Leveraging a multivariate approach towards enhanced development of direct compression extended release tablets

Extended release formulations play a crucial role in the pharmaceutical industry by maintaining steady plasma levels, reducing side effects, and improving therapeutic efficiency and compliance. One commonly used method to develop extended release formulations is direct compression, which offers several advantages, such as simplicity, time savings, and cost-effectiveness. However, successful direct compression-based extended release formulations require careful assessment and an understanding of the excipients' attributes. The scope of this work is the characterization of the compaction behavior of some matrix-forming agents and diluents for the development of extended release tablets. Fifteen excipients commonly used in extended release formulations were evaluated for physical, compaction and tablet properties. Powder properties (e.g., particle size, flow properties, bulk density) were evaluated and linked to the tablet's mechanical properties in a fully integrated approach, and data were analyzed by constructing a principal component analysis (PCA). Significant variability was observed among the various excipients. The present work successfully demonstrates the applicability of PCA as an effective tool for comparative analysis, pattern and clustering recognition and correlations between excipients and their properties, facilitating the development and manufacturing of direct compressible extended release formulations.

Asthma control and exacerbations in patients with severe asthma treated with omalizumab in Portugal

The analysis of outcomes from patients with severe asthma treated with omalizumab, using real-life prospective data, should contribute to future informed decisions about this treatment in Portugal. The aim of this study was to assess the clinical effect of omalizumab in Portuguese patients with severe persistent allergic asthma, considering specifically asthma control and exacerbations. This was an observational, prospective, multicentre study. Data were collected at routine care over a 12-month period. Disease control was defined by Control of Allergic Rhinitis and Asthma Test (CARAT) global score >24. All asthma patients already under treatment with omalizumab in 7 departments from 6 Portuguese hospitals were included (n=48). Most (77%) patients were female and the mean (SD) age was 51.9 (10.2) years old. During the study period, asthma was controlled in 34% of the visits and the 12-month exacerbation rate was 1.7 per patient (0.6 with unscheduled medical care). One-third of the patients needed unscheduled medical care because of asthma and 29% had to start or increase oral corticosteroid. There was still a 41% reduction in the total sum of oral corticosteroids usage from the first to the last trimester of the study. During routine treatment with omalizumab, Portuguese patients with severe asthma achieved asthma control in 1/3 of the visits and only 1/3 needed unscheduled or Emergency Room care because of asthma exacerbations. These outcomes support the maintenance of the clinical effect during treatment with omalizumab in routine care in Portugal.

Handgrip strength measurement as a predictor of hospitalization costs

BACKGROUND

Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied.

OBJECTIVE

To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs.

SUBJECTS/METHODS

A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status.

RESULTS

Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from €375 (58-692) to €458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from €356 (41-668) to €428 (133-724).

CONCLUSIONS

Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.

The effect of posture on body circumferences in older adults

BACKGROUND

Standards for anthropometrical assessment define that measurements must be carried out with the subject in the standing position, although this is not always possible. The effect of body position on girth measurement has not been evaluated, even though this issue is clinically relevant because it may bias nutritional assessment results. The present study aimed to evaluate the effect of body position and symmetry on girth measurement.

METHODS

A cross-sectional study was conducted on 102 older adults aged ≥65 years from care homes and tertiary hospitals. Right and left arm, waist, hip mid-thigh and calf girths were obtained with the subject standing or in the supine position. Mini-Nutritional Assessment Short-Form (MNA-SF) score and reference data percentiles (NHANES IV) misclassification according to girths assessed in the supine position was evaluated.

RESULTS

A high intraclass correlation coefficient (ICC > 0.97) and quartiles agreement (k > 0.89) were found between girth measurements conducted on participants in the standing and supine positions. According to MNA-SF, 23.5% of the participants were undernourished and 51% were at risk of undernutrition. A high agreement between MNA-SF score using calf circumference measured on standing or supine position was found (k = 0.96). A relevant agreement for NHANES IV girth percentiles by sex and age was also found (ICC > 0.89).

CONCLUSIONS

Agreement between girth measurements on standing and supine positions among older adults is high and differences do not have any clinically relevant impact on MNA-SF classification and reference data percentiles.

Respiratory mechanics after tube thoracostomy in rats

The purpose of the present study was to determine the mechanical respiratory profile after the insertion of a catheter into the pleural cavity of anesthetized, paralyzed, mechanically ventilated rats, thus stimulating the common use of chest tubes in clinical situations. Using the method of end-inflation occlusion during constant inspiratory flow in 7 adult Wistar rats, respiratory system, lung, and chest wall total resistance (0.353 +/- 0.058, 0.260 +/- 0.651, 0.091 +/- 0.012 (mean +/- SD) cmH2O.ml-1.s, respectively), viscous resistance (0.140 +/- 0.007, 0.100 +/- 0.007, 0.040 +/- 0.003 cmH2O.ml-1.s< respectively), and viscoelastic resistance (0.213 +/- 0.017, 0.160 +/- 0.022, 0.053 +/- 0.011 cmH2O.ml-1.s, respectively) as well as respiratory system, lung, and chest wall static elastance (4.51 +/- 0.27, 3.85 +/- 0.28, 0.66 +/- 0.12 cmH2O.ml-1, respectively), and dynamic elastance (5.72 +/- 0.24, 4.76 +/- 0.32, 0.96 +/- 0.17 cmH2O.ml-1, respectively) were not significantly modified after the insertion of a tube into the second right intercostal stage. We conclude that, under the present experimental conditions, a catheter inserted into the pleural space per se is not responsible for any alterations in respiratory mechanics.

Mechanical and morphometrical changes in progressive bilateral pneumothorax and pleural effusion in normal rats

Respiratory changes resulting from stepwise intrathoracic injections of 4 ml of either room air or warm (37 degrees C) Haemaccel, simulating pneumothorax and pleural effusion, respectively, were evaluated in anaesthetized, paralysed, and mechanically-ventilated rats. Respiratory system, lung, and chest wall resistances and elastances (static and dynamic) were determined in 14 animals. For this purpose, the end-inflation occlusion during constant inspiratory flow method was used. Chest wall configuration at both functional residual capacity (FRC) and end-inspiration tidal volume (i.e. FRC+(VT)) was also evaluated in: 1) 15 rats by measurements of lateral and anteroposterior diameters, and circumferences at the 3rd intercostal space and xiphoid levels; and 2) in 16 rats by measurements of thoracic cephalocaudal diameter. In addition, changes in functional residual capacity were measured. Both in pneumothorax and pleural effusion, resistances were not altered, but static and dynamic respiratory system and lung elastances increased progressively. Morphometric changes were similar at both functional residual capacity and end-inspiration; however, whereas pleural effusion increased all diameters, pneumothorax did not modify lateral diameter. Functional residual capacity was decreased in both conditions. In conclusion, pneumothorax and pleural effusion induced similar mechanical changes, but thoracic configuration was differently affected, since lateral diameters were increased in pleural effusion only.

Susceptibility of Candida spp. of clinical origin to lucknomycin, a new polyenic antibiotic

Lucknomycin is a new polyenic derivative antifungal agent obtained from a Streptomyces diastatochromogenes culture. The in vitro activity of the compound was tested against 403 strains of different Candida species of clinical origin by the Sabouraud Agar dilution method. The mean geometrical value of the minimal inhibitory concentrations (MIC) for Candida albicans was 0.85 microgram/ml, 6 times lower than the corresponding value of nystatin (5.29 micrograms/ml) and very close to that of amphotericin B (0.56 microgram/ml). Lucknomycin was also 4-10 times more active than nystatin on other Candida species, with an MIC similar to those obtained with amphotericin B.

Serological tests in the diagnosis of fungal urinary tract infection

Fungus urine cultures were performed in 646 cases. In 50 we obtained a positive result. In 35 of these and in a control group of apparently healthy adults, we made serological studies using the following techniques: Immunodiffusion; counter immunoelectrophoresis, and immunofluorescence. 4 patients has positive precipitins against somatic and metabolic antigens. We obtained histological confirmation of deep candidiasis. In another 4 patients, the precipitins were positive against metabolic antigen only and further study failed to show deep candidiasis. In a further two cases we obtained positive titers using immunofluorescence; in 1 of these deep infection was confirmed. On no occasion in our study did the use of immunodiffusion and counter immunoelectrophoresis produce either false positive or false negative results against somatic antigen.

Treatment of respiratory infections with fosfomycin

Evaluation was made of the clinical-bacteriological results of treatment with fosfomycin on a group of 27 patients with infectious respiratory pathology. The group is made up of patients with respiratory infections diagnosed as pneumonias, bronchopneumonias, acute bronchitis and chronic bronchopneumopathies. The doses of fosfomycin used varied between 4 and 12 g/day, administered during a period of 1 or 2 weeks. The results of the treatment expressed in clinical and bacteriological parameters have been successful in 15 and 21 cases for their bacteriological response and their clinical response respectively.

Clinical bacteriological evaluation of infantile bacteriuria treated with fosfomycin

The therapeutic action of fosfomycin has been studied in a group of 14 children, with simple and complicated infections of the urinary tract with congenital renal malformations. In the bacteriological study of the urine it was observed that the strains most frequently isolated were E. coli, Proteus sp. and Klebsiella sp. Of the 25 strains isolated 76% were sensitive to the disc of 50 mug fosfomycin and 24% moderately sensitive with a MIC of 64 and 128 mug/ml. The doses of fosfomycin used were 150 mg/kg/day in four administrations. In 13 cases it was administered orally alone and in one case orally and intramuscularly. The results have been good in 10 cases (71.4%) and bad in four cases. The antibiotic has shown good tolerance and no secondary effects have been noticed.