Journal of Pharma and Pharmaceutical Sciences Indirect Determination of Process Impurity Cetrimonium Bromide in Neisseria meningitidis A/C/Y/W-135-DT Conjugate Vaccine by HPAEC-PAD Method

Abstract A validated High Performance Anion Exchange-Pulsed Amperometric Detection (HPAEC-PAD) indirect method is described to determine traces of process impurity cetrimonium bromide (CTAB) in Neisseria meningitidis A/C/Y/W-135-DT conjugate vaccine. Method reported here, measures the bromide ion present in CTAB. As part of impurity profiling, samples of crude and purified meningococcal four serogroup (A, C, W-135 and Y) polysaccharides and final vialed conjugate vaccine were analyzed for CTAB content. Vaccine grade pure polysaccharides, the control and the final vaccines both formulated in phosphate buffered saline (PBS) showed sub ppm levels of CTAB impurity. PBS used in this work showed detectable bromide levels presumably due to contamination originated from saline. The proposed method is very sensitive (LOD=0.04 ppm, LOQ =0.11 ppm), accurate, reproducible and compatible with polysaccharide and PBS environments

Phase behavior of TPGS–PEG400/1450 systems and their application to liquid formulation: A formulation platform approach

Vitamin E d ‐alpha‐tocopheryl polyethylene glycol succinate (TPGS) and polyethylene glycol are common excipients used in both preclinical and commercial formulations. In this paper, the phase diagrams of TPGS and polyethylene glycol 400 (PEG 400) in the presence of either water or ethanol were constructed. The effect of water and ethanol on the cloud point temperature of TPGS–PEG 400 mixtures was investigated. In general, the cloud point temperature was reduced by the presence of either water or ethanol in the formulation. However, water was more effective in lowering the cloud point temperature than ethanol. Similarly, the phase diagram of TPGS–PEG 1450 was constructed. The cloud point temperature was observed to decrease with increasing TPGS concentration. It was found that TPGS and PEG 1450 could form a single phase when TPGS concentration was above 75%, based on differential scanning calorimetry, and FT‐Raman analysis indicated that a vibration at 1330 cm –1 disappeared in the melted single phase. In addition, a systematic melting point depression was observed for the mixtures of TPGS–PEG 1450. In the presence of Ibuprofen, a model compound, the cloud point temperature was also reduced. Finally, the extended Flory–Huggins theory for polymer solution was used to analyze the entropic and enthalpic contributions of water and ethanol to the free energy of mixing. © 2011 Wiley‐Liss, Inc. and the American Pharmacists Association J Pharm Sci 100:4907–4921, 2011Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87132/1/22659_ftp.pd

Optimization, Validation and Application of Spectrophotometric Assay for 3-Hydroxy-3-methylglutarylcoenzyme A Reductase Activity

Purpose: To improve the sensitivity and specificity of spectrophotometric 3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase activity assay.Methods: Spectrophotometric HMG-CoA reductase detection in male Wistar rat liver microsomes was optimized by applying different conditions, such as reaction buffer pH, NADPH and protein concentration, and preincubation and reaction times. The optimal set of conditions was validated using HMG-CoA reductase inhibitors, namely, pravastatin, fluvastatin, and rosuvastatin. IC50 was calculated and compared with that of a radiochemical assay. Ginkgo biloba extract’s (GBE50) inhibitory effect on HMG-CoA reductase activity was evaluated using the optimized spectrophotometric protocol.Results: The optimum assay conditions were as follows: reaction buffer pH 7.0, 100 μM NADPH, 50 μM HMG-CoA, and 200 μg/mL microsomal protein. The preincubation and reaction times were 20 and 60 min, respectively, at 37 ºC. The IC50 of pravastatin, fluvastatin, and rosuvastatin under the optimum condition was 0.026, 0.015, and 0.007 μM while for radioisotope assay, it was 0.034, 0.049 and 0.0119 μM, respectively. GBE50 significantly inhibited HMG-CoA reductase activity in a concentrationdependent manner (p < 0.05).Conclusion: These results suggest that HMG-CoA reductase activity can be detected using the improved spectrophotometric assay. This assay can facilitate the discovery and development of new HMG-CoA reductase inhibitors in vitro.Keywords: Spectrophotometry, 3-Hydroxy-3-methylglutaryl-coenzyme A reductase activity, Cholesterol metabolism, Ginkgo biloba, Pravastatin, Fluvastatin, Rosuvastati

A Survey of Kansas Physicians' Perceptions of Physician Assistant Education and Qualifications

BACKGROUND: Effective physician-physician assistant (PA) teams improve patient access and satisfaction, and increase productivity and revenue while reducing physician workload. This survey assessed perceptions of Kansas primary care physicians regarding educational requirements and qualifications of PAs, professional and legal regulations, and the most important skills and competencies for PAs to possess. Understanding these perceptions may lead to improved communication and refined expectations of physician-physician assistant teams, thereby increasing their utilization and effectiveness. METHODS: A 20-question survey was emailed to all 1,551 primary care physicians registered with the Kansas Board of Healing Arts in 2012. Descriptive data were reported as frequencies; comparisons between groups were analyzed using Chi-square. RESULTS: The response rate was 9.2% (n = 143). Physicians were highly accurate regarding the program’s generalist/primary care educational model and moderately accurate regarding the degree awarded, average pre-program grade point average, lock-step full-time curriculum, weeks of clinical rotations, recertification and continuing medical education hours, and Medicare PA fee schedule. Physicians had low accuracy regarding program and pharmacology credit hours, strict dismissal policy, pre-program healthcare experience, and co-signatory regulations. Physicians with PA supervisory experience had higher knowledge than those without (p = 0.001). Physicians most commonly selected history taking and performing physical exam as the most important skill (49%) and providing patient care that is patient-centered, efficient, and equitable as the most important competency (42%). CONCLUSIONS: Physicians often underestimated the average PA applicant qualifications, program rigor and intensity, professional regulatory standards, and co-signatory requirements. Correcting misperceptions and improving understanding of which PA skills and competencies are most valued by physicians may optimize PAs as part of the healthcare team

Diuretic action of exogenous hydrogen sulfide in spontaneously hypertensive diabetic rats

Purpose: To examine the hypothesis that in hypertensive diabetic rats hydrogen sulphide (H2S) reduces blood pressure through diuretic action in addition to its vasodilating effect.Methods: Spontaneously hypertensive rats (SHR) and Wistar-Kyoto (WKY) rats were used. SHR were divided into three groups: SHR (II), SHR diabetic (III), and SHR diabetic NaHS-Treated (IV) with a group of WKY (I) rats serving as normotensive nondiabetic control. Diabetes was produced in two SHR groups using intraperitoneal streptozotocin (STZ). One diabetic group received NaHS, a donor of H2S (56 μM/kg i.p.) daily for five weeks. Blood pressure was measured in conscious and anesthetized states in surgically prepared animals. Plasma and urinary H2S levels and electrolytes were measured weekly throughout the 35-day period.Results: SHR and diabetic SHR had higher blood pressure and lower plasma and urinary H2S levels compared to WKY controls (p < 0.05). Moreover, the SHR diabetic group had higher plasma sodium, higher absolute and fractional sodium excretions (p < 0.05) but with similar blood pressure compared to SHR controls. NaHS treatment reduced blood pressure and restored H2S and plasma sodium (p < 0.05) levels. Moreover, SHR diabetic-NaHS treated group had higher urine output and absolute urinary sodium excretion compared to the untreated SHR diabetic group (p < 0.05).Conclusion: These results suggest a possible diuretic effect of exogenous H2S in spontaneously hypertensive diabetic rats.Keywords: Spontaneously hypertensive rats, Diabetes, Hydrogen sulphide, Diuretic, Sodium excretion, Urine outpu

efficacy and safety of mineralocorticoid receptor antagonist therapy in heart failure with reduced ejection fraction

CoNCluSIoNS: The present review highlights the benefit of MRAs across the spectrum of HFrEF despite a higher incidence of hyperkalemia. Therefore, MRA therapy should not be withheld from appropriately selected patients with HFrEF because the risk of adverse events does not appear to exceed the overall benefit in mortality reduction

Increased prevalence of methicillin-resistant Staphylococcus aureus nasal colonization in household contacts of children with community acquired disease

<p>Abstract</p> <p>Background</p> <p>To measure Methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) nasal colonization prevalence in household contacts of children with current community associated (CA)-MRSA infections (study group) in comparison with a group of household contacts of children without suspected <it>Staphylococcus aureus </it>infection (a control group).</p> <p>Methods</p> <p>This is a cross sectional study. Cultures of the anterior nares were taken. Relatedness of isolated strains was tested using pulse field gel electrophoresis (PFGE).</p> <p>Results</p> <p>The prevalence of MRSA colonization in the study group was significantly higher than in the control group (18/77 (23%) vs 3/77 (3.9%); p ≤ 0.001). The prevalence of SA colonization was 28/77 (36%) in the study group and 16/77 (21%) in the control group (p = 0.032). The prevalence of SA nasal colonization among patients was 6/24 (25%); one with methicillin-susceptible <it>S. aureus </it>(MSSA) and 5 with MRSA. In the study (patient) group, 14/24 (58%) families had at least one household member who was colonized with MRSA compared to 2/29 (6.9%) in the control group (p = 0.001). Of 69 total isolates tested by PFGE, 40 (58%) were related to USA300. Panton-Valetine leukocidin (PVL) genes were detected in 30/52 (58%) tested isolates. Among the families with ≥1 contact colonized with MRSA, similar PFGE profiles were found between the index patient and a contact in 10/14 families.</p> <p>Conclusions</p> <p>Prevalence of asymptomatic nasal carriage of MRSA is higher among household contacts of patients with CA-MRSA disease than control group. Decolonizing such carriers may help prevent recurrent CA-MRSA infections.</p

PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study

Objectives: To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions. Design: A multicenter, prospective, observational study was performed between August 2018 and January 2019. Setting: Community and academic hospitals in the United States. Participants: Emergency medicine clinical pharmacists. Interventions: Recommendations classified into one of 38 intervention categories associated with cost avoidance. Measurements and Main Results: Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established categories were as follows: adverse drug event prevention (1,631 interventions;$2,225,049 cost avoidance), resource utilization (628; $310,582), individualization of patient care (6,122;$1,787,170), prophylaxis (24; $22,804), hands-on care (3,533;$2,836,811), and administrative/supportive tasks (2,046; $342,881). Mean cost avoidance was$538.61 per intervention, $875.60 per patient, and$8,213.59 per emergency medicine pharmacist shift. The annualized cost avoidance from an emergency medicine pharmacist was $1,971,262. The monetary cost avoidance to pharmacist salary ratio was between$1.4:1 and $10.6:1. Conclusions: Pharmacist involvement in the care of patients presenting to the emergency department results in significant avoidance of healthcare costs, particularly in the areas of hands-on care and adverse drug event prevention. The potential monetary benefit-to-cost ratio for emergency medicine pharmacists is between$1.4:1 and $10.6:1

Talaromyces atroroseus, a new species efficiently producing industrially relevant red pigments

Some species of Talaromyces secrete large amounts of red pigments. Literature has linked this character to species such as Talaromyces purpurogenus, T. albobiverticillius, T. marneffei, and T. minioluteus often under earlier Penicillium names. Isolates identified as T. purpurogenus have been reported to be interesting industrially and they can produce extracellular enzymes and red pigments, but they can also produce mycotoxins such as rubratoxin A and B and luteoskyrin. Production of mycotoxins limits the use of isolates of a particular species in biotechnology. Talaromyces atroroseus sp. nov., described in this study, produces the azaphilone biosynthetic families mitorubrins and Monascus pigments without any production of mycotoxins. Within the red pigment producing clade, T. atroroseus resolved in a distinct clade separate from all the other species in multigene phylogenies (ITS, β-tubulin and RPB1), which confirm its unique nature. Talaromyces atroroseus resembles T. purpurogenus and T. albobiverticillius in producing red diffusible pigments, but differs from the latter two species by the production of glauconic acid, purpuride and ZG-1494α and by the dull to dark green, thick walled ellipsoidal conidia produced. The type strain of Talaromyces atroroseus is CBS 133442

Pessary or progesterone to prevent preterm birth in women with short cervical length.: Protocol of the 4–6 year follow-up of a randomised controlled trial (Quadruple-P)

INTRODUCTION: Vaginal progesterone and a cervical pessary are both interventions that are investigated for the prevention of preterm birth (PTB). Thus far, beneficial or harmful effects of these interventions on long-term child health and development are described, but evidence is not robust enough to draw firm conclusions. With this follow-up study, we intent to investigate if progesterone or a pessary is superior for the prevention of PTB considering the child's health at 4-6 years of corrected age. METHODS AND ANALYSIS: This study is a follow-up study of the Quadruple-P trial; a multicentre, randomised clinical trial (NL42926.018.13, Eudractnumber 2013-002884-24) which randomises women with an asymptomatic midtrimester short cervix to daily progesterone or a pessary for the prevention of PTB. All children born to mothers who participated in the Quadruple-P study (n=628 singletons and n=332 multiples) will be eligible for follow-up at 4-6 years of corrected age. Children will be assessed using parental questionnaires. Main outcomes are child (neuro)development and behaviour. Other outcomes include child mortality, growth and general health. A composite of adverse child outcomes will be compared between the progesterone and pessary groups reporting OR and the corresponding 95% CI. Analyses will be performed separately for singletons and multiples and using the intention-to-treat approach. ETHICS AND DISSEMINATION: The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (WMO) did not apply to our study (W20_481 #20.531). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER: Dutch Trial Register (NL9646)