[A race against time: POEMS syndrome]. / "Verseny az idovel": a POEMS szindróma.

Background - POEMS syndrome is a potentially well manageable disease with an ascendant therapeutic arsenal nowadays. The early recognition of the syndrome is key to prevent serious multiorgan damage, and that is still a big challenge for physicians. With the following two case reports the authors aimed to highlight the consequences of late recognition of the disease and summarize the potential therapeutic options for POEMS syndrome.

Results - We have presented two patients’ cases with a long history of examination and treatment because of uncleared polyneuropathy. Through these cases we could see how serious could be the consequences of late diagnosis and despite multiorgan impairment there are still therapeutic options which could improve the patient’s condition. Although the diagnosis of POEMS syndrome is not easy, it must raise our mind the thought and be prudent when we start a treatment in polyneuropathy.

Microparticles and multi-unit systems for advanced drug delivery.

Microparticles have unique benefits in the formulation of multiparticulate and multi-unit type pharmaceutical dosage forms allowing improved drug safety and efficacy with favorable pharmacokinetics and patient centricity. On the other hand, the above advantages are served by high and well reproducible quality attributes of the medicinal product where even flexible design and controlled processability offer success as well as possible longer product life-cycle for the manufacturers. Moreover, the specific demands of patients can be taken into account, including simplified dosing regimens, flexible dosage, drug combinations, palatability, and ease of swallowing. In the more than 70 years since the first modified-release formulation appeared on the market, many new formulations have been marketed and many publications have appeared in the literature. More unique and newer pharmaceutical technologies and excipients have become available for producing tailor-made particles with micrometer dimensions and beyond. All these have contributed to the fact that the sub-units (e.g. minitablets, pellets, microspheres) that make up a multiparticulate system can vary widely in composition and properties. Some units have mucoadhesive properties and others can float to contribute to a suitable release profile that can be designed for the multiparticulate formula as a whole. Nowadays, there are some available formulations on the market, which are able to release the active substance even for several months (3 or 6 months depending on the type of treatment). In this review, the latest developments in technologies that have been used for a long time are presented, as well as innovative solutions such as the applicability of 3D printing to produce subunits of multiparticulate systems. Furthermore, the diversity of multiparticulate systems, different routes of administration are also presented, touching the ones which are capable of carrying the active substance as well as the relevant, commercially available multiparticle-based medical devices. The versatility in size from 1 µm and multiplicity of formulation technologies promise a solid foundation for the future applications of dosage form design and development.

Inhalation Dosage Forms: A Focus on Dry Powder Inhalers and Their Advancements.

In this review, an extensive analysis of dry powder inhalers (DPIs) is offered, focusing on their characteristics, formulation, stability, and manufacturing. The advantages of pulmonary delivery were investigated, as well as the significance of the particle size in drug deposition. The preparation of DPI formulations was also comprehensively explored, including physico-chemical characterization of powders, powder processing techniques, and formulation considerations. In addition to manufacturing procedures, testing methods were also discussed, providing insights into the development and evaluation of DPI formulations. This review also explores the design basics and critical attributes specific to DPIs, highlighting the significance of their optimization to achieve an effective inhalation therapy. Additionally, the morphology and stability of 3 DPI capsules (Spiriva, Braltus, and Onbrez) were investigated, offering valuable insights into the properties of these formulations. Altogether, these findings contribute to a deeper understanding of DPIs and their development, performance, and optimization of inhalation dosage forms.

Viscoelasticity of Liposomal Dispersions.

Janus-faced viscoelastic gelling agents-possessing both elastic and viscous characteristics-provide materials with unique features including strengthening ability under stress and a liquid-like character with lower viscosities under relaxed conditions. The mentioned multifunctional character is manifested in several body fluids such as human tears, synovial liquids, skin tissues and mucins, endowing the fluids with a special physical resistance property that can be analyzed by dynamic oscillatory rheology. Therefore, during the development of pharmaceutical or cosmetical formulations-with the intention of mimicking the physiological conditions-rheological studies on viscoelasticity are strongly recommended and the selection of viscoelastic preparations is highlighted. In our study, we aimed to determine the viscoelasticity of various liposomal dispersions. We intended to evaluate the impact of lipid concentration, the presence of cholesterol or 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) and the gelling agents polyvinyl alcohol (PVA) and hydroxyethylcellulose (HEC) on the viscoelasticity of vesicular systems. Furthermore, the effect of two model drugs (phenyl salicylate and caffeine) on the viscoelastic behavior of liposomal systems was studied. Based on our measurements, the oscillation rheological properties of the liposomal formulations were influenced both by the composition and the lamellarity/size of the lipid vesicles.

Comparison of the Micronaut-AM System and the EUCAST Broth Microdilution Reference Method for MIC Determination of Four Antifungals against Aspergillus fumigatus.

The Antifungal Susceptibility Testing method of the European Committee on Antimicrobial Susceptibility Testing (EUCAST-AFST) is a reference technique for the determination of the Minimum Inhibitory Concentration (MIC) of antifungals for Aspergillus fumigatus. However, it is time-consuming and requires expertise. Micronaut-AM (M-AM) is a fast, simple, time-saving, and ready-to-use new colorimetric method using an indicator (resazurin) to facilitate the visual reading. The aim of this retrospective study was to evaluate the performance of the M-AM system and compare it with the EUCAST broth microdilution reference method to determine the susceptibility of 77 A. fumigatus clinical strains to amphotericin B, itraconazole, voriconazole, and posaconazole. Overall, the essential agreements within ±2 dilutions were 100%, 62%, 58%, and 30% and the categorical agreements were 100%, 97%, 91%, and 87% for amphotericin B, itraconazole, voriconazole, and posaconazole, respectively. No categorical discrepancy was found for amphotericin B, but several categorical discordances were observed with azole antifungals. However, only 2 of the 16 azole-resistant strains confirmed by the cyp51A sequencing would have been misclassified by M-AM. The use of M-AM is probably suitable for the determination of the MICs of amphotericin B, but further evaluations are needed to confirm its usefulness for the determination of the MICs of azoles for A. fumigatus.

Application of a Reactive Agility Training Program Using Light-Based Stimuli to Enhance the Physical and Cognitive Performance of Car Racing Drivers: A Randomized Controlled Trial.

BACKGROUND: There is a need to develop strategies that could contribute to the physical and mental preparation of motorsport athletes. A common method used by experienced motorsport athlete physical trainers is flashing light devices to train or assess reactive agility, despite limited evidence. Therefore, in the present study, we determined the effects of a 6-week reactive agility training program using light-based stimuli on the physiological and cognitive abilities of car racing drivers. MATERIALS AND METHODS: The CONSORT guidelines for randomized controlled trial were used. In a single-blinded randomized controlled trial, 24 car racing drivers (EXP, n = 12; CON, n = 12) performed a comprehensive battery of cognitive tests marketed specifically at motorsport athletes from Vienna test system (VTS) at rest or during moderate intensity exercise on a bicycle. Physiological abilities were determined via a maximal incremental cardio-respiratory treadmill test. Baseline and post-intervention tests were performed on three consecutive days. Participants in EXP underwent a 6-week intervention consisting of 60-min training sessions twice a week using the Witty SEM light stimulus. RESULTS: Participants in EXP but not in CON performed some of the VTS cognitive tasks with higher accuracy and/or shorter reaction time after the intervention at rest and during exercise. Car racing drivers performed the STROOP word-reading condition more accurately when the task was performed during the exercise vs. rest, regardless of group. In addition, the intervention induced beneficial changes in peak heart rate (HR), HR at gas exchange threshold, ventilation, and relative maximal oxygen consumption (rVO2 max). In contrast, body mass and fat mass increased, while peak HR and rVO2 max decreased in CON. Finally, participants in EXP improved their reactive agility performance and reaction time throughout the training program. CONCLUSION: Overall, the reactive agility training program using light-based stimuli appeared to be efficient to induce beneficial effects on some physiological and cognitive performance measures; therefore, it may have the potential to contribute to car racing drivers' physical and mental performance.

Review on Starter Pellets: Inert and Functional Cores.

A significant proportion of pharmaceuticals are now considered multiparticulate systems. Modified-release drug delivery formulations can be designed with engineering precision, and patient-centric dosing can be accomplished relatively easily using multi-unit systems. In many cases, Multiple-Unit Pellet Systems (MUPS) are formulated on the basis of a neutral excipient core which may carry the layered drug surrounded also by functional coating. In the present summary, commonly used starter pellets are presented. The manuscript describes the main properties of the various nuclei related to their micro- and macrostructure. In the case of layered pellets formed based on different inert pellet cores, the drug release mechanism can be expected in detail. Finally, the authors would like to prove the industrial significance of inert cores by presenting some of the commercially available formulations.

Real-time coating thickness measurement and defect recognition of film coated tablets with machine vision and deep learning.

This paper presents a system, where images acquired with a digital camera are coupled with image analysis and deep learning to identify and categorize film coating defects and to measure the film coating thickness of tablets. There were 5 different classes of defective tablets, and the YOLOv5 algorithm was utilized to recognize defects, the accuracy of the classification was 98.2%. In order to characterize coating thickness, the diameter of the tablets in pixels was measured, which was used to measure the coating thickness of the tablets. The proposed system can be easily scaled up to match the production capability of continuous film coaters. With the developed technique, the complete screening of the produced tablets can be achieved in real-time resulting in the improvement of quality control.

Development and Dissolution Study of a ß-Galactosidase Containing Drinking Straw.

Today, in addition to many different physicochemical and pharmacological properties of the active ingredients and excipients, the developer of a pharmaceutical formulation must take into account several factors during the formulation process in order for the patient to cooperate to use the formulation accurately. One of the innovative solutions in paediatrics may be the use of medicated drinking straws. For our studies, we successfully prepared lactase-containing, rapid disintegration particles by two techniques commonly used in the pharmaceutical industry. The simulation of the usage of the filled straws was presented from a new perspective for the patient by an in vitro method. The effect of the temperature of the liquid used during the administration of the straw and the effect of the frequency during the application on the dissolution rate were investigated. According to our results, in the case of a straw containing rapidly dissolving particles, the temperature of the used liquid and the mode of administration (frequency) play a significant role in the release rate from the composition.

Image Analysis: A Versatile Tool in the Manufacturing and Quality Control of Pharmaceutical Dosage Forms.

In pharmaceutical sciences, visual inspection is one of the oldest methods used for description in pharmacopeias and is still an important part of the characterization and qualification of active ingredients, excipients, and dosage forms. With the development of technology, it is now also possible to take images of various pharmaceutical dosage forms with different imaging methods in a size range that is hardly visible or completely invisible to the human eye. By analyzing high-quality designs, physicochemical processes can be understood, and the results can be used even in the optimization of the composition of the dosage form and in the development of its production. The present study aims to show some of the countless ways image analysis can be used in the manufacturing and quality assessment of different dosage forms. This summary also includes measurements and an evaluation of, amongst others, a less studied dosage form, medicated foams.

Evaluation of Biodegradable PVA-Based 3D Printed Carriers during Dissolution.

The presence of additive manufacturing, especially 3D printing, has the potential to revolutionize pharmaceutical manufacturing owing to the distinctive capabilities of personalized pharmaceutical manufacturing. This study's aim was to examine the behavior of commonly used polyvinyl alcohol (PVA) under in vitro dissolution conditions. Polylactic acid (PLA) was also used as a comparator. The carriers were designed and fabricated using computer-aided design (CAD). After printing the containers, the behavior of PVA under in vitro simulated biorelevant conditions was monitored by gravimetry and dynamic light scattering (DLS) methods. The results show that in all the dissolution media PVA carriers were dissolved; the particle size was under 300 nm. However, the dissolution rate was different in various dissolution media. In addition to studying the PVA, as drug delivery carriers, the kinetics of drug release were investigated. These dissolution test results accompanied with UV spectrophotometry tracking indirectly determine the possibilities for modifying the output of quality by computer design.

Applications of machine vision in pharmaceutical technology: A review.

The goal of this paper is to give an introduction to analysis of images acquired by a digital camera with visible illumination and to review its applications as a Process Analytical Technology (PAT) which has great potential in pharmaceutical manufacturing. By utilizing in-line analytical techniques, it is possible to monitor the quality of all the material leaving a processing unit and to create models capable to predict product quality attributes, which are otherwise measured by cumbersome off-line techniques. The rapidly developing machine vision has proven its versatility in numerous applications and it has great potential as an in-line analytical tool. The ongoing conversion of the pharmaceutical industry from batch to continuous manufacturing accelerated the development of digital image analysis methods in the last decade. Among numerous other benefits, continuous technologies, equipped with digital image analysis, enable detecting disturbances in the material flow, and analyzing the products comprehensively. The purpose of this work is to give an insight into the currently available image analysis methods in the characterization of powders, crystallization, granulation, milling, mixing, tableting, film coating, in vitro dissolution testing, and residence time distribution measurements by highlighting some of the most relevant examples of application.

Investigation of propellant-free aqueous foams as pharmaceutical carrier systems.

Due to their light consistency and good spreadability, aqueous foams are considered as convenient and highly accepted drug carrier systems that are of great importance in the field of topical drug delivery. The production of a stable, easy to dose, preferably environmentally harmless foam formulation is challenging. Therefore, foam characterisation requires a complex approach: several tests are to be performed throughout the formulation. Our study primarily aims to investigate the quality attributes of propellant-free foam-forming additives. Throughout the research, we focused on acquiring knowledge about the properties of pharmaceutical excipients suitable for foam formulations and their effect on foam characteristics. Not only were the relative foam density, actuated foam weight and the foam collapse tendencies studied, but also the initial liquid properties. Along with surface tension determination, bubble-forming experiments were carried out. The bubble size and rate of formation, standardised by using a texture analyser, were followed by image analysis. Analysing the bubble-forming properties of dilute surfactant solutions allows assumptions on the properties of foam formed from the more concentrated solutions. The size and number of bubbles in the produced foams are related to the kinetics of single bubble formation. For comparison, commercially available medicated foams were studied.

Comparative Evaluation of Pellet Cushioning Agents by Various Imaging Techniques and Dissolution Studies.

Most of the commercially available pharmaceutical products for oral administration route are marketed in the tablet dosage forms. However, compression of multiparticulate systems is a challenge for the pharmaceutical research and industry, especially if the individual unit is a coated particle, as the release of the active ingredient depends on the integrity of the coating. In the present study, polymer-coated pellets tableted with different types of excipients (powder, granules, pellets) then were investigated by various tablet-destructive (microscopic) and tablet non-destructive (microfocus X-ray; microCT) imaging methods. The information obtained from the independent evaluation of the in vitro drug release profiles model is confirmed by the results obtained by image analysis, regardless of whether X-ray or stereomicroscopic images of the coated, tableted pellets were used for image analysis. The results of this study show that the novel easy-to-use, fast, and non-destructive MFX method is a good alternative to the already used microscopic image analysis methods regarding the characterization of particulates, compressed into tablets.

Physicochemical Profiling of Baicalin Along with the Development and Characterization of Cyclodextrin Inclusion Complexes.

Baicalin is a flavone glycoside extracted from Scutellaria baicalensis, a traditional Chinese herbal medicine. Numerous pharmacological effects of baicalin were reported (e.g. antioxidant, anxiolytic); nevertheless, the most important physicochemical properties influencing the pharmacokinetic behaviour and the concomitant oral bioavailability have not yet been described in a comprehensive study. The aim of this project was to characterize the acid-base, lipophilicity, biorelevant solubility and permeability properties of the drug substance and providing scientific data to support the dosage form design. Another important objective was the comparative evaluation of six various baicalin-cyclodextrin (CD) inclusion complexes along with the creation of a suitable Drug Delivery System (DDS) for this BCS IV drug. Biorelevant profiling was carried out by NMR-pH titrations, saturation shake-flask and distribution coefficients (logP) measurements, while CD inclusion studies were fulfilled by experimental methods (phase solubility, 1H/13C NMR, 2D ROESY) and computational approaches. Due to low aqueous solubility (67.03 ± 1.60 µg/ml) and low permeability (Papp = 0.037 × 10-6 cm/s), baicalin is classified as BCS IV. The γ-CD complexation significantly increased the solubility of baicalin (~ 5 times). The most promoted chemical shift change occurred in baicalin-γ-CD complex. Computational studies showed disparate binding pattern for baicalin in case of ß- and γ-CD; furthermore, the calculated complexation energy was - 162.4 kJ mol-1 for ß-CD, while it was significantly stronger for γ-CD (- 181.5 kJ mol-1). The physicochemical and structural information of baicalin and its CD complexes introduced herein can create molecular basis for a promising DDS with enhanced bioavailability containing a bioactive phytopharmacon.

Contribution of OqxAB Efflux Pump in Selection of Fluoroquinolone-Resistant Klebsiella pneumoniae.

The role of OqxAB efflux pump in Klebsiella pneumoniae was investigated in correlation with ciprofloxacin exposure. K. pneumoniae SE23 and K. pneumoniae SE191 were isolated from urinary tract infections and were analyzed in this study. Each carried oqxAB resistance determinant and exhibited ciprofloxacin MIC of 0.06 and 0.5 mg/L, respectively. Tested strains were initially exposed to their ciprofloxacin MIC values for 24 hours. Later on, the ciprofloxacin exposition has been increased to a daily 1, 2, 4, and to a final 8 mg/L. Total cellular RNA was extracted at 30, 60, 90, and 120 minutes of initial exposure and after every 24 hours. Quantitative reverse-transcriptase PCR was performed from each RNA sample. Mutation in gyrA and parC genes was analyzed in each strain and multilocus sequence typing (MLST) was performed. Ciprofloxacin exposure selected resistant strain from K. pneumoniae SE191; by contrast, K. pneumoniae SE23 was not adjustable to the increasing ciprofloxacin concentrations. During initial exposure, both oqxA and oqxB expression remained low (2-ΔCt = 1-2.03). However, increasing ciprofloxacin promoted oqxB expression as it reached fold increase of 15.8-22.8, while oqxA expression was maintained (2-ΔCt = 2-2.15). An amino acid substitution Ser83Tyr in gyrA was detected in K. pneumoniae SE191, but no additional mutations occurred as consequence to ciprofloxacin exposure. MLST identified K. pneumoniae SE191 as ST274, while K. pneumoniae SE23 belonged to the novel ST2567. Ciprofloxacin concentration-dependent upregulation of oqxAB efflux pump in K. pneumoniae is clonally related and contributes to selection for higher level of fluoroquinolone resistance.

Plasmid-mediated quinolone resistance determinants in Enterobacteriaceae from urine clinical samples.

Plasmid-mediated quinolone resistance (PMQR) determinants including, qnrA, qnrB, qnrC, qnrD, qnrS, aac(6')-Ib-cr, oqxAB, and qepA, were investigated in 214 Enterobacteriaceae strains from urine clinical samples. Antimicrobial susceptibility testing for ciprofloxacin, ceftriaxone, and imipenem was performed by broth microdilution method. All strains were screened for PMQR genes by PCR. Virulence determinants, namely afa, pap, pil, sfa/foc, and kpsMT of eight Escherichia coli strains proven positive for at least one qnr gene, were investigated by PCR. All of the eight investigated strains carried the pil gene, showing that P fimbria is a common virulence determinant among qnr positive E. coli. Out of 214 tested strains, 38 yielded any PMQR determinant, altogether 45 genes were detected namely, 6 qnrA, 1 qnrB, 2 qnrD and 8 qnrS, 9 aac(6')-Ib-cr, and 19 oqxAB; however, neither qepA nor qnrC were detected. Notably, 18 Klebsiella spp., harbored oqxAB, nine E. coli were positive for qnrS and two Morganella morganii yielded qnrD resistance determinant. In this study, we demonstrated 17.7% prevalence of PMQR-positive Enterobacteriaceae and first reported qnrD-resistance determinant in Hungary. Altogether, 25 PMQR-positive strains were susceptible or low-level resistant to ciprofloxacin with minimum inhibitory concentration (MIC) between 0.06 and 1 mg/L, suggesting that prevalence of PMQR determinants is underestimated and screening among clinical isolates exhibiting reduced susceptibility is necessary. Fluoroquinolone resistance breakpoints of Enterobacteriaceae were revised in 2017 by European Committee of Antimicrobial Susceptibility Testing indicating ciprofloxacin susceptibility only until 0.25 mg/L MIC value.

Controlled Release Oral Delivery of Apigenin Containing Pellets with Antioxidant Activity.

BACKGROUND: Drug delivery of phytochemicals has gained interest recently due to their remarkable health effects. Apigenin, a plant flavonoid, has antioxidant, anti-inflammatory and anticancer activities but its delivery is challenging. It could be absorbed through the whole intestine, however, it has poor bioavailability due to its low aqueous solubility. In Europe, the daily intake was estimated to be as low as 3 ± 1 mg. Pellets offer several advantages such as improved bioavailability and various resultant drug release profiles can be obtained by simply mixing pellets with different coatings. OBJECTIVE: The objective of our study was to develop a carrier system containing 20 mg apigenin thus enhancing intake and to offer reduction of oxidative stress which can cause inflammation in the intestine. METHOD: The apigenin powder was dispersed in aqueous solution of binding material and layered onto the inert cores in a fluidized bed apparatus. The layered cores were further coated with enteric polymers and the process parameters were optimized. RESULTS: The prepared pellets met with the requirements and have good physical characteristic. 10% (w/w) Eudragit® L was suitable for enteric coating with a complete release at pH 6.8 within 1 hour. 15% (w/w) Eudragit® FS coating ensured acid resistance ability and colonic delivery. The therapeutic efficiency was confirmed with antioxidant activity measurement by using DPPH* assay. CONCLUSION: Enteric coated spheres allow targeted delivery into the intestine and colon thus reaching the main absorption site. Pellets were proved to be an optimal delivery system for apigenin thus providing enhanced apigenin intake.

Development of oral site-specific pellets containing flavonoid extract with antioxidant activity.

Herbal medicines are recognized as an effective treatment of common diseases, mainly associated with oxidative stress. Therefore developing drug delivery systems of these biological active ingredients are gaining interest. Parsley (Petroselinum crispum L.) is a well-known culinary herb and its leaf contains high amount of apigenin, therefore it is suitable as a natural source of this flavonoid. Apigenin possess many health effects such as antioxidant, anti-inflammatory and anticancer activities. Unfortunately, these benefits are limited due to the low water solubility and bioavailability, it was recently classified as BCS II group compound. Therefore the aim of this study was to develop a carrier system for Petroselinum crispum extract, containing high amount of apigenin. Microcrystalline cellulose inert pellet cores were chosen and enteric coatings were applied. The produced multiparticulates had spherical shape, narrow size distribution and low moisture content. 10% (w/w) Eudragit® L 30 D-55 and 15% (w/w) Eudragit® FS 30 D coating was adequate for the modified release in vitro. The layered pellets demonstrated antioxidant activity. It was concluded that development of oral site-specific pellets containing flavonoid extract successful and the therapeutic effectiveness could be hypothesized.

Improvement of mechanical properties of pellet containing tablets by thermal treatment.

Batches of partially spray-dried lactose tablets with three different initial tensile strength (∼20N, ∼35N, ∼50N) were made. Changes along a 24h long thermal treatment at 100°C in tensile strength, friability, individual mass, water content, disintegration time, average free volume and wetting properties were evaluated. Caffeine containing gastroresistant pellets were gained by drug layering and filmcoating of inert microcrystalline cellulose pellet cores in fluid bed equipment. Shape, size, mechanical properties, drug content and dissolution profile of the coated pellets were determined. Batches of pellet containing tablets with three different pellet-filler ratios were compressed where partially spray-dried lactose was used as a filler-binder material.Characteristics of pellet containing tablets were evaluated before and after a 24h long thermal treatment at 100°C. Results shown that the poor initial mechanical properties (friability, tensile strength) were improved by thermal exposure while there were no remarkable alterations in drug release profiles.