DESIGN AND EVALUATION OF FAST DISSOLVING ORO-DISPERSIBLE FILMS OF METOCLOPRAMIDE HYDROCHLORIDE USING 32 MULTIFACTORIAL DESIGNS

Objective: The objective of the present work was to develop and optimize fast dissolving orodispersible films containing metoclopramide hydrochloride using 32 multifactorial designs.Methods: The films were prepared by solvent casting method using hydroxypropyl methyl cellulose E5 (HPMC E5) and sodium starch glycolate (SSG) as two independent variables in three levels in concentration 2.5, 3, 3.5% w/wand 1, 1.5, and 2 % respectively. The percent of in vitro drug release (Y1) and the disintegration time (Y2) were chosen and studied as dependent responses. The prepared films were also evaluated for their weight uniformity, thickness, surface pH, drug content, in vitro disintegration time, in vitro drug release, film stability and mechanical properties as folding endurance.Results: All the films were transparent. The films weight (mg) was ranging from 63±0.78 to 86±0.82 while the film thickness (mm) and the folding endurance range from 0.22±0.53, 50±0.58 to 0.32±0.35 and 90±0.84 respectively. The drug content (mg %) was studied, and it ranges from 98.24±1.08 to 99.07±1.02. It was found that the relative standard deviation (% RSD) met the criteria of USP specification for drug content (>6%). In vitro disintegration time was tested; all films satisfied the requirement of disintegration time for fast dissolving dosage form (>1 min), it ranged from 2.24±1.75 to 3.18±1.87 sec. The stability studies revealed no significant differences before and after storage for the all formulations.Conclusion: An optimized metoclopramide HCl film was achieved that could be a benefit to a patient suffering from emesis, in which hydroxypropyl methylcellulose (E5) was used as a film forming polymer in its high level (3.5%) in addition to sodium starch glycolate in its high level (2%).Keywords: Fast dissolving orodispersible films, Optimization, Metoclopramide HCL, 32multifactorial design

Inhibition of Adhesion and Invasion of \u3cem\u3ePseudomonas aeruginosa\u3c/em\u3e to Lung Epithelial Cells: A Model of Cystic Fibrosis Infection

Over their life time, CF patients experience multiple infections by various pneumoniacausing bacteria [6]. With more patients surviving to adulthood, chronic infections with Pseudomonas aeruginosa are coming to the forefront as a leading cause of death [7]. Problems presented by infected CF lung are multi-dimensional; the electrolyte balance and pH of the fluids are abnormal. The mucus is thick and of an alternative composition compared to normal lung and may contribute to colonization with Pseudomonas aeruginosa [2, 3, 5]. As such, research is multi-pronged and includes gene therapy to correct the defective protein, amelioration of inflammatory response and thinning of alveolar surface fluids [8, 9]. Significantly, Pseudomonas bacteria colonize the CF lung far easier than normal lung. Normal lung tissue has several naturally occurring defenses that work in concert with commonly prescribed antibiotics for recovery from lung infections [4, 10]. The CF patient appears to lack these natural defenses [1, 7].https://digitalcommons.chapman.edu/pharmacy_books/1009/thumbnail.jp

Cross-Sectional Comparison of Behavioral Risk Factors for HIV/HCV in People Who Inject Drugs (PWID) in Egypt

Background Egypt has the greatest HCV prevalence worldwide at 15% and a concentrated HIV epidemic in male people who inject drugs (PWID) at 6.8%, who are at a high risk for HCV infection as well. Injection drug use is criminalized in Egypt, and there is limited availability of harm reduction programs. Drug-use and sexual risk behaviors between PWID and the general population have not been studied there. Methods To address this gap, a cross-sectional HIV/HCV epidemiological study of 632 consenting injection drug users in Cairo and Alexandria was conducted. Bivariate logistic regression analysis was done to evaluate the associations between HIV/HCV and needle sharing or sexual practices using SAS 9.4. Results 10.6% (63/ 604) of the study population tested positive for HIV and 61.5% (384/624) tested positive for HCV. Sharing needles with more than 10 people was associated with HIV and HCV infection (OR=3.65, p-val=0.001; OR=2.05, p-val=0.02, respectably). Age was associated with both HIV and HCV (p-val=0.03 and Conclusions The results indicate that the growing epidemic among PWID in Egypt may place the general population at risk for HIV and HCV primarily through sexual contact. In Russia, repressive policies toward PWID allowed HIV to spread to the general population at the start of the epidemic in 2000. Now, 48% of HIV is heterosexually transmitted in Russia and the country contributes \u3e80% of the HIV cases in Eastern Europe and Central Asia. In response to the epidemic, even more punitive laws and regulations were introduced in Russia, and their HIV prevalence has seen a 49% increase between 2005 and 2015. A similar trajectory can be expected for Egypt if preventative measures are not taken. Common-sense harm reduction programs like clean needle exchanges and decriminalization of injection drug use should be part of a comprehensive plan to control the spread of HIV and HCV in Egypt

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Management of idiopathic intracranial hypertension with repeated lumboperitoneal shunt malfunction

Abstract Introduction The incidence of idiopathic intracranial hypertension is 1/100,000 population per year. The widely accepted surgical treatment for idiopathic intracranial hypertension (IIH) in the last four decades has been the insertion of lumboperitoneal (LP) shunt (Greer, Clin Neurosurg 15:161–174, 1968; Weisberg, Medicine 54:197–207, 1975). The LP shunt is associated with high revision rates. Patients and methods This is a prospective study that was done between 1 January 2014 and 31 December 2014, including seven patients with IIH and a lumboperitoneal shunt malfunction. These patients were treated by an insertion of a ventriculoperitoneal (VP shunt). The Medtronic medium pressure shunt was used. The patients were followed up at 1, 3, 6, and 12 months. Results In four patients, the shunt malfunction was due to slippage of the peritoneal end either into subcutaneous fat of the abdomen in three patients or into subcutaneous fat of the back (with occurrence of shunt infection) in one patient. In one patient, the failure was due to the slippage of both tubes into the subcutaneous abdominal layer, while in two patients, shunt failure was due to obstruction with adequate shunt position. All patients were females (100%). Age ranged from 22 to 48 years with mean age at 32 years. Five patients (71%) had previous one LP shunt revision surgery while two patients (29%) had previous two revision surgeries. Six patients (85%) showed elevated ICP on CSF manometry, and one patient with wound collection, who showed evident infection, was enrolled in the algorithm for positive infection. Brain imaging showed slit ventricles in five patients and near normal ventricles in two patients. All patients experienced smooth postoperative recovery. Postoperative images were satisfactory regarding position of distal and proximal shunt tubes. Headache was improved in all patients within the first postoperative day, while visual symptoms improved markedly within 2 weeks postoperatively. Conclusion The use of VP shunts is extremely beneficial in the treatment of IIH-associated LP shunt malfunction especially with the new technologies in the placement of the ventricular end, and conducting a multicenter trial is recommended to re-evaluate if the primary surgical treatment of IIH will continue to be the LP shunts or shift to the use of VP shunts

Pancreatic cystic neoplasms: Predictors of malignant behavior and management

Background/Aim: Pancreatic cystic neoplasms are being increasingly identified with the widespread use of advanced imaging techniques. In the absence of a good radiologic or pathologic test to preoperatively determine the dianosis, clinical characteristics might be helpful. The objectives of this analysis were to define the incidence and predictors of malignancy in pancreatic cysts. Patients and Methods: Patients with true pancreatic cysts who were treated at our institution were included. Patients with documented pseudocysts were excluded. Demographic data, clinical manifestations, radiological, surgical, and pathological records of those patients were reviewed. Results: Eighty-one patients had true pancreatic cyst. The mean age was 47 ± 15.5 years. There were 28.4% serous cystadenoma, 21% mucinous cystadenoma, 6.2% intraductal papillary tumors, 8.6% solid pseudopapillary tumors, 1.2% neuroendocrinal tumor, 3.7% ductal adenocarcinoma, and 30.9% mucinous cystadenocarcinoma. Malignancy was significantly associated with men (P = 0.04), older age (0.0001), cysts larger than 3 cm in diameter (P = 0.001), presence of solid component (P = 0.0001), and cyst wall thickening (P = 0.0001). The majority of patients with malignancy were symptomatic (26/28, 92.9%). The symptoms that correlated with malignancy included abdominal pain (P = 0.04) and weight loss (P = 0.0001). Surgical procedures were based on the location and extension of the lesion. Conclusion: The most common pancreatic cysts were serous and mucinous cysts. These tumors were more common in females. Old age, male gender, large tumor, presence of solid component, wall thickness, and presence of symptoms may predict malignancy in the cyst

Assessment of Knowledge, Attitude, and Practice of Risky Sexual Behavior Leading to HIV and Sexually Transmitted Infections among Egyptian Substance Abusers: A Cross-Sectional Study

Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers. Methods. This crosssectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage. Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were predicted to have higher attitude for safe sex while age and educational level did not. Conclusion. KAP of safe sexual behavior were low among drug addicts in Egypt increasing potential towards infection with STDs including HIV. The more the age and education level, the better the knowledge towards safe sexual behavior

Association of sociodemographic factors with needle sharing and number of sex partners among people who inject drugs in Egypt

People who inject drugs (PWID) are at a high risk for HIV. We conducted an evaluation of socio-demographic factors associated with injecting and sexual behaviour among PWID who had two or more visits at a drug outreach clinic in Cairo, Egypt from 2013 to 2017. Routinely collected information on socio-demographics and HIV risk behaviours were abstracted from client records. Bivariate analysis and logistic regression were conducted to evaluate associations between socio-demographics and HIV risk factors. All PWID who tested HIV-positive at the initial visit were excluded from analyses. PWID who were married were more likely to share needles or syringes in the last month of their baseline visit [adjusted odds ratio (aOR) = 4.3, 95% confidence interval (CI) = 1.4-13.1] as were unemployed PWID [aOR = 3.9, 95% CI = 1.5-10.3]. Married PWID were less likely to discontinue sharing needles/syringes [aOR = 0.4, 95% CI = 0.2-0.8] as were those living outside of the Shobra, downtown, and Imbabah districts within Greater Cairo [aOR = 0.2, 95% CI = 0.1-0.5]. No significant associations were found between socio-demographics and number of sex partners in the six months prior to the initial visit. At follow-up visit, 4.4% tested HIV-positive for an incidence rate of 3.9 per 100 person years. Sociodemographic factors should be considered when designing preventive services for PWID