No description available.

The properties of Caco-2 monolayers were compared on aluminium oxide and nitrocellulose permeable-supports. On nitrocellulose, Caco-2 cells displayed a higher rate of taurocholic acid transport than those cultured on aluminium oxide inserts. In addition, Caco-2 cells grown on these two inserts were not comparable with respect to cell morphology, cell numbers and transepithelial electrical resistance. The low adsorption potential of the aluminium oxide inserts, particularly for high molecular weight or lipophilic ligands, offers a distinct advantage over nitrocellulose inserts for drug transport studies. The carrier-mediated uptake and transport of the imino acid (L-proline) and the acidic amino acids (L-aspartate and L-glutamate) have been studied. At pH7.4, L-proline uptake is mediated via an A-system carrier. Elevated uptake and transport under acidic conditions occurs by activation of a distinct carrier population. Acidic amino acid transport is mediated via a X-AG system. The flux of baclofen, CGP40116 andCGP40117 across Caco-2 monolayers was described by passive transport. The transport of three peptides, thyrotrophin-releasing hormone, SQ29852 and cyclosporin were investigated. Thyrotrophin-releasing hormone transport acrossCaco-2 monolayers was characterised by a minor saturable (carrier-mediated,approximately 25%) pathway, superimposed onto a major non-saturable (diffusional)pathway. SQ29852 uptake into Caco-2 monolayers is described by a major saturable mechanism (Km = 0.91 mM) superimposed onto a minor passive component. However, the initial-rate of SQ29852 transport is consistent with a passive transepithelial transport mechanism. These data highlight the possibility that itsbasolateral efflux is severely retarded such that the passive paracellular transportdictates the overall transepithelial transport characteristics. In addition, modelsuitable for investigating the transepithelial transport of cyclosporin A has been developed. A modification of the conventional Caco-2 model has been developed which has a calcium-free Ap donor-solution and a Bl receiver-solution containing the minimumcalcium concentration required to maintain monolayer integrity (100 μM). The influence of calcium and magnesium on the absorption of [14C]pamidronate was evaluated by comparing its transport across the conventional and minimum calciumCaco-2 models. Ap calcium and magnesium ions retard the Ap-to-Bl flux of pamidronate across Caco-2 monolayers. The effect of self-emulsifying oleic acid-Tween 80 formulations on Caco-2monolayer integrity has been investigated. Oleic acid-Tween 80 (1 0:1) formulations produced a dose-dependent disruption of Caco-2 monolayer integrity. This disruption was related to the oleic acid content of the formulation.

No description available.

Transdermal drug delivery system is in the centre of attention in recent years. For efficient dermal drug delivery the drug has to overcome the barrier of the outermost layer of the skin, the stratum corneum. For facilitating dermal drug transport, the barrier properties of the stratum corneum can be varied by applying chemical penetration enhancers. The aim of this work was to characterize various penetration enhancers and investigate their mechanism of action. We combined well established techniques like differential scanning calorimetry (DSC) and infrared spectroscopy (IR) with confocal Raman microscopy (CRM) as an upcoming technique in skin research. CRM offers the possibility of label-free and non- destructive, chemically selective analysis of stratum corneum lipids and proteins. We used isolated human stratum corneum for incubation with the penetration enhancers. As a novel approach, the samples of treated stratum corneum were freeze dried to avoid any discrepancies which might come up with differences in the hydratation state of stratum corneum (SC). Furthermore, the structure of lipids and proteins in the stratum corneum was analyzed. In our study, stratum corneum was treated with dimethyle sulphoxide, propylene glycol, ethylene glycol, ethylene glycol-d4 and oleic acid. We observed that...

The objective of this project was to develop new controlled drug delivery systems using nanomeric particles and characterize the delivery of drugs into cells in real time by digital fluorescence imaging microscopy techniques. The project is based on the idea that it could be possible to improve efficacy of drug molecules when encapsulated in nanometer-sized particles. Due to their small dimensions the particles could permeate through cells and tissues and even through the blood brain barrier. The anti-cancer drug Doxorubicin was encapsulated into biodegradable Poly (DL-lactideco- glycolide) (PLGA) nanoparticles by simple nanoprecipitation method. The small size of these particles (<200nm) could be beneficial to realize passive tumor-targeted drug delivery through enhanced permeability and retention (EPR) effects. These drug-containing particles showed a sustained release profile. Fluorescence images indicated that these particles can be internalized by human breast cancer MCF-7 cells by non-specific endocytosis. The bioactivity of the drugs was also tested against cell culture. The results indicated that DXR-loaded PLGA nanoaprticles could be used to deliver Doxorubicin into breast cancer cells.

Patient compliance is a major factor in achieving optimal therapeutic outcomes. Pill burden, due to multiple drug therapies, has a great detrimental impact on compliance of the patient. Dose-dependent side-effects, associated with peak-trough plasma fluctuations of drugs, also have a negative impact on patient compliance with drug therapy. It is under these circumstances that zero-order drug release kinetics proves to be ideal. This is due to the lack of peak-trough fluctuations that occur with zero-order drug release, thereby minimizing the side-effects of drug therapy. Furthermore, a drug delivery system that may deliver more than one drug at a time may be beneficial to alleviate the pill burden associated with chronic diseases or specific health conditions. Novel drug delivery systems have been developed that offer zero-order or linear drug release. Amongst such systems are multilayered tablets. However these systems generally offer the delivery of just one drug. The development of a delivery system that is able to deliver up to three drugs in a zero-order manner may prove to be significantly beneficial to greatly increase patient compliance and in turn therapeutic efficacy. The purpose of this study was to design a novel triple-layered tablet (TLT) matrix targeted at achieving stratified zero-order drug release. The central factor for the establishment of the TLT was the selection of ideal and novel polymers that are capable of acting as superior drug release matrices. Modified polyamide 6,10 (PA6,10) and salted-out poly(lactic-co-glycolic acid) (PLGA) were employed as the outer drug-carrier matrices whereas poly(ethylene oxide) (PEO) was used as the middle layer drug matrix. Specialized granulation techniques and direct compression were employed to prepare the TLT matrices. Diphenhydramine HCl, ranitidine HCl and promethazine were chosen as model drugs for the study due to their similar high aqueous solubilities (100mg/mL). Matrix hardness, gel strength, swelling/erosion characteristics, Fourier Transform Infrared spectroscopy, Differential Scanning Calorimetry and in vitro drug release analysis employing High Performance Liquid Chromatography were performed on the TLT matrices in order to determine the physicomechanical and physicochemical nature of the TLT matrices. Computational molecular modeling (CMM) was employed to characterize the formation and dissolution of the TLT matrices. A box-Behnken experimental design was employed that resulted in the generation of 17 design formulations for ultimate optimization. In vivo animal studies were performed in the Large White Pig model to assess drug release behavior of the TLT. Ultra Performance Liquid Chromatography was employed for plasma sample analysis. The PA 6,10 layer provided relatively linear and controlled drug release patterns with an undesirable burst release greater than 15%, which upon addition of sodium sulphate was greatly reduced. The addition of PEO to the salted-out PLGA layer greatly reduced the initial burst release that occurred when salted-out PLGA matrix was used alone. Desirable results were obtained from FTIR, hydration and swelling/erosion analysis. CMM elucidated the possible mechanism of zero-order release from respective layers. Upon completion of the Box-Behnken design analysis, an optimized TLT formulation was established according to the formulation responses selected namely the rate constants and correlation coefficients. The TLT displayed desirable near linear release of all three drugs simultaneously over 24 hours, with approximately 10%, 50% and 90% of the drugs released in 1, 10 and 24 hours. An in vitro drug release comparison performed between the optimized TLT and the commercial tablets currently used, showed an unequivocal display of superiority of the TLT in terms of linear drug release over commercial tablets. A cardiovascular related drug regimen (Adco-simvastatin®, DISPRIN CV® and Tenormin 50®) was applied to the TLT to assess the flexibility of incorporating a range of drugs. The TLT furthermore provided near linear to linear release of the therapeutic regimen over 24 hours and maintained superiority over the commercial tablets. Benchtop Magnetic Resonance Imaging, porosity analysis and Scanning Electron Microscopy was utilized for further introspective characterization of the TLT. In vivo analysis demonstrated a definite control of drug release from the TLT as compared to commercial tablets which further confirmed the advantage of the TLT.

Effective treatment of ocular diseases presents a formidable task, dually attributed to their nature, and the presence of the ocular barriers. This was exemplified in the presented review of developments in ocular drug delivery systems. Conceptualization of novel polymeric systems with intelligent (e.g. stimulus-responsive) mechanisms and advances in nanotechnology are at the forefront of achieving directed and controlled delivery for treating vision-threatening diseases. It was thus the pertinent goal of this investigation to assimilate these observations in the design of an intelligent ocular drug delivery system. The design of an autofeedback polymeric platform, employing biodegradable polymers is exemplified through the implementation of two-way communication systems between our bodies and the delivery platform to create innovative drug delivery systems that recognize a biochemical process that is characteristic of a disease, and then responding via drug release. To achieve this intelligence in design, the delivery platform was based on novel stimulus-responsive polymeric materials. The concept of an autofeedback polymeric platform was intrinsically implemented in the design of an intelligent intraocular implant - called the I3 - employing inflammation-responsive polymers, having application as a smart release system capable of delivering controlled therapeutic levels of anti-inflammatory and/or antibiotic drug/s for posterior segment disorders of the eye in response to inflammation and infection. Inner and outer bioresponsive polymeric matrices (BPMs) were designed that released the incorporated anti-inflammatory and antibiotic in a fashion responsive to a stimulus, such as the highly reactive intermediates including hydroxyl radicals (OH.) that are released from activated leukocytes both in vitro and during acute and chronic intraocular inflammatory reactions in vivo (Hawkins and Davies, 1996). The first step in developing the intelligent device implicated design of an anti-inflammatory nanosystem (NS) with satisfactory size and surface properties, adequate permeation potential, uptake by inflamed cells, low cellular toxicity, and enhanced anti-inflammatory effect availed to the incorporated drug. A composite lipoidal-polymeric NS was developed (Lipo-Chit-PCL NS) and compared to a purely polymeric NS. The NS was ultimately enclatherated as a NS-polymer superlattice, forming the inner BPM of the I3. The designed composite lipoidal-polymeric NS attested its significant potential for selective drug delivery to inflamed tissues, demonstrating significantly enhanced tissue permeation, cell uptake, and anti-inflammatory activity compared to an indomethacin suspension. Subsequent molecular modeling revealed that the composite NS displayed an enhanced lipophilicity and superior cellular internalization efficiency. The preferred NS was subsequently selected for optimization via a Plackett-Burman Statistical Design Method. Design of the NS was proceeded by development and optimization of the inner and outer BPMs, being the stimulus-responsive component of the device, via implementation of a novel methodology for simultaneous design of the two intimately crosslinked matrices. Inflammation-responsive polymers such as hyaluronic acid, alginate, poly(acrylic) acid, and chitosan, were ultimately selected for design of the I3drug delivery system. Intensive device optimization was then undertaken, first employing a Response Surface Methodology, embodied by the Box-Behnken Design, ensued by Artificial Neural Networks. Characterization of the drug release kinetics from the optimized I3 is pivotally provided, as well as molecular modeling. The reagent (N-hydroxysuccimide, NHS) and catalyst employed (aluminium chloride, AlCl3) had a significant or notable effect on the mean dissolution time of indomethacin under normal and pathological conditions, respectively (p=0.048; p=0.058). The interaction between the inflammation-responsive hyaluronic acid and carbodiimide crosslinker emanated in a significant effect on the change in mean dissolution time of indomethacin from normal to inflammatory conditions (p=0.050). Subsequent execution of ANN with further training of the data confirmed the adequacy of the design. Analysis of the drug release kinetics from the optimum I3 under both normal and pathological conditions was in coherence with the anticipated behavior of an inherently bioresponsive device. Molecular simulations generated provided clear evidence for the catalytic effect of the hydroxyl radicals, specifically in hyaluronic acid hydrolysis. It was imperative to elucidate the intricate modus operandi of the optimized I3. The intricately crosslinked polymeric system comprising the I3 responds at an innate level predicted by its molecular make-up to inflammatory conditions as indicated by the results of the rheological analysis, MRI and SEM imaging. FTIR explicated the formation of pivotal intra- and intermolecular bonds within and between the inflammation-responsive polymers of the I3, while TMDSC confirmed the extent to which the composite polymeric system had altered from its native consituents to form a device of the desired functionality. Tensile analysis provided an indication of the overall mechanical performance of the implant. The porosity ascertained for both the inner and outer BPMs was a predictor of the overall internal architecture and potential drug release characteristics of the BPMs comprising the I3, as were critical morphological changes, visualized via SEM and interpreted via image analysis displayed during device erosion. Furthermore, molecular mechanics simulations were carried out to model the interaction between the polymeric components of the inner and outer BPM and confirmed the formation of a ‘secure-fit’ dual polymeric matrix system by highlighting the anticipated interconnectivity between the inner and outer BPM of the I3. The in vivo performance of the device was assessed to further provide a convincing argument as to the ocular suitability and overall contrasting performance under normal and inflammatory conditions. Histological assessment was key to predicting significant inflammatory changes, as well as reductions in inflammation initiated by the I3. Analysis of ocular drug levels under normal and inflammatory conditions was undertaken for correlation with in vitro results, for ultimate establishment of an in-vitro-in-vivo correlation (IVIVC). The device was well-tolerated following implantation in the rabbit eye. Investigations of drug concentrations attained and device erosion were a good indication that the I3 expresses bioresponsive capabilities in vivo. There was enhanced release of both drugs in the inflamed rabbit eye even after 7 days (the maximum period in which the induced inflammation was permitted to ensue), with indomethacin levels of 0.749±0.126μg/mL and 1.168±0.186μg/mL, and ciprofloxacin levels of 1.181±0.150μg/mL and 6.653±0.605μg/mL being attained in the normal and inflamed eye, respectively. At 28 days in the normal eye, concentrations of indomethacin detected were only 0.564±0.111μg/mL and those of ciprofloxacin were 1.226±0.209μg/mL. Furthermore, the enhanced erosion of the I3 in the inflamed eye is also exemplified, with the I3 eroding 1.504±0.505% in the normal eye and 22.609±2.421% in the inflamed eye after 7 days; and only reaching 13.830±1.010% erosion after 28 days in the normal rabbit eye. Elaboration of the IVIVC undertaken for both indomethacin and ciprofloxacin approached or attained a Level A correlation, respectively, and provided further evidence for the feasibility of the I3 and for advancement of this concept toward application in a clinical setting. Establishment of such a correlation for the inflamed rabbit eye would be the main consideration in prospective investigations.

M.Pharm., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Periodontal disease describes a chronic bacterial infection affecting the gums and bone supporting the teeth. Bacteria present in plaque produce toxins, which lead to a cascade of inflammatory events that if left untreated may lead to permanent tooth loss. A periodontal pocket forms when the free gingiva moves away from the tooth surface. Periodontal disease is prevalent worldwide and has risk factors such as HIV and diabetes with possible links to socio-economic status. This places a large portion of the South African population at risk in an already burdened health care system. Scaling and root planning (SRP) forms the keystone of periodontal therapy, involving the removal of calculus and plaque. Multiple clinical trials have proved SRP leads to improved clinical outcomes. However, it often leaves behind microorganisms leading to recolonisation. Administration of pharmacological therapy is used in combination with SRP delivering one or more drugs. Subgingival treatment of periodontal disease involves the placement of a drug delivery device within the periodontal pocket releasing model drugs over a prolonged period of time. Targeted drug delivery devices have been the focus of periodontal research over the past two decades. To date there are no commercially available local drug delivery devices in South Africa for the treatment of periodontal disease. The aim of this study was to design, formulate and evaluate (in vitro) a novel polymeric fibre system to locally deliver an antimicrobial and an anti-inflammatory drug over 10 days to the periodontal pocket for the treatment of periodontal disease. The design of a flexible fibre would easily fit within the periodontal pocket evenly delivering the model drugs to the affected site. Alginate combined with glycerol was crosslinked with barium cations forming a monolithic fibre incorporating ciprofloxacin and diclofenac sodium, as the model antimicrobial and anti-inflammatory agents respectively. A 3-Factor Box-Behnken Design was employed to statistically optimise the fibres according to their tensile properties and drug release. The optimised formulation (3.14%w/v alginate, 22.54mL glycerol and 10.00w/v barium chloride) was evaluated for its drug release and hydration behaviour at pH 4 and 6.8, vibrational transitions and tensile properties as well as antimicrobial assays, characterising the in vitro behaviour of the device. The pH of the periodontal pocket varies from pH 2-9. Crosslinked alginate matrices demonstrate pH-responsive behaviour, therefore the polymeric fibre device was tested at pH 4 and 6.8. Drug release at pH 4 occurred as a result of drug diffusing through the polymeric fibres. However, at pH 6.8 the disruption of the fibre structure led to drug release as a consequence of the swelling and erosion of the matrix. Ciprofloxacin was sufficiently released from the drug-loaded fibres inhibiting growth of Escherichia coli, Enterococcus faecalis and Streptococcus mutans over 10 days. The physicomechanical and physicochemical properties were related to the degree of crosslinking, the effect of the plasticiser and the interaction of formulation components. The polymeric fibre device formed a strong yet flexible biodegradable matrix which simultaneously released an antimicrobial and anti-inflammatory agents in phosphate buffer solution pH 6.8 over 10 days. The promising in vitro results advocate for further analysis of the fibres.

MMed (Obstetrics and Gynaecology) Faculty of Health Sciences, University of the Witwatersrand, 2009 / Objectives • To determine the prevalence of macrosomic babies delivered at Coronation (now Rahima Moosa) Hospital. • To compare the maternal and neonatal outcome of vaginally born macrosomic babies versus vaginally born babies less than 4000g. • To determine the impact that mode of delivery of the macrosomic babies had on maternal and neonatal outcome. • To compare clinical variables for macrosomia with those published in the literature, in view of identifying predictive factors. Method Retrospective record review of all women who delivered at Coronation (Rahima Moosa) Hospital from 1 January 2005- 30 June 2005. Results A total of 134 macrosomic infants were identified, of which 76 were delivered vaginally, 14 by elective caesarean section and 44 by emergency caesarean section. During the study period, there were 5800 deliveries. The incidence of macrosomia in the study population was 2.3%. Characteristics specific to the iv cohort of macrosomic infants revealed that male sex was more common (52/74 (70%) in the macrosomic group vs. 32/74 (43%) in the non-macrosomic group, p<0.0009), length of labour was increased (13.7 vs. 10.9 hours, p=0.032), as was use of augmentation (16 vs. 5, p=0.009), perineal trauma (34 vs.19, p=0.010) post partum haemorrhage (10 vs.2, p=0.016) and shoulder dystocia (5 vs. 0, p=0.03). Vaginal delivery, compared to elective or emergency caesarean section resulted in less fetal distress (1 vs. 13, p<0.0001) and puerperal fever (4 vs. 19, p=0.0001). Differences in other fetal and maternal outcomes were not significant. Conclusion Fetal macrosomia was more likely to be associated with advanced gestational age, male sex, prolonged labour, post partum haemorrhage, use of augmentation, increased perineal trauma especially episiotomy and shoulder dystocia . Expectant management, progressing labour according to a standardized partogram and no elective caesarean section on the basis of clinical and or ultrasound diagnosis of an increased estimated fetal weight, appears to be the best form of management for the suspected macrosomic.

BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). South Africa has aligned itself with these MDGs. The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. There are a number of interventions in place to try and to achieve this goal; the provision of antenatal care is one of these interventions. Antenatal care provides the expectant mother early ongoing monitoring and risk assessment of her pregnancy. It is commonly considered fact that antenatal care improves maternal and perinatal outcomes. In spite of the provision of free maternal health services in South Africa, there are still a significant number of mothers who do not attend antenatal clinics before delivery. No formal study has been done to understand the magnitude of this problem in the Limpopo Province. In view of this, it was decided to conduct this study at the Van Velden Hospital (a rural district hospital in the Mopani District in the Limpopo Province) which has been admitting a significant number of unbooked mothers even after the introduction of free maternal health services in South Africa sixteen years ago. AIM: To compare the pregnancy outcomes (maternal and perinatal) between booked and unbooked mothers who delivered at Van Velden Hospital, a district hospital in the Limpopo Province in South Africa. METHODOLOGY: The setting of this study is the Maternity Unit at the Van Velden Hospital. A cross sectional study design was used. A retrospective record review was done and information for one year (2008/09) will be extracted from the records captured in the District Health Information System. No primary data was collected for this study. RESULTS: This is the first study that looked at broad issues pertaining to the influence of booking status on pregnancy outcomes (maternal and neonatal) at a district hospital in a rural district in the Limpopo Province and probably in South Africa. The study found a prevalence of 15.7% (range: 2.7% to 32.3%) among the study population during the 12 month study period. There were no significant differences in age, marital and employment status of the subjects. However, there were a significant number of teenage pregnancies (13.2%) among the study population, which is of concern. Interestingly, more white women were found not to book in comparison to the black women. There were no significant differences in parity, gravidity and miscarriages between the two groups. Overall, unbooked mothers were more likely to have a preterm baby. This implies antenatal booking can probably prevent preterm deliveries. This study also found unbooked mothers were more likely to have C/S than booked mothers. However, there was no significant difference between booked and unbooked mothers in terms of delivery complications. There was no significant difference between booked and unbooked mothers in terms of birth weight. Although, the babies of unbooked mothers had a significantly lower Apgar score (1 minute) than booked mothers, the difference became insignificant at 10 minutes. There was no maternal mortality during this period. All mothers were discharged home. Overall, perinatal mortality among the study population was 44/ 1000 births. This study found a significant risk of perinatal morbidity (preterm delivery and low Apgar score) among the unbooked mothers. CONCLUSION: This research was undertaken to develop a model that could be used by both the provincial and national governments to evaluate the prevalence and impact of booking status of pregnant women in rural district hospitals in South Africa.