A Study of Sacral Hiatus in Dry Human Sacra in Southern Nigeria

The opening present at the caudal end of sacral canal is known as sacral hiatus. The aim of this study is to determine the anatomical variations of sacral hiatus in dry human sacra in southern Nigeria. This study was carried out on 54 dry human sacra in southern Nigeria. Various shape of the hiatus were observed which includes inverted U- shape (24.1%), inverted V-shape (33.3%), irregular (13.0%), Dumbbell (9.3%) and Bifid (5.6%). The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 66.7%. The mean length of sacral hiatus was 23.65mm. The mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 6.11mm. In conclusion, the sacral hiatus has anatomical variations and understanding of these variations may improve reliability of caudal epidural block. Keywords: sacral hiatus, dry human sacra, southern Nigeria

A Study of Sacral Hiatus in Dry Human Sacra in Southern Nigeria

The opening present at the caudal end of sacral canal is known as sacral hiatus. The aim of this study is to determine the anatomical variations of sacral hiatus in dry human sacra in southern Nigeria. This study was carried out on 54 dry human sacra in southern Nigeria. Various shape of the hiatus were observed which includes inverted U- shape (24.1%), inverted V-shape (33.3%), irregular (13.0%), Dumbbell (9.3%) and Bifid (5.6%). The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 66.7%. The mean length of sacral hiatus was 23.65mm. The mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 6.11mm. In conclusion, the sacral hiatus has anatomical variations and understanding of these variations may improve reliability of caudal epidural block. Keywords: sacral hiatus, dry human sacra, southern Nigeria

3D printed multi-drug-loaded suppositories for acute severe ulcerative colitis

Acute severe ulcerative colitis (ASUC) is a growing health burden that often requires treatment with multiple therapeutic agents. As inflammation is localised in the rectum and colon, local drug delivery using suppositories could improve therapeutic outcomes. Three-dimensional (3D) printing is a novel manufacturing tool that permits the combination of multiple drugs in personalised dosage forms, created based on each patient's disease condition. This study, for the first time, demonstrates the feasibility of producing 3D printed suppositories with two anti-inflammatory agents, budesonide and tofacitinib citrate, for the treatment of ASUC. As both drugs are poorly water-soluble, the suppositories' ability to self-emulsify was exploited to improve their performance. The suppositories were fabricated via semi-solid extrusion (SSE) 3D printing and contained tofacitinib citrate and budesonide in varying doses (10 or 5 mg; 4 or 2 mg, respectively). The suppositories displayed similar dissolution and disintegration behaviours irrespective of their drug content, demonstrating the flexibility of the technology. Overall, this study demonstrates the feasibility of using SSE 3D printing to create multi-drug suppositories for the treatment of ASUC, with the possibility of titrating the drug doses based on the disease progression

Virtually Possible: Enhancing Quality Control of 3D-Printed Medicines with Machine Vision Trained on Photorealistic Images

Three-dimensional (3D) printing is an advanced pharmaceutical manufacturing technology, and concerted efforts are underway to establish its applicability to various industries. However, for any technology to achieve widespread adoption, robustness and reliability are critical factors. Machine vision (MV), a subset of artificial intelligence (AI), has emerged as a powerful tool to replace human inspection with unprecedented speed and accuracy. Previous studies have demonstrated the potential of MV in pharmaceutical processes. However, training models using real images proves to be both costly and time consuming. In this study, we present an alternative approach, where synthetic images were used to train models to classify the quality of dosage forms. We generated 200 photorealistic virtual images that replicated 3D-printed dosage forms, where seven machine learning techniques (MLTs) were used to perform image classification. By exploring various MV pipelines, including image resizing and transformation, we achieved remarkable classification accuracies of 80.8%, 74.3%, and 75.5% for capsules, tablets, and films, respectively, for classifying stereolithography (SLA)-printed dosage forms. Additionally, we subjected the MLTs to rigorous stress tests, evaluating their scalability to classify over 3000 images and their ability to handle irrelevant images, where accuracies of 66.5% (capsules), 72.0% (tablets), and 70.9% (films) were obtained. Moreover, model confidence was also measured, and Brier scores ranged from 0.20 to 0.40. Our results demonstrate promising proof of concept that virtual images exhibit great potential for image classification of SLA-printed dosage forms. By using photorealistic virtual images, which are faster and cheaper to generate, we pave the way for accelerated, reliable, and sustainable AI model development to enhance the quality control of 3D-printed medicines

Alginate foam-based three-dimensional culture to investigate drug sensitivity in primary leukaemia cells

The development of assays for evaluating the sensitivity of leukaemia cells to anti-cancer agents is becoming an important aspect of personalized medicine. Conventional cell cultures lack the three-dimensional (3D) structure of the bone marrow (BM), the extracellular matrix and stromal components which are crucial for the growth and survival of leukaemia stem cells. To accurately predict the sensitivity of the leukaemia cells in an in vitro assay a culturing system containing the essential components of BM is required. In this study, we developed a porous calcium alginate foam-based scaffold to be used for 3D culture. The new 3D culture was shown to be cell compatible as it supported the proliferation of both normal haematopoietic and leukaemia cells. Our cell differential assay for myeloid markers showed that the porous foam-based 3D culture enhanced myeloid differentiation in both leukaemia and normal haematopoietic cells compared to two-dimensional culture. The foam-based scaffold reduced the sensitivity of the leukaemia cells to the tested antileukaemia agents in K562 and HL60 leukaemia cell line model and also primary myeloid leukaemia cells. This observation supports the application of calcium alginate foams as scaffold components of the 3D cultures for investigation of sensitivity to antileukaemia agents in primary myeloid cells

Colonic drug delivery: Formulating the next generation of colon-targeted therapeutics

Colonic drug delivery can facilitate access to unique therapeutic targets and has the potential to enhance drug bioavailability whilst reducing off-target effects. Delivering drugs to the colon requires considered formulation development, as both oral and rectal dosage forms can encounter challenges if the colon's distinct physiological environment is not appreciated. As the therapeutic opportunities surrounding colonic drug delivery multiply, the success of novel pharmaceuticals lies in their design. This review provides a modern insight into the key parameters determining the effective design and development of colon-targeted medicines. Influential physiological features governing the release, dissolution, stability, and absorption of drugs in the colon are first discussed, followed by an overview of the most reliable colon-targeted formulation strategies. Finally, the most appropriate in vitro, in vivo, and in silico preclinical investigations are presented, with the goal of inspiring strategic development of new colon-targeted therapeutics

Advancing oral delivery of biologics: machine learning predicts peptide stability in the gastrointestinal tract

The oral delivery of peptide therapeutics could facilitate precision treatment of numerous gastrointestinal (GI) and systemic diseases with simple administration for patients. However, the vast majority of licensed peptide drugs are currently administered parenterally due to prohibitive peptide instability in the GI tract. As such, the development of GI-stable peptides is receiving considerable investment. This study provides researchers with the first tool to predict the GI stability of peptide therapeutics based solely on the amino acid sequence. Both unsupervised and supervised machine learning techniques were trained on literature-extracted data describing peptide stability in simulated gastric and small intestinal fluid (SGF and SIF). Based on 109 peptide incubations, classification models for SGF and SIF were developed. The best models utilized k-Nearest Neighbor (for SGF) and XGBoost (for SIF) algorithms, with accuracies of 75.1% (SGF) and 69.3% (SIF), and f1 scores of 84.5% (SGF) and 73.4% (SIF) under 5-fold cross-validation. Feature importance analysis demonstrated that peptides’ lipophilicity, rigidity, and size were key determinants of stability. These models are now available to those working on the development of oral peptide therapeutics

Older people's priorities in health and social care research and practice: a public engagement workshop

As the world’s population ages, there is an increasing need for research that addresses the priorities of older people. A public engagement workshop focusing on the priorities of older people for research and practice in health and social care was attended by seventy-five people aged 70 years and above in London, United Kingdom (UK). The workshop aimed to identify and prioritise issues important to older people that would benefit from further research and act as a platform to promote sharing of ideas and problems related to these important issues. Key priorities emerged including loneliness and isolation, support and training for professional and family carers, post-surgical care, negative perceptions of older people and inequalities related to public services and healthcare. Participants further suggested older people should be actively involved in all stages of the research process

Medical and pharmacy students’ perspectives of remote synchronous interprofessional education sessions

Background Interprofessional education (IPE) at university level is an essential component of undergraduate healthcare curricula, as well as being a requirement of many associated regulatory bodies. In this study, the perception of pharmacy and medical students’ of remote IPE was evaluated. Methods A series of IPE sessions took place via Zoom and students’ feedback was collected after each session. Both qualitative and quantitative data were collected and analysed. Results 72% (23/32) of medical students strongly agreed that the sessions had helped to improve their appreciation of the role of pharmacists, whereas 37% (22/59) of pharmacy students strongly agreed, reporting a median response of ‘somewhat agreeing’, that their appreciation of the role of general practitioners had improved. This difference was found to be statistically significant (p = 0.0143). Amongst students who responded, 55% (53/97) identified remote teaching as their preferred mode of delivery for an IPE session. Conclusions The survey demonstrated that the students valued the development of their prescribing skills as well as the ancillary skills gained, such as communication and teamwork. Remote IPE can be a practical means of improving medical and pharmacy students’ understanding of each other’s professional roles, as well as improving the skills required for prescribing

Let's not forget those who forget! Participatory design in the context of dementia built environment : Evangelia Chrysikou

Dementia is a major cause of disability and dependency among older people worldwide. Eco-bio-psychosocially supportive design can significantly reduce agitation and depression while improving mobility and daily activities. For this we need to include dementia patients as experts while understanding the neurological changes and functional impairments associated with the progression of the disease over time. How can we support dementia patients to participate? What tools/processes can we use to involve them in the design process? The aim of this project was to map and evaluate co-design methods for dementia and neurodiversity, in order to create an eco-bio-psychosocially supportive environment. Mixed methods were used comprising a systematic literature review on co-design techniques for spaces for dementia, three workshops: a 3-day one with seven early career researchers translating patient involving methodologies to the dementia context, a round table Patient and Public Involvement and Engagement with six service providers and stakeholders cross three countries and a cross-sectoral international day conference with four academics, four early career researchers and eight stakeholders and a series of co-design workshops for dementia and neurodiversity, which were then classified according to applicability so as to generate co-production methods for living environments for dementia. This transdisciplinary project highlighted the challenges of participatory design in the context of dementia built environment. The importance of the topic was highlighted by clinicians and staff but there are still significant limitations in terms of research and methodologies. The workshops outcome was an inclusive code of conduct for participatory design and research for dementia patients, which will help to improve home and care environments for people with dementia. The framework involved aspects such as time, space, equipment in relation to people involved (carers, patients, proxies)