PROPRANOLOL HYDROCHLORIDE TOPICAL GEL FOR THE TREATMENT OF INFANTILE HEMANGIOMA

Objective: To formulate and evaluate propranolol hydrochloride topical gel for overcoming the limitations and low oral bioavailability associated with conventional therapy. Methods: The propranolol hydrochloride topical gels were prepared by the cold mechanical method. The preliminary evaluation and further characterisation studies was conducted to find the optimised formulation. The in vitro release and ex vivo permeation studies were investigated. The histopathological studies and stability studies was also assessed. Results: The propranolol hydrochloride topical gel was successfully prepared. The in vitro release of optimized topical propranolol hydrochloride gel formulation (G2) showed the highest cumulative percentage drug release that is, 95.55%±0.15 after 7.5 h. (G2) the formulation showed a higher flux value of 4.61μg/cm2/h. The histopathological study using pig skin revealed that the optimized formulation was found to be safe for topical application. Conclusion: The formulated topical gel containing propranolol Hydrochloride seems to be a promising dosage form for enhanced skin delivery of propranolol hydrochloride in treating Infantile Hemangioma

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The menstrual cup use among women in Kerala: knowledge, attitude and behaviour.

Background: Menstrual hygiene management is a critical aspect of women's health, particularly in low-resource settings. Kerala, known for its progressive social indicators, offers an intriguing context to explore the acceptance and adoption of menstrual cups. Despite this, their adoption and usage patterns remain understudied within Kerala, India, where traditional practises and taboos persist. Limited access to conventional menstrual hygiene products and environmental concerns emphasises the need for sustainable alternatives. This dissertation investigates the knowledge, attitudes, and behaviours regarding menstrual cup usage among women in Kerala, India, while proposing strategies for its wider acceptance. Methods: A cross-sectional study was conducted among women in Kerala, India, using a structured online questionnaire. The questionnaire was developed based on validated scales and previous research, addressing knowledge, attitude, and behaviour related to menstrual cup usage. Ethical approval was obtained, and data was collected through an online questionnaire. The sample comprised 60 women of diverse age groups and backgrounds. Results: Findings indicated relatively low awareness of menstrual cups, with only 42% of respondents having prior knowledge. However, among the aware, 78% held a positive attitude towards menstrual cups. Usage rates stood at 19.8%, hindered by concerns about insertion, removal techniques and limited familiarity. Interestingly, 65% of women expressed their willingness to try menstrual cups if provided with adequate information and guidance. Education emerged as a significant predictor of both knowledge and attitude, highlighting the role of awareness campaigns and educational initiatives, particularly in regions like Kerala where conservative norms prevail. Conclusion: This study underscores the importance of comprehensive menstrual health education, aiming not solely at knowledge enhancement but also addressing practical concerns and misconceptions. Although the positive attitude towards menstrual cups is promising, interventions should prioritise augmenting practical skills through workshops and guided training. Moreover, the involvement of healthcare professionals in these initiatives could enhance credibility and endorse menstrual cups as secure and dependable alternatives. Sustainable menstrual hygiene practises, exemplified by menstrual cups, possess the potential to empower women, foster environmental sustainability, and substantially enhance menstrual health. This is particularly pertinent in regions like Kerala, where social awareness is notably high

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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