Development of Mucoadhesive Electrospun Scaffolds for Intravaginal Delivery of Lactobacilli spp., a Tenside, and Metronidazole for the Management of Bacterial Vaginosis.

Bacterial vaginosis (BV) is an infection of the vagina associated with thriving anaerobes, such as Gardnerella vaginitis and other associated pathogens. These pathogens form a biofilm responsible for the recurrence of infection after antibiotic therapy. The aim of this study was to develop a novel mucoadhesive polyvinyl alcohol and polycaprolactone electrospun nanofibrous scaffolds for vaginal delivery, incorporating metronidazole, a tenside, and Lactobacilli. This approach to drug delivery sought to combine an antibiotic for bacterial clearance, a tenside biofilm disruptor, and a lactic acid producer to restore healthy vaginal flora and prevent the recurrence of bacterial vaginosis. F7 and F8 had the least ductility at 29.25% and 28.39%, respectively, and this could be attributed to the clustering of particles that prevented the mobility of the crazes. F2 had the highest at 93.83% due to the addition of a surfactant that increased the affinity of the components. The scaffolds exhibited mucoadhesion between 31.54 ± 0.83% and 57.86 ± 0.95%, where an increased sodium cocoamphoacetate concentration led to increased mucoadhesion. F6 showed the highest mucoadhesion at 57.86 ± 0.95%, as compared to 42.67 ± 1.22% and 50.89 ± 1.01% for the F8 and F7 scaffolds, respectively. The release of metronidazole via a non-Fickian diffusion-release mechanism indicated both swelling and diffusion. The anomalous transport within the drug-release profile pointed to a drug-discharge mechanism that combined both diffusion and erosion. The viability studies showed a growth of Lactobacilli fermentum in both the polymer blend and the nanofiber formulation that was retained post-storage at 25 °C for 30 days. The developed electrospun scaffolds for the intravaginal delivery of Lactobacilli spp., along with a tenside and metronidazole for the management of bacterial vaginosis, provide a novel tool for the treatment and management of recurrent vaginal infection.

Knot strength and antimicrobial evaluations of partially absorbable suture.

Partially absorbable suture is useful for orthopedic repair as it possesses the capacity to promote a balance between strength, degradation rate and minimal inflammation. Still, the availability of partially absorbable suture is scarce. So far, no study has examined the mechanical strength and anti-microbial properties of partially absorbable monofilament suture made of low-density polyethylene (LDPE)/polylactide (PLA)/chitosan (CHS); hence, the reason for this study with a view to improve knot strength, antimicrobial property and degradation rate. In this study, monofilament suture was extruded using different weight fractions of LDPE, PLA and CHS. In vitro degradation studies were carried out using phosphate buffer solution (PBS). Mechanical and morphological changes were also examined. A standard Fourier transform infrared spectral of 3433, 2909-2840, 1738, 1452, 1174, 1062, 706 cm-1 were assigned to OH group, C-H stretch, C=O vibration of ester, CH3 bending, alkyl ester and CH2 stretch, respectively. Tensile strength of knotted neat LDPE (4.84 MPa) exhibited 48.7% improvement in LDPE/PLA/CHS (60/39.5/0.5). This suggests that a good knot can be achieved to 40% weight fraction of PLA. The monofilament suture also demonstrated better antimicrobial property as the monofilament, LDPE/PLA/CHS (60/39.5/0.5) and LDPE/PLA/CHS (50/49.5/0.5) covered 12.7 mm zone of inhibition which is greater than the standard 1 mm. The suture's morphological phases show dark fibre-like rough surfaces with microstructural irregularities as PLA and CHS were added to the matrix, which is required for enhanced degradation. Thus, the partially absorbable suture produced in this study could serve as a suture for tendon repair.

Formulation and Optimization of Metronidazole and Lactobacillus spp. Layered Suppositories via a Three-Variable, Five-Level Central Composite Design for the Management of Bacterial Vaginosis.

Bacterial vaginosis, a polymicrobial clinical syndrome characterized by a shift in healthy vaginal microbiota due to bacterial colonization, is characterized by high recurrence rates after conventional treatment with an antimicrobial agent. This has necessitated the need to develop a formulation that has the potential to ensure Lactobacilli viability and bacterial clearance. This study seeks to develop and optimize a layered suppository using a five-level central composite design to ensure optimized metronidazole release and lactic acid viability. Layered suppositories were formulated using the fusion method using polyethylene glycol blend 1500/4000 and Ovucire® as suppository bases. Lactobacillus fermentum was incorporated in the molten mass before molding the solid body suppositories into the cavity of hollow-type suppositories and sealing the molten excipients. Artificial neural network model predictions for product optimization showed high predictive capacity, closely resembling experimental observations. The highest disintegration time recorded was 12.76 ± 0.37 min, with the optimized formulations showing lower times of 5.93 ± 0.98 min and an average weight of 1.17 ± 0.07 g. Histopathological observations determined high compatibility of suppositories with vaginal cells with no distortion or wearing of the vagina epithelium. This optimized formulation provides a safe and promising alternative to conventional suppositories in the treatment and prevention of the recurrence of bacterial vaginosis.

Chitosan-Based Microparticle Encapsulated Acinetobacter baumannii Phage Cocktail in Hydrogel Matrix for the Management of Multidrug Resistant Chronic Wound Infection

Objectives: Multi-drug resistant bacteria have been implicated in various debilitating infections that have led to life loss. This study developed an approach to tackle multidrug resistant Acinetobacter baumannii infection in a chronic wound model through A. baumannii phage encapsulation with resuspension in hydrogel. Materials and Methods: Two isolates of A. baumannii-specific lytic phases ɸAB140 and ɸAB150 alone, in combination (cocktail) encapsulated within a chitosan (CS) microparticle was suspended in CS hydrogel and evaluated for their therapeutic efficacy to ensure bacterial clearance in A. baumannii induced diabetic wound infection. Microencapsulation of the phage was carried out using ionic gelation techniques Biological characterization via cell cytoxicity, in vivo wound healing, histology and histomorphometry was carried out. Results: Two characterized A. baumannii phages (ɸAB140 and ɸAB150), specific to twenty A. baumannii isolates, were isolated. The encapsulated CS microparticle hydrogel exhibited a pH of 5.77 ± 0.05. The wound size reduction was most pronounced in formulation C2, which showed statistically significant wound seize reduction on days 4 and 7, 56.79 ± 2.02% and 62.15 ± 5.11%, respectively. The optimized concentration of C2 was not toxic to the cells as it adequately supported cell growth with a proliferation rate of 215 ± 7.89% compared to control (107.32 ± 4.55%). Conclusion: Microparticle carrier technology was used to show the lytic activity against multi drug-resistant A. baumannii. In vivo results showed significant wound size reduction that was most pronounced in formulation C2 on day 4.

Artificial neural network for optimizing the formulation of curcumin-loaded liposomes from statistically designed experiments.

Curcumin is a primary polyphenol of the rhizomatous perennial plant called Curcuma Longa. Curcumin interferes favorably with the cellular events that take place in the inflammatory and proliferative stages of wound healing, hence its importance in skin regeneration and wound healing. Curcumin is however lipophilic, and this must be considered in the choice of its drug delivery system. Liposomes are spherical vesicles with bi-lipid layers. Liposomes can encapsulate both lipophilic and hydrophilic drugs, hence their suitability as an ideal drug delivery system for curcumin. There is, nevertheless, a tendency for liposomes to be unstable and have low encapsulation efficiency if it is not formulated properly. Formulation optimization of curcumin-loaded liposomes was studied by the application of artificial neural network (ANN) to improve encapsulation efficiency and flux of the liposomes. The input factors selected for optimization of the formulation were sonication time, hydration volume, and lipid/curcumin ratio. The response variables were encapsulation efficiency and flux. The maximum encapsulation efficiency and flux were obtained using lipid/curcumin ratio of 4.35, sonicator time of 15 min, and hydration volume of 25 mL. The maximum encapsulation efficiency and flux predicted were 100% and 51.23 µg/cm2/h, respectively. The experimental values were 99.934% and 51.229 µg/cm2/h, respectively. Curcumin-loaded liposome formulation is a promising drug delivery system in the pharmaceutical industry when formulated using optimized parameters derived from ANN statistically designed models.

Direct Medical Cost of Treating Substance Use Disorders in Two Tertiary Hospitals in South-West, Nigeria: A Cross-Sectional Study.

INTRODUCTION: Successful interventions for substance use disorders (SUDs), though obtainable, are not effectively utilized due to the high cost of treatment. The adoption of any given therapy is often impeded by insufficient evidence of the effectiveness of such treatment. OBJECTIVE: This study aimed to assess the direct medical cost of treating SUD in two tertiary hospitals in South-West, Nigeria. METHODS: A descriptive, cross-sectional survey of patients managed for SUD at the two psychiatric hospitals was carried out between January and June 2020. The inclusion criteria were patients with SUD above 18 years of age, registered and managed at the two hospitals. Data were collected from selected patients' case notes using a standardized data collection tool and analyzed using descriptive and inferential statistics. RESULTS: The average costs of treatment for alcohol use disorder, drug use disorder, and drug and alcohol use disorder were ₦146,425.38 ± 57,388.84, ₦135,282.09 ± 53,190.39, and ₦143,877.33 ± 68,662.04, respectively. This translates to $384.82, $355.53, and $378.12, respectively. The highest contributors to SUD treatment cost are inpatient admissions and the cost of medicines; inpatient admissions include accommodation, feeding, and laundry. CONCLUSION: Considering that over 60% of the Nigerian population lives below the poverty line, the direct cost of SUD treatment is unaffordable to the patients and the health care system, which is grossly underfunded.

African oils in dermatology.

Plant and seed oils have been used for centuries and possibly millennia in Nigeria and Africa for the maintenance of healthy skin and the traditional treatment of skin disorders. In recent times, some of these oils have regained popularity due to their availability and affordability coupled with concerns about the side effects of commercially processed skin care products. This is to assess the chemical properties, current knowledge, source of procurement, indications for topical use, benefits, and possible adverse effects of six plant oils and one animal fat commonly used in Nigeria. This is a literature review and interview with traditional healers and alternative health practitioners to document the traditional, medical, cosmetics, and other usage of oils for skin and scalp care in the African context. Literature review was done on the biochemical and pharmacological properties of each of the seven oils. Searches were made from PubMed, African Journal online, Medline, and Google scholar. Medical subject heading terms used in the search include shea butter, coconut oil, palm kernel oil, palm oil, soy oil, Baobab oil, and python oil. Plant and seed oils used locally in Nigeria and other African countries for skin care and treatment have several benefits due to the constituents of the plant oils (free fatty acids, triglycerides, ceramides, phospholipids, vitamins and antioxidants) which have been shown to promote healthy skin barrier function, wound healing and have anti-inflammatory and antimicrobial effects. They are however not without adverse effects, which may be mainly due to processing and storage hygiene. Further studies are required on these oils in view of their potential in the development of novel skincare products and dermatological therapies.

Evaluation of sonication on stability-indicating properties of optimized pilocarpine hydrochloride-loaded niosomes in ocular drug delivery.

Niosomes are increasingly explored for enhancing drug penetration and retention in ocular tissues for both posterior and anterior eye delivery. They have been employed in encapsulating both hydrophilic and hydrophobic drugs, but their use is still plagued with challenges of stability and poor entrapment efficiency particularly with hydrophilic drugs. As a result, focus is on understanding the parameters that affect their stability and their optimization for improved results. Pilocarpine hydrochloride (HCl), a hydrophilic drug is used in the management of intraocular pressure in glaucoma. We aimed at optimizing pilocarpine HCl niosomes and evaluating the effect of sonication on its stability-indicating properties such as particle size, polydispersity index (PDI), zeta potential and entrapment efficiency. Pilocarpine niosomes were prepared by ether injection method. Composition concentrations were varied and the effects of these variations on niosomal properties were evaluated. The effects of sonication on niosomes were determined by sonicating optimized drug-loaded formulations for 30 min and 60 min. Tween 60 was confirmed to be more suitable over Span 60 for encapsulating hydrophilic drugs, resulting in the highest entrapment efficiency (EE) and better polydispersity and particle size indices. Optimum sonication duration as a process variable was determined to be 30 min which increased EE from 24.5% to 42% and zeta potential from (-)14.39 ± 8.55 mV to (-)18.92 ± 7.53 mV. In addition to selecting the appropriate surfactants and varying product composition concentrations, optimizing sonication parameters can be used to fine-tune niosomal properties to those most desirable for extended eye retainment and maintenance of long term stability.

Mucoadhesive Microspheres of Maraviroc and Tenofovir Designed for Pre-Exposure Prophylaxis of HIV-1: An in vitro Assessment of the Effect on Vaginal Lactic Acid Bacteria Microflora.

PURPOSE: To formulate and evaluate microspheres of the antiretroviral drugs maraviroc and tenofovir intended for a candidate vaginal microbicide and assess its effect on the vaginal lactic acid bacteria microflora. METHODS: Ionic gelation technique was used to formulate maraviroc and tenofovir microspheres with subsequent characterization. The effect of varying concentrations of the polymer, crosslinking agent and the curing time on the outcome variables viz: particle size, mucoadhesion and encapsulation efficiency were investigated. Lactic acid bacteria were isolated from the vagina of healthy women using standard microbiologic methods. The analysis of their 16S rRNA sequence data identified Lactobacillus fermentum and Enterococcus faecalis strains which were assigned GenBank accession numbers. The efficacy of the microspheres on HIV-1BaL strain was evaluated using TZM-bl indicator cells. RESULTS: The optimal maraviroc and tenofovir microspheres had particle sizes of (434.82 µm and 456.18 µm), mucoadhesion of (93.3% and 90%) and encapsulation efficiency (92.80% and 78.9%) respectively. Maraviroc release kinetics followed a zero-order model and tenofovir was released via Higuchi model. The assay of a 1 mg/mL suspension of the microspheres on the strains of Lactobacillus fermentum and Enterococcus faecalis showed a viability of 93.9% and 89.7%, respectively. There was a statistically significant difference between the mean absorbance readings of the test agent and that of the positive control (P = 0.001). The microspheres elicited a progressive decline in HIV infectivity until at a concentration of 1 µg/mL. CONCLUSION: The antiretroviral drugs loaded in the microspheres, had good mucoadhesion which is a potential for prolonged residence time in the vagina. The antiretroviral drugs were adequately released from the microspheres and showed efficacy against the HIV-1 BaL virus strain. There was no significant disruption in the growth of the lactic acid bacteria which constitute valuable bacteria microflora of the vagina.

Enzyme Responsive Vaginal Microbicide Gels Containing Maraviroc and Tenofovir Microspheres Designed for Acid Phosphatase-Triggered Release for Pre-Exposure Prophylaxis of HIV-1: A Comparative Analysis of a Bigel and Thermosensitive Gel.

The challenges encountered with conventional microbicide gels has necessitated the quest for alternative options. This study aimed to formulate and evaluate a bigel and thermosensitive gel, designed to combat the challenges of leakage and short-residence time in the vagina. Ionic-gelation technique was used to formulate maraviroc and tenofovir microspheres. The microspheres were incorporated into a thermosensitive gel and bigel, then evaluated. Enzyme degradation assay was used to assess the effect of the acid phosphatase enzyme on the release profile of maraviroc and tenofovir microspheres. HIV efficacy and cytotoxicity of the microspheres were assessed using HIV-1-BaL virus strain and HeLa cell lines, respectively. Maraviroc and tenofovir release kinetics followed zero-order and Higuchi model kinetics. However, under the influence of the enzyme, maraviroc release was governed by first-order model, while tenofovir followed a super case II transport-mechanism. The altered mode of release and drug transport mechanism suggests a triggered release. The assay of the microspheres suspension on the HeLa cells did not show signs of cytotoxicity. The thermosensitive gel and bigel elicited a progressive decline in HIV infectivity, until at concentrations of 1 µg/mL and 0.1 µg/mL, respectively. The candidate vaginal gels have the potential for a triggered release by the acid phosphatase enzyme present in the seminal fluid, thus, serving as a strategic point to prevent HIV transmission.

Development and evaluation of mucoadhesive bigel containing tenofovir and maraviroc for HIV prophylaxis.

BACKGROUND: Sexual transmission of HIV is the most common means of acquiring the disease. Topical microbicides have been investigated to prevent transmission. This study will use a specific entry inhibitor, maraviroc, and a nucleotide reverse transcriptase inhibitor (NRTI), tenofovir, a dual combination which will provide a synergist effect that can enhance the efficacy of HIV microbicides via a mucoadhesive dual compartment bigel. Bigel formulation via hydrogel organogel linkages were developed and evaluated for their physicochemical characteristics, safety, and anti-HIV efficacy. In vitro diffusion studies were performed with Franz diffusion cells having effective diffusion surface area of 1.76cm2 and receiver chamber volume of 15mL. RESULT: The bigel formulations showed a viscosity ranging from 14179 to 14560 cPs and had a good spreadability and acidic pH in the range of 4.0 ± 0.34 to 5.2 ± 0.18. The bigel formulations showed good anti-HIV activity at a concentration of 0.1 µg/mL. The in vitro release study of maraviroc from the bigel formulations showed a release rate ranging from 2.675 to 3.838 µg/cm2/min½ while the release rate for tenofovir ranged from 3.475 to 3.825 µg/cm2/min½. The bigel formulations were non-toxic to the human vagina as there was < 1 log10 change in Lactobacilli crispatus viability. CONCLUSION: This study successfully developed a dual compartment bigel containing maraviroc and tenofovir. BG C was found to be stable and safe towards vaginal and rectal epithelium, and it actively prevented HIV transmission. This bigel has the potential for long-term pre-exposure prophylaxis prevention of HIV transmission.

Formulation and Optimization of Gentamicin Hydrogel Infused with Tetracarpidium Conophorum Extract via a Central Composite Design for Topical Delivery.

OBJECTIVES: Response surface methodology coupled with statistically designed experiments has been found to be very useful in optimising multivariable processes. The aim of this study was to evaluate the influence of two independent variables, a ratio of permeation enhancers/antioxidants (transcutol and ethanolic extract of tetracarpidium conophorum EETC) and stirring rate, on the flux and permeation of gentamicin hydrogel. MATERIALS AND METHODS: A modification of free radical initial polymerization was used to formulate the gentamicin hydrogel. A 32 factorial CCD was then used to investigate the effect of independent variables of the permeation enhancer transcutol: EETC (X1), stirring speed (X2) via 14 formulation batches, which were evaluated for dependent variables flux (Y1) and amount of drug permeated after 12 hours (Y2) ex vivo. RESULTS: The results of ANOVA performed to determine the fit of the models revealed that the models were statistically significant (p<0.05) and did not show lack of fit (R2>0.80). The regression equation generated for flux was Y1=19.35 - 25.82X1 - 0.044X2 + 0.0097X1X2 + 11.86X21 and for cumulative permeation of gentamicin in 12 hours Y2=315.50 - 189.67X1 + 0.28X2 -1.29X1X2 + 123.55X21. The validity of the statistical models used for predicting flux and drug permeation was confirmed by conducting three confirmation experimental runs at the identified optimum conditions. The results showed that there was no significant difference between the experimental results and those predicted by the statistical models. CONCLUSION: The excellent correlation between the predicted and measured values shows the validity of statistical models (R2=0.95). An antioxidant and permeation enhancer has been used for the first time to investigate the influence on dependent variables. Optimization of gentamicin hydrogel using central composite statistical design is valid for the prediction of drug permeation and flux using variables in formulation.

Effect of pore size and morphology of activated charcoal prepared from midribs of Elaeis guineensis on adsorption of poisons using metronidazole and Escherichia coli O157:H7 as a case study.

Agricultural waste obtained from Elaeis guineensis mid ribs can provide a veritable source of materials which can be used as precursor materials for the production of pharmaceutical grade activated charcoal. The pore size and surface morphology of activated charcoal defines the types of molecules that could be adsorbed unto it, as surface morphology plays a significant role in determining the surface availability and areas of adsorption. The activated charcoal samples prepared from Elaeis guineensis via either physical or chemical activation was characterized via surface area using the BET method and subsequently pore structure and size analyzed by scanning electron microscopy (SEM). Physically activated Elaeis guineensis fronds activated with nitrogen gas had wide spread microporosity with micropore volume of 0.232 cc/g compared to the chemically activated with 1M and 3M phosphoric acid respectively. The commercial activated charcoal/metronidazole combination in the in vitro-pharmacodynamic model reflected no re-growth after 4 hours, however for charcoal formulated from Elaeis guineensis via chemical activation with 3M phosphoric acid and metronidazole no regrowth was seen at the second hour and this was maintained throughout the duration of the experiment. Increased macroporosity enhanced bacterial adsorption and this was further facilitated by the presence of antibacterial metronidazole in the in vitro pharmacodynamic model. Activated charcoal produced from agricultural waste obtained from Elaeis guineensis dried mid ribs consisting of increased macroporosity with mixed meso/micro porosity and antibacterial metronidazole form the best model for bacterial adsorption and will be useful in the treatment of diarrhea caused by E. coli O157:H7.

Analysis of metronidazole in equine plasma using liquid chromatography/tandem mass spectrometry and high-resolution accurate mass spectrometry.

RATIONALE: Treatment of racehorses with bicarbonate solutions to manage acidosis and muscle cramps prior to competition is banned in Pennsylvania (PA). Use of excess bicarbonate in horses causes diarrhea, requiring treatment with an antibiotic such as metronidazole (MTNZ). At present no method exists for detecting MTNZ in equine plasma. Thus, a liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for the detection, quantification and confirmation of MTNZ was developed. METHODS: The analyte was recovered from plasma by liquid-liquid extraction using methyl tert-butyl ether and separated on an ACE® C18 column with its guard column. The mobile phase comprised a mixture of 5 mM ammonium formate (pH 3.5) and acetonitrile (60:40; v/v). Mass analysis was performed on an LTQ XL linear ion trap mass spectrometer in positive electrospray ionization mode while accurate mass determination was also performed in positive electrospray ionization mode using high-resolution accurate mass spectrometry (HRAMS). RESULTS: The limit of detection (LOD), limit of confirmation (LOC) and lower limit of quantification (LLOD) were 1, 2 and 50 ng/mL, respectively. The analyte in plasma was stable at -20 and -70°C for 28 days, as well as for 24 h at 20°C in the autosampler. The percentage coefficients of variation (% CV) for the intra-day and inter-day precision for the LLOQ were 5.1:3.68 and 13.21:9.95, respectively, while the intra-day accuracy was from 98.71 to 101.57% and that of the inter-day was from 88.64 to 96.6%. The matrix effect was between 9 and 24%. The precursor → product ion transition m/z 172 → 128, a retention time of 2.92 min and the accurate mass of the [M+H](+) ion of the analyte (m/z 172.0173) were used as criteria for confirmation of the presence of MTNZ in equine plasma. CONCLUSIONS: The method is highly sensitive and selective for the detection, identification and confirmation of MTNZ in equine plasma. Thus, illegal use of MTNZ in racehorses can be routinely monitored within the US State of Pennsylvania. The method is fast, sensitive, reproducible, and reliable.