Preoperative topical estrogen application in the management of hypospadias: a systematic review.

Local estrogen therapy has been explored as an alternative to conventional testosterone therapy in children requiring urethroplasty for hypospadias. Our objective is to evaluate if preoperative estrogen stimulation reduces post-urethroplasty complications and enhances penile dimensions. A systematic search was conducted on various databases, selecting only randomized controlled trials (RCTs) that tested estrogen on hypospadias patients under 18 years. Articles underwent sorting following PRISMA guidelines and bias risk was assessed using the JBI clinical appraisal tool for RCTs. Out of 607 screened records, 10 underwent full-text review, and 4 randomized controlled trials (RCTs) were selected for analysis. The total patient cohort across studies was 387 with 174 in the estrogen group. All studies utilized topical estrogen, but in different formulations and timings. Prudence is necessary for interpreting results due to variations in formulation, timing, and hypospadias type across studies. Limited by a small number of studies and outcome presentation non-uniformity, the review suggests no change in penile dimensions or postoperative complications with topical estrogen. Further research is needed to explore wound-healing properties of estrogen in hypospadias through animal and human studies.Registration and protocol: Registered in Prospero CRD42024502183.

A review on marine source as anticancer agents.

This review investigates the potential of natural compounds obtained from marine sources for the treatment of cancer. The oceans are believed to contain physiologically active compounds, such as alkaloids, nucleosides, macrolides, and polyketides, which have shown promising effects in slowing human tumor cells both in vivo and in vitro. Various marine species, including algae, mollusks, actinomycetes, fungi, sponges, and soft corals, have been studied for their bioactive metabolites with diverse chemical structures. The review explores the therapeutic potential of various marine-derived substances and discusses their possible applications in cancer treatment.

Essential Yet Neglected Role of Primary Care Physicians in Palliation Team.

Quality home-based care for patients with the end-stage disease is increasingly being preferred. Responding to disease associated symptoms and complications may pose an array of challenges in evolving palliative care systems, as no formal institutional mechanism exists to respond to patient and caregiver's wishes. Family and primary care physicians can play an instrumental role in such scenarios by bridging the gaps between cancer specialists and patient and caregivers expectations.

A Narrative Review of Potential Future Antidiabetic Drugs: Should We Expect More?

Prevalence of diabetes mellitus, a chronic metabolic disease characterized by hyperglycemia, is growing worldwide. The majority of the cases belong to type 2 diabetes mellitus (T2DM). Globally, India ranks second in terms of diabetes prevalence among adults. Currently available classes of therapeutic agents are used alone or in combinations but seldom achieve treatment targets. Diverse pathophysiology and the need of therapeutic agents with more favourable pharmacokinetic-pharmacodynamics profile make newer drug discoveries in the field of T2DM essential. A large number of molecules, some with novel mechanisms, are in pipeline. The essence of this review is to track and discuss these potential agents, based on their developmental stages, especially those in phase 3 or phase 2. Unique molecules are being developed for existing drug classes like insulins, DPP-4 inhibitors, GLP-1 analogues; and under newer classes like dual/pan PPAR agonists, dual SGLT1/SGLT2 inhibitors, glimins, anti-inflammatory agents, glucokinase activators, G-protein coupled receptor agonists, hybrid peptide agonists, apical sodium-dependent bile acid transporter (ASBT) inhibitors, glucagon receptor antagonists etc. The heterogeneous clinical presentation and therapeutic outcomes in phenotypically similar patients is a clue to think beyond the standard treatment strategy.

Pharmacotherapy of Insomnia and Current Updates.

Insomnia is highly prevalent and is associated with a range of psychological, psychiatric, and medical conditions. Insomnia affects health by influencing cognitive, emotional and social functioning. Circadian and sleep homeostatic processes play an important role in insomnia development and its maintenance. Several efficacious treatments, both pharmacologic and non-pharmacologic, exist for the management of insomnia. Among non-pharmacologic treatments including stimulus control therapy, sleep restriction, relaxation, sleep hygiene and cognitive therapy have been shown to be efficacious. Pharmacological treatment acts as adjuvant to cognitive behavioural treatment. Despite availability of various classes drugs for insomnia treatment, none can be considered as an ideal agent. Novel therapies are still being explored and tested to arrive at a hypnotic that has acceptable side effects and tolerability profile while still being efficacious.

Indian College of Physicians (ICP) Position Statement on Pharmacovigilance.

Pharmacovigilance is the art and science of detection, understanding and prevention of adverse drug reactions and not merely a critical analysis of prescriptions and errors. This field starts with reporting by clinicians of a suspected adverse drug reaction (ADR) to the pharmacologist followed by joint causality analysis and ends at the application of new information by a clinician for benefit of patients. There are a number of ways, which can be utilised for reporting adverse effects using pen and paper format to software applications for smart phones. Varied types of activities spreading from systematic reviews to the mechanistic evaluation of ADR can be performed under the umbrella of pharmacovigilance. It is of utmost importance for clinicians to understand how to identify, communicate and understand adverse effects of drugs with an aim to prevent harm to patients.

Indian College of Physicians Position Statement: Addictive Disorders Among Persons with Diabetes Mellitus.

OBJECTIVES: Migraine, a common primary headache disorder which can be severely disabling, associated with poor health-related quality of life (HRQoL) amongst affected patients. The present study was performed to provide adequate clinical data on migraine and the management practices in India. MATERIAL AND METHODS: A cross-sectional study was designed to assess disease burden, HRQoL, symptom profile, management trends and comorbidities associated with migraine patients across ten centres in India. This study assessed HRQoL using Migraine Specific Quality of life (MSQ) and Migraine Disability Assessment Scores (MIDAS) questionnaire. Categorical variables were summarized as frequency, and percentage and continuous variables as mean and standard deviation respectively. RESULTS: A total of 705 patients were enrolled with a mean age of 35.2 years. Hypertension (7.0%) was the highest co-morbid illness associated with migraine. A higher MSQ score was observed in females as compared to males (39.3±12.4 and 37.4±11.6) while MIDAS showed a comparable score (27.7±47.6 and 27.2±35.4). Majority of migraine patients were unemployed (61.6%) and in profession, females had poor HRQoL than males by MIDAS and MSQ. Majority of patients had pulsating, bilateral attacks for the duration of 4h to 72 h. Paracetamol (47.1%) and propranolol (50.9%) was most commonly prescribed drugs for acute attack and prophylaxis, respectively. CONCLUSION: The quality of life was superior in males as compared to females amongst migraine patients in India. Hypertension was the commonest comorbidity associated with migraine. KEY MESSAGES: Migraine is associated with substantial disability with higher prevalence in females and older people (age >40 years). NSAIDs and propanol was widely prescribed drug in acute attacks and prophylaxis of migraine respectively. Cardiovascular diseases, diabetes mellitus and anxiety were common comorbidities associated with migraine.

Effect of Calcium Chloride on Release Behavior of Babul (Acacia nilotica) gum Microbeads.

BACKGROUND: Oral delivery of drugs is the most common method, but due to the inability of drugs to restrain and localize in the gastro-intestinal tract, oral administration of drugs in conventional dosage forms have short-term limitations. Carrier technology may provide many approaches for the delivery of drugs by coupling the drug to a carrier particle, such as Microspheres, nanoparticles and liposomes, which modulate the release and absorption characteristics of the drug. OBJECTIVES: The aim of this study was to prepare Diclofenac sodium microspheres using a natural polymer and show the effect of calcium chloride on the release behavior of microspheres. The microspheres of Diclofenac sodium were successfully developed by ionic gelation technique using natural polymer babul gum with sodium alginate. MATERIAL AND METHODS: Diclofenac Sodium was received as a gift sample from Aegis Pharmaceuticals Pvt. Ltd., Roorkee. Acacia nilotica gum was purchased from Ghaziabad and purification was done in the laboratory. All other excipients used analytical grade method. The microspheres of diclofenac sodium were prepared by Ionic gelation method using a natural polimer, i.e. Acacia nilotica. Calcium chloride (5% solution) was used as a cross-linking agent. In this research article all the data was presented as averages and standard deviations. RESULTS: Five formulations were successfully prepared, i.e. F1, F2, F3, F4 and F5. All the formulations were evaluated for micromeritic properties, particle size analysis, percentage yield, drug content, drug entrapment efficacy, percent moisture loss, swelling index and in vitro dissolution studies. The size of the microspheres varied between 14.55 ± 0.29 to 20.18 ± 0.15 µm and as high as 81.51 ± 0.14% entrapment efficiency for babul gum was obtained. CONCLUSIONS: Batch F1 and F5 was found to release the drug 91.35% and 75.48% respectively for 6 hrs. The formulations were found to be effective in providing controlled release of drug for a prolonged period of time.

Extraction and characterization of artocarpus integer gum as pharmaceutical excipient.

BACKGROUND: Natural polymers are widely used as excipients in pharmaceutical formulations. They are easily available, cheap and less toxic as compared to synthetic polymers. OBJECTIVES: This study involves the extraction and characterization of kathal (Artocarpus integer) gum as a pharmaceutical excipient. MATERIAL AND METHODS: Water was used as a solvent for extraction of the natural polymer. Yield was calculated with an aim to evaluate the efficacy of the process. The product was screened for the presence of Micrometric properties, and swelling index, flow behavior, surface tension, and viscosity of natural polymers were calculated. RESULTS: Using a water based extraction method, the yield of gum was found to be 2.85%. Various parameters such as flow behavior, organoleptic properties, surface tension, viscosity, loss on drying, ash value and swelling index together with microscopic studies of particles were done to characterize the extracted gum. The result showed that extracted kathal gum exhibited excellent flow properties. The gum was investigated for purity by carrying out chemical tests for different phytochemical constituents and only carbohydrates were found to be present. It had a good swelling index (13 ± 1). The pH and surface tension of the 1% gum solution were found to be 6 ± 0.5 and 0.0627 J/m2, respectively. The ash values such as total ash, acid insoluble ash, and water soluble ash were found to be 18.9%, 0.67% and 4% respectively. Loss on drying was 6.61%. The extracted gum was soluble in warm water and insoluble in organic solvents. The scanning electron micrograph (SEM) revealed rough and irregular particles of the isolated polymer. CONCLUSIONS: The results of the evaluated properties showed that kathal-derived gum has acceptable pH and organoleptic properties and can be used as a pharmaceutical excipient to formulate solid oral dosage forms.

Novel prospective in colon specific drug delivery system.

This review deals with the targeting of drugs to the lower gastrointestinal tract i.e. colon. Colonic drug delivery becomes important for localized action as well as for improved systemic availability of peptide and proteins. Drugs which have absorption window in the colonic region have been targeted using different novel technologies. pH sensitive polymers and prodrug based formulation have been used for the delivery of drugs into the colon. Different natural polymers have been used successfully for the delivery of drugs into the colon. Natural polymers are less toxic, biodegradable and easily available with a wide range of molecular weight and varying chemical compositions. One of the supporting properties associated with these polymers is that natural polymers can be used as approved pharmaceutical excipient.

Three-dimensional modeling for colloid-facilitated contaminant transport with the effect of mobile and immobile sorbents.

A conceptual equilibrium-based mathematical model for colloid-associated contaminant transport has been developed to study the impact of the subsurface environment on contaminant transport through a three-dimensional, saturated, and homogeneous groundwater flow system with uniform flow. The kinetic model's critical limitation is dealing with the more significant number of parameters utilized upon application to larger scales in three-dimensional regions when a series of transport mechanisms are incorporated. Therefore, the present study is the first attempt to study the equilibrium approach in three-dimensional regions to avoid complexities in the model. The current study, however, shows that the mere existence of colloids does not indicate that contaminants will move more quickly; rather, it also depends on how the aqueous phase interacts with the static solid matrix, captured colloid particles, and mobile colloids as well as how colloids interact with stationary solid matrix phase. We noticed that the affinity of contaminants to immobile sorbents (stationary solid matrix and captured colloids) can reduce the transport even in the presence of colloids. Three-dimensional numerical experiments reveal that contaminants infiltrate more in the downward direction in the absence of colloids and can be distributed more in the longitudinal direction and less in the downward direction when colloids are present. The dual nature of colloids is espied here: first, colloids can remove pollutants from a specific area more quickly, and second, in a similar manner, colloids can pollute a specific region more quickly.

Carbon Nanotubes for Targeted Therapy: Safety, Efficacy, Feasibility and Regulatory Aspects.

It is crucial that novel and efficient drug delivery techniques be created in order to improve the pharmacological profiles of a wide variety of classes of medicinal compounds. Carbon nanotubes (CNTs) have recently come to the forefront as an innovative and very effective technique for transporting and translocating medicinal compounds. CNTs were suggested and aggressively researched as multifunctional novel transporters designed for targeted pharmaceutical distribution and used in diagnosis. CNTs can act as vectors for direct administration of pharmaceuticals, particularly chemotherapeutic medications. Multi-walled CNTs make up the great majority of CNT transporters, and these CNTs were used in techniques to target cancerous cells. It is possible to employ Carbon nanotubes (CNTs) to transport bioactive peptides, proteins, nucleic acids, and medicines by functionalizing them with these substances. Due to their low toxicity and absence of immunogenicity, carbon nanotubes are not immunogenic. Ammonium-functionalized carbon nanotubes are also attractive vectors for gene-encoding nucleic acids. CNTs that have been coupled with antigenic peptides have the potential to be developed into a novel and efficient approach for the use of synthetic vaccines. CNTs bring up an enormous number of new avenues for future medicine development depending on targets within cells, which have until now been difficult to access. This review focuses on the numerous applications of various CNT types used as medicine transport systems and on the utilization of CNTs for therapeutical purposes.

Anti-Inflammatory and Anti-Arthritis Activity of Quercetin: A Comprehensive Review.

This comprehensive exploration delves into the multifaceted attributes of quercetin, a flavonoid with extensive health-promoting potential. The review navigates through its fundamental properties, encompassing its chemical structure, classification as a flavonoid, and its natural prevalence in various sources. Addressing solubility, stability, and bioavailability challenges, the investigation delves into innovative isolation techniques, including solvent extraction, solid-phase extraction, natural deep eutectic solvents, supercritical fluid extraction, microwave-assisted extraction, column chromatography, and high-performance thin-layer chromatography. Transitioning into pharmacological implications, the study unveils quercetin's roles in anti-inflammatory pathways, antioxidant effects, and immune modulation, reflecting its versatile significance in health management. The review highlights its impact on wound healing processes and its potential to mitigate arthritis, elucidating its holistic contributions. Culminating in an exploration of recent studies, the analysis underscores quercetin's remarkable anti-inflammatory and anti-arthritis activities, reflecting its substantial potential across various ailments. The review concludes by projecting future trajectories, emphasizing prospects for an advanced understanding of quercetin's mechanisms, sustainable extraction techniques, clinical integration, and exploration of synergistic combinations. Collectively, this review investigation underscores quercetin's dynamic role at the intersection of natural compounds and medicinal applications, offering profound implications for well- being and health enhancement.

Advances in Aerosol Formulation for Targeted Delivery of Therapeutic Agents from Nose to Brain.

The intricate anatomical and physiological barriers that prohibit pharmaceuticals from entering the brain continue to provide a noteworthy hurdle to the efficient distribution of medications to brain tissues. These barriers prevent the movement of active therapeutic agents into the brain. The present manuscript aims to describe the various aspects of brain-targeted drug delivery through the nasal route. The primary transport mechanism for drug absorption from the nose to the brain is the paracellular/extracellular mechanism, which allows for rapid drug transfer. The transcellular/intracellular pathway involves the transfer across a lipoidal channel, which regulates the entry or exit of anions, organic cations, and peptides. Spectroscopy and PET (positron emission tomography) are two common methods used for assessing drug distribution. MRI (Magnetic resonance imaging) is another imaging method used to assess the efficacy of aerosol drug delivery from nose to brain. It can identify emphysema, drug-induced harm, mucus discharge, oedema, and vascular remodeling. The olfactory epithelium's position in the nasal cavity makes it difficult for drugs to reach the desired target. Bi-directional aerosol systems and tools like the "OptiNose" can help decrease extranasal particle deposition and increase particle deposition efficiency in the primary nasal pathway. Direct medicine administration from N-T-B, however, can reduce the dose administered and make it easier to attain an effective concentration at the site of activity, and it has the potential to be commercialized.

Review on Mucormycosis: Pathogenesis, Epidemiology, Microbiology and Diagnosis.

Mucormycosis is a serious and invasive fungal infection caused by Mucorales fungi. This review article provides a concise overview of the pathogenesis, epidemiology, microbiology, and diagnosis of mucormycosis. The introduction section highlights the key microbiological properties of the pathogen and delves into the underlying mechanisms of mucormycosis pathogenesis, including the invasion and proliferation of the fungus within the host. The description of the disease section focuses on the epidemiology of mucormycosis, including its incidence, risk factors, and geographical distribution. It also explores the specific context of mucormycosis infection about COVID-19 and diabetes mellitus, highlighting the increased susceptibility observed in individuals with these conditions. A case study illustrates the clinical manifestations and challenges associated with mucormycosis, emphasizing the importance of early detection. Additionally, the review discusses the diagnosis of mucormycosis, emphasizing the significance of clinical assessment, radiological imaging, and microbiological tests for accurate and timely detection of the infection. Regarding treatment, the article covers the various therapeutic approaches, including antifungal therapy, surgical interventions, and management of underlying predisposing conditions. The limitations and challenges associated with treatment options are also addressed. This review aims to provide a comprehensive understanding of mucormycosis, equipping healthcare professionals with valuable insights into its pathogenesis, epidemiology, microbiology, and diagnostic strategies. By enhancing knowledge and awareness of this fungal infection, this review can improve patient outcomes through early diagnosis and appropriate management.

The Potential of Stem Cells in Treating Breast Cancer.

There has been a lot of interest in stem cell therapy as a means of curing disease in recent years. Despite extensive usage of stem cell therapy in the treatment of a wide range of medical diseases, it has been hypothesized that it plays a key part in the progression of cancer. Breast cancer is still the most frequent malignancy in women globally. However, the latest treatments, such as stem cell targeted therapy, are considered to be more effective in preventing recurrence, metastasis, and chemoresistance of breast cancer than older methods like chemotherapy and radiation. This review discusses the characteristics of stem cells and how stem cells may be used to treat breast cancer.

Cracking the Code of Lumpy Skin Disease: Identifying Causes, Symptoms and Treatment Options for Livestock Farmers.

The novel bovine viral infection known as lumpy skin disease is common in most African and Middle Eastern countries, with a significant likelihood of disease transfer to Asia and Europe. Recent rapid disease spread in formerly disease-free zones highlights the need of understanding disease limits and distribution mechanisms. Capripox virus, the causal agent, may also cause sheeppox and Goatpox. Even though the virus is expelled through several bodily fluids and excretions, the most common causes of infection include sperm and skin sores. Thus, vulnerable hosts are mostly infected mechanically by hematophagous arthropods such as biting flies, mosquitoes, and ticks. As a result, milk production lowers, abortions, permanent or temporary sterility, hide damage, and mortality occur, contributing to a massive financial loss for countries that raise cattle. These illnesses are economically significant because they affect international trade. The spread of Capripox viruses appears to be spreading because to a lack of effectual vaccinations and poverty in rural areas. Lumpy skin disease has reached historic levels; as a consequence, vaccination remains the only viable option to keep the illness from spreading in endemic as well as newly impacted areas. This study is intended to offer a full update on existing knowledge of the disease's pathological characteristics, mechanisms of spread, transmission, control measures, and available vaccinations.

Unveiling the potential of proteomic and genetic signatures for precision therapeutics in lung cancer management.

Lung cancer's enduring global significance necessitates ongoing advancements in diagnostics and therapeutics. Recent spotlight on proteomic and genetic biomarker research offers a promising avenue for understanding lung cancer biology and guiding treatments. This review elucidates genetic and proteomic lung cancer biomarker progress and their treatment implications. Technological strides in mass spectrometry-based proteomics and next-generation sequencing enable pinpointing of genetic abnormalities and abnormal protein expressions, furnishing vital data for precise diagnosis, patient classification, and customized treatments. Biomarker-driven personalized medicine yields substantial treatment improvements, elevating survival rates and minimizing adverse effects. Integrating omics data (genomics, proteomics, etc.) enhances understanding of lung cancer's intricate biological milieu, identifying novel treatment targets and biomarkers, fostering precision medicine. Liquid biopsies, non-invasive tools for real-time treatment monitoring and early resistance detection, gain popularity, promising enhanced management and personalized therapy. Despite advancements, biomarker repeatability and validation challenges persist, necessitating interdisciplinary efforts and large-scale clinical trials. Integrating artificial intelligence and machine learning aids analyzing vast omics datasets and predicting treatment responses. Single-cell omics reveal cellular connections and intratumoral heterogeneity, valuable for combination treatments. Biomarkers enable accurate diagnosis, tailored medicines, and treatment response tracking, significantly impacting personalized lung cancer care. This approach spurs patient-centered trials, empowering active patient engagement. Lung cancer proteomic and genetic biomarkers illuminate disease biology and treatment prospects. Progressing towards individualized efficient therapies is imminent, alleviating lung cancer's burden through ongoing research, omics integration, and technological strides.

Wound Healing, Anti-inflammatory and Antioxidant Potential of Quercetin Loaded Banana Starch Nanoparticles.

BACKGROUND: Quercetin belongs to the BCS Class IV of drugs, which means it exhibits low solubility and low permeability. Quercetin is a potent antioxidant drug candidate, but it has several drawbacks, such as a short half-life, poor stability, bioavailability, and solubility. These factors affect its reliability as a good wound-healing, anti-inflammatory, and antioxidant agent. Quercetin nanoparticles resolved these problems and offered high stability, high encapsulation efficacy, sustained and prolonged release, and enhanced accumulation at target sites with high therapeutic efficacy. METHODS: Banana starch and quercetin were used to formulate a new composition of nanoparticles. Formulated QBSN were evaluated for their antioxidant, wound healing, and anti-inflammatory potential. RESULTS: QBSN showed a good antioxidant effect against the DPPH free radical scavenging model. Inhibition of DPPH free radicals reached up to 98 percent at 40 µl. Histopathological studies of treated tissues (wound and paw edema) confirmed the potential of QBSN. CONCLUSION: In the future, prepared nanoparticles may be the choice of drug formulation for wound healing, anti-inflammatory therapy, and antioxidant therapy.