Novel Pentablock Copolymers as Thermosensitive Self-Assembling Micelles for Ocular Drug Delivery

Many studies have focused on how drugs are formulated in the sol state at room temperature leading to the formation of in situ gel at eye temperature to provide a controlled drug release. Stimuli-responsive block copolymer hydrogels possess several advantages including uncomplicated drug formulation and ease of application, no organic solvent, protective environment for drugs, site-specificity, prolonged and localized drug delivery, lower systemic toxicity, and capability to deliver both hydrophobic and hydrophilic drugs. Self-assembling block copolymers (such as diblock, triblock, and pentablock copolymers) with large solubility variation between hydrophilic and hydrophobic segments are capable of making temperature-dependent micellar assembles, and with further increase in the temperature, of jellifying due to micellar aggregation. In general, molecular weight, hydrophobicity, and block arrangement have a significant effect on polymer crystallinity, micelle size, and in vitro drug release profile. The limitations of creature triblock copolymers as initial burst release can be largely avoided using micelles made of pentablock copolymers. Moreover, formulations based on pentablock copolymers can sustain drug release for a longer time. The present study aims to provide a concise overview of the initial and recent progresses in the design of hydrogel-based ocular drug delivery systems

Prevalence, causes, and complications of acute kidney transplant rejection: survey in a single center

Backgrounds: Kidney transplantation has become a preferred surgical approach for several renal disorders. To acquire required information in basis of acute transplant rejection and its complications, it is important to determine rejection prevalence and its potential causes.Methods: In present retrospective study, during a 37-year survey, 2250 patients received conventional kidney transplantation. The patients who had suffered graft loss, death, and nephrectomy of transplanted kidney during the first month after transplantation enrolled the study and all required data recorded in designed questionnaire. Results: Of 2557 patients underwent kidney transplantation, 86 (3.36%) patients were suffered acute graft loss during the first month after transplantation, that 43 (50%) were males and 43 (50%) were females. Mean age of the patients with acute graft loss was 40.09±14.09. The most common underlying cause for acute graft loss in our study were as follows: acute rejection of transplanted kidney (34.9%), renal vein thrombosis (17.5%), heart infarction (13.9%), idiopathic (6.9%). Of 86 patients, thirty-three patients underwent nephrectomy subsequent to rejection, however, fifty-three patients well responded to medical treatment. In our study the amount of acute nephrectomy during the first month after transplantation was 38.4% (33 patients) which constituted 1.2% of the total graft losses.Conclusion: Renal vein thrombosis is the most common underlying reason for graft loss in kidney transplantation patients, and 1st week of the transplantation is the most probable postoperative time for graft rejection

Diagnostic Value of Chest Radiography in Pediatric Cardiovascular Diseases: A Retrospective Study in Tabriz, Northwest of Iran

Background and Objective: Chest X-ray is usually the first radiography performed for a newborn. This test is easily accessible and yet a basic screening method. Different results have been reported in various studies regarding the diagnostic value of chest X-ray in cardiovascular disease in children. Materials and Methods: The study was carried out retrospectively using the medical files of 100 patients under 15 years of age who were referred to Tabriz Children’s Hospital during 2013-2014. The data obtained were analyzed with SPSS-17. The mean difference test was used to compare the quantitative variables. P-values less than 0.05 were considered significant. Findings: Fifty-two patients (52%) were male. Their mean age was 4.54 1.22 (0-108) months, and the patients’ mean weight was 4.38 0.34 (1.25-27) kg. Cardiovascular examination and radiology report were negative in 70% and 57% of the patients, respectively, while cardiologic assessments revealed cardiovascular problems in 70% of the cases. The diagnostic accuracy, sensitivity, and specificity, and the positive and negative predictive value of chest X-ray in this study were 61%, 80%, 53%, 86%, and 42%, respectively. In addition, gender, age, weight, the presence or absence of clinical signs, and the type of cardiovascular disease had no effect on the diagnostic accuracy of chest X-ray. Conclusion: According to the results, chest radiography cannot be referred to as a test to confirm or rule-out cardiovascular disease in children. Therefore, when a cardiovascular disease is suspected in physical examination, echocardiography can be recommended without a need for chest X-ray

Misdiagnosis of Bland-White-Garland Syndrome: Report of Two Cases with Different Presentations

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) or Bland-White-Garland syndrome is usually an isolated cardiac anomaly but, in rare incidences, has been described with patent ductus arteriosus, ventricular septal defect, and tetralogy of Fallot. This syndrome may cause sudden death in infants and young people but in this case report we present two different types of presentation. First case was a 3 year old girl diagnosed with dilated cardiomyopathy since her infancy. Her electrocardiography showed prominent Q wave in lateral leads. Dilated right coronary artery was revealed by echocardiography. The second case was a girl with prolapsed mitral valve and chest pain but similar to first case she had prominent Q wave in lateral leads at her electrocardiography and dilated right coronary artery but without heart failure. ALCAPA in children may present with ambiguous presentations differing from dilated cardiomyopathy and full blown heart failure to an atypical chest pain attributed to prolapsed mitral valve

Preparation and evaluation of PCL-PEG-PCL micelles as potential nanocarriers for ocular delivery of dexamethasone

Objective(s): Micelles have been studied as nanoparticulate drug delivery systems for improving the topical ocular delivery of hydrophobic drugs. The objective of this study was to develop and characterize dexamethasone-loaded polycaprolactone-polyethylene glycol-polycaprolactone (PCL-PEG-PCL) micelles to improve patient compliance and enhance the ocular bioavailability of poorly water-soluble drugs. Materials and Methods: The PCL-PEG-PCL copolymers were synthesized via the ring opening polymerization of ε-caprolactone in the presence of PEG. The resulting purified copolymers were characterized by GPC, NMR, FTIR, XRD and DSC. The critical micelle concentrations (CMCs) of the copolymers mentioned were determined. Dexamethasone was loaded into polymeric micelles by film hydration method, and dexamethasone-loaded micelles were characterized by TEM and DLS. Drug release kinetics and ex vivo corneal permeability were also determined. Results: The CMC of the synthetized copolymers was approximately 0.03 mg/ml. Aqueous solutions of the resulting copolymers (400 mg/ml) rapidly formed a gel in situ at 34 °C. The TEM results exhibited the successful formation of spherical micelles. The size of the prepared micelles was approximately 40 nm. Formulated micelles sustained the release of the incorporated dexamethasone for 5 days. Conclusion: Data from ex vivo permeability tests indicated that PCL-PEG-PCL micelles can be suitable candidates for the ocular delivery of dexamethasone and, likely, other hydrophobic drugs

Blood Glucose Alterations in Spinal versus General anesthesia in those undergoing Cesarean Section Delivery

Introduction: Major body injury or surgery is associated with reproducible metabolic and hormonal responses. Alteration of blood glucose levels is one of the necessary metabolic changes to surgical stress. Surgical techniques and different methods of anesthesia are factors that can help to control and balance the body’s hormones. One of the most effective ways for decline the endocrine-metabolic response is local anesthesia. We conducted this study to compare the measurement of blood glucose before, during and after surgery and complete the pieces of anesthesia puzzle. Methods & Materials: This was retrospective cohort study performed on 126 patients between 18-38 ages under cesarean section. Sixty-three women who were undergoing spinal anesthesia have been selected as first group, and the second group was 63 patients with general anesthesia. In this study, level of glucose was recorded by glucometer 30 min before surgery (in waiting room), during operation (after childbirth) and 30 min after surgery (in recovery room) measured and recorded. Results: Average of blood glucose levels in spinal anesthesia group was significantly different between the three measurements (p value = 0.007), and also in the general anesthesia group were more significant (p value < 0.001). Mean of blood glucose 30 min before surgery in spinal and general anesthesia, were 81.49±14.64 and 84.09±10.95, respectively (p value = 0.26), and during surgery were 86.50±23.49 and 90.74±17.82 (p value = 0.256), and finally 30 min after operation were 79.93±18.35 and 94.87±16.32 ( p value < 0.001). Conclusion: Spinal anesthesia is more effective way to decease blood sugar alterations and its adverse effects on mothers hormonal system during cesarean sections

Evaluation of the VANRIS Injection Success Rate in Vesicoureteral Reflux (VUR) Treatment in Children

Background: Vesicoureteral reflux (VUR) is a common condition among children. Although, subureteral injection is a minimally invasive new method for VUR treatment, ideal bulking agent in endoscopic treatment still remains controversial. We aimed to evaluate VANTRIS subureteral injection efficacy in VUR treatment in pediatric patients. Materials and Methods: All patients who referred to Imam Khomeini hospital in Urmia-Iran, Urology ward with VUR diagnosis that had indications for open surgery, enrolled study (during Mar 2013 to Mar 2015). Prior to intervention, VUR severity, urinary tract infection (UTI) and subsequent complications determined using urine analysis and imaging. Subsequently, single injection of the VANTRIS performed for all patients and patients underwent six-month follow up including several clinical and paraclinical evaluations. Results: 31 patients with VUR diagnosis participated; of 31 patients, 18 (58.06%) children with primary UTI who had surgery indication enrolled study; of 18 patients, seven patients (38.88%) were boy and eleven patients (61.12%) were girl with mean age of 6.88 ± 2.61 years, and out of 29 refluxing rental units (RRU), 13 (44.8%) were right and 16 (55.2%) were left kidney. In current study, patients divided to two subgroups regarding their age older than five or younger than five years old and there was no significant difference between the resolution rates following VANTRIS injection in two groups (P>0.05). Eleven (38.88%) RRU detected in boy patients, nonetheless VUR resolved in all of them, postoperatively. On the other hand, of 18 RRU in female patients, complete VUR resolution observed in 16 kidneys (88.8 %), but only 2 (11.11%) kidneys had incomplete, but significant VUR resolution, where no significant difference observed. The prevalence of reflux in patients with UTI was 30% and in patients without UTI was 17%. Conclusion: The current study indicated that in all age groups of patients, the subureteral injection of the VANTRIS was an accurate and effective treatment modality for VU