Niosomes : A novel trend in drug delivery.

Niosomes are a novel drug delivery system, in which the medication is encapsulated in a vesicle. Niosomes are formations of vesicles by hydrating mixture of cholesterol and nonionic surfactants. Different novel approaches used for delivering these drugs include liposomes,microspheres, nanotechnology, micro emulsions, antibody loaded drug delivery, magnetic microcapsules, implantable pumps and niosomes. Niosomes and liposomes are equiactive in drug delivery potential and both increase drug efficacy as compared with that of free drug. Niosomes are now widely studied as an alternative to liposomes . They improve the therapeutic performance of the drug molecules by delayed clearance from the circulation, protecting the drug from biological environment and restricting effects to target cells. The application of niosomal technology is widely used to treat a number of diseases.

Prevalence & risk factors of pre-hypertension & hypertension in an affluent north Indian population.

BACKGROUND & OBJECTIVES: Urban Indians have a high prevalence of insulin resistance, hypertension and cardiovascular disease. We studied the prevalence of pre-hypertension and hypertension, as well their association with cardiovascular risk factors, in a north Indian upper socio-economic population. METHODS: A total of 1746 adults (age >or=30 yr) residing in an urban colony of high-income group residents in the city of Lucknow, north India, were invited to be enrolled for the study. The response rate was 64 per cent (n=1112). Blood pressure, anthropometry, plasma glucose in response to oral glucose tolerance test and lipids were measured. The variables contributing significantly to pre-hypertension and hypertension were analyzed by multiple logistic regression analysis. RESULTS: The age and sex adjusted prevalence of hypertension was 32.2 per cent and pre-hypertension was 32.3 per cent. In contrast to hypertension, which was highest in the age group 60-69 yr (64%), prehypertension was highest (36%) in the group 30-39 yr. There was a high prevalence of cardiovascular risk factors in the general population [central obesity (86.7%), elevated LDL cholesterol (22.8%), abnormal glucose tolerance (41.6%) and smoking (20.3% of males)]. Two or more of the cardiovascular risk factors were present in a higher proportion of hypertensive [66%, odds ratio (OR) 3.0, P<0.0001] and pre-hypertensive, (56%, OR 2.0, P<0.0001) compared to normotensive subjects (39%). Subjects with pre-hypertension had body mass index, waist-hip ratio and frequency of glucose intolerance, which was intermediate between normotensive and hypertensive subjects. In multiple logistic regression analysis, increasing age, body mass index, waist hip ratio and impaired glucose tolerance/diabetes were independent risk factors for both hypertension and pre-hypertension. INTERPRETATION & CONCLUSION: A high prevalence of pre-hypertension and hypertension were noted in affluent urban north Indians. Increasing age, body mass index, central obesity and impaired glucose tolerance/diabetes were significantly associated with both hypertension and pre-hypertension. Pre-hypertension was associated with an increased prevalence of cardiovascular risk factors.

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Hypertension and cerebrovascular disease.

Cerebrovascular disease (CVD) is the third leading cause of death in United States and hypertension is a leading cause of both stroke and heart disease. It may cause headache, acute hypertensive encephalopathy, dementia and various types of strokes e.g., thrombotic, haemorrhagic, lacunar infarcts and transient ischaemic attacks. It remains the singlemost important treatable risk factor for stroke in all age groups and modern antihypertensive therapy has its documented prevention of stroke. Hypertension in acute phase of ischaemic stroke should not be treated. Hypertension in acute stroke should be treated. In advanced centres with specialised stroke units, the favoured drugs are short acting vasodilators e.g., sodium nitroprusside and labetalol. Nifedipine is the most popular drug followed by captopril, both sublingually and orally.

Work place challenge: spirometric response in polyurethane (isocyanate) paint workers.

In industrialised countries, isocyanate is probably the most common cause of occupational asthma. The present study was conducted to see the effect on FEV1 in workers who were directly exposed to isocyanate. One hundred and fourteen workers of a rail coach factory who were involved in polyurethane paint spray were studied. Spirometry was done three times, first before starting the work, at two hours and then 6-8 hours after finishing the work to see immediate, late and dual responses. Positive response was considered when there was fall of 20% or more in forced expiratory volume in 1 second (FEV1) from base line. Sixteen per cent of the workers exposed to isocyanate developed immediate reaction, 10% developed late reaction and 6% developed dual reaction. Non-smokers were more prone to develop late and dual responses.