Purpose. To evaluate the influence of co-administered vehicles on in vitro dissolution in simulated gastric fluid of crushed immediate release tablets as an indicator for potential drug bioavailability compromise. Methods. Release and dissolution of crushed amlodipine, atenolol, carbamazepine and warfarin tablets were tested with six foods and drinks that are frequently used in the clinical setting as mixers for crushed medications (water, orange juice, honey, yoghurt, strawberry jam and water thickened with Easythick powder) in comparison to whole tablets. Five commercial thickening agents (Easythick Advanced, Janbak F, Karicare, Nutilis, Viscaid) at three thickness levels were tested for their effect on the dissolution of crushed atenolol tablets. Results. Atenolol dissolution was unaffected by mixing crushed tablets with thin fluids or food mixers in comparison to whole tablets or crushed tablets in water, but amlodipine was delayed by mixing with jam. Mixing crushed warfarin and carbamazepine tablets with honey, jam or yoghurt caused them to resemble the slow dissolution of whole tablets rather than the faster dissolution of crushed tablets in water or orange juice. Crushing and mixing any of the four medications with thickened water caused a significant delay in dissolution. When tested with atenolol, all types of thickening agents at the greatest thickness significantly restricted dissolution, and products that are primarily based on xanthan gum also delayed dissolution at the intermediate thickness level. Conclusions. Dissolution testing, while simplistic, is a widely used and accepted method for comparing drug release from different formulations as an indicator for in vivo bioavailability. Thickened fluids have the potential to retard drug dissolution when used at the thickest levels. These findings highlight potential clinical implications of the addition of these agents to medications for the purpose of dose delivery and indicate that further investigation of thickened fluids and their potential to influence therapeutic outcomes is warranted. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

Background Socio-demographics and comorbidities are involved in determining the severity and fatality in patients with COVID-19 suggested by studies in various countries, but study in Bangladesh is insufficient. Aims We designed the study to evaluate the association of sociodemographic and comorbidities with the prognosis of adverse health outcomes in patients with COVID-19 in Bangladesh. Methods A multivariate retrospective cohort study was conducted on data from 966 RT-PCR positive patients from eight divisions during December 13, 2020, to February 13, 2021. Variables included sociodemographic, comorbidities, symptoms, Charlson comorbidity index (CCI) and access to health facilities. Major outcome was fatality. Secondary outcomes included hospitalization, duration of hospital stay, requirement of mechanical ventilation and severity. Results Male (65.8%, 636 of 966) was predominant and mean age was 39.8 ± 12.6 years. Fever (79%), dry cough (55%), and loss of test/smell (51%) were frequent and 74% patients had >3 symptoms. Fatality was recorded in 10.5% patients. Comorbidities were found in 44% patients. Hypertension (21.5%) diabetes (14.6%), and cardiovascular diseases (11.3%) were most prevalent. Age >60 years (OR: 4.83, 95% CI: 2.45–6.49), and CCI >3 (OR: 5.48, 95% CI: 3.95–7.24) were predictors of hospitalizations. CCI >4 (aOR: 3.41, 95% CI: 2.57–6.09) was predictor of severity. Age >60 years (aOR: 3.77, 95% CI: 1.07–6.34), >3 symptoms (aOR: 2.14, 95% CI: 0.97–4.91) and CCI >3 vs. CCI <3 (aOR: 5.23, 95% CI: 3.77–8.09) were independently associated with fatality. Conclusions Increased age, >3 symptoms, increasing comorbidities, higher CCI were associated with increased hospitalization, severity and fatality in patients with COVID-19.

To determine the knowledge about TENS usage among professional physical therapists of Lahore city. Methods: In this study cross sectional survey was conducted in Physiotherapy department of UOL Teaching Hospital, CMH, Ghurki Teaching Hospital and Social Security Hospital, Lahore. The sample size of 117physical therapist participated in this study. Questionnaire was used to determine response of participants. Results: 117 questionnaires were filled by physical therapists, using electrotherapy (TENS) in their setup. Only 81.2% physical therapist found TENS effective as a sole treatment for acute pain, while 36.8% founds it effective as a sole treatment for chronic pain. Physical therapists 70% in Lahore prefer using gels/lotions with TENS about for prolonged relief. Majority of physical therapists (84.6%) were satisfied with the effectiveness of TENS applying with other modalities. Conclusion: TENS is frequently used among Physical Therapist aged more than 26 years. Most of physical therapist found it effective for both short and long term care. Physical therapist were frequently using it for the management of frozen shoulder pain.

To determine the knowledge about TENS usage among professional physical therapists of Lahore city. Methods: In this study cross sectional survey was conducted in Physiotherapy department of UOL Teaching Hospital, CMH, Ghurki Teaching Hospital and Social Security Hospital, Lahore. The sample size of 117physical therapist participated in this study. Questionnaire was used to determine response of participants. Results: 117 questionnaires were filled by physical therapists, using electrotherapy (TENS) in their setup. Only 81.2% physical therapist found TENS effective as a sole treatment for acute pain, while 36.8% founds it effective as a sole treatment for chronic pain. Physical therapists 70% in Lahore prefer using gels/lotions with TENS about for prolonged relief. Majority of physical therapists (84.6%) were satisfied with the effectiveness of TENS applying with other modalities. Conclusion: TENS is frequently used among Physical Therapist aged more than 26 years. Most of physical therapist found it effective for both short and long term care. Physical therapist were frequently using it for the management of frozen shoulder pain.