Influence of novel techniques on solubility, mechanical properties and permeability via hot melt extrusion technology

Hot melt extrusion (HME) was evaluated as a continuous processing technology for the manufacture of solid dispersions. The aim of the current research project was to study the effect of pressurized carbon dioxide (P-CO2) on the physico-mechanical properties of three different grades of cellulose polymers, Klucel™ ELF, EF and LF hydroxypropylcellulose (HPC) resulting from hot melt extrusion techniques, and to assess the plasticization effect of P-CO2 on the tested polymers. The physico-mechanical properties as well as the tablet characteristics of the extrudates with and without injection of P-CO2 and with non-extruded polymers were examined. P-CO2 acted as plasticizer for Klucel™ LF, EF and ELF and allofor a reduction in processing temperature during the extrusion process by 20°C as compared to the processing temperature without injecting P-CO2. Furthermore, the CO2 served as a pore former and produced foam-like structure extrudates. This morphological change resulted in an increase in bulk and tap density as well as surface area and porosity. Additionally, the hardness of the tablets of the polymers with P-CO2 was increased compared to polymer processed without P-CO2 and the non-extruded polymer. Moreover, the % friability of the tablets improved using P-CO2 processed polymer. Thus good binding properties and compressibility of the extrudates were positively influenced utilizing P-CO2 processing. The interest to incorporate a model was increased to investigate the effect of pressurized carbon dioxide (P-CO2) on the physico-mechanical properties as well as the drug release behavior. Ketoprofen (KTP), used as a model drug, was incorporated with hydroxypropylcellulose (HPC) (Klucel™ ELF, EF and LF) as a polymeric carrier to produce KTP amorphous solid dispersion using HME technique. Thermal gravimetric analysis (TGA) was used to evaluate and confirm the formulations thermal stability. Differential Scanning Calorimetery (DSC) was performed to evaluate the physical state of KTP in the extrudates. The microscopic morphology of the extrudates was changed to a foam-like structure due to expansion of the CO2 at the extrusion die. The foamy extrudates demonstrated enhanced KTP release compared to the extrudates processed without P-CO2 due to the increase in porosity and surface area of those extrudates. The moisture content of the extrudates processed with P-CO2 was slightly increased and this played a significant role in increasing KTP tablet hardness and decreasing percent friability. A concern with HME is the limitation of the drug loading due to drug-polymer miscibility. In order to solve this issue, we investigated the effect of foam like structure produced by pre P-CO2 on the drug loading and the dissolution profile of carbamazepine (CBZ) and low molecular weight hydroxypropylcellulose (HPC) matrices using HME technique. The resulted extrudates with P-CO2 injection exhibited higher surface area and porosity compared to the extrudates processed without P-CO2. Moreover, the CBZ release profile of the 20-50% drug load formulations processed with P-CO2 injection shoalmost complete drug release within 2 hours. In contrast, the drug release profiles of 20%, 30%, 40% and 50% CBZ/ Klucel™ ELF formulations processed without P-CO2 injection exhibited 90%, 86%, 80% and 73% CBZ drug release, respectively. In conclusion, HME processing assisted with P-CO2 increased the drug loading capability of CBZ in KlucelTM ELF polymeric matrix as well as optimized CBZ drug- release profiles. Drug permeability and dissolution rate are considered as key to predict the drug bioavailability. HME was used as an approach to improve solubility and permeability of the psychoactive natural product piperine. Piperine 10–40% w/w formulated in Eudragit® EPO/ Kollidon® VA 64 or Soluplus® formulation was used in this study to investigate the efficiency of various polymers to enhance the solubility and permeability of piperine via HME technique to ultimately increase its systemic absorption of the compound. Scanning electron microscopy (SEM) images shoabsence of crystals in 10% w/w piperine/Soluplus® indicating that piperine was dispersed in the Soluplus® polymer carrier in its amorphous form. However, crystals were evident in all other formulations with different ratios. Solubility of 10% and 20% piperine/Soluplus® was increased more than 160 and 45 folds in water, respectively. Furthermore, permeability studies using non- everted rat intestinal sac model demonstrated the enhancement in piperine absorption of the 10% w/w piperine/Soluplus® extrudates up to 158.9 ?g/5mL compared to 1.4 ?g/5mL in the case of pure piperine within 20 minutes

R13. Formulation development of loratadine immediate-release tablets using hot-melt extrusion coupled with 3d-printing technology

Corresponding author (Pharmaceutics and Drug delivery): Sundus Hussain Omari, [email protected]://egrove.olemiss.edu/pharm_annual_posters/1012/thumbnail.jp

Employing Hot-Melt Extrusion Technology to Enhance the Solubility of Cannabidiol (CBD)

Corresponding author (Pharmaceutics and Drug Delivery): Iman Taha, [email protected]://egrove.olemiss.edu/pharm_annual_posters_2022/1020/thumbnail.jp

Antifungal activity of Streptomyces canescens MH7 isolated from mangrove sediment against some dermatophytes

The main objective of this study is to isolate actinobacteria has antifungal activity against some dermatophytes, Epidermophyton floccosum, Trichophyton rubrum, Microsporum canis, and Candida albicans, evaluation, and optimization of various cultural and nutritional conditions for maximum antifungal metabolite production. Total 64 actinobacteria were isolated from various localities in Egypt and screened for their antifungal activity against the tested fungi. Out of 64 isolates, the identified Streptomyces canescens MH7 has a good antifungal activity and inhibits the growth of the tested fungi. This isolate was capable of producing glucanase, lipase, and amylase enzymes which are important hydrolytic enzyme in the lysis of the fungal cell wall. Several growth factors were optimized to maximize the production of antifungal metabolites. Streptomyces canescens MH7 had the best antifungal activity in starch casein broth media supplemented with starch as a carbon source, potassium nitrate as a nitrogen source, salinity of 3% (w/v), pH8, incubation temperature at 30°C, incubation for 7 days, and shaking at 180 rpm

D04. Department of Pharmaceutics and Drug Delivery

Corresponding author (Pharmaceutics and Drug Delivery): Eman Ashour, [email protected]://egrove.olemiss.edu/pharm_annual_posters/1026/thumbnail.jp

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030