ABSTRACT
Background: Nasal route of drug administration has gained popularity nowadays specially for drugs acting on nasopulmonary area. Atazanavir is an antiviral drug which has proved efficacy in different viral infection including COVID-19. Therefore the hypothesis is, if given through intra nasal route this formulation will be able to prevent the viral infection like COVID-19 by directly acting on the virus at its entry point. Objectives: This study aims to prepare a stable mucoadhesive microcrystal formulation of this antiviral drug with good permeation for intra nasal delivery. Materials and Methods: The formulation was prepared by high-speed homogenization process. Prepared microcrystals were estimated for in vitro drug release and permeation, drug excipient interaction study by DSC, FTIR and in vitro mucoadhesiveness study on agar gel plate. A short-term stability study was conducted on all formulations for 6 months. Results: The melting point and absorbance maxima of atazanavir were found as 200.9°C and 248 nm. The DSC and FTIR study results confirmed no drug excipient interaction was there in the formulation. The particle size of the formulations was found as 5-11 µm in range. Drug release was better and faster from the microcrystals as compare to pure powder drug. The flux for microcrystal formulation was found to be 100 whereas flux for the pure drug powder was 24. Formulations had sufficient mucoadhesive strength due to incorporation of HPMC 400 polymer and they were found stable after six months stability study. Conclusion: Lastly, it can be concluded that this formulation would be a promising system for the delivery through intra nasal route as it showed good drug release and permeation during a short time span in in vitro nasal condition with a particle size range suitable for intranasal delivery. However, further in vivo studies are required to confirm the hypothesis.
ABSTRACT
Introduction: Corticosteroids have shown controversial results in severe infections. Limited data is available to prove the efficacy of this drug against Coronavirus Disease 2019 (COVID19) infection. Such studies have highlighted that steroids such as dexamethasone can be effective against the patients who are exhibiting severe symptoms of COVID-19. Aim: To determine the effectiveness of dexamethasone as adjunct drug in treatment of in critical COVID-19 patients. Materials and Methods: This observational single cohort study was conducted on all COVID-19 positive patients admitted to the tertiary care hospital, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India during August 2020 to October 2020. Critically ill patients suffering from COVID-19 receiving 6 mg dexamethasone along with standard treatment protocol as prescribed by the Indian Council of Medical Research (ICMR) were included in this study. Serum interleukin-6, D-dimer, ferritin, levels along with CT values from RT-PCR of nasopharyngeal and oropharyngeal swab were recorded on the day of admission and after 7 days of dexamethasone therapy along with standard treatment protocol of ICMR. The data was analysed using descriptive statistics and paired-t test. Results: There were 22 males and 28 females enrolled in the study with mean age of males as 55 years and mean age of females as 56 years. The mean weight of males was 68.4 kg, while the mean weight of females was 59.8 kg. Statistically significant decrease in serum levels of interleukin-6, D-dimer, and ferritin after 7 days of dexamethasone treatment along with standard treatment protocol of ICMR was observed. The results were found to be significantly different with p-values=0.001, 0.003 and 0.002, respectively. Conclusion: Dexamethasone, as an adjunct drug, is an important corticosteroid that is efficient in countering the inflammatory response generated in COVID-19 patients along with standard treatment protocol of ICMR. It reduces the inflammatory markers in patients suffering from COVID-19.
ABSTRACT
Mental health is not just about absence of mental illness. It is critical that the government takes long-term economic and mental health policy measures to ensure employment, basic amenities and public health, without which mental healthcare cannot address the debilitating effects of ongoing structural violence on a majority of citizens.