Acceptability and Satisfaction of Patients and Providers With Telemedicine During the COVID-19 Pandemic: A Systematic Review.

COVID-19, also known as coronavirus disease 2019, is an extremely contagious viral sickness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After the first cases of this primarily respiratory viral illness were recorded in Wuhan, Hubei Province, China, in late December 2019, SARS-CoV-2 rapidly disseminated across the globe. Consequently, on March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. The rapid spread of the COVID-19 virus, coupled with subsequent lockdowns and social distancing measures, profoundly disrupted traditional healthcare delivery systems. Amidst the COVID-19 pandemic, telemedicine emerged as a pivotal solution for delivering healthcare services while minimizing exposure to the virus. This study aims to assess patient and provider satisfaction with telemedicine during this unprecedented period. A systematic literature search was conducted on PubMed and Google Scholar using specific MeSH terms and Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) guidelines to summarize patient and provider satisfaction concerning telemedicine using all the facts, evidence, and published literature. The analysis showed that although providers were generally satisfied with telemedicine, they were less satisfied than patients due to technical issues and difficulties transmitting documents. Patients reported high satisfaction with telemedicine, citing convenience and cost savings as major benefits. However, a lack of provider compensation was identified as a potential barrier to adoption. Most providers believed that telemedicine was only necessary in emergencies while a few recognized its potential for routine care. The study concludes that telemedicine has the potential to improve healthcare access and efficiency, but more research is needed to address technical and reimbursement issues and to determine the appropriate scope of telemedicine use. Overall, the findings of this study can inform future healthcare policies and regulations to ensure that telemedicine is used effectively and to the satisfaction of both patients and providers.

Development and optimization of kaempferol loaded ethosomes using Box-Behnken statistical design: In vitro and ex-vivo assessments.

Kaempferol (KMP) belong to flavonoid class have developed in ethosomal formulation and were evaluated for their potential to treat diabetic foot ulcers. Even though ethosomes are highly deformable, they can pass through human skin intact. KMP ethosomes were formulated using the cold method and optimized by Box-Behnken design (BBD) (three-factor, three-level (33 )). The formulation variables used for optimization are drug concentration of KMP, soylecithin content, and ethanol percentage. The optimized formulation was examined using transmission electronic microscopy (TEM), differential scanning calorimetry (DSC), Fourier transform infrared (FTIR) spectroscopy, in-vitro release, ex-vivo permeation studies, and storage stability. The optimized KMP ethosomes was found to have vesicle size (VS) of 283 ± 0.3 nm and zeta potential (ZP) of -29.67 ± 0.3 mV, polydispersity index (PDI) of 0.36, % entrapment efficiency (%EE) of 91.02 ± 0.21%, drug loading (%) of 46.23 ± 2.5% followed by good storage stability at 4°C/60 ± 5% RH. In vitro drug release of optimized KMP ethosomes was 88.2 ± 2.75%, which was approximately double when compared with pure KMP release, that is 49.9 ± 1.89%. The release kinetics for optimized KMP ethosomes follows the Korsmeyer-Peppas model. An apparent permeation coefficient of 356.25 ± 0.5 µg/cm2 was determined and compared with pure KMP (118.46 ± 0.3 µg/cm2 ) for 24 h. According to the study, ethosomes can be a cutting-edge strategy that offers a new delivery method for prolonged and targeted distribution of KMP in a variety of dosage forms including oral, topical, transdermal, and so forth.

Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents.

BACKGROUND: One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common. OBJECTIVE: The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly. METHOD: The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system. RESULTS: Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments. CONCLUSION: The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.

Enhanced Brain Delivery via Intranasal Administration of Carbamazepine Loaded Solid Lipid Nanoparticles: Optimization, Pharmacokinetic Analysis, In-vitro, and In-vivo Drug Release Study.

BACKGROUND: Carbamazepine (Cbz) is the first-line drug for epileptic seizures but exhibits fluctuation at the plasma level and side effects after oral administration.To overcome these problems, Cbz should be targeted directly into the brain. Therefore, the current experimental design was aimed to formulate and optimize the Cbz containing solid lipid nanoparticles (SLNs) for brain delivery via intranasal administration to get rid of oral complications associated with Cbz. METHODS: A full factorial design was performed to evaluate the effect of variables (X1 lipid concentration, X2 surfactant concentration, and X3 sonication time) on the response variables (size of nanoparticles, entrapment efficiency, and drug release). A two-level, three-factor design was employed herewith, and eight formulations were developed. Further, the formation of Cbz containing SLNs was characterized by compatibility, particle size, entrapment efficiency, and drug release with the support of Fourier Transform Infra-Red (FTIR), Zeta sizer, Transmission Electron Microscopy (TEM), Ultra-violet (U.V.), and High-Performance Liquid Chromatography (HPLC). RESULTS: All eight formulations were characterized through particle size, entrapment efficiency, and invitro drug release performance. Out of eight characterized formulations, SN1 showed the most promising results, including particle size of 210 ± 2.14 nm, entrapment efficiency of 42.1 ± 1.09%, and drug release of 61.3 ± 2.02% and considered an optimized batch. Additionally, the optimized batch SN1was further evaluated for an in-vivo study on male Wistar Rats. CONCLUSION: The study revealed that a high amount of drug was reached into the brain through intranasal administration compared to the intravenous route. Therefore, it can minimize the unwanted side effects of the Cbz associated with oral administration. The formulation SN1 possesses an excellent drug targeting efficiency of 3.014. Finally, the current experimental work concluded that there is a direct pathway from the intranasal route to the brain. This delivery system can be beneficial for directly delivering CNS-active drugs into the brain.

Wild banana [Ensete superbum (Roxb.) Cheesman.]: Ethnomedicinal, phytochemical and pharmacological overview.

ETHNOPHARMACOLOGICAL RELEVANCE: Ensete superbum (Roxb.) Cheesman. (Family: Musaceae), commonly known as "Wild Banana" is well recorded as popular ethnomedicine for medicinal and nutritional uses by different people and communities native to India, Ethiopia, Thailand, Myanmar and Vietnam. AIM OF THE REVIEW: Despite the wide ethnomedicinal and pharmacological studies on E. superbum, there are no concise elaborated article comprising reviews of published literature. So, herein we designed this review article to discuss the current ethnopharmacology, pharmacognosy, phytochemistry, pharmacology and intellectual property status of E. superbum. MATERIALS AND METHODS: Exhaustive literature searches were performed on E. superbum through various scientific and patent search engines such as Google Scholar, Scopus, PubMed, USPTO, Google patents, and Espacenet, using different keywords for screening of relevant information. RESULTS: E. superbum was recorded in different regions of the world for ailments such as dog bite, calculi, semen production, abortion, leucorrhoea, stomachache, immune response, pain, diabetes, psychosomatic, contraceptive, umbilical cord care, convulsions, pneumonia, cholera, labor and delivery pain, dehydration, appendicitis, chickenpox, measles, urinary problems, food poisoning, snake bites, diarrhoea, dysentery, jaundice, bone fracture, infections, fever, asthma, hiccups and leucoderma. Major bioactive phytochemicals such as triterpenoid esters, proanthocyanidin, pro-pelargonidin glucosides, pelargonidin, anigorufone, hydroxyanigorufone, ß-carboline alkaloids and fractions such as VIDR-2T, VIDR-2GC, VIDR-2GD were reported. Pharmacologically, E. superbum was found to be non-toxic (LD50 = 3235.9 mg/kg) and has been reported to possesses antiurolithiatic, antidiabetic, antifertility, anti-estrogenic, antiviral, cardiovascular and anti-inflammatory activities. CONCLUSIONS: E. superbum could be an excellent source of safe and effective medicinal and nutritional herbal remedies for human and animal consumption.

Simultaneous HPTLC analysis of ursolic acid, betulinic acid, stigmasterol and lupeol for the identification of four medicinal plants commonly available in the Indian market as Shankhpushpi.

In this study, we investigated a new, simple, sensitive, selective and precise high-performance thin-layer chromatography (HPTLC) fingerprint and quantitative estimation method for the analysis of ursolic acid, betulinic acid, stigmasterol and lupeol in Shankhpushpi botanicals. Linear ascending development was carried out in a twin trough glass chamber saturated with petroleum ether-ethyl acetate-toluene (7:2:1, v/v/v). The plate was dried, sprayed with anisaldehyde reagent and analyzed by CAMAG TLC scanner III at 580 nm. The system was found to give compact spots for ursolic acid (0.21), betulinic acid (0.29), stigmasterol (0.33) and lupeol (0.50). The relationship between the concentration of standard solutions and the peak response is linear within the concentration range of 100-600 ng/spot for ursolic acid, betulinic acid, stigmasterol and lupeol. The concentration of 134.2 and 146.1 mg of ursolic acid per gram of Clitorea ternatea (CT) and Canscora decussata (CD); 110.6 mg of betulinic acid per gram of EA; 92.75, 154.95, 31.947 and 39.21 mg of stigmasterol per gram of Evolvulus alsinoides (EA), Convolvulus pluricaulis (CP), CT and CD; 30.12 mg of lupeol per gram of CT were found. The proposed HPTLC method may use for routine quality testing and identification of Shankhpushpi botanicals.

A comprehensive review on Nymphaea stellata: A traditionally used bitter.

Nymphaea stellata Willd. (Syn. Nymphaea nouchali Burman f.) (Nymphaeaceae) is an important and well-known medicinal plant, widely used in the Ayurveda and Siddha systems of medicines for the treatment of diabetes, inflammation, liver disorders, urinary disorders, menorrhagia, blenorrhagia, menstruation problem, as an aphrodisiac, and as a bitter tonic. There seems to be an agreement between the traditional use and experimental observations, such as, hepatoprotective, anti-inflammatory, and particularly antidiabetic activity. Nymphayol, a steroid isolated from the flowers has been scientifically proved to be responsible for the traditionally claimed antidiabetic activity; it reverses the damaged endocrine tissue and stimulates secretion of insulin in the ß-cells. However, taking into account the magnitude of its traditional uses, the studies conducted are still negligible. This review is an attempt to provide the pharmaceutical prospective of Nymphaea stellata.

An update on Shankhpushpi, a cognition-boosting Ayurvedic medicine.

Shankhpushpi is an Ayurvedic drug used for its action on the central nervous system, especially for boosting memory and improving intellect. Quantum of information gained from Ayurvedic and other Sanskrit literature revealed the existence of four different plant species under the name of Shankhpushpi, which is used in various Ayurvedic prescriptions described in ancient texts, singly or in combination with other herbs. The sources comprise of entire herbs with following botanicals viz., Convulvulus pluricaulis Choisy. (Convulvulaceae), Evolvulus alsinoides Linn. (Convulvulaceae), Clitoria ternatea Linn. (Papilionaceae) and Canscora decussata Schult. (Gentianaceae). A review on the available scientific information in terms of pharmacognostical characteristics, chemical constituents, pharmacological activities, preclinical and clinical applications of controversial sources of Shankhpushpi is prepared with a view to review scientific work undertaken on Shankhpushpi. It may provide parameters of differentiation and permit appreciation of variability of drug action by use of different botanical sources.