A case report on retrieval of retained guidewire- a rare complication after central venous catheterization

Central venous catheterization (CVC) is a routine technique which is widely used in fluid resuscitation, parenteral nutrition, haemodialysis and continuous invasive hemodynamic monitoring. CVC via the Seldinger technique is a minimally invasive procedure which is increasingly and widely performed. Popularity of the Seldinger technique of vascular cannulation has resulted in widespread use of spring guide wires. Though employed to make vascular cannulation easier and safer, guide wires are not without potential hazard. While the complication rate of inserting CVC catheters is approximately 11.8%, the intravascular loss of the guide wire during CVC placement is a rare but serious complication which is completely avoidable by appropriate care.

MICROEMULSION BASED NASAL TO BRAIN DELIVERY OF DRUG ACTING ON CNS

Abstract: Background: Fluvoxamine, an antidepressant drug, has absolute bioavailability of only 53% due to high first pass metabolism. Aim: The purpose of this study was to develop and optimize mucoadhesive microemulsion containing Fluvoxamine for intranasal delivery. Materials and Methods: Based on solubility study, Acrysol K150, Tween 20 and polyethylene glycol (PEG) 400 were selected as oil, surfactant and co surfactant respectively. Microemulsions were prepared using water titration method. 2:1% w/w ratio (Tween 20:PEG 400) was selected for formulation development. The prepared microemulsions were optimized for globule size, zeta potential, pH, Viscosity and polydispersity index. The optimized batch was further characterized for% drug content, pH, viscosity and % drug diffusion. Results and Conclusion: All the parameters showed the suitability of microemulsion of Fluvoxamine for intranasal delivery. Carbapol 934P (0.3 % w/w) was used as a polymer for the preparation of mucoadhesive microemulsion to enhance the retention time in the nasal mucosa. Results of nasal toxicity study using excised sheep nasal mucosa showed comparatively no damage to epithelium and so formulation was considered safe for nasal administration. Fluvoxamine mucoadhesive microemulsion showed the highest percentage of diffusion (98.07 ± 0.710 %) after 24h during ex-vivo drug diffusion study through sheep nasal mucosa, followed by Fluvoxamine microemulsion (93.48 ± 0.674%) and finally by Fluvoxamine solution (70.57 ± 0.612%)

The role of polymorphism in various potential genes on polycystic ovary syndrome susceptibility and pathogenesis

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrinopathies affecting the early reproductive age in women, whose pathophysiology perplexes many researchers till today. This syndrome is classically categorized by hyperandrogenism and/or hyperandrogenemia, menstrual and ovulatory dysfunction, bulky multi follicular ovaries on Ultrasonography (USG), and metabolic abnormalities such as hyperinsulinemia, dyslipidemia, obesity. The etiopathogenesis of PCOS is not fully elucidated, but it seems that the hypothalamus-pituitary-ovarian axis, ovarian, and/or adrenal androgen secretion may contribute to developing the syndrome. Infertility and poor reproductive health in women’s lives are highly associated with elevated levels of androgens. Studies with ovarian theca cells taken from PCOS women have demonstrated increased androgen production due to augmented ovarian steroidogenesis attributed to mainly altered expression of critical enzymes (Cytochrome P450 enzymes: CYP17, CYP21, CYP19, CYP11A) in the steroid hormone biosynthesis pathway. Despite the heterogeneity of PCOS, candidate gene studies are the widely used technique to delineate the genetic variants and analyze for the correlation of androgen biosynthesis pathway and those affecting the secretion or action of insulin with PCOS etiology. Linkage and association studies have predicted the relationship between genetic variants and PCOS risk among families or populations. Several genes have been proposed as playing a role in the etiopathogenesis of PCOS, and the presence of mutations and/or polymorphisms has been discovered, which suggests that PCOS has a vital heritable component. The following review summarizes the influence of polymorphisms in crucial genes of the steroidogenesis pathway leading to intraovarian hyperandrogenism which can result in PCOS

Incidentally found Bilaterally Occult Femoral Hernia during Transabdominal Preperitoneal Inguinal Hernia Repair: A Case Report

Hernia is defined as an area of anatomical weakness or an abnormal protrusion of a viscous or a part of a viscous through an opening, covering it. Inguinal hernia is the most common hernia because of the presence of natural weakness like the deep ring and cord structures. The minimally invasive procedures for inguinal hernia repair include Intraperitoneal Onlay Mesh (IPOM) repair, Transabdominal Preperitoneal Repair (TAPP), and Total Extraperitoneal (TEP) repair. Laparoscopic inguinal hernia repair has the advantage of inspecting the entire myopectineal orifice, as it allows for the identification of bilateral or recurrent hernias. The principle behind laparoscopic repair includes strengthening of myopectineal orifice in all the above approaches. TAPP repair is mainly indicated for large indirect hernias or irreducible hernia. TEP repair is technically challenging to perform and has the advantage of avoiding interbowel adhesions as the peritoneum is not opened. IPOM repair is not routinely performed but has advantages in cases where there is an increased risk of spermatic cord injury seen in patients with a history of lower abdominal irradiation or a history of multiple recurrent hernia surgery. Occult contralateral inguinal hernia and the occult femoral hernia can be easily diagnosed and repaired with no extra incisions while performing TAPP repair. These hernias, if left untreated may present as recurrent hernias or as non resolution of symptoms posthernia surgery. A rare case of bilateral occult femoral hernia found during laparoscopic TAPP repair of an inguinal hernia was reported. The entire myopectineal orifice was repaired using the same mesh with no extra risk or cost

Assessment of gut microbial β-glucuronidase and β-glucosidase activity in women with polycystic ovary syndrome

Abstract PCOS is a prevalent endocrine disorder among women of reproductive age, characterized by hormonal imbalances and metabolic disturbances. This study explores the correlation between gut microbial β-glucuronidase and β-glucosidase and PCOS, focusing on their association with hormone levels and other clinical parameters. In this case-control study, fecal samples were collected from women of reproductive age, both with and without PCOS. The analysis of gut β-glucuronidase and β-glucosidase enzymes was conducted with the other clinical parameters, including body mass index, hormone levels, and hirsutism. These factors were then subjected to correlation analysis. PCOS women showed significantly higher levels of β-glucuronidase activity with a statistically significant P-value (0.05 ± 0.1 vs. 0.04 ± 0.1; P = 0.006) as well as β-glucosidase activity (0.13 ± 0.08 vs. 0.09 ± 0.05; P = 0.06) compared to the controls. This study also revealed intriguing connections between the selected enzymes and hormone levels, particularly testosterone and estradiol. Gut microbial enzymes β-glucuronidase and β-glucosidase may be used as biomarkers for early detection and monitoring of PCOS in women with metabolic challenges. It could lead to improved diagnostic tools and treatment options

Association of FTO gene variant rs9939609 with polycystic ovary syndrome from Gujarat, India

Abstract Background Polycystic ovary syndrome is a multifactorial endocrine disorder impacting women of reproductive age. Variations within the FTO gene have been linked to both obesity and type 2 diabetes mellitus. Given that PCOS is frequently associated with obesity and compromised glucose tolerance, we investigated the prevalence of the rs9939609 variant within the FTO gene among women diagnosed with PCOS and a control group. Our aim is to uncover potential correlations between this genetic variant, metabolic attributes, and endocrine markers within the Gujarat province of India. Method We enrolled a total of 114 participants, (62 individuals diagnosed with PCOS and 52 healthy controls). DNA extraction from venous blood was conducted for all participants. The rs9939609 polymorphism was investigated through tetra-primer amplification refractory mutation system-polymerase chain reaction. Furthermore, we performed biochemical assessments to quantify levels of estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), total testosterone, prolactin (PRL), and Dehydroepiandrosterone sulfate (DHEAS). Statistical analyses were carried out utilizing SPSS version 21 (IBM, USA). Results The present study did not reveal any noteworthy association between cases and controls. The frequencies of genotypes and alleles within the cohorts displayed no statistically significant differences (p = 0.25, p = 0.68, and p = 0.78, respectively). The dominant model indicated a modest risk (OR:1.13, 95%CI: 0.55 to 2.38) toward PCOS development. There was a noticeable statistical difference observed in the levels of total testosterone, DHEAS, and BMI between the case and control groups (p < 0.002, p < 0.0002, p < 0.0008). However, no variations in clinical variables were observed among genotypes within the PCOS group. Conclusion This is the first study to investigate the association of FTO gene polymorphism and PCOS in Gujarati population. Our study findings indicate that the FTO gene variant is not directly linked to the onset of PCOS. However, it appears to exert an influence on metabolic factors such as obesity and insulin resistance. Notably, our results suggest that insulin resistance is more frequently observed among PCOS patients who are obese, as compared to those with non-obese PCOS patients

Additional file 1 of Association of FTO gene variant rs9939609 with polycystic ovary syndrome from Gujarat, India

Additional file 1: Supplementary Figure 1. Recruitment of PCOS samples and healthy controls. Supplementary Table 1. Risk factors for PCOS

Intranasal Administration of Dolutegravir-Loaded Nanoemulsion-Based In Situ Gel for Enhanced Bioavailability and Direct Brain Targeting

Dolutegravir&rsquo;s therapeutic effectiveness in the management of neuroAIDS is mainly limited by its failure to cross the blood&ndash;brain barrier. However, lipid-based nanovesicles such as nanoemulsions have demonstrated their potential for the brain targeting of various drugs by intranasal delivery. Thus, the purpose of this study was to develop a Dolutegravir-loaded nanoemulsion-based in situ gel and evaluate its prospective for brain targeting by intranasal delivery. Dolutegravir-loaded nanoemulsions were prepared using dill oil, Tween&reg; 80, and Transcutol&reg; P. Optimization of the nanoemulsion particle size and drug release was carried out using a simplex lattice design. Formulations (F1&ndash;F7 and B1&ndash;B6) were assessed for various pharmaceutical characteristics. Ex vivo permeation and ciliotoxicity studies of selected in situ gels (B1) were conducted using sheep nasal mucosa. Drug targeting to the brain was assessed in vivo in rats following the nasal delivery of B1. The composition of oil, surfactant, and cosurfactant significantly (p &lt; 0.05) influenced the dependent variables (particle size and % of drug release in 8 h). Formulation B1 exhibits pharmaceutical characteristics that are ideal for intranasal delivery. The mucosal steady-state flux noticed with BI was significantly greater (p &lt; 0.005) than for the control gel. A histopathology of nasal mucosa treated with BI showed no signs of toxicity or cellular damage. Intranasal administration of B1 resulted in greater Cmax (~six-fold, p &lt; 0.0001) and AUC0&minus;&alpha; (~five-fold, p &lt; 0.0001), and decreased Tmax (1 h) values in the brain, compared to intravenous administration. Meantime, the drug level in the plasma was relatively low, suggesting less systemic exposure to Dolutegravir through intranasal delivery. In summary, the promising data observed here signifies the prospective of B1 to enhance the brain targeting of Dolutegravir by intranasal delivery and it could be used as a feasible and practicable strategy for the management of neuroAIDS

Intranasal Administration of Dolutegravir-Loaded Nanoemulsion-Based In Situ Gel for Enhanced Bioavailability and Direct Brain Targeting

Dolutegravir’s therapeutic effectiveness in the management of neuroAIDS is mainly limited by its failure to cross the blood–brain barrier. However, lipid-based nanovesicles such as nanoemulsions have demonstrated their potential for the brain targeting of various drugs by intranasal delivery. Thus, the purpose of this study was to develop a Dolutegravir-loaded nanoemulsion-based in situ gel and evaluate its prospective for brain targeting by intranasal delivery. Dolutegravir-loaded nanoemulsions were prepared using dill oil, Tween® 80, and Transcutol® P. Optimization of the nanoemulsion particle size and drug release was carried out using a simplex lattice design. Formulations (F1–F7 and B1–B6) were assessed for various pharmaceutical characteristics. Ex vivo permeation and ciliotoxicity studies of selected in situ gels (B1) were conducted using sheep nasal mucosa. Drug targeting to the brain was assessed in vivo in rats following the nasal delivery of B1. The composition of oil, surfactant, and cosurfactant significantly (p p max (~six-fold, p 0−α (~five-fold, p max (1 h) values in the brain, compared to intravenous administration. Meantime, the drug level in the plasma was relatively low, suggesting less systemic exposure to Dolutegravir through intranasal delivery. In summary, the promising data observed here signifies the prospective of B1 to enhance the brain targeting of Dolutegravir by intranasal delivery and it could be used as a feasible and practicable strategy for the management of neuroAIDS