Drug Dissolution in Oral Drug Absorption: Workshop Report

The in-person workshop "Drug Dissolution in Oral Drug Absorption" was held on May 23-24, 2023, in Baltimore, MD, USA. The workshop was organized into lectures and breakout sessions. Three common topics that were re-visited by various lecturers were amorphous solid dispersions (ASDs), dissolution/permeation interplay, and in vitro methods to predict in vivo biopharmaceutics performance and risk. Topics that repeatedly surfaced across breakout sessions were the following: (1) meaning and assessment of "dissolved drug," particularly of poorly water soluble drug in colloidal environments (e.g., fed conditions, ASDs); (2) potential limitations of a test that employs sink conditions for a poorly water soluble drug; (3) non-compendial methods (e.g., two-stage or multi-stage method, dissolution/permeation methods); (4) non-compendial conditions (e.g., apex vessels, non-sink conditions); and (5) potential benefit of having both a quality control method for batch release and a biopredictive/biorelevant method for biowaiver or bridging scenarios. An identified obstacle to non-compendial methods is the uncertainty of global regulatory acceptance of such methods.

The impact of time at home on potential yield of home-based TB contact investigation

BACKGROUND: The yield of TB contact tracing is often limited by challenges in reaching individuals during the screening process. We investigated the times at which index patients and household contacts were typically at home and the potential effects of expanding the timing of home-based contact investigation.METHODS: Index patients and household contacts in Kampala, Uganda, were asked about their likely availability at different day/time combinations. We calculated the "participant identification gap" (defined as the proportion of participants who reported being home <50% of the time) during business hours only. We then estimated the incremental reduction in the participant identification gap if hours were expanded to include weekday evenings, Saturdays, and Sundays. Statistical significance was assessed using McNemar´s tests.RESULTS: Nearly half of eligible individuals (42% of index patients and 52% of contacts) were not likely to be home during contact investigation conducted only during business hours. Expanding to weekday evenings, Saturdays, and Sundays would reduce this participant identification gap to 15% among index patients and 18% among contacts - while also reducing differences by sex and employment.CONCLUSIONS: Expanding hours for conducting contact investigation or other home-based health interventions could substantially reduce the number of individuals missed and address disparities in access to care.

High Social Support System among Elderly in a Hilly District: A Descriptive Cross-sectional Study

Introduction

Social support is an important contributing factor that promotes the health of the elderly by providing them with positive experiences, socially satisfying roles, or the ability to cope with stressful situations. The objective of this research study is to ind out the prevalence of a high social support system among the elderly in a Hilly district.

Methods

A descriptive cross-sectional study was conducted among the elderly from a hilly district of Nepal. The ethical approval was taken from Ethical Review Board (Reference number: 3050). Data were collected from 20 May 2019 to August 2019. The elderly aged 60 years and above were the study population. A convenience sampling technique was used. The face-to-face interview was taken by using a structured questionnaire. Point estimate, and 95% Conidence Interval were calculated.

Results

Out of 263 elderly people, 188 (71.48%) (66.02-76.94, 95% Conidence Interval) were provided with high support by their family members, friends, and signiicant others.

Conclusions

The prevalence of high social support among the elderly was found to be higher when compared to similar studies conducted in similar settings.

Keywords

elderly; social support; social support system.

Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization

Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe lifethreatening hemoptysis, particularly when other treatment options are unavailable or ineffective.

Magnesium sulphate in management of severe pre-eclampsia and eclampsia

BACKGROUND

Pre-eclampsia and eclampsia (PE/E) are the second leading cause of maternal mortality in Nepal accounting for 21% of all maternal deaths and 30% of all facility based maternal deaths. For treatment of severe pre-eclampsia and eclampsia (SPE/E), WHO has identified magnesium sulphate (MgSO4) as the most effective and low cost medication. The objective of the study was to explore current situation of SPE/E management using MgSO4 in 10 health facilities of Mid Western Development Region.

METHODS

Descriptive and single group pre-test, post test study design was used for the study. Data were collected by reviewing records, taking interviews and through observation. Knowledge and skills of service provider was assessed and scored (0-100%) before and after the educational intervention.

RESULTS

One year records indicate that 0.5% SPE/E cases were found in Dang Sub Regional Hospital and Pyuthan District Hospital; 0.4% in Bheri Zonal Hospital; 0.9% in Mehelkuna PHCC and 0.5% in Rajapur PHCC. In most of the hospitals, these cases were managed with MgSO4. During pre-testing none of the health facility was able to get standard score (80%) but in post test, 50% health facilities were able to get 80% or higher score.

CONCLUSIONS

Establishing national standard and providing one-time training is not sufficient, it requires refresher onsite training for propermanagement of SPE/E on time to improve maternal and neonatal health.

An ultrasonographic evaluation of solitary muscular and soft tissue cysticercosis

BACKGROUND

Cysticercosis in humans is infection with the larval form (cysticercus cellulosae) of the pork tapeworm T. solium. Encystment of larvae can occur in almost any tissue. The location of cysts in order of frequency is the central nervous system, subcutaneous tissue and striated muscle, vitreous humour of the eye and, rarely, other tissues. High resolution ultrasound can be used in the diagnosis of muscular and soft tissue cysticercosis.

OBJECTIVE

The aim of this study is to evaluate the ultrasonographic findings in cases of muscular and soft tissue cysticercosis.

MATERIALS AND METHODS

It was a retrospective review of the cases of muscular and soft tissue cysticercosis which were diagnosed by ultrasound during June 2007 to May 2009 in the department of Radiology and Imaging, Nepalgunj Medical College Teaching Hospital. A total of six patients were evaluated.

RESULT

There were four males and two females. Age of the patient ranged from 18 to 50 years. All of the patients presented with a swelling with pain in fi ve of them. There was a wide variation in the location of the cysts. In all cases ultrasound revealed a cystic lesion with an echogenic eccentric pedunculated nodule attached to the wall. The mean diameter of the cyst was 6mm. Smooth wall was present in fi ve cases whereas one of the cysts revealed irregular wall. Pericystic inflammatory changes were seen in the adjacent muscles.

CONCLUSION

Ultrasound is a safe and non-invasive method that can be used in the diagnosis of muscular and soft tissue cysticercosis.

Unusually large prostatic utricle cyst

Prostatic utricle cyst is one of the uncommon conditions and only a few cases have been reported. We present a case of unusually large prostatic utricle cyst in a 13- year- old male. He presented with burning urination and post-void dribbling of urine. A cystic mass was felt on digital per rectal examination. Ultrasound pelvis revealed a well-defined midline cystic mass posterior to the urinary bladder. Subsequent magnetic resonance imaging (MRI) of the pelvis demonstrated fluid containing cystic lesion communicating with posterior urethra. Surgical resection of the cyst was performed through the posterior sagittal approach. Follow up of the patient after three months of operation, there was complete resolution of the symptoms.

A study of wasp bites in a tertiary hospital of western Nepal

Hymenopterid stings and subsequent allergic reactions including fatal anaphylaxis are common indications for emergency department visits worldwide. Besides that, sting can cause death as a result of multi-system involvement ranging from intravascular hemolysis, rhabdomyolysis, acute renal failure, hepatic dysfunction and occasionally thrombocytopenia and coagulopathy. Eleven cases (all male, age 35.5 +/- 15.2 years) of wasp bites admitted in the Manipal Teaching Hospital (MTH), Pokhara during 01st February, 2006 to 30th October, 2007 were enrolled in this study. Mean wasp bites number was 48.7 +/- 7.1 (11-100) and mean time to reach the hospital from the bite time was 69.1 +/- 149.7 hours (1.5 h-12 days). Nine patients developed acute renal failure (ARF) and secondary hypertension. Eight patients underwent hemodialysis. Two patients stuck by more than 75 stings developed refractory pulmonary edema and died in the course of treatment. Victims with lesser numbers of wasp envenomation, who received quick initiation of alkaline diuresis and intensive dialytic support had shorter hospital stay and less severe complications.

Scimitar syndrome

A seven month old female child admitted to intensive care unit with increasing respiratory distress. Clinical examination revealed absence of cyanosis, wide and fixed normal intensity second heart sound. Chest radiograph revealed crescent like radio opacity in right lower lung and subsequent contrast enhanced computed tomography (CT) chest demonstrated abnormal vessel in right lung draining into the inferior vena cava.

Solid-pseudopapillary tumour of the pancreas: a report of a rare case

The solid pseudopapillary tumour (SPT) of the pancreas is an uncommon cystic pancreatic neoplasm mostly seen in young females. We present a large SPT in a 16-year-old female who presented with acute onset upper- and mid-quadrant abdominal pain associated with nausea and vomiting for 4 days. The lesion was demonstrated by abdominal ultrasound and by computed tomography, which was successfully removed surgically.

Parkisonism with Shy-Drager syndrome--a case report

A previously healthy 60 years old female patient presented with bradykinesia, postural instability and increased rigidity of both upper and lower limbs for 2 years and was diagnosed as Parkinsonism for last years. Later on she developed features of autonomic dysfunction including postural hypotension, hyperhydrosis and urinary incontinence so was diagnosed as Shy-Drager Syndrome. She was treated with fludrocortisone and nefidipine for the management of postural hypotension. Patient developed aspiration pneumonia during oral feeding, despite of ICU management for the same cause patient died of respiratory arrest.

When left ventricular failure complicates chronic obstructive pulmonary disease: hypoxia plays the major role

INTRODUCTION

As the chronic obstructive pulmonary disease (COPD) progress, is usually accompanied by involvement of the both left ventricle (LV) and right ventricle (RV), and their systolic and diastolic function. Signs and symptoms of LV failure can be difficult to distinguish from those of COPD.

OBJECTIVE

The study was carried out to determine the prevalence of LV systolic dysfunction in the COPD patients and to assess the possible risk factor behind such development.

MATERIAL AND METHODS

It is a prospective study of 60 cases of COPD patients with or without cor-pulmonale attending Manipal Teaching Hospital.

RESULTS

The prevalence of LV systolic dysfunction was found to be 26.7%, and the findings directly correlate with the severity of COPD i.e., the more the severity of the lung disease more the probability for the incidence of LV systolic dysfunction. These data are in support of the hypothesis that hypoxia and the excess accumulation of toxic metabolic products like lactic acid, significant right-to-left shunting through the bronchial circulation explains the diminished LV ejection fraction in severe COPD patients.

CONCLUSION

Routine echocardiography investigation of the severe COPD patients is required for assessing the status of LV function and to rule out the possible association of LV systolic dysfunction.

A rare case of pancreatic mediastinal pseudocyst

Pancreatic pseudocysts are the most common cystic lesions of the pancreas, accounting for 75-80% of such masses. Pancreatic pseudocyst with mediastinal extension is a rare clinical entity and only a handful cases report on dysphagia associated with mediastinal pseudocyst formation.1 We present a case of pancreatic mediastinal pseudocyst that presented with palpitations and dysphagia. Demonstration of cystic lesion in relation to the pancreas on ultrasound and mediastinal extension of the cyst on CT suggested the diagnosis.

Reduction of acute anterior shoulder dislocations under local anaesthesia--a prospective study

OBJECTIVE

To evaluate the application of local anaesthesia for reduction of acute anterior shoulder dislocation

DESIGN

A prospective study of patients coming with anterior dislocation of shoulder to KMCTH from July 2002 to Sep 2003.

SUBJECTS

Patients of aged 15-55 years with no associated fractures of adjoining bones.

RESULTS

A total of fifteen patients with anterior inferior shoulder dislocation were studied and all were reduced safely under local anaesthesia.

CONCLUSION

Use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective and is beneficial for countries like Nepal where health facilities are minimum in rural and suburban areas.

Comparison Between Diclosulam- and Imazapic-Based Weed Control Systems in Peanut1

Field studies were conducted in Florida and Alabama in 1998 and 1999 to evaluate imazapic [70gai/ha preemergence (PRE) or early postemergence (EPOST)], diclosulam (18 or 26 g ai/ha PRE or 18 g/ha EPOST) or imazapic + diclosulam (35 + 13 g/ha PRE or 35 + 9 g/ha EPOST). These treatments were applied alone or supplemented with either a paraquat + bentazon tank mixture or 2,4-DB. The intent was to determine if diclosulam, which has a mode of action similar to imazapic and is less persistent and less costly, could be incorporated into systems with other herbicides and thereby offer an alternative to imazapic. Maximum yield and economic return were consistently associated with only two treatments, imazapic at 70 g/ha EPOST and imazapic + diclosulam at 35 + 9 g/ha EPOST. However, none of the diclosulam-based systems provided a more favorable economic return than imazapic applied alone due to poor sicklepod control with diclosulam. Sicklepod control with diclosulam was improved with the addition of either paraquat + bentazon or 2,4-DB, but control was less than that obtained with imazapic. Diclosulam-based systems could be identified that were as effective as imazapic alone in controlling Florida beggarweed (diclosulam 26 g/ha EPOST or imazapic + diclosulam PRE or EPOST), bristly starbur (diclosulam 18 g/ha PRE or imazapic + diclosulam PRE or EPOST) and yellow nutsedge (imazapic + diclosulam EPOST). Thus, diclosulam-based systems may offer an economic advantage over imazapic in areas void of sicklepod. Neither diclosulam nor imazapic adversely affected any of five runner-type peanut cultivars (Georgia Green, Southern Runner, ViruGuard, Florida MDR 98, or Florida C-99R) when applied at twice labeled rates.