Current Aspects and Therapies for Wound healing

Injury to the skin provides a new challenge, as wound healing is a complex and intricate process. Nonhealing wounds represent a significant cause of morbidity and mortality for a large portion of the population. Delayed wound healing is one of the major therapeutic and economic issues in medicine today. Wound healing requires a concerted effort of remodeling of various components of the connective tissue in the presence of appropriate cytokines and growth factors. Unfortunately we still do not understand the actual mechanism of wound healing. This review is an effort to provide information about current challenges of wound healing and their management, recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers. Various steps like microbial control, subsidence of inflammation, regeneration of connective tissue, angiogenesis and epithelialisation should take place in a time-bound sequence. The development of new and effective interventions in Wound care remains an area of intense research

Diabetes mellitus treatment using herbal drugs

Diabetes mellitus is becoming a common metabolic disorder which has serious threat to public health in the world. There are chemicals and biochemical agent that helps in controlling diabetes but there is no permanent remedy available which helps to get recovered completely from this disorder. By conducting large number of research work, numerous traditional medicines have been found for diabetes. Substances and extracts isolated from different natural resources especially plants have always been a rich arsenal for controlling and treating diabetes problem and complication arising due to it. So this review helps the reader to understand the importance of various types of herbal and polyherbal formulations present traditionally which can be used to treat diabetes mellitus.

Regulatory aspects of medical devices in India

Today millions of patients depend on medical device based treatment for the management and diagnose of several diseases. Quality and safety of device is depends upon the regulatory guidelines. Medical device manufacturing in India should be taken seriously due to large population and the potential severity of the consequences of introducing inferior and unsafe products to the market-place. Therefore a law containing adequate guidelines of rules and regulations are required for monitoring the entry of such devices into the use in public health. The regulations define requirements of medical device design, development and manufacture to ensure that products reaching market are safe and effective. Presently in India regulatory body CDSCO is governing regulation for regulation of devices which with time, amendment introducing in the law will provide safety assurance to public health. This review provides a study on different regulatory aspects of medical device implemented in India. The present review discuss about the classification of medical devices and regulations aspects in India

Particle Size Characterization- Techniques, Factors and Quality-by-design Approach

Particle size characterization is one of the key areas involved in quality assurance. The concept of particle size and size characterization acts as a foundation for all the processes involved in theproduction of a formulation; from manufacturing to quality control operations. Particle size characterization dictates many properties of the finished product. Particle size characterization of samples is important to make a better quality product, improve its appearance, taste, texture and shelf-life. There are many instruments for particle size characterization that are available commercially. Each instrument is based on a different technique and each technique is based on a different principle. Selecting the right particle size characterization technique for the given sample is a challenging decision. The choice of technique is made according to the sample. Sometimes even a combination of techniques is used to obtain accurate results. There are several factors upon which choice of technique depends like size range, sample quantity, cost effectiveness etc. To ensure appropriate quality standards in the field of particle sizing and particle size characterization, ICH and US-FDA have recently insisted on including Quality-by-design approach in thepharmaceutical industry. Application of QBD approach to particle size characterization techniques ensures a resilient method which gives reproducible results. It aids in reducing result and method variations and promotes productivity and quality. The main objectives of this review are first, to understand the principle, instrumentation, and working of commercially used techniques and to compare their pros and cons; secondly, to study the factors which govern the choice of technique and lastly, to understand the concept of Quality by design and its role in particle size characterization through some example.Keywords:  Particle size characterization; techniques; factors;QBD

Patient satisfaction with access, affordability and quality of diabetes care at Mohalla Clinics in Delhi, India

IntroductionMohalla Clinics have been set up to provide curative care for minor ailments free of cost within walking distance in the urban slums, thus making primary care more accessible and affordable. Studies evaluating patient satisfaction with treatment of chronic conditions, such as diabetes, in these clinics are lacking.MethodsA survey of 400 type 2 diabetes patients was conducted, split equally between Mohalla clinics (MC) and Private clinics (PC) in Delhi. Responses were analyzed using STATA17, applying appropriate statistical tests for the data type (Chi-square test, Mann–Whitney U test, Wilcoxon signed rank test, or two-sample t test).ResultsSatisfaction level was high in both groups with no significant difference between mean satisfaction scores of MC patients and PC patients (Mean 3.79 vs. 3.85 respectively, p = 0.4). However, MC patients reported a significant improvement in their satisfaction score after switching to MC (Mean 3.79 vs. 3.3 for the previous facility, p < 0.05). Physician interaction with the patients was the most important factor in influencing the satisfaction score. Proximity to the clinic was the second most important factor for MC patients but was not as important for PC patients. Surprisingly, treatment success was considered an important factor for satisfaction level by < 10% MC and < 20% PC patients only, pointing to the need for patient education across both the groups. None of the MC patients mentioned free treatment as a contributory factor to high satisfaction, perhaps because most shifted from a government setup to MC. PC patients had more frequent follow-up visits and blood glucose monitoring, and longer consultation duration compared to MC patients, which were offset by access factors, thus not causing much difference to the satisfaction score between the two groups.ConclusionMohalla clinics are making diabetes treatment accessible and affordable for the marginalized population of Delhi, despite not being designed or fully equipped to care for chronic diseases such as diabetes that require multi-specialty care to monitor and manage multiple co-morbidities and long-term complications. Positive perception of physician interaction and convenient location of the clinics are the two major contributors to the high satisfaction patients expressed with diabetes care at these clinics

Stepping into small shoes: Gaining user perspective on appropriate administration devices for paediatric medication in India

A cross sectional pan-India study about use of administration devices for paediatric oral and inhalation medicines was conducted with a diverse pool of participants of various age groups. Via 634 respondents from more than 15 states in India, this study has identified the administration devices commonly used by parents/caregivers for children 0 to 18 years and by children over 10 years. It has provided insights on device ease of use, challenges faced and recommendations to facilitate the correct use of administration devices for paediatric oral and inhalation medicines. Ethics approval (DPSRU-BREC/2020/A/008)) was obtained from the Biomedical Research Ethics Committee of Delhi Pharmaceutical Sciences and Research University. The survey was completed by parents only (n = 514) and jointly by both parents and children (n = 120). The mean age of the child was 7.2 ± 4.96 years. 72% of the respondents reported that an oral medicine had been taken recently, 6.3% reported that an inhaled medicine had been taken and the remaining 21.9% reported that both an oral and inhaled medicine had been taken. The use of measuring cup was most prevalent followed by household spoons. The mean of the score for ease of use was found to be highest 4.6 ± 0.50 for oral syringe and lowest (3.8 ± 0.76) for measuring cups. The majority of them found the oral device easy to use. Difficulties were reported mostly for measuring cups and household spoons and were related to a lack of user instructions and measuring difficulties. The respondents who found the device easy to use had mostly received clear instructions from healthcare professionals. Compared to oral devices, there were very limited responses for inhalation devices (n = 175/634). Nebulisers with facemasks were most frequently used followed by manually actuated Metered dose inhalers with and without spacer. The mean of the ease-of-use score for dry powder inhalers was found to be highest (4.2 ± 0.37) followed by mist inhalers (4.0 ± 0) and manually actuated pressurised metered dose inhalers (4.0 ± 0.71). The nebulisers with facemask were reported to be difficult to use by most of the respondents despite receiving clear instructions from healthcare professionals.// The study findings add evidence to the understudied area of user experiences and perspectives on administration devices for oral and inhalation medicines in India. It highlights a need for initiatives to improve the usability, availability, and affordability of administration devices for children in India. Awareness on the importance of proper use of devices needs to be raised and sustained about the existence of affordable administration devices

Design-of-Experiments (DoE)-Assisted Fabrication of Quercetin-Loaded Nanoemulgel and Its Evaluation against Human Skin Cancer Cell Lines

Background: Quercetin (QCT) is a natural polyphenolic flavonoid showing great potential in the treatment of skin cancer. However, its use is limited owing to its poor water solubility, poor absorption, quick metabolism and excretion, as well as low stability. Preparation of nanoemulgel has been proven to be an effective approach to deliver the drugs topically due to various advantages associated with it. Objectives: This study aimed to prepare stable nanoemulgel of QCT using a Design-of-Experiments (DoE) tool for optimization, to characterize and to assess its in vivo toxicity and efficacy against human cancer cell lines in vitro. Methods: An ultrasonication emulsification method was used for the preparation of QCT-loaded nanoemulsion (QCT@NE). Box–Behnken design was used for the optimization of developed nanoemulgel. Then, in vitro characterization of prepared nanoemulsion was performed using Fourier Transform-Infra Red (FT-IR) spectroscopy, Scanning Electron Microscopy (SEM), particle size analysis, determination of zeta potential and entrapment efficiency (%EE). Further, the developed QCT-loaded nanoemulgel (QCT@NG) was characterized in vitro using texture profile analysis, viscosity and pH determination. Eventually, the cell cytotoxicity studies of the prepared nanoemulgel were performed on the skin cancer cell lines A431 followed by an acute toxicity and skin irritation study on male wistar rats in vivo. Results: The developed QCT@NE was found to be nanometric in size (173.1 ± 1.2 nm) with low polydispersity index (0.353 ± 0.13), zeta potential (−36.1 ± 5.9 mV), and showed good %EE (90.26%). The QCT@NG was found to be substantially more effective against the human skin carcinoma (A431) cell lines as compared to plain QCT with IC50 values of 108.5 and 579.0 µM, respectively. Skin irritation study showed no sign of toxicity and ensured safety for topical application. Hematological analysis revealed no significant differences between the treatment and control group in any biochemical parameter. In the nanoemulgel treatment group, there were no discernible differences in the liver enzymes, bilirubin, hemoglobin, total leukocyte and platelet counts as compared to the control group. Conclusions: The optimized QCT@NG was found to be an ideal and promising formulation for the treatment of skin cancer without showing skin irritation and organ toxicity