Effects of various penetration enhancers on percutaneous absorption of piroxicam from emulgels

A suitable emulgel formulation of piroxicam was prepared and its percutaneous permeation was investigated using Wistar rat skin and diffusion cell technique. The concentrations of the drug in receptor phase of diffusion cells were measured using HPLC method. The effect of three types of penetration enhancers (Myrj 52, cineol and Transcutol P) with different concentrations on transdermal permeation of the drug was also evaluated. Flux, Kp and enhancement ratios (ERs) of piroxicam in the presence of enhancers was measured and compared with emulgel base alone and simple commercial gel. The results showed a significant enhancement in the flux from emulgel base compared to hydroalcoholic gel formulation (9.91 folds over simple gel). The highest enhancement ratio (ER=3.11) was observed for Myrj 52 at the concentration of 0.25%. Higher concentrations of Myrj 52did not show any enhancement in the drug flux due to micelle formation and solubilization of the drug by micelles. The increase in solubility, in turn, increases the saturated concentration and reduces the thermodynamic activity of the drug. Transcutol® P with concentrations higher than 0.25% w/w showed burst transportation of the drug through the skin. All concentrations of cineol and Transcutol did not show any enhancing effects over emulgel base alone (ER <1)

Comparison of the Sedative Effect and Recovery Time of Dexmedetomidine and Fentanyl during Elective Colonoscopy

BACKGROUND AND OBJECTIVE: Various medications such as propofol or midazolam are used with or without fentanyl as sedatives for colonoscopy. Dextroduromedine is a new sedative that activates the alpha-2 adrenergic receptor in the brain and the spinal cord with sedative, analgesic and sympatholytic effects. The aim of this study was to compare the sedative effect and recovery time of dexmedetomidine and fentanyl during elective colonoscopy. METHODS: In this double – blind clinical trial, 80 colonoscopy candidates aged 20-70 years old were randomly divided into two equal groups. 1 mcg/kg dexmedetomidine was administered to the intervention group and 0.5 mcg / kg fentanyl was administered to the control group before the start of the colonoscopy. Propofol (20 mg) was administered as bolus dose if needed during colonoscopy. The sedation rate was recorded based on Ramsay standard and mean bolus dose of propofol during colonoscopy. Recovery time and pain were recorded based on Visual Analog Scale (VAS) before discharge. FINDINGS: The two groups did not have a significant difference in terms of age, gender and sedation rate. The mean bolus dose of propofol in the fentanyl group was 72±14 and in the dexmedetomidine group was 7±0.24 mg (p=0.000). The recovery time in the fentanyl group was 4.38±2.38 minutes and in the dexmedetomidine group was 2.63±1.22 minutes (p=0.000). The pain after colonoscopy was 2.30±0.69 in the fentanyl group and 1.98±0.7 in the dexmedetomidine group (p=0.039). CONCLUSION: The results of this study showed that the combination of dexmedetomidine and propofol are more suitable for colonoscopy compared to the combination of fentanyl and propofol due to shorter recovery time

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Two Case Reports of Rare Brucellosis Complications in Two Different Ranges of Age

Brucellosis is a zoonosis disease, which is endemic in Iran. One of the provinces with high prevalence of this disease is Lorestan province. Osteoarticular involvement is the most common complication of Brucellosis. In a review of related studies, cellulitis-osteomyelitis and avascular necrosis have been reported scarcely as Brucellosis complications which are described in these two cases involving a 10-year as well as a middle-aged patient

Brucellosis-Induced Avascular Necrosis of the Hip in a Middle-Aged Person

Background: Brucellosis is a zoonotic disease mostly transmitted to humans through consumption of unpasteurized dairy products and can lead to a systemic disease with any organ involvement. In this report, we describe a case of brucellosis-induced avascular necrosis of the hip. Brucellosis was diagnosed through serological tests, and avascular necrosis of the femoral head was confirmed by pelvic MRI. The patient was treated with a combination of antimicrobial treatments and referred to the orthopedic service for total hip arthroplasty. Brucellosis may present with unusual manifestations and should be always taken into consideration, particularly in endemic areas

Prevalence of latent tuberculosis in HIV positive patients: a comparison of tuberculin skin test and IgM antibodies against M.tuberculosis antigens

Background and Objective: Diagnosis of latent tuberculosis infection (LTBI) by tuberculin skin test (TST) is accompaind with limitations. A few documented data exist regarding the performance of serology tests for LTBI diagnosis in HIV infection. The aim of this study was to determine LTBI prevalency and compare TST results and IgM antibodies against M.tuberculosis antigens (IAMA) for the diagnosis of LTBI in HIV infected individuals. Materials and Methods: In this discriptive study, sixty two HIV infected subjects were chosen randomly from an addict treatment center in Ahvaz southwest Iran during 2008. The patients underwent TST, using 5 TU of purified protein derivative, and IAMA was measured. Data were analyzed using SPSS-15 software and Chi-Square test. Results: From 62 studied cases, 34 (54.8%) had positive result for TST, whereas 6 (9.7%) had positive IAMA. LTBI was diagnosed in 37 (59.7%) by either TST or IAMA. Overall concordance between TST and IAMA was 45.2%. In subjects with positive test by either TST or IAMA, only 4.8% had positive test by either diagnostic procedure. Discordant results were found in 54.8% of subjects. Positive results for both diagnostic methods in subjects with above and below 200 CD4-cell/mm3 did not show any significant differences. Conclusion: This study showed that LTBI prevalence among HIV infected individuals among addict patients, in this region is higher than other parts of the world. Also TST is a useful test for LTBI diagnosis is preferable to IAMA method