Monostotic craniofacial fibrous dysplasia: report of two cases with interesting histology

Fibrous dysplasia (FD) is a relatively rare osseous disease of unknown etiology, wherein the normal bone is replaced by collagen-rich tissue, comprising of fibroblasts and variably abundant immature woven bone. Clinically, it may involve a single bone or multiple bones. It commonly arises in the jaw bone, skull, rib, and proximal femur. Those arising in the skull and the jaw are together termed “craniofacial fibrous dysplasia.” The differential diagnosis at this location includes meningioma and metastatic carcinoma. In this report, we highlight two diagnostically challenging cases presenting with orbital swelling and headache as the main complaints. Our first case was misinterpreted as meningioma on intraoperative squash smear, and paraffin sections revealed characteristic features of FD. The second case highlights the morphological feature of non-specific cystic degeneration occurring in FD. Radiographs in such cases show cystic swelling, which is indicative of a secondary aneurysmal bone cyst

FORMULATION DEVELOPMENT AND EVALUATION OF NOVEL FIXED DOSE COMBINATION OF S (-) PANTOPRAZOLE AND MOSAPRIDE CITRATE BY TABLET IN CAPSULE APPROACH

Objective: The main objective of the present study was to formulate a fixed dose combination of chirally pure S (-) Pantoprazole and Mosapride citrate tablets. Since no systematic studies on design and development of S (-) Pantoprazole and Mosapride citrate tablets in capsule approach are available in literature, we propose to develop a suitable formulation to characterize in-vitro release profile of both the tablets in capsules. Chirally pure S (-) Pantoprazole tablets were prepared as delayed release and Mosapride citrate tablets were prepared as immediate release tablets.Methods: Enteric coating was done on S (-) Pantoprazole tablets to modify its release in 6.8 phosphate buffer. In-vitro dissolution of capsule containing both the tablets was performed in two different media, 0.1N HCl and 6.8 phosphate buffer respectively. All Physico-chemical parameters for both the tablets as well as capsules were evaluated individually and were found well within the specified limits.Result: Initially dissolution was performed in 0.1 N HCl in which immediate release tablet of Mosapride dissolve completely and pantoprazole tablets remains as it is due to enteric coating. Further tablet was placed in 6.8 phosphate buffer in which delayed release tablets of S (-) Pantoprazole gives complete release. Drug product was found stable during accelerated stability studies for 6 month at 40°C/75% RH.Conclusion: A stable and robust formulation of S (-) Pantoprazole and Mosapride citrate as fixed dose combination was developed and evaluated. Tablet in capsule approach was developed and results were well within the specified limits.Keywords: S (-) pantoprazole, Mosapride citrate, Modified release, Fixed-dose combination, Delayed release

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries