Protective Role of Ramipril and Candesartan against Myocardial Ischemic Reperfusion Injury: A Biochemical and Transmission Electron Microscopical Study

The present study was designed to investigate the role of combined administration of Ramipril and Candesartan against in vitro myocardial ischemic reperfusion injury in rat. Male Wistar albino rats were divided into five groups (n=6) and treated with saline (10 mL/kg), Ramipril (2 mg/kg), Candesartan (1 mg/kg), and the combination of both drugs, respectively 24 h before induction of global ischemia (5 min of stabilization, 9 min of global ischemia, and 12 min of reflow). Combination of Ramipril and Candesartan when compared to the monotherapy significantly increased the levels of superoxide dismutase, reduced glutathione, catalase, and nitric oxide and decreased the levels of thiobarbituric acid reactive substances. In addition, the superior protective role of combination of Ramipril and Candesartan on ischemia induced myocardial damage was further confirmed by well preserved myocardial tissue architecture in light microscopy and transmission electron microscopy analysis studies. The combination was proved to be effective in salvaging the myocardial tissue against ischemic reperfusion injury when compared to the monotherapy of individual drugs and further investigations on protective mechanism of drugs by increasing the nitric oxide level at molecular levels are needed

Okra-Thioglycolic Acid Conjugate—Synthesis, Characterization, and Evaluation as a Mucoadhesive Polymer

The success of mucoadhesive drug delivery systems relies on the type of polymer used, which becomes adhesive naturally upon hydration. Intended polymers should be able to maintain prolonged contact with biological membranes, and to protect or cater the drug to a prolonged period. Most of the hydro polymers form weak non-covalent bonds, that hinder localization of dosage forms at specific sites resulting in therapeutic inefficiency. This can be overcome by the thiol functionalization of natural polymers. In the present study, natural okra gum (OG) was extracted, followed by thiolation (TOG) and evaluated for mucoadhesion property and its role in enhancing the efficacy of repaglinide as a model drug (short-acting Type II antidiabetic drug). The thiol functionalization of OG (TOG) was confirmed by a Fourier-transform infrared spectroscopy (FTIR) study that showed a polyhedral to a spherical shape that had a rougher surface. Differential scanning calorimetry (DSC) and X-Ray Diffraction (XRD) studies of TOG indicated a decline in endothermic transition temperature and high crystallinity, respectively, in comparison to OG. CSFR (Crushing Strength: Friability Ratio), weight and thickness variations of repaglinidetablets formulated using TOG were >80% and <2.5% respectively. The highest swelling index (107.89 ± 1.99%) and strong mucoadhesion due to high disulfide bonds were observed for repaglinide TOG tablets in comparison to RG OG tablets. In-vitro release studies indicated a controlled drug release from thiolated formulations proportional to the concentration of thiomers that have a good correlation with in-vivo studies. Pharmacokinetic studies indicated higher AUC (area under the curve), longer t1/2 with thiomers. and Level A IVIV (in vitro in vivo) correlation was established from the bioavailability and dissolution data. Consequently, all the obtained results suggest that thiomers based formulations can be promising drug delivery systems, even in targeting onerous mucosal surfaces like nasal, ocular or vaginal

Dabigatran etexilate - A novel oral anticoagulant for bleeding complications

Thromboembolic disease is a common cause of morbidity and mortality. Thrombin plays a key role in thrombotic events and thrombin inhibition represents a therapeutic event for thromboembolic events and has been identified as a target of therapy of its pivotal role in coagulation process. Anticoagulation is a major intervention for the management of arterial and venous thromboembolic events. Dabigatran etexilate is an orally effective anti-thrombin drug, several animal and human trials were conformed the efficacy of this drug in reduction of major bleeding in related to acute coronary syndrome, knee replacement surgery and venous thromboembolism conditions. The therapeutic use of this drug also shows limited side effects to select the dabigatran as promising therapeutic agent in bleeding complications

Effect of Polypharmacy on Medication Adherence in Patients with Type 2 Diabetes mellitus

ABSTRACT Objective: Non-adherence to treatment is an important and often unrecognized risk factor that contributes to reduced control of blood sugar hence this study aims at assessing the level of medication adherence in diabetic patients. It also determines to investigate beliefs about medications held by people with diabetes, and whether these beliefs influence adherence. Methods: This is a cohort study done for six months in which a sample size of 160 members was included. This study was conducted in a tertiary care teaching hospital in south India. The study included participants with at least one cholesterol level measured, one clinic visit in the previous 6 months, prescribed with at least 2 drugs. Out of 160, 125 (78.1%) patients agreed to participate and agreed to be interviewed, 35 (21.8%) refused for adherence assessment and beliefs about medicines interview. The patients were interviewed by using Morisky 8 item medication adherence and beliefs about medicines questionnaire. Results and Discussion: There is no association between the adherence score and the sociodemographic variables like age, gender, level of education, duration of diabetes. Patients with normal weight have high adherence and is statistically significant with a p value of 0.0004. Patients with co morbidities have high morisky medication adherence score when compared to those who don't have co morbidities (p=0.0001). Greater the no. of medicines taken higher the concerns score (p=0.038). Necessity, concerns, and differential necessity-concerns score of adherers and non adherers are not significant. Conclusion: In this sample, patients reported very high medication adherence rates regardless of number of medicines prescribed. Most people with diabetes have positive beliefs about the necessity of their medication. However, levels of concern are also high. Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia, hypertension, and hyperlipidemia