Journal of the Faculty of Medicine Baghdad

Death rate and causes of death in the neonatal intensive care unit in the Children Welfare Teaching Hospital (2018-2021)

Sura Albermany — 2023-10-01

Background: The first month of life is the most vulnerable period and mortality during this period is an important component of under-5 mortalities. Causes of death in this period are preventable like sepsis, RDS, and asphyxia, while others are not like multiple congenital abnormalities.

Objectives: To study the death rate and main causes of death in the neonatal intensive care unit (NICU) of the Children Welfare Teaching Hospital (CWTH) through the period (2018-2021).

Patients and methods: The death per year for the four years of the study and causes of death were collected retrospectively and analyzed for total death rate and rate for each year, sex distribution, male-to-female ratio, early and late death rate, and main causes of death.

Results: it was found that the total death rate is 17.3%, male: female ratio 1.6: 1. The early neonatal death was 54.3% and the late neonatal death was 45.6%. The main causes are congenital anomalies (39%), sepsis (17.4%), prematurity (16.9%), RDS (10.8%), postoperative complications (7.5%), and birth asphyxia (1.9%).

Conclusions: The death rate in the NICU / CWTH is still high despite improvement in respiratory care and the use of invasive and noninvasive respiratory support. The death rate because of congenital abnormalities was the main cause of death.

Received: Dec,, 2022

Accepted: July, 2023

Published: Oct.2023

Acute Kidney Injury in Neonates: A Single-Center Experience

Ali Khudhair — 2023-10-01

Background: Neonatal intensive care unit infants frequently experience acute kidney damage. Estimates of the prevalence of acute kidney vary depending on the definitions used. In Iraq, studies addressing the prevalence and risk factors of acute kidney injury in this age group are scarce, none of which has implicated the KDIGO diagnostic and staging criteria.

Objectives: To describe the prevalence, demographics, risk factors, etiology, and staging of acute kidney injury using KDIGO criteria in the Neonatal intensive care unit and correlate these findings with patient outcomes.

Methods: A retrospective study was conducted in the Neonatal Intensive Care Unit/ CWTH/ Medical City Complex/ Baghdad during the period from the 1^st of August 2019 to the 15^th of January 2020. All neonates diagnosed with acute kidney injury according to KDIGO –classification 2012 and admitted to the neonatal intensive care unit were included in this study. Demographics, clinical staging, and investigations were retrieved from patients' notes.

Results: The prevalence of acute kidney damage was 7.2%. The mean gestational age of the patients was 36.8 ± 2.9 weeks, 58% of them were full-term, with a male-to-female ratio of 1.40:1. Stage I patients represented 35.1%, 43.2% were stage 2, and 21.6% had severe stage 3. Acute kidney injury-related mortality was 35.1%. The term female sex, high birth weight, and age younger than seven days at diagnosis predicted a bad prognosis. Vaginally delivered, stage III acute kidney injury-KDIGO, and peritoneal dialysis patients had the worst outcomes. Asphyxia was a major cause of acute kidney injury (P=0.001). High blood urea (P=0.01), low PH (P=0.009), low HCO3 (P=0.001), low WBC count (P=0.001), and low platelet count (0.001) were associated with unfavorable outcomes.

Conclusions: The prevalence of acute kidney injury, according to KIDGO diagnostic and staging criteria, is 7.1%. Asphyxia, female gender, and vaginal deliveries are variables associated with poor prognosis in addition to advanced illness stage and laboratory indicators.

Received: Dec. 2022

Accepted: Jun 2023

Published: Oct.2023

A Comparative Study between Dusting and Fragmentation in Intracorporeal Laser Lithotripsy in Distal Ureteric Stone

mostafa AL sunboli — 2023-10-01

Background: Ureteric stones commonly have an impact on the quality of life of the patient. There are many treatment choices for the condition, including medical treatment, extra-corporeal shock wave lithotripsy (ESWL), endoscopic intervention by ureteroscope (URS), or surgery (open or laparoscopic). Semi-rigid URS with laser lithotripsy is used to fragment ureteric stones, especially those in the distal ureter.

Objectives: To assess the efficacy and complications of the dusting versus the fragmentation method for lower ureteric stones using holmium laser lithotripsy by analyzing intra-operative and post-operative variables.

Patients and methods: One hundred and twenty patients with distal ureteric stones were included in the current study conducted in Ghazi AL-Hariri Teaching Hospital for Surgical Specialties from December 2020 to July 2022. The cases were divided into two groups: The first is the dusting group and the second is the fragmentation group. Both groups are further subdivided into the 10-15 mm and < 10 mm stone groups. The time of the operation, the rate of being stone-free, stone size, the rate of Double-J stents (DJS), and intraoperative complications were compared for the study groups.

Results: the operative time was more among Group A (dusting) than Group B (fragmentation) with a statistically significant association, stone-free rate more in Group A (dusting) than Group B (fragmentation) without a statically significant Need for DJ in Group b (fragmentation) than group a (dusting) with statically significant association Regard intraoperative complication (mucosal injury, stone migration, perforation) more in group b (fragmentation) a (dusting) without any significant association.

Conclusion: The dusting method resulted in fewer intraoperative complications (mucosal injury, stone migration, perforation) and a lower need for DJ insertion than the fragmentation method. However, it needed a longer operative time than the fragmentation method.

Received: Nov,, 2022

Accepted: April, 2023

Published: Oct.2023

A Cross-Sectional Study of Urinary Neutrophil Gelatinase-Associated Lipocalin and its Association with Steroid Responsiveness in Iraqi Children with Idiopathic Nephrotic Syndrome

ALI MOHAMMED ABD ALRIDHA — 2023-10-01

Background: Steroid-resistant nephrotic syndrome (SRNS)is associated with serious complications and financial burdens. Studies reported increased urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels in children with idiopathic nephrotic syndrome (INS).

Objectives: This study aimed to evaluate the uNGAL potential to distinguish SRNS from steroid-sensitive nephrotic syndrome (SSNS) in Iraqi children.

Patients and Methods: Children with SRNS (n=31) and SSNS (n=32) were recruited from Babylon Hospital for Maternity and Pediatrics from March to June 2022. Patients' data included demographics, clinical characteristics, and urinary lab tests. The uNGAL concentrations were measured via a commercially available ELISA kit.

Results: A significantly higher uNGAL median (p-value<0.001) was noted in the SRNS group (median [IQR] = 131.512 [30.28] ng/mL) than in the SSNS group (88.45 [41.6] ng/mL). The correlation between uNGAL levels and estimated glomerular filtration rate (eGFR) was negative (Spearman's rho coefficient = − 0.599, p<0.001). The discriminatory power ofuNGAL to discern SRNS from SSNS was significantly high (AUC=0.899, p<0.0001) with a sensitivity of 87.1% and specificity of 87.5% at an optimal cut-off value of 111.091 ng/mL.

Conclusion: uNGAL is associated with a reliable discriminatory strength to distinguish, noninvasively, children with SRNS from those with SSNS.

Received: Jan. 2023

Accepted: Jul, 2023

Published: Oct.2023

The Advantages of Combined Regional and General Anesthesia in Ophthalmic Surgery in Children

Rand Saadi Abdul-Sattar — 2023-10-01

Background: Regional anesthesia is a common procedure in an adult patient undergoing ophthalmic surgery, but it cannot be done alone in the pediatric age group. General anesthesia is accompanied by complications intra- and post-operatively.

Objectives: to determine whether or not using regional anesthesia in combination with general anesthesia in pediatric eye procedures improves patient outcomes.

Methods: Forty children, with an age range of 6 - 12 years were included in the study that was conducted at Ghazi Al-Hariri Hospital / Department of Ophthalmology and Ibn Al-Haytham (Ophthalmology Hospital), both teaching hospitals, from December 2018 to October 2019. These children were allocated into one of two groups: GA (general anesthesia) and GA-R (general anesthesia-regional anesthesia). Heart rates, mean arterial blood pressure, oculo-cardiac reaction, and postoperative nausea and vomiting were measured. All required approvals were obtained from the scientific committee of the Iraqi Board for Medical Specializations. Statistical analysis was done using SPSS V26, with a P value of <0.05 considered significant.

Results: None of the patients developed oculo-cardiac reactions or needed additives to the anesthesia given during surgery in the GA-R compared to the GA group. Intra-operative measurements of heart rates and mean arterial blood pressure were lower in the GA group than in the GA-R group (p<0.05). Compared to the GA group, the GA-R group had a lower incidence of postoperative nausea and vomiting (p<0.05). More patients in the GA group needed analgesia than in the GA-R group.

Conclusion: Using regional anesthesia as a peribulbar block with general anesthesia is a safe and successful procedure in pediatric ocular surgeries.

Received:Feb. 2023

Accepted: Sept. 2023

Published: Oct. 2023

Atherogenic Indices in Type 2 Diabetic Iraqi Patients and Its Association with Cardiovascular Disease Risk

Hind Shakir Ahmed — 2023-10-01

Background: Diabetes is a serious risk factor for atherosclerotic cardiovascular disease and an important cause of mortality. Dyslipidemia is commonly related to type 2 diabetes, and the atherogenic index of plasma is a strong marker to predict the risk of atherosclerosis and coronary heart disease.

Objective: To study the association of atherogenic indices lipids in type 2 diabetic Iraqi patients with cardiovascular disease.

Patients and Methods: This clinical study was conducted at Baghdad Teaching Hospital/ Medical City-Baghdad from October 2022 to February 2023. Sixty type 2 diabetic patients were recruited for this study: 30 patients with cardiovascular disease and 30 without cardiovascular disease. Their ages were between 40-55 years. Another 30 healthy individuals were selected as a control group.

Results: There were considerable rises in glycemic and lipid investigations in diabetic patients with cardiovascular disease compared to those without cardiovascular disease and the control group. The present results show higher levels of lipid ratios in diabetic patients with cardiovascular disease. The results also revealed high levels of non-high-density lipoprotein cholesterol for diabetic patients with cardiovascular disease (241.8±12.24 mg/dL) versus (150.1±7.12 and 68.9±5.1 mg/dL) for those without cardiovascular disease and the controls group respectively. The atherogenic index of plasma in diabetic patients with cardiovascular disease compared to diabetic and healthy control groups were (0.8±0.09) versus (0.7±0.03 and 0.2±0.08) respectively. There was a significant correlation between the atherogenic index of plasma and anthropometric factors, glycemic and lipid profile with their ratios in diabetic patients with and without cardiovascular disease.

Conclusions: The results of this study confirm that the lipid indices are risk indicators of glycemic control with higher prognostic value than traditional factors. So, non-high-density lipoprotein cholesterol and atherogenic index of plasma can be used as a significant predictor of glycemic control.

Received: Feb., 2023

Accepted: May, 2023

Published: Oct. 2023

Does the local application of Platelet-Rich Plasma Reduce Hemorrhage after Tonsillectomy? A Comparative Study

Ahmed Muhei Rasheed — 2023-10-01

Background: Tonsillectomy is one of the most common surgical operations in otolaryngology, post-tonsillectomy hemorrhage is a dangerous complication. Several methods have been used to decrease the rate of post-tonsillectomy hemorrhage, one of these methods, a relatively recent method, is local application of platelet-rich plasma (PRP) to the tonsillar beds.

Objectives: To evaluate the role of local application of autologous PRP to the tonsillar beds, at the time of tonsillectomy, in post-tonsillectomy hemorrhage.

Patients and methods: A prospective comparative study enrolled 64 patients with ages ranging from 6 to 10 years who underwent tonsillectomy with or without adenoidectomy. In each patient, PRP was applied at the time of tonsillectomy to one tonsillar bed (PRP side), while the other side was used as a control side. So, the total sides were 128 (64 PRP and 64 control sides). The patients were followed-up for 10 days and the outcome measure was the occurrence of post-tonsillectomy hemorrhage on the PRP side versus the control side. The association between the variables was established using chi-square test (X2-test).

Results: Thirty-eight patients (59.4%) were males and twenty-six patients (40.6%) were females. Adenotonsillectomy was performed in 35 patients (54.7%), while 29 patients (45.3%) underwent tonsillectomy alone. There was no post-operative hemorrhage from the adenoid beds. Post-tonsillectomy hemorrhage occurred in 1 patient (1.6%) on the PRP side and 3 patients (4.7%) on the control side (P-value=0.31).

Conclusions: The local application of autologous PRP to the tonsillar bed only once, at the time of tonsillectomy, is not significantly effective in reducing post-tonsillectomy hemorrhage.

Received: Jun. 2023

Accepted: July, 2023

Published: Oct .2023

Formulation and In Vitro Evaluation of Taste- Masked Prednisolone Orodispersible Tablets

Hiba mohammed Suza ali — 2023-10-01

Background: prednisolone is a corticosteroid with a very bitter taste acts as anti- anti-inflammatory and immune suppressant drug and it is used at any age.

Objective: To improve patient compliance by masking the bitter taste of the drug to be delivered as an orodispersible tablet.

Methods: External ionic gelation using sodium alginate (0.5%w/v) and calcium chloride (1% w/v) in presence of 0.5% w/v carbopol 940 was used to prepare taste masked beads loaded with prednisolone to be compressed as orodispersible tablets.

Results: The bitter taste of was masked by preparing beads composed of 1:1:1 (sodium alginate: Carbopol 940: prednisolone) which released only 0.77 % of the drug in pH 6.8 (pH of oral cavity).

The ODT prepared by direct compression using taste masked beads equivalent to 5 mg PRD, 3% crospovidone, 2% PVP, 1% talc, 1% magnesium stearate and combination of Avcil® PH 102 and mannitol at (1:1) ratio was the optimum formula (T6) with hardness of 3.9± 0.32 kg, , friability 0.45%, thickness 2.5 ± 0.05 mm, % drug content 98.2% ± 1.8, wetting time 18.7 ± 1.3 sec, water absorption 41 ± 2.1%, disintegration time 15.3 ± 0.5 sec. and released only 0.75% ± 0.01 of PRD in an oral pH of 6.8 within one minute (indicating good taste masking). Its release in the stomach (pH 0.1N HCl) and intestine (pH 6.8) was continued for up to two hours.

Conclusion: it can be concluded that the external ionic gelation method successfully masked the bitter taste of prednisolone and can also be formulated as taste-masked orodispersible tablets by the direct compression method.

Received: Jan. 2023

Accepted: May 2023

Published: Oct.2023

Medical Educators Satisfaction with Online Learning during the COVID-19 Pandemic

Luma k.Mohammed — 2023-10-01

Background: Medical educators’ dissatisfaction may cause them to leave the practice of teaching, where it is often hard to replace those who have left. In addition, medical teaching staff dissatisfaction may indicate adverse quality for institution/ university organizations.

Objectives: To assess teaching staff satisfaction with online learning during the COVID pandemic at Al-Nahrain University /College of Medicine, Baghdad/Iraq.

Methodology: A cross-sectional study included a convenient sample of 50% of the teaching staff participating in the online academic year 2020-2021. The faculty satisfaction questionnaire was taken from the "Bolliger and Halupa" study, based on the validated Online Course Satisfaction Survey (OCSS) questionnaire that contains four major categories: Interaction, instructor planning, institutional support, and affordance.

Results: The study included 85 medical college teachers from all departments. The total satisfaction level of participants in this study was 25.6%, which is considered low. The total satisfaction score given by the participants was (0.98), the highest score of (1) was given to the items of affordance questions, and the lowest was given for student–instructor interaction and course design and development (0.79, 0.89), respectively.

Conclusion: The satisfaction of teaching staff with online learning during the COVID-19 pandemic was generally low, especially regarding student-instructor interaction and course design and development

Received: Jan., 2023

Accepted: July 2023

Published: Oct. 2023

Preparation and Characterization of Prednisolone Acetate Microemulsion for Ophthalmic Use

Reem Alfaris — 2023-10-01

Background: Prednisolone acetate is an ester form of prednisolone. It is used topically as an ophthalmic suspension to treat many inflammatory ocular conditions, where its absorption from suspension is highly variable and has poor dose accuracy.

Objectives: The main objective of this research is to formulate and evaluate prednisolone acetate microemulsion for ophthalmic use to increase solubility, residence time, and corneal permeability of the drug to enhance patient compliance and treatment efficacy.

Methods: Twenty-four prednisolone acetate-loaded microemulsion (0.5%w/w) formulas were prepared using oleic acid, isopropyl myristate as (oil phase) (1:1), tween 80, labrasol, and cremophor EL as (surfactant), ethanol, polyethylene glycol 400, propylene glycol, transcutol P as co-surfactant and Sörensen isotonic phosphate buffer saline pH 7.4 as the aqueous phase at different Smix ratios (1:1), (1:2) and (2:1) by aqueous titration method to construct pseudoternary phase diagram to determine the existence of microemulsion region. All the prepared formulas were subjected to different evaluation tests to determine the optimum formula.

Results: observations of the microemulsion showed that it had a clear and transparent yellowish color, formulation F9 composed of oleic acid and isopropyl myristate in a ratio (1:1) as oil, twee80 as a surfactant, and propylene glycol: ethanol (1:1) in a ratio (2:1) as cosurfactant gave the best particle size (10.18nm), polydispersity index (0.2216), zeta potential (-25,91), % of transmittance (99.382%±0. 09), and drug content (100±0.16). Microemulsion formulation provided considerably higher permeability than the marketed eye drop suspension (Optipred®) and improved bioavailability.

Conclusions: The microemulsion-containing prednisolone acetate is a promising ocular carrier for the controlled release of prednisolone acetate in treating anterior segment inflammation.

Received: Dec. 2022

Accepted March 2023

Published: Oct.2023

Cytotoxic effect of Gliotoxin from Candida spp. isolated from clinical sources against cancer and normal cell lines

Noorulhuda Ojaimi Mahdi Al-Dahlaki — 2023-10-01

Background: Invasive fungal infections have become more common during the past two decades. Candida species are the most common human fungal infections. Internal injuries characterize these infections because of virulence factors, such as gliotoxin, which is a fungal toxin that is thought to be antibacterial, antifungal, and antiviral.

Objectives: To test the ability of Candida species obtained from clinical sources to produce gliotoxin as a virulence factor and investigate its cytotoxicity effects against some selected cell lines.

Materials and Methods: One hundred and ten clinical isolates of Candida species were obtained from patients attending hospitals in Baghdad from September 2021 to March 2022. They were diagnosed and characterized by routine laboratory methods and cultures. The capability of Candida isolates to secrete the gliotoxin was tested and measured by analytical methods. The cytotoxicity of produced gliotoxin was applied against normal and cancer cell lines.

Results: The 110 yeast isolates were diagnosed and identified as follows: Candida albicans, Candida tropicalis, Candida parapsilosis, Candida glabrata, Candida Krusei, Candida kefyr, Candida lusitaniae, Candida rugosa. Twenty-eight Candida isolates showed gliotoxin production. The cytotoxicity effects of gliotoxin were reported against lymphocytes and AMGM and AMJ13 cell lines in different concentrations. The highest cytotoxic effect was noticed in the concentration of 400 µg/mL of gliotoxin.

Conclusion: The results indicated that the pathogenicity of Candida was distributed among all ages, both sexes, and several types of sources of clinical isolates. Gliotoxin had an effect on normal and cancer cells.

Received: Feb., 2023

Accepted: Aug. 2023

Published: Oct. 2023

Contamination of Agricultural Soils in Some Baghdad Areas with Antibiotics Resistant Pathogenic Fecal Bacteria

Fatima Dawood — 2023-10-01

Background: Early studies have shown that agricultural soil contains various types of microorganisms, especially bacteria, including coliform bacteria (Salmonella, Shigella, Klebsiella, Escherichia coli, and Enterobacter) with fecal Gram-positive bacteria like Enterococcus faecalis. Therefore, the current study aimed to investigate the contamination of Iraqi agricultural soils with pathogenic fecal bacteria (Escherichia coli and Enterococcus faecalis) and study the antibiotic sensitivity patterns of soil-isolated bacteria because it is a dangerous indicator when transmitted to humans.

Methods: Soil samples were collected from six locations (farms) in the capital, Baghdad, which were AL-Jadria, AL-Latifia, Diyala River, AL-Jazera, and AL-Zafraniya (block 1 and block 2) during the study period from the end of November 2021 to August 2022; then were compared with the control samples (house garden). These bacteria were isolated by selective culture media and identified using the VITEK® 2 Compact system, and antibiotic sensitivity tests were carried out against 18 different antibiotics by the Kirby Power method. The t-test was used for the statistical analysis.

Results: The bacteriological study of agricultural soil showed the presence of fecal bacteria, and this is evidence of contamination of agricultural soil samples with these bacteria. The highest E. coli count was in the AL-Latifia farm (1. 48× 10³), while the highest E. faecalis count was in the Diyala River farm (2.63 × 10³). The antibiotic sensitivity profile illustrated that E. coli was resistant to ampicillin, ceftriaxone, cefoxitin, piperacillin, ceftazidime, and Teicoplanin but was sensitive to the rest of the antibiotics used, while E. faecalis was only resistant to levofloxacin and linezolid and highly sensitive to the other tested antibiotics.

Conclusion: The current study documented the presence of fecal coliform bacteria in studied soil samples, with markedly high resistance rates toward used antibiotics. These facts might be the result of irrigation with sewage water and the use of organic fertilizers

Received:March 2023

Accepted: May 2023

Published: Oct. 2023

Comparison between HSV-1 Ag detection techniques by ELISA and real-time PCR in breast cancer patients suffering from periodontitis

Saif Salahuddin Jasim — 2023-10-01

J Fac Med Baghdad

2023; Vol.65, No. 3

Received:March., 2023

Accepted: June. 2023

Published: Oct. 2023

Background: Periodontitis is a long-standing infection that destroys the gums, periodontal ligaments, and the alveolar bone that supports the teeth. Inflammation of the gums and chronic periodontitis are both caused by the bacteria in the dental plaque and the herpes viruses, especially types 1 and 2 of the herpes simplex virus.

Objectives: To compare the ELISA and real-time PCR as ways to detect the herpes simplex virus in breast cancer patients with periodontitis who are receiving chemotherapy.

Cases and methods: In this case-control study, a total of 90 subjects (30 with periodontitis with breast cancer after receiving chemotherapy, 30 with periodontitis (without chemotherapy treatment), and 30 cases which do not have periodontitis (healthy gingiva) and without breast cancer as a healthy control group. The mean ±SD age was (51.06±8.521). Enzyme-linked immunosorbent assay (ELISA) kits were used for the analysis and Real-Time PCR to detection of Herpes simplex virus-1 in saliva samples.

Results: In the present study, the incidence of HSV-1 Ag in patients having periodontitis and receiving chemotherapy was high but not significantly so compared with those having periodontitis but without chemotherapy and the healthy control group. In contrast, the result of Real-time PCR was positive (13.3%) and (10.0%), which proves the presence of HSV in most patients with periodontitis without chemotherapy and with periodontitis receiving chemotherapy but was not significant (p>0.05).

Conclusion: Real-time PCR was able to back up ELISA's findings in this study. Since ELISA is more cost-effective than real-time PCR, it is advised that the first screening may be performed using ELISA, and then positive samples might be investigated with real-time PCR to confirm the presence of HSV-DNA

Received:March., 2023

Accepted: June. 2023

Published: Oct. 2023

Preparation of Idebenone as a Thermosetting Nasal Gel for Better Bioavailability and Histopathological Effect

Hussein Jaafer — 2023-10-01

Background Idebenone is an extensively metabolized drug with poor water solubility that is used to treat Leiber’s hereditary optical neuropathy.

Objective This study aims to prepare idebenone nanoemulsion as a poloxamer-based nasal gel to overcome the extensive rate of hepatic metabolism for better bioavailability and lower histopathological effect on the nasal mucosa.

Methods The formulation strategy was based on eliciting mutual concentration reduction between the nanoemulsion and the carrier gel by setting their gelation temperature between 30-32°C to overcome the mucociliary dose washout. The o/w nanoemulsions rely on cremophor EL and transcutol as an emulsifying system to stabilize idebenone-loaded lemongrass oil. The spontaneous emulsification method was used to prepare nanoemulsions that were characterized by zeta sizer while the thermosensitive hydrogels were prepared using the cold method. In-vitro dissolution test and ex-vivo permeation study through excised sheep nasal mucosa were performed to evaluate the enhanced permeation ratio, rate of permeation, and permeation coefficient. The histopathological effect of direct application on sheep nasal mucosa was studied using optical microscopy to evaluate cellular toxicity.

Results The formula prepared from NE1 with poloxamer 407: poloxamer188 in concentrations 10:3% w/w respectively showed almost complete drug release in 120 minutes due to complete polymers blend erosion. Furthermore, thermosensitive nano-emulgel at a temperature of gelation 31.8°C was obtained at much lower concentrations of poloxamer 407 (10%) compared to previous studies. Nanoemulsions retained their globular size below 100nm due to further gel entrapment stabilization.

Conclusions Drug permeation through excised sheep nasal mucosa elicited an increase in enhanced permeation ratio to 20.3 times and other flux kinetics parameters compared to those of IDB oil dispersion. Direct cellular toxicity showed a minor inflammatory response characterized by serous infiltration of inflammatory cells and edema. In contrast, most of the epithelial cells retained their histological characteristics compared to control slides.

Received: Mar. 2023

Accepted: Aug 2023

Published: Oct.2023