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Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty‐two US pediatric institutions participated in a 10‐year review (2008–2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract‐based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non‐White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline‐based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.

Metformin is derived from galegine, a natural ingredient, and recent studies have suggested that metformin could enhance the antitumor effects of hormone ablative therapy or chemotherapy and reduce prostate cancer-specific mortality. Zyflamend is a combination of herbal extracts that reduces inflammation and comprises turmeric, holy basil, green tea, oregano, ginger, rosemary, Chinese goldthread, hu zhang, barberry, and basil skullcap. We propose a maintenance regimen with metformin and/or Zyflamend that targets cancer stem cells and the tumor microenvironment to keep the cancer dormant and prevent it from activation from dormancy. Herein, we report the clinical course of four patients who experienced a clinical response after treatment with metformin and/or Zyflamend.

Background: Tofacitinib, a pan-Janus kinase (JAK) inhibitor, initially used for the treatment of rheumatoid arthritis, was later found to have robust efficacy in Phase 2 and Phase 3 ulcerative colitis clinical trials. It had been approved by FDA for its use in the treatment of moderate to severe ulcerative colitis, in 2018. Objectives: The main objective of the present work was to develop a new colonic drug delivery system for tofacitinib using combined approaches of formulating an extended release matrix tablet along with a pH sensitive polymer coating of Eudragit® S100. Methods: The core tablets of tofacitinib were prepared by wet granulation method containing sodium carboxymethyl cellulose (CMC) as rate controlling polymer. Formulation variables used in the matrix system and pH dependent coating were optimized. Results: Negligible drug release was obtained in 0.1 N HCl and 6.4 pH phosphate buffer media, where as in 7.2 pH phosphate buffer media, the drug release increased up to 94.2±2.0%. Minimum concentration of sodium CMC was 11% (w/w) to ensure6 h's extended release of drug from the matrix tablet. While, the minimum functional coating percentage, was found to be 13% in order to obtain an adequate lag time. Conclusion: The study showed that, the lag time of the drug release was highly affected by the coating percentage of Eudragit S 100 and product temperature during coating. After the lag time, extended drug release was observed, and rate of drug release was found to be depended on the concentrations of sodium CMC used in the core tablet. The final colon targeted formulation showed no change in either its physical appearance, drug content or in dissolution pattern even after three months of storage at 40±2°C/75±5% RH. [ABSTRACT FROM AUTHOR]