Development and optimisation of atorvastatin calcium loaded self-nanoemulsifying drug delivery system (SNEDDS) for enhancing oral bioavailability: in vitro and in vivo evaluation

The objective of this study was to develop and optimise self-nanoemulsifying drug delivery system (SNEDDS) of atorvastatin calcium (ATC) for improving dissolution rate and eventually oral bioavailability. Ternary phase diagrams were constructed on basis of solubility and emulsification studies. The composition of ATC–SNEDDS was optimised using the Box–Behnken optimisation design. Optimised ATC–SNEDDS was characterised for various physicochemical properties. Pharmacokinetic, pharmacodynamic and histological findings were performed in rats. Optimised ATC–SNEDDS resulted in droplets size of 5.66?nm, zeta potential of ?19.52?mV, t₉₀ of 5.43?min and completely released ATC within 30?min irrespective of pH of the medium. Area under the curve of optimised ATC–SNEDDS in rats was 2.34-folds higher than ATC suspension. Pharmacodynamic studies revealed significant reduction in serum lipids of rats with fatty liver. Photomicrographs showed improvement in hepatocytes structure. In this study, we confirmed that ATC–SNEDDS would be a promising approach for improving oral bioavailability of ATC.     

Delayed diagnosis of systemic lupus erythematosus due to lack of competency skills in musculoskeletal examination

Deficiencies in musculoskeletal (MSK) examination skills among internal medicine residents can cause serious outcomes. We report a case of systemic lupus erythematosus with active arthritis where the diagnosis was delayed for 7 days after hospital admission due to the lack of basic skills in MSK examination.     

Socioeconomic position and prevalence of self-reported diabetes in rural Kerala, India: results from the PROLIFE study

This article aims to study the relationship between socioeconomic position (SEP) and prevalence of self-reported diabetes in a rural population in Kerala, India. This study was designed as a cross-sectional survey. Data from PROLIFE, a prospective cohort study involving the long-term follow-up of the residents of an administrative unit in Kerala, India, was used. The 33 379 households in the study area were divided into 4 groups (SEP1 to SEP4) on the basis of household assets. Prevalence of diabetes was ascertained through a lifestyle questionnaire. The proportion of self-reported diabetes was highest (at 11.1%) in SEP4, the group with the highest socioeconomic status, when compared with 3.1% in SEP1. The trend was similar in both sexes. Prevalence of self-reported diabetes increases as one moves up the socioeconomic ladder in this rural community.     

Knowledge, Attitudes and Practices of Barbers Regarding Hepatitis B and C Viral Infection in Sana’a City, Yemen

There is strong evidence that razors, barber's scissors, nail files and body piercing instruments are risk factors for transmission of hepatitis B and C. to investigate the knowledge, attitudes and practices regarding hepatitis B and C virus among barbers in Sana'a city. KAP study was conducted from July-September 2011. Two hundred and thirty four barbershops were surveyed. Out of 234 barber shops, 73.1% heard about viral hepatitis B and C. The awareness of modes of transmission of hepatitis and the different sources/risk factors were moderate, ranging from 51.6% who knew that hepatitis can be transmitted through sexual transmitted to 82.1% who knew that hepatitis can be transmitted through blood transfusion. 54.9% of barbers did not agree that it was essential to have periodic tests for HBV and HCV; however, 67.5%would themselves like to be tested for these infections. 32% washed their hands before attending each client, 59% cleaned instruments with disinfectant between clients, 96.1% washed razors with tap water before use on a new client, 92.6% also washed their razors with an antiseptic solution after every use, 87% used a new blade on new clients and 55% used disinfectants for skin cuts. In Yemen, a large number of barbers are shaving clients with an old style razor with a permanent blade. There is moderate awareness about the various modes of transmission of hepatitis among the barbers.     

Myofibroblastoma of the mandible in a 3-year-old child

Myofibroblastoma is a rare benign tumor of the head and neck region, which is characterized by a large, rapidly growing, and destructive mass. A 3-year-old boy presented with an 8-week history of a rapidly growing swelling of the right mandible. Examination revealed a firm 13-cm mass occupying the entire right body and ramus of the mandible. The clinical and radiological features were suggestive of a sarcoma. An initial biopsy taken in the referring hospital was inconclusive, and the second biopsy showed a myofibroblastic neoplasm consistent with a desmoplastic fibroma. Progressive tumor growth necessitated a tracheostomy. Right hemimandibulectomy was performed, and the defect was reconstructed with free microvascular fibula flap. Histopathology and immunocytochemistry revealed a myofibroblastoma. This entity differs from other myofibroblasts and fibroblast tumors such as inflammatory myofibroblastic tumor (IMT), myofibroma, and desmoplastic fibroma. The child has been followed up for 2 years. Conclusion: Differentiation between myofibroblasts and fibroblastic tumors as well as some malignancies can be challenging. Myofibroblastoma can behave as a malignant neoplasm, and the clinical distinction of this entity lies primarily in its recognition as a benign neoplasm.     

Effects of prevailing conditions during second Palestinian uprising on solid waste management system in Nablus city in Palestine

Since the start of the second Palestinian uprising (Al-Aqsa Intifada), and due to the Israeli activities, curfews, closures, and military checkpoints imposed since 2000, the quality of social services rendered by Nablus city has been gradually deteriorating. Solid waste management in Nablus city was badly affected by these conditions, and this situation is negatively affecting health and damaging the environment. Most of these cases were due to reasons beyond the capability of the municipality with its limited resources. This study revealed that some of the important municipal solid waste (MSW) equipment had been damaged during the uprising. The workforce in the MSW system was reduced and certain MSW-related development projects and activities have been frozen due to the current conditions. The city's medical waste incinerator had been phased out and the number of special medical containers had been reduced from 16 to 10. Some MSW compressing trucks had been out of use with no substitute. Another important figure is the number of waste collection workers which decreased from 420 to 301, although the city is growing in premises as well as population. The created unsanitary solid waste transfer station is now a pollution source on its own, causing an ugly scene at the eastern entrance of Nablus city. There should be a comprehensive and urgent solution for this problem and the needed resources should be invested.