Microencapsulation of Diclofenac Sodium by Nonsolvent Addition Technique

Purpose: To prepare, using non-solvent addition technique, diclofenac sodium-ethylcellulose microparticles with modified drug release properties.Methods: Microparticles were prepared by non-solvent addition phase separation method and characterized by micromeritics, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), x-ray diffraction (XRD), dissolution test and thermal analysis.Results: The microparticles were whitish, irregular, aggregated, and in the size range of 390 - 442 μm size. Drug embedment efficiency was 89 - 91 %. Characterisation studies indicate that there was no strong chemical interaction between the drug and the polymer in the microparticles. Polymer concentration and sustained release behavior were directly proportional.Conclusion: Non-solvent addition phase separation is a suitable method for preparing diclofenac sodium-ethylcellulose multi-unit controlled release drug delivery system.Keywords: Phase separation, Diclofenac sodium, Ethylcellulose, Non-solvent addition, Characterisation

Currently Available Tools and Teaching Strategies for the Interprofessional Education of Students in Health Professions : Literature review

Interprofessional education (IPE) is designed to provide students from different health sectors with opportunities to work together to enhance future collaboration. The implementation of IPE activities is a current trend in various countries. This review exclusively targets IPE issues involving undergraduate health profession students and highlights various approaches in different regions. A total of 28 articles published in peer-reviewed journals between January 2012 and July 2015 were assessed to determine recent trends in IPE implementation. Nine main strategies were identified: simulation-based education programmes; rotations in rural and community settings; interprofessional training wards; patient-centred case studies; theme-centred workshops; student seminars; student-delivered lectures; health promotion activities; and interactive lectures in a common setting. Many of these institutions had not restricted themselves to a single strategy and supplemented these activities with additional teaching or learning methods. Recommendations gathered from these diverse approaches may assist the development of sustainable strategies for implementing IPE in undergraduate medical curricula

Investigating the intracellular bactericidal effects of rifampicin loaded S-protected thiomeric chitosan nanocargoes against Mycobacterium tuberculosis

The antibiotic drug resistance in Mycobacterium tuberculosis (M.tb) is typically associated with immune evasion shared by pathogenic bacterium and intrinsic antimycobacterial drug resistance. These factors significantly contribute to the limited delivery of drugs intracelullary thereby posing an ever-growing threat to mankind. A promising approach to tackle this multi-drug resistance is to use nanocargoes (NCs) based drug delivery approach. The aim of the present study was to develop mannose coated S-protected thiomeric site-specific nanocargoes (MPTCh-NCs) of Rifampicin (Rif) in order to deliver drug locally inside the macrophages. This NCs-based delivery system modifies the macrophage activation states via mannose receptors and endocytosis to alter the macrophage activation state thus providing synergistic antimycobacterial effects. MPTCh-NCs were synthesized by ionic gelation method and assessed for particle size and encapsulation efficiency Moreover, MPTCh-NCs were also investigated in in vitro for drug release, macrophage uptake, buffering potential, Mycothione reductase (MTR) inhibition ability, minimum inhibitory concentration (MIC), phagolysosomal fusion, reactive oxygen species (ROS) production apoptosis and RV 1258 inhibition. The in vivo bioavailability study of MPTCh-NCs was also evaluated in male BALB/c models over a period of 72 h. The optimized MPTCh-NC formulation was nanosized (390 ± 20 nm) with better EE of Rif i.e. 73.68 ± 5.99%. The MPTCh-NCs showed better buffering capacity at different pH ranges, 35.69 folds higher macrophage uptake than Rif with P-gp inhibition potential and pronounced MTR inhibition potential. The MPTCh-NCs exhibited MIC of 16 μg/ml by drug susceptibility testing. Flow cytometric analysis of MPTCh-NCs exhibited, increased apoptosis (33.29%). Real time PCR data suggested enhanced RV 1258 inhibition potential (0.387 fold expression) of the MPTCh-NCs. In vivo results indicated increased bioavailability of MPTCh-NCs (AUC 12.31 folds higher) in comparison to conventional drug Rif. In summary, the observed capacity of the mannose coated S-protected NCs-based approach to deliver therapeutic levels of Rif selectively has potential to improve the therapeutic management against drug resistant tuberculosis

A Hyaluronic Acid Functionalized Self-Nano-Emulsifying Drug Delivery System (SNEDDS) for Enhancement in Ciprofloxacin Targeted Delivery against Intracellular Infection

Ciprofloxacin (CIP), a potent anti-bacterial agent of the fluroquinolone family, shows poor solubility and permeability, thus leading to the development of intracellular pathogens induced multi-drug resistance and biofilms formation. To synergistically improve the biopharmaceutical parameters of CIP, a hyaluronic acid (FDA approved biocompatible polymer) functionalized self-nano emulsifying drug delivery system (HA-CIP-SNEDDS) was designed in the present study. SNEDDS formulations were tested via solubility, droplet size, zeta potential, a polydispersity index, thermodynamic stability, surface morphology, solid-state characterization, drug loading/release, cellular uptake, and biocompatibility. The final (HA-CIP-SNEDDS) formulation exhibited a mean droplet size of 50 nm with the 0.3 poly dispersity index and negative zeta potential (-11.4 mV). HA-based SNEDDS containing CIP showed an improved ability to permeate goat intestinal mucus. After 4 h, CIP-SNEDDS showed a 2-fold and HA-CIP-SNEDDS showed a 4-fold permeation enhancement as compared to the free CIP. Moreover, 80% drug release of HA-CIP-SNEDDS was demonstrated to be superior and sustained for 72 h in comparison to free CIP. However, anti-biofilm activity of HA-CIP-SNEDDS against Salmonella typhi was higher than CIP-SNEDDS and free CIP. HA-CIP-SNEDDS exhibited increased biocompatibility and improved oral pharmacokinetics as compared to free CIP. Taken together, HA-CIP-SNEDDS formulation seems to be a promising agent against Salmonella typhi with a strong targeting potential

Knowledge, Attitude, and Practices of Pregnant Women Towards COVID-19: An On-site Cross-sectional Survey

Objective: To assess the knowledge, attitude, and practices (KAP) of pregnant women towards coronavirus disease 2019 (COVID-19). Methods: This on-site cross-sectional survey was conducted in the antenatal and fetal medicine clinics in a tertiary care hospital in North India. Pregnant women attending the maternal-fetal unit filled out a 31-item questionnaire assessing their KAP towards COVID-19. Correlation between KAP was assessed by using Spearman’s rank correlation. Results: Some 302 questionnaires were analyzed: more than 90% of women had correct general knowledge of COVID, but only 12.3% scored 50% or more for pregnancy-related knowledge. Some 67% of women reported more than usual anxiety, and 7.7% reported severe anxiety levels. General knowledge improved with age, education, and occupation but pregnancy-related knowledge and anxiety score were unaffected by these variables. Conclusions: Pregnant women's knowledge of COVID-19 infection, in general, is excellent and they have the correct attitude towards preventive strategies. However, knowledge and attitude towards its effect on pregnancy are limited

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Background: The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods: We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Results: Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75-1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD -3.44% per week, 95% CI -4.99 to -1.90; p < 0.0001). Conclusion: In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care

Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.

OBJECTIVE: This report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA). METHODS: Perinatal/neonatal data were collected for 9575 infants of extremely low GA (22-28 weeks) and very low birth weight (401-1500 g) who were born at network centers between January 1, 2003, and December 31, 2007. RESULTS: Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at CONCLUSION: Although the majority of infants with GAs of \u3eor=24 weeks survive, high rates of morbidity among survivors continue to be observed