Pharmacology and Therapeutics of Collagen-Based Stimulator Drug and Drug Supplement: Delivery (Management) and Approaches (Strategies).

While compiling a dissertation on collagen-based stimulator drug and drug supplements, it was considered relevant to dwell into the background, the vary basis of the subject, taking cognizance of bovine (animal) as well as human source collagen preparations. Impediments in the manufacture of source materials accompanied by complications were discouraging, bringing forth the advent of drug compositions primarily affecting collagen tissue augmentation replacing successfully the prior one. Calcium Sculptra, poly-L-lactic acid (PLLA), and calcium hydroxylapalite (CaHA) are now considered for use. There drug delivery management and strategies as well as mechanism constituted the subject matter; however, uniform availability of these drugs and drug supplements is the major handicap for their free use.

The Third Gender in a Third World Country: Major Concerns and the "AIIMS Initiative".

With a population dividend of around 1.3 billion, India is the largest democracy in the world that encompasses "unity in diversity". The kaleidoscope of the socio-cultural fabric comprises the transgender population too, which has a historical context dating back millennia and also plays a vital role as described in Hindu scriptures. The Indian transgender person's community shows a variety of gender identities and sexual orientations, which is unlikely from the West, forming a culturally unique gender group. In India, transgender persons were recognised as the 'third gender' in 2014. The third gender population of India is marginalised to a great extent in every sector. Often, transgender persons have been the subjects of sociology, psychology, and health issues. There was a dearth of data regarding their major health problems including bone health, which has not been reported in India and elsewhere before this study. Through a prospective cross-sectional study design, we aimed to determine the current health status of transgender persons with a special emphasis on bone health. Descriptive statistics were used for data analysis. The preliminary results of the study show poor bone health in the transgender population of India. The majority of transgender persons have low bone mineral density (BMD) at a much young age, even before the achievement of their peak bone mass. The health status of the transgender population in India is poor overall. Transgender persons have many impediments to optimal healthcare that requires holistic care. This study presents the current health challenges of the transgender population with a special emphasis on their bone health status as 'AIIMS initiative'. This study also shows transgender persons human rights needs to be explicitly discussed. The stakeholders of social policies require an urgent attention to unfold the major concerns encompassing transgender persons.

Multidrug-Resistant Candida auris Fungemia in Critical Care Units: Experience from a Tertiary Care Hospital in India.

Candida auris, a recently identified multiresistant Candida species, was first reported in Japan in 2009. It is different from other pathogenic yeast species because of its propensity to cause outbreaks and transmits between patients within health care settings. The invasive infections caused by C. auris are associated with high mortality rates, approaching 70% particularly in intensive care unit patients. Conventional biochemical methods are inaccurate in identifying this species of Candida. Although C. auris is frequently reported as multi-, extended-, or pan drug resistant to antifungal drugs, there is a wide variability in the susceptibility among reports worldwide. In this study we report a case series of five hospitalized patients with multidrug-resistant candidemia caused by C. auris in a tertiary hospital in India. Our finding suggests that correct identification followed by therapeutic intervention is necessary for favorable outcome in patients with C. auris fungemia.

Evaluation of Anti-inflammatory Effects of Choerospondias axillaris Fruit's Methanolic Extract in Synoviocytes and CIA Rat Model.

BACKGROUND: Rheumatoid Arthritis (RA) is an autoimmune, systemic disease mainly affecting joints. Presently, there is no specific treatment/ drug available for curing RA except few supportive medicines. Therefore, the focus has been shifted to medicinal plants for the treatment of such diseases. Choerospondias axillaris commonly known as Lupsi/Lapsi and has been reported to have several properties for the treatment of various diseases. OBJECTIVE: The present study has been conducted to explore the anti-inflammatory effects of Choerospondias axillaris fruit extract on Synoviocytes (FLS) and Collagen-Induced Arthritis (CIA) rat model. METHODS: Methanolic extract of the Choerospondias axillaris fruit was used for determining phytochemical, antioxidant and anti-inflammatory properties. Antioxidant activity of Choerospondias axillaris fruit was determined by free radicals scavenging assays and bioactive compounds were identified via LC-MS/MS analysis. Anti-inflammatory effect was investigated in RA and Osteo Arthritis (OA) primary cells and also in Collagen Induced Arthritis (CIA) rat models. Further, the medicinal properties of anti-inflammatory bioactive compounds were supported by docking studies. RESULTS: In-vitro and in-vivo studies showed significant decrease in the levels of inflammatory cytokines. Docking analysis revealed that quercetin inhibits TNF-α having -9.1 kcal/mol binding energy and 10.13 µM inhibitory constant. Quercetin also inhibits IL-6 having -6.6 kcal/mol binding energy and 21.9 µM inhibitory constant. CONCLUSION: Observed results suggest that the underutilized fruit Choerospondias axillaris can be used to reduce the inflammation of inflammatory diseases like RA.

Genome-wide identification and functional annotation of miRNAs in anti-inflammatory plant and their cross-kingdom regulation in Homo sapiens.

MicroRNAs (miRNAs) are newly discovered non-coding small (~17-24 nucleotide) RNAs that regulate gene expression of its target mRNA at the post-transcriptional levels. In this study, total 12,593 ESTs of Curcuma longa were taken from database of expressed sequence tags (dbEST) and clustered into 2821 contigs using EGassembler web server. Precursor miRNAs (pre-miRNAs) were predicted from these contigs that folded into stem-loop structure using MFold server. Thirty-four mature C. longa miRNAs (clo-miRNAs) were identified from pre-miRNAs having targets involved in various important functions of plant such as self-defence, growth and development, alkaloid metabolic pathway and ethylene signalling process. Sequence analysis of identified clo-miRNAs indicated that 56% miRNAs belong to ORF and 44% belong to non-ORF region. clo-mir-5 and clo-mir-6 were established as the conserved miRNAs, whereas clo-mir-20 was predicted to be the most stable miRNA. Phylogenetic analysis carried out by molecular evolutionary genetics analysis (MEGA) software indicated close evolutionary relationship of clo-mir-5075 with osa-MIR5075. Further, identified clo-miRNAs were checked for their cross-kingdom regulatory potential. clo-mir-14 was found to regulate various gene transcripts in humans that has been further investigated for its biostability in foetal bovine serum (FBS). The results indicated higher degree of stability of clo-mir-14 (48 h) in FBS. Thus, contribution of this miRNA to the cellular immune response during the inflamed condition of rheumatoid arthritis and adequate stability may make it a good choice for the therapeutic agent in near future.

High prevalence of vitamin D deficiency in Asian-Indian patients with fragility hip fracture: a pilot study.

OBJECTIVE: To assess vitamin D nutrition status in Asian-Indian patients with fragility hip fracture. METHODS: The study subjects included patients with non-traumatic hip fracture with age more than 50 years. Any patient who sustained fracture after road side accident of any severity was excluded. The other exclusion criteria were history of previous non-traumatic fracture or history of intake of systemic steroids, anti-osteoporotic medication, anti-tubercular or antiepileptic drugs. Routine biochemistry, serum 25-hydroxy vitamin D [25(OH)D] and BMD (DXA) were measured in all patients. Diagnosis of vitamin D deficiency (VDD) was considered when serum 25(OH)D levels were < 20 ng/ml. Age and sex matched apparently healthy subjects (without history of fracture at any site) were selected from general population. All controls under went BMD measurement at spine. RESULT: Final analysis included 43 patients, 9 men (20.9%) and 34 women (79.0%, all postmenopausal). The mean age of patients was 62.2 +/- 12.3 years (range 50.5 to 74.2 years, men--62 +/- 13.4 years; women--62.3 +/- 12.4 years; p 0.73). History of adequate sun exposure was obtained in 34.8% cases only. Fracture occurred while patients were outside home in 10/43 (23.25%) while 33/43 (76.7%) patients sustained fracture at home. Of all fractures occurring at home, 51.5% patients sustained fracture consequent to fall/slip in the bathroom. The mean serum 25(OH)D level was 9.9 +/- 4.8 ng/ml (range 5-21.5 ng/ml). All patients except one (96.7%) had VDD. No significant difference in serum 25(OH)D levels was observed between patients with and without adequate sun exposure. BMD of patients with fragility fractures were significantly low in comparison to BMD of healthy controls. (cases --0.790 +/- 0.1 gm/sq cm vs controls 0.924 +/- 0.1 gm/sq cm; p 0.000). The mean Z-score of spine BMD of cases was -1.13 +/- 1.4. No significant difference was observed in the BMD of patients with or without adequate sun exposure and with or without calcium and vitamin D supplementation at the time of fracture. Similarly, no significant difference was noted in BMD of patients with severe VDD and patients with mild to moderate VDD. All patients were contacted by telephone one year after the surgery (mean 12.3 months, range 9 to 13 months). Out of total 43 patients, 26 patients/families could be contacted, 11 (42.3%) died within one year of surgery, of which 8 patients died within first 6 months after surgery. Two patients died within 72 hours after discharge from hospital. Of 15 patients alive one year after surgery, two were able to walk without any support while 13 were able to walk with some support (stick or walker). CONCLUSION: Our study shows very high prevalence (96.7%) of vitamin D deficiency in Asian-Indian patients with fragility hip fracture. The BMD of these patients is significantly low in comparison to age and sex matched healthy controls. More fractures occurred at home than outside, with a majority of fall being in the bathroom.

Medial approach for operative treatment of the widely displaced supracondylar fractures of the humerus in childre.

Twenty-seven widely displaced supracondylar fractures of the humerus in children were treated by open reduction and cross K-wire fixation by the medial approach over a 30-month period. The mean follow-up was 14 months, average age 8 years and the mean delay in presentation 49 hours. Medial approach provided an excellent view of the medial bone pathology via an internervous plane and enabled an anatomical reduction in all cases. Cross K-wire fixation obviated the need to immobilize the elbow at 90 degrees or more flexion. No postoperative neurovascular complication was noted. Most patients regained full range of motion within 6 weeks of pin removal and no change in the carrying angle was noted. Delayed presentation, repeated manipulations and massage were responsible for loss of motion. Superficial pin tract infection was noted in 5 patients and resolved with dressings and antibiotics. No deep infection occurred. Medial approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function.