A NOVEL APPROACH TO INCREASE THE BIOAVAILABILITY OF CANDESARTAN CILEXETIL BY PRONIOSOMAL GEL FORMULATION: IN-VITRO AND IN-VIVO EVALUATION

Objective: The oral bioavailability of Candesartan cilexetil is less (<15%), so in this study an approach has been made to increase its bioavailability by proniosomal gel formulation.Methods: The proniosomal formulation of Candesartan cilexetil was prepared by slurry method, using span 60 and Tween 60 as non-ionic surfactants, maltodextrin as carrier and cholesterol and soya lecithin as stabilizers. Prepared gel formulations were evaluated for compatibility study, entrapment efficiency, vesicle size, surface morphology, in-vitro diffusion studies, in-vitro skin permeation studies, in-vivo pharmacokinetics studies, various release kinetic studies and stability studies.Results: FT-IR study showed no interaction between drugs and other excipients, drugs and excipients are compatible. Mean vesicles size of proniosome derived niosome was found in the range of 16.34 µm-32.48 µm and 7.25-16.45 µm before and after shaking. An optimized formulation A3 containing a 2:1 ratio of span 60 and cholesterol showed maximum entrapment (86.17%) and in-vitro drug release (93.8%) compared to other formulations. In-vitro skin permeation studies were carried out using Albino rat skin and results showed that formulation A3 exhibited 88.65% drug permeation in a steady-state manner over a period of 24 h with a flux value of 1.94 µg/cm2/h and enhancement ratio of 3.73. In-vivo pharmacokinetics studies of proniosomal gel formulation A3 showed a significant increase in bioavailability (1.425 folds) compared with an oral formulation of Candesartan cilexetil. Stability studies showed that proniosomal gel formulation was stable throughout its study period.Conclusion: Physiochemically stable Candesartan cilexetil proniosomal gel was formulated, which could deliver significant amount of the drug across the skin in a steady-state manner for the prolong period of time in the treatment of hypertension.Â

The Role of Mushrooms in Biodegradation and Decolorization of Dyes

Contamination of soil, water, and air by hazardous substances is the major environmental problem of today’s world. Mushroom consumption has become a tradition among many people due to its richness in flavors, proteins, and some medicinal importance. But its ability to degrade/decolorize hazardous substances and dyes by secreting various enzymes or by absorption and adsorption of colors from waste substances has made them of interest for use in the field of bioremediation. Mushroom acts as a good decomposer as it degrades cellulose and lignin of plants for their growth and development. It also maintains soil health by performing the role of hyperaccumulators. This chapter focused on the mushroom-based biodegradation/decolorization of dyes and effluents released from various industries or other sources. It also emphasizes the probable mechanisms involved in mushroom-based degradation and decolorization of dyes along with their recent achievements, advancements, and future prospective

ENHANCEMENT OF SOLUBILITY AND DISSOLUTION RATE OF ACETYLSALICYLIC ACID VIA CO-CRYSTALLIZATION TECHNIQUE: A NOVEL ASA-VALINE COCRYSTAL

Objective: This study aims to synthesize acetylsalicylic acid (ASA) cocrystals using valine as a coformer via a co-crystallization technique to increase the solubility and dissolution rate of ASA. Methods: The ASA-valine cocrystal (1:1 molar ratio) was prepared using the solvent evaporation technique with ethanol: water (50:50). The cocrystal was characterized using Fourier transform infrared spectroscopy (FT-IR), Differential scanning calorimetry (DSC), Powder X-ray diffraction (PXRD), Scanning electron microscopy (SEM), melting point to confirm the formation of cocrystal. The evaluation of cocrystal was done by drug content determination, solubility and dissolution studies. Results: The prepared cocrystal was successfully confirmed for the formation of a hydrogen bond. The melting point of prepared cocrystal was decreased compared to pure ASA and valine, which indicated the formation of a new crystalline form. The FT-IR studies showed the formation of a new hydrogen bond by shifting the-O-H,-C=O and-N-H functional groups. SEM studies ensured that the prepared cocrystals were in needle-like appearance. Finally, DSC and PXRD studies were also indicated the successful formation of ASA-valine cocrystal. The drug release of cocrystal was found to be 100% at 60th min. Where in the case of pure ASA and marketed product of ASA exhibited the dissolution rate of 59% and 69% at 60th min respectively. Conclusion: The co-crystallization technique can be adopted as the best strategy to increase the solubility and dissolution rate of BCS class 2 drugs. Therefore the prepared ASA-valine cocrystal can be a greater alternative to increase the solubility and dissolution rate compared with pure and marketed ASA

The State of Accreditation Readiness in Georgia: A Case Study

Background: Georgia’s public health districts first began exploring the idea of national public health accreditation in 2008 when Cobb & Douglas Public Health included accreditation in their strategic plan. In May 2015, Cobb & Douglas Public Health was the first Georgia public health district to achieve national accreditation status. This article discusses the current state of accreditation readiness in Georgia and explores strengths and barriers to accreditation. Methods: This study utilized a case study approach in order to examine PHAB accreditation efforts in Georgia within a reallife context. Data came from three sources: nine Accreditation Readiness Assessments, a PHAB Pre-Application Technical Assistance Survey, and state-wide Accreditation Readiness Survey. Results: The Accreditation Readiness Assessments resulted in several lessons learned about common strengths and barriers to accreditation. Strengths included a dedicated staff and supportive Boards of Health. Barriers included accreditation fees and a lack of personnel time. The PHAB Pre-application TA Survey revealed that the majority of those surveyed would recommend TA to other agencies pursuing PHAB accreditation (91%). The Accreditation Readiness Survey revealed that 14 of 18 GA public health districts are either PHAB accredited (1 district), actively pursuing PHAB accreditation (2 districts), or planning to apply (11 districts). This includes 116 of the 159 Georgia counties (73%). Conclusions: The results of this case study show that 72% of Georgia’s public health districts are engaged in accreditationrelated activities. This includes activities such as accreditation readiness assessment, community health assessment, QI council and plan development, strategic planning, and policy review

Health Districts as Quality Improvement Collaboratives and Multi-Jurisdictional Entities

Research Objective: The Georgia Public Health PBRN assessed the utility of the Multi-county Health District as a structured Quality Improvement Collaborative (QIC), and as multi jurisdictional entities for purposes of meeting standards for accreditation by the Public Health Accreditation Board. Data Sets and Sources: Data were collected from online surveys followed up with phone interviews or paper surveys to maximize participation. A newly developed clinical care QIC instrument (Schouten et al, 2010) was modified to collect data with a revised focus on QICs for public health. We retained QI culture constructs in the instrument while shifting the focus from healthcare to public health essential services related to accreditation standards. Study Design: Data was collected from a purposeful sample of local public health key informants in Georgia who were identified by the District Directors’ office as local key informants. Invitations Key informants included county and district staff and county board of health members. Analysis: Psychometric testing of the QIC assessment instrument included tests for validity and reliability. Census-based and self-reported demographic characteristics were used to compare responses. Principal Findings: Strong consensus emerged across various constituencies that Districts were critical for local public health to provide essential services. Key opinion leaders from both the rural and non-rural counties agreed that the Districts were important. Conclusion: Regionalization using Georgia Districts has major potential for supporting QI and meeting quality assurance standards associated with accreditation. Implications for Field of PHSSR: Accreditation has the potential to substantially clarify and enhance the role of public health in the 21st century. But local public health agencies, based on small municipality or county populations, are unlikely to possess and sustain capacity to meet the challenges of comprehensive essential services. Regionalization of local public health capacity is a critical emerging issue with the launching of public health accreditation

On an inequality of S. Bernstein and estimates for the moduli of the zeros of a polynomial.

The present thesis entitled “On an inequality of S. Bernstein and estimates for the moduli of the zeros of a polynomial" is an outcome of the work carried out by author during the last two years at the Post Graduate Department of Mathematics, University of Kashmir, Srinagar. This Thesis consists of four chapters. In the first chapter, we have studied inequalities on the Maximum Modulus of a Polynomial and its Derivative. In the second chapter, we considered Lacunary type polynomials and obtain inequalities concerning the polar derivative of a polynomial. The third chapter deals with certain problems concerning a family of B operators preserving the inequalities between polynomials. Fourth chapter concerns with the location of the zeros of a polynomial with restricted coefficients.Digital copy of Ph.D thesis.University of Kashmir

Clarifying and Expanding Concepts of Cross-Jurisdictional Sharing: Early Lessons Learned from Conducting QI with Georgia’s Health Districts

Research Objective: Assess the legal and organization cultural foundations for Cross-Jurisdictional Sharing (CJS) in support of local public health accreditation and QI in Georgia. Data Sets and Sources: Archival data (primarily state statutes), secondary data from previous qualitative comparative research on Deep South public health organization, secondary data from previous surveys, and oral interviews and written communication. Study Design: Primarily Qualitative design combining ethnographic and participatory research methods. Analysis: Qualitative Content analysis based on predetermined and emergent themes. Principal Findings: Georgia’s Health Districts have emerged as major CJS entities that support delivery of essential services and local public health (LPH) QI and LPH accreditation readiness, driven primarily by local organizational leadership and culture that is facilitated through enabling statutes in contrast to more top-down state-mandating statutes, regulations and directives. Conclusion: Georgia’s use of districts as multi-county public health entities serves as a primary structure for providing local public health services and has become a critical structure to address the looming demands for QI and accreditation, even though the statutes clearly establish the county as the primary local public health entity. Implications for the Field of PHSSR: This CJS structure to facilitate public health QI and accreditation in Georgia illustrates how agency cultures can emerge from local demands for economies of scale, more than formal policies generated at state level. This is a model that could be very important for advancing CJS in other regions of the country

Surgical Management of Inguinal Hernias at Bugando Medical Centre in Northwestern Tanzania: Our Experiences in a Resource-Limited Setting.

Inguinal hernia repair remains the commonest operation performed by general surgeons all over the world. There is paucity of published data on surgical management of inguinal hernias in our environment. This study is intended to describe our own experiences in the surgical management of inguinal hernias and compare our results with that reported in literature. A descriptive prospective study was conducted at Bugando Medical Centre in northwestern Tanzania. Ethical approval to conduct the study was obtained from relevant authorities before the commencement of the study. Statistical data analysis was done using SPSS software version 17.0. A total of 452 patients with inguinal hernias were enrolled in the study. The median age of patients was 36 years (range 3 months to 78 years). Males outnumbered females by a ratio of 36.7:1. This gender deference was statistically significant (P=0.003). Most patients (44.7%) presented late (more than five years of onset of hernia). Inguinoscrotal hernia (66.8%) was the commonest presentation. At presentation, 208 (46.0%) patients had reducible hernia, 110 (24.3%) had irreducible hernia, 84 (18.6%) and 50(11.1%) patients had obstructed and strangulated hernias respectively. The majority of patients (53.1%) had right sided inguinal hernia with a right-to-left ratio of 2.1: 1. Ninety-two (20.4%) patients had bilateral inguinal hernias. 296 (65.5%) patients had indirect hernia, 102 (22.6%) had direct hernia and 54 (11.9%) had both indirect and direct types (pantaloon hernia). All patients in this study underwent open herniorrhaphy. The majority of patients (61.5%) underwent elective herniorrhaphy under spinal anaesthesia (69.2%). Local anaesthesia was used in only 1.1% of cases. Bowel resection was required in 15.9% of patients. Modified Bassini's repair (79.9%) was the most common technique of posterior wall repair of the inguinal canal. Lichtenstein mesh repair was used in only one (0.2%) patient. Complication rate was 12.4% and it was significantly higher in emergency herniorrhaphy than in elective herniorrhaphy (P=0.002). The median length of hospital stay was 8 days and it was significantly longer in patients with advanced age, delayed admission, concomitant medical illness, high ASA class, the need for bowel resection and in those with surgical repair performed under general anesthesia (P<0.001). Mortality rate was 9.7%. Longer duration of symptoms, late hospitalization, coexisting disease, high ASA class, delayed operation, the need for bowel resection and presence of complications were found to be predictors of mortality (P<0.001). Inguinal hernias continue to be a source of morbidity and mortality in our centre. Early presentation and elective repair of inguinal hernias is pivotal in order to eliminate the morbidity and mortality associated with this very common problem

Understanding the complexities of prevalence of trans fat and its control in food supply in Pakistan

Pakistan is among the nations with a high intake of trans‐fatty acids (TFAs), a major dietary risk factor of noncommunicable diseases (NCDs). Efforts are underway in the country to eliminate industrially produced TFAs from the food supply in keeping with the priority targets of the World Health Organization (WHO) for 2019‐2023. We reviewed the TFA content reported in industrially produced foods and discuss the regulatory landscape for TFAs, to facilitate the required policy changes in Pakistan and ultimately eliminate the TFA burden from industrial food products. The study components include review of published research and product labels as well as review of prevailing food regulations for TFA‐related information. A set of recommendations was also prepared to eliminate TFAs from Pakistan after national consultation workshops conducted in year 2019. Vanaspati ghee (partially hydrogenated vegetable oil), bakery shortening, hard margarines, and fat spreads are identified as the major sources of TFAs. Federal and provincial food authorities have recently established the limits for TFAs in few products; however, the TFA regulations are insufficient and not in line with global best practices. This study informs a comprehensive national strategy for TFA elimination based on knowledge of TFA prevalence associated regulatory control. We recommend to (1) promote actions toward replacement of traditional vanaspati ghee/bakery fats with healthier alternatives; (2) develop and implement best regulatory practices in line with WHO recommendations; and (3) amend food labeling laws so that clear information will be provided to inform consumers healthy food choices