Formulation and Evaluation of Ginger Extract Loaded Nanoemulgel for the Treatment of Rheumatoid Arthritis

Ginger is a potent anti-inflammatory; in the present study the nanoemulgel of ginger extract was formulated for treating rheumatoid arthritis through topical application. The main objective of nanoemulgel formulation was to enhance the bioavailability of ginger extract through topical route and also to reduce the dose of ginger extract. First the nanoemulsion was prepared with the help of ternary phase diagram, using water titration method. The Smix (surfactant and co-surfactant) and extract were mixed together then titrated with water. The Smix was used at the ratio of 1:1, 1:2, and 2:1. The isopropyl myristate is used as oil, tween 80 as surfactant, ethanol as co-surfactant and water was used as aqueous phase and, 32 formulations were prepared. The particle size was found in the range of 60.32 to 230.8nm for formulations F1 to F4. The zeta potential was found between -16.6 to -24.4 and the polydispersibility index was found to be 0.687 to 0.892. Nanoemulsion was converted into nanoemulgel by using carbopol 934 as gelling agent in various concentrations. The rheological properties, spreadability, pH, thermodynamic stability and drug release were also determined. On the basis of thermodynamic stability, spreadability and drug release, the nanoemulgel F4* was considered as best formulation. Keywords: nanoemulgel, nanoemulsion, ternary phase diagram, rheumatoid arthritis, ginger extract, co-surfactan

Current State of Fetal Heart Disease Counseling and Training: Room for Improvement? : Endorsed by the Fetal Heart Society

We sought to describe the fellowship experiences and current practice habits of pediatric cardiologists who counsel patients with fetal heart disease (FHD) and to identify fellowship experiences related to FHD counseling perceived as valuable by respondents as well as opportunities for improvement. A cross-sectional survey of attending pediatric cardiologists who care for patients with FHD was performed. The respondents\u27 demographics, fellowship experiences related to FHD counseling, reflections on fellowship training, and current practice habits were collected. The Fetal Heart Society endorsed this survey. There were 164 survey responses. 56% of respondents did not have 4th-year subspecialty training in fetal cardiology. Observing and performing FHD counseling were the most commonly used methods of training, with the highest perceived effectiveness. The number of counseling sessions observed and performed correlated moderately with confidence in FHD counseling skills at fellowship graduation. Extracardiac pathology and neurodevelopment were the least frequently addressed topics in fellowship training and in current practice. Fewer than 50% of respondents received formal education and feedback in counseling techniques during fellowship training. A significant proportion of practicing pediatric cardiologists provide FHD counseling with only standard categorical training. This highlights the potential importance of expanding FHD counseling education into categorical fellowship curricula. We suggest increasing opportunities for fellows to perform FHD counseling and receive feedback as this is a valued and beneficial experience during training. A formalized curriculum including extracardiac pathology and neurodevelopment and the use of evidence-based workshops in counseling techniques may address identified gaps in fellowship education