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Background We present a rare and challenging case showing how an allergy to oral medications and cervical stenosis can complicate fertility treatment. The novelty lies in the exclusive use of injectable medications for both in vitro fertilization and frozen embryo transfer, the use of non-oral medications for luteal support, the off-label gonadotropin regimen for frozen embryo transfer stimulation, and the use of cervical dilatation to allow an atraumatic embryo transfer. Case presentation A 32-year-old white woman with long-term anovulatory infertility had a rare allergy to oral agents commonly used in reproductive medicine and a history of large loop excision of the transformation zone surgery, resulting in cervical stenosis. She was diagnosed with type D polycystic ovary syndrome and required ovarian stimulation for timed intercourse or intrauterine insemination, which needed to be conducted with injectable gonadotropins. However, owing to a very short cervix, which represented a contraindication for multiple pregnancy, and the anticipated difficulty in achieving monofollicular ovulation because of a high ovarian reserve, ovarian stimulation for in vitro fertilization was chosen. To reduce the risk of ovarian hyperstimulation syndrome, fresh embryo transfer was cancelled. Stimulation was conducted exclusively with injectable medications for in vitro fertilization, off-label for frozen embryo transfer, and with non-oral medications for luteal support. In addition, cervical dilatation was required because of stenosis from previous surgery, enabling an atraumatic embryo transfer. A successful pregnancy was achieved, resulting in a live birth at 33 weeks of gestation. Conclusion This case demonstrates that exclusive use of injectable and non-oral medications and cervical dilatation can overcome significant barriers such as oral medication allergy and cervical stenosis, leading to a successful live birth in a complex infertility case. It underscores the need for an individualized approach when standard protocols are not feasible.

This book describes the theories, applications, and challenges for different oral controlled release formulations.This book differs from most in its focus on oral controlled release formulation design and process development.

Background Oral Medication administration is one of the paramount nursing procedures, where nurses must pay their utmost commitment. The vital aims are to reduce medication errors and ensure patient safety. The objectives of this study were to evaluate whether the nursing students could learn and retain the basic guidelines for oral medication administration when they are taught using a video-assisted teaching method compared with the lecture-demonstration method and to assess the students’ attitudes towards the two types of teaching methods. Methods This study was conducted as a quasi-experimental study with a pre and post-test design. Forty-five students in the first year of the bachelor’s degree in nursing programme participated. All the participants completed a self- administered questionnaire, including socio demographic data and questions of oral medication administration. Subsequently, participants were randomly assigned to two groups. Oral medication administration procedure was taught using two different teaching methods. Finally, the post-test knowledge scores of both groups were assessed and analysed using the paired-sample t-test. Results The results revealed that there was no significant difference in terms of age, gender and type of residence of students in the two groups. When comparing the pre-test mean score and post-test mean score using paired sample t-test, there was a statistically significant difference in both video demonstration group (t = − 4.533, p < 0.001) and lecture-demonstration group (t = − 4.208, p < 0.001). Almost all the students obtained good knowledge scores regardless of the method used in teaching oral medication administration. However, when comparing post-test scores of both groups using an independent sample t-test, it was identified that there was no significant difference between the two groups. Therefore, it was difficult to identify which method was effective than the other. According to the student feedback obtained at the end of the study, 67% of them preferred to have more video demonstrations in their skills classes. Conclusion The results of this study suggested that oral medication administration can be effectively taught using lecture-demonstration and video-demonstration teaching methods.

Background This study aimed to determine and compare quality of life, level of daily living activities, and sexual satisfaction in two groups: insulin users and oral medications. Materials and methods This prospective cohort study was conducted on patients attending the diabetes clinics at Baghdad Hospital in Iraq between 2021 and 2024. The number of patients in the study was 130 participants including two groups (using insulin vs. oral medication). At First, after one year, and after three years, all participants completed four questionnaires: Quality of Life, Sexual Satisfaction, and Activities of Daily Living. Results According to the results, activity daily living, quality of life and sexual satisfaction in both groups decreased over time from first to the third time, and this difference was significant in the all three variables except in the oral medications group quality of life was not significant ( p  = 0.68), also in the insulin group sexual satisfaction was not significant ( p  = 0.72). In the between-group comparison showed quality of life just three years later difference was significant ( p  = 0.017). In the Activities of daily living variable, no significant difference was observed between the two groups at any time. However, in the sexual satisfaction the insulin group’s score was higher at one year and three years later, and the difference was significant at both mentioned times ( p  = 0.049, and p  = 0.054 respectively). Discussion This study found that in both groups’ daily activities, quality of life, and sexual satisfaction reduced over time.

The oral route is the most preferred route for systemic and local drug delivery. However, the oral drug delivery system faces the harsh physiological and physicochemical environment of the gastrointestinal tract, which limits the bioavailability and targeted design of oral drug delivery system. Innovative pharmaceutical approaches including nanoparticulate formulations, biomimetic drug formulations, and microfabricated devices have been explored to optimize drug targeting and bioavailability. In this review, the anatomical factors, biochemical factors, and physiology factors that influence delivering drug via oral route are discussed and recent advance in conventional and novel oral drug delivery approaches for improving drug bioavailability and targeting ability are highlighted. We also address the challenges and opportunities of oral drug delivery systems in future.

One of the critical factors that affect medication adherence is cost-sharing (the percentage that a patient pays out-of-pocket to cover health expenses), which sometimes may become a barrier to initiate or refill prescription medications. The primary aim of this study was to assess the association between adherence to oral antidiabetic medications (OADs) using the Adherence to Refills and Medicines Scale for Diabetes (ARMS-D) questionnaire and cost-sharing among patients with type 2 diabetes. The secondary aim was to evaluate the extent to which patients are adherent to their OADs, and which factors were significantly affecting patients' adherence to their OADs. Four hundred adult patients that visited the Diabetes Clinic of the Jordan University Hospital who were on OADs were interviewed by the researcher and were asked to complete the study questionnaire. The questionnaire consists of two sections: patients' characteristics and ARMS-D. Simple and multivariable linear regression analyses were used to assess the determinants (demographic, clinical, and economic characteristics) associated with patient's adherence to their OADs. When measured by ARMS-D (sores range from 11 to 44), where higher scores indicate lower adherence, 71% of participants reported lower adherence (scores > 11) to their OADs, while 29% achieved full adherence (scores = 11). Our analysis identified that there was no significant association between adherence to OADs and cost-sharing ( > 0.05). However, multiple regression analysis revealed that demographic factors, such as age and education level, along with clinical factors, such as the number of pills per day, the number of anti-diabetic-medications side effects, and frequent episodes of hyperglycemia, were significantly affecting patients' adherence to OADs ( < 0.05). The key findings of this study indicate that the effect of patients' characteristics on adherence is therefore caused primarily by demographic and clinical factors rather than economic factors.

Protein and peptide therapeutics require parenteral administration, which can be a deterrent to medication adherence. For this reason, there have been extensive efforts to develop alternative delivery strategies, particularly for peptides such as insulin that are used to treat endocrine disorders. Oral delivery is especially desirable, but it faces substantial barriers related to the structural organization and physiological function of the gastrointestinal tract. This article highlights strategies designed to overcome these barriers, including permeation enhancers, inhibitors of gut enzymes, and mucus-penetrating and cell-penetrating peptides. It then focuses on the experience with oral peptides that have reached clinical trials, including insulin, calcitonin, parathyroid hormone and vasopressin, with an emphasis on the advances that have recently led to the landmark approval of an oral formulation of the glucagon-like peptide 1 receptor agonist semaglutide for the treatment of type 2 diabetes.Oral delivery of peptide therapeutics could have benefits for treatment adherence, but it faces barriers related to the structural organization and physiological function of the gastrointestinal tract. This article highlights strategies to overcome these barriers and discusses experience with oral peptides that have reached clinical trials, including the recent landmark approval of an oral formulation of semaglutide for the treatment of type 2 diabetes.

The oral route is the most common and practical means of drug administration, particularly from a patient’s perspective. However, the pharmacokinetic profile of oral drugs depends on the rate of drug absorption through the intestinal wall before entering the systemic circulation. However, the enteric epithelium represents one of the major limiting steps for drug absorption, due to the presence of efflux transporters on the intestinal membrane, mucous layer, enzymatic degradation, and the existence of tight junctions along the intestinal linings. These challenges are more noticeable for hydrophilic drugs, high molecular weight drugs, and drugs that are substrates of the efflux transporters. Another challenge faced by oral drug delivery is the presence of first-pass hepatic metabolism that can result in reduced drug bioavailability. Over the years, a wide range of compounds have been investigated for their permeation-enhancing effect in order to circumvent these challenges. There is also a growing interest in developing nanocarrier-based formulation strategies to enhance the drug absorption. Therefore, this review aims to provide an overview of the challenges faced by oral drug delivery and selected strategies to enhance the oral drug absorption, including the application of absorption enhancers and nanocarrier-based formulations based on in vitro, in vivo, and in situ studies.

There are unique challenges in the formulation, manufacture, analytical chemistry, and regulatory requirements of low-dose drugs. This book provides an overview of this specialized field and combines formulation, analytical, and regulatory aspects of low-dose development into a single reference book. It describes analytical methodologies like dissolution testing, solid state NMR, Raman microscopy, and LC-MS and presents manufacturing techniques such as granulation, compaction, and compression. Complete with case studies and a discussion of regulatory requirements, this is a core reference for pharmaceutical scientists, regulators, and graduate students.