Application of design space and quality by design methodologies combined with ultra high-performance liquid chromatography for the optimization of the sample preparation of complex pharmaceutical dosage forms

Accurate and precise analytical measurements play a significant role in assessments and decisions that are made throughout the drug development process. Developing a robust and reliable sample preparation is essential for drug product formulations to generate consistent results guaranteeing the product quality. However, due to the complex nature of the different pharmaceutical formulations with diverse excipients, developing robust sample preparation methods can be challenging and time consuming. Ensuring sample extraction robustness of pharmaceutical dosage forms becomes increasingly important with the potential impact to patient safety, product efficacy, and business efficiency. In this work we demonstrate and evaluate potential application of Quality by Design (QbD) principles to develop and optimize a robust sample preparation method in combination with the chromatographic analytical technique for a solid pharmaceutical dosage form. Practicability and utility of a QbD approach in optimization of sample preparation of this drug product are demonstrated as the active pharmaceutical ingredient (API) used in the drug product is proven to be highly sensitive for hydrolysis during analysis. Finally, the ultra-high-performance liquid chromatography method with UV detection that was applied during the design of experiments (DoE) was validated as per regulatory requirements. This systematic approach in analytics could provide guidance for the pharmaceutical industry in the development of robust sample preparation methods for different pharmaceutical dosage forms thus significantly reduce risks associated with the method transfers at clinical and commercial manufacturing sites.

Substances, relationships and the omnipresence of the body: an overview of Ashéninka ethnomedicine (Western Amazonia)

Indigenous Amazonian ethnomedicine usually relies on numerous forms of healing, exercised by both specialists and non-specialists. Such is the case among the "Asheninka del Ucayali" (Arawak from the Peru-Brazil border). This paper attempts to elicit the underlying consistencies of their manifold, often contradictory practices and statements.It draws on ethnographic data gathered between 1997 and 2000, and is essentially based on my own interviews and participant observation. Concerning some specific points these data are also compared with ethnobotanical findings, to highlight significant peculiarities of the Asheninka approach.The first question is about the nature of a "good medicine". When the Asheninka borrow botanical knowledge from another ethnic group and comment the fact, the contrast between indigenous self-assessments and objective ethnobotanical measurements points out a crucial difference: While the Western approach focuses essentially on chemical effectiveness of the plants themselves, Asheninka people pay much more attention to relational aspects.The relational dimension also involves the plants themselves, as a sort of person. The point has implications in Asheninka shamanism and herbalism. A shaman does not necessarily need to be a good botanist. His main concern is managing a network of personal relationships involving all kinds of living beings. This network is supposed to be the mainspring of illness - a belief shared by both shamans and ordinary people.However, most ordinary people have detailed herbal knowledge. In fact, this everyday herbalism amounts to an alternative explanatory model. Such a coexistence of two contrasting explanatory systems is frequent in Amazonia. Among the Asheninka, nevertheless, the underlying hierarchy is clear: the herbal, apparently more materialistic, approach is embedded in the shamanic, plainly relational, model.

Regeneration of rat sciatic nerve across a LactoSorb bioresorbable conduit with interposed short-segment nerve grafts

OBJECT

This study was conducted to evaluate peripheral nerve regeneration through a conduit composed of a bioresorbable material (LactoSorb).

METHODS

Sprague-Dawley rats weighing approximately 250 g were randomized into five groups. A 20-mm-long sciatic nerve gap was created, then it was bridged by a reverse nerve autograft (Group I), an empty silicone tube (Group II), a silicone tube containing a short (2-mm) interposed nerve segment (Group III), an empty LactoSorb conduit (Group IV), or a LactoSorb conduit containing a 2-mm interposed nerve segment (Group V). The intact sciatic nerve served as the control in each animal. At 16 weeks postoperatively, no nerve regeneration was observed through either the empty silicone tube or the empty LactoSorb conduit. There was regeneration in all animals receiving the reverse autograft as well as in all animals receiving the silicone or LactoSorb conduit containing the 2-mm interposed nerve segment. Effective regeneration was assessed based on histological, electrophysiological, and morphometric criteria.

CONCLUSIONS

The results indicate that a conduit made of resorbable material will support sciatic nerve regeneration over a critical gap defect.

Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial

A deficit of mitochondrial energy metabolism may play a role in migraine pathogenesis. We found in a previous open study that high-dose riboflavin was effective in migraine prophylaxis. We now compared riboflavin (400 mg) and placebo in 55 patients with migraine in a randomized trial of 3 months duration. Using an intention-to-treat analysis, riboflavin was superior to placebo in reducing attack frequency (p = 0.005) and headache days (p = 0.012). Regarding the latter, the proportion of patients who improved by at least 50%, i.e. "responders," was 15% for placebo and 59% for riboflavin (p = 0.002) and the number-needed-to-treat for effectiveness was 2.3. Three minor adverse events occurred, two in the riboflavin group (diarrhea and polyuria) and one in the placebo group (abdominal cramps). None was serious. Because of its high efficacy, excellent tolerability, and low cost, riboflavin is an interesting option for migraine prophylaxis and a candidate for a comparative trial with an established prophylactic drug.

[Late form with psychiatric presentation of Wilson's disease, with pseudo-compulsive stereotyped movements. Neuro-radiological correlations]

Wilson's disease rarely starts after the third decade and may present with misleading psychiatric signs. We observed a 39-year-old white male who developed hysterical behaviour followed by frank delusional psychosis. Secondary neurological symptoms like astasia and dyarthria were misinterpreted as drug-induced. Despite a treatment with D-penicillamine and zinc sulfate there was further deterioration with anarthria and pseudo-compulsive stereotypies. These latter signs cleared after five months, whereas astasia and abasia remained the same and MRI imaging showed further deterioration characterized by marked bilateral putaminal cavitation. SPECT imaging could not predict the clinical evolution. Our case emphasizes that Wilson's disease can have variable initial presentations, and confirms the relationship between pseudo-compulsive stereotypies and bilateral lenticular lesions, as already described in other diseases of the basal ganglia.

Sodium valproate in severe migraine and tension-type headache: an open study of long-term efficacy and correlation with blood levels

We performed an open prospective study of the prophylactic efficacy of sodium valproate in 56 patients among which 35 migraineurs, 7 chronic tension-type headache patients and 14 patients with combined headaches. We compared the mean number of headache days per month during a one-month-baseline period without prophylactic treatment and during the last month of a 6-month-treatment course. Among secondary parameters, we assessed headache intensity, adverse experiences and we measured valproate blood levels after one and after six months of treatment. Sixty percent of migraineurs had a 75% or more improvement in the number of headache days under sodium valproate, most of the remaining attacks being less severe. There was no significant improvement in chronic tension-type headache patients and only a mild effect in patients with combined headaches, almost exclusively on the migraine component. Thirty percent of patients reported adverse effects of which none was serious: there were 3 drop-outs. We found a moderate, but statistically significant, correlation between efficacy and blood levels of sodium valproate.

High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study

If the brain of migraineurs is characterized between attacks by a reduction of mitochondrial phosphorylation potential, riboflavin, which has the potential of increasing mitochondrial energy efficiency, might have prophylactic effects in migraine. In this preliminary open pilot study, 49 patients suffering from migraine (45 without aura, 4 with aura) were treated with 400 mg of riboflavin as a single oral dose for at least 3 months. Twenty-three patients received in addition 75 mg of aspirin. Mean global improvement after therapy was 68.2% and there was no difference between the two groups of patients. With the exception of one patient in the riboflavin plus aspirin group who withdrew because of gastric intolerance, no drug-related side effects were reported. High-dose riboflavin could thus be an effective, low-cost prophylactic treatment of migraine devoid of short-term side effects. A placebo-controlled trial of its efficacy seems worthwhile.

No significant effect of an "atraumatic" needle on incidence of post-lumbar puncture headache or traumatic tap

We compared the incidence of post-lumbar puncture headache and of red blood cells in the first CSF sample (traumatic tap) in 35 inpatients punctured with a standard 20 G Yale needle and in 26 patients punctured with Sprotte's "atraumatic" needle. No significant difference was found between the two groups in incidence of headache or in frequency of traumatic taps.

Blood magnesium levels in migraine

Serum and erythrocyte magnesium levels were screened between attacks in patients with migraine without aura (n = 38) and with aura (n = 6), and for comparison in a group of patients suffering from chronic tension-type headache (n = 25) as well as a group of neurological, non-headache patients (n = 19). Serum magnesium levels were not significantly different between the four groups of patients. In contrast, magnesium in erythrocytes was on average significantly reduced in patients with migraine without aura compared to the other groups. It is hypothesized that this reduction might be due to an abnormal regulation of intracellular magnesium possibly reflecting at the periphery changes observed in the brain of migraineurs.