Product standardisation as a tool to control prescribing costs a case study of alginate liquid preparations

Introduction Product standardisation involves promoting the prescribing of pre-selected products within a particular category across a healthcare region and is designed to improve patient safety by promoting continuity of medicine use across the primary/secondary care interface, in addition to cost containment without compromising clinical care (i.e. maintaining safety and efficacy). Objectives To examine the impact of product standardisation on the prescribing of compound alginate preparations within primary care in Northern Ireland. Methods Data were obtained on alginate prescribing from the Northern Ireland Central Services Agency (Prescription Pricing Branch), covering a period of 43 months. Two standardisation promotion interventions were carried out at months 18 and 33. In addition to conventional statistical analyses, a simple interrupted time series analysis approach, using graphical interpretation, was used to facilitate interpretation of the data. Results There was a significant increase in the prescribed share of the preferred alginate product in each of the four health boards in Northern Ireland and a decrease in the cost per Defined Daily Dose for alginate liquid preparations overall. Compliance with the standardisation policy was, however, incomplete and was influenced to a marked degree by the activities of the pharmaceutical industry. The overall economic impact of the prescribing changes during the study was small (3.1%). Conclusion The findings suggested that product standardisation significantly influenced the prescribing pattern for compound alginate liquid preparations within primary care across Northern Ireland. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

The effect of alginate-based edible coatings enriched with essential oils constituents on Arbutus unedo L. fresh fruit storage

The effect of coating Arbutus unedo fresh fruit with alginate-based edible coatings enriched with the essential oils compounds (EOC) eugenol (Eug) and citral (Cit) was studied. The minimum inhibitory concentrations (MIC) against the main postharvest pathogens were determined for Eug and Cit giving values of 0.10 and 0.15 (w/v), respectively. Twelve formulations of edible coatings were used: sodium alginate (AL) was tested at 1 and 2% (w/v) with incorporation of Eug and Cit at MIC and double MIC or their combination at MIC. Arbutus berries were dipped in those solutions for 2 min, and then stored at 0.5 degrees C. Control consisted of uncoated fruit. On days 0, 14 and 28, samples were taken to perform physicochemical and biochemical analysis [color CIE (L*, h degrees), firmness, soluble solids content (SSC), weight Loss, trolox equivalent antioxidant capacity (TEAC), microbial growth and taste panels]. Results showed that edible coatings of 1% AL were the best to maintain most quality attributes of the commodity through storage at 0.5 degrees C. The incorporation of Cit and Eug into the alginate edible coatings improved the coatings in most cases, AL 1% + Eug 0.20% and AL 1% + Cit 0.15% + Eug 0.10% being those that better preserved sensory and nutritional attributes and reduced microbial spoilage. Thus, these coatings may be useful for improving postharvest quality and storage life of fresh arbutus fruit. (C) 2014 Elsevier B.V. All rights reserved.

Développement d’une matrice prébiotique pour l’encapsulation des probiotiques bactériocinogènes, destinée à l’alimentation animale - de la physicochimie à la biopharmacie

L’antibiorésistance est un problème de santé publique majeur, causé principalement par l’usage abusif d’antibiotiques dans les élevages. Les probiotiques sont une alternative potentielle aux antibiotiques. Cependant, acheminer ces microorganismes vivants et fonctionnels jusqu’au côlon est un grand défi, à cause du pH et des sels biliaires à affronter lors du passage gastro-intestinal. L’objectif de ce travail était de développer une matrice prébiotique capable de maintenir la survie et l’activité des probiotiques pendant le transit gastro-intestinal et de permettre leur libération dans le côlon. Pour atteindre cet objectif, cinq types de matrices sphériques (A, AI5, AI10, AI15, AI20) à base d’inuline (0 %, 5 %, 10 %, 15 % et 20 %) et d’alginate (2 %) ont été préparés par la méthode d’extrusion/gélification ionotropique. Trois souches probiotiques ont été utilisées au cours du développement des billes : Pediococcus acidilactici UL5 (UL5), Lactobacillus reuteri (LR) et Lactobacillus salivarius (LS). Dans un premier temps, toutes les formulations ont été caractérisées d’un point de vue physicochimique et microbiologique. Ces analyses ont permis de révéler une distribution homogène de l’inuline et de l’alginate au sein des matrices et ont démontré que la viabilité et la capacité antimicrobienne des souches utilisées n’étaient pas affectées par l’encapsulation. À la lumière de ces résultats, trois formulations A, AI5 et AI20 ont été sélectionnées pour la suite de l’étude. Dans un deuxième temps, la mucoadhésion et le comportement des billes A, AI5 et AI20 ont été étudiés dans les parties supérieures du tractus gastro-intestinal. Ces études ont démontré que la présence de l’inuline améliore les propriétés mucoadhésives des billes. Elles ont également établi que seule la formulation AI5 résiste jusqu’à la fin de la digestion. Ce comportement est expliqué en partie par l’interaction alginate-inuline décelée par spectroscopie infrarouge à transformée de Fourier (FTIR). Cette interaction était stable pour les billes AI5 au pH 6,8 mais instable pour la formulation AI20. Enfin, le comportement et la dynamique bactérienne de la formulation AI5 dans les milieux coliques fermenté et non fermenté ont été étudiés. Cette étude a révélé que les billes AI5 se dégradent et libèrent la totalité des bactéries après environ 4 heures d’incubation dans le milieu fermenté. Cette dégradation est due aux enzymes très abondantes dans ce milieu. En conclusion, la formulation AI5 s’est avérée être un très bon véhicule pour protéger les bactéries dans les parties supérieures du tube digestif et favoriser leur libération dans le côlon. Elle pourrait donc, être utilisée pour une application en alimentation animale.

Myoglobin-biomimetic electroactive materials made by surface molecular imprinting on silica beads and their use as ionophores in polymeric membranes for potentiometric transduction

Myoglobin (Mb) is among the cardiac biomarkers playing a major role in urgent diagnosis of cardiovascular diseases. Its monitoring in point-of-care is therefore fundamental. Pursuing this goal, a novel biomimetic ionophore for the potentiometric transduction of Mb is presented. It was synthesized by surface molecular imprinting (SMI) with the purpose of developing highly efficient sensor layers for near-stereochemical recognition of Mb. The template (Mb) was imprinted on a silane surface that was covalently attached to silica beads by means of self-assembled monolayers. First the silica was modified with an external layer of aldehyde groups. Then, Mb was attached by reaction with its amine groups (on the external surface) and subsequent formation of imine bonds. The vacant places surrounding Mb were filled by polymerization of the silane monomers 3-aminopropyltrimethoxysilane (APTMS) and propyltrimethoxysilane (PTMS). Finally, the template was removed by imine cleavage after treatment with oxalic acid. The results materials were finely dispersed in plasticized PVC selective membranes and used as ionophores in potentiometric transduction. The best analytical features were found in HEPES buffer of pH 4. Under this condition, the limits of detection were of 1.3 × 10−6 mol/L for a linear response after 8.0 × 10−7 mol/L with an anionic slope of −65.9 mV/decade. The imprinting effect was tested by preparing non-imprinted (NI) particles and employing these materials as ionophores. The resulting membranes showed no ability to detect Mb. Good selectivity was observed towards creatinine, sacarose, fructose, galactose, sodium glutamate, and alanine. The analytical application was conducted successfully and showed accurate and precise results.

Acute Eosinophilic and Neutrophilic Pneumonia following Transarterial Chemoembolization with Drug-Eluting Beads Loaded with Doxorubicin for Hepatocellular Carcinoma: A Case Report.

At an intermediate or advanced stage, i.e. stage B or C, based on the Barcelona Clinic Liver Cancer classification of hepatocellular carcinoma (HCC), transarterial chemoembolization (TACE) may be offered as a treatment of palliative intent. We report the case of a patient suffering from acute respiratory distress syndrome after TACE with drug-eluting beads loaded with doxorubicin for HCC. To our knowledge, this is the first case described where a bronchoalveolar lavage was performed, and where significant levels of alveolar eosinophilia and neutrophilia were evident, attributed to a pulmonary toxicity of doxorubicin following liver chemoembolization. © 2014 S. Karger AG, Basel.

Biocompatibilité des microcapsules d'alginate : purification d'alginate, réaction immunitaire de l'hôte et protection du receveur

L’immuno-isolation des îlots de Langerhans est proposée comme moyen d’effectuer des transplantations sans prise d’immunosuppresseurs par le patient. Cette immuno-isolation, par l’entremise d’une microcapsule composée d’alginate et de poly-L-lysine (microcapsule APA), protège le greffon d’une éventuelle attaque du système immunitaire du receveur grâce à sa membrane semi-perméable. Cette membrane empêche le système immunitaire du receveur de pénétrer la microcapsule tout en laissant diffuser librement les nutriments, le glucose et l’insuline. Avant l’application de cette technique chez l’humain, quelques défis doivent encore être relevés, dont la biocompatibilité de ce système. La biocompatibilité fait ici référence à la biocompatibilité du biomatériau utilisé pour la fabrication des microcapsules, l’alginate, mais aussi la biocompatibilité des microcapsules reliée à leur stabilité. En effet, il a été remarqué que, lors d’implantation in vivo de microcapsules fabriquées avec de l’alginate non purifiée, ceci induisait un phénomène nommé Réaction de l’Hôte contre la Microcapsule (RHM). De plus, il est connu que la stabilité des microcapsules APA peut influencer leur biocompatibilité puisqu’une microcapsule endommagée ou brisée pourrait laisser s’échapper les cellules du greffon chez le receveur. Nous croyons qu’une compréhension des processus d’initiation de la RHM en fonction de l’efficacité des procédés de purification d’alginate (et donc des quantités de contaminants présents dans l’alginate) ainsi que l’augmentation de la stabilité des microcapsules APA pourront améliorer la biocompatibilité de ce dispositif, ce que tente de démontrer les résultats présentés dans cette thèse. En effet, les résultats obtenus suggèrent que les protéines qui contaminent l’alginate jouent un rôle clé dans l’initiation de la RHM et qu’en diminuant ces quantités de protéines par l’amélioration des procédés de purification d’alginate, on améliore la biocompatibilité de l’alginate. Afin d’augmenter la stabilité des microcapsules APA, nous décrivons une nouvelle technique de fabrication des microcapsules qui implique la présence de liaisons covalentes. Ces nouvelles microcapsules APA réticulées sont très résistantes, n’affectent pas de façon négative la survie des cellules encapsulées et confinent les cellules du greffon à l’intérieur des microcapsules. Cette dernière caractéristique nous permet donc d’augmenter la biocompatibilité des microcapsules APA en protégeant le receveur contre les cellules du greffon.

Continuous production of L-glutaminase by an immobilized marine Pseudomonas sp BTMS-51 in a packed bed reactor

A marine Pseudomonas sp BTMS-51, immobilized by Ca-alginate gel entrapment was used for the production of extracellular Lglutaminase under repeated batch process and continuous process employing a packed bed reactor (PBR). Immobilized cells could produce an average of 25 U/ml of enzyme over 20 cycles of repeated batch operation and did not show any decline in production upon reuse. The enzyme yield correlated well with the biomass content in the beads. Continuous production of the enzyme in PBR was studied at different substrate concentrations and dilution rates. In general, the volumetric productivity increased with increased dilution rate and substrate concentrations and the substrate conversion efficiency declined. The PBR operated under conditions giving maximal substrate conversion efficiency gave an average yield of 21.07 U/ml and an average productivity of 13.49 U/ml/h. The system could be operated for 120 h without any decline in productivity

Aprofitament de residus vegetals per a la concentració i separació d'ions metàl·lics de solucions aquoses

La adsorció sobre carbó actiu és un tractament habitual para a l'eliminació de metalls contaminants d'afluents aquosos. Amb la finalitat de reduir el cost dels tractament actuals s'està estudiant la utilització d'adsorbents de baix cost com a substituts dels sorbents convencionals que s'utilitzen usualment en els tractaments d'aigües. En aquesta tesi s'ha avaluat la possibilitat d'aprofitar diversos residus vegetals procedents de processos agrícoles o residus industrials, com a sorbents per a l'eliminació de metalls de solucions aquoses. En concret, el treball s'ha centrat en assolir dos grans objectius, primer de tot, conèixer la possibilitat d'utilitzar el pinyol d'oliva com a adsorbent de metalls divalents de solucions aquoses, com són el Cd(II), Cu(II), Ni(II) i Pb(II), i en segon lloc, avaluar la utilització de quatre residus vegetals (escorça de yohimbe, rapa de raïm, suro i pinyol d'oliva) per a l'extracció de Cr(VI) de solucions aquoses i utilitzar el residu vegetal més apropiat com a base per tal d'obtenir un nou sorbent, amb més bona morfologia per ser utilitzat en sistemes d'eliminació de Cr(VI) en continu. Les dades cinètiques d'adsorció es van tractar amb el model cinètic de pseudo-segon ordre, amb el que es van determinar la velocitat inicial d'adsorció dels metalls. Els models d'isotermes d'equilibri de Langmuir i Freundlich es van utilitzar per descriure els equilibris d'adsorció i calcular els paràmetres de les isotermes. En els assajos amb mescles binàries de metalls, els resultats es van tractar amb el model ampliat de Langmuir. En aquest treball s'ha determinat, primerament, que el pinyol d'oliva és un bon sorbent dels metalls divalents estudiats. S'ha determinat que l'adsorció dels metalls varia amb el pH de la solució i que la presència de sals en la solució provoca una davallada en l'adsorció. També es va determinar la competència en l'adsorció entre els metalls al realitzar assajos en mescles binàries. Amb els estudis d'extracció de Cr(VI) amb els quatre materials s'ha determinat que aquests vegetals poden adsorbir el Cr(VI) en solució, tot i que la rapa i la yohimbe són els materials que presenten unes capacitats d'adsorció més elevades. Les anàlisis amb espectroscòpia electrònica de Raig-X realitzats en la rapa de raïm i la yohimbe en contacte amb Cr(VI) varen demostrar la presència del metall en els dos estats d'oxidació, Cr(VI) i Cr(III), evidenciant la participació del mecanisme de reducció de Cr(VI) en l'adsorció del metall sobre els materials. Amb l'encapsulació de la rapa de raïm es va incrementar significativament la capacitat d'adsorció del metall respecta a la seva utilització en la forma original. Les dades experimentals es van tractar amb un model de difusió i es va determinar el coeficient de difusió en l'adsorció en el sorbent amb diferent percentatge de rapa en l'interior. Finalment s'han realitzat estudis preliminars d'adsorció de crom hexavalent en continu utilitzant columnes de petites dimensions farcides amb el sorbent format per boles de rapa encapsulada en alginat càlcic. En aquests assajos s'ha determinat l'efecte en l'adsorció de metall de diversos paràmetres d'operació, com la concentració inicial de metall, el cabal i l'alçada de llit. El model de transferència de matèria i difusió en columna emprat pel tractament de les dades experimentals va mostrar l'efecte de la concentració inicial i del cabal en els coeficients de difusió i transferència de matèria. El model BDST no va predir correctament el temps de servei en els diferents paràmetres d'operació experimentats a causa de la complexitat del procés d'adsorció. Amb aquests assajos preliminars s'han establert les bases de l'adsorció de Cr(VI) amb el nou sorbent en sistemes en continu amb la finalitat de realitzar estudis posteriors d'eliminació del metall en columnes de majors dimensions.

Production and evaluation of dry alginate-chitosan microcapsules as an enteric delivery vehicle for probiotic bacteria

This study investigates the production of alginate microcapsules, which have been coated with the polysaccharide chitosan, and evaluates some of their properties with the intention of improving the gastrointestinal viability of a probiotic (Bifidobacterium breve) by encapsulation in this system. The microcapsules were dried by a variety of methods, and the most suitable was chosen. The work described in this Article is the first report detailing the effects of drying on the properties of these microcapsules and the viability of the bacteria within relative to wet microcapsules. The pH range over which chitosan and alginate form polyelectrolyte complexes was explored by spectrophotometry, and this extended into swelling studies on the microcapsules over a range of pHs associated with the gastrointestinal tract. It was shown that chitosan stabilizes the alginate microcapsules at pHs above 3, extending the stability of the capsules under these conditions. The effect of chitosan exposure time on the coating thickness was investigated for the first time by confocal laser scanning microscopy, and its penetration into the alginate matrix was shown to be particularly slow. Coating with chitosan was found to increase the survival of B. breve in simulated gastric fluid as well as prolong its release upon exposure to intestinal pH.

In vitro fermentation and prebiotic potential of novel low molecular weight polysaccharides derived from agar and alginate seaweeds

Fermentation properties and prebiotic potential of novel low molecular weight polysaccharides (LMWPs) derived from agar and alginate bearing seaweeds was investigated. Ten LMWPs were supplemented to pH, temperature controlled anaerobic batch cultures inoculated with human feces from three donors, in triplicate. Microbiota changes were monitored using Fluorescent in-situ hybridization and short chain fatty acids, the fermentation end products were analysed using gas chromatography. Of the ten LMWPs tested, Gelidium seaweed CC2253 of molecular weight 64.64 KDa showed a significant increase in bifidobacterial populations from log(10) 8.06 at 0 h to log(10) 8.55 at 24 h (p = 0.018). For total bacterial populations, alginate powder CC2238 produced a significant increase from log(10) 9.01 at 0 h to log(10) 9.58 at 24 h (p = 0.032). No changes were observed in the other bacterial groups tested viz. Bacteroides, Lactobacilli/Enterococci, Eubacterium rectale/Clostridium coccoides and Clostridium histolyticum. The polysaccharides also showed significant increases in total SCFA production, particularly acetic and propionic acids, indicating that they were readily fermented. In conclusion, some LMWPs derived from agar and alginate bearing seaweeds were fermented by gut bacteria and exhibited potential to be used a novel source of prebiotics.

Enhanced viability of corneal epithelial cells for efficient transport/storage using a structurally-modified calcium alginate hydrogel

Aims: Therapeutic limbal epithelial stem cells could be managed more efficiently if clinically validated batches were transported for ‘on-demand’ use. Materials & methods: In this study, corneal epithelial cell viability in calcium alginate hydrogels was examined under cell culture, ambient and chilled conditions for up to 7 days. Results: Cell viability improved as gel internal pore size increased, and was further enhanced with modification of the gel from a mass to a thin disc. Ambient storage conditions were optimal for supporting cell viability in gel discs. Cell viability in gel discs was significantly enhanced with increases in pore size mediated by hydroxyethyl cellulose. Conclusion: Our novel methodology of controlling alginate gel shape and pore size together provides a more practical and economical alternative to established corneal tissue/cell storage methods.

Rheological and thermal behaviour of poly(N-isopropylacrylamide)/alginate smart polymeric networks

Interpenetrating polymeric networks based on sodium alginate and poly(N-isopropylacrylamide) (PNIPAAm) covalently crosslinked with N,N′-methylenebisacrylamide have been investigated using rheology, thermogravimetry, differential scanning calorimetry, X-ray diffraction measurements and scanning electron microscopy (SEM). An improved elastic response of the samples with a higher PNIPAAm content and increased amount of crosslinking agent was found. The temperature-responsive behaviour of the hydrogel samples was evidenced by viscoelastic measurements performed at various temperatures. It is shown that the properties of these gels can be tuned according to composition, amount of crosslinking agent and temperature changes. X-ray scattering analysis revealed that the hydrophobic groups are locally segregated even in the swollen state whilst cryo-SEM showed the highly heterogeneous nature of the gels.

Multi-responsive hydrogels based on N-isopropylacrylamide and sodium alginate

Hydrogels consisting of sodium alginate and N-isopropylacrylamide covalently crosslinked with N,N′-methylenebisacrylamide were prepared. The mixed-interpenetrated networks obtained were characterized using elemental analysis, Fourier transform infrared and Raman spectroscopy, swelling measurements and environmental scanning electron microscopy. The thermo- and pH-responsive properties of these hydrogels were evidenced by their swelling behaviour, which depended also on the amount of crosslinking agent and hydrogel composition.

Layer-by-layer coating of alginate matrices with chitosan–alginate for the improved survival and targeted delivery of probiotic bacteria after oral administration

The oral administration of probiotic bacteria has shown potential in clinical trials for the alleviation of specific disorders of the gastrointestinal tract. However, cells must be alive in order to exert these benefits. The low pH of the stomach can greatly reduce the number of viable microorganisms that reach the intestine, thereby reducing the efficacy of the administration. Herein, a model probiotic, Bifidobacterium breve, has been encapsulated into an alginate matrix before coating in multilayers of alternating alginate and chitosan. The intention of this formulation was to improve the survival of B. breve during exposure to low pH and to target the delivery of the cells to the intestine. The material properties were first characterized before in vitro testing. Biacore™ experiments allowed for the polymer interactions to be confirmed; additionally, the stability of these multilayers to buffers simulating the pH of the gastrointestinal tract was demonstrated. Texture analysis was used to monitor changes in the gel strength during preparation, showing a weakening of the matrices during coating as a result of calcium ion sequestration. The build-up of multilayers was confirmed by confocal laser-scanning microscopy, which also showed the increase in the thickness of coat over time. During exposure to in vitro gastric conditions, an increase in viability from <3 log(CFU) per mL, seen in free cells, up to a maximum of 8.84 ± 0.17 log(CFU) per mL was noted in a 3-layer coated matrix. Multilayer-coated alginate matrices also showed a targeting of delivery to the intestine, with a gradual release of their loads over 240 min.