Enhancing anti-inflammatory effect of brucine nanohydrogel using rosemary oil: a promising strategy for dermal delivery in arthritic inflammation

Brucine (BRU), an active constituent of Strychnos nux-vomica L., is one of the potential agents to control subside swelling in arthritis. However, its hydrophobic nature, poor permeation, shorter half-life, narrow therapeutic window, and higher toxicity impede its clinical applications. Hence, this investigation was aimed to develop and evaluate novel BRU loaded β-cyclodextrin (β-CD) nanosponges (BRUNs) hydrogel consisting rosemary essential oil (RO), which have been tailored for delayed release, enhanced skin permeation, and reduced irritation, while retaining anti-oxidant and anti-inflammatory activities of this bioactive. Firstly, BRUNs were fabricated by melt technique and characterized appropriately. BRUNs6 demonstrated two fold enhancement in BRU solubility (441.692 ± 38.674) with minimum particle size (322.966 ± 54.456) having good PDI (0.571 ± 0.091) and zeta potential (-14.633 ± 6.357). In vitro release results demonstrated delayed release of BRU from BRUNs6 (67 ± 4.25%) over 24 h through molecular diffusion mechanism. Further, preserved anti-inflammatory (53.343 ± 0.191%) and antioxidant potential (60.269 ± 0.073%) of bioactive was observed in BRUNs6. Hence, this Ns batch was engrossed with Carbopol®934 hydrogel with RO and characterized. In vitro (release and anti-inflammatory activity), ex-vivo (skin permeability) and in vivo (carrageenan-induced inflammation) assays along with irritation study were conducted for fabricated hydrogels. Results revealed that in vitro release of BRU was further delayed from Ns hydrogel with RO (56.45 ± 3.01%) following Fickian mechanism. Considerable enhancement in skin permeability (60.221 ± 0.322 µg/cm2/h) and preservation of anti-inflammatory activity (94.736 ± 2.002%) was also observed in BRUNs6 hydrogel containing RO. The irritation of BRU was found reduced (half) after its entrapped in Ns. Further, as a proof of concept, BRUNs6 hydrogel with RO effectively reduced (75.757 ± 0.944%) carrageenan-induced inflammation in rat model in comparison to pure BRU (54.914 ± 1.081%). Hence, BRUNs hydrogel with RO can be considered as a promising alternative for dermal delivery of BRU in arthritis.

Neurologic Events and Outcomes in Patients Receiving Proton and Photon Reirradiation for High Grade Non-Codeleted Gliomas

PURPOSE/OBJECTIVE(S)

Patients undergoing reirradiation (ReRT) for high grade glioma are at risk for tumor progression, pseudoprogression, and radiation necrosis. We investigated factors associated with neurologic events and disease control after re-irradiation with protons and photons at a single academic center.

MATERIALS/METHODS

We reviewed records and MRIs of patients receiving scanning beam proton (since center opening in 2016) and photon (since 2015) reirradiation in ≥10 fractions for grade 3 anaplastic astrocytoma (AA) and grade 4 glioblastoma (GBM), excluding 1p19q co-deleted oligodendrogliomas and extensive multifocal/leptomeningeal disease. The primary endpoint was time from ReRT to ≥ grade 2 pseudoprogression or radiation necrosis (PsP/RN, grade 2: moderate symptoms requiring outpatient steroids/bevacizumab, grade 3: severe symptoms leading to admission or surgical intervention). Dose was converted to EQD2 using a/b = 3. Cox proportional hazards model was used to calculate survival and time to PsP/RN.

RESULTS

A total of 53 patients were included (26 protons, 27 photons, median KPS 80). Patients receiving protons had more favorable features. Compared to the photons, the proton group was younger (48 vs. 58) and more likely to have AA (46% vs. 22%) and resection within 3 months (42% vs 26%). The proton group also had a longer interval from prior RT (57 vs. 39 months) and were less likely to receive bevacizumab at reRT (15% vs. 59%). CTV was 130 cc for protons vs 99 cc for photons, and most had active disease at time of ReRT identified on planning MRI (76% protons, 85% photons). Median OS was 10.5 months (14.1 months protons, 8.1 months photons), with time from initial RT the only significant factor on multivariate analysis. Median PFS was 9.4 months (9.8 months protons, 6.2 months photons). 9 patients (18%) had ≥ grade 3 PsP/RN (8 proton, 1 photon) and 21 patients (41%) had ≥ grade 2 PsP/RN (16 proton, 5 photon). Grade 3 events included 1 seizure (photon group), 1 hemorrhage, 1 thalamic stroke, 1 shunt placement, 1 re-resection, and PSP4 4 PsP/RN requiring admission. Protons were associated shorter time to ≥ grade 2 PsP/RN (4 months vs. not reached, p = 0.027). When accounting for bevacizumab use at time of reRT, the association between protons and PsP/RN lost significance but there remained a trend (grade 2, p = 0.095, HR 2.4; grade 3, p = 0.105, HR 5.8). CTV, MGMT status, EQD2, and interval from prior RT were not associated with PsP/RN.

CONCLUSION

High grade neurologic events were common in patients with predominantly active, unresected high grade gliomas receiving ReRT. Though ascertainment and survival bias are significant limitations, pseudoprogression and necrosis appeared to be more prominent in patients receiving protons. These results contribute to ongoing efforts to both optimize ReRT for high grade glioma and investigate biologic effects of proton therapy.

Solid Lipid Nanoparticles Embedded Hydrogels as a Promising Carrier for Retarding Irritation of Leflunomide

Leflunomide (LEF), a disease-modifying anti-rheumatic drug, has been widely explored for its anti-inflammatory potential in skin disorders such as psoriasis and melanoma. However, its poor stability and skin irritation pose challenges for topical delivery. To surmount these issues, LEF-loaded solid lipid nanoparticles (SLNs) integrated with hydrogels have been developed in the present investigation. SLNs developed by microemulsion techniques were found ellipsoidal with 273.1 nm particle size and -0.15 mV zeta potential. Entrapment and total drug content of LEF-SLNs were obtained as 65.25 ± 0.95% and 93.12 ± 1.72%, respectively. FTIR and XRD validated the successful fabrication of LEF-SLNs. The higher stability of LEF-SLNs (p < 0.001) compared to pure drug solution was observed in photostability studies. Additionally, in vitro anti-inflammatory activity of LEF-SLNs showed good potential in comparison to pure drugs. Further, prepared LEF-SLNs loaded hydrogel showed ideal rheology, texture, occlusion, and spreadability for topical drug delivery. In vitro release from LEF-SLN hydrogel was found to follow the Korsmeyer-Peppas model. To assess the skin safety of fabricated lipidic formulation, irritation potential was performed employing the HET-CAM technique. In conclusion, the findings of this investigation demonstrated that LEF-SLN hydrogel is capable of enhancing the photostability of the entrapped drug while reducing its skin irritation with improved topical delivery characteristics.

Formulation Strategies for Enhancing Pharmaceutical and Nutraceutical Potential of Sesamol: A Natural Phenolic Bioactive

Natural plants and their products continue to be the major source of phytoconstituents in food and therapeutics. Scientific studies have evidenced the benefits of sesame oil and its bioactives in various health conditions. Various bioactives present in it include sesamin, sasamolin, sesaminol, and sesamol; among these, sesamol represents a major constituent. This bioactive is responsible for preventing various diseases including cancer, hepatic disorders, cardiac ailments, and neurological diseases. In the last decade, the application of sesamol in the management of various disorders has attracted the increasing interest of the research community. Owing to its prominent pharmacological activities, such as antioxidant, antiinflammatory, antineoplastic, and antimicrobial, sesamol has been explored for the above-mentioned disorders. However, despite the above-mentioned therapeutic potential, its clinical utility is mainly hindered owing to low solubility, stability, bioavailability, and rapid clearance issues. In this regard, numerous strategies have been explored to surpass these restrictions with the formulation of novel carrier platforms. This review aims to describe the various reports and summarize the different pharmacological activities of sesamol. Furthermore, one part of this review is devoted to formulating strategies to improve sesamol's challenges. To resolve the issues such as the stability, low bioavailability, and high systemic clearance of sesamol, novel carrier systems have been developed to open a new avenue to utilize this bioactive as an efficient first-line treatment for various diseases.

Comparative evaluation of dithranol-loaded nanosponges fabricated by solvent evaporation technique and melt method

Background

Dithranol, a standard drug for psoriasis, has lured keen attention by virtue of its antioxidant, anti-proliferative and anti-inflammatory activities. However, its poor stability and solubility critically impair the formulation design, evaluation and administration. To improve these issues, dithranol was encased in β-cyclodextrin nanosponges using solvent evaporation technique. Previously, nanosponges containing dithranol were developed in our laboratory using melt technique. Herein, a comparison of nanosponges prepared by both techniques was also included.

Results

Different nanosponge batches were engineered using diphenyl carbonate as cross-linker with β-cyclodextrin as polymer employing solvent evaporation technique. Dithranol was loaded in nanosponges via lyophilization. Fourier transform infrared spectroscopy, differential scanning colorimeter and powdered X-ray diffraction studies confirmed successful encapsulation and complexation of this drug in β-cyclodextrin nanosponges. The effect of a variable amount of cross-linker on the solubility, encapsulation efficiency, zeta potential, particle size and polydispersity index was evaluated in fabricated nanocarriers. Further, β-cyclodextrin nanosponge batches were subjected to solubility studies, photostability examination and antioxidant activity analysis and compared with previously prepared dithranol-loaded nanosponges. From the present studies results, it was concluded that dithranol-loaded nanosponges using solvent evaporation technique not only improved solubility and photostability but also preserved the antioxidant efficacy of the chosen drug.

Conclusion

The overall results emphasized moral guidance concerning encapsulation, evaluation and characterization and accredited dithranol solubilization, photostability and antioxidant potential. However, solvent evaporation and melt method are easy and promising methods to fabricate nanosponges for dithranol. This comparative study demonstrated the parameters which were affected by chosen techniques. Further, from the results of present studies, it was concluded that the formulation scientists should select the preparation technique based on the objective of their research work and requirement of desired features.

Graphical abstract

Formulation, Characterization, Anti-Inflammatory and Cytotoxicity Study of Sesamol-Laden Nanosponges

Sesamol (SES) possesses remarkable chemotherapeutic activity, owing to its anti-inflammatory and antioxidant potential. However, the activity of SES is mainly hampered by its poor physicochemical properties and stability issues. Hence, to improve the efficacy of this natural anti-inflammatory and cytotoxic agent, it was loaded into β-cyclodextrin nanosponges (NS) prepared using different molar ratios of polymer and crosslinker (diphenyl carbonate). The particle size of SES-laden NS (SES-NS) was shown to be in the nano range (200 to 500 nm), with a low polydispersity index, an adequate charge (-17 to -26 mV), and a high payload. Field emission scanning electron microscopy, thermogravimetric analysis, and Fourier transform infrared spectroscopy were used to characterize the bioactive-loaded selected batch (SES-NS6). This batch of nanoformulations showed improved solubilization efficacy (701.88 µg/mL) in comparison to bare SES (244.36 µg/mL), polymer (β-CD) (261.43 µg/mL), and other fabricated batches. The drug release data displayed the controlled release behavior of SES from NS. The findings of the egg albumin denaturation assay revealed the enhanced anti-inflammatory potential of SES-NS as compared to bare SES. Further, the cytotoxicity assay showed that SES-NS was more effective against B16F12 melanoma cell lines than the bioactive alone. The findings of this assay demonstrated a reduction in the IC₅₀ values of SES-NS (67.38 μg/mL) in comparison to SES (106 μg/mL). The present investigation demonstrated the in vitro controlled release pattern and the enhanced anti-inflammatory and cytotoxic activity of SES-NS, suggesting its potential as a promising drug delivery carrier for topical delivery.

Phonon anharmonicity in binary chalcogenides for efficient energy harvesting

Thermoelectric (TE) materials have received much attention due to their ability to harvest waste heat energy. TE materials must exhibit a low thermal conductivity (κ) and a high power factor (PF) for efficient conversion. Both factors define the figure of merit (ZT) of the TE material, which can be increased by suppressing κ without degrading the PF. Recently, binary chalcogenides such as SnSe, GeTe, and PbTe have emerged as attractive candidates for thermoelectric energy generation at moderately high temperatures. These materials possess simple crystal structures with low κ in their pristine forms, which can be further lowered through doping and other approaches. Here, we review the recent advances in the temperature-dependent behavior of phonons and their influence on the thermal transport properties of chalcogenide-based TE materials. Because phonon anharmonicity is one of the fundamental contributing factors for low thermal conductivity in SnSe, Sb-doped GeTe, and related chalcogenides, we discuss complementary experimental approaches such as temperature-dependent Raman spectroscopy, inelastic neutron scattering, and calorimetry to measure anharmonicity. We further show how data gathered using multiple techniques helps us understand and engineer better TE materials. Finally, we discuss the rise of machine learning-aided efforts to discover, design, and synthesize TE materials of the future.

Evaluation of solubility, photostability and antioxidant activity of ellagic acid cyclodextrin nanosponges fabricated by melt method and microwave-assisted synthesis

Ellagic acid (EA) is a polyphenolic bioactive with a wide range of pharmacological activities. Regrettably, it possesses poor solubility, stability and permeability (in the gastrointestinal tract); and first-pass metabolism. Therefore, to address these challenges, the present research was aimed to encapsulate EA in cyclodextrin nanosponges (CDNS). Herein, the melt method and microwave-assisted technique have been employed for crafting CDNS. EA was loaded in CDNS via freeze-drying, followed by appropriate characterization. EA-CDNS were also assessed for encapsulation, particle size, zeta potential, and polydispersity index, which presented satisfactory results. In vitro, antioxidant activity was conducted using the DPPH (2, 2-diphenyl-1-picrylhydrazyl) assay. The solubilization efficacy of EA was analyzed in distilled water and compared with CDNS, which demonstrated ten folds augmentation for the selected batch. A remarkable improvement in the photostability of EA was also observed after its inclusion. In nutshell, the results demonstrated the superiority of the melt method in terms of solubility, entrapment, photostability, and antioxidant potential.

Novel Dermal Delivery Cargos of Clobetasol Propionate: An Update

Dermal disorders such as psoriasis and eczema are associated with modifications in the chemical and molecular composition of the skin. Clobetasol propionate (CP), a superpotent topical glucocorticoid, is widely used for the therapeutic management of various skin conditions, owing to its strong anti-inflammatory, antipruritic, vasoconstrictive, and antiproliferative activities. Safety studies demonstrated that CP is safer for a shorter period, however, with prolonged application, it shows secondary side effects such as photosensitivity, Cushing-like syndrome, allergic contact dermatitis, osteonecrosis, hypopigmentation, steroid acne, and skin atrophy. Therefore, the US FDA (United States Food and Drug Administration) has restricted the usage of CP to not more than 15 days. Research scientists addressed its several formulations and drug delivery issues, such as low water solubility, less stability, photodegradation, and poor absorption, by incorporating them into novel nanobased delivery platforms. With the utilization of these technologies, these drawbacks of CP have been resolved to a large extent to reestablish this moiety. This article explores the physicochemical properties and mechanism of action of CP. Additionally, an attempt has been made to discover and highlight the possible features of the novel nanosystems, including nanoemulsions, nanosponges, solid lipid nanoparticles, nanostructured lipid carriers, and nanogels, reported for CP. The stability and safety concerns of CP, along with its commercial status, are also discussed.

Pressure-Induced Structural Behavior of Orthorhombic Mn3(VO4)2: Raman Spectroscopic and X-ray Diffraction Investigations

The effect of high pressure on the structure of orthorhombic Mn₃(VO₄)₂ is investigated using in situ Raman spectroscopy and X-ray powder diffraction up to high pressures of 26.2 and 23.4 GPa, respectively. The study demonstrates a pressure-induced structural phase transition starting at 10 GPa, with the coexistence of phases in the range of 10-20 GPa. The sluggish first-order phase transition is complete by 20 GPa. Importantly, the new phase could be recovered at ambient conditions. Raman spectra of the recovered new phase indicate increased distortion and as a consequence the lowering of the local symmetry of the VO₄ tetrahedra. This behavior is different from that reported for isostructural compounds Zn₃(VO₄)₂ and Ni₃(VO₄)₂ where both show stable structures, although almost similar anisotropic compression of the unit cell is observed. The transition observed in orthorhombic Mn₃(VO₄)₂ could be due to the internal charge transfer between the cations, which favors the structural transition at lower pressures and the eventual recovery of the new phase even upon pressure release in comparison to other isostructural compounds. The experimental equation of state parameters obtained for orthorhombic Mn₃(VO₄)₂ match excellently with empirically calculated values reported earlier.

TB free India: Reaching the unreached tribal population under National Tuberculosis Elimination Programme

India is the highest TB burden country in the world. The burden however is not uniform in different strata including tribal population - one of the key affected populations in the country. As the evidences from tribal population are hardly available, most of the policies and strategies implemented under National Tuberculosis Elimination Programme (NTEP) are usually based on the evidences from general populations. NTEP is continuously taking steps to strengthen TB services in tribal areas. The Social Action Plan including Tribal Action Plan is in place and the appropriate strategies are incorporated in the National Strategic Plan (NSP) to ensure universal access to quality TB services to vulnerable population groups. However, its implementation becomes challenging especially in tribal areas as different tribal groups have their own unique ways of dealing with health issues. These issues are therefore required to be addressed holistically involving all the stakeholders. In view of this a symposium was jointly organized by the Central TB Division (CTD), Govt. of India and ICMR - National Institute of Research in Tribal Health (NIRTH), Jabalpur on 17th and 18th December, 2019 at ICMR - NIRTH, Jabalpur. It provided an excellent platform for all the stakeholders from different parts of the country to share their experiences in tuberculosis particularly among marginalized populations. The recommendations emerged out of this interactive symposium highlight the sincere effort of NTEP to tackle TB situation in tribal population and show the way forward towards India's TB elimination goal by 2025 especially in hard to reach tribal areas.

Costs of TB services in India (No 1)

BACKGROUND:

There is a dearth of economic analysis required to support increased investment in TB in India. This study estimates the costs of TB services from a health systems’ perspective to facilitate the efficient allocation of resources by India’s National Tuberculosis Elimination Programme.

METHODS:

Data were collected from a multi-stage, stratified random sample of 20 facilities delivering TB services in two purposively selected states in India as per Global Health Cost Consortium standards and using Value TB Data Collection Tool. Unit costs were estimated using the top-down (TD) and bottom-up (BU) methodology and are reported in 2018 US dollars.

RESULTS:

Cost of delivering 50 types of TB services and four interventions varied according to costing method. Key services included sputum smear microscopy, Xpert^® MTB/RIF and X-ray with an average BU costs of respectively US$2.45, US$17.36 and US$2.85. Average BU cost for bacille Calmette-Guérin vaccination, passive case-finding, TB prevention in children under 5 years using isoniazid and first-line drug treatment in new pulmonary and extrapulmonary TB cases was respectively US$0.76, US$1.62, US$2.41, US$103 and US$98.

CONCLUSION:

The unit cost of TB services and outputs are now available to support investment decisions, as diagnosis algorithms are reviewed and prevention or treatment for TB are expanded or updated in India.

Hyperinfection with Strongyloides stercoralis presenting as acute abdomen in a patient on corticosteroid therapy: A case report

Infection with Strongyloides stercoralis, a human pathogenic roundworm, is common in tropical countries like India. Owing to its variable clinical presentation and irregular larval output in stool, it often remains neglected and underdiagnosed. Signs and symptoms are largely dependent on the immune status of the infected individual. Alteration in the host immunity due to chronic use of steroids can surge the number of parasites and cause hyperinfection syndrome. This can be catastrophic with a fatal outcome. Focus on early detection and treatment of the parasite in at-risk patients is imperative to reduce mortality. We summarize here an interesting case of hyper infection syndrome of strongyloidiasis with gangrenous bowel changes later progressing to burst abdomen.

340 Pre-operative Screening and Treatment of Iron Deficiency Anaemia in Upper GI Cancer Surgery

Introduction

NICE guidelines recommend intravenous iron for patients with iron deficiency anaemia (IDA) before major elective surgery to reduce blood transfusion rate. The aim of this audit was to assess pre-operative screening for anaemia and treatment of IDA in patients undergoing Upper GI (UGI) cancer surgery.

Method

A retrospective audit of all patients who underwent UGI cancer surgery in year 2019 at a tertiary centre. Data were collected from electronic records.

Results

Pre-operative haemoglobin level was performed in 110/111 (99.1%) patients. 43 (39.1%) patients were found to be anaemic using the WHO definition and 9/43 (20.9%) were severely anaemic (Hb &lt; 100g/L). All anaemic patients had iron status checked and 26/43 (60.5%) patients were diagnosed with IDA. 17/43 (39.5%) anaemic patients received treatment, including IV iron (n = 8), blood transfusion (n = 3), oral iron (n = 3), and both IV iron and blood transfusion (n = 3). Anaemic patients (n = 17) who received treatment had a significant improvement in anaemia (P = 0.005).

Conclusions

This audit has demonstrated good pre-operative anaemia and IDA screening; however anaemic patients are not adequately treated, and IV iron is not routinely offered. Pre-operative anaemia treatment is effective in improving haemoglobin level. We have implemented a new anaemia treatment pathway and MDT proforma to improve the quality of care.

Modelling the potential impact of adherence technologies on tuberculosis in India

BACKGROUND: For patients taking standard first-line tuberculosis treatment, missing 10% or more of their doses increases the risk of relapse six-fold. Digital technologies offer new approaches to adherence support for TB patients. We estimated the potential impact of new adherence technologies in India.METHOD: We developed a mathematical model of TB transmission dynamics in India, capturing the independent effects of missed doses and treatment default on post-treatment recurrence. We simulated the impact of interventions to address both missed doses and treatment default in the public and private healthcare sector.RESULTS: Adherence interventions, if deployed optimally in the public sector alone, would reduce cumulative TB incidence by 7.3% (95% credible intervals [CrI] 4.7-11) between 2020 and 2030, and by 16% (95% CrI 11-23) if also deployed in the private sector. This impact is roughly proportional to the effectiveness of the interventions. Reducing missed doses reduced incidence by 12% (95% CrI 7.0-18), while reducing treatment default reduced incidence by 7.9% (95% CrI 3.2-13).CONCLUSION: Minimising missed doses is at least as important as promoting treatment completion. Our results suggest that emerging technologies to improve treatment adherence could have a substantial impact on TB incidence and mortality in India.

Sleep problems in opioid dependent patients maintained on buprenorphine

Introduction

Opioid dependent individuals frequently complain of sleep problems in withdrawal and during abstinence.

Objectives

The objectives were to assess the subjective sleep parameters among buprenorphine-maintained opioid-dependent patients and to correlate it with socio-demographics, concomitant drug use and treatment related variables

Methods

Using a cross-sectional study design, 106 hundred six opioid-dependent patients maintained on buprenorphine for at least six months and on same dose in past month were interviewed. Sleep was assessed by Pittsburgh sleep quality index (PSQI) and Epworth sleepiness scale. Association between subjective sleep parameters, socio-demographics, concomitant drug use and treatment related variables was also studied.

Results

All participants were males. Their mean age was 41.1 years (SD:14.3). The mean duration of illicit opioid use was 10 years (IQR: 5,22). About 63.2% (n=67) had PSQI scores more than 5 denoting sleep problem. The scores obtained in Epworth Sleeping Scale were in normal range. Mean subjective total sleep time of the sample was 403.5 (SD 94.8) minutes and median sleep latency was 35 (IQR 18.8, 62.5) minutes. Subjective total sleep time was significantly higher in participants who had use tobacco in the past three months (p value=0.03) and who were in moderate ASSIST risk category (p value=0.04). Subjective sleep latency was significantly higher (p value=0.04) in participants who had used opioids in last three months. It was observed that age was a significant predictor of subjective total sleep time and OST compliance was a significant predictor of sleep latency.

Conclusions

A sizeable proportion of opioid dependent patients on buprenorphine have sleep problems

Acetylcholinesterase Inhibitory Potential of Various Sesquiterpene Analogues for Alzheimer's Disease Therapy

Alzheimer's disease (AD) is a gradually growing irreversible illness of the brain that almost affects every fifth person (aged > 80 years) in the world. World Health Organization (WHO) also revealed that the prevalence of this disease will enhance (upto double) significantly upto 2030. The poor cholinergic transmission at the synapse is considered to be one of the main reasons behind the progression and occurrence of this disorder. Natural inhibitors of acetylcholine (ACh) such as galanthamine and rivastigmine are used commercially in the treatmentof AD. The biomolecules such assesquiterpenes, possess a great structural diversity and are responsible for a plethora of pharmacological properties. The potential of various sesquiterpenes as anticholinesterase has been reviewed in this article. For this purpose, the various databases, mainly PubMed, Scopus, and Web of Science were investigatedwith different keywords such as "sesquiterpenes+acetylcholinesterase" and "sesquiterpenes+cholinesterase+inhibitors" in the surveyed time frame (2010-2020). A vast literature was evident in the last decade, which affirms the potential of various sesquiterpenes in the improvement of cholinergic transmission by inhibiting the AChE. After data analysis, it was found that 12 compounds out of a total of 58 sesquiterpenes were reported to possess IC50 < 9μM and can be considered as potential candidates for the improvement of learning and memory. Sesquiterpene is an important category of terpenoids, found to possess a large spectrum of biological activities. The outcome of the review clearly states that sesquiterpenes (such as amberboin, lipidiol,etc) from herbs could offer fresh, functional compounds for possible prevention and treatment of AD.

Analytical tools and evaluation strategies for nanostructured lipid carrier-based topical delivery systems

INTRODUCTION

The inception of nanostructured lipid carriers (NLCs) proved to be a revolutionary step toward the treatment of dermatological disorders. To uncover its true potential, it is imperative that the system be characterized and evaluated comprehensively.

AREAS COVERED

The present review has been written to furnish an in-depth account of analytical tools and evaluation procedures under one roof. Besides discussing the challenges of topical delivery and benefits of NLCs, the paper elaborates on their physicochemical characterization. Further, in vitro evaluation of NLCs for dermatological benefits, followed by their evaluation in a hydrogel/cream base is covered. Lastly, disease-specific evaluation of NLC-based formulations is presented.

EXPERT OPINION

The research endeavors for NLCs have largely focused on the fabrication of NLCs for different bioactives. However, scientific efforts should be aimed toward the lesser explored realm of NLCs, i.e. exploitation of analytical techniques, such as Parelectric spectroscopy, Electron Spin Resonance, and Nuclear Magnetic Resonance spectroscopy. NLCs have been proven for their potential to foster the therapeutic modalities applicable to cutaneous disorders. More attention needs to be devoted to their evaluation for disease-specific parameters. The futuristic steps must involve clinical studies, to lay the path for their commercialization.

Phonon-based partition of (ZnSe-like) semiconductor mixed crystals on approach to their pressure-induced structural transition

The generic 1-bond → 2-mode "percolation-type" Raman signal inherent to the short bond of common A_1-xB_xC semiconductor mixed crystals with zincblende (cubic) structure is exploited as a sensitive "mesoscope" to explore how various ZnSe-based systems engage their pressure-induced structural transition (to rock-salt) at the sub-macroscopic scale-with a focus on Zn_1-xCd_xSe. The Raman doublet, that distinguishes between the AC- and BC-like environments of the short bond, is reactive to pressure: either it closes (Zn_1-xBe_xSe, ZnSe_1-xS_x) or it opens (Zn_1-xCd_xSe), depending on the hardening rates of the two environments under pressure. A partition of II-VI and III-V mixed crystals is accordingly outlined. Of special interest is the "closure" case, in which the system resonantly stabilizes ante transition at its "exceptional point" corresponding to a virtual decoupling, by overdamping, of the two oscillators forming the Raman doublet. At this limit, the chain-connected bonds of the short species (taken as the minor one) freeze along the chain into a rigid backbone. This reveals a capacity behind alloying to reduce the thermal conductivity as well as the thermalization rate of photo-generated electrons.

Topical delivery of clobetasol propionate loaded nanosponge hydrogel for effective treatment of psoriasis: Formulation, physicochemical characterization, antipsoriatic potential and biochemical estimation

Clobetasol propionate (CP), a superpotent topical corticosteroid, holds great promise for psoriasis treatment. However, common side effects like skin atrophy, steroidal acne, hypopigmentation and allergic contact dermatitis associated with it, hamper its utility for topical application. Taking this into consideration, the current work was aimed to fabricate CP loaded cyclodextrin nanosponge (CDNS) based hydrogel, to alleviate the aforementioned side effects, while controlling drug release. Nanosponges were crafted employing β-cyclodextrin (polymer) and diphenyl carbonate (cross linker) and evaluated appropriately. The selected formulation augmented 45 folds water solubility, with respect to pure CP. The formulation possessed entrapment efficiency (56.33 ± 0.94%), particle size (194.27 ± 49.24 nm) with polydispersitive index (0.498 ± 0.095), surface charge (-21.83 ± 0.95 mV) and drug release (86.25 ± 0.28%). Selected CP-CDNS were found crystalline and uniform in size. Further, in vitro cell viability analysis has been performed using THP1 cells to evaluate cytocompatibility of CP nanosponges. The chosen CP nanosponges were then embedded into Carbopol hydrogel, and characterized for rheological behaviour, spreadability, and texture profile. The developed nanoformulations were also assessed in vivo using mouse tail model. Histological and biochemical assessments have been conducted to explore their antipsoriatic activity via oxidative stress biomarkers. The degree of orthokeratosis was observed remarkably (p < 0.001) amplified by CP-CDNS14 hydrogel as compared to untreated group (control) and CP hydrogel. In addition, drug activity and change in epidermal thickness were found significant. Our findings altogether advocated the profound potential of prepared CP nanogel in the topical treatment of psoriasis, with improved patient compliance.

Therapeutic Potential of Citronella Essential Oil: A Review

Mosquito-borne diseases such as malaria, filariasis, chikunguniya, yellow fever, dengue and Japanese encephalitis are the major cause of remarkable morbidity and mortality in livestock and humans worldwide. Since ancient times, aromatic plants are used for their medicinal value. Essential oils derived from these plants may be used as effective alternatives/adjuvants in pharmaceuticals, biomedical, cosmetic, food, veterinary and agriculture applications. These oils have also gained popularity and interest for prevention and treatment of various disorders. However, several reports on adverse effects including skin eruption, contact artricaria or toxic encephalopathy in children are available for synthetic repellent in the literature. Thus, natural insect repellents like essential oils have been explored recently as an alternative. One such essential oil studied widely, is citronella oil, extracted mainly from Cymbopogon nardus. This essential oil has exhibited good efficacy against mosquitoes. It is a mixture of components including citronellal, citronellol, geraniol as major constituents contributing to various activities (antimicrobial, anthelmintic, antioxidant, anticonvulsant antitrypanosomal and wound healing), besides mosquito repellent action. Citronella essential oil is registered in US EPA (Environmental protection agency) as insect repellent due to its high efficacy, low toxicity and customer satisfaction. However, poor stability in the presence of air and high temperature limits its practical applications. Since specific knowledge on properties and chemical composition of oil is fundamental for its effective application, the present review compiles and discusses biological properties of citronella oil. It also sheds light on various formulations and applications of this essential oil.

Diagnosis and Screening of Patients with Hereditary Transthyretin Amyloidosis (hATTR): Current Strategies and Guidelines

The outlook for transthyretin amyloidosis (ATTR) is changing with the availability of new and emerging treatments. ATTR now appears to be more common than previously thought and is no longer viewed as an obscure diagnosis with a grim prognosis. Now more than ever, there is growing emphasis on the need for early diagnosis because the treatments appear to be most effective if started in earlier stages of the disease. Diagnosing ATTR is a challenge as it may initially present with nonspecific symptoms and it is often thought of as a diagnosis of exclusion. Increased awareness is imperative as new treatments offer hope and have the potential to change the disease trajectory. ATTR commonly presents with neurological and cardiac features. Transthyretin (TTR) is a protein produced in the liver which misfolds either due to genetic mutations or due to aging and results in deposition of amyloid fibrils in organs and tissues. Apart from the traditional imaging modalities, newer techniques including echocardiographic strain imaging, magnetic resonance imaging (MRI), and nuclear scintigraphy, as well as the increased availability of genetic testing are aiding in making a timely diagnosis. In this review, we present the current understanding of the ATTR disease process, diagnostic and surveillance approaches, newer treatment modalities, and the future directions.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Endoscopic Botulinum toxin as a treatment for delayed gastric emptying following oesophagogastrectomy

INTRODUCTION

The incidence of delayed gastric emptying (DGE) following oesophagogastrectomy with gastric conduit reconstruction is reported to be between 1.7% and 50%. This variation is due to differing practices of intraoperative pylorus drainage procedures, which increase the risk of postoperative biliary reflux and dumping syndrome, resulting in significant morbidity. The aim of our study was to establish rates of DGE in people undergoing oesophagogastrectomy without routine intraoperative drainage procedures, and to evaluate outcomes of postoperative endoscopically administered Botulinum toxin into the pylorus (EBP) for people with DGE resistant to systemic pharmacological treatment.

METHODS

All patients undergoing oesophagogastrectomy between 1 January 2016 and 31 March 2018 at our unit were included. No intraoperative pyloric drainage procedures were performed, and DGE resistant to systemic pharmacotherapy was managed with EBP.

RESULTS

Ninety-seven patients were included. Postoperatively, 29 patients (30%) were diagnosed with DGE resistant to pharmacotherapy. Of these, 16 (16.5%) were diagnosed within 30 days of surgery. The median pre-procedure nasogastric tube aspirate was 780ml; following EBP, this fell to 125ml (p<0.001). Median delay from surgery to EBP in this cohort was 13 days (IQR 7-16 days). Six patients required a second course of EBP, with 100% successful resolution of DGE before discharge. There were no procedural complications.

CONCLUSIONS

This is the largest series of patients without routine intraoperative drainage procedures. Only 30% of patients developed DGE resistant to pharmacotherapy, which was managed safely with EBP in the postoperative period, thus minimising the risk of biliary reflux in people who would otherwise be at risk following prophylactic pylorus drainage procedures.

Microsponge Based Gel of Tea Tree Oil for Dermatological Microbial Infections

Objective:

Tea Tree Oil (TTO), derived from Melaleuca alternifolia possesses broad spectrum antimicrobial potential. However, its therapeutic utility is impaired due to its high volatility, poor aqueous solubility and low stability in the presence of light, oxygen and temperature. The present study was attempted to investigate Ethyl Cellulose (EC) microsponges (MSs) as topical carriers for TTO to circumvent above mentioned limitations.

Methods:

TTO MSs were prepared using quasi emulsion solvent diffusion technique. The effect of formulation variables on the production yield, entrapment efficiency, particle size and drug release of MSs was investigated. The optimized MSs were dispersed into Carbopol 934 gel and evaluated for drug release, skin irritation, antibacterial activity and photostability.

Results:

Scanning electron microscopy revealed spherical and porous nature of TTO microsponges. The optimized MSs possessed particle size of 36.98 μm, percent entrapment efficiency of 93.12% and percent cumulative drug release of 79.18%, respectively. MS-loaded gels were found nonirritant. In addition, TTO loaded MS gels exhibited good stability. Antimicrobial effect of TTO MS gel showed broader zones of inhibition in comparison to TTO gel.

Conclusion:

The findings of our study suggest that MS loaded gel could prove alternative to conventional antibacterial formulations for dermatological microbial infections.

Dithranol: An Insight into its Novel Delivery Cargos for Psoriasis Management

OBJECTIVE

Dithranol (DTH) is a well-known moiety that has long been used promisingly to impede and treat skin disorders, particularly psoriasis. Nowadays, a rekindled interest in the use of DTH for this disorder has been observed. Side effects associated with conventional topical formulations of this moiety have aroused the interest of the scientific community in investigating novel cargos of DTH for psoriasis management.

RESULTS

Previous research has evidenced the anti-inflammatory and anti-proliferating potential of DTH. Numerous studies have indicated that DTH inhibits polymorphonuclear (PMN) leucocyte, modulates epidermal cell receptors and promotes anti-psoriatic action. However, some deterrent factors like poor solubility, stability, toxicity, staining and skin irritation hamper its use as a potential therapeutic agent. With the adoption of novel drug delivery technologies, the above mentioned inherent limitations of DTH have been compensated to reestablish this drug moiety.

CONCLUSION

This article reviews novel drug delivery aspects, safety concerns, clinical evidence, current status, and future opportunities of DTH in the management of psoriasis. Further, it will update researchers on this promising drug moiety, which is free from systemic adverse responses in comparison to other therapeutic molecules like steroids, for psoriasis treatment.

Structural investigation of borosilicate glasses containing lanthanide ions

High level radioactive actinides are produced as a side product in reprocessing spent nuclear fuel, for which safe long-term-inert immobilizer matrices are needed. Borosilicate glasses are of great potential amongst the candidates of suitable inert materials for radioactive waste immobilization. Understanding the effects of actinide addition to a borosilicate glass matrix is of great importance in view of waste immobilization. Here we present structural studies of a simplified glass-matrix, - 55SiO₂·10B₂O₃·25Na₂O·5BaO·5ZrO₂ - upon adding lanthanide (Ln-)oxides: CeO₂, Nd₂O₃, Eu₂O₃, in two different concentrations 10% and 30w% each, to investigate the effects of lanthanides (Ln) taken as chemical surrogates for actinides. Neutron diffraction combined with of Reverse Monte Carlo simulations show that all investigated glass structures comprise tetrahedral SiO₄, trigonal BO₃ and tetrahedral BO₄ units, forming mixed ^[4]Si-O-^[3]B and ^[4]Si-O-^[4]B linkages. ¹¹B Magic Angle Spinning Nuclear Magnetic Resonance is indicative of simultaneous presence of trigonal BO₃ and tetrahedral BO₄ units, with spectral fractions strongly dependent on the Ln addition. Ln-addition promote the BO₃ + O^-→[BO₄]^- isomerization resulting in lower fraction of boron in BO₃, as compared to BO₄ units. Raman spectra, in full agreement with neutron diffraction, confirm that the basic network structure consists of BO₃/trigonal and SiO₄/BO₄ tetrahedral units. Second neighbour atomic pair correlations reveal Ce, Nd, Eu to be accommodated in both Si and B sites, supporting that the borosilicate-matrix well incorporates Ln-ions and is likely to similarly incorporate actinides, opening a way to radioactive nuclear waste immobilization of this group of elements in a borosilicate glass matrix.

Ecofriendly Ethyl Cellulose Microsponges of Citronella Oil: Preparation, Characterization and Evaluation of Cytotoxicity and Larvicidal assay

Background:

Citronella Oil (CO) was used by the Indian army as mosquito repellant to repel mosquitoes at the beginning of the 20th century and later in 1948, it was registered in the USA for commercial purposes. Due to its ecofriendly nature, CO possesses immense potential as a mosquito repellent.

Methods:

Citronella oil is a valuable alternative to synthetic mosquito repellents commonly used nowadays. However, its volatile nature, poor stability in air and high temperature restrict its application. Its direct application on skin may lead to skin irritation. To surmount the above-mentioned issues, the present research aims to develop Microsponge (MS), a novel dosage form for enhancing the utility and safety of CO. Quasi emulsion solvent diffusion method was chosen for crafting MS using ethyl cellulose with various drug-polymer ratios and characterized. In vitro cytotoxicity evaluation was also carried out to check the dermal safety of COMS.

Results:

The present results revealed that the size of all prepared formulation lies in the micro range (20 ± 3 to 41 ± 4 μm), with good payload (42.09± 3.24 to 67.08± 6.43%). The results of FE-SEM depicted that MS were spherical in shape with porous nature. Cytotoxicity results indicated that COMS were safe on skin cells, when compared to pure CO. The optimized MS were also assessed for larvicidal assay against larvae of Anopheles culicifacies.

Conclusion:

The CO micro-formulations were found to possess enhanced stability of this oil. Entrapment of CO in MS resulted in a better vehicle system in terms of safety, stability and handling benefits of this oil.