Ahmed Khames. Modification of the Release Properties of Lornoxicam Gastroretentive Floating Tablets with the Naturally Occurring Okra Mucilage

Abstract: The aim of the present investigation is to study the effect of Okra mucilage on the buoyancy and release properties of lornoxicam floating gastroretentive tablets. Lornoxicam floating tablet formulae were prepared using HPMC K100M and/or Alginate as floating, release controlling polymers at different drug polymer ratios. Okra mucilage was added to the proposed tablet formulae both as dry powder and as granulating aqueous solution. The prepared tablets were evaluated for weight uniformity, hardness, friability, drug content, swelling index, in-vitro buoyancy, and in-vitro drug release. Results showed that incorporation of Okra mucilage into a floating tablet matrix positively affected the swelling and buoyancy where the swelling index increased to reach 221, 193, and 224 % in comparison to 211, 182, and 208 % respectively, the floating lag-time was shortened to be 0.23 minutes while the total floating duration was extended to exceed 12 hours. The drug release was retarded to be 85.3, and 75.7 % in comparison to 97.7, and 93.4 % respectively after 12 hours without any effect on the drug release kinetics, where the release still follows zero order kinetics. The floating tablet matrix properties and drug release were affected with Okra mucilage ratio and also the incorporation method. Depending on these results, it can be concluded that the naturally occurring Okra mucilage is a promising additive to improve the floating and release properties of gastroretentive floating matrices

The Effect of Brachytherapy Safety Education on Knowledge, Performance, and Attitude of Radiology Nurses

Context: Brachytherapy is one of the cancer treatment modalities. Like any treatment, it can produce acute and delayed side effects. Unfortunately, patients getting brachytherapy experience many side effects that may affect their all quality of life aspect. So, nurses working in radiotherapy settings must be confident about their knowledge, competence, and technical skills. Therefore, holding continuing education programs for nurses is necessary. Aim: This study aimed to determine the effect of brachytherapy safety education on radiology nurses' knowledge, attitude, and performance.Methods: Quasi-experimental one-group pre-posttest design was utilized to achieve this study on nurses working at Ayadi El Mostakabal Hospital, Alexandria, Egypt. Four tools were used to collect the necessary data. A self-administered questionnaire was designed to collect the necessary data about the nurses. Radiology Nurses’ Knowledge Assessment Questionnaire to assess nurses' knowledge regarding nursing interventions for patients getting brachytherapy. Nurses’ Performance Observational Checklist to assess the actual nurses’ performance provided to patients getting brachytherapy. Radiology Nurses' Attitude Assessment Scale (RNAAS) measures nurses' professional attitudes and the influence of safety training programs on nurses' attitudes. Results: There was a statistically significant difference between nurses' knowledge, performance, and attitude between the initial assessment, immediate, two weeks later, and three months of educational program implementation at p=0.001. Regarding the relationship between studied nurses' knowledge and their characteristics, there was a relationship between nurses’ knowledge in the initial assessment and their age, marital status, and nurses’ years of experience at p=0.001, 0.002, and 0.0, respectively. While in the post-program implementation, the only relation was found between the nurses’ knowledge score and years of experience p=0.007, 0.053, and0.011 in immediate, two weeks later, and after three months of program implementation, respectively. There was no relation found between nurses' performance and their characteristics throughout program implementation phases. Conclusion: The current study findings concluded that radiation safety education for nurses regarding brachytherapy resulted in a statistically significant improvement in nurses' knowledge, performance, and attitude. Periodic and consistent update in-services training of nurses to improve their knowledge and practice enforces nurses to follow the approved guideline. Future studies are recommended to investigate nurses' knowledge and performance of radiation protection in the general ward or specialized departments

Assessment of Heavy Metals Pollution In Euphrates River Water, Amiriyah Fallujah, Iraq.

The concentrations of heavy metals (Cd, Cr, Fe, Ni and Pb) in water samples for the Euphrates River in Amiriyah Fallujah, Iraq were evaluated to assess the pollution level. Ten sites were selected along the study area and sampled during December 2013 to March 2014. The decreasing trend of metals were observed in water as  Pb > Fe > Cr > Cd > Ni. The concentration of the studied metals was higher than the recommended guidelines for drinking and aquatic life, indicated that the water is not safe for drinking and aquatic life uses. There were significant differences in the concentrations of heavy metal  during the sampling period. Heavy pollution index (HPI) results showed that the water was seriously polluted  with Cd, Cr and Pb. According to metal index (MI) results, the water is seriously threatened with metal pollution and unsafe for drinking, irrigation and aquatic life uses. Principal components analysis (PCA) suggests that the Cd, Cr and Pb are derived from anthropogenic sources. Keywords: River pollution; Pollution index, Metal Index; Euphrates; Ira

CD4 T-HELPER CELL COUNT IS AN ALTERNATIVE PROMISING MARKER FOR DOSING CYCLOSPORINE IN KIDNEY TRANSPLANT PATIENT

Objective: The study was aimed to find out the correlation between cyclosporine blood concentrations and (Clusters of Differentiation 4) CD4 T-helper cell count (percentage) in order to use the latter parameter as an alternative marker for cyclosporine dosing. Besides, the study was also aimed to find out the optimum dosing strategy for Iraqi patients requiring cyclosporine therapy in Iraqi hospitals using TDM approach.Methods: One hundred and twenty subjects participated in the study. The subjects are involved two groups; group A was 80 patients (53 males and 27 females) using cyclosporine twice daily (Sandimmune® oral solution containing cyclosporine 100 mg/ml) and they had kidney transplantation for more than one year. The ages of the patients were 15-45 y (mean±SD =31.962±8.8207); and. Group B included 40 healthy control subjects (24 males and 16 females) with ages of 15-45 y (mean±SD =31.666±8.1606). According to the condition and the need of the patients, they were administered cyclosporine dose range of 1-10 mg/kg/d. Ten ml blood samples were withdrawn from each patient after fasting for about 12 h for monitoring trough/minimum blood concentration (C0) of cyclosporine and for determination of (Clusters of Differentiation 4) CD4 T-helper cells count at C0. Other 10 ml of blood was then withdrawn after 2 h of cyclosporine administration to be used for monitoring maximum/peak cyclosporine blood cyclosporine (Cmax) after 2 h of drug intake (C2) and for determination of (Clusters of Differentiation 4) CD4 T-helper cells count at C2. Five ml of blood samples were withdrawn from each control subject for determination of (Clusters of Differentiation 4) CD4 T-helper cells count.Results: Good correlations were found between cyclosporine dose administered to each patient and the resulted C0 and C2. The majority of patients (66 patients=82.5%) had C0 of 150-200 ng/ml and C2 of 700-900 ng/ml, which are within the therapeutic range. The range of cyclosporine doses that produce therapeutic C0 and C2 was 4.1-9 mg/kg/d. The mean total lymphocyte count and percentage decreased significantly in all patients compared to the control subjects (1.26±0.60 vs.1.98±0.66 e3/uL) and (19.92±13.77 vs. 28.88±10.22), respectively. A similar trend was found for the total lymphocyte count and percentage of patients with cyclosporine C0, and C2 within the therapeutic range (66 patients) compared to the control subjects (1.34±0.57 vs. 1.98±0.66) and (18.98±10.93 vs. 28.88±10.22), respectively. Good negative correlations were found between lymphocyte count and percentage versus C0 for all patients and for patients with C0 within the therapeutic range. Similarly, good negative correlations were found between lymphocyte count and percentage versus C2 for all patients and for patients with C2 within the therapeutic range. The (Clusters of Differentiation 4) CD4 T-helper cell percentage at C0 decreased significantly in all patients and patients with cyclosporine blood concentrations within the therapeutic range (66 patients) compared to the control subjects (24.33±10.31 vs. 35.83±9.11) and (25.50±2.44 vs. 35.83±9.11), respectively. Similarly, (Clusters of Differentiation 4) CD4 T-helper cell percentage at C2 decreased significantly in all patients and patients with cyclosporine blood concentrations within the therapeutic range compared to the control subjects (22.60±9.28 vs. 35.83±9.11) and (21.50±2.16 vs. 35.83±9.11), respectively. The range of (Clusters of Differentiation 4) CD4 T-helper cell percentages at C0 for patients with cyclosporine blood levels above the therapeutic concentrations was 21.65-23.43; for patients with cyclosporine blood levels within the therapeutic concentrations, the range was 23.70-29.00; and for patients with cyclosporine blood levels below the therapeutic concentrations, the range was 29.80-34.60. Good negative correlations were found between (Clusters of Differentiation 4) CD4 T-helper cell percentage and C0 for all patients and for patients with blood concentrations of cyclosporine within the therapeutic range. The (Clusters of Differentiation 4) CD4 T-helper cell percentage range at C2 for patients with cyclosporine blood levels above the therapeutic concentrations was 13.40-18.20; for patients with cyclosporine blood levels within the therapeutic concentrations, the range was 18.50-22.23; and for patients with cyclosporine blood levels below the therapeutic concentrations, the range was 22.76-24.42. Identically, good negative correlations were found between (Clusters of Differentiation 4) CD4 T-helper cell percentage and C2 for all patients and for patients with blood concentrations of cyclosporine within the therapeutic range. For patients with cyclosporine blood levels above therapeutic concentrations; the minimum percentage of (Clusters of Differentiation 4) CD4 T-helper cell at C2 was 13.40, whereas, the maximum percentage of (Clusters of Differentiation 4) CD4 T-helper cell at C0 was 20.23. For patients with cyclosporine blood levels within therapeutic concentrations; the minimum percentage of (Clusters of Differentiation 4) CD4 T-helper cell at C2 was 18.50, whereas, the maximum percentage of (Clusters of Differentiation 4) CD4 T-helper cell at C0 was 29.00. For patients with cyclosporine blood levels below therapeutic concentrations; the minimum percentage of (Clusters of Differentiation 4) CD4 T-helper cell at C2 was 23.40, whereas, the maximum percentage of (Clusters of Differentiation 4) CD4 T-helper cell at C0 was 34.60.Conclusion: Good negative (reciprocal) correlations were demonstrated between cyclosporine blood concentrations at C0 and C2 versus The percentage of (Clusters of Differentiation 4) CD4 T-helper cell. Therefore, the percentage of (Clusters of Differentiation 4) CD4 T-helper cell may be used as an alternative or surrogate marker for optimum cyclosporine dosing than the traditional dosing strategy using TDM, since the former approach is direct for reflecting drug safety and efficacy, beside, it is the affordable, fast and simple approach. The range of cyclosporine doses that produce therapeutic C0 and C2 in Iraqi kidney transplant patients was 4.1-9 mg/kg/d

Preparation and Characterization of Sildenafil Loaded Solid Lipid Nanoparticles: Drug Delivery System Suitable for Nebulization

ABSTRACT The primary indication of sildenafil is the treatment of erectile dysfunction. It is also effective in pulmonar

Formulation and Characterization of Eplerenone Nanoemulsion Liquisolids, An Oral Delivery System with Higher Release Rate and Improved Bioavailability

Because Eplerenone (EPL) is a Biopharmaceutical Classification System (BCS) class-II drug and is prone to extensive liver degradation, it suffers from poor bioavailability after oral administration. This work aimed to prepare liquisolids loaded with EPL-nanoemulsions (EPL-NEs) that have a higher drug release rate and improved bioavailability by the oral route. Based on solubility studies, mixtures of Triacetin (oil) and Kolliphor EL/PEG 400 surfactant/co-surfactant (Smix) in different ratios were used to prepare EPL-NE systems, which were characterized and optimized for droplet size, zeta potential, polydispersity index (PDI), and drug content. Systems were then loaded onto liquisolid formulations and fully evaluated. A liquisolid formulation with better drug release and tableting properties was selected and compared to EPL-NEs and conventional EPL oral tablets in solid-state characterization studies and bioavailability studies in rabbits. Only five NEs prepared at 1:3, 1:2, and 3:1 Smix met the specified optimization criteria. The drug release rate from liquisolids was significantly increased (90% within 45 minutes). EPL-NE also showed significantly improved drug release but with a sustained pattern for four hours. Liquisolid bioavailability reached 2.1 and 1.2 relative to conventional tablets and EPL-NE. This suggests that the EPL-NE liquisolid is a promising oral delivery system with a higher drug release rate, enhanced absorption, decreased liver degradation, and improved bioavailability

Investigation of the effect of solubility increase at the main absorption site on bioavailability of BCS class II drug (risperidone) using liquisolid technique

BCS class II drugs usually suffer inadequate bioavailability as dissolution step is the absorption rate limiting step. In this work, the effect of solubility increase at the main absorption site for these drugs was investigated using risperidone as a drug model. Liquisolid technique was applied to prepare risperidone per-oral tablets of high dissolution rate at intestinal pH (6.8) using versatile nonionic surfactants of high solubilizing ability [Transcutol HP, Labrasol and Labrasol/Labrafil (1:1) mixture] as liquid vehicles at different drug concentrations (10–30%) and fixed (R). The prepared liquisolid tablets were fully evaluated and the dissolution rate at pH 6.8 was investigated. The formulae that showed significantly different release rate were selected and subjected to mathematical modeling using DE25, MDT and similarity factor (f2). Depending on mathematical modeling results, formula of higher dissolution rate was subjected to solid state characterization using differential scanning calorimetric (DSC), infrared spectroscopy (IR) and X-ray diffraction (XRD). Finally, the drug bioavailability was studied in comparison to conventional tablets in rabbits. Results showed that liquisolid tablet prepared using Labrasol/Labrafil (1:1) mixture as liquid vehicle containing 10% risperidone is a compatible formula with law drug crystallinity and higher dissolution rate (100% in 25 min). The drug bioavailability was significantly increased in comparison to the conventional tablets (1441.711 μg h/mL and 137.518 μg/mL in comparison to 321.011 μg h/mL and 38.673 μg/mL for AUC and Cpmax, respectively). This led to the conclusion that liquisolid technique was efficiently improved drug solubility and solubility increase of BCS class II drugs at their main absorption site significantly increases their bioavailability

Preparation and Identification of Novel 1, 3-Oxazepine Derivatives by Cycloaddition Reactions [2+5] of Selected Carboxylic Acid Anhydrides with Imines Derived from 4-methyl aniline

Novel 1,3-oxazepine derivatives have been synthesis via (2+5) cycloaddition reaction of imines and selected cyclic carboxylic acid anhydrides by refluxing in dry benzene. Imines have been prepared by thermal condensation of 4-methyl aniline and para substituted benzaldehyde in absolute ethanol under reflux conditions. The structure of the target compounds were Identified by some physical properties and spectral data of FT-IR and 1H-NMR

Ultrasound -guided erector spinae plane block (ESPB) versus intravenous opioids based analgesia in patients with rib fractures

ABSTRACTBackground There has been a great interest in the erector spinae plane block (ESPB) to control pain in patients who are presented with rib fractures. ESPB has been shown to achieve adequate analgesia with little adverse effects, although its effectiveness in comparison to other analgesic alternatives has not been sufficiently studied.Aim of the study Our target was to compare the effectiveness of ESPB and opioid based analgesia in relieving pain in rib fractures patients.Methodology Fifty-two patients between 21 and 60 years old, divided into 2 equal groups, received either Ultrasound-guided (US) ESPB with 20 ml of bupivacaine 0.25% or intravenous (IV) morphine 0.1 mg/kg then IV Patient-controlled analgesia (PCA) containing morphine. Assessment of visual analogue scale (VAS) score before and after spirometer exercise at baseline, then at 30 minutes, 6 hours, and 12 hours after the intervention was done. Also Peak Inspiratory Flow Rate (PIFR) was measured by an incentive spirometer, first 12-hour morphine consumption as rescue analgesia was calculated, the incidence of complications was noted, and patients satisfaction was assessed.Results The VAS score was higher in morphine group compared to ESPB group before and after spirometry. PIFR was higher in ESPB group. Less opioid consumption and side effects, along with better patient satisfaction, were recorded in the ESPB group.Conclusion Erector spinae plane block provided superior analgesia and improved respiratory function for IV PCA morphine. Furthermore, ESPB was linked to fewer side effects, less opioid use, and better patient satisfaction

Preparation and Evaluation of Orodispersible Tablets Containing Hydroxylbutyl-β-Cyclodextrin-Simvastatin Solid Dispersion

Purpose: To formulate simvastatin orodispersible tablets with high dissolution rate and enhanced bioavailability. Methods: Simvastatin solid dispersions in β- cyclodextrin, hydroxylpropyl-β-cyclodextrin, and hydroxylbutyl-β-cyclodextrin were prepared in different drug: polymer ratios by kneading and solvent evaporation methods. Compatibility was investigated by Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) Based on the results of solubility studies, the most suitable solid dispersion was selected and formulated into orodispersible tablets using Emcosoy and K-polacrillin as superdisintegrants, and mannitol and Pullulan as diluents. The tablets were evaluated for wetting and disintegration times, water absorption, and in vtro dissolution. Results: Increase in drug solubility was dependent on polymer type, concentration and preparation method. Simvastatin-hydroxylbutyl-β-cyclodextrin solid dispersion mixture prepared in 1:2 drug: polymer ratio by solvent evaporation method had a higher solubility than other dispersions. DSC and FTIR indicated the formation of solid dispersion without chemical interaction between simvastatin and polymer. Orodispersible tablet prepared with Emcosoy and Pullulan showed least wetting and disintegration times (20 and 35 s, respectively), fastest water sorption rate, and the highest dissolution rate (100 % after 20 min). Conclusion: Orodispersible tablets prepared with Emcosoy as superdisintegratnt and Pullulan as diluents and containig simvastatin solid dispersion in hydroxylbutyl-β-cyclodextrin provides optimum water solubility and hence, drug bioavailability