Problems and perceived needs for medical ethics education of resident physicians in Alexandria teaching hospitals, Egypt

There is a call for greater preparation for the ethical challenges encountered by physicians in their future professional duties. This study in Egypt aimed to reveal problems and perceived needs for medical ethics education of resident physicians working at University of Alexandria hospitals. In a descriptive, cross-sectional survey, 128 residents answered a self-administered questionnaire. More than half were of the opinion that their medical ethics course was ineffective; 56.3% mentioned poor curricular planning. The majority complained that the subject was not tailored to specialties, the course was too short, there was a shortage of resources to facilitate the educational process and that assessment was done for knowledge but not for skills. Problems related to staffing were low staff: student ratios and staff lack of experience. Trainees, regardless of clinical discipline, felt that there was a great need for improvement to their medical ethics education

Problems and perceived needs for medical ethics education of resident physicians in Alexandria teaching hospitals, Egypt

There is a call for greater preparation for the ethical challenges encountered by physicians in their future professional duties. This study in Egypt aimed to reveal problems and perceived needs for medical ethics education of resident physicians working at University of Alexandria hospitals. In a descriptive, cross-sectional survey, 128 residents answered a self-administered questionnaire. More than half were of the opinion that their medical ethics course was ineffective; 56.3% mentioned poor curricular planning. The majority complained that the subject was not tailored to specialties, the course was too short, there was a shortage of resources to facilitate the educational process and that assessment was done for knowledge but not for skills. Problems related to staffing were low staff:student ratios and staff lack of experience. Trainees, regardless of clinical discipline, felt that there was a great need for improvement to their medical ethics education

Knowledge, perceptions and practices towards medical ethics among physician residents of University of Alexandria hospitals, Egypt

This cross-sectional study was conducted to assess the knowledge, perceptions and practices towards medical ethics of physician residents at university hospitals in Alexandria, Egypt. A self-administered structured questionnaire was used for knowledge and perceptions and a checklist for observations of doctor -patient interactions in the outpatient setting. Only 18.0% of the 128 participating residents had obtained their knowledge from their medical education and 29.9% were dissatisfied with the roles played by the ethics committee. Most of the residents had satisfactory knowledge and 60.2% had satisfactory perceptions regarding ethical issues. The lowest perception score was in the domain of disclosing medical errors. Only 48.0% of the residents were compliant with the principles of medical ethics in practice and 52.0% of patients were dissatisfied with their treating physicians. The study identified areas of unsatisfactory knowledge and practices towards ethical issues so as to devise means to sensitize residents to these issues and train them appropriately

Preparation and in vitro evaluation of self-nanoemulsifying drug delivery systems (SNEDDS) containing clotrimazole.

This study sought to formulate and evaluate a self-nanoemulsified drug delivery system (SNEDDS) for clotrimazole (CT), a poorly water-soluble antimycotic drug, used in vaginal delivery. SNEDDS was developed to increase the CT dissolution rate, solubility, and ultimately bioavailability. The solubility of CT in various oils, surfactants, and co-surfactants was determined. Based on solubility studies, oil phase (oleic acid without or with coconut oil), surfactant (Tween 20), and co-surfactants (PEG 200 and n-butanol) were selected and grouped in two combinations for phase studies. Pseudo-ternary phase diagrams were used to evaluate the area of self-nanoemulsification. Essential properties of the prepared systems with regard to emulsion droplet size and turbidity value were determined. In order to investigate the potential for interaction between any of the SNEDDS ingredients used, FTIR spectroscopy was performed. In vitro release studies were performed with SNEDDS formulations in capsules, and the plain drug served as a control. The droplet size of the nanoemulsion was greatly affected by the ratio of the surfactant and co-surfactant. Based on the results with regard to droplet size, turbidity values, and complete drug release after 3 h, three optimized formulations were selected; each contained oleic acid/coconut oil/Tween 20/PEG 200/n-butanol in ratios of 10:0:60:15:15 (%, w/w), 7.5:2.5:53.5:13.3:13.3 (%, w/w), and 6.7:3.3:60:10:10 (%, w/w), respectively. Results suggested that the prepared SNEDDS formulations produced acceptable properties in terms of immediate drug release and could increase the bioavailability of CT.

Comparative evaluation of ketoconazole-ß-cyclodextrin systems prepared by coprecipitation and kneading.

Ketoconazole (KZ), an imidazole antifungal, was formulated into inclusion complexes via coprecipitation and kneading with ß-cyclodextrin (ß-CD) as a carrier in 1:1 and 1:2 drug to carrier ratios. The KZ-ß-CD solid complexes were characterized by X-ray diffraction and differential scanning calorimetry (DSC). The diffraction pattern of the pure drug revealed the drug to be highly crystalline in nature, as indicated by numerous distinctive peaks. The lack of numerous distinctive peaks of the drug in KZ-ß-CD complexes prepared by the two methods revealed that a large number of the drug molecules were dissolved in a solid-state carrier matrix with an amorphous structure. The thermograms of the KZ-ß-CD complexes showed a strong reduction in the intensity and broadening of drug peaks somewhat in both kneading and coprecipitation systems, suggesting that the drug is monomolecularly dispersed in the ß-CD cavity. The prepared tablets of KZ-ß-CD solid complexes prepared by the two methods were evaluated for their quality control testing, and an in vitro release study and the results of quality control complied with pharmacopeial requirements and the release profiles indicated complete drug release after 30 min. The kinetic parameters obtained from release data were analyzed in order to explain the mechanism of drug release and revealed non-Fickian transport. Accelerated stability testing at 35°C, 45°C, and 55°C and at 75% relative humidity was carried out for six months and revealed somewhat stable systems as indicated by a t(90) of about 2 years for both KZ-ß-CD systems. A microbiological in vitro assay of KZ from the prepared tablets was performed using Candida albicans as a model fungus, and KZ had improved microbiological activity when administered as an inclusion complex with ß-CD. The results confirmed the benefit of using CDs as a useful tool to enhance the dissolution and hence bioavailability of poorly water-soluble drugs by forming solubilizing systems when exposed to gastrointestinal fluid.

Novel regioselective formation of S- and N-hydroxyl-alkyls of 5-(3-chlorobenzo[b]thien-2-yl)-3-mercapto-4H-1,2,4-triazole and a facile synthesis of triazolo-thiazoles and thiazolo-triazoles. Role of catalyst and microwave.

Regioselective alkylation of 5-(3-chlorobenzo[b]thien-2-yl)-4H-1,2,4-triazole (1) with hydroxy alkylating agents 2, 3, 13, and the 2,3-O-isopropylidene-1-O-(p-tolylsulfonyl)-glycerol (10) afforded the corresponding S-alkylated derivatives 6, 7, 11, and 14 under both conventional and microwave irradiation conditions; bentonite as a solid support gave better results, with no change in regioselectivity. A facile intramolecular dehydrative ring closure of 6, 7, 11, and 14 using K(2)CO(3) in DMF afforded the corresponding fused triazolo-thiazines and thiazolo-triazole 17-19. The isopropylidenes and acetyl derivatives of the products were prepared.

Bioavailability assessment of salbutamol sulfate suppositories in human volunteers.

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.

Honey, a prospective antibiotic: extraction, formulation, and stability.

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.

Release and rectal absorption of ethosuximide from suppositories in rabbits.

Ethosuximide was formulated in different suppository bases. In vitro release experiment demonstrated more rapid and higher release of the drug from water soluble polyethylene glycol (PEG) bases than from Witepsol fatty bases. Rectal administration in PEG 400:4000 and 400:6000 to rabbits gave high plasma levels where Cmax was 45.66 and 42.66 micrograms.ml-1, respectively; while, in the presence of Witepsol E76 and W35 it was 34.00 and 28.33 micrograms.ml-1, respectively. The systemic availability was 89.39%, 82.72%, 58.80% and 47.45% when the bases were PEG 400:4000, PEG 400:6000, Witepsol E76 and Witepsol W35, respectively.

Adsorption characteristics of certain antibiotics to veegum and activated charcoal.

Adsorption of streptomycin sulphate and neomycin sulphate to veegum and activated charcoal in water or buffered solution was studied. Both antibiotics demonstrated a significant reduction in their activity, particularly in water. The activity of streptomycin sulphate decreased in the following order: veegum in water greater than activated charcoal in water greater than veegum in buffer greater than activated charcoal in buffer and their calculated adsorption coefficients were 111 X 10(-3), 57 X 10(-3), 33 X 10(-3) and 25 X 10(-3) (respectively), while neomycin sulphate was affected in the following decreasing order: activated charcoal in water greater than activated charcoal in buffer greater than veegum in water greater than veegum in buffer. The calculated adsorption coefficients were 64 X 10(-3), 47 X 10(-3), 34 X 10(-3) and 26 X 10(-3) (respectively). The mechanism of adsorption was discussed.

Influence of some humectants on the physical characteristics of solidified sodium stearate-based sticks.

Synopsis A comparative study was conducted on the influence of widely used humectants [glycerol, propylene glycol (PG), polyethylene glycols 400 and 600 (PEG 400 and PEG 600)] on the physical characteristics of solidified sodium stearate-based sticks (SSSS). - Sticks prepared with PG or PEG 600 generally tended to be harder than the corresponding ones containing glycerol or PEG 400; - PG lowered the penetrability of the sticks while PEG 400 tended to increase it. Glycerol or PEG 600 produced sticks with intermediate penetrability values; - all investigated sticks showed practically acceptable softening points; - PG-based sticks showed the lowest yield by abrasion values while PEG 400-based ones showed the highest such values. Glycerol or PEG 600 produced sticks with intermediate behaviour; - sticks prepared with PG generally showed the highest tendency to dry by evaporation. There was a clear tendency towards reduction in evaporation with all the considered humectants, proportional to humectant concentration increase; - sticks formulated with PEGs showed considerably longer disintegration times than those formulated with glycerol or PG; - all sticks showed a plastic thixotropic flow behaviour; - static and dynamic yield value-humectant concentration curves exhibited an almost identical behaviour with all investigated systems; - generally speaking, SSSS with PG showed the highest dynamic and static yield values while those formulated with PEG 400 showed the lowest such values; the presence of PEG 400 or glycerol resulted in sticks with intermediate behaviour in this respect; - PG produced sticks showing the highest thixotropic breakdown by shear; glycerol came next in this respect. PEG-based sticks showed strong fluctuations in their thixotropic breakdown-humectant concentration behaviour; - PG gave sticks with the highest plastic viscosity; they, indeed, had a tough texture. Glycerol or PEG 600-based sticks had intermediate plastic viscosities and acceptable spreading characteristics. PEG 400-based sticks had the lowest plastic viscosity and best spreading characteristics; - almost all sticks investigated proved to be stable after 18 months storage as far as.

Effect of certain additives on stability of streptomycin sulphate.

The effect of certain additives on the stability of streptomycin sulphate at 37 and 60 degrees C, for one month was studied. In pure distilled water, streptomycin sulphate was stable for 21 d at 37 degrees C, while at 60 degrees C a significant loss occurred after only three d. The effect of McIlvain buffer at different pH values showed maximum stability at pH values of 6.5 and 7. The stability was altered when Sörensen buffer at pH = 6.5 was used. On the other hand, the effect of other commonly used additives demonstrated that at 37 degrees C Aerosil 200, kaolin and pectin did not cause any significant loss, while bentonite caused significant decrease in the activity after 15 d. In contrast, activated charcoal and veegum reduced the activity to 54.5% and 57.5%, after just 1 d and to zero after 4 d, respectively. At 60 degrees C, the rate of decomposition of streptomycin sulphate was highly accelerated.

Biological availability of sulfamethoxypyridazine and sulfisomidine polymers.

Dissolution rates and apparent solubilities of forms I, II and III of Sulfamethoxypyridazine (1) and forms I and II of sulfisomidine (2) were determined in water at 37 degrees C. The ratios of apparent solubilities of I:II:III for 1 forms and I:II for 2 forms were 1:1.18:1.25 and 1:1.32 respectively. Upon long contact of 2 with water the ratio of II:I decreased. This has been attributed to gradual transformation of 2 from form II to I. Gastrointestinal absorption of form III of 1, in human volunteers, was studied in comparison with the more stable form I. The same study was carried out on forms I and II of 2. Data were correlated and expressed in availability rate constants (K1), applying the one compartment open: model. This and other parameters show that form III of 1 is 1.4 times as much absorbed as form I, and that the availability of the metastable form II of 2 is 1.2 times as much absorbed as the stable form I.

Investigation of the discolouration developed in aged chloramphenicol suppositories.

The colouring matter developed in aged chloramphenicol (1) suppositories formulated with polyethylene glycol base was separated by extraction with water/n-butanol mixture, n-butanol or abs. alcohol. These extracts were tested for colour stability, the presence of the main degradation products of 1 p-nitrophenylaminopropandiol (2) and p-nitrobenzaldehyde (3), and investigated by TLC and absorption spectrum. Results showed that the extracted matter gave the tests for the main degradation products of 1. TLC of n-butanol layer of the first mixture or n-butanol extract gave 2 spots with different RF values identified as 2 and 3. In the case of abs. alcohol extract 2 spots adhering to each other were obtained. The same spots in the latter case were obtained for an equimolecular condensation product of 2 and 3 (obtained by condensation in acid medium). The absorption spectrum of the extracted matter showed high absorbance in the visible region and maxima appeared only in the UV region. The condensation product of 2 and 3 gave the same absorbance pattern and did not produce Schiff's base. The colour of the aqueous layer of the first mixture faded gradually which assured its not being due to azocompounds. These findings indicated that the discolouration may be due to complex formation. Using model systems of known chemical reactions showed that discolouration is due to complex formation between 2 and 3 between 1 and 2.

Antimicrobial activity of chloramphenicol in solid dispersion systems.

The effect of solid dispersion techniques on the antimicrobial activity of chloramphenicol has been studied and it was proven that the antimicrobial activity of chloramphenicol is not affected when the drug is present as a coprecipitate with carbowaxes (4.000, 6.000, 12.000), and PVP 11.000 and 40.000) also in fusion systems with these polymers. In contrast, the antimicrobial activity of the drug is enhanced when it is present in the from of a solid dispersion system.

Availability of norethisterone acetate from combined oral contraceptive tablets.

The availability of norethisterone acetate in HCl (0.1 mol/l) from combined oral contraceptive tablets in the presence of certain proprietary preparations and adsorbent drugs which are used as antacids, intestinal adsorbents and for peptic ulcer was investigated. The percent dissolution of the hormone in the presence of these drugs was greatly reduced depending mainly on the nature of the adsorbent drugs.

PIP: An in vitro analysis of the adsorptive power of commonly used preparation for antacids, intestinal adsorbents, and peptic ulcer drugs to norethisterone acetate revealed a reduction of the availability of norethisterone acetate in HCl (0.1 mol/1), depending on the nature of the adsorbent tested (activated charcoal, magnesium trisilicate, dried aluminum hydroxide gel, and light kaolin). Increasing the concentration of the adsorbents reduced the percent dissolution of the hormone drug, from 25% with 1% of activated charcoal to 0% with 3% or more of the adsorbent. Activated charcoal exhibited the worst effect. It was concluded that since adsorbents alter the pharmacological effect of oral contraceptives, it is inadvisable to co-administer oral contraceptives with antacids, intestinal adsorbents, and peptic ulcer drugs.

Effect of certain additives on the dissolution rate of chloramphenicol.

A study was conducted on the effect of certain additives on the dissolution rate of chloramphenicol. The effect of adsorbents, natural and synthetic surface active agents, diluents and lubricants was studied. Many of these additives increased the dissolution rate of chloramphenicol from capsules.

Effect of vehicles on the spermicidal potency of certain drugs.

Different spermicidal drugs were formulated into ointments, creams, pastes and jellies and tested for their spermicidal potency on human sperms adopting a modified in vitro technique. Of the formulae tested, those incorporated in Carbopol 934 of polyethylene glycol base exhibited the most prevailing spermicidal activity.