Adjusted green spectrophotometric determination of favipiravir and remdesivir in pharmaceutical form and spiked human plasma sample using different chemometric supported models

The environmentally friendly design of analytical methods is gaining interest in pharmaceutical analysis to reduce hazardous environmental impacts and improve safety and health conditions for analysts. The adaptation and integration of chemometrics in the development of environmentally friendly analytical methods is strongly recommended in the hope of promising benefits. Favipiravir and remdesivir have been included in the COVID-19 treatment guidelines panel of several countries. The main objective of this work is to develop green, tuned spectrophotometric methods based on chemometric based models for the determination of favipiravir and remdesivir in spiked human plasma. The UV absorption spectra of favipiravir and remdesivir has shown overlap to some extent, making simultaneous determination difficult. Three advanced chemometric models, classical least squares, principal component regression, and partial least squares, have been developed to provide resolution and spectrophotometric determination of the drugs under study. A five-level, two-factor experimental design has been used to create the described models. The spectrally recorded data of favipiravir and remdesivir has been reviewed. The noise region has been neglected as it has a negative impact on the significant data. On the other hand, the other spectral data provided relevant information about the investigated drugs. A comprehensive evaluation and interpretation of the results of the described models and a statistical comparison with accepted values have been considered. The proposed models have been successfully applied to the spectrophotometric determination of favipiravir and remdesivir in pharmaceutical form spiked human plasma. In addition, the environmental friendliness of the described models was evaluated using the analytical eco-scale, the green analytical procedure index and the AGREE evaluation method. The results showed the compliance of the described models with the environmental characteristics.

Quercetin: Putative effects on the function of cryopreserved sperms in domestic animals

Quercetin is one of the most used antioxidant flavonoids and largely exists in many fruits and vegetables because of its capability to scavenge the free reactive oxygen species (ROSs) by repressing lipid peroxy radical fusion, metal ion chelating through enzyme inhibition, and adopting the repair mechanisms. It also exhibits various biological actions, including antioxidative, anti-inflammatory and antimicrobial activities. Furthermore, it contributes well to sustaining the endogenous cellular antioxidant defence system. The process of cryopreservation is associated with increased oxidative stress, and some steps are potential sources of ROSs, including the method of semen collection, handling, cryopreservation culture media, and thawing, which result in impaired sperm function. Several antioxidants have been proposed to counteract the harmful impact of ROS during semen cryopreservation. The antioxidant capability of quercetin has been verified in different animal species for providing valuable defence to sperm during the cryopreservation process. The beneficial properties of quercetin on various parameters of fresh and post-thaw sperm in different species are clarified in this review. More in-depth investigations are required to clarify quercetin's mechanism of action in different animal species.

Effect of hyperbaric oxygen treatment on diabetic foot ulcers: A meta-analysis

The meta-analysis aimed to assess the effect of hyperbaric oxygen treatment on diabetic foot ulcers. Using dichotomous or contentious random or fixed effect models, the outcomes of this meta-analysis were examined and the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. 17 examinations from 1992 to 2022 were enrolled for the present meta-analysis, including 7219 people with diabetic foot ulcers. Hyperbaric oxygen treatment had a significantly higher healed ulcer (OR, 14.39; 95% CI, 4.02-51.52, p < 0.001), higher adverse event (OR, 2.14; 95% CI, 1.11-4.11, p = 0.02), lower mortality (OR, 0.22; 95% CI, 0.07-0.71, p = 0.01) and higher ulcer area reduction (MD, 23.39; 95% CI, 11.79-34.99, p < 0.001) compared to standard treatment in patients with diabetic foot ulcers. However, hyperbaric oxygen treatment and standard treatment had no significant difference in amputation (OR, 0.62; 95% CI, 0.22-1.75, p = 0.37), major amputation (OR, 0.59; 95% CI, 0.18-1.92, p = 0.38), minor amputation (OR, 0.64; 95% CI, 0.15-2.66, p = 0.54) and healing time (MD, -0.001; 95% CI, -0.76 to 0.75, p = 0.99) in patients with diabetic foot ulcers. The examined data revealed that hyperbaric oxygen treatment had a significantly higher healed ulcer, adverse event, and ulcer area reduction and lower mortality, however, there was no significant difference in amputation and healing time compared to standard treatment in patients with diabetic foot ulcers. Yet, attention should be paid to its values since most of the selected examinations had a low sample size and some of the comparisons had a low number of selected studies.

Simultaneous green TLC determination of nirmatrelvir and ritonavir in the pharmaceutical dosage form and spiked human plasma

Quantitative analysis of pharmaceutical compounds up to Nano gram levels is highly recommended to introduce feasible and sensitive tool for determination of the compounds in the pharmaceutical and biological samples. Nirmatrelvir plus ritonavir was recently approved in the US, the UK and Europe as a new co-packaged dosage form for the treatment of COVID-19. The objective of this work was to develop a more sensitive TLC method based on using β-cyclodextrin as a chiral selector additive in the mobile phase for simultaneous determination of nirmatrelvir and ritonavir in pure form, pharmaceutical formulation and spiked human plasma. The analysis procedures were developed using TLC aluminum silica gel plates and methanol-water- 2% urea solution of β-cyclodextrin (40:10:.5, by volume) as a mobile phase with UV detection at 215 nm. The developed method was successfully applied over a linearity range of 10-50 ng/band for both nirmatrelvir and ritonavir. The method was validated for limits of detection and quantitation, accuracy, precision, specificity, system suitability, and robustness. Furthermore, the eco-friendliness of the proposed method was assessed using the analytical eco-scale and the green analytical procedure index. The described method exhibited compliance with green analytical chemistry principles based on common green metric values.

Efficacy of pentasodium diethylenetriamine pentaacetate in ameliorating anosmia post COVID-19

BACKGROUND

COVID-19 has been frequently demonstrated to be associated with anosmia. Calcium cations are a mainstay in the transmission of odor. One of their documented effects is feedback inhibition. Thus, it has been advocated that reducing the free intranasal calcium cations using topical chelators such as pentasodium diethylenetriamine pentaacetate (DTPA) could lead to restoration of the olfactory function in patients with post-COVID-19 anosmia.

METHODOLOGY

This is a randomized controlled trial that investigated the effect of DTPA on post-COVID-19 anosmia. A total of 66 adult patients who had confirmed COVID-19 with associated anosmia that continued beyond three months of being negative for SARS-CoV-2 infection. The included patients were randomly allocated to the control group that received 0.9 % sodium chloride-containing nasal spray or the interventional group that received 2 % DTPA-containing nasal spray at a 1:1 ratio. Before treatment and 30 days post-treatment, the patients' olfactory function was evaluated using Sniffin' Sticks, and quantitative estimation of the calcium cations in the nasal mucus was done using a carbon paste ion-selective electrode test.

RESULTS

Patients in the DTPA-treated group significantly improved compared to the control group in recovery from functional anosmia to hyposmia. Additionally, they showed a significant post-treatment reduction in the calcium concentration compared to the control group.

CONCLUSION

This study confirmed the efficacy of DTPA in treating post-COVID-19 anosmia.

Efficiency of platelet-rich plasma in the management of burn wounds: A meta-analysis

The meta-analysis aimed to assess the efficiency of platelet-rich plasma (PRP) in the management of burn wounds (BWs). Using dichotomous or contentious random- or fixed-effects models, the outcomes of this meta-analysis were examined and the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. Thirteen examinations from 2009 to 2023 were enrolled for the present meta-analysis, including 808 individuals with BWs. PRP had significantly shorter healing time (MD, -5.80; 95% CI, -7.73 to -3.88, p < 0.001), higher healing rate (OR, 3.14; 95% CI, 2.05-4.80, p < 0.001), higher healed area percent (MD, 12.67; 95% CI, 9.79-15.55, p < 0.001) and higher graft take area percent (MD, 4.39; 95% CI, 1.51-7.26, p = 0.003) compared with standard therapy in patients with BW. However, no significant difference was found between PRP and standard therapy in graft take ratio (OR, 1.70; 95% CI, 0.86-3.34, p = 0.13) and infection rate (OR, 0.55; 95% CI, 0.20-1.47, p = 0.23) in patients with BW. The examined data revealed that PRP had a significantly shorter healing time, a higher healing rate, a higher healed area percent and a higher graft take area percent; however, no significant difference was found in graft take ratio or infection rate compared with standard therapy in patients with BW. Yet, attention should be paid to its values since all of the selected examinations had a low sample size and some comparisons had a low number of selected studies.

Mahzari H, M. Alhamdhi S, Y. Alhazmi T, Y. Hassani K, S. Alamri A, Alsubaihi AI, M. Alotaibi F. Assessment of Knowledge, Attitude, and Practice of Pharmacists towards Drug Interactions in Saudi Arabia

Background: Drug interactions, which are generally encountered in medical prescriptions, may lead to severe health issues. Pharmacists in both the public and private pharmacy setting are by profession in a unique position to gain and use their competencies to find and prohibit drug interactions. Aim of the Study: To assess knowledge, attitude and practice of pharmacists toward drug interactions in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted using a self- administered questionnaire. Results: Two hundred sixty-three pharmacists participated in the survey and results were expressed in frequencies and percentages. The mean age of participant pharmacists was (31.7) years showing a relatively young participant’s population. Males were (75.3%), while females were (24.7%). Majority of pharmacists (67.3%) were working in public sector. Half of them had a bachelor’s degree in pharmacy as their latest academic degree. Participants’ averages of awareness, attitude and practice regarding drug interactions, correct knowledge of drug-drug, drug-food, drug-disease interactions were, (90.7%), (65.3%), (67.7%), (61.7%) respectively. Most (79.8%) of the participants asserted that the notified doctors usually agree with pharmacists’ opinion and decision. This percentage indicates a good cooperation when compared to other studies. Conclusion: Pharmacists’ knowledge about drug interactions was inadequate. Lack of knowledge of drug interactions may lead to improper patient counseling and the appearance of adverse effects. There is a need to improve the knowledge and to uplift the level of awareness of pharmacists about the potential drug interactions that are clinically related.

Higher sensitive selective spectrofluorometric determination of ritonavir in the presence of nirmatrelvir: application to new FDA approved co-packaged COVID-19 pharmaceutical dosage and spiked human plasma

BACKGROUND

Ritonavir was recently combined with nirmatrelvir in a new approved co-packaged medication form for the treatment of COVID-19. Quantitative analysis based on fluorescence spectroscopy measurement was extensively used for sensitive determination of compounds exhibited unique fluorescence features.

OBJECTIVE

The main objective of this work was to develop higher sensitive cost effective spectrofluorometric method for selective determination of ritonavir in the presence of nirmatrelvir in pure form, pharmaceutical tablet as well as in spiked human plasma.

METHODS

Ritonavir was found to exhibit unique native emission fluorescence at 404 nm when excited at 326 nm. On the other hand, nirmatrelvir had no emission bands when excited at 326 nm. This feature allowed selective determination of ritonavir without any interference from nirmatrelvir. The variables affecting fluorescence intensity of ritonavir were optimized in terms of sensitivity parameters and principles of green analytical chemistry. Ethanol was used a green solvent which provided efficient fluorescence intensity of the cited drug.

RESULTS

The method was validated in accordance with the ICH Q2 (R1) standards in terms of linearity, limit of detection (LOD), limit of quantification (LOQ), accuracy, precision and specificity. The described method was successfully applied for ritonavir assay over the concentration range of 2.0-20.0 ng/mL.

CONCLUSION

Ritonavir determination in the spiked human plasma was successfully done with satisfactory accepted results.

A meta-analysis evaluating wound infections and other complications following distal versus complete gastrectomy for gastric cancer

A meta-analysis investigation was carried out to measure the wound infections (WIs) and other postoperative problems (PPs) of distal gastrectomy (DG) compared with total gastrectomy (TG) for gastric cancer (GC). A comprehensive literature investigation till February 2023 was used and 1247 interrelated investigations were reviewed. The 12 chosen investigations enclosed 2896 individuals with GC in the chosen investigations' starting point, 1375 of them were TG, and 1521 were DG. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilized to compute the value of the WIs and other PPs of DG compared with TG for GC by the dichotomous approaches and a fixed or random model. TG had significantly higher overall PP (OR, 1.58; 95% CI, 1.15-2.18, p = 0.005), WIs (OR, 1.69; 95% CI, 1.07-2.67, p = 0.02), peritoneal abscess (PA) (OR, 2.99; 95% CI, 1.67-5.36, p < 0.001), anastomotic leakage (AL) (OR, 1.90; 95% CI, 1.21-2.97, p = 0.005) and death (OR, 2.26; 95% CI, 1.17-4.37, p = 0.02) compared to those with DG in individuals with GC. TG had significantly higher overall PP, WIs, PA, AL and death compared to those with DG in individuals with GC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.

Development of Coumarin-Based Probe for Spectrofluorometric Lead Determination in the Human Plasma: Exploring an Association With Otitis Media

Chronic otitis media poses a significant global health challenge, particularly burdening low socioeconomic areas, notably in developing nations. Despite its prevalence, the role of lead in chronic otitis media remains largely overlooked. This study introduces an innovative spectrofluorometric technique for highly sensitive lead detection in human plasma samples at the nano-level. The method capitalizes on the interaction between lead ions and 7,8-dihydroxy-4-phenylcoumarin, generating a distinct fluorescent product. This complex exhibit modified fluorescence characteristics compared to free 7,8-dihydroxy-4-phenylcoumarin, emitting at 505 nm when excited at 330 nm. This shift, accompanied by an increase in fluorescence intensity, enables precise lead quantification even within complex plasma matrices. Validation confirmed a consistent linear relationship within the 200-4000 ng/mL range. Application of the validated method revealed elevated lead levels in plasma samples from chronic otitis media patients compared to healthy controls. These findings suggest a potential link between lead exposure and chronic otitis media development, though further research is warranted for confirmation. This research underscores the importance of considering lead's impact on chronic otitis media etiology and progression, especially in vulnerable populations.

A Meta-Analysis Examining the Impact of Consuming Nitrogen-Free Analogs of Essential Amino Acids on the Progression of Chronic Renal Disease

Background and Objectives: We conducted a meta-analysis to assess the impact of nitrogen-free substitutes for essential amino acids on the progression of chronic kidney disease (CKD). Materials and Methods: A comprehensive literature review conducted up to November 2024 identified 15 studies that involved 1596 participants with CKD at baseline; among them, 797 were on very-low-protein diets (LPDs) enriched with nitrogen-free analogs (NFA), while 799 followed a standard LPD. Results: A very-LPD utilizing NFA showed significantly improved estimated glomerular filtration rate (MD, 1.00; 95% CI, 0.35-1.64, p = 0.002), reduced serum creatinine (MD, -0.44; 95% CI, -0.75 to -0.13, p = 0.006), decreased blood urea nitrogen (MD, -35.34; 95% CI, -64.27 to -6.42, p = 0.02), and lower parathyroid hormone levels (MD, -1.25; 95% CI, -2.33 to 0.18, p = 0.02) when compared to a standard LPD in patients with CKD. Nevertheless, the very-LPD with NFA resulted in no significant differences in serum albumin (MD, 0.08; 95% CI, -0.03 to 0.19, p = 0.14), serum cholesterol (MD, -17.25; 95% CI, -42.79 to 8.29, p = 0.19), serum phosphorus (MD, -0.41; 95% CI, -0.97 to 0.15, p = 0.15), and serum calcium (MD, 0.16; 95% CI, -0.06 to 0.39, p = 0.16) compared to a typical LPD in subjects with CKD. Conclusions: A very-LPD supplemented with NFA showed a notably higher estimated glomerular filtration rate, decreased serum creatinine levels, lower blood urea nitrogen, and reduced parathyroid hormone levels; however, there were no significant differences observed in serum albumin, serum cholesterol, serum phosphorous, and serum calcium when compared to a standard LPD in individuals with CKD. Additional research is necessary to confirm these results.

A Meta-Analysis Examining the Effect of Perioperative Biologic Disease-Modifying Anti-Rheumatic Medications on Postoperative Wound Complications in Various Orthopedic Surgeries

This meta-analysis was designed to compare the risk of postoperative wound complications in various orthopedic surgeries (OSs) affected by the perioperative use of biologic disease-modifying anti-rheumatic drugs (bDMARDs). The odds ratio (OR) and mean difference (MD), with 95% confidence intervals (CIs), were calculated using dichotomous or continuous random or fixed-effect models, based on the meta-analysis data. This study incorporated 14 investigations conducted between 2005 and 2023, encompassing a total population of 19,021 individuals undergoing diverse OSs. Participants who continued their bDMARDs exhibited a substantially higher incidence of postoperative surgical site infections (OR, 1.39; 95% CI, 1.12-1.72, p = 0.002) compared to those who withheld bDMARDs. However, the study did not find any statistically significant difference between the continuation or withholding of bDMARDs regarding delayed wound healing (OR, 2.02; 95% CI, 1.00-4.06, p = 0.05) or disease flares (OR, 0.59; 95% CI, 0.28-1.25, p = 0.17). The results show that patients who continued their bDMARDs had a notably higher incidence of postoperative surgical site infections. However, no significant differences were observed in delayed wound healing or disease flares when compared to those who withheld bDMARDs. It is important to acknowledge the limitations of this analysis, such as the relatively small number of participants and the limited number of studies available for certain comparisons, which may impact the validity of the findings.

Prevalence of surgical site wound infection after spine surgery in nasal colonization of methicillin-resistant Staphylococcus aureus: A meta-analysis

The purpose of the meta-analysis was to evaluate and compare the prevalence of surgical site infection (SSI) after spine surgery (SS) in nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random- or fixed-effect models. For the current meta-analysis, 14 examinations spanning from 2014 to 2022 were included, encompassing 18 410 people who were tested for nasal colonization after SS. MRSA-positive had a significantly higher SSI (OR, 3.65; 95% CI, 2.48-5.37, p < 0.001) compared with MRSA-negative in SS subjects. However, no significant difference was found between methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus negative (OR, 0.94; 95% CI, 0.32-2.79, p = 0.91), and Staphylococcus aureus positive and negative (OR, 2.13; 95% CI, 0.26-17.41, p = 0.48) in SS subjects. The examined data revealed that MRSA colonization had a significant effect on SSI; however, methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus had no significant effect on SSI in SS subjects. However, given that some comparisons included a small number of chosen studies, attention should be given to their values.

Impact of negative pressure wound drainage compared with natural wound drainage after thyroid tumour surgery: A meta-analysis

We conducted a meta-analysis to compare the effectiveness of negative pressure wound drainage to that of spontaneous wound drainage after thyroid tumour surgery. A thorough analysis of the literature up to July 2022 revealed that, of the 1234 patients who used surgery for thyroid tumours, 615 used negative pressure wound drainage and 619 used natural wound drainage. To measure the influence of negative pressure wound drainage in comparison to natural wound drainage following thyroid tumour surgery, mean difference (MD) and odds ratio (OR) with 95% confidence intervals (CIs) were measured using the contentious and dichotomous approaches with a random or fixed-effect model. Subjects who used negative pressure wound drainage had significantly higher averages for drained material (OR, 12.52; 95% CI, 6.78-18.26, P = 0.001), shorter drain placement times (MD, -1.06; 95% CI, 1.57 to -0.55, P = .001), lower rates of infection at the surgical site (OR, 0.17; 95% CI, 0.05-0.60, P = .006), higher rates of wound healing (OR, 5.91; 95% CI, 1.56-22.34, P = .009), and lower rate of wound seroma (OR, 0.21; 95% CI, 0.10-0.42, P < .001) in subjects after thyroid tumour surgery in comparison to subjects who used natural wound drainage after thyroid tumour surgery. Those who used negative pressure wound drainage had significantly higher averages of drained material, shorter drain placement times, lower rates of wound infection at the surgical site, higher rates of wound healing, and lower rates of wound seroma. Care must be used when analysing the results because of the small sample size of 7 of the 13 studies included in the meta-analysis and the lack of studies in several comparisons.

In Vitro and Randomized Controlled Clinical Study of Natural Constituents' Anti-HPV Potential for Treatment of Plantar Warts Supported with In Silico Studies and Network Analysis

The aim of this study is to evaluate the anti-HPV potential of a Moringa olifera Lam seed, Nigella sativa L. seed, and Musa Acuminata peel herbal mixture in the form of polymer film-forming systems. A clinical trial conducted in outpatient clinics showed that the most significant outcome was wart size and quantity. Compared to the placebo group, the intervention group's size and number of warts were considerably better according to the results. Chemical profiling assisted by LC-HRMS led to the dereplication of 49 metabolites. Furthermore, network pharmacology was established for the mixture of three plants; each plant was studied separately to find out the annotated target genes, and then, we combined all annotated genes of all plants and filtered the genes to specify the genes related to human papilloma virus. In a backward step, the 24 configured genes related to HPV were used to specify only 30 compounds involved in HPV infection based on target genes. CA2 and EGFR were the top identified genes with 16 and 12 edges followed by PTGS2, CA9, and MMP9 genes with 11 edges each. A molecular docking study for the top active identified compounds of each species was conducted in the top target HPV genes, CA2 and EGFR, to investigate the mode of interaction between these compounds and the targets' active sites.

A meta-analysis examining the impact of obesity on surgical site wound complications in patients undergoing primary ovarian cancer surgery

The meta-analysis sought to evaluate and compare the effect of obesity on surgical site wound problems in subjects after primary ovarian cancer surgery. The results found by this meta-analysis were analyzed, and then odds ratio (OR) and mean difference (MD), at 95% confidence intervals (CIs), were calculated. These models might be dichotomous or contentious, random, or fixed effect models. The current meta-analysis included nine exams from 2009 to 2023, including 4362 females with primary ovarian cancer surgeries. Obesity had a significantly higher risk of surgical site wound infections (OR, 2.90; 95% CI, 2.27-3.69, p < 0.001), and wound problems (OR, 4.14; 95% CI, 1.83-9.34, p < 0.001) compared to non-obesity in females with primary ovarian cancer surgeries. It was revealed, by examining the data, that obesity was associated with significantly higher incidence of surgical site wound infections, and wound problems compared to non-obesity in females with primary ovarian cancer surgeries. However, attention should be given to the values because some of the comparisons included a small number of chosen studies,.

A Meta-Analysis to Assess the Probable Association of Hypertension During Pregnancy and Placenta Accreta

Background and Objectives: A meta-analysis was conducted to assess the probable association of hypertension during pregnancy and placenta accreta (PA). Materials and Methods: A systematic literature search was conducted up to November 2024, resulting in the identification of 10 studies encompassing 128,589 pregnant women. They reported associations between the possible impacts of hypertension during pregnancy and PA. The odds ratio (OR), with 95% confidence intervals (CIs), was computed to evaluate the possible association of hypertension during pregnancy and PA, utilizing a dichotomous approach with either a random or fixed-effect model. Results: No significant difference was found between hypertension during pregnancy and control (no hypertension during pregnancy) in the occurrence of PA (OR, 0.74; 95% CI, 0.52-1.04, p = 0.08). Also, no significant difference was found between pregnant women with PA and control (no PA) in the occurrence of hypertension (OR, 1.15; 95% CI, 0.61-2.19, p = 0.66). Conclusions: Hypertension during pregnancy has no impact on the occurrence of PA, and vice versa. More research is desired to approve these outcomes.