Nonalcoholic fatty liver disease and cognitive impairment: A prospective cohort study

BACKGROUND & AIMS

Nonalcoholic fatty liver disease (NAFLD) is prevalent and may affect cognitive function. We studied associations of NAFLD with risk of cognitive impairment. Secondarily we evaluated liver biomarkers (alanine aminotransferase (ALT), aspartate aminotransferase (AST), their ratio, and gamma-glutamyl transpeptidase).

METHODS

In a prospective cohort study, the REasons for Geographic and Racial Differences in Stroke, among 30,239 black and white adults aged ≥45,495 cases of incident cognitive impairment were identified over 3.4 years follow up. Cognitive impairment was identified as new impairment in two of three cognitive tests administered every two years during follow up; word list learning and recall, and verbal fluency. 587 controls were selected from an age, race, sex-stratified sample of the cohort. The fatty liver index was used to define baseline NAFLD. Liver biomarkers were measured using baseline blood samples.

RESULTS

NAFLD at baseline was associated with a 2.01-fold increased risk of incident cognitive impairment in a minimally adjusted model (95% CI 1.42, 2.85). The association was largest in those aged 45-65 (p interaction by age = 0.03), with the risk 2.95-fold increased (95% CI 1.05, 8.34) adjusting for cardiovascular, stroke and metabolic risk factors. Liver biomarkers were not associated with cognitive impairment, except AST/ALT >2, with an adjusted OR 1.86 (95% CI 0.81, 4.25) that did not differ by age.

CONCLUSIONS

A laboratory-based estimate of NAFLD was associated with development of cognitive impairment, particularly in mid-life, with a tripling in risk. Given its high prevalence, NAFLD may be a major reversible determinant of cognitive health.

Lipoprotein(a) and Risk of Ischemic Stroke in the REGARDS Study

Objective- Increased Lp(a) [lipoprotein(a)] is associated with coronary heart disease risk, but links with stroke are less consistent. Blacks have higher Lp(a) levels and stroke incidence than whites but have been underrepresented in studies. We hypothesized that Lp(a) is a risk factor for ischemic stroke and that risk differs by race. Approach and Results- REGARDS (Reasons for Geographic and Racial Differences in Stroke) recruited 30 239 black and white US adults aged ≥45 in 2003-2007 to study regional and racial differences in stroke mortality. We measured baseline Lp(a) by immunonephelometric assay in 572 cases of incident ischemic stroke and a 967-person cohort random sample. The hazard ratio of stroke by baseline Lp(a) was calculated using Cox proportional hazards models, stratified by race. Lp(a) was modeled in sex- and race-specific quartiles, given known differences in distributions by race and sex. Interactions were tested by including interaction terms in the proportional hazards models, with P<0.10 considered statistically significant. After adjustment for age, sex, and stroke risk factors, being in the fourth versus the first Lp(a) quartile was weakly associated with ischemic stroke overall, hazard ratio, 1.45 (95% CI, 0.96-2.19). In blacks, the hazard ratio was 1.96 (95% CI, 1.10-3.46), whereas in whites HR was 1.14 (95% CI, 0.64-2.04); P interaction=0.12. Lp(a) was lower in men than women, but associations with stroke in men and women were similar. Conclusions- We confirm that Lp(a) is a risk factor for ischemic stroke. Further research is needed to confirm the role of racial differences of the Lp(a) risk multiplier in ischemic stroke.

ABO blood group is associated with peripheral arterial disease in African Americans: The Multi-Ethnic Study of Atherosclerosis (MESA)

INTRODUCTION

Peripheral artery disease (PAD) affects 8.5 million Americans and thus improving our understanding of PAD is critical to developing strategies to reduce disease burden. The objective of the study was to determine the association of ABO blood type with ankle brachial index (ABI) as well as prevalent and incident PAD in a multi-ethnic cohort.

METHODS

The Multi-Ethnic Study of Atherosclerosis includes non-Hispanic White, African, Hispanic, and Chinese Americans aged 45-84. ABO blood type was estimated using ABO genotypes in 6027 participants who had ABI assessed at the baseline exam. Associations with ABO blood type were evaluated categorically and under an additive genetic model by number of major ABO alleles. After excluding those with ABI>1.4, prevalent PAD was defined as ABI≤0.9 at baseline and incident PAD as ABI≤0.9 for 5137 participants eligible for analysis.

RESULTS

There were 222 prevalent cases and 239 incident cases of PAD. In African Americans, each additional copy of the A allele was associated with a 0.02 lower baseline ABI (p=0.006). Each copy of the A allele also corresponded to 1.57-fold greater odds of prevalent PAD (95% CI, 1.17-2.35; p=0.004), but was not associated with incident PAD. No associations were found in other racial/ethnic groups for ABI, prevalent PAD, or incident PAD across all races/ethnicities.

CONCLUSIONS

Blood type A and the A allele count were significantly associated with baseline ABI and prevalent PAD in African Americans. Further research is needed to confirm and study the mechanisms of this association in African Americans.

Association of stroke risk biomarkers with stroke symptoms: the Reasons for Geographic and Racial Differences in Stroke cohort

Essentials Stroke symptom history predicts future stroke and may indicate prior unrecognized stroke. We studied associations of stroke symptoms with stroke risk biomarkers. Several stroke risk biomarkers were independently associated with stroke symptom history. Findings support a hypothesis that stroke symptoms may represent unrecognized stroke.

SUMMARY

Background History of stroke symptoms in the absence of prior diagnosed stroke or transient ischemic attack (TIA) is associated with future stroke risk, as are biomarkers of inflammation, cardiac function and hemostasis. Objective To better elucidate the pathobiology of stroke symptoms, we studied associations of these biomarkers with history of stroke symptoms. Methods The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-7. In cross-sectional analyses in a random sample of 960 participants without prior stroke or TIA, levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), fibrinogen, factor VIII (FVIII), factor XI (FXI), C-reactive protein (CRP) and D-dimer were studied in relation to self-reported history of six sudden onset stroke symptoms. Results There were 190 participants with at least one stroke symptom and 770 without. Adjusting for age, race, sex and stroke risk factors, NT-proBNP, FXI, CRP and D-dimer in the top vs. bottom quartile were associated with prevalent stroke symptoms with odds ratios 2.69 (95% confidence interval [CI], 1.45-4.98), 1.65 (95% CI, 1.00-2.73), 2.21 (95% CI, 1.32-3.71) and 2.14 (95% CI, 1.22-3.75), respectively. Conclusions Strong associations of stroke risk biomarkers with stroke symptoms in persons without a clinical history of cerebrovascular disease support a hypothesis that some of these stroke symptoms represent unrecognized cerebrovascular disease. Future work is needed to determine whether these biomarkers identify persons with stroke symptoms who have a particularly high stroke risk.

ABO blood type, factor VIII, and incident cognitive impairment in the REGARDS cohort

OBJECTIVE

To assess the relationships among ABO group, factor VIII (FVIII), and incident cognitive impairment in a large, prospective cohort study of black and white adults in the United States using a nested case-control design.

METHODS

Incident cognitive impairment was defined using cognitive domain tests over a mean follow-up of 3.4 years. ABO blood group was measured by genotyping in a nested case-control sample of 495 cases with cognitive impairment and 587 controls.

RESULTS

Those with blood group AB and those with higher FVIII had an increased risk of cognitive impairment, adjusting for age, race, region, and sex (respective odds ratios 1.82, 95% confidence interval [CI] 1.15-2.90; and 1.24, 95% CI 1.10-1.38 for 40 IU/dL higher FVIII). Mean FVIII was higher in those with blood type AB (142 IU/dL; 95% CI 119-165) compared with O (104 IU/dL; 95% CI 101-107), and FVIII mediated 18% of the association between AB group and incident cognitive impairment (95% CI for mediation -30% to 68%).

CONCLUSIONS

Blood group AB and higher FVIII were associated with increased incidence of cognitive impairment in this prospective study. The association of blood group AB with incident cognitive impairment was not significantly mediated by FVIII levels.

Prognostic utility of biochemical markers of cardiovascular risk: impact of biological variability

BACKGROUND

Although a variety of biochemical markers are used to help predict the risk of cardiovascular disease, the prognostic utility of any marker used as a risk assessment tool is dependent on the long- and short-term biological variability that the marker shows in different individuals.

METHODS

We measured total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol; triglycerides; high-sensitivity C-reactive protein (hsCRP); total fibrinogen; and γ' fibrinogen in blood samples collected from 15 apparently healthy individuals over the course of 1 year. Repeated measures variation estimates were used to calculate short- and long-term intraclass correlation coefficients (ICC), within- and between-subject coefficients of variation (CVI and CVG, respectively), validity coefficients, and indices of individuality for each marker.

RESULTS

HDL cholesterol demonstrated the lowest variability profile, with an ICC of 0.84 and CVI of 11.1 (95% CI: 8.3, 17.0). hsCRP showed the highest levels of short- and long-term within-subject variability [CVI (95% CI): 54.8 (32.8, 196.3) and 77.1 (53.3, 141.3), respectively]. Stated differently, it would require five separate measurements of hsCRP, performed on samples collected over multiple days, to provide the risk assessment information provided by a single measurement of HDL cholesterol. γ' Fibrinogen demonstrated an ICC of 0.79 and CVI of 14.3 (95% CI: 10.6, 21.9).

CONCLUSIONS

hsCRP showed very high biological variability, such that a single measurement of hsCRP lacks sufficient clinical utility to justify routine measurement. The variability profile of γ' fibrinogen was not markedly different than HDL cholesterol, necessitating only a limited number of measurements to establish an individual's risk of cardiovascular disease.

Early developmental elevations of brain kynurenic acid impair cognitive flexibility in adults: reversal with galantamine

Levels of kynurenic acid (KYNA), an endogenous α7 nicotinic acetylcholine receptor (α7nAChR) antagonist, are elevated in the brain of patients with schizophrenia (SZ) and might contribute to the pathophysiology and cognitive deficits seen in the disorder. As developmental vulnerabilities contribute to the etiology of SZ, we determined, in rats, the effects of perinatal increases in KYNA on brain chemistry and cognitive flexibility. KYNA's bioprecursor l-kynurenine (100mg/day) was fed to dams from gestational day 15 to postnatal day 21 (PD21). Offspring were then given regular chow until adulthood. Control rats received unadulterated mash. Brain tissue levels of KYNA were measured at PD2 and PD21, and extracellular levels of KYNA and glutamate were determined by microdialysis in the prefrontal cortex in adulthood (PD56-80). In other adult rats, the effects of perinatal l-kynurenine administration on cognitive flexibility were assessed using an attentional set-shifting task. l-Kynurenine treatment raised forebrain KYNA levels ∼3-fold at PD2 and ∼2.5-fold at PD21. At PD56-80, extracellular prefrontal KYNA levels were moderately but significantly elevated (+12%), whereas extracellular glutamate levels were not different from controls. Set-shifting was selectively impaired by perinatal exposure to l-kynurenine, as treated rats acquired the discrimination and intra-dimensional shift at the same rate as controls, yet exhibited marked deficits in the initial reversal and extra-dimensional shift. Acute administration of the α7nAChR-positive modulator galantamine (3.0mg/kg, i.p.) restored performance to control levels. These results validate early developmental exposure to l-kynurenine as a novel, naturalistic animal model for studying cognitive deficits in SZ.

Role of electrostatic interactions in binding of thrombin to the fibrinogen γ' chain

Thrombin binds to the highly anionic fibrinogen γ' chain through anion-binding exosite II. This binding profoundly alters thrombin's ability to cleave substrates, including fibrinogen, factor VIII, and PAR1. However, it is unknown whether this interaction is due mainly to general electrostatic complementarity between the γ' chain and exosite II or if there are critical charged γ' chain residues involved. We therefore systematically determined the contribution of negatively charged amino acids in the γ' chain, both individually and collectively, to thrombin binding affinity. Surface plasmon resonance binding experiments were performed using immobilized γ' chain peptides with charged-to-uncharged amino acid substitutions, i.e., Asp to Asn, Glu to Gln, and pTyr to Tyr. Individually, the substitution of uncharged for charged amino acids resulted in only minor changes in binding affinity, with a maximal change in K(d) from 0.440 to 0.705 μM for the Asp419Asn substitution. However, substitution of all three charged amino acids in a conserved β-turn that is predicted to contact thrombin, pTyr418Tyr, Asp419Asn, and pTyr422Tyr, resulted in the loss of measurable binding, as did substitution of all the flanking charged amino acids. In addition, the binding of the γ' chain to thrombin was weakened in a dose-dependent manner with increasing NaCl concentration, resulting in a net loss of three or four ion pairs between thrombin and the γ' chain. Therefore, although each of the individual charges in the γ' chain contributes only incrementally to the overall binding affinity, the ensemble of the combined charges plays a profound role in the thrombin-γ' chain interactions.

Discussion of the enabling environments for decentralised water systems

Decentralised water supply systems are becoming increasingly affordable and commonplace in Australia and have the potential to alleviate urban water shortages and reduce pollution into natural receiving marine and freshwater streams. Learning processes are necessary to support the efficient implementation of decentralised systems. These processes reveal the complex socio-technical and institutional factors to be considered when developing an enabling environment supporting decentralised water and wastewater servicing solutions. Critical to the technological transition towards established decentralised systems is the ability to create strategic and adaptive capacity to promote learning and dialogue. Learning processes require institutional mechanisms to ensure the lessons are incorporated into the formulation of policy and regulation, through constructive involvement of key government institutions. Engagement of stakeholders is essential to the enabling environment. Collaborative learning environments using systems analysis with communities (social learning) and adaptive management techniques are useful in refining and applying scientists' and managers' knowledge (knowledge management).

Association between γ' fibrinogen levels and inflammation

The γ' fibrinogen isoform produces clots that are stiffer and more resistant to breakdown than the more common fibrinogen isoform, γA. Increased levels of γ' fibrinogen are associated with several forms of cardiovascular disease. The purpose of this cross-sectional study was to investigate the relationship between γ' fibrinogen, an emerging risk factor for cardiovascular disease, and inflammatory markers in subjects with a chronic inflammatory state. The 284 subjects for this study came from the Periodontitis And Vascular Events (PAVE) study, and γ' fibrinogen and total fibrinogen in plasma were measured by ELISA. Information on patient demographics and health status, as well as levels of C-reactive protein (CRP), an inflammatory marker, have previously been collected for this study. The mean (SE) γ' fibrinogen level in the subjects was 0.622 (0.017) mg/ml. Levels of γ' fibrinogen were correlated with CRP (p = 0.006), with a one unit increase in CRP associated with a 1.9% increase in γ' fibrinogen, after adjustment for potential confounders. Total fibrinogen was not correlated with γ' fibrinogen in these subjects. The number of dental sites with evidence of tissue inflammation was also significantly associated with γ' fibrinogen levels. These results provide an important step in the evolution of γ' fibrinogen not only as a general risk factor for cardiovascular disease, but as a potentially useful biomarker for assessing a patient's inflammatory state and associated cardiovascular disease risk.

Cortical kynurenic acid bi-directionally modulates prefrontal glutamate levels as assessed by microdialysis and rapid electrochemistry

Using two in vivo methods, microdialysis and rapid in situ electrochemistry, this study examined the modulation of extracellular glutamate levels by endogenously produced kynurenic acid (KYNA) in the prefrontal cortex (PFC) of awake rats. Measured by microdialysis, i.p. administration of KYNA's bioprecursor L-kynurenine dose-dependently elevated extracellular KYNA and reduced extracellular glutamate (nadir after 50 mg/kg kynurenine: 60% decrease from baseline values). This dose-dependent decrease in glutamate levels was also seen using a glutamate-sensitive microelectrode array (MEA) (31% decrease following 50 mg/kg kynurenine). The kynurenine-induced reduction in glutamate was blocked (microdialysis) or attenuated (MEA) by co-administration of galantamine (3 mg/kg i.p.), a drug that competes with KYNA at an allosteric potentiating site of the alpha 7 nicotinic acetylcholine receptor. In separate experiments, extracellular glutamate levels were measured by MEA following the local perfusion (45 min) of the PFC with kynurenine (2.5 microM) or the selective KYNA biosynthesis inhibitor S-ethylsulfonylbenzoylalanine (S-ESBA; 5 mM). In agreement with previous microdialysis studies, local kynurenine application produced a reversible reduction in glutamate (nadir: -29%), whereas perfusion with S-ESBA increased glutamate levels reversibly (maximum: +38%). Collectively, these results demonstrate that fluctuations in the biosynthesis of KYNA in the PFC bi-directionally modulate extracellular glutamate levels, and that qualitatively very similar data are obtained by microdialysis and MEA. Since KYNA levels are elevated in the PFC of individuals with schizophrenia, and since prefrontal glutamatergic and nicotinic transmission mediate cognitive flexibility, normalization of KYNA levels in the PFC may constitute an effective treatment strategy for alleviating cognitive deficits in schizophrenia.

Physical characterization of polyethylene glycols by thermal analytical technique and the effect of humidity and molecular weight

Polyethylene glycols (PEGs) are well known as excipients in tablet dosage formulations. PEGs are generally known to be inert and have very few interactions with other components in the solid dosage forms. However, the physical nature of PEGs and how they affect the disintegration of tablets is not very well understood for the different molecular weights of PEGs. The knowledge of the effect of molecular weight of PEGs on their physical properties and the effect of humidity on the physical properties of PEGs are important parameters for the choice of a PEG to be acceptable as an excipient in pharmaceutical formulations. This study was done to determine the precision of the DSC physical properties for a wide range of PEGs with varying molecular weights from 194 to 23000 daltons. Nine different molecular weights of PEGs were examined in a DSC controlled Heat-Cool-Heat-Cool-Heat (HCHCH) cycle and the observed reproducible values of melting temperature, heat of fusion, crystallization temperature and the heat of crystallization were compared with values obtained from the literature and the observed percent crystallinity was again cross-checked by X-ray Diffraction (XRD) studies. The comparison values indicated acceptable precision. This study was also done to check the effect of humidity on the DSC physical properties for the entire range of PEGs. The results indicated that humidity probably has a higher effect on the physical properties of the low molecular weight PEGs as compared to the high molecular weight PEGs.

Evaluation of the drug-polymer interaction in calcium alginate beads containing diflunisal

Calcium alginate gel beads have been developed in recent years as a unique vehicle for oral drug delivery due to their excellent biocompatibility, biodegradability, simple method of preparation, abundant sources, low cost and minimal processing requirements. The objective of this study was to evaluate the drug-polymer interaction in calcium alginate beads containing diflunisal. Diflunisal loaded calcium alginate beads were successfully prepared by ionotropic gelation from solution of sodium alginate and diflunisal into calcium chloride solution. The weight ratio of drug to polymer was selected as 1:1. The calcium alginate beads were characterized by size, Scanning Electron Microscopy (SEM), weight uniformity and drug entrapment efficiency. The existence of a possible interaction between diflunisal and the calcium alginate was investigated by Differential Scanning Calorimetry (DSC), Powder X-Ray Diffraction (PXRD) and Fourier Transform Infra-Red (FTIR) analysis. Drug loaded beads were spherical to oval in shape with low drug entrapment efficiency. The drug was found to be present inside the beads as crystalline to semicrystalline form with no significant physical or chemical interaction between drug and excipients. The results implied that calcium alginate beads can be used as a suitable controlled release carrier for diflunisal.

An Improved High-Performance Liquid Chromatography Assay for Spironolactone Analysis

This study prepared an extemporaneously formulated liquid suspension dosage form (5 mg/ml) from commercially available 25 mg tablets. Stability-indicating HPLC assay procedures were established and utilized to analyze the concentration of the drug. The method proved to be a simple model since it does not contain a buffer system. The mobile phase used was the same as that suggested by the manufacturer for the storage of the column. Therefore, the solvent system saves analytical processing time, since it does not require a change in the mobile phase before or after the analysis. The analytical method has been shown to be stability-indicating. The results have shown that there is no interference from any of the degradation products obtained from stressing spironolactone by heat and extremes in pH or with the internal standard, hydrocortisone 21-acetate.

Fibrinogen Hershey IV: a novel dysfibrinogen with a gammaV411I mutation in the integrin alpha(IIb)beta(3) binding site

The carboxyl terminal segment of the fibrinogen gamma chain from gamma408-411 plays a crucial role in platelet aggregation via interactions with the platelet receptor alpha(IIb)beta(3). We describe here the first naturally-occurring fibrinogen point mutation affecting this region and demonstrate its effects on platelet interactions. DNA sequencing was used to sequence the proband DNA, and platelet aggregation and direct binding assays were used to quantitate the biological effects of fibrinogen Hershey IV. The Hershey IV proband was found to be heterozygous for two mutations, gammaV411I and gammaR275C. Little difference in aggregation was seen when fibrinogen Hershey IV was compared to normal fibrinogen. However, less aggregation inhibition was observed using a competing synthetic dodecapeptide containing the V411I mutation as compared to the wild-type dodecapeptide. Purified fibrinogen Hershey IV also bound to purified platelet alpha(IIb)beta(3) with a lower affinity than wild-type fibrinogen. These findings show that the gammaV411I mutation results in a decreased ability to bind platelets. In the heterozygous state, however, the available wild-type fibrinogen appears to be sufficient to support normal platelet aggregation.

Crystal forms of tolbutamide from acetonitrile and 1-octanol: effect of solvent, humidity and compression pressure

The possibility of obtaining tolbutamide polymorphs was investigated using the solvents acetonitrile and 1-octanol. Tolbutamide is an oral hypoglycemic agent that exists in four polymorphic forms. Characterization of the various polymorphs was carried out by differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), infrared spectroscopy (FTIR), optical microscopy and dissolution studies. Form A, crystallized from acetonitrile, resembled the form I polymorph, while form O, crystallized from 1-octanol, resembled the form III polymorph. Tablets of both form A and form O were produced at compression pressures of 2500 lbs and 5000 lbs using cornstarch and talc and were exposed to 40%, 75% and 95% RH conditions. DSC and PXRD studies did not show any significant drug-excipient interaction. Moreover, the change in the crystalline state of either form upon exposure to humidity was not evident. Dissolution studies showed a significantly lower drug release rate from form O tablets compressed at 5000 lbs pressure and exposed to 95% RH. Pressure and humidity had no significant effect on the dissolution profiles on the form A tablets. It was concluded that form A was the robust choice for further formulation development.

A high-performance liquid chromatography assay for yohimbine HCl analysis

The analysis used yohimbine HCl solution prepared from commercially available yohimbine HCl powder. Stability-indicating high-performance liquid chromatographic (HPLC) assay procedures were established and utilized to analyze the concentration of the drug. The method proved to be a simple model since it does not contain a buffer system. The mobile phase used, a methanol:water 70:30 ratio, was similar to that suggested by the manufacturer for the storage of the column. Therefore, the solvent system saves analytical processing time since it does not require a change in the mobile phase before and after the analysis. The analytical method has been shown to be stability indicating. The assay method showed a retention time for yohimbine of 4.2 min; for caffeine, the internal standard, it was 2.3 min. The standard deviation and the coefficient of variation were under acceptable limits of 2% and were specifically 1.51% and 1.35% for within-day and between-day samples, respectively. The results showed that the degradation products obtained from stressing yohimbine HCl by heat and extremes in pH did not interfere with the yohimbine HCl peak, although the internal standard, caffeine, did show some interference due to having a retention time similar to the degradation products.

Analysis of extemporaneous alprostadil formulaions

Twenty-two extemporaneous alprostadil (PGE1) injection solutions samples from five different suppliers and three Caverject (Pharmacia and Upjohn, Inc., Bridgewater, NJ) samples from three different lots, all intended for the clinical treatment of erectile dysfunction, were analyzed to determine PGE1 concentration, assess formation of the PGE1 aqueous breakdown product (PGA1), define pH and assess active microbial contamination. High-pressure liquid chromatography (HPLC), pH meter and cell culture techniques were used to conduct the analyses. Of the 22 extemporaneously formulated samples, six showed PGE1 concentrations 10% greater than their listed amounts and seven showed PGA1 weight fractions corresponding to at least 1.5% of the total prostaglandidn content. It should be noted that no standard has been published in the United States Pharmacopeia/National Formulary for this preparation as of this date. All samples were within the pH range 4.5 to 6.0. Four samples tested positive for active microbial contamination. In adition, nearly all the extemporaneously formulated samples contained what appeared to be benzyl alcohol, and about one half had at least two other undefined peaks within their HPLC chromatograms. In contrast, all three Caverject samples were within +/- 7.5% of their listed PGE1 concentrations while showing PGA1 prostaglandins weight fractions of less 0.6%, all were within the pH range 4.0 to 4.5 and all tested negative for active microbial contamination. Chromatograms of the Caverject samples also diplayed peaks consistent with the presence of benzyl alcohol but did not exhibit addtional undefined peaks. The results suggest that significant variations in PGE1 concentration and in PGA1 formation, accompanied by the possibility of microbial contamination, can occur as a result of the extemporaneous formulation and subsequent transfer of this type of product as a premixed solution intended for treating erectile dysfunction.

Stability of Magnesium Sulfate in 0.9% Sodium Chloride and Lactated Ringers solutions

Storage stability test were peformed on two extemporaneous formulation alternatives to the commercially available magnesium sulfate injection solutions that are in 5% dextrose or in water. Preparations of the commercial water for injection formulation and two alternative formulations in lactated Ringers and in 0.9% sodium chloride were stored at room temperature in glass bottles and in polyvinyl chloride bags over a three-month period. Solutions were monitored for gross precipitation and for changes in magnesium, sulfur and calcium levels as measured by elemental analysis using atomic absorption spectroscopy and inductively coupled plasma atomic emission spectroscopy. The results demonstrate no consistent decreases in measured elemental concentrations or gross signs of precipitation for any formulation tested.

The formulatiion development and stability of spironolactone suspension

The purpose of this study was to extemporaneously formulate a liquid dosage form from commercially available tablets and establish the chemical stability of the drug. A suspension of spironolactone (5mg/mL) was formulated from 25-mg spironolactone tablets. Stability-indicating, high perfpromance liquid chromatography assay procedures were used to analyze the concentration of the drug. Chemical stability was predicted using accelerated stability studies. The stability studies were conducted at four temperatures, namely 5*, 30*, and 50*, and 60*C. The spironolactone suspension showed less than 10% degradation at all four temperatures for a period of three months. It appears that the formulation may be stable for longer periods of time; however, the investigation did not extend past this timeline and no recommendation should be implied.

The formulation development and stability of metronidazole suspension

The purpose of this study was to extemporaneously formulate a liquid dosage form from commercially available tablets and establish the chemical stability of the drug. A suspension of metronidazole (15 mg/mL) was formulated from 500-mg metronidazole tablets. Stability-indicating, high-performance liquid chromatography assay procedures were utilized to analyze the concentration of the drug. Chemical stability was predicted using accelerated stability studies conducted at four temperatures, namely, 40 deg, 50 deg, 60 deg, and 70 deg C for metronidazole. The Arrhenius plot was used to predict the shelf-life of the metronidazole suspension at room temperature. The shelf-life was calculated from the initial concentration and k0 was found to be 73 years. Howwever, it would be more reasonable to expect that a quantity lasting no more than 90 days should be prepared and dispensed.

Stability of allopurinol suspension compounded from tablets

The stability of allopurinol as an extemporaneous suspension compounded form tablets was studied. The allopurinol suspension (20 mg/mL) was prepared by incorporating pulverized 300-mg allopurinol tablets into the suspending vehicle containing sodium carboxymethylcellulose and magnesium aluminum silicate (Veegum). Lycasin (a syrup vehicle that is 75% maltilol was added to this mixture. Appropriate antioxidants, preservatives, sweeteners and flavoring agents also were used. Samples of the suspension were stored in amber-colored glass bottles at 50 deg, 60 deg, 70 deg, and 80 deg C. At various times during the 97-day study period, the concentration of allopurinol in each sample was determined by a stability-indicating high performance liquid chromatography assay procedure. At the same time, samples were inspected visually for signs of caking or settling and evaluated for redispersibility and pourability. The aqueous solubility of allopurinol as a function of temperature also was studied. It was found that the aqueous solubility of allopurinol increased with an increase in the temperature. A zero-order reaction was assumed for the suspension. The kinetics of degradation were determined and the energy of activation and shelf-life were calculated using the Arrhenius plot. During the study period all samples remained homogenous and showed no signs of caking or settling. The allopurinol suspension compounded from tablets was found to be pharmaceutically acceptable and easily pourable and redispersible. The energy of activation for the suspension was found to be 21.92 kcal/mol. The shelf-life (t90) of the suspension was found to be 8.3 years at room temperature.

Stability of an extemporaneously formulated levothyroxine sodium syrup compounded from commercial tablets

The stability of 40 micrograms/mL extemporaneously formulated syrup from commercially available levothyroxine sodium tablets, using sorbitol 70% as the diluting vehicle, was studied. The concentration of levothyroxine sodium in the formulation was 40 micrograms/mL. The protocol included accelerated stability testing at temperatures of 40 deg, 50 deg, 60 deg, and 70 deg C and a high-performance liquid chromatography assay procedure using testosterone propionate as the internal standard. The data were analyzed using an Arrhenius plot to determine the shelf-life of formulation. The shelf-life was found to be approximately 15 days at 25 deg C and 47 days at 5 deg C.

Stability of procainamide hydrochloride syrups compounded from capsules

The stability of procainamide hydrochloride in two oral syrups, one prepared with sucrose and the other with maltitol, was studied. A syrup containing powder from 500-mg procainamide hydrochloride capsules, simple sucrose syrup, and other additives was prepared; the theoretical initial concentration of procainamide hydrochloride was 50 mg/mL. Three samples each were stored at 40, 50, 60, and 70 degrees C. Drug concentration was measured with high-performance liquid chromatography at times ranging from 2 to 107 days. In a second study, a syrup containing powder from 500-mg procainamide hydrochloride capsules, a maltitol-based syrup vehicle, and other additives was prepared; the theoretical initial drug concentration was 50 mg/mL. Three samples each were stored at 40, 50, 60, and 70 degrees C. Drug concentration was measured at times ranging from 7 to 187 days. For the sucrose-based syrup, there was apparent first-order degradation of procainamide hydrochloride at all temperatures. An Arrhenius plot was used to calculate a shelf life of the syrup of 456 days at 25 degrees C. Most samples turned brown over time, and pH values were constant. For the maltitol-based syrup, drug degradation appeared to be biphasic; an initial period during which concentrations remained at nearly 100% was followed by apparent first-order degradation. Arrhenius plotting gave a shelf life of 97 days at 25 degrees C. Most samples turned brown over time, and pHs remained constant. Arrhenius plots indicated that in a maltitol-based oral syrup, procainamide hydrochloride was more stable than in a sucrose-based syrup when the storage temperature was above 37 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Stability of hydralazine hydrochloride syrup compounded from tablets

The stability of hydralazine hydrochloride in an oral syrup and with various adjuvants that might be used in a liquid formulation was studied. A syrup containing triturated hydralazine hydrochloride 50-mg tablets, a maltitol-based syrup vehicle, and other additives was prepared; the theoretical initial concentration of hydralazine hydrochloride was 1.25 mg/mL. Three samples were each stored at 5, 40, 50, 60, and 70 degrees C. Drug concentration was measured with high-performance liquid chromatography at times ranging from 2 to 23 days. In a second study, five 50-mL solutions were prepared: (1) hydralazine 1% with no pH adjustment, (2) hydralazine 1% with pH adjusted to 6.33, (3) hydralazine 1% and edetate disodium 1% with no pH adjustment, (4) hydralazine 1% and edetate sodium 1% with no pH adjustment, and (5) hydralazine 1% and sodium bisulfite 1% with no pH adjustment. Drug concentration was determined after storage for one week at 50 degrees C. There was apparent first-order degradation of hydralazine hydrochloride at all temperatures. An Arrhenius plot was used to calculate a shelf life of the syrup of 5.13 days at 25 degrees C. There were no changes in pH or physical appearance. In the second study, hydralazine hydrochloride solution turned yellow immediately after edetate sodium [corrected] was added; at one week the loss of drug was 29%. Addition of sodium bisulfite caused a more intense yellow coloration, and loss of drug at one week was 80%. Changes in pH were minimal. An Arrhenius plot showed that hydralazine hydrochloride was relatively unstable in an oral syrup at room temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

A stochastic interpretation of the Riemann zeta function

We give a stochastic process for which the terms of the Riemann zeta function occur as the probability distributions of the elementary random variables of the process.

Influence of dielectric constant on sedimentation rate of concentrated suspensions of aluminum and magnesium hydroxides

Sedimentation of dilute pharmaceutical suspensions obeys Stokes's law, which assumes that there is no interaction between particles. The behavior of concentrated pharmaceutical suspensions is generally interpreted by use of modifications of Stokes's law that do not consider chemical interaction between particles. Properties of the medium itself, such as dielectric constant and surface tension, have not been included in the established equations. The present work shows that the dielectric constant of the medium has a distinct effect on the rate of sedimentation of the systems investigated.

Stability of acetazolamide in suspension compounded from tablets

The stability of acetazolamide in an extemporaneous suspension compounded from tablets was studied. Acetazolamide 25-mg/mL suspension was prepared by levigating the comminuted 250-mg tablets with 70% sorbitol solution. The mixture was incorporated into a suspension vehicle containing magnesium aluminum silicate and carboxymethylcellulose sodium. Appropriate sweeteners, flavoring agents, preservatives, humectants, and pH adjusters were then added. The suspension was stored in amber glass bottles at 5, 22, 30, 40, and 50 degrees C. Samples were analyzed for the concentration of acetazolamide by stability-indicating high-performance liquid chromatography on days 3, 7, 11, 18, 24, 32, 42, 54, and 79. For batches stored at 5, 22, and 30 degrees C, the initial acetazolamide concentration was maintained during the entire 79 days of the study. However, the concentrations in the batches stored at 40 and 50 degrees C were below 90% of the initial value after 79 and 32 days, respectively. The Arrhenius plot was used to predict a shelf life of the suspension at room temperature of 371 days. Acetazolamide oral suspension 25 mg/mL was stable for at least 79 days at 5, 22, and 30 degrees C. The formulation should be maintained at pH 4-5 and stored in amber glass bottles.

Interpretation of the hindered settling of calcium carbonate suspensions in terms of permeability

Many pharmaceutical formulations are produced in the form of concentrated suspensions. Calcium carbonate suspensions are used in this study and interpreted as the "model" for the behavior of such suspensions. The behavior of concentrated suspensions of powders in a liquid medium cannot be treated by the simple application of the normal principles of free fall and the use of Stokes Law pertaining to the viscous resistance offered by the surrounding fluid to fall. A single particle operating by the Stokes principle obeys this relationship. This law applies to the behavior of particles at low concentration in a liquid medium and is the basis for particle size distribution methods. At higher concentrations, however, the particles do not enjoy the freedom of unhindered fall. The system subsides "en bloc," and it is common practice to offer a modification to the Stokes equation which takes into consideration some function of the porosity of the system. There have been a considerable number of equations developed and modified based on this principle. However, an alternative method is to approach the problem by dealing with the permeability of a bed of powders in a liquid in which the bed is slowly altering with time. This is best achieved by the use of the permeability equation developed and presented by Kozeny-Carmen. This equation, as well as the Richardson-Zaki expression, are related to show that the Kozeny parameter K varies with the suspension porosity under sedimentation conditions. The values of K are often larger than the value normally reported (i.e., approximately 5). The data and treatment outlined here are extended to include not only the calcium carbonate suspensions, but other systems previously mentioned in the literature.

Stability of aspirin in solid mixtures

It has been shown that the degradation of aspirin in mixtures may be monitored by thermal analytical techniques. The methodology employed differential scanning calorimetry and thermal gravimetric analysis by standard techniques providing simple and rapid analysis for screening the stability of aspirin in mixtures. The degradation was found to depend on the nature of the additive but, in particular, the presence of acidic or basic groups within its structure.

Thermodynamics of aqueous solutions of parabens

The solubility of a related series of parabens was determined in water at four temperatures. The parabens chosen were the methyl through n-butyl p-hydroxybenzoates, and the temperature variations were 5 degrees increments from 25 to 40 degrees. These solutes are useful preservatives, especially combinations of the methyl and propyl ester derivatives. The chemical relationship of these compounds varied by successive linear methylene additions on the ester portion of the molecules. The thermodynamic values obtained for these aqueous systems could be related to these molecular variants since the remainder of the molecule was constant. For the overall thermodynamics, the free energy functions such as the ideal, actual, and excess were found to be smooth, nonlinear functions of the number of carbon atoms in the alkyl portion of the paraben esters. A linear relationship with the number of carbon atoms in the ester portion of these esters was found with the partial excess free energy of the solute.

Solubility profiles and thermodynamics of parabens in aliphatic alcohols

The solubility of a series of compounds was determined in a wide polarity spectrum of normal aliphatic alcohols over a limited temperature range. The solutes chosen were the methyl through n-butyl p-hydroxybenzoates, several of these being useful preservatives. Solubility profiles were determined for these compounds, and the effect of temperature upon their solubility behavior was investigated. The solubility of the solutes is expressed in several concentration notations; mole fraction plots showed a variable twin peak array as a function of the dielectric constant for the solutes studied. Since heats of fusion were available and data were generated as a function of temperature, thermodynamic parameters for these systems could be calculated. The relationship of these parameters to multiple solubility peak array is discussed.

Molecular orbital calculations for parabens: a possible mechanism of action

Molecular orbital calculations were carried out on the series benzoic acid, p-hydroxybenzoic acid, methylparaben, and ethylparaben. The characteristic trends of this entire series of preservatives are demonstrated by these members. The computer program used was Iterated Extended Hückel Theory. These systems were characterized in terms of atomic charge distributions, effect of hydroxyl and ester groups (both sterically and electronically), preferred molecular conformations, and distinguishing features of molecular orbitals. Through this approach, it was hoped that a common mode of action for all members of this series could be detected and that the trend(s) in this feature would correlate with known trends in activity of members of this series.

Solubility of straight-chain and branched alkyl barbiturates in straight-chain alcohols

The solubilities of a series of chemically related barbiturates, including some medically useful ones as well as phenobarbital, were determined at 25 degrees in the straight-chain alcohols methanol through butanol. The solubility values are given in both milligrams per milliliter and the mole fraction notation. The solubility in methanol was the highest and decreased nonlinearly for the solubility in 1-butanol. In several cases, mole fraction solubility gave shouldering or peaking as a function of the carbon number of the solvent. This series of barbiturates was broken down into two subsets of straight-chain and branched alkyl barbiturates, and solubility ratios in these subsets were considered.