Hema

ABSTRACT Prostate cancer is a significant health concern in the Czech Republic, with a high incidence rate among men. This study assesses the current practices and management strategies of Czech oncologists in treating metastatic prostate cancer. A survey of 27 oncologists revealed that 42.2% of patients were currently with metastatic castration-resistant prostate cancer (mCRPC), followed by 27.6% with non-metastatic hormone-sensitive prostate cancer (nmHSPC), 22.7% with metastatic hormone-sensitive prostate cancer (mHSPC), and 7.4% with non-metastatic castration-resistant prostate cancer (nmCRPC). The majority of referrals (74.1%) came from urologists. Specific treatment choices for mCRPC patients included abiraterone (40.7%) and enzalutamide (29.6%). The findings highlight the need for early detection and intervention strategies to improve patient outcomes and support the design of future clinical trials.

ABSTRACT Retinopathy of prematurity (ROP) was known as Retrolental Fibroplasia is a leading cause of blindness among Premature Neonates. ROP is disorder of retinal blood vessels due to abnormal response of Premature Neonates retinal vasculature to prematurity and oxygen therapy for its management. Incidence and severity of ROP increases with decreasing birth weight and gestational age. Early identification and timely screening of neonates with risk factors helps to provide an opportunity for effective treatment. Beta blockers, most commonly propranolol, has been suggested for early prevention of ROP and treatment of existing ROP in preterm neonates. This study is to determine the role of prophylactic Oral Propranolol in prevention of ROP in Premature Neonates (26-35weeks GA) and to compare incidence of ROP in Premature Neonates (26-35weeks GA) receiving Oral Propranolol with one receiving Placebo. This is a comparative observational study conducted in the NICU of Rural Tertiary Care Hospital. The study includes Premature Neonates 26-35 weeks of Gestational Age (GA), grouped in ratio 1:1 with one group receiving Oral Propranolol and other Placebo which were followed for ROP screening 4 weeks after Postnatal Age. There is less incidence of diagnosis of ROP in Premature Neonates receiving Oral Propranolol. Hence such Premature Neonates require less therapeutic intervention in future. Thus, Oral Propranolol is an effective treatment in the management of ROP in Premature Neonates thereby decreasing the incidence of Progression and severity of ROP. Keywords: ROP, Premature Neonates, Oral Propranolol, Anti-VEGF, PRP laser.

ABSTRACT Transdermal drug delivery system (TDDS) was designed to sustain the release and improve the bioavailability of drug and patient compliance. Among the various types of transdermal patches, matrix dispersion type systems disperse the drug in the solvent along with the polymers and solvent is allowed to evaporate forming a homogeneous drug-polymer matrix. Tizanidine Hydrochloride, an imidazoline derivative, is α2-adrenergic agonist and centrally acting myotonolytic skeletal muscle relaxant with a structure unrelated to other muscle relaxants. Tizanidine hydrochloride having lower bioavailability (40%) due to first pass metabolism by the liver. So, bioavailability can be increased by transdermal route. The object of the study was to develop Matrix Type Transdermal Patch of Tizanidine HCl. Transdermal patches were prepared by solvent evaporation method using Eudragit RS 100 and PVP polymers by incorporating Polyethylene Glycol and Propylene Glycol as plasticizer. Standard procedures were used to analyze the prepared films for various physicochemical parameters(weight variation, thickness uniformity, % moisture content, %moisture uptake, Folding Endurance and drug content). drug release (Franz diffusion cell) and skin irritation test. The drug and polymer compatibility was studied by DSC. Among all the formulations, the F1 prepared by using Eudragit RS 100 and PEG 400 as plasticizer is the better formulation for control release of drug up to 6 hrs of time. Results of the present study encouraged that the Tizanidine HCl with Eudragit RS 100 transdermal patch can be used as controlled drug delivery system and frequency of administration can be minimized. The kinetic models used were Zero order, First order Higuchi’s and Korsmeyer–Peppas model. Transdermal patches were successfully prepared for Tizanidine Hydrochloride and their evaluation suggested excellent quality and uniformity in patch characteristics. This can have potential applications in therapeutic area offering advantages in terms of reduced dosing frequency, improved patient compliance and bioavailability. Keywords: Tizanidine Hydrochloride, Eudragit RS 100, Matrix type, polyvinylpyrrolidone, Transdermal patche

AIDS is a syndrome caused by infection with Human Deficiency Virus (HIV), a member of Lentivirus subfamily of retrovirus family. Serotypes HIV-1 is most virulent. The virus is transmitted sexually, vertically, through contaminated blood transfusion, syringes, needles, blades, tattooing, etc. The incubation period is 3 months to five years depending on pre-existing immunosuppressant. The T-helper lymphocytes are major target of viruses because CD4 receptor is present predominantly on it. And hence the progressive immunodeficiency state resulting from T-cell deficiency (T4/ CD4) with viremia with opportunistic infection which leads to malignancy or cachexia. In children the clinical features includes failure to thrive, severe recurrent infections, lymphadenopathy, delayed development, Persistent weight loss, chronic diarrhea, microcephaly, hepatospeenomegaly, chronic Parotid swelling, lymphocytic interstitial pneumonia, recurrent otitis media. Pediatric HIV has been categorized in four types as N, A, B, C. In Allopathy there is no specific treatment yet for HIV infection and immunodeficiency state rather than preventative aspects. However antiretroviral drugs can improve the quality of life and prolong it. Ayurveda provides a number of single, compound herbal, Herbomineral Rasayan drugs contributing unique Rasayan Therapy having diversified actions on different systems of the body like Immunomodulation, Antioxidant. Also several of drugs have its own Adaptogenic effect on Psychological, Neurological, Endocrine systems etc, which also helps in the HIV-AIDS. Scientific studies showed that Ayurvedic preparations were effective in improving immune status and quality of life of the patients having HIV-AIDS.

Breast carcinoma is one of the most common cancers in women. The important preoperative diagnostic modalities include ultrasonography and cytology. Prior to operation cytological grading of breast carcinomas would be desirable for the selection of patients for neoadjuvant therapy. This study has been carried with the aim to evaluate and correlate Robinson’s cytological grading with modified Bloom Richardson histological grading system for infiltrating ductal carcinoma. The period of study was one year (January 2015- December 2015), comprising of 56 female patients attending both outpatient departments (OPD) as well as admitted in ward. Fine needle aspiration cytology (FNAC) smears of invasive breast carcinoma, were graded according to the Robinson’s grading system. The corresponding histological sections were graded according to Elston and Ellis’ Nottingham modification of Bloom Richardson method. Out of 56 cases, 15 (27%) cases were graded as grade I, 31 (55%) grade II, and 10 (18%) grade III on cytology, whereas 16 (29%), 32 (57%) and 8 (14%) cases were graded as grade I, II and III on histology. The concordance rate between cytology and histology grades were 73.3%, 81% and 70% for grade I, II and III tumor respectively. Absolute concordance rate was 76.78%. Apart from being simple and non-invasive investigation, cytologic grading method could be comparable with histologic grading system and a useful parameter for selecting neoadjuvant chemotherapy in patients of breast carcinoma.

Major depressive disorder is usual in patients experiencing an episode of myocardial infarction. Different coronary heart disease risk factors do influence the chances of occurrence of post-Myocardial Infarction Depression.The purpose of this work was to test the influence of various coronary heart disease risk factors on the chances of occurrences of the post-Myocardial Infarction Depression.The study was conducted on Patients of Acute myocardial infarction (n=100) attending cardiology Out Patient Department of Assam medical college, Dibrugarh, Assam in 4 to 6 weeks after the index event. The screening was done by The Primary Care Evaluation of Mental Disorders and diagnoses of Major Depressive Disorder were established according to the Diagnostic and Statistical Manual for Mental Disorders fourth edition Test Revision criteria. The severity of the depression was assessed by Beck Depression Inventory. Logistic regression analysis was utilized for the analysis.Among the four coronary risk factor variables past history of Myocardial Infarction was found to be influencing the chances of occurrence of post-MI depression ( p = 0.015, Wald = 5.910).Persons having past history of Myocardial Infarction are more susceptible to develop post-Myocardial Infarction Depression.

The main aim of the formulation was to prepare Nasal in situ gel for cyproheptadine HCl using an admixture of pH sensitive polymer i.e. carbopol 940 and viscosifying agent i.e. HPMC K100 M in order to achieve a sustained release of drug. The Nasal in situ gel containing cyproheptadine HCl was prepared by taking carbopol 940 and HPMC K100 M in different ratios. The concentrations of carbopol 940 and HPMC K100 M were investigated using 32 full factorial design. The parameters determined were pH, physical appearance, drug content, gelling capacity, Mucoadhesive strength, viscosity, in vitro drug release. The drug excipient compatibility study was carried out by using Fourier transform infrared spectroscopy(FTIR). The pH values in situ gels were between 5.0 to 6.0. Drug content values were between 98% to 100%. The release profile of in situ gels exhibited a sustained release of cyproheptadine HCl. Drug release was dependent on the concentration of carbopol 940 and concentration of HPMC K100 M. Cyproheptadine HCl was successfully formulated as an nasal in situ gel to deliver drug for 8 h. The drug release of the nasal in situ gel decreased with decrease in concentration carbopol 940 and viscosity increased with increasing levels of HPMC K100 M. The drug release and viscosity could be adjusted and modified by varying the ratio of polymer and viscosifying agent. The optimized formulation F8 (0.6 % w/v carbopol 940 and 0.4 % w/v of HPMC K100 M) provide drug release of 8 h and release drug immediately after it is instilled into the nose. Formulation F8 was seen to be stable after one month of stability study.

Nivolumab is a fully human monoclonal antibody against programmed cell death 1 receptor (PD-1). Acting as an immune checkpoint inhibitor, it has emerged as a promising therapeutic method for advanced malignancy, inducing durable responses in patients with solid tumors. It can be associated to very unusual immune mediated toxicity against multiple tissues. Here, we describe a patient with metastatic clear cell renal cell carcinoma, who received nivolumab as fourth line therapy and experienced muscular weakness and pain secondary to rhabdomyolysis and myasthenia gravis. This case portrays a very uncommon yet potentially fatal side effect of nivolumab, seen in less than 1% of patients across all clinical trials. As immunotherapy evolves and its efficacy is proven in more tumor types, the overall use of this class of drugs will increase and their uncommon side effects may be evident more frequently. To our knowledge, this is the first case of fatal myasthenia gravis reported in a patient with renal cell carcinoma treated with anti-PD1 therapy.

In July 2005, the FDA issued an alert for healthcare professionals regarding dissolution media effects on drug release from a SR dosage form not involving a hydrophilic matrix, i.e., alcohol-Palladone interaction1. Hence, the aim of present works was to check the effect of Hydro alcoholic dissolution media in sustained release polymer and investigate the influence of hydro-alcoholic media on drug release for metoprolol Succinate sustained release tablets. Metoprolol succinate is a drug used for Hypertension and it is suitable drug candidate for extended release due to its short Half-life. Combination of HPMC K4M and HPMC K100M, Carbopol 934 P, Chitosan, HPMC K100 M: Ethyl Cellulose (4:1), Sodium-Carboxyl Methyl Cellulose were used as a polymer matrix to control the release of Metoprolol succinate up to 12 hrs. The Sustained release tablets of Metoprolol succinate were prepared by Wet granulation method. All the tablets were evaluated for the Pre-compression and post Compression Parameter. In-vitro dissolution study was done in Normal Dissolution Media, Phosphate Buffer pH 6.8 and also in 10 %, 20 %, 30 % and 40% v/v ethanol solutions for up to 12 hrs. All HPMC, Chitosan, Sodium-CMC preparation did not fail in hydro-alcoholic media, while Carbopol 934 P preparation show highest differences compare to all other. The highest dissolution was found to be more than 80 % in 12 hours for 40 % v/v ethanol solution in Carbopol 934 P ,which was not comply with standard range of drug release by USFDA and show dose dumping of Formulation. Kinetic model application confirmed that the release of Metoprolol succinate follows zero order as well as Korsmeyer-Peppas model. From these studies it was concluded that Carbopol 934 P formulation indicated highest signs of a potential dose dumping compare with other formulation.