Phytochemicals and Novel Nanotherapeutic Approaches in the Management of Rheumatic Diseases

Over 100 types of arthritis have been recognized in which the dominating forms are osteoarthritis and rheumatoid arthritis. Joint stiffness, pain, swelling, lowered range of motion of joints affected, redness around joints are the main complications of almost all types of arthritis. Medications like non-steroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids, and immunosuppressants are only used to control the symptoms of the disease but are not able to alleviate them properly. However, with the incorporation of disease-modifying antirheumatic drugs (DMARDs) as well as tumor necrosis factor inhibitors (TNFi) in treatment, there are now promising therapeutic options to select from for the management of rheumatoid diseases. Nanotherapeutic approach has enabled us to deliver the disease-modifying agents directly to the inflammation site, thus eschewing off-target and unwanted systemic effects. Therefore, it provides an opportunity to reconsider the therapeutic compounds that were considered too toxic to be administrated via oral or parenteral route.

The Subcutaneous Injection of Organophosphate: A Case Report

Organophosphate (OP) poisoning is prevalent in developing countries. Toxicity occurs by voluntary injection, inhalation, and absorption. Self-injection is rare. The current case report describes a 61-y/o male with subcutaneous self-injected one cc OP poisoning presenting with delayed drowsiness, nausea, and vomiting. He was treated and presented a good clinical response to treatment with pralidoxime and had a successful recovery. Diagnosis of OP compound toxicity by the parenteral route is a challenge. By observing patients, the dose, and the time between poisoning until the time to start treatment, we can conclude different presentations and outcomes of OP poisoning.

A Recent Update on Oral Anticoagulants

Atrial Fibrillation is very common among Americana; it is the irregular rhythm of the heart usually present with or without symptoms. It causes the formation of clots, clots go to the brain and cause a stroke. Anticoagulants have been known for a few decades to cause abrupt decrease around 50%) in the rate of stroke and prevent clotting at the required location and can cause bleeding. Anticoagulants aims for the safeguard and therapy of thromboembolism to prevent stroke. Previously used Anticoagulants are Warfarin, low molecular weight heparin and heparin. There were shortcoming of the drugs like parenteral route of administration, requires frequent monitoring due to variability in response, the onset of action is slow and there is bleeding in response to the drugs .In addition to heparin and vitamin k antagonist, anticoagulants that act on enzymatic agility or vigor brought about by of thrombin and factor Xa was exquisitely formulated. Implementation of the foresaid oral Anticoagulants requires knowledge of necessitate the comprehension of discrete indication, contraindications, characteristics. Research and repeated clinical trials have led to acceptance of few newer drugs which are working classically styled but better than Warfarin. In the last few years, Pradaxa (dabigatran), Xarelto (rivaroxaban), and Eliquis (dabigatran) have all been authorised by the FDA (apixaban). All three are ‘blood thinners,’ like warfarin, that lessen the overall risk of stroke associated with atrial fibrillation while also causing bleeding.

Energy target achievement and its determinants in critically ill COVID-19 patients in Indonesia

Introduction. Achievement of energy target in critically ill Covid-19 patients in Intensive Care Unit (ICU) is challenging. This study was aimed to depict the possibility of achieving energy target and its determinants in critically ill Covid-19 patients. Methods. A cross sectional study was conducted in ICU of dr. Kariadi Hospital Semarang, Indonesia. Secondary data were obtained from Covid-19 patients who were in ICU for minimum 3 days, from March to December 2020. Data collected included age, sex, Body Mass Index (BMI), comorbidities, Modified Nutrition Risk in Critically Ill (mNUTRIC) score, energy intake, route of nutrition delivery (enteral or combination of enteral and parenteral nutrition), lactate status, ICU length of stay (LOS), duration of mechanical ventilator and mortality. Risk Prevalence calculations were conducted to measure risks. Variables with significant associations and p< 0.25 were included in multiple logistic regression. Results. A total of 188 subjects were included in the analysis. Most patients were male (62.8%) and obese (61.8%). As much as 56.9% patients were able to achieve energy target of 20 kcal/kgBW on day 3 of ICU stay. Those with low risk mNUTRIC score and nutrition delivery was through enteral and parenteral route were more likely to achieve target energy of 20 kcal/kgBW in the first 3 days in the ICU. Conclusions. Achieving energy target of 20 kcal on day 3 of ICU stay for critically ill Covid-19 patients is feasible. Low mNutric score and nutrition delivery through enteral and parenteral route were two determinants for the achievement.

A mucosal antibody response is induced by intra-muscular SARS-CoV-2 mRNA vaccination

Vaccines against SARS-CoV-2 administered via the parenteral route (intra-muscular = i.m.) are effective at preventing COVID-19 in part by inducing neutralizing antibodies in the blood. The first line of defense against SARS-CoV-2 is in the upper respiratory tract, yet we know very little about whether COVID-19 vaccines induce immunity in this compartment, if at all. We analysed salivary antibodies against the SARS-CoV-2 Spike protein and its receptor binding domain (RBD) following 2 i.m. injections of either BNT162b2 or mRNA-1273 vaccines. Salivary anti-Spike/RBD IgG was detected after 1 dose and increased further after dose 2, reflecting the systemic immune response. Interestingly, salivary anti-Spike/RBD IgA associated with the secretory component (sIgA) was detected in nearly all vaccinated participants after one dose of mRNA vaccine, with anti-Spike sIgA diminishing after dose 2. Vaccination with ChAdOx1-S (Ad) followed by mRNA induced similar levels of salivary anti-Spike/RBD IgG and IgA, and both mRNA/mRNA and Ad/mRNA regimes provoked modest neutralizing capacity in this biofluid. Our results demonstrate that SARS-CoV-2 mRNA/mRNA and Ad/mRNA vaccination induces antibodies in the saliva, and in response to one dose of mRNA, a compartmentalized and transient antigen-specific sIgA response is generated that does not correlate with systemic immunity.

Incidence of hepatitis B and hepatitis C in Pediatric ward in General hospital, Bhopal (M.P)

To determine the incidence of HBV and HCV in pediatric ward in Rajeev Gandhi General Hospital and College, Bhopal. (M.P.) Viral hepatitis caused by HCV and HBV represents a major public health problem in India. These viruses share common modes of transmission, as parenteral route. Hospital base study of pediatric cases admitted to hospital during a period from March 2019 to February 2020. Pediatric cases were studied for the incidence of HBsAg and HCV Ab by ELISA, Rapid technique. The positive result was confirmed with line immuno-assay. The study showed positive HBsAg in 12 patients and HCV in 2 cases out 25 cases represented with acute hepatitis from a total of 1762 pediatric cases were submitted in this study, with incidence rate of 0.68% and 0.11% respectively.: The incidence of HBV and HCV are low, therefore active program need to be applied to control the spread of infection among the population.

Remdesivir and Hydroxychloroquine: A Compassionate Use in Covid-19

Objective:: Early in December 2019, a mass of sufferers with Novel Coronavirus Pneumonia (SAS-CoV-19) in Wuhan (China) roused worldwide concern. Hardly any drugs showed the light of hope concerning the depletion in the period of treatment and virological suppression is troubled. Furthermore, numerous sufferers have undergone off-label use or compassionate use treatments as well as antiretroviral, antiparasitic agents, anti-inflammatory compounds, and convales-cent plasma in either oral/parenteral route. This study aims to compile and analyze the efficient value of Remdesivir and Hydroxychloroquine and give an insight to their drug profile in the treatment and management of COVID-19 patients. Method:: The literature search from PubMed, Crossref, Springer, Bentham Sciences, Google Scholar, DOAJ, ScienceDirect, and MEDLINE by using keywords like COVID-19, SAS-COV-2, Remdesivir, and hydroxychloroquine was done and ap-propriate peer-reviewed review articles, as well as research articles, were included and compiled in this review paper. The figures were prepared by using ChemOffice 2016 (ChemDraw Professional 2016) and Microsoft Office. Results:: The results of this study indicate that remdesivir in 5/10 studies from collected literature show a reduction in time of recovery and 5/10 shows no variance and having limitations. However, 6/12 shows an increase in the survival/reduction in time of recovery and 6/12 shows no effect or has limitations in the case of hydroxychloroquine. Conclusion:: There is a need to assess more pharmacokinetics and randomized controlled trials (RCT) for both remdesivir and hydroxychloroquine. Furthermore, studies should be conducted in different combinations along with hydroxychloro-quine and remdesivir to get efficient results.

Chandipura Virus’ Oncolytic Potential in Experimentally Induced Tumor in Mice

Chandipura virus (CHPV) is a tropical pathogen, suggesting its involvement in childhood encephalitis syndrome in India. No reports are available in adult human beings for its pathogenicity. Similarly, in adult mice, the virus does not develop pathogenesis by parenteral route except for intracranial route of infection. The virus is remarkably nonpathogenic to adult immunocompromised nude mice. In vitro in tissue culture, the CHPV infects and kills many types of cells. All of these properties could qualify the CHPV to be a candidate virus for tumor therapy. To prove this, an experimentally induced tumor in a mouse was infected with live CHPV. The results showed that intra-tumoral injection reduced the volume of tumor and increased the longevity of the mice. The study concludes that the CHPV may be a safe tumor therapy virus. More precisely, the discovery of CHPV protein with oncolytic potential may lead to the development of novel drugs/therapeutics.

EVALUASI PENGGUNAAN ANTIBIOTIK PADA PASIEN PASCABEDAH APENDISITIS AKUT DI RSUD KABUPATEN PASURUAN TAHUN 2018 (Penelitian dilakukan di Instalasi Rawat Inap RSUD Kabupaten Pasuruan)

Acute appendicitis is an infection that occurs in vermiform appendix, and because of that it needs to do appendectomy immediately. Appendectomy is included in clean contaminated operation category which allows Surgical Site Infection (SSI). The antibiotics use in post-surgical patients to prevent the infections. The aims of this study to identify profile and determine the quantity and quality of antibiotics use. This study used cross sectional study with retrospective data on patient’s medical records after surgery for acute appendicitis in General Hospital Pasuruan Regency on January-December 2018. Data analysis was performed descriptively. The result of this study showed that the highest profile of the antibiotic use for mono therapy was Cefuroxime (25.81%) and for combination therapy were Phosphomycin + Metronidazole (8.06%) and Ceftriaxone + Metronidazole (8.06%). The quantity of antibiotics use by using Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) method was obtained total DDD value 52.01 DDD/100 patient-days with the highest antibiotic was Metronidazole parenteral route 14.00 DDD/100 patient-days. Antibiotics included in Drug Utilization 90% (DU 90%) segment were (Metronidazole, Ceftriaxone, Phosphomycin, Cefuroxime, Gentamicin) by parenteral route. The quality of antibiotics use based on the Infectious Disease Society of America (IDSA) Guidelines, appropriate indication (11.86%), appropriate dose (52,54%), appropriate interval (22,03%), appropriate route (96.61%) and appropriate duration of treatment (28.81%).