Publications by authors named "Mohammed Mahdi"

21 Publications

  • Page 1 of 1

A Challenging Case of Carcinoid Crisis in a Patient With Neuroendocrine Tumor.

Cureus 2021 Jun 13;13(6):e15626. Epub 2021 Jun 13.

Critical Care Medicine, Capital Health System, Trenton, USA.

The critical state of circulatory collapse and hypoperfusion that results in end-organ damage has been called shock. Carcinoid crisis is a rare cause of shock, which is difficult to identify in the presence of infection. It occurs due to the release of vasoactive amines into the systemic circulation following an inciting event. In the presence of a neuroendocrine tumor, carcinoid crisis should be suspected in case of resistant shock. Herein, we report a rare case of carcinoid crisis, in which a quick response to the somatostatin analog therapy, octreotide, was helpful to confirm the diagnosis.
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http://dx.doi.org/10.7759/cureus.15626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275054PMC
June 2021

Acquired Gerbode Defect in a Patient With Infective Endocarditis of Bicuspid Aortic Valve.

Cureus 2021 May 31;13(5):e15352. Epub 2021 May 31.

Cardiovascular Disease, Mount Sinai Hospital, New York, USA.

Aortic valve abscess is a fatal complication of infective endocarditis. Transthoracic echocardiography is the initial imaging obtained in suspected infective endocarditis. However, its accuracy in detecting cardiac complications remains low, thus should be followed by transesophageal echocardiography if the clinical situation permits. Here, we present a case of a bicuspid aortic valve infective endocarditis caused by S and complicated with aortic valve abscess and acquired Gerbode defect, which appeared as a tricuspid valve vegetation on transthoracic echocardiography.
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http://dx.doi.org/10.7759/cureus.15352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244663PMC
May 2021

From an Incidental Finding to an Emergent Treatment: A Case Report of a Hepatic Adenomatosis and Large Ruptured Hepatic Adenoma.

Case Rep Gastrointest Med 2021 19;2021:9963440. Epub 2021 Jun 19.

Cancer Center, Capital Health Hopewell, Two Capital Way, Pennington, NJ 08534, USA.

. Hepatic adenoma is an uncommon benign liver tumor presenting as solitary lesions or even rarely as hepatic adenomatosis. Large lesions carry a risk of rupture, hemorrhage, and malignant transformation. This case report aims to increase awareness about risk factors for hepatic adenomas, considering the increasing prevalence of obesity and the widespread use of oral contraceptive pills. . A 20-year-old obese female who was taking oral contraceptive pills for seven years presented to the emergency department with vomiting and abdominal pain caused by gastroenteritis. On imaging, multiple hepatic adenomas, including two lesions 6 and 9 cm in diameter, were incidentally found. During the hospitalization, the patient suddenly developed acute anemia and rupture of the largest lesion, which was promptly treated with arterial embolization. . Obesity and exposure to hormones are well-known risk factors for hepatic adenomas. The incidence of hepatic adenomas is steadily increasing because of the prevalence of obesity, especially among females. Lifestyle interventions for weight loss and discontinuation of oral contraceptive pills are considered a conservative treatment of hepatic adenomas. Large lesions possess the risk of malignant transformation and rupture and require surgical excision.
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http://dx.doi.org/10.1155/2021/9963440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238616PMC
June 2021

Characteristics and outcomes of cancer patients with covid-19 at a safety-net hospital.

Cancer Treat Res Commun 2021 Jun 10;28:100418. Epub 2021 Jun 10.

Department of Hematology and Oncology, Capital Health Regional Medical Center, Trenton, NJ, United States.

Patients with cancer are a vulnerable population during the COVID-19 pandemic due to underlying immunosuppression, pre-existing comorbidities, and poor nutrition. There is a lack of data describing the disease course of cancer patients with COVID-19 disease. Therefore, we analyzed data from cancer patients with COVID-19 who were admitted to our hospital. Cancer patients were categorized into two groups as survivors and non-survivors of COVID-19. Among 68 cancer patients with COVID-19, 27% of patients were admitted to ICU, and 37% of the patients died. The median age was 72, and non-survivors were older than survivors (p = 0.001). Non-survivors had higher comorbidity scores, late-stage cancer, and worse ECOG performance status than survivors (all p values<0.005). Non-survivors also had significantly lower lymphocyte count and albumin level but higher lactate dehydrogenase, C-reactive protein, fibrinogen, troponin, and ferritin levels than survivors. On multivariable analysis, increased age and mechanical ventilation were associated with increased odds of death. We report no association between anti-cancer treatments and mortality from COVID-19 disease. In summary, cancer patients have higher mortality of COVID-19 infection than the general population. In addition to generally known risk factors, the high mortality rate in cancer patients with COVID-19 is associated with several cancer-specific factors.
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http://dx.doi.org/10.1016/j.ctarc.2021.100418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189837PMC
June 2021

Unilateral Proptosis due to Orbital Metastasis of Paratesticular Leiomyosarcoma.

Eur J Case Rep Intern Med 2021 2;8(3):002315. Epub 2021 Mar 2.

Department of Hematology and Oncology, Capital Health Regional Medical Center, Trenton, NJ, USA.

Paratesticular leiomyosarcomas are uncommon malignant tumours that originate from smooth muscle and show aggressive tumour behaviour due to a high incidence of local recurrence and distant metastasis. Orbital metastasis is also rare and associated with a poor prognosis. Clinical suspicion plays an essential role in the diagnosis of orbital leiomyosarcoma because of its uncommon presentation. Comprehensive neuroimaging and histopathological work-up are warranted for definitive diagnosis and management. To date, surgical resection remains the best curative treatment. However, leiomyosarcomas are usually friable and unencapsulated, which makes surgery challenging. Also, whether adjunctive chemotherapy will alter the long-term prognosis remains to be determined. Herein, we report the case of a middle-aged man who presented with proptosis and decreased vision, who was subsequently diagnosed with metastatic orbital leiomyosarcoma from a primary paratesticular tumour. We performed orbital enucleation with negative margins. The patient is currently under systemic pazopanib chemotherapy.

Learning Points: Orbital metastasis from paratesticular leiomyosarcoma is rarely encountered and shows aggressive behaviour.Clinical suspicion plays an essential role in diagnosing orbital leiomyosarcoma as this is an uncommon and atypical cause of proptosis and can be easily misdiagnosed by physicians.Curative surgical treatment should be considered due to the high recurrence rate.
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http://dx.doi.org/10.12890/2021_002315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046287PMC
March 2021

Massive biventricular thrombi complicating new-onset heart failure in a patient with suspected COVID-19.

J Cardiol Cases 2021 Mar 14. Epub 2021 Mar 14.

Department of Cardiology, Capital Health Regional Medical Center, Trenton, NJ, United States.

The World Health Organization nominated SARS-CoV-2 as the cause of the Coronavirus Disease 2019 (COVID-19) and has been granted as a pandemic. COVID-19 is an emerging threat due to the risk of microvascular, venous, and arterial thrombosis, thereby exacerbating organ injury and mortality. Although the exact mechanism of extensive thromboembolism and myocardial injury caused by SARS-CoV-2 is not illuminated, it is clear that COVID-19 related hypercoagulation increasing the fatality of the disease. Herein, we reported a patient with extensive biventricular thrombi along with the new-onset severe systolic dysfunction as an unusual catastrophic presentation of COVID-19. In our patient, there was both a right atrial "clot in transit" from his DVT as well as extensive muralized biventricular thrombus from severe global hypokinesis. We believe that the hypercoagulable state of his COVID-19 infection, along with severe systolic dysfunction, caused this unusual presentation. Although the hypercoagulable state of COVID-19 is well recognized, there have not been any reported cases of extensive de-novo intracardiac thrombus as of yet. We urge awareness of severe and potentially fatal extensive thrombosis and cardiac failure as the initial clinical presentation of possible SARS-CoV-2.
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http://dx.doi.org/10.1016/j.jccase.2021.02.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955911PMC
March 2021

Acute Mitral Regurgitation: An Unusual Cause of Unilateral Pulmonary Consolidation.

Cureus 2021 Jan 14;13(1):e12707. Epub 2021 Jan 14.

Cardiology, Capital Health Regional Medical Center, Trenton, USA.

Unilateral pulmonary consolidation generally indicates infectious pneumonia. In this case report, we describe a patient with infective endocarditis and acute mitral valve regurgitation who developed acute unilateral pulmonary consolidation that resolved dramatically after mechanical ventilation and diuretic therapy. The prompt resolution of the consolidation with treatment suggests pulmonary edema. This case report highlights that rare conditions such as acute pulmonary edema should be considered in the differential diagnosis of patients who present with unilateral pulmonary consolidation to avoid delay in appropriate treatment.
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http://dx.doi.org/10.7759/cureus.12707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883524PMC
January 2021

Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce.

Hum Resour Health 2020 09 1;18(1):61. Epub 2020 Sep 1.

Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), 1140 Connecticut Avenue NW, Washington, DC, USA.

Background: The Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy.

Methods: MoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes.

Results: Knowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2-23.5%) and 22.3% (95% confidence interval 13.2-31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV.

Conclusions: Similar to other Project ECHO evaluation results in the United States of America, Namibia's Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.
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http://dx.doi.org/10.1186/s12960-020-00503-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466396PMC
September 2020

Frontal sinus inverted papilloma managed with Draf III.

J Surg Case Rep 2020 Aug 22;2020(8):rjaa180. Epub 2020 Aug 22.

Department of Otolaryngology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Inverted papilloma (IP) is a rare benign tumor that originates from nasal and paranasal sinus mucosa. Although it is considered a benign lesion, it is locally aggressive and has risk between 7 and 15% for malignant transformation. The management of frontal sinus (FS) IP is still challenging due to its rarity and local invasiveness. We report a rare case of IP originating from FS, and to review the literature to delineate the possible surgical strategy. A 52-year-old male presented with long-standing history of bilateral nasal obstruction and left eye proptosis. Sinus navigation computed tomography showed soft tissue density occupying frontal, ethmoid, right sphenoid sinuses with extension to nasal cavities, postnasal space and left orbital space plus erosive bony changes. Transnasal endoscopic biopsy suggested IP the lesion was completely resected by Draf III procedure. After 1 month of the surgery, the patient is doing well with no complaints.
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http://dx.doi.org/10.1093/jscr/rjaa180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442918PMC
August 2020

Intranasal lobular capillary hemangioma: A series of five cases.

Respir Med Case Rep 2020 11;30:101073. Epub 2020 May 11.

Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

Background: Lobular capillary hemangiomas (LCH) are acquired benign vascular lesions of the skin and mucous membranes mostly affecting the head and neck region. Involvement of the nasal cavity is extremely rare and can manifest as epistaxis and nasal obstruction.

Case Series: In this case series, we present five cases of intranasal LCH. Three cases are of pregnant women that presented with epistaxis and nasal obstruction. The first was surgically treated during her pregnancy with preoperative embolization of the tumor for vascular control, while the other two patients were treated after delivery. The two other cases are of a post trauma pediatric patient, and an elderly lady with multiple co-morbidities, both presenting with recurrent nose bleeds and nasal obstruction. Surgical excision was performed with no complications observed post-operatively.

Discussion: The etiology of LCH is unknown, but certain predisposing factors have been associated with the development of LCH and include pregnancy and trauma. The anterior portion of the nasal septal mucosa and the tip of the inferior turbinate are commonly involved sites. Computed tomography scans and histopathology are used to diagnose LCH. Treatment is surgical excision with or without pre-operative embolization.

Conclusion: LCH are rare tumors of the nasal cavity. Treatment of these lesions is surgical with or without preoperative vascular control.
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http://dx.doi.org/10.1016/j.rmcr.2020.101073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236058PMC
May 2020

A Universal Electrolyte Formulation for the Electrodeposition of Pristine Carbon and Polypyrrole Composites for Supercapacitors.

ACS Appl Mater Interfaces 2020 Mar 5;12(11):13386-13399. Epub 2020 Mar 5.

Department of Materials, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.

Electrodeposition of conducting polymer-carbon composites from an electrolyte precursor solution is a facile one-step approach to fabricate device-ready electrodes for energy storage. A key challenge in this approach is the dispersion of the carbon nanomaterials with the aqueous precursor solution with previous approaches either heavily oxidizing the carbon nanomaterials or using high concentrations of anionic surfactants as dopants. However, the former reduces the electrical conductivity of carbon, while the latter reduces the ionic mobility of the conducting polymer due to the large anion size. Herein, for the first time we present a quaternary electrolyte formulation for the fabrication of pristine carbon and polypyrrole (PPy) composites that does not sacrifice either electron or ion mobility. The electrolyte uses lithium perchlorate (20 mM) as a supporting electrolyte and dopant, sodium dodecylbenzenesulfonate at a very low concentration (1.43 mM) as a surfactant, together with pristine carbon nanomaterials and pyrrole monomers. The order of magnitude difference between the concentration of the dopant and surfactant ion allows the as-deposited PPy to be doped predominantly by small-sized and mobile perchlorate anions. Composites of PPy with carbon black, carbon nanotubes, and electrochemical exfoliated graphene (EEG) have been successfully prepared using this new quaternary electrolyte. The as-fabricated PPy/EEG composite electrodes showed a specific capacitance of 348.8 F g with a high rate capability (190.7 F g at 71 A g). Supercapacitor devices based on the PPy/EEG composite electrodes exhibit a high rate behavior up to 500 mV s and a long cycle life of 5000 cycles.
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http://dx.doi.org/10.1021/acsami.0c01216DOI Listing
March 2020

Correlation of oxidation reduction potential and total motile sperm count: its utility in the evaluation of male fertility potential.

Asian J Androl 2020 May-Jun;22(3):317-322

Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar.

Oxidative stress (OS) is detrimental to sperm functions, and the oxidation reduction potential (ORP) is a good measure of OS as it considers the balance between oxidants and reductants. Total motile sperm count (TMSC) is viewed as the single most important semen analysis parameter that can predict male infertility severity, and its correlation with ORP has never been undertaken. The objectives of this study were to assess the correlation between ORP and TMSC, to identify the ORP cutoff value based on the TMSC result, and to compare this cutoff value with previously reported ORP cutoff values in literature. One thousand one hundred and sixty-eight infertile patients and 100 fertile controls were enrolled. Demographic and semen data of the participants were retrieved and analyzed. Wilcoxon's rank-sum test compared variables between infertile men and fertile controls; Spearman's correlation assessed the static ORP (sORP)-TMSC relationship for the whole sample and among each group individually. Using a 20×10TMSC threshold, receiver operator characteristic (ROC) analysis determined the sORP cutoff associated with the highest predictive values. TMSC was significantly negatively correlated with sORP across all participants (r = 0.86, P < 0.001), among infertile patients (r = 0.729, P < 0.001), and among fertile controls (r = 0.53, P < 0.001). A 20-million TMSC threshold determined an sORP cutoff value of 2.34 mV/10sperm/ml to be associated with 82.9% sensitivity, 82.8% specificity, 91.5% positive predictive value (PPV), 68.5% negative predictive value (NPV), and 82.9% overall accuracy. Compared with previously reported cutoff values in searched literature, the 2.34 mV/10sperm/ml cutoff value identified in our study yielded the highest overall diagnostic accuracy in the evaluation of infertile men.
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http://dx.doi.org/10.4103/aja.aja_75_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275803PMC
June 2021

Two-Step Electrochemical Intercalation and Oxidation of Graphite for the Mass Production of Graphene Oxide.

J Am Chem Soc 2017 12 27;139(48):17446-17456. Epub 2017 Nov 27.

National Graphene Institute, University of Manchester , Oxford Road, Manchester, M13 9PL, U.K.

Conventional chemical oxidation routes for the production of graphene oxide (GO), such as the Hummers' method, suffer from environmental and safety issues due to their use of hazardous and explosive chemicals. These issues are addressed by electrochemical oxidation methods, but such approaches typically have a low yield due to inhomogeneous oxidation. Herein we report a two-step electrochemical intercalation and oxidation approach to produce GO on the large laboratory scale (tens of grams) comprising (1) forming a stage 1 graphite intercalation compound (GIC) in concentrated sulfuric acid and (2) oxidizing and exfoliating the stage 1 GIC in an aqueous solution of 0.1 M ammonium sulfate. This two-step approach leads to GO with a high yield (>70 wt %), good quality (>90%, monolayer), and reasonable oxygen content (17.7 at. %). Moreover, the as-produced GO can be subsequently deeply reduced (3.2 at. % oxygen; C/O ratio 30.2) to yield highly conductive (54 600 S m) reduced GO. Electrochemical capacitors based on the reduced GO showed an ultrahigh rate capability of up to 10 V s due to this high conductivity.
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http://dx.doi.org/10.1021/jacs.7b08515DOI Listing
December 2017

Gellan gum fluid gels for topical administration of diclofenac.

Int J Pharm 2016 Dec 24;515(1-2):535-542. Epub 2016 Oct 24.

Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK. Electronic address:

Diclofenac topical formulations are often preferred for drug administration to patients who experience serious GIT problems. Absorption of the drug through the skin, however, can be challenging due to the natural protective feature of the stratum corneum (SC). In this article, fluid gels prepared from gellan gum were explored as a topical drug delivery vehicle. Rheological analysis of the formulations showed that it was possible to produce a topical gel with a viscosity and the mechanical strength similar to that of the commercially available Voltaren gel using 1% w/w of a 50:50 low acyl/high acyl (LA/HA) gellan blend. Soft-tribology was used to assess the lubrication properties of gellan fluid gels. The lubrication of the gellan gum fluid gel formulations at high rubbing speeds was similar to the lubrication of the Voltaren gel. The use of gellan gum dramatically increased skin permeation of diclofenac when compared with the commercially available formulation and could be controlled by changing the gellan gum concentration and/or sodium ion concentration in the formulation. This study highlights the potential use of fluid gels that can be easily tuned to have physical properties suitable for topical formulations with the added advantage of increasing drug permeation.
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http://dx.doi.org/10.1016/j.ijpharm.2016.10.048DOI Listing
December 2016

Lessons learned from the PMTCT program in Swaziland: challenges with accepting lifelong ART for pregnant and lactating women - a qualitative study.

BMC Public Health 2016 10 24;16(1):1119. Epub 2016 Oct 24.

Center for International Health, University of Bergen, Bergen, Norway.

Background: Swaziland has one of the highest HIV prevalence rates in sub-Saharan Africa, 26 % of the adult population is infected with HIV. The prevalence is highest among pregnant women, at 41.1 %. According to Swaziland's prevention of mother-to-child transmission (PMTCT) guidelines, approximately 50 % of pregnant women are eligible for antiretroviral therapy (ART) by CD4 criteria (<350 cells/ml). Studies have shown that most mother-to-child transmission and postnatal deaths occur among women who are eligible for ART. Therefore, ensuring that ART eligible women are initiated on ART is critical for PMTCT and for mother and baby survival. This study provides insight into the challenges of lifelong ART initiation among pregnant women under Option A in Swaziland. We believe that these challenges and lessons learned from initiating women on lifelong ART under Option A are relevant and important to consider during implementation of Option B+.

Methods: HIV-positive, treatment-eligible, postpartum women and nurses were recruited within maternal and child health (MCH) units using convenience and purposive sampling. Participants came from both urban and rural areas. Focus group discussions (FGDs) and structured interviews using a short answer questionnaire were conducted to gain an understanding of the challenges experienced when initiating lifelong ART. Seven FGDs (of 5-11 participants) were conducted, four FGDs with nurses, two FGDs with women who initiated ART, and one FGD with women who did not initiate ART. A total of 83 interviews were conducted; 50 with women who initiated ART and 33 with women who did not initiate. Data collection with the women was conducted in the local language of SiSwati and data collection with the nurses was done in English. FGDs were audio-recorded and simultaneously transcribed and translated into English. Analysis was conducted using thematic analysis. Transcripts were coded by two researchers in the qualitative software program MAXqda v.10. Thematic findings were illustrated using verbatim quotes which were selected on the basis of being representative of a specific theme. The short-answer interview questionnaire included specific questions about the different steps in the woman's experience initiating ART; therefore the responses for each question were analyzed separately.

Results: Findings from the study highlight women feeling overwhelmed by the lifetime commitment of ART, feeling "healthy" when asked to initiate ART, preference for short-course prophylaxis and fear of side effects (body changes). Also, the preference for nurses to determine on an individual basis the number of counseling appointments a woman needs before initiating ART, more information about HIV and ART needed at the community level, and the need to educate men about HIV and ART.

Conclusion: Women face a myriad of challenges initiating lifelong ART. Understanding women's concerns will aid in developing effective counseling messages, designing appropriate counseling structures, understanding where additional support is needed in the process of initiating ART, and knowing who to target for community level messages.
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http://dx.doi.org/10.1186/s12889-016-3767-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078916PMC
October 2016

Drug release from E chemistry hypromellose tablets using the Bio-Dis USP type III apparatus: An evaluation of the effect of systematic agitation and ionic strength.

Colloids Surf B Biointerfaces 2016 Jul 24;143:481-489. Epub 2016 Mar 24.

School of Life Sciences, University of Sussex, JMS Building, Falmer, Brighton, UK; Drug Applied Research Centre and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.

The aim of the study was to evaluate the effect of systematic agitation, increasing ionic strength and gel strength on drug release from a gel-forming matrix (HPMC E10M, E4M and E50LV) using USP type III Bio-Dis apparatus with theophylline as a model drug. The triboelectric charging; particle sizing, water content, true density and SEM of all the hypromellose grades, theophylline and formulated blends were characterised. The results showed that balanced inter-particulate forces exist between drug particles and the excipient surface and this enabled optimum charge to mass ratio to be measured. Agitation and ionic strength affected drug release from E50LV and E4M tablet matrices in comparison to the E10M tablet matrices. Drug release increased substantially when water was used as the dissolution media relative to media at pH 1.2 (containing 0.4M NaCl). The results showed all f2 values for the E10M tablet matrices were above 50 suggesting the drug release from these tablet matrices to be similar. Rheological data also explained the different drug release behaviour with the stress required to yield/erode being 1Pa, 150Pa, and 320Pa, for the E50LV, E4M and E10M respectively. The stiffness of the gel was also found to be varied from 2.5Pa, 176.2Pa and 408.3Pa for the E50LV, E4M and E10M respectively. The lower G' value can be explained by a softer gel being formed after tablet introduction into the dissolution media thereby indicating faster drug release.
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http://dx.doi.org/10.1016/j.colsurfb.2016.03.066DOI Listing
July 2016

Development of mucoadhesive sprayable gellan gum fluid gels.

Int J Pharm 2015 Jul 8;488(1-2):12-9. Epub 2015 Apr 8.

Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK. Electronic address:

The nasal mucosa provides a potentially good route for local and systemic drug delivery. However, the protective feature of the nasal cavity make intranasal delivery challenging. The application of mucoadhesive polymers in nasal drug delivery systems enhances the retention of the dosage form in the nasal cavity. Several groups have investigated using low acyl gellan as a drug delivery vehicle but only limited research however, has been performed on high acyl gellan for this purpose, despite its properties being more conducive to mucoadhesion. High acyl gellan produces highly elastic gels below 60°C which make it difficult to spray using a mechanical spray device. Therefore, in this study we have tried to address this problem by making fluid gels by introducing a shear force during gelation of the gellan polymer. These fluid gel systems contain gelled micro-particles suspended in a solution of un-gelled polymer. These systems can therefore behave as pourable viscoelastic fluids. In this study we have investigated the rheological behavior and mucoadhesion of fluid gels of two different types of gellan (high and low acyl) and fluid gels prepared from blends of high and low acyl gellan at a 50:50 ratio. The results demonstrated that by preparing fluid gels of high acyl gellan, the rheological properties were sufficient to spray through a standard nasal spray device. Moreover fluid gels also significantly enhance both high acyl and low acyl gellan mucoadhesion properties.
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http://dx.doi.org/10.1016/j.ijpharm.2015.04.011DOI Listing
July 2015

Evaluation of gellan gum fluid gels as modified release oral liquids.

Int J Pharm 2014 Nov 27;475(1-2):335-43. Epub 2014 Aug 27.

Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK. Electronic address:

Oral liquids are often preferred for drug administration to patients for whom swallowing is difficult, however, formulating modified release versions can be challenging. A potential route to achieve modified release in oral liquids is by using fluid (sheared) gels formed by introducing a shear field during gelation in gel-forming biopolymers. These fluid gels can act as pourable viscoelastic fluids but retain true gel micro/nano structure. Here, we have demonstrated that fluid gels have potential as paediatric oral liquids preventing release of ibuprofen in simulated gastric fluid. Subsequent release at pH 7.4 was affected by the duration of exposure and magnitude of acid pH with a linear relationship between onset of release and the preceding acidic exposure duration. Delayed release was a result of increasing gel stiffness, a consequence of the acidity of the initial release media and exposure time. A much faster release rate was measured when exposure time in acid was 10 min compared with 60 min. This study highlights the potential to design fluid gels that are tuned to have a specified stiffness at a particular pH and exposure time. This could enable the preparation oral liquids with modified release behaviour.
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http://dx.doi.org/10.1016/j.ijpharm.2014.08.044DOI Listing
November 2014

Improved detection of incident HIV infection and uptake of PMTCT services in labor and delivery in a high HIV prevalence setting.

J Acquir Immune Defic Syndr 2011 Aug;57(4):e85-91

Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Swaziland.

Objective: To maximize prevention of mother-to-child transmission of HIV (PMTCT) effectiveness and increase identification of HIV status in maternity units in Swaziland.

Design: With a quasi-experimental design, 3 maternity units were randomly assigned to the training intervention and 3 units were controls.

Methods: Targeted on-site training was provided to nurse-midwives in intervention sites. HIV status was recorded with testing offered to women presenting with unknown and distant negative status. Cord blood was obtained and tested for HIV antibodies and presence of nevirapine as a marker of PMTCT intervention coverage. Contingency tables and χ² tests were used to test for associations between frequencies of events.

Results: Of the 2444 enrolled women, 215 (9%) arrived in maternity with unknown status and 1398 (58%) had tested HIV negative in antenatal clinic. Significantly more HIV-negative women (45%) and women with unknown status (96%) in intervention sites were tested compared with similar women in control sites, 14% and 65%, respectively (P < 0.0001 for both). Nevirapine coverage in HIV-positive cord blood was significantly higher in intervention sites (80%) than in control sites (69%, P < 0.0001). Cumulative HIV incidence was 4% with an incidence rate of 16.8 per 100 person-years. Antiretroviral prophylaxis coverage in seroconverters was significantly higher in intervention sites 54% (13 of 24) than the control group [26% (9 of 34), P = 0.03].

Conclusions: In high HIV prevalence settings, such as Swaziland, the incidence of HIV during pregnancy is high. An on-site training intervention for maternity nurses significantly increases the identification of HIV infection and maximizes the provision of PMTCT interventions.
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http://dx.doi.org/10.1097/QAI.0b013e31821acc6eDOI Listing
August 2011

Intraoperative assessment of technical skills on live patients using economy of hand motion: establishing learning curves of surgical competence.

Am J Surg 2010 Jan;199(1):81-5

Division of Urology, Mount Sinai & Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.

Background: On surgical simulators, measures of economy of hand motion have been shown to be reliable, valid, and objective measures of technical competence. Our goal was to validate hand-motion analysis (HMA) as an objective measure of surgical skill on real patients.

Methods: HMA (hand movement frequency, hand travel distance) was evaluated serially on 2 standardized, live patient surgeries (vasectomy, vasectomy reversal) for both a novice and experienced surgeon. HMA parameters were correlated with blinded, case-matched assessments of technical skill using previously validated global rating scales and surgical checklist scores applied to unedited surgical videos. Serial hand-motion data from the novice and experienced surgeon were plotted to establish competency-based learning curves over time.

Results: Intraoperative HMA correlated significantly with case-matched global rating and checklist scores. Meaningful improvements in the number of hand movements and hand travel distance were shown over time for the novice surgeon, but remained stable for the experienced surgeon.

Conclusions: Intraoperative assessment of economy of hand motion represents a feasible, objective, and valid measure of technical skill and can be used to establish competency-based surgical learning curves.
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http://dx.doi.org/10.1016/j.amjsurg.2009.07.033DOI Listing
January 2010
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