DESIGN & DEVELOPMENT OF SOLID SELF MICRO-EMULSIFYING OSMOTIC DRUG DELIVERY SYSTEM FOR ISRADIPINE

Objective: The objective of the study was to design and develop self-microemulsifying osmotic pump tablet Isradipine, a BCS Class IV antihypertensive agent for improved solubility and obtain controlled release characteristics. Material & Methods: Methodology for undertaken project involved pre-formulation studies, comprising of analytical method adoption and drug: excipient compatibility studies. Further steps involve formulation and characterization of liquid SMEDDS of Isradipine. Developed SMEDDS was incorporated into selected adsorbent and compressed with osmotic agents, a binder and lubricant into tablet. Tablets were film coated with semi-permeable membrane and drilled with orifice. Final formulation was optimized for various formulation components and evaluated on various dimensions, among dissolution profiling and stability studies. Results and Discussion: Solubility studies in oils, surfactants and co-surfactants were carried out and SMEDDS formulation was finalized as Isradipine (11.63%), Gelucire 50/13 (34.88%), Lutrol F127 (30.23%) and Transcutol P (23.26%). Neusilin US 2 was selected as adsorbent in 1:1 ratio based on excellent adsorption and huge surface area. Final optimized formulation of tablet comprises of core tablet and functional coatings of cellulose acetate (60%) and PEG 400 (40%) with 5% film coating build up. Developed formulation was optimized for various formulation components and evaluated for release kinetics and accelerated stability study. Conclusion: The developed novel SME-OPT of Isradipine will be a promising template for formulating controlled release dosage form of BCS Class II and IV bioactive agents. The technology used for the preparation of SME-OPT is relatively simple manufacturing technology which can be easily adopted in industrial units on a commercial scale

REVIEW OF RECENT STUDIES ON STATISTICAL OPTIMIZATION IN DRUG DELIVERY TECHNOLOGIES

Statistical modeling and experimental design are essential tools in field of drug delivery during product development and can be divided into formula and process optimization. Experimental design allows efficient experimentation in which all or a large subset of factors are together varied over a set of experiments, in contrast to the traditional approach of varying only one variable at time (OVAT). Good estimates for the required composition, geometry, dimensions and preparation procedure of various types of delivery systems will be available, taking into account the desired administration route, drug dose and release profile. Thus, the number of required experimental studies during product development can be significantly reduced, saving time and reducing costs. The present review discusses types of designs and methodologies used recently in academic as well as industrial research for optimization of novel drug delivery systems

Implementation of drone based delivery of medical supplies in North-East India: experiences, challenges and adopted strategies

Timely delivery of medical supplies is essential in the healthcare sector, which is hampered by factors such as poor transportation network, traffic and adverse environmental conditions. Alternatively, drone operations can leapfrog the last mile logistic solutions in hard-to-reach terrains. The present paper elucidates the implementation process of drone-based delivery of medical supplies, operational challenges and innovations adopted by scientists in Manipur and Nagaland. Three districts, Bishnupur, Imphal West and Churachandpur from Manipur and two districts, Mokokchung and Tuensang from Nagaland, were selected for the study. Regulatory and ethical approvals and coordination with state health and administrative authorities were accorded. Implementation and operational challenges faced by the research team were recorded elaborately in the field diaries and assessed qualitatively. The experiences encountered by the team for case-to-case based permission and coordination with the central and state aviation authorities, district administration and health authorities were observed. The drone-related technical and logistic challenges were identified as the deployment of suitable drones, payload capacity, time management for operations, and transportation of drones. The officials adopted mitigation strategies to overcome field-based challenges. Drone-based deliveries of medical supplies are proving to be time efficient, however, overcoming operational challenges could provide an effective long-term deployment strategy

Role of Physiotherapy in Hospitalised Patients of COVID-19 disease

Introduction: Respiratory physiotherapy is one of the therapeutic methods in various respiratory viral infections. Breathing exercises with other interventions, could enhance the total lung capacity and symptom alleviation in patients with virus-related acute respiratory distress syndrome (ARDS). Aim: To study the clinical evaluation of the role of physiotherapy in hospitalised patients of covid-19 diseases. Method: This was an Observational (prospective, cross-sectional) study. 187 patients were recruited and diagnosed as COVID-19 as per RTPCR at NSCB Medical College, Jabalpur (MP). Patients were randomised into the physiotherapy group and controlled group. Patients in the physiotherapy group were undergone positional changes, prone ventilation, Breathing exercise, Resistive training, Passive joint motion, Muscle stretching, Bedside standing training, endurance exercise by a specialized physiotherapist. Mean cough severity index, MMRC grade, respiration rate and peripheral blood saturation were recorded before and after intervention and compared with the controlled group. Result: There was significant improvement found in MMRC grade and respiration rate after physical therapy in the physiotherapy group (p-value < 0.05). Exertional dyspnoea and cough severity index significant deceased in physiotherapy group. The positive change was found in peripheral blood saturation. There was decreased in hospitalization stay in the physiotherapy group as compared to the controlled group. Conclusion: Our study revealed the positive effect of physiotherapy on covid-19 disease in terms of symptoms and hospitalization duration among the physiotherapy group. Physiotherapy exerts a beneficial role in the management of the covid-19 disease

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions