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Clinical Nutrition (Edinburgh, Scotland) Apr 2023Accumulating scientific evidence supports the benefits of parenteral nutrition (PN) with fish oil (FO) containing intravenous lipid emulsions (ILEs) on clinical... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Accumulating scientific evidence supports the benefits of parenteral nutrition (PN) with fish oil (FO) containing intravenous lipid emulsions (ILEs) on clinical outcomes. Yet, the question of the most effective ILE remains controversial. We conducted a network meta-analysis (NMA) to compare and rank different types of ILEs in terms of their effects on infections, sepsis, ICU and hospital length of stay, and in-hospital mortality in adult patients.
METHODS
MEDLINE, EMBASE, and Web of Science databases were searched for randomized controlled trials (RCTs) published up to May 2022, investigating ILEs as a part of part of PN covering at least 70% of total energy provision. Lipid emulsions were classified in four categories: FO-ILEs, olive oil (OO)-ILEs, medium-chain triglyceride (MCT)/soybean oil (SO)-ILEs, and pure SO-ILEs. Data were statistically combined through Bayesian NMA and the Surface Under the Cumulative RAnking (SUCRA) was calculated for all outcomes.
RESULTS
1651 publications were retrieved in the original search, 47 RCTs were included in the NMA. For FO-ILEs, very highly credible reductions in infection risk versus SO-ILEs [odds ratio (OR) = 0.43 90% credibility interval (CrI) (0.29-0.63)], MCT/soybean oil-ILEs [0.59 (0.43-0.82)], and OO-ILEs [0.56 (0.33-0.91)], and in sepsis risk versus SO-ILEs [0.22 (0.08-0.59)], as well as substantial reductions in hospital length of stay versus SO-ILEs [mean difference (MD) = -2.31 (-3.14 to -1.59) days] and MCT/SO-ILEs (-2.01 (-2.82 to -1.22 days) were shown. According to SUCRA score, FO-ILEs were ranked first for all five outcomes.
CONCLUSIONS
In hospitalized patients, FO-ILEs provide significant clinical benefits over all other types of ILEs, ranking first for all outcomes investigated.
REGISTRATION NO
PROSPERO 2022 CRD42022328660.
Topics: Humans; Soybean Oil; Network Meta-Analysis; Parenteral Nutrition; Fat Emulsions, Intravenous; Fish Oils; Olive Oil; Fatty Acids, Omega-3; Sepsis
PubMed: 36878111
DOI: 10.1016/j.clnu.2023.02.008 -
Korean Journal of Anesthesiology Jun 2023Currently, lipid emulsion (LE) is widely used to treat local anesthetic systemic toxicity (LAST). LE also ameliorates intractable cardiovascular collapse caused by... (Review)
Review
Currently, lipid emulsion (LE) is widely used to treat local anesthetic systemic toxicity (LAST). LE also ameliorates intractable cardiovascular collapse caused by lipid-soluble non-local anesthetic drug toxicity. This review aims to provide the underlying mechanism of LE resuscitation in drug toxicity (including LAST) and a detailed description of LE treatment and to discuss further research directions. We searched for relevant articles using the following keywords: "local anesthetic systemic toxicity or LAST or toxicity or intoxication or poisoning" and "Intralipid or lipid emulsion". The underlying mechanisms of LE treatment can be classified into indirect and direct effects. One indirect effect known as the lipid shuttle is a commonly accepted mechanism of LE treatment. The lipid shuttle involves the absorption of highly lipid-soluble drugs (e.g., bupivacaine) from the heart and brain through the lipid phase, which are then delivered to the muscle, adipose tissue, and liver for storage and detoxification. The direct effects include inotropic effects, fatty acid supply, attenuation of mitochondrial dysfunction, glycogen synthase kinase-3β phosphorylation, and inhibition of nitric oxide. These mechanisms appear to act synergistically to treat drug toxicity. The recommended protocol for LE treatment of LAST is as follows: a bolus administration of 20% LE at 1.5 ml/kg over 2-3 min followed by 20% LE at 0.25 ml/kg/min. LAST most commonly occurs after intravenous administration of local anesthetics. However, non-local anesthetic drugs that cause drug toxicity are orally administered. Further studies are needed to determine the optimal dosing schedule of LE treatment for non-local anesthetic drug toxicity.
Topics: Humans; Pharmaceutical Preparations; Fat Emulsions, Intravenous; Anesthetics, Local; Bupivacaine; Drug-Related Side Effects and Adverse Reactions
PubMed: 36704816
DOI: 10.4097/kja.23031 -
British Journal of Clinical Pharmacology Jun 2023Infusion of lipid emulsion for drug overdose arose as a treatment for local anaesthetic systemic toxicity (LAST) initially based on laboratory results in animal models...
Infusion of lipid emulsion for drug overdose arose as a treatment for local anaesthetic systemic toxicity (LAST) initially based on laboratory results in animal models with the subsequent support of favourable case reports. Following successful translation to the clinic, practitioners also incorporated lipid emulsion as a treatment for non-local anaesthetic toxicities but without formal clinical trials. Recent clinical trials demonstrate a benefit of lipid emulsion in antipsychotic, pesticide, metoprolol and tramadol overdoses. Formal trials of lipid emulsion in LAST may never occur, but alternative analytic tools indicate strong support for its efficacy in this indication; for example, lipid emulsion has obviated the need for cardiopulmonary bypass in most cases of LAST. Herein, we describe the pre-clinical support for lipid emulsion, evaluate the most recent clinical studies of lipid emulsion for toxicity, identify a possible dose-based requirement for efficacy and discuss the limitations to uncontrolled studies in the field.
Topics: Animals; Emulsions; Xenobiotics; Drug Overdose; Anesthetics, Local; Tramadol
PubMed: 36454165
DOI: 10.1111/bcp.15620 -
Advances in Colloid and Interface... Jul 2022Antibubbles are unusual physical objects consisting of a liquid core(s) surrounded by a thin air film/shell while in a bulk liquid. Antibubbles carry two air-liquid... (Review)
Review
Antibubbles are unusual physical objects consisting of a liquid core(s) surrounded by a thin air film/shell while in a bulk liquid. Antibubbles carry two air-liquid interfaces, i.e., one with the inner liquid and the other with the outer liquid. The distinct structure of antibubbles makes them quite attractive for drug and therapeutic delivery, although their potential applications have not been realized so far. The major challenge in this regard is a short-lived span of antibubbles, which is usually in the order of a few minutes to a few hours based on the stabilization mechanism used. We present a critical overview of different techniques that can be used to generate antibubbles. This includes a more commonly applied conventional approach in which the air-film is created through surface entrapment when a liquid jet/drop falls on a bulk liquid. The other available options rely on entirely different mechanisms for antibubble formation, for instance, through drop encapsulation by a submerged air bubble, or through evaporation/sublimation of volatile oil from a W/O/W double emulsion. Furthermore, the mechanisms of antibubble formation and collapse, and the factors affecting their stability have been discussed explicitly; and wherever required, the concept is correlated to other allied physical objects such as bubbles, liquid marbles, etc. Finally, the potential applications, research gaps in the existing knowledge, and some directions for future research are provided towards the end of this article.
Topics: Emulsions
PubMed: 35526307
DOI: 10.1016/j.cis.2022.102688 -
Ultrasonics Sonochemistry Apr 2022The aim of this study was to develop high load-capacity antibubbles that can be visualized using diagnostic ultrasound and the encapsulated drug can be released and...
The aim of this study was to develop high load-capacity antibubbles that can be visualized using diagnostic ultrasound and the encapsulated drug can be released and delivered using clinically translatable ultrasound. The antibubbles were developed by optimising a silica nanoparticle stabilised double emulsion template. We produced an emulsion with a mean size diameter of 4.23 ± 1.63 µm where 38.9 ± 3.1% of the droplets contained a one or more cores. Following conversion to antibubbles, the mean size decreased to 2.96 ± 1.94 µm where 99% of antibubbles were <10 µm. The antibubbles had a peak attenuation of 4.8 dB/cm at 3.0 MHz at a concentration of 200 × 10 particles/mL and showed distinct attenuation spikes at frequencies between 5.5 and 13.5 MHz. No increase in subharmonic response was observed for the antibubbles in contrast to SonoVue®. High-speed imaging revealed that antibubbles can release their cores at MIs of 0.6. In vivo imaging indicated that the antibubbles have a long half-life of 68.49 s vs. 40.02 s for SonoVue®. The antibubbles could be visualised using diagnostic ultrasound and could be disrupted at MIs of ≥0.6. The in vitro drug delivery results showed that antibubbles can significantly improve drug delivery (p < 0.0001) and deliver the drug within the antibubbles. In conclusion antibubbles are a viable concept for ultrasound guided drug delivery.
Topics: Contrast Media; Drug Delivery Systems; Emulsions; Microbubbles; Nanoparticles; Ultrasonography
PubMed: 35358937
DOI: 10.1016/j.ultsonch.2022.105986 -
International Journal of Molecular... Jun 2021In order to overcome the limitations associated with vaginal administration of drugs, e.g., the short contact time of the drug form with the mucosa or continuous carrier... (Review)
Review
In order to overcome the limitations associated with vaginal administration of drugs, e.g., the short contact time of the drug form with the mucosa or continuous carrier wash-out, the development of new carriers for gynecological use is necessary. Furthermore, high individual anatomical and physiological variability resulting in unsatisfactory therapeutic efficacy of lipophilic active substances requires application of multicompartment drug delivery systems. This manuscript provides an up-to-date comprehensive review of the literature on emulsion-based vaginal dosage forms (EVDF) including macroemulsions, microemulsions, nanoemulsions, multiple emulsions and self-emulsifying drug delivery systems. The first part of the paper discusses (i) the influence of anatomical-physiological conditions on therapeutic efficacy of drug forms after local and systemic administration, (ii) characterization of EVDF components and the manufacturing techniques of these dosage forms and (iii) methods used to evaluate the physicochemical and pharmaceutical properties of emulsion-based vaginal dosage forms. The second part of the paper presents (iv) the results of biological and in vivo studies as well as (v) clinical evaluation of EVDF safety and therapeutic efficacy across different indications.
Topics: Administration, Intravaginal; Chemical Phenomena; Drug Carriers; Drug Compounding; Drug Delivery Systems; Emulsions; Female; Humans; Microbiota; Mucous Membrane; Pharmaceutical Preparations; Theranostic Nanomedicine
PubMed: 34208652
DOI: 10.3390/ijms22126455 -
Pflugers Archiv : European Journal of... Feb 2021Developing biocompatible, synthetic oxygen carriers is a consistently challenging task that researchers have been pursuing for decades. Perfluorocarbons (PFC) are... (Review)
Review
Developing biocompatible, synthetic oxygen carriers is a consistently challenging task that researchers have been pursuing for decades. Perfluorocarbons (PFC) are fascinating compounds with a huge capacity to dissolve gases, where the respiratory gases are of special interest for current investigations. Although largely chemically and biologically inert, pure PFCs are not suitable for injection into the vascular system. Extensive research created stable PFC nano-emulsions that avoid (i) fast clearance from the blood and (ii) long organ retention time, which leads to undesired transient side effects. PFC-based oxygen carriers (PFOCs) show a variety of application fields, which are worthwhile to investigate. To understand the difficulties that challenge researchers in creating formulations for clinical applications, this review provides the physical background of PFCs' properties and then illuminates the reasons for instabilities of PFC emulsions. By linking the unique properties of PFCs and PFOCs to physiology, it elaborates on the response, processing and dysregulation, which the body experiences through intravascular PFOCs. Thereby the reader will receive a scientific and easily comprehensible overview why PFOCs are precious tools for so many diverse application areas from cancer therapeutics to blood substitutes up to organ preservation and diving disease.
Topics: Animals; Blood Substitutes; Drug Compounding; Emulsions; Fluorocarbons; Humans; Oxygen
PubMed: 33141239
DOI: 10.1007/s00424-020-02482-2 -
Molecules (Basel, Switzerland) Dec 2022Advancement in nanotechnology has unleashed the therapeutic potentials of dietary polyphenols by enhancing bioavailability, improving biological half-life, and allowing... (Review)
Review
Advancement in nanotechnology has unleashed the therapeutic potentials of dietary polyphenols by enhancing bioavailability, improving biological half-life, and allowing site-specific drug delivery. In this review, through citation of relevant literature reports, we discuss the application of nano-pharmaceutical formulations, such as solid lipid nanoparticles, nano-emulsions, nano-crystals, nano-polymersomes, liposomes, ethosomes, phytosomes, and invasomes for dietary polyphenols. Following this, we highlight important studies concerning different combinations of nano formulations with dietary polyphenols (also known as nanophytopolyphenols). We also provide nano-formulation paradigms for enhancing the physicochemical properties of dietary polyphenols. Finally, we highlight the latest patents that were granted on nano-formulations of dietary polyphenols. Based on our review, we observe that nanosized delivery of herbal constituents, spices, and dietary supplements have the ability to improve biological processes and address issues connected with herbal treatments.
Topics: Drug Delivery Systems; Nanoparticles; Polyphenols; Biological Availability; Emulsions; Dietary Supplements
PubMed: 36557841
DOI: 10.3390/molecules27248706 -
BioMed Research International 2022Hypertension is one of the most important causes of mortality, affecting the health status of the patient. At the same time, hypertension causes a huge health and... (Review)
Review
Hypertension is one of the most important causes of mortality, affecting the health status of the patient. At the same time, hypertension causes a huge health and economic burden on the whole world. The incidence and prevalence of hypertension are rising even among young people in both urban as well as rural communities. Although various conventional therapeutic moieties are available for the management of hypertension, they have serious flaws such as hepatic metabolism, reduced dose frequency, poor aqueous solubility, reduced bioavailability, and increased adverse effects, making the drug therapy ineffective. Therefore, it is required to design a novel drug delivery system having the capability to solve the constraints associated with conventional treatment of hypertension. Nanotechnology is a new way of using and manipulating the matter at the molecular level, whose functional organization is measured in nanometers. The applications of nanotechnology in the field of medicine provide an alternative and novel direction for the treatment of cardiovascular diseases and show excellent performance in the field of targeted drug therapy. Various nanotechnologies based drug delivery systems, such as solid lipid nanoparticles, nanosuspension, nanoemulsion, liposome, self-emulsifying systems, and polymeric nanoparticles, are available. Among them, nanoemulsion has provided a niche to supplement currently available therapeutic choices due to numerous benefits like stability, ease of preparation, enhanced drug absorption, reduced hepatic metabolism, increased dose frequency, enhanced bioavailability, and encapsulation of hydrophilic as well as hydrophobic drugs. This present review provides an in-depth idea about progression in treatment of hypertension, constraints for antihypertensive drug therapy, need of nanoemulsions to overcome these constraints, comparative analysis of nanoemulsions over other nanostructure drug delivery systems, pharmacodynamics studies of nanoemulsions for treatment of hypertension, recent patents for drug-loaded nanoemulsions meant for hypertension, and marketed formulations of nanoemulsions for hypertension.
Topics: Adolescent; Antihypertensive Agents; Drug Delivery Systems; Emulsions; Humans; Hypertension; Liposomes; Nanoparticles
PubMed: 35463984
DOI: 10.1155/2022/4109874 -
Molecules (Basel, Switzerland) Nov 2022Pickering emulsions are emulsion systems stabilized by solid particles at the interface of oil and water. Pickering emulsions are considered to be natural,... (Review)
Review
Pickering emulsions are emulsion systems stabilized by solid particles at the interface of oil and water. Pickering emulsions are considered to be natural, biodegradable, and safe, so their applications in various fields-such as food, cosmetics, biomedicine, etc.-are very promising, including as a vehicle for essential oils (EOs). These oils contain volatile and aromatic compounds and have excellent properties, such as antifungal, antibacterial, antiviral, and antioxidant activities. Despite their superior properties, EOs are prone to evaporation, decompose when exposed to light and oxygen, and have low solubility, limiting their industrial applications. Several studies have shown that EOs in Pickering emulsions displays less sensitivity to evaporation and oxidation, stronger antibacterial activity, and increased solubility. In brief, the application of Pickering emulsions for EOs is interesting to explore. This review discusses recent progress in the application of Pickering emulsions, particularly as EO carriers, drug carriers, antioxidant and antimicrobial carriers, and in active packaging.
Topics: Emulsions; Oils, Volatile; Antioxidants; Excipients; Anti-Bacterial Agents
PubMed: 36431978
DOI: 10.3390/molecules27227872