Modified geometry three-layered tablet as a platform for class II drugs zero-order release system

Purpose: To optimize a geometrical design of three-layered tablets for controlling the release of indomethacin (Ind) as a BCS class II model.Methods: The core formulation was optimized to ensure non-disintegrating tablet with a slow release behavior. Three-layered tablets were prepared by a single-step direct compression method by manual feeding of a hydrophobic layer in the bottom followed by Ind core layer and another hydrophobic layer at the top using 6 and 12 mm round compression sets. Four batches were prepared, differing only in either thickness of the drug layer or tablet diameter. A number of factors were studied, including tablet thickness to diameter ratio and drug layer surface area. The rate of Ind released was determined using USP dissolution apparatus I.Results: The optimum drug layer formulation contained Ind (40%), polyvinylpyrolidone K30 (40 %), and ethyl cellulose (20 %). The t50% (time taken for 50 % drug release) for the four three-layered tablet batches with varying diameter to thickness ratios were in the range of 1.5 to 3.7 h. The diameter to thickness ratios were in good correlation with % Ind release after 4 h (R2 = 0.94). It was found that all batches complied with zero order kinetic model.Conclusion: The new one-compression phase applied in this study is successful in producing threelayered tablets in a single-step with very good mechanical attributes. The approach of designing a controlled release tablet via control of the surface area of drug release is feasible for non-swelling matrices.Keywords: Controlled release, Indomethacin, BCS class II drugs, Ethyl cellulose, Release kinetics, Direct compressio

A Successfully Treated Case of Aspergillus Flavus Fungal Keratitis Caused by Stale Bread Corneal Injury

Abstract Fungal keratitis is difficult to treat that can result in corneal blindness requiring penetrating keratoplasty and in fungal endophthalmitis. We report a case of fungal keratitis following a recent eye trauma by stale bread particle. Ophthalmological and Microbiological investigation revealed a fungal keratitis with aspergillus flavus. The case was successfully treated with oral antifungal (voriconazole), and combination of topical antifungal medications. The patient responded well to the antifungal treatment and gain 20/20 vision with complete resolution of the fungal keratitis and absence of recurrence. Early presentation and diagnosis are the key factor toward successful management of fungal keratitis

Assessment of patient-controlled analgesia versus intermittent opioid therapy to manage sickle-cell disease vaso-occlusive crisis in adult patients

Background: Vaso-occlusive crisis (VOC) is one of the acute complications of sickle-cell disease (SCD). Treatment mainly relies on hydration and pain control by analgesics. The specific aim of this study was to assess potential health outcomes within the first 72 h of admission between intermittent and patient-controlled analgesia (PCA) by opioids among VOC patients. Methods: A retrospective chart review study was conducted to determine SCD patients with VOC. Using the hospital electronic system, the following data were collected: patient's age, gender, blood pressure, heart rate, respiratory rate, oxygen saturation, and pain score on admission and daily for 3 days as well as the cumulative opioid analgesic dose for 72 h which is reported as morphine equivalent. Results: One hundred and seventeen patients were screened over a period of 5 years. Of those, 99 (84.6%) met the study inclusion criteria, and 18 patients (15.4%) were excluded from the study. During the first 72 h of admission, a significant reduction in pain score was observed in patients on intermittent intravenous (IV) administration compared to those in the PCA group (P < 0.0004) where the mean pain scores were 3 and 5, respectively. The total amount of morphine administered over 72 h of admission was significantly higher in PCA group (777 ± 175 mg) as compared to the intermittent IV administration group (149 ± 74 mg) (P < 0.000003). Clinically significant hypotension or respiratory depression was not observed in both groups over the 72 h of admission. Conclusion: During the first 72 h of admission, intermittent IV administration of morphine was more effective than PCA infusion in pain control