Formation of stable palm kernel oil esters nanoemulsion system containing hydrocortisone

A physical and chemically stable palm kernel oil esters emulsion system with nanosized droplet was developed as a delivery system for hydrocortisone (hydrophobic drug). A simple low energy emulsification method was used in forming the nanoemulsions. The influence of added solvents (isopropanol and ethanol) on particle size and stability of oil in water nanoemulsion was investigated. Formation of nanoemulsion with solvent, increase the solubility of hydrocortisone in the oil phase and thus make the nanoemulsion more stable. Reducing the solvent to lipoid ratio showed no significant difference in the mean particle size. However, after solvent removal particle size increased over time. As for zeta potential value, all nanoemulsions exhibited values below -30 mV which indicated good stability. The DSC thermograms for stable nanoemulsions proved that hydrocortisone is in a non-crystalline state, suggesting that hydrocortisone is homogenized well in the nanoemulsion system. These results showed that nanoemulsion with solvent appear to be a promising transdermal delivery vehicle for hydrocortisone

Encephalitis followed by optic neuritis: a case report and review of literature

Encephalitis has been included in the causes of optic neuritis, but post encephalitic optic neuritis has been rarely reported. Majority of the cases of optic neuritis are either idiopathic or associated with multiple sclerosis, especially in western countries. This is very important in the Asian population where the incidence and prevalence of multiple sclerosis is not as high as in the Western countries. Although post infectious optic neuritis is more common in children, it can also be found in adults and is usually seen one to three weeks after a symptomatic infective prodrome. Here, we present a case of a 48 year-old-male who developed optic neuritis following viral encephalitis. His first presentation was with severe headache of two weeks duration. Viral encephalitis was diagnosed and treated. The patient presented again three weeks later with right eye pain and other features typical of optic neuritis. Corticosteroid therapy facilitated prompt recovery. Optic neuritis is an uncommon manifestation of encephalitis. It is important that both doctors and patients remain aware of post infectious cause of optic neuritis, which would enable a timely diagnosis and treatment of this reversible cause of vision loss

Genetic polymorphisms and drug interactions leading to clopidogrel resistance: why the Asian population requires special attention

Ischemic heart disease and stroke are the two leading causes of death worldwide. Antiplatelet therapy plays the most significant role in the management of these cardiovascular and cerebrovascular occlusive events to prevent recurrent ischemic attack. Clopidogrel, an antiplatelet drug, is widely prescribed either alone or in combination with aspirin as dual antiplatelet therapy for the prevention of vascular occlusive events. The antiplatelet response to clopidogrel varies widely. Hyporesponders and nonresponders are likely to have adverse cardiovascular events during follow-up. Some drugs, such as proton pump inhibitors (omeprazole), calcium channel blockers, selective serotonin reuptake inhibitors (nefazadone), coumarin derivatives (phenprocoumon), benzodiazepines, sulfonylurea, erythromycin, and itraconazole, decrease the antiplatelet effect of clopidogrel when administered concomitantly. Decreased response to clopidogrel is common among Asians due to genetic polymorphisms associated with clopidogrel resistance, and it is nearly 70% in some of the Asian communities. It is necessary to study Asian populations, because there are a large number of Asians throughout the world due to increased migration. Current guidelines do not make genetic testing or platelet response testing mandatory prior to clopidogrel prescription. Therefore, it is important for clinicians treating Asian patients to keep in mind the interindividual variability in response to clopidogrel when prescribing the drug

Predictors of stroke-associated pneumonia after the first episode of acute ischaemic stroke

Objectives: Pneumonia is one of the most common complications of stroke with significant impact on patients' outcome. The aim of this study is to look for the predictors of stroke-associated pneumonia (SAP) and its 30-day mortality and to analyse the survival of ischaemic stroke patients with pneumonia. Methodology: This is a prospective observational study, involving all acute first time ischaemic stroke patients admitted to a tertiary hospital that fulfilled the inclusion and exclusion criteria over a 6-month period. Demographic data were obtained on admission. Patients were reassessed for SAP, on day 5 and day 30. Assessment was done using the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index and modified Rankin scale (MRS). All patients with pneumonia were assessed with the pneumonia severity index (PSI) for SAP. Results: One hundred and twenty patients were enrolled consecutively within the 6-month study period. 15.8% developed SAP. Independent predictors of SAP were clinical dysphagia (OR 76.32; 95%CI 4.46 to 1307.05), random blood glucose (RBS) on admission (OR 1.34; 95%CI 1.06 to 1.68) and NIHSS score on admission (OR 1.15; 95%CI 1.02 to 1.30). Independent predictors for 30-day mortality were NIHSS score on day 5 (OR 1.20; 95%CI 1.08 to 1.33) and occurrence of pneumonia (OR 14.90; 95% CI 3.34 to 66.42). There was a significant difference in mean survival between SAP and non-SAP patients. Conclusions: Clinical dysphagia, RBS on admission and NIHSS score on admission were independent predictors of SAP. NIHSS score on day 5 and pneumonia were independent predictors of 30-day mortality. SAP patients had shorter survival time compared to non-SAP patients

An unsual finding of brain magnetic resonance imaging in a hypertensive patient

Brain edema in patients with hypertensive encephalopathy frequently affects the parietooccipital white matter. Hypertensive encephalopathy is thus included as a differential diagnosis in reversible posterior leukoencephalopathy syndrome. Diffuse white matter involvement rarely occurs. We report a 41-year old woman with hypertensive encephalopathy with diffuse and non-enhancing white matter hyper-intensities throughout the whole brain on magnetic resonance imaging (MRI). These hyperintensities spared the grey matter on T2-weighted and FLAIR sequence. These unusual finding on brain MRI was attributed to severe vasogenic cerebral edema resulting from accelerated hypertension

Computational simulation of palm kernel oil-based esters nano-emulsions aggregation as a potential parenteral drug delivery system

The self-assembled structure of palm kernel oil-based esters (PKOEs) nano-emulsions has shown a great potential used for parenteral drug delivery applications. Here, all-atom level molecular dynamics (MD) was applied to investigate the aggregation process of PKOEs nano-emulsion system. The system consisted of palm kernel oil-based esters (PKOEs) and dipalmitoylphosphatidylcholine (DPPC) in water. The ratio of all constituents was taken from the homogenous region of a ternary phase diagram determined experimentally. The molecules started to aggregate very rapidly from random configurations. A doughnut-like toroidal assembled structure formed at 50 ns with PKOEs surrounded by DPPC molecules. The structural and dynamical properties of the self-assembled doughnut-like toroidal aggregate were analyzed using the principle moment of inertia, eccentricity and radius of gyration. The aggregation structures were compact with the average radius of gyration of 4.10 (±0.02) nm over the last 5 ns. Additionally, both hydrophobic and hydrophilic interactions were involved in aggregation process with a total solvent accessible surface area of 551.72 (±5.88) nm2

Mediators of the effect of the psycho-educational intervention on the psychological well-being of caregiving daughters and daughter in-laws of stroke survivors

Background: The objective of this study was to determine whether the randomly assigned intervention is associated with a change in the mediators including threat appraisal, coping behaviors, confidence in knowledge, and preparedness which is in turn accompanied by changes in the caregivers’ psychological well-being. Methods: A total of 96 caregiving daughters and daughter in-laws of stroke survivors participated in the study in which 49 cases were randomly assigned to the intervention and 47 to the control group. Data was collected before, immediately after and 12 weeks following interventions. Results: The results of mixed ANOVA revealed a statistically significant difference in psychological well-being score between intervention and control groups. Our findings from the multiple mediator analyses supported the mediating effect for only two of the five hypothesized mediators. The intervention affected psychological well-being indirectly through changes in threat appraisal and perceived preparedness. Multiple mediator models accounted for 34.3% of the variance in the psychological well-being change. Conclusion: The results of this study show the importance of mediators’ evaluation in interventional studies of stroke survivor caregivers

Andrographolide downregulates pro-inflammatory cytokines and free radical productions to prevent dopaminergic neuro-degeneration induced by lipopolysaccharide

Oxidative stress and inflammation triggers the production of free radicals and toxic pro-inflammatory cytokines leading to neurodegeneration. Down-regulation of oxidative stress and inflammatory mediators offers defence against development and progression of the disease. Andrographolide is the most abundant diterpene lactone isolated from the leaves of Andrographis paniculata. Despite the increasing literature studies on the anti-inflammatory effect of andrographolide, there is still paucity regarding its neuroprotective role as can be ascertained from the search of literature. The present study investigated the potential therapeutic role of andrographolide as a neuroprotective agent via in vitro model of lipopolysaccharide (LPS)-induced brain injury using microglial (BV2) and dopaminergic (N27) cells. Pre-treatment of andrographolide at non-cytotoxic concentration range (0.25-2.0 µM) of BV2 cells followed by LPS dose-dependently suppressed nitric oxide production, pro-inflammatory cytokines (TNF-α, IL-6) as well as attenuating intracellular reactive oxygen species (ROS) and thiobarbituric acid reactive substance (TBARS) compared to cells without andrographolide pretreatment. Further, conditioned media (CM) of the pretreatment had diminished toxicity towards dopaminergic neurons as compared to CM without pretreatment. Keywords: Andrographolide; Proinflammatory cytokines; oxidative stress; microglial; dopaminergic neurodegeneration

Challenges faced and lessons learned: a multi-component prospective memory training program for Malaysian older adults

The surrounding circumstances and environments of Malaysian older adults could make conducting interventions (mainly in terms of clinical or randomized controlled trials) a challenge. Working with older adults and facing cultural issues could be challenging. Objective: This paper illustrates a significant perspective of some of the challenges faced while conducting a randomized controlled trial exploring the impact of a multi-component intervention that included strategy- and process-based prospective memory (PM) training among Malaysian older adults. Methods: The current study was a randomized controlled trial (RCT) and therefore the challenges were presented in accordance with the CONSORT statement style. Results: A discussion on how these issues were addressed is provided. Conclusion: Some suggestions were presented to help researchers plan and create interventions for similar studies and to support a practical method of addressing all related challenges