A multi-state evaluation of the association between mental health and firearm storage practices.

Firearm storage method is a potentially modifiable risk factor for suicide. Using data from a large, multi-state survey, we sought to determine whether there is an association between mental health and household firearm storage practices, and characterize that association by state of residence. Participants who endorsed the presence of a household firearm and answered the mental health questions in the 2016-2017 Behavioral Risk Factor Surveillance System from eight states were included (n=26,949). Exposures were recent poor mental health (≥14 vs. 0-13 days/past month), and diagnosis of depression. Outcomes were household firearm storage practices (loaded, and both loaded and unlocked). Using Poisson regression, we calculated adjusted prevalence ratios (aPR) overall and stratified by state of residence. Of adults endorsing a household firearm, 35.1% reported storing a firearm loaded, and of those, 53.4% reported that the firearm was both loaded and unlocked. Neither recent poor mental health nor depression was associated with loaded (aPR 1.14 [95% CI: 0.95-1.37] and aPR 0.94 [95% CI 0.80-1.09], respectively) or loaded and unlocked (aPR 1.08 [95% CI 0.88-1.42] and aPR 1.04 [95% CI 0.88-1.22], respectively) firearm storage. In the setting of highly prevalent loaded firearm storage, no differences in storage practices by mental health indicators were observed across eight states despite disparate firearm policies and local culture. The lack of difference in storage practices by mental health indicators across several states highlights an opportunity to improve means safety counseling practices, and the need for dedicated evaluation of state-level firearm storage policies.

Dialysis disequilibrium on CKRT: avoiding the steep slippery slope.

BACKGROUND: Current guidelines for initiation of kidney replacement do not include specific recommendations for prescription parameters and monitoring. CASE OUTLINE: A 16-year-old girl presented with kidney failure with creatinine of 19.8 mg/dL and BUN of 211 mg/dL. She initiated continuous kidney replacement therapy (CKRT) with clearance of 1,300 mL/min/1.73 m2 which was increased to 1,950 mL/min/1.73 m2 at 17 h of stable therapy. COMPLICATIONS: At 31 h of therapy, she developed generalized seizure activity. CT imaging was negative for acute intracranial process, and EEG demonstrated diffuse encephalopathy. CKRT was discontinued, and BUN was noted to be 47 mg/dL at that time (a 79% reduction from presenting BUN). KEY MANAGEMENT POINTS: • The potential for development of DDS is not isolated to intermittent hemodialysis and may occur later in presentation. • A decreased clearance rate should be considered in those with risk factors for development of dialysis disequilibrium syndrome (DDS). • Frequent monitoring of BUN/serum osmolality is important to allow for adjustment of the KRT prescription following initiation of therapy. • Additional research is needed to guide risk assessment for DDS and therapeutic timing and goals in the early stages of KRT initiation. • Inclusion of more specific guidelines surrounding DDS would assist in providing important support for nephrologists. LIST OF RELEVANT GUIDELINES: KDIGO clinical practice guideline for acute kidney injury [1] Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease [2] The Renal Association Clinical Practice Guideline Acute Kidney Injury (AKI) [3] The Japanese Clinical Practice Guideline for Acute Kidney Injury [4].

Cerium-photocatalyzed aerobic oxidation of benzylic alcohols to aldehydes and ketones.

We have developed a cerium-photocatalyzed aerobic oxidation of primary and secondary benzylic alcohols to aldehydes and ketones using inexpensive CeCl3·7H2O as photocatalyst and air oxygen as the terminal oxidant.

Trainees' use of supervision for therapy with sexual minority clients: A qualitative study.

In the supervision literature, research on sexual orientation considerations often focuses on sexual minority supervisees and less often on their work with sexual minority clients. Yet both heterosexual and sexual minority supervisees serve sexual minority clients and may have different supervision needs. Twelve predoctoral interns from 12 APA-accredited counseling center internships were interviewed about how they made use of supervision for their work with a sexual minority client. The sample consisted of 6 heterosexual-identified supervisees and 6 supervisees who identified as lesbian, gay, or queer (LGQ). Data were analyzed using consensual qualitative research. All participants reported positive gains from supervision that carried over to their work with heterosexual and sexual minority clients, even when not all supervisors disclosed or discussed their own sexual orientation. Heterosexual supervisees used supervision to ensure that their heterosexuality does not interfere with an affirmative experience for their sexual minority client, whereas LGQ supervisees used supervision to explore differences in sexual identity development between themselves and their client to minimize the negative impact of overidentification. Thus, affirmative supervision may unfold with different foci depending on supervisees' sexual identity. Implications for training and supervision are discussed. (PsycINFO Database Record

Diluted sodium hypochlorite (bleach) in dogs: antiseptic efficacy, local tolerability and in vitro effect on skin barrier function and inflammation.

BACKGROUND: Diluted sodium hypochlorite represents an inexpensive and widely available topical antiseptic, but there are no tolerability and efficacy data in veterinary dermatology. OBJECTIVES: To determine the in vivo antibacterial effect and tolerability of topical diluted bleach application and to assess its in vitro effect on skin barrier lipids and anti-inflammatory properties on keratinocytes. METHODS: Topical hypochlorite at 0.05% and tap water were applied to both sides of the thorax of four healthy dogs. The anti-inflammatory effect on canine keratinocytes was determined by real-time polymerase chain reaction; skin barrier integrity was assessed by evaluating stratum corneum lipid changes in canine stratified epidermal constructs. RESULTS: The cell viability of primary keratinocytes treated with water and diluted hypochlorite at 0.005 and 0.01%, reduced the percentage of viable cells by 10%. The exposure of primary keratinocytes to 0.005% diluted hypochlorite significantly reduced the induction of inflammatory genes chemokine ligand-2 (CCL2; P = 0.015) and thymus and activation-regulated chemokine (TARC/CCL17, P = 0.032). There were no changes in skin lipid ceramide and nonceramide fractions in stratified epidermal constructs cultured for 17 days with 0.05% hypochlorite. Topical hypochlorite at 0.05% and tap water were well-tolerated without signs of skin irritation. Although a marked reduction in bacterial counts was seen within 20 min of diluted bleach application compared to the tap water control, this was only marginally significant (P = 0.06). CONCLUSIONS AND CLINICAL IMPORTANCE: The results indicate that a topical diluted bleach solution, at either 0.05 or 0.005% hypochlorite concentrations, is a well-tolerated antiseptic that also exhibits anti-inflammatory properties.

The effect of miscellaneous oral dosage forms on the environmental pollution of sulfonamides in pig holdings.

BACKGROUND: Due to antibiotic treatment of humans and animals, the prevalence of bacterial resistances increases worldwide. Especially in livestock farming, large quantities of faeces contaminated with antibiotics pose a risk of the carryover of the active ingredient to the environment. Accordingly, the aim of the present study was the evaluation of the benefit of different oral dosage forms (powder, pellets, granula) in pigs concerning the environmental pollution of sulfadiazine. Two subtherapeutic dosages were evaluated in powder mixtures to gain information about their potential to pollute the pig barn. Furthermore, a new group of pigs was kept in the stable after powder feeding of another pig group to determine the possible absorption of environmentally distributed antibiotics. Pigs were orally treated with three dosage forms. Simultaneously, sedimentation and airborne dust were collected and plasma and urine levels were determined. RESULTS: All formulations result in comparable plasma and urine levels, but massive differences in environmental pollution (powder > pellets, granula). Pigs housing in a contaminated barn exhibit traces of sulfadiazine in plasma and urine. CONCLUSION: Using pharmaceutical formulations like pellets or granula, the environmental pollution of sulfonamides can significantly be diminished due to massive dust reduction during feeding.

Effects of ceftiofur treatment on the susceptibility of commensal porcine E.coli--comparison between treated and untreated animals housed in the same stable.

BACKGROUND: Healthy farm animals have been found to act as a reservoir of extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli). Therefore, the objective of the study was to determine the input of antimicrobial active ceftiofur metabolites in the stable via faeces and urine after intramuscular administration of the drug to pigs and the elucidation of the Escherichia coli ESBL resistance pattern of treated and untreated pigs housed in the same barn during therapy. METHODS: For determination of the minimal inhibitory concentration (MIC) the method of microdilutionaccording to the recommended procedure of the Clinical and Laboratory Standards Institute was used. Inaddition to that, a qualitative determination was performed by agar dilution. Unsusceptible E. coli speciesselected via agar dilution with cefotaxime were confirmed by MALDI-TOF and ESBL encoding genes wereidentified by PCR. The amounts of ceftiofur measured as desfuroylceftiofur (DFC) in the different probes (plasma, urine, faeces and dust) were analysed by UPLC-MS/MS. RESULTS: In a first experiment two groups of pigs (6 animals per group) were housed in the same barn in two separated boxes. One group (group B) were treated with ceftiofur according to the licence (3 mg/kg administered intramuscularly (i.m.) on three consecutive days, day 1-3). During a second treatment period (day 29-31) an increased rate of ESBL resistant E. coli was detectable in these treated pigs and in the air of the stable. Moreover, the second group of animals (group A) formerly untreated but housed for the whole period in the same stable as the treated animals revealed increased resistance rates during their first treatment (day 45-47) with ceftiofur. In order to investigate the environmental input of ceftiofur during therapy and to simulate oral uptake of ceftiofur residues from the air of the stable a second set of experiments were performed. Pigs (6 animals) were treated with an interval of 2 weeks for 3 days with different doses of ceftiofur (3 mg/kg, 1 mg/kg and 0.3 mg/kg i.m.) as well as with 3 mg/kg per os) and the renal and biliary excretion of ceftiofur as its active metabolite were measured in comparison to the plasma levels. In addition to that, probes of the sedimentation dust and the air of the stable were analysed for drug residues. CONCLUSION: The present study shows that treatment of several animals in a stable with ceftiofur influences the resistance pattern of intestinal Escherichia coli of the treated as well as untreated animals housed in the same stable. During therapy with the drug which was administered by injection according to the licence we detected nameable amounts of ceftiofur and its active metabolites in the dust and air of the stable.

Influence of xylazine on the function of the LiDCO sensor in isoflurane anaesthetized horses.

OBJECTIVE: Previous studies showed an influence of xylazine on the LiDCO sensor in vitro and in standing horses, but did not prove that this interaction caused error in LiDCO measurements. Therefore, agreement of cardiac output (CO) measurements by LiDCO and bolus-thermodilution (BTD) was determined in horses receiving xylazine infusions. STUDY DESIGN: Prospective, experimental study. ANIMALS: Eight Warmblood horses. METHODS: All horses were premedicated with xylazine. Anaesthesia was induced with midazolam and ketamine and was maintained with isoflurane in oxygen. During six hours of anaesthesia CO measurements and blood samples were taken before, during and after a 60 minute period of xylazine infusion. Pairs of LiDCO and bolus thermo-dilution (BTD) measurements of CO were performed. Sensor voltages exposed to blood and saline were measured before, during and after xylazine infusion and compared using Bland-Altman method of agreement with corrections for repeated measures. RESULTS: The CO values (mean ± SD) before xylazine were 34.8 ± 7.3 and 36.4 ± 8.1 L minute(-1) for BTD and LiDCO, respectively. After starting the xylazine infusion, the CO values for BTD decreased to 27.5 ± 6.1 L minute(-1) whereas CO values measured by LiDCO increased to 54.7 ± 18.4 L minute(-1) . One hour after discontinuing xylazine infusion, CO values were 33 ± 6.7 and 36.5 ±11.9 L minute(-1) for BTD and LiDCO, respectively. The difference between saline and blood exposed sensor voltages decreased during xylazine infusion and these differences were positive numbers before but negative during the infusion. There were correlations between xylazine plasma concentrations, CO differences and sensor voltage differences (saline - blood). CONCLUSIONS AND CLINICAL RELEVANCE: This study proved that xylazine infusion caused concentration dependent bias in LiDCO measurements leading to an overestimation of readings. Sensor voltage differences (saline - blood) may become valuable clinical tool to predict drug-sensor interactions.

The effects of chemical and physical penetration enhancers on the percutaneous permeation of lidocaine through equine skin.

BACKGROUND: The effect of physical and chemical permeation enhancers on in vitro transdermal permeation of lidocaine was investigated in the horse.Therefore, the effect of six vehicles (phosphate-buffered saline (PBS), 50% ethanol, 50% propylene glycol, 50% isopropylalcohol, 50% isopropylalcohol/isopropylmyristate and 50% dimethylsulfoxide) was examined as well as the effect of microneedle pretreatment with different needle lengths on transdermal drug delivery of lidocaine.The skin was obtained from the thorax of six Warmblood horses and was stored up to two weeks at - 20°C. Franz-type diffusion cells were used to study the transdermal permeation through split skin (600 µm thickness). The amount of lidocaine in the receptor fluid was determined by UV-VIS high-performance liquid chromatography. RESULTS: All investigated vehicle supplementations diminished the transdermal flux of lidocaine through equine skin in comparison to pure PBS except dimethylsulfoxide, which resulted in comparable permeation rates to PBS. The maximum flux (Jmax) was 1.6-1.8 fold lower for lidocaine applied in 50% ethanol, propylene glycol, isopropylalcohol and isopropylalcohol/isopropylmyristate. A significant higher Jmax of lidocaine was observed when lidocaine was applied in PBS onto microneedle pretreated skin with similar permeation rates in both needle lengths. After 6 hours, 1.7 fold higher recovery rates were observed in the microneedle pretreated skin samples than in the untreated control samples. The lagtimes were reduced to 20-50% in the microneedle pretreated skin samples. CONCLUSION: Microneedles represent a promising tool for transdermal lidocaine application in the horse with a rapid systemic bioavailability.

Effects of dexmedetomidine and xylazine on cardiovascular function during total intravenous anaesthesia with midazolam and ketamine and recovery quality and duration in horses.

OBJECTIVES: To compare cardiovascular effects and recovery quality and duration of total intravenous anaesthesia (TIVA) with xylazine-ketamine-midazolam or dexmedetomidine-ketamine-midazolam. STUDY DESIGN: Prospective, randomized experimental cross-over trial. ANIMALS: Eight adult warmblood horses. METHODS: After sedation with acepromazine and either xylazine [0.5 mg kg(-1) , intravenously (IV)] or dexmedetomidine (3.5 µg kg(-1) IV) anaesthesia was induced with ketamine and midazolam and maintained with a constant rate infusion (CRI) of xylazine (1 mg kg(-1)  hour(-1) ) [XKM] or dexmedetomidine (7 µg kg(-1)  hour(-1) ) [DKM] in combination with midazolam (0.1 mg kg(-1)  hour(-1) ), and ketamine infusion (initially 3 mg kg(-1)  hour(-1) ) for 120 minutes. Ketamine infusion rate was increased in response to positive reactions to electrical nociceptive stimulation performed every 30 minutes. Heart rate (HR), mean arterial blood pressure (MAP) and cardiac output (Q˙t) were measured before treatment (baseline), after sedation (not Q˙t), and during anaesthesia. Xylazine, dexmedetomidine, midazolam and ketamine kinetics were calculated, from plasma drug concentrations. Twenty minutes after end of TIVA, flumazenil (0.01 mg kg(-1) IV) was administered. Recovery quality and duration were assessed. Two-way analysis of variance with repeated measurements or Wilcoxon signed rank test as relevant were used to analyse data with an alpha of 5%. RESULTS: Compared to baseline, MAP did not change, while similar, but limited, decreases in HR and Q˙t were observed in both TIVA's. Mean ketamine doses of 3.7 mg kg(-1)  hour(-1) were required with both treatments. Plasma concentrations of dexmedetomidine and xylazine showed high intra- and inter-individual changes with elimination half-lifes of 46 ± 7 minutes and 64 ± 13 minutes, respectively. Recovery quality was good to excellent with mean duration of 37 ± 16 and 46 ± 21 minutes after stopping TIVA with XKM and DKM, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Both drug combinations are suitable to maintain anaesthesia for two hours, with good cardiovascular and good to excellent recovery conditions.

A pharmacist's role in increasing access to menstrual products: an education and advocacy approach.

Individuals who menstruate grapple with diverse challenges in menstrual and reproductive health. This includes financial burdens, societal stigmas, and negative mental and physical health implications. Period poverty, marked by insufficient access to menstrual products, education, and sanitation, remains a prevalent and poorly addressed issue. Alarming statistics highlight the extent of this problem and shed light on the staggering number of individuals lacking access to essential menstrual products. The discourse extends to the safety and accessibility of a diverse array of menstrual products. A comprehensive comparison of the cost of available period products was conducted using data obtained from various retail websites. The often-overlooked potential indirect expenses and profound impacts on quality of life were also discussed. Amidst other public health initiatives, pharmacists have emerged as pivotal advocates and educators. Pharmacists are poised to drive initiatives that increase access to menstrual products through public health education and advocacy. By providing education on different menstrual product options, pharmacists can empower individuals to make informed decisions based on their needs. This perspective illuminates the complex impacts of menstruation on individuals and proposes that pharmacists can play a role in overcoming barriers to access. The proposed strategies, rooted in education, research, and advocacy, pave the way for enhancing access, reducing stigma, and elevating the quality of life for those navigating the intricate complexities of menstruation.

Synovial distribution of "systemically" administered acetylsalicylic acid in the isolated perfused equine distal limb.

BACKGROUND: This study investigated synovial concentrations of acetylsalicylic acid (ASA) and its metabolite salicylic acid (SA) in the equine fetlock joint following systemic administration of ASA. Salicylates were chosen because SA is the only nonsteroidal anti-inflammatory drug for which threshold levels exist for plasma and urine in equine sports. To avoid animal experiments, the study was conducted using an ex vivo model of the isolated perfused equine distal limb in combination with plasma concentrations obtained from literature.Salicylate concentrations in the joint were determined using microdialysis and high performance liquid chromatography (HPLC). Any anti-inflammatory effect of synovial ASA concentrations was assessed using an ASA EC50 (half maximal effective concentration) determined in equine whole blood. RESULTS: The ASA concentration in the synovial fluid (n=6) reached a maximum of 4 µg/mL, the mean concentration over the entire perfusion period was 2 µg/mL. Maximum SA concentration was 17 µg/mL, the average was 14 µg/mL. ASA and SA concentration in the synovial fluid exceeded systemic concentrations 2 h and 3.5 h after "systemic" administration, respectively. CONCLUSIONS: ASA and SA accumulated in the in the synovial fluid of the ex vivo model despite decreasing systemic concentrations. This suggests a prolonged anti-inflammatory effect within the joint that remains to be further elucidated.

Ceruminal diffusion activities and ceruminolytic characteristics of otic preparations - an in-vitro study.

BACKGROUND: An in-vitro setup was established in order to determine a) the diffusion activities of eight otic preparations (Aurizon®, Eas Otic®, Epi Otic®, Otifree®, Otomax®, Panolog®, Posatex®, Surolan®) through synthetic cerumen, and b) the ceruminolytic capacity and impregnation effects of these products. The main lipid classes of canine cerumen produced with moderate, non-purulent otitis externa were determined by thin layer chromatography and were subsequently used to produce a standardised synthetic cerumen (SCC). SCC was filled into capillary tubes, all of which were loaded with six commercially available multipurpose otic medications and two ear cleaners, each mixed with two markers in two experimental setups. These two marker compounds (Oil red O and marbofloxacin) were chosen, since they exhibit different physicochemical drug characteristics by which it is possible to determine and verify the diffusion activity of different types of liquids (i.e. the otic preparations). A synthetic cerumen described in the literature (JSL) was also used for comparison as its lipid composition was different to SCC. The diffusion activities of the otic preparations through both types of synthetic cerumen were studied over 24 hours. A second in-vitro experiment determined both the ceruminolytic activity and impregnation effect of the otic preparations by comparing the weight loss or weight gain after repeated incubation of JSL. RESULTS: Canine cerumen is mainly composed of triglycerides, sterol esters, fatty acid esters and squalene. The diffusion experiments showed a high diffusion efficacy along with a high impregnation effect for one test product. All the other products exhibited a lower diffusion activity with a mild to moderate impregnation effect. A mild ceruminolytic activity was observed for the two ear cleaners but not for any of the otic medications. CONCLUSIONS: The present study demonstrates that there are significant differences in the diffusion characteristics and ceruminolytic properties of the eight tested otic preparations.

Comparison of three different sampling methods for canine skin lipids.

BACKGROUND: Epidermal lipids are of major interest in dermatological research, especially in canine atopic dermatitis. Owing to the existence of several sampling methods, the interpretation of study results is often complicated. OBJECTIVES: This study aimed to compare three different sampling methods and to establish a minimally invasive method for collecting canine epidermal lipids. ANIMALS AND METHODS: Skin samples from five dogs with no obvious skin abnormalities were taken from the caudal back and the inguinal region postmortem. Samples consisted of heat-separated epidermis of three skin biopsies, three scrapes and three skin scrubs. Lipids were analysed by high-performance thin-layer chromatography; the resulting bands were identified by using corresponding standards, retardation factors and mass spectrometry. The influences of the sampling method, the body site and the ceramide standards were investigated. RESULTS: Between body sites, significant differences were found for cholesterol sulphate, cholesteryl esters and triglycerides. Significant differences between sampling methods were detected for all lipid fractions except for cholesterol sulphate and glucosylceramides within the lipid profile, and for at least four ceramide classes within the ceramide profile. The most obvious discrepancies were found between heat-separated epidermis and skin scrub. The reproducibility was high for scraping and skin scrub, but was lowest for heat-separated epidermis. Furthermore, this study revealed a marked influence of ceramide standards on the results regarding the ceramide profile. CONCLUSIONS AND CLINICAL IMPORTANCE: Scraping and skin scrub are comparably suitable methods for skin lipid sampling, whereas the analysis of heat-separated epidermis may not be the method of first choice.

Dermatophagoides farinae house dust mite allergen challenges reduce stratum corneum ceramides in an experimental dog model of acute atopic dermatitis.

BACKGROUND: Ceramides are essential stratum corneum (SC) lipids and they play a pivotal role in maintaining effective cutaneous barrier function. OBJECTIVES: The present study aimed at determining the effect of a Dermatophagoides farinae house dust mite (Df-HDM) allergen challenge on SC ceramides of atopic dogs experimentally sensitized to these allergens. ANIMALS: Six Df-HDM-sensitized atopic Maltese-beagle dogs were used. METHODS: Prechallenge SC was obtained by cyanoacrylate stripping. One week later, the dogs were challenged topically with Df-HDM allergens, which resulted in mild to moderate inflammation 24 h later. Two weeks after challenge, SC of lesional and nonlesional skin was obtained. Finally, SC was collected from challenge sites 2 months after lesion resolution. The different SC lipids were quantified blindly by thin-layer chromatography. RESULTS: Significantly lower amounts of ceramides [AH], [AP], [AS], [NP], [EOP], [NS] and [EOS] were observed in lesional SC compared with prechallenge samples, while no significant effect was found on the amount of other lipids, including cholesterol and free fatty acids. The ceramide profile of nonlesional skin generally showed the same postchallenge reduction pattern. Ceramide amounts returned to normal within 2 months after lesion remission. CONCLUSION AND CLINICAL IMPORTANCE: These findings suggest that the allergic reactions caused by Df-HDM allergens lead to a selective reduction of SC ceramides, not only at sites of inflammation but also at sites away from those of allergen application. There is normalization of ceramide amounts after inflammation subsides. These observations suggest that the deficiency of ceramides observed in canine atopic skin occurs, at least in part, secondary to inflammation.

The in vitro use of the hair follicle closure technique to study the follicular and percutaneous permeation of topically applied drugs.

Recent studies on follicular permeation emphasise the importance of hair follicles as diffusion pathways, but only a limited amount of data are available about the follicular permeation of topically applied drugs. This study examines the use of a hair follicle closure technique in vitro, to determine the participation of hair follicles in transdermal drug penetration. Various substances, with different lipophilicities, were tested: caffeine, diclofenac, flufenamic acid, ibuprofen, paracetamol, salicylic acid and testosterone. Diffusion experiments were conducted with porcine skin, the most common replacement material for human skin, in Franz-type diffusion cells over 28 hours. Different experimental settings allowed the differentiation between interfollicular and follicular permeation after topical application of the test compounds. A comparison of the apparent permeability coefficients of the drugs demonstrates that the percutaneous permeations of caffeine and flufenamic acid were significantly higher along the hair follicles. In the cases of paracetamol and testosterone, the follicular pathway appears to be of importance, while no difference was found between interfollicular and follicular permeation for diclofenac, ibuprofen and salicylic acid. Thus, the hair follicle closure technique represents an adequate in vitro method for gaining information about follicular or percutaneous permeation, and can replace in vivo testing in animals or humans.

The comparability of in vitro and ex vivo studies on the percutaneous permeation of topical formulations containing Ibuprofen.

In order to avoid in vivo experiments and to gain information about the suitability of surrogates for skin replacement, Franz-type diffusion cell experiments were conducted by using three ibuprofen-containing formulations (cream, gel and microgel) on bovine split-skin samples and cellophane membranes. Moreover, ex vivo examinations were performed on the isolated perfused bovine udder, to study the comparability of in vitro and ex vivo experimental set-ups. Depending on the formulation, noticeable differences in the permeation of Ibuprofen occurred in vitro (udder skin) and ex vivo (isolated perfused bovine udder), but not in the cellophane membrane. The rates of ibuprofen permeability (cream > gel > microgel) and adsorption into the skin (gel > microgel > cream) varied with the formulation, and were probably caused by differences in the ingredients. Furthermore, different storage conditions and seasonal variation in the collection of the skin samples probably led to differences in the amounts of ibuprofen adsorption apparent in the isolated bovine udder and udder skin. In vitro diffusion experiments should be preferred to experiments on isolated organs with regard to the costs involved, the throughput, and the intensity of labour required, unless metabolism of the drug in the skin, or cell-cell interactions are of particular interest.

Psychiatric Diagnoses in Children With CKD Compared to the General Population.

Rationale & Objective: Children with chronic kidney disease (CKD) are subject to physical and psychosocial challenges, which may confer greater risk of developing psychiatric disorders. We sought to examine key psychiatric diagnoses in children with CKD compared with those in the general pediatric population and assess the correlation between parent-reported diagnosis and self-reported symptoms of depression. Study Design: Cross-sectional. Setting & Participants: Children ages 2-17 years receiving current medical care who participated in the Chronic Kidney Disease in Children Study (CKiD) or the National Survey of Children's Health. Exposure: CKD. Outcomes: Parent-reported diagnoses of depression, anxiety, or attention-deficit and hyperactivity disorder (ADHD). Analytical Approach: Using Poisson regression, we determined the age, sex, and race-adjusted prevalence ratio comparing diagnoses between children with CKD and those in the general population overall and within subgroups of sex, race, maternal education status, and CKD stage. Secondarily, we examined the correlation between depression status using standardized self-reported screening instrument scores and parent-reported diagnosis. Results: Eight hundred seventy-five children with CKD and 72,699 children in the general population were included. Those with CKD had an adjusted prevalence ratio of 1.32 (95% CI, 1.01-1.73) for depression, 0.72 (95% CI, 0.52-0.99) for anxiety, and 1.03 (95% CI, 0.86-1.25) for ADHD. The results were similar across subgroups of CKD stage, sex, race, or maternal education. The correlation between parent-reported diagnosis and instrument-detected depression was weak, r = 0.13 (95% CI, 0.03-0.23). Limitations: Retrospective parent- or self-reported data were used. Conclusions: Children with CKD had a higher prevalence of parent-reported depression, equivalent prevalence of attention-deficit and hyperactivity disorder, and lower prevalence of anxiety diagnoses compared to other children. These findings are inconsistent with results of prior studies and suggest that baseline assessments used in CKiD may have limited utility in describing psychiatric disorders among children with CKD. Improved mental health assessment approaches in pediatric nephrology are needed.