Is low amniotic fluid index an indicator of fetal distress and hence delivery?

Background: Amniotic fluid Index (AFI) is an indicator of fetal well-being. Low AFI is considered to be one of the indications for delivery as it may be associated with fetal distress and birth asphyxia. We sought to determine whether low AFI is an indicator of fetal compromise and an indication to deliver.Methods: This prospective, observational study was conducted at Department of Obstetrics & Gynecology, KMC, Manipal University, India, between August 2013 and Aug 2014. A total of 150 subjects that had induced labor or direct caesarean section for various indications and also having low-normal (5-8) / low (<5) AFI, were recruited. Subjects with fetal anomalies were excluded. Outcome variables studied were, fetal distress in labor, thick meconium stained amniotic fluid, mode of delivery in induced labor, perinatal asphyxia, and respiratory distress syndrome.Results: Out of 150 subjects, 68 (45.4%) had low and 82 (54.6%) had low-normal AFI. Both the groups were matched for demographic characteristics and confounding factors for neonatal outcome. In low AFI group the incidence of Low APGAR (11.7%), perinatal asphyxia (11.7%) and RDS (16.1%) were significantly higher compared to those in low-normal group (3.6%, 1.2% and 2.4% respectively) p = 0.057, 0.006 and 0.002. There was no significant difference between the groups with respect to mode of delivery when labor was induced.Conclusions: Low AFI, especially when it is <5, is an indicator of fetal compromise and one may anticipate perinatal asphyxia and RDS. Hence it is prudent to contemplate delivery when the AFI is between 5 and 8

Estudio de la Lidocaína al 0,5% y en Combinación de Lidocaína al 0,25% con Fentanilo y Vecuronio en Anestesia Regional Intravenosa para Cirugías de Miembros Superiores

ResumenJustificativa y objetivosLa anestesia regional intravenosa (ARIV) para cirugías de miembros superiores con la tradicional dosis alta de lidocaína, puede conllevar a efectos colaterales que amenazan la vida. Para evitar esos efectos colaterales potencialmente amenazadores, muchas técnicas modificadas de ARIV fueron experimentadas con el uso de una dosis baja de lidocaína, relajante muscular y opioide.Materiales y métodosEl presente estudio se hizo con 60 pacientes no medicados previamente, con clasificación ASA 1-2, para comparar las características sensoriales y motoras, los parámetros cardiorrespiratorios y los efectos colaterales durante el período intraoperatorio y de deflación pos torniquete, entre los pacientes que recibieron 40mL de lidocaína al 0,5% sola (n = 30) y los que recibieron una combinación de 40mL de lidocaína al 0,25% con 0,05mg de fentanilo y 0,5mg de vecuronio (n = 30) en ARIV para cirugías ortopédicas de miembros superiores. Los resultados se analizaron usando el teste t de Student pareado para identificar la significancia estadística. Resultado: La diferencia entre los dos grupos con relación al tiempo promedio de inicio y completo bloqueo sensitivo y motor, fue estadísticamente significativo. Sin embargo, hubo un completo bloqueo sensitivo y motor en ambos grupos 15 minutos después de la inyección de la solución anestésica. Conclusiones: Aunque la pequeña demora observada al inicio y durante la obtención completa de los bloqueos sensitivo y motor, teóricamente pueda atrasar el inicio de la operación entre 10 y 15 minutos, clínicamente ese tiempo se gastaría en la preparación del campo quirúrgico. Por tanto, esa combinación puede ser usada con seguridad y eficacia en la anestesia regional intravenosa para las cirugías ortopédicas de miembros superiores con menor posibilidad de toxicidad anestésica local

Inferior venacaval compression due to excessive abdominal packing

AbstractInferior venacaval compression is a common problem in late pregnancy. It can also occur due to compression of inferior venacava by abdominal or pelvic tumors. We report a case of acute iatrogenic inferior venacaval compression due to excessive abdominal packing during an intraabdominal surgery

Brain simulation as a cloud service: The Virtual Brain on EBRAINS

The Virtual Brain (TVB) is now available as open-source services on the cloud research platform EBRAINS (ebrains.eu). It offers software for constructing, simulating and analysing brain network models including the TVB simulator; magnetic resonance imaging (MRI) processing pipelines to extract structural and functional brain networks; combined simulation of large-scale brain networks with small-scale spiking networks; automatic conversion of user-specified model equations into fast simulation code; simulation-ready brain models of patients and healthy volunteers; Bayesian parameter optimization in epilepsy patient models; data and software for mouse brain simulation; and extensive educational material. TVB cloud services facilitate reproducible online collaboration and discovery of data assets, models, and software embedded in scalable and secure workflows, a precondition for research on large cohort data sets, better generalizability, and clinical translation

Design and optimization of novel in situ gel of mercaptopurine for sustained drug delivery

Mercaptopurine is a purine antagonist, belonging to the class of antimetabolites. Its oral absorption is erratic and variable throughout GIT, with bioavailability of 5-37% and belongs to Biopharmaceutical Classification System (BCS) class IV. The focus of the present study was to improve solubility of mercaptopurine and to release the drug uniformly throughout the GIT by formulating into a novel in situ gel tablet. By in vitro swelling studies, xanthan gum was selected as the best gelling polymer and the tablets were prepared by direct compression. Sodium chloride was used as a release modifier to improve the release of drug from the tablet. A 32 full factorial design was applied to optimize the percentage of xanthan gum and sodium chloride to get desired swelling index and release profile. Tablets were evaluated for weight variation, hardness, friability, disintegration time, drug content, in vitro swelling studies and in vitro dissolution studies. The best optimized formulation showed good swelling index and extended the release up to 12 h, where as conventional tablet released the drug within 45 min. The results indicate that mercaptopurine loaded in situ gel tablet could be effective in sustaining drug release for a prolonged period of time throughout the GIT, which can possibly improve the oral bioavailability.Mercaptopurine é um antagonista da purina, pertencente à a classe dos antimetabólitos. A sua absorção oral é errática e variável através do TGI, com biodisponibilidade de 5-37 % e pertence à classe IV, de acordo com o Sistema de Classificação Biofarmacêutica. O foco do presente estudo foi melhorar a solubilidade da mercaptopurina e liberar o fármaco uniformemente através do TGI, por meio da nova formulação de comprimidos que se tornam gel in situ. Por meio de estudos de inchamento, a goma xantana foi selecionada como o o melhor polímero gelificante e os comprimidos foram preparados por compressão direta. O cloreto de sódio também foi usado como agente modificador de liberação para aprimorar a liberação do fármaco do comprimido. Aplicou-se planejamento fatorial 32 para otimizar a porcentagem de goma xantana e de cloreto de sódio para se alcançar o índice de inchamento e o perfil de liberação desejáveis. Os comprimidos foram avaliados quanto à variação de peso, dureza, friabilidade, tempo de desintegração, conteúdo de fármaco, estudos in vitro de inchamento e de dissolução. A formulação mais bem otimizada mostrou bom índice de inchamento e liberação prolongada acima de 12 h, em comparação com um comprimido convencional, que libera o fármaco em 45 minutos. Os resultados indicam que a 6-mercaptopurina carregada no comprimido de gelificação in situ poderia ser eficaz para a liberação controlada por período de tempo prolongado através do TGI, o que pode, possivelmente, aprimorar a biodisponibilidade oral

Optimization (Central Composite Design) and Validation of HPLC Method for Investigation of Emtricitabine Loaded Poly(lactic-co-glycolic acid) Nanoparticles: In Vitro Drug Release and In Vivo Pharmacokinetic Studies

The objective of the current study is to develop nanoparticles (NPs) drug delivery system of emtricitabine solely using poly(lactic-co-glycolic acid) (PLGA) and evaluate its in vitro and in vivo release performance by systematically optimized HPLC method using Formulation by Design (FbD). NPs were evaluated for in vitro release and in vivo absorption study. The desired chromatographic separation was achieved on a Phenomenex C18 (250 mm × 4.6 mm I.D., 5 μm) column, under isocratic conditions using UV detection at 280 nm. The optimized mobile phase consisted of a mixture of 40 mM phosphate dihydrogen phosphate buffer (pH 6.8), methanol, and 2% acetonitrile in a ratio of (83 : 15 : 2, v/v/v) at a flow rate of 1 mL/min. The linear regression analysis for the calibration curves showed a good linear correlation over the concentration range 0.040–2.0 μg/mL, with retention time of 4.39 min. An average encapsulation efficiency of 74.34% was obtained for NPs. In vitro studies showed zero-order release and about 95% drug being released within 15 days in PBS (pH 7.4). In conclusion, the proposed optimized method was successfully applied for the determination of in vitro and in vivo release studies of emtricitabine NPs

Response surface methodology and process optimization of sustained release pellets using Taguchi orthogonal array design and central composite design

Furosemide is a powerful diuretic and antihypertensive drug which has low bioavailability due to hepatic first pass metabolism and has a short half-life of 2 hours. To overcome the above drawback, the present study was carried out to formulate and evaluate sustained release (SR) pellets of furosemide for oral administration prepared by extrusion/spheronization. Drug Coat L-100 was used within the pellet core along with microcrystalline cellulose as the diluent and concentration of selected binder was optimized to be 1.2%. The formulation was prepared with drug to polymer ratio 1:3. It was optimized using Design of Experiments by employing a 32 central composite design that was used to systematically optimize the process parameters combined with response surface methodology. Dissolution studies were carried out with USP apparatus Type I (basket type) in both simulated gastric and intestinal pH. The statistical technique, i.e., the two-tailed paired t test and one-way ANOVA of in vitro data has proposed that there was very significant (P≤0.05) difference in dissolution profile of furosemide SR pellets when compared with pure drug and commercial product. Validation of the process optimization study indicated an extremely high degree of prognostic ability. The study effectively undertook the development of optimized process parameters of pelletization of furosemide pellets with tremendous SR characteristics