Sustained-release diclofenac potassium orally disintegrating tablet incorporating eudragit ERL/ERS: possibility of specific diclofenac-polymer interaction

Sustained-release diclofenac potassium orally disintegrating tablet (ODT) formulations have been prepared and investigated. The ODTs were prepared by incorporating diclofenac potassium (DP), as a model for negatively ionizable drugs, in microcapsules that were prepared by the solvent evaporation method from a mixture of DP and different ratios of Eudragit RS and Eudragit RL, which are positively ionized synthetic polymers. The ODTs were prepared by direct compression of mixtures containing microcapsule formula M4, crospovidone as a superdisintegrant and water soluble excipients (mannitol or lactose and sorbitol). Diclofenac potassium ODT F2, showed acceptable hardness (4.08 KP) slight friability (2.13 %) and disintegration time of 22.41 s with a sustained drug release profile. Microcapsule characterization (DSC and FT-IR) and dissolution behavior suggests the presence of specific interaction between the carboxylate group of diclofenac and the quaternary ammonium group in the polymers     

Interleukin-6 at discharge predicts all-cause mortality in patients with sepsis

Purpose

Interleukin-6 (IL-6) is a proinflammatory cytokine that plays a central role in the pathogenesis of sepsis. We aim to investigate the association between IL-6 and all-cause mortality in patients with sepsis.

Methods

A cohort of 40 elderly patients with sepsis was identified between March 2009 and June 2010 at Rambam Health Medical Campus, Haifa, Israel. The cohort was followed up for all-cause mortality occurring during the 6 months after hospital discharge. Cox proportional hazard model was used to assess the association between IL-6 and all-cause mortality.

Results

Iinterleukin-6 at discharge had a higher predictive accuracy for all-cause mortality when compared with IL-6 at admission. The area under the curve was 0.752 (P = .015) and 0.545 (P = .661), respectively. Eleven (27.5%) patients died during follow-up; the subjects who died have higher IL-6 levels at discharge (median, 50.6 pg/mL [interquartile range, 39.6-105.9]) compared with survivors at the end of follow-up (median, 35.4 [interquartile range, 15.8-49]; P = .014). The risk of all-cause mortality was higher in subjects with IL-6 levels above the median compared with subjects with lower IL-6 levels (log-rank P = .017). On multivariate Cox proportional analysis, adjusting for the potential confounders, IL-6 at discharge remained an independent predictor for 6 month all-cause mortality (hazard ratio, 6.05 [1.24-24.20]) for levels above the median compared with lower levels.

Conclusions

Iinterleukin-6 at discharge is an independent predictor of all-cause mortality in patients with sepsis. Compared with IL-6 at admission, IL-6 at discharge better predicts all-cause mortality.     

Prevalence of Vitamin D<Subscript>3</Subscript> Deficiency in Orange County Residents

With the prevalence of sunlight exposure in Orange County, California, one would expect it to be rare and unusual to find high incidence of Vitamin D deficiencies among its residents. This study evaluated the concentration of Vitamin D3 as part of a larger study to evaluate bone health in Orange County residents. Our preliminary data shows that 19.2% of the 151 subjects evaluated had low Vitamin D3 (<30 pg/ml) and illuminates a growing problem in the United States. We speculate that the widespread sensitivity to skin cancer and sun exposure, the increased use of sun-screens and the filtering of UV waves in automobile glass has put the public at risk for low Vitamin D.     

Radiologic Improvement After Early Medical Intervention in Localised Facial Morphea

We report the case of a young girl who presented with hemiparesis, seizures, and subtle features consistent with a linear form of facial morphea (en coup de sabre). She was treated with pulsed parenteral steroids and oral steroids and started on methotrexate. Magnetic resonance imaging results and neurologic problems improved after 6 months. Switching off inflammation early in the course of disease seemed to reverse some of the central nervous system changes. Assessment of children with unexplained hemiparesis and seizures should include careful examination of the face and scalp, looking for subtle signs of skin change and asymmetry. This is one of the few reported cases of neuroradiologic improvement after immunosuppressive treatment in a child with en coup de sabre.     

Determinants of households’ food insecurity with severity dimensions in Pakistan: Varying estimates using partial proportional odds model

This study is conducted to determine the impact of some selected socioeconomic and demographic factors on households’ food insecurity in Pakistan. Data are taken from national‐level survey Household Integrated Income and Consumption Survey 2015–2016. Inclusion of gender dimensions of some important factors and estimation of varying estimates at four severity levels of households’ food insecurity status using partial proportional odds model may be considered unique features of the study. It is concluded that household's income, employment, agricultural income, donations, parental education level and some households’ characteristics are important factors for improving food security in Pakistan. Maternal education, and maternal paid employment compared to paternal education, and paternal paid employment show strong positive effects to improve severe food insecurity. Couple paid employment, livestock ownership and operating agricultural land seem to have the most effective role for improving food security. Social welfare programmes and religious institution of Zakat are helpful to cope with severe food insecurity in Pakistan. Some special efforts or development strategies are recommended to improve food insecurity of rural households and Baluchistan province. Moreover, the observed U‐type quadratic impact of household size and the adverse impact of dependency ratio induce effective policies to control high birth rate in Pakistan. Hence, creation of employment opportunities especially for women, appreciation of couple paid employment, easy access to education for women, steps to raise level of education, growth of agricultural sector, rural development, social welfare and development schemes for Baluchistan, and continuation of Benazir Income Support Program are recommended to overcome severe and moderate level food insecurity in Pakistan. Since socioeconomic conditions and food insecurity issues of developing countries and especially in South Asian countries are homogeneous and therefore, the analysis in this study might be relevant to South Asian region.