Administration Techniques Research Articles

Monetary Flood Damage Prediction Based On Machine Learning Models

Flooding has increased by 50%, and for the past 25 years, the United States has experienced a flooding event every 2 to 3 days [1]. The Federal Emergency Management Agency (FEMA) is the only resource people utilize to determine whether their homes are at risk for flooding. FEMA maps are costly, outdated, and lack predictive accuracy, leaving homeowners unaware and unprepared for potential dangers [2]. Additional tools are needed to ascertain accurate estimates of flood damages, but computational methods require rich datasets, which are difficult to obtain for flooding events [3]. We create a model that predicts monetary damages using various factors related to the flood event, such as duration, location, and cause. We utilize a flood dataset from the National Oceanic and Atmospheric Administration (NOAA) and data pre-processing techniques to handle missing values and remove irrelevant features [4]. We generate aggregate predictions by leveraging linear regression, random forest regression, XGBoost regression, and neural networks. Our findings show we can effectively use upsampling techniques to combat limited flood data. We show that floods with higher monetary damages are easier to predict, which is important because these floods inflict greater hardship on communities. The results improve preparedness for flood-related risks, property value assessments, and the accuracy of insurance policy underwriting [2]. Ultimately, the model provides a preliminary study on how individuals can make better-informed decisions and prepare for the impact of flooding in their communities. We hope this work encourages further machine learning applications to help prepare citizens for natural disasters.

HYALURONIC ACID BEYOND SKIN REJUVENATION: THE INTERSECTION BETWEEN BEAUTY AND SAFETY IN COMPLIANCE WITH THE NEW EU MEDICAL DEVICES REGULATION

Hyaluronic acid-based mesotherapy has become a highly popular and valuable option for facial rejuvenation, with a renowned efficacy and safety profile.The new European Regulation (EU) 2017/745 on medical devices remarks the need for post-market clinical follow-up to guarantee safety and efficacy during the entire life cycle of medical devices. In line with the new regulation, we aimed to further evaluate the clinical performance and safety of hyaluronic acid-based mesotherapy within routine practice in a period of 9 weeks. The present work is anobservational, prospective, open and non-controlled study in a cohort of patients treated with hyaluronic acid-based mesotherapy for facial aging. Patients between 30 and 75 years old, treated with hyaluronic acid 1% injections for facial rejuvenation, were included. Point-by-point and epidermal administration techniques were usedin three visits (initial, 3 weeks and 6 weeks). The outcomes were measured using GAIS for efficacy and VAS for patient satisfaction. A total of 25 patients underwent hyaluronic acid mesotherapy in the face or neck, and were followed up for 9 weeks. Throughout the study, a significant improvement (p < 0.05) in skin appearance and hydration was observed in both groups between first and last visit. No significant differences were observed between the two groups. All participants showed increased skin hydration and/or reduced fine lines. In conclusion, hyaluronic acid-based mesotherapy is effective for facial and neck skin boosting, with an excellent safety profile, highlighting the potential of linear hyaluronic acid as a non-surgical solution for skin rejuvenation.

Exploring the Impact of Optimized Probiotic Supplementation Techniques on Diabetic Nephropathy: Mechanisms and Therapeutic Potential.

Worldwide, diabetic nephropathy (DN) is a significant contributor to end-stage renal failure and chronic kidney disease. Probiotic supplementation has recently gained popularity as a potential nutritional therapy in several clinical trials aimed at improving renal function, inflammation, oxidative stress, dyslipidemia, glycemic control, and inflammation. However, they still need to undergo a thorough assessment of DN. It is crucial that the optimal dosage, duration, and combination of probiotic strains administered for the purpose of slowing down the advancement of DN be assessed. Based on the available publications, including relevant randomized controlled trials, systematic reviews, and meta-analysisfrom 2013-2023 from search engines like MEDLINE (PubMed), Scopus, and Web of Science, a literature review was generated using the keywords "gut microbiota," "gut microbiome," "diabetic kidney disease," "diabetic nephropathy," "probiotic," and "prebiotic." Multiple clinical trials focusing on probiotic administration techniques revealed changes in renal, glucose, and lipid biomarkers. Probiotic supplementation using Bifidobacterium bifidum, Lactobacillus acidophilus, and Streptococcus thermophilus for 12 weeks indicated a reduction in glycosylated hemoglobin, fasting blood glucose, and the microalbuminuria/creatinine ratio. Multispecies as well as single-species probiotic administration containing Lactobacillus, Bifidobacterium, and Streptococcus thermophilus spp. greater than 4*109colony forming units (CFU)/day for 8-12 weeks in DN patients improves renal metabolic markers and reduces the progression of disease patterns. Optimal supplementation techniques of probiotics in conjunction with prebiotics and synbiotics in DN benefit glycaemic control, renal function, blood lipid profile, inflammation, and oxidative stress. Future randomized controlled trials supplementing specific probiotics coupled with prebiotics and synbiotics, with larger sample sizes and longer follow-up times, will generate more reliable findings for the impact of probiotic supplementation on DN.

A Study to Develop a Device to Aid in the Administration of Corticosteroid Nasal Spray to Improve Efficacy

Allergic rhinitis and chronic rhinosinusitis represent conditions stemming from two pivotal pathophysiological factors: hypersensitivity reactions and inflammation.(Bjermer et al., 2019; Liva et al., 2021; Nur Husna et al., 2022) Patients afflicted with chronic rhinosinusitis experience symptoms that profoundly impact their quality of life. (Sapsaprang et al., 2015) Consequently, treatment guidelines consistently advocate for the utilization of intranasal corticosteroids (INC) in cases of severe disease or disruptive symptoms. (Bousquet et al., 2020; Dykewicz et al., 2020; Emeryk et al., 2019; Scadding et al., 2017) However, clinical evidence suggests that during episodes of nasal mucosal inflammation, tissue edema can hinder the comprehensive dispersion of INC particles into deeper nasal recesses, thus impeding their therapeutic reach to affected regions. (Abdelhafeez, 2022; Rollema et al., 2022; Sher & Ross, 2014) Conversely, presently available nasal spray formulations, particularly aqueous solutions commonly employed in Thailand, exhibit limitations in achieving efficient particle dispersion. Consequently, the effective delivery of INC is significantly contingent upon proper medication administration techniques, including bottle priming and synchronized inhalation during actuation. Literature reviews have divulged that many INC users frequently mismanage or inefficiently apply the medication, particularly during the actuation process.(Al-Rasheedi, 2023; May & Dolen, 2019) Common issues include improper alignment of the nasal spray nozzle, inadequate force exerted during actuation, and failure to synchronize inhalation with medication release, collectively contributing to suboptimal treatment outcomes.

A Cell-Based Nasal Model for Screening the Deposition, Biocompatibility, and Transport of Aerosolized PLGA Nanoparticles.

The olfactory region of the nasal cavity directly links the brain to the external environment, presenting a potential direct route to the central nervous system (CNS). However, targeting drugs to the olfactory region is challenging and relies on a combination of drug formulation, delivery device, and administration technique to navigate human nasal anatomy. In addition, in vitro and in vivo models utilized to evaluate the performance of nasal formulations do not accurately reflect deposition and uptake in the human nasal cavity. The current study describes the development of a respirable poly(lactic-co-glycolic acid) nanoparticle (PLGA NP) formulation, delivered via a pressurized metered dose inhaler (pMDI), and a cell-containing three-dimensional (3D) human nasal cast model for deposition assessment of nasal formulations in the olfactory region. Fluorescent PLGA NPs (193 ± 3 nm by dynamic light scattering) were successfully formulated in an HFA134a-based pMDI and were collected intact following aerosolization. RPMI 2650 cells, widely employed as a nasal epithelial model, were grown at the air-liquid interface (ALI) for 14 days to develop a suitable barrier function prior to exposure to the aerosolized PLGA NPs in a glass deposition apparatus. Direct aerosol exposure was shown to have little effect on cell viability. Compared to an aqueous NP suspension, the transport rate of the aerosolized NPs across the RPMI 2650 barrier was higher at all time points indicating the potential advantages of delivery via aerosolization and the importance of employing ALI cellular models for testing respirable formulations. The PLGA NPs were then aerosolized into a 3D-printed human nasal cavity model with an insert of ALI RPMI 2650 cells positioned in the olfactory region. Cells remained highly viable, and there was significant deposition of the fluorescent NPs on the ALI cultures. This study is a proof of concept that pMDI delivery of NPs is a viable means of targeting the olfactory region for nose-to-brain drug delivery (NTBDD). The cell-based model allows not only maintenance under ALI culture conditions but also sampling from the basal chamber compartment; hence, this model could be adapted to assess drug deposition, uptake, and transport kinetics in parallel under real-life settings.

(272) Botulinum Toxin Injection in Vulva and Vagina: Evidence from a Literature Systematic Review

Abstract Introduction Vaginismus, vulvodynia and chronic pelvic pain are a group of pain syndromes that may have, in addition to pain, other types of symptoms. Often no specific etiology can be identified, and the choice of treatment is complicated. Although several treatment methods have been proposed, evidence-based therapies are limited. Therapies can be classified in medical, surgical and interventional treatment. Interventional therapy contemplates injection therapy with botulinum toxin, proposed in 1997 Objective To evaluate the BoNT injection in the comprehensive care of vaginismus, vulvodynia and chronic pelvic pain and to enhance the impact on the sexual arousal. Methods 1108 patients, Randomized Controlled Trials (RCT) were 7. The Retrospective Studies Without a control group were 4, With a control group: 1. Besides, the Prospective Studies Without a control group were, . 2 patients were With a control group. The BoNT Dosage Range was: Minimum: 12 UI Maximum: 500 UI Types of BoNT Products: Botox® (onabotulinumtoxinA): 14 Xeomin® (incobotulinumtoxinA): 3 Dysport® (abobotulinumtoxinA): 3 Unspecified BoNT Product: 1 EMG-Guided Injection: 5 I used as BoNT Administration Techniques, the Digital Palpation: 12, the unspecified Injection Procedure: 4. My methods were 17 patients in Intramuscular Injection, 3 patients with Vaginal Submucosal Plane, and one patient with Subcutaneous Injection. Results For Vaginismus, Significant improvement in sexual and orgasmic dysfunction Successful intercourse Reduction of vaginal muscle resistance Improved sexual function (evaluated by Female Sexual Function Index) Pain reduction and improved quality of life (Short-Form Health Survey) BoNT reduced muscular hyperactivity. Both BoNT and placebo improved sexual pain, function, and distress for patients with vulvodynia, Significant improvement in pain 4, improved quality of life 2 and increase of sexual activity due to the reduced pelvic hypertonicity. Other Study Results: Significant improvement in pelvic pain [22, 23, 31, 32] Reduction of vaginal pressure [32] Improvement in quality of life, sexual activity, and reduced pelvic floor muscles myoelectrical activity [31] Conclusions Different endpoints and different methods of analysis. Different types of participants. Various techniques and timing. Adverse events. For this reason, even though BoNT seems a promising treatment, a clear standardization in clinical guidelines is still lacking. A clear standardization is needed for practical guidelines. Future perspectives should address reproducible protocols for BoNT administration. Disclosure No.

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

Background: Oxygen is an essential medical therapy which saves a lot of lives. It is administered as a corrective treatment for conditions resulting in hypoxia (low level of oxygen in the blood). So, the nurse should have more skills and experience to performing this procedure in the aim to maintain the patient's life safe and avoid complications associated with incorrect oxygen administration technique. Objective: The study was conducted to assess the level of knowledge, attitude and practice towards oxygen therapy administration and associated factors among nurses and midwives at Yekatit 12 Hospital Medical college in 2022. Method: To achieve the research objectives a hospital based cross-sectional study was applied. The sample size drawn was 198. Pertinent data for the study were gathered through structured questionnaires. Descriptive and multiple logistic regression were used in the analysis of independent and outcome variables. Result: Data is collected from 211 participants and my response rate is (198)93.8%. Among 198 nurse and midwives 50.5% were males, 49.5% with the range of 30-39yrs and most of them (48.5%) have work experience of 6-9yrs.The mean score of knowledge, attitude and practice were 5.7(SD=1.608),4.01(SD=1.837) and 14.5(3.49) respectively. It is found that the level of knowledge was adequate in 117(59.1%) and poor 81 (40.9%) of participants. Practical skill is found to poor in 63.1% of participants and factors associated with this were absences of oxygen therapy guide line, not participating in any training about oxygen therapy and supply of oxygen delivery system with P-value of 0.01, 0.02 and 0.002 respectively. work experience also contributes for poor practice. Conclusion: There is a clear practical gap among nurses and midwives working in Y12HMC and this study also shows as there is poor attitude in almost have of the participants which high compared to another research. The possible associated factors for poor practice were identified as work experience less than 1yr and absence of training and oxygen guideline. So, to enhance safe use of oxygen therapy the referral hospital needs to push its effort for improving the practice and attitude of nurses and midwives towards oxygen therapy by facilitating trainings, increases the availability of guideline and supply of oxygen.

Platelet Rich Plasma (PRP) Changing Facial Aesthetics

This article provides a thorough examination of Platelet-Rich Plasma (PRP) therapy in the context of facial aesthetics. We delve into the scientific principles behind PRP, exploring its rich growth factor content and regenerative potential. The review encompasses a comprehensive analysis of recent studies and clinical trials, highlighting the efficacy of PRP in enhancing skin texture, reducing wrinkles, and promoting collagen synthesis. Furthermore, we discuss the procedural aspects of PRP application in facial aesthetics, including patient selection, preparation, and administration techniques. A critical evaluation of the safety profile and potential side effects is also presented, offering practitioners and patients valuable insights into the risk-benefit profile of PRP in facial rejuvenation and review of literature. The article concludes with a forward-looking perspective on emerging trends and future directions in PRP research for facial aesthetics. By synthesizing current knowledge and addressing key considerations, this review serves as a valuable resource for clinicians, researchers, and individuals interested in the evolving landscape of non-invasive facial enhancement modalities.

Documentation of Ethnomedicinal Uses of Wild Plants Growing in Kodo Mountain by Kurdish Tribe of Iraq

Medicinal plants have a long history of different uses and are still of great importance in the daily life of the Kurds living in the Kurdistan province of Iraq. The present review provides comprehensive phytochemical and pharmacological information about medicinal plants growing in the Kodo Mountain area. In fact, no systematic study of the bioresources from this unique region has yet been reported in the scientific literature, even if local villagers have been consuming several plants as nutrition and ethnomedical food for centuries, until today. The data reported in this paper were obtained through interviews with local herbal healers and people living in villages around the Kodo Mountains. They concern 40 plants belonging to 16 botanical families, which are considered medicinal by the local population. The present study recorded and examined the demographic information given by the study participants, the local names and the parts used of the plants, the preparation and administration techniques, and the treatments for diseases. The most frequently cited families were Asteraceae (32.5 %), Lamiaceae (10 %), Brassicaceae, Malvaceae, and Papaveraceae (7.5 % each). The main parts of the plants used for medicinal purposes were leaves (36 %) and flowers (29.5 %). They were administered as decoctions (42 %), raw (26 %), or powder (14 %). Several important phytochemicals have been isolated from the used plants, including flavonoids (60 %), terpenoids (45 %), phenolic acids (42.5 %), polyphenolic compounds (40 %), and essential oils (30 %). The plant ethnomedicinal and pharmacological uses were supported by their antibacterial (18%, Apiaceae, Lamiaceae, Papaveraceae), anti-inflammatory (18%, Malvaceae, Asteraceae, Papaveraceae), anti-oxidant (16%, Malvaceae, Apiaceae, Lamiaceae, Asteraceae, Papaveraceae), anti-cancer (9%, Lamiaceae, Papaveraceae, Asteraceae), anti-parasitic (8%, Asteraceae), hepatoprotective (7%, Asteraceae, Lamiaceae, Papaveraceae, Fabaceae), anti-diabetic (5%, Asteraceae, Fabaceae), anti-fungal (5%, Amaryllidaceae, Umbelliferae, Asphodelaceae, Orchidaceae), anti-spasmodic (4%, Asteraceae, Papaveraceae), and diuretic (3%, Asteraceae, Amaryllidaceae, Plantaginaceae) activities. This study illustrates the significance of traditional medicinal plants that have been utilized for treatment and healing the wounds and curing the illnesses Kurdish tribe in Kodo mountain, north-east part of Kurdistan Region in Iraq, that can be used as reference for further investigations for the researchers in future.

Phosphodiesterase Inhibition as a Therapeutic Strategy for Chronic Obstructive Pulmonary Disease: Where We Have Been and What Lies Ahead.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent inflammatory lung condition characterized by chronic respiratory symptoms and airflow obstruction that often lead to diminished quality of life. Non-pharmacologic management for patients with COPD involves smoking cessation and healthy lifestyle changes. Pharmacologic treatments include inhaled bronchodilators with or without the use of inhaled corticosteroids, which can be administered through inhalation or nebulization. In addition, oral medications including macrolide antibiotics and phosphodiesterase (PDE) 4 inhibitors can help reduce exacerbation risk. However, many of these medications provide suboptimal disease control, owing to limited efficacy, increased risk of adverse events with long-term use, or difficulty in administration technique. PDE3 plays an important role in maintaining smooth muscle function, and PDE4 plays a crucial role in the inflammatory response in airway smooth muscle. Direct molecular inhibition of PDE3 or PDE4 has been shown to provide benefit in COPD. Dual PDE3 and PDE4 inhibition may therefore have synergistic anti-inflammatory and bronchodilator effects. These results have been observed in clinical trials of nebulized ensifentrine, a novel, dual-action PDE3 and PDE4 inhibitor that is the first in its class to be approved by the US Food and Drug Administration for maintenance treatment of COPD in adult patients. In this review, we explore the pathophysiologic mechanisms of COPD, describe current paradigms and methods of drug delivery for the treatment of the disease, and illustrate how dual inhibition of PDE3 and PDE4 may provide additional benefit to current standard-of-care regimens.

Novel use of local analgesia prior to intramuscular magnesium sulphate injection compared to mixed local analgesia with magnesium sulphate to reduce pain: a randomised crossover study in patients being managed for eclampsia and preeclampsia.

The World Health Organization (WHO) recommended addition of local anesthetic to reduce the intense pain of intramuscular injection of 50% Magnesium Sulphate (MgSO4) salt solution has been found to be ineffective. We tested whether giving the local anesthetic 5 min before the MgSO4 injection would reduce pain. We conducted a prospective cross-over trial where each participant with pre-eclampsia or eclampsia received sequential and mixed injection methods in random sequence during sequential MgSO4 administrations. Pain and preference were assessed using descriptive words, a numeric pain scale and direct comparison between the two injection methods. Differences were measured using the Wilcoxon signed rank test, risk ratios with 95% confidence intervals and the Chi squared or Fisher's test. The administration techniques were refined based on an initial pilot of 8 participants. We enrolled 49 consented participants and analysed data from 41 post-pilot participants The sequential injection method had a non-significantly lower mean pain score than the mixed injection method (3.1 vs. 3.3, p = 0.44). Severe pain was reported for 3/41 vs. 9/41, p = 0.12. The sequential injection method was perceived to be more painful by 13 (37%) vs. 22 (63%) participants (p = 0.03). The sequential injection was preferred by 21(60%) vs. 14 participants (40%) (p = 0.1). Our results consistently favoured the novel sequential injection method. The lack of statistical significance for most results is not surprising given the small sample size. Given the potential for clinically important benefits to women, a larger study to confirm these results is justified. https://pactr.samrc.ac.za/, Identifier (PACTR202201521544765).

Updates on Gene Therapy for Neovascular Age-related Macular Degeneration: A Review

Abstract Age-related macular degeneration (AMD) remains a leading cause of irreversible vision loss worldwide, with neovascular AMD accounting for the majority of severe vision loss cases. Current treatments, primarily anti-vascular endothelial growth factor (anti-VEGF) therapies, have revolutionized AMD management but are limited by the need for frequent intravitreal injections. Gene therapy has emerged as a promising approach to address these limitations, offering the potential for long-term therapeutic effects from a single administration. This review examines the latest advancements in gene therapy for neovascular AMD, focusing on current approaches, delivery systems, and clinical progress. Anti-angiogenic strategies, including VEGF trap and anti-VEGF antibody gene therapies, are at the forefront of clinical development. Promising candidates like RGX-314 and ADVM-022 have demonstrated sustained VEGF suppression and reduced treatment burden in early-phase trials. Neuroprotective, anti-inflammatory, and complement modulation approaches are also being explored to address the multifaceted nature of AMD pathogenesis. Advancements in vector engineering, particularly with adeno-associated virus variants, have improved gene delivery efficiency and specificity. Novel administration routes, such as suprachoroidal delivery, are being investigated to optimize safety and efficacy. While early clinical data show encouraging safety profiles and potential for long-term efficacy, challenges remain, including immune responses to vectors and transgenes, and the need for precise dosing and administration techniques. As gene therapy for neovascular AMD progresses, key areas for future research include optimizing vector design for enhanced retinal penetration, developing combinatorial approaches targeting multiple disease pathways, and exploring personalized treatment strategies based on genetic risk profiles. The potential of gene therapy to provide durable therapeutic effects with a single administration holds promise for transforming AMD management, potentially improving patient outcomes and quality of life while reducing healthcare burden.

Analysis of Mining Rent Sharing : Case of the Kamoa-Kakula Project

This article aims at analyzing the rent sharing within the framework of the Kamoa-Kakula project which consists of the exploitation of a copper mine, located in the DRC. Based on data from the Integrated Development Plan of this project, published in October 2020, we used the FARI model approach to analyze the tax regime of the 2018 mining code and estimate the share falling to the State and the investors. Analysis of the results of our estimates shows, on the one hand, that the tax burden is close to observed international trends. Expected state revenues are USD 7.3 billion, according to the base scenario, while the Average effective tax rate (AETR) would be between 40.6 and 53.1%. On the other hand, although the innovations introduced increase the AETR, the latter tends to increase with the profitability of the project. Which allows us to conclude that this tax regime remains progressive, despite the increase in tax rates. Although theoretically, this new code seems advantageous for the State, its implementation should be accompanied by measures aimed at strengthening tax administration and control techniques, with the aim of confronting tax optimization practices.

Analysis of physical and biological delivery systems for DNA cancer vaccines and their translation to clinical development.

DNA cancer vaccines as an approach in tumor immunotherapy are still being investigated in preclinical and clinical settings. Nevertheless, only a small number of clinical studies have been published so far and are still active. The investigated vaccines show a relatively stable expression in in-vitro transfected cells and may be favorable for developing an immunologic memory in patients. Therefore, DNA vaccines could be suitable as a prophylactic or therapeutic approach against cancer. Due to the low efficiency of these vaccines, the administration technique plays an important role in the vaccine design and its efficacy. These DNA cancer vaccine delivery systems include physical, biological, and non-biological techniques. Although the pre-clinical studies show promising results in the application of the different delivery systems, further studies in clinical trials have not yet been successfully proven.

Minimizing the Pain of Local Anesthesia Administration in Interventional Radiology with an Anesthetic Portal Technique

Abstract Objective This article assesses the effectiveness of a standardized local anesthetic (LA) technique designed to minimize the pain of local anesthesia administration in interventional radiology (IR). Materials and Methods A prospective study compared participants' experience in a control group (n = 63) of random LA administration techniques to a separate experimental group (n = 60) with a standardized technique based on known methods to minimize the pain of LA. Participants in each group were surveyed after LA administration to assess perceived pain and number of times a painful stick was felt. Participants were also asked to compare LA pain to prior experiences with LA, and to compare the overall pain experienced during the procedure to expected pain. Statistical Analysis Ordinal variable distribution analyses were performed using the Wilcoxon rank sum test. Categorical variable analyses were performed with the Pearson's global exact chi-square test. Results Pain of LA (mean 1.1 vs. 3.3 on a 0–10 scale, p < 0.001), number of times a painful stick was felt (mean 0.8 vs. 1.9 times, p < 0.001), and overall pain during the procedure (mean 1.5 vs. 3.4 on 0–10 scale, p < 0.001) were significantly less using the standardized versus random techniques. Compared with prior experiences of LA, pain using the standardized technique was less in 77.6%, the same in 22.4%, and more in 0% of patients while pain using the random technique was less in 46.4%, the same in 39.3%, and more in 14.3% of patients (p < 0.05). Conclusion Severity and frequency of pain from LA administration in IR procedures is minimized using a standardized anesthetic portal technique. This technique may also decrease overall pain experienced during IR procedures as well.

Unraveling medication errors in enteral tube administration: A cross-sectional study in geriatric patients receiving home health care

BackgroundMedication administration through enteral feeding tubes requires careful consideration, as several medications are unsuitable for such administration due to interactions with feeding formulas or adverse effects when crushed. These errors can lead to feeding tube obstruction, reduced drug efficacy, or drug toxicity. ObjectiveThis study aimed to assess medication errors in geriatric patients using enteral feeding tubes who were enrolled in a home health care program. MethodThis was a cross-sectional observational study conducted at the Ministry of Health Government Hospital in Makkah City, Saudi Arabia. Medication errors related to chronic oral drugs in geriatric patients using enteral feeding tubes were evaluated, including inappropriate medications for enteral tube administration, inappropriate preparation, drug-nutrient interaction, and availability of liquid formulation, following established guidelines. ResultsOf the total 233 medications prescribed to 46 patients receiving enteral tube feeding at home, 49.3% exhibited at least one form of medication error, totaling 135 errors. Medication errors were highly prevalent among the patients (93.4%), with the leading cause being the administration of medications unsuitable for enteral feeding tubes (33.3%), predominantly due to the use of controlled release or enteric-coated formulations. ConclusionThis study underscores the high prevalence of medication errors in older patients receiving enteral feeding at home. To ensure patient safety and optimal outcomes, healthcare professionals should utilize available resources and seek expert advice when selecting medications and dosage forms for tube-fed patients. Pharmacists play a critical role in promoting safe drug use and can greatly contribute by educating patient caregivers on proper medication preparation and administration techniques, thus preventing harm to patients.

Y-Branched Titanium Dioxide Nanotubes as a Potential Antimicrobial Coating for Implants

The early loss of dental implants can be avoided with systemic antibiotics, however there are potentially significant side effects. Consequently, the use of local drug administration techniques is necessary to make dental implant therapy more practical. In this study, Y-branched nanotubes were prepared by non-expensive and simple anodization in two steps. Tests were performed to highlight their potential for local antibiotic administration. Y-branched nanotubes were able to incorporate a dose of Tetracycline and ensure its electrochemical stability. The presence of tetracycline significantly enhanced antibacterial efficacy, resulting in an increase of up to 55% for Escherichia coli and Pseudomonas aeruginosa and 50% for Staphylococcus aureus. The comparable antibacterial effects of the nanostructured surfaces highlight the potential of tetracycline in promoting antimicrobial action. Moreover, the addition of tetracycline does not influence the structural, morphological and stability properties of the nanostructured deposited TiO2 films.

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients.

(1) Background: Postdural puncture headache (PDPH) remains a serious complication in obstetric patients. While the epidural blood patch represents the current gold standard in therapy, a growing number of alternative measures are thought to be beneficial for clinical management. The purpose of this study was to retrospectively analyze the efficacy of intranasal lidocaine administration to treat PDPH in obstetrics at our university hospital; (2) Methods: A retrospective analysis of the medical records of patients with PDPH has been performed focusing on the techniques of administration, dosing, treatment duration, impact on pain intensity as well as side effects of intranasal lidocaine; (3) Results: During the study period, 5610 obstetric patients received neuraxial anesthesia, of whom 43 (0.77%) developed PDPH. About one third of the patients with PDPH after spinal anesthesia (n = 8), epidural anesthesia (n = 5) or both (n = 2) were treated with intranasal lidocaine. Lidocaine was administered either via gauze compresses (GC, n = 4), a mucosal atomization device (MAD, n = 8) or with a second-line mucosal atomization device due to low gauze compress efficacy (n = 3). All patients treated with lidocaine refused the epidural blood patch. Nebulization of lidocaine resulted in a significant reduction in pain intensity after the first dose (p = 0.008). No relevant side effects developed except sporadic temporal pharyngeal numbness. The utilization of the mucosal atomization device averted the necessity for an epidural blood patch, whether employed as the primary or secondary approach; (4) Conclusions: Our data imply that the mucosal atomization device enhances the efficacy of intranasal lidocaine administration in obstetric patients suffering from PDPH.

Inhaled drug delivery: a randomized study in intubated patients with healthy lungs

BackgroundThe administration technique for inhaled drug delivery during invasive ventilation remains debated. This study aimed to compare in vivo and in vitro the deposition of a radiolabeled aerosol generated through four configurations during invasive ventilation, including setups optimizing drug delivery.MethodsThirty-one intubated postoperative neurosurgery patients with healthy lungs were randomly assigned to four configurations of aerosol delivery using a vibrating-mesh nebulizer and specific ventilator settings: (1) a specific circuit for aerosol therapy (SCAT) with the nebulizer placed at 30 cm of the wye, (2) a heated-humidified circuit switched off 30 min before the nebulization or (3) left on with the nebulizer at the inlet of the heated-humidifier, (4) a conventional circuit with the nebulizer placed between the heat and moisture exchanger filter and the endotracheal tube. Aerosol deposition was analyzed using planar scintigraphy.ResultsA two to three times greater lung delivery was measured in the SCAT group, reaching 19.7% (14.0–24.5) of the nominal dose in comparison to the three other groups (p < 0.01). Around 50 to 60% of lung doses reached the outer region of both lungs in all groups. Drug doses in inner and outer lung regions were significantly increased in the SCAT group (p < 0.01), except for the outer right lung region in the fourth group due to preferential drug trickling from the endotracheal tube and the trachea to the right bronchi. Similar lung delivery was observed whether the heated humidifier was switched off or left on. Inhaled doses measured in vitro correlated with lung doses (R = 0.768, p < 0.001).ConclusionOptimizing the administration technique enables a significant increase in inhaled drug delivery to the lungs, including peripheral airways. Before adapting mechanical ventilation, studies are required to continue this optimization and to assess its impact on drug delivery and patient outcome in comparison to more usual settings.

Big peptide drugs in a small molecule world.

A quarter of a century ago, designer peptide drugs finally broke through the glass ceiling. Despite the resistance by big pharma, biotechnology companies managed to develop injectable peptide-based drugs, first against orphan or other small volume diseases, and later for conditions affecting large patient populations such as type 2 diabetes. Even their lack of gastrointestinal absorption could be utilized to enable successful oral dosing against chronic constipation. The preference of peptide therapeutics over small molecule competitors against identical medical conditions can be achieved by careful target selection, intrachain and terminal amino acid modifications, appropriate conjugation to stability enhancers and chemical space expansion, innovative delivery and administration techniques and patient-focused marketing strategies. Unfortunately, however, pharmacoeconomical considerations, including the strength of big pharma to develop competing small molecule drugs, have somewhat limited the success of otherwise smart peptide-based therapeutics. Yet, with increasing improvement in peptide drug modification and formulation, these are continuing to gain significant, and growing, acceptance as desirable alternatives to small molecule compounds.