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Behera V, Gireesh Reddy G, Shreedhara CG, Kishan A, Kalra K, Ananthakrishnan R, Subramaniam J, Balasubramaniam J. An Improvised Cost-Effective Repair Technique for Management of Broken Luer Connections of Tunneled Dialysis Catheter and Salvage Existing Catheter. Semin Dial 2024; 37:273-276. [PMID: 38432229 DOI: 10.1111/sdi.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/03/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Mechanical problems like break or crack in Luer connectors or hubs, clamps, and tubings are common non-infectious complications of tunneled dialysis catheters (TDC), which may lead to other TDC complications and the need to insert a new catheter. These can be tackled using TDC repair kits or spare parts, which are often not available, resulting in the insertion of a new TDC that increases morbidity, TDC-related procedures, and healthcare costs. We discuss two cases of broken Luer connections of TDC, which were managed by exchanging the broken Luer connector of TDC with the similar Luer connector of a temporary dialysis catheter. Both the repaired TDCs are thereafter functioning well. This improvised technique provides an easy, effective, long-lasting option that salvages the existing TDC and reduces the cost factor.
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Affiliation(s)
| | | | | | - A Kishan
- Institute of NephroUrology, Bengaluru, India
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Jasuja S, Gallieni M, Jha V, Vachharajani T, Bhalla AK, Tan J, Tan CS, Basnet NB, Herath N, An HPH, Kim YS, Kim Y, SampathKumar K, Sahay M, Ramachandran R, Alexander S, Bhargava V, Balasubramaniam J, Voss D, Ogbac FE, Gunawan A, Goh BL, Lin CC, Khan J, Shiham I, Ayub H, Hein MA, Iqbal S, Srisawat N, Gao B, Sajiv C, Wilkinson C, Pichthida T, Rana DS, Sagar G, Bahl A, Tawakley S, Gaur M. Practice of dialysis access interventional nephrology procedures in the Asia-Pacific region: Getting lay of the land. Nephrology (Carlton) 2023; 28:672-681. [PMID: 37697492 PMCID: PMC7615839 DOI: 10.1111/nep.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/23/2023] [Accepted: 08/12/2023] [Indexed: 09/13/2023]
Abstract
AIM This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA). METHODS The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey. RESULTS Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel. CONCLUSION The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.
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Affiliation(s)
| | - Maurizio Gallieni
- DIBIC “L. Sacco”, Università degli Studi di Milano, Milano, Italy
- The Journal of VA, USA
| | | | - Tushar Vachharajani
- John D. Dingell Veterans Affair Medical Center, Detroit, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
| | | | - Jackson Tan
- Rimba Dialysis Center, Simpang, Brunei Darussalam
- Univeristy of Brunei Darussalam, Bandar Seri Begawan, Brunei
- RIPAS Hospital, Bandar Seri Begawan, Brunei
| | | | | | | | | | - Yong Soo Kim
- College of Medicine, St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Yaeni Kim
- College of Medicine, St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | - David Voss
- Middlemore Hospital, Auckland, New Zealand
| | | | - Atma Gunawan
- St Luke’s Medical Center, Quezon City, Philippines
- Dr Saiful Anwar General Hospital, Malang, Indonesia
| | | | | | | | | | | | - Min Aung Hein
- Defence Services Medical Academy (DSMA), Yangon, Myanmar
| | - Sarwar Iqbal
- BIRDEM General Hospital, Dhaka, Bangladesh
- Ibrahim Medical College, Dhaka, Bangladesh
| | | | - Bihu Gao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Cherian Sajiv
- Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Catherine Wilkinson
- Cairns and Hinterland Hospital and Health Service, Cairns North, Queensland, Australia
| | - Thim Pichthida
- School of Medicine, International University, Phnom Penh, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - D. S. Rana
- Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | | | - Anupam Bahl
- Indraprastha Apollo Hospital, New Delhi, India
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Jeloka TK, Abraham G, Bhalla AK, Balasubramaniam J, Dutta A, Gokulnath, Gupta A, Jha V, Khanna U, Mahajan S, Nayak KS, Prasad KN, Prasad N, Rathi M, Raju S, Rohit A, Sahay M, Sampathkumar K, Sivakumar V, Varughese S. Continuous Ambulatory Peritoneal Dialysis Peritonitis Guidelines - Consensus Statement of Peritoneal Dialysis Society of India - 2020. Indian J Nephrol 2021; 31:425-434. [PMID: 34880551 PMCID: PMC8597799 DOI: 10.4103/ijn.ijn_73_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/08/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022] Open
Abstract
Continuous ambulatory peritoneal dialysis (CAPD) related peritonitis is a major cause of technique failure, morbidity, and mortality in patients on CAPD. Its prevention and management is key to success of CAPD program. Due to variability in practice, microbiological trends and sensitivity towards antibiotics, there is a need for customized guidelines for management of CAPD related peritonitis (CAPDRP) in India. With this need, Peritoneal Dialysis Society of India (PDSI) organized a structured meeting to discuss various aspects of management of CAPDRP and formulated a consensus agreement which will help in management of patients with CAPDRP.
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Affiliation(s)
- Tarun K Jeloka
- Department of Nephrology, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Georgi Abraham
- Department of Nephrology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - A K Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - J Balasubramaniam
- Department of Nephrology, Kidney Care Centre, Tirunelveli, Tamil Nadu, India
| | - A Dutta
- Department of Nephrology, Fortis Hospital and Kidney Institute, Kolkata, West Bengal, India
| | - Gokulnath
- Department of Nephrology, Apollo Hospital, Bengaluru, Karnataka, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - V Jha
- The George Institute for Global Health, New Delhi, India
| | - Umesh Khanna
- Department of Nephrology, Lancelot Kidney and GI Centre, Mumbai, Maharashtra, India
| | - Sandeep Mahajan
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - K S Nayak
- Department of Nephrology, Virinchi Hospitals, Hyderabad, Telangana, India
| | - K N Prasad
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute, Chandigarh, India
| | - Sreebhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Anusha Rohit
- Department of Microbiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Hospital, Hyderabad, Telangana, India
| | - K Sampathkumar
- Department of Nephrology, Meenakshi Mission Hopsital and Research Centre, Madurai, Tamil Nadu, India
| | - V Sivakumar
- Department of Nephrology, SriVenkateshwara Institute of Medical sciences, Tirupati, Andhra Pradesh, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Thanigaivel S, Durgadevi H, Balasubramaniam J, Mythily V, Elanchezhiyan M. Comparative evaluation of the anti-Hepatitis B virus activity of Centella asiatica and Camellia sinensis (green tea). BMC Infect Dis 2014. [PMCID: PMC4080439 DOI: 10.1186/1471-2334-14-s3-p21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Venkatesan EP, Pranesh MB, Gnanashanmugam G, Balasubramaniam J. Tenofovir induced Fanconi syndrome: A rare cause of hypokalemic paralysis. Indian J Nephrol 2014; 24:108-9. [PMID: 24701043 PMCID: PMC3968597 DOI: 10.4103/0971-4065.127898] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report a 55-year-old female who presented to the emergency department with acute onset quadriparesis. She was diagnosed to have acquired immunodeficiency syndrome 7 years ago and was on tenofovir based anti-retroviral therapy for past 10 months. As the patient also had hypophosphatemia, glucosuria and proteinuria Fanconi syndrome (FS) was suspected. She improved dramatically over next 12 h to regain normal power and also her renal functions improved over next few days. Tenofovir induced FS presenting as hypokalemic paralysis is very rare complication and is the first case reported from India.
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Affiliation(s)
- E P Venkatesan
- Department of Neurology, PSG Institute of Medical Science and Research, Coimbatore, India
| | - M B Pranesh
- Department of Neurology, PSG Institute of Medical Science and Research, Coimbatore, India
| | - G Gnanashanmugam
- Department of Neurology, PSG Institute of Medical Science and Research, Coimbatore, India
| | - J Balasubramaniam
- Department of Nephrology, Kidney Care Centre, Thirunelveli, Tamil Nadu, India
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Mohana Raghava Srivalli K, Lakshmi PK, Balasubramaniam J. Design of a novel bilayered gastric mucoadhesive system for localized and unidirectional release of lamotrigine. Saudi Pharm J 2012; 21:45-52. [PMID: 24109205 DOI: 10.1016/j.jsps.2012.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/13/2012] [Indexed: 11/19/2022] Open
Abstract
Lamotrigine is a BCS class II drug with pH dependent solubility. The bilayered gastric mucoadhesive tablets of lamotrigine were designed such that the drug and controlled release polymers were incorporated in the upper layer and the lower layer had the mucoadhesive polymers. The major ingredients selected for the upper layer were the drug and control release polymer (either HPMC K15M or polyox) while the lower MA layer predominantly comprised of Carbopol 974P. A 2(3) full factorial design was constructed for this study and the tablets were optimized for parameters like tablet size, shape, ex vivo mucoadhesive properties and unidirectional drug release. Oval tablets with an average size of 14 mm diameter were set optimum. Maximum mucoadhesive bond strength of 79.3 ± 0.91 * 10(3) dyn/cm(2) was achieved with carbopol when used in combination with a synergistic resin polymer. All the tested formulations presented a mucoadhesion time of greater than 12 h. The incorporation of methacrylic polymers in the lower layer ensured unidirectional drug release from the bilayered tablets. The unidirectional drug release was confirmed after comparing the dissolution results of paddle method with those of a modified basket method. Model independent similarity and dissimilarity factor methods were used for the comparison of dissolution results. Controlled drug release profiles with zero order kinetics were obtained with polyox and HPMC K15M which reported t 90% at 6th and 12th hours, respectively. The "n" value with polyox was 0.992 and that with HPMC K15M was 0.946 indicating an approximate case II transport. These two formulations showed the potential for oral administration of lamotrigine as bilayered gastric mucoadhesive tablets by yielding highest similarity factor values, 96.06 and 92.47, respectively, between the paddle and modified basket method dissolution release profiles apart from reporting the best tablet physical properties and maximum mucoadhesive strength.
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Key Words
- #, sieve number
- %, percentage
- 23 full factorial design
- API, active pharmaceutical ingredient
- BCS, biopharmaceutical classification system
- BGMT, bilayered gastric mucoadhesive tablets
- Bilayered gastric mucoadhesive tablets
- CR layer, control release layer
- G, grams
- HCl, hydrochloric acid
- Lamotrigine
- MA layer, mucoadhesive layer
- MDT, mean dissolution time
- Methacrylic polymers
- Mg, milligrams
- Modified basket dissolution model
- USP, United States pharmacopoeia
- UV, ultra violet
- Unidirectional drug release
- Zero order release
- cms, centimetres
- f1, difference factor
- f2, similarity factor
- h, hours
- mL, millilitre
- min, minute
- mm, millimetre
- n, release exponent (power law Korsmeyer Peppas equation)
- nm, nanometre
- r2, correlation coefficient
- rpm, revolution per minute
- sec, seconds
- °C, degrees centigrade
- ≈, approximately equivalent to
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Affiliation(s)
- K Mohana Raghava Srivalli
- Department of Pharmaceutics, G. Pulla Reddy College of Pharmacy, Osmania University, Hyderabad 500 028, Andhra Pradesh, India ; Research and Development Centre, RA Chem Pharma Limited, Road No. 18, IDA, Nacharam, Hyderabad 500 076, Andhra Pradesh, India
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Balasubramaniam J, Srinatha A, Pandit JK. Studies on Indomethacin Intraocular Implants Using Different in vitro Release Methods. Indian J Pharm Sci 2011; 70:216-21. [PMID: 20046715 PMCID: PMC2792478 DOI: 10.4103/0250-474x.41458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 03/02/2008] [Accepted: 03/28/2008] [Indexed: 11/05/2022] Open
Abstract
Intra ocular implants of sodium alginate alone and in combination with hydroxypropylmethylcellulose with or without calcium chloride were formulated with indomethacin as a model drug. The drug release from the implants was evaluated using static method, continuous flow through apparatus (developed in house), USP dissolution and agar diffusion. Except in the static method, indomethacin particle size did not impart any effect on the drug release. In agar diffusion method, an increase in agar concentration from 1 to 2% resulted in a significant decrease (P< 0.005) in the amount of drug released. Inclusion of hydroxypropylmethylcellulose (33.3, 41.6 and 50% w/w), resulted in decrease of indomethacin release irrespective of the method of dissolution study. The agar diffusion method and the continuous flow through methods seem to simulate to a certain extent the in vivo conditions as far as the placement of the device and the hydrodynamic diffusion layer around the intra ocular implant is concerned. The static method and USP method affected the hydrodynamic diffusion layer either too slowly or too fast.
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Affiliation(s)
- J Balasubramaniam
- ISP (Hong Kong) Limited, H. No 6-3-1090/A, Bhupal Towers, Rajbhavan Road, Somajiguda, Hyderabad-500 082, India
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Shravani D, Lakshmi P, Balasubramaniam J. Preparation and optimization of various parameters of enteric coated pellets using the Taguchi L9 orthogonal array design and their characterization. Acta Pharm Sin B 2011. [DOI: 10.1016/j.apsb.2011.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kesavan K, Balasubramaniam J, Kant S, N. Singh P, K. Pandit J. Newer Approaches for Optimal Bioavailability of Ocularly Delivered Drugs: Review. Curr Drug Deliv 2011; 8:172-93. [DOI: 10.2174/156720111794479925] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/30/2010] [Indexed: 11/22/2022]
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Garg A, Singh S, Rao VU, Bindu K, Balasubramaniam J. Solid state interaction of raloxifene HCl with different hydrophilic carriers during co-grinding and its effect on dissolution rate. Drug Dev Ind Pharm 2009; 35:455-70. [PMID: 19048425 DOI: 10.1080/03639040802438365] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study investigated the effects of different classes of hydrophilic carriers (poly vinyl pyrrolidones [PVPs] [Plasdone K-25 and Plasdone S-630], cellulosic polymers [hydroxypropyl methyl cellulose and hydroxy propyl cellulose], and Sodium Alginate) on the solid state and dissolution rate of Raloxifene hydrochloride (R-HCl). Solid state characterizations of co-ground mixtures and physical mixtures in 1:1 and 1:2 ratios of drug to polymer were performed by employing laser diffractometer for particle size and differential scanning calorimetry (DSC) for solid state interactions. The results of particle size studies showed that only co-grinding with PVPs was more effective in the reduction of particle size than the milling of drug alone. DSC study indicated that the crystalline nature of the drug was reduced after co-grinding with PVPs when compared with their corresponding physical mixtures. The hydrophilic carriers other than PVPs did not reduce the crystalline nature of the drug significantly. X-ray diffraction and scanning electron microscopy were carried out for selected batches to confirm DSC results. Significant enhancement in dissolution rate and extent was observed with co-ground mixtures of drug and PVPs. Plasdone S-630 was found to be a better carrier for R-HCl in terms of achieving improvement in dissolution. In vitro dissolution data can be described by Hixson-Crowell model, indicating the drug release mechanism predominated by erosion.
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Affiliation(s)
- Anuj Garg
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India
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11
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Balasubramaniam J, Bindu K, Rao VU, Ray D, Haldar R, Brzeczko AW. Effect of Superdisintegrants on Dissolution of Cationic Drugs. DISSOLUT TECHNOL 2008. [DOI: 10.14227/dt150208p18] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Singh S, Singh J, Muthu M, Balasubramaniam J, Mishra B. Gastroretentive Drug Delivery System of Metoclopramide Hydrochloride: Formulation and In vitro Evaluation. Curr Drug Deliv 2007; 4:269-75. [DOI: 10.2174/156720107782151287] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Metformin microspheres with sodium alginate alone and in combination with gellan were prepared using an emulsion-cross linking method. The prepared microspheres were evaluated for their physico-chemical characteristics like particle size, morphology using SEM, incorporation efficiency, equilibrium water content (swelling) and in vitro drug release. The effect of various formulation variables like polymer concentration (sodium alginate; and proportion of gellan in microspheres prepared by a combination of sodium alginate and gellan), drug loading, crosslinking agent concentration and cross-linking time on the in vitro dissolution of the prepared microspheres were evaluated. The results showed that both the particle size and the incorporation efficiency were proportional to the polymer concentration. In case of microspheres containing both sodium alginate and gellan, the mean diameter and the incorporation efficiency were higher than the corresponding microspheres containing only alginate, both increasing with an increase in proportion of gellan. The prepared microspheres were found to be discrete and spherical in shape and were successful in sustaining the drug release for 8 hours. Incorporation of gellan caused a significant decrease in drug release. The release followed a biphasic profile, in all cases, characterized by an initial phase of moderate drug release followed by a phase of higher release. Further, the kinetic treatment of the dissolution data revealed the prevalence of matrix diffusion kinetics.
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Affiliation(s)
- J Balasubramaniam
- ISP (Hong Kong) Limited, 6-9-1090 /A, Rajbhavan Road, Bhupal Towers, Somajiguda, Hyderabad 500 082, India.
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Rajinikanth PS, Balasubramaniam J, Mishra B. Development and evaluation of a novel floating in situ gelling system of amoxicillin for eradication of Helicobacter pylori. Int J Pharm 2006; 335:114-122. [PMID: 17141986 DOI: 10.1016/j.ijpharm.2006.11.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 10/27/2006] [Accepted: 11/01/2006] [Indexed: 01/01/2023]
Abstract
The aim of this study was to develop a new intra-gastric floating in situ gelling system for controlled delivery of amoxicillin for the treatment of peptic ulcer disease caused by Helicobacter pylori (H. pylori). Gellan based amoxicillin floating in situ gelling systems (AFIG) were prepared by dissolving varying concentrations of gellan gum in deionized water containing sodium citrate, to which varying concentrations of drug and calcium carbonate, as gas-forming agent, was added and dissolved by stirring. The formulation variables like concentration of gellan gum and calcium carbonate significantly affected the in vitro drug release from the prepared AFIG. The in vivo H. pylori clearance efficacy of prepared AFIG in reference to amoxicillin suspension following repeated oral administration to H. pylori infected Mongolian gerbils was examined by polymerase chain reaction (PCR) technique and by a microbial culture method. AFIG showed a significant anti-H. pylori effect in the in vivo gerbil model. It was noted that the required amount of amoxicillin for eradication of H. pylori was 10 times less in AFIG than from the corresponding amoxicillin suspension. The results further substantiated that the prepared AFIG has feasibility of forming rigid gels in the gastric environment and eradicated H. pylori from the gastrointestinal tract more effectively than amoxicillin suspension because of the prolonged gastrointestinal residence time of the formulation.
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Affiliation(s)
- P S Rajinikanth
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi-221005, India.
| | - J Balasubramaniam
- Research and Development Centre, ISP (Hong Kong) Limited, Somajiguda, Hyderabad-500082, India
| | - B Mishra
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi-221005, India.
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Barat R, Srinatha A, Pandit JK, Ridhurkar D, Balasubramaniam J, Mittal N, Mishra DN. Niridazole biodegradable inserts for local long-term treatment of periodontitis: possible new life for an orphan drug. Drug Deliv 2006; 13:365-73. [PMID: 16877312 DOI: 10.1080/10717540500398126] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Periodontal pocket inserts of niridazole (NZ) made with Resomer(R) (grades RG 503H and RG858, designated as RH and RG, respectively) were studied. Various formulation variables were evaluated to obtain a biodegradable delivery systems showing device degradation and drug depletion parallel to each other in vitro. Drug release from the prepared inserts was evaluated using a static dissolution setup (for 1 month). Incorporation of 3 parts of RG in 1 part of RH inserts caused a 50% decrease in the initial release rate. The RH-NZ inserts showed a spurt in release around the 10th day of the study, which coincided with the decrease in device weight, suggesting onset of device degradation. Pilot-scale clinical trials in 12 patients indicated improvements in clinical indices from the baseline values. The average pocket depth was reduced significantly (alpha = 0.05) from 6.34 +/- 1.86 mm at baseline to 5.94 +/- 0.28 mm after 28 days of treatment.
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Affiliation(s)
- Romi Barat
- Ranbaxy Research Laboratories, Gurgaon, India
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Pandit JK, Nath G, Balasubramaniam J, Srinatha A. In vitromicrobiological evaluation of polyvinyl alcohol-based ocular inserts of Ciprofloxacin hydrochloride. Indian J Pharm Sci 2006. [DOI: 10.4103/0250-474x.29631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Film-type scleral implants of indomethacin with gellan gum were prepared by solvent casting and evaluated for uniformities of thickness, weight, drug content, and surface pH. The effect of plasticizers like glycerol, propylene glycol (PG), and polyethylene glycol 200, and 400 on the void volume of free gellan films (placebo) was calculated from the water content of the films. The drug release from the prepared implants was determined using a static dissolution set-up developed and optimized in our laboratory. Based on the results of the void volume and initial drug release studies, glycerol and PG were selected as the plasticizers for the gellan-based implants. The morphology of the drug-free films (containing 10% and 40% of PG) and the drug-loaded films (before and after dissolution and crosslinked) was studied using scanning electron microscopy. Further, the effect of plasticizer concentration, gellan concentration, effect of crosslinking technique, and duration of crosslinking using calcium chloride on in vitro drug release characteristics were evaluated. Selected batches of the implants were subjected to pharmacodynamic studies, after scleral placement, in uveitis-induced (intravitreal injection of bovine serum albumin 50 microg/ml) rabbit eyes. The release of indomethacin from the prepared implants followed matrix diffusion kinetics with diffusion co-efficient (n) values ranging between 0.358 to 0.708 and seemed to depend on both gellan and plasticizer concentration. Surface crosslinking with 10% calcium chloride for 8 hr retarded drug release (1.42 times less than noncrosslinked implant) and was optimum. The pharmacodynamic studies showed a marked improvement in the various clinical parameters (congestion, keratitis, flare, clot, aqueous cells, and synechias) in the implanted eye compared with the control eye in the rabbits. The scleral implants survived up to 3 weeks in vivo.
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Affiliation(s)
- J Balasubramaniam
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India.
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Kumar MT, Rajeswari C, Balasubramaniam J, Pandit JK, Kant S. In vitro and in vivo characterization of scleral implant of indomethacin: role of plasticizer and cross-linking time. Drug Deliv 2004; 10:269-75. [PMID: 14612343 DOI: 10.1080/drd_10_4_269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Film-type scleral implants of indomethacin using sodium alginate and PEG 400 and 600 (3, 5, 8, and 10% w/w w.r.t. sodium alginate) as plasticizers were fabricated by solvent casting. The prepared implants were cross-linked by treatment with calcium chloride 10, 20, and 30% w/v solution, for periods between 1 to 24 hr. Uniformity of thickness, weight, and drug content and surface pH of the implants were evaluated. The influence of plasticizer type/concentration and crosslinking time/concentration of calcium chloride on indomethacin release was studied on a static dissolution setup developed by us. Selected batches of the implants were subjected to pharmacodynamic studies, after scleral placement, in uveitis-induced (intravitreal injection of bovine serum albumin 50 microg/ml) rabbit eyes. The release of indomethacin from the implants was influenced by the concentration and nature of plasticizers used. Chemical cross-linking with calcium chloride was successful in retarding the drug release. The pharmacodynamic studies showed a marked improvement in the various clinical parameters (congestion, keratitis, flare, clot, aqueous cells, and synechias) in the implanted eye when compared with the control eye in the rabbits. The implants survived for 2 weeks in vivo.
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Affiliation(s)
- M Thilek Kumar
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India
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Abstract
The poor bioavailability and therapeutic response exhibited by the conventional ophthalmic solutions due to precorneal elimination of the drug may be overcome by the use of in situ gel forming systems that are instilled as drops into the eye and undergo a sol-gel transition in the cul-de-sac. Our present work describes the formulation and evaluation of an ophthalmic delivery system of an antibacterial agent, CPH, based on the concept of ion-activated in situ gelation. Gelrite gellan gum, a novel ophthalmic vehicle that gels in the presence of mono or divalent cations, present in the lacrimal fluid was used alone and in combinations with sodium alginate as the gelling agent. The developed formulations were therapeutically efficacious and provided sustained release of the drug over an 8-hr period in vitro.
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Affiliation(s)
- J Balasubramaniam
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India
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Verma MM, Kumar MT, Balasubramaniam J, Pandit JK. Dissolution, bioavailability and ulcerogenic studies on piroxicam-nicotinamide solid dispersion formulations. Boll Chim Farm 2003; 142:119-24. [PMID: 12806831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Solid dispersions with different ratios of Piroxicam and Nicotinamide (as a carrier) were prepared by fusion method. Drug-carrier interactions in the solid state were ascertained using phase-diagram, X-ray diffraction (XRD) and Differential scanning colorimetry (DSC). Select ratios of the formed piroxicam-nicotinamide solid dispersions and their corresponding physical mixtures were formulated into tablets and capsules. The dissolution characteristics of the formed solid dispersions, physical mixtures and their formulations were compared with pure piroxicam in 900 ml of 0.1 N HCl (pH 1.2) at 37 +/- 0.5 degrees C, 50 rpm using USP XXI paddle apparatus. Solid dispersion capsule PNC1 (containing 1:5--drug-carrier ratio solid dispersion) and the corresponding physical mixture capsule PNC1A were used for bioavailability studies in healthy human volunteers. Further, ulcer indices of the prepared solid dispersion and their corresponding physical mixture were compared with pure piroxicam in rats. The DSC, XRD and phase diagram indicated the formation of solid dispersed system. The prepared dispersion showed better dissolution than the corresponding physical mixture and pure drug. The fabricated formulation complied with the pharmacopoeial limits for physico-chemical properties and the solid dispersion capsules PNC1 and PNC2 (containing 1:9 ratio of drug to carrier solid dispersion) showed 3 and 6.6 fold increase and 3.2 and 8 fold increases in dissolution rate compared to the corresponding physical mixture capsules (PNC1A and PNC2A), respectively. The solid dispersion capsule PNC1 showed significantly higher absorption and dissolution and consequently better bioavailability than the corresponding physical mixture capsule (PNC1A) in healthy human volunteers. The ulcer indices of the prepared dispersions were significantly lower than the corresponding physical mixture and pure drug.
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Affiliation(s)
- M Mohan Verma
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India
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Verma MM, Kumar MT, Balasubramaniam J, Pandit JK. Bioavailability studies on fast release formulations of indomethacin. Boll Chim Farm 2002; 141:176-80. [PMID: 12197414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Indomethacin-nicotinamide solid dispersions were prepared by fusion method. Drug-carrier interaction in the liquid and solid states were studied using phase solubility data and differential scanning colorimetry (DSC). DSC revealed the formation of an eutectic mixture of indomethacin and nicotinamide. Tablets and capsules, formulated from the solid dispersions showed significantly better dissolution and enhanced absorption rate in human volunteers, compared to commercial capsule of indomethacin.
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Affiliation(s)
- M M Verma
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India
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Abstract
A new kit for screening for sickle cell haemoglobin (haemoglobin S) has been evaluated. The kit is based on the principle that cells containing haemoglobin S, which have been induced to sickle by exposure to a reducing agent in a phosphate buffer, do not pass through a gel contained in microtubules. In theory, they can thus be distinguished from cells that do not contain haemoglobin S. In practice, the kit was found to be insensitive and unreliable for the detection of haemoglobin S. Homozygosity and heterozygosity for haemoglobin S could not be reliably distinguished. Similarly, patients with haemoglobin S who had been transfused could not be distinguished reliably from those who had not been transfused. In conclusion, unless improved performance can be demonstrated, use of this kit cannot be recommended.
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Affiliation(s)
- J Balasubramaniam
- Department of Haematology, St Mary's Hospital, Praed Street, London, W21NY, UK
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Balasubramaniam J, Kumar MT, Pandit JK, Kant S. In vitro and in vivo characterization of scleral implants of indomethacin. DIE PHARMAZIE 2001; 56:793-9. [PMID: 11683126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Scleral implants of indomethacin with sodium alginate as carrier were fabricated and evaluated for various physico-chemical properties such as uniformity of thickness, weight, drug content, surface pH, percent dissolution and water up-take capacity (swelling index). The effect of drug particle size, polymer concentration, drug loading, plasticizer concentration, and effects of physical reinforcement (freeze-thawing for 3 and 6 cycles) and chemical cross-linking with calcium chloride, on the in vitro drug release characteristics were evaluated. Selected batches of the implants were subjected to pharmacodynamic studies, after scleral placement, in uveitis induced (intravitreal injection of Bovine Serum Albumin (BSA)-50 micrograms/ml) rabbit eyes. The release of indomethacin from the prepared implants followed predominantly matrix diffusion kinetics. Swelling and moisture absorption/loss studies correlated well with the in vitro release studies. The pharmacodynamic studies showed a marked improvement in the various clinical parameters (congestion, keratitis, flare, clot, aqueous cells and synechias), in the implanted eye when compared to the control eye in the rabbits.
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Affiliation(s)
- J Balasubramaniam
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, India
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Kumar MT, Pandit JK, Balasubramaniam J. Novel therapeutic approaches for uveitis and retinitis. J Pharm Pharm Sci 2001; 4:248-54. [PMID: 11737991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
A virtual increase in the number of patients undergoing immunosuppressant therapy and those suffering from AIDS has created a unique class of population suffering from virulent uveitis and retinopathies. A very common pathogen implicated in retinopathy in such patients is the cytomegalovirus (CMV).
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Affiliation(s)
- M T Kumar
- Department of Pharmaceutics, Institute of Technology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Kumar D, Balasubramaniam J, Pandit J. A Study of Mucoadhesive Bond Strength of Buccoadhesive Compacts for Systemic Drug Delivery: In-vitro/ In-vivo correlation. Sci Pharm 2001. [DOI: 10.3797/scipharm.aut-01-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Compacts prepared from binary combinations of Carbopol® 934 P (CP), Polycarbophil (Noveon® AA1, PC) and Hydroxy propyl cellulose (Klucel®, HPC) and coated on all but one flat surface with Poly Methyl Methacrylate - PMMA (chloroformic solution) were evaluated for mucoadhesive bond strength on a modified mucoadhesive bond strength apparatus using rabbit stomach mucosa (SM) and small intestine mucosa (SIM). In -vitro mucoadhesion tests indicated that the detachment force increased linearly with concentration of CP/PC in the compacts. Mucoadhesion of the compacts with SIM were higher when compared to SM. The compacts with higher proportions of CPIPC showed longer buccoadhesion time (time the compact remained in contact with the buccal mucosa) than HPC alone in humans. In-vivo buccoadhesevity of the coated compacts was studied in healthy human volunteers. An index was used to study the redness and ulceration of the contact buccal mucosa.
Compacts with higher proportions of CP/PC showed longer buccoadhesion time than HPC alone. Significant correlation coefficient (r) values (P<0.01) were obtained between in-vitro fracture strength of the compacts and in-vivo buccoadhesion time. Hence, the in-vitro mucoadhesive model developed by us provides useful information on the residence time of the compact for systemic drug delivery in the oral cavity, and compacts containing less than 50% of CP/PC were safer to use in humans.
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Balasubramaniam J. Phenformin induced lactic acidosis in an elderly NIDDM patient. J Assoc Physicians India 1995; 43:231-2. [PMID: 11256924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Balasubramaniam J. Pyeloureteritis cystica. J Assoc Physicians India 1995; 43:73-4. [PMID: 9282663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Balasubramaniam J. Holter monitoring in chronic renal failure before and during dialysis. J Assoc Physicians India 1994; 42:753. [PMID: 7883683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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