In vitro profiling of fenofibrate solid dispersion mediated tablet formulation to treat high blood cholesterol.

OBJECTIVE: Fenofibrate (FNF), an anti-hyperlipidemic agent, suffers from poor water solubility (0.000707mg/ml) and belongs to class II drug as per BCS, shows a slow dissolution rate. The current investigation aimed to fabricate a fast-dissolving tablet of FNF (not available in the commercial market) using solid dispersion technique employing Vitamin E-D-α-Tocopheryl polyethylene glycol 1000 succinate (vitamin E TPGS) as molecular biomaterial to enhance dissolution rate and reduce the time required to reach the systemic circulation. MATERIALS AND METHODS: Firstly, carrier material was selected based on the release study via preparing solid dispersion using the melting method, and prepared solid dispersion was characterized. Secondly, fast-dissolving tablets from solid dispersion were fabricated using the direct compression tool and characterized for X-ray diffraction (XRD) pattern, friability, hardness, content uniformity, weight variation and in vitro disintegration test. RESULTS: The X-ray diffraction study confirmed the successful formation of solid dispersion using vitamin E TPGS by analyzing the change in physical state. The fabricated solid dispersion exhibited higher drug content than a physical mixture of FNF. An excipient interference study was also performed in methanol and 0.75% w/v sodium lauryl sulphate. It revealed no significant alterations in the absorption peak of FNF as analyzed using UV spectroscopy at 287nm. In addition, water absorption ratio phase solubility and wetting time were also assessed. In -vitro release of FNF from developed tablets was found significantly higher (93.23%±3.11; p<0.001) as compared to prepared compressed tablet of pure FNF (12.21±2.34%). The dissolution rate was also determined, and data were then kept to various kinetic models such as zero-order chemical kinetic, first-order chemical kinetic, Hixon-Crowell and Higuchi chemical kinetic. CONCLUSION: A complete and sequential in vitro and physicochemical characterization of developed formulation was carried out to set-up improved and effective treatment for high blood cholesterol.

Synthesis and characterization of polyphenols functionalized graphitic hematite nanocomposite adsorbent from an agro waste and its application for removal of Cs from aqueous solution.

In this study, Polyphenols functionalized Graphitic Hematite Nanocomposite (PGHN) was used as an adsorbent to remove Caesium (Cs) ions from a simulated solution. The nanocomposite was produced by synthesizing iron oxide nanoparticles using orange peel extract (OPE) as the reducing and capping agent in the presence of graphite produced from sugarcane bagasse. The nanocomposite exhibited a scaly morphology and the mean particle size of rhombohedral structured hematite nanoparticles was found to be 148.9 nm. The simulated solution of Cs ions was treated with PGHN and the treatment conditions were optimized by batch method. The concentration of Cs ion in the treated solution was determined using atomic emission spectroscopy (AES). The maximum Cs adsorption of 97.95% was attained at an optimum condition of pH - 9.0 and adsorbent dose - 70 mg/mL for treatment period of 110 min. The experimental data of adsorption fitted well with pseudo 1st order kinetics and was favorable for both Langmuir and Freundlich isotherm models. The study reports a facile method for the production of nanocomposite using agro-wastes such as sugarcane bagasse and orange peels. The synthesized nanocomposite was used as an adsorbent for the removal of toxic Cs and can be further used for industrial wastewater treatment.

Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes.

Introduction: To compare short- and midterm outcomes of the first 55 patients undergoing robot-assisted kidney transplant (RAKT) with patients undergoing open kidney transplant (OKT) during the same period in a tertiary care hospital. Materials and Methods: Data of all end-stage renal disease patients undergoing renal transplant were prospectively maintained. All graft kidneys were harvested laparoscopically. Both RAKT and OKT were performed using standardized techniques, and all RAKTs were performed by a single experienced robotic surgeon. Chi-square test/Fisher exact test was done for categorical data, and Mann-Whitney U test was done for continuous data. Discrete variables were expressed in absolute numbers and percentages. For all tests, p < 0.05 was considered significant. All results were expressed as mean ± standard deviation or median with range. Results: Between April 2016 and September 2018, 55 patients underwent RAKT. The same was compared with 152 patients who underwent OKT. The two groups were comparable in terms of age, gender, and body mass index. Duration on hemodialysis was significantly higher in the RAKT group, and hemoglobin and donor kidney glomerular filtration rate was significantly better in the RAKT group. Requirement of perioperative analgesia was significantly less in the RAKT group. Rewarm ischemia time was significantly longer in the RAKT group. The fall in serum creatinine was slower in RAKT group till 3 months. The serum creatinine levels were statistically similar in the two cohorts at 3 months (p = 0.082), which was maintained at median 29 months of follow-up (p = 0.067). Tacrolimus levels on postoperative day 2 were found to be significantly higher in RAKT cohort (17.98 ± 14.41) vs OKT cohort (11.38 ± 6.93). Surgical-site infections were rare in the RAKT group. Conclusions: RAKT confers advantage of decreased wound morbidity with similar functional outcomes compared with OKT in midterm. It looks promising; however, long-term follow-up of larger numbers of patients is needed.

Beating the Odds: A Full-Term Delivery After Liver Transplantation of a Pregnant Hyperthyroid Patient at 19 Weeks' Gestation for Propylthiouracil-Induced Acute Liver Failure.

Liver transplantation (LT) for acute liver failure is an uncommon occurrence in the setting of pregnancy given the risk of fetal demise, and rarely is it undertaken with a viable fetus. Maternal hyperthyroidism increases fetal risk in the setting of LT, particularly in the setting of thyrotoxicosis. We report the first case of propylthiouracil-induced acute liver failure in a hyperthyroid patient in her second trimester resulting in LT. The multidisciplinary management led to a favorable outcome for the patient and the subsequent delivery of a healthy infant at 38-weeks' gestation.

Laparoscopic Live Donor Nephrectomy: Comparison of Outcomes Right Versus Left.

OBJECTIVE: To compare outcomes between right- and left-sided laparoscopic live donor nephrectomy (LDN). Left LDN (LLDN) remains the side of choice whenever possible because the left renal vein is longer; however, there are some donors in whom the right kidney is taken for donation due to anatomical or functional reasons. Right LDN (RLDN) is perceived to be difficult due to anatomical factors. Therefore, many surgeons have a bias for left kidney donation or will do right side donation as an open donor nephrectomy. At our institution, we routinely perform RLDN when indicated and herein compare the outcomes between right- and left-sided LDN. METHODS: From January 2007 to January 2017, 1850 laparoscopic donor nephrectomies were conducted at the Max Super Speciality Hospital. Of these, 168 were right-sided donor nephrectomies and 1682 were left-sided donor nephrectomies. All the donor case records were retrospectively reviewed; the operative time, warm ischemia time, intraoperative events, blood loss, and postoperative parameters were recorded. The kidney recipient data were also recorded. RESULTS: The donor demographic characteristics were comparable between 2 groups. Among other variables, operating time was significantly less in RLDN (120 minutes) versus the LLDN group (146 minutes). Intraoperative estimated blood loss (118 mL in RLDN; 126 mL in LLDN), warm ischemia time (4.8 minutes in RLDN; 5.2 minutes in LLDN) and hospital stay (4.2 days in RLDN; 4.3 days in LLDN) was comparable. Vascular complications occurred in four patients in the RLDN group and six cases in the LLDN group. Recipient outcomes were comparable. CONCLUSIONS: With adequate experience, RLDN can be accomplished in a safe manner with comparable outcomes to LLDN.

Evaluation of line-probe assay for molecular analysis and drug susceptibility of extra-pulmonary tuberculosis.

SETTING: Most epidemiological studies on Mycobacterium tuberculosis focus on pulmonary tuberculosis (TB), whereas extra-pulmonary TB (EPTB) remains poorly explored. OBJECTIVE: To study the rate of resistant EPTB cases among individuals with suspected EPTB using a commercial line-probe assay (LPA), polymerase chain reaction (PCR) and reverse hybridisation test. We also examined the molecular profile of the EPTB isolates obtained at the Himalayan Institute of Medical Sciences, Dehradun, India. DESIGN: EPTB samples were collected from 249 patients with clinical and radiological suspicion of EPTB and subjected to automated liquid culture, PCR and GenoType MDRTBplus according to the manufacturers' instructions. RESULTS: A diagnostic yield of 15% was observed among individuals with suspected EPTB using MGIT™ (Mycobacterium Growth Indicator Tubes), which increased to 38% on LPA and PCR. LPA results had 100% concordance with MGIT, with all culture-positive samples also being positive on LPA. However, 70.2% of LPA-positive samples did not grow Mycobacterium tuberculosis in liquid culture. Two (2.1%) of the culture-negative EPTB PCR-positive samples were multidrug-resistant, 20 (21.2%) were rifampicin-monoresistant and 12 (12.7%) isoniazid-monoresistant on LPA. CONCLUSION: Given the paucibacillary nature of EPTB, we demonstrated that PCR and LPA can have a vital role in establishing TB diagnosis in extra-pulmonary tissues.

Loss of end-differentiated ß-cell phenotype following pancreatic islet transplantation.

Replacement of pancreatic ß-cells through deceased donor islet transplantation is a proven therapy for preventing recurrent life-threatening hypoglycemia in type 1 diabetes. Although near-normal glucose levels and insulin independence can be maintained for many years following successful islet transplantation, restoration of normal functional ß-cell mass has remained elusive. It has recently been proposed that dedifferentiation/plasticity towards other endocrine phenotypes may play an important role in stress-induced ß-cell dysfunction in type 2 diabetes. Here we report loss of end-differentiated ß-cell phenotype in 2 intraportal islet allotransplant recipients. Despite excellent graft function and sustained insulin independence, all examined insulin-positive cells had lost expression of the end-differentiation marker, urocortin-3, or appeared to co-express the α-cell marker, glucagon. In contrast, no insulin+ /urocortin-3- cells were seen in nondiabetic deceased donor control pancreatic islets. Loss of end-differentiated phenotype may facilitate ß-cell survival during the stresses associated with islet isolation and culture, in addition to sustained hypoxia following engraftment. As further refinements in islet isolation and culture are made in parallel with exploration of alternative ß-cell sources, graft sites, and ultimately fully vascularized bioengineered insulin-secreting microtissues, differentiation status immunostaining provides a novel tool to assess whether fully mature ß-cell phenotype has been maintained.

Treatment of HCV infection in liver transplant recipients with ledipasvir and sofosbuvir without ribavirin.

BACKGROUND: Ledipasvir and sofosbuvir is a well-tolerated regimen with high sustained virological response (SVR) rates in pre-liver transplant patients infected with chronic hepatitis C virus (HCV), but data in liver transplant recipients outside of clinical trials is limited. AIM: To address this knowledge gap and assess SVR rates without the use of ribavirin in liver transplant recipients METHODS: This is a retrospective study examining the treatment of 75 post-liver transplant recipients with ledipasvir and sofosbuvir without ribavirin. Differences between SVR cohorts and predictors of SVR were analysed in an intention-to-treat (ITT) fashion. RESULTS: A total of 408 genotype 1, HCV patients were treated with ledipasvir/sofosbuvir from October 2014 to August 2015 at our centre. Seventy-three patients were post-liver transplant and were treated with a median of 2.9 years from transplant. Ledipasvir/sofosbuvir achieved an SVR12 of 95.9%. African Americans made up 28.8% of the cohort. Sixty-three per cent of patients were treated previously, including 13.7% of patients previously treated with direct-acting antivirals. Only 2.7% had recurrent allograft cirrhosis, and the majority (90.4%) was on calcineurin inhibitor based immunosuppressive therapy. Approximately 82% of patients had chronic kidney disease (CKD) stage 2 or 3. In univariate logistic regression, only detectable week 8 viral load was predictive of failure to achieve SVR. CONCLUSION: Our data confirm excellent SVR outcomes and favourable safety and tolerability profiles with ledipasvir/sofosbuvir without ribavirin in post-liver transplant recipients infected with HCV, despite treatment guidelines to use ribavirin.

Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis.

UNLABELLED: Slipped capital femoral epiphysis (SCFE) may lead to symptomatic femoroacetabular impingement (FAI). We report our experience of arthroscopic treatment, including osteochondroplasty, for the sequelae of SCFE. Data were prospectively collected on patients undergoing arthroscopy of the hip for the sequelae of SCFE between March 2007 and February 2013, including demographic data, radiological assessment of the deformity and other factors that may influence outcome, such as the presence of established avascular necrosis. Patients completed the modified Harris hip score (mHHS) and the non-arthritic hip score (NAHS) before and after surgery. In total, 18 patients with a mean age of 19 years (13 to 42), were included in the study. All patients presented with pain in the hip and mechanical symptoms, and had evidence of FAI (cam or mixed impingement) on plain radiographs. The patients underwent arthroscopic osteoplasty of the femoral neck. The mean follow-up was 29 months (23 to 56). The mean mHHS and NAHS scores improved from 56.2 (27.5 to 100.1) and 52.1 (12.5 to 97.5) pre-operatively to 75.1 (33.8 to 96.8, p = 0.01) and 73.6 (18.8 to 100, p = 0.02) at final follow-up, respectively. Linear regression analysis demonstrated a significant association between poorer outcome scores and increased time to surgery following SCFE (p < 0.05 for all parameters except baseline MHHS). Symptomatic FAI following (SCFE) may be addressed using arthroscopic techniques, and should be treated promptly to minimise progressive functional impairment and chondrolabral degeneration. TAKE HOME MESSAGE: Arthroscopy of the hip can be used to treat femoroacetabular impingement successfully following SCFE. However, this should be performed promptly after presentation in order to prevent irreversible progression and poorer clinical outcomes.

Phenotypic Detection and Antibiogram of ß-lactamase-producing Proteus Species in a Tertiary Care Hospital, India.

BACKGROUND: Proteus species cause a variety of community- and hospital-acquired illnesses. Synthesis of ß-lactamases is the predominant mechanism for resistance to ß-lactam antibiotics. Among the ß-lactamases, extended spectrum ß-lactamases (ESBLs) and AmpC ß-lactamases are the most common. AIM: The objective of this study was to determine the occurrence of ESBL and AmpC ß-lactamases in Proteus species among various clinical isolates at a tertiary care hospital, India. MATERIALS AND METHODS: This study was done to identify various species of Proteus from clinical samples (n = 3922). Antimicrobial susceptibility was performed by Kirby-Bauer disc diffusion method. ESBL production was detected by modified double-disc synergy test and indirect modified three-dimensional tests and AmpC ß-lactamase production by AmpC disc test and modified Hodge test. RESULTS: Proteus species were isolated in 5.4% (101/1876) specimens. Three Proteus species isolated were Proteus mirabilis 62.4% (63/101), Proteus vulgaris 29.7% (30/101), and Proteus penneri 7.9% (8/101). ESBL producers confirmed by both tests were of 88.1% (89/101). Only AmpC ß-lactamase was produced by four isolates. Coproduction of ESBL and AmpC ß-lactamase was observed in 58.4% (52/89) of isolates. Twelve isolates were non-ß-lactamase producers. Multidrug resistance (MDR) was found in 95.1% (96/101) of isolates, 50.5% (51/101) were possibly extensively drug resistant and none were pan drug resistant. None of the isolates were resistant to piperacillin-tazobactam. P. penneri isolates exhibited high resistance to most of the antibiotics. CONCLUSIONS: A high prevalence of ESBL and AmpC ß-lactamases was found that concurrently showed MDR. Phenotypic methods for the detection of ß-lactamases are easy and simple and can be implemented in routine diagnostic laboratories along with susceptibility testing. These data will assist the clinicians in the management and control of infections.

Possibility of scrub typhus in fever of unknown origin (FUO) cases: an experience from Rajasthan.

PURPOSE: Fever of unknown origin (FUO) has multiple causes. Scrub typhus is less known cause of FUO in India. The present study reports a recent epidemic of scrub typhus amongst cases of FUO from different areas of Rajasthan, India. There was high mortality in undiagnosed cases of FUO which lead to the diagnosis of scrub typhus. OBJECTIVE: To study the possibility of scrub typhus as a causative factor in FUO cases by qualitative detection of IgM antibodies with ELISA. MATERIALS AND METHODS: From September 2012 to December 2012, 271 serum samples of FUO cases were analysed for IgM antibodies to Orientia tsutsugamushi along with dengue, malaria, typhoid, tuberculosis and brucellosis. RESULTS: Scrub typhus IgM antibodies by ELISA were detected in 133 (49.1%) patients. Scrub typhus positivity was significantly higher among female in comparison to males (P<0.05). Maximum positivity of scrub typhus was found in females of 46-60 years age group. The laboratory parameters were abnormal in most of the patients as evident by thrombocytopenia (63%), deranged liver functions (56%) and renal functions (25%). CONCLUSION: The present study emphasises the importance of scrub typhus among cases of FUO especially after rainy season and during early cooler months. The study also highlights the significance of ELISA method for rapid and early reporting and ruling out scrub typhus in FUO cases.

Local tetra patterns: a new feature descriptor for content-based image retrieval.

In this paper, we propose a novel image indexing and retrieval algorithm using local tetra patterns (LTrPs) for content-based image retrieval (CBIR). The standard local binary pattern (LBP) and local ternary pattern (LTP) encode the relationship between the referenced pixel and its surrounding neighbors by computing gray-level difference. The proposed method encodes the relationship between the referenced pixel and its neighbors, based on the directions that are calculated using the first-order derivatives in vertical and horizontal directions. In addition, we propose a generic strategy to compute nth-order LTrP using (n - 1)th-order horizontal and vertical derivatives for efficient CBIR and analyze the effectiveness of our proposed algorithm by combining it with the Gabor transform. The performance of the proposed method is compared with the LBP, the local derivative patterns, and the LTP based on the results obtained using benchmark image databases viz., Corel 1000 database (DB1), Brodatz texture database (DB2), and MIT VisTex database (DB3). Performance analysis shows that the proposed method improves the retrieval result from 70.34%/44.9% to 75.9%/48.7% in terms of average precision/average recall on database DB1, and from 79.97% to 85.30% and 82.23% to 90.02% in terms of average retrieval rate on databases DB2 and DB3, respectively, as compared with the standard LBP.

Total elbow replacement with the Coonrad-Morrey prosthesis: our medium to long-term results.

INTRODUCTION: Semiconstrained total elbow replacement is now a well recognised and reliable surgical option for advanced elbow disease, mainly rheumatoid arthritis. METHODS: We report a retrospective analysis of 31 primary total elbow replacements in 28 patients with a mean follow-up duration of 55 months. The mean age of the patients was 65 years. The indications included 27 cases of rheumatoid arthritis, 3 fractures and 1 case of osteoarthritis. Twenty-one elbows in nineteen patients were assessed using the Mayo elbow performance score (MEPS) in a special follow-up clinic. In the other nine patients (ten elbows), the assessment was carried out with case notes and x-rays. RESULTS: The mean pre-operative MEPS in the 21 elbows recalled was 40. This improved to 89 post-operatively (range: 55-100). Sixteen of the twenty-one elbows were considered excellent, two good, two fair and one poor. The range of movement was recorded in eight of the other ten elbows and the mean was 98°. At the last follow-up visit, x-rays were normal in 23 elbows although the ulnar component was loose in 3, the humeral component loose in 2. There were also two cases of non-union of the medial epicondyle and one patient had mild heterotopic ossification. Complications included one infection, which needed irrigation and debridement with a satisfactory final result, and two cases of ulnar nerve palsy/neurapraxia. Two elbows were considered failures due to severe pain caused by prosthetic loosening. These were referred for revision surgery. CONCLUSIONS: Excellent pain relief and good function can be achieved in the medium and long term with the Coonrad-Morrey-semiconstrained total elbow replacement prosthesis in patients with severe destructive elbow arthropathy.

Directional binary wavelet patterns for biomedical image indexing and retrieval.

A new algorithm for medical image retrieval is presented in the paper. An 8-bit grayscale image is divided into eight binary bit-planes, and then binary wavelet transform (BWT) which is similar to the lifting scheme in real wavelet transform (RWT) is performed on each bitplane to extract the multi-resolution binary images. The local binary pattern (LBP) features are extracted from the resultant BWT sub-bands. Three experiments have been carried out for proving the effectiveness of the proposed algorithm. Out of which two are meant for medical image retrieval and one for face retrieval. It is further mentioned that the database considered for three experiments are OASIS magnetic resonance imaging (MRI) database, NEMA computer tomography (CT) database and PolyU-NIRFD face database. The results after investigation shows a significant improvement in terms of their evaluation measures as compared to LBP and LBP with Gabor transform.

Accommodation: its relation to refractive errors, amblyopia and biometric parameters.

AIM: To study accommodation in relation to different refractive errors, amblyopia and to measure the anatomical changes in the accommodating eye MATERIALS AND METHODS: We studied the amplitude of accommodation (AA) in 150 patients in the age group 11 ± 30 years which included emmetropes, myopes, hypermetropes and hypermetropic amblyopes using the Royal Air Force (RAF) rule. The anterior chamber depth (ACD), axial length (AxL) and lens thickness (LT) changes during accommodation were measured using an A-scan. Myopes and hypermetropes were further divided based on the amount of refractive error : less than 2D, 2 -4D and greater than 4D. RESULTS: Corrected low myopes had the highest accommodation amplitude (p less than 0.05) followed by emmetropes. Corrected hypermetropes were found to have the lowest amplitude of accommodation (p less than 0.05). The amblyopic eye had a significantly low AA compared to the non-amblyopic eye (p less than 0.05). ACD decreased (p less than 0.05) and LT increased (p less than 0.05) during accommodation. The AxL increase was maximum in myopes (p less than 0.05) followed by hypermetropes but the change was not significant in hypermetropes (p greater than 0.05). CONCLUSION: The amblyopic eye has low amplitudes of accommodation proving the benefit of near adds in amblyopic patients. Prolonged near work might induce myopia in susceptible eyes by increasing the axial length.

Mask leak in one-person mask ventilation compared to two-person in newborn infant manikin study.

AIM: To compare a new two-person method (four hands) of delivering mask ventilation with a standard one-person method using the Laerdal self-inflating bag (SIB) and the Neopuff (NP) infant resuscitator in a manikin model. BACKGROUND: Recent studies of simulated neonatal resuscitation using bag and mask ventilation techniques have shown facemask leak levels of 55-57% in expert hands. METHODS: 48 participants were randomly paired and instructed to give mask ventilation for a 2-min period as single-person resuscitators, then as two-person paired resuscitators at set pressures for NP and set parameters for SIB. Airway pressure, flow, inspiratory tidal volume, expiratory tidal volume and mask leak were recorded. RESULTS: A total of 21 578 inflations were recorded and analysed. For SIB, mask leak was greater (11.5%) with single-person compared to two-person (5.4%; mean difference 6.1%, 95% CI 1.5 to 10.7, p<0.01). For NP, mask leak was greater for single-person (22.2%) compared to two-person (9.1%; mean difference 13.1% 95% CI 3.6 to 22.6, p<0.01). For single-person mask ventilation, mask leak was greater with NP (22.2%) compared to SIB (11.5%; mean difference 10.7%, 95% CI 1.4 to 19.7, p<0.01). For two-person mask ventilation, mask leak was greater for NP (9.1%) compared to SIB (5.4%; mean difference 3.7%, 95% CI 0.1 to 6.4, p<0.05). CONCLUSIONS: Two-person mask ventilation technique reduces mask leak by approximately 50% compared to the standard one-person mask ventilation method. NP mask ventilation has higher mask leak than Laerdal SIB for both single- and two-person technique mask ventilation.

Ventilator-delivered mask ventilation compared with three standard methods of mask ventilation in a manikin model.

BACKGROUND: Little is known regarding the variations in effective ventilation during bag and mask resuscitation with standard methods compared with that delivered by ventilator-delivered mask ventilation (VDMV). AIM: To measure the variations in delivered airway pressure, tidal volume (TV), minute ventilation (MV) and inspiratory time during a 3-min period of mask ventilation comparing VDMV with three commonly used hand-delivered methods of bag and mask ventilation: Laerdal self-inflating bag (SIB); anaesthetic bag and T-piece Neopuff. METHODS: A modified resuscitation manikin was used to measure variation in mechanical ventilation during 3-min periods of mask ventilation. Thirty-six experienced practitioners gave positive pressure mask ventilation targeting acceptable chest wall movement with a rate of 60 inflations/min and when pressures could be targeted or set, a peak inspiratory pressure (PIP) of 18 cm water, positive end-expiratory pressure (PEEP) of 5 cm water, for 3 min with each of the four mask ventilation methods. Each mode was randomly sequenced. RESULTS: A total of 21 136 inflations were recorded and analysed. VDMV achieved PIP and PEEP closest to that targeted and significantly lower variation in all measured parameters (p<0.001) other than with PIP. SIB delivered TV and MV over twice that delivered by VDMV and Neopuff. CONCLUSION: During 3-min periods of mask ventilation on a manikin, VDMV produced the least variation in delivered ventilation. SIB produced wide variation and unacceptably high TV and MV in experienced hands.

New spectrophotometric estimation of indomethacin capsules with niacinamide as hydrotropic solubilizing agent.

BACKGROUND: Hydrotropic solubilization process involves cooperative intermolecular interaction with several balancing molecular forces, rather than either a specific complexation event or a process dominated by a medium effect, such as co-solvency or salting-in. MATERIALS AND METHODS: In the present investigation, hydrotropic solution of 2 M niacinamide was employed as the solubilizing agent to solubilize the poorly water-soluble drug, indomethacin, from the capsule dosage form for spectrophotometric determination in ultraviolet region. RESULTS: Hydrotropic agent used did not interfere in the spectrophotometric analysis. In preliminary solubility studies, it was found that there was more than fivefold enhancement in the aqueous solubility of indomethacin (poorly water-soluble drug) in 2 M niacinamide solution as compared to its aqueous solubility at 28 ± 1°C. CONCLUSION: The proposed method is new, simple, safe, environmentally friendly, economic, accurate and cost-effective and can be successfully employed in routine analysis.

Mixed hydrotropy: novel science of solubility enhancement.

Conventional furosemide tablets are practically insoluble in water, have slow onset of action (45-60 min) and poor bioavailability (39-53%), and therefore cannot be given in emergency clinical situations like hypertension or pulmonary edema. So purpose of research was to provide a fast dissolving oral dosage form of furosemide, which can provide quick onset of action by using concept of mixed hydrotropy. Initially solubility of furosemide was determined individually in 4 hydrotropic agents namely urea, sodium acetate, sodium benzoate, sodium citrate at concentration of 10, 20, 30 and 40% w/v solutions using purified water as solvent. Highest solubility was obtained in 40% sodium benzoate solution. Then different combinations of 2, 3 and 4 hydrotropic agents in different ratios were used to determine solubility, so that total concentration of hydrotropic agents was always 40%. Highest solubility was obtained in solution of urea+sodium benzoate+sodium citrate at optimum ratio of 15:20:5. This optimized combination was utilized in preparing solid dispersions by common solvent technique using distilled water as solvent. Solid dispersions were evaluated for flow properties, XRD, DSC, SEM and were also compressed to form tablets. Dissolution studies of conventional and prepared tablets were done using USP Type II apparatus. It was concluded that the concept of mixed hydrotropic solid dispersion is novel, safe and cost-effective technique for enhancing bioavailability of poorly water-soluble drugs by dissolving drug in nonionized form. The magical enhancement in solubility of furosemide is clear indication of its potential to be used in future for other poorly water-soluble drugs in which low bioavailability is major concern.

New spectrophotometric estimation of ornidazole tablets employing urea as a hydrotropic solubilizing additive.

Quantitative spectrophotometric analysis of poorly water-soluble drugs involves use of various organic solvents. Major drawbacks of organic solvents include high cost, volatility and toxicity. Safety of analyzer is affected by toxicity of the solvent used. In the present investigation the use of organic solvent has been avoided, making the method environmentally friendly. Urea has demonstrated enhancement in aqueous solubilities of a large number of poorly water-soluble drugs, thereby widely used as a hydrotropic agent. There was more than 10-fold enhancement in the solubility of ornidazole in 10 M urea solution as compared to its solubility in distilled water. In the present investigation, hydrotropic solution of urea (10 M) was employed as solubilizing agent to solubilize the poorly water-soluble drug, ornidazole, from fine powder of its tablet dosage form for spectrophotometric determination in ultraviolet region at 319 nm. Beer's law was obeyed in the concentration range of 5-25 µg/ml in presence of urea. Presence of urea did not interfere in the analysis. Proposed method is new, rapid, simple, accurate, and reproducible. Statistical data proved the accuracy, reproducibility and the precision of the proposed method.