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Eplerenone, a Class-II according to the biopharmaceutical classification system (BCS), with poor water solubility, resulting in low bioavailability. To address these limitations, this study aimed to improve the drug solubility and dissolution rate, by formulating it as nanocrystals (NCs). The NCs were intended to enhance Eplerenone's solubility, thereby increasing its bioavailability when taken orally. Additionally, load it as a sublingual fast-dissolving film to be released immediately and enhance effectiveness by avoiding first-pass metabolism. Using the solvent anti-solvent precipitation method, nanocrystals (NCs) of Eplerenone were prepared, and the impact of different factors on their particle size (PS) and polydispersity index (PDI) was investigated. The majority of the NCs formulations exhibited nanoscale particle sizes. Notably, the optimized formulation, F8(with 0.05% soluplus), showed a lower particle size (94.15nm), a high dissolution velocity (96.75%), and no drug-excipient interactions. Subsequently, an oral thin film containing PVA polymer and the optimized EPL nanocrystals was developed. The study results suggested that the immediate release of EPL nanocrystals from the sublingual film led to enhanced therapeutic action, improved efficacy, and increased bioavailability, as it bypassed first-pass metabolism by hepatic enzymes. Overall, nanocrystal-based sublingual films hold promise for enhancing the effectiveness of Eplerenone.

Abstract The simian parasite Plasmodium knowlesi is the predominant species causing human malaria infection, including hospitalisations for severe disease and death, in Malaysian Borneo. By contrast, there have been only a few case reports of knowlesi malaria from Indonesian Borneo. This situation seems paradoxical since both regions share the same natural macaque hosts and Anopheles mosquito vectors, and therefore have a similar epidemiologically estimated risk of infection. To determine whether there is a true cross-border disparity in P. knowlesi prevalence, we conducted a community-based malaria screening study using PCR in Kapuas Hulu District, West Kalimantan. Blood samples were taken between April and September 2019 from 1000 people aged 6 months to 85 years attending health care facilities at 27 study sites within or close to jungle areas. There were 16 Plasmodium positive samples by PCR, five human malarias (two Plasmodium vivax, two Plasmodium ovale and one Plasmodium malariae) and 11 in which no species could be definitively identified. These data suggest that, if present, simian malarias including P. knowlesi are rare in the Kapuas Hulu District of West Kalimantan, Indonesian Borneo compared to geographically adjacent areas of Malaysian Borneo. The reason for this discrepancy, if confirmed in other epidemiologically similar regions of Indonesian Borneo, warrants further studies targeting possible cross-border differences in human activities in forested areas, together with more detailed surveys to complement the limited data relating to monkey hosts and Anopheles mosquito vectors in Indonesian Borneo.

Abstract Plasmodium knowlesi infections in Malaysia are a new threat to public health and to the national efforts on malaria elimination. In the Kapit division of Sarawak, Malaysian Borneo, two divergent P. knowlesi subpopulations (termed Cluster 1 and Cluster 2) infect humans and are associated with long-tailed macaque and pig-tailed macaque hosts, respectively. It has been suggested that forest-associated activities and environmental modifications trigger the increasing number of knowlesi malaria cases. Since there is a steady increase of P. knowlesi infections over the past decades in Sarawak, particularly in the Kapit division, we aimed to identify hotspots of knowlesi malaria cases and their association with forest activities at a geographical scale using the Geographic Information System (GIS) tool. A total of 1064 P. knowlesi infections from 2014 to 2019 in the Kapit and Song districts of the Kapit division were studied. Overall demographic data showed that males and those aged between 18 and 64 years old were the most frequently infected (64%), and 35% of infections involved farming activities. Thirty-nine percent of Cluster 1 infections were mainly related to farming surrounding residential areas while 40% of Cluster 2 infections were associated with activities in the deep forest. Average Nearest Neighbour (ANN) analysis showed that humans infected with both P. knowlesi subpopulations exhibited a clustering distribution pattern of infection. The Kernel Density Analysis (KDA) indicated that the hotspot of infections surrounding Kapit and Song towns were classified as high-risk areas for zoonotic malaria transmission. This study provides useful information for staff of the Sarawak State Vector-Borne Disease Control Programme in their efforts to control and prevent zoonotic malaria.

Background: 1,3-oxazolidinones are an important class of antibiotics that are recognized with higher activities against Gram-positive bacteria. linezolid, tedizolid phosphate, and radezolid are important examples of this group. Aim: The aim of this review is to study the effect of 1,3-oxazolidinone derivatives as Gram-positive antibacterial agents. Results: There are many methods for preparing the oxazolidinone derivatives. Many patents Three new antibacterial oxazolidinones are linezolid, tedizolid phosphate, and radezolid. They differ in the side chain according to their structure-activity relationship. Conclusion: Study the structure-activity relationship (SAR) of oxazolidinone derivatives as new antibacterial agents.

A green HPLC method for lamivudine (3TC), zidovudine (AZT) and nevirapine (NVP) determination in fixed-dose combination tablets was developed using ethanol as both one of the mobile phases and the solvent for sample preparation. This method was validated according to ICH Q2(R1) guideline. Additionally, the method was adapted to complete the analysis of five related substances described in the International Pharmacopoeia (Ph. Int.), five other known related substances and two excipients. The separation was obtained with a C18 column (ARV4 5 µm 250 × 3.0 mm, Interchim) using a gradient mode with 0.1M ammonium acetate buffer (pH 4.5) and ethanol as mobile phase at 35°C, a flow rate of 0.4 mL/min, at 270 nm and an injection volume of 10 µL. The combination of ethanol (biodegradable and low-cost alternative solvent) with the use of a column diameter of 3 mm instead of 4.6 mm as used in pharmacopoeias, makes the wastes of the analysis more environmentally friendly and allows the use of a conventional HPLC pump (

Abstract Plasmodium knowlesi, a simian malaria parasite responsible for all recent indigenous cases of malaria in Malaysia, infects humans throughout Southeast Asia. There are two genetically distinct subpopulations of Plasmodium knowlesi in Malaysian Borneo, one associated with long-tailed macaques (termed cluster 1) and the other with pig-tailed macaques (cluster 2). A prospective study was conducted to determine whether there were any between-subpopulation differences in clinical and laboratory features, as well as in epidemiological characteristics. Over 2 years, 420 adults admitted to Kapit Hospital, Malaysian Borneo with knowlesi malaria were studied. Infections with each subpopulation resulted in mostly uncomplicated malaria. Severe disease was observed in 35/298 (11.7%) of single cluster 1 and 8/115 (7.0%) of single cluster 2 infections (p = 0.208). There was no clinically significant difference in outcome between the two subpopulations. Cluster 1 infections were more likely to be associated with peri-domestic activities while cluster 2 were associated with interior forest activities consistent with the preferred habitats of the respective macaque hosts. Infections with both P. knowlesi subpopulations cause a wide spectrum of disease including potentially life-threatening complications, with no implications for differential patient management.

Background and Purpose: The presence of yeasts in the urine is not synonymous with urinary tract infection since it can result in simple colonization or contamination. Regarding this, it is required to further clarify the epidemiological profile of funguria. Accordingly, the present study was conducted to establish the epidemiology of funguria in the Mohammed VI Teaching Hospital of Oujda, Morocco. Materials and Methods: This retrospective study was conducted on all urine samples sent for cytobacteriological examination to a microbiology laboratory over a period of 28 months (i.e., from March 2016 to June 2018). After the removal of duplicates, the urine samples were treated according to the recommendations of the medical microbiology standards. Results: A total of 15,165 urine samples were collected. Urinary colonization accounted for 4.94% (n=749) of cases. The infections of the urinary tract accounted for 5.35% (n=811) of cases. Microbial isolates (n=1,669) in colonization and urinary tract infections were dominated by bacteria (93.47%, n=1,560). Furthermore, the yeasts accounted for 6.53% (n=109) of the isolates. Candida albicans was isolated from 56.88% (n=62) of funguria cases. The risk factors for funguria in our series were essentially old age, admission to intensive care unit, and broad-spectrum antibiotic therapy. Conclusion: The current level of knowledge about the clinical situations leading to funguria with the improvement and popularization of efficient identification techniques for yeasts other than C. albicans should redress the epidemiology of funguria. This should allow the knowledgeable societies to establish the rules of interpreting the cytobacteriological examination of the urine in case of funguria, as for bacteriuria.

To monitor the incidence of Plasmodium knowlesi infections and determine whether other simian malaria parasites are being transmitted to humans, we examined 1,047 blood samples from patients with malaria at Kapit Hospital in Kapit, Malaysia, during June 24, 2013–December 31, 2017. Using nested PCR assays, we found 845 (80.6%) patients had either P. knowlesi monoinfection (n = 815) or co-infection with other Plasmodium species (n = 30). We noted the annual number of these zoonotic infections increased greatly in 2017 (n = 284). We identified 6 patients, 17–65 years of age, with P. cynomolgi and P. knowlesi co-infections, confirmed by phylogenetic analyses of the Plasmodium cytochrome c oxidase subunit 1 gene sequences. P. knowlesi continues to be a public health concern in the Kapit Division of Sarawak, Malaysian Borneo. In addition, another simian malaria parasite, P. cynomolgi, also is an emerging cause of malaria in humans.

Solar systems connected to the grid are crucial in addressing the global energy crisis and meeting rising energy demand. The efficiency of these systems is totally impacted by varying weather conditions such as changes in irradiance and temperature throughout the day. Additionally, partial shading (PS) adds to the complexity of the nonlinear characteristics of photovoltaic (PV) systems, leading to significant power loss. To address this issue, maximum power point tracking (MPPT) algorithms have become an essential component in PV systems to ensure optimal power extraction. This paper introduces a new MPPT control technique based on a novel reptile search optimization algorithm (RSA). The effectiveness of the proposed RSA method is evaluated under different weather conditions with varying irradiance and partial shading. The results of the RSA algorithm are compared to other existing bio-inspired algorithms and show superior performance with an average efficiency of 99.91%, faster dynamic response of 50 ms, and less than 20 watts of oscillation. The RSA-MPPT based technique provides higher efficiency, faster settling time, and minimal oscillation around the maximum power point (MPP), making it a reliable solution for effective solar power harvesting.

This article handles the challenging problem of identifying the unknown parameters of solar cell three models on one hand and of photovoltaic module three models on the other hand. This challenge serves as the basis for fault detection, control, and modelling of PV systems. An accurate model of PV is essential for the simulation research of PV systems, where it has a significant role in the dynamic study of these systems. The mathematical models of the PV cell and module have nonlinear I-V and P-V characteristics with many undefined parameters. In this paper, this identification problem is solved as an optimization problem based on metaheuristic optimization algorithms. These algorithms use root mean square error (RMSE) between the calculated and the measured current as an objective function. A new metaheuristic amalgamation algorithm, namely biogeography-based teaching learning-based optimization (BB-TLBO) is proposed. This algorithm is a hybridization of two algorithms, the first one is called BBO (biogeography-based optimization) and the second is TLBO (teaching learning-based optimization). The BB-TLBO is proposed to identify the unknown parameters of one, two and three-diode models of the RTC France silicon solar cell and of the commercial photovoltaic solar module monocrystalline STM6-40/36, taking into account the performance indices: high precision, more reliability, short execution time and high convergence speed. This identification is carried out using experimental data from the RTC France silicon solar cell and the STM6-40/36 photovoltaic module. The efficiency of BB-TLBO is checked by comparing its identification results with its own single algorithm BBO, TLBO and newly introduced hybrid algorithms such as DOLADE, LAPSO and others. The results reveal that the suggested approach surpasses all compared algorithms in terms of RMSE (RMSE min, RMSE mean and RMSE max), standard deviation of RMSE values (STD), CPU (execution time), and convergence speed.

Excessive unprotected sun exposure is a significant risk factor for skin damage and skin cancers. In recent decades, the incidence of skin cancer has increased dramatically worldwide, reaching epidemic proportions. Skin cancer is the most common type of cancer worldwide, and the ninth most common malignancy in Saudi Arabia. Sun protection is a key primary preventive strategy against skin cancer and skin damage induced by sun exposure.Herein, a cross-sectional study was made to evaluate the knowledge, attitude, and practices toward sun exposure, and the use of sun protection among non-medical female students on the Sulaymaniyah campus of the King Abdul-Aziz University. Also, we identified the reasons that prevented the students from using sun protection measures. A special-designed, self-administered questionnaire was applied on a sample size of 501 students. We found that most students were aware of the risks of unprotected sun exposure. Nevertheless, a view of sunscreen as harmful was reported (34.1%). Seeking shade and wearing protective clothing were the most used sun protection methods (58.1% and 43.1%, respectively). Sunscreen users made up only one third of our sample (23.6%). However, the majority of students (64.9%) did not know about the sun protection factor of sunscreen products. Discomfort felt on the skin was the most commonly reported reason for avoiding the use of sunscreen (40.7%). When comparing our study with Western studies, we found a high level of awareness among our sample of students. Significant differences in the attitude toward the application of suntan and sun protection products might be due to differences in cultural background. Our results spotted the need for future health education programs for our society that focus on the significant importance of sunscreen, as well as the correct methods of application. Keywords: Sun exposure, sun protection, sunscreen

L'électrophorèse des protéines sériques (EPS) est une analyse de routine dans la pratique quotidienne d'un laboratoire de biologie médicale. Le but de notre étude est d'analyser les différents profils électrophorétiques rencontrés dans notre pratique courante. Nous avons mené une étude transversale portant sur 410 échantillons sériques qui ont été collectés dans le cadre de l'analyse de routine au sein du laboratoire de biochimie du Centre Hospitalier Universitaire (CHU) Mohammed VI d'Oujda. L'électrophorèse des protéines sériques a été réalisée sur automate Capilarys2 Flex piercing de Sebia. 241 sérums de femmes et 169 sérums d'hommes ont été collectés. Âgés de 1 à 91 ans avec une moyenne d'âge de 49 ans. 19,5% des EPS étaient normales, l'hypo-albuminémie a été noté chez 34% des cas, un syndrome inflammatoire chronique dans 19,5% des cas, un syndrome néphrotique chez 2% des cas, 5,8% de nos patients avaient un bloc béta-gamma, une hypogammaglobulinémie a été observée dans 8,5% des cas, et 29 pics monoclonaux ont été notés, une bis-albuminémie a été objectivée chez 2 patients. Sur les 410 prélèvements: 92 immunofixations ont été réalisées dont 23 étaient positives (objectivant une gammapathie monoclonale). Cette étude met en évidence la variabilité des motifs de prescription d'une électrophorèse des protéines sériques, ainsi que l'importance des données cliniques pour une interprétation meilleure.

Abstract Background In spite of efforts to employ risk-based strategies to increase monitoring efficiency in the academic setting, empirical evidence on their effectiveness remains sparse. This mixed-methods study aimed to evaluate the risk-based on-site monitoring approach currently followed at our academic institution. Methods We selected all studies monitored by the Clinical Trial Unit (CTU) according to Risk ADApted MONitoring (ADAMON) at the University Hospital Basel, Switzerland, between 01.01.2012 and 31.12.2014. We extracted study characteristics and monitoring information from the CTU Enterprise Resource Management system and from monitoring reports of all selected studies. We summarized the data descriptively. Additionally, we conducted semi-structured interviews with the three current CTU monitors. Results During the observation period, a total of 214 monitoring visits were conducted in 43 studies resulting in 2961 documented monitoring findings. Our risk-based approach predominantly identified administrative (46.2%) and patient right findings (49.1%). We identified observational study design, high ADAMON risk category, industry sponsorship, the presence of an electronic database, experienced site staff, and inclusion of vulnerable study population to be factors associated with lower numbers of findings. The monitors understand the positive aspects of a risk-based approach but fear missing systematic errors due to the low frequency of visits. Conclusions We show that the factors mostly increasing the risk for on-site monitoring findings are underrepresented in the current risk analysis scheme. Our risk-based on-site approach should further be complemented by centralized data checks, allowing monitors to transform their role towards partners for overall trial quality, and success.

Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body.

Objective: To find out normal size and shape of yolk sac in pregnancies between 5-12 weeks of gestation, its association with pregnancy outcome and correlation of various fetal parameters with mean yolk sac diameter. Method: 95 pregnant women of 20-30 years age group with amenorrhoea 1 month 5 days to 7 days selected randomly for this study from August 2009 to October 2010, underwent TVS fortnightly from 5-11 weeks of gestation and at 12 weeks either of the TVS or TAS to visualize changes in mean yolk sac diameter (MYSD) and yolk sac (YS) shape and pregnancy outcomes. Results analyzed by Z-test and correlation coefficient found out between various parameters. Results: In Pregnancies with normal outcome (n=72), MYSD was progressively increased from 3.17 mm at 5-5.2 weeks of GA to 5.03 mm at 9-9.2 weeks of GA. At 11 weeks YS either disappeared (73.61%) or MYSD decreased (26.38%) with round & regular shape. Highly significant difference with p value

Introduction: Healthcare providers are an important link with the general public to impart knowledge regarding contraception. They are an important source of providing information regarding different methods of contraception, their proper use and removing the myths from the couple's mind. However, their own attitude and practice of contraception are often lacking., Objective: This study was conducted to assess the attitude and practice of contraception over the last 1 year of nurses in a tertiary care hospital in Jaipur., Methods: The study was conducted on 410 nurses in a tertiary care hospital. All were given a questionnaire that was duly filled by them, and the data obtained was analysed., Results: All were aware of at least one family planning method. Only 84% knew that contraceptives could space the pregnancy. Very few had correct knowledge about the fertile period or lactational amenorrhoea. Few were aware of emergency contraception and its proper implication (6.83%) The commonest was the barrier method (70%) followed by natural method (41.46%). There was shifting from natural method to barrier method and OC pills for few cycles., Conclusion: Health workers have knowledge regarding contraception yet fail to use it regularly. Proper attitude and practice are essential to prevent unintended pregnancies and prevention of STDs. Their use will enhance counselling skills for general population.

Objective: To evaluate salpingoscopic tubal mucosal grading and to find out correlation between laparoscopic external tubal appearance and salpingoscopic mucosal appearance., Design: Prospective observational study., Intervention: Salpingoscopy and laparoscopy., Materials and Methods: Thirty-seven infertile women between 21 and 40 years of age group who attended infertility clinic at IKDRC, Ahmedabad, from May 2015 to August 2015, were enrolled in the study. Laparoscopic tubal morphology was classified as regular, convoluted and hydrosalpinx. Salpingoscopic findings were graded (Grade I-Grade V) according to Brosens classification., Results: Laparoscopic appearance of tube was regular in 18 (48 %), convoluted in 17 (45.94 %), and hydrosalpinx in 2 (5.4 %) women. Salpingoscopic findings were graded as Grade I in 14 (37.83 %), Grade II in 10 (27.02 %), Grade III in 8 (21.62 %), Grade IV in 3 (8.10 %), and Grade V in 2 (5.4 %) women. Discordance between laparoscopic and salpingoscopic findings, i.e. regular appearance on laparoscopy and Grade III-Grade V appearance on salpingoscopy, was found in 38.88 % women., Conclusion: Laparoscopy alone might not be sufficient to predict tubal integrity and salpingoscopic endotubal grading may help in infertility treatment selection decisions. Early counselling towards IVF-ET can be encouraged in cases with higher grade.

Ovarian torsion (also termed as adnexal torsion) refers to partial or complete rotation of the ovary and a portion of fallopian tube along its supplying vascular pedicle. It occurs commonly in reproductive age group; more on the right side (60%) and often presents with acute lower abdominal pain lasting for few hours and up to 24 h, accounting for 2.7% of acute gynecological conditions. It is one of the devastating conditions, hampering blood supply of ovary which may lead to total necrosis of ovarian tissue and complications, if not diagnosed and managed in time. Hence, we present a case on a twisted ovarian cyst in postmenopausal woman with unusual symptomatology leading to delayed diagnosis and loss of an ovary.

Objective: To study the cases of obstetric hysterectomy performed over a period of 1 year (January 2008 to December 2008) in tertiary care center to estimate the incidence, indications, and maternal outcome following the procedure., Materials and Methods: A retrospective analysis of 20 cases of emergency obstetric hysterectomies performed during the study period., Results: During the study period, there were 11,356 deliveries and 20 emergency hysterectomies were done, giving an incidence of 0.17%. 75% cases were unbooked. Ruptured uterus was the most common indication for the procedure, followed by atonic Post-partum haemorrhage (PPH). Six out of 10 cases of rupture uterus had a previous cesarean delivery. Maternal mortality was 15% due to late referral., Conclusion: Emergency obstetric hysterectomy though a rare operation, still remains a life-saving procedure with which every obstetrician must be conversant. Regular antenatal care, identification of high-risk cases, and prompt referral can reduce the incidence of this operation.

Background: Adverse cardiovascular effect of hypothyroidism has been identified in many studies. Early identification of patients with sub-clinical hypothyroidism may lead to early treatment and thereby favourable effect on cardiovascular morbidity and mortality., Objectives: To find out the association of sub clinical hypothyroidism and left ventricular dysfunction and also to find out relationship between systolic and diastolic dysfunction in these patients., Material and Methods: A total 30 cases of sub clinical hypothyroidism along with 15 age sex matched healthy control subjects were included in study. Serum TSH, T4, T3 hormone level was measured and those who were found to have sub-clinical hypothyroidism underwent for 2DEcho., Results: Significant reduction in peak early filling velocity (PE) (p<0.001) and early filling time velocity integral (Ei) (p<0.001). Ratio of early and late peak velocities (PE/PA) (p<0.001), ratio of time velocity integral of early and atrial filling (Ei/Ai) (p<0.001) and ratio of the early peak to average velocity (PE/M) (p<0.001) were also reduced. Mean EF was 54.9± 5.55 as compared to 55.7 ± 3.46 of control subjects with a T.value of 0.48 ,however there was significant diastolic dysfunction in case of hypothyroid patients (mean Ei/Ai = 1.35 ± 0.53) as compared to control group subjects (mean Ei/AI = 2.11 ± 0.26) with a T value of 5.22., Conclusion: Sub-clinical hypothyroidism showed significant diastolic dysfunction in the absence of significant impairment of systolic function.