Formulation and evaluation of fluconazole pro-niosomal gel for topical administration.

The present investigation was aimed to explore the potential of proniosomal gel for the topical delivery of fluconazole. Fluconazole-loaded proniosomes were prepared by the coacervation method using different nonionic surfactants (spans and tweens) and evaluated for various parameters like size, shape, stability, entrapment efficiency, in-vitro release, ex-vivo skin permeation and retention study. Results showed that proniosomes composed of span 20 (F1), span 60 (F4), span 80 (F7) were more stable compared with tween 20 (F10) and tween 80 (F13) with smaller size, “i.e.” 4.08±0.18 μm, 2.61±0.15 μm, 2.01±0.12 μm, 8.56±0.20 μm, and 7.10±0.31 μm, respectively, along with higher entrapment efficiency (approx. >46%). Ex-vivo skin penetration and retention studies revealed that cutaneous deposition was affected by the nature of surfactant and vesicle size. Therefore the proniosomes containing span 60 having high amount of drug retained in skin, “i.e.” 25.97±1.28 which can help in localized delivery of drug especially in fungal mediated skin diseases, thereby increased efficacy for prolonged period can be achieved.

Efficacy of a low cost protocol in reducing noise levels in the neonatal intensive care unit.

Objective. To examine the effectiveness and cost of implementing a noise reduction protocol in a level III neonatal intensive care unit (NICU). Methods. A prospective longitudinal study was done in a level III NICU, wherein a noise reduction protocol that included behavioral and environmental modification was implemented. The noise levels were measured sequentially every hour for 15 days before and after this intervention. The statistical significance of the reduction in noise levels after implementation of the protocol was tested by paired sample student's t-test. Cost was calculated using the generalized cost effectiveness model of the World Health Organisation. The present study has 80 % power with 95 % confidence to measure 2 dB differences between groups for the maximum recommended of 50 dB. Results. The protocol in the present study reduced noise levels in all the rooms of the NICU to within 60 dB with high statistical significance (p< 0.001). The extent of noise reduction in the rooms of the NICU was as follows : ventilator room by 9.58 dB (95 % confidence interval: 6.73 – 12.42, p < 0.001) , stable room by 6.54 dB (95 % confidence interval: 2.92 – 4.16 , p < 0.001), isolation room by 2.26 dB (95 % confidence interval: 1.21 – 3.30, p < 0.001) , pre-term room by 2.37 dB(95 % confidence interval: 1.22 – 3.51, p < 0.001)and extreme preterm room by 2.09 dB (95 % confidence interval: 1.14 – 3.02, p < 0.001). The intervention was most cost-effective in the ventilator room, requiring Rs. 81.09 to reduce 1 dB and least effective in the extreme pre-term room requiring Rs. 371.61 to reduce 1 dB. Conclusion. The high efficacy and affordability of noise reduction protocols justify the need for implementation of these measures as a standard of care in neonatal intensive care units.

Neem oil poisoning.

We report an unusual case of neem oil poisoning in a previously normal 5 year old child. The child presented with refractory seizures and was having metabolic acidosis. Late neurological sequelae in the form of auditory and visual disturbances, and ataxia were present.