Development of novel formulations to enhance in vivo transdermal permeation of tocopherol

Tocopherol represents a big challenge for transdermal permeation owing to its extreme hydrophobicity and large molecular mass. The aim of the present study was to develop alpha-tocopherol (T) topical formulations and evaluate the ex vivo and in vivo permeation. Franz diffusion cells were used for the ex vivo permeation, and neonatal rats were used for in vivo permeation. Seven gel formulations and 21 liquid formulations were investigated for physical stability, viscosity and permeation of T. Analysis of T was performed by a validated HPLC method using a UV detector.The ex vivo permeation from gel and emulsion formulations was very poor (0.001–0.015 %). The highest permeation was observed from monophasic liquid formulations containing dimethyl sulfuxide (DMSO), tocopheryl polyethylene glycols (TPGs), propylene glycol, ethanol, and 9.5 % T. The in vivo results demonstrated higher retention in the epidermis compared to subcutaneous tissues; 1377 and 1.13 µg g–1, respectively. Increasing T concentration from 4.8 to 9.5 % did not increase the amount permeated or % of T retained. It was concluded that simple solutions of T in presence of DMSO and TPGs are more promising systems for effective transdermal permeation; compared to gel, emulsion or oleaginous systems

Effect of routine pre-operative urethral catheterization of women undergoing minor gynaecological surgeries on urinary symptoms and urinary infections: a randomized control study

Background: The prevalence of urinary tract infection increases in young sexually active women, and women with previous UTI. Routine urethral catheterization performed for bladder evacuation before minor gynecological procedures and it is not clear whether this routine urethral catheterization associated with increased incidence of bacteriuria or UTIs or not. This study designed to detect the effect of routine uretheral catheterization for women undergoing minor gynecological surgeries on urinary symptoms and urinary infections.Methods: Two hundred and forty women infertile women scheduled for uterine assessment by diagnostic hysteroscopy before in-vitro fertilization in assisted reproduction unit of Ahmadi Hospital, Kuwait Oil Company were included in this study. Participants were randomized into; group I (catheterized group) and group II (non-catheterized group). Participants’ urine samples compared pre-operatively and post-operatively and they asked to complete about their pre and post-operative urinary symptoms.Results: Post-operative dysuria, frequency and urgency were significantly higher in catheterized group (22 (18.33%), 26 (21.66%) and 18 (15%); respectively) compared to non- catheterized group [5 (4.16%), 7 (5.83%) and 4 (3.33%); respectively]. Relative risk of dysuria, frequency and urgency after catheterization were 4.4, 3.7 and 4.5; respectively (95% CI; 1.7-11.2, 1.67-8.22 and 1.56-12.9; respectively). Asymptomatic bacteriuria, UTIs and subsequent need for antimicrobial therapy were also significantly high in catheterized group [15 (12.5%), 18 (15%) and 18 (15%); respectively) compared to non-catheterized group (3 (2.5%), 2 (1.96%) and 2 (1.96%); respectively]. Relative risk of asymptomatic bacteriuria and UTIs after catheterization in women undergoing minor gynecological procedures were 5 and 9; respectively (95%CI; 1.48-16.8 and 2.1-37.9).Conclusions: Catheterization in women undergoing minor gynecological surgery was associated with increased risk of dysuria, frequency, urgency, ASB, UTIs and subsequent antimicrobial therapy. Surgeons should revise the practice of routine preoperative catheterization for women undergoing minor gynecological procedures

Hypothyroidism: morphological and metabolic changes in the testis of adult albino rat and the amelioration by alpha-lipoic acid

Background: The objective of this study is to evaluate the influence of carbimazole- induced hypothyroidism on the testes of adult albino rats and the probable protective effect of alpha-lipoic acid (ALA). Materials and methods: The rats were divided into four groups; control group, ALA group, carbimazole, and carbimazole + ALA groups. Rats were exposed to ALA (60 mg/kg body weight) or carbimazole (1.35 mg/kg body weight), or both, administered via gavages for 30 days. Results: Morphometric analysis revealed a significant decrease in tubular diameter, germinal epithelium thickness, and interstitial space as compared to the controls. Also, rats exposed to carbimazole showed a significant decline in testicular weight, sperm motility, and count. Additionally, deterioration of the testicular architecture was observed. ALA supplementation resulted in a significant improvement in the tubular diameter and germinal epithelium thickness, but no significant improvement regarding interstitial space was observed. Another observation was the significant decline in serum testosterone and follicle-stimulating hormone (FSH) in the carbimazole group, indicating reduced steroidogenesis. A significant reduction in reduced glutathione content was detected in the testes of the carbimazole group compared with the controls, while malonaldehyde concentration significantly increased. Conversely, ALA supplementation ameliorated the toxicity induced by hypothyroidism as illustrated by enhanced reproductive organ weights, testosterone, luteinizing hormone, and FSH levels, testicular steroidogenesis, and oxidative stress parameters. Conclusions: Hypothyroidism altered testicular antioxidant balance and negatively affected spermatogenesis. On the other hand, ALA through its antioxidant properties alleviated testicular toxicity in carbimazole-exposed rats

Interleukin-6 bedside test in detecting chorioamnionitis in women with preterm premature rupture of fetal membranes

Objectives: About 30–80% of preterm deliveries following preterm premature rupture of fetal membranes (PPROM) are complicated by histological chorioamnionitis. To evaluate the accuracy of Interleukin-6 (IL-6) bedside test in detecting chorioamnionitis in women with PPROM.Material and methods: One hundred and ten (110) pregnant women with PPROM > 24 and < 34 weeks’ gestation, admitted for conservative management were included in this study. Participants were examined on admission using sterile speculum examination for assessment of IL-6 in the cervico-vaginal secretions using the IL-6 bedside test. The IL-6 bedside test was repeated for all participants once termination of pregnancy (TOP) decided. After TOP, placenta, umbilical cord, and fetal membranes samples were examined for histologic detection of chorioamnionitis (gold standard). The histological results were compared with IL-6 bedside test results to evaluate the accuracy of IL-6 bedside test in detecting chorioamnionitis in women with PPROM.Results: The IL-6 bedside test had 98.6% sensitivity, 94.7% specificity, 97.3% positive predictive value (PPV), 97.3% negative predictive value (NPV) and 97.3% overall accuracy in detecting chorioamnionitis. The sensitivity, specificity, NPV and overall accuracy of IL-6 bedside test (98.6%, 94.7%, 97.3%, and 97.3%; respectively) were significantly higher than the clinical and laboratory parameters of chorioamnionitis (65.3%, 57.9%, 46.8%, and 62.7%; respectively) (p = 0.04, 0.02, 0.001 and 0.03; respectively).Conclusions: The IL-6 bedside test is an accurate, non-invasive bedside test with 98.6% sensitivity, 94.7% specificity, 97.3% PPV, 97.3% NPV, and 97.3% overall accuracy in detecting chorioamnionitis. The IL-6 bedside test had significantly higher sensitivity, specificity, NPV, and overall accuracy than the clinical and laboratory parameters of chorioamnionitis

Accuracy of Gray‑scale and Three‑dimensional Power Doppler Ultrasound Parameters in the Diagnosis of Morbidly Adherent Placenta

Background: Morbidly adherent placenta (MAP) is usually associated with excess blood loss, bladder injuries, and hysterectomies.Aim: This study was designed to evaluate the accuracy of grayscale and three-dimensional (3D) power Doppler ultrasound parameters in the diagnosis of MAP. Subjects and Methods: Fifty pregnant women ≥28 weeks’ gestation with suspected MAP were included randomly in this prospective study. Two-dimensional (2D) transabdominal gray-scale ultrasound and 3D power Doppler scans were done for studied women to confirm placental location and findings suggestive of MAP. Intraoperative findings and histopathology results of removed uteri in the cases were managed by hysterectomies compared to preoperative sonographic findings using Student’s t-test and Mann–Whitney U-test for quantitative data, Chi-square test for qualitative data to detect the accuracy of 2D transabdominal gray-scale ultrasound and 3D power Doppler parameters in the diagnosis of MAP. Results: Best 2D gray scale ultrasound parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa– bladder interface (81.8% sensitivity) and exophytic mass invading bladder (94.9% specificity, 66.7% positive predictive value (PPV), and 84.1% negative predictive value [NPV]). Best 3D power Doppler parameters for the detection of emergency hysterectomies in the studied cases were disruption of uterine serosa–bladder interface (90.9% sensitivity, 68.8% specificity, and 47% PPV) and crowded vessels over peripheral subplacental zone (93.2% NPV). Conclusion: 3D power Doppler is a useful complementary tool to 2D gray-scale ultrasound for antenatal diagnosis of MAP. Crowded vessels over peripheral sub-placental zone and disruption of uterine serosa–bladder interface were the best 3D power Doppler parameters for the detection of difficult placental separation, considerable intraoperative blood loss, and emergency hysterectomies in the studied cases.KEY WORDS: Three‑dimensional power Doppler, gray-scale, morbidly adherent placent

AmnioQuick® Duo+ for diagnosis of premature fetal membranes rupture

Background: Failure to identify women with premature fetal membranes rupture associated with infectious morbidities. Evaluation of the accuracy of AmnioQuick® Duo+ in diagnosing premature fetal membranes rupture compared to conventional diagnostic tests was the aim of this study.Methods: 220 pregnant women ≥37 and <39 weeks` gestation studied and classified into two groups; study group (premature fetal membranes rupture) and control group (no premature fetal membranes rupture). Participants examined by trans-abdominal ultrasound (TAS) and vaginal speculum to visualize amnion leaking and for collection of samples for fern, nitrazine and AmnioQuick® Duo+ tests on admission. A final diagnosis whether the studied women had PROM or not at the initial presentation made after delivery.Results: Sensitivity and specificity of the AmnioQuick® Duo+ to diagnose PROM was 93.6% and 86.4%; respectively compared with 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. Positive predictive value, negative predictive value and accuracy of AmnioQuick® Duo+ to detect PROM were 87.3%, 93.1% and 90%; respectively compared with 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ test had higher accuracy to detect premature fetal membranes rupture compared to conventional diagnostic tests.Conclusions: AmnioQuick® Duo+ is accurate bedside immunoassay test, better than the individual conventional diagnostic tests and can used as complementary test to improve the management of women with women premature fetal membranes rupture

Diagnostic accuracy of PremaQuick in detection of preterm labor in symptomatic women

Objectives: Failure to identify women at risk of preterm labor (PTL) leads to failure to implement standard measures. This study designed to evaluate the accuracy of PremaQuick test in detection of PTL in women presented with threatened preterm labor (TPTL). Material and methods: One hundred and twenty-two (122) pregnant women, singleton pregnancy, &lt; 37 weeks, admitted with TPTL included in this study, and were compared to 122 controls. After thorough evaluation, participants were examined using sterile vaginal speculum for cervico-vaginal fluid (CVF) sampling, and PremaQuick test. The CVF sampling was followed by trans-vaginal sonographic (TVS) assessment of cervical length (CL). Participants were managed according to hospitals policy thorough their admission, and after discharge in the ante-natal clinics till delivery. After delivery, the delivery data were compared by the recorded participants` data on admission. Results: The PremaQuick test had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL &lt; 25 mm (p = 0.005, 0.005, 0.01, 0.002; respectively). Conclusions: The PremaQuick is an accurate bedside test in detection of PTL in women presented with TPTL. It had 95.1% sensitivity, 97.5% specificity, 97.5% positive predictive value, 95.2% negative predictive value, and 96.3% overall accuracy in detection of PTL. The PremaQuick had significantly higher true negative rate, specificity, positive predictive value, and overall accuracy in detection of PTL compared to CL &lt; 25 mm

Protein/Creatinine ratio versus 24-hours urine protein in preeclampsia

Objectives: Proteinuria is one of the diagnostic criteria of preeclampsia (PE). Measurement of 24-hour urine protein is the gold standard method for detection of proteinuria in PE. The 24-hour urine sampling is time-consuming, and inconvenient. To evaluate the accuracy of protein/creatinine (P/C) ratio in detection of significant proteinuria ( &gt; 1 g/24-hours urine) in PE. Material and methods: One hundred and ten (110) preeclamptic women were included in this study and admitted for blood pressure monitoring, 24-hour urine collection, fetal well-being assessment and spot urine sample for measuring of P/C ratio. After thorough history and clinical examination, routine antenatal investigations were done for the women included in the study according to the hospital protocol, and to excluded pre-existing chronic renal disease. Twenty-four-hour urine collection started on the morning following hospital admission. Spot urine samples were obtained shortly before the 24-hour urine collection for measuring of P/C ratio. Collected data statistically analyzed to evaluate the accuracy of P/C ratio in detection of significant proteinuria in PE. Results: The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% positive predictive value (PPV), 90.2% negative predictive value (NPV), and 94.5% overall accuracy in detection of significant proteinuria ( &gt; 1 g/24-hour urine) in PE. Conclusions: The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% PPV, 90.2% NPV, and 94.5% overall accuracy in detection of significant proteinuria ( &gt; 1 g/24-hour urine) in PE. This study suggests the use of P/C ratio as an alternative to 24-hour urine protein to detect significant proteinuria in PE

Effect of Progesterone Therapy versus Diet Modification on Constipation during Pregnancy

Background: Pregnant women may experience constipation for the first time or their existing constipation symptoms increase in severity during pregnancy.Aim: To compare the effect of progesterone versus diet modification in the treatment of constipation during pregnancy.Subjects and Methods: Women aged ≥18 years with functional constipation according to the Rome III criteria from obstetrics outpatients’ clinic and midwife practices included in this study. Participants divided into two groups; control group managed with diet modifications and study group pregnant women with threatened miscarriage and advised to take vaginal progesterone ≥1 week. Participants completed a nonvalidated questionnaire created by the authors during the whole week before intake of progesterone or diet modifications and after treatment phase. Independent Student’s t‑test and Chi‑square (X2) test were used for statistical analysis to compare between two studied groups. Primary outcome measures; change in defecation frequency.Results: Sensation of anorectal obstruction and sensation of incomplete evacuation were significantly less in Group B (progesterone therapy) compared to Group A (diet modification) (54% [154/281] and 62.98% [177/281] vs. 89.76% [614/684] and 91.08% [623/684], respectively) (P = 0.04 and 0.03, respectively). Straining during defecation and manual maneuvers to facilitate evacuation were significantly less in Group B compared to Group A (63.7% [179/281] and 19.9% [56/281] vs. 94.59% [647/684] and 86.54% [592/684], respectively) (P &lt; 0.01 and 0.02, respectively). Episodes of abdominal pain and presence of reflux episodes were also significantly less in Group B compared to Group A (18.5% [52/281] and 17.43% [49/281] vs. 84.11% [589/684] and 75% [513/684], respectively) (P = 0.01 and 0.03, respectively). Conclusions: Estrogen, rather than progesterone, may be a detrimental factor of constipation during pregnancy via decreased bowel movement. Progesterone therapy seems to be effective in the treatment of functional constipation during pregnancy. A randomized placebo controlled trial is required to confirm the data of this study.KEY WORDS: Constipation, diet modification, pregnancy, progesteron