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Fanconi anaemia is a rare, autosomal recessive bone marrow failure syndrome characterised by congenital anomalies and haematological abnormalities. Literature on anaesthetic management is limited due to its heterogeneous presentation and scarcity of clinical trials addressing anaesthetic considerations; with most information derived from case reports, we report successful anaesthetic management of a 7-year-old child with a history of allogeneic bone marrow transplant for correction of pancytopenia, presenting for an emergency lower limb surgery, emphasises the importance of meticulous perioperative care, an individualised plan focused on preventing and managing perioperative complications, is essential as these patients need as a thorough evaluation of congenital, syndromic and tumour-related complications as well as careful attention to haematological deficiencies.
BACKGROUND:By encouraging treatment adherence and lowering mortality, dietary supplements can serve as adjuvant therapy for the success of medical interventions. We determined the effect of locally accessible food supplements on treatment outcomes, and health-related quality of life in patients with pulmonary tuberculosis initiating anti-tuberculosis treatment (ATT) in Odisha, India. METHOD:Between September 2017 and December 2018, implementation research in patients with newly diagnosed sputum smear-positive pulmonary tuberculosis initiating ATT in five districts of the tribal belt of Odisha, offered food supplements along with ATT in a phased manner. Clinical symptoms, anthropometry, sputum for M. tuberculosis (M. tb), health-related quality of life and return to normal function were assessed periodically, and favourable treatment outcome (cure or treatment completed) was measured at the end of treatment. The effect of the food supplement on unfavorable outcomes (treatment failure, death, or lost-to-follow-up) was modelled using mixed-effects Poisson regression to determine the risk factors. RESULTS:Among the 761 participants enrolled, 614 participants received the food supplement and 147 did not receive the food supplement. Among the 614 participants in the supplement group, 537 (87%) had a favorable outcome and among the 147 participants in the no-supplement group, 113 (77%) had a favorable outcome (p = 0.0017). Higher age (>55 years) [aRR = 2.1(95% CI: 1.1-3.8)], male gender [aRR = 1.7(95% CI: 1.2-2.9)], and smear grading ≥2+ [aRR = 1.5 (95% CI: 1.1-2.2)] were associated with unfavorable treatment outcomes. Nutritional status, quality of life and lung health showed significant improvement from baseline in the supplement group. CONCLUSION:Improvement in the nutritional status of the patient can be considered a predictor of treatment success rates. Early food supplementation has a positive impact on the nutritional status.
Effervescent drug delivery systems (EDDS) have gained significant attention in the pharmaceutical industry due to their unique characteristics and potential advantages over conventional dosage forms. This comprehensive review aims to provide an in-depth understanding of EDDS, including their formulation strategies, underlying mechanisms, and diverse applications in drug delivery. EDDS are effervescent dosage forms that release drugs upon water dissolution, leading toward carbon dioxide gas generation. The effervescence, resulting from the reaction between an acid and a base, facilitates rapid drug dissolution and enhances drug bioavailability. The primary components of an EDDS include an active pharmaceutical ingredient (API), effervescent agents (e.g., organic acids and bases), binders, disintegrants, and other excipients. Effervescent tablets, granules, powders, and effervescent-coated dosage forms are commonly employed formulations. Several factors, such as pH, temperature, solubility, and particle size, influence the drug’s effervescence process and subsequent release kinetics. The drug release mechanisms from EDDS can be attributed to various phenomena, including effervescence-driven disintegration, gas evolution, and solubilization. The effervescence-induced carbon dioxide bubbles mechanically disrupt the dosage form, leading to enhanced drug dissolution and subsequent release. Additionally, the carbon dioxide gas acts as a propellant, providing rapid drug delivery and potentially improving patient compliance. EDDS find applications in diverse therapeutic areas, including analgesics, antacids, dietary supplements, and antiviral agents. They offer several advantages, such as improved drug stability, enhanced bioavailability, increased patient convenience, and ease of administration, particularly for populations with swallowing difficulties. Furthermore, EDDS can be tailored to achieve controlled release, targeted drug delivery, and taste masking through appropriate formulation modifications. However, challenges associated with EDDS include their sensitivity to environmental conditions, potential drug degradation during effervescence, and the need for specialized packaging to maintain stability. The selection of suitable effervescent agents, excipients, and manufacturing processes is crucial to overcome these limitations and ensure consistent product performance. In conclusion, effervescent drug delivery
