Formulation and Evaluation of Bilayer Tablet of Acebrophylline and N-Acetylcysteine

This study aimed to develop an immediate-release bilayer tablet of acetylcysteine. Combination of Acebrophylline and Acetylcysteine are indicated for the successful treatment and relief of Asthma. Prepared bilayer tablets were film coated in a conventional coating pan. Formulation properties such as content uniformity, hardness, and friability found to be satisfactory. In vitro dissolution studies of bilayer tablets were conducted for 60 minutes. Samples were analyzed by HPLC. The formulation (F1-F9) showed an acceptable range and complied with the internal specification for weight variation, thickness, hardness, friability, in vitro drug release. The drug content of Acebrophylline and Acetylcysteine in tablet were constant but major degradation of Acetylcysteine to form N,N Diacety-L-cysteine degradation was greatly reduced by the introduction of antioxidants of Propylgallate, Vitamin E, and Butylated Hydroxyl Toluene (BHT) as a variable in 23-factor design of experiments and optimized. Accordingly, A = 398.51 , B = 800, and C = 800 mcg used for optimized batch. The level of N,N Diacety-L-cystine reduced to 0.78. Accelerated stability profile of bilayer tablets was found to be satisfactory. No sign of degradation was observed in HPLC analysis. Hence, it is finally concluded that, the Bilayer tablet technology can be successfully applied for Immediate-release layer of Acebrophylline and Acetylcysteine

Shades of gray in vaccine decision making: Understanding, exploring, and addressing the challenges of influenza vaccine hesitancy in Ontario community pharmacies

Background: Two-thirds of Canadian adults currently do not receive the annual influenza vaccine. Vaccine hesitancy (VH), the voluntary delay or refusal of vaccination services despite availability is a significant contributor to the poor uptake of several vaccines including the influenza vaccine. The overarching intent of this thesis was to gain a nuanced understanding of the community pharmacists’ experiences with influenza VH and explore means to best address it. Methods: This thesis is comprised of three studies. The first study was a quantitative descriptive analysis of an exploratory cross-sectional online survey of 885 pharmacists. This study aimed to provide an overview of pharmacists’ perceived knowledge, attitudes and practices pertaining to influenza VH. The second study was a qualitative interpretive analysis of in-depth semi-structured interviews with 22 pharmacists. An implementation science lens was then used to examine the results from the first two studies to guide the selection of a behavioural target and inform intervention design. Based on these findings, the third study included a cost-utility analysis of a novel remunerated community pharmacist consultation service on influenza vaccination for Ontario seniors from a provincial payer perspective. Results: Pharmacists’ self-reported knowledge of influenza vaccine and disease, their confidence and ability to identify and address influenza VH was generally high. Pharmacists’ engagement with patients on the influenza vaccine was found to be modulated by a complex and mutually reinforcing constellation of attitudes and behaviours which included: a binary (pro-vaccine or anti-vaccine) perception of patient vaccination decisions; a conflation of those expressing hesitancy with those that are anti-vaccine; and a passive approach to patient engagement. Despite possessing the requisite knowledge and skills, workflow barriers such as limited time, inadequate staffing, and poor remuneration were found to restrict optimal patient engagement on influenza vaccinations. Offering pharmacists a CAD $15 consultation fee to engage with seniors on the influenza vaccine was estimated to be both cost-effective and clinically effective. Conclusion: Facilitating optimal practice scope for pharmacists, and capitalizing the additional convenience and accessibility offered through the community pharmacy setting presents a promising means to address influenza VH. Conventional tools to aid health professionals in addressing influenza VH rely on augmenting the vaccine provider’s knowledge and skills; however, our analysis suggests that reorienting efforts to enhance the provider’s motivation and opportunity to engage with patients on influenza vaccine conversations are likely to be more effective in the community pharmacy setting

Restoration of neglected fracture dislocation hip in elderly: a case report

Neglected traumatic fracture dislocation of the hip is a challenging problem due to soft tissue contractures, adhesions, fibro fatty tissue filling acetabulum, avascular necrosis, arthritis and myositis ossificans. These types of injury often get missed at initial evaluation in the presence of distracting injuries and in poly trauma patients. Femoral head fractures account for only 7-16% of all hip fracture dislocations, with combined femoral head and acetabular fractures in elderly being even lower. Literature favours primary hip replacement as compared to hip salvage in age above 60 years and in patients with neglected hip fracture dislocations of more than 3 months duration due to high chances of afore mentioned complications. Here, we report a case of 69 years old male with neglected hip fracture dislocation associated with posterior acetabular wall and femoral head fracture for the challenges in management with a total hip replacement

Bone marrow concentrate efficacy in treatment of chronic aseptic nonunion

Background: Bone marrow is a rich source of osteoprogenitor cells that proliferate and differentiate into osteoblasts. Traditionally, autologous iliac bone grafts have been used in treatment of nonunion. This technique has its associated morbidity, which include donor site pain, infection, scarring, and nerve injury. The use of percutaneous bone marrow stem cells (BMSC) avoids these morbidities with comparable clinical results.Methods: We studied twenty patients of aseptic nonunion where bone marrow was aspirated from the anterior iliac crest, concentrated on a cell separator, and then injected into the nonunion site under c-arm guidance. Each nonunion received a relatively same amount of concentrated bone marrow. The volume of callus was calculated by dimensions obtained from RISPACS software in our institution.Results: There was an average of 29,418 mm3 of callus formation with a minimum of 4,455 mm3 and maximum of 68,460. The average time of union was 12 weeks with minimum of 6 weeks and maximum of 24 weeks.Conclusions: The percutaneous bone marrow concentrate injection provides an effective and a safe alternative method for the treatment of a chronic long standing non-union

Outcome following proximal femoral nailing with helical head screw for intertrochanteric and subtrochanteric fractures

Background: Intertrochanteric fractures are seen commonly in two patient groups, older osteopenic patients after a low-energy fall and younger patients involved in high-energy trauma. Early surgical intervention is advocated in the majority of these patients to reduce the complications associated with long-term immobilization.Methods: In this study proximal femoral nailing with helical head screw is used to achieve initial stability and early mobilization of the patients to avoid complications. In 60 patients undergoing proximal femoral nailing with helical head screw for intertrochanteric fractures the results of surgery were meticulously followed.Results: The patients were assed clinically and radiologically for time of union rate of infection stability and implant failure. All fracture in our study unites within 8 months following surgery.Conclusions: Our study concludes that proximal femoral nailing with helical head screw is the best method of treatment for intertrochanteric fracture as it leads to lesser complications

Giant cell tumour with intra-articular extension: a case report

Giant cell tumour is usually a benign but locally aggressive tumour. Intra-articular extension of giant cell tumour is rare. Treatment options are limited in such cases. I present here a 33 year old male with a history of swelling around his right knee for 6 months. Patient was diagnosed clinically, radiologically and histologically as giant cell tumour. Patient was treated by surgical excision of the tumour and reconstruction with custom mega prosthesis

Synthesis and Structural Analysis of Nanocrystalline MnFe2O4

AbstractNanocrystalline form of manganese ferrite (MnFe2O4) has been synthesized by simple sol-gel auto combustion method using citric acid as chelating agent. The obtained nanocrystalline powders of manganese ferrite were subjected to structural and magnetic measurements. Temperature dependent magnetization was also carried out for the single phase nanocrystalline manganese ferrite and the results have been discussed in detail

Does obesity, duration of symptoms and pre-operative knee movements amend discharge readiness and outcomes following total knee arthroplasty?

Background: Total knee arthroplasty (TKA) being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants and in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of hospital stay yet improving the functional outcome with better patient satisfaction.Methods: The study design is a retrospective analysis of 1022 patients of primary elective TKA, performed in our institution. The targeted indicators were sex, body mass index (BMI), pre-operative knee range of movements (ROM), knee deformity and duration of symptoms were analyzed.Results: Analyzing these patients, we found the average LOS is 6.4 days, and obesity, pre-op ROM and deformity all play a role to delay the discharge readiness in the patients. Our study showed that LOS after TKA is multifactorial.Conclusions: In acute setting for readiness of discharge the preoperative knee movements, deformity and patients’ functional abilities can be used to segregate patients who may require close monitoring or intensive physiotherapy

Optimizing Pre-Trained Models of Deep Learning for Identification of Plant Disease

The Plant diseases should be identified early to prevent the economic loss of farmers and ensure the availability of food for humans. The plant disease identification can be automated by using the Artificial Intelligence techniques. Researchers have proposed many deep learning methods for identifying plant diseases. Deep learning models use an increased number of parameters, it requires higher computational power, training a deep learning model from start requires more time. In this article we utilized transfer learning along with fine tuning for identification of plant diseases. Cassava plant disease dataset was utilised for training. and evaluate the suggested model. The performance accuracy achieved by Resnet50 is 73.12 % and fine-tuned Resnet50 is 80.84 %. The fine-tuned model achieves greater accuracy with a lesser amount of parameters Impact Statement–Artificial Intelligence is evolving all around the world. The AI techniques are used to automate the process of plant disease identification. Traditional methods are not accurate and time consuming. To help the farmers in diagnosing plant disease and stop economic loss to them, we employ deep learning models to do the work. The pretrained models predict the plant diseases, further we fine-tune them in order to get high accuracy. Early identification of the diseases accurately will avoid loss and improve productivity of the crops