Gluten and Aluminum Content in Synthroid ® (Levothyroxine Sodium Tablets)

Abstract

Introduction

Inquiries from healthcare providers and patients about the gluten and aluminum content of Synthroid^® (levothyroxine sodium tablets) have increased. The objective of this study was to measure and evaluate the gluten content of the raw materials used in the manufacturing of Synthroid. Additionally, this study determined the aluminum content in different strengths of Synthroid tablets by estimating the amount of aluminum in the raw materials used in the manufacturing of Synthroid.

Methods

Gluten levels of three lots of the active pharmaceutical ingredient (API) and one lot of each excipient from different vendors were examined. The ingredients in all current Synthroid formulations (strengths) were evaluated for their quantity of aluminum.

Results

Gluten concentrations were below the lowest limit of detection (<3.0 ppm) for all tested lots of the API and excipients of Synthroid tablets. Aluminum content varied across tablet strengths (range 19–137 µg/tablet). Gluten levels of the API and excipients were found to be below the lowest level of detection and are considered gluten-free based on the US Food and Drug Administration (FDA) definition for food products. Across the various tablet strengths of Synthroid, the maximum aluminum levels were well below the FDA-determined minimal risk level for chronic oral aluminum exposure (1 mg/kg/day).

Conclusion

These data demonstrate that Synthroid tablets are not a source for dietary gluten and are a minimal source of aluminum.

Funding

AbbVie Inc.

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Correction of dropped head deformity through combined anterior and posterior osteotomies to restore horizontal gaze and improve sagittal alignment

Abstract

Objective

The aim of this study is to present our technique for a large focal correction of a partially flexible dropped head deformity through combined anterior and posterior osteotomies, as well as anterior soft tissue releases.

Methods

One patient with dropped head deformity underwent an anterior and posterior osteotomy with anterior soft tissue release.

Results

The patient recovered well, with postoperative radiographs demonstrating significant improvement in coronal and sagittal alignment. His C2–C7 sagittal vertical axis improved from 7.5 cm preoperatively to less than 4 cm postoperatively and his C2–C7 sagittal Cobb improved from 35° of kyphosis to 10° of lordosis.

Conclusion

In this report, we present our technique for a large focal correction of a partially flexible dropped head deformity through combined anterior and posterior osteotomies and anterior soft tissue releases. These more conservative osteotomies permitted gradual deformity correction and alleviated the need for pedicle subtraction osteotomy. We were able to restore horizontal gaze and improve sagittal malalignment. Although the technique we present here is one of many possible options for managing the deformity, we believe this combined approach is safe and effective and well tolerated by patients.

http://ift.tt/2sRN82Y

Urgent need to strengthen and expand screening and other cancer control programs in the CARICOM Caribbean

Abstract

Purpose

With high mortality in breast, cervical, prostate, and colorectal cancers in Caribbean Community (CARICOM) countries, we examined cancer control initiatives including screening as well as the implementation of relevant international and regional mandates.

Methods

Secondary data were used to examine cancer control initiatives, which included the presence of national policies, programs, and screening services as well as the implementation of international and regional mandates. To identify the data, an on-line search was conducted using Google/Google Scholar.

Results

Data were available for 14 of the 15 full members of CARICOM. Although only six countries had distinct cancer control policies, strategies or action plans, all 14 had key elements of cancer control programs. Screening services were available in the 14 countries for cervical, in 12 countries for breast and in 11 for colorectal cancer. However, only four countries had screening policies. In addition, screening guidelines were available for cervical cancer in nine countries, in one country for breast and in none for colorectal cancer. Selected tobacco control policies were present in the 14 countries and immunization policies for human papillomavirus (HPV) in 13. Treatment services included chemotherapy in 10 countries and radiotherapy in six. Nine countries had palliative care services for patients with advanced disease. The countries were at different stages of implementation/compliance with international and regional mandates and frameworks.

Conclusions

There is an urgent need to develop and implement comprehensive and customized cancer control policies addressing screening programs, treatment and palliative care.

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High-touch surfaces: microbial neighbours at hand

Abstract

Despite considerable efforts, healthcare-associated infections (HAIs) continue to be globally responsible for serious morbidity, increased costs and prolonged length of stay. Among potentially preventable sources of microbial pathogens causing HAIs, patient care items and environmental surfaces frequently touched play an important role in the chain of transmission. Microorganisms contaminating such high-touch surfaces include Gram-positive and Gram-negative bacteria, viruses, yeasts and parasites, with improved cleaning and disinfection effectively decreasing the rate of HAIs. Manual and automated surface cleaning strategies used in the control of infectious outbreaks are discussed and current trends concerning the prevention of contamination by the use of antimicrobial surfaces are taken into consideration in this manuscript.

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Development of rigid toughened photocurable epoxy foams

Abstract

This study present a fast and efficient method for preparing photocurable rigid epoxy foams. A system based on the anionic photopolymerization of diglycidyl ether of bisphenol A (DGEBA) combined with a thiol-ene photopolymerization, was used. A tertiary diamine curing agent functionalized with four allyl groups was used in conjunction with a multifunctional thiol. The presence of several basic species, like tertiary amines, thiolates, polythioethers and alkoxide groups induced the anionic ring opening polymerization of the epoxy groups. At the same time the double bonds of the curing agent reacted with the multifunctional thiol generating polythioethers. The flexibility of the polythioethers modified the properties of the epoxy polymers, improving their toughness. Benzenesulfonyl hydrazide as foaming agent and zinc oxide as activator were added to DGEBA to produce the epoxy foams. The photopolymerization kinetics showed that conversion of the epoxide groups reached 80% in 600 s. Thermal curing studies performed by DSC showed that the main curing exotherm were determined at 84–89 °C, which match the temperature at which the photocuring was carried out in the UV light chamber (85 °C). It was found that the viscosity of the formulations plays a key role in the pore size of the foamed polymer, the higher the viscosity the larger the pore sizes. It was also determined that the impact resistance of the produced foams increased with increasing concentration of the thiol-ene system, as a consequence of a greater amount of polythioethers present in the co-network.

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Novel approach to the maxillary sinusitis after sinus graft

Abstract

Background

Postoperative infection occurs when bone graft material is dislodged into the maxillary sinus cavity and most of the patients are often uncomfortable with the drainage and irrigation procedures to eradicate the infection. In this case report, we share a technique in treating patients with such condition.

Material and methods

A 47-year-old patient was referred after sinus elevation using the crestal socket osteotome, bone graft, and implant insertion at a local clinic. Clinical and radiographic findings confirmed the diagnosis of right maxillary sinusitis. A surgical and medical treatment regimen was applied.

Results

By using this technique for irrigation, we were able to achieve successful results, and the patient was satisfied due to less discomfort during the irrigation process.

Conclusion

This method is a patient-friendly technique for sinus irrigation. It is not only limited to sinus grafted patients, but also maxillary sinusitis patients in any other type of odontogenic infection.

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A simple technique for repositioning of the mandible by a surgical guide prepared using a three-dimensional model after segmental mandibulectomy

Abstract

Background

Mandibular reconstruction is performed after segmental mandibulectomy, and precise repositioning of the condylar head in the temporomandibular fossa is essential for maintaining preoperative occlusion.

Methods

In cases without involvement of soft tissue around the mandibular bone, the autopolymer resin in a soft state is pressed against the lower border of the mandible and buccal and lingual sides of the 3D model on the excised side. After hardening, it is shaved with a carbide bar to make the proximal and distal parts parallel to the resected surface in order to determine the direction of mandibular resection. On the other hand, in cases that require resection of soft tissue around the mandible such as cases of a malignant tumor, right and left mandibular rami of the 3D model are connected with the autopolymer resin to keep the preoperative position between proximal and distal segments before surgical simulation. The device is made to fit the lower border of the anterior mandible and the posterior border of the mandibular ramus. The device has a U-shaped handle so that adaptation of the device will not interfere with the soft tissue to be removed and has holes to be fixed on the mandible with screws.

Results

We successfully performed the planned accurate segmental mandibulectomy and the precise repositioning of the condylar head by the device.

Conclusions

The present technique and device that we developed proved to be simple and useful for restoring the preoperative condylar head positioning in the temporomandibular fossa and the precise resection of the mandible.

http://ift.tt/2tHwYcq