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The International Journal of Risk &... 2023Renal transplants are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for analgesic purposes.
BACKGROUND
Renal transplants are often prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for analgesic purposes.
OBJECTIVE
Considering the dearth of data, we carried out the present study to evaluate the use of various NSAIDs and the incidence of acute kidney injury (AKI) in transplant patients.
METHODS
A retrospective study amongst renal transplant patients prescribed at least one dose of NSAID was carried between January and December 2020 at the Department of Nephrology, Salmaniya Medical Complex, Kingdom of Bahrain. The patients' demographic details, serum creatinine values, and drug-related details were obtained. The Kidney Disease Improving Global Outcomes (KDIGO) criteria were used for defining AKI.
RESULTS
Eighty-seven patients were included. Forty-three patients were prescribed diclofenac, 60 received ibuprofen, six received indomethacin, 10 were administered mefenamic acid, and 11 received naproxen. Due to multiple courses of NSAID prescription, a total of 70 prescriptions were identified for diclofenac, 80 for ibuprofen, six for indomethacin, 11 for mefenamic acid, and 16 for naproxen. No significant differences were observed in the absolute (p = 0.08) and percent changes in serum creatinine (p = 0.1) between the NSAIDs. Twenty-eight (15.2%) courses of NSAID therapy met the KDIGO criteria for AKI. Age (OR: 1.1, 95% CI: 1.007, 1.2; p = 0.02), concomitant everolimus (OR: 483, 95% CI: 4.3, 54407; p = 0.01), and mycophenolate + cyclosporine + azathioprine (OR: 63.4E+006, 95% CI: 203.2157 to 19.8E+012; p = 0.005) administration were observed with significant risk of NSAID-induced AKI.
CONCLUSION
We observed possible NSAID-induced AKI to an extent of around 15.2% in our renal transplant patients. No significant differences were observed in the incidence of AKI between various NSAIDs and none of them had either graft failure or death.
Topics: Humans; Ibuprofen; Naproxen; Retrospective Studies; Diclofenac; Kidney Transplantation; Mefenamic Acid; Creatinine; Anti-Inflammatory Agents, Non-Steroidal; Acute Kidney Injury; Indomethacin
PubMed: 37154186
DOI: 10.3233/JRS-220065 -
Water Research Jun 2023Natural sunlight can reduce the chemicals of emerging concern (CECs) and biological effects from the discharged domestic wastewater. But the aquatic photolysis and...
Natural sunlight can reduce the chemicals of emerging concern (CECs) and biological effects from the discharged domestic wastewater. But the aquatic photolysis and biotoxic variations of specific CECs detected in secondary effluent (SE) were not clear. In this study, 29 CECs were detected in the SE, and 13 medium- and high-risk CECs were identified as target chemicals based on their ecological risk assessment. To comprehensively explore the photolysis properties of the identified target chemicals, the direct and self-sensitized photodegradation of the target chemicals, even the indirect photodegradation in the mixture, were investigated and compared with these photodegradation in the SE. Of the 13 target chemicals, only five chemicals (including dichlorvos (DDVP), mefenamic acid (MEF), diphenhydramine hydrochloride (DPH), chlorpyrifos (CPF), and imidacloprid (IMI)) underwent direct and self-sensitized photodegradation processes. The removal of DDVP, MEF, and DPH was attributed to self-sensitized photodegradation, which was mainly mediated by •OH; CPF and IMI primarily relied on direct photodegradation. Synergistic and/or antagonistic actions that occurred in the mixture improved/decreased the rate constants of five photodegradable target chemicals. Meanwhile, the biotoxicities (acute toxicity and genotoxicity) of the target chemicals (including individual chemicals and the mixture) were significantly reduced, which can explain the reduction of biotoxicities from SE. For the two refractory high-risk chemicals, atrazine (ATZ) and carbendazim (MBC), algae-derived intracellular dissolved organic matter (IOM) on ATZ, and IOM and extracellular dissolved organic matter (EOM) on MBC had slightly promotion for their photodegradation; while peroxysulfate, and peroxymonosulfate served as sensitizers were activated by natural sunlight and effectively improved their photodegradation rate, and then reduced their biotoxicities. These findings will promote the development of CECs treatment technologies based on sunlight irradiation.
Topics: Sunlight; Photolysis; Dissolved Organic Matter; Dichlorvos; Water Pollutants, Chemical
PubMed: 37148692
DOI: 10.1016/j.watres.2023.120002 -
International Journal of Molecular... Apr 2023This study examines the influence of mefenamic acid on the physical and chemical properties of silica aerogels, as well as its effect on the sorption characteristics of...
This study examines the influence of mefenamic acid on the physical and chemical properties of silica aerogels, as well as its effect on the sorption characteristics of the composite material. Solid state magic angle spinning nuclear magnetic resonance (MAS NMR) and high-pressure C NMR kinetic studies were conducted to identify the presence of mefenamic acid and measure the kinetic rates of CO sorption. Additionally, a high-pressure T-T relaxation-relaxation correlation spectroscopy (RRCOSY) study was conducted to estimate the relative amount of mefenamic acid in the aerogel's pores, and a high-pressure nuclear Overhauser effect spectoscopy (NOESY) study was conducted to investigate the conformational preference of mefenamic acid released from the aerogel. The results indicate that mefenamic acid is affected by the chemical environment of the aerogel, altering the ratio of mefenamic acid conformers from 75% to 25% in its absence to 22% to 78% in the presence of aerogel.
Topics: Mefenamic Acid; Kinetics; Silicon Dioxide; Magnetic Resonance Spectroscopy; Magnetic Resonance Imaging
PubMed: 37108046
DOI: 10.3390/ijms24086882 -
AAPS PharmSciTech Apr 2023The current study aimed to see the effects of poloxamer P407 on the dissolution performance of hydroxypropyl methylcellulose acetate succinate (AquaSolve™ HPMC-AS...
The current study aimed to see the effects of poloxamer P407 on the dissolution performance of hydroxypropyl methylcellulose acetate succinate (AquaSolve™ HPMC-AS HG)-based amorphous solid dispersions (ASD). A weakly acidic, poorly water-soluble active pharmaceutical ingredient (API), mefenamic acid (MA), was selected as a model drug. Thermal investigations, including thermogravimetry (TG) and differential scanning calorimetry (DSC), were conducted for raw materials and physical mixtures as a part of the pre-formulation studies and later to characterize the extruded filaments. The API was blended with the polymers using a twin shell V-blender for 10 min and then extruded using an 11-mm twin-screw co-rotating extruder. Scanning electron microscopy (SEM) was used to study the morphology of the extruded filaments. Furthermore, Fourier-transform infrared spectroscopy (FT-IR) was performed to check the intermolecular interactions of the components. Finally, to assess the in vitro drug release of the ASDs, dissolution testing was conducted in phosphate buffer (0.1 M, pH 7.4) and hydrochloric acid-potassium chloride (HCl-KCl) buffer (0.1 M, pH 1.2). The DSC studies confirmed the formation of the ASDs, and the drug content of the extruded filaments was observed to be within an acceptable range. Furthermore, the study concluded that the formulations containing poloxamer P407 exhibited a significant increase in dissolution performance compared to the filaments with only HPMC-AS HG (at pH 7.4). In addition, the optimized formulation, F3, was stable for over 3 months when exposed to accelerated stability studies.
Topics: Poloxamer; Solubility; Chemistry, Pharmaceutical; Spectroscopy, Fourier Transform Infrared; Hot Temperature; Drug Compounding; Calorimetry, Differential Scanning; Drug Stability
PubMed: 37100926
DOI: 10.1208/s12249-023-02562-3 -
Spectrochimica Acta. Part A, Molecular... Aug 2023Recently, Chemometric calibration methods in spectrophotometric analysis are achieving significant attention in the quality control of resolving drug mixtures and...
Recently, Chemometric calibration methods in spectrophotometric analysis are achieving significant attention in the quality control of resolving drug mixtures and pharmaceutical formulations containing two or more drugs with overlapping spectra. The simple univariate methods have been used over the last few decades and has proven to be highly efficient and easy to apply. In this study, a comparative study was performed between some univariate and multivariate methods to determine if chemometric methods can substitute univariate methods in pharmaceutical analysis. In this study, three chemometric techniques were compared to seven univariate techniques to resolve a mixture of mefenamic acid and febuxostat in their raw materials, dosage forms and spiked human plasma. Mefenamic acid and febuxostat were used together for treatment of gout. The applied chemometric methods are partial least squares (PLS), artificial neural network (ANN) and genetic algorithm partial least squares (GA-PLS), while the used univariate methods include first derivative, second derivative, ratio spectra, derivative ratio spectra, ratio subtraction, Q-Absorbance ratio and mean centering spectrophotometric methods. The ten proposed methods were found to be green, sensitive, and rapid. They are simple and did not require any pre-separation steps. The results of both univariate and multivariate approaches were statistically compared with the reported spectrophotometric methods using student's t test and ratio variance F-test. They were also compared with each other, using one-way analysis of variance (ANOVA). These methods were assessed and validated according to ICH guidelines. The studied drugs were analyzed in their pharmaceutical dosage forms and spiked human plasma with good recoveries using the developed methods, which qualify them for routine quality control of the studied drugs.
Topics: Humans; Mefenamic Acid; Febuxostat; Spectrophotometry; Analysis of Variance; Least-Squares Analysis; Pharmaceutical Preparations
PubMed: 37019003
DOI: 10.1016/j.saa.2023.122670 -
Analytical Methods : Advancing Methods... Apr 2023Characteristics, performance and applications of potentiometric membrane sensors are described for the determination of mefenamic and phenylanthranilic ions. Ion...
Characteristics, performance and applications of potentiometric membrane sensors are described for the determination of mefenamic and phenylanthranilic ions. Ion associates of mefenamic, ClO, and phenylanthranilic ions with crystal violet (counter-cation) as ion exchange sites have been used as ionophores in the plasticized one- and two-layer membrane ion-selective electrodes. The LOD is reported to be 8.4 × 10 M for mefenamic acid, and 5.1 × 10 M for phenylanthranilic acid. The cations of basic dyes (crystal violet) are characterized by significant delocalization of the positive charge and polarizability. This may explain the better selectivity of the developed sensors. These sensors were used for the direct assay of mefenamic and -phenylanthranilic acids in model solutions and applications studied in commercial pharmaceutical preparations.
PubMed: 37000565
DOI: 10.1039/d2ay02092k -
The British Journal of General Practice... Apr 2023Heavy menstrual bleeding (HMB) is common and can affect women's lives. Evidence on women's experiences and their treatment of this problem after seeking primary care is...
BACKGROUND
Heavy menstrual bleeding (HMB) is common and can affect women's lives. Evidence on women's experiences and their treatment of this problem after seeking primary care is lacking.
AIM
To explore women's experiences of HMB and their medical treatment up to 10 years after initial management in general practice.
DESIGN AND SETTING
This was a qualitative study in UK primary care.
METHOD
Semistructured interviews with a purposeful sample of 36 women who had participated in the ECLIPSE trial of medical treatments for HMB in primary care (levonorgestrel-releasing intrauterine system or other usual medical treatments - oral tranexamic acid, mefenamic acid, combined oestrogen-progestogen; or progesterone alone). Data were analysed thematically and a process of respondent validation was undertaken.
RESULTS
Women reported the wide-ranging and debilitating impact of HMB on their lives. They had often normalised their experience underlining persisting societal taboos about menstruation and reflecting low general awareness of HMB as treatable. Women commonly delayed seeking help for several years. They could then be frustrated by lack of a medical explanation for HMB. Women who had pathology identified felt able to make better sense of their HMB. Experiences of medical treatments varied considerably but were strongly influenced by the perceived quality of healthcare interactions with clinicians. Other influences on women's treatment included considerations for their fertility, health concerns, family and peers, and views when approaching menopause.
CONCLUSION
Clinicians should be aware of the considerable challenges faced by women with HMB; widely differing experiences of, and influences on, their treatment; and the value of patient-centred communication in this context.
Topics: Female; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Menorrhagia; Primary Health Care; Progesterone; Qualitative Research
PubMed: 36997220
DOI: 10.3399/BJGP.2022.0460 -
BMC Women's Health Mar 2023Primary dysmenorrhea is considered as one of the women's main problems during reproductive age. The present study aimed to investigate the effect of vitamin D on the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Primary dysmenorrhea is considered as one of the women's main problems during reproductive age. The present study aimed to investigate the effect of vitamin D on the severity of dysmenorrhea and menstrual blood loss.
METHODS
This double-blind, randomized, placebo-controlled trial, was performed on 84 single female college students between 18 and 25 years old who living in dormitories. Students with primary dysmenorrhea and vitamin D deficiency were divided into experimental (n = 42) and control (n = 42) groups. Five days before the putative beginning of their next menstrual cycle, the experimental group received 300,000 IU vitamin D (50,000 IU, two tablets every 8 h), and the control group received a placebo (oral paraffin). The effects of the supplement on the severity of dysmenorrhea and menstrual blood loss were evaluated one cycle before and during two successive cycles. Using the visual analog scale (VAS), verbal multidimensional scoring system (VMS), and pictorial blood assessment chart (PBLAC) questionnaires. Fisher's exact, Chi-square, independent sample t-test and repeated measurements were used.
RESULTS
In total, 78 of the 84 students completed the study (39 students per group). The intervention resulted in a significant reduction in the mean scores of both the VAS and VMS in the experimental group, in the first and second menstrual cycles (p < 0.001, p < 0.001, respectively), but not in the means score of PBLAC. Mefenamic acid consumption at the first and second menstruation period, in the experimental group was lower than the control group (p = 0.009, p < 0.001, respectively).
CONCLUSIONS
The results indicate that vitamin D supplementation could decrease the severity of primary dysmenorrhea and the need to consume pain-relief medications. Contrariwise vitamin D supplementation had no significant effect on menstrual blood loss.
TRIAL REGISTRATION
This trial was registered in the Iranian Registry of Clinical Trials with code IRCT201305212324N on 18/1/2014. URL of registry: https://en.irct.ir/trial/1964 .
Topics: Female; Humans; Adolescent; Young Adult; Adult; Dysmenorrhea; Menstruation; Vitamin D; Iran; Mefenamic Acid; Hemorrhage
PubMed: 36973702
DOI: 10.1186/s12905-023-02284-5 -
European Journal of Pharmaceutics and... May 2023For solid oral dosage forms drug solubility in intestinal fluid is an important parameter influencing product performance and bioavailability. Solubility along with...
For solid oral dosage forms drug solubility in intestinal fluid is an important parameter influencing product performance and bioavailability. Solubility along with permeability are the two parameters applied in the Biopharmaceutics and Developability Classification Systems (DCS) to assess a drug's potential for oral administration. Intestinal solubility varies with the intestinal contents and the differences between the fasted and fed states are recognised to influence solubility and bioavailability. In this study a novel fed state simulated media system comprising of nine media has been utilised to measure the solubility of seven drugs (ibuprofen, mefenamic acid, furosemide, dipyridamole, griseofulvin, paracetamol and acyclovir) previously studied in the fasted state DCS. The results demonstrate that the fed nine media system provides a range of solubility values for each drug and solubility behaviour is consistent with published design of experiment studies conducted in either the fed or fasted state. Three drugs (griseofulvin, paracetamol and acyclovir) exhibit very narrow solubility distributions, a result that matches published behaviour in the fasted state, indicating that this property is not influenced by the concentration of simulated media components. The nine solubility values for each drug can be utilised to calculate a dose/solubility volume ratio to visualise the drug's position on the DCS grid. Due to the derivation of the nine media compositions the range and catergorisation could be considered as bioequivalent and can be combined with the data from the original fed intestinal fluid analysis to provide a population based solubility distribution. This provides further information on the drugs solubility behaviour and could be applied to quality by design formulation approaches. Comparison of the fed results in this study with similar published fasted results highlight that some differences detected match in vivo behaviour in food effect studies. This indicates that a combination of the fed and fasted systems may be a useful in vitro biopharmaceutical performance tool. However, it should be noted that the fed media recipes in this study are based on a liquid meal (Ensure Plus) and this may not be representative of alternative fed states achieved through ingestion of a solid meal. Nevertheless, this novel approach provides greater in vitro detail with respect to possible in vivo biopharmaceutical performance, an improved ability to apply risk-based approaches and the potential to investigate solubility based food effects. The system is therefore worthy of further investigation but studies will be required to expand the number of drugs measured and link the in vitro measurements to in vivo results.
Topics: Humans; Solubility; Acetaminophen; Griseofulvin; Pharmaceutical Preparations; Intestines; Administration, Oral; Intestinal Absorption
PubMed: 36934829
DOI: 10.1016/j.ejpb.2023.03.005 -
Materials (Basel, Switzerland) Feb 2023In this work, we studied conformational equilibria of molecules of mefenamic acid in its diluted solution in scCO under isochoric heating conditions in the temperature...
In this work, we studied conformational equilibria of molecules of mefenamic acid in its diluted solution in scCO under isochoric heating conditions in the temperature range of 140-210 °C along the isochore corresponding to the scCO density of 1.1 of its critical value. This phase diagram range totally covers the region of conformational transitions of molecules of mefenamic acid in its saturated solution in scCO. We found that in the considered phase diagram region, the equilibrium of two conformers is realized in this solution. In the temperature range of 140-180 °C, conformer I related to the first, most stable polymorph of mefenamic acid prevails. In the temperature range of 200-210 °C, conformer II, which is related to the second metastable polymorph becomes dominant. Based on the results of quantum chemical calculations and experimental IR spectroscopy data on the mefenamic acid conformer populations, we classified this temperature-induced conformational crossover as an entropy-driven phenomenon.
PubMed: 36837033
DOI: 10.3390/ma16041403