Effect of different permeation enhancers on topical miconazole nitrate preparations

Miconazole nitrate was formulated into different topical preparations, including gels with different polymers, ointments as oleaginous, water-soluble bases and cream. In vitro skin permeation studies through rabbit skin to a receptor medium of [1:1] Methanol: phosphate buffer [pH6] For a period of 8 hour was studied. Different chemical enhancers as menthol, isopropyl myristate [IPM], oleic acid and ethanol, were incorporated into miconazole carbopol 934 P gel in different concentrations. They showed improved increase in Flux through rabbit skin. The best formula which showed significant flux was miconazole carbopol 934 p gel containing 10% menthol with the highest permeation of miconazole nitrate

Formulation and evaluation of cosmeceutical preparations loaded with triclosan beads

The present study aims at sustainment of the antibacterial action of Triclosan when applied to the scalp or the skin by Preparation of Triclosan-alginate beads in different concentration of sodium alginate beads, different ratios of drug-sodium alginate and with different concentrations of calcium chloride. The prepared beads were subjected to the drug entrapment efficiency. Incorporation of beads[4: 1 of drug: sodium alginate in 0.5% w/v] in cosmoceuticals preparations viz., cold cream, carbopol 934 gel, sodium carboxymethyl cellulose gel and Texapon N70 shampoo were subjected to determination of pH of different cosmoceuticals preparations before and after incorporation of beads, release studies of triclosan beads with and without drug beads, then Invitro release studies of cosmoceuticals preparation containing 1% in beads and 1% of free triclosan and 2% beads was determined using Franz-type diffusion cell in phosphate buffer of pH 5.8. Rheology of triclosan beads with and without free triclosan in pharmaceutical preparations were done in comparison with plain ones. The results reveled that, the highest rate and extent of Triclosan-l%in beads and 1%of free drug was given by CMC gel base which exhibited plastic thixotropic flow curve, the drug lowest release was exhibited by Texapon N70 shampoo .Pertaining to the release of Triclosan 2% beads, it was evident that the highest release was from CMC gel base which exhibited plastic thixotropic flow curve, while the least release rate was from Texapon N70 shampoo exhibited plastic thixotropic flow curve with smaller extent

Combined fascial and prosthetic mesh repair for abdominal incisional hernias

Objective: Incisional hernias complicate up to 11% of incisions with a possible recurrent rate of 44%. W of the applicability and validity of combined fascial and prosthetic mesh repair in the management of incisional hernia

Methods: Forty patients [17M: 23F] were included in the study. Patients were subjected to hernia repair by a technique using both combining fascia and polypropylene mesh in the repair of all ventral incisianal hernias, regardless the site afpmm incision. Patients were followed up for morbidity or recurrence

Results: Post-operative complications included seroma formation in 6 patients, superficial wound infection in three and deep venous thrombosis in one. Post-operative hospital stay ranged from 1 to 22 days with a meal of 7.2 days. Patients were followed-up for a median of 21.3 months [range 9 to 49 months]. Two patients [5%] reported a pasistzut null local induration and one [2.5%] reported persistent local pain. Single recurrence [2.5%] was encountered in this study

Conclusion: This technique is a tension free repair applicable to all types of incisional hernias, most of due leak is lying deep under the rectus sheath and it has an acceptable complication rate with low recurrence rate

Road traffic accidents in Bahrain

To determine [a] the incidence of Road Traffic Accident [RTA] casualties treated at Salmaniya Medical Complex [SMC] and its distribution characteristics; [b] injury severity and casualty types; and [c] the affect on SMC health system. A total of 23,006 RTA casualties between the ages of 1 to 99 years from 1996 to 2001 were studied at SMC Emergency and Inpatient facilities. The data were collected from database of case records. The incidence of RTA casualties treated at SMC were 73.59% Bahrainis, 26.38% non-Bahrainis. Male Bahraini drivers between the age of 15 and 29 represented 13.90% of RTA casualties treated at SMC. Drivers between the age of 15 to 17 inclusive, accounted for 187 of RTA casualties between 1996 and 2001. The incidence of RTA injuries treated at SMC indicated 42.5% increase in casualties treated from 1996 to 2001. Slight injuries increased 27.2% while ambulance cases increased by 244.6% and inpatient admissions increased by 18.8%. Inpatient deaths decreased by 75%. SMC records indicate that the incidence of death is decreasing while police reports indicate that the incidence of death has increased by 75%. SMC records do not include all police recorded deaths, and police records do not include SMC inpatient deaths unless payment cases. Fractures represented 46.76% of all inpatient injuries, followed by intra-cranial injuries [29.76%]. Total days of care for RTA casualties over six years were 31,595 days with an estimated economic cost of 3,097,869.7 Bahrain Dinars. The evidence strongly supports the need for tougher enforcement of legislation and policy for speed limits, seat belts, driver education programs, and collaborative studies to support road traffic accident prevention and safety

Impact of triage in accident and emergency departments in Bahrain

We aimed to assess the impact of triage by physicians on the workload and expenditure of the Accident and Emergency [AE] Department of Salmaniya Medical Complex, Bahrain. We analysed three sets of data: patient visits to the AE Department over a 9-month period; patient visits 1 year previously; and forecast patient visits over 9 months starting from July 1999. The referral of patients to AE cubicles was reduced by 54.4% after the implementation of the triage, and reduction in the workload was statistically significant. The reduction in health care expenditure was estimated at between 15.3% and 17.3%. We conclude that triage by physicians can be cost-effective and can reduce the AE Department workload, freeing more time to manage life-threatening and urgent cases

Lattissimus dorsi musculocutaneous flap in management of advanced cancer breast

To determine the effectiveness of the use of lattissimus dorsi muscle in management of advanced cancer breast. Plastic surgery service, Surgical Department, Salmaniya Medical Complex, Bahrain. Review of all cases of advanced cancer of breast necessitating use of flaps for coverage of skin defect after or management of advanced cancer breast. The flaps survived completely in all the 8 patients. Lattissimus dorsi is a very useful flap in management of advanced cancer breast cases

Analysis of cuses of death at the salmaniya medical complex, bahrain, 1995

This study was undertaken to identify the underlying causes of death as recorded in the death certificates over a one year period [1995] at the Salmaniya Medical Complex [SMC], Bahrain. The 741 death certificates reviewed in this study represented 88% of 842 deaths occurred at SMC, and 41% of the total 1786 deaths in Bahrain, as reported in the National Health Data of the Ministry of Health. The underlying causes of death as recorded in the SMC and the National Data showed differences that were statistically significant [P<0.005]. Moreover, there was lack of concordance between the documented cause of death and the underlying disease in 26.9% of cases in the reviewed certificates. This discordance was specifically noticed in the case of deaths assigned to cardiovascular disease and septicemias, where more deaths were assigned to these two categories than was justified from the records. Furthermore, diseases like researchers were able to reinterpret the records and revise the recorded causes of death and the underlying diseases. It was also noticed that death could not be attributed to any specific cause in 3.1% of reviewed certificates. It is concluded that the death certificates should be recorded by experienced clinicians and should represent the correspondence between the actual cause of death and the underlying disease, thus maintaining the relationship between morbidity and mortality statistics

survey of ambulance service at the ministry of health, state of Bahrain, with special reference to utilization of services

Bahrain is an island of population 508037 as per 1991 census, 64% Bahraini nationals and the rest are expatriates. The Emergency Medical Services developed in 1985 within the Department of Accident and Emergency at Salmaniya Medical Centre, which is the largest government hospital, providing ambulance services on the island. The study aims to provide a survey of the current ambulance services within the Ministry of Health and its utilization

Physicians to patient ratio in the accident and emergency department of Salmaniya medical centre

The average annual number of patients seen in Accident and Emergency [A/E] Department in Salmaniya Medical Center [SMC] is 170,293 and the average time spent by the SMC A/E physician is 10.45 minutes/patient. The purpose of this study is to calculate the optimal number of physicians needed to look after these patients using the Bahrain Civil Service Bureau formula. Our figures indicated a need for a minimum of 33 physicians, but the Department is now run on 16 doctors only. One of the most difficult questions to answer in emergency medicine is "How many physicians on an average do we need to cover our emergency department"? The answer to this question is complex and depends on many factors such as the qualifications and experience of the emergency physicians, the patients flow, the philosophic attitude towards treatment of patients in A/E, the acuteness of the illness, management procedure and the financial structure on which the Emergency Department physicians group is based

Supraventricular tachyarrthmias efficacy of verapamil

verapamil is the drug most widely used in the management of supraventricular tachyarrhythias [SVT] in the absence of contraindications. Hypotention complicating SVT is not considered an absolute contraindication for the use of IV verapamil. The purpose of this study was to assess the efficacy of IV Verapamil in SVT. And its safety in the patients with arterial hypotension. The study was retrospective conducted in Salmaniya Medical Center, Accident and Emergency Department. Inclusion criteria were: SVT [defined as narrow complex tachycardia with regular R.R. interval and rate of 150 BPM or more, systolic blood pressure between 90 and 150mm/Hg. 60 consecutive cases were included, age range 27-70 years, female male = 46 14 i.e. ration 3 1. all patients with organic heart diseases, heart failure, thyroid disease or ECG abnormality rather than SVT. Were excluded from the study. Verapamil was administered in 58 patients. One patient converted spontaneously to NSR before treatment and one patient reverted with carotid massage. Carotid massage was tried as first line therapy in only 2 patients. Three patients did not respond to verapamil but reverted following digoxin IV efficacy of verapamil was 94.8% [55/58]. Hypotension following verapamil was not encountered in any patient. Hematological investigations were done in 59 patients [98.3%] and chest radiographs were done in 59 patients [98.3%]. These had no influence on the management and so were deemed unnecessary. 12 patients [20%] were admitted to rule out ischemic heart disease. The remaining was discharged from A/E within few hours

comparison between the completeness of referral letters from primary to secondary health care centres in Bahrain in 1992 and 1993

This study was undertaken to describe the informative aspect of the referral letters from primary health care to accident and emergency at Salmaniya Medical Center. 638 referrel letters were deficient in various aspects. 23.35% of the referral letters were efficient regarding the age of the patient, and on 8.6%, the sex of the patient was not recorded. The past history of the patientwas not recorded on 88.87%. duration of the disease was not mentioned on 37.6%. clinical finding were not mentioned on 37.46%, and investigation were not mentioned on 79.31%. the identity of the referring physician was on 36.06% and telephone numbers of the health centers were not recorded on 74.93%

Over-utilization of pathology services by accident and emergency department

The over utilization of laboratory services by the accident and emergency [A/E] department at Salmaniya Medical Center is reported. 12583 test procedures ordered for the month of November 1992 for 14607 patients were analysed. BD. 488,484 estimated as yearly test expenditure. A proforma to curtail unnecessary tests is proposed which will reduce the expense by 6.1%

Profile of attendance in accident and emergency department: Salmaniya medical centre

Accident and Emergency Department [A and E] of Salmaniya Medical Centre [SMC] is designed to manage life threatening and urgent medical conditions. The Salmaniya Medical Centre Accident and Emergency Department serves all the population of Bahrain. The Department served 144997 patients in 1991 and 163044 patients in 1992. This study was undertaken to evaluate the patterns of attendance at the SMC/A and E department