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Renata Jo&nacute;czyk,1 Christoph Beuter,2 Beata Bulawa,2 Stefan Buller,2 Christoph Eibl,2 Christian Elling,2 Michael Gautrois,2 Jens Rengelshausen,2 Carsten Schmidt,2 Guido Thömmes,2 Feras Khalil2 1Center for Hospital Health Care Services, Clinic of Pediatric Surgery, Subdivision of Pediatric Urology, Rzeszow, Poland; 2Grünenthal GmbH, Aachen, GermanyCorrespondence: Feras Khalil, Grünenthal GmbH, Zieglerstraße 6, Aachen, 52078, Germany, Tel +49 241 569 3295, Email feras.khalil@grunenthal.comBackground: This prospective, open-label trial was conducted to fulfil a post-approval commitment made to the competent authorities to extend the indication of the strong opioid analgesic tapentadol hydrochloride oral solution (OS) to the pediatric population.Patients and Methods: The trial assessed the pharmacokinetic (PK) profile of tapentadol, tapentadol-O-glucuronide and tapentadol-O-sulfate after administration of multiple doses of tapentadol OS (1.25 mg tapentadol/kg bodyweight every 4 h for up to 72 h) in children aged 2 to < 7 years after a painful event that produces acute pain requiring treatment with a strong analgesic. The obtained PK data were integrated into a previously developed population PK (popPK) model based on single-dose data and then a model-based PK evaluation was performed. The primary trial endpoint was the area under the concentration-time curve at steady state for the dosing interval (AUCτ,ss) for tapentadol.Results: Ten children received tapentadol OS; all completed the trial. Multiple administrations of the trial medication resulted in tapentadol serum concentrations within the concentration range predicted by the previously developed popPK model. The estimated model-based AUCτ,ss values for tapentadol ranged from 142 to 321 h•ng/mL. They were within the predicted exposure range with no higher than expected accumulation for the employed dosing regimen and also within the targeted steady state exposure range observed in adults receiving multiple doses of immediate release tapentadol 50 to 100 mg. The treatment regimen was safe and well tolerated.Conclusion: The findings confirm the linear and predictable PK profile of tapentadol hydrochloride. The good agreement between the observed data and the model predictions shows the value of modelling and simulations in the planning and analysis of pediatric clinical trials and the ability to utilize the established PK models to predict multiple dose exposure.Keywords: acute pain, children, multiple dosing, pharmacokinetics, popPK model, tapentadol

Mahmoud A Allam,1 Youssef A Nassar,1 Hosameldeen S Shabana,1 Sadek Mostafa,1 Farag Khalil,1 Hendawy Zidan,1 Mohammed Abo-Ghebsha,2 Amir Abdelghaffar,3 Ahmed Essmat,3 Essam Elmahdi4 1Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 2Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 3Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 4Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, EgyptCorrespondence: Mahmoud A AllamDepartment of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, 11884, EgyptTel +20222602687Fax +20224020184Email dr.mahmoudallam75@gmail.comBackground and Aim: Diabetic peripheral neuropathy (DPN) is one of the most common and disabling complications of DM. Many studies documented the prevalence of clinical and subclinical hypothyroidism (SCH) in diabetic patients but not in the particular group of patients with DPN. The present study aimed to determine the prevalence of SCH in DPN patients and to evaluate its association with severity of DPN.Patients and Methods: The present cross-sectional study was conducted on 300 consecutive patients with DPN. The clinical manifestations of DPN were documented according to the validated Arabic version of the Michigan Neuropathy Screening Instrument. Severity of DPN was categorized into mild (6– 8 points), moderate (9– 11 points) or severe (12+ points) according to the Toronto Clinical Scoring System. All patients were submitted to careful history-taking and full clinical and neurological examination. Patients were diagnosed with SCH if they had TSH level above the upper limit of the normal reference range in association with normal free thyroxine (FT4) level.Results: SCH was prevalent in 53 patients (17.7%, 95% CI: 13.5%– 22.5%). Patients with SCH had significantly higher frequency of severe DPN (52.8% versus 28.3%, p=0.003). It was also shown that patients with SCH had significantly higher HbA1c (8.4 ± 1.0 versus 7.3 ± 1.2%, p< 0.001) and HOMA-IR (3.7 ± 0.8 versus 2.7 ± 0.9, p< 0.001) when compared with patients without SCH. Logistic regression analysis identified patients’ age [OR (95% CI): 1.06 (1.03– 1.08), p< 0.001], HbA1c [OR (95% CI): 2.2 (1.7– 2.9), p< 0.001] and SCH [OR (95% CI): 7.7 (3.6– 15.5), p< 0.001] as independent predictors of DPN severity.Conclusion: The present study showed that SCH is highly prevalent in DPN patients and is independently related to its severity.Keywords: diabetes mellitus, diabetic peripheral neuropathy, subclinical hypothyroidism, thyroid hormones, thyroid dysfunction

Mariëlle Eerdekens, Tatjana Radic, Melanie Sohns, Feras Khalil, Beata Bulawa, Christian Elling Grünenthal GmbH, Aachen, GermanyCorrespondence: Mariëlle EerdekensGrünenthal GmbH, Zieglerstraße 6, 52078 Aachen, GermanyTel +49 241 569 1090Email marielle.eerdekens@grunenthal.comAbstract: The opioid analgesic tapentadol was the first pain medication to be developed for the treatment of pain in children under a formal process established by the regulatory authorities. This article summarizes the outcomes of the pediatric development program for tapentadol across the entire age range from birth (including neonates) to adolescents < 18 years of age. In addition, the challenges experienced when designing and conducting the pediatric tapentadol clinical trials as well as the interactions with the regulatory authorities are discussed. As a first outcome, the oral solution of tapentadol was authorized in the EU in 2018 as a new treatment option in the hospital setting for moderate to severe acute pain in children from 2 to < 18 years of age.Keywords: pain, pediatric, regulations, tapentadol, review

Abstract Nowadays, the use of natural wastes and adsorbents along with their modification by simple and new methods based on metal oxides to remove dye pollutants has been the focus of many researchers. In this study, for the first time, simple and low-cost modification of eggshell (EGS) with tungsten oxide (WO3) based on the photochemical modification method as a green, ultra-fast, cost-effective, and biodegradable adsorbent is reported to remove of methylene blue (MB) dye pollutant. The EGS modified by WO3 was investigated by EDX, EDX mapping, XRD, FE-SEM, and UV–Vis Diffuse Reflectance (DRS) analyses. The obtained results show that the modified EGS by WO3 has more than ten times (78.5%) the ability to remove MB dye pollutant within 3 min compared to bare EGS (11%). Various parameters including dye pollutant pH, dye concentration, adsorbent dosage, and reusability of the WO3/EGS adsorbent for removal of MB dye pollutant were investigated and the result show that the adsorbent capacity of WO3/EGS is 1.64 mg g−1. EGS adsorbent The synthesis of WO3/EGS adsorbent with a novel photochemical method as a fast and very cheap adsorbent with excellent efficiency can be a promising alternative adsorbent for various purposes in removing dye pollutants from water environments.

The incident solar energy that impinges upon the photovoltaic cells undergoes a conversion process, resulting in the generation of electrical energy and conversion of absorbed energy into heat. This increase in temperature adversely affects the performance of the panel, leading to a decrease in its overall efficiency. This study examines the properties and performance of phase change materials, specifically paraffin wax, natural beeswax, and a combination of paraffin wax and beeswax, in comparison to a solar panel lacking any phase change substance. The experiment was conducted in the climatic conditions of Iraq, namely in the city of Hawija, located southwest of Kirkuk, during the summer of 2022. The prevailing environmental temperature throughout this period averaged 44 °C. The experiment involved comparing plate temperature, electrical power, and electrical efficiency. The results indicated that all the materials caused a decrease in the temperature of the board at the beginning of the experiment and for a short duration. Nevertheless, as the phase change material (PCM) undergoes melting, the dissipation of heat becomes unfeasible, resulting in a gradual increase in temperature. It was observed that there was a rise in temperature during the afternoon hours. According to the recorded data, the use of beeswax resulted in a decrease in temperature by 4 °C in comparison to the reference plate that did not incorporate phase change materials (PCM). Additionally, the efficiency of the photovoltaic (PV) system increased by 1% when compared to the PV Compared with PV (reference). The efficiency of the solar panel with beeswax ranged from 13% to 14%. According to the findings, the integration of phase-change materials with solar panels has been observed to effectively lower the temperature of the panels, hence enhancing their overall efficiency. Consequently, this approach represents a viable and advantageous choice.

Medial arcuate ligament syndrome (MALS) is an anatomoclinical entity underestimated in most situations due to the lack of specific signs. However, the consequences can be disastrous if the diagnosis is not seriously considered and investigations are not fully undertaken to confirm this hypothesis. We report a case of Median Arcuate Ligament Syndrome in a young woman who presented to the Emergency Department with moderate postprandial pain. All investigations were carried out promptly, with no abnormalities, and the diagnosis was retained on the evidence of a well-performed and appropriately interpreted abdominal CT. This case illustrates a rare cause of epigastralgia simulating a surgical emergency. This condition should be considered when biological and often radiological investigations are inconclusive. The relative youth of the patient is often suggestive, but confirmation is based on a CT scan with injection of a well-technical contrast product, or angiography. Treatment is debatable between a conservative approach and surgery. Surgical approach is discussed depending on the degree of vascular stenosis and the impact on the digestive tract. However, the recurrence of symptoms may be a contributory factor in the therapeutic decision. The impact could be lethal depending on the degree of stenosis and consequently on the repercussions on the digestive tract. A multidisciplinary approach is required for its management.

Yaniv Voller. The Kurdish Liberation Movement in Iraq: From Insurgency to Statehood. London and New York: Routledge, 2014. 175 pages. Hardcover $145.00 Introduced into the Middle East following World War [...]