Acute mesenteric haematoma and hematoperitoneum following a coughing episode induced by COVID-19.

Acute mesenteric haematoma (AMH) is a rare condition and established causes include blunt trauma, aneurysmal rupture, acute pancreatitis and anticoagulant use. A male patient in his 50s presented with abdominal pain and loss of consciousness that was immediately preceded by a prolonged coughing episode. A computed tomography (CT) abdomen-pelvis revealed two acute mesenteric haematomas and haematoperitoneum and admission swabs diagnosed coronavirus disease 2019 (COVID-19). The patient had no other acute clinical issues and was not taking anticoagulants. The haematomas were managed conservatively and a follow up computed tomography (CT) 4 weeks post-discharge revealed significant improvement. No clear vessel was identified as the source of the bleed in any of the investigations. This case represents a rare instance of AMH and haematoperitoneum with no established cause. We theorize that the combination of the patient's systemic response to COVID-19 and raised intra-abdominal pressure caused by coughing contributed to the bleeding.

Effect of Erythropoiesis Stimulating Agents on Clinical Outcomes in Breast Cancer Patients: A Systematic Review of Randomised Controlled Trials.

The impact of erythropoiesis stimulating agents (ESAs) on clinical outcomes among breast cancer patients is debatable. Current review is aimed to ascertain the efficacy of ESAs among breast cancer patients. Randomised controlled trials (RCTs) were electronically searched. Primary outcomes were mortality, blood transfusion requirements and thromboembolic events (TEEs); whereas, secondary outcomes were safety, tumor progression, anemia treatment, hemoglobin levels and quality of life (QOL). Out of 11 RCTs including 6,849 participants, 9 RCTs reported 2,312 deaths with overall mortality of 33.7%. Mortality reported for epoetin alfa (EA), epoetin beta (EB) and darbepoetin alfa (DA) was 41.24%, 73.1% and 8.99% respectively. TEEs reported for EA, EB and DA were 5.88%, 9.28% and 2.85%, respectively. Serious adverse events were 39.04%, 36.29%, 1.53% for EA, EB and DA, respectively. Tumor progression for EA and EB was 37.53% and 95.46%, respectively. No tumor progression was reported with DA. Erythropoietin reported no mortality, TEEs, serious ADRs and tumor progression. About 9% patients required transfusions during ESA therapy. Current evidence suggests that use of ESA reduces transfusion need but increases mortality and risks of TEEs.

Development and Evaluation of Optimized Thiolated Chitosan Proniosomal Gel Containing Duloxetine for Intranasal Delivery.

Proniosomes offer excellent potential for improved drug delivery, through versatile routes, by overcoming the permeation barriers faced by several drugs. The study was aimed to develop a thiomer gel containing duloxetine proniosomes for the intranasal delivery, improving its bioavailability and brain delivery through olfactory system. Duloxetine-loaded proniosomes were optimized through Design-Expert Software, prepared by coacervation phase separation method and then characterized in vitro for different vesicle features, and permeation enhancement potential using various techniques. The formulation F2, out of all the trials, fulfilled the maximum requisite of highest entrapment efficiency (76.21 ± 1.24%) and minimum vesicle size (223.91 ± 11.07 nm). The F2 was embedded in thiolated chitosan gel rendering it mucoadhesive and further characterized. The in vitro release showed a sustained drug release from the mucoadhesive proniosomal gel with only 54% drug release as compared to that of 71% from proniosome over 8 h, following Higuchi drug release model. Ex vivo permeation studies showed the enhancement ratio for the mucoadhesive proniosomal gel to be 1.86-fold greater than proniosomes, indicating a significant improvement in transmucosal permeation. The results suggest that incorporation of proniosomes into thiolated gel can significantly improve its mucoadhesion and retention time in the nasal cavity for providing a sustained drug release. Thus, gel formulation could be considered as a promising approach for efficient intranasal drug delivery of duloxetine. Graphical Abstract.

Proniosomes derived niosomes: recent advancements in drug delivery and targeting.

Vesicular drug delivery systems have gained wide attention in the field of nanotechnology. Among them proniosomes become the superior over other vesicular carriers. Proniosomes are dry formulations of water soluble nonionic surfactant coated carrier system which immediately forms niosomes upon hydration. They have the capability to overcome the instability problems associated with niosomes and liposomes and have the potential to improve solubility, bioavailability, and absorption of various drugs. Furthermore, they offer versatile drug delivery concept for enormous number of hydrophilic and hydrophobic drugs. They have the potential to deliver drugs effectively through different routes at specific site of action to achieve controlled release action and reduce toxic effects associated with drugs. This review discusses the general preparation techniques of proniosomes and mainly focus on the applications of proniosomes in drug delivery and targeting. Moreover, this review demonstrates critical appraisal of the literature for proniosomes. Additionally, this review extensively explains the potential of proniosomes in delivering drugs via different routes, such as oral, parenteral, dermal and transdermal, ocular, oral mucosal, vaginal, pulmonary, and intranasal. Finally, the comparison of proniosomes with niosomes manifests the clear distinction between them. Moreover, proniosomes need to be explored for proteins and peptide delivery and in the field of nutraceuticals and develop pilot plant scale up studies to investigate them in industrial set up.

Nanotechnology: from In Vivo Imaging System to Controlled Drug Delivery.

Science and technology have always been the vitals of human's struggle, utilized exclusively for the development of novel tools and products, ranging from micro- to nanosize. Nanotechnology has gained significant attention due to its extensive applications in biomedicine, particularly related to bio imaging and drug delivery. Various nanodevices and nanomaterials have been developed for the diagnosis and treatment of different diseases. Herein, we have described two primary aspects of the nanomedicine, i.e., in vivo imaging and drug delivery, highlighting the recent advancements and future explorations. Tremendous advancements in the nanotechnology tools for the imaging, particularly of the cancer cells, have recently been observed. Nanoparticles offer a suitable medium to carryout molecular level modifications including the site-specific imaging and targeting. Invention of radionuclides, quantum dots, magnetic nanoparticles, and carbon nanotubes and use of gold nanoparticles in biosensors have revolutionized the field of imaging, resulting in easy understanding of the pathophysiology of disease, improved ability to diagnose and enhanced therapeutic delivery. This high specificity and selectivity of the nanomedicine is important, and thus, the recent advancements in this field need to be understood for a better today and a more prosperous future.