TOPICAL DELIVERY OF NANOEMULSION FOR ANTIPSORIATIC DRUGS

Psoriasis is an autoimmune disorder of the skin characterized by relapsing episodes of inflammatory lesions and hyperkeratotic plaques with worldwide occurrence of around 2–5%. Psoriasis is a disease known to be caused by multitude of both genetic and environmental factors such as trauma, drugs, infection, alcohol, smoking and stress but its accurate origin is still not known. Further, available treatment options are associated with both inappropriate cosmetic appearance and related toxicities leading to poor patient compliance in long term use. Nanotechnology based drug delivery system has immense potential to enhance the bioavailability and effectiveness of drugs in their dosage forms, especially lipophilic drugs. Lipid based carrier system can overcome the lipid imbalance and normal moisturizing factors. Nanoemulsions, as one of a new carrier apparently have the prospective to conquer numerous problems related with topical antipsoriatic therapy. This delivery system could perhaps offer a good alternative in topical psoriasis treatment. Not only on how nanoemulsions prepared, but it depends on the active ingredients used and the selection of oil could as well enhance the efficiency of topical treatment towards psoriasis. A good combination of both active and suitable oils would result a better treatment and better effect. Keywords: Topical nanoemulsion, Antipsoriatic therapy, Critical quality attributes

Premalignant lesions of prostate and their association with nodular hyperplasia and carcinoma prostate

BACKGROUND: A relatively new development in the arena of prostatic histopathological study is the premalignant proliferative changes in the glandular epithelium, possibly relating to carcinoma. Two major categories have come up, namely prostatic intraepithelial neoplasia (PIN) and atypical adenomatous hyperplasia (AAH). AIMS: The aims of present study were to identify foci of the two putative premalignant conditions viz. PIN and AAH in ducto-acinar lining epithelia of 200 prostatectomy specimens and their association with nodular hyperplasia and adenocarcinoma prostate. MATERIAL AND METHODS: Micro sections from 200 prostatectomy specimens, received in the Department of Pathology, PGIMS, Rohtak, were extensively studied for the presence and association of premalignant conditions. Significant values were obtained by employing Chi-square (x2) test, with P value <0.05 as significant. RESULTS: Out of 177 cases of nodular hyperplasia, 53 (29.9%) showed PIN and 38 (20.3%) showed presence of AAH. All 6 cases (100%) of pure carcinoma revealed foci of PIN. Out of the remaining 23 cases of carcinoma with nodular hyperplasia, foci of PIN were observed in 16 cases (94.1%) and AAH in 2 cases (11.7%). High-grade PIN was observed in 20 cases (86.9%) of the total 23 cases of carcinoma, with/without nodular hyperplasia and 20 cases (11.2%) of nodular hyperplasia. Low-grade PIN was observed in 33 cases (18.6%) of nodular hyperplasia and in only 1 case (5.8%) of carcinoma prostate with nodular hyperplasia. CONCLUSION: PIN, especially high-grade type was the most commonly observed premalignant lesion, in cases of adenocarcinoma, thereby suggesting it to be the likely precursor of carcinoma prostate. AAH showed a weaker association with carcinoma

Rare Form of Crusted Scabies in Diabetes: A Case Report

Crusted scabies is an uncommon manifestation of parasitic infection caused by Sarcoptes scabiei var. hominis. This variant of scabies is seen in various immunocompromised states. Uncontrolled diabetes is an immunocompromised state which is characterized by increased incidence of various infections, and rarely, may be associated with this rare crusted scabies, which may pose a real diagnostic challenge. A high index of suspicion is required for timely and correct diagnosis in the best interest of the patient and the public health point of view to prevent the spread of this highly contagious infestation

Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects

This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations. Six original articles were included in the final review: two with non-human subjects and four with human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-human subjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and 1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopic suturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success and low complication rate

NIOSOMES:THE UNIQUE VESICULAR DRUG CARRIERS

Drug targeting is the ability to direct a therapeutic agent specifically to desired site of action with little or no interaction with nontarget tissue. Niosomes are one of the best carriers for drug targeting. Niosomes are self assembled vesicles composed primarily of synthetic surfactants and cholesterol. They are analogous in structure to the more widely studied liposomes formed from biologically derived phospholipids. Niosomes are biodegradable, relatively nontoxic, more stable and inexpensive, an alternative to liposomes. The method of preparation of niosome is based on liposome technology. The basic process of preparation is the same i.e. hydration by aqueous phase of the lipid phase which may be either a pure surfactant or a mixture of surfactant with cholesterol. After preparing niosomal dispersion, unentrapped drug is separated by dialysis centrifugation or gel filtration. Niosomes can be SUV (Small Unilamellar Vesicles), MLV (Multilamellr Vesicles) or LUV (Large Unilamellar Vesicles). Niosomal drug delivery is potentially applicable to many pharmacological agents for their action against various diseases

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Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Endoscopic Sleeve Gastroplasty - A New Tool to Manage Obesity

Obesity is a growing pandemic across the world. Dietary restrictions and behavior modifications alone have a limited benefit. Bariatric surgery, despite being the current gold standard, has limited acceptance by patients due to cost and associated morbidity. In our review, we have discussed nine original studies describing endoscopic sleeve gastroplasty (ESG). A total of 172 subjects successfully underwent ESG. Of 65 subjects with follow up data, 95.4% (62/65) had intact gastric sleeve confirmed via esophagogastroduodenoscopy or oral contrast study at the end of study specific follow up interval (the longest being 6 months). Individual studies reported a technical success rate for intact gastric sleeve from as low as 50% to as high as 100%. A statistically significant p<0.05) weight loss was reported in seven of the eight studies with available data. None of the patients experienced any intra-procedure complications, and approximately 2.3% (4/172) of patients experienced major post-procedure complications; however, no mortality was reported. Majority of the studies reported relatively high incidence of minor post-procedure complications, which improved with symptomatic treatment alone. Good patient tolerance with comparable clinical efficacy in achieving and sustaining desired weight loss makes ESG an attractive option to consider among other bariatric therapies

Cytomorphological features of oncocytic variant of papillary thyroid carcinoma with lymphocytic thyroiditis

Cytological diagnosis of hurthle cell lesions of thyroid is a diagnostic dilemma. Presence of hurthle cells on fine needle aspiration (FNA) leads to a wide range of differential diagnosis including benign and malignant entities. The oncocytic variant of papillary thyroid carcinoma (PTC) is one entity of the vast list of differentials of which very few cases have been reported to date. We report a case of oncocytic variant of PTC in a 28-year-old female diagnosed on cytomorphology. The findings of FNA smears of the first aspirate were not sufficient for a definitive diagnosis. Repeat FNA was done to rule out the possibility of autoimmune thyroiditis/thyroid neoplasm. The repeat FNA smears showed oncocytic cells present in papillary and loosely cohesive clusters. Many of the cells displayed nuclear features of PTC and the case was finally diagnosed as PTC; oncocytic variant. Thyroidectomy specimen revealed PTC; oncocytic variant with lymphocytic thyroiditis in the surrounding tissue. Thus, in cytology practice, concurrent autoimmune thyroiditis may pose a problem in diagnosis of PTC; oncocytic variant