Simultaneous quantification of Losartan Potassium and its Active Metabolite, EXP3174 in Rabbit Plasma by Validated HPLC-PDA

Herein we report a novel, accurate and cost-effective validated analytical method for quantification of losartan potassium and its active metabolite, EXP 3174 in rabbit plasma by reversed phase-high performance liquid chromatography. Valsartan was used as an internal standard. The method was validated as per ICH guidelines. The analytes were extracted in rabbit plasma using liquid-liquid extraction technique and analyzed at 247 nm after separation through a reverse phase C₁₈ column. The isocratic mobile phase used is a mixture of acetonitrile, water and glacial acetic acid in the ratio of 60:40:1v/v/v maintained at pH 3.4. All calibration curves showed a good linear relationship (r>0.995) within test range. Precision was evaluated by intra and inter-day tests with RSDs <1.91%, accuracy validation recovery 86.20-101.11%. Based on our results, the developed method features good quantification parameters and can serve as effective quality control method for standardization of drugs.

Change in REVEAL Lite 2 and COMPERA 2.0 risk status in patients with pulmonary arterial hypertension initiating oral treprostinil on dual background therapy: a retrospective chart review

Background

Post-hoc analyses of the FREEDOM-EV study demonstrated that addition of oral treprostinil (ORE) to background monotherapy improves risk in patients with pulmonary arterial hypertension (PAH). Evidence is needed to understand the incremental effect of ORE added to dual background therapy with an endothelin receptor antagonist (ERA) and phosphodiesterase-5 inhibitor (PDE5)/soluble guanylate cyclase stimulator (sGC).

Purpose

To describe longitudinal changes in REVEAL Lite 2 and COMPERA 2.0 risk status in patients initiating ORE on dual background therapy.

Methods

A multisite, double-blind retrospective chart review of PAH patients was conducted by US PAH-treating physicians and included patients meeting prior diagnostic PAH criteria (mPAP ≥25 mmHg/PAWP ≤15 mmHg/PVR &gt;3 WU), age ≥18 at diagnosis, began a PAH treatment 01/2014–03/2017, and had NT-proBNP/BNP, WHO functional class (FC), and 6-minute walk distance (6MWD) at baseline visit. Baseline was most recent assessment prior to ORE initiation. This analysis included a subset of patients on dual background therapy at time of ORE initiation without prior prostacyclin use. Follow-up was evaluated in 0–6 and 6–12 months after ORE initiation.

Results

30 (61.2%) of 49 ORE patients were on dual background therapy at time of ORE start; 23 had baseline assessments while on dual background therapy and were included in this analysis. At baseline, mean (SD) 6MWD was 140.9 (49.8) m and 21 (91.3%) patients were FC III. Prior to ORE, median (IQR) time on ERA was 6.6 (5.5–7.6) months and PDE5/sGC was 3.7 (3.3–5.7) months. After ORE start, median (IQR) time to follow-up was 4.3 (3.4–5.6) months in 0–6 months and 10.9 (9.6–11.6) months in 6–12 months. Using REVEAL Lite 2, baseline mean (SD) REVEAL Lite 2 risk score was 7.9 (0.8); 1 (4.4%), 2 (8.7%), and 20 (87%) patients were in the low, intermediate, and high risk strata, respectively. In 0–6 months (n=22), 13 (59.1%) patients improved and 9 (40.9%) stabilized REVEAL Lite 2 risk strata from baseline. In 6–12 months (n=22), mean (SD) REVEAL Lite 2 risk score was 6.5 (1.1); 15 patients (68.2%) improved, 6 (27.3%) stabilized, and 1 (4.6%) worsened REVEAL Lite 2 risk strata from baseline. Using COMPERA 2.0, at baseline, 1 (4.4%) patient was in the intermediate-low and 22 (95.7%) patients were in the intermediate-high risk strata. In 0–6 months (n=15), 10 (66.7%) patients improved and 5 (33.3%) patients stabilized COMPERA 2.0 risk strata from baseline. In 6–12 months (n=17), 15 (88.2%) patients improved and 2 (11.8%) stabilized COMPERA 2.0 risk strata from baseline.

Conclusion

Of patients initiating oral treprostinil in this study, most were on dual background therapy and at high risk by REVEAL Lite 2 or intermediate-high risk by COMPERA 2.0. This analysis suggests adding ORE to dual background therapy can improve risk status in patients, with clinical benefit attained within 6 months and continued incremental improvement through first year of therapy.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): United Therapeutics Corporation

Development, method validation and simultaneous quantification of eleven bioactive natural products from high altitude medicinal plant by high performance liquid chromatography

Herein, a novel, rapid, reliable, simple method validation and simultaneous quantification of eleven bioactive compounds mostly xanthones have been described. ICH guidelines were used for the analytical method validation. Good linearity, repeatability, intra-day and inter-day precision, accuracy and reliability is well illuminated in the method validation procedure. The calibration curves showed a good linear relationship (r>0.999) within test range. Precision was evaluated by intra- and inter-day tests with RSDs <2.79%, accuracy validation recovery 74.16-91.84%. On quantification study, validated method described the high content of bioactive xanthone derivative including 1-hydroxy-3, 5-dimethoxyxanthone (7), 2-(allyloxy)-8-hydroxy-1, 6-dimethoxyxanthone (6) 1, 7, 8-trihydroxy-3-methoxyxanthone (9) and Coxanthone E (5) in the C. ovata which is advantageous due to numerous pharmacological and biological effects associated with these compounds mostly anti-cancers, antioxidant, anti-inflammatory, anti-mutagenic and anti-obesity activity. The bulk abundance of these compounds can also be used for the further modification to produce better lead molecules for drug discovery with low toxicity and high potency. The proposed method makes it possible to determine simultaneously all bioactive compounds in one run and can be extended for marker based standardization of herbal formulations in medicinal and pharmaceutical industries.

Effects of anisotropy and regime of diffusion on the measurement of lattice diffusion coefficient of hydrogen in metals

The lattice diffusion coefficient of hydrogen in metals is commonly measured by permeation tests. Such tests assume isotropic diffusivity with a set-up which measures permeation flux only along one direction. The measured values of the lattice diffusion coefficient are strongly influenced by the trapping of hydrogen at microstructural defects. These factors lead to highly inaccurate determination of the lattice diffusion coefficient, more so in an anisotropic medium. In this work, we present a three-dimensional (3D) diffusion equation in non-dimensional form for an anisotropic medium with source and sink terms which account for detrapping and trapping of hydrogen. The concentration of hydrogen at lattice and trap sites is assumed to be in a local equilibrium. An initial boundary value problem of the permeation test is formulated and the governing partial differential equation is implemented in a 3D finite-element code. The influence of anisotropic diffusivity on the measurement of lattice diffusion coefficient is shown by numerical simulations. Asymptotic analysis of the governing equation reveals that the lattice diffusion coefficient can only be measured in certain regimes when performing permeation tests at varying temperatures. The nonlinear behaviour of Arrhenius plots of diffusion coefficient versus inverse of temperature due to trapping is analytically and numerically predicted.

Cisplatin-Vinorelbine Combination Chemotherapy in Locally Advanced Non-Small Cell Lung Cancer

Aim

The North Milan Group presents the results of a phase II study on a cisplatin-vinorelbine combination schedule in the treatment of locally advanced non-small cell lung cancer to evaluate its activity and tolerability.

Methods

Seventy-six consecutive patients entered the study. Patients’ characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, 0-1; 17 stage IIIa and 59 stage IIIb. There were 49 squamous cell carcinomas, 20 adenocarcinomas, and 7 large cell carcinomas. All patients had not been previously treated and showed measurable disease. Treatment consisted of vinorelbine, 25 mg/m2 on days 1 and 8, plus cisplatin, 80 mg/m2 on day 1, administered intravenously every 21 days for three standard courses.

Results

Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CR+PR) of 56.7%; 18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months: it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evaluated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases.

Conclusions

The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results are fully comparable to others obtained with vinorelbine in two/three drug combination chemotherapy regimens.

Cardiotoxicity during Chemotherapy for Advanced Gastroenteric Tumors

The authors report two cases of patients with advanced gastroenteric carcinoma, which developed different cardiotoxicity patterns after the administration of cytotoxic drugs. The firsts patient showed a picture of dilatative cardiomyopathy with associated symptoms of angina pectoris and congestive heart failure; the second patient presented a cardiac arrhythmia after several administrations of S-fluorouracil. The possible mechanisms of these toxic effects, as well as the drug interactions are briefly discussed. Cardiotoxicity of cytotoxic drugs should be considered by oncologists even in patients with no previous history of cardiac disease.

Synthesis and biological evaluation of novel bavachinin analogs as anticancer agents

A library of 28 analogs of bavachinin including aliphatic and aromatic ethers, epoxide, chalcone, oxime, semicarbazide, oxime ether and triazole derivatives have been synthesized and evaluated for cytotoxicity against four different human cancer cell lines. Bio-evaluation studies exhibited better cytotoxic profile for many analogs compare to bavachinin. Best results were observed for a 1,2,3-triazole analog (17i) with IC₅₀ values 7.72, 16.08, 7.13 and 11.67 μM against lung (A549), prostate (PC-3), colon (HCT-116) and breast (MCF-7) cancer cell lines respectively. This analog showed three and four fold improvement in cytotoxicity against HCT-116 and A549 cell lines than parent molecule (1). Structure activity relationship (SAR) study for all synthesized analogs was carried out. Further, mechanistic study of the lead molecule (17i) revealed that it inhibits colony formation and in vitro migration of human colon cancer cells (HCT-116). Also, it induced the morphological changes and mediated the apoptotic cell death of HCT-116 cells with perturbance in mitochondrial membrane potential (MMP) and PARP cleavage.

Analysis of electro-permeation of hydrogen in metallic alloys

A reaction-diffusion type modelling framework is presented to analyse both electro-permeation (EP) and thermal desorption spectrometry (TDS) measurements of hydrogen in metallic alloys. It is assumed that the kinetics of hydrogen motion is governed by diffusion through the lattice, along with trapping/detrapping at specific sites such as dislocations, grain boundaries, etc. It is shown that the trapping and detrapping rates are typically much faster than the diffusion rate, and consequently a simplification of the governing equations suffices such that local equilibrium exists between lattice and trapped hydrogen. Using this local equilibrium assumption, we then present an asymptotic analysis of the governing kinetic equation for the EP test. This asymptotic analysis reveals that four regimes of behaviour exist, ranging from negligible trapping to the complete filling of deep traps. The analysis suggests that EP tests should be so-arranged that three regimes of behaviour are spanned, in order to extract the relevant material properties associated with hydrogen transport. The numerical solutions presented in this study support the asymptotic analysis. The hydrogen kinetics framework is also deployed to analyse both EP and TDS tests on the same martensitic steel. The EP measurements all lie in regime I and are thus insufficient to uniquely determine both the trap density and binding energy. Reasonable agreement is obtained between measurements and numerical predictions of TDS tests using parameters estimated from the EP tests. Further improvements in measurements are required to confirm the fidelity of this modelling approach.This article is part of the themed issue 'The challenges of hydrogen and metals'.

Biologically active xanthones from Codonopsis ovata

Five new xanthones, named coxanthones A-E (1-5), together with 21 known secondary metabolites (6-26) that include seven xanthones, five flavonoids, two steroids and seven triterpenoids were isolated from the chemically unexplored whole plant Codonopsis ovata. The structures of new metabolites were elucidated by HRMS, interpretation of NMR spectra and other spectroscopic techniques. The absolute configuration of the stereogenic centre of coxanthone B (2) was determined by electronic circular dichroism (ECD) spectroscopy. This is the first report of xanthones from the genus Codonopsis. All isolated metabolites were evaluated for cytotoxic activity by SRB assay against six human cancer cell lines A549 (lung), PC-3 (prostate), HCT-116 (colon), MCF-7 (breast), SF-295 (CNS), and MDAMB-435 (melanoma). Among the new compounds, coxanthone B (2) exhibited significant inhibitory activity against SF-295 and MDAMB-435 with IC₅₀ values of 7.0 and 15.0 μM, respectively. Coxanthone A (1) displayed cytotoxicity against A549 cell line at IC₅₀ value of 22.5 μM. Cytotoxic activity of 1-hydroxy-3,5-dimethoxyxanthone (7), swertiperenine (9) and 1,7,8-trihydroxy-3-methoxyxanthone (10) are reported here first time that exhibited the IC₅₀ values of 3.0, 5.0 and 21.0 μM against A549, MDAMB-435, and A549 cell lines, respectively. Kaempferol (13) showed most potent cytotoxic activity with an IC₅₀ values in the 1.0-2.3 μM range against all tested cancer cell lines.

Synthesis and anti-proliferative evaluation of novel 3,4-dihydro-2H-1,3-oxazine derivatives of bakuchiol

Anti-proliferation study of new bakuchiol analogs revealed the anti-pancreatic potential of aliphatic oxazine derivatives of bakuchiol that activate caspase-9 and -3 and cleave PARP-1.

Objective measurement of erythema in psoriasis using digital color photography with color calibration

BACKGROUND

Traditional metrics for evaluating the severity of psoriasis are subjective, which complicates efforts to measure effective treatments in clinical trials.

METHODS

We collected images of psoriasis plaques and calibrated the coloration of the images according to an included color card. Features were extracted from the images and used to train a linear discriminant analysis classifier with cross-validation to automatically classify the degree of erythema. The results were tested against numerical scores obtained by a panel of dermatologists using a standard rating system.

RESULTS

Quantitative measures of erythema based on the digital color images showed good agreement with subjective assessment of erythema severity (κ = 0.4203). The color calibration process improved the agreement from κ = 0.2364 to κ = 0.4203.

CONCLUSION

We propose a method for the objective measurement of the psoriasis severity parameter of erythema and show that the calibration process improved the results.

Intended intramuscular gluteal injections: are they truly intramuscular?

CONTEXT

In patients with obesity, intramuscular injections may be deposited subcutaneously due to an increase in gluteal fat. We aimed to use abdominal CT done in our institute for gluteal fat thickness to test our hypothesis.

MATERIALS AND METHODS

After IRB approval, CT scans of the abdomen and pelvis of the past 6 months were analyzed. The thickness of gluteal region subcutaneous fat was measured in a standardized manner.

RESULTS

Out of 700 CT scans, studied, 476 were males and 224 were females. The average gluteal fat thickness was 2.34 cm +/- 1 cm. The average fat thickness in males was 1.98 cm +/- 0.98 cm whereas in females was 3.0 cm +/- 1.2 cm. Subcutaneous granulomas were seen in 17 cases and one injection granuloma in the intramuscular plane.

CONCLUSION

A significant number of female patients had increased gluteal fat thickness beyond the reach of routinely used needles. The medications in these patients will thus be unintentionally injected to subcutaneous plane, possibly altering the pharmacokinetics.

Regulatory role of miR-2909 in cell-mediated immune response

Keeping in view the micromanagement of immune response by micro RNAs, the present study was directed to explore the role of miR-2909 in the differentiation and maturation of T-lymphocytes within the population of normal human peripheral blood mononuclear cells maintained in in vitro culture. The results of such a study revealed that miR-2909 had the inherent capacity to significantly increase Treg (CD4+CD25+Foxp3+) cell population and dominant Th1-type cytokine (especially with decrease in IL-4 level and higher levels of INF-β and INF-γ) profile. Based upon these results, we propose that miR-2909 may modulate native immunity in general and help in providing protective immunity against viral infections in particular.

Infraorbital ethmoid (Haller's) cells: a panoramic radiographic study

OBJECTIVE

Haller's cells or infraorbital ethmoid cells refer to the ethmoidal pneumatization of the superior aspect of the maxillary sinus and floor of the orbit. The clinical importance of these entities initiated this study with an aim to determine the prevalence and characteristics of Haller's cells on panoramic radiographs.

METHODS

The study group comprised 600 healthy adults of both genders with an age range of 18-60 years. One panoramic radiograph for each of the patients was made and interpreted for the presence of Haller's cells. The data collected were subjected to statistical analysis: frequencies/percentages, descriptive statistics, χ(2) test and cross-tabulation (contingency table analysis) to obtain the results.

RESULTS

Haller's cells were noted in 96 patients, accounting for a prevalence of 16%. Of these patients, 77.1% were unilateral while 22.9% were bilateral. Among 96 cases, a total of 204 cells were found. The majority of the cells were round or ovoid in shape. The unilocular type of Haller's cells occurring unilaterally was statistically significant.

CONCLUSION

This study has attempted to explore the characteristics of Haller's cells on panoramic radiographs. A description of Haller's cells on these radiographs may prove vital in enumerating the differential diagnosis for patients afflicted with intractable orofacial pain and reduce the risk of untoward intraoperative complications during endonasal procedures.

Annular vesiculobullous eruptions in type 2 reaction in borderline lepromatous leprosy: a case report

An untreated case of BL presented with clinical features of type 2 reaction (T2R) confirmed by histopathology. The case was a 18-year-old female with borderline lepromatous leprosy who developed annular vesiculobullous eruptions oversome of the pre-existing plaques on arms and upper back along with fever and severe neuritis after a short course of ofloxacin intake prescribed for urinary tract infection. In addition to the above lesions, some of the existing lesions showed acute exacerbation characterized by erythema, oedema, tenderness and vesiculobullous eruption. This can be considered as an example of leprous exacerbation as described in older literature. T2Rs are common in lepromatous leprosy and not so uncommonly are observed in borderline lepromatous leprosy. The vesiculobullous and crusted lesions developing over the existing borderline plaques, some of them presenting in an annular pattern in T2R in the form of leprous exacerbation, have been reported rarely in the literature.

Serology in autoimmune pancreatitis

Autoimmune pancreatitis (AIP) is the pancreatic manifestation of a systemic immune-driven, inflammatory process that can involve organs such as the bile duct, salivary glands and lymph nodes, in addition to the pancreas. Many of the presenting signs and symptoms of AIP, including painless jaundice, weight loss and mild epigastric pain, are characteristic of pancreatic adenocarcinoma; thus, obtaining an accurate diagnosis to avoid unnecessary surgery is imperative. AIP responds very well to steroid treatment, although it may recur in up to 20% to 40% of cases. The diagnostic criteria for AIP are histological, radiographic, clinical and laboratory-based in nature. Although no international consensus on diagnostic criteria has yet been made, some of the diagnostic features of AIP include elevated gamma globulin, immunoglobulin, and, in particular, immunoglobulin G4 fraction (IgG4). The search for a distinct serological marker of AIP has included antibodies to a wide range of antigenic stimuli. To date, there have been studies of AIP and antibodies to lactoferrin, carbonic anhydrase isoforms II and IV, pancreatic secretory trypsin inhibitor (PSTI or SPINK) as well as to less sensitive or specific markers of autoimmunity, such as antinuclear antibody and rheumatoid factor. Although there are some preliminary strengths of association with PSTI antibodies, none of these biomarkers appears to be sensitive or specific enough to serve as distinctive evidence of AIP. At the current time, elevations of IgG4 to greater than 280 mg/dL remain the most reliable and reproducible indicator that a patient has AIP.

Late postpartum eclampsia at five weeks post-delivery

Postpartum eclampsia is a serious and unexpected complication. A relative increase in the incidence of postpartum eclampsia has been noted in the last few years. Late postpartum eclampsia, though initially controversial, is now recognised up to four weeks after delivery. We present such a case occurring in a 26-year-old woman. This patient, who had undergone lower segment caesarean section due to pregnancy-induced hypertension, presented with typical features of postpartum eclampsia 34 days after an asymptomatic interval.

The Misgav Ladach method: a step forward in the operative technique of caesarean section

INTRODUCTION

Caesarean delivery remains the most common intraperitoneal surgical procedure in obstetric and gynaecologic practice. Since time immemorial there have been countless efforts to improve the technique of caesarean section. One such innovative breakthrough technique is the Misgav Ladach method of caesarean of section. The objective of this trial was to compare the intraoperative and short-term postoperative outcomes between the conventional and the Misgav-Ladach technique for caesarean section.

MATERIALS AND METHOD

The randomized prospective comparative study was carried out in the department of Obstetrics and Gynaecology, B.P Koirala Institute of Health Sciences, Dharan Nepal. Four hundred patients were randomized to either Misgav Ladach or the Conventional method of caesarean section. Only term pregnancies with singleton foetuses' were included whereas pregnancies with previous caesarean section were excluded from the study. The study period was from September 2001 to September 2004.

RESULT

There was not much difference in the demographic variables between the two groups. The age of the patients ranged between 18-40 years. The mean age of patients in Misgav Ladach and conventional group was 24.5 and 23.6 years respectively. Foetal distress was the commonest indication for caesarean section followed by non progress of labour. The mean incision to delivery interval, operating time and blood loss in the Misgav Ladach group was 1 minute 30 seconds, 16 minutes and 35 0ml as compared to 3 minutes, 28 minutes and 600 ml in the conventional group respectively. 3.5%of patients in the Misgav Ladach group showed febrile morbidity as compared to 7% in the conventional group. 19% from conventional group and only 4%from Misgav Ladach group required added analgesia. Almost equal number of patients (10-12) in each group experienced significant headache.).0.1%in the Misgav group and 5% in the Conventional group required post operative blood transfusion. Four patients from the conventional group had their wound gaped. The number of neonates requiring intensive care was sixteen (8% ) in the conventional group and 3 (1.5%) in the Misgav group.6.5% from conventional group and 2% from Misgav Ladach group required maternal intensive care admissions.

CONCLUSION

Misgav-Ladach technique has been be associated with shorter operative time, quicker recovery, and lesser need for postoperative medications, when compared with traditional caesarean section. It has also been shown to be more cost-effective. A further advantage of the technique may be the shorter time taken for the delivery of the child.