sumatriptan succinate (sc) (DFN 11 / Zembrace SymTouch / DFN11)

Pharmacokinetics of inhaled prednisolone for adrenal crisis: an exploratory study.

Berends Julia M E JME, Vulto Annet A, van den Wijngaard Pascalle A PA, Vos Michel J MJ et al.

An adrenal crisis is a potentially life-threatening medical emergency, which requires rapid treatment with glucocorticoids. Guidelines advise immediate self-administration of hydrocortisone by intramuscular injection using an emergency management kit in case an adrenal crisis is suspected. However, self-injection is often not performed due to administration complexity or patient anxiety. Pulmonary administration of glucocorticoids may be a more patient-friendly and suitable alternative, especially when administered using a dry powder inhaler. Before advancing to the development of a dry powder inhaler, we aimed to evaluate whether the pharmacokinetics of inhaled prednisolone sodium succinate are suitable for the outpatient treatment of adrenal crisis. Twelve healthy participants (aged 23-31 years, 50% females) received two separate doses of prednisolone sodium succinate, equivalent to 56.1 and 112.2 mg prednisolone on separate occasions, administered via a nebulizer. The primary outcome was the time to reach a target plasma concentration of 200 nmol/L. The median times to achieve this plasma concentration (excluding the nebulization time of approximately 10 minutes) were 17 (13 - 23) minutes and 9 (5-11) minutes for the 56.1 and 112.2 mg doses, respectively. Furthermore, pulmonary administered prednisolone sodium succinate was well tolerated. The results of this study, particularly the short time to the target plasma concentration, indicate that prednisolone sodium succinate is rapidly absorbed via the lungs and that the pharmacokinetics of inhaled nebulized prednisolone sodium succinate are suitable for the outpatient treatment of adrenal crisis.

Assessing Plantar Skin Epidermal Layer in Response to Various Insole Hardness via Deep Learning Enabled Optical Coherence Tomography Analysis.

Prisilla Ardha Ardea AA, Jan Yih-Kuen YK, Liau Ben-Yi BY, Tai Chien-Cheng CC et al.

We tested walking interventions using adjustable air-insoles with hardness values of 80, 160, and 240 mmHg over walking durations of 10 and 20 min. Optical coherence tomography (OCT) was used to measure the thickness of the stratum corneum (SC) and living epidermis (ED) in three different locations: the big toe (T1), first metatarsal head (M1), and second metatarsal head (M2), and deep learning was used to compare the difference in thickness between SC and ED. The results indicate that SC thickness increases in M1 is statistically significant after 20 min walking interventions using 80 mmHg insole hardness, and SC thickness decreases in T1 and M1 are statistically significant after 20 min walking using 160 mmHg insole hardness. Changes in SC and ED thickness observed in this study highlight their potential relevance in evaluating plantar tissue health in the context of DFU prevention.

Correction: Succinate and lactate produced as conserved biomarkers through chronic and transient substrate-level phosphorylation: from microorganisms to cancer.

Lee Derek C DC, Duraj Tomas T, Chinopoulos Christos C, Seyfried Thomas N TN

Thermotherapy for prevention of perineal pain after vaginal birth: Evaluation of warm compresses and cold packs using a factorial randomized controlled trial.

Blanc-Petitjean Pauline P, Rollet Clara C, Meunier Géraldine G, Mandelbrot Laurent L et al.

Perineal pain is common after vaginal birth and might affect maternal well-being and mother-infant bonding. We aimed to evaluate the impact of heat or cooling therapy at delivery on postpartum perineal pain. This pilot open-label, multicenter 2 × 2 factorial randomized controlled trial included all women without history of vaginal birth, randomly (1:1) assigned to receive heat therapy (HT, warm compresses) or standard care (SC) during pushing, and cooling therapy (CT, cold pack) or SC during immediate postpartum. The primary outcome was the mean of repeated measures of perineal pain intensity (0-10 scale) during the first 24 h. Secondary outcomes included perineal healing, additional analgesic use, childbirth experience, and perineal injuries. Analyses were conducted on a complete-case intention-to-treat basis. From May 2022 to December 2023, 115 women were enrolled and 105 randomized (early termination at 50% of the planned inclusions). Pain intensity was not statistically different between groups: HT versus SC (4.0 ± 2.5 vs. 3.6 ± 2.2, mean difference [95% CI] = 0.43 [-0.56, 1.41]; P = 0.39); CT versus SC (4.3 ± 2.5 vs. 3.4 ± 2.2, mean difference = 0.93 [-0.04, 1.91]; P = 0.06). No statistically significant interaction was observed. HT was not associated with any difference in terms of perineal tear (respectively, with and without HT, for first, second, and third degree tear: 49.0 vs. 54.9%, 37.3 vs. 31.4%, and 5.9 vs. 5.9%; P = 0.94). No clear evidence of benefit of heat or cooling therapy for preventing postpartum perineal pain was observed. These non-pharmaceutical methods were generally well accepted by the women and were easy for midwives to implement. Further studies are needed to explore optimal timing, modalities, and target populations. The PERISAFE protocol was registered in the ClinicalTrial database (2021-03-03, No.NCT04778631). The first participant was recruited in May 2022 (2022-05-16).