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"PURPOSE: Interstitial pneumonia (IP) is a progressive and irreversible fibrosis and can be fatal if acute exacerbation (AE) occurs. While a useful risk-scoring system has been established for lung surgery, no risk evaluation exists for AE of IP related to non-pulmonary surgery. The objective of this review is to describe the management for patients with IP.METHODS: We experienced three hepatectomy cases with IP. The first was a 72-year-old male patient diagnosed with hepatocellular carcinoma. Preoperative computed tomography (CT) revealed IP with reticular shadow at the base of both lungs. After hepatectomy, his IP became acutely exacerbated and did not improve with steroid or sivelestat treatment. The second was a 74-year-old male patient diagnosed with hepatocellular carcinoma, and the third was a 75-year-old male patient with liver metastasis. In both these cases, CT revealed a reticular shadow in the lung fields, with increased serum KL-6 levels. We administered pirfenidone for perioperative management, during which time no respiratory complications occurred.RESULTS: Perioperative management with pirfenidone for hepatectomy accompanied by IP was successful in our cases.CONCLUSION: We reviewed reports on the perioperative prevention, intraoperative risk factors, and treatment of postoperative AE of IP and summarized the perioperative management techniques for IP patients undergoing non-pulmonary surgery."

"Pirfenidon yang dihantarkan secara peroral mengalami metabolisme lintas pertama, sehingga memerlukan dosis tinggi dan berpotensi menyebabkan efek samping sistemik. Oleh karena itu, pengembangan rute alternatif bagi pirfenidon perlu dilakukan. Penelitian sebelumnya melaporkan bahwa sistem penghantaran intrapulmonal berbasis solid lipid nanoparticles (SLN) dapat terdeposit dengan baik pada area alveolus paru-paru. Namun, karakteristik SLN dapat dipengaruhi oleh rasio lipid terhadap obat, jenis dan konsentrasi polimer. Oleh karena itu, optimisasi dengan metode permukaan respon perlu dilakukan untuk memperoleh formula SLN pirfenidon (P-SLN) yang optimal untuk penghantaran intrapulmonal. Lima belas formula disusun berdasarkan desain Box Behnken dengan tiga faktor yaitu, rasio lipid terhadap obat, jenis polimer dan konsentrasi polimer, serta tiga respon, meliputi ukuran partikel, PDI dan efisiensi penjerapan. Formula P-SLN optimal dikarakterisasi meliputi morfologi, kadar lembab, performa aerodinamik, studi disolusi dan stabilitas. Hasil optimisasi menunjukkan bahwa P-SLN optimal tersusun dari rasio lipid terhadap obat 6:1 dan 0,5% Plasdone K-29/32 (FO1). P-SLN FO1 memiliki bentuk sferis dengan ukuran partikel 212,67 nm, PDI 0,39, efisiensi penjerapan 95,02%, dan kadar lembab 1,59%. FO1 memiliki mass median aerodynamic diameter berkisar antara 0,54–12,12 μm. Selain itu, FO1 melepaskan pirfenidon sebanyak 89,61% dan 69,28% dalam medium pH 4,5 dan pH 7,4 selama 45 menit. Sebagai kesimpulan, FO1 terbukti memiliki karakteristik yang sesuai untuk menghantarkan pirfenidon melalui rute intrapulmonal.

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Orally administration of pirfenidone undergoes first-pass metabolism, hence requires high dose level and leads to systemic side effects. Therefore, it is necessary to develop an alternative route of administration for pirfenidone. Previous research reported that the solid lipid nanoparticle-based (SLN) intrapulmonary drug delivery system (IPDDS) was deposit well in the alveolar region of the lungs. However, the characteristics of SLN could be influenced by lipid-to-drug ratio, polymer type and concentration. Therefore, optimization using response surface methodology was carried out to obtain the optimized pirfenidon-loaded SLN (P-SLN) formula for IPDDS. Box-Behnken design was applied to create 15 formulas comprising three factors, including lipid-to-drug ratio, type and concentration of polymer and three responses, including particle size, PDI and entrapment efficiency. The optimized P-SLN formula was characterized, including morphology, moisture content, aerodynamic performance, dissolution and stability studies. The optimization results yielded an optimized P-SLN comprised a lipid-to-drug ratio of 6:1 and 0.5% Plasdone K-29/32 (FO1). The P-SLN FO1 had a spherical shape with a particle size of 212.67 nm, PDI of 0.39, entrapment efficiency of 95.02%, and moisture content of 1.59%. FO1 had a mass median aerodynamic diameter ranging from 0.54–12.12 μm. In addition, FO1 release 89.61% and 69.28% pirfenidone for 45 minutes in buffer medium pH 4.5 and pH 7.4. In conclusion, FO1 was proven to have an appropriate IPDDS characteristics for delivering pirfenidone."

"Idiopathic Pulmonary Fibrosis (IPF) merupakan penyakit gangguan paru yang diderita oleh mayoritas pasien geriatri. Terdapat keterbatasan administrasi obat yang dialami oleh pasien populasi khusus, pasien disfagia, pediatri, dan geriatri. Pirfenidon digunakan sebagai agen terapi fibrosis paru idiopatik dengan dosis besar untuk satu kali konsumsi. Ketersediaan pirfenidon dalam bentuk tablet konvensional menjadi salah satu permasalahan dalam regimen terapi, terutama pada pasien disfagia. Oleh karena itu, pengembangan tablet cepat hancur (TCH) yang dirancang untuk hancur dalam mulut setelah kontak dengan sedikit air menjadi alternatif sediaan tablet konvensional. Penelitian ini bertujuan untuk memperoleh formulasi TCH yang memiliki waktu hancur kurang dari 1 menit, keregasan kurang dari 1%, dan kekerasan dalam rentang 1-3 kP melalui metode cetak pelarut. TCH pirfenidone dibuat dalam 3 (tiga) formulasi yang memiliki variasi pada jumlah disintegrant yang digunakan, yaitu variasi konsentrasi croscarmellose sodium 18 mg (F1), 28 mg (F2), dan 38 mg (F3). Evaluasi dilakukan setelah pencetakan tablet yang meliputi evaluasi penetapan kadar, keseragaman sediaan, kekerasan, keregasan, organoleptis, waktu pembasahan, waktu hancur, uji disolusi, dan uji stabilitas. TCH F2 menghasilkan hasil tablet paling baik dengan waktu disintegrasi 29,31 detik dan waktu pembasahan 27,26 detik. Sedangkan uji stabilitas TCH ketiga formulasi tidak menunjukkan perubahan yang signifikan selama penyimpanan 4 minggu.

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Idiopathic pulmonary fibrosis (IPF) is a pulmonary disorder that affects the majority of geriatric patients. There are limitations to drug administration experienced by special populations of patients, especially dysphagia, pediatrics, and geriatrics. Pirfenidone is used as a therapeutic agent for idiopathic pulmonary fibrosis in large doses. The availability of pyrphenidone in conventional tablet form is one of the problems in the therapeutic regimen, especially in patients with dysphagia. Therefore, the development of rapidly disintegrating tablets (TCH), which are designed to disintegrate quickly in the mouth upon contact with a small water amount, is an alternative to conventional tablet preparations, less than 1% and a hardness in the range of 1-3 kP through the solvent impression method. Pirfenidone TCH was made in three formulations that had variations in the amount of disintegrant used, namely variations in the concentration of croscarmellose sodium (18 mg (F1), 28 mg (F2), and 38 mg (F3)).  The three formulations produce a flat tablet with a slightly rough surface and uniform size. TCH F2 produced the best tablet results with a disintegration time of 29.31 seconds and a wetting time of 27.26 seconds. While the TCH stability test of the three formulations did not show significant changes during 4 weeks of storage. "