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Ashraf Ahmad Zaghloull,1 Moetaz Elsergany,2 Nagwa Abou El-Enein,1 Hamda Alsuwaidi,3 Mohamed Ayoub3 1Health Administration and Behavioral Sciences Department, High Institute of Public Health, University of Alexandria, Alexandria, Egypt; 2e-School Health and Environmental Studies, Hamdan Bin Mohamed eUniversity, Dubai, United Arab Emirates; 3College of Health Sciences, University of Sharjah, United Arab Emirates. Background: Self-medication and acquisition of over-the-counter (OTC) medications are emerging community health issues. Besides being a cheap alternative for treating common illnesses, the behavior entails serious ramifications, such as medication wastage, increasing pathogen resistance, and adverse drug reactions. The present study was conducted to explore the extent of OTC medications in households in Sharjah, United Arab Emirates (UAE), including native UAE and expatriate families. Methods: The study employed a population-based, cross-sectional, analytical study design. The study population included native and expatriate households residing in the Emirate of Sharjah, UAE. The snowball sampling technique was used, and the sample included a total of 335 households. Results: Expatriate households acquired more OTC medications than did native households (adjusted odds ratio [aOR]=1.7). The demographic determinants for expatriate households were number of family members (aOR=1.6), age of children in the family (aOR=1.8), and annual income (aOR=0.5). Expatriate households purchased more OTC medication practices than did native households (aOR=2.2). In the statistical sense, expatriate household practices were buying medication upon relatives' advice (aOR=0.3), storage condition of medication (aOR=2.4), and disposal of expired medication (aOR=0.6). The highest percentages of OTC medications in native and expatriate households were those related to gastric and ear, nose, and throat illnesses. Conclusion: The presence of OTC medications in expatriate households was two-fold more common than in native households in Sharjah, UAE. There were significant associations for behaviors related to the reasons why OTC medications were purchased and stored within the household for both native and expatriate families. Keywords: over-the-counter medication, pattern, odds ratio, household, Sharjah

Yasir Ahmed Mohammed Elhadi, Ashraf Ahmed Zaher Zaghloul, Noha Ahmed El Dabbah Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria, EgyptCorrespondence: Yasir Ahmed Mohammed Elhadi, Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, 165 El Horrya Avenue, Alexandria, Egypt, Tel +20 1556494566, Email hiph.yelhadi@alexu.edu.egPurpose: Knowledge of insured clients’ utilization behavior is essential for developing evidence-based interventions for reform activities. This study explored the magnitude and determinants of voluntary out-of-network physician visit utilization among an insured population under the National Health Insurance Fund (NHIF) of Sudan.Methods: This study was a cross-sectional survey conducted at the primary healthcare centers of NHIF in Al Jazirah state in Sudan. A structured interview questionnaire was used to collect data related to socio-economic and health insurance characteristics of NHIF clients and to assess their utilization behavior. Data were collected from September to October 2021.Results: Of 768 NHIF clients who were interviewed (mean age 46 years, 55.1% females), 63.2% reported using out-of-network physician visits during the last six months prior to the interview. The median out-of-pocket payment for the last out-of-network physician visit was 5000 Sudanese pounds. The regression analysis revealed that clients’ gender, marital status, self-reported health, overall rating of the quality of care, rating of the general practitioner care, and ease of referral to a specialist were the significant determinants for seeking out-of-network physician care.Conclusion: A high magnitude of out-of-network physician visit utilization was found among the insured NHIF clients of Al Jazirah state in Sudan. Policymakers should address issues identified in the current study to reduce patients’ leakage to out-of-network services.Keywords: out-of-network, physician visit, health insurance, healthcare utilization, Sudan

Background: Obstetric Violence (OV) is a public health matter that affects women and their children with an incidence rate between 18.3-75.1% globally. The delivery institution of public and private sectors represents a potential factor contributing to OV. This study aimed to assess OV existence among sample of pregnant Jordanian women and its risk factors domains between public and private hospitals., Methodology: This is a case-control study including 259 recently delivered mothers from Al-Karak Public and Educational Hospital and The Islamic Private Hospital. A designated questionnaire including demographic variables and OV domains was used for data collection., Results: A significant difference was seen between patients delivering in the public sector compared to patients delivering the private sector in education level, occupation, monthly income, delivery supervision and overall satisfaction. Patients delivering in the private sector showed a significantly less physical abuse by the medical staff compared to patients delivering in the public sector, and patients delivering in a private room also showed a significantly less OV and risk of physical abuse compared to patients delivering in shared room. In public settings, medications information was lesser versus the private ones, additionally, there is significant association between performing episiotomy, physical abuse by staff and the delivery in shared rooms in private settings., Conclusion: This study showed that OV was less susceptible during childbirth in private settings compared to public settings. Educational status, low monthly income, occupation are risk factors for OV; also, features of disrespect and abuse like obtaining consent for episiotomy performance, delivery provision updates, care perception based on payment ability and medication information were reported.

Background: Diagnosis of flexible flatfoot is usually based upon radiographic or clinical measures. Radiographic measures pose a potential risk of radiation exposure especially in Paediatric population. Clinicians need a valid, accurate, easily used, noninvasive and cost effective measure to evaluate static foot posture clinically. Although, foot posture index-6 (FPI-6) are commonly used in clinical practice, its validity and diagnostic accuracy in evaluation of paediatric flexible flatfoot have not been fully proven yet., Objectives: To investigate validity and diagnostic accuracy of FPI-6 to determine Paediatric flexible flatfoot between ages of 6-18 years using radiographic findings as the gold standard measure., Study Design: Cross-sectional study., Methods: A cross-sectional study conducted on 612 participants (1224 feet) with flexible flatfoot aged 6-18 years (mean age ± standard deviation of 12.36 ± 3.39 years). The results of FPI-6 were compared to the gold standard radiographic measures and displayed on the receiver operating characteristic curve. Intra-rater reliability, sensitivity, specificity, predictive values and likelihood ratios were calculated. Posttest probability was calculated from Fagan nomogram., Results: FPI-6 demonstrate high intra-rater reliability (ICC = 0.96) with p value < 0.001. FPI-6 showed a sensitivity of 83.7%, a specificity of 80.4, a positive predictive value of 64.7, a negative predictive value of 92, a positive likelihood ratio of 4.62 and a negative likelihood ratio of 0.20. FPI-6 shows moderate diagnostic accuracy [AUC = 0.82; 95%CI (0.78-0.85)]., Conclusion: FPI-6 is valid with moderate diagnostic accuracy to determine paediatric flexible flatfoot between ages of 6-18 years., Competing Interests: Declaration of competing interest None declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Reliability of clinical measures of static foot posture has been widely debated. However, validity of these measures has not been fully established especially in a pediatric population. The purpose of the study was to investigate reliability and validity of normalized truncated navicular height (NTNH) in assessment of static foot posture to determine flatfoot in children and adolescents using radiographic measures as a criterion gold standard measure., Methods: A sample of 612 participants aged 6-18 years (12.3±3.3) were enrolled in the study. Clinical assessment of static foot posture using NTNH was compared to the gold standard radiographic measures. Reliability, validity and diagnostic accuracy were investigated. The optimal cutoff point for flatfoot using NTNH was calculated., Results: NTNH demonstrated sensitivity of 98.4%, high positive predictive (PV +) value of 89.2%. The positive likelihood ratio was 19 and the negative likelihood ratio was 0.02. The area under the receiver operating curve (AUC) was 0.96 indicating high validity and diagnostic accuracy of NTNH. The optimal cutoff point for diagnosing flatfoot was NTNH≤0.195., Conclusion: NTNH is a valid and diagnostically accurate clinical measure of static foot posture in children and adolescents., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: There has been a growing awareness that patients are subject to injuries that can be prevented as a direct consequence of health care. Error disclosure is an effective technique to restore the lost trust with the health care system., Objective: The current study aimed to develop a valid and reliable scale to determine the factors facilitating the disclosure of health professionals in health organizations., Methods: This study had a cross-sectional design that consisted of 722 responses (response rate of 68.3%) from 1 private and 1 public hospital in Sharjah, United Arab Emirates. The data collection tool included 23 items rated on a Likert scale ranging from 5, strongly agree, to 1, strongly disagree.The internal consistency was established through calculating the split-half reliability for part 1 (12 items), which had a Cronbach coefficient of 0.65, and part 2 (11 items), which had a Cronbach coefficient of 0.62. Scale validity was assessed with the Kaiser-Meyer-Olkin measure of sampling adequacy, which had a value of 0.62, and the Bartlett test of sphericity (approximated χ = 13012.2, P = 0.0001) supported the factorability of the correlation matrix. The varimax rotation revealed 5 components that explained 77.8% of the total variance., Results: The varimax rotation revealed 21 items loaded on the following 5 factors: fear of disclosure and provider image consequences (factor 1), apology (factor 2), organizational culture toward patient safety (factor 3), professional ethics and transparency (factor 4), as well as patient and provider education (factor 5)., Conclusions: The disclosure of medical mistakes requires preliminary considerations to effectively and compassionately disclose these events to patients. The validity and reliability of the results support the use of this scale at hospitals as part of the health care providers' disclosure processes.

Background: Metformin hydrochloride (MtHCL) is an oral antidiabetic drug and has many other therapeutic benefits. It has poor bioavailability, narrow absorption window and extensive liver metabolism. Moreover, children and elders face difficulty to swallow the commercial oral tablets., Objectives: Preparation, in vitro/in vivo evaluation of MtHCL suppositories for rectal administration to solve some of these problems., Methods: Suppository fatty bases (Witepsol ® , Suppocire ® and Massa ® ; different grades) and PEG bases 1000, 4000 and 6000 (different ratios), were used to prepare rectal suppository formulations each containing 500 mg drug. These were characterized for manufacturing defects, and pharmacotechnical performance and formulations showing superior results were subjected to bioavailability testing in human volunteers compared with the commercial oral tablet (Ref) applying LC-MS/MS developed analytical technique., Results: The preparation method produced suppositories with satisfactory characteristics and free of manufacturing defects. The fatty bases were superior compared with PEG bases regarding the physical characteristics. Three formulations were chosen for bioavailability testing and the results showed comparable bioavailability compared to the Ref., Conclusions: The fatty bases showed superior characteristics compared with the PEG bases. MtHCL formulated in selected fatty bases could be a potential alternative to the commercial oral tablets particularly for pediatric and geriatric patients.

Objective: The study aimed to identify healthcare providers' obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families., Design: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai., Setting and Participants: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure., Results: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X2 = 5.1), and being a physician (X2 = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X2 = 9.8), and any type of medical error regardless the cause, extent of harm (X2 = 8.7). Variables included in the binary logistic regression model were; status (Exp β (Physician) = 0.39, 95% CI 0.16-0.97), gender (Exp β (Male) = 4.81, 95% CI 1.84-12.54), and medical errors during the last year (Exp β (None) = 2.11, 95% CI 0.6-2.3)., Conclusion: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians' apprehension and make them more comfortable with disclosure conversations.

Tocopherol represents a big challenge for transdermal permeation owing to its extreme hydrophobicity and large molecular mass. The aim of the present study was to develop alpha-tocopherol (T) topical formulations and evaluate their ex vivo and in vivo permeation. Franz diffusion cells were used for ex vivo permeation, and neonatal rats were used for in vivo permeation. Seven gel formulations and 21 liquid formulations were investigated for physical stability, viscosity and permeation of T. Analysis of T was performed by a validated HPLC method using a UV detector. The ex vivo permeation from gel and emulsion formulations was very poor (0.001-0.015%). Highest permeation was observed from monophasic liquid formulations containing dimethyl sulfoxide (DMSO), tocopheryl polyethylene glycols (TPGs), propylene glycol, ethanol and 9.5% T. The in vivo results demonstrated higher retention in the epidermis compared to subcutaneous tissues, 1377 and 1.13 μg g⁻¹, respectively. Increasing T concentration from 4.8 to 9.5% did not increase the amount permeated or % of T retained. It was concluded that simple solutions of T in the presence of DMSO and TPGs were more promising systems for effective transdermal permeation compared to gel, emulsion or oleaginous systems.

Nurses' knowledge of pressure ulcer prediction, prevention and management plays a very important role in the incidence and prevalence of pressure ulcers in health-care systems. The aim of the current study was to assess the nurse's knowledge about prevention and management of pressure ulcer at one of the largest health insurance hospitals in Alexandria. A descriptive cross-sectional study using an interview questionnaire format to assess the nurses' knowledge (n = 122) regarding prevention of pressure ulcers. The overall mean per cent score for nurses was below the minimum acceptable level. The mean per cent score for nurses was below 70% for nine measures of the 15 correct measures, which accounted for 60% of the measures of pressure ulcer prevention. Correct answers for non-useful measures for preventing pressure ulcers accounted for 66% of the non-useful measures on the questionnaire. It had been concluded that the nurses' knowledge regarding pressure ulcer prevention is below the acceptable levels., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Objective: To investigate the ability of α-tocopherol acetate (TA) and α-tocopherol (T), widely used ingredients in cosmetics, to cross the epidermal barrier using the neonatal rat as a model., Materials and Methods: The content of T and TA in four marketed products (A-D) and two experimental formulations (F1, F2) was investigated by HPLC. An in vitro permeation study was performed in neonatal rat epidermis using diffusion cells. In vivo permeation was studied in neonatal rats after repeated application of the products and analysis of T and TA in the stratum corneum/deeper skin layers., Results: Variable contents of TA were found in the marketed products (0.12-0.53%). No vitamin permeation was detected through the stratum corneum as in vitro biological barrier after 4 h. No detectable T and TA were seen in the in vivo permeation study in the epidermis. Variable degrees of drug penetration (4.3-12.6%) of the applied dose into the deeper skin layers were observed, depending on the formulation. In vivo application of TA-containing preparations did not result in any transformation of TA into T under the described experimental conditions., Conclusion: TA and T exhibited variable skin penetration and TA did not transform into T under the experimental conditions. The data underscored the need for further studies to optimize such formulations to improve vitamin E transdermal permeation and eventually achieve the expected cosmetic/therapeutic outcome., (Copyright © 2011 S. Karger AG, Basel.)

Introduction: Patient appointment systems are of great importance for efficiently managing outpatient clinics as well as patient satisfaction as an indirect indicator for quality care rendered., Purpose: To describe the hourly block and standard sequential scheduling appointment systems at two different hospitals, as well as to assess the patients' opinions regarding their waiting time in both systems. STUDY SETTINGS: The study was conducted at ENT (Ear, Nose, and Throat) clinics in two of the biggest and reputable private hospitals in Alexandria. Hospital A follows the standard appointment system and Hospital B follows the hourly block appointment system., Study Design: A cross-sectional descriptive study was designed to compare the two settings., Results: For new cases, the mean time was longer for the standard system with regards to access time (12.2 ± 5.9) days, while the mean time was longer in the hourly block system with regards to punctuality, waiting time, and consultation time (28.5 ± 12.3, 27.5 ± 17.1, and 14.5 ± 9.0 minutes, respectively). For return cases, the mean time was longer for the standard system with regards to access and punctuality times (14.5 ± 6.1 days and 48.9 ± 27.0 minutes, respectively), while the highest mean times in the hourly block system were for waiting and consultation (19.4 ± 6.9 and 12.3 ± 3.9 minutes, respectively). Most of the patients in both systems preferred the standard appointment system to the hourly block system (73.3% for Hospital A and 55.0% for Hospital B)., Conclusion: Every health care organization should know how to choose the most appropriate method of appointment system and how best to organize it to meet the needs of its patients. Patient scheduling is an important tool for efficient outpatient department management as well as rationally operating outpatient resources and critical areas like physician productivity, patient satisfaction, and practice profits.

A specific HPLC method, with an RP-C-18 column and a UV detector, for simultaneous determination of vitamin E (tochopherol, T)/T acetate (TA) in four commercial and two experimental cosmetic products is described. Three solvent systems for extraction of T/TA were assessed: isopropyl alcohol; 10:90 v/v hexane-methanol mixture (method 1); and methanol alone (method 2). The procedure was accurate, as indicated by high recovery (97.8-101.8% and 100.1-102.5% for T and TA, respectively) and precise (RSD was only 0.9-3.26% and 0.73-3.35% for T and TA, respectively). The limits of detection for T and TA were 200 and 300 ng/ml, respectively, while the limits of quantitation were 250 and 400 ng/ml, respectively. The range of reliable quantification was 5-50 μg/ml. Isopropanol as solvent resulted in a turbid extract. Method 1 and method 2 of extraction showed high recovery (98.5-99.9% and 97.2-97.9% for T and TA, respectively). After a few weeks of analysis, method 1 resulted in retention time drift, peak broadening, non-reproducible results, and progressive loss of HPLC-column integrity. Methanol alone (method 2) was equally as efficient as that of the mixture of methanol with 10% hexane (method 1) for extraction. The described analytical procedure proved to be accurate, precise, and suitable for simultaneous determination of T and TA in real commercial cosmetic products.

Background: This study investigated the physical interaction of gliclazide (GLC) with a hydrophilic carrier, that is, macrogol [polyethylene glycol (PEG)]. Different molecular weights of PEG (4000, 10,000, and 20,000) were used in different drug : carrier weight ratios (1 : 1, 1 : 2, 1 : 5, and 1 : 10)., Method: Preliminary screening was done by phase solubility studies to characterize the liquid state interaction between the drug and the carrier. Solid dispersions (SDs) of GLC and PEG in different ratios were prepared by fusion technique and by physical mixing. The solid-state interaction between the drug and the carrier was examined by performing differential scanning calorimetry and Fourier transform infrared spectroscopic studies. SD with satisfactory characteristics was selected for the formulation of tablets by wet granulation method and compared with the commercial brand for in vitro dissolution., Results: It was evident from phase solubility studies that the drug solubility increased linearly with increasing PEG concentrations. In vitro dissolution of GLC improved significantly in the SDs prepared by fusion method as compared with the original drug and physical mixtures. Scanning electron microscopy images showed well-defined changes in the surface topography of GLC, thus confirming the effective formation of a fused binary system. The SD tablets showed a significant improvement in the drug release profile than that of the commercial brand., Conclusion: It was thus concluded that SD formulations of GLC can be successfully used to design a solid dosage form of the drug, which would have significant advantages over the current marketed tablets.

Background: Clinical supervision is considered one of the vital support systems for effective high-quality health services. The quality of the relationship between supervisor and provider is the single most important factor for effective supervision., Objectives: This study was conducted to identify the health care providers' views in family health centers (FHC) and units (FHU) regarding the supervisory visits in terms of supervisor roles., Material and Methods: A descriptive cross-sectional study was conducted in 20% of FHC and FHU of four randomly selected districts (out of seven administrative districts) affiliated to MOH in Alexandria governorate, Egypt. The study population included all family physicians, pharmacists, and dentists, who were present in the study settings at the time of the study (40 physicians, 23 dentists and 19 pharmacists). A self-administered questionnaire was used and included 11 categories of key supervision practices to be assessed., Results: High rating had the highest percentage for giving feedback to supervisees and facility (57.3%), seeking client input (56.1%), discussing data (53.7%), making suggestions (47.6%), promoting participation of supervisees (46.3%), discussing previous visit (43.9%) and roles of developing rapport with supervisees (36.6%). The highest percentage of moderate rating was accounted for the role of problem identification with supervisees (50.0%). Low rating had the highest percentage for the roles of giving education or on-the-job training (40.2%), problem solving with supervisees (43.9%), and discussing the next visit (44.9%)., Conclusion and Recommendations: All newly appointed clinic supervisors should have access to a formal induction program which introduces them to particular aspects of management, leadership and communication skills as well as technical aspects of their job. Training sessions for both supervisors and providers on problem solving, problem identification, and team building are also required.

Objective: The objective of the study was to explore the difference in stress levels among nurses working at two different health care organizations and the determinants of nurse stress within each organization. Job stress is defined as the harmful emotional and physical reactions resulting from the interactions between the worker and her/his work environment where the demands of the job exceed the worker's capabilities and resources., Methodology: A convenient sample of nurses in two hospitals in Alexandria; Shark Al Madina (n = 120) and Karmouz (n = 170) hospitals. All nurses present at the time of the study were approached to be included in the study. The response rate for Shark Al Madina hospital was 94% and for Karmouz hospital, 71%. Data collection took place using a nurse stress questionnaire previously developed and tested for validity and reliability to measure stress in clinical nursing practice. The 5% level of significance was used throughout the statistical analysis for all relevant tests., Results: The highest mean stress scores were the same for both hospitals. The dimension of coping with new situations was 2.7 ± 0.6 at Shark Al Madina hospital and was 2.5 ± 0.7 at Karmouz hospital while the dimension of job security was 2.7 ± 0.6 and 2.5 ± 0.7 at Shark Al Madina and Karmouz hospitals, respectively. Stepwise multiple regression for Shark Al Madina hospital model revealed workload (β = 1.38), security (β = 5.04), and shortage of support staff (β = 3.39). For the Karmouz hospital model, stepwise multiple regression revealed security (β = 4.78) and shortage of resources (β = 3.66)., Conclusion: Stressors among nurses appear to be the same despite the differences in organizational or hierarchical structure where they work or the type of consumer they serve. It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent nurse burnout. This could be achieved with job redesign, modification of shift work systems, and by offering occupational health education as well as assurance regarding job security especially during the global financial crisis.

Objective: The study was conducted to identify the satisfaction dimensions in relation to anticipated nurse turnover in an academic medical institution using an ordinal regression model., Methodology: A cross-sectional descriptive study was designed to describe nurse job satisfaction in relation to their intention to stay at King Faisal University's Hospital, Al-Khobar, Saudi Arabia. All nurses available at the time of the study were included (499 nurses in different departments). The response rate was 55.3% (276 questionnaires suitable for analysis). A self-administered questionnaire with 26 items was developed for this study with a five-point Likert scale ranging from 1 = highly dissatisfied to 5 = highly satisfied)., Results: Nurses were least satisfied with the hospital's benefits (1.2 ± 0.4), hospital policies (1.4 ± 0.5), bonuses (1.1 ± 0.3), fairness of the performance appraisal system (1.5 ± 0.5) paid time off (1.5 ± 0.5), and recognition of achievements (1.5 ± 0.5). The mean general job satisfaction score was 2.2 ± 0.4. Ordinal regression analysis revealed leadership styles and challenging opportunities as predictive dimensions for the intention to stay., Conclusion: There are nurse job satisfaction dimensions other than salary and incentive that may be anticipated with the intention to stay in the health facility. Namely, leadership styles in the health organization and challenging opportunities at work.

The aim of the present study was to use factorial design to enhance the dissolution rate of nimesulide using solid binary systems with the hydrophilic carriers D-mannitol and polyethylene glycol (PEG 4000). Two-factor full factorial design was employed to investigate the effects of the drug/carrier ratio (X(1), 10 and 20%) and the method of　preparation (X(2), physical or co-melted mixture) on　the percent drug release after 60 min (Y(1)). Drugcarrier co-melted mixtures were prepared by melting the carriers D-mannitol or PEG with the drug. For physical mixtures, the drug and carrier were mixed thoroughly in a mortar until a homogeneous mixture was obtained. Drug-carrier interactions were investigated by differential scanning calorimetry (DSC). All prepared mixtures were filled in hard gelatin capsules, size 0, and then their dissolution rate was tested. The results showed an increase in the solubility of the drug with increasing polymer concentrations. Thermal analysis revealed no notable differences regarding thermal events of nimesulide, D-mannitol, PEG 4000, and their physical or comelted mixtures. The percent drug released after 60 min was 29.5% for nimesulide alone, 37.14 and 32.0% for a PEG/Physical mixture with a 10 or 20% drug/polymer ratio, and 69.7 and 53.1% for a PEG/Co-melted mixture with the same ratios. For nimesulide/D-mannitol, this percent drug released was 33.57 and 29.6% for a physical mixture and 63.13 and 48.04% for a co-melted mixture. Formulations with PEG showed an increase in solubility as well as dissolution in comparison to those prepared with D-mannitol. Factorial design was successfully used to optimize the dissolution rate of nimesulide. The chosen polymers caused a notable increase in drug solubility and co-melted formulations generally showed a higher dissolution than those prepared with physical mixtures.

In vitro characterization of alpha-tocopherol SEDDS formulations was performed by (1) lipolysis in bio-relevant media, and (2) physical assessment by dissolution, particle size, and turbidity analyses. Both methods were statistically correlated using a 25-run, five-factor multiple-level d-optimal mixture design. Independent variables were SEDDS composition [vitamin E (12.5-25%), Tween 80 (10-40%), labrasol (0-10%), alcohol (0-10%), and captex 355 (20-50%)]. Measured responses were percent lipolysis, percent vitamin E retained in the aqueous layer of the digestion medium, and percent vitamin E dissolved in the dissolution medium. Percent lipolysis ranged from 0% to 66.3%. Percent vitamin E retrieved in the aqueous layer of the digestion and dissolution media ranged from 3% to 29.3% and from 25.9% to 101.7%, respectively. Turbidity ranged from 28 to 403JTU and the average droplet size was >1.0 microm. All formulation ingredients had significant (p<0.05) effect on percent lipolysis. Only two factors, Tween and vitamin E had significant effect on vitamin retention in the aqueous layer post-lipolysis. Tween, labrasol, and captex 355 had significant effect on vitamin E dissolution. Poor correlation was observed between the responses. Formulation ingredients influenced each response differently; and therefore, each method can only reveal distinctive characteristics of the SEDDS formulation and may not be used interchangeably.

Objective: The study was conducted with the aim to construct a unified nurse appraisal format to be used at hospitals performing under different healthcare organizations in the Eastern Province in the Kingdom of Saudi Arabia., Methodology: The study included hospitals representing different healthcare organizations within the Eastern Province. The target population included Hospital head nurses and nurse supervisors and the snowball sampling technique was employed to select the panel subjects., Results: The final draft resulted into the agreed upon performance dimensions which included namely; quality standards, work habits, supervision/leadership, staff relations and interpersonal skills, attendance and punctuality, problem solving, oral communication, productivity results, coordination, innovation, record keeping., Conclusion: Nurse managers have to continuously assess competence of practicing nurses to assure qualified and safe patient care. A nurse appraisal form was constructed concurrently with this study results and was proposed to be used at all Eastern Region hospitals. This study is considered an initial step for further efforts and studies to be conducted to reach both national and international nursing appraisal dimensions and unify them for the sake of best health promotion.

Nursing is generally perceived as a demanding profession. There is a rising necessity for healthcare administrators to tackle the aspects leading to nurse stress and work burnout as a means towards maintaining a stable and continuous workforce at healthcare institutions.The study aimed at the development of a reliable and valid tool for measuring nursing staff stress and burnout at the University Hospital of King Faisal University, Saudi Arabia. A cross-sectional descriptive study was designed. All registered high nurses working at the hospital were included in the study. The total number accounted for 260 nurses. The study revealed a valid and reliable scale. Such results were indicated through face validity, content validity, and principal component analysis using the varimax rotation for the fifteen statements included in the questionnaire. The PCA explained 56.4% of the variance and concluded 3 main components under which the statements would be categorized. Dimensions were given suitable headings as follows; work aspects, working conditions, and workload. Reliability was assessed and revealed an internal consistency (Cronbach alpha=0.8) and a split-half Spearman-Brown coefficient for unequal length r= 0.79. In conclusion, the study demonstrated a short valid and reliable scale to assess the stressful areas for nurses. The scale is convenient for use by healthcare managers at different medical situations. Further studies are recommended for the use of the tool on representative samples of Saudi nurses.

Unlabelled: Utilization of care is very important because of its link to access, quality of care and because of its importance to outcome. The aim of the study was to clarify the barriers towards accessibility to the Health Insurance of the Medical Union plan and to explain reasons why participants covered by other health insurance systems are using the Health Insurance Medical Union (HIMU). The study was carried out at the health insurance project situated in Alexandria Medical Syndicate. The insured members of HIMU included four specialties namely; physicians, pharmacists, dentists and veterinarians and their families. The sample amounted to 782 members. The highest reasons for participation in the project were freedom of choice of laboratory and/or radiology clinics 73.9%, affiliated providers (physicians and hospitals) offer good quality care to members 62.6%, and simplicity of getting services and/or referral system 59.2%. Whereas the highest reasons for not participating or continuing with the project were high premiums for members: high premium of parents accounted for the highest percentage (13.8%) followed by that of the spouse 9.3%, then high premium for members 5%, and high premium for children 4.9%. The reason that the period of participation was unsuitable for members (October-November-December) accounted for 4.9%., Recommendations: as a result of reviewing the system of determining premiums there were possibilities of a decrease in the annual premium for those beneficiaries who revealed low subsidies, decreasing cost sharing paid by beneficiaries for both outpatient and inpatient services in some essential services e.g. pregnancy and delivery, as well as vigorous control procedures regarding quality of medical care provided, art of care and price of medical services.

Objectives: To assess and compare the bioavailability of three different oral dosage forms of vitamin A in rats. The formulations included vitamin A self-nanoemulsified drug delivery (SNEDD) optimized formulation-filled capsule (F1), vitamin A SNEDD optimized formulation compressed tablet (F2) and vitamin A oily solution-filled capsules without any additives (control, F3)., Materials and Methods: Bioavailability was assessed after a single oral dose of the three formulations using three groups of rats, each group comprising 6 rats. Blood samples were collected at baseline and over the next 8 h. Plasma was separated and extracted to obtain the drug, which was measured by HPLC. Statistical data analysis was performed using the Student t test and ANOVA with p < 0.05 as the minimal level of significance., Results: From the pharmacokinetic parameters, both F1 and F2 showed improved bioavailability compared to F3. The values of AUC +/- SD were 3,080.7 +/- 190.2, 2,137.1 +/- 130.5 and 1,485.2 +/- 80.1 ng x h/ml for F1, F2 and F3, respectively. The Tmax was 1 h in case of F1 and F2 as compared to 1.5 h for F3. The Cmax +/- SD was 799.5 +/- 48.5, 656.2 +/- 64.4 and 425.8 +/- 33.1 for F1, F2 and F3, respectively. The increase in AUC, Cmax and Tmax was significant (p < 0.05). The bioavailability calculated from the AUC for F1 and F2 relative to F3 was 207.4 and 143.8%, respectively. The bioavailability increased almost twofold and 1.4 times for F1 and F2, respectively., Conclusions: The study showed that the newly developed vitamin A SNEDD formulations increased the rate and extent of drug absorption compared to the oily drug solution. The present investigation demonstrated that vitamin A SNEDD optimized formulations, either as filled capsules or as compressed tablets, were superior to its oily solution with regard to their biopharmaceutical characteristics., (2007 S. Karger AG, Basel)

The purpose of this work was to study the effect of organic solvent and surfactant type on the in vitro release behavior in general and on the burst release in particular of beta-estradiol from PLA/PLGA microspheres. Also the effect of these variables on the encapsulation efficiency was investigated. The microspheres were prepared by solvent evaporation technique using dichloromethane (DCM), ethyl acetate (EtAc), tetrahydrofuran (THF), chloroform (CHCl3) or acetone (AC) as organic solvent and polyvinyl alcohol (PVA), Tween 80, sodium lauryl sulfate (SLS) or benzalkonium chloride (BKCI) as surfactant. The obtained microspheres were tested for encapsulation efficiency and in vitro drug release using 50% methanol/buffer pH 7.4 as dissolution medium. EtAC and PVA formulations showed the highest encapsulation efficiency and the lowest burst release. These microspheres were further characterized for particle size distribution, SEM and zeta potential. The results suggested that these materials could be starting materials to prepare a beta-estradiol biodegradable controlled delivery system.

The purpose of this work was to evaluate the main and interaction effects of formulation factors on the drug encapsulation efficiency of beta-estradiol biodegradable microspheres by applying response surface methodology. A secondary purpose was to obtain an optimized formula for long-term therapy of osteoporosis. A three factor, three level Box-Behnken experimental design was used to get 15 experimental runs. The independent variables were drug/polymer ratio (X1), dispersing agent concentration (X2), and deaggregating agent concentration (X3). The dependent variables were percentage encapsulation efficiency (Y1), cumulative percent drug released (Y2), and percentage yield of the microspheres (Y3). The formulations were prepared by emulsion solvent evaporation technique using ethyl acetate as organic solvent. The optimized formulation was maximized for encapsulation efficiency and further characterized for the particle size distribution, scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared (FT-IR). The mathematical relationship obtained between X1, X2, X3, and Y1 was: Y1 = -129.85 + 29.35X1 + 129.99X2 + 64.82X3 - 3.2X1X2 - 0.29X1X3 - 35.83X2X3 - 2.05X(2)(1) - 13.23X(2)(2) - 5.92X(2)(3) (R2 = 0.99) The equation showed that X1, X2, and X3 affect Y1 positively but interaction between any two of these factors affects Y1 negatively. The most significant interaction was between X2 and X3. The finding indicated that controlled releases beta-estradiol biodegradable microspheres with high encapsulation efficiency and low pulsatile release can be prepared and the quantitative response surface methodology applied helped in understanding the effects and the interaction effects between the three factors applied.

Utilization of health Insurance services by children can be influenced by many factors, such as health care need, availability of transportation, and geographic access to care. Utilization rates may be affected by certain barriers which include: physical unavailability geographical, financial, psychological and socio-cultural or organizational barriers. This study was carried out to study the pattern of utilization of services provided by the Students' Health Insurance Programme in Alexandria by preparatory school students. A cross-sectional descriptive study was performed to identify the understudied variables. A sample of 1121 school students was included. They were from general preparatory schools (public and private) who utilized any health service within the last 6 months prior to the start of the study. A relevant questionnaire was designed for data collection through an interview with the student's parent during a visit to the school clinic. It was found that the highest percentage of public school students preferred to obtain medical services at the school physician clinic (51.2%) whereas, the highest percentage of private school students preferred to obtain medical services at a private physician (74.0%). The highest percentage of both public and private school students had knowledge regarding the time of service (47.0% and 36.5%, respectively). As regards public schools the highest mean satisfaction score was for the dimension of school physician examination (2.20+/-0.6), whereas, the highest mean satisfaction score for private school students was for the dimension of referral procedures to the specialist (2.30+/-0.5). It was concluded that accessibility barriers towards the programme could be handled through, distribution of brochures at the beginning of every scholastic year and further simplification of administrative procedures and paper work cycles adopted by the programme.

The aim of this study was to evaluate the extent of provider adherence to evidence-based guidelines for diabetes care and the extent of glycemic, blood pressure, and lipid control in patients with diabetes in a developing country. A retrospective cohort study was carried out to evaluate diabetes care provided under Health Sector Reform Program (HSRP) in a major medical center in Alexandria, Egypt. Data on care provided for 137 patients were abstracted from medical records. Several process measures were studied including annual proportion of patients with measurements of blood glucose, blood pressure, and lipid levels. Patient outcomes on these measures were also examined. Logistic and poisson regressions were used to study factors related to having measurements done and number of measurements respectively. Multilevel analysis was then used to examine rate of change in patient outcomes and factors associated with this rate over one year of follow-up. For 137 patients with diabetes, annual testing was adequate for fasting blood glucose (FBG) (94.1%), blood pressure (100%), foot (92.7%), and fundus examination (86.6%) was adequate. On the other hand less attention was given to total cholesterol (60.6%), triglycerides (52.6%) and albuminuria (10.3%). At the end of 1 year follow-up, 89.2% did not meet the target level of fasting blood glucose of < 130 mg/dl. A total of 40.2% and 46.7% did not meet the goal of 130 mmHg for systolic and 80 mmHg for diastolic blood pressure. Fifty nine percent, and 76.4% did not meet the goal of total cholesterol level of <200 mg/dl, or triglycerides level of <150 mg /dl respectively. There was evidence of suboptimal treatment with insulin, antihypertensive drugs, and lipid- lowering drugs. This study demonstrates that diabetes care provided under HSRP is unsatisfactory. As a result more effort to increase compliance with evidence based guidelines in diabetes care is needed.

Beta-estradiol has been recommended for the long-term therapy of osteoporosis and its oral formulations are subjected to intensive first pass metabolism. The present investigation was aimed at preparing and characterizing biodegradable microparticles of beta-estradiol with polymers such as PLA, PLGA 85/15, PLGA 75/25, and their mixtures. The microparticles were prepared by solvent evaporation method using methylene chloride as a solvent and polyvinyl alcohol as a surfactant. The drug-polymer ratios were 1:3, 1:5, and 1:7. The prepared microparticles (twelve formulations) were tested for encapsulation efficiency and in vitro drug release in 50% methyl alcohol/phosphate buffer pH 7.4. The results showed that the encapsulation efficiency varied from 81 to 100% and the formulation fabricated from PLGA 85/15 (1:3) showed less burst and consistent long time release. This formulation when further characterized displayed irregular spherical shape with an average particle size of 72 microm. The crystallinity of the drug was reduced when investigated using X-ray diffractometry. No chemical interaction between the drug and the polymer was observed as evidenced by FT-IR analysis. The results indicated that beta-estradiol biodegradable microparticles with PLGA 85/15 (1:3) could be a suitable approach for long term therapy of osteoporosis.

The kinetics of sorption of Cu(2+) on a Saudi clay mineral (bentonite) was investigated at 20+/-0.5 degrees C using different weights of the clay (0.5, 1.0, 1.5, and 2 g). Each weight represents a certain sample size. The order of the process appeared to be 1 with respect to the Cu(2+), and 112 with respect to the clay surface area. The rate was found to depend on internal diffusion.,which produced a decrease in the specific rate of sorption as a function of time. Sorption characteristics were described using two site Langmuir isotherms. The desorption experiments proved that Cu(2+) ions are chemisorbed on the bentonite surface. The maximum adsorption obtained was 909 mg Cu(2+)/g clay. This value is of great significance, as it is much higher than any reported one.

Objective: The aim of this study is to determine patient's gender preferences in choosing general practitioners and specialists for both general and specific health issues at primary health care centers in Alexandria, Egypt., Methods: A descriptive cross-sectional study was conducted at Smouha Health Center, Alexandria Governorate, Alexandria, Egypt. The study was conducted between the period January -- March 2004. A pre-designed questionnaire was used. The format included 3 main sections, namely, socio-demographic, beliefs towards provider's gender, and providers' preferences of patients., Results: Both male and female patients preferred a male physician for consultation and clinical management of cases. The highest percentage of male patients (81.4%) and female patients (41.0%) preferred physician of the same gender, and such preference was of personal reasons for males (97.9%) and females (96.6%), while basing on traditions and norms for male (62.9%) and female (63.4%). Significant results of the stepwise logistic regression analysis in relation to socio-demographic factors on provider preference revealed that job and income were the significant determinants of gender preference for the sample under study., Conclusion: Patients prefer physicians of the same gender, but in actual practice a male physician is believed to be more competent.

The aim of this paper is to investigate women health and status as well as to study gender gap in three poor urban settings in Alexandria. Poor families were identified and invited to participate in the study through the help of local informants. The study included 172 families, 53 from Abu-Kir, 57 from El-Dahreya and 62 from Wadi El-Kamar area. An interviewing questionnaire was used to collect data form the wives as well as their husbands about household family members. Wives and husbands who participated in the study were clinically examined. Their weight and height were measured. For those who accepted to participate, stool, urine and blood analyses were performed. Female to male comparison as well as sex ratio of some parameters were used to investigate gender gap. Results showed that females were the head of the family in 19.8% of the families. In 18% of the families, wives participated in the family income. Illiteracy represented 94.2% among females aged 45+ years, and unemployment was 97.4%. The rate of ill health increased with age from 36% for girls to 90% among older women (45+) compared to 71% among older males. Cardiovascular and orthopedic disorders represented the most reported problems among older females and males. Diarrhea and ARI episodes were rather more frequent among females than among males. About 60% of examined women suffered from obesity, 45% had gynecological problems, 38% had parasitic infections in stool, and 45% had anemia. Female to male sex ratio was low for <6 and 60+ years old. In conclusion, poor women suffer from high burden of socio-economic disadvantage, gender inequality and ill-health.

The present work is a retrospective study designed to examine the assumption that emergency arrivals at the Sporting Students' Hospital in Alexandria follow a Poisson distribution. Data about all arrivals at the emergency room (ER) for the year, 2000 (43076 arrivals) was extracted from the records of the emergency department and classified by age, sex, school, reason for visit, date and time of visit. Data analysis revealed that 12.9% of the total arrivals indicated hospital admission either to the inpatient units (12.5%) or the ICU (0.4%). Goodness of fit test showed that admissions to the ICU fit the Poisson distribution but those admitted to the inpatient units did not follow the assumed distribution. However the latter group did not fit exactly the normal distribution which indicated that deviance from the Poisson is due to the large mean non-elective admissions (14.74% per day). Hence the Poisson assumption is not excluded as the inpatient emergency admissions are still randomly distributed and independent. Univariate and multivariate Poisson regression of the daily emergency admissions gave another clue to the goodness of fit of emergency admissions to the Poisson process. Regression analysis showed significantly higher loge number of emergency admissions among the age group 12 or more, male students, medical conditions in contrast to injuries, governmental schools, and at 04:00-11:59 pm in contrast to midnight to 07:59 am. Results of the present study indicated the random nature of demand for emergency admission which affects use of bed stock. A prospective study of these admissions on daily basis is needed.

The purpose of this investigation was to evaluate the bioavailability of three salbutamol sulfate suppository formulations. The formulations were; 2 mg salbutamol sulfate in Suppocire NA base containing 6% Eudispert gel (F1), 2mg salbutamol sulfate in Witepsol H15 base containing 3% methyl cellulose gel (F2), and 2 mg salbutamol sulfate in Witepsol W25 base containing 3% methyl cellulose gel (F3). The formulations were administered via rectal route in six healthy male adult volunteers. The bioavailability of the three suppository formulations was compared with the oral bioavailability of salbutamol sulfate 2mg tablets (F4). Six volunteers participated in a four-way crossover study, where each study was separated from the other by an interval of 1 weak. Venous blood samples of 5 ml were taken immediately before dosing and after predetermined time intervals of 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6 and 8 h. The result showed that Cmax +/- S.D. observed were 12.96 +/- 2.11, 14.78 +/- 2.33, 10.02 +/- 1.42 and 11.51 +/- 1.22 ng ml(-1) for F1, F2, F3 and F4, respectively. The Tmax +/- S.D. were found to be 1.91 +/- 0.20, 1.83 +/- 0.26, 2.50 +/- 0.00 and 2.67 +/- 0.24 h for F1, F2, F3 and F4, respectively. AUC +/- S.D. values were 40.25 +/- 1.88, 42.16 +/- 1.55, 28.62 +/- 1.98 and 37.63 +/- 1.44 ng h per ml for F1, F2, F3 and F4, respectively. The relative bioavailabilities of the investigated formulations were 112.04, 106.96 and 76.06 for formula F2, F1 and F3, respectively, when compared with the oral preparation (F4). The finding indicates that the bioavailability of salbutamol sulfate can be enhanced by delivering it rectally with Suppocire NA base containing 6% Eudispert gel or with Witepsol W25 base containing 3% methyl cellulose to match that of oral tablets. Salbutamol sulfate can be rectally administered in patients who are less compliant with the oral administration.

Purpose: To determine if tetradecyl-beta-maltoside (TDM) and dimethyl-beta-cyclodextrin (DMbetaCD) enhance pulmonary absorption of insulin and to investigate if they do so by a reversible action on respiratory epithelium., Methods: Insulin formulated with saline, TDM, or DMbetaCD was administered intratracheally, after laryngoscopic visualization, as a spray to anesthetized rats. Reversibility studies were conducted in intact rats by administering insulin at different time points after administration of TDM or DMbetaCD. The pharmacodynamics and pharmacokinetics of insulin formulations were assessed by measuring plasma glucose and plasma insulin concentrations., Results: When insulin formulated with increasing concentrations (0.06-0.25%) of TDM or DMbetaCD were administered to anesthetized rats, there was a concentration-dependent decrease in plasma glucose and increase in plasma insulin concentrations. The relative bioavailability of insulin formulations containing TDM was higher (0.34-0.84%) than that of formulations containing DMbetaCD (0.19-0.48%). When insulin was administered 120 min after an agent was administered, in the reversibility study, no significant change in plasma glucose and insulin levels occurred compared to control., Conclusions: Both TDM and DMBCD enhance pulmonary absorption of insulin, with TDM being more efficacious than DMbetaCD in enhancing insulin absorption via pulmonary administration. The effects of TDM and DMbetaCD on respiratory epithelium are reversible, and the epithelium reestablishes its normal physiologic barrier 120 min after exposure to these agents.

An isocratic reversed phase high-performance liquid chromatographic (HPLC) method with ultraviolet detection at 205 nm has been developed for the determination of cyclosporin-A (CyA) in rat blood and plasma. Naproxen was successfully used as an internal standard. Blood or plasma samples were pretreated by liquid-liquid extraction with diethyl ether. The ether extract was evaporated and the residue was reconstituted in acetonitrile-0.04 M monobasic potassium phosphate buffer (pH 2.5) solvent mixture. After washing with n-hexane, 30 microl of the reconstituted solution was injected into HPLC system. Good chromatographic separation between CyA and internal standard peaks was achieved by using a stainless steel analytical column packed with 4 microm Nova-Pak Phenyl material. The system was operated at 75 degrees C using a mobile phase consisting of acetonitrile-0.04 M monobasic potassium phosphate (pH 2.5) (65:35 v/v) at a flow rate of 1 ml/min. The calibration curve for CyA in rat blood was linear over the tested concentration range of 0.0033-0.0166 M with a correlation coefficient of 0.989. For rat plasma, the range of the concentrations tested were between 0.002 and 0.0166 M and showed linearity with a correlation coefficient of 0.953. The intra- and inter-run precision and accuracy results were 1.24-21.87 and 3.1-12.23%, respectively. The low volume of blood or plasma needed (200 microl), simplicity of the extraction process, short run time (5 min) and low injection volume (30 microl) make this method suitable for quick and routine analysis.

The purpose of this study is to examine the influence of Azone upon the skin target site free drug concentration (C(*)) and its correlation with the in vivo antiviral efficacies of cidofovir (HPMPC) and acyclovir (ACV) against HSV-1 infections. Formulations of HPMPC and ACV with or without Azone were used. The in vitro skin flux experiments were performed and the C(*) values were calculated. For the in vivo efficacy studies, hairless mice cutaneously infected with HSV-1 were used and three different treatment protocols were carried out. The protocols were chosen based upon when therapy is initiated and terminated in such a way to assess the efficacy of the test drug to cure and/or prevent HSV-1 infections. A finite dose of the formulation was topically applied twice a day for the predetermined time course for each protocol and the lesions were scored on the fifth day. For ACV formulation with Azone, the C(*) values and hence the in vivo efficacy were much higher than those for that without Azone. In protocol #1, however, early treatment did not increase the in vivo efficacy of ACV when compared with the standard treatment protocol #3. In protocol #2 where the treatment was terminated on the day of virus inoculation, the efficacies for both ACV formulations were completely absent. Although the estimated C(*) values for HPMPC formulations with and without Azone were comparable, formulation with Azone was much more effective than that without Azone in all treatment protocols. HPMPC formulations with Azone at similar flux values were much more effective in "treating and preventing" HSV-1 infections than those without Azone. For ACV formulations, in contrast, addition of Azone has failed to show any effect on the preventive in vivo antiviral efficacy and the enhancement of ACV in vivo antiviral efficacy was merely the skin permeation enhancement effect of Azone.

Purpose: To prepare and evaluate a suppository dosage form of salbutamol sulfate. The prepared formulae with and without different concentrations of gels were tested for hardness, melting time, content uniformity, and drug release. The stability of some of the selected formulae was assessed., Methods: Salbutamol sulfate was formulated as a rectal suppository with emulsifying fatty bases (suppocire and witepsol) and water-soluble bases (PEG) adopting the molding from a melt technique. Physical characteristics and dissolution profiles of the prepared formulations were determined as the responses. The effects of adding gels, methyl cellulose (MC), and Eudispert (Eud) and their concentrations (1, 3, and 6%) on these responses were also investigated. Formulations showing high rank order were scaled up for shelf-life stability study for one year., Results: The results showed that all the investigated formulae have acceptable physical characteristics with respect to hardness, melting time (except F7), and uniformity of drug content. The amount of drug dissolved in 100 min of dissolution time was inversely affected by the melting point of the fatty base. The release from PEG bases was found to be molecular weight dependent. Addition of 1% MC or Eud gel increased the release from all the investigated formulae. Increasing gel concentration to 3% then to 6% showed different effects on the release. The degradation of salbutamol sulfate in the investigated formulae was found to be a first-order reaction., Conclusions: Rectal suppository of salbutamol sulfate could be prepared as an alternative to the oral dosage form to circumvent the first-pass metabolism.

The purpose of this investigation was to compare the bioavailability of three coenzyme Q10 (CoQ10) formulations in dogs using an open, randomized, multiple-dose crossover design. The formulations included a powder-filled capsule (A, control) and two soft gelatin formulations (Q-Gel as the water-miscible form of CoQ10, B and Q-Nol as the water-miscible form of ubiquinol, the reduced form of CoQ10, C). Formulations were evaluated in pairs, allowing a washout period of 14 days prior to crossing over. Blood samples were collected from each animal prior to dosing to determine the endogenous plasma CoQ10 concentrations. Serial blood samples were collected for 72 hr and plasma CoQ10 concentrations were determined by high-performance liquid chromatography. Plasma concentration-time profiles were corrected for endogenous CoQ10 concentrations. Results showed that the relative bioavailabilities of formulations B and C were approximately 3.6 and 6.2-fold higher than that of control formulation A. The AUC(microgram.hr/mL) +/- SD, Cmax(microgram/mL) +/- SD, and Tmax(hr) +/- SD for formulations A, B, and C were 1.695 +/- 0.06, 6.097 +/- 0.08, and 10.510 +/- 0.10; 0.096 +/- 0.035, 0.169 +/- 0.038, and 0.402 +/- 0.102; and 4.2 +/- 1.48, 4.1 +/- 1.57, and 4.5 +/- 0.58, respectively. While no significant differences were observed between Tmax values of the three formulations, the AUC and Cmax values for formulations B and C were significantly higher than those of the control (p < 0.05). The present investigation demonstrates that soft gelatin capsules containing water-miscible CoQ10 formulations B (Q-Gel) and C (Q-Nol) are superior to powder-filled formulations with regard to their biopharmaceutical characteristics.

The objectives of the present study were (1) to evaluate the effect of formulation ingredients on the release rate of Ubiquinone from its adsorbing solid compact; and (2) to prepare and evaluate an optimized self-nanoemulsified tablet formulation. A three factor, three-level Box-Behnken design was used for the optimization procedure, with the amounts of copolyvidone (X(1)), maltodextrin (X(2)) and microcrystalline cellulose (X(3)) as the independent variables. The response variable was cumulative percent of Ubiquinone emulsified in 45 min with constraints on weight, flowability index, tensile strength, friability and disintegration time of the dry powdered emulsion and the resultant compact. Based on the experimental design, different Ubiquinone release rates and profiles were obtained. Mathematical equations and response surface plots were used to relate the dependent and independent variables. The regression equation generated for the cumulative percent emulsified in 45 min was Y(6)=64.10-12.32X(1)-4.36X(2)-25.53X(3)+6.99X(1)X(2)+3.97X(1)X(3)+9.70X(2)X(3)-8.98X(1)(2)16.22X(2)(2)+17.10X(3)(2). The optimization model predicted an 85.4% release with X(1), X(2) and X(3) levels of 66.6, 560.1 and 100, respectively. A new formulation was prepared according to these levels. The observed responses were in close agreement with the predicted values of the optimized formulation.

Structure is considered one of the three major approaches to the evaluation of quality the other two being process and outcome. Appraisal of structure involves the attributes of the settings in which care is delivered that includes the material resources, the human resources, and the organizational structure. The aim of the study was to assess the quality of nursing care provided at tne neonatal intensive care unit (NICU) at Princess Badia Teaching Hospital, Jordan, as regards the various components of structure domain within the context of quality. A checklist for structure assessment was developed which included criteria classified under three main areas namely, material resources, human resources, and organizational structure. Results revealed certain deviations from the recommended compliance scores for each area. Recommendations were proposed to stress the importance of the NICU being specifically built to reflect practice, environment, and cultural needs, as well as continuous education activities of NICU staff. Documented policy and procedure manuals were also recommended for assuring maintained quality care at the NICU.

Physician satisfaction with their job is a topic of importance to physicians in practice, physicians in training, health administrators, and health executives. Stress among physicians arises due to inadequate demands of the job in relation to worker's abilities, frustrated aspirations, and dissatisfaction with regard to aimed goals. The cross-sectional study design was conducted at 7 randomly selected Maternal and Child Health (MCH) centres, affiliated to seven medical zones in Alexandria. The study sample consisted of all physicians working at the studied MCH centres. A questionnaire designed for data collection was distributed to all physicians available and who accepted to participate in the study. The questionnaire included 4 sections measuring, socio-demographic characteristics, overall satisfaction and global satisfaction, an eight-dimension satisfaction scale, and a four-dimension stress scale. The questionnaire was distributed to 100 physicians out of whom 77% responded. Satisfaction scale was on a scale ranging from 6 (greatly satisfied) to 1 (greatly dissatisfied). Stress was on a scale ranging from 6 (greatly stressed) to 1 (greatly unstressed). The total mean satisfaction score for the sample under study was 3.3 +/- 0.6 with a significant difference among zones (F = 4.4, p < 0.05), and the total mean stress score for the sample under study was 3.8 +/- 0.7 with a significant difference among zones (F = 2.4, p < 0.05). It is recommended that decision makers at the MOHP find ways to raise the physicians' pay, efficient planning of resources, and find opportunities for future promotion.

Purpose: Naproxen CR tablets have been obtained from its microspheres prepared by coprecipitation with Eudragit L100-55. The purpose of this work was to evaluate the main and interaction effects of deaggregating agent concentration (X1), compression pressure (X2) and amount of precipitating water (X3) on naproxen release. A secondary purpose was to obtain an optimized naproxen controlled release solid oral dosage form with a predictable 12 h drug release., Method: Eudragit L100-55 (10 g) was dissolved in 100 ml of ethyl alcohol, and 30g of naproxen was dispersed in it with stirring. Purified water (100mL, cooled to 4 degrees C) containing calcium chloride as a deaggregating agent was added to an alcoholic solution and homogenized. The mixture was filtered to obtain microspheres. Drug content analysis was performed spectrophotometrically at 332 nm. Tablets were prepared by compressing microspheres containing 500mg of naproxen after adding 1% magnesium stearate. Dissolution was performed by the USP specifications of naproxen tablets. A 3-factor 3-level Box-Behnken design was employed to get 15 experimental runs. The independent variables used were X1, X2 and X3. The dependent variables were dissolution at different time points with constraints on yield value and angle of repose of the microspheres, and hardness and thickness of the tablets. The dissolution constraints were placed such that the naproxen is released for 12 h by Higuchi's square root of time kinetics., Results: The mathematical relationship obtained between X1, X2, X3 and the cumulative per cent of naproxen dissolved in 12 h with various constraints (Y5) was Y5 = 92.39 - 1.13X1 - 4.84X2 - 2.12X3 - 2.26X1X2 - 0.5X1X3 - 0.4X2X3 + 2.4X(1)(2) - 0.4X(2)(2) (R2 = 0.9). The equation shows that X1, X2 and X3 affected the release inversely, and the most significant interaction was between X1 and X2. Y5 has been maximized for optimization of naproxen release., Conclusions: Controlled release tablets of naproxen with predictable drug release characteristics were obtained by compressing its microspheres with Eudragit L100-55.

Old and recent reports show that honey has beneficial effects on the skin as antiseptic for wounds, burns and ulcers and as a healing promoter. Many investigators confirmed the usefulness of honey in the treatment of skin infections as well as internal diseases. The factors behind these effects are not completely explained. The aim of this study is: a) to investigate the antimicrobial activity of crude honey, b) to separate the fractions responsible for its activity, c) to formulate the honey extract as semisolid dosage forms, d) to study its release, and e) to determine its stability. The results showed that the ethylacetate honey extract showed antibacterial, anticandida and antifungal effects at low concentration. The release of honey extract from different ointment bases was depending on the constituents of the base, and its stability was found to be temperature and base dependent.

A novel method was developed for the quantitative determination of ubidecarenone (CoQ10) in aqueous media using non aqueous reversed phase liquid chromatography. Standards were prepared by melting the compound in Cremophor EL followed by dilution with distilled water. Samples were then analyzed by a Reverse Phase HPLC method using a Waters Novapak C18, 3.9 x 150 mm column. The mobile phase used was methanol: n-hexane (9:1) at a flow rate of 1.5 ml/min. Response of the detector to the analyte was linear (r: 0.999) over the range of 2.5-100 micrograms ml-1, with a limit of detection of 0.17 microgram ml-1. Acetone used to solubilize CoQ10 in the surfactant and Cremophor EL did not interfere with sample analysis. This method provided a convenient and alternative approach to the existing methods that require organic solvent extractions prior to analysis. Besides, this method enabled the separation of major photolytic decomposition products of CoQ10.

The objectives of the present study were to screen the formulation and process variables for the preparation of extended release naproxen tablets with Eudragit L100-55. The tablets were prepared by compression of microspheres that were obtained by a coprecipitation technique. The process involved dissolution of naproxen and Eudragit L 100-55 in alcohol USP followed by the addition of an aqueous solution containing a surfactant and deaggregating agents. The mixture was stirred for a specified time period to obtain microspheres, which were filtered and air-dried to a constant weight. The microspheres were then compressed to obtain plain tablets with a diameter of 12 mm. A 7-factor 12-run Plackett-Burman screening design was employed to evaluate the main effects of homogenization time (X1), rate of water addition (X2), amount of polymer (X3), amount of precipitating solution (X4), concentration of electrolytes (X5), compression pressure (X6), and the concentration of lubricant (X7) on the rate of drug release. The response variable was cumulative percent of naproxen dissolved in 12 h in simulated intestinal fluid with constraints on responses that included percent yield, hardness, thickness, and the angle of repose. Mathematical relationship for percent of naproxen dissolved in 12 h (Y5) with various factors yielded the following polynomial equation; Y5 (% dissolved in 12 h) = 95.48 + 0.53 X1 + 3.51 X2 + 3.84 X3 - 3.80 X4 - 2.46 X5 - 2.90 X6 - 3.91 X7. The results showed that all the seven factors affected, with varying order, the release of naproxen from its compressed tablets.

The objective of this study was to develop and validate an instrument pertinent for the Egyptian culture and situation suitable for use by health centres' administrators as a complementary tool for assessing the quality of outcome of care rendered. The study describes an attempt to develop and validate an instrument of patient satisfaction with primary health settings in Alexandria. A systematic randomized sample (227) of patients attending the outpatient clinics at 4 primary health centres in Alexandria were included in the study. The instrument included a section for respondents' characteristics, and the other section was a 5-point Likert-type scale ranging from highly satisfied (5) to highly dissatisfied (1) was developed by adapting items from other measures of patient satisfaction in the literature. The internal consistency of the instrument was determined, and the Cronbach's alpha coefficient for all scales was 0.80. Using the principal components factor analysis factor loadings for the scale items were high on seven factors. The factors were named technical care, accessibility, structure, humaneness, respect, in return for cost, and the waiting time. The study supports that the instrument is a reliable and valid measure for patient satisfaction suitable for Egyptian primary health settings.

Today more than 50% of marketed drugs are chiral. It has been well recognized that the stereochemistry of chiral drugs has a major influence on their pharmacological, pharmacokinetic, and toxicological actions. Studies on enantiomeric differences in the percutaneous permeation of chiral compounds have been actively pursued in recent years. Stratum corneum, the rate-limiting barrier in transdermal permeation, is made up of keratin and ceramide, which could potentially provide chiral environment. Transdermal delivery is often facilitated by the presence of penetration enhancers, which act primarily by altering the diffusion by disrupting the highly ordered membrane structure or by affecting the partitioning behavior of the diffusant molecules. Enantioselective permeation was observed with some chiral excipients including terpene enhancers. While studies on crystalline structures of pure enantiomers and racemates are helpful in understanding the basis for differentiation of physicochemical properties, prediction and control of permeability of enantiomers and racemates based on the physicochemical characteristics would be highly beneficial. The flux characteristics of enantiomers and racemates appear to be dependent upon their thermodynamic properties. Such analyses have a predictive value and are useful in the transdermal drug product development of chiral molecules. While the decision to market either an individual enantiomer or racemate lies strictly under the control of the sponsors, the guidance of the Food and Drug Administration is very helpful. This review presents an overview of the skin structure and transport and a concise review of enantioselective permeation with or without chiral enhancers. Regulatory perspectives on chiral drug product development are also discussed.

The ion-pair dissociation constants, K(D), of the ion-pair formed between chloropentamminecobalt(III) ion (CpX(2+)) and a variety of dicarboxylate ligands, have been determined from EMF measurements of a cell composed of glass and calomel electrodes. Measurements were made in water and in aqueous binary mixtures of ethyl alcohol, over a wide range of solvent composition (0-60 wt% ethyl alcohol), at six different temperatures (ranging from 30 to 55 degrees C at intervals of 5 degrees C). The thermodynamic parameters of association DeltaG(ass)(0), DeltaH(ass)(0) and DeltaS(ass)(0) have been calculated and discussed. DeltaH(ass)(0)-DeltaS(ass)(0), DeltaS(ass)(0)-DeltaS(1(or 2))(0), DeltaG(ass)(0)-G(1(or 2))(0) and DeltaH(ass)(0)-DeltaH(1(or 2))(0) correlations among different solvent media and different dicarboxylate ligands were examined (where 1 and 2 denote the first and the second dissociation reactions of the studied dicarboxylic acids). The pK(D) value has been correlated with the dielectric constant of the medium according to Born's equation.

The first and second dissociation constants of tartaric, maleic and phthalic acids have been determined using EMF method in water-ethanol mixed solvents, over a wide range of solvent composition (0-60 wt% ethanol) at six different temperatures (ranging from 30 to 55 degrees C at intervals of 5 degrees C). The thermodynamic parameters (DeltaG degrees , DeltaH degrees and DeltaS degrees ) for the first and the second ionization reactions were calculated from the well known equations. The results have been discussed in terms of the solute-solvent interactions and were compared with those of malic, malonic and succinic acids in the same mixed solvents.