Osmotically Regulated Two-Compartment Asymmetric Membrane Capsules for Simultaneous Controlled Release of Anti-Hypertensive Drugs

In the present study, asymmetric membrane capsules (AMCs) with two compartments were successfully developed for simultaneous delivery of two poorly water-soluble drugs, Atenolol and Amlodipine Besylate, by using solubility modulation approach. Scanning electron microscopy (SEM) before dissolution showed presence of outer dense region and inner porous region for the prepared asymmetric membrane and the pore size increased after dissolution for both outer and inner layer. Diffuse reflectance spectroscopy (DRS) showed no incompatibility between the drug(s) and the excipients used in the study. The developed system was able to control the release of ATN and AMB by increasing the solubility through buffering agents of different strengths (0.25N to 1.0N). As the level of buffering agent was increased, the solubility of drugs also increased inside the asymmetric membrane capsule. The developed system was independent of the agitation intensity of the dissolution fluid but was dependent on the polymer diffusibility and osmotic pressure of the media, which clearly stated that osmotic pumping was the primary mechanism of drug(s) release from AMCs. The results of in-vitro demonstration of effect of membrane thickness on dissolution fluid entering AMCs showed that as the membrane thickness increased the volume of dissolution fluid entering into AMC decreased. The release kinetic studies of different formulations of AMCs showed that formulation code six, which consists of the highest amount of osmotic agents and optimum amount of buffering agents, was the best formulation, and it followed zero order release kinetics (r2=0.9990 for ATN and r2=0.9988 for AMB)

PRE-ANALYTICAL VARIABLES IN CLINICAL CHEMISTRY: TRAINING MEDICAL UNDERGRADUATES THROUGH CASE BASED DISCUSSION

Background: Pre-analytical variables in clinical chemistry are factors prior to the biochemical analysis of samples affecting laboratory test results accounting for 32-75% of errors leading to misdiagnosis, decreased quality of medical care services and wastage of monetary resources. Aim: To educate first year medical undergraduates about pre-analytical variables through case based discussion and lecture method of teaching and assess the gain in knowledge by these methods. Methods and material: Two batches of medical students namely A (N=50) and B (N=52) were assessed for their background knowledge on the topic using an MCQ based questionnaire (pre-test). Batch A and B were taught through didactic lecture and case based discussion respectively. Post-test questionnaire was conducted to test the gain in knowledge of both batches. Delayed post-test was conducted after 2 weeks to assess retention of knowledge amongst students. Results: Pre-test scores of Batch A and B were not significantly different indicating that both batches had similar background knowledge of topic. Post-test scores vs. pre-test scores were significantly higher in both batches implying that both batches benefitted from their respective teaching sessions. But post-test score of Batch B was significantly higher than that of Batch A indicating higher gain of knowledge through case based discussion. Delayed post-test score was also significantly higher in Batch B vs. A implying better retention of knowledge through case based discussions. Conclusion: Topic ˜Pre-analytical variables in clinical chemistry must be included in undergraduate medical curriculum. Case based discussion could be an effective module for teaching the same. Key words: Case based discussion; Didactic lecture; Medical students; Medical education; Pre-analytical variables

PRE-ANALYTICAL VARIABLES IN CLINICAL CHEMISTRY: TRAINING MEDICAL UNDERGRADUATES THROUGH CASE BASED DISCUSSION

Background: Pre-analytical variables in clinical chemistry are factors prior to the biochemical analysis of samples affecting laboratory test results accounting for 32-75% of errors leading to misdiagnosis, decreased quality of medical care services and wastage of monetary resources. Aim: To educate first year medical undergraduates about pre-analytical variables through case based discussion and lecture method of teaching and assess the gain in knowledge by these methods. Methods and material: Two batches of medical students namely A (N=50) and B (N=52) were assessed for their background knowledge on the topic using an MCQ based questionnaire (pre-test). Batch A and B were taught through didactic lecture and case based discussion respectively. Post-test questionnaire was conducted to test the gain in knowledge of both batches. Delayed post-test was conducted after 2 weeks to assess retention of knowledge amongst students. Results: Pre-test scores of Batch A and B were not significantly different indicating that both batches had similar background knowledge of topic. Post-test scores vs. pre-test scores were significantly higher in both batches implying that both batches benefitted from their respective teaching sessions. But post-test score of Batch B was significantly higher than that of Batch A indicating higher gain of knowledge through case based discussion. Delayed post-test score was also significantly higher in Batch B vs. A implying better retention of knowledge through case based discussions. Conclusion: Topic ˜Pre-analytical variables in clinical chemistry must be included in undergraduate medical curriculum. Case based discussion could be an effective module for teaching the same. Key words: Case based discussion; Didactic lecture; Medical students; Medical education; Pre-analytical variables

Evaluation of oral fast disintegrating tablet of taste masked famotidine in rat

The purpose of this research was to formulate fast-disintegrating tablets of famotidine by using tasteless complex of famotidine. Famotidine is a commonly used antiulcer drug but major disadvantage is its bitterness and low bioavailability. A fast-disintegrating dosage form has been developed as a user- friendly formulation that disintegrates in the mouth immediately. In this study the bitter taste of famotidine was masked by making complex with ion exchange resin Indion 214. The drug-resin complexes were characterized by infrared spectroscopy and thermal analysis. Famotidine oral fast disintegrating tablets were prepared by direct compression method by using different superdisintegrants. The prepared tablets were found to comply with various official specifications. Tablet containing crospovidone as superdisintegrating agent showed superior organoleptic properties, along with excellent in vitro disintegrating time and drug release, as compared to other formulation. The in vivo anti ulcer activity in rats shown that there was no bioavailability change due to complexation and tablet had good antiulcer activity.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Clinico-biochemical correlation with special reference to oxidized LDL and small dense LDL in Indian women with CAD

In women with coronary artery disease (CAD), clinical presentation is different enough from men which lead to missed or delayed diagnosis of CAD. We therefore assessed the major risk factors and biomarkers in female subjects with CAD. Venous sample of control, unstable angina (UA) and myocardial infarction (MI) patients were taken. In Both UA and MI patients, predominant risk factor was menopause (76.7% UA, 86.7% MI) followed by hypertension (56.7% UA, 60% MI), central obesity (56.7% MI, 56.7% UA), dyslipidemia (50% UA, 50% MI) and diabetes mellitus (50% UA, 33.3% MI). Total serum cholesterol and LDL cholesterol were highly significant (p<0.001) in MI and UA as compared to controls. LDL cholesterol was significantly increased (p<0.05) in MI as compared to UA. Triglycerides and HDLCholesterol were also increased but not at the significant level (p>0.05). Apolipoprotein (ApoB), small dense LDL and oxidized-LDL (Ox-LDL) were highly significant (p<0.001) in MI and UA as compared to controls. Based on discriminate analysis ox-LDL is a potential marker to discriminate cases of UA from controls while ApoB is the reliable marker which can discriminate the cases of MI from UA and controls

Formulation and evaluation of biphasic release tablet containing diclofenac beads

The purpose of the present research work was to produce a biphasic delivery system for Diclofenac sodium. A dual component tablet made up of a sustained release beads and immediate release tablet coat was prepared by direct compression using super disintegrating agent. Both the beads and coat contained a model drug (diclofenac sodium). The sustained release effect was achieved with polymers chitosan and sodium alginate. The in vitro release profile from these tablets showed the desired biphasic behavior, the diclofenac contained in the fast releasing component was dissolved within 15 min, whereas the drug in the beads was released upto 8 h.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Bioactive compounds of edible fruits with their anti-aging properties: a comprehensive review to prolong human life

Aging is a complicated biological process in which functional and structural alterations in a living organism take place over time. Reactive oxygen species is one of the main factors responsible for aging and is associated with several chronic pathologies. The relationship between aging and diet is quite interesting and has attained worldwide attention. Healthy food, in addition to dietary antioxidants, are required to delay the process of aging and improve the quality of life. Many healthy foods such as fruits are a good source of dietary nutrients and natural bioactive compounds which have antioxidant properties and are involved in preventing aging and other age-related disorders. Health benefits linked with healthy consumption of fruit have drawn increased interest. A significant number of studies have documented the advantages of fruit intake, as it suppresses free-radical development that further reduces the oxidative stress created in the body and protects against several types of diseases such as cancer, type 2 diabetes, inflammatory disorders, and other cardiovascular diseases that ultimately prevent aging. In addition, fruits have numerous other properties like anti-inflammatory, anti-cancerous, anti-diabetic, neuroprotective, and have health-promoting effects. Mechanisms of various bioactive compounds that aids in preventing various diseases and increases longevity are also described. This manuscript provides a summary of various bioactive components present in fruits along with their health-promoting and antiaging properties

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

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