Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry.

BACKGROUND AND METHODS: Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry. RESULTS: Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p < 0.001), median age in MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs. 69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0-2) at seven days or discharge was similar (53% vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were low (<1.4%) in both groups. CONCLUSIONS: Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing the burden of stroke in this young population should be prioritized.

Chemical composition and antimicrobial activity of European propolis.

Three propolis samples from Austria, Germany and France were investigated by GC/MS, where eleven compounds were being new for propolis. The samples showed some similarities in their qualitative composition. Phenylethyl-trans-caffeate, benzyl ferulate and galangin were predominant in German propolis. Benzyl caffeate was predominant in French sample. Pinocembrin was predominant in French and Austrian propolis and trans-p-coumaric acid was predominant in all samples. The antimicrobial activity against Staphylococcus aureus; Escherichia coli, and Candida albicans was evaluated. German propolis showed the highest antimicrobial activity against Staphylococcus aureus and Escherichia coli. While Austrian propolis has the highest activity against Candida albicans. French propolis was effective against all pathogens but less than German and Austrian propolis.

Development of a microemulsion-based formulation to improve the availability of poorly water-soluble drug.

The objective of our investigation was to design a thermo-dynamically stable microemulsion formulation of the model drug piroxicam with minimum surfactant concentration in order to improve its solubility. The solubility of piroxicam in different oils was examined. Effects of the co-surfactant:surfactant ratio and water content on microemulsion formulation were evaluated. Phase studies were performed for systems composed of oleic acid as the oil phase, Tween-80 as surfactant, and propylene glycol as co-surfactant at a constant percentage of water to elucidate the effect of microemulsion components on the area of microemulsion formulation. The viscosity and conductivity of certain microemulsion formulations were examined as a function of water dilution. The results showed that oleic acid, Tween-80, and propylene glycol resulted in the highest solubilization of piroxicam. The amount of water that was successfully incorporated into a microemulsion system was directly proportional to the co-surfactant:surfactant ratio and inversely proportional to the percentage amount of the oil phase present in the system. Microemulsion systems displayed changes in their viscosity and conductivity upon water dilution. The pre-microemulsion systems could be used as solvents to provide enhanced solubilizing capacity and stabilization for the solubilized drug. These systems could be loaded with the drug and stored in their original form in order to produce a microemulsion containing the drug in situ upon aqueous dilution. The incorporation of piroxicam in microemulsion formulations led to enhancement of the piroxicam release profile by allowing constant and regular in vitro release as well as reducing piroxicam's particle size to that suited to a microemulsion. Thus, the usage of a microemulsion technique led to improvement in piroxicam availability, suggesting the potential for technique's use as a topical vehicle for piroxicam delivery.

Preparation, characterization, and stability studies of piroxicam-loaded microemulsions in topical formulations.

The main purpose of this work was to determine the in vitro release of piroxicam in microemulsion formulations from different pharmaceutical topical preparations including different gel bases, such as, methyl cellulose (MC), carboxy methyl cellulose (CMC), hydroxypropyl methyl cellulose (HPMC), Carbopol 934, Carbopol 940, and Pluronic F-127 bases. The effect of the employed gel bases on the in vitro release profiles of piroxicam was examined to choose the base which gave the highest in vitro release. The kinetic treatments and parameters derived from in vitro release of piroxicam formulations were calculated according to different kinetic orders or systems. These gel formulations were selected for rheological and stability studies. Stability studies were conducted to investigate the change in drug content, viscosity, and pH of the semisolid formulations. The results showed that, the incorporation of piroxicam in microemulsion formulas could lead to enhancement of piroxicam release profiles by allowing constant and regular in vitro release. Three percent MC gel base showed the highest release of piroxicam-microemulsion after 180 min (97.70%) followed by 3% HPMC (94.0%) when compared to bases containing piroxicam alone. All the medicated gel bases containing piroxicam exhibit pseudoplastic flow with thixotropic behavior. The degradation of piroxicam from its topical formulations was found to be a zero-order reaction based on the mean value of correlation coefficients. All formulations were quite stable. The shelf life of the gel containing HPMC base was about 2.85 years. Considering the in vitro release, rheological properties and shelf life, HPMC gel base containing 0.5% piroxicam in a microemulsion formula was the best among the studied formulations.