Sustained ophthalmic delivery of pH triggered Cromolyn sodium in situ gel

The research study intends to formulate pH triggered in situ gel of Cromolyn sodium composed of Polyacrylic acid (carbopol 934) polymer in combination with Hydroxypropyl Methylcellulose (HPMC K4M) polymer at 1:1, 1.5:1, 2:1 molar ratio by utilizing pH trigger method. Formulations were evaluated for pH, viscosity, gelling capacity, drug content and in vitro drug release. Results of Carbopol 934 and HPMC K4M based in situ gelling systems at 1:1, 1.5:1, 2:1 shown that the formulations were fluid state at room temperature in a formulated pH (pH 4.5) and went through fast progress into the viscous gel phase at the pH of the tear fluid 7.4. The viscosity of formulated pH triggered in situ gel at 2:1 molar ratio shown excellent result compares to 1:1, 1.5:1 molar ratio. The in vitro drug release of the developed in situ gelling formulations at 1:1, 1.5:1, 2:1 molar ratios increases the contact time and showed a non – fickian diffusion type of release behavior with 94.45%, 83.26%, 70.48% respectively over 8 hours periods compared with that of marketed formulation that shows 99.4% over 4 hours. Thus, the developed system at 2:1 molar ratio acts as a viable alternative to conventional eye drops and also prevent the rapid drainage.

A comparative study of azelastine, cromolyn and olopatadine ophthalmic solution in vernal keratoconjunctivitis in a tertiary care hospital-open label parallel group study design

Background: Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, external ocular inflammatory disease primarily affecting young boys living in warm, dry climates with seasonal variations. The disease causes lot of discomfort to the patient and sometimes can predispose to serious problems like shield ulceration and keratoconus. A number of drugs are used in the management of the condition, with variable results. The aims and objectives of this study was to compare the efficacy and safety of the drugs, cromolyn sodium, azelastine and olopatadine ophthalmic solutions in the treatment of VKC.Methods: Sixty patients of VKC were studied over a period of 6 weeks. They were divided into 3 groups randomly to receive one of the drugs under study. Symptoms and signs were recorded after detailed questioning and examination according to modified criterion of Tabbara and Arafat.Results: There was significant reduction in the mean itching scores with olopatadine as compared to cromolyn sodium and azelastine (p<0.05). Olopatadine significantly decreased mean lacrimation scores as compared to cromolyn sodium and azelastine (p<0.005). Olopatadine, cromolyn and azelastine showed significant reduction of corneal stippling, but no drug was significantly better than the other. Both cromolyn and olopatadine showed reduction of limbal edema equally (p<0.05), olopatadine reduced limbal edema more significantly as compared to azelastine (p<0.05).Conclusions: All the three drugs were found to be safe in the treatment of VKC. Olopatadine may be preferred over the other two drugs since it reduced both itching and discharge most significantly.

High and daily exposure to precariousness negatively impacts the prescriptions of general practitioners to precarious populations: an observational pharmaco-epidemiological study investigating inequalities in access to health care in France

Background The association between precariousness and lack of access to health care is well-documented. Prescribing drugs is one promising marker for this health care inequality. A recent study, carried out on the entire French population, has developed a new measurement model based on the 20 most prescribed molecules. It reports that drugs, targeting diseases known to more affect precarious populations, are under-prescribed by general practitioners (GP) to these populations. If these findings highlight unequal drugs prescriptions between populations despite epidemiological factors, it is still unknown whether a high and daily exposure to precariousness negatively impacts GPs prescriptions. Here, we investigated whether there are more inequalities in prescriptions of GPs who are highly and daily exposed to precariousness, compared to GPs who are less exposed to precariousness. Methods This retrospective pharmaco-epidemiological study compared the Defined Daily Dose relative to different reimbursed drugs prescribed by GPs to precarious and non-precarious patients in four French regions respectively with low and high precariousness prevalence in 2015. Data were analyzed using repeated-measures ANOVAs (Sphericity correction: Greenhouse-Geisser; Post-Hoc Tests, Bonferroni corrected). Results 2 out of 20 molecules were significantly over-prescribed (tamsulosine and timolol) and 7 were under-prescribed (amoxicillin, econazole, ciclopirox, prednisolone, paracetamol, cromolyn sodium, ibuprofen) to precarious populations in regions with high precariousness prevalence. Conclusions The over-reimbursement of tamsulosine and timolol did not reflect the negative impact of exposure to precariousness on the GPs prescriptions but a failure of the health system to compensate for inequalities in access to chirurgical treatments. In contrast, the under-reimbursement of amoxicillin, ciclopirox and econazole indicated an effect of the exposure to precariousness on GPs’ prescriptions, these molecules targeting acute diseases that affect more significantly precarious than non-precarious populations. The same explanation is probably suitable for the under-reimbursement of prednisolone, paracetamol, cromolyn sodium, and ibuprofen, although their various indications render difficult to delimitate the clinical purpose at the basis of their prescription. We assume that exhausting working conditions, repeated exposures to difficult living conditions, and repeated experiences of failure impairs empathic skills in GPs, leading to burnout which negatively impacts the quality of care and, thus, prescriptions.