FORMULATION OPTIMIZATION AND EVALUATION OF MOUTH DISSOLVING FILM OF RAMOSETRON HYDROCHLORIDE

Objective: Ramosetron Hydrochloride is found to be more potent and having a longer duration of action with the least side effects, but the major drawback is it undergoes hepatic first-pass metabolism so our aim is to prepare mouth dissolving film (MDF) of Ramosetron hydrochloride for rapid relief in emesis. Methods: The mouth dissolving films of Ramosetron Hydrochloride were prepared by using the solvent casting method. Films were formulated using HPMC E5 (Hydroxy Propyl Methyl Cellulose) as a film-forming agent, PEG400 (Polyethylene glycol) as a plasticizer and Aspartame as the sweetening agent. A 32 full factorial design was applied considering the concentration of HPMC E5 (X1) and concentration of PEG400 (X2) as independent variables and % cumulative drug release (Y1) (CDR), disintegration time (Y2) (DT) and tensile strength (Y3) (TS) as dependent variables. The prepared films were evaluated for thickness, folding endurance, tensile strength, disintegration time, drug content uniformity and taste masking by E-tongue. The results indicated that factors X1 and X2 were found to be having a positive effect on DT and TS and negative effects on CDR. Results: The optimized formulation was found to be the best with 94.00±0.85% in vitro drug release, 33.22±0.75 sec DT and 1.359±0.005 g/mm2 tensile strength. Concentration of aspartame was optimized with E-tongue taking into consideration increased electric potential with decreasing bitterness. Conclusion: Thus, a rapidly dissolving oral film of Ramosetron Hydrochloride with successful taste masking and immediate in vitro drug release was prepared using a solvent casting technique

No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis

Background/Aims We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction. Methods Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed. Results Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%–95.2%) and 92.1% (95% CI, 68.4%–98.4%), clinical success rates of 88.6% (95% CI, 85.4%–91.1%) and 89.6% (95% CI, 79.0%–95.1%), adverse event rates of 11.4% (95% CI, 8.1%–15.9%) and 14.7% (95% CI, 4.4%–39.1%), and reintervention rates of 10.3% (95% CI, 6.7%–15.4%) and 3.5% (95% CI, 1.6%–7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40–9.18; p=0.008). Conclusions No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent

Congenital malformations at birth in 7,922 consecutive deliveries at Patan Hospital, Nepal

Introductions: Congenital malformations need to be identified and intervenedearly to save lives and prevent sufferings. Many birth defects have well knownincidence/prevalence rates but these have not been studied thoroughly in thelocal population of Nepal. The current study was undertaken to determine theprevalence of congenital malformation at birth, to classify them systematically,to study risk factors and immediate outcome of the newborn babies afflicted.Methods: This was a cross sectional study. All newly delivered babies wereexamined carefully for congenital malformation and when detected, theparents were interviewed in detail.Results: Over the 10 months of study period 7,922 babies were delivered outof which 90 were stillborn. The number of babies with malformations was 64(0.81%). Polydactyli was observed in 12 (19%) babies whereas cleft lip/palateand malformations of ears in seven (11%) each. Musculoskeletal system wasaffected in 31 (35%) cases and craniofacial in 18 (21%). Nine (14%) mothers had bad obstetric history and eight (13%) had illness/medication during pregnancy.Conclusions: Congenital malformation is a significant cause of morbidity andmortality in Patan hospital. Our findings support many established thoughtslike higher rates in stillbirths but also challenge some age-old beliefs like higherrates in babies born to older mothers.Keywords: adverse outcome, congenital malformation, perinatal mortality, riskfacto

The United States COVID-19 Forecast Hub dataset

Academic researchers, government agencies, industry groups, and individuals have produced forecasts at an unprecedented scale during the COVID-19 pandemic. To leverage these forecasts, the United States Centers for Disease Control and Prevention (CDC) partnered with an academic research lab at the University of Massachusetts Amherst to create the US COVID-19 Forecast Hub. Launched in April 2020, the Forecast Hub is a dataset with point and probabilistic forecasts of incident cases, incident hospitalizations, incident deaths, and cumulative deaths due to COVID-19 at county, state, and national, levels in the United States. Included forecasts represent a variety of modeling approaches, data sources, and assumptions regarding the spread of COVID-19. The goal of this dataset is to establish a standardized and comparable set of short-term forecasts from modeling teams. These data can be used to develop ensemble models, communicate forecasts to the public, create visualizations, compare models, and inform policies regarding COVID-19 mitigation. These open-source data are available via download from GitHub, through an online API, and through R packages

Virtual Reality in Pediatric Oncology

The mere thought of undergoing an invasive bedside procedure such as intravenous placement can have profound effects on pediatric oncology patients. If the outcome produces a negative experience for these patients, they will be apprehensive when encountering healthcare professionals during subsequent procedures and might inadvertently cause future procedures to be repeated due to preconceived fears. Currently, conventional methods to treat pain and anxiety in this patient population consist of premedicating patients with analgesia and anxiolytics. Most pediatric hospitals offer these traditional options to patients while there is a safer, noninvasive, feasible, and pleasant option that exists for patients to receive instead. Additionally, traditional medications can produce unexpected side effects that can last longer than expected and would require further medications to combat these side effects. Evidence shows that virtual reality, or VR for short, offers patients significant benefits while reducing their pain and anxiety levels. VR combines the use of computer software with a head-mounted device, or HMD, to immerse the patient in the virtual world with the objectives of decreasing their awareness of the present environment, reducing pain and anxiety levels, and offering a pleasant and enjoyable experience for the user. The equipment can be reused after being thoroughly disinfected, making it an extremely feasible option. The following PICOT question will be evaluated:In pediatric oncology patients undergoing invasive bedside medical procedures (P), how effective is the use of virtual reality distraction (I) compared to routine care (C) in reducing pain and anxiety (O) before and during the procedure over the course of three months (T)? Several evaluation tools will be used to measure the efficacy of this intervention and scorecard metrics will be analyzed. By offering patients and their caregivers this viable option, patient outcomes will be improved, which will increase satisfaction among patients and caregivers alike. Therefore, the utilization of VR is indicated and recommended for practice as it is a safer alternative to pain medications and anxiolytics for pediatric oncology patients who undergo invasive bedside procedures

Building the Toolbox of Devices to Optimize a Practice in Submucosal Endoscopy

Endoscopic submucosal dissection (ESD) is a technically complex and still evolving procedure. As a result, there are many advances in the technology and tools available to assist the endoscopist. This article delves into the various tools developed for ESD including electrosurgical knives, caps, injection agents, and traction devices. The authors discuss tools available as well as their respective pros, cons, and technical considerations for use. Overall, the choice of tools depends on a multitude of factors from availability, cost, lesion characteristics, and the endoscopist’s familiarity and proficiency

A community study of South Fishtail Bay.

As we have shown, the South Fishtail region of Douglas Lake contains a variety of habitats, each representing slightly different abiotic factors. By comparing past and present studies, we can see the difference in communities as they relate to species populations. This seems to show the greatest diversity and abundance of species in the structurally complex habitats of Douglas Lake. Moreover, species tend to cluster regions which are beneficial for their reproductive and survival success. It is the overlap of these different fish populations which serve as the basis for community structure and study.http://deepblue.lib.umich.edu/bitstream/2027.42/54500/1/2938.pdfDescription of 2938.pdf : Access restricted to on-site users at the U-M Biological Station

Impact of major hepatocellular carcinoma policy changes on liver transplantation for hepatocellular carcinoma in the United States

Since its inception in 2002, Model for End-Stage Liver Disease (MELD)-based allocation has undergone a series of revisions, especially with respect to exception points. Hepatocellular carcinoma (HCC) is the most common indication for MELD exceptions, and as a result of higher transplant proportions and lower waitlist mortality, a series of policy changes have been implemented to deprioritize HCC transplants. We examined the impact of HCC exception policy changes on transplant and waitlist mortality rates. We evaluated Organ Procurement and Transplantation Network/United Network for Organ Sharing data on adult patients from January 1, 2005, to June 4, 2021, focusing on waitlist mortality and deceased donor liver transplantation (DDLT) proportions. The data were divided into four policy eras: (1) MELD 22 points at waitlisting with an increase in points every 3 months (i.e., elevator) (January 2005-October 2015), (2) delay and cap at MELD 34 points (October 2015-May 2019), (3) delay and fixed exceptions based on donor service area (DSA) median MELD at transplantation minus three (MMaT-3; May 2019-February 2020), and (4) delay and fixed exceptions based on the MMaT-3 of centers within 250 nautical miles (i.e., acuity circles; February 2020-June 2021). We evaluated (a) changes in the proportions of DDLTs for patients with HCC exceptions within each era nationally and by DSA and (b) waitlist mortality in the three recent policy eras, focusing on mortality in the 6 months after the 6-month delay period. The percentage of adult DDLT with HCC exceptions decreased through the four eras: 22.9% (n = 14,049), 17.9% (n = 4598), 14.3% (n = 851), and 12.4% (n = 1425), respectively. Of the 51 DSAs analyzed, the annual percent change in DDLTs for patients with HCC exceptions was negative (i.e., decreased) in 47 (92.2%). Waitlist mortality remained stable. All HCC policy implementations led to a decrease in the percentage of transplants for HCC without an increase in waitlist mortality. The impact is not uniform across geographic areas

No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis

Background/Aims: We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction.Methods: Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed.Results: Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%-95.2%) and 92.1% (95% CI, 68.4%-98.4%), clinical success rates of 88.6% (95% CI, 85.4%-91.1%) and 89.6% (95% CI, 79.0%-95.1%), adverse event rates of 11.4% (95% CI, 8.1%-15.9%) and 14.7% (95% CI, 4.4%-39.1%), and reintervention rates of 10.3% (95% CI, 6.7%-15.4%) and 3.5% (95% CI, 1.6%-7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40-9.18; p=0.008).Conclusions: No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent