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Gallo G, Trompetto M, Fulginiti S, La Torre M, Tierno S, Cantarella F, Vanini P, Tomasicchio G, Altomare DF, Rinaldi M, Santoro GA, Currò G, Grossi U. Efficacy and safety of Propionibacterium extract gel versus glyceryl trinitrate ointment in the treatment of chronic anal fissure: a randomized controlled trial. Colorectal Dis 2023; 25:1698-1707. [PMID: 37029603 DOI: 10.1111/codi.16576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/09/2023]
Abstract
AIM Chronic anal fissure (CAF) is an extremely frequent finding in clinical practice. Several topical agents have been proposed for its treatment with the common goal of increasing anodermal blood flow to promote healing. The aim of this study was to compare the efficacy and safety of a Propionibacterium extract gel (PeG) and 0.4% glyceryl trinitrate ointment (GTN) in patients with CAF. METHOD Patients were randomly allocated to a PeG or GTN group and medication was administered every 12 h for 40 days. The primary outcome was the success rate, as measured by a decrease in the REALISE scoring system for anal fissure at 10, 20 and 40 days after initiating either treatment. The secondary outcomes recorded at the same time points were healing rate, visual analogue scales for itching and burning, rate of complications and adverse events, patient quality of life and satisfaction, and cost analysis. RESULTS A total of 120 patients were enrolled, and 96 patients (PeG, n = 53; GTN, n = 43) completed the primary outcomes. A significant decrease over time in the REALISE score was observed in both groups. Adverse events occurred more frequently in the GTN group than in the PeG group, peaking at visit 1 [37 (63.8%) vs. 2 (3.4%), respectively], with headache being the most prevalent. The between-treatment cumulative average costs per patient were significantly higher for GTN than that for PeG at each follow-up visit. There were no other significant differences between the two groups for any of the other outcomes. CONCLUSION While there was no difference in healing rates between the two treatments, PeG was more cost-effective and associated with fewer adverse events.
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Affiliation(s)
- Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - Serena Fulginiti
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Marco La Torre
- Department of Surgery, Sapienza University of Rome, Rome, Italy
- Pelvic and Proctological Center, University Pittsburgh Medical College (UPMC), Salvator Mundi International Hospital, Rome, Italy
| | - Simone Tierno
- Pelvic and Proctological Center, University Pittsburgh Medical College (UPMC), Salvator Mundi International Hospital, Rome, Italy
| | | | - Paolo Vanini
- Centro Proctologico e Perineologico, Ospedali Privati Forlì, Forlì, Italy
| | - Giovanni Tomasicchio
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Donato Francesco Altomare
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - Marcella Rinaldi
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | | | - Giuseppe Currò
- Department of Health Sciences, General Surgery Unit, University of Catanzaro, Catanzaro, Italy
| | - Ugo Grossi
- II Surgery Unit, Regional Hospital Treviso, AULSS2 Marca Trevigiana, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padua, Padua, Italy
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Safety Assessment of Starch Nanoparticles as an Emulsifier in Human Skin Cells, 3D Cultured Artificial Skin, and Human Skin. MOLECULES (BASEL, SWITZERLAND) 2023; 28:molecules28020806. [PMID: 36677864 PMCID: PMC9866426 DOI: 10.3390/molecules28020806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
Emulsion systems are widely used in various industries, including the cosmetic, pharmaceutical, and food industries, because they require emulsifiers to stabilize the inherently unstable contact between oil and water. Although emulsifiers are included in many products, excessive use of emulsifiers destroys skin barriers and causes contact dermatitis. Accordingly, the consumer demand for cosmetic products made from natural ingredients with biocompatibility and biodegradability has increased. Starch in the form of solid nanosized particles is considered an attractive emulsifier that forms and stabilizes Pickering emulsion. Chemical modification of nanosized starch via acid hydrolysis can effectively provide higher emulsion stability. However, typical acid hydrolysis limits the industrial application of starch due to its high time consumption and low recovery. In previous studies, the effects of starch nanoparticles (SNPs) prepared by treatment with acidic dry heat, which overcomes these limitations, on the formation and stability of Pickering emulsions were reported. In this study, we evaluated the safety of SNPs in skin cell lines, 3D cultured skin, and human skin. We found that the cytotoxicity of SNPs in both HaCaT cells and HDF cells could be controlled by neutralization. We also observed that SNPs did not induce structural abnormalities on 3D cultured skin and did not permeate across micropig skin tissue or human skin membranes. Furthermore, patches loaded with SNPs were found to belong in the "No irritation" category because they did not cause any irritation when placed on human skin. Overall, the study results suggest that SNPs can be used as a safe emulsifier in various industries, including in cosmetics.
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Green Extraction of Polyphenols from Waste Bentonite to Produce Functional Antioxidant Excipients for Cosmetic and Pharmaceutical Purposes: A Waste-to-Market Approach. Antioxidants (Basel) 2022; 11:antiox11122493. [PMID: 36552701 PMCID: PMC9774313 DOI: 10.3390/antiox11122493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
In an ever-growing perspective of circular economy, the development of conscious, sustainable and environmental-friendly strategies to recycle the waste products is the key point. The scope of this work was to validate the waste bentonite from the grape processing industries as a precious matrix to extract polyphenols by applying a waste-to-market approach aimed at producing novel functional excipients. The waste bentonite was recovered after the fining process and opportunely pre-treated. Subsequently, both the freeze dried and the so-called "wet" bentonites were subjected to maceration. PEG200 and Propylene Glycol were selected as solvents due to their ability to dissolve polyphenols and their wide use in the cosmetic/pharmaceutical field. The extracts were evaluated in terms of yield, density, pH after water-dilution, total phenolic (Folin-Ciocalteu) and protein (Bradford) contents, antioxidant power (DPPH), amount of some representative polyphenols (HPLC-DAD), cytocompatibility and stability. Both solvents validated the bentonite as a valuable source of polyphenols and led to colored fluids characterized by an acidic pH after water-dilution. The best extract was obtained from the wet bentonite with PEG200 and highlighted the highest phenolic content and consequently the strongest antioxidant activity. Additionally, it displayed proliferative properties and resulted almost stable over time. Hence, it might be directly used as polyphenols-enriched functional novel raw material for cosmetic and pharmaceutics purposes.
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Shah N, Hussain M, Rehan T, Khan A, Khan ZU. Overview of polyethylene glycol-based materials with a special focus on core-shell particles for drug delivery application. Curr Pharm Des 2021; 28:352-367. [PMID: 34514984 DOI: 10.2174/1381612827666210910104333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/10/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
Polyethylene glycols (PEG) are water-soluble nonionic polymeric molecules. PEG and PEG-based materials are used for various important applications such as solvents, adhesives, adsorbents, drug delivery agents, tissue engineering scaffolds, etc. The coating of nanoparticles with PEG forms core-shell nanoparticles. The PEG-based core-shell nanoparticles are synthesized for the development of high-quality drug delivery systems. In the present review, we first explained the basics and various applications of PEGs and PEG-based composites materials and then concentrated on the PEG-based core-shell nanoparticles for biomedical applications specifically their use in drug delivery.
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Affiliation(s)
- Nasrullah Shah
- Department of Chemistry, Abdul Wali Khan University Mardan, Mardan, KP 23200. Pakistan
| | - Manzoor Hussain
- Department of Chemistry, Abdul Wali Khan University Mardan, Mardan, KP 23200. Pakistan
| | - Touseef Rehan
- Department of Biochemistry, Shaheed Benazir Bhutto Women University, Peshawar, KP 45000. Pakistan
| | - Abbas Khan
- Department of Chemistry, Abdul Wali Khan University Mardan, Mardan, KP 23200. Pakistan
| | - Zubair Ullah Khan
- Department of Chemistry, Abdul Wali Khan University Mardan, Mardan, KP 23200. Pakistan
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Wang Z, Lin L, Xu H. Stability of the PEG Fatty Acid Glycerides Based O/W Emulsions. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-2020-2344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In the present work, oil-in-water (O/W) emulsion systems were prepared by using the PEG-7 lauric acid glycerides as the emulsifiers and the liquid paraffin as the oil phase. The influence of processing parameters such as emulsification temperature, stirring speed, emulsifier concentration, oil-water volume ratio and polymer addition on the stability of the emulsion systems was investigated. In order to determine the optimal conditions for the preparation of the emulsion systems based on PEG-7 lauric acid glycerides, a laser drop size analyser and a rotational rheometer were used. As the stability of the O/W emulsion systems increased, the average droplet size of the O/W emulsions measured by the laser droplet size analyser became smaller and the viscosity, storage modulus and loss modulus of the O/W emulsions measured by the rotational rheometer became larger. The following optimal conditions were determined in this study: emulsification temperature 80°C, stirring speed 500 r/min, emulsifier concentration 5 wt%, oil-water volume ratio 1:1 and added amount of xanthan gum 0.2 wt%. The droplet morphology of the O/W emulsion prepared under the optimal conditions, which was characterised by a super high magnification microscope, is small. Furthermore, the long-term stability of the emulsion system prepared under the optimal conditions was investigated over a period of time (4 weeks). The O/W emulsion proves to be well stable even after 4 weeks, with a water separation rate of 0%.
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Teaima MH, Mohamed MAA, Abd El Rehem RT, Tayel SA, El-Nabarawi MA, Fouad SA. Enhanced Transdermal Delivery of Bisoprolol Hemifumarate via Combined Effect of Iontophoresis and Chemical Enhancers: Ex Vivo Permeation/In Vivo Pharmacokinetic Studies. Pharmaceutics 2021; 13:682. [PMID: 34068544 PMCID: PMC8151755 DOI: 10.3390/pharmaceutics13050682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Bisoprolol hemifumarate (BH) is an antihypertensive drug that is used as first-line treatment for chronic hypertension and angina pectoris. Our study was performed to enhance the transdermal delivery of BH, a hydrophilic drug active with high molecular weight, through differently prepared hydrogels. The synergistic effect of permeation enhancers and iontophoresis was investigated via both ex vivo and in vivo permeation studies. Ex vivo iontophoretic permeation studies were performed by using male albino Wistar rat skin. Cellosolve® hydrogel (F7) showed a 1.5-fold increase in Q180, Jss, and FER compared to F5 (lacking permeation enhancer). BH pharmacokinetic data were studied in human volunteers, following transdermal delivery of F7, using Phoresor® Unit II iontophoresis device, compared to conventional oral tablets. F7 showed 1.9- and 2-fold higher values of Cmax and AUC0-40, respectively compared to Concor® tablets, as well as a smaller Tmax (2.00 ± 2.00 h). The relative bioavailability of F7 was found to be 201.44%, relative to Concor® tablets, demonstrating the significantly enhanced transdermal permeation of BH from the selected hydrogel by iontophoresis, in human volunteers. Finally, results showed the successful utility of permeation enhancers combined with iontophoresis in significantly enhanced transdermal permeation of BH, despite its large molecular weight and hydrophilic nature. Therefore, this strategy could be employed as a successful alternative route of administration to conventional oral tablets.
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Affiliation(s)
- Mahmoud H. Teaima
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt; (R.T.A.E.R.); (S.A.T.); (M.A.E.-N.)
| | | | - Randa Tag Abd El Rehem
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt; (R.T.A.E.R.); (S.A.T.); (M.A.E.-N.)
| | - Saadia A. Tayel
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt; (R.T.A.E.R.); (S.A.T.); (M.A.E.-N.)
| | - Mohamed A. El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt; (R.T.A.E.R.); (S.A.T.); (M.A.E.-N.)
| | - Shahinaze A. Fouad
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Ahram Canadian University, Giza 19228, Egypt;
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Gallo G, Grossi U, Di Tanna GL, Santoro GA, De Paola G, Clerico G, Realis Luc A, Trompetto M, Sammarco G. Short-Term Outcomes of Polycarbophil and Propionibacterium acnes Lysate Gel after Open Hemorrhoidectomy: A Prospective Cohort Study. J Clin Med 2020; 9:jcm9123996. [PMID: 33321707 PMCID: PMC7763882 DOI: 10.3390/jcm9123996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Pain is the most common complication after open excisional hemorrhoidectomy (OEH). We assessed the effectiveness of polycarbophil and Propionibacterium acnes lysate gel (Emorsan®Gel) on pain control after OEH. Research design and methods: Fifty consecutive patients undergoing OEH were included. All patients received stool softeners and oral analgesia in the post-operative period. Emorsan®Gel was also used topically by the last 25 patients (Emorsan®Gel group (EG)) until Post-Operative Day 20 (POD 20). The primary outcome was the effectiveness of Emorsan®Gel on pain relief using an 11-point visual analogue scale (VAS). Morbidity, wound healing (WH), and time to work were documented at POD 1, POD 10, POD 20, and POD 40. Results: Of the 50 patients enrolled, twenty-eight (56%) were males; median age, 49 (range, 28–73) years. The VAS score decreased over time in all patients, with significantly lower scores at POD 20 in the EG (1.44 (SD, 1.16) vs. 2.12 (0.93) in the control group (CG); p = 0.045). All patients in the EG achieved complete WH at last follow-up, compared to only 17 (68%) in the CG (p = 0.004). The likelihood of WH was 66% higher in the EG (OR, 1.66 [95%CI, 0.80–3.44; p = 0.172). Conclusions: Emorsan®Gel is safe and effective at reducing pain after EOH, promoting earlier WH compared to standard care treatment.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
- Correspondence:
| | - Ugo Grossi
- Tertiary Referral Pelvic Floor Center, IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, 31100 Treviso, Italy; (U.G.); (G.A.S.)
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sidney, NSW 2042, Australia;
| | - Giulio Aniello Santoro
- Tertiary Referral Pelvic Floor Center, IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, 31100 Treviso, Italy; (U.G.); (G.A.S.)
| | - Gilda De Paola
- Department of Medical and Surgical Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
| | - Giuseppe Clerico
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy; (G.C.); (A.R.L.); (M.T.)
| | - Alberto Realis Luc
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy; (G.C.); (A.R.L.); (M.T.)
| | - Mario Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, 13100 Vercelli, Italy; (G.C.); (A.R.L.); (M.T.)
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Viale Europa, 88100 Catanzaro, Italy;
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Zhang Y, Lane ME, Moore DJ. An Investigation of the Influence of PEG 400 and PEG-6-Caprylic/Capric Glycerides on Dermal Delivery of Niacinamide. Polymers (Basel) 2020; 12:polym12122907. [PMID: 33291576 PMCID: PMC7761779 DOI: 10.3390/polym12122907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/03/2022] Open
Abstract
Polyethylene glycols (PEGs) and PEG derivatives are used in a range of cosmetic and pharmaceutical products. However, few studies have investigated the influence of PEGs and their related derivatives on skin permeation, especially when combined with other solvents. Previously, we reported niacinamide (NIA) skin permeation from a range of neat solvents including propylene glycol (PG), Transcutol® P (TC), dimethyl isosorbide (DMI), PEG 400 and PEG 600. In the present work, binary and ternary systems composed of PEGs or PEG derivatives combined with other solvents were investigated for skin delivery of NIA. In vitro finite dose studies were conducted (5 μL/cm2) in porcine skin over 24 h. Higher skin permeation of NIA was observed for all vehicles compared to PEG 400. However, overall permeation for the binary and ternary systems was comparatively low compared with results for PG, TC and DMI. Interestingly, values for percentage skin retention of NIA for PEG 400:DMI and PEG 400:TC were significantly higher than values for DMI, TC and PG (p < 0.05). The findings suggest that PEG 400 may be a useful component of formulations for the delivery of actives to the skin rather than through the skin. Future studies will expand the range of vehicles investigated and also look at skin absorption and residence time of PEG 400 compared to other solvents.
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Affiliation(s)
- Yanling Zhang
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK;
- Correspondence:
| | - Majella E. Lane
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK;
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