Antacid Tablets Research Articles

Exploring the synergistic effect in polyherbal chewable antacid tablets: formulation and evaluation study

Abstract Polyherbal chewable tablets of Phyllanthus emblica and Glycyrrhiza glabra were developed with the objective to formulate an effective, safe and convenient dosage form for acid-related disorders. A standard calibration curve was constructed for Polyherbal extracts through UV-Spectrophotometry, achieving an absorbance maximum at 275 nm. Compatibility between the drug and excipients was examined through FTIR studies. Various pre-compression parameters, like bulk density, tapped density, compressibility index, Hausner’s ratio and angle of repose, were assessed for the powder blend. The tablets were evaluated for post-compression parameters, such as thickness, hardness, friability, and weight variation and disintegration time. The drug release study was conducted in vitro. The acid-neutralizing capacity of the formulated batches was compared with marketed formulations. The calibration curve showed a high correlation coefficient (r2=0.9972), suggesting accuracy and reliability. FTIR analysis confirmed the compatibility between the drug and excipients. Pre-compression studies revealed an acceptable range for all parameters, indicating good flow properties. For instance, Carr’s Index for all batches varied from 14.31% to 24.41%, and the angle of repose ranged from 33.7 to 35.21 degrees. Post-compression parameters were within the standard limits with hardness between 4.9 to 6.1 kg/cm2 and friability less than 1% for all batches. In vitro drug release showed a gradual increase over time with PF9 achieving 98.63% release at 60 min. The acid-neutralization capacity was highest for the combined extract at 27.83±0.34 mEq/g and PF9 batch at 28.12±0.43 mEq/g, demonstrating their effectiveness in neutralizing acid. The study successfully formulated a Polyherbal chewable tablet with optimized pre and post-compression parameters. The tablet exhibited promising in vitro drug release and an efficient acid-neutralizing capacity. It holds potential as an effective treatment option for acid-related disorders.

Effect of Food, Crushing of Tablets, and Antacid Coadministration on Maribavir Pharmacokinetics in Healthy Adult Participants: Results From 2 Phase 1, Open-Label, Randomized, Crossover Studies.

The effect of food composition, tablet crushing, and antacid coadministration on maribavir pharmacokinetics was assessed in 2 Phase 1 studies in healthy adults. In the first, a single maribavir 400-mg dose was administered under fasting conditions, with a low-fat/low-calorie or a high-fat/high-calorie meal. In the second, a single maribavir 100-mg dose was administered under fasting conditions, as a crushed tablet, or as a whole tablet alone or with an antacid. The 90% confidence intervals of the geometric mean ratios were within 80%-125% for area under the concentration-time curve (AUC), but not for maximum plasma concentration (Cmax) for low-fat/low-calorie and high-fat/high-calorie meals versus fasting or for whole tablet with antacid versus whole tablet alone. The 90% confidence intervals of the geometric mean ratios for AUC and Cmax were within 80%-125% for crushed versus whole tablet. Maribavir median time to Cmax value in plasma under fed conditions was delayed versus fasting conditions, but there was no statistical difference for crushed versus whole tablet or with versus without antacid. As the antiviral efficacy of maribavir is driven by AUC but not Cmax, findings suggest that maribavir can be administered with food or antacids or as a crushed tablet.

Air Swallowing and Breathing Exercises Reduce the Severity of Acute Gastroesophageal Reflux Symptoms and Give a Clue into the Role of Oxygen in Digestion: A Case Report with Extended Discussion

A case is reported where a patient, after using a tooth whitening gel containing the active ingredient hydrogen peroxide over 2 days, found that the expected onset of postprandial gastroesophageal reflux symptoms (RS) did not occur. Hydrogen peroxide can also be formed when oxygen in air dissolves in water contained in the gut lumen and so the role of oxygen, rather than potentially toxic hydrogen peroxide, was investigated as a treatment for RS. Air swallowing can provide oxygen to the gut lumen, and breathing exercises can supply oxygen from the blood to the gut epithelium. Air swallowing and breathing exercises (ASBE) were performed as required over 34 days, and it was found that a single ASBE session (3-8 ASBE over 30 seconds) brought temporary relief from RS over 1-2 hours. Up to 3 sessions of ASBE were required and resolved RS over 74% of days, reducing the need to take antacid tablets. To understand the impact oxygen could have on RS, the oxidation potential for oxygen, calculated as mmol electrons/100 ml (2-3 breaths) of swallowed air, was calculated and compared to the reported values for the antioxidant content of various foods. It was found that 100 ml of swallowed air has the potential to oxidize 1 serving of coffee, red wine, or orange juice, known refluxogenic or trigger foods that can cause RS. Based on the finding that ASBE can reduce RS and a brief review of the role oxygen plays in digestion, a hypothetical oxygen model for digestive reflux was proposed. For the model, the reflux of digesting food to the more oxygenated esophageal regions is triggered by refluxogenic foods high in antioxidants that react with oxygen in the lumen to create an inadequate supply necessary for aerobic digestion, resulting in gastroesophageal reflux. As the ASBE did not resolve all RS, with ≈26% remaining unresolved, the oxygen supply was considered only a part of the complex digestive reflux mechanism.

Air Swallowing and Breathing Exercises Reduce the Severity of Acute Gastroesophageal Reflux Symptoms and Give a Clue into the Role of Oxygen in Digestion: A Case Report with Extended Discussion

A case is reported where a patient, after using a tooth whitening gel containing the active ingredient hydrogen peroxide over 2 days, found that the expected onset of postprandial gastroesophageal reflux symptoms (RS) did not occur. Oxygen in air dissolves in water contained in the gut lumen to form hydrogen peroxide, and so the role of oxygen, rather than potentially toxic hydrogen peroxide, was investigated as a treatment for RS. Air swallowing can provide oxygen to the gut lumen, and breathing exercises can supply oxygen from the blood to the gut epithelium. Air swallowing and breathing exercises (ASBE) were performed as required over 34 days, and it was found that a single ASBE session (3-8 ASBE episodes over 30 seconds) brought temporary relief from RS over 1-2 hours. Up to 3 sessions of ASBE were required and resolved RS over 74% of days, reducing the need to take antacid tablets. To understand the impact oxygen could have on RS, the oxidation potential for oxygen, calculated as mmol electrons/100 ml (2-3 breaths) of swallowed air, was calculated and compared to the reported values for the antioxidant content of various foods. It was found that 100 ml of swallowed air has the potential to oxidize 1 serving of coffee, red wine, or orange juice, known refluxogenic or trigger foods that can cause RS. Based on the finding that ASBE can reduce RS and a brief review of the role oxygen plays in digestion, a hypothetical oxygen model for digestive reflux was proposed. For the model, the reflux of digesting food to the more oxygenated esophageal regions is triggered by refluxogenic foods high in antioxidants that react with oxygen in the lumen to create an inadequate supply necessary for aerobic digestion, resulting in gastroesophageal reflux. As the ASBE did not resolve all RS, with ≈26% remaining unresolved, the oxygen supply was considered only a part of the complex digestive reflux mechanism.

SAT247 CODE STEMI Due To Excessive Ingestion Of TUMS

Abstract Disclosure: E. Hershkop: None. Hypercalcemia is defined as a serum calcium greater than 10.5mg/dL. It is most commonly caused by malignancy or hyperparathyroidism; a less common cause is excess calcium ingestion, referred to as Milk Alkali Syndrome (MAS). Severe hypercalcemia can lead to renal failure, arrhythmias, and coma. A rare EKG finding is ST elevation mimicking an acute ST Elevation Myocardial Infarction (STEMI). We describe a case of severe hypercalcemia caused by excessive ingestion of TUMS antacids that presented as diffuse ST elevations on EKG which were mistaken for an acute MI. To our knowledge, this is the first case in the literature describing hypercalcemia with ST elevations caused by excessive TUMS ingestion. Case: A 74 year old male with a history of diabetes, hypertension, stroke, and acid reflux presented for recurrent falls due to leg weakness. He endorsed constipation with bowel movements every 5-6 days. Upon further questioning, he reported taking 6 to 7 TUMS antacid tablets (each containing 200mg calcium) daily for the past two months to treat ‘heartburn’. He denied having chest pain. His medications included hydrochlorothiazide, losartan, amlodipine, atorvastatin, glimepiride, and famotidine. On physical exam he had reduced strength in both lower extremities - 1/5 left, 3/5 right. EKG on arrival showed ST elevation in leads III, aVF, and V1-V5, with T wave inversions in aVR and aVL, suggestive of a STEMI. A STEMI code was called. Since he denied chest pain, troponins were lateralized at 0.1 ng/mL, and an echocardiogram showed no wall motion abnormalities, cardiology recommended conservative management. Laboratory evaluation revealed calcium of 15.5 mg/dL, albumin of 3.8 g/dL, BUN of 39 mg/dL, creatinine of 2.2 mg/dL, magnesium of 1.4 mg/dL, phosphorus of 3 mg/dL, 25-OH vitamin D of 24 ng/mL, PTH of 9 pg/mL, undetectable 1-25 OH vitamin D and PTHrP, and normal TSH and SPEP. CT head/chest/abdomen/pelvis showed no evidence of malignancy. He was treated with IV hydration and 1 dose of calcitonin. His calcium level, leg strength, and ST elevations began to improve within 12 hours and returned to normal within four days. Conclusion: Our patient had severe hypercalcemia likely secondary to excessive consumption of oral antacid tablets, as other causes were ruled out, and his EKG findings masqueraded as a STEMI-a rare presentation of hypercalcemia. Consumption of supplements may be overlooked when investigating hypercalcemia and should be specifically asked about. In addition, providers should be aware of EKG changes found in hypercalcemia to avoid unnecessary cardiac intervention. Presentation: Saturday, June 17, 2023

FORMULATION AND EVALUATION OF POLYHERBAL ANTACID TABLET

With ever increasing issue of hyperactivity both idiopathic and drug induced, the available allopathic antacids on chronic use are source of many side effects which can cause great discomfort to the patient. Hence, ayurveda approved herbs with antacid property used daily in one way or the other by the population can prove to be the best alternative to the issue of acidity. Hence, we developed a Polyherbal antacid tablet for the concerned issue along with expectation of great safety profile. KEYWORD: - Polyherbal antacid, Hyperacidity, acid neutralizing capacity

Iceberg Lettuce Reduces the Severity of Gastroesophageal Reflux Symptoms: Two Case Reports

Gastroesophageal reflux is a common disease and generally occurs when a portion of the contents of the stomach pass through the lower esophageal sphincter and into the esophagus and returns. If gastroesophageal reflux occurs regularly then symptoms of gastroesophageal reflux disease or GERD can develop. Typical gastroesophageal reflux symptoms (RS) are often defined as heartburn/discomfort or a feeling that stomach contents could reflux into the oesophagus. Gastroesophageal RS are commonly managed by making dietary and lifestyle changes but may also require the use of antacid tablets or proton pump inhibitors (PPIs). Two cases are presented where the effects of consuming iceberg lettuce (IL) on the severity of RS, classified as mild, medium or severe, are reported. It was found for both patients, IL consumed after a meal could resolve mild RS, resolve or reduce the severity of moderate RS, and reduce the severity of severe RS to mild or moderate symptoms, but not resolve them.

Analysis of antacid tablets using the alkalimetric titration method

Titrimetry is a quantitative analysis concerned with measuring the volume of a solution of known concentration required to react with the substance to be determined. On the other hand, alkalimetry determines the levels of acidic compounds that are reacted with essential standard solutions. Antacids can treat stomach disorders resulting from excess stomach acid production. The active ingredient is a mixture of magnesium hydroxide and aluminum hydroxide which is a weak base that reacts with acids. This study aims to determine whether the levels of antacid tablets in several pharmacies in Bandar Lampung City by looking at the expiration date meet USP30_NF25 requirements, namely between 90.0% -110% of the amount stated on the label. The method used is alkalimetry with a back titration technique, in which excess acid is added to the sample to react with antacids, and the excess acid is titrated using sodium hydroxide with phenolphthalein solution as an indicator.

EFFECT OF POLYHERBAL FORMULATION OF Boerhavia diffusa, Sesbania grandiflora, Moringa olifera, AND Solanum nigrum AGAINST GASTROENTERITIS AND ITS VALIDATION USING In silico APPROACH

Boerhavia diffusa, Sesbania grandiflora, Moringa olifera, and Solanum nigrum are indigenous plants that have been used in traditional medicine for treating various gastroenteritis. The present study aimed to demonstrate the Acid-neutralizing capacity, invitro anti-urease, anti-oxidant, inhibition of lipid peroxidation ability, anti- Inflammatory, and H+/K+ ATPase inhibition activity of hydroalcoholic extract of the polyherbal formulation. The phytochemicals present in the polyherbal formulation (PHF) were identified by GC – MS analysis. The total Phenolic Content and total Flavonoid content of phytochemicals were quantified. Phytochemical interactions with the active sites of urease were supported by Molecular docking analysis. The results revealed that 0.02 mg of phenolic content and 0.013 mg of flavonoids per gram of plant extract were observed, PHF had acid- neutralizing capacity better than the standard antacid tablet, 38% of anti-urease activity towards urease enzyme, 64% of inhibition of lipid peroxidation against oxidation of lipid bilayer, 59% of inhibition of protein denaturation, 37% of haemolysis inhibition, 80% of H+/K+ ATPase inhibition activity in the goat parietal cells. There were 14 functional compounds tend to interact with the enzyme urease. But two compounds directly interacted with the active site of ureases.

Analysis of gastrointestinal acid-neutralizing potency of some commercial antacid tablet formulations

In dyspepsia, formulations known as antacids are regularly used to alleviate symptoms as quickly as possible. Gastric contents are acidic; therefore, antacids are usually weak bases with the potential to neutralize excess acid and raise gastric pH accordingly. Acid-neutralizing capacity is what determines the effectiveness of an antacid. Some antacid tablets formulation from different manufacturers were tested for their acid-neutralizing capacity and effectiveness for patients in this study. The South-East region of Nigeria had pharmacies vending antacids of different brands. To remove potential bias from the study, the brands were coded A-F. Labels on all samples indicated that they would expire more than one year from now. To determine each antacid tablet's acid-neutralizing capacity, the titrimetric method was used. In terms of acid-neutralizing capacity, brands D, A, B, C, F, and E showed the greatest acid-neutralizing capacity (8.2mEq/g), and brand E showed the lowest capacity (5.7 mEq/g). An analysis of the ANC of all the tablets found that they exceeded the FDA standard of >5mEq for antacids. An inexpensive, simple, and easy-to-use titrimetric method could be used routinely to monitor antacid tablet quality.

Analysis of gastrointestinal acid-neutralizing potency of some commercial antacid tablet formulations

Analysis of gastrointestinal acid-neutralizing potency of some commercial antacid tablet formulations

Another case of milk–alkali syndrome or a learning opportunity?

SummaryMilk–alkali syndrome (MAS) is a triad of hypercalcaemia, metabolic alkalosis and renal insufficiency. In this study, we present a case of milk–alkali syndrome secondary to concurrent use of over-the-counter (OTC) calcium carbonate-containing antacid tablets (Rennie®) for dyspepsia and calcium carbonate with vitamin D3 (Adcal D3) for osteoporosis. A 72-year-old woman presented with a 2-day history of nausea, vomiting, epigastric pain, constipation, lethargy and mild delirium. Past medical history included osteoporosis treated with daily Adcal D3. Initial blood tests showed elevated serum-adjusted calcium of 3.77 mmol/L (normal range, 2.2–2.6) and creatinine of 292 µmol/L (45–84) from a baseline of 84. This was corrected with i.v. pamidronate and i.v. fluids. She developed asymptomatic hypocalcaemia and rebound hyperparathyroidism. Myeloma screen, vasculitis screen and serum angiotensin-converting enzyme (ACE) were normal, while the CT of the chest, abdomen and pelvis showed renal stones but no malignancy. A bone marrow biopsy showed no evidence of malignancy. Once the delirium resolved, we established that prior to admission, she had been excessively self-medicating with over-the-counter antacids (Rennie®) as required for epigastric pain. The increasing use of calcium preparations for the management of osteoporosis in addition to easily available OTC dyspepsia preparations has made MAS the third most common cause of hypercalcaemia hospitalisations. Educating patients and healthcare professionals on the risks associated with these seemingly safe medications is required. Appropriate warning labels on both calcium preparations used in the management of osteoporosis and OTC calcium-containing preparations would prevent further similar cases and unnecessary morbidity and hospital admission.Learning pointsWhat is known?An association between high-dose calcium supplementation and hypercalcaemia crisis has been seen in case studies.After as little as 1 week of excessive calcium carbonate ingestion, patients can present with symptomatic hypercalcemia, acute renal failure and metabolic alkalosis (1).Women aged 50 and younger need 1 g of calcium per day, while aged 51 and older need 1.2 g (1).Although the amount of calcium required for MAS is generally thought to be more than 4 g per day, there have been reports at intakes as low as 1.0–1.5 g per day in pre-existing risk factors including renal impairment (2).What this study adds?The danger of excessive ingestion of antacid is not adequately highlighted to prescribers and patients.Appropriate warning labels on OTC calcium-containing preparations could prevent unnecessary morbidity and hospital admission.

Iatrogenic Hypocalcemia With Treatment of Milk-Alkali Syndrome

Hypercalcemia is common disorder with the most likely etiology being primary hyperparathyroidism in the outpatient setting and malignancy in the hospitalized. With emergence of proton pump inhibitors and histamine blockers, milk-alkali syndrome has become a rarity. We report a unique case of hypercalcemia secondary to milk-alkali syndrome overtreated with bisphosphate therapy resulting in hypocalcemia.A 77-year-old woman with a past medical history of hypertension, gastroesophageal reflux disease presented with slurring of speech for 2 days with nausea and vomiting. Labs showed a calcium of 15.4 mg/dL, with an albumin of 4.0 g/dL. Other pertinent labs showed an ionized calcium of greater than 7.3 mg/dL, pH of 7.49, PTH of 15 pg/mL, PTHrP of 9 pg/mL, vitamin D 25-OH of 16 ng/mL, TSH of 2.16 IU/mL and acute kidney injury. Patient was started on intravenous fluids and given both calcitonin and pamidronate on presentation by the admitting team. When seen in consultation, history revealed that patient was consuming more than eight calcium carbonate antacid tablets daily and was also on hydrochlorothiazide. The calcium level decreased to 8.7 mg/dL within 48 hours. There was a concern for potential hypocalcemia due to pamidronate. Patient was advised to restart calcium carbonate 500 mg twice daily upon discharge with close follow up. However, supplementation was not started and repeat calcium was 6.7 mg/dL twelve days later. The calcium normalized within a week after starting temporary calcium supplementation.A now rare cause of hypercalcemia, milk-alkali syndrome is often overlooked in the differential diagnosis resulting in overtreatment and potentially dangerous hypocalcemia. Emergent management of intravenous hydration and bisphosphonate therapy is often immediately given by clinicians. Bisphosphonate therapy is not immediately effective and demonstrates calcium lowering effects by the second to fourth day. However, patients with milk-alkali syndrome generally improve with intravenous hydration and cessation of the causative agent. This case demonstrates the importance of obtaining a proper history with a complete list of medications and over the counter supplementations prior to treatment.

FRET-based ‘ratiometric’ molecular switch for multiple ions with efficacy towards real-time sampling and logic gate applications

Fluorescent nanoaggregates comprised of rhodamine based amphiphilic probe has been designed, which can simultaneously detect Al 3+ , Cr 3+ and F¯ ions in the aqueous medium (pH 7.4). Mechanistic investigation indicates that both the carbonyl oxygen of the spirolactam ring and the nitrogen center of indole participate in the coordination of metal ions. Consequently, metal ion-binding induces the opening of the spirolactam ring and allows the Förster energy transfer from indole to xanthene moiety. As a result, the colorless probe solution turns pink in presence of metal ions, with ratiometric fluorescence change from blue to yellow. Further, the addition of fluoride leads to dissociation of preformed Al 3+ -complex, resulting in the fading of pink color and reverting the fluorescence signal to the original. This not only serves as a tool to discriminate between Al 3+ and Cr 3+ ion but also acts as a strategy for detecting fluoride in the aqueous medium. Thus, using a single FRET probe, ‘ratiometric’, naked-eye sensing of multiple ions was achieved. Also, considering the differential response of probe molecule towards Cr(III) and Cr(VI), a colorimetric assay for biogenic thiols was developed. Simultaneously, a combinatorial molecular logic gate was designed based on the multiple ion sensing ability of the probe molecule. Further, the system showed real-time detection of Al 3+ and Cr 3+ in natural water samples, estimation of Al 3+ in antacid tablets and fluoride in mouthwash, etc. Lastly, low-cost, reusable paper strips were developed, which offers an alternative strategy for on-site detection of metal ions without engaging any sophisticated instruments or trained personnel. • Ratiometric sensing of Al 3+ , Cr 3+ and F − ions at nanomolar levels in water. • Assay for biogenic thiols based on differential response for Cr(III) and Cr(VI). • Design combinatorial logic gate based on multiple ion sensing. • Analysis of real-life samples: fluoride in mouthwash, Aluminium in antacid tablets. • Low-cost, reusable paper strips for onsite detection of ions.

Voltammetric pH Measurements in Unadulterated Foodstuffs, Urine, and Serum with 3D-Printed Graphene/Poly(Lactic Acid) Electrodes.

The pH of a system is a critical descriptor of its chemistry-impacting reaction rates, solubility, chemical speciation, and homeostasis. As a result, pH is one of the most commonly measured parameters in food safety, clinical, and environmental laboratories. Glass pH probes are the gold standard for pH measurements but suffer drawbacks including frequent recalibration, wet storage of the glass membrane, difficulty in miniaturization, and interferences from alkali metals. In this work, we describe a voltammetric pH sensor that uses a three-dimensional (3D)-printed graphene/poly(lactic acid) filament electrode that is pretreated to introduce quinone functional groups to the graphene surface. After thoroughly characterizing the pretreatment parameters using outer-sphere and inner-sphere redox couples, we measured pH by reducing the surface-bound quinones, which undergo a pH-dependent 2e-/2H+ reduction. The position of the redox peak was found to shift -60 ± 2 mV pH-1 at 25 °C, which is in excellent agreement with the theoretical value predicted by the Nernst Equation (-59.2 mV pH-1). Importantly, the sensors did not require the removal of dissolved oxygen prior to successful pH measurements. We investigated the impact of common interfering species (Pb2+ and Cu2+) and found that there was no impact on the measured pH. We subsequently challenged the sensors to measure the pH of unadulterated complex samples, including cola, vinegar, an antacid tablet slurry, serum, and urine, and obtained excellent agreement compared to a glass pH electrode. In addition to the positive analytical characteristics, the sensors are extremely cheap and easy to fabricate, making them highly accessible to a wide range of researchers. These results pave the way for customizable pH sensors that can be fabricated in (nearly) any geometry for targeted applications using 3D printing.

S1409 A Rare Case of Symptomatic Multiseptate Gallbladder in a Young Female

INTRODUCTION: Multiseptate gallbladder is a rare congenital anomaly. Usually, these cases are incidentally found during surgery or imaging. We present the case of a young female patient who had intermittent epigastric pain and was found to have a septated gallbladder for which she ultimately required cholecystectomy to get symptomatic relief. CASE DESCRIPTION/METHODS: A 19 year old female with no prior medical history, presented with intermittent postprandial epigastric abdominal pain for 6 months. The pain would begin soon after meal intake, would be moderately severe and continue for the next 2–3 hours. No specific foods patterns were noted as a trigger. She tried to treat the pain with calcium based antacid tablets to attempt to alleviate her pain, but these did not offer any relief. Her pain was also associated with nausea but no other gastrointestinal symptoms were present. Family history was significant for symptomatic cholelithiasis in the patient’s sister requiring cholecystectomy. Social history was positive for active cigarette use. There was mild right upper quadrant tenderness on palpation during physical exam. Labs revealed a mildly elevated total bilirubin of 1.57 mg/dL while other LFTs, electrolytes, renal function and CBC were within normal limits. Urine pregnancy test was negative. An abdominal ultrasound revealed a gallbladder with multiple septations (Image 1) and hepatic steatosis. She underwent esophagogastroduodenoscopy which was normal and biopsies of her stomach and small bowel were also normal. The pain continued despite conservative management and so subsequently she had laparoscopic cholecystectomy which resulted in cessation of her pain during follow up clinic visit a few weeks after her surgery. The gallbladder tissue was sent for pathological evaluation, which showed mild chronic cholecystitis (Image 2). DISCUSSION: To our knowledge, multiseptate gallbladder has been rarely reported in the literature and chronic cholecystitis is not a common etiology. Symptoms usually occur due to transient impaired emptying of bile from the gallbladder. Some patients have had co-existing pancreatic and biliary duct abnormalities as well as gallbladder or bile duct cancer. Most of the cases were symptomatic and required therapy. Treatment options include conservative measures such as intake of a modified diet or treatment with ursodeoxycholic acid which have limited benefit and patients usually ultimately require cholecystectomy as definitive treatment.Figure 1.: US abdomen showing multiple septations in the gallbladder. No thickening of gallbladder wall or pericholecystolic fluid seen.Figure 2.: & E stain (10X) showing mild chronic cholecystitis with lymphocytic inflammation within the lamina propria (red arrows) and muscularis (blue arrows). Fibrosis and metaplastic changes are absent.

Chewable Antacid Tablets: Are Disintegration Tests Relevant?

A recently published FDA guidance on chewable tablets has addressed the quality attributes of this class of dosage forms. This study evaluated disintegration as a quality attribute for a number of commercially available chewable antacid tablets. Additionally, acid-neutralizing-capacity values were evaluated. A number of the products exhibited prolonged disintegration times-which were far longer than those of conventional immediate-release tablets. The mean disintegration times ranged from 6 to more than 60min in distilled water and from 9 to over 60min in 0.1N HCl. The products with longer disintegration times had higher breaking force and tensile strength values. Despite the range in disintegration times, all products met the criteria for acid-neutralizing capacity. These results indicate a need for patients to be aware of the need to thoroughly chew antacid tablets upon administration. Given these considerations, disintegration testing would be a useful quality control test in evaluating these dosage forms as the implicit assumption by the manufacturer that patients will chew the product sufficiently may not be met in every case.

Analysis of prescription pattern of antibiotics among patients with respiratory tract infections at a tertiary care hospital

Respiratory tract infections are very common in developing countries like India. The main objective of the present study is to analyze prescription pattern of antibiotics given to outpatients with respiratory tract infections visiting our Hospital and to assess the rationality of these prescriptions given, using World Health Organisation core drug prescribing indicators. A total of 423 prescriptions were analysed after screening for inclusion and exclusion criteria. The number of males were 271 (64%) and females 152 (36%). 232 (54.84%) patients belonged to >60 years age group. Among the various respiratory tract infections, 148 patients (34.98%) were diagnosed to have Chronic Obstructive Pulmonary Disease (COPD), 141 patients (33.33%) Pulmonary Tuberculosis, 71 patients (16.78%) Bronchial Asthma, 34 patients (8.03%) Pneumonia and 29 patients (6.85%) had Upper Respiratory Tract Infections (URTIs). The total number of drugs prescribed were 2368 out of which 447 (18.87%) were mucolytics/expectorants, 433 (18.28%) antibiotics, 350 (14.78%) bronchodilators, 332 (14.02%) corticosteroids, 295 (12.45%) Antitubercular Treatment Category (ATT CAT) drugs, 209 (8.82%) antacids, 112 (4.72 %) anti histamines, 98 ( 4.13%) vitamin tablets, and 92 (3.88) miscellaneous drugs. The most commonly used mucolytic/ expectorant was a fixed dose combination of acebrophylline+ acetylcysteine (327). The most common corticosteroid prescribed was Prednisolone (217). The antibiotics that were commonly prescribed were azithromycin (122), doxycycline (84), ciprofloxacin (82), cefpodoxime + clavulanic acid (61), ceftriaxone (32), amoxicillin + clavulanic acid (27) and piperacillin+ tazobactam (8). Ranitidine (184), levocetrizine (68) or fexofenadine (36), vitamin b complex (79) were the most commonly prescribed antacid, antihistamine and vitamin tablet respectively. The drug formulations prescribed were oral 1842 (77.78%) , inhalations 375 (15.83%), injections 55 (2.32%), syrup 37 (1.56%), gel 36 (1.52%), powder 23 (0.97%). An average of 5.59 drugs was prescribed per prescription. Percentage of drugs prescribed by generic name was 456 (19.3%). Percentage of encounter with antibiotics prescribed was 94%. Percentage of encounters with injection was 9.25%. Percentage of drugs from NLEM was 40.09%. Percentage of fixed dose combinations prescribed were 13.38% . In our study it is observed that more number of drugs can be prescribed from National List of Essential Medicines. Prescription of drugs by generic name also needs improvement. Since the study is done on outpatient setting , culture and sensitivity reports might not be readily available. So choosing an antibiotic might be a dilemma for the physician. There is hence a need for educational programmes in order to facilitate rational use of antibiotics and promote sensible use of available resources. Every hospital should also follow standard treatment guidelines taking into consideration the sensitivity pattern of the organisms in the locality to promote rational prescribing. This study serves to spotlight the current prescribing trends in patients with respiratory tract infectons visiting our hospital.

Contactless conductivity detector from printed circuit board for paper-based analytical systems

This work presents a capacitively coupled contactless conductivity detector (C4D) etched out from a printed circuit board (PCB) as potential sensor for paper-based analytical systems. Two lines of any desirable pattern forming 35-μm thick planar copper electrodes were produced on a PCB plate (40 mm × 60 mm) by photolithography. The final PCB plate was covered with polypropylene film to serve as the insulating layer for the C4D detector. The film also protected the copper electrodes from corrosion. Electrodes made in this planar geometry make the PCB-C4D suitable as sensor for flat devices such as paper-based analytical devices. For this work, plain paper strips were employed as sample reservoir and as fluidic channel without hydrophobic pattern. A dried paper strip was first placed over the sensor, followed by dispensing a fixed volume of the liquid sample onto the paper. Entrapment of the liquid sample in the paper strip leads to reproducible size and position of the detection zone of the sample liquid for the capacitive coupling effect. High precision was obtained with %RSD ≤1% (n = 18) for standard solutions of KCl. Soil suspensions could be analyzed without prior filtration by placing a drop onto the paper strip extending away from the detector zone. The paper strip filtered out soil particles at the surface of the paper. Therefore, only soil filtrate moved towards the detection zone by lateral flow. The C4D detection using paper strip showed high tolerance to soil suspension with turbidity up to 6657 NTU, offering direct analysis of soil salinity. Cleaning with moist tissue paper between samples is adequate even for dirty samples such as soil suspension. We also monitored conductivity of acid-base reaction in the microfluidic paper channels, which was later applied to the quantification of bicarbonate in water and in antacid tablet (“Soda Mint Tablet”).

Hypercalcemia secondary to excessive self-medication with antacids causing acute pancreatitis: a case report

Excessive self-medication with over-the-counter drugs is an issue commonly encountered by health care professionals. It can result in uncommon presentations of life-threatening illnesses. These medications are frequently overlooked by clinicians when taking histories from patients, and their risks are often downplayed. We present the case of a 35-year-old woman with acute pancreatitis secondary to hypercalcemia. This condition occurred due to long-term excessive self-administration of calcium-rich antacid tablets. Her clinical course involved multifactorial rebound hypocalcemia after treatment and multiple complications from the abuse of other non-prescription medications. Acute pancreatitis secondary to antacid-induced milk-alkali syndrome has been minimally reported in the literature. There are no reports describing rebound hypocalcemia as a complication of its treatment or presenting this pathology in the context of multiple over-the-counter drug abuse. This case highlights the importance of taking thorough drug histories, including non-prescription medications, in acute clinical assessments.