Polysorbate enhanced progesterone loaded drug diffusion from macromolecular fibrous patches for applications in obstetrics and gynaecology

Progesterone, a steroidal hormone, is used as pharmacotherapy in the clinical practice of obstetrics and gynaecology. There are however considerable bioavailability issues with the currently available formulation. Widening the range of progesterone formulations will increase the usefulness of this drug in a variety of clinical interventions. We undertook this study to create an ideal transdermal progesterone patch, which requires a reliable system to host and release drugs sustainably. This study investigates the use of a combined fatty acid, polysorbate 80 in distilled water or ethanol, with the well-known polymer polyvinylpyrrolidone (PVP). The rheology of the polymer solutions was investigated with incremental changes in either PVP or polysorbate. For each polymer solution, electrospinning was used to create fibre systems, which were characterised by scanning electron microscopy. The optimal polymer solution consisted of 2 g of PVP in 20 ml of ethanol with 4 ml of polysorbate. Performance analysis was completed by carrying out two drug release studies: direct submersion of fibres in PBS and transdermal drug delivery of fibres across a cellulose acetate membrane using Franz Diffusion Cells. The results have shown that the polysorbate loaded fibre systems reached near 100% drug release (over two weeks) and nearly 5 times faster than the fibres without polysorbate. This confirms the penetrative enhancing capabilities of polysorbate widely presented in literature. Kinetic release studies and geometric models were also used to observe the experimental behaviour compared to expectations. Experimental results closely fit both the Makoid Banakar model and the Geometric Equation

Histopathological study of pancreatobiliary tumors in a tertiary care center: a 7 year study

Background: The aim of this study was to comprehensively analyse the histopathological spectrum of pancreatobiliary tumors with special reference to ampulla of Vater.Methods: The retrospective study was done for 5 years and a prospective study was carried out for 2 years in the Department of Pathology.Results: A total of 110 cases were included; 103 underwent a standard Whipple procedure and 7 underwent localised resection (partial pancreatectomy). The average age was 52.64 years (16-80 years) and males outnumbered females (3:2). Malignant (93.63%) lesions outweighed benign lesions (6.36%). Among malignant lesions, 71 (68.93%) were peri-ampullary, 15 (14.56%) were pancreatic, 11 (10.67%) were duodenal and only 6 (5.825%) were cholangiocarcinoma. The most common presenting feature was jaundice followed by pain in the abdomen. The mean tumor size was 2.38 cm (0.5-15cm). The pathological stage of most of the tumors was T2 (58.2%), followed by T3 (22.7%), T1 (11.8%) and T4 was only 1.8%. Proximal duodenal resection margin was free in 90.9%, distal duodenal resection margin was free in all cases, CBD resection margin was involved in only 2 cases (1.8%), while the pancreatic duct resection margin was involved in 2.7%. The nodal status was N0 in 61.8%, N1 in 23.6% and Nx in 9.1%.Conclusions: Adenocarcinoma (well differentiated-47.3%) is the most common histological variant of pancreatobiliary region

Pseudocyst of pinna: a clinical experience

Background: Pseudocyst of pinna is an intracartilagenous accumulation of fluid in pinna and is hardly encountered in routine ENT practice. The etiology is unclear. It is seen to affect most commonly middle-aged males. Medical treatment is ineffective. Various treatments are suggested in the literature. The aims of the paper were to study the clinical and demographic characteristic of patients with pseudocysts.Methods: Forty patients were diagnosed with pseudocyst of the auricle between July 2016 and July 2019 on the basis of clinical characteristics, colour of aspirated fluid and absence of infection. Clinical and demographic characteristics were noted.Results: Out of 40 patients only five were females. Involvement of left side was seen more than right one. None had bilateral involvement. Adults in the age group of 31-45 were commonly affected. Most common site of involvement was triangular fossa.Conclusions: Pseudocyst of the pinna is a benign condition characterized by intracartilagenous accumulation of fluid. The disease is seen commonly unilaterally in middle aged males. Many modalities of treatment have been recommended in the literature with varied recurrence and failure rates

Society and Learning Research Priority Area - Research share September 2021

The session, held in September 2021, is an introduction to the work of Society and Leaning Research Priority Area (RPA), in which we examine the nature and role of the RPA as well as the ways in which it supports research in the university. The largest part of the event is an opportunity for staff to share a slide on their research, including the focus of the work, ongoing and potential projects, and opportunities for others to get involved

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Histopathological study of pancreatobiliary tumors in a tertiary care center: a 7 year study

Background: The aim of this study was to comprehensively analyse the histopathological spectrum of pancreatobiliary tumors with special reference to ampulla of Vater.Methods: The retrospective study was done for 5 years and a prospective study was carried out for 2 years in the Department of Pathology.Results: A total of 110 cases were included; 103 underwent a standard Whipple procedure and 7 underwent localised resection (partial pancreatectomy). The average age was 52.64 years (16-80 years) and males outnumbered females (3:2). Malignant (93.63%) lesions outweighed benign lesions (6.36%). Among malignant lesions, 71 (68.93%) were peri-ampullary, 15 (14.56%) were pancreatic, 11 (10.67%) were duodenal and only 6 (5.825%) were cholangiocarcinoma. The most common presenting feature was jaundice followed by pain in the abdomen. The mean tumor size was 2.38 cm (0.5-15cm). The pathological stage of most of the tumors was T2 (58.2%), followed by T3 (22.7%), T1 (11.8%) and T4 was only 1.8%. Proximal duodenal resection margin was free in 90.9%, distal duodenal resection margin was free in all cases, CBD resection margin was involved in only 2 cases (1.8%), while the pancreatic duct resection margin was involved in 2.7%. The nodal status was N0 in 61.8%, N1 in 23.6% and Nx in 9.1%.Conclusions: Adenocarcinoma (well differentiated-47.3%) is the most common histological variant of pancreatobiliary region