Current approaches in smart nano-inspired drug delivery: A narrative review.

Background and Aim: The traditional drug delivery approach involves systemic administration of a drug that could be nonspecific in targeting, low on efficacy, and with severe side-effects. To address such challenges, the field of smart drug delivery has emerged aiming at designing and developing delivery systems that can target specific cells, tissues, and organs and have minimal off-target side-effects. Methods: A literature search was done to collate papers and reports about the currently available various strategies for smart nano-inspired drug delivery. The databases searched were PubMed, Scopus, and Google Scholar. Based on selection criteria, the most pertinent and recent items were included. Results: Smart drug delivery is a cutting-edge revolutionary intervention in modern medicines to ensure effective and safe administration of therapeutics to target sites. These hold great promise for targeted and controlled delivery of therapeutic agents to improve the efficacy with reduced side-effects as compared to the conventional drug delivery approaches. Current smart drug delivery approaches include nanoparticles, liposomes, micelles, and hydrogels, each with its own advantages and limitations. The success of these delivery systems lies in engineering and designing them, and optimizing their pharmacokinetics and pharmacodynamics properties. Conclusion: Development of drug delivery systems that can get beyond various physiological and clinical barriers, as observed in conventionally administered chemotherapeutics, has been possible through recent advancements. Using multifunctional targeting methodologies, smart drug delivery tries to localize therapy to the target location, reduces cytotoxicity, and improves the therapeutic index. Rapid advancements in research and development in smart drug delivery provide wider and more promising avenues to guarantee a better healthcare system, improve patient outcomes, and achieve higher levels of effective medical interventions like personalized medicine.

Knowledge, perception and usage of E-learning among medical undergraduates in Andhra Pradesh, India.

Electronic gadgets help to get study material outside classroom and it is used for self-directed learning which helps user to overcome limitations of Conventional teaching methods. Medical education is constantly growing and evolving with rapid speed. So, it is necessary to keep the upcoming medical graduates and established medical practitioners updated in this competitive world. For this, E-learning is the important tool in the medical field. This cross-sectional study was conducted in the medical college of Andhra Pradesh. Total 285 medical students were included in this study and data is obtained from semi structured self-administrative questionnaire. Among 285 students 99.6% students had smartphone and 89.5% were aware of E-learning. Most of the students 96.1% were Conversant with use of internet and 75.4% participants were aware of academic websites. Majority of students 73% agreed that E-learning helps in writing exams and 87.4% students recommended provision of free internet by institute for e-learning. All students were aware about e-learning and using it in the medical field. So, it is necessary to provide essential facility at institutional level for e-learning.

Bromocriptine: does this drug of Parkinson's disease have a role in managing cardiovascular diseases?

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality worldwide. Bromocriptine is a partial antagonist for D1 dopamine receptors while also serving as a selective agonist on D2 dopamine receptors as a dopamine receptor agonist. Apart from prolactin inhibiting action, bromocriptine has some beneficial effects on the blood pressure, plasma norepinephrine levels and vascular resistance. Dopamine D2 receptor activation of bromocriptine is associated with the antihypertensive effect, which lowers blood pressure via inhibiting sympathetic nerve activity and Na/K ATPase activity. Plasma levels of the pro-inflammatory cytokines such as interleukin (IL)-1B and IL-18, chemokine CCL2/ MCP-1/, and the pro-inflammatory hormone prolactin, all of which are elevated and linked to accelerated cardiometabolic illness, were decreased because of bromocriptine therapy. The most common side effects of Bromocriptine use are dizziness, nausea, headache, vomiting and hypotension. Bromocriptine is mainly contraindicated in patients with syncope with hypotension, psychosis, and type I diabetes mellitus. The authors suggest that developing therapies directed to increase D2 receptor expression and function by drugs like Bromocriptine can provide practical and novelistic approaches to prevent and manage myocardial and renal injury in the cardiovascular disease patients.

Epidemiology, clinical presentation and treatment outcomes in patients with COVID-19 in an ambulatory setting: a cross sectional study during the massive SARS-CoV-2 wave in India.

The COVID-19 pandemic, caused by SARS-CoV-2, has profoundly affected developing countries like India. This retrospective cross-sectional analysis investigated epidemiological, clinical characteristics, treatment strategies, and outcomes for hospitalized COVID-19 patients during the Massive SARS-CoV-2 Wave in India. Among 233 patients, the median age was 47.33 years, mostly male. Hospital stays averaged 8.4 days. Common symptoms include fever (88.41%), dry cough (56.2%), myalgia (44.20%), and shortness of breath (22.8%). The most common comorbidities were diabetes mellitus (52%) and hypertension (47.2%). Elevated biomarkers include D-dimer (24.4%), CRP (32.1%), ferritin (26.60%), and others. Prescription analysis revealed that antibiotics (42.6%), Antivirals (37%), anthelmintics (20.30%), vitamins and nutritional supplements (20.71%) and glucocorticoids (12.8%) were the most commonly prescribed. Oxygen therapy was needed by 19.31% of patients in the moderate and severe categories within 24 hours of admission. The mortality rate was 8.58%. The surge led to increased hospitalizations and mortality, particularly among young adults. Diabetes and hypertension were correlated with mortality. Irregular use of drugs lacking evidence, like antibiotics and anthelmintics, vitamins and nutritional supplements, was observed in COVID-19 management. This study underscores the impact of the pandemic in India and highlights the need for evidence-based treatments.

Prevalence of overweight and obesity and their effect on COVID-19 severity and hospitalization among younger than 50 years versus older than 50 years population: A systematic review and meta-analysis.

Cohort studies have shown that both overweight and obesity have their impact by increasing hospitalization with COVID-19. We conducted a systematic literature search in PubMed, Google Scholar, and MedRxiv databases following the PRISMA guidelines. Statistical analyses were performed using STATA software version 16 MP (Stata Corp, College Station, TX, USA) and Med Calc software version 22.009(Med Calc software Ltd, Ostend, Belgium). The primary outcome was to measure the prevalence of overweight and obesity and their impact on the risk of hospitalization among COVID-19 patients under and above 50 years of age. In total, 184 studies involving 2,365,377 patients were included. The prevalence of overweight was highest among those younger than 50 years of age over those older than 50 years of age, (26.33% vs. 30.46%), but there was no difference in obesity (36.30% vs. 36.02%). Overall, the pooled prevalence of overweight and obesity among hospitalized COVID-19 patients was 31.0% and 36.26%, respectively. Compared with normal weight, the odds of hospitalization with overweight (odds ratio [OR] 2.186, 95% confidence interval [CI] [1.19, 3.99], p < 0.01) and obesity (OR 3.069, 95% CI [1.67, 5.61], p < 0.001) in those younger than 50 years and obesity (OR 3.977, 95% CI [2.75, 5.73], p < 0.001) in the older than 50 years age group were significantly high. The increased prevalence of overweight and obesity among the under 50 years age group and obesity among the older than 50 years age group significantly increased the rate of COVID-19 infections, severity and hospitalization.

Current management of diabetes patients with COVID-19.

INTRODUCTION: Diabetes mellitus (DM) and the 2019 coronavirus (COVID-19) appear to interact in both directions. There is mounting proof that patients with DM have a worse COVID-19 prognosis than those without it. Pharmacotherapy is also known to affect in view of the possible interplay between drugs and the pathophysiology of the above conditions in a given patient. AREAS COVERED: In this review, we discuss the pathogenesis of COVID-19 and its connections with diabetes mellitus. We also analyze the treatment modalities for COVID-19 and diabetes patients. The possible mechanisms of the different medications and their management limitations are also systematically reviewed. EXPERT OPINION: COVID-19 management as well as its knowledge base is changing constantly. The Pharmacotherapy and the choice of drugs also need to be specifically considered in view of the concomitant presence of these conditions in a patient. Anti-diabetic agents must be carefully evaluated in diabetic patients in view of the disease's severity, blood glucose level, appropriate treatment, and other components that could aggravate adverse events. A methodical technique is anticipated to enable the safe and rational use of drug therapy in COVID-19-positive diabetic patients to take.

Current management of diabetes patients with COVID-19.

INTRODUCTION: Diabetes mellitus (DM) and the 2019 coronavirus (COVID-19) appear to interact in both directions. There is mounting proof that patients with DM have a worse COVID-19 prognosis than those without it. Pharmacotherapy is also known to affect in view of the possible interplay between drugs and the pathophysiology of the above conditions in a given patient. AREAS COVERED: In this review, we discuss the pathogenesis of COVID-19 and its connections with diabetes mellitus. We also analyze the treatment modalities for COVID-19 and diabetes patients. The possible mechanisms of the different medications and their management limitations are also systematically reviewed. EXPERT OPINION: COVID-19 management as well as its knowledge base is changing constantly. The Pharmacotherapy and the choice of drugs also need to be specifically considered in view of the concomitant presence of these conditions in a patient. Anti-diabetic agents must be carefully evaluated in diabetic patients in view of the disease's severity, blood glucose level, appropriate treatment, and other components that could aggravate adverse events. A methodical technique is anticipated to enable the safe and rational use of drug therapy in COVID-19-positive diabetic patients to take.

Prophylactic use of hydroxychloroquine (HCQS) in COVID-19: A questionnaire-based study in health care professionals.

Background: Coronavirus disease-2019 (COVID-19) pandemic has engulfed the whole world with millions getting infected and losing their lives. Health care professionals (HCPs) who are in the front line of fighting with COVID-19 are particularly vulnerable and it is crucial to protect them from COVID-19. In this regard, the Indian Council of Medical Research (ICMR) has recommended hydroxychloroquine (HCQS) chemoprophylaxis in HCPs. However, considering the lack of sufficient evidence the HCP are in a dilemma about this aspect. Moreover, there is a paucity of data on use of HCQS as a chemoprophylaxis among Indian HCP. Hence, this study was carried out to study the extent of use and also the perception of Indian HCP toward use of HCQS as a chemoprophylaxis for COVID-19. Materials and Methods: This was a cross-sectional study done on 205 HCPs working across India. The responses were collected electronically using a prevalidated semi-structured questionnaire. Results: 62.9% (129/205) respondents reported having taken HCQS chemo-prophylaxis for COVID-19 while 34.7% (76/205) did not take it. Among HCP, who did not take the prophylaxis, the main reasons cited were concern about adverse effects (61.5%) and lack of robust evidence (24%). Only 14% of respondents felt that there was sufficient evidence to justify use of HCQS for prophylaxis while an overwhelming majority (86%) felt otherwise or were uncertain. Conclusion: The majority of participants felt that despite a lack of proven efficacy, ICMR guidelines on HCQS prophylaxis in COVID-19 are justified considering the pandemic situation. Our study also found that HCQS is well tolerated by participants and there was no reported serious adverse effect and cardiac-related side effects among them.

RésuméContexte: La pandémie de maladie à coronavirus-2019 (COVID-19) a englouti le monde entier avec des millions de personnes infectées et perdant leur des vies. Les professionnels de la santé (HCP) qui sont en première ligne dans la lutte contre le COVID-19 sont particulièrement vulnérables et il est essentiel de les protéger du COVID-19. À cet égard, le Conseil indien de la recherche médicale (ICMR) a recommandé l'hydroxychloroquine (HCQS) chimioprophylaxie chez les professionnels de la santé. Cependant, compte tenu du manque de preuves suffisantes, le professionnel de la santé est confronté à un dilemme à propos de cet aspect. En outre, il y a peu de données sur l'utilisation du HCQS comme chimioprophylaxie parmi les professionnels de la santé indiens. Par conséquent, cette étude a été menée pour étudier l'étendue de l'utilisation et aussi la perception des professionnels de la santé indiens à l'égard de l'utilisation du HCQS comme chimioprophylaxie pour le COVID-19. Matériel et Méthodes: c'était un étude transversale réalisée sur 205 professionnels de la santé travaillant en Inde. Les réponses ont été recueillies par voie électronique à l'aide d'un système semi-structuré prévalidé questionnaire. Résultats: 62,9% (129/205) des répondants ont déclaré avoir suivi une chimioprophylaxie HCQS pour le COVID-19, tandis que 34,7% (76/205) ne l'a pas pris. Parmi les professionnels de la santé qui n'ont pas pris de prophylaxie, les principales raisons invoquées étaient la préoccupation concernant les effets indésirables (61,5%) et le manque de preuves solides (24%). Seulement 14% des répondants estimaient qu'il y avait des preuves suffisantes pour justifier l'utilisation du HCQS à des fins prophylactiques alors qu'un une écrasante majorité (86%) pensait le contraire ou était incertaine. Conclusion: La majorité des participants ont estimé que malgré un manque de efficacité, les lignes directrices de l'ICMR sur la prophylaxie du HCQS dans le COVID-19 sont justifiées compte tenu de la situation pandémique. Notre étude a également révélé que Le HCQS est bien toléré par les participants et aucun effet indésirable grave ni effet secondaire cardiaque n'a été signalé parmi eux. Mots-clés: Chimioprophylaxie, COVID-19, hydroxychloroquine, Conseil indien de la recherche médicale.

Prevalence of self-medication in rural area of Andhra Pradesh.

BACKGROUND: The consumption of medicine without consulting a doctor is called self-medication. In the recent decade, the prevalence of self-medication was increased mainly in the developing countries. The reason varies from the nonavailability of doctors to economical reason. But people are not aware of the side effects and interactions of drugs. This is risky behavior and may lead to death. The objective of this study is to find out the prevalence and various reasons, sources, and common drugs used for self-medication. MATERIALS AND METHODS: A cross-sectional community-based study conducted in Visakhapatnam district, Andhra Pradesh. 166 houses were selected by using a simple random sampling method. One respondent from one household was interviewed by using a semi-structured questionnaire. The data obtained were analyzed by using SPSS V22. Chi-square and Fisher exact tests were applied to find associations. Phi, Cramer Rao V, and contingency coefficient were applied to find the strength of association. A value of P < 0.05 was considered significant. RESULTS: Among 166 subjects, the majority (58.4%) of participants were in the age group between 18-30 and most of them were female 142 (85.5%). The prevalence of self-medication was 68.1%. The main source of self-medication was directly from the pharmacy, that is, pharmacists (72.6%). Analgesics were commonly (85%) self-medicated drug. The main indication for self-medication was headache (78.8%) and fever (66.4%). CONCLUSION: The prevalence of self-medication was high and which is hazardous to health. This needs prompt legislative action.