Oral Medication Administration Research Articles

Deep pelvis and low visceral fat mass as risk factors for neurogenic bladder after rectal cancer surgery

BackgroundPostoperative neurogenic bladder (PONB) frequently occurs as a complication after rectal cancer surgery. This study aimed to analyze risk factors for developing PONB after rectal cancer surgery, particularly the association between pelvic anatomy and visceral fat mass.MethodsWe included 138 patients who underwent rectal resection for lower rectal cancer in our department between 2017 and 2021. PONB was defined as the need for urethral catheter reinsertion or oral medication administration for urinary retention after catheter removal with severe NB that required treatment for ≥ 60 days. We obtained visceral fat area (VFA) at the umbilical level based on a CT scan and measured five pelvic dimensions.ResultsOf the 138 patients, 19 developed PONB, with 16 being severe cases. PONB more frequently occurs in patients with a height of < 158 cm, age ≥ 70 years, surgery lasting ≥ 8 h, intraoperative bleeding volume ≥ 150 mL, lateral lymph node dissection, and narrower pelvis. It was more prevalent in cases with low VFA. Conversely, gender, body mass index (BMI), and medical history showed no significant correlations. Multivariate analysis revealed older age, prolonged surgery, and low VFA as independent risk factors for PONB. Independent risk factors for severe PONB included low VFA, older age, prolonged surgery, and deep pelvis.ConclusionLower VFA, older age, and prolonged surgery are independent risk factors for developing PONB. Additionally, a deep pelvis is an independent risk factor for severe PONB. Delicate surgical techniques should consider the risk of nerve injury in cases with low VFA and deep pelvis.

Revolutionizing treatment for topical fungal infections: evaluating penetration-enhancer-containing vesicles as a fluconazole delivery system: Ex-vivo and in-vivo dermal testing

Fungal infections pose a significant challenge in numerous developing nations and worldwide, necessitating urgent solutions. Oral administration of antifungal medications often leads to severe adverse reactions. Hence, employing topical delivery systems is preferred to ensure efficient dermal delivery of antifungal agents while minimizing side effects. Furthermore, the incorporation of penetration enhancers into nanocarriers loaded with antifungal agents has demonstrated enhanced efficacy in combating mycotic infections. Consequently, ultra-deformable penetration enhancer-containing vesicles (PEVs) were developed to explore this promising approach. In this study, Labrasol® and Transcutol® were used as penetration enhancers in formulating ultra-deformable PEVs containing the antifungal agent Fluconazole (FCZ). The PEVs underwent comprehensive characterization, including measurements of particle size (PS), charge, and entrapment efficiency (EE%). The results revealed that the size of tested PEVs ranged from 100 to 762 nm. All particles exhibited a negative charge, with a minimum zeta potential (ZP) of −38.26 mV, and an intermediate entrapment efficiency (EE%) that reached approximately 40%w/w. Ex-vivo studies demonstrated the ability of PEVs to deliver FCZ to the dermis while minimizing transdermal delivery. The selected formula was tested in-vivo using candidiasis-induced rat model and showed a superiority in its antifungal effect against Candida Albicans compared to the drug control. Stability studies were executed for the selected formula, and revealed good stability shown by the insignificant change in the PS, ZP& EE% over a six-month period.

Do Orally Disintegrating Tablets Facilitate Medical Adherence and Clinical Outcomes in Patients with Post-stroke Dysphagia?

Orally disintegrating tablets (ODTs) dissolve rapidly in contact with saliva and have been reported to facilitate oral administration of medications in swallowing difficulties. However, their clinical benefits remain unclear because no previous studies have examined whether ODTs facilitate medication adherence and clinical outcomes in patients with post-stroke dysphagia. This study evaluated the association between ODT prescriptions and clinical benefits using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. Using a large Japanese commercial medical and dental claims database, we identified patients aged ≥ 65years with post-stroke dysphagia between April 2014 and March 2021. To compare 1-year outcomes of medication adherence, cardiovascular events, and aspiration pneumonia between patients taking ODTs and non-ODTs, we performed hd-PS matching. We identified 11,813 patients without ODTs and 3178 patients with ODTs. After hd-PS matching, 2246 pairs were generated. Medication adherence for 1year, based on the proportion of days covered, was not significantly different between the non-ODT and ODT groups before (0.887 vs. 0.900, P = 0.999) and after hd-PS matching (0.889 vs. 0.902, P = 0.977). The proportion of cardiovascular events (0.898 vs. 0.893, P = 0.591) and aspiration pneumonia (0.380 vs. 0.372, P = 0.558) were also not significantly different between the groups. This study found no significant differences in medication adherence, cardiovascular diseases, or aspiration pneumonia between the non-ODT and ODT groups in patients with post-stroke dysphagia. Both groups achieved a proportion of days covered exceeding 80%. Clinicians may consider prescribing ODTs or non-ODTs based on patient preferences rather than solely on post-stroke conditions.

Review of Oral Tablet

Abstract: Oral drug delivery is noninvasive, has a high rate of patient compliance, is easy to handle, and doesn't require any special sterile settings, it is the most popular method of administration. Nevertheless, a number of physical, biological, and pharmacological obstacles that certain medications must overcome in order to be absorbed into the systemic circulation reduce their therapeutic efficiency. The use of nanocarriers to deliver drugs orally has proven to be an effective solution to the aforementioned problems and is being explored as a potential replacement for oral medication administration. This chapter provides an overview of the latest developments in the use of nanocarriers for oral medication delivery in the treatment of different disorders. The chapter also describes how diverse nanocarrier designs and technologies improve therapeutic potential by overcoming physical, biological, and biochemical obstacles. it is easy to produce, has few sterility limitations, is less expensive, has flexible dosage form design, and has high patient compliance, oral drug delivery (ODD) is the most convenient and favored method of drug administration. However, low medication bioavailability—which is influenced by three crucial factors—is one of the difficulties associated with oral drug delivery. The other is solubility. Many mathematical models that predict the medication's rate of solubility and dissolution have been developed in order to achieve efficient drug absorption in vivo. Similarly, models that are noncellular and cellular determine permeability. Furthermore, the medication's behavior in the gastrointestinal tract (GIT) is influenced by physiological parameters, such as pH, microbial colonization, and enzymes, as well as intrinsic drug properties. A drug's dosage form is a method of getting it into a living organism. The medicine must be administered to the site of action at a rate and concentration that will maximize therapeutic benefit and minimize side effects in order to provide the intended result. Although the oral method is still commonly used, swallowing tablets and capsules can be a regular problem. As a result, numerous studies on cutting-edge drug delivery methods have been conducted. This review focuses on oral dispersible tablets, a novel approach to drug delivery systems that are currently more focused on formulation and set a new course that not only helped patients increase their level of therapy compliance.

Competency-Based Medication Administration and Error Reporting.

Accuracy is needed with medication administration, a skill that involves rule-based habits and clinical reasoning. This pilot study investigated the use of an evidence-based checklist for accuracy with oral medication administration and error reporting among prelicensure nursing students. Checklist items were anchored in the mnemonic C-MATCH-REASON© (Client, Medication, ADRs, Time, Client History, Route, Expiration date, Amount, Site, Outcomes, Notation). Nineteen participants randomly assigned to crossover sequence AB or BA (A: checklist; B: no checklist) practiced simulation scenarios with embedded errors. Nursing faculty used an observation form to track error data. Using the C-MATCH-REASON© checklist compared with not using the checklist supported rule adherence (p = .005), knowledge-based error reduction (p = .011), and total error reduction (p = .010). The null hypothesis was not rejected for errors found (p = .061) nor reported (p = .144), possibly due to sample size. C-MATCH-REASON© was effective for error reduction. Study replication with a larger sample is warranted. [J Nurs Educ. 2024;63(5):320-327.].

Medication Lubricants for Oral Delivery of Drugs: Oral Processing Reduces Thickness, Changes Characteristics, and Improves Dissolution Profile.

Swallowing oral solid dosage forms is challenging for those who have medication swallowing difficulties, including patients with dysphagia. One option is to mix the drug (whole or crushed) with a thick vehicle (medication lubricant). Previous in vitro studies consistently suggest that thick vehicles could impact the dissolution of solid dosage forms, potentially influencing their therapeutic effectiveness, but do not account for changes that happen during oral processing and swallowing. This study aims to investigate the potential impact of medication lubricants on drug release and examine the effect of oral processing. In vitro dissolution of whole and crushed paracetamol tablets mixed with five commercially available medication lubricants (two IDDSI level 2, two IDDSI level 3, and one IDDSI level 4) were tested with and without oral processing; a medication lubricant with/without paracetamol was placed in the mouth (five healthy volunteers), prepared for swallowing, but then expectorated and assessed for physical characteristics and drug release. Medication lubricants, both alone and mixed with crushed paracetamol tablets, showed a significant decrease in viscosity after oral processing. Without oral processing, IDDSI level 3 and 4 lubricants significantly delayed the dissolution of paracetamol tablets. After oral processing, particularly with crushed tablets, there was a substantial increase in the dissolution rate. These findings suggest that dissolution testing overestimates the impact of medication lubricants on drug dissolution. Therefore, using in vitro dissolution tests to predict the dissolution rate of medications mixed with thick vehicles is discouraged. It is essential to consider ways to incorporate the effects of the oral environment and oral processing on thick vehicles used for oral medication administration.

Unveiling the potential of microsponges: Enhancing oral bioavailability

Oral medication administration is widely recognized as the most practical and widely used method. Medications with a short half-life and easy absorption in the gastrointestinal tract are quickly removed by the bloodstream. To avoid these issues, oral controlled-release formulations have been created. There are a ton of novel formulation approaches in the realm of medication delivery systems. One new novel approach that is becoming increasingly well-liked these days is the usage of microsponges. A wide variety of active chemicals can be entrapped by the highly cross-linked, porous, polymeric structure that makes up the Microsponges Delivery System (MDS). Various polymers like ethyl cellulose, polystyrene, etc., have been utilized in forming microsponges and these active microsponges can be incorporated into formulations, such as capsules, gel, and powders, and have a broad package of benefits. The microsponges have satisfactory stability over pH values ranging from 1 to 11, they exhibit reasonable stability at temperatures as high as 130, and entrapment efficiency is great, reaching 50–60%. The preparation of microsponges involves the Quasi-emulsion solvent method, and the emulsion solvent diffusion method the release of drug through microsponges increases with increasing drug-polymer ratio and lowering polymer wall thickness. The microsponges are characterized for visual characterization, zeta potential, entrapment efficiency, and drug content. This review is focused on their advantages over other dosage forms, methods of preparation, characterization, and application of microsponges.

Abstract TP121: Using Visual Cues to Improve Dysphagia Screening Compliance in Acute Stroke Patients

Introduction: Dysphagia or difficulty swallowing after a stroke is a common neurological symptom which occurs in 35-67% of all acute stroke patients. Dysphagia can lead to complications such as aspiration, pneumonia, dehydration, weight loss or death. National guidelines recommend dysphagia screening before oral intake in stroke patients to reduce hospital acquired pneumonia. A dysphagia screening tool used by nurses at the bedside that allows for the direct observation of the patient’s ability to swallow is the Water Swallow Test. Upon analysis of patient data, a practice gap was identified in which the dysphagia screening was not performed prior to first oral intake of medication. With collaboration of our multi-disciplinary stroke team to identify opportunities for improvements in the dysphagia performance measure, we hypothesized that if a visual cue was in place prior to first oral administration of medication, we can improve our compliance in the dysphagia performance measure. Method: When a patient presents with stroke symptoms, a purple dot sticker will be placed on the patient’s identification band. This purple dot sticker will serve as a visual cue that will trigger a reminder to the nurse when scanning the patient’s identification band prior to administration of the first oral medication to perform the dysphagia screening. If screening has been performed and the patient passed, the purple sticker will be removed. If the patient fails the screening, the nurse will notify the provider and the patient will be kept NPO (no meds) pending a speech/swallow consult. Upon admission, SBAR handoff to the floor will include failure of dysphagia screening / NPO status and an order for a speech/swallow consult. Result: In 2022, the dysphagia screening compliance was 67%. Following the visual cue implementation, our compliance improved to 100% in June 2023 and 92% in July 2023. Conclusion: Preliminary metrics indicate that this tool has positively impacted our compliance rate. Education to the staff is ongoing. Integration of the visual tool into our hospital guidelines for care of the acute stroke patient is under consideration pending additional analysis of compliance rates.

Effectiveness of Lignocaine with and without Pre-operative Oral Ibuprofen in Controlling Pain in Primary Mandibular Molars with Irreversible Pulpitis in 5 to 9-Year-Old Children: A Randomized Controlled Trial.

Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA). In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

A Single Center Exploratory Survey of Patients and Nurses on post-Surgical Oral Opioid Delivery Through Patient-Controlled Analgesia.

The most common route of opioid delivery is nurse-administered pills. However, there are numerous challenges such as nursing burden, opioid diversion, medication delay, and patient dissatisfaction. In this study, we conducted two surveys, first to assess patients' and nurses' opinions on the current administration of opioids in pill form, followed by their attitudes towards an innovative concept of oral medication delivery based on a medical device currently undergoing research and development within the University, patient-controlled dispenser and deactivator (PCDD) that allows patients to self-administer liquid oral opioids on demand based on physician prescription. Questionnaires were developed, verified and deployed to assess nurse and post-surgical patient opinions on the current administration of opioids in pill form, as well as the proposed new concept of patient -controlled administration of oral liquid medication via an illustration of PCDD, from September 2022 through July 2023 at a major academic tertiary care center. Quantitative and qualitative data were collected from postoperative patients and nurses from surgical specialties including General Surgery, Surgical Oncology, Trauma Surgery, Orthopedics, and Neurosurgery. Forty-three patients and 53 nurses were interviewed. Seventy percent of patients frequently called nurses for pain medication post-surgery 1-4 times daily, and 32% of patients were told each day by nurses that they could not receive medication because they were not due yet. Medication delay caused 24% of patients to worry about nursing availability for medication delivery. Likewise, nurses reported that half of patients receive delayed medication (22 minutes median delay time) and half of nursing time was spent administering pain medication. Nurses expressed moderate satisfaction with their current delivery of medication (median satisfaction score 6.5 out of 10). When being introduced to the concept of PCDD via a product illustration, 15% of patients said that they prefer liquid medication and 51% said they prefer PCDD or were interested in trying it. Nurse-administered pills are a common but suboptimal method for postoperative pain management. Based on patient and nurse feedback, patient controlled self-administered liquid oral opioid delivery is conceptually innovative, practically viable and potentially a preferred alternative for timely and less nurse-exhaustive pain management.

Management of the Diabetic Microalbuminuria with Ayurvedic intervention- A Case Report

Background: One of the most prevalent side effects of diabetes, diabetic nephropathy causes Hypoalbuminemia, chronic kidney damage and end-stage renal failure worldwide. This study was performed for the effectiveness of the Ayurvedic treatment in the patient presented with the complications of Diabetic Microalbuminuria with special reference of Kaphaja Shotha. A 67-year-old, male patient consulted to the Ayurveda hospital with generalized body swelling, difficulty in breathing on the rest, Fatigue for 2 years, following secondary prevention for two years. Design: Single Case report. Materials and Methods: In this prospective case study, conducted on a subject experiencing edema as a complication of diabetic nephropathy for two years, the individual was admitted to the Indoor Patient Department of Medicine. Over a period of three months, the subject was assessed every 15 days. The intervention involved the administration of oral medications including mainly Gokshuradi guggulu, Punarnavadi guggulu, Hingwastak Churna, Triphala Churna, Syrup Neeri KFT, and Gomutra Haritaki. The edema reduced progressively, and there was an alleviation of associated symptoms such as difficulty in breathing and fatigue. Additionally, the subject showed improvement in renal function parameters and reported an enhanced sense of well-being. Results: Laboratory investigation showed protein in urine and hypoalbuminemia with normal blood urea and S. Creatinine., which was corrected after treatment, increased serum albumin from 1.9 (g/dl) to 3.9(g/dl) and serum globulin from 1.7(g/dl) to 2.7 (g/dl). After 18 days, a significant improvement was noted in all the clinical features, blood investigations, Chest X ray of the patient and no any unwanted effects were noted during the study period. The case was managed without encountering any adverse effects, following the treatment regimen for Shotha. Keywords: Diabetic Microalbuminuria, Hypoalbuminemia, Kaphaja Shotha

A Review on: Formulation and Evaluation of Herbal Medicated Chewing Gum

One portable method of medicine delivery is chewing gum. It may be used to provide medications orally, either systemically or locally. In recent years, significant progress has been made in research and technology related to the oral medication administration route. Medicated chewing gum has gained international attention throughout the year due to its ability to promote patient compliance in both pediatric and geriatric patients as well as the general population. The Mayan Indians used to clean their teeth and refresh their breath by chewing tree resin from the sapodilla tree a thousand years ago. Over the course of the year, herbal chewing gum has been more widely accepted as a medication delivery method. Herbal chewing gum today contains a number of substances. A variety of characteristics, including color, stickiness, hardness, and in vitro drug release, are assessed for the prepared product. Chewing gum can be utilized as a portable medication delivery mechanism for oral drug administration, both systemic and local. The majority of people find chewing gum to be enjoyable. Medicated gum preparations frequently require organic solvents to solubilize the active ingredients, and it can be challenging to remove these organic solvents from the finished product.

Development of an Administration Guideline of Oral Medicines to Patients with Dysphagia.

Background and Objectives: There is increasing evidence that patients with dysphagia often have limited access to suitable oral dosage forms, especially when administered via an enteral feeding tube (FT). In addition, there is a lack of clear and readily available information from drug manufacturers on how to administer medications to patients with dysphagia. This study aimed to develop a practical guide for healthcare professionals to increase the safe and effective administration of oral medications to patients with dysphagia. Materials and Methods: The data were collected from existing English databases and handbooks available to develop an easy-to-use tabular guideline presenting all relevant information using keywords and short expressions. The working group differentiated 514 formulation types, and the information was collected and added to the guideline separately. In addition, the instructions for the patients taking the medicines orally or via FT were described separately. Results: The guideline consisted of 24 keywords or short expressions developed by the working group and described the instructions to use them. The guideline contained 343 active pharmaceutical ingredients and 19 fixed-dose combinations. Conclusions: Knowledge about proper medication preparation and administration for patients with swallowing difficulties is limited but essential. It is crucial to encourage drug manufacturers to provide this information as a standard to ensure the safe and effective use of medications for all patient groups.

Metoxifluran, an inhalation analgesic that opens up new possibilities in anesthesia

Although numerous clinical guidelines for pain management have been published over the past decade, inadequate pain relief remains a major public health problem. Currently, several methods of analgesia are available for the treatment of acute pain, including intravenous analgesia, epidural anesthesia, and oral administration of medications. However, the existing methods of analgesia still do not cover all the needs of proper analgesia, the search for new forms of release, methods of administration and methods of analgesia continues. Currently, non-invasive methods of analgesia are being actively implemented, which include a transdermal delivery system of analgesics (in particular, fentanyl hydrochloride), intranasal and inhalational analgesia, in which the delivery of analgesics is controlled by both the doctor and the patient. The purpose of this article is to review the inhaled analgesic methoxyflurane, which is administered by means of an individual inhaler and is used for the treatment of acute pain.

AYURVEDOKTA AUSHADHI CHIKITSA OF NAADIVRANA – A CASE REPORT

Here we are presenting a case of 35-year-old female patient, diagnosed with sinus tract in left anterior perianal and posterior vulval region along with collection in anterolateral vulval region and was suggested to undergo operative for the same. We corelated the symptoms with Naadivrana and designed our treatment protocol. The main aim of treatment was to heal the tract formed and to avoid abnormal granulations. Our treatment included administration of Ayurvedic oral medications viz. Somtajvir, Sukshma Triphala and Triphala Guggulu which helped the patient to be symptom-free within a duration of 4 months. Significant positive changes were observed on MR Fistulogram also.

The Impact of Covid-19 on The Incidence of Periodontitis Cases and its Therapeutic Management During The Pandemic

ABSTRACTIntroduction: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2. Periodontitis is an infection of the periodontal tissue that causes inflammation with the potential for the spread of intravascular microorganisms throughout the body. According to Riskesdas, periodontitis cases in Indonesia reached 74.1%. The purpose of this study was to determine the impact of COVID-19 on the incidence of periodontitis cases and their therapeutic management during the pandemic. Methods: Descriptive qualitative research using primary and secondary data in three primary health care on Kediri Tabanan. Results: The incidence of Periodontitis is in the first rank with the most cases in two Puskesmas. Oral drug therapy and extraction are the treatment options used in the treatment of periodontitis cases during the pandemic. Discussion: The high incidence of periodontitis during the COVID-19 pandemic is caused by patients who are afraid to visit the dentist. Patients coming to the dentist when the condition of the teeth is damaged and experiencing mobility. In addition, the dental polyclinic only serves patients with medical emergencies. Tools in the dental polyclinic are damaged due to never being used during the pandemic. Transmission process that occurs through aerosols produced in the practice of dental services makes the therapy be limited. Drug administration and extraction are options in the management of periodontitis cases. Conclusion: The impact of the COVID-19 pandemic has resulted in a high number of periodontitis cases. Oral medication administration and extraction an option for periodontitis therapy in the dental polyclinic of primary health care.

Intrinsic and extrinsic dental erosion: literature review

Dental erosion is the irreversible loss of tooth structure by a chemical process, without bacterial involvement. Its etiology is multifactorial, characterized by factors of chemical, biological and behavioral origin, being divided into intrinsic or extrinsic origin. Objective: To present the main factors that may trigger erosion lesions, relating them to the concept, diagnosis, clinical features, etiological factors, prevention and treatment. Material and methods: Scientific articles found in PubMed (English), SciELO (Portuguese) and Google Acadêmico (Portuguese) between the years 2010 and 2022. Results: Intrinsic factors are those associated with the presence of endogenous acids such as gastric acid, somatic disorders, periods of pregnancy, alcoholism and gastrointestinal problems. Extrinsic factors are related to eating habits, frequent intake of acidic beverages and foods, and oral administration of medications. The most common clinical characteristic is loss of enamel luster, a smooth, U-shaped surface, which with persistent exposure to acid forms concavities and excavations on the occlusal and incisal surfaces. It affects the palatal surface of the upper anterior teeth and the occlusal surface of the posterior teeth. The consequences of dental erosion include dental hypersensitivity and marginal degradation of existing restorations. Conclusion: Dental erosion can cause serious complications, requiring patient compliance. The professional’s knowledge of the etiological factors, associated with a good anamnesis and a detailed clinical examination, decides the best treatment, whether preventive or restorative for more severe cases, thus improving the patient’s quality of life.

Developing guidance for feeding tube administration of oral medications.

Drug administration through feeding tubes presents many challenges to the healthcare provider. There is little information available on medications than can be delivered safely when crushed and what efforts can be implemented to minimize clogging the feeding tube. Our institution requested a comprehensive examination of all oral medications for the feeding tube route. This report is a synopsis of the physical evaluation of 323 different oral medications for their appropriateness for feeding tube administration with distal site in either the stomach or jejunum. A worksheet was created for each medication. This document contained a review of the chemical and physical properties that would contribute to delivery of the medication. Each medication was then studied for the degree of disintegration, pH, osmolality, and potential to form clogs. For drugs that needed to be crushed, the volume of water needed to dissolve the drug, time for that process, and volume needed to rinse the tube after administration was also studied. The results of this review are summarized in a table and based on a composite of the documents cited, tests conducted, and author's judgements based all the data collected. Thirty-six medications were identified as inappropriate for feeding tube administration, and an additional 46 medications were identified as inappropriate for direct jejunal administration. The information produced by this study will enable clinicians to make informed choices in selecting, compounding, and rinsing medications through feeding tubes. Using the template provided, they will be able to evaluate a drug not studied here for potential issues in feeding tube administration.

Biosynthesized selenium nanoparticles to rescue coccidiosis-mediated oxidative stress, apoptosis and inflammation in the jejunum of mice.

One of the most crucial approaches for treating human diseases, particularly parasite infections, is nanomedicine. One of the most significant protozoan diseases that impact farm and domestic animals is coccidiosis. While, amprolium is one of the traditional anticoccidial medication, the advent of drug-resistant strains of Eimeria necessitates the development of novel treatments. The goal of the current investigation was to determine whether biosynthesized selenium nanoparticles (Bio-SeNPs) using Azadirachta indica leaves extract might treat mice with Eimeria papillata infection in the jejunal tissue. Five groups of seven mice each were used, as follows: Group 1: Non-infected-non-treated (negative control). Group 2: Non-infected treated group with Bio-SeNPs (0.5 mg/kg of body weight). Groups 3-5 were orally inoculated with 1×103 sporulated oocysts of E. papillata. Group 3: Infected-non-treated (positive control). Group 4: Infected and treated group with Bio-SeNPs (0.5 mg/kg). Group 5: Infected and treated group with the Amprolium. Groups 4 and 5 daily received oral administration (for 5 days) of Bio-SeNPs and anticoccidial medication, respectively, after infection. Bio-SeNPs caused a considerable reduction in oocyst output in mice feces (97.21%). This was also accompanied by a significant reduction in the number of developmental parasitic stages in the jejunal tissues. Glutathione reduced (GSH), glutathione peroxidase (GPx), and superoxide dismutase (SOD) levels were dramatically reduced by the Eimeria parasite, whereas, nitric oxide (NO) and malonaldehyde (MDA) levels were markedly elevated. The amount of goblet cells and MUC2 gene expression were used as apoptotic indicators, and both were considerably downregulated by infection. However, infection markedly increased the expression of inflammatory cytokines (IL-6 and TNF-α) and the apoptotic genes (Caspase-3 and BCL2). Bio-SeNPs were administrated to mice to drastically lower body weight, oxidative stress, and inflammatory and apoptotic indicators in the jejunal tissue. Our research thus showed the involvement of Bio-SeNPs in protecting mice with E. papillata infections against jejunal damage.

Comparison of the efficacy of Sufentanil and Morphine Titration for patient-controlled Subcutaneous Analgesia in severe advanced cancer pain.

To compare the efficacy and side effects of sufentanil and morphine titration for patient-controlled subcutaneous analgesia (PCSA) in severe advanced cancer pain management. A retrospective analysis was performed on the patients who were treated by two cancer centers with PCSA for severe advanced cancer pain at the Fourth Hospital of Hebei Medical University and Baoding No.1 Hospital between 2018 and 2021. These patients were divided into a sufentanil group and a morphine group. The drug dosage of the two groups was recorded. The pain intensity, sleep quality and adverse event rate (AER) were compared and analyzed between the two groups. PCSA was successful in 95.2% (120/126) of the patients. In all cases, titration was successful within 24 hour, followed by oral administration of sustained-release opioid medications at 208.4 ±75.1 mg in the sufentanil group and at 207.9±66.3 mg in the morphine group. There was a significant difference in pain intensity and sleep quality before and after titration (P <0.05). Both groups exhibited a decline in their heart rates during titration. Compared with the baselines before titration, the mean heart rates were significantly reduced in both groups (P <0.05). The sufentanil group had an AER lower than that of the morphine group. Short-term use of sufentanil supports PCSA for patients with severe advanced cancer pain can achieve effective and rapid pain management, it is worth clinical implementation and application.