Comparative dissolution profiles of representative quinolones in different media.

BACKGROUND: Quinolones have a broad spectrum of activity against bacteria and are a class of synthetic antimicrobial modeled after nalidixic acid. OBJECTIVE: To determine the dissolution efficiencies of ciprofloxacin and sparfloxacin in 0.1NHCL, deionized water, 0.1 M acetic acid and pH 7.4 phosphate buffer. METHODS: The in-vitro dissolution profiles of ciprofloxacin (250 mg and 500 mg) and sparfloxacin (200 mg) tablets were studied in the respective media using US Pharmacopoeia (USP) Apparatus II. In order to monitor the comparative rate of dissolution, samples were withdrawn from the medium for quantification over nine pre-determined time points during a total period of two hours. Samples were analyzed by an HPLC method capable of concurrent elution of ciprofloxacin/sparfloxacin. RESULTS: The medium with most stable release pattern for the representative quinolones was 0.1M acetic acid, followed by 0.1NHCl, distilled water and pH 7.4 buffer respectively. The %Q30 of Ciprofloxacin(CP) and Sparfloxacin(SP) was found to conform entirely to both USP2004 and FDA specifications. Sparfloxacin was found to be unstable due to cloudiness observed in 0.1N HCl medium. The CP and SP showed highest %Q(max) in 0.1M acetic acid compared to other media. This result has implication in the choice of medium for dissolution testing of quinolones, particularly for comparative purposes in the absence of specific monograph recommendations. Furthermore, it supports the change from 0.1N to 0.01NHCI for ciprofloxacin in the USP as a monographic modification. CONCLUSION: We conclude that there is a need to have a general-purpose dissolution medium for comparing profiles of different quinolones, 0.1M acetic acid may be a suitable candidate. Furthermore, the study may serve as guidance to the drug regulatory authorities in formulation of monographs for the drugs.

Cervical screening in under 25s: a high-risk young population.

OBJECTIVE: The changes to the UK NHS cervical screening programme launched in April 2004 recommend that the first cytological screening should be undertaken at the age of 25 years rather than at 20 years. This study analyses Papanicolaou smear diagnoses of women under 25 years in Lewisham Borough of London to determine the incidence of cervical intraepithelial neoplasia (CIN) in this age group. There are concerns that delaying the onset of cervical screening in this population may increase the risk of cervical cancer. STUDY DESIGN: Pap smear results of 2793 women (2617 between 20 and 24 years and 176 below 20 years) over a period of 1 year from 1 April 2003 to 31 March 2004 were analysed. Appropriate colposcopy referrals and the results of cervical biopsies performed were followed up. RESULTS: Of the 2793 cervical smears analysed: 1997 (71.5%) were normal; 375 (13.4%) inadequate; 144 (5.1%) borderline; 208 (7.4%) showed mild dyskaryosis and 69 (2.5%) showed high-grade lesions (moderate to severe dyskaryosis). One hundred and eighty-two women were referred to colposcopy: 34% showed histological evidence of high-grade precancerous lesions (CIN 2 or 3); 27% CIN 1 and 0.5% koilocytosis only. Thirteen percent had normal colposcopy while 22% did not attend. CONCLUSION: The Lewisham population of young women under the age of 25 years is vulnerable to potential precancerous cervical lesions. This may reflect a high level of sexual activity among the young girls. Absence of screening in this age group may miss these high-grade cervical lesions that could progress to cervical cancer in the near future. We reinforce the importance of cervical screening in the highly vulnerable sexually active population under 25.

The decision-to-delivery interval for emergency caesarean section: is 30 minutes a realistic target?

OBJECTIVE: To evaluate whether a 30-minute decision-to-delivery interval is a realistic target for emergency caesarean section. DESIGN: An audit of all emergency caesarean sections over five separate periods. SETTING: A district general hospital. PARTICIPANTS: Five groups of women (343 women) with an indication for emergency caesarean section. METHODS: Following an initial survey, a structured time sheet was introduced, followed by four other surveys to complete the audit cycle. MAIN OUTCOME MEASURE: The proportion of caesarean sections where the decision-to-delivery interval was achieved within 30 minutes. The reasons for delay. RESULTS: In the first survey of 73 emergency caesarean sections, the time to deliver the infant exceeded 30 minutes in 47 women (64%). The main sources of delay were transferring the women to the operating theatre and starting the anaesthetic. After the introduction of a structured time sheet, there was an improvement with each survey, but the target of 30 minutes was reached in only 71% of caesarean sections in the final survey. CONCLUSIONS: The introduction of a time sheet can improve the decision-to-delivery interval for emergency caesarean section; however, a universal standard of 100% in 30 minutes is unrealistic.