3D culture, resulting in widespread cell death.

Abstract P4-03-02: Casting a wide net: Finding actionable results in non-breast cancer (BC) genes on multi-gene panel testing (MGPT) in a BC cohort

Background: MGPT for hereditary cancer syndromes allows for concurrent analysis of genes associated with many different cancer types. This may lead to the identification of unexpected mutations in genes with no BC link. The objective of this study was to examine the landscape of pathogenic mutations in a BC cohort who underwent MGPT, to assess if there was clinical suspicion for identified mutations and if the results would affect subjects' medical management.

Methods: Retrospective review of subjects with BC seen at a single institution who underwent MGPT from 1/1/15- 5/31/18 was conducted. MGPT was defined as testing of more than the 9 genes associated with BC (ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, STK11, TP53). Deidentified pedigrees were analyzed by genetic counselors to determine whether there was clinical suspicion of the presence of the mutations using national testing guidelines or clinical diagnostic criteria.

Results: Among 3044 subjects, 365 (12%) were found to have one pathogenic mutation in at least one cancer susceptibility gene. Subjects with mutations in APC I307K, moderate-penetrance BC genes (NBN, RAD50, BARD1), and MUTYH were excluded from further analysis. We identified 52 pathogenic mutations in genes not typically associated with risk for BC in 51 (2%) subjects (table 1). There was clinical suspicion for the identified mutation in 17 (33%).

Table 1:Non-BC gene mutation landscape Number of MutationsClinical Suspicion (%)Lynch syndrome117 (64%)MLH110MSH221MSH632PMS254Ovarian181 (6%)BRIP1*111RAD51C40RAD51D30SHDx62 (33%)SDHA*30SDHC*32Other156 (40%)FH10HOXB13*32MITF32NF142VHL40CDKN2A21 (50%)Total5217 (33%)*Contains individuals that also have a mutation in a BC susceptibility gene

Conclusion: Of 3044 BC patients who underwent MGPT, 2% were found to have a pathogenic gene mutation that would have been missed by a smaller BC gene panel. Medical or surgical management would be affected by the MGPT result in 86% of subjects. Only 6% of subjects with genetic risk for ovarian cancer had a family history of this disease. The single FH and 3 of 4 VHL mutations are only associated with disease in the biallelic state; these findings do not affect the subjects' care, but have implications for reproductive risk. The HOXB13 mutations were found in female subjects only, but would have implications for their male relatives. NF1 mutations are associated with BC risk, but were included in this analysis due to a historically distinct clinical phenotype. Only 50% of NF1+ subjects had a clinical diagnosis or family history of NF1. In all cases, cascade testing was offered to at-risk family members, allowing for cancer and reproductive risk stratification and management. This study demonstrates how comprehensive MGPT can provide a more complete and personalized cancer risk assessment for BC patients and their families.

Citation Format: Culver S, Kipnis L, Stokes S, Bychkovsky B, Scheib R, Rana H, Garber J. Casting a wide net: Finding actionable results in non-breast cancer (BC) genes on multi-gene panel testing (MGPT) in a BC cohort [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-03-02.

The psychological and psychosocial impact of the Pakistan Kashmir earthquake after 8 months: a preliminary evaluation by PACTT

Natural disasters are complex events that challenge the coping abilities of individuals and communities (Alexander, 2005). They are characterised by substantial loss, physical injury and economic hardship, as well as by extensive internal displacement and damage to the infrastructure, as exemplified by the Pakistan Kashmir earthquake of 8 October 2005. Measuring 7.6 on the Richter scale, it affected an area of 30000 square miles and a population of 3.6 million. Approximately 90000 were killed, 200000 were injured and 3.5 million were left homeless (Khan, 2006). Based on a literature review and estimates from the World Health Organization (WHO), the National Plan of Action for Mental Health and Psychosocial Relief of Earthquake Survivors anticipated high levels of trauma-related psychopathology (Rana et al, 2006).

Diabetes insipidus after discontinuation of vasopressin infusion for septic shock

WHAT IS KNOWN AND OBJECTIVE

Despite widespread use of vasopressin for the treatment of septic shock, few cases of diabetes insipidus (DI) following its discontinuation have been reported.

CASE SUMMARY

A 54-year-old man presented with pneumonia progressing to septic shock, requiring norepinephrine and vasopressin for refractory hypotension. After clinical improvement, the patient on 3 separate occasions developed polyuria and severe hypernatremia upon discontinuation of vasopressin, with prompt recovery upon its resumption.

WHAT IS NEW AND CONCLUSION

Occurrence of DI upon discontinuation of vasopressin infusion appears to be rare, but incidence may be underestimated due to a paucity of published reports. Actual incidence and underlying mechanism of this phenomenon remain to be elucidated.

Evaluation of 976 nm Multimode Single Emitter Laser Diodes for Efficient Pumping of 100 W+ Yb-doped Fiber Laser

<p>Experimental evaluation of spectral and power-current (P-I) characteristics of fiber coupled single emitter multimode laser diodes used for development of efficient pumping assembly is reported. Fiber coupled laser diodes emitting around 976 nm are best suited for pumping Yb-doped fiber lasers because of excellent coupling efficiency and reduced thermal load. We have experimentally investigated emission spectrum of fiber coupled multimode laser diodes at different temperatures and drive currents. It is found that peak emission wavelength shifts towards the longer wavelength with increase in temperature and drive current. P-I characteristics of fiber coupled laser diodes have been obtained and presented for drive current from 0.4 A to 11.5 A. Based on experiment, we have constructed spectrally matched laser diode assembly for efficient pumping of 100 W fiber laser. It requires very precise control of temperature and drive current to maintain the emission spectrum. Total 162 W power is pumped in to the Yb-doped fiber laser cavity through multi-mode pump combiners and we have obtained 110 W fiber laser output power @1070 nm. The achieved optical-to-optical efficiency is 68 per cent.</p>

Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal

BACKGROUND

Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International.

METHODS

Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 .

RESULTS

There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities.

CONCLUSIONS

Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to reduce the incidence of stillbirths and intrauterine asphyxia.

Maternal and Neonatal Health Knowledge, Service Quality and Utilization: Findings from a Community Based Quasi-experimental Trial in Arghakhanchi District of Nepal

BACKGROUND

As part of the Partnership for Maternal and Newborn Health Project (PMNH), HealthRight International collaborated with Mother and Infant Research Activities (MIRA) to conduct operations research in Arghakhanchi district of Nepal to explore the intervention impact of strengthening health facility, improving community facility linkages along with Community Based Newborn Care Program (CB-NCP) on Maternal Neonatal Care (MNC) service quality, utilization, knowledge and care seeking behavior.

METHODS

This was a quasi-experimental study. Siddahara, Pokharathok, Subarnakhal,Narpani Health Posts (HPs) and Thada Primary Health Care Center(PHCC)in Electoral Constituency-2 were selected as intervention sites and Arghatosh, ,Argha, Khana, Hansapur HPs and Balkot PHCC in Electoral Constituency-1 were chosen as controls. The intervention started in February 2011 and was evaluated in August 2013. To compare MNC knowledge and practice in the community, mothers of children aged 0-23 months were selected from the corresponding Village Development Committees(VDCs) by a two stage cluster sampling design during both baseline (July 2010) and endline (August, 2013) assessments. The difference in difference analysis was used to understand the intervention impact.

RESULTS

Local resource mobilization for MNC, knowledge about MNC and service utilization increased in intervention sites. Though there were improvements, many effects were not significant.

CONCLUSIONS

Extensive trainings followed by reviews and quality monitoring visits increased the knowledge, improved skills and fostered motivation of health facility workers for better MNC service delivery. MNC indicators showed an upsurge in numbers due to the synergistic effects of many interventions.

Analysis of Obstetric Near Miss Cases of Different Health Facilities of Electoral Constituency Two of Arghakhanchi District

Aims: This study was done to identify and analyze obstetric near miss cases at health facilities of electoral constituency number 2 (EC 2) of Arghakhanchi district, Nepal. Methods: After receiving one day training on identifying obstetric near miss cases, health facility staff of EC 2 of Arghakhanchi district filled up WHO derived obstetric near miss forms for eight months duration. Causes of obstetric near miss cases were identified and analyzed in SPSS 16. Results: There were 31 obstetric near miss cases reported from different health facilities of EC 2 of Arghakhanchi. The commonest cause of obstetric near miss was Post-partum Hemorrhage (85%, n=26) followed by obstructed labor and ante partum hemorrhage (6%, n= 2) each. The leading cause of PPH was retained placenta/placental tissue in 55% cases (14) followed by atonic uterus (27%, n= 7). Two fifth of the mothers (39%, n=12) developed complication during labor. The most common complication developed after labor was hemorrhage. Conclusions: This study highlighted PPH as the most common serious obstetric problem in the health facilities and indicates the need for provision of blood transfusion at the health facility at least at Arghakhanchi. DOI: http://dx.doi.org/10.3126/njog.v9i2.11760

Kinetics of two different iron formulations and their effect on diurnal variation of serum iron levels

Iron polymaltose complex (IPC) is a recently marketed preparation with questionable bioavailability. We compared the absorption kinetics of IPC with ferrous sulfate. We also studied the effect of oral iron on diurnal variation. The study was conducted in eight healthy, non-smoking, non-alcoholic volunteers after obtaining their written informed consent and after Institutional Ethical Committee approval. The study was conducted in three phases: during the first phase no drugs were given, whereas in the second and third phases, ferrous sulfate (66 mg elemental iron) and IPC (100 mg elemental iron) were given in a randomized, two-way, cross-over design, with a wash-out period of 1 week. The blood samples were collected, iron levels estimated and the pharmacokinetic parameters calculated. Circadian rhythm in iron levels was demonstrated by cosinor analysis with a mesor of 93.6 microg/dl, acrophase 10.40 h and amplitude of 26.4 microg/dl. Evening levels were higher as compared with morning levels. Drug treatment increased the mesor (115.7 microg/dl; p < 0.05), delayed the acrophase (11.30 h; p < 0.05) and increased the amplitude (38.5 microg/dl; p < 0.05). The bioavailability of ferrous sulfate was significantly greater as compared with IPC with greater Cmax and AUC (p < 0.05). A clear cut circadian rhythm in iron concentrations was demonstrated. Ferrous sulfate was shown to have significantly higher bioavailability as compared with IPC. Further studies having hemoglobin levels as an endpoint may be planned.

ICS-II USA research locations: environmental, dental care delivery system, and population sociodemographic characteristics

Secondary data sources are used to describe the ICS-II USA research locations in terms of external environment, dental care delivery system, and population sociodemographics. The Native American reservations located in Arizona, New Mexico, and South Dakota were rural, while the other research locations were primarily urban. Baltimore, Maryland, and the Native American communities had fluoridated water, but San Antonio did not. Dental services in Baltimore and San Antonio were predominantly financed by private sources, with a small public health component. Dental care services in Native American communities were largely Indian Health Services (IHS) financed by the US Government. Each geographical area exhibited diverse characteristics indicating unique challenges for the delivery of community and clinical dental services.

ICS-II USA research design and methodology

The purpose of the WHO-sponsored International Collaborative Study of Oral Health Outcomes (ICS-II) was to provide policy-markers and researchers with detailed, reliable, and valid data on the oral health situation in their countries or regions, together with comparative data from other dental care delivery systems. ICS-II used a cross-sectional design with no explicit control groups or experimental interventions. A standardized methodology was developed and tested for collecting and analyzing epidemiological, sociocultural, economic, and delivery system data. Respondent information was obtained by household interviews, and clinical examinations were conducted by calibrated oral epidemiologists. Discussed are the sampling design characteristics for the USA research locations, response rates, samples size for interview and oral examination data, weighting procedures, and statistical methods. SUDAAN was used to adjust variance calculations, since complex sampling designs were used.

Consumer satisfaction

Patient satisfaction with dental care is compared across six United States groups: Whites in Baltimore and San Antonio, African-Americans in Baltimore, Hispanics in San Antonio, and Native Americans in the Southwest and the Dakotas. First, differences in patient satisfaction across ethnic groups and between two age groups (65-74 years old and 35-44 years old) are considered. Generally, people from all age and ethnic groups were satisfied with the last dental visit. Second, patient satisfaction is conceptualized as an oral health outcome influenced by characteristics of the dental service utilizer: predisposing sociodemographic characteristics, predisposing oral beliefs, enabling characteristics, oral needs, oral health behaviors, and oral health status. Multivariate analyses by age and ethnic group are used to identify characteristics that influence patient satisfaction. Sociodemographic characteristics were important among the elderly. Strong oral health beliefs influenced patient satisfaction among younger adults. Enabling characteristics were important predictors among the Native American groups. This model explained 15%-30% of the variability in patient satisfaction among the study age and ethnic groups.

Indicators of oral health in diverse ethnic and age groups: findings from the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations

Racial-ethnic group differences are assessed using a standardized set of oral health indicators, as well as various predisposing, enabling and need characteristics collected in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. The unique data set contains comparable data on African-American, Native American, Hispanic, primarily Mexican-American, and White adults. Age group differences in oral health indicators are also compared in two adult age cohorts (35-44 and 65-74 years). Since data were collected from geographically diverse regions of the United States, differences in oral health indicators are considered within the context of different dental care delivery systems and external environments. Results indicate that the gap in oral health between Whites and ethnic minority groups is pervasive across research locations and age cohorts. Variation in regional dental care delivery systems and the varying effects of race-ethnicity and age cohort suggest that alternative health promotion strategies will be needed for improving oral health in diverse populations.

Urinary kallikrein excretion during inhibition of endogenous angiotensin II in the pig

This study was performed to assess the possible contribution of endogenous angiotensin II (AII) to the regulation of urinary kallikrein excretion. The AII antagonist saralasin or the saline vehicle was infused into the aorta above the renal arteries of pigs under halothane-O2/N2O anaesthesia. Systemic and renal functional parameters were followed for 140 min and during stimulation of the reninangiotensin system by haemorrhage. Urinary kallikrein excretion, determined as kininogenase activity, was increased immediately upon both initiation and termination of the 2 h saralasin infusion into pigs not subjected to haemorrhage. Renal cortical blood flow (RCBF) was maintained, in both saline and saralasin-treated animals at blood pressures as low as 70 mm Hg, while glomerular filtration rate was dissociated during saralasin infusion. As long as RCBF was maintained, urinary kallikrein excretion rate was elevated during the progressive hypotension in both saline and saralasin-treated animals. These findings confirm a close relationship between the maintenance of RCBF and increased activity of the kallikrein-kinin system whether or not AII is antagonized, and indicate that during haemorrhage the kallikrein-kinin system is stimulated by a mechanism not involving AII.

Urinary kallikrein excretion in healthy young infants

Nineteen healthy hospitalized children aged between 3 weeks and 10 years and 20 others aged between one month and 16 years have been investigated for their excretion rate of active and total urinary kallikrein. Twelve hour urine samples were obtained between 7 p.m. and 7 a.m. and blood was drawn at the end of the urine collection period. Urinary kallikrein activity was measured by a synthetic substrate and a direct RIA and urinary sodium excretion, urine volume and plasma renin activity (PRA) were determined. Urinary kallikrein activity was found to be between 0 and 6 micrograms/24h and constituted approximately 10-20% of total kallikrein. When urinary kallikrein excretion rate was correlated with the sodium excretion rate the relationship was found to be positive and significant as was the correlation found between urine volume and urinary kallikrein excretion rate. No correlation could be found between PRA and urinary kallikrein excretion. Although a tendency of higher total kallikrein excretion was seen in older children, the amount excreted from all children per kilogram body weight was constant at 0.8 microgram/kg.

Effect of the protease inhibitor aprotinin on renal hemodynamics in the pig

Aprotinin, the serine protease inhibitor that also inhibits glandular (urinary) kallikrein, or vehicle was infused into the aorta above the renal arteries of anesthetized pigs. Renal hemodynamic and functional parameters were followed over time and during hemorrhagic hypotension. Both renal cortical blood flow and glomerular filtration rate were maintained in vehicle-treated animals at mean arterial pressures as low as 70 mm Hg. As long as renal cortical blood flow and glomerular filtration rate were maintained during the progressive hypotension, urinary excretion rate of kallikrein (as defined by kinin-generating activity) was increased. In contrast, all aprotinin-treated animals had a decreased excretion rate, and the renal cortical blood flow declined with the mean arterial pressure during hemorrhage. The pattern of glomerular filtration rate and plasma renin activity was comparable in both aprotinin-treated and vehicle-treated hemorrhaged animals. Our findings suggest that the endogenous renal kallikrein-kinin system is required for functional renal vasodilatation to maintain renal cortical blood flow during hemorrhage and is therefore directly or indirectly responsible for adjustment of preglomerular resistance.