Formulation and Evaluation of Sustained Release Bilayer Tablets of Glimepiride and Metformin HCl.

Metformin is an oral antidiabetic biguanide drug for the treatment of type 2 diabetes, in particular, in overweight and obese people and those with normal kidney function. It is a class III high soluble, low permeable compound slowly and incompletely absorbed from the gastrointestinal tract and the absolute bioavailability of a single 500mg dose is reported to be 50%-60%. The compound also has relatively short plasma elimination half-life of 1.5 to 4.5 hrs, hence Metformin HCl has to be administered two or three times per day. Glimepiride is one of the third generation sulfonylurea drugs useful for control of diabetes. It maintains a more physiologic regulation of insulin secretion and the risk of hypoglycaemia is less than with other sulfonylurea. It‟s a white hydrophobic powder, practically insoluble in water; bioavailability is 100%, half-life is 5 hrs and available dose is generally 1mg or 2mg once a day. Glimepiride and Metformin simultaneously targets insulin resistance and insulin deficiency type II diabetes. The aim is to develop a combination drug therapy for anti diabetic tablet formulation having different mechanism of action to complement each other and together effectively lower blood glucose level. The immediate release layer of Glimepiride is prepared by direct compression method using SSG as superdisintegrant with other excipients and sustained release layer of Metformin HCl are prepared by wet granulation method using HPMC and Xanthan Gum as polymer in different concentration with other excipients. The present work was aimed towards developing a bilayer tablets containing Glimepiride as immediate release and Metformin HCl as sustained release. The tablets were prepared using techniques of wet granulation and compression. The optimization of the tablets was done based on experimental result such as its physiochemical parameters, dissolution and content uniformity. The tablets produced were stable and reliable. The result suggested that various variables affecting the dissolution of the tablets. Formulation F6 shows better dissolution. So it is suggested that for highly water soluble drug like Metformin HCl, it is desirable to use combination of different polymer for sustained release layer and incorporation of superdisintegrant like SSG in immediate release layer. The release data further indicated that combination of SCMC and HPMC K 100M can give the sustained release effect followed by the initially burst release effect due to the superdisintegrant SSG in immediate release layer. HPMC K100M polymer controlled the release of Metformin HCl up to 10 hrs intended for once daily administration. The release data of in vitro study indicates that formulation follows zero order, Higuchi equation and diffusion takes place via non-fickian transport. Formulation F6 found to be stable at accelerated stability as per the ICH guidelines for a period of 3 months. Finally it concluded that Glimepiride as immediate release and Metformin HCl as sustained release indicate promising potential of both drugs in the form of bilayer tablets an alternative to the conventional dosage form

A comparative evaluation of frictional resistance and surface roughness of silver coated and uncoated stainless-steel bracket wire assembly- An in-vitro study

Silver ions act as potent antimicrobial agents. Silver coating of brackets and the archwires can help reduce the formation of white spot lesions and caries which is commonly seen with fixed orthodontic treatment. However, this may affect the friction and surface roughness of the bracket-wire assembly which in turn affects the biological tooth movement. MATERIAL AND METHODS: A total of 60 samples were included in the study which was divided into four groups. Group-1: * 15 silver coated 0.022 x 0.028" slot MBT prescription maxillary central incisor brackets * 15 silver coated 0.019 x 0.025" stainless-steel wires; Group-2: * 15 uncoated 0.022 x 0.028" slot MBT prescription maxillary central incisor brackets * 15 silver coated 0.019 x 0.025" stainless-steel wires; Group-3: * 15 silver coated 0.022 x 0.028" slot MBT prescription maxillary central incisor brackets * 15 uncoated 0.019 x 0.025" stainless-steel wires; Group-4: * 15 uncoated 0.022x0.028" slot MBT prescription maxillary central incisor brackets * 15 uncoated 0.019 x 0.025" stainless-steel wires. All brackets and wires used were of American Orthodontics, St. Paul, USA. Surface modification of wires and brackets was carried out using the Vacuum Coating Unit model by Thermal Vacuum Evaporation method with silver nanoparticles (10 nm size). The frictional resistance of all brackets and wires was checked using Universal Testing Machine. RESULTS: On comparison of maximum load, it was found that friction was highest in group 3, followed by group 1, group 4 and group 2. The mean difference between all groups was found to be statistically significant with a P value Group 1> Group 2> Group 3 *Wire roughness: Group 4> Group 1> Group 2> Group 3. CONCLUSIONS: This study concluded that friction was least when only the wire was coated with silver and the bracket was uncoated and it was the most when the bracket was coated and the wire was uncoated. The surface roughness after the friction test was the least when the wire was uncoated. Key words:Silver nanoparticles, Frictional Resistance, Surface Roughness

Difference in clinical profile between juvenile onset and adult-onset systemic lupus erythematosus: a meta-analysis

The aim was to systematically review the studies that compared clinical and serological variation between adult-onset systematic lupus erythematosus (aSLE) andjuvenile-onset systematic lupus erythematosus (jSLE). A comprehensive literature search was done, in various available electronic databases for relevant publication that compared juvenile onset SLE and adult onset SLE. The data of adverse clinical features, serological profile and mortality were extracted. Juvenile onset was defined as 18 years. The methodological quality of study was assessed by Newcastle Ottawa scale (NOS) criteria and R version 3.3.1 was used for analysis and ORs and 95% CIs, were used as statistical parameter. A total of 14,920 patients; (12,230: aSLE, and 2,690: jSLE) were included. Renal involvement especially nephritis was significantly more in j-SLE OR: 2.18, 95% CI: [1.81;2.62]; I2=10.8% whereas musculoskeletal was significant in aSLE O.R: 0.64; C.I: [0.44; 0.93]; I2=83.4%. Seizure and malar rash were significantly higher in J-SLE OR:1.69, CI: [1.31; 2.18]; I2=31.1%,1.43; C.I [1.04; 1.97]; I2=82%, respectively. Raynaud’s phenomenon and pleuritis were significantly higher in adult onset SLE. Anemia and thrombocytopenia were significantly higher in juvenile onset SLE. Anti-ds DNA, anti-histone, and anti-ribosomal-P were more frequent in juvenile-onset SLE while, anti-Ro was more common in adult-onset disease. The cause of mortality was not significantly different in both groups. Renal biopsy of class III and IV combined and class V were significantly more in adult-onset SLE. SLEDAI was higher in j-SLE. Meta-analysis indicated that, regardless of many similar clinical and serological manifestations, there is still some variation between adult-onset SLE and juvenile-onset SLE. Although, SLE disease is continuum from juvenile to adult but disease aggressive in juvenile onset SLE

Painless Presentation of a Deadly Disease:Type A Aortic Dissection Requiring the Bentall Procedure

Aortic dissection is a relatively uncommon, although catastrophic, disease which requires early and accurate diagnosis and treatment for patient survival. Aortic dissection can be difficult to diagnose due to the diverse symptom presentation, which can lead to later diagnosis, resulting in a higher mortality rate. Here we present a case of type A aortic dissection with a varied symptom presentation, highlighting the importance of early detection and the Bentall procedure for management of such cases. A 50-year-old man with no known medical history presented with bilateral lower extremity swelling and fatigue for 2 weeks. The patient denied any chest pain or dyspnoea. Vital signs showed blood pressure of 160/76 mmHg, pulse of 103 bpm, respiratory rate of 18, and temperature of 36.7°C. Laboratory findings indicated a BNP of 1901 pg/ml and troponin of 0.5 ng/ml. An initial diagnosis of decompensated heart failure was made, and IV Lasix was started. Subsequently, an echocardiogram indicated an EF of 50–55% and ascending dissection of the aorta. A CT angiogram of the chest and abdomen confirmed this diagnosis. This patient presented with unusual symptoms of aortic dissection without the typical presentation of chest pain. It is important to consider aortic dissection in a cardiac-related case as prompt imaging can help confirm the diagnosis. We explore the risks and benefits of the Bentall procedure for the management and early detection of aortic dissectio

Functional and radiological outcome following proximal fibular osteotomy in patients with knee osteoarthritis: a prospective study

Background: Osteoarthritis of knee is a common joint disease, with a prevalence of about 30 percent of individuals older than 60 years of age. Medial compartmental OA Knee, is by far the most prevalent variant of degenerative tibio-femoral joint disease and makes upto 90% of uni-compartment knee OA. Proximal Fibular Osteotomy (PFO), which essentially is resection of upper fibular diaphysis, had become increasingly adopted for the surgical intervention in the last decade. Aim: To Assess the functional and radiological Outcome In Patients Who Had Medial Compartment Knee Arthritis following Proximal Fibular Osteotomy. Materials and methods: The study was done in the Department of Orthopaedics, at Chettinad Hospital & Research institute, Tamil Nadu. The study population included total 22 cases with knee medial compartmental osteoarthritis and underwent Proximal Fibular Osteotomy. Results: In our study, mean age group of cases was 52.51 years. The mean post-operative VAS was 1.4 which was significantly lesser than pre-operative value. Significant improvement in the functional and clinical outcome, was observed. The post-operative medial joint space and knee joint ratio, were significantly enhanced.Conclusion: PFO is a suitable option for pain relief, as well as to achieve a painless knee ROM to benefit activities of daily life in patients with medial compartment osteoarthritis

Functional Outcome of Arthroscopic Reconstruction of Anterior Cruciate Ligament Injuries Using Semitendinosis-Gracilis Graft

To determine the functional outcome of arthroscopic ACL reconstruction using semitendinosis- gracilis graft, in patients with anterior cruciate ligament tears. Materials and Methods: This is a prospective observational study, of the patients Aged >18 years to <55 years old, who underwent, Arthroscopic reconstruction of anterior cruciate ligament injuries using semitendinosis-gracilis graft, at Chettinad Hospital and Research Institute (CH&RI), during the period, 11/3/2020 to 15/4/2021(13 months). Follow up period till 15/10/2021. Patients satisfying the inclusion criteria, alone were included, in this study. Total 36 patients were included in this study. The patients, were followed up, at the end of the 3rd, 6th month, from the date of surgery. Results: The mean age of the patients of the study was 33.03 ± 8.89 years with minimum age of 20 years and maximum age of 55 years. In present study at 3 months, 66.67% of patients had fair lysholm score followed by 22.22% had poor score and 11.11% of cases had good score. The mean lysholm score at 3 months was 74.58 ± 8.12 with minimum score of 58 and maximum score of 86. At 6 months 63.89% of patients had good lysholm score followed by 30.56% of cases had excellent score and 5.56% of cases had fair score with mean lysholm score at 6 months was 91.47 ± 5.78 with minimum score of 78 and maximum score of 100. The mean knee society score of patients at 3 months was 76.83 ± 5.71 with minimum score of 61 and maximum score of 86. The mean knee society score at 6 months was 92.97 ± 5.58 with minimum score of 77 and maximum score of 100. The mean distance in single hop test was 81.39 ± 11.05cms with minimum distance of 51cms and maximum distance of 103cms. Conclusion: ACL reconstruction with semi-tendinosis and gracilis graft gives good functional outcomes which might be due to the advancements in the surgical techniques and fixation device

A prospective study in management of lumbar radiculopathy patients with selective nerve root block

Background: Prolapsed Intervertebral Disc (PID) was considered to be the commonest cause of sciatica among many others. Though the presentation of sciatica was paradoxical, in which, some people experienced sciatica without any disc prolapse on MRI/CT, whereas some people showed a prolapsed disc without experiencing any of the symptoms related to sciatica. This gave rise to different explanations that a disc prolapse in itself , is not enough to cause sciatica, and there might be some local chemical agents that might be the causative factor due to their insulting attitude on the nerve roots. Objectives: To study the functional outcome of patients with Posterior Lumbar Intervertebral disc prolapse (PLIVDP), Lumbar Canal Stenosis, and Lumbar radiculopathy after Selective Nerve Root Block at the corresponding level. Materials and Methods: A prospective cohort study on the functional outcome of patients with lumbar radiculopathy with Intervertebral disc prolapse or lumbar canal stenosis. Outcome measures used in this study are Owestry disability index score and Numerical rating scale. All patients had taken an MRI scan, which was classified according to the Michigan state university classification. After initial check up, pre-anaesthetic check up, selected patients were given Selective Nerve Root Block with Methyl Prednisolone and local anaesthetic Bupivacaine. Patients were scored at Immediate post Op, 3 weeks and 3 months after the injection was given and the data was collected. Results: A total of 127 patients were given Selective Nerve Root Block in the study period. Patients that were aged from 20-80 years were included. Average pre-injection ODI scores (in percent) were 75.24, at 1 month 20.52 and at 4 months 19.86, with a p value of <0.001. Mean NRS ratings pre injection were 8.73, Immediate post op were 1.89, at 4 weeks it was 1.48 and 4 months 1.27. Mean SLR (in degrees) Pre Injection was 48.3, Immediate was 80.00, at 4 weeks was 80.2 and at 4 months was 80.5. Conclusion: Selective Nerve Root Block is a good therapeutic procedure for pain management in the patients with Lumbar radiculopathy, and it can be used as a standard procedure, before advising the patient for any form of surger

Laparoscopic total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis

Aim: The aim was to study the feasibility of the laparoscopic approach in the management of ulcerative colitis, to assess the functional results at 1-year and to review of literature on the topic. Materials and Methods: All patients presenting for surgical management of histopathologically proven ulcerative colitis during the study period were included in the study. All patients presenting in a non-emergency setting were offered a two-stage procedure (Group A). The first-stage consisted of laparoscopic total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) with a diverting split end ileostomy. Ileostomy was closed in the second stage. For patients presenting in acute setting (Group B), the first-stage consisted of laparoscopic TPC with end ileostomy followed by IPAA with diverting split end ileostomy in the second-stage and finally ileostomy closure in the third-stage. The technique is described. Results: A total of 31 cases underwent laparoscopic TPC-IPAA, of which 28 belonged to Group A and 3 were included in Group B. All surgeries were successfully completed laparoscopically without need for conversion. The average operating time was 375 min in Group A (range: 270-500 min) and 390 min in Group B (range: 250-480 min). Oral diet was resumed at a mean of 3.4 days (range: 1.5-6 days) and the mean hospital stay was 8.2 days (range: 4-26 days). Overall morbidity rate was 16.2%; re-operation rate was 9.7% while mortality was nil. Conclusions: Laparoscopic TPC-IPAA is feasible in acute as well as non-acute setting in patients needing surgical management of ulcerative colitis