Physicochemical Characterization and Dissolution Properties of Meloxicam-Gelucire 50/13 Binary Systems

A solid dispersion of Meloxicam (MX), a poorly soluble, non steroidal anti-inflammatory drug, and Gelucire 50/13 was prepared by spray drying. Spherical microparticles were yielded with smooth surfaces as observed by scanning electron microscopy. According to differential scanning calorimetry and powder X-ray diffractometry analysis, MX was transformed from the crystalline state to the amorphous state as confirmed by the disappearance of its melting peak and the crystalline peaks. The dissolution tests at pH 7.4 revealed that the dissolution rate of encapsulated MX was 2.5-fold higher than that of the corresponding physical mixture and fourfold higher than the drug alone, respectively. The microparticles prepared at a ratio of 1:4 (drug/Gelucire) exhibited a 4-fold higher anti-inflammatory activity on the paw edema of rats in comparison to the drug alone. All in all, this work reveals that spray drying is a suitable technique for preparation of solid dispersions with improved biopharmaceutical and pharmacological characteristics of MX

Enucleation versus standard pancreatic resection for benign lesions and borderline tumors: a comparative study

Background: Enucleation of pancreatic benign lesions and borderline tumors, compared with standard pancreatic resection, may avoid postoperative impairment of the metabolic pancreatic functions. However, its influence on postoperative morbidity and disease recurrence seems obscure. Therefore, the choice between both approaches remains controversial. Objective: To evaluate the outcome of enucleation compared with standard pancreatic resection (SPR) of pancreatic benign lesions and borderline tumors among patients presented to Sohag University Hospital. Patients and Methods: Adult patients who underwent enucleation (group A) versus standard resections (group B) of pancreatic benign lesions and borderline tumors at Sohag University Hospital (June 2017 - May 2021) were prospectively enrolled. Both surgical techniques were compared regarding their influence on postoperative metabolic functions of the pancreas, surgical complications, and disease recurrence. Results: Sixteen patients (eight per group) with comparable gender and age distribution were eligible. Group A had significantly shorter operative time, lower amounts of intra-operative blood loss and less transfusions compared to group B. Likewise, patients in group A exhibited significantly reduced severity of surgical complications, including postoperative pancreatic fistula, and required significantly shorter periods of hospital stay. The incidence of new onset diabetes mellitus and pancreatic exocrine insuffficiency were significantly lower among patients in group A compared with those in group B. During follow-up, no recurrence was found in both groups. Conclusion: It could be concluded that enucleation of pancreatic benign lesions and borderline tumors preserves pancreatic metabolic functions, reduces postoperative morbidity and confers satisfactory oncologic outcome

Closure of emergency midline laparotomy over subcutaneous closed suction drain to mitigate incisional surgical site infection, dehiscence and hernia: A prospective comparative study

Background: The role of subcutaneous closed suction drainage (SCSD) during closure of emergency midline laparotomy (EML) for reduction of incisional surgical site infection (ISSI) remains debatable. Objective: The aim of the work was to investigate whether SCSD could minimize ISSI in the setting of emergency abdominal surgery. Patients and Methods: Adult patients with non-traumatic acute abdomen who underwent EML from June 2017 to January 2021 by single surgical team at Sohag University Hospital were prospectively enrolled. Patients were randomized according to EML incision closure technique into group A without SCSD and group B with closure of EML over SCSD. Both groups were compared regarding ISSI, wound dehiscence and incisional hernia. Results: Fifty-four patients were eligible (27 per group) with median age of 62 (range: 19-81) years. Both groups were comparable regarding gender and age. Group B exhibited significantly lower rates of ISSI (3 patients, 11%) and wound dehiscence (zero) compared with group A, (12 patients, 44%) and (5 patients, 15%), respectively. Likewise, the duration of hospital stay was significantly shorter among patients in group B versus those in group A. Relaparotomy was required in 2 cases due to disruption of small bowel anastomosis in group A and leaking repair of duodenal ulcer in group B. After a median follow-up of 26 (range: 7 - 44) months, the protective effect of SCSD against ISSI correlated with significantly lower incidence of incisional hernia in group B (1 patient, 3.7%) in comparison with group A (5 patients, 18.5%). Conclusion: It could be concluded that mitigation of ISSI, wound dehiscence and incisional hernia with subcutaneous closed suction drainage favors its routine application during closure of non-traumatic EML

Self-Emulsifying Drug Delivery Systems: Easy to Prepare Multifunctional Vectors for Efficient Oral Delivery

Self-emulsifying drug delivery systems (SEDDS) have been mainly investigated to enhance the oral bioavailability of drugs belonging to class II of the Biopharmaceutics Classification System. However, in the past few years, they have shown promising outcomes in the oral delivery of various types of therapeutic agents. In this chapter, we discuss the recent progress in the application of SEDDS for oral delivery of protein therapeutics and genetic materials. The role of SEDDS in enhancing the oral bioavailability of P-glycoprotein and cytochrome P450 3A4 substrate drugs is also highlighted. Also, we discuss the most critical evaluation criteria of SEDDS. Additionally, we summarize various solidification techniques employed to transform liquid SEDDS to the more stable solid self-emulsifying drug delivery systems (s-SEDDS) that are associated with high patient compliance. This chapter provides a comprehensive approach to develop high utility SEDDS and their further transformation into s-SEDDS

The Outcome of Diabetic Patients with Cardiomyopathy in Critical Care Unit: Hospital and Short-Term Outcome in a Period of Six Months to One Year

BACKGROUND: Diabetes mellitus (DM) is a major risk factor for heart failure (HF) and coronary artery disease (CAD). DM may cause structural changes involving the left ventricle (LV) systolic and diastolic function. AIM: To compare patients who have diabetes and ischemic cardiomyopathy (ICM) to those with diabetic cardiomyopathy (DMCMP) regarding LV systolic function, diastolic function, in hospital long term and short-term mortality. METHODS: Ninety diabetic patients with heart failure and left ventricular ejection fraction (LVEF) ≤ 35%, admitted to Critical Care Medicine department Cairo University were divided into two groups based on coronary angiography results; group I (ICM) n = 48 patients and group II (DMCMP) n = 42 patients. RESULTS: Group I patients had higher mean age (63 ± 7 years), (p = 0.004), Hypertension (p ˂ 0.001) and dyslipidemia (p = 0.008) were significantly more present in group I compared to group II. No significant differences were found regarding LVEF, global longitudinal strain (GLS), E/A and E/É ratio in both groups. A significant difference in the wall motion score index (WMSI) in group I; (1.4 ± 0.4) versus group II; (1.1 ± 0.2), (p = 0.005) was found. In the study, 6 patients had a cardiogenic shock with no documented in-hospital mortality. At 6 months, statistically, significantly higher mortality rates were found in group I, (p = 0.006), while at one year there was no significant difference in the mortality between the two groups, (p = 0.077). In comparison of the survived and non-survived patients at 6 months and one year in group I (ICM) there was a significant difference in LVEF (40 ± 6% vs 23 ± 6%, p ˂ 0.001), GLS (- 8.1 ± 2.4 vs - 4.6 ± 2.6, p = 0.007), E/A (1.25 ± 0.91 vs 1.8 ± 0.5, p = 0.038), E/É (11.68 ± 7.5 vs 21.3 ± 3.6, p = 0.001) respectively. In group ll (DMCMP) there was no documented mortality at 6 months follow up, however, at one year there was statistically significant difference in the mortality between survived and non-survived patients; the LVEF (35 ± 8% vs 25 ± 2%, p = 0.014), GLS (-7.9 ± 2.9% vs -5 ± 0.1%, p = 0.032), E/A (1.45 ± 0.8 vs 3.3 ± 0, p = 0.006) respectively. The E/É ratio in group ll was not significantly different between the groups (15.73 ± 5.3 vs 15 ± 1, p = 0.873). CONCLUSION: The combination of cardiomyopathy and diabetes affects LV systolic and diastolic function; however; ischemic cardiomyopathy and diabetic cardiomyopathy had a similar systolic and diastolic function. Ischemic cardiomyopathy is associated with worse prognosis compared to diabetic cardiomyopathy

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Background: Cavity shaving (CS) entails circumferential tissue removal from residual lumpectomy cavity following tumor resection during breast conserving surgery (BCS). It could allow detection of occult multifocal breast cancer (OMFBC).Objectives: This study aimed to highlight the impact of unidentified OMFBC as essential risk factor for local recurrence after BCS. Patients and Methods: Eligible breast cancer patients for BCS and CS were prospectively enrolled. Patients with negative margins of “resected tumor specimens” were designated as group A whereas group B comprised those with positive margins. OMFBC, diagnosed in the additionally shaved margins of the “residual lumpectomy cavity” as malignant breast tissues with intervening normal areas, was investigated in both groups. The study was conducted through the period from November, 2017 to March, 2021.Results: Forty-two patients with median age of 43 years were studied. Group A included 32 patients (76.2%)compared with 10 (23.8%) in group B. Overall, OMFBC was confirmed in the additionally shaved margins in 6 (14.3%) patients. OMFBC rate was less in group A (4/32 patients, 12.5%) compared to B (2/10 patient, 20%), however the difference did not reach statistical significance. In group B, another 1 patient showed persistent positive margins without evidence of OMFBC. All 7 patients with positive CS margins (6 with OMFBC and 1 with persistent positive margin without evidence of OMFBC) had their treatment strategy switched to modified radical mastectomy. Local recurrence occurred in only one among the remaing 35 patients (2.9%) who were treated by BCS with CS. Conclusions: CS improves outcome of BCS by reducing the rate of positive margins, enabling diagnosis of occult multifocal breast cancer and reducing local recurrence

Multi-Finishing of Polyester and Polyester Cotton Blend Fabrics Activated by Enzymatic Treatment and Loaded with Zinc Oxide Nanoparticles

The present work discusses the possibility of applying enzymatic treatments for fabric surface activation that can facilitate the loading of zinc oxide nanoparticles (ZnO NPs) onto polyester (PET) and polyester cotton blend (PET/C) fabrics prepared by sol-gel method. Activated polyester fabrics loaded by ZnO NPs were investigated by the use of scanning electron microscopy (SEM), electron dispersion emission X-ray (EDX) and Fourier transformed infrared spectroscopy (FT-IR). The functionality of activated polyester fabrics loaded by ZnO NPs was evaluated by analyzing its antimicrobial activity and UV protection efficiency. Antimicrobial activity of activated polyester fabrics and loaded by ZnO NPs was tested against Gram-positive (Bacillus mycoides), Gram-negative (Escherichia coli), and nonfilamentous fungus (Candida albicans). The level of UV protection was verified by the UV protection factor (UPF) of polyester fabrics. Activated post-treated polyester fabrics exhibited outstanding antimicrobial and UV protection efficiency. The achieved antimicrobial function and UV protection on the polyester fabrics are durable with repeated laundering processes even after five washing cycles

Scaffold Repurposing Reveals New Nanomolar Phosphodiesterase Type 5 (PDE5) Inhibitors Based on Pyridopyrazinone Scaffold: Investigation of In Vitro and In Silico Properties

Inhibition of PDE5 results in elevation of cGMP leading to vascular relaxation and reduction in the systemic blood pressure. Therefore, PDE5 inhibitors are used as antihypertensive and antianginal agents in addition to their major use as male erectile dysfunction treatments. Previously, we developed a novel series of 34 pyridopyrazinone derivatives as anticancer agents (series A–H). Herein, a multi-step in silico approach was preliminary conducted to evaluate the predicted PDE5 inhibitory activity, followed by an in vitro biological evaluation over the enzymatic level and a detailed SAR study. The designed 2D-QSAR model which was carried out to predict the IC50 of the tested compounds revealed series B, D, E and G with nanomolar range of IC50 values (6.00–81.56 nM). A further docking simulation model was performed to investigate the binding modes within the active site of PDE5. Interestingly, most of the tested compounds showed almost the same binding modes of that of reported PDE5 inhibitors. To validate the in silico results, an in vitro enzymatic assay over PDE5 enzyme was performed for a number of the promising candidates with different substitutions. Both series E and G exhibited a potent inhibitory activity (IC50 = 18.13–41.41 nM). Compound 11b (series G, oxadiazole-based derivatives with terminal 4-NO2 substituted phenyl ring and rigid linker) was the most potent analogue with IC50 value of 18.13 nM. Structure–activity relationship (SAR) data attained for various substitutions were rationalized. Furthermore, a molecular dynamic simulation gave insights into the inhibitory activity of the most active compound (11b). Accordingly, this report presents a successful scaffold repurposing approach that reveals compound 11b as a highly potent nanomolar PDE5 inhibitor worthy of further investigation

Outcome of Acute Kidney Injury (AKI) in Coronavirus Disease 2019 (COVID-19) patients

Background: Coronavirus Disease 2019 (COVID-19) is a globally emerging illness, resulting in potential effects on public health and global economies. Objectives: To assess the incidence of Acute Kidney Injury among patients who are infected with COVID-19, and to evaluate risk factors. Patients and methods: This study enrolled100 adult patients infected with COVID-19 and recently diagnosed with polymerase chain reaction (PCR). The patients were submitted to clinical examination and laboratory testing for ESR, CRP, CBC, Serum creatinine, and D-dimer. Patients were also assessed radiologically by CT Chest. Highresolution computed tomography Parenchymal abnormalities on HRCT were assessed. AKI patients were classified based on Acute Kidney Injury Network staging. Results: The mean age of all studied patients was 48.1 ± 10.8 years and mean BMI of all studied patients was 31.3 ± 4.6 kg/m2, 51 patients were males (51%) and 49 females (49%). There were 35 patients (35%) with a mild infection, 23 patients (23%) with moderate, and 42 patients (42%) with severe in the studied patients. The overall AKI prevalence among COVID-19 patients was 18 %. All of them were grade III AKI. Our study revealed that old age, severity of infection, dyspnea, elevated CRP, ALT, AST, PT, INR, Urea, and Creatinine were considerable distinct predictors for AKI. Conclusion: The Prevalence of AKI among COVID-19 patients was 18 %. Old age, the severity of infection, dyspnea, elevated CRP, increased serum urea, Creatinine were significant independent predictors for AKI