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Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula
Tang Ee Ling Serene,Shelat Vishalkumar G,Junnarkar Sameer Padmakumar,Huey Cheong Wei Terence,Low Jee Keem,Wang Bei,Woon Wei Liang Winston 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.4
Backgrounds/Aims: Traditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days’ (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF). Methods: We conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used. Results: 5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93-1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low. Conclusions: Patients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.
Gandhi Jeet,Suthar Disha,Patel Hetal,Shelat Pragna,Parejiya Punit 경희대학교 융합한의과학연구소 2021 Oriental Pharmacy and Experimental Medicine Vol.21 No.3
A widespread of superficial fungal infections deals with concerns related to current therapeutic regimen such as drug resistance and adverse events associated with the same which leads exploration of natural oils as an antifungal agent. The aim of present work is to the development of clove oil loaded microemulsion based gel for treatment of superficial fungal infections. The microemulsion based gel was prepared by phase titration method and optimized using D-optimal design considering globule size, drug permeation and drug retention on skin as critical quality attributes. The MIC and zone of inhibition of clove oil was found to be 2.2 mg/ml and 38 mm respectively. A pale to yellowish transparent microemulsion had a globule size, zeta-potential and PDI of 14.41 nm, 0.73 and 0.0113 respectively indicating a stable microemulsion. A clove oil loaded microemulsion based gel (CLMBG) with a pH of 6.27 and viscosity of 12.87 m.pas/sec exhibited a comparable texture profile to marketed preparation. The drug release of the CLMBG with a drug content of 102.6 ± 4% in acetate buffer pH 5.5 was 98.5 ± 0.35% ensuring complete drug release from the formulation. Ex-vivo drug permeation study and skin irritation study dictated the retention of drug at site of action and the formulation to be non-irritant. The antifungal study proved the formulation to have similar efficacy as the marketed product (clobet gel). The stability study indicated the product to be safe, efficacious and stable formulation. From the above results, it can be derived that clove oil loaded microemulsion based gel can be a promising alternative to current antifungal regimens.
Laparoscopic splenectomy for splenic rupture secondary to metastatic choriocarcinoma
Tan Ming Ngan Aloysius,Vishalkumar G Shelat 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.1
Gestational choriocarcinoma is a rare and aggressive type of gestational trophoblastic neoplasia, which is characterized by early vascular invasion and widespread metastases. Choriocarcinoma metastasizes hematogenously, and bleeding from metastases is common. Splenic rupture from a metastatic tumour is exceedingly rare, with only a few reports. We report a case of a 41-year-old female presenting with acute abdomen and haemorrhagic shock secondary to splenic rupture from metastatic choriocarcinoma, which was managed with emergency laparoscopic splenectomy.
Development of phenytoin intranasal microemulsion for treatment of epilepsy
Sheetal Porecha Acharya,K. Pundarikakshudu,Pratik Upadhyay,Pragna Shelat,Anita Lalwani 한국약제학회 2015 Journal of Pharmaceutical Investigation Vol.45 No.4
The objective of the present investigation was to prepare phenytoin microemulsion for intranasal administration by application of experimental design. Phenytoin microemulsion was prepared by water titration method. The concentration of oil (X1), surfactant (X2) and cosurfactant (X3) were selected as independent variables, in a simplex centroid design, from microemulsion region obtained from pseuodoternary phase diagram while the globule size (Y1) and cumulative phenytoin diffused at 60 min (Y2) through sheep nasal mucosa were taken as dependent variables. Mathematical models were generated for the response variables. The validity of the generated equations was established using check point batches. Microemulsion that had a smaller globule size of dispersed phase and high level of % drug diffusion was desirable. The generated mathematical equations were used to identify the desirable zone where all the criteria for the responses were satisfied and an optimum batch was recognized. Ex-vivo study of optimum microemulsion on sheep nasal mucosa shows absence of nasal toxicity. It was found that faster recovery from seizures was obtained in rats treated with intra nasal phenytoin microemulsion in comparison to the rats treated with oral microemulsion and nasal solution. Higher concentration of phenytoin was found in rats treated with intranasal microemulsion in comparison to the rats treated with phenytoin solution administered intraperitoneally. Gamma scintigraphy results also suggested faster availability of drug into brain when microemulsion was administered intranasally.
Bhavesh S. Barot,Punit B. Parejiya,Pragna K. Shelat,Gaurang B. Shah,Dharmik M. Mehta,Trupti V. Pathak 한국약제학회 2015 Journal of Pharmaceutical Investigation Vol.45 No.1
Intravenous iron formulations comprising ofiron/iron–oxyhydroxide–carbohydrate complex are anestablished therapy for the treatment of iron deficiency anemia. These preparations should be subjected to exhaustive physicochemical and toxicological studies in order to establish their safety and efficacy. Following VenoferⓇ (innovator iron–sucrose formulation), variousiron sucrose similar have entered into the market with equivalent physicochemical and toxicological profile. This report describes the physicochemical and toxicological studies of a novel iron sucrose injection (IS-Claris). IS-Claris and VenoferⓇ were subjected to various physicochemical studies such as elemental and chemical analysis;X-ray diffraction; particle size and distribution; labile iron detection, Mo¨ssbauer and Raman spectroscopy. The presenceof iron oxides in IS-Claris and VenoferⓇ could be confirmed by the major peaks at 24.65˚ (2θ) and 38.2˚ (2θ). The iron sucrose samples demonstrated similar reduction peaks of Fe(III) to Fe in their respective polarograms. The average diameter of the core of IS-Claris and VenoferⓇ was estimated to be 2.92 ± 0.01 and 2.77 ± 0.63 nm, respectively. The Mo¨ssbauer spectra of IS-Claris and VenoferⓇ showed a doublet with an isomer shift δ = 0.43 ± 0.01 mm/s. Moreover, the other physicochemical specifications of IS-Claris were comparable to VenoferⓇ. The toxicological studies demonstrated that IS-Claris safety profile is equivalent to VenoferⓇ. It could be concluded that IS-Claris could be used as a potential alternative to VenoferⓇ with similar clinical implications.
Punit B. Parejiya,Rakshit C. Patel,Dharmik M. Mehta,Pragna K. Shelat,Bhavesh S. Barot 한국약제학회 2013 Journal of Pharmaceutical Investigation Vol.43 No.4
Present study aims at formulation and development of quick dissolving film of nebivolol hydrochloride applying simple lattice experimental design using three hetero polymers hydroxypropyl methylcellulose, pullulan and polyvinyl pyrrolidone. Films were prepared using solvent casting technique and optimized formulation was derived by desirability function. Regression equations and contour plots were executed to narrate dependent variables,i.e. percentage drug release in 30 s (Y30), tensile strength,elastic modulus, percentage elongation and load at yield, to independent variables. Results of the experimental design revealed that the independent factors hydroxypropyl methylcellulose and pullulan significantly influenced the mechanical properties and percentage drug release from the film which was ultimately reflect in the formulation of optimized batch. The high % drug release of the film in simulated saliva and simulated gastric fluid indicated that it can be successfully used in drug delivery systems for drugs with high first-pass metabolism.
Percutaneous transhepatic biliary drainage catheter fracture
Jia Rui Kwan,Keith Sheng Hng Low,Rahul Lohan,Vishal G Shelat 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.3
Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.