Novel Emulsion Base for Vaginal Yeast Infection with Half Drug Concentration

The dissolution of the drug in the vaginal cavity strongly influences the efficacy of the product due to insufficient moisture at the vaginal site. This study was undertaken to develop semi-solid dosage forms of miconazole nitrate to optimize its release. Formulations containing miconazole nitrate at 2% were developed using hypromellose gel, non-ionic emulsion, and cationic emulsion. The effect of penetration enhancers such as propylene glycol, dimethyl sulfoxide (DMSO), and diethylene glycol monoethyl ether at various concentrations was studied. Diffusion studies were carried out to evaluate the drug release and compared it against a commercial product. Formulation with the highest drug release was further evaluated at half (1%) drug concentration. Formulation with reduced drug levels along with the commercial product was evaluated for drug release for an extended time using human cadaver skin. The general order of average cumulative drug release from three bases was observed to be cationic emulsion > hydroxypropyl methylcellulose >non-ionic emulsion. Among all samples, the cationic emulsion with 5% DMSO gave a maximum drug release of 7.27 ± 0.2 mg/cm2 with a flux of 0.70 mg/cm2/min compared to only 3.09 ± 0.1 mg/cm2 drug release with 0.51 mg/cm2/min flux for brand product. The average cumulative drug release for formulation with half (1%) drug and brand (2% drug) over a period of 12 h through human cadaver skin was observed to be 8.28 ± 0.9 mg/cm2 and 8.71 ± 0.9 mg/cm2, respectively. This observation was in conformance with the in vitro antifungal studies showing an equivalent zone of inhibition. Keywords: Cationic emulsion, Drug release, Dimethylsulfoxide, In vitro antifungal study

Managing and Recovering from the COVID-19 Pandemic – Dubai We Learn Research Report

In this time of crisis, benchmarking and learning from global best practices have never been more important. It was for this reason the Dubai Government Excellence Program (DGEP) launched an accelerated benchmarking initiative called “Dubai We learn – Conquering COVID-19” to provide best practices and ideas to Dubai Executive Council’s Supreme Committee of Crisis and Disaster Management with the aim “for Dubai to become a Global Best Practice in Managing and Recovering from the COVID-19 Pandemic”

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Correlation between clinical symptoms and cone beam computed tomography finding in temporomandibular disorders patients

Background: Abnormalities of temporomandibular joint, masticatory muscles, and/or related structural abnormalities are known as temporomandibular disorders. The use of cone beam computed tomography for temporomandibular imaging is becoming more prevalent. Aim: This study was carried out to analyse correlation between clinical symptoms and cone beam computed tomography finding in temporomandibular disorders patients. Methods and materials: This study looked at cone beam computed tomography pictures and clinical records of 40 patients with temporomandibular joint issues who sought treatment in Sangli district of Maharashtra between 2016 and 2018. The type of condylar bony change was classified based on the cone beam computed tomography images using both Koyama et al's classification and Ahmad et al's image analysis criteria. An orofacial pain specialist took a complete history and did a clinical assessment on all of the participants. The average pain intensity level self-reported in the previous week was graded on a 0 to 10 verbal rating scale, with "0" indicating no pain and "10" indicating the worst pain possible. Results: The greatest condyle bony change and verbal pain rating had a poor association. There was no statistically significant link between maximum condyle alteration and maximum openness