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Background and Purpose: Chronic pain remains a major clinical problem that needs effective therapeutic agents. Glutamate delta 1 (GluD1) receptors and the protein cerebellin 1 (Cbln1) are down-regulated in the central amygdala (CeA) in models of inflammatory and neuropathic pain. One treatment with Cbln1, intracerebroventricularly (ICV) or in CeA, normalized GluD1 and reduced AMPA receptor expression, resulting in lasting (7-10 days) pain relief. Unlike many CNS-targeting biological agents, the structure of Cbln1 suggests potential blood-brain barrier penetration. Here, we have tested whether systemic administration of Cbln1 provides analgesic effects via action in the CNS., Experimental Approach: Analgesic effects of intravenous recombinant Cbln1 was assessed in complete Freund's adjuvant inflammatory pain model in mice. GluD1 knockout and a mutant form of Cbln1 were used., Key Results: A single intravenous injection of Cbln1 mitigated nocifensive and averse behaviour in both inflammatory and neuropathic pain models. This effect of Cbln1 was dependent on GluD1 receptors and required binding to the amino terminal domain of GluD1. Time course of analgesic effect was similar to previously reported ICV and intra-CeA injection. GluD1 in both spinal cord and CeA was down -regulated in the inflammatory pain model, whereas GluD1 expression in spinal cord but not in CeA, was partly normalized by intravenous Cbln1. Importantly, recombinant Cbln1 was detected in the synaptoneurosomes in spinal cord but not in the CeA., Conclusions and Implications: Our results describe a novel mechanism by which systemic Cbln1 induces analgesia potentially by central actions involving normalization of signalling by spinal cord GluD1 receptors., (© 2023 British Pharmacological Society.)

The primary motive of the current work is to achieve smaller mean particle size with narrow size distribution that can enhance the bioavailability of azithromycin (ARZ), an essential requirement due to its poor water solubility. Recrystallization of ARZ was evaluated using cooling as well as antisolvent crystallization approaches in the presence of ultrasonic irradiation with detailed study into effect of different parameters such as ultrasonic power, time and temperature. Ultrasound assisted antisolvent crystallization at low temperatures (<10℃) yielded best size reduction up to 80% with narrower distribution and also gave better yield of the product, that too within 5 min of sonication. With scale up considerations, recirculation mode of operation was also evaluated which offered promising results for the size reduction. Images captured using optical microscope and SEM revealed a nearly uniform rod/plate-shaped geometry. Increase in amorphous nature of ARZ was confirmed based on XRD analysis. FTIR analysis showed no significant changes in the functional groups when compared to the original sample. Overall, the work demonstrated an improved reprocessing approach based on the use of ultrasound with insights into effect of operating parameters and effect of ultrasound on various characteristics., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Scaling is a major problem in the thermal desalination operation which is mainly attributed to the deposition of salts on the tube, thereby increasing the resistance to heat transfer. To reduce or prevent the formation of scale on heat transfer surfaces, treating desalination concentrates and precipitating sparingly soluble salts can be a promising method. In the present work, the effect of ultrasound pretreatment to the synthetically prepared sea water as desalination feed has been investigated with an objective of intensifying salt removal process and avoiding scale formation leading to better heat transfer rates. A lab scale double pipe heat exchanger setup was designed and operated under simulated conditions of the thermal desalination operation. Total operational volume of 2000 ml was used for all experiments with a fixed flow rate of 5 ml/s. To understand the process of scaling, synthetic seawater was prepared as per the ASTM D 1141-98 and was used for scale deposition experiments. The experiments conducted using untreated synthetic seawater confirmed substantial scaling and drop in the heat transfer coefficient from an initial value of 776 W/m 2  K to 603 W/m 2  K (about 22%) after 24 h operation as compared to deionized water. SEM-EDX analysis was performed to investigate the morphology and main components of the scale. Subsequently, synthetic seawater was treated with ultrasound under continuous flow condition for removal of salts responsible for scaling. It was demonstrated that pretreatment resulted into salt crystallization, after which, the crystals were separated and the filtered solution was passed through the heat exchanger to check the effects on heat transfer rate. It was confirmed that the heat transfer rate was found to be higher with a value of 797 W/m 2  K. Overall an effective approach based on ultrasound to remove the scale forming components has been demonstrated with established best conditions as 70% amplitude for 30 min of irradiation at fixed frequency of 20 kHz and 50% duty cycle., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The present study deals with the size reduction based on the recrystallization (antisolvent approach using water) of 3,3'-Diamino Diphenyl Sulfone (DADPS) using different types of cavitational reactors as an alternative to the conventional process of mechanical size reduction, which is an energy intensive approach. Ultrasound was applied for fixed time specific to the reactors namely ultrasonic probes at different power dissipation levels and also ultrasonic bath. A High Speed Homogenizer was also used at varying speeds of rotation to establishing the efficacy for size reduction. The processed sample was analysed for particle size and morphology using particle size analyser and optical microscopy respectively. The final yield of recrystallization was also determined. The power density in W/L and power intensity in W/m 2 calculated for each equipment has been used to establish efficacy for size reduction since all devices had dissimilar configurations. Based on the studies of varying power intensity of the different US equipment, it was established that larger the power intensity and power density, smaller was the resultant final particle size after treatment for same time. Among the various ultrasonic devices used, Sonics VCX750 probe yielded the best size reduction of 85.47% when operated at 40% amplitude for 60 min for a volume of 200 ml. A High Speed Homogenizer used at 7000 rpm gave 92.35% of size reduction in 15 min operation and also demonstrated the best energy efficiency. The work has elucidated the comparison of different cavitational devices for size reduction for the first time and presented the best reactors and conditions for the desired size reduction., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Recent literature supports the removal of myomas during cesarean section, which traditionally was considered a relative contraindication, given a higher complication rate. This study is to share our experience of cesarean myomectomy in the last decade., Methods: This study is a retrospective review of our prospectively maintained database, from January 2008 to December 2017, at a tertiary care level teaching institution. All patients who underwent myomectomy during cesarean section were included. There were no exclusions., Results: A total of twenty patients underwent myoma removal along with the cesarean operation during this period with a mean age of 30 years. Majority of patients were nulliparous (70%). Common comorbidities were diabetes mellitus (40%) and hypothyroidism (20%). Mean size of myomas were 5.33 cm (± 2.08), and the number varied from one to three. The most common location was the posterior surface of the uterus with the commonest variety being subserous. Most patients were discharged on the fifth postoperative day., Conclusion: This study demonstrates that cesarean myomectomy to be a safe and feasible procedure in experienced hands. It offers the advantage of avoiding a second surgery in selected patients., Competing Interests: Conflict of interestNo author has any potential conflict of interest., (© Federation of Obstetric & Gynecological Societies of India 2019.)

The present study investigates the use of ultrasound in size reduction based on recrystallization of a commercially important compound, 3,3'-diaminodiphenyl sulfone, popularly known as DADPS. Typically the applications of DADPS depends on the size distribution, more importantly on the mean size and hence the ultrasound assisted recrystallization has been applied for controlling the size as an alternative to energy intensive mechanical size reduction. For the size reduction studies, DADPS was dissolved in methanol and irradiated with ultrasound during the anti-solvent crystallization operation using water. Effect of different operating parameters such as temperature, rate of addition of antisolvent and its nature (whether neutral, acidic or basic) and ultrasonic parameters such as time of irradiation, power dissipation and duty cycle on the mean size and overall distribution has been studied. The particle characteristics of the original sample and processed samples have been analyzed using particle size analyzer, optical microscopy and X-Ray Diffraction (XRD). The positive effect of ultrasound for size reduction was clearly established from particle size analysis with reduction in the mean size to almost one-third the initial value under optimum conditions of 100 W as the power dissipation, 70% as the duty cycle and 60 min as the time of operation. In terms of the trends of the operating parameters, an increase in the rate of addition of antisolvent yielded the best results in terms of lower size and also alkaline conditions for antisolvent gave better size reduction. The microscopic images revealed a uniform and well-defined crystal shape on processing using ultrasound while XRD analysis established that ultrasound did not alter the crystalline structure. Ultrasound was overall established as an effective approach for size reduction without any changes in the crystalline structure., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Vaccines are one of the greatest public health achievements, preventing both mortality and morbidity. However, overall immunization rates are still below the 90% target for Healthy People 2020. There remain significant disparities in immunization rates between children of different racial/ethnic groups, as well as among economically disadvantaged populations. There are systemic issues and challenges in providing access to immunization opportunities. In addition, vaccine hesitancy contributes to underimmunization. Multiple strategies are needed to improve immunization rates, including improving access to vaccines and minimizing financial barriers to families. Vaccine status should be assessed and vaccines given at all possible opportunities., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A new simple, economical, rapid, precise and accurate method for simultaneous determination of rabeprazole sodium and itopride hydrochloride in capsule dosage form has been developed. The method is based on ratio spectra derivative spectrophotometry. The amplitudes in the first derivative of the corresponding ratio spectra at 231nm (minima) and 260nm were selected to determine rabeprazole sodium and itopride hydrochloride, respectively. The method was validated with respect to linearity, precision and accuracy.

A new, simple column reversed-phase high-performance liquid chromatographic (HPLC) method for simultaneous determination of rabeprazole sodium (RAB) and domperidone (DOM) in a combined tablet dosage form has been developed and validated. Determination was performed using a Jasco HPLC system with a HiQ SiL octadecylsilane (C18) column (250 x 4.6 mm id), acetonitrile-0.1 M ammonium acetate (50 + 50, v/v) mobile phase, and paracetamol as an internal standard. The detection was performed using a UV detector set at 280 nm. The method was validated with respect to linearity, accuracy, precision, and robustness. Beer's law was obeyed in the concentration range of 1.0-10.0 and 0.5-5.0 microg/mL for RAB and DOM, respectively. The method has been successfully applied for the analysis of drugs in a pharmaceutical formulation.

Simple, accurate, precise, and sensitive ultraviolet spectrophotometric and reversed-phase high-performance liquid chromatographic (RP-HPLC) methods for simultaneous estimation of escitalopram oxalate (ESC) and clonazepam (CLO) in combined tablet dosage form have been developed and validated. The spectroscopic method employs an absorbance correction method using 238.6 and 308 nm as 2 wavelengths for estimation with methanol and water as solvents. Beer's law is obeyed in the concentration range of 10.0-50.0 and 0.5-3.0 micro/mL for ESC and CLO, respectively. The RP-HPLC method uses a Jasco HPLC system with HiQ SiL C18 column (250 x 4.6 mm id) acetonitrile-0.005 M tetrabutylammonium hydrogen sulfate (55 + 45, v/v) as the mobile phase, and satranidazole as an internal standard. The detection was carried out using an ultraviolet detector set at 287 nm. For the HPLC method, Beer's law is obeyed in the concentration range of 10.0-60.0 and 0.5-3.0 microg/mL for ESC and CLO, respectively. Both methods have been successfully applied for the analysis of the drugs in a pharmaceutical formulation. Results of analysis were validated statistically and by recovery studies.

Three methods viz. Absorbance Ratio Method (I), Dual Wavelength Method (II) and First Order Derivative Spectroscopic Method (III) for simultaneous estimation of Rabeprazole sodium and Itopride hydrochloride have been developed. The drugs obey Beer's law in the concentration range 2-20 microg/ml for RAB and 5-75 microg/ml for ITO. The results of analysis of drugs have been validated statistically and by recovery studies.

The purpose of this study was to determine whether education, feedback, and provider prompts decrease the rate of missed vaccine opportunities; and the reasons for missed opportunities in the post-intervention group. A nonrandomized, before and after study to evaluate the effect of education, feedback, and provider prompts on missed opportunities was conducted in an inner-city community health center with a predominantly hispanic population. Vaccine opportunities were defined as visits of children 36 months or younger who were vaccination-eligible by ACIP guidelines. Consecutive sampling was used to identify two groups of children with vaccine opportunities: pre- and post-intervention. Feedback was given to vaccine providers on the frequency of missed opportunities in the pre-intervention group. The ACIP recommended vaccine schedule and true vaccine contraindications were reviewed. Nursing personnel were taught to identify and tag charts of children with vaccine opportunities. Physicians were asked to record vaccination status and the reason any vaccination was deferred. Missed opportunities decreased significantly, from 49% (173/352) to 13% (45/344), after the interventions (p < 0.001). The reasons for the 45 missed opportunities in the post-intervention sample were parent refusal (15.6%), moderate or severe illness (15.6%), and incorrect documentation as "up-to-date" (13.3%). In 28.9% there was a missed opportunity for simultaneous immunization. No reasons were documented for the remaining missed opportunity visits (26.6%). The interventions, which emphasized improving provider knowledge of vaccinations and screening vaccine status at each visit, effectively decreased missed opportunities.

Tinea capitis is a common superficial fungal infection of the scalp in children, particularly in those of African descent. Trichophyton tonsuran, an anthropophilic dermatophyte, is responsible for the majority of cases in North America. The clinical presentations are variable and include: (i) a "seborrheic" form that is scaling, often without noticeable hair loss; (ii) a pustular, crusted pattern, either localized or more diffuse; (iii) a "black dot" variety characterized by small black dots within areas of alopecia; (iv) a kerion, which is an inflammatory mass; and (v) a scaly, annular patch. Most experts still consider griseofulvin to be the drug of choice, but recommend a higher dosage of 20-25 mg/kg/day for 8 weeks because of the increase in treatment failures. Despite a history of having an excellent tolerability profile, the long treatment course and higher doses required for griseofulvin have led to consideration of new antifungal agents for this infection. Terbinafine, itraconazole, and fluconazole compartmentalize in skin, hair, and nails, thereby allowing shorter treatment courses of < or =4 weeks. All have generally been shown to be effective in the treatment of tinea capitis and appear relatively well tolerated, with gastrointestinal symptoms being the most common adverse effect. Monitoring for liver enzyme elevations is generally unnecessary if therapy is limited to

Background: The opioid meperidine induces spinal anesthesia and blocks nerve action potentials, suggesting it is a local anesthetic. However, whether it produces effective clinical local anesthesia in peripheral nerves remains unclear. Classification as a local anesthetic requires clinical local anesthesia but also blockade of voltage-dependent Na+ channels with characteristic features (tonic and phasic blockade and a negative shift in the voltage-dependence of steady-state inactivation) involving an intrapore receptor. The authors tested for these molecular pharmacologic features to explore whether meperidine is a local anesthetic., Methods: The authors studied rat skeletal muscle mu1 (RSkM1) voltage-dependent Na+ channels or a mutant form heterologously coexpressed with rat brain Na+ channel accessory beta1, subunit in Xenopus oocytes. Polymerase chain reaction was used for mutagenesis, and mutations were confirmed by sequencing. Na+ currents were measured using a two-microelectrode voltage clamp. Meperidine and the commonly used local anesthetic lidocaine were applied to oocytes in saline solution at room temperature., Results: Meperidine and lidocaine produced tonic current inhibition with comparable concentration dependence. Meperidine caused phasic current inhibition in which the concentration-response relationship was shifted to fivefold greater concentration relative to lidocaine. Meperidine and lidocaine negatively shifted the voltage dependence of steady-state inactivation. Mutation of a putative local anesthetic receptor reduced phasic inhibition by meperidine and lidocaine and tonic inhibition by lidocaine, but not meperidine tonic inhibition., Conclusions: Meperidine blocks Na+ channels with molecular pharmacologic features of a local anesthetic. The findings support classification of meperidine as a local anesthetic but with less overall potency than lidocaine.

Objectives: To determine the prevalence of the carrier state in household contacts in children with tinea capitis, the duration of the carrier state, factors associated with carriage, and the proportion of carriers who develop clinical disease., Design: Cross-sectional, cohort, prevalence study., Setting: General pediatric clinic serving an indigent, inner-city, African American population., Patients: Household contacts in children with tinea capitis. Index cases and carriers (no clinical evidence of infection) were identified by culture. Carriers were monitored until the results of their culture became negative, they developed clinical disease, or a 6-month period had elapsed., Results: Fifty-six index cases and 114 contacts (50 adults and 64 children) were evaluated. Ninety-eight percent of the dermatophytes identified in index cases and 100% in carriers were Trichophyton tonsurans. At the initial visit, 18 (16%) of 114 (95% confidence interval [95% CI], 10-24) of contacts were carriers and 14 (32%) of 44 of the families studied had at least 1 carrier. At the 2-, 4-, and 6-month visits, the carrier state persisted in 7 (41%) of 17 (95% CI, 19-67), 3 (20%) of 15 (95% CI, 4-48), and 2 (13%) of 15 (95% CI, 2-40), respectively. Three of the carriers were lost to follow-up. Of the carriers, 1 (7%) of 15 (95% CI, 0.2-32) developed tinea capitis. Univariate and multivariate analysis showed no association of carrier state to age, sex, comb sharing, or cosleeping. However, cosleeping and comb sharing were common among the contacts, occurring 75% and 78% of the time, respectively, making statistical correlation difficult with our sample size., Conclusions: Initial prevalence of asymptomatic carriage of dermatophytes among household contacts of a child with tinea capitis was 16%, with 41% of carriers persisting up to 2 months. Thirty-two percent of families had at least 1 member who was a carrier. Seven percent of the carriers developed an active infection. Treatment of carriers with sporicidal shampoo should be considered since they may act as a reservoir for infection or develop active disease. The high prevalence of cosleeping and comb sharing may be important factors in the spread of the disease.

Lymphomas and leukemias account for a large portion of orbital tumors. Orbital lymphoma accounts for 55% of malignant orbital tumors in adults. Idiopathic orbital inflammatory pseudotumors are pathologic entities that often challenge ophthalmologists and radiologists. This article describes the MR and CT features of orbital lymphoma, leukemia, and some other lymphoproliferative disorders.

Objectives: To determine 1) the frequency of missed vaccine opportunities (VOs) in inner city children