Formulation and evaluation of Fluconazole Nanosuspensions: In vitro characterization and transcorneal permeability studies.

The aim in this study was to develop and evaluate a nanofluconazole (FLZ) formulation with increased solubility and permeation rate using nanosuspensions. The FLZ nanosuspensions were stabilized using a variety of stabilizing agents and surfactants in various concentrations. The FLZ nanosuspension was characterized in vitro using particle size, zeta potential, X-ray powder diffraction (XRPD), and solubility. In addition, the ex vivo ocular permeation of FLZ through a goat cornea was analyzed. The results showed that the particle size of all nanosuspension formulations was in the nanometer range from 174.5 ± 1.9 to 720.2 ± 4.77 nm; that of the untreated drug was 18.34 µm. The zeta potential values were acceptable, which indicated suitable stability for formulations. The solubility of the nanosuspensions was up to 5.7-fold higher compared with that of the untreated drug. The results of the ex vivo ocular diffusion of the FLZ nanosuspensions showed the percentage of FLZ penetrating via the goat cornea increased after using Kollicoat to stabilize the nanosuspension formulation. Consequently, when using a nanosuspension formulation of Kollicoat, the antifungal activity of the drug strengthens.

Fluconazole nanoparticles prepared by antisolvent precipitation technique: Physicochemical, in vitro, ex vivo and in vivo ocular evaluation.

The goal of this research was to prepare and characterize nanonized particles of the antifungal drug, fluconazole (FLZ) using antisolvent precipitation nanonization technique to improve its ocular permeation. The impact of various concentrations of different stabilizers, namely Pluronic F-127 (PL F 127), Kollicoat IR (KL), hydroxypropyl methylcellulose E3 (HPMC), xanthan gum (XG), polyvinyl pyrrolidone K30 (PVP), and sodium lauryl sulfate (SLS) upon the resulting nanoparticles was investigated. Additionally, the ex vivo release of the FLZ nanonized particles from ophthalmic gel bases was studied by using goat cornea, and the ocular pharmacokinetics of appropriate ophthalmic gel base containing optimized drug nanoparticle formula compared to the untreated drug were studied in rabbits. FLZ nanoparticles were successfully prepared with different concentrations of stabilizers. However, the effects of these stabilizers on nanoparticle size and zeta potential values varied according to the concentration and type of stabilizer used. Based on differential scanning calorimetry, the drug was in its amorphous state in the tested nanoparticle formulations. The results of ex vivo ocular diffusion of the FLZ nanoparticle gel formulations revealed an improvement compared to that with the FLZ untreated gel. Nanoparticle formula (F3) prepared by using 5% PL F127 showed small particle size (352 ± 6.1 nm) with zeta potential value of -18.3 mV with highest ex vivo release rate from goat cornea (100% after 6 h). Moreover, the AUC0-8h from ocular application of FLZ from sodium alginate gel containing nanoparticle formula F3 was 1.4-fold higher than that after its administration in the untreated formula. Based on our findings, the ophthalmic gel formulations containing FLZ nanoparticles enhanced drug corneal permeation and improved the ocular pharmacokinetic parameters.

Endoscopic Sleeve Gastroplasty in 109 Consecutive Children and Adolescents With Obesity: Two-Year Outcomes of a New Modality.

OBJECTIVES: Endoscopic sleeve gastroplasty (ESG) uses full-thickness sutures that restrict the stomach to a sleeve-like configuration. There is no published evidence on endoscopic tissue apposition techniques in pediatric patients. In this article, we report our ESG experience with the first 109 pediatric patients with obesity who underwent ESG under our care. METHODS: ESG was offered as a day-case procedure under a standardized protocol and clinical pathway that included surgical, medical, and endoscopic modalities for the treatment of pediatric and adult obesity. ClinicalTrials.gov Identifier: NCT03778697. RESULTS: The 109 patients in this study had a baseline body mass index and age of 33.0 ± 4.7 and 17.6 ± 2.2 (range: 10-21) years, respectively. Ninety-nine (90.8%) were females. The mean procedure time was 61 ± 19 minutes. The mean % total weight loss at 6, 12, 18, and 24 months was 14.4% ± 6.5%, 16.2% ± 8.3%, 15.4% ± 9.2%, and 13.7% ± 8.0%, respectively. Fourteen adolescents visited the ambulatory clinic for analgesia. One patient (aged 19.8 years) requested removal of endoscopic stitches due to abdominal pain, and another underwent Redo-ESG for insufficient weight loss. There were no blood transfusions, emergency admissions, mortality, or significant morbidity. DISCUSSION: In this first study to date on ESG in pediatric patients, we observed that the procedure is safe and effective in children and adolescents with obesity. Significant weight loss occurs during the first 2 years without mortality or significant morbidity, and this weight loss seems to be maintained.

Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients.

BACKGROUND AND AIMS: Questions related to the safety and long-term efficacy of endoscopic sleeve gastroplasty (ESG) are not yet answered. Here we report weight loss, morbidity, revisions, and comorbidity resolution during the first 18 months after primary ESG. METHODS: This is a consecutive case series from a prospective observational study executed in a specialized center with a standardized pathway for multimodal management of obesity. RESULTS: The 1000 patients in this study had a baseline body mass index of 33.3 ± 4.5 kg/m2 and age of 34.4 ± 9.5 years. Eight hundred ninety-seven patients (89.7%) were women. Mean percentage of total weight loss at 6, 12, and 18 months was 13.7% ± 6.8% (n = 369; follow-up rate = 423; 87.2%), 15.0% ± 7.7% (n = 216; follow-up rate = 232; 93.1%), and 14.8% ± 8.5% (n = 54; follow-up rate = 63; 85.7%), respectively. Lost to follow-up at the 12- and 18-month visits were 6.9% and 14.3%, respectively. Thirteen of 17 cases of diabetes, all 28 cases of hypertension, and 18 of 32 cases of dyslipidemia were in complete remission by the third month. With regard to postoperative complaints, 924 patients (92.4%) complained of nausea or abdominal pain that was controlled with medications during the first week after ESG. Twenty-four patients were readmitted: 8 for severe abdominal pain, of whom 3 had ESG reversal; 7 for postprocedure bleeding, 2 of whom received 2 units of packed red blood cells each; 4 for perigastric collection with pleural effusion, 3 of whom underwent percutaneous drainage; and 5 for postprocedure fever with no sequelae. Eight patients were revised to sleeve gastrectomy, and 5 had redo-ESG. No patient required an emergency intervention, and there were no mortalities. CONCLUSIONS: ESG appears to be well tolerated, safe, and effective. Significant weight loss occurs during the first 18 months without mortality or significant morbidity. Some patients require revision or reversal during the first year.

Laparoscopic Sleeve Gastrectomy After Endoscopic Sleeve Gastroplasty: Technical Aspects and Short-Term Outcomes.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) utilizes full-thickness sutures to plicate the greater curvature of the stomach. As with other weight loss interventions, some patients end up requiring revision to another procedure for insufficient weight loss or weight regain, discomfort, and procedure-related adverse events. OBJECTIVES: In this paper, we report our technique and short-term outcomes of revisional sleeve gastrectomy (LSG) after ESG. SETTING: Specialized medical center with standardized multidisciplinary protocols for medical, surgical, and endoscopic management of obesity. METHODS: A combined laparoscopic-endoscopic technique that identifies plication orientation and the location of anchors and sutures was employed. This prepares the stomach for safe stapling, excluding sutures and anchors from the staple line and the retained sleeve. Hereby, we report this technique with its short-term safety and efficacy outcomes. RESULTS: Twenty patients (16 female; mean age 40 ± 6 years) underwent revisional LSG from a total of 1665 (1.2%) who underwent primary ESG. Mean body mass index at the time of primary and revision procedures were 35.0 ± 4.0 and 35.2 ± 3.8 kg/m2, respectively. Nadir % total weight loss (%TWL) after primary ESG was 7.7 ± 3.5%. %TWL at 6 and 12 months after LSG was 21.0 ± 2.7 (n = 11) and 25.6 ± 4.1 (n = 8), respectively. There were no missed follow-up visits. Additionally, there was no mortality, prolonged hospital stay, adverse events, reoperations, or readmissions. CONCLUSIONS: Based on this combined laparoscopic-endoscopic technique, laparoscopic sleeve gastrectomy is a safe and feasible revision option for patients who fail ESG.

Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study.

BACKGROUND: Although plastic surgery has been gaining a lot of popularity recently, there seems to be limited perception and a poor understanding of this field by both medical professionals, including medical students, and the general public. This might alter referral patterns as well as medical students' choice to pursue a career in plastic surgery. OBJECTIVE: The purpose of this study was to assess knowledge and perception of plastic surgery among medical students and to explore the influencing factors underlying particular beliefs. METHODS: Data for this cross-sectional study were collected between August 22 and December 22, 2017. The questionnaire was formulated on the basis of our own study objectives and from available questionnaires with similar objectives. It was composed of 14 questions divided into three main parts: demographics, the specialty of plastic surgery, and media involvement and its effect on plastic surgery. The study was conducted via an online questionnaire among medical students in all years at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20. RESULTS: A total of 886 medical students participated in this study. We achieved a response rate of 56.79%. The mean age of the participants was 21.2 years. The mean awareness score was 9.7 (SD 4.2) for female students and 8.3 (SD 4.2) for male students (P<.001). The condition most commonly known to be treated by a plastic surgeon was burns (70.3% of responses). CONCLUSIONS: Medical students do not have adequate awareness of plastic surgery, and early exposure to this specialty may enhance their awareness.

Metadata Correction: Perception of Plastic Surgery and the Role of Media Among Medical Students: Cross-Sectional Study.

[This corrects the article DOI: 10.2196/12999.].

Bariatric surgery in monogenic and syndromic forms of obesity.

Currently, no topic is more controversial in bariatric surgery than performing these procedures on children with monogenic and syndromic forms of obesity. The medical community and the caregivers of those patients are struggling to find a solution that can alleviate their suffering and save their life. In all forms of obesity, dieting and physical activity do not result in significant weight loss and is associated with a high rate of weight regain. Additionally, effective medical therapy is not available yet. While there is significant debate about the risks and benefits of bariatric surgery in the adolescent population, there is an increasing number of studies that demonstrate the success of this option for the appropriate patients. Similarly, our experience demonstrated the same success not only in normal children and adolescents but also in those with monogenic and syndromic form of obesity.