An Insight into Acute Disseminated Encephalomyelitis.

BACKGROUND: Acute disseminated encephalomyelitis (ADEM), a neural and immune related state that occur when cerebrospinal system's damaged by extensive swelling. Although manifestation is possible no matter the age, adolescents have a greater probability that adults. The purpose of present manuscript is to provide recent advancement and enhance knowledge of the disease. METHOD: The literature search on etiology, pathophysiology, diagnosis and treatment was carried out using the online database of Scifinder, Medline, Pubmed and GoogleScholar, Scopus etc. Result: Although the cause of ADEM remains unclear, it is believed to be caused by the inflammation in those with genetic sensitivity to an environmental stimulation. When people have altered levels of awareness or multifocal neurological abnormalities, ADEM is a possibility as a diagnosis. The diagnosis of ADEM is dependent on a combination of clinical, radiologic symptoms and the exclusion of illnesses that mimic ADEM; there is no one test that can establish the diagnosis. The inflammation in a child's brain and spinal cord is treated with medication. Prednisone will occasionally be given to youngsters for a brief amount of time. CONCLUSION: Most children with ADEM improve with high doses of methylprednisolone. Cyclophosphamide and hypothermia was need to individual. Most investigations show that 50%-75% of individuals completely recover between the first and sixth month of their condition.

An Updated Insight into Phytomolecules and Novel Approaches used in the Management of Breast Cancer.

Breast cancer is a widespread condition that kills more women from cancer-related causes than any other type of cancer globally. Women who have estrogen-dependent, initial metastatic breast cancer frequently receive treatment with surgery, radiation therapy, and chemotherapy. They may also get more specialized treatments like tamoxifen or aromatase inhibitors (anastrozole or letrozole). The World Health Organisation reported in 2012 that by 2030, breast cancer will be more common worldwide. There are several phytochemicals, such as isoflavones, coumestans, lignans, and prenylflavonoides. Isoflavones have been shown in studies to prevent the spread of breast cancer and to trigger apoptosis. Targeting BCs in metastatic breast cancer may be made possible by combining well-formulated phytochemicals in nanoparticles or other novel drug delivery agents with currently accepted endocrine and/or conventional chemotherapies. Cell signaling, regulation of cell cycles, oxidative stress action, and inflammation could be positively impacted by phytoconstituents. They have the ability to alter non-coding RNAs, to prevent the proliferation and regeneration of cancer cells. The availability of novel approaches helps in disease targeting, safety, effectiveness and efficacy. The current literature helps to know the available drugs i.e. phytoconstituents or novel drug delivery like nanoparticle, microsphere, micelles, liposomes and neosomes. The literature has been taken from PubMed, Google Scholar, SciFinder, or other internet sites.

An Insight of Naturally Occurring Phytoconstituents and Novel Approaches Towards the Treatment of Diabetes.

BACKGROUND: The rising in diabetes incidents has clearly become one main worldwide health problem. Individuals suffering from diabetes are still more susceptible to many long-term and short-term side effects, which most often cause fatalities. Even though chemically synthesized anti-diabetic entities are capable of helping manage and treat, there has been significant risks related with their prolong and repetitive use. Hence, there is a requirement for safer and novel approaches that might be formed and utilized. OBJECTIVE: Aim of the present review is to explain the naturally occurring phytochemicals and novel approach as anti-diabetic agents in the treatment of diabetes and its related issues. METHOD: A survey of Google scholar, Research Gate, Pubmed, Science Direct, NCBI database was carried out conducted to determine a most hopeful phytochemicals and novel drug delivery systems in the management of diabetes. RESULT: The study stressed the significance of phytomolecules and some novel approaches researched or reported in the literature for the management and cure of diabetes. It is suggested that changes in lifestyle can help patients and like nutritional support, assessment and lifestyle guidance must be individualized based on physical and functional capacity. Further evaluations and improved preventative medicine were the result of improving patient outcomes. CONCLUSION: Conventional or synthetic drugs provide relief for short time but nanoformulations of phytomolecules offer an improved therapeutic with fewer negative side effects. Herbal medicines are rich in phytoconstituents and possess variety of health benefits. This review is compilation of phytoconstituents and novel drug delivery system of phytomolecules i.e. nanoparticles, niosomes, microsphere, microparticle and others.

A Promising Approach of Dermal Targeting of Antipsoriatic Drugs via Engineered Nanocarriers Drug Delivery Systems for Tackling Psoriasis.

Psoriasis is a complex autoimmune skin condition with a significant genetic component. It causes skin inflammation and is characterized by flaky, silvery reddish spots that can worsen with age. This condition results from an impaired immunological response of T-cells and affects 2-5% of the global population. The severity of the illness determines the choice of treatment. Topical treatments are commonly used to treat psoriasis, but they can have several adverse effects. Biological therapy is another option for treating specific types of psoriasis. Recently, new nanoformulations have revolutionized psoriasis treatment. Various nanocarriers, such as liposomes, nanostructured lipid nanoparticles, niosomes, and nanoemulsions, have been developed and improved for drug delivery. The use of nanocarriers enhances patient compliance, precise drug delivery, and drug safety. This review aims to suggest new nanocarrier-based drug delivery systems for treating psoriasis. It discusses the importance of nanocarriers and compares them to traditional treatments. Anti-psoriatic drugs have also been investigated for cutaneous delivery using nanocarriers. The review also covers various factors that influence dermal targeting. By highlighting several relevant aspects of psoriasis treatment, the review emphasizes the current potential of nanotechnology. Using nanocarriers as a drug delivery technique may be a promising alternative treatment for psoriasis.

Myocardial Infarction as a Consequence of Mitochondrial Dysfunction.

Acute myocardial infarction is an event of myocardial necrosis caused by unstable ischemic syndrome. Myocardial infarction (MI) occurs when blood stops flowing to the cardiac tissue or myocardium and the heart muscle gets damaged due to poor perfusion and reduced oxygen supply. Mitochondria can serve as the arbiter of cell fate in response to stress. Oxidative metabolism is the function of mitochondria within the cell. Cardiac cells being highly oxidative tissue generates about 90% of their energy through oxidative metabolism. In this review, we focused on the role of mitochondria in energy generation in myocytes as well as its consequences on heart cells causing cell damage. The role of mitochondrial dysfunction due to oxidative stress, production of reactive oxygen species, and anaerobic production of lactate as a failure of oxidative metabolism are also discussed.

Localized Delivery of Drugs through Medical Textiles for Treatment of Burns: A Perspective Approach.

The topical delivery offers numerous benefits, such as the ability to deliver drugs specifically on site selectively, prevents fluctuations in the levels of the drug, improved compliance, and improved self-medication capacity. Skin is the main route of the administration of the drug delivery system (DDS) and burns mainly cause skin damage. A burn is a kind of damage caused to skin and tissues by fire, ice, electrical energy, pollutants, friction, and radiation. There are three different types of burns, including superficial epidermis burns, partial-thickness dermis that stretch to the papillary and reticular dermis, and full-thickness burns that cover the dermis whole. The objective of the present review article is to focus on fabrication techniques of medical textiles, different types of polymers used for designing medicated textiles, skin burn conditions, and application of medicated textiles for treatment of burn along with other applications. Cream, ointment, and gel are the dosage forms used in burns. Intravenous fluids, wound care, assorted antibiotics, surgical and alternative medicines, burned creams and salami, dressings can be used to treat wounds. Nanofibers are nanometer-specific fibers that encapsulate drugs inside them and cure wounds. Nanofibers have all the properties that speed up wound healing. The properties are mechanical integrity, proper timing of wound addiction, temperature homeostasis facilitation and gas exchange, absorption of exudates. The nanofibers have been used in burn care and have been highly efficient and non-toxic.

A Review on Mechanistic and Pharmacological Findings of Diabetic Peripheral Neuropathy including Pharmacotherapy.

BACKGROUND: Chronic hyperglycemia and related complications involving peripheral nerves in diabetes are one of the most severe microvascular complications with an average prevalence of 50-60%. Diabetic neuropathy is among the vascular disorders of diabetes, the most debilitating and crippled, lethal condition impacting patients's quality of life. METHODS: In the present review article, several hypotheses associated with the pathogenesis of Diabetic Peripheral Neuropathy (DPN) have been introduced, among them metabolic pathways associated with polyol pathway, oxidative stress, production of reactive oxygen species (ROS) amplified under chronic hyperglycemic conditions and activation of transcription factor Nuclear factor-κB (NF- κB). The review article also possesses pathogenetic and pharmacologic treatments along with others, including acupressure, lidocaine, and capsaicin for DPN. CONCLUSION: It may be concluded that we can combat the pathogenesis of DPN with different suggested treatments.

A Technical Approach of Solubility Enhancement of Poorly Soluble Drugs: Liquisolid Technique.

BACKGROUND: Solubility is one of the significant pre-formulation properties which regulate the desired concentration of drug in the systemic circulation. Most of the newly discovered chemical entities show poor solubility which consequently leads to poor bioavailability. To enhance the bioavailability of such type of drugs is a big challenge for pharmaceutical scientists. Liquisolid technology is a new and advanced technology used to transform the liquid medication into dry, free-flowing and easily compressible dosage form incorporation with the carrier and coating material. OBJECTIVES: This review represents the technical perspective of Liquisolid technologies that overcome the demerits of classic formulation strategies and amend the bioavailability of the poorly soluble drug. This technique is also approaches the stability, hygroscopicity and agglomeration issue which are mainly occurring in other techniques for solubility enhancement. CONCLUSION: Several technologies have been utilized to minimize the solubility problem but due to the complicated and expensive machinery fails to achieve the desired bioavailability of the poorly soluble drugs. Therefore, Liquisolid technology has been introduced as an innovative and promising technique that recovers the demerits of classic formulation strategies and also improves the bioavailability of the poorly soluble drug. This article exhibits the technical approach of the liquisolid system by improving the solubility as well as bioavailability of water-insoluble drugs.

Formulation and evaluation of the topical ethosomal gel of melatonin to prevent UV radiation.

BACKGROUND: Clinically, melatonin (MLT) has variable oral absorption and extensive first-pass effect, making its oral mode less preferable. Ethosomes are able to permeate intact through the human skin due to its high deformability. AIM: Present study assessed topical potential of ethosomes loaded with MLT for the prevention of UV radiation. METHODS: Melatonin was encapsulated using different ratios of ethanol, soya lecithin, and cholesterol. Prepared ethosomes were characterized for scanning electron microscopy (SEM), zeta potential, % entrapment efficiency (%EE), in vitro drug release kinetics. Then, optimized formulation was incorporated in gel and evaluated for viscosity, pH, extrudability, homogeneity, skin irritation study, spreadability, in vitro skin permeation study, flux, and stability. RESULTS: Ethosomes were spherical in structure as confirmed by SEM, and zeta potential was in range of -12.4 mV to -27.4 mV. %EE of the vesicles was in the range of 49.61%-78.047%. Cumulative percentage drug release from various ethosomal formulations was ranged from 64.82%-81.01%. F3 was selected as optimized formulation on the basis of highest %EE, zeta potential, and in vitro drug release. An ethosomal gel of optimized formulation F3 was prepared by using carbopol 934 and compared with plain gel formulation. G3 formulation showed pseudoplastic rheological behavior, optimum pH, spreadability and also showed maximum % in vitro drug permeation with flux 13.85 µg/cm2 /hr and followed zero-order release kinetics which was good for topical drug delivery system. CONCLUSION: This research suggested that MLT loaded ethosomes can be potentially used as a topically drug delivery system.

1,4-Dihydropyridine: A Dependable Heterocyclic Ring with the Promising and the Most Anticipable Therapeutic Effects.

Nowadays, heterocyclic compounds act as a scaffold and are the backbone of medicinal chemistry. Among all of the heterocyclic scaffolds, 1,4-Dihydropyridine (1,4-DHP) is one of the most important heterocyclic rings that possess prominent therapeutic effects in a very versatile manner and plays an important role in synthetic, medicinal, and bioorganic chemistry. The main aim of the study is to review and encompass relevant studies related to 1,4-DHP and excellent therapeutic benefits of its derivatives. An extensive review of Pubmed-Medline, Embase and Lancet's published articles was done to find all relevant studies on the activity of 1,4-DHP and its derivatives. 1,4-DHP is a potent Voltage-Gated Calcium Channel (VGCC) antagonist derivative which acts as an anti-hypertensive, anti- anginal, anti-tumor, anti-inflammatory, anti-tubercular, anti-cancer, anti-hyperplasia, anti-mutagenic, anti-dyslipidemic, and anti-ulcer agent. From the inferences of the study, it can be concluded that the basic nucleus, 1,4-DHP which is a voltage-gated calcium ion channel blocker, acts as a base for its derivatives that possess different important therapeutic effects. There is a need of further research of this basic nucleus as it is a multifunctional moiety, on which addition of different groups can yield a better drug for its other activities such as anti-convulsant, anti-oxidant, anti-mutagenic, and anti-microbial. This review would be significant for further researches in the development of several kinds of drugs by representing successful matrix for the medicinal agents.

Pharmacist involvement in the patient care improves outcome in hypertension patients.

OBJECTIVE: The main objective of this study was to assess the effects of pharmaceutical care interventions in patients with essential hypertension in Lakshmi Pat Singhania Institute of Cardiology, Kanpur, India. METHODS: The study was carried out from July 2010 to August 2011. Pharmaceutical care was provided for 54 patients (intervention group) which was comprised of the patient education, the prescription assistance and the life style modifications and motivation for health. Then the clinical outcome as well as health related quality of life (HRQOL) were compared with the control group (48 patients) in which the pharmaceutical care was not provided. Furthermore, the effect of pharmaceutical care intervention on HRQOL was assessed using Short Form-36 (SF-36), a general health related quality of life questionnaire used to evaluate the QOL of patients. Blood pressure (BP) measurements and QOL survey was performed at baseline and at the follow-up session. FINDINGS: The difference between blood pressure readings from the baseline to the second follow-up was significant for systolic [(P = 0.0001), 12.24 mmHg] and diastolic BP [(P = 0.001), 5.17 mmHg] in the intervention group. The questionnaire used to evaluate the QOL of patients also showed improvement in the mean score for intervention group. CONCLUSION: Results from our study showed that applying pharmaceutical care to hypertensive patients can help in the control of these patients' blood pressure, and consequently lower the risk that hypertension poses in cardiovascular disease. Successful implementation of pharmaceutical care has the potential to increase patients' satisfaction with their pharmacists' activities and may increase patients' expectations that pharmacists will work on their behalf to assist them with their healthcare needs.

Carbon nanotubes as a novel drug delivery system for anticancer therapy: a review

Carbon nanotubes (CNTs) were discovered in 1991 and shown to have certain unique physicochemical properties, attracting considerable interest in their application in various fields including drug delivery. The unique properties of CNTs such as ease of cellular uptake, high drug loading, thermal ablation, among others, render them useful for cancer therapy. Cancer is one of the most challenging diseases of modern times because its therapy involves distinguishing normal healthy cells from affected cells. Here, CNTs play a major role because phenomena such as EPR, allow CNTs to distinguish normal cells from affected ones, the Holy Grail in cancer therapy. Considerable work has been done on CNTs as drug delivery systems over the last two decades. However, concerns over certain issues such as biocompatibility and toxicity have been raised and warrant extensive research in this field.

Os nanotubos de carbono foram descobertos em 1991 e suas propriedades físico-químicas únicas demonstradas, despertando interesse em sua aplicação em vários campos, incluindo a entrega liberação de fármacos. As propriedades únicas dos nanotubos de carbono, tais como a facilidade de captação pela célula, carga alta de fármaco, ablação térmica, entre outras, tornaram-nos úteis para terapia de câncer, uma das doenças mais difíceis dos tempos modernos, pois sua terapia envolve a distinção entre as células normais saudáveis e as afetadas pela doença. Os nanotubos de carbono têm um papel importante nessa área porque fenômenos como EPR permitem que estes possam distinguir as células normais das afetadas, que é o Santo Graal na terapia do câncer. Trabalho considerável tem sido feito ao longo das duas últimas década com nanotubos de carbono, como sistemas de liberação de fármacos. No entanto, preocupações sobre algumas questões, como biocompatibilidade e toxicidade, surgiram ao longo do tempo, demandando extensas pesquisa nesse campo.

Neutraceutical approaches to control diabetes: A natural requisite approach.

OBJECTIVE: The aim of this study is to screen the polyherbal preparation for antidiabetic activity in rats. MATERIALS AND METHODS: The blood glucose lowering activity of the polyherbal preparation-I (1:1:1 of wheat germ oil, Coraidrum sativum, and Aloe vera) was studied in normal rats after oral administration at doses of 1.0 ml/kg and 2.0 ml/kg and polyherbal preparation-I, II (wheat germ oil, fresh juice of C. sativum, and A. vera in the ratio of 2:2:1), and III (wheat germ oil, fresh juice of C. sativum and A. vera in the ratio of 1:2:2) on alloxan-induced diabetic rats, after oral administration at doses of 1.0 ml/kg and 2.0 ml/kg. Blood samples were collected from the tail vein method at 0, 0.5, 1, 2, 4, 8, 12, and 24 h in normal rats and in diabetic rats at 0, 1, 3, 7, 15, and 30 days. Blood plasma glucose was estimated by the GOD/POD (glucose oxidase and peroxidase) method. The data were compared statistically by using the one-way ANOVA method followed by the Dunnett multiple component test. Statistical significance was set at P < 0.05. RESULTS: The polyherbal preparation-I produced significant (P < 0.05) reduction in the blood glucose level of normal rats and polyherbal preparation-I, II, and III produced significant (P < 0.01) reduction in the blood glucose level of diabetic rats during 30-day study and compared with that of control and glibenclamide. CONCLUSION: The polyherbal preparation-I showed a significant glucose lowering effect in normal rats and polyherbal preparation-I, II, and III in diabetic rats. This preparation is going to be promising antidiabetic preparation for masses; however, it requires further extensive studies in human beings.

Genetic predisposition to oxcarbazepine induced Stevens-Johnson syndrome.

Stevens-Johnson syndrome (SJS) is a rare immunologic reaction that may involve skin or various mucosal surfaces. The etiology may range from multiple pharmacologic agents to viral infections. Associated findings can range from minimal skin and mucosal involvement to extensive dermal exfoliation, nephritis, lymphadenopathy, hepatitis, and multiple serologic abnormalities. We report a female patient of 38 years with a history of drug allergy who was administered oxcarbazepine for the management of right partial bronchial seizure due to left parasagittal mass lesion following which she developed papular rashes all over the body and diagnosed as SJS. Although carbamazepine (CBZ) is the most common cause of SJS, a new anticonvulsant, oxcarbazepine, which is structurally related to CBZ, has been shown to induce SJS.

Aliskiren: An orally active renin inhibitor.

Renin inhibitors are antihypertensive drugs that block the first step in the renin-angiotensin system. Their mechanism of action differs from that of the angiotensin-converting enzyme inhibitors and angiotensin-receptor antagonists, but like these drugs, renin inhibitors interrupt the negative feedback effects of angiotensin II on renin secretion. The renin-angiotensin-aldosterone system (RAAS) has long been recognized to play a significant role in hypertension pathophysiology. Certain agents that modify the RAAS can control blood pressure and improve cardiovascular outcomes. Optimization of this compound by Novartis led to the development of aliskiren - the only direct renin inhibitor which is clinically used as an antihypertensive drug. Aliskiren is the first of a new class of antihypertensive agents. Aliskiren is a new renin inhibitor of a novel structural class that has recently been shown to be efficacious in hypertensive patients after once-daily oral dosing. In short-term studies, it was effective in lowering blood pressure either alone or in combination with valsartan and hydrochlorothiazide, and had a low incidence of serious adverse effects. It was approved by the Food and Drug Administration in 2007 for the use as a monotherapy or in combination with other antihypertensives. Greater reductions in blood pressure have been achieved when aliskiren was used in combination with hydrochlorothiazide or an angiotensin-receptor blocker. The most common adverse effects reported in clinical trials were headache, fatigue, dizziness, diarrhea, and nasopharyngitis. Aliskiren has not been studied in patients with moderate renal dysfunction; as an RAAS-acting drug, it should be prescribed for such patients only with caution.

Studies on development of controlled delivery of combination drug(s) to periodontal pocket.

AIM: The aim of this study to develop the controlled delivery of combination drug(s) to periodontal pocket. MATERIALS AND METHODS: In the present investigation mucoadhesive gel formulations were prepared using carboxy methylcellulose (CMC), methylcellulose (MC), hydroxyethylcellulose (HEC), polyvinylpirrolidone (PVP), polycarbophil (PC), and poloxamer. Each formulation was characterized in terms of polarizing light microscopy, gelation, gel melting, hardness, compressibility, adhesiveness, cohesiveness, syringeability, adhesion to a mucin disk, rheological studies, drug release, and antibacterial activities. Addition of CMC and PVP to the gel favored hexagonal phase formation. The gelation temperature was decreased linearly with an increasing concentration of drug(s), whereas, the melting temperature increased with the concentration of drug(s). Increasing the concentrations of each polymeric component significantly increased formulation hardness, compressibility, adhesiveness, mucoadhesion, and syringeability, yet a decreased cohesiveness. Increased time of contact between the formulation and mucin significantly increased the required force of detachment. Drug release from all formulations was non-diffusion controlled and significantly decreased as the concentration of the polymer was increased, due to the concomitant increased viscosity of the formulations and the swelling kinetics of PC, following contact with the dissolution fluid. RESULT: Antibacterial studies revealed that a gel with 30% HEC had a growth inhibition zone on agar with all three strains. CONCLUSION: Formulations containing HEC exhibited superior physical characteristics for improved drug delivery to the periodontal pocket and are now the subject of long-term clinical investigations.

Cyclodextrins in delivery systems: Applications.

Cyclodextrins (CDs) are a family of cyclic oligosaccharides with a hydrophilic outer surface and a lipophilic central cavity. CD molecules are relatively large with a number of hydrogen donors and acceptors and, thus in general, they do not permeate lipophilic membranes. In the pharmaceutical industry, CDs have mainly been used as complexing agents to increase aqueous solubility of poorly soluble drugs and to increase their bioavailability and stability. CDs are used in pharmaceutical applications for numerous purposes, including improving the bioavailability of drugs. Current CD-based therapeutics is described and possible future applications are discussed. CD-containing polymers are reviewed and their use in drug delivery is presented. Of specific interest is the use of CD-containing polymers to provide unique capabilities for the delivery of nucleic acids. Studies in both humans and animals have shown that CDs can be used to improve drug delivery from almost any type of drug formulation. Currently, there are approximately 30 different pharmaceutical products worldwide containing drug/CD complexes in the market.