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Background: This study explored the most suitable materials for incorporating cyano-phycocyanin (C-PC) into hydrogels, focusing on maintaining the C-PC's long-term structural integrity and stabilityNext, the release of C-PC from the hydrogels and its skin penetration were investigated. Methods: A series of 1% (w/w) C-PC hydrogels was prepared using various gelling agents and preservatives. Spectrophotometric measurements compared the amount of C-PC in the hydrogels to the initially added amount. After selecting the most suitable gelling agent and preservative, two C-PC hydrogels, with and without propylene glycol (PG) (Sigma-Aldrich, St. Louis, MO, USA), were produced for further testing. In vitro release studies utilized modified Franz-type diffusion cells, while ex vivo skin-permeation studies employed Bronaugh-type cells and human skin. Confocal laser scanning microscopy analyzed C-PC accumulation in the skin. Results: The findings demonstrated that sodium alginate (Sigma-Aldrich, St. Louis, MO, USA), hydroxyethyl cellulose (HEC) (Sigma-Aldrich, St. Louis, MO, USA), and SoligelTM (Givaudan, Vernier, Switzerland) are effective biopolymers for formulating hydrogels while maintaining C-PC stability. After 6 h, C-PC release from the hydrogel containing PG was approximately 10% or 728.07 (±19.35) μg/cm2, significantly higher than the nearly 7% or 531.44 (±26.81) μg/cm2 release from the hydrogel without PG (p < 0.05). The ex vivo qualitative skin-permeation study indicated that PG enhances C-PC penetration into the outermost skin layer. Conclusion: PG's ability to enhance the release of C-PC from the hydrogel, coupled with its capacity to modify the skin barrier ex vivo, facilitates the penetration of C-PC into the stratum corneum. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to characterize the reimbursement policy for orphan drugs (ODs) in Central and Eastern European (CEE) countries in relation to the availability and impact of clinical evidence, health technology assessment (HTA) procedure, selected economic indicators, and the drug type according to indications. Materials and methods: A list of authorized medicines with orphan designation and information about active substance, Anatomical Therapeutic Chemical (ATC) classification, and therapeutic area was extracted from the web-based register of the European Medicines Agency (EMA). A country-based questionnaire survey was performed between September 2021 and January 2022 in a group of selected experts from nine CEE countries (an invitation was sent to 11 countries). A descriptive and statistical analysis was conducted to determine statistical significance, correlations, between the drug or country characteristic and the positive recommendation or reimbursement of ODs. Results: The proportion of reimbursed orphan drugs differed between countries, ranging from 17.7% in Estonia to 49.6% in Hungary (p < 0.001). The odds that ODs were reimbursed were reduced in countries with a "strong" level of impact of drug safety and efficacy on reimbursement decisions (p=0.018), the presence of other additional specific clinical aspects (e.g., genomic data) considered in the reimbursement decision (p < 0.001) and mandatory (without exception) safety assessments (p=0.004). The probability that ODs were reimbursed was increased in countries with a "moderate" level of impact of drug safety and efficacy on reimbursement decisions (p=0.018), when reimbursement decisions are dependent on the EMA registration status and orphan drug designation (p < 0.001), the presence of the "positive HTA recommendation guarantees reimbursement" policy (p < 0.001), higher GDP per inhabitant (p=0.003), and higher healthcare expenditure (p < 0.001). Conclusion: We found that there are differences among CEE countries in the reimbursement of orphan drugs, and we identified aspects that may influence these differences. Safety, efficacy, and specific clinical aspect issues significantly influenced reimbursement decisions. Antineoplastic and immunomodulating agents drugs were the largest group of ODs and increased the chance of getting a positive recommendation. The higher GDP per inhabitant and healthcare expenditures per inhabitant were positively linked to the chance that an OD receives reimbursement. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) management requires a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication‐related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Methods: Allergic Rhinitis and its Impact on Asthma (ARIA) first published a reference document on the pharmacist's role in allergic rhinitis management in 2004. Several guidelines were developed over the past 20 years improving the care of allergic rhinitis patients through an evidence‐based, integrated care approach. Results: This ARIA/EAACI/FIP Position Paper is based on the latest ARIA in the Pharmacy guidelines and provides: (a) a structured approach to pharmacists identifying people with AR and/or allergic conjunctivitis as well as those at risk of poor disease control; (b) an evidence‐based clinical decision support tool for optimising the management of allergic rhinitis in the community pharmacy; and (c) a framework of referral to the physician. Conclusion: This document is not intended to be a mandatory standard of care but is provided as a basis for pharmacists and their staff to develop relevant local standards of care for their patients, within their local practice environment. Pharmacy care varies between countries, and the guide should be adapted to the local situation. [ABSTRACT FROM AUTHOR]

Water-based propolis extracts usually contain up to 10-fold lower quantities of active ingredients due to poor solubility in water of propolis bioactive compounds when compared with ethanol-based extracts. Since ethanol-based extracts are of limited use, water-based extracts are preferred nowadays. The application of alternative extraction techniques should be evaluated to improve extraction efficiency. Aqueous propolis extracts were prepared using purified water and propylene glycol, 2-hydroxypropyl-beta-cyclodextrin and sodium bicarbonate aqueous solutions. A microwave-assisted extraction method was applied in cycles. The total concentration of hydroxycinnamic acids in aqueous propolis extract produced by four extraction cycles was determined to be 1502.1 ± 130.1 μg/mL and 20% propylene glycol, 10% 2-hydroxypropyl-beta-cyclodextrin and 5% sodium bicarbonate aqueous solutions, increasing the total concentration of hydroxycinnamic acids by 1.6, 1.7 and 1.9-fold, respectively. An application of microwave-assisted extraction method and the procedure of repeating extraction cycles reliably increased the quantity of hydroxycinnamic acids in aqueous propolis extracts. Similarly, the presence of propylene glycol, 2-hydroxypropyl-β-cyclodextrin and sodium bicarbonate increased the concentration of the hydroxycinnamic acids in propolis extracts. [ABSTRACT FROM AUTHOR]

Background Potentially inappropriate prescribing is frequent among elderly patients admitted to hospitals in many countries. However, the impact of hospitalization on potentially inappropriate medications and potential prescribing omissions has not been studied in depth. Objective This study aimed to investigate the impact of hospitalization on the prevalence of potentially inappropriate medications and potential prescribing omissions among elderly patients admitted to and discharged from an acute care geriatric clinic. Setting Geriatric wards of a teaching hospital in Lithuania. Method This observational cross-sectional study included 76 subjects aged ≥ 65 years. The Beers 2015 Criteria, the EU(7)-PIM list, and the second versions of the Screening Tool of Older Person's Prescriptions and the Screening Tool to Alert doctors to Right Treatment were applied to detect potentially inappropriate medications and potential prescribing omissions. Data were extracted from patient's medical records. Main outcome measure Prevalence of potentially inappropriate medications and potential prescribing omissions on hospital admission and hospital discharge. Results Potentially inappropriate medications were identified among 44.7% to 69.7% of patients upon hospital admission and 59.2% to 72.4% upon hospital discharge. The prevalence of potentially inappropriate medications had increased upon discharge based on each set of criteria. Potential prescribing omissions were detected in 93.4% of patients at admission and 96.1% of patients at discharge. Conclusion Potentially inappropriate prescribing is highly prevalent among older patients hospitalized in the studied setting in Lithuania and hospitalization had not reduced potentially inappropriate medications and potential prescribing omissions. There is a need for interventions aiming to reduce potentially inappropriate prescribing among elderly patients. [ABSTRACT FROM AUTHOR]

Pharmacists are trusted health care professionals. Many patients use over‐the‐counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)‐pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA‐pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care. [ABSTRACT FROM AUTHOR]

Summary: Background: Mobile technology may help to better understand the adherence to treatment. MASK‐rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient‐centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries. Objectives: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App. Methods: An observational cross‐sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach. Results: A total of 12 143 users were registered. A total of 6 949 users reported at least one VAS data recording. Among them, 1 887 users reported ≥7 VAS data. About 1 195 subjects were included in the analysis of adherence. One hundred and thirty‐six (11.28%) users were adherent (MPR ≥70% and PDC ≤1.25), 51 (4.23%) were partly adherent (MPR ≥70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non‐adherent to medications (MPR <70%). Of those, the largest group was non‐adherent to medications and the time interval was increased in 442 (36.68%) users. Conclusion and clinical relevance: Adherence to treatment is low. The relative efficacy of continuous vs on‐demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication‐taking behaviour in a real‐world setting. [ABSTRACT FROM AUTHOR]

The search of possibilities to improve the functional properties of textile materials has been continuing for years with the aim to provide higher hygiene characteristics offer advanced therapeutic functionality. One of available approaches to provide new properties for textiles is the inclusion of natural ingredients. Propolis extracts are successfully used in practical therapeutics for accelerated wound healing and cell proliferation processes. In this study, pure multi-filament yarns and yarns saturated with propolis were developed and characterized. The effect of preparation and formulation parameters on the characteristics of yarns was evaluated; the release of propolis extract components from yarns and their possible cytotoxicity on cell formation was also determined. [ABSTRACT FROM PUBLISHER]

Natural oils are commonly used in topical pharmaceutical formulations as emulsifiers, stabilizers or solubility enhancers. They are presented as safe and inert components, mainly used for formulation purposes. It is confirmed that natural oils can affect the skin penetration of various substances. Fatty acids are mainly responsible for this effect. Current understanding lacks reliable scientific data on penetration of natural oils into the skin and their skin penetration enhancement potential. In the current study, fatty acid content analysis was used to determine the principal fatty acids in soybean, olive, avocado, sea-buckthorn pulp, raspberry seed and coconut oils. Time of flight secondary ion mass spectrometry bioimaging was used to determine the distribution of these fatty acids in human skin ex vivo after application of the oils. Skin penetration enhancement ratios were determined for a perspective antioxidant compound dihydroquercetin. The results demonstrated skin penetration of fatty acids from all oils tested. Only soybean and olive oils significantly increased the skin distribution of dihydroquercetin and can be used as skin penetration enhancers. However, no correlation can be determined between the fatty acids' composition and skin penetration enhancement using currently available methodological approaches. This indicates that potential chemical penetration enhancement should be evaluated during formulation of topically applied products containing natural oils. [ABSTRACT FROM AUTHOR]

The successful topical therapy of onychomycosis depends on effective drug release and penetration into nail, which can be achieved by using an adequately developed delivery system. This study evaluated and compared effect of film-forming polymers Eudragit RL100, Eudragit RS100, and ethyl cellulose on naftifine hydrochloride release from experimental nail lacquer formulations. Quality of formulations was evaluated by determining drying time and water resistance. Interactions between active pharmaceutical ingredient and excipients were investigated using microcalorimetry and FT-IR. Optimization of nail lacquer formulations was performed by naftifine hydrochloride release testing. Release of naftifine hydrochloride increased with increasing concentration of Eudragit RL100. Plasticizer triacetin affected the release of naftifine hydrochloride, when Eudragit RS100 polymer was used. Ethyl cellulose polymer was determined to be not applicable for naftifine hydrochloride nail lacquer formulations. Two compositions of nail lacquers were optimized and could be used in further development of transungual delivery systems. [ABSTRACT FROM AUTHOR]

Since biological activity of medicinal plants is dependent on cultivation area, climatic conditions, developmental stage, genetic modifications and other factors, it is important to study flora present in different growing sites and geographical zones. This study was focused on screening of antioxidant activity ofC. angustifoliumharvested in six different locations in Lithuania. The total contents of phenolic compounds, flavonoids and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity were evaluated by spectrophotometric methods. A correlation between radical scavenging activity and total phenolic compounds content was observed (correlation coefficient 0.98). HPLC with online post-column DPPH radical scavenging reaction detection was used for the separation of extracts. Oenothein B, rutin and one unidentified compound were predominant. Volatile compounds were analysed using solid-phase microextraction coupled with gas chromatography–mass spectrometry. Based on the analysis of volatiles, all samples were classified into two chemotypes: (I) with predominant α- and β-caryophyllenes and (II) with predominant anethole. [ABSTRACT FROM PUBLISHER]

Antibacterial, antiviral, antifungal, antioxidant, anti-inflammatory, and anticancer activities of propolis and its ability to stimulate the immune system and promote wound healing make it a proper component for wound dressing materials. Silver nanoparticles are recognized to demonstrate strong antiseptic and antimicrobial activity; thus, it also could be considered in the development of products for wound healing. Combining propolis and silver nanoparticles can result in improved characteristics of products designed for wound healing and care. The aim of this study was to formulate electrospun fast dissolving mats for wound dressing containing propolis ethanolic extract and silver nanoparticles. Produced electrospun nano/microfiber mats were evaluated studying their structure, dissolution rate, release of propolis phenolic compounds and silver nanoparticles, and antimicrobial activity. Biopharmaceutical characterization of electrospun mats demonstrated fast release of propolis phenolic compounds and silver nanoparticles. Evaluation of antimicrobial activity on Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Proteus vulgaris, Bacillus subtilis, Bacillus cereus, and Candida albicans strains confirmed the ability of electrospun mats to inhibit the growth of the tested microorganisms. [ABSTRACT FROM AUTHOR]

Nowadays targeted drug delivery is one of the areas widely investigated in the biomedical application of modern technologies. Propolis is well known natural material because of its confirmed antimicrobial and anti-inflammatory activity, and for these reasons it could be considered as a candidate in developing wound healing textile materials. Electrospun bicomponent mats of poly(vinyl alcohol) (PVA) and aqueous propolis solution were manufactured and analysed in this study. It was observed that the concentration of phenolic acids in aqueous propolis solution or the amount of aqueous propolis in the electrospinning solution had no significant influence on the structure of electrospun mats. From bicomponent PVA/aqueous propolis solutions fewer nanofibres with a diameter of up to 100 nm were electrospun, nor from PVA solution containing no added substances. Analysis of phenolic compound release kinetics demonstrated that up to 86 - 96% of vanilic acid, caffeic acid, vanillin acid, p-coumaric acid and ferulic acid had been released from the electrospun PVA/aqueous propolis solution mats in 15 min. It was concluded that electrospun mats from biocomponent PVA/aqueous propolis nano-microfibres may be considered for developing a drug delivery system for local application. [ABSTRACT FROM AUTHOR]

Fatty acids classified as chemical penetration enhancers (CPEs) might cause the fluidization and perturbation of stratum corneum (SC) lipid matrix. The penetration of oleic, linoleic, lauric and capric acids into human skin was studied by time-of-flight secondary ion mass spectrometry (TOF-SIMS) imaging and related to fatty acids enhancing effect on lipophilic model drug tolnaftate penetration into human epidermis and dermis ex vivo. Fatty acid enhancing effect on tolnaftate penetration into human skin was evaluated using Bronaugh-type flow-through diffusion cells. After in vitro penetration studies visualization and spatial localization of fatty acid molecules in human skin were performed using TOF-SIMS. Penetration of oleic, linoleic, lauric and capric acids into human skin was compared to the control skin sections by ion images and intensity profiles. Only oleic acid significantly (P<0.05) enhanced tolnaftate penetration into epidermis (enhancing ratio equal to 1.867). CPE might have no effect on model drug penetration enhancement, but might penetrate itself into the skin. [ABSTRACT FROM AUTHOR]

Abstract Objective: Nonadherence to the prescribed antibiotic treatment is a widespread problem, affecting not only individual patients, but also public health. As measures to predict it are still lacking, we aimed to design an instrument to identify nonadherence risk in short-term antibiotic therapies. Methods: Patient adherence was assessed by pill count and an extensive set of standardized questions, newly developed according to the five-dimension adherence model proposed by the World Health Organization. It combined previously validated questionnaires and original questions adapted from our exploratory survey. The extensive set was analyzed prospectively in adult patients treated with antibiotics in outpatient settings. The number of items was reduced stepwise keeping as many of five factor subgroups as possible. The items were dichotomized as positive (indicating nonadherence risk) or negative. Results: One third (32%) of the respondents (N = 122) did not adhere to the prescribed antibiotic regimen. The extensive set of questions was reduced to a short questionnaire. It consisted of four items independently associated with nonadherence (P < 0.05) and covered three of the five analyzed factor subgroups: healthcare-related factor (consultations about medicines), therapy-related factor (complexity of treatment), and patient-related factors (forgetfulness, health behavior). The sum of 0-1 positive answers indicated an adherent patient, and 2-4 a risky patient. Such a differential approach led to relatively good sensitivity, specificity, and total predictive value (80%, 82%, and 81%, respectively) in our sample. Conclusion: The short measure representing the multiple factor subgroups was developed to identify nonadherence to antibiotic treatment with acceptable levels of sensitivity, specificity, and predictive values. It could be valuable for healthcare professionals, especially in primary healthcare. Considering limitations of the study (medium sample size, justification of patient's responses, no re-test), future studies could continue investigations on the validity and elaboration of this instrument in larger samples. [ABSTRACT FROM AUTHOR]

5-Aminolevulinic acid (5-ALA) has been used for treatment of different skin diseases (e.g., skin cancer, actinic keratosis (AK), psoriasis, and acne). The quality of the treatment is directly associated to the amount of 5-ALA that penetrates into skin. 5-ALA was extracted from skin samples after performing the experiment with Bronaugh cells for 4 hours. Two methods were developed by applying different column systems and mobile phase compositions: YMC-Pack Hydrosphere C18 column (250 × 4 mm, 5 µm) in series with Hichrom Hypersil H5ODS (150 × 4 mm, 5 µm), mobile phase consisted of 0.1% TFA in water with 2% of ACN (method A); ACE 3AQ column (150 × 4 mm, 3 µm) eluted with 0.05% TFA in water (method B). Exploratory fluorimetric analysis requiring pre-column or post-column derivatization did not warrant the expectations of simple and effective analysis; therefore, ELS detection for 5-ALA was considered. Parallel chromatography was applied for double-validation of the methods in order to correctly evaluate the possibility of ELSD application for 5-ALA detection and the quantification amount in skin extracts. The retention time and adequate lowest limit of quantification (LLOQ) of 5-ALA were determined in both methods: 5.5 min and 20 µg/ml (method A); 6.2 min and 8.4 µg/ml (method B). Both HPLC-ELSD methods proved to be simple, accurate, precise, reliable, and showed reproducible values in the concentration range of 20–200 µg/ml in human skin extracts. [ABSTRACT FROM PUBLISHER]

Naftifine is used to treat fungal skin infections as it inhibits dermatophytes, which are the cause of onychomycosis. However, naftifine's ability to permeate the human nail barrier has not been investigated, thus, the antimycotic potential is not clearly established. This work aims to evaluate the effect of penetration enhancing factors on the accumulation of naftifine hydrochloride through human nail clippings. Naftifine polymeric nail lacquers with Eudragit RL100 were developed as a suitable delivery system. Low penetration of naftifine into nail has been determined as less than 10% of applied drug dose accumulated in the nail layers. Incorporation of thioglycolic acid into formulations resulted in increased accumulation of antifungal agent in the nail layers by 100% compared with a control group. Salicylic acid did not effect naftifine accumulation in the human nail. The permeation of naftifine through the nail increased by threefold when the thioglycolic acid-containing formulation was applied and the nail was pretreated with a fractional CO2 laser. Structural changes of the nail barrier, induced by fractional CO2 laser, were visualized by microscopy. The results suggest, that naftifine nail penetration could be significantly increased when physical and chemical enhancing factors are applied. [ABSTRACT FROM AUTHOR]

The paradigm of how we manage allergic rhinitis is shifting with a growing understanding that it is a complex process, requiring a coordinated effort from healthcare providers and patients. Pharmacists are key members of these integrated care pathways resolving medication-related problems, optimizing regimens, improving adherence and recommending therapies while establishing liaisons between patients and physicians. Community pharmacists are the most accessible healthcare professionals to the public and allergic rhinitis is one of the most common diseases managed by pharmacists. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines developed over the past 20 years have improved the care of allergic rhinitis patients through an evidence-based, integrated care approach. In this paper, we propose an integrated approach to allergic rhinitis management in community pharmacy following the 2019 ARIA in the pharmacy guidelines. [ABSTRACT FROM AUTHOR]

Topical monotherapy of nail infection is limited by poor drug permeability into the human nail plate. Numerous substances and methods are applied to improve the antifungal agent delivery across the nail plate. This work aimed to evaluate the effect of chemical and physical enhancers on the accumulation and permeation of amorolfine hydrochloride through human nail clippings. Polymeric nail lacquers with Eudragit E100 were developed as a potentially suitable delivery system for amorolfine hydrochloride. Incorporating thioglycolic acid and urea into formulations provided increased accumulation of antifungal agent in nail layers of up to 100% and 57%, respectively. Structural changes of nail barrier, induced by fractional CO2 laser, were visualized by microscopy. The permeation of amorolfine hydrochloride through the nail increased twofold when thioglycolic acid-containing formulation was applied and the nail was pretreated with a fractional CO2 laser. The results suggest that this novel combination of enhancers has the potential to be an effective option for topical drug delivery through the nail, and increased the efficacy of treatment. [ABSTRACT FROM AUTHOR]