One step conservative surgery: an approach to manage placenta accreta spectrum

The incidence of placenta accreta spectrum (PAS) has been arisen over past few decade, attributed to increasing caesarean section rate from 1:2500 to 1:500. Caesarean hysterectomy cases are increasing to prevent morbidity and mortality in PAS. The conservative approach for PAS is to prevent postpartum hemorrhage and to preserve the uterus. We present a case of placenta accreta spectrum where we had done one step conservative surgery. A 35year old woman G3P2A0 with 32 weeks of twin pregnancy with previous caesarean section with complaints of premature rupture of membrane was admitted in emergency labour room. Patient went into preterm labour on third day of admission and delivered two live preterm babies. Placenta could not be removed after delivery. Manual removal of placenta was tried but placenta could not be removed completely and bleeding was excessive after the procedure. Medical management of postpartum hemorrhage was done. On local examination there was no cervico-vaginal tear and laceration, upper segment of uterus appeared to be well contracted, lower segment ballooned up and bleeding was still excessive. Decision of emergency laparotomy was taken. Patient underwent emergency laparotomy for postpartum hemorrhage followed by segmental resection of invaded area, bleeding stop. Post operative period is uneventful.In young and low parity patient, one step conservative surgery can be considered a uterine preserving approach in the absence of placenta praevia

Influence of polymethacrylates and compritol on release profile of a highly water soluble drug metformin hydrochloride

Aims: The present investigation studied effect of polymethacrylates Eudragit RSPO, Eudragit RLPO and compritol 888 ATO on release profile of highly water soluble drug metformin hydrochloride (MET). Materials and Methods: The solid dispersions were prepared using drug:polymer ratios 1:1 and 1:5 by coevaporation and coprecipitation techniques. Solid dispersions were characterized by infrared Spectroscopy (IR), differential scanning calorimetry (DSC), X-ray diffractometry (XRD) as well as content uniformity, in vitro dissolution studies in 0.1 N HCl pH 1.2, phosphate buffer pH 6.8. Results and Discussion: Results of the studies suggested that there were progressive disappearance or changes of prominent peaks in IR, X-ray diffraction and thermotropic drug signals in coevaporates and coprecipitates with increased amount of polymers. Moreover, the in vitro release of highly water soluble MET could be extended at higher drug:polymer ratios. Conclusion: It was summarized that Eudragit RLPO had greater capacity of drug release than Eudragit RSPO and Comproitol 888 and its coevaporates in 1:5 drug:polymer ratio (F11) displayed extended drug release with comparatively higher dissolution rates (92.15 % drug release at 12 hour) following near Zero order kinetics (r2 =0.9822).Objetivo: La presente investigación estudia EL efecto de polimetacrilato Eudragit RSPO, Y RLPO EUDRAGIT compritol 888 ATO en el perfil de liberación de un farmaco altamente soluble en agua como es el clorhidrato de metformina (MET). Materiales y Métodos: Las dispersiones sólidas se prepararon utilizando fármaco:polímero en proporciones 1:1 y 1:5 por técnicas de coprecipitación y coevaporation. Las dispersiones sólidas se caracterizaron por espectroscopía de infrarrojo (IR), calorimetría diferencial de barrido (DSC), difracción de rayos X (DRX), así como uniformidad de contenido, los estudios de disolución in vitro de 0,1 N HCl pH 1.2 , tampón fosfato pH 6.8 . Resultados y Discusión: Los resultados de los estudios sugiere que hubo desaparición progresiva o cambios de los picos en IR, señales termotrópicos de fármaco en coevaporados y coprecipitados con aumento de la cantidad de polímeros de difracción de rayos X. Por otra parte, la liberación in vitro de MET altamente soluble en agua podría extenderse a rangos más altos de fármaco : polímero. Conclusión: Se resume Y RLPO EUDRAGIT que había mayor capacidad de liberación de fármacos de Eudragit RSPO y Comproitol 888 y su coevaporates en 1:5:polímero relación drogas (F11) extendidos liberación de fármacos con tasas comparativamente mayor disolución (92,15 % liberación de fármacos a las 12 horas) cercano a cero orden cinética (r2 = 0,9822 )

Influencia de compritol polimetracrilato en el perfil de liberaciónde un farmaco altamente soluble en agua, clorhidrato de metformina

Aims: The present investigation studied effect of polymethacrylates Eudragit RSPO, Eudragit RLPO and compritol 888 ATO on release profile of highly water soluble drug metformin hydrochloride (MET).Materials and Methods: The solid dispersions were prepared using drug:polymer ratios 1:1 and 1:5 by coevaporation and coprecipitation techniques. Solid dispersions were characterized by infrared Spectroscopy (IR), differential scanning calorimetry (DSC), X-ray diffractometry (XRD) as well as content uniformity, in vitro dissolution studies in 0.1 N HCl pH 1.2, phosphate buffer pH 6.8.Results and Discussion: Results of the studies suggested that there were progressive disappearance or changes of prominent peaks in IR, X-ray diffraction and thermotropic drug signals in coevaporates and coprecipitates with increased amount of polymers. Moreover, the in vitro release of highly water soluble MET could be extended at higher drug:polymer ratios.Conclusion: It was summarized that Eudragit RLPO had greater capacity of drug release than Eudragit RSPO and Comproitol 888 and its coevaporates in 1:5 drug:polymer ratio (F11) displayed extended drug release with comparatively higher dissolution rates (92.15 % drug release at 12 hour) following near Zero order kinetics (r2 =0.9822).Objetivo: La presente investigación estudia EL efecto de polimetacrilato Eudragit RSPO, Y RLPO EUDRAGIT compritol 888 ATO en el perfil de liberación de un farmaco altamente soluble en agua como es el clorhidrato de metformina (MET).Materiales y Métodos: Las dispersiones sólidas se prepararon utilizando fármaco:polímero en proporciones 1:1 y 1:5 por técnicas de coprecipitación y coevaporation. Las dispersiones sólidas se caracterizaron por espectroscopía de infrarrojo (IR), calorimetría diferencial de barrido (DSC), difracción de rayos X (DRX), así como uniformidad de contenido, los estudios de disolución in vitro de 0,1 N HCl pH 1.2 , tampón fosfato pH 6.8.Resultados y Discusión: Los resultados de los estudios sugiere que hubo desaparición progresiva o cambios de los picos en IR, señales termotrópicos de fármaco en coevaporados y coprecipitados con aumento de la cantidad de polímeros de difracción de rayos X. Por otra parte, la liberación in vitro de MET altamente soluble en agua podría extenderse a rangos más altos de fármaco : polímero.Conclusión: Se resume Y RLPO EUDRAGIT que había mayor capacidad de liberación de fármacos de Eudragit RSPO y Comproitol 888 y su coevaporates en 1:5:polímero relación drogas (F11) extendidos liberación de fármacos con tasas comparativamente mayor disolución (92,15 % liberación de fármacos a las 12 horas) cercano a cero orden cinética (r2 = 0,9822 )

Synthesis and biological evaluation of a novel series of 2-(2'-isopropyl-5'-methylphenoxy)acetyl amino acids and dipeptides

A series of new 2-(2'-isopropyl-5'-methylphenoxy)acetyl amino acids and peptides have been synthesized by coupling the 2-(2'-isopropyl-5'-methylphenoxy)acetic acid with amino acid methyl esters/dipeptides using DCC as coupling agent and TEA as base. The structures were elucidated by elemental analyses as well as FTIR, 1H NMR, 13C NMR and MS spectral data. The newly synthesized compounds were also evaluated for antibacterial and antifungal activities. Compounds (2, 6 and 15) were found to exhibit potent antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus and compounds (13, 14 and 16) were found to be potent antifungal agents against pathogenic Candida albicans.KEY WORDS: Phenoxy acetic acid, Amino acids, Dipeptides, Antibacterial activity, Antifungal activity.Bull. Chem. Soc. Ethiop. 2006, 20(2), 235-245

Prva potpuna sinteza i biološko vrednovanje himenamida E

A new potent bioactive, proline-rich cyclic heptapeptide hymenamide E (13) was synthesized using the solution phase technique by cyclization of the linear peptide Boc-Phe-Pro-Thr-Thr-Pro-Tyr-Phe-OMe (12) after proper deprotection at carboxyl and amino terminals. Linear peptide segment was prepared by coupling the tripeptide unit Boc-Phe-Pro-Thr-OH (10a) with the tetrapeptide unit Thr-Pro-Tyr-Phe-OMe (11a) using dicyclohexylcarbodiimide as the coupling agent and N-methylmorpholine as the base. Structures of all new compounds were characterized by IR, 1H NMR spectral data as well as elemental analyses. In addition, the structure of compound 13 was verified by 13C NMR, fast atom bombardment mass spectroscopy and differential scanning calorimetry. The newly synthesized cyclopeptide was screened for its antibacterial, antifungal and anthelmintic activities against eight pathogenic microbes and two earthworm species. Compound 13 showed potent antifungal activity against Candida albicans and Ganoderma species comparable to that of griseofulvin as a reference drug and potent anthelmintic activity against earthworms Megascoplex konkanensis and Eudrilus species in comparison to piperazine citrate.Novi biološki aktivni ciklički heptapeptid himenamid E (13) sintetiziran je ciklizacijom linearnog peptida Boc-Phe-Pro-Thr-Thr-Pro-Tyr-Phe-OMe (12) nakon uklanjanja zaštitnih skupina sa C-terminalnih i N-terminalnih aminokiselina. Linearni peptidni segment pripravljen je spajanjem tripeptidne jedinice Boc-Phe-Pro-Thr-OH (10a) s tetrapeptidnom jedinicom Thr-Pro-Tyr-Phe-OMe (11a) u prisutnosti dicikloheksilkarbodiimida i N-metilmorfolina kao baze. Strukture novih spojeva potvrđene su IR i 1H NMR spektroskopijom i elementarnom analizom, a struktura spoja 13 i 13C NMR, spektroskopijom masa i diferencijalnom pretražnom kalorimetrijom. Novosintetizirani ciklopeptid testiran je na antibakterijsko, antifungalno i anthelmintičko djelovanje na osam patogenih mikroorganizama i dva parazita. Spoj 13 snažno djeluje antifungalno na gljivice Candida albicans i vrste Ganoderma i anthelmintički na nametnike Megascoplex konkanensis i vrste Eudrilus. Kao poredbene ljekovite tvari uporabljeni su grizeofulvin i piperazin citrat

Prva potpuna sinteza i biološko vrednovanje himenamida E

A new potent bioactive, proline-rich cyclic heptapeptide hymenamide E (13) was synthesized using the solution phase technique by cyclization of the linear peptide Boc-Phe-Pro-Thr-Thr-Pro-Tyr-Phe-OMe (12) after proper deprotection at carboxyl and amino terminals. Linear peptide segment was prepared by coupling the tripeptide unit Boc-Phe-Pro-Thr-OH (10a) with the tetrapeptide unit Thr-Pro-Tyr-Phe-OMe (11a) using dicyclohexylcarbodiimide as the coupling agent and N-methylmorpholine as the base. Structures of all new compounds were characterized by IR, 1H NMR spectral data as well as elemental analyses. In addition, the structure of compound 13 was verified by 13C NMR, fast atom bombardment mass spectroscopy and differential scanning calorimetry. The newly synthesized cyclopeptide was screened for its antibacterial, antifungal and anthelmintic activities against eight pathogenic microbes and two earthworm species. Compound 13 showed potent antifungal activity against Candida albicans and Ganoderma species comparable to that of griseofulvin as a reference drug and potent anthelmintic activity against earthworms Megascoplex konkanensis and Eudrilus species in comparison to piperazine citrate.Novi biološki aktivni ciklički heptapeptid himenamid E (13) sintetiziran je ciklizacijom linearnog peptida Boc-Phe-Pro-Thr-Thr-Pro-Tyr-Phe-OMe (12) nakon uklanjanja zaštitnih skupina sa C-terminalnih i N-terminalnih aminokiselina. Linearni peptidni segment pripravljen je spajanjem tripeptidne jedinice Boc-Phe-Pro-Thr-OH (10a) s tetrapeptidnom jedinicom Thr-Pro-Tyr-Phe-OMe (11a) u prisutnosti dicikloheksilkarbodiimida i N-metilmorfolina kao baze. Strukture novih spojeva potvrđene su IR i 1H NMR spektroskopijom i elementarnom analizom, a struktura spoja 13 i 13C NMR, spektroskopijom masa i diferencijalnom pretražnom kalorimetrijom. Novosintetizirani ciklopeptid testiran je na antibakterijsko, antifungalno i anthelmintičko djelovanje na osam patogenih mikroorganizama i dva parazita. Spoj 13 snažno djeluje antifungalno na gljivice Candida albicans i vrste Ganoderma i anthelmintički na nametnike Megascoplex konkanensis i vrste Eudrilus. Kao poredbene ljekovite tvari uporabljeni su grizeofulvin i piperazin citrat

Cystic fibrosis presenting as small bowel obstruction in pediatric patient: a case report

Intestinal obstruction complete or incomplete has been found commonly in patients with cystic fibrosis in all age groups with variable presentation. Prevalence of intestinal obstruction in children with cystic fibrosis is 7-8%. Neonates present with meconium ileus due to inspissated meconium and complete obstruction. This case demonstrates similar presentation in a pediatric patient. A six day old male patient presented in the pediatric surgery department with abdominal distention, vomiting and fever. Patient was operated and intraoperative meconium plug was seen along with dilated proximal bowel, filled with sticky meconium. Resected gut segment was received in the Department of Pathology. Grossly dilated gut segment on cut section was seen filled with thick putty like greenish fecal matter. Histopathological examination showed features consistent with cystic fibrosis. There are multiple causes for intestinal obstruction in neonates, cystic fibrosis can be one of them which needs to be considered by the clinicians. Such cases need to be reported for better understanding of their clinico-pathological presentation and prevalence

Combinational effect of angiotensin receptor blocker and folic acid therapy on uric acid and creatinine level in hyperhomocysteinemia-associated hypertension

© 2019 International Union of Biochemistry and Molecular Biology, Inc. Homocysteine [HSCH2CH2CH(NH2)COOH] (Hcy) is a sulfur-containing amino acid of 135.18 Da of molecular weight, generated during conversion of methionine to cysteine. If there is a higher accumulation of Hcy in the blood, that is usually above 15 µmol/L, it leads to a condition referred to as hyperhomocysteinemia. A meta-analysis of observational study suggested an elevated concentration of Hcy in blood, which is termed as the risk factors leading to ischemic heart disease and stroke. Further experimental studies stated that Hcy can lead to an increase in the proliferation of vascular smooth muscle cells and functional impairment of endothelial cells. The analyses confirmed some of the predictors for Hcy presence, such as serum uric acid (UA), systolic blood pressure, and hematocrit. However, angiotensin-converting enzyme inhibitors angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) alone are inadequate for controlling UA and creatinine level, although the addition of folic acid may be beneficial in hypertensive patients who are known to have a high prevalence of elevated Hcy. We hypothesized that combination therapy with an ARB (olmesartan) and folic acid is a promising treatment for lowering the UA and creatinine level in hyperhomocysteinemia-associated hypertension

Čvrsta disperzija meloksikama: faktorijalno dizajnirani dozirani pripravak za gerijatrijsku populaciju

The objective of the present work was to improve the dissolution properties of the poorly water-soluble drug meloxicam by preparing solid dispersions with hydroxyethylcellulose (HEC), mannitol and polyethylene glycol (PEG) 4000 and to develop a dosage form for geriatric population. Differential scanning calorimetry, X–ray diffractometry, Fourier transform infrared spectroscopy and scanning electron microscopy were used to investigate the solid-state physical structure of the prepared solid dispersions. Higher in vitro dissolution of solid dispersions was recorded compared to their corresponding physical mixtures and the pure drug. PEG 4000 in 1:9 drug to carrier ratio exhibited the highest drug release (100.2%), followed by mannitol (98.2%) and HEC (89.5%) in the same ratio. Meloxicam-PEG 4000 solid dispersion was formulated into suspension and optimization was carried out by 23 factorial design. Formulations containing higher levels of methyl cellulose and higher levels of either sodium citrate or Tween 80 exhibited the highest drug release.Cilj rada bio je poboljšati topljivost meloksikama u vodi pripravom čvrstih disperzija s hidroksietilcelulozom (HEC), manitolom i polietilen glikolom 4000 (PEG 4000) te razviti dozirani pripravaka za gerijatrijsku populaciju. Za ispitivanje fizičke strukture pripravljenih čvrstih disperzija korištene su diferencijalna pretražna kalorimetrija, difraktometrija rentgentskim zrakama, FTIR i pretražna elektronska mikroskopija. Čvrste disperzije su u in vitro uvjetima pokazale bolju topljivost u odnosu na fizičku smjesu i čistu ljekovitu tvar. Najbolje oslobađanje lijeka (100,2%). postignuto je iz disperzija s PEG 4000 (omjer ljekovite tvari i nosača 1:9). Slijede manitol (98,2%) i HEC (89,5%) (isti omjer meloksikama i polimera). Čvrsta disperzija meloksikama s PEG 4000 prevedena je u suspenziju te optimirana 23 faktorijalnim dizajnom. Najbolje oslobađanje ljekovite tvari postignuto je iz pripravaka koji sadrže veći udio etilceluloze i natrijevog citrata, odnosno Tween 80

Improved Pharmacokinetics of Aceclofenac Immediate Release Tablets Incorporating its Inclusion Complex with Hydroxypropyl-β-Cyclodextrin

The present investigation reports the various pharmacokinetic parameters of immediate release aceclofenac tablets incorporating its inclusion complex with hydroxypropyl-β-cyclodextrin. The tablets were prepared using aceclofenac: hydroxypropyl-β-cyclodextrin in a 1:1 molar ratio by the direct compression method (TKN). The results were compared with those of the marketed brand (MKT) and pure drug (TAC). The P-values indicated that mean plasma concentrations were significantly different among all three formulations administered (P<0.05, P<0.01). TKN showed significantly higher plasma levels when compared to the pure drug (P<0.01). The Cmax and AUC(0-∞) of TKN were significantly higher (P<0.05) compared to the pure drug and marketed formulation. Furthermore, the first-order overall elimination rate constant (Kel) of TKN was also significantly higher (P<0.05) compared to the pure drug and its marketed formulation. These results suggested that tablets prepared by incorporating the AC-HPβCD inclusion complex (TKN) would provide a more rapid onset of pharmacological effects in comparison to the marketed formulation and pure drug