5-Fluorouracil as a targeted lacrimal gland therapy for chronic Stevens-Johnson syndrome: A pilot study

Purpose: The surgical technique of periglandular 5?fluorouracil (5?FU) injection and its effects on the morphology and function of the main lacrimal gland of patients with severe dry eye disease due to Stevens–Johnson syndrome (SJS) are reported. Methods: 5?FU, as a potential antifibrotic agent, is given in the dose of 0.1 ml (50 mg/ml), subconjunctivally into the periglandular fibrosed area of the palpebral lobe of the main lacrimal gland. The injection is given using 30G needle into the subconjunctival plane and not into the substance of palpebral lobe. Results: Eight eyes (eight lobes) of seven chronic SJS patients (mean age, 32.5 years, <5 mm Schirmer) received the injection. All eight lobes demonstrated a visible reduction in the conjunctival congestion and scarring over the lobar area. The mean OSDI scoring improved from 65.3 to 51.1. Three patients with mean pre?injection Schirmer I values of 4 mm showed a mean change of 1 mm at four weeks following a single injection. The tear flow rate per lobe for the above three patients improved from 0.22, 0.12, and 0.16 ?l/min to 0.31, 0.12, and 0.21 ?l/min, respectively. Another patient with pre?injection Schirmer of 4 mm showed no change in tear flow. Three eyes with zero baseline Schirmer values (no visible secretory opening) had no improvement in tearing or ocular surface staining. Conclusion: Local 5?FU injection alters morphology of the conjunctiva overlying the palpebral lobe in SJS patients, but fails to show any significant effect on tear secretion.

Aqueous-deficient dry eye disease: Preferred practice pattern guidelines on clinical approach, diagnosis, and management

Dry eye disease (DED) is a broad term that includes a diverse group of clinical disorders. Aqueous-deficient dry eye (ADDE), a subtype of DED, is characterized by decreased tear production by the lacrimal gland. It can be seen in up to one-third of individuals with DED and can be comorbid with a systemic autoimmune process or occur secondary to an environmental insult. Since ADDE can be a source of long-term suffering and severe visual impairment, early identification and adequate treatment are imperative. Multiple etiologies can underlie ADDE, and it is critical to identify the underlying cause to not only improve the ocular health but also to improve the overall quality of life and well-being of affected individuals. This review discusses the various etiologies of ADDE, highlights a pathophysiology-based approach for evaluating underlying contributors, outlines various diagnostic tests, and reviews treatment options. We present the current standards and discuss ongoing research in this field. Through this review, we propose a treatment algorithm that would be useful for an ophthalmologist in diagnosing and managing individuals with ADDE.

Dry eye disease and risk factors for corneal complications in chronic ocular graft-versus-host disease

Purpose: The current study was carried out to evaluate the clinical features and management outcomes of dry eye disease (DED) in chronic ocular GvHD following allogenic hematopoietic stem cell transplantation (HSCT). Methods: A retrospective review of consecutive patients diagnosed with chronic ocular GvHD between 2011 and 2020 was performed at a tertiary eye care network. Multi?variate regression analysis was carried out for identifying risk factors associated with progressive disease. Results: A total of 34 patients (68 eyes) with a median age of 33 years [inter?quartile range (IQR) 23–40.5] were studied. The most common indication for HSCT was acute lymphocytic leukemia (26%). Ocular GvHD developed at a median of 2 years (IQR 1–5.5 years) after HSCT. Aqueous tear deficiency was present in 71% of the eyes, of which 84% had a Schirmer value of <5 mm. The median visual acuity at presentation and that after a median follow? up of 6.9 months were comparable at 0.1 log minimum angle of resolution (logMAR) (P = 0.97). Topical immunosuppression was required in 88% of cases, and with this, improvement in corneal (53%, P = 0.003) and conjunctival staining scores (45%, P = 0.43) was noted. A progressive disease was present in 32% with persistent epithelial defects being the most common complication. Grade 2 conjunctival hyperemia [odds ratio (OR): 2.6; P = 0.01] and Schirmer’s value <5 mm (OR: 2.7; P = 0.03) were found to be associated with progressive disease. Conclusion: Aqueous deficient DED is the most common ocular manifestation of chronic ocular GvHD, and the risk of the disease progression is greater in eyes with conjunctival hyperemia and severe aqueous deficiency. Awareness among ophthalmologists of this entity is essential for its timely detection and optimal management.

Severe cicatricial entropion repair using mucous membrane graft in Stevens–Johnson syndrome

Background: Severe cicatricial entropion in Stevens–Johnson syndrome (SJS) patients is difficult to treat and is associated with a higher recurrence rate. Also, entropion in the presence of lid margin mucous membrane graft (MMG) further complicates the surgical anatomy and approach. Purpose: To report a modified surgical technique of repairing severe upper eyelid cicatricial entropion in an SJS patient with history of lid margin MMG. Synopsis: Cicatricial entropion in patients with SJS is entirely different from trachomatous cicatricial entropion. The involvement of the lid margin with keratinization, tarsal scarring, persistent conjunctival inflammation, and unhealthy ocular surface affects the surgical approach and outcomes. Conjunctiva?sparing surgery with reconstruction of the lid margin using MMG, flattening and repositioning the anterior lamella, and covering the bare tarsus with MMG rather than leaving it raw are the necessary modifications in this technique from conventional anterior lamellar recession. The video demonstrates the surgical technique for harvesting and preparation of a labial MMG, the splitting of the anterior and posterior lamella of the lid margin, scar tissue release between the lash line and the tarsus, repositioning of the anterior lamella, and anchoring of the labial MMG. Highlights: Anterior lamellar recession combined with MMG wrapping the lid margin and bare tarsus offers good cicatricial entropion repair outcomes. Removal of fat and submucosa from the mucosal graft should be done for better cosmesis. Adequate separation of the scar tissues from the lash line and the tarsus is essential.

Can Ultrasound?Guided Erector Spinae Plane Block Replace Thoracic Epidural Analgesia for Postoperative Analgesia in Pediatric Patients Undergoing Thoracotomy? A Prospective Randomized Controlled Trial

Background:Many analgesic modalities have been investigated in pediatrics for thoracotomy. We studied the analgesic efficacy of unilateral continuous ultrasound?guided erector spinae plane block (ESPB) compared to a thoracic epidural in pediatric patients undergoing thoracotomy. Materials and Methods: A prospective, randomized, observer?blinded, controlled study. Pediatric patients (2–7 years) scheduled for right or left thoracotomy under general anesthesia (GA) were enrolled in the study. We randomly assigned patients into two groups: The thoracic epidural analgesia (TEA) group received GA with an epidural catheter. The ESPB group received GA with a unilateral ultrasound?guided erector spinae plane catheter. The primary outcome was postoperative cumulative opioid consumption for 24 h. Results: The total intraoperative fentanyl requirement was 35.4 ± 11.44 µg in the TEA group and 30.4 ± 9.08 µg in the ESPB group (t?value 1.53013, P value: 0.134). The total postoperative fentanyl requirement was comparable in both the groups and clinically nonsignificant (44 ± 2.82 in the TEA group vs. 44.25 ± 13.72 in the ESPB group, t?value = ?0.02412, P = 0.981). The median (IQR) Face, Legs, Activity, Cry, and Consolability (FLACC) score at 0, 2, 4, 8, 12, and 24 h time points in the ESPB was equivalent to the TEA group. At 6 h time point, the TEA group had a significantly lower FLACC score than the ESPB group (1[1.75, 1] in the TEA group and 2 [2, 1] in the ESPB group, P value = .02, U = 117.5, z?score = ?2.218). The complications were higher in the TEA group (urine retention 20% and hypotension 40%) than in the ESPB group (0 and 0%). Conclusions: This study shows that the ESPB provides similar postoperative analgesia to the TEA in pediatric patients undergoing thoracotomy. The ESPB is simpler, faster, and has a lower complication rate

Management of Twak vikruti: a case report

In today抯 era skin disease is very commonly found. As there is no specific and permanent treatment available in modern science therefore people are attracting towards Ayurvedic treatments for skin related issues and diseases. Twak(skin) is the largest organ of human body which protects and covers whole body. It is one of five gyanendriya that is Sparsh gyanendriya(sense organ). Nowadays people use so many chemical products internally as well as externally for looking good which causes the imbalance of dosh, dhatuand mala (fecal product). These are the fundaments of human body and skin is the outer most protective organ. So, whenever anything uncommon happened with body, skin start showing some symptoms like redness, swelling, due to dushti of doshas (imbalance/toxicity of dosha).A male patient of 36years old came in our hospital with the complains of Twak kandu(skin itching), Krushna varnata (hyper pigmentation), Krushna varni pitikotpatti (rashes), Vali(wrinkles) and Rukshta(dryness) which was diagnosed as Twak vikruti(skin disease) and treated with complete ayurvedic treatment Shaman chikitsa(internal medicine) along with Shodhan chikitsa(body purification treatment).

Vesicouterine fistula: a case report

Vesicouterine fistula represents a rare urogenital fistula, accounting for approximately 1-4% of genitourinary fistulas. Iatrogenic reasons have been shown to be most common cause. Surgical excision is the mainstay of treatment. Less than 5% patients respond to conservative management. Authors report a case of successful conservative management of vesicouterine fistula.

Effect of Curcumin Gel along with SRP in Chronic Gingivitis Cases

Introduction: Turmeric also known as Curcuma longa thatis widely used as a spice, preservative, coloring agent, and asa household remedy is coming a long way as an alternativemanagement option for periodontal conditions. Curcumin themain yellow bioactive part of turmeric has huge spectrum ofactivity such as anti-inflammatory, antioxidant, antimutagenic,anticarcinogenic, anticoagulant, antidiabetic, antifertility,antibacterial, antiprotozoal, antiviral, antivenom, antiulcer,antifibrotic, hypotensive, and hypocholesteremic activities.The present study was conducted with the aim to determinethe effect of curcumin gel along with SRP in chronic gingivitiscases.Material and methods: The present prospective studyconsisted of 30 subjects as cases and controls respectively.The study was conducted in the department of periodontics ofthe hospital. Scaling was performed by piezoelectric scaler bytrained personnel. After, thorough clearance curcumin gel waslocally applied amongst the cases. All the patients were givensame postoperative instructions and medicaments. Followup was performed after 30 days and the values of gingivalindex were noted. All the data thus obtained was arranged ina tabulated form and analysed using SPSS software. Studentt test was used for statistical analysis and probability value ofless than 0.05 was regarded as significant.Results: The present study consisted of 30 patients as casesand 30 as controls. The mean age of the subjects was 36.42+/-5.22 years. The mean value at day 0 amongst the cases and thecontrols was 2.61+/-0.54 and 2.65+/-0.66 respectively. Themean value at day 30 amongst the cases and the controls was1.90+/-0.38 and 1.45+/-0.45 respectively. On applying studentt test there was a significant improvement amongst the casescompared to the controls on Day 30.Conclusion: Application of curcumin gel could also lead to adecrease in the chances of surgical treatment after SRP as thepocket depth improves significantly

Effect of Curcumin Gel along with SRP in Chronic Gingivitis Cases

Introduction: Turmeric also known as Curcuma longa thatis widely used as a spice, preservative, coloring agent, and asa household remedy is coming a long way as an alternativemanagement option for periodontal conditions. Curcumin themain yellow bioactive part of turmeric has huge spectrum ofactivity such as anti-inflammatory, antioxidant, antimutagenic,anticarcinogenic, anticoagulant, antidiabetic, antifertility,antibacterial, antiprotozoal, antiviral, antivenom, antiulcer,antifibrotic, hypotensive, and hypocholesteremic activities.The present study was conducted with the aim to determinethe effect of curcumin gel along with SRP in chronic gingivitiscases.Material and methods: The present prospective studyconsisted of 30 subjects as cases and controls respectively.The study was conducted in the department of periodontics ofthe hospital. Scaling was performed by piezoelectric scaler bytrained personnel. After, thorough clearance curcumin gel waslocally applied amongst the cases. All the patients were givensame postoperative instructions and medicaments. Followup was performed after 30 days and the values of gingivalindex were noted. All the data thus obtained was arranged ina tabulated form and analysed using SPSS software. Studentt test was used for statistical analysis and probability value ofless than 0.05 was regarded as significant.Results: The present study consisted of 30 patients as casesand 30 as controls. The mean age of the subjects was 36.42+/-5.22 years. The mean value at day 0 amongst the cases and thecontrols was 2.61+/-0.54 and 2.65+/-0.66 respectively. Themean value at day 30 amongst the cases and the controls was1.90+/-0.38 and 1.45+/-0.45 respectively. On applying studentt test there was a significant improvement amongst the casescompared to the controls on Day 30.Conclusion: Application of curcumin gel could also lead to adecrease in the chances of surgical treatment after SRP as thepocket depth improves significantly

Tubercular pyometra in a young unmarried female - dilemma and pitfalls in diagnosis: a rare case report with review of literature

This rare case is the first case being reported as tubercular pyometra in a young unmarried woman. Diagnosis of genital tuberculosis which is a form of EPTB (extra pulmonary TB) can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granuloma on histopathology and failure to culture mycobacterium tuberculosis do not exclude the diagnosis of EPTB. A 25-year-old unmarried, government employee from Bihar presented to our OPD with secondary amenorrhea for two months carrying with her an USG, CT and MRI done in Bihar suggesting enlarged uterus with fluid collection. CT-also reported few enlarged lymph nodes. Her preoperative investigations revealed an elevated ESR and x-ray chest was normal. Dilatation was done under ultrasonic guidance in OT and 150 cc of thick caseous material was drained A gentle curettage was done on lateral wall near cornea and both the caseous material and endometrial tissue was sent for gram staining, TB-PCR (polymerase chain reaction), NAAT (nucleic acid amplification techniques) and culture. In the post-operative period gram staining for AFB, NAAT, TB-PCR all came negative and it was difficult to convince patient to take ATT. However, on day 10, HPE report came as granuloma suggestive of TB and patient was put on ATT. Culture too was reported negative later.  Paucibacillary female genital TB (FGTB) is difficult to diagnose because of varied presentation and limitations of diagnostic tests A raised ESR is presumptive but non-specific. Other tests are x-ray chest, HSG, endometrial tissue for TB PCR nucleic acid amplification techniques (NAAT, HPE and culture (conventional or Bactec). Patients with EPTB are, however, more likely to have negative sputum smear results and many EPTB cases do not have direct lung involvement.  Currently, there are no standard guidelines or algorithm for the diagnosis of FGTB. Female genital TB has varying presentation and diagnosis is difficult because of the paucibacillary nature.

Successful outcome in a perplexing case of Roberts uterus: a rare uterine anomaly, a rare case report with review of literature

Robert uterus is a rare Mullerian development anomaly with very few cases reports available. It presents with triad of morphologic features of - Blind hemi cavity with or without unilateral hematometra, contralateral unicornuate uterine cavity and normal uterine fundus with or without small external indentation. The major difficulty lies in making the diagnosis of Robert’s uterus. All the reported cases of Robert’s uterus have been managed differently according to patient’s complaints. A 25-year-old married female, resident of Agra presented to gynecology OPD of Dr RML Hospital and associated PGIMER in June 2013, with primary infertility and cyclical left sided dysmenorrhoea since menarche. Patient was consulting at her hometown Agra for 2 years and had an USG and MRI pelvis report of Feb. 2013 with her showing unicornuate uterus with rudimentary horn. Infertility investigations were done in our hospital. HSG report was of localized spill on right with left tubal block. Patient was posted for diagnostic hystero-laproscopy which was further followed by laprotomy, after which we could reach to a diagnosis of Robert uterus with non-communicating left cavity and with severe endometriosis. Patient needed a second hysteroscopy for lysis of septum and subsequently conceived with IVF. She delivered a healthy male baby of 2.65 kg by elective LSCS at 37 weeks with associated breech presentation with gestational hypertension with severe IHCP on 20 June 2019. Paediatric surgeons and gynecologists should be aware of this rare atypical obstructive Mullerian malformation and its management to avoid inappropriate management delays in these patients. A timely diagnosis and definite treatment have a great impact on future reproductive and endocrine function.

Placenta accreta not previa: a rare case report of placenta accreta in an unscarred uterus

Placenta accreta spectrum disorders are usually associated with direct surgical scar such as caesarean delivery, surgical termination of pregnancy, Dilatation and curettage, Myomectomy, Endometrial resection and Asherman’s syndrome. It can also be associated with non-surgical scar and uterine anomalies. Rarely it can be encountered in unscarred uterus. Mrs X, 35-year female, unbooked patient, G7P2L2A4 with nine months of amenorrhoea reported in emergency of RML Hospital on 30/07/2019 with history of labour pains since 2 days. Patient gave history of four dilatation and curettage for incomplete abortion. On examination patient was found to be severely anaemic (Hb -6 gm). 2 Packed RBC were transfused preoperatively. There was no progress in labour beyond 6 cm for 4 hours. Patient was thus taken for LSCS for NPOL, with blood on flow. Intraoperatively, after delivery of the baby placenta which was fundo-posterior did not separate. In view of parity and morbidly adherent placenta (clinical grade III), subtotal hysterectomy was done. Patient was transfused 4 PRBC, 4 FFP and 2 platelets. Uterus with placenta in situ was sent for histopathology. Patient was in ICU for 2 days and recovered well. Post-operative period was uneventful. Placenta accreta is defined as abnormal trophoblast invasion of whole or a part of placenta into myometrium of uterine wall. Caesarean delivery is associated with increased risk of placenta accrete and the risk increases with each caesarean section, from 0.3% in woman with one previous caesarean delivery to 6.47% for woman with five or more caesarean deliveries. Placenta accreta spectrum disorders occur in 3% of woman diagnosed with placenta previa and no prior caesarean. In the developing world, the obstetrician should be prepared to encounter un diagnosed placenta accrete even in absence of previous LSCS. Curretage following MTP is also a risk factor, so vigourous currettage should be avoided to prevent endometrial damage.

Hindi translated version of menopausal rating score questionnaire: a method to evaluate post menopausal symptoms in India

Background: There are large number of post menopausal patients in India deserving more care and attention than is given at present.MRS questionnaire in Hindi (MRS-H), a translated and validated version of original MRS Scale (MRS-E), self assessed by patients in their own native language. This tool can be used to assess and document current quality of life as well as improvement with treatment of severe post menopausal symptoms, in Indian population.Methods: 30 bilingual English and Hindi speaking postmenopausal patients were recruited for this study.MRS Questionnaire has 11 questions covering somatic, pschycological and genitourinary symptoms of menopause. The scoring system is simple. Hindi translation of MRS Questionare was done from English (MRS-E) to Hindi (MRS-H) by 4 independent translations using standard protocol. The MRS-H was tested for internal validity and also compared with MRS - E.Results: Quality of life is a subjective perception modified by the cultural habitat in which one lives. MRS-H showed high validity and good co-relation with MRS-E. The MRS-H possessed good convergent and discriminant validity. MRS-H showed anICC (Intraclass coefficient) was more than 0.5 and cronbach alpha more than0.5. There was found to be strong correlation between MRS-E and MRS-H questionnaire with all correlation value above 0.7.Conclusions: The authors recommend the use of the self assessed MRS-H in Hindi should be used to assess menopausal complaints and relief with treatment in India.

Interaction network analysis of YBX1 for identification of therapeutic targets in adenocarcinomas

Human Y-box binding protein-1 (YBX1) is a member of highly conserved cold-shock domain protein family, which isinvolved in transcriptional as well as translational regulation of many genes. Nuclear localization of YBX1 has beenobserved in various cancer types and it’s overexpression has been linked to adverse clinical outcome and poor therapyresponse, but no diagnostic or therapeutic correlation has been established so far. This study aimed to identify differentiallyexpressed novel genes among the interactors of YBX1 in different cancer types. Analysis of RNA-Seq data for colorectal,lung, prostate and stomach adenocarcinoma identified 39 unique genes, which are differentially expressed in the fouradenocarcinoma types. Gene-enrichment analysis for the differentially expressed genes from individual adenocarcinomawith focus on unique genes resulted in a total of 57 gene sets specific to each adenocarcinoma. Gene ontology forcommonly expressed genes suggested the pathways and possible mechanisms through which they affect each adenocarcinoma type considered in the study. Gene regulatory network constructed for the common genes and network topologywas analyzed for the central nodes. Here 12 genes were found to play important roles in the network formation; amongthem, two genes FOXM1 and TOP2A were found to be in central network formation, which makes them a common targetfor therapeutics. Furthermore, five common differentially expressed genes in all adenocarcinomas were also identified.

Can Score Versus Other Anthropometric Indices To Assess Nutritional Status In New-Borns

Background: Foetal malnutrition is one of the common cause of morbidity and mortality in neonates in a developing country like India and needs to be identified at birth. Objective: To assess foetal nutrition using CAN score and to compare it with other anthropometric indices. Methods: Prospective observational study consisting of 500 singleton full term neonates, assessed for foetal malnutrition using CAN score and then compared with other methods like Ponderal Index, MAC/OFC ratio and Weight for gestational age. Results: CAN score identified 66.4% babies as malnourished whereas Ponderal index identified 51.2% followed by MAC/OFC ratio as 45.6% babies. 62.8% babies were AGA and 37.2% babies were SGA according to weight for gestational age. Conclusion: CAN scoring system is a simple method of identifying foetal malnutrition which can be missed by other methods.

Somatization disorder: Are we moving towards an over-generalized and over-inclusive diagnosis in DSM-V?

Introduction: The confusion around the diagnosis of ‘medically unexplained symptoms’ has lead to a paradigm shift in criteria for diagnosis of somatization disorder. Aims: 1. To compare the socio-demographic variables in patients of somatization disorder 2. To compare the levels of depressive and anxiety scores of patients of somatization disorder along with the severity of disorder. Material and Methods: Somatization patients visiting the psychiatry outdoor of TMMC & RC, were randomly selected and diagnosed as per DSM-IV TR. After obtaining informed consent and applying exclusion criteria, demographic and clinical details were obtained on a self designed Performa. The HAM-A scale and MADRS scale were applied to calculate anxiety and depression scores. Results: The prevalence of somatization disorder was 2.35% in men and 6.7% in women. Females were significantly higher in number. Headache was the chief complaint. The anxiety scores and MADRS scores were highest in patients complaining of chest pain. The HAM-A and MADRS scores increased significantly as number of complaints increased. Female patients and patients belonging to rural background had significantly higher number of complaints. Illiterate patients had a significantly higher duration of illness. Conclusion: Somatization disorder comprises unique group of patients with high co-morbidities and longer duration of illness. It is imperative to identify and clarify severity of this subgroup as treatment decisions need to be modified accordingly.

Recombinant interferon alpha 2b for ocular surface squamous neoplasia: An efficient and cost‑effective treatment modality in Asian Indian patients.

Purpose: The purpose was to study the efficacy of interferon alpha 2b (INF α2b) in the treatment of ocular surface squamous neoplasia (OSSN) and analyze its cost‑effectiveness in India. Study Design: This was a retrospective study of thirty patients with OSSN treated with topical INF α2b (1 MIU/cc) ± perilesional INF α2b (5 MIU/cc). Results: The tumor involved cornea (n = 9, 30%), conjunctivo‑limbal‑corneal surface (n = 19, 63%), or bulbar conjunctiva (n = 2, 7%). The mean basal dimension of the tumor was 16 mm. The tumors belonged to Tis (n = 6, 20%) or T3 (n = 24, 80%) based on the American Joint Committee Classification, 7th edition. In the six patients with Tis, three cycles of topical INF α2b were used for immunoprevention. In the remaining 24 patients, INF α2b was advised for immunoreduction, but served as immunotherapy with 100% tumor regression in 22 (92%) cases, and resulted in 95% immunoreduction in 2 (6%) cases. Complete tumor regression by immunotherapy (n = 22) was achieved with a mean number of three topical INF α2b cycles and two perilesional injections. All these 22 patients received three additional topical INF α2b cycles after complete tumor regression. For immunoreduction (n = 2), both patients received six cycles of topical INF α2b which was three perilesional INF α2b injections. The mean total treatment cost per patient with INF α2b was INR 9164 ($US 137). Based on maximum basal diameter of tumor at presentation, the mean total treatment cost per patient with INF α2b was INR 4866 ($US 73) for eyes with microscopic evidence of tumor residue (n = 6), INR 9607 ($US 143) for tumors ≤10 mm (n = 13), and INR 10,985 ($US 164) for tumors >10 mm (n = 11), with two patients needing additional surgical excision for complete tumor control. Conclusion: INF α2b can be used for immunoreduction, immunotherapy, or immunoprevention of OSSN. INF α2b is a cost‑effective treatment modality for OSSN at an average total treatment cost of INR 9164 ($US 137) per patient.

Formulation and Evaluation of Solid Lipid Nanoparticle (SLN) Based Topical Gel of Etoricoxib.

The objective of present investigation was to prepare & evaluate solid lipid nanoparticle (SLN) based topical gel of non- steroidal anti-inflammatory drug (NSAID) etoricoxib for the treatment of arthritis which would attenuate the gastrointestinal related toxicities associated with oral administration. SLN were formulated by melt emulsification and solidification at low temperature method using stearic acid & tween 80. All the formulation were subjected to particle size, particle size distribution, zeta potential, scanning electron microscopy, crystallinity study by DSC and in-vitro release studies. It has been observed that, the high lipid concentration containing formulation have higher entrapment as compare to other two formulation. The SLN- dispersion shows 70.766% entrapment & zeta potential of the formulation were -25.6 which indicates the stability of formulation. The In Vitro drug release rate of gel was evaluated using Modified franz diffusion cell containing dialysis membrane with phosphate buffer pH 7.4 as the receptor medium. The in-vitro release was carried out in comparison with a carbopol gel & hydroxypropylmethylcellulose (HPMC) gel. The permeability parameters steady-state flux (Jss) was significantly increased in SLN-F3C (carbopol) formulation as compared with SLN-F3HPMC (hydroxypropyl methylcellulose) formulation. It was concluded that the Etoricoxib loaded SLN based gel formulation containing carbopol was suitable for topical application and shows much better result of anti-inflammatory activity.